Abstract
In 1962 before an assembled audience at Rice University in Houston, Texas, President John F. Kennedy delivered an address that changed the course of America's role in space and in the world. It firmly entrenched a nation as a leader in technology and innovation. He said “We choose to go to the Moon! We choose to go to the Moon in this decade and do the other things
This portion of Kennedy's quote, “….not because they are easy, but because they are hard…,” is key to understanding what drives transformation. It is easy for us to follow a course of action to which we have grown accustomed and are familiar with. This was the case in late 1950s and early 1960s. There were many in government, industry, and the public who were fine with the way things were. Many believed that sending a human being into space was hard. But technology changed all of that with the launch of Sputnik in 1957. We had to change, and change came with challenges and conflict. You have to be up for the challenge and accept that hard work pays off.
Why is this important in healthcare? Let us examine the current paradigm. Telemedicine, telehealth, mobile health, electronic health, connected health, etc., are all terms in our lexicon. We see it all around us and it has been accepted, adopted, adapted, and integrated across the landscape of healthcare but often comes against a number of challenges. Often times we hear people say it is “too hard to change” or “that is not how we have done it in the past” or “that's too expensive.” We have also witnessed, based on misunderstanding, misconception, or even lack of vision, that change does not happen. It is too hard to change. We can certainly say “If it was easy, everyone would do it.”
If you look at the landscape of healthcare delivery in the United States, you will see where telemedicine and telehealth have been integrated successfully at various levels. We are confident that this integration did not happen by chance. Someone, or a small group of individuals, pushed the system of which they were a part; they were persistant and it paid off. It would be easy for someone to say “well the cost is too high” or “that is a big challenge for our clinical team to adopt.” As we pointed out in previous editorials, there is a cost of doing something and a cost of not doing something. Change is often very difficult and can be extremely disruptive. Just read the news at the end of 2017!
As the 1960s unfolded, technology and innovation, long hours of dedicated engineers, scientific and medical personnel, challenges in society nationally and internationally, and political machinations provided a fertile ground for a growing national space program—not because it was easy, but because it was hard. The outcomes of those endeavors laid the foundation for us today. Whether we are an entrepreneur, policy maker, or a member of a cog in a wheel, we face difficult challenges. We can freely choose to not change, and our business or our way of life may change in ways that may not be as productive. For example, we can continue to ask our patients to travel to us for routine care, or we can integrate everyone into the continuum of care that is beneficial to all. The consequences of inaction or benign neglect will surely be more costly in the end. Why not be part of change and not lay back and say it is too hard to do this, or too hard to do that!
Integrating telemedicine and telehealth are not easy to implement, but what is the alternative? Every element on the healthcare system will suffer in some way. Think of this in a holistic view. Healthcare is a system much like the human body. Each has subsystems that support the entire system. The brain must have oxygen delivered by the circulatory system, which gets the oxygen from the respiratory system. The central supply of a hospital get its supply of gauze and surgical instruments from a supplier, but it is based on usage and a robust inventory system. The point is that these are symbiotic relationships. However, various subsystems often may not work in concert with one another.
Consider what happens when you stub you toe. Your body reacts immediately. But you try to compensate by walking a little differently. First, your leg begins to hurt because of the way you are walking. That translates into a sore hip and potentially a sore back. This simple illustration highlights how every system in the human body is dependent on the other. Healthcare is no different. The correct treatment and management of disease and injury lead to better outcomes. Here, technology plays a significant role. Not because it is easy but because it is hard.
What's In This Issue?
This is the first issue of our 24th year. As we closed out 2017, our 23rd volume, we had a record number of submissions from all over the world. Our job as editors, along with our outstanding pool of reviewers, is to trim over 325 submissions down to approximately 160 or so of the most outstanding articles. This is a difficult task and one we are very proud of doing. Our reviewers, listed at the end of this issue, help us with this task. Let us know if you would like to be an active reviewer.
This issue has some wonderful articles from China, France, the United Kingdom, and the United States. Each offers a review or original research that will be of great help to your own efforts with regard to telemedicine and telehealth integration.
We anticipate another record year of submissions and an increase in our impact factor in June. During 2018, we will begin planning for our 25th anniversary.
Thank you very much for using this Journal as your journal of choice!