Abstract
The History of Telemedicine, by Rashid Bashshur and Gary Shannon, is a remarkable chronicle of the evolution of health-care technologies with telecommunications at their heart. It succeeds in portraying the sweep of events and the evolution of technologies that have taken telemedicine to the brink of becoming a mainstream health-care delivery system. Bashshur and Shannon carefully explain why some things work and others fail. They connect the dots between events and discoveries made worlds apart, thus producing important lessons.
The History of Telemedicine consists of six parts. Part I, entitled ‘Orientation of This Book’, explains that one aim in writing the book was to place telemedicine in its proper context as a technological innovation with the potential to solve persistent problems in the health-care industry. Thus the book places telemedicine in the contexts of various health-care delivery systems around the world and stresses that telemedicine remains a work in progress. This is unsurprising as the environments in which telemedicine seems to take hold are themselves ever changing.
Part II, entitled ‘The Roots and Context of Telemedicine,’ describes the history of technology in telemedicine, as well as the rationale for telemedicine. This section contains a remarkable collection of historical facts, many of which will be unfamiliar to today's telemedicine workforce. Bashshur and Shannon begin their coverage of the roots of telemedicine with legends dating back nearly 3000 years. Homer's Odyssey includes a description of the use of telecommunications in antiquity, in the form of ‘frictories’. These were fires used to signal information regarding the progress of the Trojan War; the medical implications are a matter for historical speculation. Then, moving to the nineteenth century in a giant leap forward, the authors describe a network of light-reflection stations (i.e. 50 heliograph stations) spanning vast areas of the American southwest territories; these were used mostly for military applications. One might infer, although it is not specifically stated, that Arizona and New Mexico would be ripe for telemedicine. These states now have large telemedicine programmes.
One lesson from Bashshur and Shannon's descriptions of early telecommunication systems is that remarkably sophisticated telecommunications networks have existed for a very long time. Human beings are intrinsically communicative animals who have used their capacity for invention to create technology to assist communication at long distances. No wonder the Greek prefix ‘tele-’, which can be translated roughly as ‘far off’, is at the root of our telehealth lexicon of today.
Part III, on the ‘Pioneer Era of Telemedicine’, divides this era into two chapters, the first on ‘The Genesis of Telemedicine (1870 to 1955)’, and the second on ‘The Pioneering Period (1955 to 1972)’. Bashshur and Shannon define the Genesis Period as that in which individual pioneers made rudimentary attempts to send medical information over a distance. During the Pioneering Period, small telemedicine programmes provided proof-of-concept demonstrations of the potential value of telemedicine.
Part IV also consists of two chapters. The first is entitled, ‘The Coming-of-Age Era of Telemedicine’ and describes relatively large, high profile programmes that began emerging towards the end of the preceding Pioneering Period. For example, in the USA, NASA created a mobile telemedicine project (STARPAHC) on an Arizona Indian Reservation in the early 1970s. NASA's objective was to demonstrate the technologies being developed for space missions in the context of terrestrial applications. The results were valuable and well documented by Bashshur during his earlier career as a program analyst. STARPAHC was an impressive proof-of-concept demonstration of many future telemedicine applications. Unfortunately, it was relatively short lived, a major concern of some of the tribal leaders from the start. Other projects, modelled after the pioneering telemedicine programme at Logan Airport in the late 1960s and early 1970s, were abundant by 1975, but few survived into the 1980s – a quiet decade for telemedicine – before the next wave.
The second chapter in Part IV is entitled, ‘The Maturation Period/Telehealth Initiatives across North America’ and describes the next wave of telemedicine programmes, emerging in the 1980s. Bashshur and Shannon's coverage of North American programmes emerging in the 1990s consists of comparisons of a few carefully selected model programmes in the USA plus a survey of Canadian programmes. Readers in other countries with proud heritages in telemedicine, such as Australia and Norway, might regard this as being somewhat provincial, an argument not without merit. Perhaps international readers would have been comforted by a prominent disclosure that this book was not intended to be encyclopaedic in its coverage. On the other hand, historical accounts are not necessarily expected to cover their subject matter comprehensively, although the observations and conclusions should have universal lessons, as is true for the present book.
Part V, ‘The Transformation of Telemedicine’ represents outstanding scholarship. The authors show how telemedicine could be transformed by changes in health care and information technologies, and how health-care delivery could be transformed by emerging telemedicine applications.
Part VI, entitled ‘The Evidence’, underlines the fact that despite the thousands of papers that have been published on many facets of telemedicine, the field still needs additional clinical studies, especially outcomes studies, as well as persuasive voices to move telemedicine into the mainstream of health care. The tone of the authors is that of visionaries who have been playing the game for a long time but do not necessarily see the goal line quite yet. Bashshur and Shannon state that ‘The adoption of telemedicine by the mainstream is going to depend heavily on evidentiary, logistic, and financial considerations’. In other words, much of the history of telemedicine yet remains to be written.
The History of Telemedicine is an authoritative and scholarly account of the development and implementation of telemedicine and telehealth. It is highly recommended.