Abstract
The development, integration, and utilization of telemedicine have been underway for more than a century—perhaps even longer. Nevertheless, it is no longer a scientific endeavor; it has become reality and has made a significant impact worldwide on healthcare delivery. Although there were testbeds and evaluation studies conducted in the 1970s and 1980s and significant operational needs, for example, in support of human spaceflight in the early 1960s, telemedicine really entered into a steep growth phase in the 1990s. About this time, several individuals came together and forged the creation of a professional organization, the American Telemedicine Association (ATA), using their personal resources and personalities. In addition, several of these same individuals helped establish a professional peer-reviewed journal. This journal was the Telemedicine Journal (now known as the Telemedicine and e-Health Journal). Beginning in 2014, the Journal will celebrate its 20th year. Over the coming year, we will reflect on the Journal and its impact on how we deliver healthcare.
Twenty years ago—seems like a long time ago! A lot has happened in the past 20 years—faster computers, smartphones, mobile phones, iPads, iPods, three-dimensional printers, a prolific Web presence, a pretty decent Internet (accessible worldwide), electronic health records, etc. We of course are all 20 years older, and that means we have more sage advice based on our experiences; at least we hope that's the case anyway. Our experiences—published in this journal—and the ever-changing or, better yet, rapidly changing technology have made telemedicine and e-health different today than at any time in the past.
As the ATA took shape, Drs. Rashid Bashshur, Mark Goldberg, and Jay Sanders began thinking about developing a scientific journal where research knowledge and experience could be shared in a peer-reviewed arena. In late 1994, Mary Ann Liebert of Mary Ann Liebert, Inc., Publishers, who was thinking along the same lines, approached Dr. Goldberg, who was then at the Massachusetts General Hospital where he was involved in the development of American Telemedicine International. She recruited Dr. Goldberg to become the founding Editor-in-Chief of a new peer-review publication, the Telemedicine Journal. Dr. Goldberg recruited an Editorial Board with Dr. Jay Sanders and Dr. Rashid Bashshur as Senior Editors. As with any new journal, soliciting manuscripts is always challenging. In the early years, new submissions were often of insufficient quality; however, the rejection rate was quite low. What might have been published in 1995 would not be considered today for publication. Initially authors submitted articles on diskettes (remember those?) or on compact disks, which were sent via the U.S. Postal Service to the Editor. In 2006, Liebert Publishers began using a Web-based submission portal called Manuscript Central. Today, everything is Web-based, and it is much easier to track and review manuscripts.
Over the past two decades, the Telemedicine and e-Health Journal has grown in stature. It began with quarterly issues (four per year in 1995–2003), then six per year (2004–2007), and then 10 (2008–2012), and finally it became a monthly publication in 2013. Dr. Rashid Bashshur became the Editor-in-Chief in 1997, and in 2005, Mr. Charles Doarn and Dr. Ronald Merrell became the Editors. During this entire 20-year period, the journal has been closely aligned with ATA and in recent years has become an official journal of the International Society for Telemedicine and e-Health and the Canadian Telehealth Forum (Forum canadien de le télésanté). In the first 13 years, fewer than 100 manuscripts were submitted annually. Beginning in 2007, the number of submissions has steadily grown each year, to over 360 in 2013. With this growth, the rejection rate has also grown from approximately 20% to nearly 55% in the past 2 years and is expected to grow to 65–70% in the coming years. From the journal's onset in 1995 until this issue, there have been nearly 1,700 articles in 13,000 pages on a wide variety of subjects published. These include original research, brief communications, opinion pieces, letters to the editors, guidelines from the ATA, and special issues from across the globe.
The Journal is available worldwide in print and online in over 140 countries with downloads measuring in the tens of thousands. Although each year the majority of submissions has come from the United States, we have seen an increase in submissions from countries like China, Iran, Brazil, and Serbia. This is certainly a testament to the reach of the Journal and its impact on research and practice worldwide. Telemedicine is widely available in some form on all seven continents and in low Earth orbit.
Upcoming Features
As we begin the celebration of our first two decades, you will notice several things in the Journal. First, the cover will indicate our 20th anniversary. In addition, we have invited a variety of true pioneers and leaders in telemedicine and in healthcare to send a perspective to us for publication. This list includes our emeritus editors, Mark Goldberg and Rashid Bashshur, true telemedicine pioneers Jay Sanders and Ronald Weinstein, and leaders of the ATA and current presidents of several international organizations. These perspectives will be dispersed throughout the issues in Volume 20 and will reflect the individual's thoughts about the Journal's journey and its contribution to practice and research.
We reflected on how best to illustrate the evolution of telemedicine over the past 20 years and the Journal's role. When the Journal started there were very few programs, most of them funded by the government. There were only a few companies that were involved, and they were mostly working on government-funded initiatives. NASA's efforts in 1993–1994 began to push forward the concept of Web-based telemedicine as we have reported on in earlier issues. The U.S. Army's effort in telemedicine began in earnest with the Medical Diagnostic Imaging System (MDIS) program in this same time period (1991). It evolved into the Medical Advanced Technology Management Office (MATMO) in 1993 and then to the Telemedicine and Advanced Technology Research Center (TATRC) in 1998. The Federal government's efforts in the United States through the aforementioned organizations and others, including the U.S. Department of Health and Human Services, the National Library of Medicine, and the U.S. Department of Agriculture, helped move the research portfolio forward. The outcome of much of this research was then peer-reviewed and published in the Journal. Coupled with advances in telecommunications, accessible bandwidth, and computing power, the industrial presence began to grow. Today, there are numbers of large and small companies that have participated in the expansion of telemedicine.
To best illustrate the contribution of the Journal, we will address 11 specific topics in editorials in the coming issues (Numbers 2–12) of Volume 20. These, in no specific order, are (1) standards, (2) m-health, (3) business acumen, (4) disaster medicine, (5) disease management, (6) military, (7) Internet and health information technology, (8) vulnerable populations, (9) international activities, both commercial and humanitarian, (10) education, and (11) space medicine and extreme terrestrial analogs. These expanded editorials will discuss how the past 20 years of work, as cited in the literature, has evolved. What the contributions that have been made in the Journal have been used to further the development of processes, technologies, setting of standards, and, most importantly, what the future holds.
What's in This Issue?
In this issue, we bring you a wide variety of research outcomes in applying technology in palliative care, telestroke, cardiac rehabilitation, economic outcomes, remote monitoring, remote prescribing standards, m-health, weight loss, text messaging in human immunodeficiency virus clinics, and telepsychotherapy. These articles come from around the world, including China, Denmark, Poland, Portugal, the United Kingdom, and the United States. They reflect the growth and capabilities that telemedicine can bring to the solutions we all seek for many of the challenges we face in healthcare.
A Special Thanks!
At the end of this issue, we have given our thanks and appreciation to those reviewers from 2013. We also extend our thanks and appreciation to Rashid Bashshur and Mark Goldberg and those individuals who have served on the editorial board of the Telemedicine and e-Health Journal (or the Telemedicine Journal) since it was founded. Your contributions have made the Journal the top journal on telemedicine worldwide. We also extend to you an invitation to submit new research opportunities as we move into our third decade.
Of course no journal can be successful without a dedicated and committed publisher. Mary Ann Liebert has been a true visionary in establishing this journal and investing in its production. She has been a dear friend to the Editors, and her staff, including Vicki Cohn, have been wonderful to work with. Although the staff has changed over the years, the contribution of copyediting, manuscript layout and design, and printing have been very supportive, and we extend our thanks and appreciation to them.
From humble beginnings to today, Happy 20th Anniversary, and we look forward to continuing our work well into the future.