Economic studies and 'technical' evaluation of telemedicine: the case of telemonitored polysomnography

Information and communication technology (ICT) is not yet integrated into c urrent medical practice and frequently, organizational patterns of health c are production are held responsible for this situation. However, and quite paradoxically, measures recently taken in France indicate that a preferenti al role is granted to ICT in order to promote the development of healthcare networks. In this context, one should carefully examine which factors, oth er than organizational ones, can explain the very slow diffusion of telemed icine. Actually, medical assessment of telemedicine is very seldom and the medical community is unable to appreciate the extent that this technology w ould modify the quality of care provided. Furthermore, and as a consequence of the former, there is no economic evaluation of telemedicine application s and its effects, in terms of productivity, remain virtual. In this articl e, based on an early evaluation of telemonitored polysomnography to diagnos e sleep apnea syndrome, we show that it is possible, even at an experimenta l stage, to produce appropriate and convincing clinical results stating the true technological effectiveness (choice of an adequate clinical trial, se lection of appropriate endpoints). Specific attention is given to the techn ical conditions in which the technology is assessed, we also provide most o f the data that should be taken into account to foresee the major organizat ional transformations of the production processes. Our results show that ea rly clinical ad hoc evaluations of telemedicine applications can be conduct ed promptly, providing strong clinical results and useful data for any fort hcoming economic evaluation. (C) 1999 Elsevier Science Ireland Ltd. All rig hts reserved.