While telemedicine programme objectives, technologies and even philosophies will differ, certain common factors that enhance programme success can be identified. For example, a programme design which is driven by technological imperatives is likely to fail. It must also be recognized that telemedicine programmes cannot force remote sites to use their services. Thus developers must assess the needs for the proposed telemedicine service from a clinical, economic and technical perspective. From a clinical perspective, it is important to remember that certain clinical services can be provided via telemedicine while others cannot. Programme developers must recognize the significant role of the remote team in sustaining services; the on-site presenter is essential for the successful practice of telemedicine. Evaluating a telemedicine programme should be viewed as an integral step in its design and implementation. One site may define effectiveness in terms of access to services while another may measure success by cost savings. The success of future telemedicine programmes will be strongly related to their ability to recognize that they should be used to enhance current health-care delivery rather than to replace it.
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