Academic journal article Generations

Telemedicine: Communication Technologies That Revolutionize Healthcare Services

Academic journal article Generations

Telemedicine: Communication Technologies That Revolutionize Healthcare Services

Article excerpt

Simple, effective applications now; virtual reality and simulation soon.

Today is an exciting yet challenging time to be an aging American. Advances in technology and the shifting age demo-graphics in the United States will have many effects-not least in the area of healthcare resources and expenditures.

As a result of the dramatically increasing healthcare costs and other challenges in providing quality, accessible healthcare services to an aging society, healthcare providers and policy makers are looking for alternatives to help older people who need care to remain at home and limit use of inpatient services rather than face long stays in expensive institutions. Telemedicine, the use of communication technologies to deliver healthcare services, has garnered significant attention during recent years as a solution to address both access and cost concerns. This article provides an overview of the evolution of telemedicine applications, with ethical and policy implications for the long term.


The application of telemedicine has evolved over the past five decades. The first generation of telemedicine, which is still very much in use, mainly serves to enable a healthcare provider to consult with a patient who is in a different place; the consultation can take place live, concurrently, or not, using a tape or other form of transmission that allows for nonconcurrent, or asynchronous, interaction. Early on, telemedicine was defined as the use of interactive or two-way television for diagnosing or treating a patient who is at a different location (Willemain and Mark, 1971). The U.S. Department of Health and Human Services (2006) currently defines the term telehealth as "the use of electronic information and telecommunications technologies to support long-distance clinical care, patient and professional health-related education, public health and health administration."

Interactive video-a concurrent interaction between two or more sites connected by videohas traditionally been the technology used for medical diagnosis, care, and education. The University of Kansas Medical Center has employed telemedicine for more than a decade. Patients located in rural Hays, Kansas, for example, are able to interact with oncologists from the medical center, which is more than 250 miles away in Kansas City. For some medical communication, particularly related to radiology, pathology, and often dermatology, clinicians employ store-andforward video connections, by which audio clips, video clips, still images, or data can be held and transmitted or received at a later time. The recipient is free to choose when to review the content of the transmission.

Wittson and colleagues (1961) were the first to employ telecommunication for medical purposes, in 1959 when they set up telepsychiatry consultations via microwave transmission between the Nebraska Psychiatric Institute in Omaha and the state mental hospital 112 miles away. In the same year, Montreal was the site for Jutra's (1959) pioneering teleradiology, which allowed for the transmission of radiographie images to distant sites, where experts could review them at their convenience.

In the 19705, several major projects, including the Space Technology Applied to Rural Papago Advanced Healthcare project of NASA, provided valuable insights that paved the way for such future telemedicine endeavors as provision of home healthcare, or telehome health (Dunn et al., 1980).

While the decades of the 1960s, 1970s, and 19805 exhibited a series of telemedicine pilot and demonstration projects, the 1990s proved to be a period of more rapid growth. New, fairly inexpensive technologies made it possible to digitize and compress video, audio, and other imaging information, which could then be transmitted over telephone lines with relatively narrow bandwidths instead of through more expensive satellites or relatively unavailable private cable or fiberoptic lines. …

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