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The History of Telemedicine
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Alan Shepard became the first American in space on May 5, 1961. For decades, the primary method of communication with Astronauts was via radio, which had several limitations and relatively low signal quality. During those years, flight surgeons diagnosed the Astronauts over the old radio system. The Johnson Space Center took pride when Soft phones were installed aboard the International Space Station. The Soft phone, as well as other advanced communication capabilities made diagnosing sick Astronauts a much-appreciated luxury.

Similarly, telemedicine has been used to treat soldiers on the battlefield who have no immediate access to a physical doctor. When a soldier gets sick, the doctors frequently conduct a consultation via radio, diagnose and have medication administered or delivered.

The practice of medicine through telecommunications, or telemedicine, began in the early 1960's when the National Aeronautics and Space Administration (NASA) first put men in space. Physiological measurements of the astronauts were telemetered from both the spacecraft and the space suits during NASA space flights. These early efforts were enhanced by the development of satellite technology which fo stered the development of telemedicine.

NASA funded telemedicine research projects in the late 1960's and early 1970's. According to Basher, Armstrong, and Youssef (1975), there were fifteen telemedicine projects active in 1975.

One pioneer telemedicine project, STARPAHC, or Space Technology Applied to Rural Papago Advanced Health Care, was developed by NASA to deliver health care to the Papago Indian Reservation in Arizona. The project, which ran from 1972-1975, was implemented and evaluated by the Papago people, the Indian Health Service, and the Department of Health, Education, and Welfare. The goal was to provide health care to the isolated Papago Reservation. A van, which carried a variety of medical instruments including electrocardiograph and x-ray machine, was staffed by two Indian paramedics. The van was linked to specialists at the Public Health Service Hospital by a two-way microwave transmission (Telemedicine Research Center, 1997).

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In 1974, NASA conducted a study with SCI Systems of Houston to determine the minimal television system requirements for accurate telediagnosis. A high-quality videotape was made of an actual medical exam conducted by a nurse but supervised by a physician watching on closed-circuit television. These videotapes were systematically electronically degraded to less than broadcast quality. The original and degraded videos were then shown to randomly selected groups of physicians who attempted to reach a correct diagnosis (Telemedicine Research Center, 1997).

The results, reported in "Final Report: Video Requirements for Remote Medical Diagnosis" (SCI Systems, Inc., 1974), included: 1) statistical significance between the means of the standard monochrome system and the lesser quality systems did not occur until the resolution was reduced below 200 lines or until the frame rate was below10 frames a second; 2) there was no significant difference in the overall diagnostic results as the pictorial information was altered; 3) there was no significant difference in remote treatment designations of TV system type that would cause detriment to patients; and 4) the supplementary study of transmissions of 25 cases using televised radiographic film showed no diagnostic differences between the televised evaluations and direct evaluations if the televised evaluations were above 200 lines and special optical lenses and scanning techniques were utilized (Telemedicine Research Center, 1997).

In 1989, NASA conducted the first international telemedicine project, Space Bridge to Armenia/Ufa, after a powerful earthquake struck the Soviet Republic of Armenia in December 1988. An offer of medical consultation was extended to the Soviet Union by several medical centers in the United States. Telemedicine consultations were conducted under the guidance of the US/USSR Joint Working Group on Space Biology using video, audio, and facsimile between a medical center in Yerevan, Armenia and four medical centers in the United States. This project was extended to Ufa, Russia to aid burn victims there after a fiery railway accident (Telemedicine Research Center, 1997).

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