Evaluation of new technologies in healthcare systems : what ' s the context ?

Telehealthcare is an ideal vehicle for seeing evaluation in context. It is clear that evaluation techniques applied to other technologies – for example, the randomized controlled trial, or systematic review of randomized controlled trials – are difficult to apply in the face of very rapid technological advance and pressure on (and from) clinicians, service managers and policy makers, either to introduce these systems or to resist them [3]. In this paper we point to some of the problems inherent in the current evaluation literature [4] and to a way of recon-textualizing both evaluation procedures and telehealthcare technologies themselves. Telehealthcare encompasses a broad spectrum of telecommunications and information technologies which allow access to healthcare expertise at a distance by a wide variety of means ranging from real-time videoconferenc-ing to transmission of real-time or pre-recorded images and/or data. Such systems – where a communications technology mediates between professionals and patients, or between different groups of professionals – are an area of rapid technological development. These systems have attracted significant interest both from clini-cians and policy makers across the healthcare sector. They seem to promise a number of key organizational and professional benefits for both service users (for example, in improving accessibility to numerically scarce specialist clinicians for larger numbers of patients); and for clinicians (for example, in rationalizing 'throughput' in specialist clinics and reducing waiting times). There is now a large body of research literature that presents results from small-scale demonstration projects and feasibility studies in the form of 'evaluation'. Yet knowledge about efficacy and utility, as norma-tive components of the evaluation of such systems , is still limited. Despite the growing interest and use of tele-healthcare systems, research which supports the medical effectiveness and cost effectiveness of the technology remains surprisingly limited [5] [6]. Even where a substantial body of literature exists and creates the illusion of a wide-ranging programme of evaluation – for example, relating to the cost effectiveness of telehealthcare systems or to patient satisfaction with them – systematic reviews and analyses of the existing literature indicate that here too, many gaps remain in knowledge [7] [8]. Moreover, important difficulties with evaluation and research Evaluation of new technologies in health-care systems: what's the context? Evaluation is an essential component of the introduction of new technologies, treatment modalities and models of service delivery across the health-care sector. Such work attracts significant levels of public funding, but little attention has been …