Verne imagined sensitive mirrors connected by wire as devices for telecommunication, a German technologist, Hugo Gernsback went for the “teledactyle” allowing doctors to not only see their patients through a view screen but also to touch them from miles away with spindly robot arms. These concepts help us understand the development curve of telemedicine and what we could expect in the future.

Verne imagined landing on the Moon

Past visionaries have always been very imaginative when it came to pushing the outermost boundaries of humankind even further off the usual. One of the most genius thinkers was French writer and father of science fiction, Jules Verne. He mentioned one hundred and eight sci-fi concepts and inventions in his vast oeuvre – seventy was already realized: the spaceship, the television, the machine gun, air conditioning or the atomic bomb.

He fantasized about a colossal submarine powered by electricity crisscrossing the oceans, the Nautilus, decades before the modern submarine was built. He drew up the concept of space travel in his tale From The Earth To The Moon. Not only that but he also gave calculations and described the entire process: a capsule called “projectile” is fired off into space. He guessed it would be the Americans who’d do it and foretold the place of launch right within 50 miles: a facility in South Florida. Also, he imagined the capsule to splash down in the ocean and to be recovered from the sea.

Regarding communication technology, Verne predicted that news would be read out to people instead of written down in newspapers, and in his article In the Year 2889, he described the “phonotelephote”—a forerunner to today’s video conferencing technologies. The device allowed “the transmission of images using sensitive mirrors connected by wires,” Verne wrote. He was the first to daydream about conference calls – and thus the technology enabling telemedicine.

telemedicine
Diagram of the interior of Verne’s “projectile”. Source: https://scifi.stackexchange.com/

The teledactyle is ready for patients

The one who translated the idea of the “phonotelephote” into medicine was called Hugo Gernsback. At the dawn of the radio age, in 1925, the never-resting German technologist invented the concept of the “teledactyle” that would allow doctors not only to see their patients through a view screen but also touch them from miles away with spindly robot arms. As Gernsback explained it, the device would have made it possible to “feel at a distance”. He basically described the function and aim of telemedicine – going a “tiny bit” further than technology would allow it today.

He wrote that “The doctor of the future, by means of this instrument, will be able to feel his patient, as it were, at a distance. The doctor manipulates his controls, which are then manipulated at the patient’s room in exactly the same manner. The doctor sees what is going on in the patient’s room by means of a television screen. Every move that the doctor makes with the controls is duplicated by radio at a distance. Whenever the patient’s teledactyle meets with resistance, the doctor’s distant controls meet with the same resistance. The distant controls are sensitive to sound and heat, all important to the future diagnosis.”

Thus, the “teledactyle” was actually much more than telemedicine today – sensing the patient not only through vision and hearing, but also touch. Humanity is unfortunately not as advanced as several decades ago futurists thought it would be, but who knows, maybe we’ll get there at some point. Just look at the concept of the Hug Shirt! It allows people to send hugs over distance – just like a text message. It can feel the strength, duration, and location of the touch, skin warmth, and the heart rate of the sender. The actuators then recreate the same touch sensation on the shirt worn by the distant loved.

telemedicine
Source: www.labr-mg.org.br

NASA and the Erl-King

It is evident that the demand for effective home-based care has been around for centuries. The tragic ballad by the German poet, Johann Wolfgang von Goethe, The Erl-King, would not have been written if telemedicine had been around. According to the story, a dad gallops through dark forests in the night to bring his son to the doctor. The little boy is hallucinating due to fever, most likely, and imagines the Erl-King calling him. It’s a hauntingly beautiful poem – but wouldn’t it be much better if the boy could have stayed at home and received medication without the need to go anywhere?

Alternative ways were sought to solve these burning issues from the dawn of technological advancement – and that’s where telemedicine jumps in. Already an 1879 article in the Lancet talked about using the telephone to reduce unnecessary office visits. Every invention was tried at how it fits the medical arena. For example, since the 1920s, the radio has been used to give medical advice to clinics on ships. Later on, in the 1950s, medical personnel started doing experiments with closed-circuit television. Probably one of the earliest and most famous uses of hospital-based telemedicine was in the late 1950s and early 1960s when a closed-circuit television link was established between the Nebraska Psychiatric Institute and Norfolk State Hospital for psychiatric consultations.

Nevertheless, many technologies had to be perfected to make telemedicine possible on a wide scale. Thus, it is absolutely not surprising that space research was the area where the method developed fully. In the 1970s, NASA first began performing physiologic monitoring over distance. Then further developed this technology with a pilot with the Papago Indians, the Space Technology Applied to Rural Papago Advanced Health Care (STARPAHC) project – and truly demonstrated the feasibility of a consortium of public and private partners working together to provide medical care to remote populations via telecommunication.

telemedicine
Moritz von Schwind: Erlkönig. Illustration.

Defibrillation on the phone, eVisits and the point of care

June 25, 1989, marked a real breakthrough in telemedicine. That was the first time a patient was successfully defibrillated by telephone – and that was just a beginning of the myriads of ways how phones could play a role in telemedicine. The advancement of telecommunication technologies brought new forms of patient-doctor remote communication all the time. With the appearance of the World Wide Web, sending electronic messages became the new norm of exchanging information. Afterward, video chat programs such as Skype appeared. The practice of telemedicine spread around, and soon humanity woke up to the fact that eVisits are possible on our smartphones.

You don’t need to go to a hospital or any other healthcare facility, you can be anywhere on the planet. That’s the main difference in how earlier visions pictured telemedicine and how it finally evolved. The “teledactyle” imagines the patient in a medical setting, so they imagined the point-of-care remaining mainly the hospital room – or perhaps the home of the bedridden patient. Thus, there is no mobility here: everyone from the patient until the doctor – even the nurse in the background – stays in their lane. Moreover, Gernsback’s vision shows no change in the medical methods: the patient is examined with touch, sound, and a “remote stethoscope”.

telemedicine
www.foley.com

Telemedicine will disappear, personal visits will gain higher value

In the end, telemedicine materialized quite differently as the “teledactyle” predicted it, and we should recognize how much human behavior changed and how the meaning of “medical care settings” transformed. We are not bound by hospital rooms – either physically, or mentally. Telemedicine is mostly about receiving medical care through phone, video or chat anywhere in the whole wide world. Moreover, with the prevalence of trackers, wearables and health sensors, the measurement of data, as well as the retrieval of archived data with the help of the EMRs, is possible – thus the traditional examination methods are on their way out.

At the same time, telemedicine is soaring, and the phenomenon will most likely not slow down in the future. It is projected that it will evolve into a $34 billion industry by 2020 and further integrates into healthcare becoming a crucial part of everyday medicine. In the future, the telemedical process is most likely to be a lot more efficient. Thus, the patient will be the point of care turning to the physician via any kind of platform sharing text, sound or video. A lot of background information will already be available to the doctor even in the case of new patients as the medical professional could retrieve archived health data and patients can share their own health information received through portable health technologies.

As telemedicine means a viable medical option and the human resources crisis in healthcare doesn’t seem to abate before long, the method will become more widespread than ever. After a while, the “telemedicine” expression will likely to disappear, even. As the majority of cases will go down due to telemedical methods, people will consider telemedical visits the norm, and the personal visit a highly valued, rare asset due to the shortage of medical professionals.