The word ‘telemedicine’ appeared for the first time back in 1948, when a pair of hospitals in West Chester and Philadelphia, Pennsylvania, used the telephone line to transfer X-ray images from one to the other — a distance of 24 miles. Canadian radiologists at Montreal’s Jean-Talon Hospital described the event in their internal literature as ‘telemedicine,’ and later ‘teleradiology’ — and immediately set about setting up a system to do the same thing with their own satellite centers.
The first widely-recognized use of telemedicine using video was way back in the 1959s — in Nebraska of all places. The University of Nebraska Psychiatric Institute set up a two-way closed circuit television system and delivered the signal to classrooms in order to allow students to observe and contribute to psychiatric examinations.
As in many areas of technology in the 60s, the next big steps in the field were taken by NASA. Telemetry was already in place in many places across the Space Shuttle; adding a few systems to keep track of the astronaut’s vital signs was an obvious choice. Similarly, the development of video telehealth was a necessity to be able to track the well-being of astronauts who were spending extended periods in orbit. That technology was quickly assimilated by the military, and then spread among the private sector. There, it found particular use in tracking the health of oil rig workers hundreds of miles from shore.
1974 saw the publishing of the first in-depth investigation into the possibilities of remote diagnosis, with NASA putting a nurse and patient in one room and having the nurse perform a thorough examination. The sound and video quality were as high as the technology would allow — but later, before either one was played back for a doctor, both were deliberately degraded. The goal was to determine the ‘minimum useful level’ of sound and video quality — in other words, the level of quality at which the doctors tested were no longer able to confidently give a diagnosis based on the recordings of the exam.
In the late 80s and early 90s, the government of Norway took a keen interest in the developing field of telehealth. Already possessed of a universal health care program, and with distant, inaccessible regions that were cut off from the rest of the world for months at a time, Norway saw the potential for powerful returns on research, and poured money into development efforts.
In the USA, the 1996 Telecommunications Act created a fund for rural healthcare centers to develop telecommunications and broadband Internet services, leading to a focus on the rural areas for telemedicine funding that continues today. In 2003, the Veterans Administration began to invest heavily in three areas: at-home remote monitoring, ‘store-and-forward’ imaging, and clinical videoconferencing. As a result, in 2013, more than half a million veterans of the US armed services accessed one or more of these telemedicinal services.
Telemedicine had arrived — and yet it’s still coming. The development of the mobile market has added an entirely new dimension to the old concepts that guided the early years. Where will the field end up? Only time will tell!