Abstract
Our field is rapidly changing, and the long-term aspiration of full incorporation into the warp and woof of global healthcare is being realized. Telemedicine and e-health are the inevitable tools to craft a new model of care delivery that responds to the needs with efficiency, humanity, and affordability. Care of patients in an information continuum with a global resource of expertise is inescapable and no longer the stuff of the imagination or utopian planning. Telemedicine and e-health are hardly a technical marvel to add on or embellish healthcare but a foundation to realistically meet the expectation of an advancing and better-informed world with ever-expanding demands for health and welfare but limited resources.
Our journal has been at the forefront chronicling the development of this field since 1994. At the outset plenary meetings of the major organizations could be held in a small hotel conference room. Now such organizations as the American Telemedicine Association (ATA) must host many thousands of participants in a plethora of specialty sessions and courses with a cavernous vendor area presenting the best in new technology and services.
There have been huge changes in the sophistication of the readers, the authors, and the technology of telemedicine. In the early years, the term “telemedicine” was pretty much one for the cognoscenti, and the readership was rather limited. However, in the last decade the readership has extended to most of the major medical libraries in the world, and Telemedicine and e-Health represents the membership of the largest telemedicine associations in the world.
However, there is another aspect of this maturity and growth. In a search of PubMed under telemedicine over the past year, fewer than 20% of the articles are in what would generally be considered telemedicine journals. Where are the rest? The huge majority is in the mainstream of medical and engineering and informatics literature, and that is entirely appropriate.
Our journal has been an official outlet of the ATA and the International Society for Telemedicine and e-Health (ISfTeH), the two largest telemedicine associations in the world. The ATA is made up of more than 80 institutional members, 86 corporate members, and thousands of individuals from industry, academia, healthcare, and government. The organization has a significant voice in health policy debates and planning in the United States and manages to encourage newness while advancing current practices. The organization also serves a large international community. There are 13 Special Interest Groups (SIGs) that form the core of the membership representing business, technology, policy, scholarship, and medical specialties. The SIGs have created 10 clinical guidelines that are often taken as whole cloth into the policy statements of the appropriate clinical discipline. The impact is immense and allows telemedicine practice to move forward with full approbation by the professional societies. The ISfTeH includes representation from 73 national groups and territories. It is a nongovernmental organization in official relationship with the World Health Organization (WHO) and is closely allied in mission and purpose with the International Telecommunications Union and the United Nations Organization for Outer Space Affairs. ISfTeH has a huge voice in planning international telecommunications endeavors, standards, and policies that advance the role of telemedicine in global health, including the Millennium Development Goals.
So where is information about telemedicine published? It might be in the Bulletin of the WHO. Or it might be in public health journals and policy journals. The articles might be in informatics publications or engineering journals as well. Most importantly, telemedicine is a frequent part of the pages of the most important medical and nursing journals in the world. The most competitive journals are glad to present to their general readers the activities of telemedicine in such specialties as ophthalmology, dermatology, psychiatry, surgery, pediatrics, pathology, and disaster medicine. Generalist journals such as the New England Journal of Medicine do not need to explain to their readers what telemedicine is. They know and are hungry to learn of new applications and lessons in medicine as a whole, as well as specific practices.
Readers of telemedicine may no longer think of themselves as part of the telemedicine community. They are part of health information technology, users of medical records, information management, service providers, and the daily practice of electronic healthcare. They are individuals interested in effective distant learning and the exploding areas of m-health with a myriad of apps that will shape the face of medical practice in the coming decade.
What then should be the province of the traditional telemedicine journals and our hardcore readers? Is telemedicine simply going to merge with the mainstream of healthcare or disperse into highly specialized endeavors and no longer have any identity? Well, at least not yet. Our journal is overwhelmed with submissions, and our electronic downloads are growing exponentially with a steady expansion in readership. We must reject articles that certainly would have been highly competitive even 5 years ago. Our readers are too far along to be swayed by a pilot study unless there is something very different in the approach. The readers are not interested any longer in yet another iteration of an application that has been well tested in multiple venues. The readers are quite aware of the limits of implementation due to resources and computer training by the user and have a great deal of evidence about what to do with user perceptions. Those areas are just not new knowledge any longer. That is actually very reassuring and reflects a profound measure of progress in telemedicine.
What is our 20%? We are very proud to publish the newest in technology and engineering that will spark the imagination of our industrial and clinical readers to create applications that will constitute the next quantum leap, as has m-health. Our clinical readers are looking for validation, outcomes, and solid and critical clinical trials that will serve to facilitate evidence-based programs. Our policy readers and economists are great contributors in the area of business modeling, policy constructs, and presentations of challenging problems that perhaps the practitioners through their advocacy and curiosity may solve. Our engineering readers and graduate students look at clinical problems from a technical perspective and find new solutions and thus academic projects to bring back to all of us new tools from their research. Then we are always grateful for those thoughtful scholars who provide reviews and meta-analyses to help in the overview and larger sense of the present and future. Our journal is a forum for the disagreements, the conflicts, and problems of telemedicine and is always pleased to offer authors the opportunity to debate and dissent. These areas may not reach the level of general medical readership and may not be quite ready for policy writers. These articles are the background for the ones that will ultimately support a practice guideline and will end up in a Cochrane Review. Telemedicine and e-Health has its role, and it will continue to be a vital one that your editors will pursue with vigor and all the energy we can summon.
This editorial is a loud bravo to our readers and authors. You have come so very far, and the path ahead is one of great enlightenment and great challenge and one that will summon all your talent and creativity. Telemedicine is not done. Its role in the fabric of healthcare may be integral now, but it is dynamic and almost certainly destined to serial fundamental shifts with disruptive technology in the area of electronic communication, information management, human factors, human communication, and the evolving role of the health worker. With Telemedicine and e-Health, that worker will be a consummate individual and team member, effective, superbly informed, caring, and always available to meet the needs of patients.