2002

Telemedicine - Past its prime?

Telemedicine - past its time?

Ivar Skjåk Nordrum, MD PhD, Associate Professor, Department of Laboratory Medicine, Faculty of Medicine, Norwegian University of Science and Technology. Senior Consultant, Department of Pathology and Medical Genetics, St. Olavs Hospital - University Hospital of Trondheim. Senior Consultant, Norwegian Centre of Telemedicine, University Hospital of Northern Norway

Telemedicine came of age about 15 years ago. Modern telemedicine began with teleradiology rapidly succeeded by such services as telepathology and teledermatology. The goal was to render qualified diagnostic services independent of geographical location. These new services were possible because of the boom in telecommunication technologies at that time. Many politicians and members of the medical community embraced the new opportunities offered by telemedicine.

During the following years there was a lot of activity. Telemedicine organisations were created and numerous conferences were held. Telemedicine found its place in the promising era of information and communication technologies. Activities included in the concept of telemedicine increased.

Today, the themes of conferences are still much the same as they were ten years ago, and the investments made in telemedicine projects do not seem to have paid of sufficiently in the establishment of running services. Why is this the case? Is this the expected timeline for implementation of new services that do not fit into the existing organisation of medical services? When will an accelerated growth phase take place? Before answering these questions, it is necessary to clarify the meaning of the term telemedicine

The word telemedicine implies medical services delivered at a distance. Initially telemedicine was based on transfer of images enabling a diagnosis to be made in a clinical setting. Today, telemedicine embraces a variety of clinical and non-clinical activities like e-learning, electronic patient records, and interactive and static web sites. Should the term telemedicine include medical information not directly related to diagnosis and treatment? And, what is "tele"? Is it the transfer of images or other data to a neighbouring office, building or the next city? Or should it imply data transfer across some organisational boundaries, e.g. to another hospital? Is it telemedicine when text documents are transferred electronically instead by the postal service? My opinion is that terms like telemedicine and telepathology have become of little informative value, at that they should be replaced with terminology describing the particular activities

The goal of telemedical centres today should be to focus on and give birth to clinical telemedicine in close collaboration with the medical environment. The focus should be set on how to organise new activities and stimulate professionals to be the driving force. Approved projects should be strengthened and the number of projects should be reduced. Projects have limited value in themselves unless a reasonable number lead to the establishment of a regular service in the field. Telemedicine is a catchword that is long past its prime. Since telemedicine came of age about 15 years ago in terms of a limited number of different clinical services telemedicine has not reached its prime on a broader scale. For telemedicine to realise its true potential it is necessary to define specific goals, focus on research, organisational aspects and the active participation of professionals working in the clinical setting.

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