Therefore, evaluation frameworks for telemedicine can also be complex with many potential inputs, activities, outputs, outcomes, and stakeholders.
This may be one reason for a lack of established telehealth evaluation protocols .
However, negative impacts, such as functional weakening of primary care and concentration of patients into large hospitals are concerns.
Physician-to-patient-based telemedicine is controversial among stakeholders because the prospects of telemedicine from all the parties are different.
Technological advances using telemedicine and telehealth are growing in healthcare fields, but the evaluation framework for them is inconsistent and limited.
This paper suggests a comprehensive evaluation framework for telemedicine system implementation and will support related stakeholders' decision-making by promoting general understanding, and resolving arguments and controversies.
In addition, a number of sub-factors for each dimension of the service should be considered for the evaluation framework.
For example, for the economic aspects, measurements should include evaluations of not only costs and benefits for multiple stakeholders but also insurance coverage and reimbursement. Approaches to Comprehensive Evaluation Telemedicine services are complex in nature compared with traditional provider-to-patient on-site healthcare delivery services.
Specifically, the following research objectives were taken into consideration: 1) analyzing the existing alternative evaluation strategies, methodologies, frameworks, and approaches for telemedicine and telehealth in addition to those for health information systems in general, 2) gaining insight into multiple dimensions and factors that influence the quality and outcomes of telemedicine and telehealth systems by determining the attributes that may serve as barriers or facilitate the system, and 3) identifying common themes and issues in constructing an evaluation framework. However, while telemedicine refers to remote clinical services, such as consultation, diagnosis, treatment, and transfer of medical data, telehealth can refer to remote non-clinical services, such as administrative procedures, training, and education, in addition to clinical services .
However, more studies and published documents on telemedi cine are found than on telehealth because the clinical practice of telemedicine services involves more obstacles and barriers, such as licenses, reimbursement, etc.