Telemedicine 1.0 vs Telemedicine 2.0. History of Telemedicine. Part 2

Telemedicine 1.0 refers to the early types of Telemedicine applications characterized by custom, bulky hardware specifically created for Telemedicine and designed for specific usage cases, such as psychiatry consults in ER and requiring special skills and training to operate. Telemedicine 2.0 typically refers to applications running on Web 2.0 technologies that are characterized by collaboration, usability, interoperation, and openness features.

Telemedicine 1.0
First proposals to transmit stethoscope readings and other instrument data over existing communication channels (telephone, radio, etc.) were made in the first half of the 1900s. In 1906 Einthoven, the father of electrocardiography, first investigated on ECG transmission over telephone lines. He discussed this in an article “Le telecardiogramme” at the Archives Internationales Physiologie.

In the April 1924 issue of Radio News magazine for the first time depicted using television and microphone for a patient to communicate with a doctor, including use of heartbeat and temperature indicators. The concept was an imagination of the future, as U.S. residents did not yet have televisions in their homes, and radio adoption was just gaining steam.

In the late 1950s and early 1960s the first uses of telemedicine to transmit video, images, and complex medical were explored. The first case of a real-time video telemedicine consultation took place in 1959 at the University of Nebraska when interactive telemedicine was used to transmit neurological examinations. After this experiment other projects were executed. They focused on transmission of medical data such as fluoroscopy images, x-rays, stethoscope sound, and electrocardiograms (ECGs) to provide access to health care in rural areas and urban medical emergency situations.

1960 marked the first experiment in telepsychiatry and it took place also in Nebraska. Closed-circuit television connected Nebraska Psychiatric Institute and Norfolk State Hospital for consultations. The next year a report on radio telemetry for patient monitoring was published in the Anesthesiology journal. Later in the decade Nebraska Psychological Institute joined a program of healthcare delivery by NASA.

NASA played a major role in the development of telemedicine. Starting from 1960s the agency partnered with Lockheed Corporation, and U.S. Indian Health Service in a remarkable Space Technology Applied to Rural Papago Advanced Health Care (STARPAHC) project. This program tested satellite-based communications to offer health consultations to astronauts and Native Americans in distant reservations. The project provided telemedicine access to the Papago tribe in a remote American Indian reservation using the same technologies intended for astronauts on space missions. Within the project medical data received from electrocardiograph and x-ray machine was transmitted to specialists at the Public Health Service Hospital using two-way microwave transmissions.

This project set the foundation for other implementations of telemedicine for the benefit of the general public. For example, establishment in 1967 of a medical station at Boston’s Logan International Airport that was linked to Massachusetts General Hospital (MGH). Physicians at MGH provided medical care to patients at the airport 24 hours a day, using a two-way microwave audio/video link. In 1970s paramedics in remote Alaskan and Canadian villages were linked with hospitals in distant towns or cities via ATS-6 satellites.

The first medical specialty to fully embrace telemedicine was radiology. In 1980 grant-sponsored projects proved benefits of telemedicine for the area and in 1980s some radiologists began to use teleradiology systems to transmit images for consultations.  Cold war provided technological advancement that found their way to telemedicine. The US Department of Defense funded several teleradiology projects in the 1970s and 1980s that resulted in the Digital Imaging Network Project which was later utilized by radiologists.

Another push to the development of telemedicine and its international importance was provided by a massive earthquake in 1989 in the former Soviet Republic of Armenia. To aid the ailing region the U.S. offered the Soviet Union to use a one-way international telemedicine network for consultations between Yerevan, Armenia, and four medical centers in the U.S. Unlike other technology transfer solutions with a  direct military application, remote medical communications had a clear humanitarian purpose.

Telemedicine 2.0

The “2.0” typically refers to applications running on Web 2.0 technologies that are characterized by collaboration, usability, interoperation, and openness features. Telemedicine 2.0 is characterized as:

  •      Using existing computing device belonging to patient or physician
  •      Communicating over the Internet and using standard web infrastructure
  •      Using inexpensive off-the shelf equipment for gathering clinical data
  •      Easy to use — can be used directly by patient or physician without special training

The current stage in telemedicine history began on the rise of the Internet in the 1990s. It brought numerous advancements that were in line with global trends, such as globalization, content publishing, consumer demand:

  •      Communication speed
  •     Storage capabilities
  •      Standard formats for data transmission
  •      Security (encryption, password protection, access levels, etc.)
  •      Application development — new programming languages (JavaScript), frameworks, and open-source software (Apache)
  •      The Cloud – using virtual servers hosted by an infrastructure provider
  •      Applications for information digitizing (digital cameras, scanners, etc.)

