Telemedicine - is the cart being put before the horse?

• A large literature base on telemedicine exists, but the evidence base for telemedicine is very limited. There is little practical or useful information to guide clinicians and health policymakers. • Telemedicine is often implemented based on limited or no prior formal analysis of its appropriateness to the circumstances, and adoption of telemedicine by clinicians has been slow and patchy. • Formal analysis should be conducted before implementation of telemedicine to identify the patients, conditions and settings that it is likely to benefit. • Primary studies of telemedicine tend to be of insufficient quality to enable synthesis of formal evidence. • Methods typically used to assess eff ectiveness in medicine are often difficult, expensive or impractical to apply to telemedicine. • Formal studies of telemedicine should examine efficacy, effectiveness, economics and clinician preferences. • Successful adoption and sustainable integration of telemedicine into routine care could be improved by evidence-based implementation.