Nationally, because few programs have demonstrated sustained clinical and business benefits from telemedicine, role models are scarce. Evidence from other areas suggests that respected opinion leaders are important instruments of change because they serve as role models and trustworthy sources of information (or endorsement) for peer-oriented clinicians (Wolinksy, 1988; Soumerai and Avorn, 1990; IOM, 1992a). For those considering the introduction of a telemedicine program, the involvement of a range of specialists from a project's outset can help pave the way to acceptance by a broader community of colleagues.
The scarcity of rigorous evaluations of clinical telemedicine—the stimulus for this report—may also discourage clinicians and other decisionmakers. Little information is available to document how telemedicine can help health care organizations or clinicians improve health outcomes, promote better quality of care, manage costs, attract patients, reduce administrative hassles, or otherwise be of benefit. In addition, practitioners may be concerned that the early adoption of a new and relatively untested technology might be poorly regarded by the people they rely on for support and collaboration. A cautious approach to untested treatment modalities is generally expected of clinicians, and tolerance for "mistakes" in medicine is low. In time, recognized standards for telemedicine practice and direction from accrediting bodies may reduce this concern.
Absent an accessible body of knowledge to draw upon, clinicians and institutions must find their own paths anew. Journals, conferences, seminars, and Internet-based sources are beginning to fill the information vacuum, but the committee concluded from its sampling of these sources that more is sometimes promised than delivered by way of clear, accurate, and usable guidance. Moreover, in an era when health care institutions see each other as rivals not only within but also across communities, the climate for sharing information and experience is not always favorable.
Societal readiness is also an issue. Although some evidence suggests considerable patient acceptance of telemedicine in some settings (e.g., rural areas), it is not clear that patients are generally ready to accept that these new technologies will benefit them. The broader use of telemedicine may require, in addition to evidence