examples, is very easy to follow by any reader who may not have had an opportunity toundertake outcome-driven research. Drawn from conceptual, theoretical and practicalperspectives, the book provides unsurpassed guidance through its practical steps. Theauthor separates the commonly identi®ed problems such as running over budget,di�erences of opinions with key stakeholders, and missed completion deadlines, fromthose that are usually overlooked or neglected. He cites these as budgetary control, timeand activity management, management of stakeholder relationships, product marketingand ethical issues.The book is a practical text that focuses on how to overcome the problems of

management in research projects to ensure success in all aspects of the project.Approaching the book from the perspective of a reader in health research proved quiterewarding as it clari®ed those aspects that seemed unclear before. These included thetreatment of non-human resources, stake-holder relationships, and marketing of the endproduct. In conclusion, the book is viewed as a practical reference tool that provides aneasy access to a wealth of information on the practical problems that are usuallyencountered in research and it also guides researchers (both old and new) with clarity.It is a comprehensive and highly readable text. Any reader would bene®t from its

contents as it provides the analytical tools for understanding, analysing and evaluatinghealth research projects.This book is valuable for a cross-section of a readership that includes academics,

nurses, doctors, policy-makers, planners, managers and researchers.

DENNIS MULOPE MULIKELELA

University of Zambia, Institute for Economic and Social Research

J. FIELD (Ed.), Telemedicine: A Guide to Assessing Telecommunications in Health Care,Washington DC: National Academy Press, 1996, 271 pp. Price (UK) £32.95 hb.

TelemedicineÐ the use of information and telecommunication technologies to provideand support health care when distance separates the participantsÐ is receivingincreasing attention as the costs of technology fall. Projects are being undertaken bothin remote areas, where health care access may be di�cult, and in more urban locations, ashealth organizations attempt to maximize access to expert opinion. In line with the callfor evidence of e�ectiveness of health interventions, there is a demand for better evidenceof the e�ectiveness of health information systems, including telemedicine. Althoughtelemedicine projects started about 30 years ago, there is a scarcity of sound evaluation.The National Library of Medicine (USA) asked the Institute of Medicine to develop abroad framework for evaluating clinical telemedicine. The report is aimed at policymakers, clinicians, managers and patients. It will also assist researchers with an interest inevaluating information and communications technologies.The report format provides a clear and logical way around the wealth of information,

with the summary succinctly capturing the main points. Those who wish to select outspeci®c areas can do so. Each section is clearly labelled and has a conclusion; a usefultechnique is the use of shaded boxes to summarize key points within the text of eachsection. The introduction includes principles and de®nitions on which the remainingchapters are built. The following four chapters discuss the evolution of telemedicine andthe range of current applications; technical and human infrastructure; policy issues;and, past and current evaluation projects. The focus is on activities within the USA:in particular, the policy chapter concentrates on US issues with an emphasis onprofessional licensure, malpractice, medical privacy and telecommunication law. It isinteresting to note that there are insurer and health plan restrictions on fee-for-servicepayments for most telemedicine consultations. This is viewed as a major barrier to

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&1997 John Wiley & Sons, Ltd.

the development of telemedicine in the USA. Failure to link projects to majororganizational plans and business objectives, plus poor planning, are cited as reasonswhy pilot projects did not survive.A broad evaluation framework is proposed, and discussed, which focuses on the

e�ects of telemedicine on quality, accessibility, cost and acceptability of health care. It issuggested that this broad framework will strengthen evaluation designs and promotecomparable evaluations so that a stronger base of knowledge about telemedicine can bebuilt. During the exploration of current activities, the Institute of Medicine identi®ed anindependent, non-pro®t-making organization that pools information from multipleevaluations. The collaboration approach has enabled tools to be developed to supportevaluations; for example: the `Evaluation Question Hierarchy' has been designed togenerate speci®c questions tailored to particular problems so that researchers do nothave to start anew on each project. It is believed that the use of a common questionstructure will be one way of encouraging pooling of data from di�erent projects.Although many elements of the evaluation framework can be found in evaluation

methods publications, the telemedicine report does include two aspects that are lesscommonly covered. The framework highlights the need for documentation, not only onhow the technical infrastructure and the clinical processes of care were intended tooperate, but also the tracking of what actually occurs. There is also an emphasis on theinclusion of a business plan which should state how the implementation and evaluationare designed to provide information that decision makers can use to decide whether theapplication is sustainable.Recognition of the need for evaluation methods in health information systems is a

current vogue on both sides of the Atlantic, with publications of methodological textson how to design, carry out and interpret studies; and the problems of evaluation inmedical informatics (Friedman and Wyatt, 1996). The added value of this book formanagers, clinicians and policy makers interested in telemedicine is the inclusion of thespecial characteristics of telemedicine that warrant particular notice from evaluatorsand decision makers. As acknowledged within the text, the report has focused onactivities in the USA, but the proposed framework and suggestion of pooling ofinformation from di�erent evaluations is applicable worldwide.

REFERENCE

Friedman, C. P., Wyatt, J. C. (1996) Evaluation Methods in Medical Informatics. NewYork: Springer.

RUTH ROBERTS

School of Postgraduate Studies in Medical and Health Care

T. F. DONOHUE and C. R. SPROUSE, Drug Formularies and the PharmaceuticalIndustry: Thriving in the Managed Care Era, Massachusetts: Parexel InternationalCorp., 1995. 142 pp. Price unknown.

This book is a useful reference document for anyone who wants to know more about thestructure and purpose of health maintenance organizations (HMOs).Its focus is to examine formularies as an important part of managed care. In setting

this scene, the authors start by giving a good overview of the reasons why managed careorganizations started. They also describe the di�erent models and outline the purposeof pharmacy bene®t management schemes. Essentially, both arose as a result of rising

BOOK REVIEWS 237

&1997 John Wiley & Sons, Ltd.