Abstract
Here in the United States, we are celebrating our 250th birthday as a nation. What started out as a collection of colonies under the British Crown (1607–1776), ended in armed rebellion—a revolution! Over the next 250 years, those 13 original colonies grew into 50 states and 14 territories, often through significant strife and natural and human-made challenges. While America celebrates its semiquincentennial, let us not forget what a revolution is all about. In an emerging nation, it is about change—often abrupt and violent, where citizens are passionate about their beliefs and take action. In the context of health care delivery, it is about change—hopefully not through violent change; although one could posit change can be obstructed by those who do not want or like change.
From victory over the British Empire to the recent circumnavigation of the moon earlier this year, American men and women from all walks of life have contributed to the pillars of the physical and biological sciences, engineering, medicine, public health, telecommunications, and computing power, all enabling a much higher standard of care. Many of these standards were symbiotically shared or migrated naturally worldwide. Most of this revolution occurred in the 20th century. Over the course of history, change has come from a perceived need, a conflict, or a threat to humanity itself.
The aforementioned individuals—our ancestors from all corners of the world—came here to seek freedom and opportunity. The wealth of any nation can be measured in treasury—monetary resources or a successful nation can be measured by what its citizenry does. The resultant innovation and discovery from being inquisitive have enabled better health care, better education, a better quality of life, etc. This is where telemedicine and telehealth have benefited. As I have written about in the past, telemedicine and telehealth crept along in the 20th century and into early 21st century. Then came the pandemic, which changed everything.
Today, while we are still concerned about COVID, our unease might be elevated because of Hantavirus, which causes Hantavirus pulmonary syndrome or hemorrhagic fever with renal syndrome or the Ebola outbreak from the Bundibugyo strain in the Democratic Republic of the Congo and Uganda, which may be a death sentence for many. There is concern the latter could become a huge public health issue. Nevertheless, the technology and other tools we have today can help us contain, respond and treat individuals.
While telemedicine and telehealth are much more readily available and integrated into health care delivery today, it was somewhat of a revolutionary change, often met with resistance from many levels of the health care delivery system—dare I say the “establishment.” Moving forward, we must now be aware and concerned about artificial intelligence (AI). Over my own nearly four decades in this field, I have heard plenty of individuals—very smart individuals who have said “that’s never going to happen.” While I have said this before, it is worth repeating.
So, as we begin the next 250 years, technology we thought would never be possible will in fact change the paradigm of health care delivery and education in revolutionary ways. While all physicians learn how Dr. William Osler revolutionized medical education through case learning, it is not out of the realm of possibility this task could be accomplished by an AI-based avatar. Now that is revolutionary! There is no doubt that technology and innovation will change the fabric of medicine. The question is “is the medical establishment ready for this revolution?”
For those in the United States, Happy 4th of July.
What Is in This Issue?
As with all issues, this one contains some wonderful submissions from Australia, Canada, Germany, Malaysia, Spain and the United States, each demonstrating a unique perspective on how telemedicine has been integrated in health care. The review article by Scheid et al. on the cost-benefit analysis of the application of telemedicine in mission support is poignant. In addition, the scoping review by Dr. Yan et al. presents a compelling summary of the virtual care system with the Canadian Health Care System.