Additionally, each interactive session between local provider and the distant consultant provides immediate, problem-based continuing education. Learning in this problem-based setting generally tends to be highly effective and efficient, and will contribute to increased quality of care. As computer networks and other communications technologies develop, it will be critical that they be integrated both vertically and horizontally with each other Current hardware and software development strategies often build upon competition rather than cooperation between developers. As these systems develop it is important that standards be constructed to insure that each is compatible with the others. Additional research on quality of care achieved with telemedicine is needed Preliminary studies have indicated that the quality of care provided via telemedicine can be nearly or fully equal to that of conventional delivery systems.
Additional research is needed, however, to fully evaluate quality.
Federal and state agencies responsible for certifying and reimbursing healthcare costs should actively engage in dialogue with investigators to identify research questions and design appropriate studies. As with other important biomedical research questions, funds should be allocated for this research. It is anticipated that most telemedicine will be intrastate in which medical licensure issues are surmountable. As provider networks evolve, however, many will appropriately cross state lines. With the advent of advanced telecommunications technologies, and a single national medical licensure examination, alternatives to state-specific licensing should be examined.