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   Worldwide, people living in rural and
   remote areas struggle to access timely,
   quality specialty medical care. Residents
   of these areas often have substandard
   access to specialty health care, primarily
   because specialist physicians are more
   likely to be located in areas of
   concentrated population. Because of
   innovations in computing and
   telecommunications technology, many
   elements of medical practice can be
   accomplished when the patient and health
   care provider are geographically separated.
   This separation could be as small as across
   town, across a state, or even across the
   world. Broadly defined, telemedicine is the
   transfer of electronic medical data (i.e.
   high resolution images, sounds, live video,
   and patient records) from one location to
   another. This transfer of medical data may
   utilize a variety of telecommunications
   technology, including, but not limited to:
   ordinary telephone lines, ISDN, fractional
   to full T-1's, ATM, the Internet,
   intranets, and satellites. Telemedicine is
   utilized by health providers in a growing
   number of medical specialties, including,
   but not limited to: dermatology, oncology,
   radiology, surgery, cardiology, psychiatry
   and home health care.

   Trends observed nationally include:

     1. using telemedicine in correctional
        facilities and home health care
        settings, can significantly reduce the
        time and costs of patient
     2. fine-tuning the management and
        allocation of rural health care
        emergency services by transmitting
        images to key medical centers for long
        distance evaluation/triage by
        appropriate medical specialists;
     3. permitting physicians doing clinical
        research to be linked together despite
        geographical separation, sharing
        patient records and diagnostic images.
     4. improving medical education for rural
        health care professionals, where
        rotations is made possible by linking
        several community hospitals together
        with the sponsoring medical school.

   In general, the numerous and ever expanding
   applications of telemedicine allows its
   users to reduce the burdens inferior health
   care access through utilization of
   technology. Because of telemedicine,
   geographical isolation need no longer be an
   insurmountable obstacle to the basic needs
   of timely and quality medical care.

   While the explosion of interest in
   telemedicine over the past four or five
   years makes it appear that it's a
   relatively new use of telecommunications
   technology, the truth is that telemedicine
   has been in use in some form or other for
   over thirty years. The National Aeronautics
   and Space Administration (NASA) played an
   important part in the early development of
   telemedicine (Bashshur and Lovett, 1977) .
   NASA's efforts in telemedicine began in the
   early 1960s when humans began flying in
   space. Physiological parameters were
   telemetered from both the spacecraft and
   the space suits during missions. These
   early efforts and the enhancement in
   communications satellites fostered the
   development of telemedicine and many of the
   medical devices in the delivery of health
   care today. NASA provided much of the
   technology and funding for early
   telemedicine demonstrations, two of which
   are mentioned below. A book by Rashid L.
   Bashshur published in 1975 (Bashshur R.L.
   et al. 1975) lists fifteen telemedicine
   projects active at the time. There were
   several pioneering efforts not only in the
   US, but all over the world. A few of these
   and some later projects are worth examining
   briefly. To find articles about these
   programs, follow the links to the
   Bibliographic database, which will give you
   a reference and abstract (if available),
   which describes these programs. Many of
   these programs have other articles besides
   those listed which describe them. To find
   these, do a word search in the
   Bibliographic database on the project of

   Space Technology Applied to Rural Papago
   Advanced Health Care (STARPAHC):
   One of the earliest endeavors in
   telemedicine, STARPAHC delivered medical
   care to the Papago Indian Reservation in
   Arizona. It ran from 1972-1975 and was
   conceived by the National Aeronautics and
   Space Administration (NASA), engineered by
   NASA and Lockheed, and implemented and
   evaluated by the Papago people, the Indian
   Health Service and the Department of
   Health, Education and Welfare. Its goals
   were to provide health care to astronauts
   in space and to provide general medical
   care to the Papago Reservation. A van
   staffed by two Indian paramedics carried a
   variety of medical instruments including
   electrocardiograph and x-ray. The van was
   linked to the Public Health Service
   hospital and another hospital with
   specialists by a two-way microwave
   telemedicine and audio transmission.
   (Bashshur, 1980).

