In 1994, the National Laboratory for the Study of Rural Telemedicine was established at the University of Iowa with support from the U.S. National Library of Medicine. The purpose of the Laboratory was to determine health care delivery needs in the rural setting, develop technical approaches toward their solution, and test these applications in community settings.

A major impetus for the project was the availability of the Iowa Communications Network (ICN), a 2,800-mile fiber-optic telecommunications system established by the State of Iowa by legislative action in 1987. This state-of-the-art system has a point of presence in each of Iowa’s ninety-nine counties and is currently in use for a variety of educational and state governmental purposes. Iowa’s hospitals and physicians’ clinics had been granted access to the ICN, along with selected federal agencies, and representatives are engaged in a statewide planning process to define the details and standards of the state’s telemedicine network using the ICN.

Prior to the current project, several types of telemedicine were in place at the University of Iowa hospitals and Clinics (UIHC), which, along with the Iowa City Department of Veterans Affairs Hospital, serves as the primary teaching hospital for the health sciences.

Teleradiology is an application with substantial promise, but many (largely technical) questions remain regarding its widespread use [5]. The first of two radiology-related projects will determine cost-effective protocols for interpretation of routine and subspecialty radiographs within a three-tier system of hospitals. Time and cost of care will be compared against similar hospitals using more traditional teleradiology methods.

A second teleradiology project will support more advanced three-dimensional image analysis (volumetric computed tomography) in the test-bed hospitals, addressing the technical, educational, and clinical requirements for such an undertaking. In the final stages of the project, formal receiver operator characteristics (ROC) methods will be applied to community-based applications of the three-dimensional
technology.