In the last few years, Telemedicine has emerged and has been accepted as an effective set of tools, techniques and technologies with the potential to provide high quality healthcare services at attractive costs. Telemedicine has become particularly relevant and important for rural and poor communities that do not have direct access to resources, or specialists. This comes as a direct result of the efforts allocated by organizations and individuals in pioneering research in this exciting field and has resulted in an even greater influx of resources made available for more R&D projects, pilots and studies.

As is the case with most specialised fields, research in telemedicine is faced with particular challenges, a fact exacerbated by the variety of the diverse disciplines involved. Admittedly, a large part of the addressed issues stem from the sensitivity of the general field of medicine and its life-altering potential. Such general issues include ethical and legal matters, design and authoring of research protocols, receiving approval from Institutional Review Boards, confidentiality, informed consent of a study’s subject, etc. Further to coping with the usual aspects of these issues, telemedicine research also needs to cope with their technological perspective, as defined by the Information and Communication Technologies (ICT) that will be used in each specific study.

Beyond these general issues, research in the field of telemedicine is also faced by unique challenges, the most important of which are presented below:

·         Working methodology. The diversity of technologies and scientific fields involved in Telemedicine complicates the definition and design of research processes. Each specific part of an application needs to be individually addressed using appropriate methodologies from the respective fields.

·         Patient participation. Enrolling patients in telemedicine studies has been notoriously difficult, with rates of rejection reaching as high as 75%, with recent reviews showing that over one third of research studies are based on samples of roughly 20 patients.

·         Diversity of partners. A typical telemedicine research will need input from extremely diverse fields, such as: psychology, health sciences, law, business marketing, computer science, telecommunications and engineering. A major effort is required in order to coordinate the necessary processes and information flows that will transcend such disparate cultures.

·         Geographical dispersion. Partnering institutions and organizations in telemedicine research are not only worlds apart in a metaphorical sense (as mentioned in the previous point), but also literally so: partners are usually dispersed over wide geographical areas – even continents – with some of the participating sites being rural locations with limited access availability. These factors further complicate the efficient management of the research work.

·         Confidentiality/data protection. In addition to the confidentiality constraints that are shared among all medical studies, the electronic transmission of medical information (usually including sensitive personal data) adds a level of complexity to the issue.

·         Patient consent. Acquiring informed consent from patients is exceptionally challenging for telemedicine research, since patients that usually have their expenses covered by private or public insurance will be reluctant to opt for remotely delivered services. The usual exception to this refers to chronic conditions, in which frequent travelling to distant locations is ruled out (thus the large amount of research in the field of chronic conditions treatment).

Despite the challenges mentioned above, the field of research in telemedicine brings much-needed promises for solving the issues of shortages in healthcare resources and experts. Telemedicine presents rich commercial opportunities accompanied by the potential to provide healthcare to currently underserved populations in both rural and urban environments. Accordingly, it is imperative for practitioners and researchers in the field to conquer these challenges and for governing institutions to facilitate this task.

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