   Nebraska Medical Center:
   The Nebraska Psychiatric Institute was one
   of the first facilities in the country to
   have closed-circuit television in 1955. In
   1964 a $480,000 grant from the National
   Institute for Mental Health allowed a
   two-way link between the psychiatric
   institute and Norfolk State Hospital, 112
   miles away. The link was used for
   education, and for consultations between
   specialists and general practitioners. In
   1971 the Nebraska Medical Center was linked
   with the Omaha Veterans Administration
   Hospital and VA facilities in two other
   towns. The psychiatric institute also
   experimented with group therapy.
   (Benschoter, R.A. 1971) .

   Massachusetts General Hospital/Logan
   International Airport Medical Station:
   This station was established in 1967 to
   provide occupational health services to
   airport employees and to deliver emergency
   care and medical attention to travelers.
   Physicians at MGH provided medical care to
   patients at the airport using a two-way
   audiovisual microwave circuit. The Medical
   Station was staffed by nurses 24 hours/day,
   supplemented by in-person physician
   attendance during four hours of peak
   passenger use. Evaluation of diagnosis and
   treatment of the nurse-selected patients
   was made by participating personnel and
   independent physician observers. Analysis
   was also made of the accuracy of microwave
   transmission. Inspection, auscultation, and
   interpretation of roentgenograms and
   microscopic images were also performed.
   Necessary hands-on procedures were
   performed by the nurse-clinicians. (Murphy,
   R.L. Jr. and Bird K.T.(1974) and (Murphy,
   R.L. Jr., et al (1972) ).

   Alaska ATS-6 Satellite Biomedical
   In 1971, 26 sites in Alaska were chosen by
   the National Library of Medicine's Lister
   Hill National Center for Biomedical
   Communication to see if reliable
   communication would improve village health
   care. It used ATS-1, the first in NASA's
   series of Applied Technology Satellites
   launched in 1966. This satellite was made
   available in 1971, and was still in use in
   1975. The primary purpose was to
   investigate the use of satellite video
   consultation to improve the quality of
   rural health care in Alaska. Satellite
   ground stations permitting transmission and
   reception of black and white television
   were installed at four locations, and a
   receive-only television capability was
   installed at the Alaska Native Medical
   Center in Anchorage. All five sites had
   two-way audio. Two of the locations had no
   resident physician. Simultaneous two-way
   video capability was not available,
   although the one-way video could be
   switched for transmission from any site
   except Anchorage. This was an exploratory
   field trial, not a rigorous experiment.
   Evaluation of the project was done by the
   Institute for Communications Research at
   Stanford University. It was determined that
   the satellite system was workable, could be
   used effectively by health aides at the
   various locations, and could be used for
   practically any medical problems except
   emergency care (emergencies could not wait
   for scheduled transmission times). It was
   also determined that the "unique
   capabilities of the video transmission may
   play a critical role in 5-10% of the cases
   selected for video presentation. Otherwise,
   there was little measurable difference
   between the effect of video and audio
   consultation." (Foote, D. et al. 1976) and
   (Foote, D. 1977).

   Video Requirements for Remote Medical
   In 1974 NASA contracted with SCI Systems of
   Houston to conduct a study to determine the
   minimal television system requirements for
   telediagnosis. The experiment was conducted
   with a help of a simulated telemedicine
   system. First, a high-quality videotape was
   made of actual medical exams conducted by a
   nurse under the direction of a physician
   watching on closed-circuit television. This
   was the baseline for the study. Next, these
   videotapes were electronically degraded to
   simulate television systems of less than
   broadcast quality. Finally, the baseline
   and degraded video recordings were shown
   (via a statistically randomized procedure)
   to a large number of physicians who
   attempted to reach a correct medical
   diagnosis and visually recognize key
   physical signs for each patient. Six
   television systems were investigated: two
   systems were compatible with transmission
   over full bandwidth television channel,
   while the other four allowed more detailed
   investigation of the frame rate and
   horizontal bandwidth required for each
   medical case. The following four results
   were found: 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 reduced below 10
   frames/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
   as a function of TV system type that would
   cause detriment to patients; 4) the
   supplementary study of radiographic film
   televised transmission (25 cases) showed
   that no diagnostic differences occurred
   between the TV evaluations and the direct
   film evaluations for TV resolutions above
   200 lines if special optical lenses and
   scanning techniques were utilized. (SCI
   Systems, Inc. 1974).

