F. Some history of the fieldsites
The history of the companies and hospitals that comprise my field-sites is complex and intersectional enough that I never managed to uncover all of the details. "Telemedicine" at MGH, even when not under that name, is proudly traced back to the late sixties. Being a high-profile academic medical center, all manner of research projects have been begun, continued, abandoned, or concluded. The residue of these projects sometimes hold over, since the hospital is large and bureaucratically slow-moving; it is possible for individuals and projects to continue well past results into parasitism, before someone notices, or the money simply fails to arrive. I occasionally saw old equipment from ventures I had heard about, heard stories of people in offices that no one could locate, or whose function people just couldn't pinpoint. A catalogue of such people places and technologies would update Borges, or Kafka.
In the eighties, MGH started funnelling money into commercial ventures of various kinds. Adrian Gropper related three: a nursing home venture, a home care and pharmacy venture, and a PACS company called RStar (which, according to a lecture by Dr. James Thrall, Chief of Radiology at MGH, was begun in 1992). This last one is what brought Adrian, Sean, and Jonathan together initially. These ventures were not unusual for the eighties, but they were unusual for the healthcare world, which went through a series of high-profile financial fiascos during this time. According to Adrian, the executives started referring to proposals by whether they passed "The Globe Test"— meaning that the venture was a safe one if it didn't show up on the front page of the Boston Globe, regardless of what they said about you. It was a lose-lose situation for most of these attempts, because if they failed it was a waste of healthcare money that should have gone to charity, and if they succeeded it was an abuse of non-profit, charity status to make money.
RStar was a PACS business when Adrian joined it, and at about the time he did (the early 1990's), it was in the middle of a major management shake up. The chairman of the hospital (J. Buchanan) and the second in command had moved to take over the company, partially, for the chairman, as a retirement move out of the hospital, but also because the radiology department was unhappy with the role and performance of this company. They intended to turn R*Star away from the PACS business and towards telemedicine, which during this time, far more than in 1998-9, was a powerful buzzword. They intended to leverage the reputation of MGH, which had recently merged with BWH (December of 1993) to sell services to people around the world. This company focussed much of its resources on the creation of this business: the marketing of reputation, financing and general business issues. Adrian, Sean and Jonathan have all at one point or another expressed a certain outrage at the way the management of R*Star viewed technology and engineers— as the least important part of the business, just above janitorial staff.
Eventually the company tried to develop a consortium of hospitals and clinics that could sell the service of telemedicine abroad. MGH founded an additional venture called American Telemedicine International, which was to be the service component to RStar. Apparently, Rstar either dwindled to nothing, or was folded into A.T.I. before A.T.I. was sold to a company called Wellcare, which was a Dutch holding company connected to a series of Saudi Arabian interests which would eventully organize under the multinational label (Headquartered in Bermuda) of WorldCare. A series of promotional videos from 1993 and 1994 show A.T.I./Wellcare engaging in fairly high-profile demonstration projects in Saudi Arabia. One in particular, called "The Global Cure" features J. R. Buchanan offering to bring "the expertise of the West, to the rest of the world." The demonstration required the creation of technology that would allow images to be digitized and sent via a hub and spoke network of routers between MGH and Riyadh and Jedda. The system was not internet-based, but it was the technology out of which the idea for Amicas emerged. From about 1994 until 1998, WorldCare took over this technology and developed the business of A.T.I. into a consortium that included MGH, Cleveland Clinic, Duke Medical Center and Johns Hopkins Medical School. For several years the President of A.T.I./Wellcare was Mark Goldberg, a well-known name in the academic world of telemedicine, and a senior editor of the Telemedicine Journal. When Sean left RStar, he spent some time working for one of the Medical Informatics groups in Boston, Peter Szolovits' Clinical Decision Group at MIT, helping with a project called "Guardian Angel" that intended to provide a secure medical record for pateints. By late 1996, they had come together to form what would become Amicas (which went by the name Autocytgroup, Inc. until the fall of 1998, the name of Adrian's medical device consulting business).
Also in approximately 1996, Partners Information Service had decided to begin a clinical telemedicine research department, and had asked Dr. J. Kilborn to head it up. The group he collected consisted of some people in patient TV and Video production from Brigham and WOmen's hspital (BWH), with the existing business of teleradiology consultations that were being managed by WorldCare. The Partners Telemedicine Center (PTC) became the bureaucratic home of telemedcine, even though there existed several different interests including WorldCare, Agfa, Amicas/Autocyt and the Radiology department's own homegrown projects. Add to this the fact that BWH, now part of Partners, also had its on teleradiology project called Brahms, run by Ramin Khorosani and Bill Hanlon in the Radiology department at BWH. By the time my fieldwork finished, none of this was any less confusing. The sheer size of Partners lent momentum to such competing endeavors, but it also served to frustrate people absolutely, since there was neither anyone in charge, nor any sense that someone could be in charge of it all. A general sense of paranoia affected everyone involved.
Last Modified 11-Sep-99 9:22 PM ckelty@mit.edu
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