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This essay explores computer profiling and surveillance systems developed by the hospitality industry in the 1960s and 1970s. Hotels and motels partnered with computer corporations and were among the first industries to create computer networks and management systems, using them for practical applications like reservations as well as to police guests and monitor hotel labor. However, there is no sustained history of the hospitality industry's role in computer research and design. Drawing on archival documents, trade journals, architectural literature, and hotel ephemera, this article shows how hospitality venues made computer profiling and surveillance seem welcoming, convenient, and user-friendly. The computer systems developed for hotels helped acclimate publics to the networked environments of contemporary everyday life, where digital devices and services ambiguously care for and surveil consumers, even in their own homes.

Since the early studies exploring the use of SMS text messaging for health intervention, text messaging has played a pivotal role in the advancement of mobile health. As an intervention modality, text messaging has provided vital learnings for the design and delivery of interventions, particularly in low-resource settings. Despite the advances in technology over the last 25 years, text messaging is still being used in largely the same way to deliver health information, behavior change interventions, and support. The strong, consistent evidence for the benefits of this type of intervention has made text messaging a routine part of health interventions around the world. Key to its success is its simplicity, alongside the benefit of being arguably the most accessible form of consumer digital health intervention. Text message interventions are well suited for public health interventions due to their low cost, vast reach, frequent use, high read rates, and ability to be tailored and personalized. Furthermore, the nature of text messaging interventions makes them ideal for the delivery of multilingual, culturally tailored interventions, which is important in the context of increasing cultural diversity in many countries internationally. Indeed, studies assessing text message-based health interventions have shown them to be effective across sociodemographic and ethnic groups and have led to their adoption into national-level health promotion programs. With a growing focus on artificial intelligence, robotics, sensors, and other advances in digital health, there is an opportunity to integrate these technologies into text messaging programs. Simultaneously, it is essential that equity remains at the forefront for digital health researchers, developers, and implementers. Ensuring digital health solutions address inequities in health experienced across the world while taking action to maximize digital inclusion will ensure the true potential of digital health is realized. Text messaging has the potential to continue to play a pivotal role in the delivery of equitable digital health tools to communities around the world for many years to come. Further new technologies can build on the humble text message, leveraging its success to advance the field of digital health. This Viewpoint presents a retrospective of text messaging in health, drawing on the example of text message-based interventions for smoking cessation, and presents evidence for the continued relevance of this mobile health modality in 2025 and beyond., (©Rosie Dobson, Robyn Whittaker, Lorien C Abroms, Dale Bramley, Caroline Free, Hayden McRobbie, Melanie Stowell, Anthony Rodgers. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 17.12.2024.)

IBD care has gone through a real transformation over the last century, moving from the mere unidirectional interaction between the physician and the patient to a stronger framework with multiple stakeholders who interconnect and strengthen each other. The patient has evolved from a passive subject to the central pole in the care pathway. Key elements of the future framework include patient self-care and empowerment, and remote monitoring [eHealth]. This care will be delivered by a multidisciplinary team acknowledging the pivotal role of the IBD nurse, and emphasising and measuring the quality of its work. The big challenge for the future is to establish a financially viable model to make this evolution durable in the long term, and this by using the principles of value-based health care., (© The Author(s) 2024. Published by Oxford University Press on behalf of European Crohn’s and Colitis Organisation.)

COVID-19 has changed the nature of medical consultations, emphasizing virtual patient counselling, with relevance for patients with diabetes insipidus (DI) or hyponatraemia. The main complication of desmopressin treatment in DI is dilutional hyponatraemia. Since plasma sodium monitoring is not always possible in times of COVID-19, we recommend to delay the desmopressin dose once a week until aquaresis occurs allowing excess retained water to be excreted. Patients should measure their body weight daily. Patients with DI admitted to the hospital with COVID-19 have a high risk for mortality due to volume depletion. Specialists must supervise fluid replacement and dosing of desmopressin. Patients after pituitary surgery should drink to thirst and measure their body weight daily to early recognize the development of postoperative SIAD. They should know hyponatraemia symptoms. Hyponatraemia in COVID-19 is common with a prevalence of 20-30% and is mostly due to SIAD or hypovolaemia. It mirrors disease severity and is an early predictor of mortality. Hypernatraemia may also develop in COVID-19 patients, with a prevalence of 3-5%, especially in ICU, and derives from different multifactorial reasons, for example, due to insensible water losses from pyrexia, increased respiration rate and use of diuretics. Hypernatraemic dehydration may contribute to the high risk of acute kidney injury in COVID-19. IV fluid replacement should be administered with caution in severe cases of COVID-19 because of the risk of pulmonary oedema.

