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EDUCATION AND PRACTICE History
" The STARPAHC collection: part of an archive
of the history of telemedicine
Gary Freiburger, Mary Holcomb and Dave Piper
Arizona Health Sciences Library, University of Arizona, Tucson, Arizona, USA
Summary
An early telemedicine project involving NASA, the Papago Tribe (now the Tohono O’odham Indian Nation), the
Lockheed Missile and Space Company, the Indian Health Service and the Department of Health, Education and
Welfare explored the possibilities of using technology to provide improved health care to a remote population in
southern Arizona. The project, called STARPAHC (Space Technology Applied to Rural Papago Advanced Health
Care), took place in the 1970s and demonstrated the feasibility of a consortium of public and private partners
working together to provide medical care to remote populations via telecommunication. In 2001 the Arizona
Health Sciences Library acquired important archival materials documenting the STARPAHC project and in
collaboration with the Arizona Telemedicine Program established the Arizona Archive of Telemedicine. The
material is likely to interest those studying early attempts to use technology to deliver health care at a distance, as
well as those studying the sociological ramifications of technical and scientific projects among indigenous
populations.
Introduction
In 2001 several boxes of documents relating to a 1970s
telemedicine project came to light. The materials
consisted of reports, correspondence and photographs
of a telemedicine project conducted on the Papago
reservation in Arizona (now called the Tohono
O’odham reservation). The project was called
STARPAHC (Space Technology Applied to Rural Papago
Advanced Health Care). The University of Arizona
agreed to archive these materials in the hope that the
collection would form the nucleus of an archive of
historical materials related to telemedicine.
The STARPAHC project
The STARPAHC project was conceived and sponsored
by NASA, assembled by the Lockheed Missiles and
Space Corporation, managed and evaluated by the US
Indian Health Service, and used and evaluated by the
Papago Nation. The original budget was US$4.26
million in 1973 dollars. The project employed
advanced technology to deliver medical services on the
Papago Indian reservation; extensive evaluation criteria
were used.
1
The STARPAHC system included a control centre
located in the Indian Health Service hospital on the
Papago reservation which was staffed by physicians and
a system operator. There was a remote clinic in the
village of Santa Rosa located 50 km away which was
staffed by a physician assistant. There was also a mobile
health unit staffed by a physician assistant and a
laboratory technician (Figures 1 and 2). Finally, there
was a referral centre at the Indian Health Service
hospital in Phoenix with access to medical specialists
(Figure 3). Two-way video, audio and data commu-
nications linked these units, which were used
primarily for remote diagnosis. Communications were
provided via microwave (video, voice, data), VHS radio
(voice, data) and telephone (voice, data, pre-recorded
video).
The project was active from 1973 until 1977.
2
Subsequently, Bashshur summarised the significance of
the programme as follows:
NASA and the Indian Health Service demonstrated
the organizational and technological capacity to
provide medical care to remote populations;
Journal of Telemedicine and Telecare 2007; 13: 221–223
Accepted 1 March 2007
Correspondence: Gary Freiburger, Arizona Health Sciences Library,
University of Arizona, Tucson, AZ 85724, USA (Fax: þ1 520 626 2922;
Email: garyf@ahsl.arizona.edu)
....................................... ................................
the approach to the design and implementation of
this mode of care delivery was effective and holds
promise for other situations;
the efficacy of remote telemetry and non-physician
medical personnel in the provision of medical care
was demonstrated;
the cooperation and advance planning on the part
of all the participants in the project can serve as a
model for others.
3
The STARPAHC collection
Although archives are often located in university
libraries, the term ‘library’ is not synonymous with the
term ‘archive’; librarians are not necessarily trained as
archivists, nor in most cases are archivists trained as
librarians. In general, librarians organize items such as
books, journals, audiovisual and digital materials, most
of which are not unique. In contrast, archivists
organize items from the records of a person, company
or institution into a unique aggregation. Library
materials are usually arranged according to an
established classification scheme such as the National
Library of Medicine system, while archival collections
are arranged according to provenance (i.e. office or
person of origin) and original order. In addition, library
materials are described individually and listed in a
library catalogue, while an archival collection is
described as an aggregate by means of a finding aid.
