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 -- Glossary -- Abbreviations -- C Committee Biographies -- Index.