Developing medical informatics

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.

The efficient provision of quality health services to all citizens in the future is one of the most difficult challenges facing all governments. Health care technology and treatment is improving dramatically at the same time as most governments are faced with aging populations, pressuring future health spending in the medium to long term. Thus there is a double challenge: to improve the quality and accessibility of health care for all citizens, whilst constraining overall costs. These challenges will be impossible to meet without the deployment and widespread use of fully integrated, interoperable and modernised health systems. Digital technologies can improve the productivity and scope of health care. This potential is not being fully exploited - only 1% of total health spending is used on information technology. In summary, secure services have to be developed linking hospitals, laboratories, pharmacies, primary care centres and homes of people.

Telemedicine has been in use in some form or other for over thirty years, although its use dramatically increased in the late 1990s. 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.

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 include: (a) using telemedicine in correctional facilities and home health care settings can significantly reduce the time and costs of patient transportation; (b) 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; (c) permitting physicians doing clinical research to be linked together despite geographical separation, sharing patient records and diagnostic images; (d) improving medical education for rural health care professionals, where rotations is made possible by linking several community hospitals together with the sponsoring medical school.

What was reportedly the first telemedicine system was set up in Nebraska 40 years ago, when Omaha's Nebraska Psychiatric Institute and the state mental hospital about 200 kilometers away used two-way, closed circuit microwave TV to transmit demonstrations with patients to first-year medical students.

Large medical telemedicine networks are being constructed around the world, and things have come far enough for the existence of the Journal of Telemedicine and Telecare, the establishment of the International Society for Telemedicine and the recent convening (1998) of the Fourth International Conference on the Medical Aspects of Telemedicine.