Telemedicine 2.0

Like telework in general, telemedicine has a long, if obscure, history. The idea behind telemedicine is that information technology might be able effectively to facilitate the delivery of medical services without the collocation of patient and physician. Clearly, there are some apparent limits to the variety of such services. The doctor is in one location, the patient somewhere entirely else. I can easily imagine a tele-visit to the doctor’s office where, via color TV, the doctor has me stick out my tongue, takes a blood pressure reading, possibly with the aid of a local assistant, and prescribes some pills. That’s basically the state of the art in the mid 1970s. Let’s call that telemedicine 0.9.

The significant distinction between “ordinary” telework and telemedicine is the location independence issue. Many forms of information work are relatively insensitive to the locations of the participants. I can write a report anywhere and still get it delivered to its intended recipients anywhere else. But medical interactions? I used to joke that brain surgery was not a good candidate for telework; a certain intimacy between the surgeon’s hands and the patient’s skull seemed to be in order.

But, like almost everything else, the times they are a-changin’. Technology marches on and it alters the perspective for telemedicine. Let’s glance at telemedicine 2.0

An article by Melissa Healy in the 16 December 2009 Los Angeles Times triggered my miniscing about this. Titled “Airman gets long-distance pancreas fix” the article describes how the functioning of the Afghanistan-blasted pancreas of an Air Force Senior Airman may be revived. The process involved sending the remains of the airman’s pancreas across the country from Walter Reed Army Medical Hospital to Miami’s Miller School of Medicine. There the “organ’s delicate islet cells were extracted and purified” and sent back to Walter Reed for infusion into the airman’s liver. He is now doing nicely, thank you.

Well, is this true telemedicine? After all, what mostly was transported back and forth was stuff, not just information. Still, it was not possible for the physicians in Miami to come to DC with all their equipment and knowledge in sufficient time so the key exchanges were between physicians in different locations.

OK, how about the aforementioned brain surgery? With contemporary robotics technology it is possible (and has been done, although I don’t have the exact reference at hand) to operate on a patient’s brain, by the robot, with the “attending” physician thousands of km away, viewing the details via TV and instrument readouts. The robot may even have steadier “hands” than the distant surgeon, adding a safety factor to a delicate operation. Of course common practices like having distant specialists reading X-rays (possibly computer-enhanced) in order to give instant advice on procedures is now well-established.

The convergence of broadband telecommunications and medical technology is steadily expanding the reach of telemedicine. This has important implications for health care globally. In 1970 I gave a presentation to the incoming director of NASA, Jim Fletcher, about the use of communications satellites to transmit crucial medical information from the US to stricken communities in East Africa. That seemed slightly far-fetched then. Today it’s routine. Access to quality medical care, a scarce commodity, can become available to a much broader audience, and at a much lower cost—with telemedicine 2.0

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