Propelled by the information superhighway and the breadth of emerging computer and communication technologies, telemedicine will change the face of medicine and methods of interaction between providers and patients. Access, quality and cost of health care may all improve, but not without the sacrifice of some time-honored norms in medical practice.1
Telemedicine is a rapidly emerging and evolving concept in the medical industry that increasingly poses new legal questions that could have widespread ramifications. Telemedicine is not the practice of medicine itself, but rather a tool that aids health care professionals in providing medical treatment and care to patients using modern communications technologies. Through this delivery mechanism, health care providers can offer or support clinical practice at a distance-- across both geographic and time barriers.2 The most common use of telemedicine has helped provide health care to rural communities via communications technologies including interactive audio and video monitoring.3 Individuals in largely rural areas far removed from hightech urban or university medical centers are now able to access a full range of medical specialists and advanced treatment options without having to travel out of the areas in which they live.
A. What is Telemedicine?
Telemedicine refers to the use of electronic communication and information technologies to deliver health care at a distance. National Aeronautics and Space Administration ("NASA") scientists first created telemetric technologies for the space program to provide for the long-- distance measurement and transmission through space of the astronauts' physiological data:5 The most basic examples of telemedicine in use today include communications between health care providers and their patients over the Internet, via e-mail or audio-visual conferencing. Through "store and forward" technology, telemedicine images can be digitally stored and forwarded to a distant health care provider.6 This interaction does not occur in real time, so it is most frequently used in the fields of radiology and pathology, because these professionals frequently provide services at some point of time after their patient visit; for example, an x-ray can be taken at one time and viewed later. A more technologically advanced use of telemedicine, which is rapidly developing now, is the use of digital interactive or simultaneous video, audio, and data transmission equipment.7 This technology broadcasts a patient's examination in one location to a health care provider miles away. Telemedical professionals can configure this interactive system to allow the transmission of electronic signals from specially equipped stethoscopes, sonograms, otoscopes, endoscopes, and other diagnostic tools.8 The most advanced systems involve controlled robotic surgical operations, in which robots are controlled from one location to perform surgeries in another locale.9 In each of these uses, the medical information is delivered through various technologies, including the Internet, telecommunications lines (copper wire or fiberoptic), and satellite transmissions.10 The transmission mode requires integration and compatibility with a variety of hardware and software components (e.g., software that compresses radiological images for speedier transmission or enhanced computerized imagery).11
The term "telehealth" is often used interchangeably with telemedicine. However, telehealth specifically refers to health-related activities, such as continuing education for health care providers, the administration of health care service, medical and bio-scientific research, and public health activities.12 Telemedicine instead refers to the actual practice of medicine over a distance using communications technologies.
B. Benefits and Present Applications
Texas, along with many other states that have vast and largely inaccessible rural areas, can readily benefit from using telemedicine technology to help treat traditionally underserved rural inhabitants. …