Abstract
What are the prognostics for the next steps in telemedicine? Probably one should not be too confident; however, there are recent trends that are clear and predictive at the same time.
Patient centered health care is a given. The importance of the patient is central in expectations for health, choices in health care alternatives, and metrics for outcomes. Patients decide as active partners in health and disease management. This is so logical it is astounding that it took so long! However, it is the patient position and role in the leviathan enterprise of health care that has its own dynamics. The patient has moved to the center of an enterprise that none of us seems to really control; they are truly welcome to the show!! It was always theirs.
What we would like to comment upon in terms of the future is a little different. What are patients as consumers telling us about their interaction with others and external entities, including health care? We would concede that they are saying a lot and we really must pay attention in order to best care for them in the coming times. Let us consider a few examples where patient, as consumer, will be the driver of health care delivery and configuration in the short term.
Let us first consider the toys they buy. Here at the beginning of the year there are customary products that focus on fitness, behaviors, and lifestyle. However, these products are not coming from the health community but the electronics sector. Devices track the number of steps taken, heart rate, and so many other things that constitute well-being and healthy behaviors. Digital devices that guide one toward better behaviors and attitudes are abundant and are selling like crazy. They are not prescriptions or part of a medical regimen; they are out there, and the consumer is buying them like mad. This is important, and we should study the matter carefully as we design better monitors that assist in telemedicine.
Second, there is the matter of choice. Shopping is swinging rapidly to online outlets. So what? In the past shopping involved tactile interaction with the fabric, careful matching of garments, their color, and textures. Shopping entailed a fitting room and studying how the garment clung to you and felt as you walked around in it. This is not the same with online purchasing. Large stores are disappearing, and brown trucks patrol our neighborhoods with smiley-faced boxes just as ice cream truck fleets once patrolled in the summer and milk delivery trucks marked the start of day. The ceremony of buying a car involved feeling the upholstery, smelling the interior, driving it for goodness sake, listening to the hum of the engine and for reasons never clear, kicking the tires. It is now considered an alternative to consumers who study the car online, order it, and have it delivered to their doors or collect it at a car vending machine. One would never have thought about this approach previously, but the consumer is creating this hugely popular alternative. What does this imply for the ways consumers will make health choices and engage in care?
There is also the matter of interpersonal relations and information gathering. People eschew conversations in the verbal sense in strong favor of electronic expletives and confidences. They seek information at the touch of the finger from curious sources that become powerful agents of truth or fiction. They form attitudes on momentous questions from these sources and are guided in personal and societal decisions without resort to print media, libraries, lecture halls, or advisors. This satisfies the consumer and in telemedicine we should pay attention.
Finally, there is the matter of confidentiality. People will put the wildest personal details onto the internet through social media and are shocked when their very private lives are now in the public domain. There is not much complaint in fact. It is nice to have hundreds of digital friends and followers on social media. The difference between fame, indiscretion, and privacy invasion seems more blurred. The consumer drives this. It is not a nefarious plot foisted on them by evil forces, and let us observe that in the main, they do not seem to mind. So much of our work in privacy is perhaps far more important to health care people, regulators, and attorneys than to the public. Odd as this is, none of these observations are intended to disparage the consumer. For example, we do not condemn the persistence and pervasiveness of some very strange alternative medicine practices. They are just a fact of life and our responsibility to understand in order to advocate for our patients.
So, what do these few examples of huge change by the consumer mean to us in telemedicine? Do we have any role in the impact of these changes on health care and the tool of telemedicine we have worked so hard to insinuate into the mainframe of health care? It would be an act of hubris to believe we can change these matters. However, we can study them because we care so very much about our patients. We can listen to the profound value changes in our patients and try to relate them to health care, and then we must take our research tools and adapt to the drivers among our consumer patients.
There are so many opportunities for technology in the interest of health care to be brought into this new domain of interaction, choice, and information. By doing so, we will never be irrelevant or recidivist. We can stay current with our patients at the center of our care. But to do so through ardent study, listening, and adaptation, we are motivated by our need to serve.
We look forward to out-front research in the changing world of our patients. We have published in your journal so much on technology, behavior modification, and perception in a scientific mode in the past, and look forward to doing so with ever greater pertinence in the years to come.