Telemedicine: a cautious welcome

Abstract

What is telemedicine? There are various definitions of telemedicine. The most general one (“medicine at a distance”) covers the whole range of medical activities, including treatment and education.1 There are many successful examples of distance education in medicine, including the continuing medical education programme run by the Mayo clinic and delivered by satellite2 and the teaching of surgery to undergraduates by means of Britain's Super-JANET network.3 On the other hand, there has been little work on distance treatment, and it is difficult to envisage anything other than a minority role for it in future. It is the area of telemedicine where the professional is remote from the patient or specimen in which there has been, and will continue to be, major activity. Well known examples include: Teleradiology—Radiographic images are transmitted to a radiologist for interpretation Telepathology—A pathologist can look down, and in some cases control, a microscope located several hundred miles away Teleconsulting—The doctor and patient are in different places, joined by some sort of communications link, such as medical videoconferencing. In its simplest form this kind of telemedicine uses the telephone; more recently, full colour, two way, video and audio links have been used. It is important to understand that telemedicine is a process not a technology. The process of telemedicine has become much more feasible in the past few years as a result of technological advances and continuing cost reductions. Because it is feasible, people are beginning to try it out (there is nothing wrong with this—indeed, it may be unethical not to try out a new technique if there is a reasonable suspicion that it may be advantageous). As is well known, there is at present little scientific evidence that telemedicine works. However, it is equally true that many other healthcare innovations have not been properly evaluated either.4 View larger version: In this window In a new window Teleradiology workstation in Cork. The system connects six major referring hospitals to both neurosurgical departments in the Republic of Ireland. (Supplied by Dr W P Gray, Wessex Neurological Centre) View larger version: In this window In a new window Telepathology workstation at University Hospital of Troms(empty set). Three departments of pathology and five peripheral hospitals without surgical pathologists use the system, mainly for remote diagnosis of frozen sections. (Supplied by Dr R Elford, Memorial University of Newfoundland) View larger version: In this window In a new window Teleconsulting room at Kansas University Medical Center. The Kansas Telemedicine Project consists of 12 rural and two urban sites. (Supplied by Dr G Doolittle, University of Kansas)