The first era of the global proliferation of surgical advancements involved surgical infection rate and technique breakthroughs by Lister, Halsted, and others. This was propagated by letters, academic papers, and international visits. While success was achieved, it was at a suboptimal pace. In the current era of minimally invasive surgical approaches, these methods are inadequate. This paper chronicles the development and application of virtual learning and telementoring as force multipliers to speed procedural adoption and proliferation., (© 2021 Wiley Periodicals LLC.)

Changes that COVID-19 induced in endocrine daily practice as well as the role of endocrine and metabolic comorbidities in COVID-19 outcomes were among the striking features of this last year. The aim of this statement is to illustrate the major characteristics of the response of European endocrinologists to the pandemic including the disclosure of the endocrine phenotype of COVID-19 with diabetes, obesity and hypovitaminosis D playing a key role in this clinical setting with its huge implication for the prevention and management of the disease. The role of the European Society of Endocrinology (ESE) as a reference point of the endocrine community during the pandemic will also be highlighted, including the refocusing of its educational and advocacy activities.

Telemedicine has become a privileged mode of medical practice providing medical care while reducing the transmission of Covid-19 among patients, families, and clinicians. The law established in 2018 settled a legal framework for telemedicine in Tunisia. However, thelatterremains not sufficient in itself, as legal issues remain especially delimiting the precise conditions for this exercise and to expose the limits of responsibility of each party involved among its organizers, its health service providers, and its users. Several medico-legal issues may be generated by the practice of telemedicine in Tunisia. Our paper aimed to discuss these medico-legal issues relating to telemedicine in anticipation of its legislation.

Telemedicine is fast becoming integrated into health care as a way to increase access for patients, particularly across the urban/rural divide. Use of telemedicine in neonatology is a newer, yet rapidly expanding modality. This review outlines the history of telemedicine, the evolution of its current uses in neonatology, requirements for starting a telemedicine program, and potential future uses., (Copyright © 2019 by the American Academy of Pediatrics.)

Introduction: U.S. military forces have engaged in combat in mature areas of operations (AOs) in Iraq and Afghanistan that allow for casualty evacuation to definitive surgical care within "The Golden Hour." Future combat casualty care will be complex and challenging. Facing the medical demand of the Multi-Domain Battlefield remains an uncertain problem set. What can be anticipated is that a near peer adversary will not allow freedom of movement, air superiority, or uninterrupted communications. Telemedicine is one solution that can aid in this environment because it can reduce the medical footprint in a theater of operation by bringing the remote expert's knowledge and experience to the point of need., Materials and Methods: Telemedicine can augment the capabilities of caregivers in austere, operational settings using synchronous or asynchronous technology to optimize the care of casualties who are delayed in evacuation to higher levels of care. These technologies have been implemented and tested over the past 30 yr. We reviewed the historical literature about military telemedicine and assembled current leaders in military telemedicine to write this review., Results: This manuscript reviews the history of and current capabilities of military telemedicine., Conclusions: Broad implementation of telemedicine in the operational setting is challenged by network limitations and cyber security concerns. Reliable, high bandwidth, low latency, secure communications that is necessary for advanced telemedicine capabilities (i.e., procedural telementoring) will not likely be available at all times during future engagements. The military must develop and train a full spectrum of telemedical support options that include low-to-high bandwidth solutions. Telemedicine is not a substitute for deploying anticipated medical resources or optimizing training: telemedicine is plan B where plan A is training, deployment, and casualty evacuation. Nevertheless, when network and communications resources are sufficient, telemedicine brings advanced expertise to austere, resource-limited contexts when timely evacuation is not possible.

