Are We on the Fence?

The 24-7 news cycle is really ramping up now! It seems like at every turn, disaster lurks. Across the world, we face crises that may very well test our limits. We face many challenges in our country as well. Humanitarian crisis, affordable and accessible healthcare, cybersecurity, what is true and what is not true, and of course many others. We draw your attention to how some of these events, not just from the beginning of 2017 but also those over the past decade or two, have changed human society and our relentless hope for a better tomorrow.

Often we find ourselves mulling over a decision, which job to take, which school to go to, where should we eat tonight, should we deploy telemedicine—you get the point. Any and all of these decision points put us on the proverbial fence. Any decision should obviously be made based on facts and a thorough analysis of available data. However, we often see decisions made purely on opinion or individuals are either uninformed or not interested in change. This can be a detriment to growth and perhaps even sustainability. There are plenty of examples of corporations that either refuse to change or change too late. Perhaps they also have been on the fence and could not commit to option A or option B.

Sometimes a business model is developed and it is quite successful, but then it is abandoned only to be dusted off and used again in the future. To illustrate, consider the Sears & Roebuck Company. In the late 1880s, Richard Sears and Alvah Roebuck ran a “mail-order” watch company. The watch company began to distribute catalogs filled with consumer products that people needed, especially in rural areas. A consumer would decide what they needed from looking at the catalog, send a telegraph message, or use the phone to place an order, and the purchased item would come by parcel post via the U.S. Postal Service. Eventually, department stores would be built and consumers would flock to the mall to make their purchases. Fast forward to the 21st century, today we look at catalog, make a purchase online, and the purchased goods are sent directly to our home or office. Is Amazon, LL Bean, or even Macy's a new model, or just an old idea using faster and better technology?

Another example is computers and computer software. When computers became more widely available, you would use a “dumb” terminal while the “brain” of the computer with all its software was located somewhere else. Eventually, the computers got better, faster, and had the software installed directly on them. Or as a consumer you could buy it and install it yourself. Today, we are beginning to go back to the “dumb” terminals, wherein the software, data, etc. are in the cloud.

These two examples illustrate how very large businesses evolve. The companies may change or even cease to exist. However, what once was a successful venture changed only to come back and be more valuable to the consumer than ever before. An entire industry could face challenges with advancing technology and choose not to change immediately or perhaps ever. The implication is that decision-maker(s) are on the fence. They are not sure what to do.

In healthcare, we can see the same challenges. Should we adapt new technology? Some kinds of technology are very disruptive! Is it fear that keeps us from making decisions? Is it that it doesn't fit the paradigm we learned in school or what we are accustomed to? Or is it all about money? Nascent technology in telemedicine and e-health can significantly alter the business model of a healthcare institution. Imagine how three dimensional printing and hand-held devices can alter the landscape of the laboratory, or so patients can remain in their homes and do not have to go to the hospital at all. Perhaps a 600-bed hospital only needs 400 beds. What does that do to the profitability of that hospital?

We can assume that new and smarter technology must be invested in and there is a cost associated with this, juxtaposed to doing nothing to upgrade, modify, or improve the processes. Clearly, there are large corporations that did not change and adapt. Just look around and see what has happened to iconic American industries. How many business leaders and politicians sat on the fence for far too long?

There is no doubt in our minds that we must adapt and change our paradigm and our thinking. Profitability is important but patient care and public health are much more imperative. Across the world, we see change. Some of it is scary or at least that is what we are led to believe. However, we do know that health must be sustainable to maintain a healthy and productive workforce. Otherwise, the results are deprecating to society as a whole, which will affect each of us. If you are on the fence, get off and do something. Make a change and embrace it. You, your patients, and the community will benefit!!

American Telemedicine Association

Well, we all gathered for the annual American Telemedicine Association (ATA) meeting in Orlando, Florida, and what a meeting it was! The ATA is to be commended for a well-orchestrated event. It provided wonderful opportunities for networking, looking at some awesome technologies that can help in clinical practice and education, and most importantly, the opportunity to interact with other like-minded individuals who are doing the much needed research and reporting on it.

This year, the Telemedicine and e-Health awarded the best article for 2016 to Rashid Bashshur, Joel Howel, Kathryn Harmes, Noura Bashshur, and Charles R. Doarn for their work “The Empirical Foundations of Telemedicine Intervention in Primary Care,” which appeared in the May 2016 issue. ¹

What's in This Issue?

The ATA provided two key guideline documents; the ATA Guidelines for Teleburn by Theurer et al. and ATA Telestroke Guidelines by Demaerschalk et al., which will serve as excellent references in the treatment of burns and stroke. These guidelines, like all guidelines, have been developed with subject matter expertise and are vetted through several mechanisms within the ATA to ensure correctness and applicability to the field.

A systematic review of e-Health and m-Health among African Americans highlights the challenges of engaging African Americans in research initiatives in e-Health and m-Health. Additional articles were from Australia, Canada, Germany, Greenland, South Korean, and the United States. The articles include discussion on Web-based tools, diabetes, clinical research, telerehabilitation in stroke recovery, telemedicine in corporate health management, global information systems analysis, smartphones in Australia, and telemedicine in Greenland.

Each of these articles and those published in this journal should help you get off the fence!