Health On the Net

Telemedicine has now come of age

Michael E. DeBakey MD
Distinguished Service Professor of Surgery, and Director
DeBakey Health Center
Baylor College of Medicine
Houston, Texas, USA

First Published in:
Vol. 1, No. 1, 1995
Mary Ann Liebert, Inc. Publishers

Although television was first demonstrated publicly at the New York World's Fair in 1939, its development was interrupted by World War II, but resumed in 1946. In 1953, "natural color" telecasts began, coast-to-coast viewing became generally available, and its growth and development mushroomed.

In 1965, Comsat launched the world's first intercontinental communications satellite, called "Early Bird," and placed it in an orbit that would provide communication services between North America and Europe. In response to Comsat's request to demonstrate the potential of telemedicine, among the various uses of "Early Bird", I perfomed an open-heart operation at The Methodist Hospital on May 2, 1965. The procedure consisted of replacement of the aortic valve with an artificial prosthesis. As I performed the operative procedure, representatives of the Geneva University Medical Faculty in Geneva, Switzerland, watched the operation. I described the operation as it was in progress and answered questions from the group in Geneva, whom I could see and hear on my monitor in the operating room through the interactive television link-up that "Early Bird" afforded. Sitting in their amphitheater, the European physicians could also see and hear me. The Director-General of the World Health Organization, Dr. M.G. Candau, participated, along with Professors Jean-Claude Rudler, Charles Mentha, and others, in what was a successful experiment in the intercontinental exchange of medical knowledge through the use of interactive television.

During the past several decades, television has expanded rapidly to become the main source of entertainment, news presentation, and general public information. An estimated 98 percent of households in this country have television, with an average of two sets per household. Although medical television has grown more slowly, it, too, has now come of age. Telemedicine began in the 1950s as closed circuit systems presented at national medical society meetings, with conferences or presentations of major surgical procedures in auditoriums or conference rooms usually sponsored by pharmaceutical or commercial instrument firms. In the 1980s, this type of support sponsored the Hospital Satellite Network and the Cable Health Network, which subsequently became Lifetime Medical Television. A decade later, American Medical Television for physicians was launched by the American Medical Association.

In recent years, interest in telemedicine has intensified, and its application greatly expanded both for purposes of continuing medical education and for patient consultation. During Operation Restore Hope in Somalia, telemedicine was used to provide remote consultation for military purposes by allowing access to specialists at Walter Reed Army Medical Center. The Navy has its own telemedicine link between Zagreb and the National Naval Medical Center in Bethesda through the U.S. hospital it staffs, which supports U.N. forces in Croatia. The National Library of Medicine is providing grantes to fund telemedicine projects designed for patient care through city-wide, as well as area-wide, networks in a number of states. The Office of Rural Health Policy is sponsoring grants in a number of states to support the use of telemedicine for the improvement of health care in rural areas. In 1991, the Medical College of Georgia initiated one of the most advanced telemedicine networks, designed to permit its physicians to examine and treat patients in certain rural areas of the state. It has proved so successful that the college now plans to expand the network throughout the entire state.

Having now come of age, telemedicine has the potential of having a greater impact on the future of medicine than any other modality. In the most remote areas, it can bring high-quality health care where none is now available. In global health care, it can enhance and standardize the quality of medical care throughout the world. Through its mobile units, it can provide urgently needed health care in instances of natural disaster, such as earthquakes, or in military operations. It is the most cost-effective means of providing continuing medical education. By linkage between a medical facility and individual homes, it can provide home health care and health education. Telemedicine is, in the final analysis, bringing reality to the vision of an enhanced accessibility of medical care and a global network of health care.


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