A Brief History of Telemedicine
Throughout history, humankind has sought various ways to receive medical care, and as technology has advanced, so has our ability to receive and deliver this care.
While the COVID-19 pandemic has put a spotlight on our ability to deliver medical visits in the home, all via the internet and video technologies that have evolved significantly over the last several years, the scope of telemedicine is much broader than the ‘Zoom visits’ we see today.
To start, telemedicine is a term coined in the 1970s, essentially meaning ‘healing at a distance.’ Or more specifically by the World Health Organization (WHO) which offers this broad sweeping definition:
“The delivery of health care services, where distance is a critical factor, by all health care professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and for the continuing education of health care providers, all in the interests of advancing the health of individuals and their communities.”
The first application of telemedicine came with the invention of the telegraph in 1844, used to send simple signals such as Morse code, the telegraph found a use by the Union Army in the Civil War to communicate troop casualties, coordinate patient transport, and request medical supplies for troops.
As sound communication technology progressed, with the invention of the telephone by Alexander Graham Bell in 1876, people began finding ways to apply the transmission of sounds to medical care. According to The Lancet, a phone was first used to diagnose croup in a pediatric patient, and by 1910 was used to transmit sounds from a stethoscope that a patient held in place on their chest to a physician several miles away (effectively dubbed the ‘telecardiogram’).
Then as television communication began in 1927, medical experts began finding ways in which to transmit imagery, and in 1948 physicians began transmitting radiologic images between hospitals in Pennsylvania. Eventually, in the 1960s in the first video link was then used by the University of Nebraska to conduct psychiatric and neurologic consultations 112 miles away with Norfolk State Hospital.
With various methods of wireless transmission available, the United States faced a new problem as it entered the space race in the 1960s. Existing transmission methods did not exist to reach astronauts who were orbiting the globe, so satellite technology was developed to facilitate this. In 1972, NASA’s satellite technology began providing telecommunication support for small communities across much of rural Alaska and its larger healthcare entities (effectively creating a hub and spoke model).
In the 1990s and early 2000s, telemedicine entered its developmental years. With advancements in the world-wide web, computers, broadband, and smart phone technology, more and more people/organizations would have access to these technologies at lower and lower entry prices.
However, while small pilot experiments showed early success in reducing costs and improving quality of care, reimbursement mechanisms did not keep up with this technological innovation. It was not until 1999 when the Centers for Medicare and Medicaid (CMS) began reimbursing telemedicine visits; and would be another 10 years, during the 2008 Great Recession until the US Government passed the Health Information Technology for Economic and Clinical Health Act (HITECH) as part of the American Reinvestment & Recovery Act (ARRA) to support the funding of health technology and broadband in communities across the country. Ironically, in an industry that seems to have too much regulation, it was this regulation that spurred the growth of health technologies (e.g. electronic health records) that we see today.
Today, telemedicine can be bucketed into the following three delivery mechanisms:
Store-and-Forward
Also known as ‘asynchronous telemedicine’ this method of telemedicine can be compared to email or text messaging.
o In a patient to physician relationship, this could look like a patient sending a physician a picture of their rash to see if additional treatment is needed (aka e-visits).
o Whereas in a physician-to-physician relationship, a physician may share imaging, lab, or other diagnostic reports with another physician to receive a consult or second opinion (aka e-consults).
Remote Monitoring
Also known as ‘telemonitoring,’ remote monitoring allows a physician or care team to monitor a patient at a distance, in real-time.
o In a hospital setting, this could include monitoring a patient’s vital signs who is in an ICU several miles away (e-ICU) where it may be infeasible for a critical care physician to travel to multiple locations across a state.
o Outside of the hospital, remote monitoring can help manage chronic conditions, such as diabetes, while a patient is at home by monitoring an individual’s glucose levels over time. This information could then be used to help coach the individual on dietary habits or adjust medication levels.
Real Time Telemedicine
This is likely what comes to mind when you think telemedicine. Within real-time, video or phone visits, clinical teams can easily see a patient for primary or urgent care, follow-up visits, or ongoing support around medication management for long-term illness.
Fast forward to today, even as organizations saw year-over-year growth in the thousands of percent due to the pandemic, telemedicine still represents a small percentage of the overall visit volume across the world.
While this growth is expected to continue by several hundred percent over the next 5 years, there are many factors that are key to this sustained growth. In future articles, I plan to discuss these factors more in-depth and offer an analysis on all areas of people, process, technology, and regulation needed to further scale digital health.
Sources:
Nesbitt T.S., & Katz-Bell J (). History of telehealth. Rheuban K, & Krupinski E.A.(Eds.), Understanding Telehealth. McGraw-Hill. https://accessmedicine.mhmedical.com/content.aspx?bookid=2217§ionid=187794434
(WHO), W. H. (2009). Telemedicine: Opportunities and Developments in Member States. Geneva, Switzerland: WHO Press.
Chiron Health. Best Practices in Telemedicine: The Definitive Guide. Date Accessed: January 2021.
