Filed under: Telemedicine | Tags: communications, EHR, electronic health records, future medicine, healthcare provider, History, History of Medicine, medical history, modern medicine, neurology, new medical techniques, physicians, telehealth, telemedicine, telepathology, x-ray imaging
Telemedicine is the practice of medicine at a distance; interaction that occurs remotely with the physician removed from direct contact with either the patient or other physicians. Telemedicine can include all phases of the physician-patient relationship, from evaluation (including pathology) to diagnosis and treatment. Although recent breakthroughs in telecommunications technologies have accelerated the advancement of telemedicine, the desire to seek medical counsel regardless of the proximity of the healthcare provider is a common thread throughout medical history. The mechanism has changed, but medicine has long worked to remove the barriers of distance and time.
As early as the Middle Ages, “telepathology” was employed in the form of sending urine samples over distance to physicians for analysis. Prescriptions were carried over miles to patients before the advent of postal services. With the postal service came written letters describing symptoms to physicians, who would reply with diagnoses and treatment plans. These are all examples distinctly foreshadowing the emails and blog centered care that is now gaining a foothold.
Eventually, a milestone was reached when the telegraph allowed transmission of x-ray images. By the late 1800’s, telephony allowed direct 2-way communication between physicians. Still, a physical connection was required, and physicians at sea or without telephone access were at a loss. The radio broke that barrier by the 1920’s, and by the middle of the century, television technology brought real time images into the equation.
Near the end of the last century the most rapid, indeed explosive, growth of telemedicine utilization resulted from the symbiosis of computer technology, wireless communication networks and the internet. The ease of access to telemedicine that modern communication technology provides has broadened the scope of services. “Telehealth,” the utilization of remote presence to monitor health conditions, rather than responding to acute emergencies, is essentially commonplace. Moreover, well-care and health education have benefitted as well.
Today, we do not think twice about calling patients or colleagues on a phone, logging onto a computer for laboratory results, or reviewing radiology images on a TV screen. Soon, electronic health records (EHR’s) will be the norm. There are even technologies on the horizon which will become a partner with the doctor in establishing a diagnosis. The question for our future is when does new remote presence technology become standard of care? Inevitably, we will lose the “tele” and acknowledge that we are completely free of distance as an obstacle to patient care.
Filed under: Telemedicine | Tags: acute stroke care, AcuteCare Telemedicine, EMG, History of Medicine, hospitals, medical history, medical technology, medicine, MRI, neurology, Technology, teleneurology
This is a photo of the first MRI scanner in the world. It is presently on display as an artifact at the London Science Museum in the Wellcome History of Medicine exhibit, but the scanner only dates back to 1971. The first images it produced were extremely coarse and only showed rough shadows of what the brain really looked like. It is incredible to think that just 40 years later, we are able to see the brain and other organs as substantially clearer three-dimensional images. With the immensely improved technology, we can even see the circulation of blood in the brain and its metabolic activity as it is being used. There are other fascinating exhibits at the museum, including devices used in attempts to ameliorate the human condition dating from long before the MRI scanner came about.
Besides the usual trephining tools used to burr holes in the skull and buckets to catch the blood from ‘therapeutic’ lobotomies, there is this; an early 19th century EMG machine used to measure nerve conductions in diagnosis of peripheral nervous system disorders:
It seems that one would place a limb at the bottom of this arc and the weights would be dropped onto them, causing a reflex which was recorded by the machine. The time and distance of the nerve impulse was measured giving the speed at which the impulse moved down a nerve. It sounds painful, but compared to the advances of the MRI scan, the nerve conduction studies we do today are relatively similar to what this machine did.
With the advent of the Internet and the rise of telemedicine, our skills as physicians are undergoing another paradigm shift. The magnitude of the change brought on by telemedicine technologies is closer to that of the leaps made by the MRI scan than those of the EMG. For the first time, physicians can see patients in real-time from hundreds of miles away, markedly increasing the efficiency and productivity of our field. Perhaps one day, this same exhibit will include one of our current devices, denoted as an “early robot,” and serve as a curiosity to the lines of people that pass by. Whatever the result, we will probably always look back on the strides we are making today and the people behind them as the next great pioneers in the history of medicine.
AcuteCare Telemedicine Blog 