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SUMMARY
Pages 1-15

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From page 1...
... Other applications such as telesurgery involve exotic technologies and procedures that are still in the experimental stage. The use of interactive video for such varied purposes as psychiatric consultations and home monitoring of patients attracts much attention and news coverage, although such applications are far from routine in everyday medical practice.
From page 2...
... The objective is to encourage evaluations that will guide policymakers, reassure patients anc! clinicians, inform health plan managers, anc!
From page 3...
... Despite recent growth, obstacles to widespread use of clinical telemedicine persist. For example, although many groups are working to develop hardware and software standards, it remains frustrating and difficult to put together systems in which the components operate predictably and smoothly together, work in different settings without extensive adaptation, and accommodate replacement components.
From page 4...
... They include · the rapid advance of information and telecommunications technologies, which exposes systematic and often expensive evaluations to obsolescence as key hardware and software components of telemedicine applications move from state of the art to outmoded; · a complex and often unwieldy technical infrastructure, which may yield disappointing evaluations until it becomes more ubiquitous and user-friendly; · a diverse and sometimes dazzling array of telemedlicine technologies and uses that may distract managers and evaluators from the task of identifying practical, affordable, and sustainable ways to achieve defined quality, access, or cost objectives; and · the ?
From page 5...
... to provide guidance to decisionmakers considering whether to adopt, substantially redesign, or discontinue telemedicine programs. The fast pace of change and other uncertainties surrounding telemedicine applications argue strongly for an evaluation plan to
From page 6...
... Such analyses are appropriately keyed to a business plan that explicitly states how the evaluation will provide information to help decisionmakers determine whether a telemedicine application is useful, con
From page 7...
... The latter attempts to control some important threats to validity through statistical adjustments and other means when random assignment of participants, homogeneous populations, or strict treatment protocols are not feasible. Sophisticated computer-based patient information systems are gradually making such designs more practical and robust.
From page 8...
... For example, if a telemedicine application is more costly than the alternative and performs less well (e.g., produces fewer health benefits) , it should not be adopted.
From page 9...
... Broader community effects may also be considered. For example, although improved access to health care for rural populations has been an important objective of many telemedicine projects, policymakers may also be interested in the effects of telemedicine on the survival of rural health care providers and the implications of such effects on the economic health of rural areas including their ability to attract or maintain business, educational, and other resources.
From page 10...
... They also lack good analyses of the infrastructure implications and financial requirements for sustaining telemedicine past an initial "test of concept" period. Although individual research approaches will vary, the evaluation and implementation of telemedicine projects will benefit by the · .
From page 11...
... Was the application associated with differences in patients' knowledge of their health status, their understanding of the care options, or their compliance with care regimens? Was the application associated with differences in diagnostic accuracy or timeliness, patient management decisions, or technical performance?
From page 12...
... ? What was the utilization of telemedicine services before, during, and after the study period for target population and clinical problems ?
From page 13...
... How dlid! the costs of the application relate to the benefits of the telemedicine application compared to the alternativets)
From page 14...
... Evaluating Clinician Perceptions Were attending/cons? ~Iting clinicians satisfied with the telemedicine application compared to the alternativefs)
From page 15...
... Overall, how satisfied were the attending/consulting clinicians with the telemedicine service?


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