Telemedicine or Remote Health Care, the practice of medicine using telecommunications (for example, standard telephone systems, fiber-optic cables, satellite communications). This usually involves the diagnosis or treatment of illness by a doctor, who is not in direct contact with the patient, using the two-way picture and sound transmission. It can also take the form of patient data being passed between general practitioners and laboratories and hospitals. As such, telemedicine places strong demands on telecommunication security to ensure that patient confidentiality is maintained.
This rapidly evolving area of medicine is particularly well developed in countries where local health care centres are separated by large distances from medical specialists in town or city hospitals (for example, in some areas of the United States, Canada, and Australia) or where the climatic geography of a region may result in seasonal transport problems (such as Scandinavia, particularly northern Norway). Telemedicine is also of great value in the provision of medical aid between countries: for example, in the 1988 earthquake in Soviet Armenia, a satellite link (“spacebridge”) was provided to medical facilities in the United States.
The idea of performing medical examinations through the telecommunications network is not new. Shortly after its invention, the telephone was used to transmit heart and lung sounds made by a patient to an expert in another part of the country so that he or she could assess the state of the organs. Later, in 1906, attempts were made to diagnose heart conditions by the use of the telephone to convey electrocardiograms (heart traces). However, these early attempts were unsuccessful due to the poor transmission systems available at the time.
The practice of telemedicine was accelerated in the 1960s, with the development of the technology for picture transmission using closed-circuit television systems linked to standard telephone lines. Remote diagnosis and consultation in radiology (for example, X-rays), psychiatry, and general medical education were the first areas to benefit from this technological advance, with pictures and sound from one site being transmitted to a specialist for diagnosis at another. The next ten years saw a number of successful trials in the United States, Canada, and Australia to evaluate the feasibility of telemedicine systems to deliver improved health care to geographically remote areas.
Over the past decade the rapid development of computer technology, in particular, digital image processing, has meant that remote consultation using telemedicine has become available to a wide range of medical services at relatively low cost. In primary health care, general practitioners can consult with a specialist in a large hospital who may be hundreds of kilometres away. Future developments will involve medical services to the remotest areas of the planet (such as Antarctica) and extend into space; NASA and the European Space Agency are already evaluation systems for use in manned space stations.
Claire Elizabeth Lewis
Andrew Keith Graham