Background and Objectives: The uses of robotics in surgery were hypothesized as far back as 1967, but it took nearly 30 years and the nation's largest agency, the Department of Defense, in conjunction with innovative startups and established research agencies to complete the first fully functional multipurpose surgical robot. Currently, the most prominently available multipurpose robotic surgery system with US Food and Drug Administration approval is Intuitive Surgical Inc.'s da Vinci Surgical System, which is found in operating rooms across the globe. Although now ubiquitous for minimally invasive surgery, early surgical robot prototypes were specialty focused. Originally, multipurpose robotic systems were intended for long-distance trauma surgery in battlefield settings. While there were impressive feats of telesurgery, the marketable focus has veered from this goal. Initially developed through SRI International and Defense Advanced Research Projects Agency, surgical robotics reached private industry through two major competitors, who later merged., Methods: A thorough search of PubMed, Clinical Key, EBSCO, Ovid, ProQuest, and industry manufacturers' websites yielded 62 relevant articles, of which 51 were evaluated in this review., Conclusion: We analyzed the literature and referred to primary sources by conducting interviews with present and historical leaders in the field to yield a detailed chronology of surgical robotics development. As minimally invasive robotic procedures are becoming the standard of care, it is crucial to comprehensively document their historical context and importance as an emerging and evolving discipline., Competing Interests: Conflict of interest: Jacques Marescaux is the president of both IRCAD and IHU Institutes, which are partly funded by Karl Storz, Medtronic, and Siemens Healthcare. Ms George and Drs Brand, LaPorta, and Satava have nothing to disclose. These views are those of the authors and not of the US Department of Defense.

Historically, the US military has utilized centralized store-and-forward (S&F) telemedicine programs for health care providers in remote locations worldwide. In the civilian community, new methods and platforms for teledermatology have been created based largely on those used by the military to maximize access to and the efficiency of health care, including secure direct-to-consumer (DTC) mobile applications for patients, live interactive methods, and integrated S&F platforms for dermatology services within electronic health record (EHR) systems. By incorporating similar innovative teledermatology methods and platforms, the US military health care system may benefit from increased accessibility and productivity.

Telemedicine is slowly transforming the way in which healthcare is delivered and has the potential to improve access to subspecialty expertise, reduce healthcare costs, and improve the overall quality of care. While many subspecialty fields within medicine today have either experimented with or begun to implement telemedicine platforms to enable remote consultation and care, dermatology is particularly suited for this care system as skin disorders are uniquely visible to the human eye. Through teledermatology, diagnostic images of skin disorders with accompanying clinical histories can be remotely reviewed by teledermatologists by any number of modalities, such as photographic clinical images or live video teleconferencing. Diagnoses and treatment recommendations can then be rendered and implemented remotely. The evidence to date supports both its diagnostic and treatment accuracy and its cost effectiveness. Administrative, regulatory, privacy, and reimbursement policies surrounding this dynamic field continue to evolve. In this review, we examine the history, evidence, and administrative landscape surrounding teledermatology and discuss current practice guidelines and ongoing controversies.

Background: The advancement of mobile technology had positively influenced healthcare services. An emerging subfield of mobile technology is mobile health (m-Health) in which mobile applications are used for health purposes. The aim of this study was to analyze and assess literature published in the field of m-Health., Methods: SciVerse Scopus was used to retrieve literature in m-Health. The study period was set from 2006 to 2016. ArcGIS 10.1 was used to present geographical distribution of publications while VOSviewer was used for data visualization. Growth of publications, citation analysis, and research productivity were presented using standard bibliometric indicators., Results: During the study period, a total of 5465 documents were published, giving an average of 496.8 documents per year. The h-index of retrieved documents was 81. Core keywords used in literature pertaining to m-Health included diabetes mellitus, adherence, and obesity among others. Relative growth rate and doubling time of retrieved literature were stable from 2009 to 2015 indicating exponential growth of literature in this field. A total of 4638 (84.9%) documents were multi-authored with a mean collaboration index of 4.1 authors per article. The United States of America ranked first in productivity with 1926 (35.2%) published documents. India ranked sixth with 183 (3.3%) documents while China ranked seventh with 155(2.8%) documents. VA Medical Center was the most prolific organization/institution while Journal of Medical Internet Research was the preferred journal for publications in the field of m-Health. Top cited articles in the field of m-Health included the use of mobile technology in improving adherence in HIV patients, weight loss, and improving glycemic control in diabetic patients., Conclusion: The size of literature in m-Health showed a noticeable increase in the past decade. Given the large volume of citations received in this field, it is expected that applications of m-Health will be seen into various health aspects and health services. Research in m-Health needs to be encouraged, particularly in the fight against AIDS, poor medication adherence, glycemic control in Africa and other low income world regions where technology can improve health services and decrease disease burden.

