Abstract
The summer of 2012 in the United States will certainly go down in the record books as the hottest since records were started. The temperature in many parts of the United States was in the triple digits Fahrenheit for a number of days straight in June and July. Temperatures and associated heat indices above 105°F caused death and a surge on the electrical grid. Records in excess of 22,000 were broken. While we have seen temperatures soar, this in itself is not abnormal. What is abnormal is that the sustained heat wave has been crippling and will have an impact on both human health and the economy because of crop damage. When the heat is on, we are grateful for air conditioning.
The summer of 2012 will also be remembered for the U.S. Supreme Court's controversial ruling on President Obama's signature legislation, the Patient Protection and Affordable Care Act (PPACA) or, as it has become known, Obamacare. This landmark change in the U.S. approach to healthcare has been declared quite legal, but the controversy is not done. Legislation makes it clear that there is a focus of responsibility for healthcare in the United States, and the central government will try to make something work. This is new. The U.S. Constitution does not guarantee healthcare at all. This legislation moves the United States in many ways into the global mainstream of central approaches to healthcare coordination. The heat has been turned up on this legislation. Many people will debate the merits of the ruling and how the Supreme Court's upholding of PPACA implied that the bill was constitutional under Congress's power to tax. The U.S. House of Representatives has moved to vote on overturning the legislation, and the presidential election will no doubt feel the heat of this debate. So everyone has a dog in this fight. Everyone stands to gain and lose. So the heat is on for all of us. With that said, our healthcare system (best in the world?) is on an unsustainable path. Something must be done to improve the system. One might even say we have no system in the United States. Demand, aging population, technology, labor costs, and legal issues are but a few components of what is driving costs up. Inaction in the United States and resumption of previous fractured paths of profit-driven hospitals and investor-owned insurance are fraught with great danger.
Technology of course can also be embraced as a tool to bring cost down, and this is where health information technology (HIT), informatics, e-health, and telemedicine come in. Many hospitals are implementing electronic health records. This is a long and arduous process and involves extensive training and upfront costs, hence the idea that technology is a cost driver, not a cost reducer. However, the reduction in cost can only be realized in the long term and is measured by various factors, such as reduction in errors, better access by more people, reduction in transportation costs, reduction in hospital stays, etc. The application of telemedicine clearly has an added benefit. The PPACA has telemedicine-related activities embedded in the law related to areas including the Center for Medicare and Medicaid Innovation, telehealth/remote monitoring for accountable care organizations, community-based collaborative care networks, and health in the home. It will be both challenging and interesting to see telemedicine as a growing element of PPACA and healthcare reform regardless of how it moves forward.
Congress and future presidents may very well modify and embellish the law, but HIT and telemedicine will continue to be a growing element and foundational base of healthcare reform. The heat is on indeed!
Research and development of telemedicine continue to march forward. Colleagues worldwide are applying technologies in the delivery of healthcare with excellent results. This issue contains a wide variety of articles from around the world, including Taiwan, Sub-Saharan Africa, Georgia, Greece, Venezuela, Sweden, and the United States.
The article by Reynolds et al. 1 presents data on the use of robotic “remote presence” in intensive care units. An article from Venezuela by Sanabria and Orta 2 highlights two decades of work using telemedicine and how it has impacted society. Other articles discuss the application of Web-based tools, telepharmacy, and clinical and ethical issues in virtual environments.
As editors we also feel the heat. This journal is seeing a great surge in submissions. In our efforts to make this journal the number one journal in telemedicine and e-health worldwide, showcasing the best in telemedicine, we have perforce become much more selective. Some scientific journals have very high rejection rates, and some have low. Telemedicine and e-Health is in the middle and moving in the direction of a higher rate. Why is this important? When the Journal becomes highly selective, the articles being submitted, reviewed, and deemed worthy of publication become the best of the best. The best science, the best business approaches, the best application in clinical settings, and the best outcomes. These experiences reported by our colleagues serve as tools for helping us develop and integrate telemedicine and e-health systems that create better access, enhance healthcare, and improve outcomes. Thus we look forward to a growing number of submissions. So find an air-conditioned room and start writing. In the words of Glen Frey and his theme song from Beverly Hills Cop—“The Heat is On!”