Abstract
Does this title reflect on you? We know where we are at any single point in time. In many cases, we pretty much know where we are going and where we have been. But do we really know where our personal health will be in 10 years, 20 years, or even where our entire health system will be in those same decadienal milestones?
Perhaps a generation ago, in the 20th century, we might have hoped or planned that things would continue to get better. Although technology and innovation began to slowly accelerate from 1900, it seemed gradual and we might have even laid out a plan for where we wanted to go. Today technology is moving so fast we literally cannot catch our breath. Whatever plans we may lay out for the next 10–20 years in our individual lives or in health care and medicine, it may be for naught, literally, because of innovation.
A number of years ago, the Interstate Highway System began to be refurbished. Lanes were added, bridges were rebuilt, and cloverleaf interchanges were added or modified. Here is a thought—when they built bridges or overpasses in the 1950s through the 1980s, they did so with lots of urban planning, yet the overpasses were not built for more than two to three lanes of one-way traffic. For the past 20 years or so, many of the new overpasses can fit 8–10 lanes one way. Why? Because we are much more forward thinking because of technology and utilization. By the time we get traffic worked out, we will be sitting in the back seat!
Today we see lots of construction of new hospitals, new rooms, patient experience events, small minute clinics, devices that can be used in the home, and so on. The point is, there is investment everywhere. But is it smart investment? There are pros and cons. New is “cool,” but is it really necessary?
To illustrate, we use the following vignette. In the mid-1990s, we were asked to support a NASA/Centre National D'Etudes Spatiales (CNES, the French Space Agency) meeting on telemedicine in Toulouse, France. The meeting was held in the Hôtel Dieu de Toulouse on the Garonne River. Built in the Middle Ages (12th century), it served as a shelter and hospital for people on a pilgrimage from Spain. 1 During a break in our meeting, our group assembled on a brick and mortar stand that protruded over the Garonne River below for a group photograph. On the opposite side of the river was an exact replica of the stand that on which we were assembled. A question was posited about what once stood here. A bridge once spanned the river at this point was the answer. That bridge was built in the eighth century. Immediately to the right of our meeting site was another bridge, similar to those on the back of the Euro banknotes. The follow-up question was when was the “new” bridge carrying the Rue de Metz, which was crowded with buses, cars, trolleys, bicycles, and pedestrians, built? The answer was astonishing. The Reu de Metz bridge was built in the 13th century. The other bridge lasted for almost 500 years before it was removed. So the bridge's function was well planned.
It is not entirely clear that we think that far ahead today. Just watch how our buildings and construction projects come and go! We must always make things better.
By the way, the outcome of this meeting was a final report of the G8 (G7+Russia) on interoperability of telemedicine systems. 2,3
Another vignette is that of the use of web-based maps in our cars or on our phones versus the old fashion paper map or atlas. When planning a vacation, we sort of have a roadmap of where we are going. We plot our destination in our smart phone and it literally guides us from door to door. A paper atlas or map does not do the same as easily as the new approach. Indeed, what is the future of paper maps? 4 Although the new technology continues to improve such that we arrive at our destination with little trepidation, we miss lots of things along the way. A paper map or atlas has points of interest that you will definitely not see on your phone which tells you when and where to turn.
Is this an issue? You might ask why does it matter? We actually employ both in our destination. We know where we are at any point in time—a snapshot. We have good idea where we want to go, and we have the tools that help us along on the journey. They complement one another.
In adopting and integrating telemedicine and telehealth into the fabric of medicine requires creative thinking and a malleable roadmap. It is not so easy to change direction abruptly but enough sway to adapt. This is vitally important in moving medicine and health care forward. Our roadmap must look at where we are and where we need to be. We cannot wait for change to pass us by. We need to be active participants in change. As we continue to be bombarded by innovation, we must be willing to adapt. Telemedicine and telehealth are change agents. They are fundamentally changing the health care landscape.
If our objective is to drive directly to Miami Beach, our phones will tell us exactly how to get there. But it will not tell us those awesome places to stop along the way. Do not lose site of the destination. Our ultimate destination is to enable better health care and enhance the capabilities that today's technology is bringing and tomorrow's technology that we will not be able to survive without—metaphorically speaking!
What Is in This Issue?
In this issue, we bring you an opinion piece on virtual care, a meta-analysis on the effectiveness of phone-based text messaging, a case study on a unique polar bear encounter and psychological care through telemedicine, and finally, a wide range of original research articles from around the world.