Striving for evidence in e-health evaluation: lessons from health technology assessment.

Evaluation is crucial to the integration of e-health applications into the health-care system and their ultimate sustainability. However, e-health evaluation is often criticized for the poor quality of research design, the lack of common outcome indicators and the absence of an agreed theory. Health technology assessment (HTA) could offer a sound methodological basis for e-health evaluation. However, there have been major concerns about the applicability of the HTA approach to the evaluation of e-health initiatives. Evaluators -- and decision makers -- must accept that telehealth evaluation may serve different purposes for different stakeholders, and therefore concede that no single evaluation framework or methodology, even the randomized controlled trial, is totally objective. To address the complex environment of telehealth evaluation, a participatory strategy is useful, whereby stakeholders are involved in the study design and definition of evaluation questions at each phase. This will also build confidence between the evaluation team and the stakeholders, facilitating informed decision making through an integrated knowledge mobilization activity.