Telemedicine

Introduction
Definition of Telemedicine
History of Telemedicine
Current Trends in Telemedicine
Online Telemedicine Resources

Introduction
The development of telecommunications and computer technology since the 1960's
Space Age has implications for the improvement of the quality of health care for those
who live in remote or isolated areas where access to quality health care has traditionally
been a problem (Samuelson, 1986; Zundel, 1996).
Telemedicine, the use of two-way telecommunications technology, multimedia, and
computer networks to deliver or enhance health care, is a growing trend internationally,
with the United States, Canada, the United Kingdom, and Scandinavia among the
leaders in developing this field (Basher et al., 1975; Foote, 1976; Basher and Lovett,
1977; Picot, 1985; Cronin, 1995).
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Definition of Telemedicine
Telemedicine is defined by the Telemedicine Information Exchange (1997) as the "use
of electronic signals to transfer medical data (photographs, x-ray images, audio, patient
records, videoconferences, etc.) from one site to another via the Internet, Intranets,
PCs, satellites, or videoconferencing telephone equipment in order to improve access to
health care." Reid (1996) defines telemedicine as "the use of advanced
telecommunications technologies to exchange health information and provide health
care services across geographic, time, social, and cultural barriers."
According to the Telemedicine Report to Congress (1997), "telemedicine can mean
access to health care where little had been available before. In emergency cases, this
access can mean the difference between life and death. In particular, in those cases
where fast medical response time and specialty care are needed, telemedicine
availability can be critical. For example, a specialist at a North Carolina University

Hospital was able to diagnose a rural patient's hairline spinal fracture at a distance,
using telemedicine video imaging. The patient's life was saved because treatment was
done on-site without physically transporting the patient to the specialist who was located
a great distance away."
In addition, the 1997 report states that "Telemedicine also has the potential to improve
the delivery of health care in America by bringing a wider range of services such as
radiology, mental health services, and dermatology to underserved communities and
individuals in both urban and rural areas."
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Brief History of Telemedicine

The practice of medicine through telecommunications, or telemedicine, began in the
early 1960s when the National Aeronautics and Space Administration (NASA) first put
men in space. Physiological measurements of the astronauts were telemetered from
both the spacecraft and the space suits during NASA space flights. These early efforts
were enhanced by the development of satellite technology which fo stered the
development of telemedicine.
NASA funded telemedicine research projects in the late 1960s and early 1970s.
According to Basher, Armstrong, and Youssef (1975), there were fifteen telemedicine
projects active in 1975.
One pioneer telemedicine project, STARPAHC, or Space Technology Applied to Rural
Papago Advanced Health Care, was developed by NASA to deliver health care to the
Papago Indian Reservation in Arizona. The project, which ran from 1972-1975, was
implemented and evaluated by the Papago people, the Indian Health Service, and the
Department of Health, Education, and Welfare. The goal was to provide health care to
the isolated Papago Reservation. A van, which carried a variety of medical instruments
including electrocardiograph and x-ray machine, was staffed by two Indian paramedics.
The van was linked to specialists at the Public Health Service Hospital by a two-way
microwave transmission (Telemedicine Research Center, 1997).
In 1974, NASA conducted a study with SCI Systems of Houston to determine the
minimal television system requirements for accurate telediagnosis. A high-quality
videotape was made of an actual medical exam conducted by a nurse but supervised
by a physician watching on closed-circuit television. These videotapes were
systematically electronically degraded to less than broadcast quality. The original and
degraded videos were then shown to randomly selected groups of physicians who
attempted to reach a correct diagnosis (Telemedicine Research Center, 1997).

The results, reported in "Final Report: Video Requirements for Remote Medical
Diagnosis" (SCI Systems, Inc., 1974), included: 1) statistical significance between the
means of the standard monochrome system and the lesser quality systems did not
occur until the resolution was reduced below 200 lines or until the frame rate was
below10 frames a second; 2) there was no significant difference in the overall diagnostic
results as the pictorial information was altered; 3) there was no significant difference in
remote treatment designations of TV system type that would cause detriment to
patients; and 4) the supplementary study of transmissions of 25 cases using televised
radiographic film showed no diagnostic differences between the televised evaluations
and direct evaluations if the televised evaluations were above 200 lines and special
optical lenses and scanning techniques were utilized (Telemedicine Research Center,
1997).
In 1989, NASA conducted the first international telemedicine project, Space Bridge to
Armenia/Ufa, after a powerful earthquake struck the Soviet Republic of Armenia in
December 1988. An offer of medical consultation was extended to the Soviet Union by
several medical centers in the United States. Telemedicine consultations were
conducted under the guidance of the US/USSR Joint Working Group on Space Biology
using video, audio, and facsimile between a medical center in Yerevan, Armenia and
four medical centers in the United States. This project was extended to Ufa, Russia to
aid burn victims there after a fiery railway accident (Telemedicine Research Center,
1997).
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Current Trends in US Telemedicine

Telemedicine technology has increased and the cost of equipment has decreased in the
past ten years, resulting in an increase in the number of telemedicine research projects
and increase in the scope of those projects. The Telemedicine Information Exchange
(1997) lists over 130 telemedicine research sites. The "4th Annual Telemedicine
Program Review" (Grigsby and Allen, 1997) lists 80 active telemedicine programs in
1996, in 38 states and Washington, D.C., 8 of which use only store and forward
technology and 72 of which use two-way interactive audio-visual technology. There are
1,032 total telemedicine sites (hubs and spokes) which performed 21,274 consultations,
91% (19,380) of which were interactive audio-visual and 9% (1,894) of which were store
and forward.
Since 1993, when there were only twelve active programs in the US, the number of
programs has doubled yearly, while program activity (number of consultations) has
tripled since 1995. The top five types of consults in 1996 were: mental health (21%),
trauma care (16%), cardiology (12%), dermatology (11%), and surgery (8%).

Emergency or trauma telemedicine emerged in 1996 as one of the fastest growing

applications of this technology (Ibid. 1997).
Early projects using telemedicine in rural health care proved to have great beneficial
effects on patient survival and recovery, but the equipment was expensive and rather
cumbersome (Park 1974; Grundy et al. 1977; Grundy, Jones and Lovitt, 1982). As the
cost and size of the equipment has come down, and the technical quality has gone up,
telemedicine has become much more feasible to use in rural health care (Dakins 1995).
Teresa Smith Welsh
e-mail: twelsh@utk.edu
Updated 6/20/99
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