Telemedicine A Guide to Assessing Telecommunications for Health Care (1996) / Chapter Skim
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2 EVOLUTION AND CURRENT APPLICATIONS OF TELEMEDICINE
2 EVOLUTION AND CURRENT APPLICATIONS OF TELEMEDICINE
Pages 34-54
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From page 34... ...
Evolution and Current Applications of Telemedicine EVOLUTION OF DISTANCE COMMUNICATION People have been communicating over considerable distances by sounds or visible signals for centuries. Drums, horns, and other instruments have been used and are still used in some places to send messages using certain sound patterns that correspond to prearranged codes.
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From page 35... ...
These innovations include manual switchboards to connect multiple telephone lines, loaded circuits to reduce distortion over long distances, vacuum tube amplifiers to boost signals, and automatic switching systems, to name just a few. Telephone circuits can also carry still and video images as well as audio signals and data, and radio signals have been used to extend the reach of telephone communication.
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From page 36... ...
In that year, clinicians at the University of Nebraska used two-way interactive television to transmit neurological examinations and other information across campus to medical students (Benschoter et al., 1967; Wittson and Benschoter, 1972~. They next explored its use for group therapy consultations, and in 1964 they established a telemedicine link with the Norfolk State Hospital (~12 miles away)
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From page 37... ...
The first experimental television transmission did not occur until 1927. Photo courtesy of the Radiology Information System Consortium, Reston, Virginia.
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From page 38... ...
established in 1963 a telecommunications link with a medical station staffed by nurse clinicians at Boston's Logan Airport (Bird, 1972~. In 1968, MGH added an interactive television microwave link that provided electrocardiograph, stethoscope, microscopy, voice, and other capabilities.
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From page 39... ...
, only one of the formal telemedicine programs that was started before 1986 survived into the mid-199Os. That program, established by the Memorial University of Newfoundland, began in 1977 with a three-month demonstration project involving one-way television and two-way audio.
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From page 40... ...
Private organizations have also been tracking and reporting public and private telemedicine programs (Telemedicine Monitor, 1995~. For example, the state health policy program of George Washington University surveyed and analyzed state government initiatives to support telemedicine as discussed further in Chapter 4 (Lipson and Henderson, ~995)
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From page 41... ...
This diversity underscores the challenge of designing evaluation strategies, measures, and data collection methods to fit different settings, populations, clinical conditions, and objectives. Telerafdiology As indicated earlier, the most common current applications of telemedicine (other than general telephone and fax communications)
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From page 42... ...
These developments made institutional adoption of digital radiology feasible and facilitated the development of multi-institutional teleradiology networks. Several sites on the World Wide Web provide radiology and pathology images for educational purposes, and some programs are testing or
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From page 43... ...
In general, the wider use of digital radiology within health care centers can be expected to provide an additional impetus for tele 6For instance, teledermatology is not yet widespread, although dermatological problems are a common source of requests for consultations in telemedicine programs. In its test of telemedicine to support deployed troops in Somalia and elsewhere, the military has found a high frequency of dermatology consults (Walters, 1996)
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From page 44... ...
They illustrate how academic medical centers may look to telemedicine as a way to expand markets nationally and internationally and to offset revenue losses in a changing health care and government environment. As two experienced academic teleradiology experts have described it, "to be digitally aware is to realize the new era of competition" in a cost-constrained environment (Mun and Freedman, 1996~.
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From page 45... ...
Evaluations of these kinds of program are discussed in Chapter 5. One of the of Jest telephone-based monitoring programs has been operated by Veterans Affairs Medical Centers in San Francisco and Washington, D.C.
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From page 46... ...
Colorado, North Carolina, and Texas are among the states with operational programs, and other states are considering or testing programs. A major objective of prison telemedicine is to avoid the high costs of either bringing medical specialists to prison (the costs of which are high partially owing to adverse working conditions)
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From page 47... ...
Because prison telemedicine programs are generating relatively large number of cases, they offer considerable potential for systematic evaluation such as those undertaken and planned by Texas Tech and the University of Texas Medical Branch at Galveston. One early program has been operated by the East Carolina University (ECU)
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From page 48... ...
Current funding sources include service contracts with EOHSC, Greater Oregon Behavioral Health, Inc. (a nonprofit managed behavioral health care organization responsible for delivering public behavioral health care services to consumers in eastern Oregon under the Oregon Health Plan demonstration)
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From page 49... ...
Fourth, training and support for users focused on establishing comfort with technologies at a level equivalent to that for the telephone. Postsurgical Monitoring in an Urban Nursing Home The postsurgical monitoring program developed by Stanford University Medical Center and nearby Lytton Gardens Health Care Center offers an example of a telemedicine application prompted by focal initiative without federal grant funding.8 This program grew out of discussions initiated by Lytton Gardens, a skilled nursing and residential facility that provides a continuum of services and living arrangements for low-income senior citizens.
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From page 50... ...
video camera (mounted above the computer monitor) , large video display monitor, microphone, speakers, CODEC (an electronic COder/DECoder device)
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From page 51... ...
Stanford already has one such contract with the San lose Medical Group for dermatology services, and it also is linked to the Drew Health Foundation (a community health center) for telecardiology services, with other services to be added in the future.
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From page 52... ...
that included a number of rural sites.9 The organization's telemedicine system has administrative, educational, and community service as well as clinical uses. It is being constructed with a mix of funds including internal resources, a grant from the ORHP, contracts and other arrangements with a consortium of rural hospitals (the Rural Health Alliance)
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From page 53... ...
The remote sites have been spending up to $70,000 for backup emergency services of uneven quality. Allina could offer them the telemedicine link and transfer arrangement for $40,000 to $50,000 on a contractual basis and could sometimes successfully bill patients' insurers for services.
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From page 54... ...
The evaluation framework presented later in this report reflects this conclusion.
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