based on fluoroscopy images transmitted by coaxial cable (Jutra, 1959). In 1961, the journal Anesthesiology reported on radiotelemetry for patient monitoring (Davis et al., 1961). Ship-to-shore transmission of electrocardiograms (ECGs) and x-rays was reported in 1965 (Monnier et al., 1965),1 and transoceanic transmission was reported soon thereafter (Hirschman et al., 1967).
Although the Nebraska program and many of the other early telemedicine applications arose out of concerns about the limited access of remote populations to a variety of health services, urban uses also appeared fairly early. In 1967, physicians at the University of Miami School of Medicine and the City of Miami Fire Department reported their pioneering use of existing voice radio channels to transmit electrocardiographic rhythms from fire-rescue units to Jackson Memorial Hospital (Nagel et al., 1968). Today, it is commonplace for paramedics to transmit cardiac rhythms and 12-lead ECGs to hospital emergency departments. These and certain other kinds of emergency telemetry are now so routine and so much a part of mainstream health care that they are often not mentioned as telemedicine applications.
In another early use of telecommunications technologies to assist in urban emergency and urgent situations, Massachusetts General Hospital (MGH) established in 1963 a telecommunications link with a medical station staffed by nurse clinicians at Boston's Logan Airport (Bird, 1972). In 1968, MGH added an interactive television microwave link that provided electrocardiograph, stethoscope, microscopy, voice, and other capabilities. During the same period, MGH also established a telepsychiatry link with the Veterans Administration Hospital in Bedford, Massachusetts, that continued to operate until the mid-1980s (Crump and Pfeil, 1995).
A report from the National Academy of Engineering (NAE) on communications technologies in urban areas suggested other uses of telemedicine that would be applicable in urban as well as rural areas (NAE, 1971). One such use involved physician services for nursing home patients; another use involved the supervision of nonphysician providers in ambulatory care clinics. The Mt. Sinai School of Medicine in New York City tested the latter application when it established in 1972 a black-and-white cable television link to support