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Telemedicine and Clinical Rotations: Worth Investigating?

Telemedicine had its beginnings in the 1950s and 1960s when it was used to transmit video, images, and complex medical data. In 1959, theUniversity ofNebraskaused interactive video to transmit neurological examinations, widely considered the first case of a real-time video telemedicine consultation.Other programs, typically based in an academic setting, followed suit. They focused on transmission of medical data such as fluoroscopy images, x-rays, stethoscope sound, and electrocardiograms. Early telemedicine projects were used to provide access to health care in rural areas and in urban medical emergency situations. In the 1960s, the National Aeronautics and Space Administration, Lockheed Corporation, and the US Indian Health Service partnered to work on the Space Technology Applied to Rural Papago Advanced Health Care project, which provided telemedicine access to an American Indian reservation using the same technologies intended for astronauts on space missions. Additional grantand government-supported telemedicine initiatives followed, focusing on providing medical care in war zones, at remote scientific stations like Antarctica, and in correctional facilities (reducing unnecessary transport to hospitals), as well as the digital transmission of radiology images. These initial deployments of telemedicine were large undertakings that required considerable staff and organizational changes. The use of telemedicine has spread rapidly but unevenly due to the variety of barriers discussed below. It is increasingly integrated into the operations of hospitals, specialty departments, home health agencies, private physician offices, patient homes, and workplaces. Products and services related to telemedicine are often part of a larger investment by government and health care institutions, businesses, and other stakeholders involved in either information technology or the delivery of clinical care. The potential of telemedicine delivery models is growing exponentially due to advances in information technology, widespread availability of Internet connectivity, and the proliferation of compact devices such as smart phones and tablet computers. Telemedicine stakeholders include diverse groups such as traditional medicine, academia, technology and telecommunications companies, e-health companies, allied professional and nursing associations, medical societies, government, the military, and regulatory agencies such as state medical licensing boards. Many of the stakeholders’ interests overlap and may conflict. Each has a part to play in eliminating barriers to the advancement of telemedicine while maintaining professional, ethical, and equitable aspects of health care delivery.