title: Trends in telemedicine assessment indicate neglect of key criteria for predicting success.
abstract: OBJECTIVE
  This innovative analysis aims to quantify the use of evaluation criteria in telemedicine and to identify current trends in metric adoption. The focus is to determine the frequency of actual performance metric reporting in telemedicine evaluation, in contrast to systematic reviews where assessment of study quality is the goal.
  
  
  METHODS
  Automated literature search identified telemedicine studies reporting quantitative performance metrics. Studies were classified by telemedicine class; store-and-forward (SAF), real-time consultation (RTC) and telecare (TC), and study stage. Studies were scanned for evaluation metric reporting, i.e. clinical outcomes, satisfaction, patient quality and cost measures.
  
  
  RESULTS
  Evaluation metric use was compared among telemedicine classes, and between pilot and routine use stages. Diagnostic accuracy was reported significantly more frequently in pilots for RTC and TC. Cost measures were more frequently reported in routine use for TC. Clinical effectiveness and hospital attendance were better reported in routine use for SAF. Comparison also revealed different evaluation strategies. In pilots, SAF favoured diagnostic accuracy, compared to RTC and TC. TC preferred clinical effectiveness evaluations and TC more frequently assessed patient satisfaction. Cost was only reported in less than 20 per cent of studies, but most frequently in RTC. Routine use led to increased reporting of all metrics, except diagnostic accuracy. Clinical effectiveness reporting increased significantly with routine use for RTC and SAF, but declined for TC.
  
  
  CONCLUSIONS
  Clinical outcomes and patient satisfaction were reported frequently in telemedicine studies, but reporting of other performance metrics was rare. Understanding current trends in metric reporting will facilitate better design of future telemedicine evaluations.
authors.affiliation: School of Computing and Information Engineering, University of Ulster, Newtownabbey, UK. d.jackson1@ulster.ac.uk
authors.forename: Duncan E
authors.initials: DE
authors.lastname: Jackson
authors.forename: Sally I
authors.initials: SI
authors.lastname: McClean
mesh_terms: D001291:Attitude of Health Personnel; D006801:Humans; D017063:Outcome Assessment, Health Care; D013673:Technology Assessment, Biomedical / Q000379:methods / Q000639:trends*; D017216:Telemedicine / Q000592:standards*