Apple Pie or Peach Cobbler

The other day an individual was being interviewed on one of those frequency modulation (FM) radio stations in the 87–89 MHz range about issues with respect to unfolding events in the Middle East regarding politics, populations, human rights, land, etc. The interviewee commented that many issues are like “apple pie or peach cobbler.” You may also have also heard the term “apples and oranges.” Tough comparison, as they are not the same—apple pie and peach cobbler, that is.

So we posit that telemedicine, telehealth, healthcare reform, health information technology, informatics, etc., are all part of the future of medicine and health. What is striking, however, is that different people and different organizations have different opinions or beliefs on what these terms mean and even more importantly how they are integrated in the Patient Affordability and Accountability Act and/or changes in federal policy toward existing programs and systems. This has become very apparent during the election season in the United States, although by the time you read this editorial, the election will have been completed, and we will know who the President will be for the next 4 years. The conflicting stories, spin, and who said what often cannot be compared with reality or, in the case of telemedicine, the growing amount of evidence that it does work, saves time and money, and has high utility.

Over the last several months, we have heard ad nauseam what each candidate will do or not do to senior citizens, to middle income or middle class people, to Medicare, etc. These arguments and positions are like apple pie and peach cobbler. The only similarity is that they are both considered dessert! One can argue that in order to make healthcare reform work, there must be a resultant decrease in something else—a sort of zero-sum game. On the other hand, you could raise revenue to offset redistribution of diminishing resources. Regardless of how healthcare reform is defined in the coming 4 years or four decades, the utilization of information technology and the approach to practice will serve as a significant adjunct in moving healthcare forward.

Many healthcare business leaders, physicians, and non-physicians are in conflict with regard to what terms like telemedicine, telehealth, e-health, mobile health, medical informatics, etc., mean. Of course, these are all part of medicine and healthcare, but not all are apple pie or peach cobbler. Some often put each of these terms in the same basket. I am sure you have heard someone say that telemedicine is video-teleconferencing, or others say, that's not telemedicine, that's the patient-centered medical home. Again, apple pie or peach cobbler! Clearly, in this case they are related but not the same thing. It is very important to make sure that in this growing field there is common terminology and common understanding of what the path forward is.

For many individuals and organizations, there are more and more resources available to help them understand what telemedicine and telehealth are. These resources include the Department of Health and Human Services's Health Resource and Services Administration Office of Rural Health Policy's Office for the Advancement of Telehealth-funded resource centers (www.telehealthresourcecenter.org/), peer-reviewed scientific literature, professional associations with a vetted interest in telemedicine such as the American Telemedicine Association, and numerous other organizations. Significant amounts of knowledge and information are readily available and necessary for this discipline to move forward. Naysayers must not conflict truths and half-truths—apple pie and peach cobbler. Healthcare must change, and it must adapt new ways of doing things. Regardless, if it is apple pie or peach cobbler, they are both great with ice cream and whipped cream; just be clear which one you want.

What's in This Issue?

This issue contains a wide variety of papers that highlight applications of telemedicine in Brazil, Denmark, Germany, India, Iran, South Korea, the United Kingdom, and the United States. They cover neuropsychology, mobile teledermatology, Internet-based technology in the treatment of Parkinson's disease, e-health and gender/age in a national healthcare system, applications with nurses, telerehabilitation, chronic obstructive pulmonary disorder, and home-based monitoring. Each of these articles is a very good example of implementation and application of telemedicine. Although some international activities may not fit your needs, the lessons our colleagues have learned may be helpful to us on our path forward.

So take a good look at what we have put together for you in this issue. While you are reading these examples of how telemedicine is being implemented worldwide, have some dessert—apple pie or peach cobbler—your choice. Just remember the distinction!