Telemedicine—the use of information and telecommunications technologies to provide and support health care when distance separates the participants—is receiving increasing attention not only in remote areas where health care access is troublesome but also in urban and suburban locations.
Yet the benefits and costs of this blend of medicine and digital technologies must be better demonstrated before today's cautious decision-makers invest significant funds in its development.
Telemedicine presents a framework for evaluating patient care applications of telemedicine. The book identifies managerial, technical, policy, legal, and human factors that must be taken into account in evaluating a telemedicine program. The committee reviews previous efforts to establish evaluation frameworks and reports on results from several completed studies of image transmission, consulting from remote locations, and other telemedicine programs.
The committee also examines basic elements of an evaluation and considers relevant issues of quality, accessibility, and cost of health care.
Telemedicine will be of immediate interest to anyone with interest in the clinical application of telemedicine.
- Telemedicine
- Copyright
- Acknowledgments
- Contents
- Telemedicine
- Summary
- TELEMEDICINE PAST AND PRESENT
- CHALLENGES IN EVALUATING CLINICAL TELEMEDICINE
- A FRAMEWORK FOR EVALUATION
- BASIC EVALUATION QUESTIONS
- CONCLUSION
- APPENDIX: QUESTIONS ABOUT THE QUALITY, ACCESSIBILITY, COST, AND ACCEPTABILITY OF TELEMEDICINE
- Evaluating Quality of Care and Health Outcomes
- Evaluating Access to Care
- Evaluating Health Care Costs and Cost-Effectiveness
- Evaluating Patient Perceptions
- Evaluating Clinician Perceptions
- 1 Introduction and Background
- TELEMEDICINE IN CONTEXT
- THE DEMAND FOR EVIDENCE OF EFFECTIVENESS
- STUDY ORIGINS AND APPROACH
- TERMS AND DEFINITIONS
- Telemedicine
- Classifying Clinical Applications of Telemedicine
- Evaluation
- STRUCTURE OF THE REPORT
- 2 Evolution and Current Applications of Telemedicine
- EVOLUTION OF DISTANCE COMMUNICATION
- DEVELOPMENT OF TELEMEDICINE
- CURRENT APPLICATIONS OF TELEMEDICINE
- Growth and Diversity
- Teleradiology
- Care in the Home and Other Nonclinical Sites
- Telemedicine for Prison Populations
- Rural Telepsychiatry
- Postsurgical Monitoring in an Urban Nursing Home
- Telemedicine in a Managed Care System
- CONCLUSION
- 3 The Technical and Human Context of Telemedicine
- THE TECHNICAL INFRASTRUCTURE
- Variation in User Needs and Circumstances
- Variety and Complexity of Technologies
- Information Carrying Capacity
- Information Transmission Media
- Information Restructuring and Digital Technologies
- Making the Pieces Work Together
- Standards for Hardware and Software
- Managing the Old and the New
- HUMAN FACTORS AND THE ACCEPTANCE OF TELEMEDICINE
- Growing Recognition of Human Factors
- Practical Human Factors
- Problems Related to Equipment
- Difficulty of Incorporating Telemedicine into Existing Practice
- Inadequate Assessment of Needs and Preferences
- Cultural and Socioeconomic Factors
- Professional Culture and Image
- Lack of Documented Benefit
- Lack of Payment for Telemedicine Services
- Health Care Restructuring
- CONCLUSION
- 4 The Policy Context of Telemedicine
- NATIONAL COMMUNICATIONS AND INFORMATION INFRASTRUCTURE POLICY
- STATE PROGRAMS AND INITIATIVES
- PROFESSIONAL LICENSURE AND DISTANCE MEDICINE
- Current Policies
- Issues
- Policy Options
- A Note on Credentialing
- MALPRACTICE LIABILITY
- Current Policies
- Issues
- Policy Options
- PRIVACY, CONFIDENTIALITY, AND SECURITY
- Current Policies
- Issues
- Policy Options
- Technical and Administrative Options
- PAYMENT POLICIES FOR TELEMEDICINE
- Fee-for-Service Payment and Telemedicine
- Per Case or Other Bundled Payment Methods
- Capitation Payment/Fixed Budget
- Other Financing Mechanisms
- REGULATION OF MEDICAL DEVICES
- CONCLUSION
- 5 Past and Current Evaluations of Telemedicine
- EVALUATION EFFORTS IN TELEMEDICINE
- EVALUATION FRAMEWORKS
- Joint Working Group on Telemedicine
- Department of Defense
- Department of Veterans Affairs
- Health Care Financing Administration
- Center for Health Policy Research
- Telemedicine Research Center
- EXAMPLES OF INDIVIDUAL RESEARCH STRATEGIES
- Studies to Compare Digital versus Conventional Images
- Evaluations of Automated, Telephone-Based Services