4
Since none of the staff at the Arizona Health Sciences
Library was a professionally trained archivist, an
archivist was hired to carry out the work. The aim was
to organize the papers, reports and photographs
(approximately 3 m of shelf space) into an archive usable
by researchers. In addition, policies were to be established
so that the collection could be maintained and additional
collections could be added to create a general archive of
telemedicine. Over a seven month period, working an
average of twenty hours a week, the archivist reviewed
the contents of the collection, stored documents,
publications and photographs in acid-free binders and
boxes, and created a finding aid for future researchers.
After processing, the STARPAHC collection occupied
approximately 2.6 m of shelf space. The documentary
material was organized into 22 storage containers and
there were two large framed pictures in addition. The
reports, correspondence and photographs are from the
period 1970–1991, but the bulk of the material is from
the period 1972–1978. The collection was organized
into seven distinct series based on the manner in which
the materials were collected, filed and maintained by
three of the people directly involved in the project:
James W Justice, the STARPAHC evaluation officer and
Figure 1 Exterior view of the mobile health unit on location
Figure 2 Interior view of the mobile health unit with medical
personnel, neonatal patient and mother
Figure 3 The STARPAHC sites. The distance between Sells and
Phoenix is approximately 220 km
G Freiburger et al. The STARPAHC collection
222 Journal of Telemedicine and Telecare Volume 13 Number 5 2007
....................................... ................................
medical director; Peter G Decker, the Indian Health
Service project engineer; and Norman Belasco,
STARPAHC’s project officer and chief of NASA’s
Integrated Medical and Behavioral Laboratory. The first
six record series were organized chronologically. The
seventh series contained undated material.
Once the processing of the collection was complete
and the finding aid had been prepared, press releases
were sent to major library and archival publications to
let others know of its existence. A record for the finding
aid was created and added to the OCLC WorldCat
database to ensure that researchers could locate the
collection from anywhere in the world (see http://
worldcat.org/oclc/53231018).
Significance of the STARPAHC
collection
The STARPAHC project represented the ‘first
generation’ of telemedicine, a generation which has
been said to be unsuccessful because the projects were
not sustained and because telemedicine was not widely
adopted for health-care delivery. Nevertheless, first
generation telemedicine projects provided evidence
of the feasibility of remote consultation, the clinical
effectiveness of several clinical functions, training and
education.
5
The press release announcing the archive of
telemedicine project, stated that ‘This collection will be
of great value to scholars interested in the historical roots
of ‘e-health care’, its early successes and failuresy
Arizona has had important experiences with multi-
cultural telemedicine for more than a generation. As
other major institutions extend their e-health networks
around the world, the Arizona experiences provide a
frame of reference for studies on the critical roles of tele-
communications in health care in the information age.’
6
In the last five years, the STARPAHC collection has
been consulted several times by researchers from
Arizona and elsewhere. The material is likely to interest
those studying early attempts to use technology to
deliver health care at a distance, as well as those
studying the sociological ramifications of technical and
scientific projects among indigenous populations.
From the library’s perspective, an important lesson in
regard to establishing archival collections is that the
processing and managing costs are not insignificant
and are easily underestimated. For future collections,
the library will need to seek specific funding.
Nevertheless, we urge people from other telemedicine
programmes to document their history and preserve
important documents in collaboration with their own
institutional libraries.
References
1 Lovett JE, Bashshur RL. Telemedicine in the USA: an overview.
Telecomm Policy 1979;3:3–14
2 Lockheed Missiles and Space Company, Inc. STARPAHC Systems
Report. 30 October 1977: 2 vols. Report number: LMSC-D566138
3 Bashshur RL. Technology Serves the People : The Story of a Co-operative
Telemedicine Project by NASA, The Indian Health Service and the Papago
People. Tucson, AZ: Indian Health Service, Office of Research and
Development, 1980:107–9
4 Hunter GS. Developing and Maintaining Practical Archives: A
How-To-Do-It Manual. New York, NY: Neal-Schuman, 1997:
6–10
5 Bashshur RL. Telemedicine and the health care system. In: Bashshur
RL, Sanders JH, Shannon GW, eds. Telemedicine: Theory and Practice.
Springfield, IL: Charles C Thomas, 1997:5–35
6 Weinstein RS. Comments in Arizona Health Sciences Center press
release file 2001. See http://www.ahsc.arizona.edu/opa/news/sep01/
telemed.htm (last checked 16 February 2007)
G Freiburger et al. The STARPAHC collection
Journal of Telemedicine and Telecare Volume 13 Number 5 2007
223
