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MGH

Published On September 21, 2018

TECHNOLOGY

Doctoring on a Screen

Telemedicine made its first broadcast 50 years ago in an airport clinic.

On Oct. 4, 1960, an Electra turboprop with 72 passengers and crew took off from Logan Airport in Boston, struck a flock of starlings and plummeted into the shallow waters of nearby Winthrop Bay. Gawkers flooded the scene, delaying emergency vehicles from reaching survivors. The death toll would climb to 62. The difficulty of getting to the airport led health authorities to build a new clinic right on site—a step that led in turn to the first sophisticated use of telemedicine.

While the airport clinic would be of limited use during another crash, it was invaluable for most of the emergencies that arose among the 12,000 employees at the airport or the 50,000 passengers that passed through daily. That said, there was rarely enough work to occupy a full-time physician.

Massachusetts General Hospital internist Kenneth Bird moonlighted as the first head of the new clinic at Logan. In 1967, after a particularly frustrating commute from the airport into the city, Bird was venting with his colleagues in the emergency department. According to Jay Sanders, who was then an ED resident, Bird started to spitball a new approach. “What if I bought two TV cameras and put one at Logan Airport and one here in the emergency room, and I began to examine patients over TV? What do you think?” Sanders, now president and CEO of the consulting firm Global Telemedicine Group, remembers saying it was the stupidest idea he’d ever heard.

By April 1968, Bird had secured a broadcast channel with the Federal Communications Commission’s approval and began beaming audio-visual data between the airport and the hospital. At MGH, a physician sat in front of two television monitors, installed in a recessed desktop, and looked into a camera specially designed for low-light situations, which avoided the need to light up the emergency room like a television studio. At Logan, the doctor’s image appeared on a 17-inch screen directly above a similar camera trained on the patient. Nurses could operate a separate telemicroscope to magnify and transmit images of urine or blood smears.

The so-called Logan station began to work out its kinks, and was soon producing research about what came to be known as telemedicine. Pathologists found they could make diagnoses using the black-and-white images from the remote cameras. They also found ways to transmit patients’ pulse rate, blood pressure and EKG data. Not every obstacle was within their control, however. Transmission failed during heavy rain and snow, and became distorted in extreme cold.

Many early critics of the system, such as MGH psychiatrist Tom Dwyer, were eventually won over. Dwyer had predicted that the technological interface would erode much of what was gained by seeing a patient face to face. But Dwyer found he could not only connect to patients remotely, but also that camera close-ups and other framing techniques could help reinforce his message.

The Logan clinic closed in the 1970s because of cuts in federal funding. But by then, the Logan link had already paved the way for many things that are taken for granted today, such as remote diagnostic imaging, digital videoconferencing and the electronic transmission of medical records.