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Imagine managing your patients with virtual technology—technology that permits patients access to health care from their home or wherever they may be; technology that provides you, the clinician, with better ways to manage your patient’s chronic disease. Telemedicine and telehealth are tools that have enabled a new approach and perhaps a fundamental change in addressing your needs as a clinician and, more importantly, the needs of your patients. These tools are focused on enabling more efficient and better health care.

Over the past 100 years or so, medical care has evolved as a direct result of innovation. This innovation will continue to push the boundaries of what is possible. Sensors, robotics, artificial intelligence, high-speed communications, massive storage systems, computing power, informatics, and smart medical systems are but a few of the tools you will use in clinical practice in the coming years.

This chapter provides a summary of what telemedicine and telehealth are and how they are being integrated into clinical practice and medical education. It lays out an historical timeline, defines terms, highlights empirical evidence, discusses challenges and barriers and clinical applications, and presents an update on the patient-centered healthcare system.


In the 19th century, innovation in electricity and telephony changed the way we all lived and worked. The introduction of these two technologies led to better medical care. Lighting in the operating theater (Figure 68–1) and patient examination room, tools for individuals to communicate with one another across some distance, and many other applications of these new technologies led to modernization of health care. Röntgen’s discovery of x-rays in 1895 changed how we diagnose and treat our patients. Laparoscopic surgery, developed at the beginning of the 20th century and perfected in the 1980s, helped lead the way to robotic surgery. William Osler’s work in the early 20th century led medicine into a new paradigm in education, training, and clinical practice.

Figure 68–1.

Operating theater in the late 19th century.

These and a myriad of technologies laid the foundation for our healthcare systems today. Some of these changes did not come about overnight, and some challenged the very foundation of medicine at the time. For example, it took several decades for Laennec’s stethoscope to become a standard tool. Most of his colleagues thought he was not following the standard of care. The same can be said for hand washing. In 1847, Ignaz Semmelweis was severely ridiculed by his contemporaries for his efforts to institute handwashing between the cadaver lab and the delivery room and between patients, thus reducing puerperal fever (Streptococcus pyogenes) and lessoning the burden of mortality in delivering mothers and their infants. The thinking at the time was “Gentlemen don’t have dirty hands.” An interesting point here is that midwives of this period ...

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