Telemedicine in critical care: problems in design, implementation, and assessment.

We introduced telemedicine, i.e., telecommunications for delivery of health services, to alleviate scarcity and maldistribution of critical care services. For 18 months, we used interactive television to provide consultation with university-based critical care physicians for patients in the ICU of a 100-bed hospital. Telemedicine "visits" (1548) were made to 395 patients. Television consultation had greater clinical and educational impact than consultation using the telephone. Equipment was expensive but proved to be reliable and easy to use. Interactive television extended the availability of specialist expertise, but full exploitation of this technology for delivery of critical care services was not achieved. Extensive background research, currently underway at the University of Pittsburgh, is necessary before the next telemedicine demonstration.