History and Evolution of Telemedicine

Telemedicine is defined as the use of telecommunications to provide medical information and

services It may be as simple as two health professionals discussing a case over the telephone, or as
sophisticated as using satellite technology to broadcast a consultation between providers at facilities
in two countries, using videoconferencing equipment or robotic technology. The first is used daily by
most health professionals, and the latter is used by the military and some large medical centers.
Telemedicine enables a physician or specialist at one site to deliver health care, diagnose patients,
give intra-operative assistance, provide therapy, or consult with another physician or paramedical
personnel at a remote site. Telemedicine system consists of customized medical software integrated
with computer hardware, along with medical diagnostic instruments connected to the commercial
VSAT (Very Small Aperture Terminal) at each location or fibre optics.
Although, telemedicine could potentially affect all medical specialties, the greatest current applications
are found in radiology, pathology, cardiology and medical education. Perhaps the greatest impact of
telemedicine may be in fulfilling its promise to improve the quality, increase the efficiency, and expand
the access of the healthcare delivery system to the rural population and developing countries.
Models
Real-Time - This is the most common use in Telemedicine. In this model, live video allows the
provider, patient and specialist to all communicate together to achieve the best outcome for the
patient.
Store and Forward (asynchronous) - Used when both health providers are not available or not
required at the same time. The provider's voice or text dictation on the patient's history, current
affliction including pictures and/or video, radiology images, etc.,are attached for diagnosis. This record
is either emailed or placed on a server for the specialist's access. The specialist then follows up with
his diagnosis and treatment plan.
Home Health Telemedicine - When a patient is in the hospital and he is placed under general
observation after a surgery or other medical procedure, the hospital is usually losing a valuable bed
and the patient would rather not be there as well. Home health allows the remote observation and
care of a patient. Home health equipment consists of vital signs capture, video conferencing
capabilities, and patient stats can be reviewed and alarms can be set from the hospital nurse's
station, depending on the specific home health device.

History and Evolution

In its early manifestations, African villagers used smoke signals to warn people to stay away from the
village in case of serious disease. In the early 1900s, people living in remote areas in Australia used
two-way radios, powered by a dynamo driven by a set of bicycle pedals, to communicate with the
Royal Flying Doctor Service of Australia.
Shortly after the invention of the telephone, attempts were made to transmit heart and lung sounds to
a trained expert who could assess the state of the organs. However, poor transmission systems made
the attempts a failure. Below is an interesting time line of its evolution found on
http://users.forthnet.gr/ath/giovas/telemed/:
1906: ECG Transmission
Einthoven, the father of electrocardiography, first investigated on ECG transmission over telephone
lines in 1906! He wrote an article “Le telecardiogramme” at the Archives Internationales Physiologie
1920s: Help for ships
Telemedicine dates back to the 1920s. During this time, radios were used to link physicians standing
watch at shore stations to assist ships at sea that had medical emergencies.
1924: The first exposition of Telecare
Perhaps it was the cover showed below of "Radio News" magazine from April 1924. The article even
includes a spoof electronic circuit diagram which combined all the gadgets of the day into this latest
marvel!
1955: Telepsychiatry
The Nebraska Psychiatric Institute was one of the first facilities in the country to have closed-circuit
television in 1955. In 1971 the Nebraska Medical Center was linked with the Omaha Veterans
Administration Hospital and VA facilities in two other towns.
1967: Massachusetts General Hospital
This station was established in 1967 to provide occupational health services to airport employees and
to deliver emergency care and medical attention to travelers.
1970s: Satellite telemedicine
Via ATS-6 satellites. In these projects, paramedics in remote Alaskan and Canadian villages were
linked with hospitals in distant towns or cities.