[Difficulties of incorporating telemedicine in health organizations: analytical perspectives]

Socioeconomic transformations at the end of the twentieth century and the beginning of the twentyfirst century pose major challenges to health systems, particularly to western societies with high technological systems and an aging population, in a political context of health expense reduction. The incorporation of information and communication technologies to health care systems, which has been called <>, has created enormous expectations in this context. Telemedicine has been one of pioneer experiences. Despite the early beginnings of telemedicine and the efforts invested, more widespread use of this technology remains difficult and controversial. Most projects last just the feasibility phase and are then forgotten. The traditional model of medical technologies assessment explains this phenomenon, based on the difficulty of obtaining the empirical evidence needed to support widespread adoption of telemedicine, as a consequence of the problems of conducting traditional studies of clinical efficacy and cost-effectiveness. In the last few years, a different analytical approach has emerged. This perspective indicates that the consolidation (or otherwise) of telemedicine projects will depend on the results of interaction between technology and the context where it is applied and not only on clinical results. Better and deeper empirical knowledge of these interaction processes is needed to increase the spread of telemedicine.