Although getting diagnosed and being able to purchase medicine over the Internet is seen as something new, the concept itself is old.

Initially defined as telemedicine, it has been going on in the US since the 1960s.

In an article in the Telemedicine Journal in September 1999, Huseyin Tanriverdi and Suzanne Iacono Ph.D. reported that the US health care system was confronting major problems in terms of accessibility, quality and cost, and that telemedicine was seen as a solution to these problems.

The July Journal of the American Medical Association defined telemedicine as the "utilization of new computer-based communication technology for medical purposes... permitting broader access to expertise and second opinions without travel."

Carol A. Ferri and Sharon R. Klein recently wrote in MD Computing "telemedicine is in fact the transmission of healthcare data electronically, whether the device used is as basic as a telephone or as sophisticated as a computerized medical device.

It wasn't until the late 1980s with advances in telecommunication that online consultations really began to take off. It all started in radiology. Tanriverdi and Iacono reported that Alpha-A, a group affiliated with a medical school in Boston initiated it.

A team, identified as RADCARE, evolved from Alpha-A with a dream of transforming the way films were viewed and making radiology electronic.

This young group of radiologists developed their own system because they wanted to improve the diagnostic quality of images and the speed at which the images were displayed on a computer screen. It took about three years for them to perfect a cutting edge quality system.

From this group, another group, WeCare, emerged to sell the groups' radiology expertise. Online consultations, however, were prohibited across state lines and reimbursement was limited.

As a result they focused on international markets and within 6 months they had linked eight international sites to Alpha A and the number of consultations reached 750 in radiology and 150 in other medical specialties.

Tanriverdi and Iacono further reported that "as of May 1997 teleradiology was being used routinely in domestic and international markets....In other medical specialties 40 physicians out of a total of 400 were using international telemedicine to conduct about 400 consultations annually."

The September issue of the Telemedicine Journal reported on a study at the department of defense on the Internet based Pacific Oncology Outreach Project.

The project "was designed to facilitate the delivery of cancer care to Tripler Army Medical Center (TAMC) located in Honolulu, Hawaii to the military beneficiaries encompassed by the Pacific Region. The region included over 750,000 individuals eligible for medical care dispersed across 12 time zones and separated by vast bodies of water.

In Northern California access to military cancer treatment facilities was challenged as a result of mandated downsizing and closure of military facilities.

Since 1993, seven facilities closed including two major medical centers that provided comprehensive care for cancer patients."

Consultations were done using a secure server where a patient's history was submitted electronically to the Pacific Oncology Web site. The site included radiology, pathology and photographic images relevant to the cases.

Other information included special questions and issues for discussion by the specialists involved. A Net meeting was then set up for those participating in the online consultation.

The report concluded that as a result of the Internet based Pacific Oncology Outreach Project, "As of March 1999, 16 aeromedical evaluations were avoided...and the system ensured that those patients who required MedEvacs were entered into clinical pathways without delay."

The article reported that "Picture quality was "good" or "excellent" in 92.9% of transmitted documents and 95.5% of live images."

The results determined that diagnosis was made in 84.8% of transmitted cases versus 93.8% of live cases.

The study further concluded, "low bandwidth (128 kb/s) telemedicine application in surgery is reliable in evaluating remote cases. Loss of image quality was not possible in 15.2% of transmitted vs 6.2% of live cases, suggesting factors other than technical quality...."

The Telemedicine journal evaluated the effectiveness of digital photography for dermatologic diagnosis in comparison to actual in person diagnosis. The results showed that there was 83% agreement between in person versus digital diagnosis.

As telemedicine began to gain momentum in the 90s many states were forced to make changes to the laws governing medicine. Telemedicine became especially important for rural areas where there were fewer physicians.

Ferri and Klein reported that "by 1999, more than 25 states had enacted legislation on telemedicine and, although a few states reciprocate, most require full licensure in each state for the practice of interstate telemedicine."

They further reported that reimbursement for telemedicine services under Medicare only came into effect with the Balanced Budget Act of 1997, which mandates Medicare reimbursement for telemedicine consultations in rural areas.

Associated Press reported in March that Upstate Medical University in Syracuse and Columbia University in New York City would be using a federal grant to deliver health care through the Internet over the next four years to 750 rural and inner-city diabetes patients.

It was reported that if the $28 million study proves successful it could potentially provide greater access to health care for millions of Americans.

Attitudes seem to be changing. Ferri and Klein also reported that in May, the national health benefits company, First Health Group Corporation based in Illinois, announced they would be the first managed care company to make payments for Internet consultation between patients and physicians.

Advancements in technology will see other major changes in medicine in the near future. In July Reuters Health reported that a new virtual -reality 'glove' has been developed that "allows a physician to feel the same sensations a colleague feels while performing an abdominal exam."

Reuters reported "Dr. Thenkurussi Kesavadas and his colleagues at State University of New York at Buffalo developed the device by attaching a sensor to a physician's index finger with a thimble -sized cap, no thicker than a latex glove. As the physician puts pressure on the patient's abdomen to check for problems, such as tumors or an enlarged liver, the sensor records every move his hand makes.

Using a powerful graphics computer, the Buffalo researchers applied the data recorded by the virtual -reality glove to a digital 3-D model of the patient's body to mimic the pressure and force of the physician's fingers on the tissue. On the other end, another physician can insert his or her finger into a robotic feedback device, or haptic thimble, touch the computer screen and recreate the original exam."

In other developments Reuters reported in July that a "new Internet- based system, MediMOM, automatically sends messages to a pager, cell phone or e-mail to alert subscribers that it is time for them to take their medication, check their blood glucose, or take care of themselves in other ways."

These developments are just the tip of the iceburg in what we can expect to see in techno medicine in the very near future.