The use of telecommunications technology to provide the healthcare services, telemedicine, has been in use since the 1860s. The use of technology has ranged from providing medical care to far-off places during wartimes to monitoring physiological measurements of astronauts in space. Since the 1990s, reports have been published on diagnoses of neurological diseases with the use of video links. Studies confirm that the neurological examinations, including the National Institutes of Health Stroke Scale, performed during teleneurology are dependable. The transfer of stroke patients in rural hospitals to bigger medical centers delays treatment while there exists current and projected shortage of neurologists. Telestroke provides the solution. Patients suspected of acute stroke need a noncontrast computerized tomography (CT) scan for tissue plasminogen activator administration. Vascular imaging such as CT angiography, magnetic resonance angiography, and digital subtraction angiography can help show large-vessel occlusion or critical stenosis responsive to endovascular therapy. A standard protocol can be followed to decide a vascular modality of choice, considering advantages and disadvantages of each imaging modality. Telestroke solves the problems of distance and of shortage of neurologists. Neuroimaging plays a vital role in the delivery of telestroke, and the telestroke doctor should be comfortable with making a decision on selecting an appropriate vascular imaging modality., (Copyright © 2016 by the American Society of Neuroimaging.)

Developments in cyberhealth are now accessible to all patients and healthcare professionals. These tools enable expert advice to be provided remotely and ensure a continuity of care for all those who need it. Telecare is developing across the world, as are networks of nurses who practise it and researchers who analyse the results., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

An MDHAQ/RAPID3 (multidimensional health assessment questionnaire/routine assessment of patient index data) was developed from the HAQ over 25 years, based on observations made from completion by every patient (with all diagnoses) at every routine rheumatology visit since 1980. Modification of the HAQ was viewed as similar to improving a laboratory test, with a primary focus on clinical value for diagnosis, prognosis, and/or management, as well as feasibility for minimal effect on clinical workflow. Rigorous attention, was also directed to validity, reliability, other methodologic and technological considerations, but after clinical value and feasibility were established. A longer "intake" MDHAQ was introduced for new patients to record a complete past medical history - illnesses, hospitalisations, surgeries, allergies, family history, social history and medications. MDHAQ scales not found on the HAQ record complex activities, sleep quality, anxiety, depression, self-report joint count, fatigue, symptom checklist, morning stiffness, exercise status, recent medical history, social history and demographic data within 2 pages on one sheet of paper. An electronic eMDHAQ/RAPID3 provides a similar platform to pool data from multiple sites. A patient may be offered a patient-administered, password-protected, secure, web site, to store the medical history completed on the eMDHAQ. This eMDHAQ would allow a patient to complete a single general medical history questionnaire rather than different intake questionnaires in different medical settings. The eMDHAQ would be available for updates and correction by the patient for future visits, regardless of electronic medical record (EMR). The eMDHAQ is designed to interface with an EMR using HL7 (health level seven) and SMART (Substitutable Medical Apps, Reusable Technology) on FHIR (Fast Healthcare Interoperability Resources), although implementation requires collaboration with the EMR vendor. Advanced features include reports for the physician formatted as a medical record note of past medical history for entry into any EMR without typing or dictation, and a periodic "tickler" function to monitor long-term outcomes with minimal effort of the physician and staff. Nonetheless, clinical use of an eMDHAQ should be guided primarily not by the latest technology, but by value and feasibility in clinical care, the same principles that guided development of the pencil-and-paper MDHAQ/RAPID3.

e- and m-Health communication technologies are now common approaches to improving population health. The efficacy of behavioral nutrition interventions using e-health technologies to decrease fat intake and increase fruit and vegetable intake was demonstrated in studies conducted from 2005 to 2009, with approximately 75% of trials showing positive effects. By 2010, an increasing number of behavioral nutrition interventions were focusing on body weight. The early emphasis on interventions that were highly computer tailored shifted to personalized electronic interventions that included weight and behavioral self-monitoring as key features. More diverse target audiences began to participate, and mobile components were added to interventions. Little progress has been made on using objective measures rather than self-reported measures of dietary behavior. A challenge for nutritionists is to link with the private sector in the design, use, and evaluation of the many electronic devices that are now available in the marketplace for nutrition monitoring and behavioral change.

