information). Other access indicators included rates of vaccine-preventable childhood diseases and rates of immunizations. For all such indicators and measures, the 1993 report discussed the nature and limits of available data sources.

Telemedicine remains at such an early stage of implementation and diffusion that the committee would not expect it to have had effects that would be evident from such population-based analyses. Furthermore, information on the use of telemedicine services is not routinely available in major national databases so that it would not now be possible to link the availability of telemedicine in different areas to differences in access measures. The kinds of routine and specialized surveys and other data collection instruments used to obtain information for the databases described in the IOM report on access may, however, provide useful models for those devising measurement and data collection strategies for telemedicine projects employed by health systems that serve well-defined populations. Even so, relatively few clinics, health plans, or organizations have the combination of reasonably well-defined patient or enrollee populations, detailed clinical and administrative databases, and resources for special surveys that more sophisticated measures of access would require.

In reviewing telemedicine evaluation activities, the committee identified several access-related indicators that evaluators had used or hoped to obtain through existing or specially created data collection processes. These indicators, which do not—in and of themselves—consider the appropriateness of services, include

  • use of telemedicine services over time;
  • changes in the number of traditional consultations;
  • changes in waiting time for specialist appointments;
  • changes in rates of missed appointments for consultations;
  • patient willingness to participate in a telemedicine consultation; and
  • patient or clinician attitudes about the timeliness of consultations and the burden of different consultation options.

Particularly with the increase in competition in the health care system, health care organizations have established a variety of performance indicators related to certain dimensions of access. These



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