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Telemedicine has a fairly long and rich history when one considers its roots both in the context of medicine and communication. 1 Recent evidence clearly supports the use of telemedicine in a wide variety of clinical specialties in terms of feasibility, satisfaction, cost effectiveness, and clinical outcomes. 27 The success of telemedicine is evidenced by the recent rapidity with which it has become a commercial enterprise that provides services “on demand” to patients outside of the traditional health care enterprise. 810 The American Telemedicine Association (ATA) actually has an accreditation program that “recognizes organizations providing online, real-time patient health services that comply with operational, clinical and consumer-related standards. The program promotes patient safety, transparency of operations and adherence to all relevant laws and regulations.” 11

Clearly telemedicine is here to stay, but it does and will take many forms just as traditional health care always has. Many factors contribute to the success of individual programs, of which many are discussed in the other chapters in this book, especially as they relate to individual clinical specialties. Common to the success of all enterprises, from academic to commercial endeavors, is the degree to which telemedicine becomes integrated into the existing system in order to effectively and efficiently deliver telehealth solutions. Again, many factors affect the successful integration of new delivery modes into established systems, but this chapter deals with two: leveraging common points between new and existing technologies and health care environments, and optimizing the environment within which telemedicine is practiced from a human factors perspective. To address the first point, we provide an overview of perhaps the most successful telemedicine application: teleradiology. Afterward we provide a review of some of the more common human factors issues that should be considered during the planning, implementation, and operation of telemedicine services.


Teleradiology is unique among telemedicine applications in that it grew out of the evolution of the specialty itself. Radiology by its nature is probably the most technology-dependent clinical specialty in existence and thus had an advantage over nearly all other specialties by having technology, technical support, practice procedures and knowledge, and research programs in place even before the “tele” option arose. Yet even with this infrastructure, radiology faced (and still faces) challenges when it came to convincing users that it was at least as good as traditional film-based radiology in terms of quality, diagnostic accuracy, cost, and utility.

Teleradiology has its origins in the development of digital radiography. For over 80 years patient care depended on film-based radiology, but these images had to be physically transported throughout a hospital, between hospitals, and between cities. This was very labor intensive and often involved radiologists doing “windshield” duty, driving from small town to small town to interpret batches of cases that had been acquired over the previous week or even month, delaying interpretation and thus treatment. Film-based radiology ...

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