Telemedicine - Telenor

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resources, and partly how telemedicine
can contribute to fulfil central healthpolitical
objectives. This perspective
reaches far into the way of organising
health services, and not least of all how
co-operation and sharing of labour
should be arranged.
Why telemedicine?
The superior goal of the health services is
to fight sickness and promote health.
Considerable resources are used for
health purposes. Typical for European
countries are health expenses to an
amount of 7-9 % of gross national product,
and it is steadily increasing. The
health trade is characterised by a rapid
development of medical technology. This
applies to advanced instruments for diagnosing
and treatment, drugs, technical
remedies for nursing and biotechnology.
One of the greatest challenges for the
health services is to match the expectation
of the population to the health services
to the services which can be delivered
on a large scale.
Another characteristic feature is a large
production of knowledge through
research and practical clinical work. The
classical medical field is steadily divided
into more specialised fields. At the same
time the contact with other fields is
extended. The health services will
change character, partly because, in addition
to the curative and preventive
medicine, there will be more emphasis on
predictive medicine based on the development
in biochemistry and molecular
biology.
In organising health services these development
trends point towards a larger
division of work duties and a centralisation
of specialised functions. New professional
environments and new equipment
for diagnosing and treatment
require comprehensive efforts of as well
economic as organisational character. In
the first place this will be important on a
national level by the fact that some institutions
will have nationwide responsibility
for certain specialities imposed on
them. In the long run we can se a need
for greater international sharing of
labour.
Another challenge for the public health
services is that the population during the
next ten years will be changed with
regard to composition of age groups.
Older people, who are the major users of
health services, will considerably
increase in number. In Norway the num-
ber of persons over the age of 80 has
doubled since 1970. Towards the year
2020 this number will increase further.
The part of the population over the age of
90 will increase considerably. In general,
there will be more heavy users of the
health services at the same time as there
will be fewer persons in the age group
which can produce health services and
contribute to the economic resources
needed by the health services. In addition,
an increased number of handicapped
and chronically sick persons is
expected (St. meld. (White Paper) No.
41, 1987-88).
As an answer to the increasing cost of
running the institutions of the health services
(hospitals, nursing homes), we will
have a change towards greater emphasis
on primary health service. In Norway we
are already phasing over to more day
care activity where staying time in hospital
is reduced and in the nursing sector a
transition to homebased care.
In light of these challenges telemedicine
must be assessed as a tool for more efficient
exploitation of available resources.
Telecommunication will never replace
the physician or other health workers
involved in a patient relation. Instead, it
gives a possibility of increasing the integration
between various health services
and in this way contributes to better care
directed towards the patient.
From technological
curiosity to economical
benefit
The idea of using telecommunication for
medical purposes is as old as the spread
of the telecommunication means. Soon
after the invention of the telephone
experiments were made to transfer heart
and lung sounds to a skilled specialist
who could give an opinion of the state of
the organ. The inventor of the electrocardiograph,
Wilhelm Einthoven, started
experiments with remote consultations
via the telephone network (Einthoven,
1906). Also in Norway such possibilities
were utilised. Haukeland Hospital established
in the 1920’s a service where ships
at sea could consult physicians in hospitals
via Bergen Radio in case of accident
and sickness. It has ben said that the
physicians not only contributed with
diagnoses and proposals for treatment,
but also complicated surgical operations
were performed by help of instructions
via radio (Rafto, 1955).
During the 1950’s and 60’s many individual
experiments with medical services
were carried out on the basis of telecommunication.
Often it was enthusiasts with
medical background who saw the possibilities
as the teletechnology gradually
developed. We may safely assert that
those experiments were mainly directed
towards the technology, even if medical
and organising matters were on the
agenda. The equipment used was poorly
adapted to the services to be practised.
The cost might be so high that the data
obtained could not be generalised and
lead to safe conclusions (Bashur and
Lovett, 1977).
Gradually the starting point for development
of telemedicine changed towards
the solution of concrete medical problems.
Such a field was supervision of
physiological functions of crews in space
ships (Pool, Stonesifter and Balasco,
1975). Another field was improvement of
primary health services in areas with
scattered population (Fuchs, 1979, Dunn
and Higgins, 1984). Telecommunication
was put to use for remote consultations
and remote diagnoses and for distance
education of medical personnel at
remote locations.
With the linking up of teletechnology
with data technology the horizon of
telemedicine was appreciably extended
in the 1980’s. Within medical computer
science a series of data programs and
systems were developed of both administrative
and medical varieties. Even if they
were intended to take care of internal
tasks in institutions, they laid the foundation
for new and also improved older
telemedical methods. As an example,
digital picture processing has now
obtained a central place in several
telemedical applications.
However, at the same time it may be
asserted that while the health services
have been progressive in adaptation of
advanced medical technology, far less
attention has been focused on the use of
telecommunication and information processing.
Introduction and acceptance of
this type of technology have been slower
within the health services than in several
other fields (AIM, 1992). This concerns
the more administrative sides for personnel,
institutions, and patients, but especially
within medical treatment. This is in
contrast to the fact that the health services
have been very information intensive
at all levels. As an example a hospital
bed in Europe represents a yearly production
of X-rays amounting to an aver-