   Memorial University of Newfoundland (MUN):
   MUN was an early participant in the
   Canadian Space Program. The joint
   Canadian/U.S. Hermes satellite provided
   Canadians with an opportunity to use
   satellite technology in distance education
   and medical care. Since 1977, The
   Telemedicine Centre at MUN has worked
   toward developing interactive audio
   networks for educational programs and the
   transmission of medical data. Among the
   guidelines followed were: use the simplest
   and least expensive technology; be
   flexible; involve the users from the
   beginning of the project; seek
   administrative support in hospitals,
   clinics and other agencies; and include
   evaluation. The MUN Teleconferencing
   System, a province-wide network consisting
   of five dedicated circuits, began
   programming in 1977. There are
   installations in all provincial hospitals,
   community colleges, university campuses,
   high schools, town halls and education
   agencies. MUN has been active in
   international teleconferencing, and played
   a significant role in the School of
   Medicine at the Univ. of Nairobi, Kenya in
   the 1960-70s. In 1985 MUN became involved
   in the International Satellite Organization
   (Intelsat), linking to Nairobi and Kampala,
   which later was extended to six Caribbean
   countries. MUN has been a model for the
   judicious and low-cost use of telemedicine
   technology . They have proven that many
   times there is no need for the higher-end,
   higher-cost videoconferencing equipment.
   (House and Roberts, 1977).

   The North-West Telemedicine Project:
   This project was set up in 1984 in
   Australia to pilot test a government
   satellite communications network (the
   Q-Network). The project goals were to
   provide health care to people in five
   remote towns south of the Gulf of
   Carpentaria. Two-thirds of these people
   were Aborigines or Torres Strait Islanders.
   The Q-Network consisted of 20 two-way
   earth-stations and 20 one-way
   (television-receivers only) earth stations.
   The hub of the network was the Mount Isa
   Base Hospital. All sites were supplied with
   a conference telephone, fax, and
   freeze-frame transceivers. Evaluation for
   the project showed that the technology did
   improve the health care of these remote
   residents. While it was impossible to
   calculate the operating costs of the
   telemedicine network separate from the
   other functions of the network, some
   healthcare costs were reduced. Fewer
   patients and specialists flew to and from
   these remote areas for routine
   consultations, and fewer patients were
   evacuated for emergency reasons. (Watson,

   The NASA SpaceBridge to Armenia/Ufa
   In 1989 NASA conducted the first
   international telemedicine program, Space
   Bridge to Armenia/Ufa. In December of 1988
   a massive earthquake hit the Soviet
   Republic of Armenia. An offer was extended
   from the United States to the Soviet Union
   for medical consultation from the site of
   the disaster in Armenia to several medical
   centers in the U.S. Under the auspices of
   the U.S./U.S.S.R Joint Working Group on
   Space Biology, telemedicine consultations
   were conducted using one-way video, voice,
   and facsimile between a medical center in
   Yerevan, Armenia and four medical centers
   in the U.S. The program was extended to
   Ufa, Russia to facilitate burn victims
   after a terrible railway accident. This
   project demonstrated that medical
   consultation could be conducted over a
   satellite network crossing political,
   cultural, social, and economic borders.
   (Pers. Commun. Chuck Doarn, NASA, January
   1996). The last ten years have seen a
   steady increase in the number of
   telemedicine projects throughout the U.S.
   and internationally. As more government
   funding became available in the early 90s,
   and as technology costs continue to
   decrease, telemedicine is possible for a
   wider spectrum of users. An article in
   Telemedicine Today, Spring 1995 (Allen and
   Allen, 1995) lists the top twenty
   interactive television telemedicine sites
   in the U.S. by number of consultations for
   1994. The Active Telemedicine Projects in
   the TIE lists over 130 sites

   Descriptions of these and other early
   projects may be found in various
   publications or as more obscure government
   funding reports listed in the TIE
   Bibliography. A search using the text word
   of the project you are interested in, or a
   search using "telemedicine" as a keyword
   and "history" as a subcategory will bring
   up these citations. Many will have
   abstracts, and the full citations will
   allow you to obtain these documents from
   your local library.

   This page was last updated on Wednesday,
   July 07, 1999