Abstract
In the rolling hills of Kentucky or in a neighborhood near you, there are beautiful white picket fences that delineate an enclosed area. Perhaps the fence is there to keep the horses in and the others out, or it may just be ornamentation. Some fences often showcase a beautiful home. Some are meant to keep people out. Nevertheless, it is a barrier for free movement from Point A to Point B. Think of the westward expansion in the “wide open” spaces, and then came barbwire! Freedom is key in seeking healthcare, be it knowledge or care itself. This is a driving force in the economy. If someone tells you what you can and can't do within the law, of course, then you interrupt commerce and life itself. We have heard a lot about this lately!
Each time the laboratory develops something that makes things better, an inordinate amount of time passes for it to settle in and be adopted. Often these developments have been seen as threats to the “status quo,” and it might have taken decades to be fully integrated. The stethoscope and handwashing come to mind. But what of the telephone and typewriter or the assembly line, or even barbwire for that matter? Innovation should not be seen as a barrier. It should be seen as a tool for making things better. When Henry Bessemer's process was developed, it made steel production much more profitable and was widely considered the catalyst for reducing the cost of converting pig iron into steel. Better chemistry methods made the Bessemer process obsolete. This is a great analogy of how a need drove an entire industry and with it modernization through the industrial revolution to today. With cheaper steel you could reach the heights, meaning tall buildings. The steel magnates moved forward and became extremely wealthy, and philanthropy became a thing. There were of course shackles, metaphorically, on the industry, but it nevertheless moved forward.
There are, of course, many other barriers with which we are familiar. Some are needed; some may be more of a hindrance than anything else. In medicine, innovation has moved so rapidly forward that the systems built to support a growing economy cannot keep pace. Patents, laws, regulations, processes, and attitudes, among others, now shackle progress. Whether this is real or perceived, you must observe how telemedicine has evolved and how it has been slowly allowed to extend its reach. Are we focused on protectionism of an industry, or are we in pursuit of better healthcare, better access for everyone? Safety in patient care is paramount. There must be checks and balances. One cannot just hang a sign on the door and sell some cheap form of medicine. Telemedicine and telehealth are proven tools for enabling better healthcare. The research points to that and has at least in the Journal for over 2 decades. That's before we had “smart” devices!
Recently, the American Telemedicine Association in one of its news alerts reported that a Board in a state has proposed yet another anti-telehealth policy. Although there is merit in assuring the public that telemedicine and telehealth are excellent tools for enabling access and addressing unmet needs, it is ludicrous to place barriers and shackles on progress. Innovation and discovery up and through the 20th Century were key to what we have today. What once was measured in centuries, decades, or years can now be measured in months. Once again think of the continually evolved mobile/smartphone business model over the last 3 years or so.
If we agree that the technology that we all use in our daily lives, our smartphones, our computers, our transportation systems, are making a difference, why then do we debate whether seeing a patient who is not in the same room a problem, and why is there so much consternation? Why do we have 50 different states with 50 different systems? Are we talking about what is best for the patient or what is best for the provider? Sometimes the fence has to be broken down to move to the next level. Have you ever been caught in a corn maze? You want to cut through the rows to the next row, but you may feel guilty, or you may not even see the other path and you have to stay on the path you are on.
The application and integration of telemedicine and telehealth continue to move forward, reaching more individuals than ever before. There are those who choose to keep its growth in check and those who want to go directly to consumers. The path forward is to navigate through the fences, ensuring safety, advocacy, and access to all—even if it means we change our centuries-old model.
What's in This Issue?
Aside from the wonderful original research articles in this issue, we draw your attention to two excellent pieces. The first is a noteworthy interview by Michael Hoad with Dr. Stephen Klasko, President of Thomas Jefferson University and CEO of Jefferson Health. 1 Recently, Mary Ann Liebert, Publishers published its inaugural issue of Healthcare Transformation, of which Dr. Klasko is the Editor. He is very forward thinking about telemedicine and healthcare and the path that it is on moving into the future. This thought-provoking interview can serve as a reminder of where we are going. The articles that appear in Telemedicine and e-Health can also serve as a roadmap for the journey that we are on.
The second piece we draw your attention to is the piece by Bashshur et al. entitled “The Empirical Foundations of Telemedicine Interventions in Primary Care.” 2 This article reviews the data and progress of the application of telemedicine throughout the world where patient and physician interface with one another. It is an outstanding addition to the Journal.
We are very pleased to provide this issue to you as well as the abstracts for the Annual American Telemedicine Association meeting here in Minneapolis.