A major limitation to this study was that a specific cost-effectiveness analysis was not performed as the set-up of equipment, bandwidth, licensing of software, and faculty and CHN salaries were all included free-of-charge to our program. While most economic evaluations of telemedicine have failed to show significant cost savings (29), there is a paucity of data overall and especially in the educational (non-direct patient care) usage of telehealth. This is likely due to the fact that equipment, time, and software used are typically shared among projects in an academic setting, and there is no clear tracking of costs spent or saved with the specific telehealth program. Additionally, instructor and learner time commitments were not calculated for our evaluation. While further research exploring cost-effectiveness will be critical to future program expansion and replication, such studies remain a challenge to conduct. This is especially true in the academic setting where the actual costs of shared university resources and faculty time commitments for a specific telehealth program are hard to quantify, making it particularly difficult to estimate the future costs of scale-up, to generalize any findings and to replicate the study results in other non-academic settings.