Objectives: Consumer Health Informatics (CHI) is a rapidly growing domain within the field of biomedical and health informatics. The objective of this paper is to reflect on the past twenty five years and showcase informatics concepts and applications that led to new models of care and patient empowerment, and to predict future trends and challenges for the next 25 years., Methods: We discuss concepts and systems based on a review and analysis of published literature in the consumer health informatics domain in the last 25 years., Results: The field was introduced with the vision that one day patients will be in charge of their own health care using informatics tools and systems. Scientific literature in the field originally focused on ways to assess the quality and validity of available printed health information, only to grow significantly to cover diverse areas such as online communities, social media, and shared decision-making. Concepts such as home telehealth, mHealth, and the quantified-self movement, tools to address transparency of health care organizations, and personal health records and portals provided significant milestones in the field., Conclusion: Consumers are able to actively participate in the decision-making process and to engage in health care processes and decisions. However, challenges such as health literacy and the digital divide have hindered us from maximizing the potential of CHI tools with a significant portion of underserved populations unable to access and utilize them. At the same time, at a global scale consumer tools can increase access to care for underserved populations in developing countries. The field continues to grow and emerging movements such as precision medicine and the sharing economy will introduce new opportunities and challenges.

Background: A review of activities of Centro Internazionale Radio Medico (International Radio Medical Centre, CIRM) from its foundation in 1935 until its 80th anniversary in 2015 was accomplished. CIRM was founded in 1935 to provide medical assistance via radio to ships with no doctor on board and other distant patients who cannot be reached by a doctor. In 1950 CIRM was established as a non-profit-making foundation and has benefited since 1957 from an annual contribution from the Italian government., Methods: Review of CIRM case histories and other published material from 1935 to 2015 and presenting them in a scientific yet simplified manner through the use of basic mathematical analysis. All the data was collected from CIRM's official archives in Rome., Results and Conclusions: The results achieved by the Centre over 80 years include medical assistance to 81,016 patients on board ships (as well as on small islands and aircraft), with more than 500,000 medical messages received and transmitted. CIRM from its inception was organised into a medical service, a telecommunications service and a studies section. In 2002 the Centre was recognised as the Italian Telemedical Maritime Assistance Service (TMAS). In the 2010 the Centre was reorganised as a structure articulated in 4 departments, namely maritime telemedicine, telecommunication, research and occupational medicine. This was achieved to cover the different activities related to comprehensive health protection of seafarers. The 24-h continuous medical service is provided by doctors at the CIRM headquarters. The doctor on duty gives instructions for managing the case and continues to follow the patient with subsequent appointments until recovery or landing. In case of emergencies CIRM co-ordinates the transfer of patients assisted on board ships to a hospital ashore. CIRM has developed innovative approaches for the treatment of diseases and accidents on board of seagoing vessels by introducing standard telemedicine equipment on board ships, allowing the transmission of biomedical data from ships to the Centre. These new solutions are aimed at bringing a significant improvement of medical care for seafarers.

We have reached a critical convergence in psychiatry between the changing systems of health care structure and funding, our evolution into a technology-based society, and growth in the science and delivery of psychiatric treatments. Fostered by this convergence is the maturation over the past two decades of telepsychiatry, in the form of live interactive video conferencing, as a critical tool to improve access, increase quality and reduce costs of psychiatric treatment. This article reviews the history and evolution of telepsychiatry including implications for the field in order to provide individual psychiatrists and psychiatric organizations guidance on how to formulate current and strategic directions. This article begins with a broad overview of the history of medicine providing contextualization of the development of the field of telepsychiatry. It concludes with projected trends and recommendations.

The delivery of psychiatric care via video-teleconferencing (VTC) technology is thought to have reached a tipping point. As a medical speciality with relatively few material or technical requirements for service delivery, psychiatry has been one of the earliest to embrace the possibility of providing evaluations and treatment at a distance. Such technical infrastructure as is necessary can often be found in the institutions already in existence. It was natural therefore that institutionally based telepsychiatry would lay the foundation for the development of the field. In this article we review the history and development of institutional VTC in a wide variety of clinically supervised settings such as hospitals, outpatient clinics, and forensic settings. We cite evidence supporting institutionally sponsored use and expand on key takeaways for the development and expansion of videoconferencing in these settings. We also speculate on the future direction and development of psychiatric care provided by these arrangements.

