Telemedicine Applications
23.2.1 Brief History of Telemedicine
Primitive forms of telemedicine had already been
practiced hundreds of years ago. An example is the lepers' use of bells
to warn others to stay way. In the Middle Ages, information about bubonic plague was transmitted across Europe using bonfires. [11] Some wealthy families back then also sent urine samples to their doctors for diagnosis. [12] The telegraph was used to transmit casualty lists and medical supplies orders in the American Civil War, [13] and also in the early 1900s for medical consultations, diagnosis, and transmission of dental x-rays. [14], [15] A description of using the telephone to transmit amplified sounds from a stethoscope for remote auscultation appeared in 1910. [16], [17] In 1920, the Seaman's Church Institute of New York probably became the first organization to provide medical care using radio.
Telemedicine using modern communication
technologies only appeared in the past few decades. The first practices
of true telemedicine occurred around the 1950s. An article in 1950
described the transmission of radiologic images between West Chester
and Philadelphia using the telephone. Based on this, radiologists at
Jean-Talon Hospital, Montreal, set up a teleradiology system in the
1950s. Telemedicine using interactive video started in 1959, when a
two-way closed circuit television (CCTV) was used to transmit
neurological examinations and other information at the University of
Nebraska. [18]
In 1964, they established a link with the Norfolk State Hospital to
provide services such as speech therapy, neurological examinations,
diagnosis of difficult psychiatric cases, case consultations, and
education and training. By the 1960s, the National Aeronautics and
Space Administration (NASA) and the U.S. Indian Health Service deployed
a satellite-based telemedicine system, which included mobile
examination rooms, x-ray imaging, and ECG facilities, in the Papago
Indian reservation. Another early example of mobile telemedicine is the
Alaska ATS-6 Satellite Biomedical Demonstration, which assessed the
viability of improving village health care in Alaska using satellite
for video consultation.
23.2.2 Internet-Based Telemedicine Applications
Telemedicine has advanced tremendously in the
past few years, due to the growth of the Internet and availability of
low-cost personal computers (PC). By the mid-1990s, many had started to
explore medical applications on the Internet. To begin, PC applications
for Web browsing, e-mail access, and file transfer were proposed for
medical information exchange. [19]
The first telemedicine applications using the Internet operated in
store-and-forward mode. As an early example, in 1993 a medical team in
London transmitted ultrasound images of a fetus to the Fetal Treatment
Program in San Francisco for surgical opinion. [20]
In 1996, Yamamoto et al. demonstrated digitization and transmission of
radiographic and medical images using a scanner, a digital camera, and
PCs connected to the Internet. [21]
Scanned radiographic images and digital medical images were stored as
JPEG files in a PC, and then transmitted over the Internet between
Hawaii, Tennessee, and Texas using a file transfer protocol (FTP)
program, the World Wide Web, and Prodigy. Connections established via
high-speed local area network (LAN) and via 14.4k baud modem were
tested. Many health care professionals today are still using e-mail and
other forms of store-and-forward technologies for low-cost
telemedicine. [22], [23]
The Internet has been used also in remote patient
monitoring. Magrabi et al. developed a Web-based longitudinal ECG
monitoring system that stored recorded ECGs at a Web server for remote
offline analysis and viewing. [24] Park et al. set up a real-time patient-monitoring system based on 100 Base-T Ethernet LAN. [25]
Besides providing patients' general information, it allowed doctors to
monitor patients' ECG, respiration, temperature, blood oxygen
saturation, and blood pressure in real-time. Teleconferencing
facilities also were available. There are other similar Internet-based
systems that acquire vital signs through a short-range wireless link. [26], [27], [28]
23.2.3 Importance of Mobility in Telemedicine
Advances in telecommunications and mobile
computing have stimulated numerous researches and developments in
mobile telemedicine applications over the past few years. These
applications are becoming more and more feasible as technologies
evolve. Telemedicine is no longer limited to usage only within
hospitals and clinics. Its coverage is expanding into homes,
workplaces, outdoors, airplanes, and even into outer space. Mobility is
obviously a trend in telemedicine.
Telemedicine is probably the only option in
remote, isolated areas where no medical facility is available.
Equipment used would not be stationary, but should be designed for
long-distance transport and easy setup. Efforts in providing an
integrated health care service to patients have eventually lead to
emphasis in home health care, patient monitoring, and other
patient-centered telehealth programs. In these cases, the patients or
medical staffs often are not in the hospital, and telemedicine based on
mobile communications acts as a bridge between the two parties. Mobile
telemedicine has been used also in emergencies, where immediate
attention and consultation are needed.
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