TELEMEDICINE

Telemedicine includes all medical activities in diagnosis, therapeutic s or social medicine undertaken by means of an electronic transfer med ium, thereby enabling the transmission of visual and acoustic informat ion in these fields over long distances without the doctor being perso nally present at the requested consultation. Most experience in teleme dicine has been gathered in diagnosis, especially with respect to tele radiology and telepathology; however, an increasing number of institut ions have obtained experience in teledermatology, telepsychiatry, tele cardiology, telesurgery, etc. The quality of the transmitted images is adequate for diagnostic application. However, the transfer rates of n ormal telephone lines are not satisfactory and these telephone nets wi ll be replaced by ISDN and broad band or satellite connections in the near future. The lack of uniform transfer standards is the most import ant constraint in telepathology. This fact is one explanation for the fast growth of the Internet, which is based on unified transmission st andards. The rapid expansion of telemedicine is inevitable and the inc reased use of this tool will induce profound changes in the medico-soc ial environment. Then is a fear of institutional concentration, at the expense of small institutions. This development can be minimised by a ugmenting the scope to encompass telemedicine in all interdisciplinary fields, with the consequent full integration of small institutions. T elemedicine is an appropriate technique for quality assurance in all a reas of medicine, since it permits simultaneous ''soft'' quality contr ol, in conjunction with assumption of co-responsibility by the control institution.