The transmission speed defaults to the user with the slowest speed. With patience, however, and a narrow, well-defined agenda, some useful medicine can be accomplished at this level. For example, a 3-month trial was conducted this spring using still image phones between the dermatology departments of Yale and the VA Medical Center. Residents were guided through excisional surgery of malignant lesions. Developing a reliable delivery system has been slow, which contributed to the cautious pace of telemedicine in the early 90's.
Reliability is still an issue for some aspects of some technologies.
Although the technology appears as simple and as familiar as turning on a TV set, in fact multiple technical elements are involved and users must be trained to operate the equipment. In our experience telemedicine projects require broadbased planning, installation, and operational support. Its importance Well-developed telemedicine programs have been around in Nebraska and Iowa since the 1960's, but telemedicine became a hot new concept only very recently when it was evident that health care reform was underway. Health care cost containment has become a national priority, and the failure to pass federal reform has spurred local changes. In many countries outside of the US the fiscal realities of health care are equally compelling.