Internet clearly had a positive impact on telemedicine and healthcare in general. Transition to electronic medical records (EMRs) provided access to medical information for medical providers and patients. Patient portals have become common, where patients can look up their lab results, refill prescriptions, or send a secure message to their physician. Patients also have access to medical information online. Growth in use of wearable devices enables easier access to health data that can be tracked online and stored for analytical and diagnostic purposes. Among these wearables are

  •      Smartphone cameras
  •      Digital stethoscopes
  •      Ophthalmoscopes (for eye exams)
  •      Otoscopes (for ear exams)
  •      Vital sign monitoring devices
  •      Wearable biosensors

Telemedicine 1.0 vs Telemedicine 2.0. History of Telemedicine. Part 1

The history of the Telemedicine development has gone in the close parallel to the history of communication and information technologies. As the ultimate goal and the technical prerequisite of telemedicine is the ability to communicate medical data over a distance.

Telemedicine in it’s primitive form was practiced in ancient times. As an example, news about an outbreak of a dangerous disease could be sent over long distance using a variety of media channels besides human messengers: fires, smoke signals, drums, horns etc.

Modern Telemedicine as we know it gained momentum with the advent of technology. First inventions that gave rise to Telemedicine were the telegraph and the telephone. With these media almost anyone could send a message or make a call. Telegraph was widely used in military situations due to the speed.

Telephone brought the era of the connected world. Major city hospitals and doctor offices installed telephones and within a few years, many city residents also had telephones in their homes. Therefore medical advice could be given directly to patients.

These days most of us prefer asynchronous communication methods, such as text messages but the telephone was the foundation for many communication and telemedicine technologies. The historycan be divided into 2 parts: Telemedicine 1.0 and Telemedicine 2.0

What is telemedicine?

Digital technologies have transformed the ways people communicate, collaborate and make decisions, healthcare and well-being included.

In the era of increased awareness of diseases and general interest in well-being, both patients and doctors are looking for on-demand healthcare which results in improved outcomes due to instant interaction and availability of health data. Therefore, it’s no surprise that telemedicine is enjoying growth.

Telemedicine: several important trends

US data shows that in 2016 market penetration for telemedicine was less than .5% while the potential is estimated at 400+ million consults – approximately one-third of the 1.25 billion annual U.S. ambulatory care visits.

  • Aging of population in developed countries is increasing the pressure over the healthcare system and healthcare spending. It is forecasted that in the US it will be increasing by 5.8% per year between 2018 and 2015. 38% of doctor visits, including 27% of Emergency Room (E.R.) visits could have been replaced with telemedicine.
  • The average Emergency Room (ER) cost visit is calculated at the level of $1,233 based on 2008 NIH data. This reflects the median cost for visits that did not lead to result in a hospital admission. Due to healthcare costs inflation, this number is expected to grow.
  • A 2016 survey by the NIH concluded that between 94 percent and 99 percent were “very satisfied” with telehealth, while one-third of respondents preferred telemedicine session to an in-office doctor visit. Additionally, studies show that the quality of telehealth services is equal to the traditional walk-in consultations.
  • A survey found that 23% of people did not see a doctor with their health conditions due to long wait times in clinics.
  • Telemedicine makes time usage more efficient for both patients and doctors. A study published in 2015 in the American Journal of Managed Care, by researchers at Harvard Medical School, concluded that the average doctor visit took 121 minutes; 37 minutes of travel time, 64 minutes of waiting time, and just 20 minutes of face-to-face time with physicians. A 2017 Medscape survey shows that 56% of all physician visits included only 16 minutes or less of actual face-to-face time with patients. Such ineffective usage of time can be reorganized by telehealth service introduction.
  • Telehealth can address such issues as access to care at nights and on weekends, and shortages of physicians and specialists in rural areas. Only in the US approximately 15% of the population lives in rural areas and only 10% of the nation’s physicians practice in rural areas. Inadequate distribution of specialists is even more striking in other parts of the world.
  • Telemedicine can address the issue of growing shortages of Primary Care Physicians (PCP): the total number of PCPs in the US can only meet 50% or less of the population’s needs while almost 65 mln Americans don’t have access to primary care providers.
  • Telehealth is the preferred healthcare method by the millennials: 60% are willing to replace in-office visits with telehealth sessions. They appreciate convenience and lower costs of telemedicine, especially in non-emergency cases. This is confirmed by a 2015 survey that found that just 43% of millennials were likely to visit a Primary Care Physician for non-emergency treatment, as opposed to seeking a more convenient telehealth option.According to 2014 Towers Watson study, telemedicine can provide up to 6$ bln in annual healthcare costs for employers that constitute up to 8% of total operating expenses. These expenses may be redirected to lower-cost alternatives, decrease costs for avoided follow-up visits and lead to increased employee productivity, improved health through earlier treatments, reduced stress and decreased employee burden of sharing healthcare costs.