Assessment of Approaches to Evaluating Telemedicine

Telemedicine is part of the expanding use of communications technology in health care, or " telehealth, " being used in prevention, disease management, home health care, long-term care, emergency medicine, and other applications. The diversification of such applications and continued advances in communications technologies, including the Internet, are raising expectations for telemedicine. However, the considerable attention focused on the technological aspects of telemedicine during the last decade has been accompanied by a lack of validated or well-demonstrated approaches for evaluating telemedicine. For program funding and policy making, there is increasing need to develop and adapt evaluative frameworks for telemedicine. In the mid-1990s, the National Library of Medicine (NLM) requested that the Institute of Medicine (IOM) develop a broad framework for telemedicine evaluation. In 1996, based on the deliberations of a 15-member expert committee, the IOM released its report, Telemedicine: A Guide to Assessing Telecommunications in Health Care. The report presented a framework built upon five main evaluation elements: 1) quality of care and health outcomes, 2) access to care, 3) health care costs and cost-effectiveness, 4) patient perceptions, and 5) clinician perceptions (IOM 1996). Since 1996, the field of telemedicine has continued to evolve and mature. Recently, the DHHS Office of the Assistant Secretary for Planning and Evaluation (ASPE) contracted with The Lewin Group to assess current approaches to evaluating telemedicine. In particular, ASPE requested that Lewin extend or otherwise update the 1996 IOM framework for telemedicine evaluation as it applies to teleconsultations. The purpose of this study is not to evaluate telemedicine, but rather to identify the different kinds of issues on which telemedicine evaluations can focus, and the kinds of information that such evaluations can yield. This report is intended to guide future evaluators and policy makers in selecting the questions that they want to answer regarding the value of telemedicine programs, and in designing evaluations that will best serve their interests and purposes. This report confirms and provides examples of many of the points raised by the original 1996 IOM framework. In some cases, however, this report provides greater depth or complexity, identifies supplemental issues, and diminishes the importance of ones included in the IOM framework. Some of the differences between this report and the IOM's derive from an additional four years of experience with telemedicine, including practical findings about the barriers to acceptance and use of telemedicine. The following are the main findings of this report. …