Telemedicine: A new framework for evaluation

Recent strategies for evaluating telemedicine attempt to incorporate broad issues such as medical effectiveness, optimal strategies for blending face to face and telemedicine, the direct and indirect costs of telemedicine ser vices, accessibility, and patient and provider satisfaction. To address the se issues, a scheme of evaluating telemedicine for a series of medical cond itions or diagnoses has been recommended. The primary problem with this eva luation scheme is the need to assess telemedicine for each condition in whi ch its use is proposed.-This paper suggests an alternative framework for ev aluation based on the clinical tasks that a physician or other health care provider must do to assess, treat, and follow patients. These tasks, which are employed in the care of most conditions, include visual tasks, auditory tasks, and instrumentation and palpation tasks. For each clinical task, th e technology requirements for tools and settings would first be established . The scope and limitation of the tools for those tasks would be identified and the need for integration with face-to-face care could be assessed. Fin ally, the outcomes of the interaction of tasks, tools, and settings could b e assessed across broad categories of tasks rather for than a single diseas e or condition. Such broadly oriented telemedicine assessment would allow a single evaluation of telemedicine for a proposed task and decrease the nee d to evaluate each new program or new use of telemedicine technology. Regio n specific patient and provider satisfaction will likely still be required for each program.