Randomized control trials are the standard for the examination of costs and benefits because they allow for the recognition of outcomes solely attributable to the program under review by comparing the difference in outcomes of the defined treatment and control groups. Some of the researchers used randomized control trials but the sample sizes were small. Not using randomized control trials might have created biases. Journals that publish research on telemedicine or telehealth ought to set the bar high for the quality in methods utilized so that decision makers on coverage of these services do not have to rely on research with sub par methodologies. Another gap in the research on telemedicine and telehealth is that is it cannot be generalized. Most of the researches conducted are on a particular medical specialty, application, and technology or in special geographic locations. This makes it difficult to generalize the results for economic evaluation. The greater parts of the studies explore one particular type of telemedicine or telehealth program example, teledermatology or telepsychiatry. The problem is that though these programs are benefiting these areas of expertise, they do not have the range essential to smooth the process of extensive