Telemedicine: Theory and practice

Headnote

Telemedicine: Theory and practice. Edited by Rashid L. Bashshur, Jay H. Sanders, and Gary W. Shannon. $89.95'. Pp. 435. Springfield, IL: Charles C Thomas, 1997.

This publication is the edited work of 25 physicians, researchers, technologists, and theorists with combined practical, evaluative, and analytical experience in telemedicine. Their goal is to "present a comprehensive assessment and a scholarly perspective on telemedicine in the 1990s" (p. xv). Furthermore, the editors state that, like its predecessor (Bashshur, Armstrong, & Youssef, 1975), the book is intended to represent the state of the art.

Structurally, the volume is divided into five sections, each of which approaches the topic from a different perspective. The first section, titled "The Context of Telemedicine," attempts to identify from a policy perspective how telemedicine might be integrated into the overall health care system. The second section, "The Technology of Telemedicine," was contributed by a biomedical engineer who competently addresses the full spectrum of telemedicine-enabling technologies. The third and by far largest section of the book provides in-depth discussions on six applications: teleradiology, telepathology, telemedicine and primary care, teledermatology, teleoncology, and telepsychiatry. Each is authored by one or more clinicians who are intimately familiar with the subject material. The fourth major section addresses telemedicine systems. The first chapter in this section, authored by Jim Grigsby, offers perhaps the most comprehensive description of telemedicine to be found, and gives the neophyte the best overall picture of the field. The remaining chapters address military and correctional telemedicine systems. The final section is a single chapter by Richard Satava, who speculates on the future of telemedicine. Based largely on current "bleeding edge" technical innovations, this chapter is an informed representation of the near-future of telemedicine applications.

This is a very useful book for a broad range of audiences. No one will need to read every chapter, but each one will be of interest to someone. It will take a rightfully deserved place on the shelves of anyone who has more than a passing interest in telemedicine. However, in this reviewer's opinion, it does not attain its own established goals-perhaps because they were unattainable from the start. The pace at which telemedicine is evolving is staggering. As a result, it has become extremely difficult to maintain a grasp on all the technological innovations being developed, the new applications being explored, and the numerous innovative telemedicine delivery models being tried and implemented. What was new knowledge 18 months ago is common knowledge today. This reality makes a conventionally published book on the subject at risk of being inaccurate, or at least incomplete, even before the ink dries.

A case in point is the chapter on telepsychiatry, which was a particular disappointment to this reviewer. This chapter presents a perspective on telepsychiatry that is confined to a review of the available literature. As a result, the authors grossly underrepresent the number of centers across the United States currently providing telepsychiatry services, the variety of settings in which telepsychiatry is practiced, and the numerous therapeutic benefits being realized. Similarly, they seriously underestimate the number of patients to whom telepsychiatry services have been delivered. They leave the impression that telepsychiatry has a dubious past, and at best a questionable future. This is a surprising representation from three respected researchers who have contributed so much to the field. There are numerous possible explanations for the many unfortunate oversights in this chapter. It is possible that in the spirit of presenting a "scholarly perspective," the authors limited themselves to a review of the "literature." Clearly, however, not every leading telepsychiatry effort is represented in the literature, in which case one could argue that "scholarly" and "state of the art" are mutually exclusive.

One might alternatively suggest that telemedicine is evolving so rapidly that the process by which manuscripts become published volumes predisposed this work to being outdated when it hit the shelves. This is in itself a statement of the merits of the information age, in which such manuscripts can be published electronically, updated frequently, and accessed by millions simultaneously.

This volume periodically misses the mark in terms of highlighting the most representative sources of telemedicine expertise. It lacks attention to some essential topic areas, such as the telemedical role of nurses and other nonphysician providers, and telehome health, which entails delivering services directly to patients in their homes. Nonetheless, it is a volume worthy of review and will contribute to any reader's overall understanding of this promising health care delivery modality.

Footnote

*When Mr. Reid wrote this review, he was director of the Menninger Center for Telepsychiatry.

References

Reference

References

Bashshur, R. L., Armstrong, P. A., & Youssef, Z. I. (Eds.). (1975). Telemedicine: Explorations in the use of telecommunications in health care. Springfield, IL: Charles C Thomas.