The history of telemedicine depends on how you define it.
The fascinating 2009 book, History of Telemedicine by Rashid L. Bashshur, PhD, and Gary W. Shannon, PhD, tells of radio consultations from medical centers in Norway, Italy, and France in the 1920s, 1930s, and 1940s for patients aboard ships at sea.
With the advent of the telephone in the early 1900s, long-distance medical care came into common practice. Doctors could speak with their patients and give medical advice, as well as consult with other medical providers when they needed guidance. That’s the beginning of telemedicine as it’s loosely defined today.
In the 1940s, Images Transmitted by Telephone
Another source, the Institute of Medicine’s Telemedicine: A Guide to Assessing Telecommunications in Healthcare, edited by M.J. Field, recounts some fascinating anecdotes from the early days when images began to be transmitted by telephone.
- 1924: The magazine Radio News imagined the future in its cover depiction of a “radio doctor” linked to a patient by sound and a live picture on a television-like device.
- 1948: Radiologic images were transmitted by telephone between West Chester and Philadelphia, Pennsylvania, a distance of 24 miles. An article about the achievement was reportedly the first reference to telemedicine in medical literature.
- 1950s: Building on this early work in the U.S., Canadian radiologists in Montreal created a teleradiology system.
In the 1950s, Video Transmission Begins
If you define telemedicine as the transmission of video, images and medical data—the way it is typically done today—you can trace its origins back to the 1950s and 1960s, when universities began to research new ways to provide healthcare to rural areas and to respond faster to medical emergencies. The Institute of Medicine book notes some key dates:
- 1959: The University of Nebraska used two-way interactive television to transmit neurological examinations and other information across campus to medical students.
- 1964: The University established a telemedicine link with a hospital 100 miles away to provide speech therapy, neurological examinations, diagnosis of difficult psychiatric cases and more. Although this program and others were designed to extend health services to remote areas, urban uses also appeared in the 1960s.
- 1967: Physicians at the University of Miami School of Medicine and the City of Miami Fire Department used existing voice radio channels to transmit electrocardiographic rhythms from fire-rescue units to a local hospital in 1967.
NASA Plays a Role in the 1960s
The American Telemedicine Association recounts NASA’s role in telemedicine’s development. In 1969, Neil Armstrong and his fellow astronauts wore medical telemetry and cardiac monitoring devices during the first moon landing. But there was much more involvement by NASA in telemedicine’s early days, including the testing of satellite-based communications to provide medical services to astronauts.
The next few decades saw other government initiatives related to telemedicine, including a series of teleradiology projects in the 1970s and 1980s and the implementation of civilian and military teleradiology. In the 1980s, some radiologists began to use inexpensive systems for “on-call” screening of images.
A Waning of Interest, then Explosion
High transmission costs are cited as a major reason for the waning of interest in telemedicine in the early and mid-1980s. As mentioned in the Institute of Medicine book, a demonstration project started in Newfoundland in 1977 was the only formal telemedicine program started before 1986 that survived into the mid-1990s, and it tells the tale. The project involved one-way television and two-way audio. Though the test showed the value of television, the project team concluded that much of the educational material and data could be provided more quickly and less expensively by telephone, videotape and print materials.
Nonetheless, technology innovation and lower costs began to fuel renewed interest in telemedicine toward the end of the 1980s. Since then, as technology has advanced, so has telemedicine. The rise of the Internet in the 1990s triggered the information explosion, and created a perfect support system for practically all the information used in telemedicine. The growth of broadband networks facilitated remote patient monitoring, electronic health records and other technology-based services like telemedicine.
Today, Telemedicine has gone Mainstream
As the American Telemedicine Association reminds us, we’ve come a long way:
- Phones today have more computational capacity than many of those first systems that went to the moon.
- Video-based transactions are now commonplace in hospitals and healthcare systems around the country.
- Patient consultations via video conferencing, transmission of still images, remote monitoring of vital signs—all are standard components of telemedicine in hospitals today.
In addition to technology advancements, the Affordable Care Act and the creation of Accountable Care Organizations (ACOs), with their emphasis on coordinated care and increased patient engagement, have also fueled the growth of telemedicine in the form we know it today.
The growth has been so dynamic that the American Hospital Association in 2015 declared that telehealth had moved into the mainstream. “Telehealth increasingly is vital to our health care delivery system, enabling health care providers to connect with patients and consulting practitioners across vast distances,” reads an AHA Trendwatch from January 2015.
Telemedicine is expected to grow from 250,000 patient users in 2013 to more than 7 million patient users in 2019.That’s quite a journey from those land-to-sea radio consultations in the 1920s.