About 50 years ago, Norman Jefferis Holter invented a device that opened the possibility of recording heart activity over long periods of time. This invention, together with the rapid developments in electronics, has enabled a revolutionary change in the diagnosis and management of cardiac diseases. Ambulatory cardiac monitors have decreased in size to the point of becoming wearable or implantable and are able to monitor heart activity for months or even years. In addition, new telecommunication systems allow clinicians to remotely access cardiac events and to respond within a short period of time. Novel advances in computing and algorithm development are expanding the clinical applications of ambulatory devices with more complex automatic interpretation of the electrocardiographic signal. This article reviews the state of the art of these techniques from both clinical and technical approaches, covering a historic perspective up to today, and discusses current applications, challenges, and future directions.

This Review focuses on the application of telemedicine to the care of patients with acute stroke (telestroke), from the prehospital setting through hospitalization. Telestroke has grown remarkably in the past decade and has entered mainstream care for patients with acute stroke. Telestroke enables such patients to be remotely evaluated, thereby allowing optimal treatment and management even in clinically underserved areas and removing geographical disparities in access to expert care. Telestroke systems enable thrombolytic treatment to be administered in community and rural hospitals, and facilitate the appropriate transfer of patients with complex conditions (who require critical care services and neurosurgical or intra-arterial interventions) to a comprehensive stroke centre. Decision-analytic models show that telestroke is cost-effective from both a societal and a hospital perspective. Limitations to the use of telestroke in the USA include the need for state licensing and credentialling of physicians, and the technical requirements of a minimum network bandwidth (which is still lacking in some regions). However, the opportunity exists for telestroke to become the backbone of an electronic stroke unit and to be used to identify and enrol patients in clinical trials of acute stroke treatment. The use of telestroke in the prehospital setting has been hampered by limited telecommunication availability, but these problems might be mitigated by fourth-generation cellular data networks.

This article provides background information on the history of telemedicine in Arizona and the Arizona Telemedicine Program (ATP). Following a brief overview of the growth of the ATP over the past 16 years, special focus is directed toward a description of the ATP business model, sustainability efforts of the Program, and ATP's future directions and goals. The ATP was established by the Arizona State Legislature in 1996 and, today, operates a large university-based statewide telemedicine consortium. It provides a spectrum of telemedicine support services to dozens of independent healthcare organizations throughout Arizona and bordering states. The ATP's backbone is a regional, 160-site dedicated healthcare and education broadband telecommunications network called the Arizona Telemedicine Network (ATN). The ATN is a fixed-cost network operated 24/7 by ATP engineers. In addition to providing access to the ATN, the ATP also provides its member individuals and organizations with benefits including biomedical communications services and expertise, telemedicine training on financial, legal, regulatory, and administrative support aspects, and access to subspecialty telemedicine consultation services.

The Japanese Antarctic Research Expedition (JARE) has had a presence in Antarctica since 1956. The Syowa station is 15,000 km from Japan and evacuation of patients is impossible during the winter months. From 1956 to 2003, a total of 4932 telemedical consultations were undertaken, i.e. every member of the station needed an average of 4 medical consultations each winter. Forty five percent of the consultations were surgical or orthopaedic cases, 23% were for internal medicine and 12% were for dental problems. In the early 1980s, satellite radio-telephony was found to be useful for consultations, but did not have the ability to transmit medical pictures. Email was transmitted by the International Mobile Satellite Organization (INMARSAT) but the connection was only available every 2 hours and the maximum message size was 100 kByte. In 2004, the International Telecommunications Satellite (INTELSAT) system made a connection constantly available, and increased the maximum message size to 10 MByte. Transmission of still and moving pictures became possible. Scheduled consultations are performed monthly. A doctor in Japan can ask the patient questions and perform a proxy examination with the assistance of the Antarctic doctor. Real-time telemedicine is very effective in orthopaedic and surgical cases, skin, eye and dental troubles. Still pictures are more effective for understanding in detail skin and eye problems. Emergency consultations are effective if adequate consulting staff are available.

