Document Type



This monograph is a documented history of the planning and development process of a major advanced telemedicine system call Space Technology Applied to Rural Papago Advanced Health Care (STARPAHC). This history was prepared to document basic processes. Projects such as STARPAHC usually result in volumes of technical system descriptions, evaluation reports and technical performance analyses. This report provides a good description of the high degree and quality of productive functional relationships developed among the participating agencies and the private sector.The project was conceived and sponsored by both the National Aeronautic and Space Administration (NASA) and Lockheed Missile and Space Company (LMSC). STARPAHC was not the first attempt to implement a telemedicine system in the United States. Ultimately, STARPAHC would provide a full communications range, two-way television, audio and data communications between the central station at Sells, Arizona on the Papago Reservation, and a fixed satellite clinic at Santa Rosa, a regularly scheduled mobile health clinic, and a full facility hospital-based clinic at Phoenix. The program presumed that the telemetry and remote monitoring equipment developed for the space program would have eventually made its way into the open market. The study rests on the conclusion that some form of telemedicine is the ""invariant pattern of the future.""The time periods for the research and demonstration projects were insufficient to reach definitive conclusions regarding the cost-effectiveness of telemedicine in relation to other modes of health service delivery. In an intensively technological system, the capital investment may only be recovered over an extended period of time, and services must be distributed over a large number of patients/clients. Problems with program objectives led to situations where it was not clear whether telemedicine was intended to supplement, enhance, or replace existing delivery systems. Funding was severely curtailed before many of the problems could be resolved. The STARPAHC project may prove to be the most successful model for the future of telemedical diagnostics. In terms of costs, it used the least expensive technology (audio-link and slow-scan TV). In terms of quality, it provided an opportunity to have a second option for diagnostic purposes, clinical decision making, and specialist consultation done rapidly and efficiently. In terms of acceptance, both providers and patients were happy to have the system.Reinitiate funding for telemedicine.

Publication Date



Indian Health Service, Staff Office of Planning, Evaluation and Research, Rockville, MD 20857 (E-106).