Taking Up the Challenge.

Proven capacity to enable both valid diagnostic decisions and effective management decisions should be required before health care innovations are adopted in routine practice. Various care models, although distinct in capacity for information acquisition and status of effectiveness and efficiency assessment, are marketed as telemedicine. Ability to meet criteria of effective and efficient decision making depends heavily on both the type of clinical problem at hand and the diagnostic and communication tools included in the telemedicine model. As an example of a problem-type-specific, connected care model supported by a well-developed evidence base, we review research findings that support widespread implementation of a model for primary care pediatrics. But, as an understanding of disruptive innovations would predict and as our experience has shown, such evidence is not sufficient by itself to ensure adoption and dissemination. Disruptive innovations are "cheaper, simpler, more convenient products and services that start by meeting the needs of less demanding customers." Such innovations threaten the value of existing services and organizations offering them. Consequently, dominant provider organizations positioned to develop telemedicine, but with important revenue streams threatened by telemedicine, anticipate negative financial impact. Accordingly, these organizations typically obstruct the adoption of disruptive innovations, or are at least slow to adopt them. Organizations funding health services research, investigators, provider organizations, individual providers, and payers, all share responsibility for developing the evidence base supporting connected care. For models supported by a solid evidence base, the challenge extends to ensuring widespread availability of this useful service.