23.2 Telemedicine Applications


23.2 Telemedicine Applications

23.2.1 Brief History of Telemedicine

Primitive forms of telemedicine had already been practiced hundreds of years ago. An example is the lepers' use of bells to warn others to stay way. In the Middle Ages, information about bubonic plague was transmitted across Europe using bonfires. [11] Some wealthy families back then also sent urine samples to their doctors for diagnosis. [12] The telegraph was used to transmit casualty lists and medical supplies orders in the American Civil War, [13] and also in the early 1900s for medical consultations, diagnosis, and transmission of dental x-rays. [14], [15] A description of using the telephone to transmit amplified sounds from a stethoscope for remote auscultation appeared in 1910. [16], [17] In 1920, the Seaman's Church Institute of New York probably became the first organization to provide medical care using radio.

Telemedicine using modern communication technologies only appeared in the past few decades. The first practices of true telemedicine occurred around the 1950s. An article in 1950 described the transmission of radiologic images between West Chester and Philadelphia using the telephone. Based on this, radiologists at Jean-Talon Hospital, Montreal, set up a teleradiology system in the 1950s. Telemedicine using interactive video started in 1959, when a two-way closed circuit television (CCTV) was used to transmit neurological examinations and other information at the University of Nebraska. [18] In 1964, they established a link with the Norfolk State Hospital to provide services such as speech therapy, neurological examinations, diagnosis of difficult psychiatric cases, case consultations, and education and training. By the 1960s, the National Aeronautics and Space Administration (NASA) and the U.S. Indian Health Service deployed a satellite-based telemedicine system, which included mobile examination rooms, x-ray imaging, and ECG facilities, in the Papago Indian reservation. Another early example of mobile telemedicine is the Alaska ATS-6 Satellite Biomedical Demonstration, which assessed the viability of improving village health care in Alaska using satellite for video consultation.

23.2.2 Internet-Based Telemedicine Applications

Telemedicine has advanced tremendously in the past few years, due to the growth of the Internet and availability of low-cost personal computers (PC). By the mid-1990s, many had started to explore medical applications on the Internet. To begin, PC applications for Web browsing, e-mail access, and file transfer were proposed for medical information exchange. [19] The first telemedicine applications using the Internet operated in store-and-forward mode. As an early example, in 1993 a medical team in London transmitted ultrasound images of a fetus to the Fetal Treatment Program in San Francisco for surgical opinion. [20] In 1996, Yamamoto et al. demonstrated digitization and transmission of radiographic and medical images using a scanner, a digital camera, and PCs connected to the Internet. [21] Scanned radiographic images and digital medical images were stored as JPEG files in a PC, and then transmitted over the Internet between Hawaii, Tennessee, and Texas using a file transfer protocol (FTP) program, the World Wide Web, and Prodigy. Connections established via high-speed local area network (LAN) and via 14.4k baud modem were tested. Many health care professionals today are still using e-mail and other forms of store-and-forward technologies for low-cost telemedicine. [22], [23]

The Internet has been used also in remote patient monitoring. Magrabi et al. developed a Web-based longitudinal ECG monitoring system that stored recorded ECGs at a Web server for remote offline analysis and viewing. [24] Park et al. set up a real-time patient-monitoring system based on 100 Base-T Ethernet LAN. [25] Besides providing patients' general information, it allowed doctors to monitor patients' ECG, respiration, temperature, blood oxygen saturation, and blood pressure in real-time. Teleconferencing facilities also were available. There are other similar Internet-based systems that acquire vital signs through a short-range wireless link. [26], [27], [28]

23.2.3 Importance of Mobility in Telemedicine

Advances in telecommunications and mobile computing have stimulated numerous researches and developments in mobile telemedicine applications over the past few years. These applications are becoming more and more feasible as technologies evolve. Telemedicine is no longer limited to usage only within hospitals and clinics. Its coverage is expanding into homes, workplaces, outdoors, airplanes, and even into outer space. Mobility is obviously a trend in telemedicine.