The history of telemedicine is at times presented to commence in the 20th century. Events in Central Australia in 1874 show that the history goes further back, when the newly constructed telegraph played an important telemedicine role not only in enabling care for a wounded person, but also in uniting a dying man with his wife 2000 kilometres away. Innovation with the tools at hand has proven to be effective to bridge the tyranny of distance in the delivery of health care.

Telemedicine (TM)-providing health services and information via a telecommunications device to patients or colleagues separated by distance-holds the promise of improving access to care, diagnosis and assessment, patient monitoring, treatment adherence, and positive health outcomes. TM is still evolving, and numerous obstacles must be overcome before it reaches its full potential. Major obstacles include licensure and reimbursement issues along with the development of TM care standards. While many studies have addressed TM's effectiveness, findings, although positive, are tempered because of small sample size and other methodological problems. Successful TM is clinically driven where a need is first identified and then a TM solution fulfills that clinical need.

On December 7, 1988, an earthquake destroyed a significant portion of the Spitak Region of Soviet Armenia. The destruction resulted in significant death toll, building and infrastructure destroyed, and the displacement of hundreds of thousands of people. The entire local medical infrastructure was significantly damaged. Before the disaster, the space medical leadership of the United States and the Union of Soviet Socialist Republics were collaborating on joint activities in medicine and biology. The leaders of this collaborative effort devised an approach to support a disaster recovery utilizing telecommunications assets. This effort was focused on healthcare in a postdisaster event and became known as the Spacebridge to Armenia. This spacebridge was put in place 5 months after the calamity and operated for several months in the spring-summer of 1989. The spacebridge was extended to Ufa, Russia, in response to a second disaster. The influence of the Spacebridge to Armenia in the 20 years since has been significant. This article summarizes how telemedicine has evolved from the response to the earthquake in 1988. It presents lessons learned and illustrates the many influences that have been made.

Technological innovations in medical care have led to the development of telemedicine programs in both rural and urban environments. The necessity for telemedicine has increased immensely as more cost-effective treatment options have become available for both patients and physicians through the addition of telecommunication technologies to medical practice. The development of telemedicine systems began as a means of providing access to health care resources for individuals living in isolated rural areas, grew into advanced medical intervention techniques for soldiers on the battlefield, and have become prevalent in urban medical centers both as a resource to the underserved populations and as a platform for physicians off-site to conduct patient consults remotely. Urban telemedicine systems, as monitored in the Mercy Health System (Philadelphia, Pennsylvania) and AtlantiCare Regional Medical Center (Atlantic City, New Jersey), display the enormous benefits of telemedicine as a form of preliminary analysis of patients for the treatment of various medical conditions including chronic disease, mental health disorders and stroke. However, the initiation of telemedicine programs requires new protocols and safeguards to be initiated to protect patient confidentiality/privacy, ensure the appropriate licensure of physicians practicing across state borders, and educate patients on the use of new technological systems. Telemedicine represents the progression of medicine in the presence of improving communication technologies and should be instituted in all urban medical centers. This conclusion is based upon the ethical responsibility to treat all persons with dignity and respect, which in this case, mandates the provision of the most cost-effective, beneficial medical care for all populations.

Teledermatology is a developing application of telemedicine. Studies and reviews regarding diagnostic accuracy, efficacy, and feasibility of teledermatology applications have been published in the literature. There are two main methods of teledermatology technology to use: store-and-forward and real-time videoconferencing. Teledermatology is a proven, effective diagnostic tool for skin lesions.

Summary: During the last decade we assisted to relevant progress in rehabilitation studies and in technological development. From the combination of these issues rises the tele-rehabilitation--a subfield of telemedicine consisting of a system to control rehabilitation "at distance"--as an actual possibility of application and a promising development in the future. The present paper offers a short review of the state of the art in the field of tele-rehabilitation, with a special focus on upper limb tele-rehabilitation. The experience is also briefly reported of the preliminary application of the H-CAD (home care activity desk) system and the HELLODOC (Healthcare service linking tele-rehabilitation to disabled people and clinicians) tele-rehabilitation service, conducted by the authors within two European projects in the period 2003-2005 and 2005-2007 respectively.