Telemedicine

Telemedicine is the use of telecommunications technologies to enable health professionals to diagnose, provide information, and deliver health services when they are not available for on-site service delivery. Telemedicine may involve direct interaction with a conscious patient (e.g., taking a history and deciding on needs), direct physiological monitoring of a specific patient (e.g., transmission of a 12-lead electrocardiogram), analysis of test information (e.g., teleradiology), or real-time intervention (e.g., telesurgery).

Of course, medicine has used basic telecommunications techniques, such as telephony, as soon as they became available. Facsimile is a routine way to send reports and orders. Some of the first users of pagers were physicians, although there is a persistent rumor that the inventor of the pager could never find a doctor willing to treat the source of all those annoying pages.

Not always considered telemedicine, but really the lowest-end example, are telephone calls to a Public Safety Answering Point (e.g., dialing 911, 112, or other national emergency number), in which a dispatcher follows written procedures to determine if and what type of emergency medical personnel should be sent to the caller, and also to guide a layman caller through immediate interventions such as cardiopulmonary resuscitation (CPR).'

Emergency medical technicians may use telemedical methods to consult with their medical control officer, and determine whether an advanced intervention is appropriate. A good example is deciding whether to administer a thrombolytic drug such as alteplase (also known as tissue plasminogen activator (TPA)) to a patient whose electrocardiogram indicates an acute myocardial infarction (AMI). Thrombolytic drugs are expensive, but cost-effective when given to an AMI patient within 6 hours of the event; they may be able to reverse the damage to the heart.

Teleradiology, especially when a radiologist will interpret a fixed image, rather than performing a real-time procedure such as fluoroscopy, is increasingly common. One efficient application is to have rural or lightly-staffed hospitals transmit their images, taken of an emergency room patient at night, to a radiologist who is in normal office hours in another time zone.

One area that may or may not be considered telemedicine involves invasive or interventional procedures where the clinician is at the same location as the patient, but the primary information to the physician comes through electronics (e.g., television cameras in an endoscope). Another aspect is robotic surgery, where a microsurgical manipulator actually cuts, cauterizes, etc., but under the direct control of a physician using a joystick, vernier dials, etc. In the robotic example, the control system may smooth out almost unnoticeable hand tremor present in the surgeon.