- Describing Deployment Telemedicine
- Research Under Way on Teledermatology Services for Rural Areas
- Three Research Initiatives on Effectiveness and Cost-Effectiveness
- CONCLUSION
- 6 A Framework for Planning and Improving Evaluations of Telemedicine
- PLANNING FOR EVALUATION
- Establishing Evaluation Objectives
- Setting Priorities
- Determining the Feasibility of Evaluation
- ELEMENTS OF AN EVALUATION
- Project Description and Research Questions
- Strategic and Clinical Objectives
- Level and Perspective of Evaluation
- Business or Project Management Plan
- Research Design and Analysis Plan
- Characteristics of Experimental and Comparison Groups
- Technical, Clinical, and Administrative Processes
- Measurable Outcomes
- Sensitivity Analysis
- Documentation of Methods and Results
- EVALUATION AND CONTINUOUS IMPROVEMENT
- CONCLUSION
- ADDENDUM: EXPERIMENTAL, QUASI-EXPERIMENTAL, AND NONEXPERIMENTAL DESIGNS
- 7 Evaluating the Effects of Telemedicine on Quality, Access, and Cost
- EVALUATION CRITERIA AND QUESTIONS
- QUALITY OF CARE
- Definitions and Concepts
- Questions about Quality of Care and Patient Outcomes
- Processes of Care
- Outcomes of Care
- Adjustments for Patient Risk or Severity of Illness
- Other Quality of Care Issues
- EVALUATING ACCESS
- Definitions and Concepts
- Questions about Access to Care
- EVALUATING COSTS AND COST-EFFECTIVENESS OF TELEMEDICINE
- Level and Perspective of the Analysis
- Definitions and Concepts
- Conceptual Challenges
- Question about Costs and Cost-Effectiveness
- Decision Rules for Analyzing Cost-Effectiveness Results
- PATIENT AND CLINICIAN PERCEPTIONS
- Methods and Focus
- Questions about Patient and Clinician Perceptions
- DESIRABLE ATTRIBUTES OF EVALUATION CRITERIA
- CONCLUSION
- 8 Findings and Recommendations
- THE TECHNICAL, HUMAN, AND POLICY CONTEXT FOR TELEMEDICINE EVALUATIONS
- CHALLENGES AND PROGRESS IN EVALUATING TELEMEDICINE
- Challenges Facing Evaluators
- Progress in Improving Telemedicine Evaluations
- FRAMEWORK FOR EVALUATING TELEMEDICINE
- Evaluation Principles
- Planning for Evaluation
- Elements of an Evaluation
- Evaluating Quality, Access, Cost, and Acceptance
- CONCLUSION
- References
- Appendixes
- A Examples of Federal Telemedicine Grants
- Office Of Rural Health Policy (Orhp), Department Of Health And Human Services
- MDTV, West Virginia University, Robert C. Byrd Health Sciences Center, Morgantown, West Virginia
- University of North Carolina at Chapel Hill, Department of Medicine, Program on Aging, Chapel Hill, North Carolina
- Rapid City Regional Hospital, Rapid City, South Dakota
- Eastern Montana Telemedicine Network, Deaconess-Billings Clinic Health Systems, Billings, Montana
- The Mid-Nebraska Telemedicine Network, Good Samaritan Hospital, Kearney, Nebraska
- Mary Imogene Bassett Hospital, New York
- REACH-TV, East Carolina University School of Medicine, Greenville, North Carolina
- High Plains Rural Health Network, Fort Morgan, Colorado
- Kentucky Telecare, University of Kentucky Medical Center, Lexington, Kentucky
- University of Minnesota Telemedicine Project, Minneapolis, Minnesota
- Missouri Telemedicine Network, University of Missouri-Columbia, Missouri
- WAMI Rural Telemedicine Network, University of Washington School of Medicine, Department of Family Medicine, Seattle…
- National Library Of Medicine (Nlm), Department Of Health And Human Services
- Testbed Networks
- Virtual Reality for Medicine
- Collaborative Technology for Real-time Treatment of Patients
- Health Care Financing Administration, Department Of Health And Human Services
- Iowa Health System Telemedicine Demonstration
- University of Michigan School of Public Health, Medical College of Georgia, and MDTV of West Virginia
- MDTV, West Virginia University, Robert C. Byrd Health Sciences Center, Morgantown, West Virginia
- REACH-TV, East Carolina University School of Medicine, Greenville, North Carolina
- National Telecommunications And Information Administration, Department Of Commerce
- City-County Health Department of Oklahoma County, Oklahoma
- Columbia University Health Sciences Division, New York
- Commonwealth of Pennsylvania
- Saint Louis University School of Public Health, Missouri
- B Glossary and Abbreviations
- C Committee Biographies
- Index
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