Telemedicine and remote patient monitoring.

DEFINED BROADLY, TELEMEDICINE is the use of electronic information and communications technologies to provide and support health care when distance separates the participants. The term is also applied more narrowly to medical applications that use interactive video, typically for specialty or subspecialty physician consultations. Sometimes the term telehealth is used to encompass educational, research, and administrative uses as well as clinical applications that involve nurses, psychologists, administrators, and other nonphysicians. Telemedicine using interactive video made its debut about 40 years ago to support neurologic and psychiatric services in Nebraska. Through the early 1990s, telemedicine mostly involved specialty consultations via videoconference technology. Recently, more attention has focused on noninteractive applications, including those that use relatively inexpensive store-andforward technologies to save and then transmit text and images (essentially, multimedia e-mail). Both interactive and noninteractive technologies are increasinglyusedorpromoted for remote monitoring of health status in homes and other settings. Given the range of applications and technologies, evaluating the effectiveness of telemedicine means individually evaluating different combinations of technologies and clinical or other uses.