Telemedicine provides the scope to remove the barrier of distance from delivery of health care. In so doing it has the potential to strengthen primary care and local health delivery, and to optimise the use of secondary and tertiary specialist resources. However, it can have disbenefits and perverse effects which are as yet inadequately addressed.

Development of telemedicine to date has been led by new technological opportunities, linked to clinical interests. Whilst not inappropriate, this alone is not adequate. All health care activities should be to promote health and treat ill-health, and therefore the interests of the consumer and of society should predominate. More complete research and policy analysis of telemedicine are therefore needed.

This paper argues for a more holistic and integrated view of telemedicine to be taken, to ensure that technology is harnessed to meet need. To this end, it puts telemedicine into the overall context of health care interests, and describes methodologies to assess patient attitudes and societal priorities.

Given the need to avoid the unanticipated adverse effects which have bedevilled other new health care technologies, and the particular risks of uncontrolled consultations and commerce across national boundaries, the paper goes on to advocate routine use of integrated risk analysis of telemedicine applications at research and policy levels. The need for an effects-orientated analytic framework, and for international policy collaboration to protect users of services available by global telecommunications, is identified.