Telemedicine: barriers and opportunities in the 21st century (Reprinted from Journal of Internal Medicine, vol 247, pg 615-628, 2000)

This paper aims to examine how health telematics will develop in the first 10 years of the new millennium and, in particular, to assess what operation al, ethical and legal barriers may lie in the way of this development. A de scription of the key principles and concepts involved in telemedicine and a short historical overview of telemedicine's evolution over the past centur y are followed by consideration of why empirical research into 'info-ethics ' and other deontological and legal issues relating to telemedicine is bein g necessarily catalysed by, amongst others, the European Commission. Four evolving health telematics applications are examined in some detail: e lectronic health records; the transmission of visual media in disciplines s uch as teleradiology, teledermatology, telepathology and teleophthalmology; telesurgery and robotics and the use of call centres and decision-support software. These are discussed in the light of their moral, ethical and cult ural implications for clinicians, patients and society at large. The author argues that telemedicine presents unique opportunities for both patients and clinicians where it is implemented in direct response to clear clinical needs, but warns against excessive reliance upon technology to th e detriment of traditional clinician-patient relationships and against comp lacency regarding the risks and responsibilities - many of which are as yet unknown - that distant medical intervention, consultation and diagnosis ca rry.