Introduction to Telemedicine
This introduction to telemedicine is based on a presentation given by Dr. Susan Zollo, Director of the Telemedicine Resource Center at the University of Iowa. Contact firstname.lastname@example.org
The Institute of Medicine defines telemedicine as "...the use of electronic information and communications technologies to provide and support health care when distance separates the participants..."
The most common applications today are in transmission of high-resolution X-rays, cardiology, orthopedics, dermatology and psychiatry. Often, interactive video and audio are used for patient consultations and guidance on procedures; sometimes video briefings and records of specific operations are kept on a network in digital form. Groups of physicians, teachers and researchers often "meet" across large distances. Telemedicine also embraces the management of electronic patient records, access to libraries and databases on the Web and on private networks, and extensive use of e-mail by many in the medical profession.
Telemedicine arose originally to serve rural populations, or any people who are geographically dispersed -- where time and the cost of travel make access to the best medical care difficult. Now, it is increasingly being used in mainstream medicine, to allow doctors the world over to share expensive resources and valuable experience.
Telemedicine is increasingly global in its reach; in 1997 there were 188 active programs around the world, including Israel, Chile, India, Taiwan, Japan and the USA.
The availability of telemedicine is dependent to a large degree on telecommunications, and on high bandwidth; the field is concerned with advanced telecomm equipment and standards, methods of increasing effective bandwidth and network performance, costs of installation and operation, security, confidentiality and reliability, and with government legislation aimed at furthering progress in these areas.
The importance of bandwidth may be seen in a simple example. With a 28.8 Kbps dial-up connection, transmission of a standard X-ray takes 30 minutes; with a T1 line at 1.5 Mbps it takes 30 seconds; with a high-speed DS3 circuit, it takes 1 second. Clearly, productivity and usability of telemedicine data depends on the availability of high bandwidth.
In the Middle East, Greenstar is demonstrating how high-quality medical care can be brought to virtually any village, powered by solar energy and wireless data communications. This demonstration begins with the visit by the President of the United States to the region in December, 1998, as part of the ongoing peace process.
Dr. Khalid Moidu, an adviser to Greenstar on telemedicine, adds to this narrative:
The earliest example of telemedicine was in the physiological monitoring of astronauts, through pioneering work done by NASA. The Gemini and Apollo astronauts in the 1960's had two-way video connections with space medical experts in Houston, and developed a quite natural mode of interaction from orbit that featured taking care of routine health questions and needs, and early experiments on the effects of weightlessness.
This was followed by trials at Boston's Logan Airport, and participation by native American reservations in the STARPHAC program.
Telemedicine in the developed world is really "virtual transportation." In critical situations, the ability to keep a patient where he is and not have to stage an emergency evacuation, with all its costs and dangers, can be vital to the patient's survival and quality of life. But in the developing world, telemedicine delivers access to a high level of care where it is simply not available, at any cost.
So Greenstar, with its built-in infrastructure of power and telecommunications, delivers the platform on which telemedicine can exist in the developing world, and through which knowledge and experience can be effectively diffused.
In mid-November, 1998, a Russian sailor on his competition yacht in the stormy South Atlantic 400 miles from Capetown had an accident. Victor Yazykov had injured his arm, and it became badly infected. He was in serious danger. Fortunately, he had satellite-based e-mail powered by solar energy, in a small, inexpensive system on board. Over a period of days he exchanged messages with Dr. Daniel Carlin at the New England Medical Center, and was able to successfully perform minor surgery on his arm by getting detailed email instructions, encouragement and support.Yazykov survived, and is expected to make a full recovery. "The arm getting better," he wrote. "Very grateful to doctor."
A scenario is outlined which shows, in a vivid and easily-understood way, how advanced technology can make direct, personal medical diagnosis and treatment available to anyone, anywhere. This involves a two-way live video conference over a local network ibetween a patient and a doctor, discussing a simple medical condition of tendonitis; the patient receives diagnosis, treatment, prescription and followup.