R.WOOTTON
In April 1924 the issue of Radio News magazine include a drawing of a physician viewing his patient over the radio which include a TV screen ; TV was not invented until 1929. First cross state demostration of telemedicine probably occurred in 1951 New York World´s Fair. In 1957 Albert Jutras started doing teleradiology in Montreal and in 1959 Cecil Wittson started at the Nebraska Psychiatric Institute a tele-education and telepsychiatry program.
L.LARENG
France history of Telemedicine can be sumarized as
1945 Centre of Maritim Health Care consultation
1960 Telephone and radiophone consultations ( i.e. ECC )
1968 Creation of the SAMU ( Service d´aide Medical d´urgence )and SMUR ( service mobile d´urgence and reanimation )
1970 Number regional 15- Centres 15.
1984 Definition of the medical secret, and the numbers for phone connections : 15 ( Health Care ), 17 ( Police ), 18 ( Fireman )
1989 Creation of the European Institute of Telemedicine
1991 European Commission decision to instaled the European number 112 before 31 Dicember 96
1996 the group of G7 of the EU have programm the GETS ( Global Emergency Telemedicine Service )
S.PEDERDEN
The history of telemedicine in Norway can be summarized as
1920 Haukeland hospital established a service for Health care support of ships by radiolinks
1980- Started in the UHT ( University Hospital Tromso ) the use of Telemedicine
1986 - First use of Videoconferencing for medical purposes. Telnor ( telecommunication company ) start to invest in Telemedicine equipments
1992 started the EPMR ( electronic patient medical record for GPs
1993 the Ministry of Health and Social Affairs has designed UHT a national competence center for Telemedicine and opened the UHT department of Telemedicine. Started the ultrasound transmission
1995 the statistics of the UHT were 700 videoconferening sessions and 200 session involved patients for remote consultation. 7000 teleradiology examinations
1996, August 1st, Norway become the first country to implement a nation-wide telemedicine reimbursement schedule for Telemedicine services. Specialist: 400 Kr, Radiologists 150Kr per exam.
There is a lack of barries within the country regarding licensing issues.
There is no restriction to the practice of Telemedicine, the only extra-training to provide telemedicine consultations is to learn how to use the system. It is reponsability of the specialist to determine if the quality of the telemedicine connection is adequate; if he makes a diagnosis and treatment recommendations it is understood that he has accepted the telecommunications link as satisfactory
A. SOUSA
The history of Telemedicine in Portugal can be summarized as
1997, January , Portuguesse Governement accept by law the payment for any Telemedicine delivery procedure.
O.FERRER-ROCA
The history of Telemedicine in Spain can be summariced as
1990. Telecommunication General Directoria of Spain sponsor inside of the Star Iniciative the project : REVISA ( Network of Health Care Videophones ) of the Canary islands( 1,5 millions inhabitans, 7 isaldns ) . All islands and the referal hospitals in the big islands were provided with Telemedicine facilities base on a High Resolution Videophone and Videocarmas for Videocapture of the Teleconsultations. High resolution static images were sent with a losless compresion through analog Videophones ( 9.600 bauds ) ( 1-2 min /image )for cosultation. Activitivy was high during the 3 first years and decreased dramatically when the monetary support provided by the project ended.
1996 a private company called Tele-Rx have been stablished on the South of Spain providing diagnostic Teleradiology services on a hired basis : Month fees of 175000 pts that include equipment, handling, maintainance and training. Prices of cosultation are : 500-1000 pts per conventional x-ray and 4000-2500pts per special radiographic analysis ( CT, MR ), the diagnosis is send by fax. In 1997 the number of hospitals linked in this network were 4 private radiology centers and also 4 public hospitals use their services .
1997 At the present moment legal aspects are not solved , legally speaking clinical history should have hand written signatures and a fotographic copy of all x-rays should be included . Payments of Teleservices in Medicine are not recognized by public Health autorities .
D. SOTIRIOU
History of Telemedicine in Greece
Perhaps the first quotations of the use of Telematic services in the antique world are contained in the Homer´s Odysseia where the use of " frictories " was described i.e. fires whose controlled smoke was used to transfer information about the progress of the Trojan War. The system was extended from Troia in Asia Minor and along the Greek coast line to Argos and Mycene.
In more recent times the late Professor Skevos Zervos ( 1875-1958 ) of the School of Medicine of the University of Athens, has developed a system allowint him to axamine a patient from distance. The examination was concerning auscultation and cardiac pulses. The data could be transmitted in any place arround the globe. The virtues of the system were demonstrated in several experiments conducted in plenary sessions of the Athens Medical Society at the National University of Athens, at the National Technical University of Athens and at the Athens Academy during which the signals were transmitted from several Athens hospitals and various Greek cities. Professor´s Zervos " innovation " has been published in the Annals of the Athens Medical Society ( 1946-1956 ). Professor Zervos has proposed the system to be used on board of the Greek ships that were offering regular service between Piraeus and New York. The communication vost could not be afforded at that time and the system was not used.
In 1976 cardiologist George Papakonstantimou with technical support form the National Technical Univiersity of Athens has developed a system allowing the transfer of EKG using dial up PSTN lines. The system is in use even today. Since 1987 the Hellenic Cross has implemented medical instructions services to the crews of the merchant marine fleet.
In 1989 the Medical Physics Laboratory of the University of Athens started a new era in the porivsion of the Telemedicine Services, by demonstrating convincingly the advantage for the primary healtcare units the capture and transmission of X-ray pictures of relatively high resolution to a supporting hospital. In 1992 the Greek Ministry of Health financed the installation of Telemedicine reminals in 12 Healthcare Centres throught the country. This large scale pilot system in use since then with significantly beneficial results for the remote populations. The Sismanoglion General Hospital in Athens is the support center, where all requests for support is directed. More than 3.000 cases have been supported so far.
In 1995 Medical Physics Laboratory has implemented the Telecardiology Network TALOS to support primary healthcare units in the Aegean area. Digital EKG equipments are now installed in 10 primary units. The EKG traces are transmitted wia the dial-up PSTN network in 3-30 seconds to the Cardiology Clinics of the Onassis Cardiac Surgery Centre for evaluation and support. Onassis CSC has also developed a medical protocol allowing the administration by the remote physicians a thombolytic factor APSAC to patients suffering from acute myocardial infaction. The TALOS network is not expanding very rapidily but the Cardiology Clinic of the Tzmeron General Hospital in Yhaeus is ready to act as a support centre for the Aesean Islands. A similar network is going to be introduce in the inmediate future in all primary healthcare units of the Kavals Prefecture in Macedonia in Northern Greece.
Currently MPL is working for the description and implementation of a European patform for Telemedicine Services involving the exchange of the electronic healthcare record of the patient. The system has been successfully demonstrated using WWW technologies and ISDN,PSTN and VSAT communication channels. The systems is expected to provide Telemedicine Services accross Europe and aeroplane passengers before the end of 1998. Project HERMES is co-financed by the Commission of the European Union and the participating institutions form Scotland, Greece, Germany and Portugal. HERMES has been designed by the Telemedicine Gruop of the School of Medicine of the University of Edinburgh and the Medical Physics Laboratory of the School of Medicine of the University of Athens.
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Revisado: martes, 10 junio 1997.
Con el soporte informático y de comunicaciones
del CICEI, Universidad
de Las Palmas de Gran Canaria