Telemedicine is probably the only option in remote, isolated areas where no medical facility is available. Equipment used would not be stationary, but should be designed for long-distance transport and easy setup. Efforts in providing an integrated health care service to patients have eventually lead to emphasis in home health care, patient monitoring, and other patient-centered telehealth programs. In these cases, the patients or medical staffs often are not in the hospital, and telemedicine based on mobile communications acts as a bridge between the two parties. Mobile telemedicine has been used also in emergencies, where immediate attention and consultation are needed.

[11]Craig, J., Introduction, in Introduction to Telemedicine, Wootton, R. and Craig, J., Eds., Royal Society of Medicine Press, Glasgow, 1999.

[12]Sosa-Iudicissa, M., Wootton, R., and Ferrer-Roca, O., History of telemedicine, in Handbook of Telemedicine, Ferrer-Roca, O. and Sosa-Iudicissa, M., Eds., IOS Press, Amsterdam, 1988.

[13]Field, M.J., Telemedicine: A Guide to Assessing Telecommunications in Health Care, National Academy Press, Washington, D.C., 1996.

[14]Holland, J.J., Classic episodes in telemedicine: treatment by telegraph, J. Telemed. Telecare, 3 (4), 223, 1997.

[15]Kenny, E., Classic episodes in telemedicine: diagnosis by telegraph, J. Telemed. Telecare, 4 (4), 223, 1998.

[16]Craig, J., Introduction, in Introduction to Telemedicine, Wootton, R. and Craig, J., Eds., Royal Society of Medicine Press, Glasgow, 1999.

[17]Sosa-Iudicissa, M., Wootton, R., and Ferrer-Roca, O., History of telemedicine, in Handbook of Telemedicine, Ferrer-Roca, O. and Sosa-Iudicissa, M., Eds., IOS Press, Amsterdam, 1988.

[18]Field, M.J., Telemedicine: A Guide to Assessing Telecommunications in Health Care, National Academy Press, Washington, D.C., 1996.

[19]McKinney, W.P. and Bunton, G., Exploring the medical applications of the Internet: a guide for beginning users, Am. J. Med. Sci., 306 (3), 141, 1993.

[20]Fisk, N.M. et al., Intercontinental fetal surgical consultation with image transmission via Internet, Lancet, 341, 1601, 1993.

[21]Yamamoto, L.G. et al., Telemedicine using the Internet, Am. J. Emerg. Med., 14 (4), 416, 1996.

[22]Yamamoto, L.G. and Suh, P.J., Accessing and using the Internet's World Wide Web for emergency physicians, Am. J. Emerg. Med., 14 (3), 302, 1996.

[23]Della Mea, V., Internet electronic mail: a tool for low-cost telemedicine, J. Telemed. Telecare, 5 (2), 84, 1999.

[24]Magrabi, F. et al., Web based longitudinal ECG monitoring, in Proc. 20th Ann. Int. Conf. IEEE EMBS, Chang, H.K. and Zhang, Y.T., Eds., Hong Kong, 20 (3), 1155, 1998.

[25]Park, S. et al., Real-time monitoring of patients on remote sites, in Proc. 20th Ann. Int. Conf. IEEE EMBS, Chang, H.K. and Zhang, Y.T., Eds., Hong Kong, 20 (3), 1321, 1998.

[26]Kong, K.Y., Ng, C.Y., and Ong, K., Web-based monitoring of real-time ECG data, Comput. Cardiol., 27, 189, 2000.

[27]Pollard, J.K., Rohman, S. and Fry, M.E., A Web-based mobile medical monitoring system, in International Workshop on Intelligent Data Acquisition and Advanced Computing Systems: Technology and Applications, Foros, 32, 2001.

[28]Bai, J. et al., A portable ECG and blood pressure telemonitoring system, IEEE Eng. Med. Biol. Mag., 18 (4), 63, 1999.




Wireless Internet Handbook. Technologies, Standards and Applications
Wireless Internet Handbook: Technologies, Standards, and Applications (Internet and Communications)
ISBN: 0849315026
EAN: 2147483647
Year: 2003
Pages: 239

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