The literature review was conducted by a direct search of the MEDLINE database (citations of peer-reviewed journal literature), the primary bibliographic database maintained by the National Library of Medicine.
Assessment of Approaches to Evaluating Telemedicine. Appendix B: Relevant Literature Review Findings
A review of the current literature was conducted to update, as appropriate, the IOM evaluation framework. The goal of the literature review is to update the IOM study with any relevant information having arisen within the last three years, and second, to supplement any gaps that may have been identified.
The Indian Health Service (IHS) is funding 40-50 small telemedicine programs across the country. To date, the IHS has performed few formal evaluations. It performed a cost-benefit analysis on teleradiology, which included exclusively store-and-forward technology. The IHS also evaluated patient and clinician perceptions of a telepsychiatry program
The National Library of Medicine (NLM) offers two programs to encourage the use and development of telecommunications infrastructure. The High Performance Computing and Communications Program funds Internet access for health professions engaged in education, research, clinical care, and administration. The second program supports projects that dev
Assessment of Approaches to Evaluating Telemedicine. C. Health Resources and Services Administration
The HRSA Office for the Advancement of Telehealth (OAT) promotes the use of modern telecommunications and information technologies to bring state-of-the-art health care and health information to every community, particularly medically underserved and isolated regions. OAT has worked to expand HRSA's evaluation activities and coordinate the develop
Assessment of Approaches to Evaluating Telemedicine. B. Health Care Financing Administration(now known as Centers for Medicare and Medicaid Services(CMS))
In October of 1996, HCFA(now known as CMS) initiated a demonstration project to allow reimbursement of teleconsulting services by Medicare beneficiaries at 57 Medicare-certified facilities. The objectives of this project are to assess the feasibility, acceptability, cost, quality, and access to services that could be made available through Medicar
AHRQ's Center for Information Technology conducts and supports studies of health information systems, computerized patient record systems, and medical decision analysis, including data standards, automated medical records, and decision support systems. As a participant in the national High Performance Computing and Communications (HPCC) Program, A
Within HHS, the bulk of telemedicine initiatives support and funding is provided by four agencies: the Agency for Healthcare Research and Quality (AHRQ), Health Care Financing Administration(now known as Centers for Medicare and Medicaid Services(CMS)) (HCFA(now known as CMS)), Health Resources and Services Administration (HRSA), and National Inst
Much of the present study serves to confirm and reinforce the 1996 IOM evaluation framework. The recent literature and interviews with telemedicine providers and other telemedicine experts provided examples of, and otherwise helped to elucidate many of the points raised by that framework.
The time horizon of a study refers to the study duration or length of follow-up for data collection. The time horizon for a comparative evaluation should be long enough to capture the stream of relevant health and economic effects that are sufficient to detect any differences in these between the intervention and control groups. To not do so may y
In clinical trials or other comparative studies, randomization refers to the technique of assigning subjects (usually patients) to an experimental intervention (often a new treatment) group and a control groups based only on chance distribution. The purpose of randomization is to reduce the opportunity for selection bias when assigning patients to
Evaluating the impact of teleconsultations requires some basis of comparison. Consistent with remarks in the literature, several of our expert interviewees indicated that a recurrent weakness in telemedicine evaluations has been the lack of a clearly defined control group. In general, a comparator should be the standard or level of care that would
The perspective of evaluation refers to the standpoint from which costs and benefits of a program or intervention are realized. For instance, the perspective of an evaluation of a teleconsultation program may be that of one or more of: society overall, third-party payers (e.g., Medicare, state Medicaid programs, or managed care organizations), a "
A fundamental consideration in evaluating a telemedicine application is specifying the scope or focus of evaluation. Doing so may not be as straightforward as in the case of a new drug or new medical device. In a narrow sense, an evaluation may focus on a particular store-and-forward technology or a two-way interactive television system. In a broa
The evaluation of technology is usually influenced, and sometimes triggered, by its progress through its lifecycle. One set of terms that is used to describe stages of technological maturity includes "future," "experimental," "investigational," "established," and "obsolete" (The Lewin Group 2000). Future technologies are in a conceptual stage, ant
The literature on telemedicine evaluation expresses concern about the rigor and consistency of methods used in the field. In a field where large, prospective randomized clinical trials (RCTs) are the methodological gold standard for evaluating the safety and efficacy of pharmaceuticals and other medical interventions, teleconsultations and other t
Unlike most new technologies that diffuse smoothly into health care delivery, implementing telemedicine systems, and teleconsultations in particular, often presents departures from standard means of health care delivery, administration, and financing. Most new medications, medical devices, and medical procedures are delivered within already existi
Among the various attributes of impacts of telemedicine, satisfaction of patients (and sometimes patients' relatives) has been the one evaluated most often. Aspects of patient satisfaction that typically are evaluated are: convenience, comfort during a consult, comparison to in-person consultation, privacy concerns, and willingness to use telemedi
Acceptance of telemedicine by physicians, nurses, and other health personnel was cited by the respondents as being of moderate to high importance in telemedicine evaluation. If clinicians are not comfortable with the technology, or judge that the technology decreases their control over patient care, they may avoid using it, thereby precluding othe
The appropriateness of a technology refers to a judgment about whether the technology should be used in particular circumstances. Appropriateness is a function of other evaluation attributes such as access, safety, effectiveness, and cost in a particular situation. For example, the appropriateness of a teleconsultation system may depend on its acc