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It was not easy to develop a monitoring and evaluation framework for telemedicine since evaluation frameworks for telemedicine are very complex with many potential inputs, activities, outputs, outcomes, and stakeholders.
In addition, a number of sub-factors for each dimension of the service should be considered for the evaluation framework.
For example, for the economic aspects, measurements should include evaluations of not only costs and benefits for multiple stakeholders but also insurance coverage and reimbursement. Approaches to Comprehensive Evaluation Telemedicine services are complex in nature compared with traditional provider-to-patient on-site healthcare delivery services.
The most important point is that the public who are direct consumers of services have not had an opportunity to form or express their opinions regarding telemedicine.
Inequality of accepting specialized information or knowledge about telemedicine, which includes complex and multifaceted characteristics, leads to the limitation of public understanding .
On the other hand, most success factors for telemedicine service can be expanded to telehealth since both systems use much of the same infrastructure of ICT equipment and networks, and they are used by the same types of professionals and consumers.
Therefore, this study mainly emphasizes clinical telemedicine services for developing the factors of the evaluation framework. Need for Evaluation Framework We need a comprehensive evaluation framework for telemedicine and telehealth because the systems are very complex with multiple stakeholders and indirectly valued by multiple factors.
Technological advances using telemedicine and telehealth are growing in healthcare fields, but the evaluation framework for them is inconsistent and limited.
This paper suggests a comprehensive evaluation framework for telemedicine system implementation and will support related stakeholders' decision-making by promoting general understanding, and resolving arguments and controversies.
Although many countries, especially developed countries, tend to pursue telemedicine services aiming to improve healthcare accessibility and lower healthcare expenditures , telemedicine is not utilized and developed actively due to lack of legal and policy support for responsibility of services, absence of effective evidence, instability of information and communication technology, and insufficient infrastructure for education and training systems .
In particular, after the Korean government announced the revised medical law allowing physician-to-patient-based telemedicine, telemedicine has become a more divisive issue with physicians' firm opposition due to the insecurity of patients' health and other drawbacks.