TECHNOLOGIC ADVANCES IN UROLOGY IMPLICATIONS FOR THE TWENTY-FIRST CENTURY zyxwvu 0094-0143/98 $8.00 + z .OO TELEMEDICINE Present Applications and Future Prospects Joseph C. Kvedar, MD, Eric Menn, and Kevin R. Loughlin, MD z THE MOVEMENT OF BUSINESS TO PLACE-INDEPENDENCE The dissemination of information technol- ogy has created an environment that enables efficient communication between people in a time and place-independent manner (Fig. 1). Such advances as on-line banking, facsimile transmission, cellular phones, and the in- ternet have enabled the business community, in many cases, to move away from the desk- bound past. Indeed, in both the workplace and the home, a merger is taking place, blending telephony, videoconferencing, com- puting, and even television entertainment. HEALTH CARE LAGS FOR A NUMBER OF REASONS Where does health care fit in this rapidly changing time and place-independent envi- ronment of using advanced technologies to enhance business practice? Some points serve to illustrate. In 1969, when the Apollo space mission landed on the moon (a project that would have been impossible without comput- ers), there was not a single significant clinical computer application in health care delivery (James Thrall, MD, personal communication). The banking industry has overcome concerns about the security of financial data to a degree that most banking transactions and informa- tion storage reside in electronic media. For a number of reasons including security con- cerns, health care providers still function largely in a world where handwritten notes vastly outnumber computerized medical re- cords. As long as the delivery of health care occurs in an environment where the stan- dards are face-to-face encounters and paper documents, alternative models that include place-independent care and electronic solu- tions will face slow adoption. Physicians Are Trained to Collect Data in a Face-to-Face Environment The key, initial data that a physician gath- ers in order to draw conclusions about a patient's state of health are contained in the history and physical examination. Since the time of Hippocrates, medical information has been gathered in this manner. Seasoned clini- cians are able to make accurate diagnoses a large part of the time based on this informa- tion alone. The idea of not using these data in routine patient care and not collecting them face-to-face suggests to some gross negligence or even malpractice. The utility of the history and physical examination has received close From the Department of Surgery, Brigham and Women's Hospital, Harvard Medical School (KRL); and Partners Telemedicine (JCK, EM), Boston, Massachusetts UROLOGIC CLINICS OF NORTH AMERICA VOLUME 25 * zyxwvutsrqponm NUMBER 1 * FEBRUARY 1998 137