hat requires only five electrode attachments to the patient's chest. Another key component is software that analyzes the ECG every 30 seconds for signs of ischemia and heart damage. Once patients are attached to the monitor, ambulance medics push a button to send the first reading to an emergency department computer. An audible alert accompanies the transmission. If the software detects changes in subsequent ECGs, it automatically transmits them, as well. Drew chose Santa Cruz County as a testing ground for the system because the county is large and mountainous and has only two hospitals, both located near the coast. For many residents, hospital transit times are long. "If hospital teams had advance notice of the patient's condition, it would give them time to get ready for immediate treatment," says Drew. Drew and her researchers are now studying the impact that the mobile phone-delivered heart data is having on patients. Drew says it will take five years and the enrollment of hundreds of patients to determine whether the system is worth the cost. "It would be irresponsible to spend the money nec- essary to equip thousands of ambulances with the system unless it can be shown that, overall, outcomes such as better long-term health and survival are improved," says Drew. Although telemedicine has enabled greater access to health services, the potential communication problems it brings could interfere with the technol- ogy's potential to improve the diagnosing and treating of illness. Telemedicine is certainly valuable for delivering health-related services to remote areas, but the dynamics of the interactions associated with it can increase the likelihood of uncertainty, frustration, and unmet expectations for all involved, says Richard L. Street, a health communication authority at Texas A&M University. Street, working with the Texas Tech University telemedicine program, has analyzed teleconsultations involving videoconferencing between a patient and ON THE MENU-TELECOM SERVICES primary care giver at one location 