3.3.2. Lack of operating standards and evidence Respondents pointed out that another major obstacle was that telecare is a new type of service; therefore, there are no standard operating guidelines to follow. Due to a lack of process guidance and the inability to see the patients in person, case managers worry about taking medical responsibility for malpractice. Physicians are unwilling to be the testing participants for the implementation of telecare. Meanwhile, since there is a lack of confirmed clinical effectiveness of telecare, there are also issues in obtaining relevant national health insurance payments.