CHAPTER 1 Telematics in healthcare: new paradigm, new issues Ruth Roberts, Michael Rigby and Katherine Birch Introduction There is certain to be a signi®cant increase in the use of telemedicine applications in healthcare delivery as we move into the twenty-®rst century, but there is a related major concern that these initiatives will be policy or technology led rather than evidence based, and that they will be based on old paradigm structures without consideration of the eects and challenges of the new paradigm that they create. For this reason, in December 1998 the Nueld Trust sponsored an expert working meeting at the Royal Society of Medicine to consider these issues. This book is based on the contributions presented there, includ- ing the valuable plenary discussion. This chapter will set the scene and introduce the topic of telemedi- cine. Chapters from the expert contributors at the working meeting then follow. The contributors of papers and participants in the plenary discussion raised several key points and issues which are incorporated into Chapter 16, and the concluding chapter looks towards the twenty- ®rst century and the need for the potential signi®cance of the eects of telemedicine to be considered in a global context as well as by individual nations. The virtue in virtuality As we enter the twenty-®rst century, it is self-evident that telecom- munications will play an increasingly major part in the way that society functions and in how we live. The virtual organisation has already become part of daily life even before the ordinary citizen has become familiar with the concept. Telephone banking, telephone retail-selling,