“The Americans have need of the telephone, but we do not. We have plenty of messenger boys.” – Sir William Preece, Chief Engineer, British Post Office, 1878
“This telephone has too many shortcomings to be considered as a means of communication. The device is of inherently no value to us.” – Western Union internal memo, 1876
A recent article called The State of Teleheath, written by respected colleagues in the New England Journal of Medicine, looks at the challenges telemedicine and telehealth face as technology.
- A shift in focus from increasing access to healthcare to a focus on convenience and cost.
- A change from caring for acute conditions to caring for episodic and chronic conditions.
- Migration from hospitals and satellite clinics to home and mobile devices.
They also identify four potential barriers to telemedicine and telehealth, and provide legitimate solutions:
- Reimbursement: limited coverage, fear of abuse or overuse.
- Clinical concerns: lower quality patient-physician relationships, physical examination vs in person visits.
- Fragmentation of care: potential for narcotic prescribing abuse, legal issues.
- Credentialing: licensure, and social / geographic limitations which limit access.
The review is well written and comprehensive, by established and respected authors and leaders in the field. And we also share their concern about many of the challenges that telemedicine faces.
But when we step back and consider all of the indicators that telemedicine is actually gaining huge momentum and overcoming many of the barriers that used to exist, we tend to come to a different conclusion about the "state of telehealth." We step back and look at how technologies become tools, particularly three examples that healthcare providers use every day:
- The telephone
- The fax
- The stethoscope.
Telephones, of course, are now so common that we don't think of them as technology -- we think of them as a tool, or just a daily part of our lives. The fax took 50 years to be adopted and (although it can easily replaced by Hybrid Store-and-Forward Telemedicine®), it persists to this day. The stethoscope was invented by Laënnec in 1816 but did not reach its non digital state of the art until after 1956.
Telemedicine and telehealth are still thought of, by mainstream medicine, as technology. The opportunity is to move on to incorporating “telemedicine” not as something different, but as just part of the fabric of seamless care. This will be done by simply changing our mindset. Just as we have done with the telephone, fax, and stethoscope. Each of these is just an everyday tool, and two -- the stethoscope and the telephone -- are symbols of medicine. Imagine the image of a doctor with a stethoscope around the neck and a telephone against the ear. You probably see a worried look on that doctor's face, but undoubtedly you are not seeing a technology barrier.
Our conclusion? The state of telehealth is strong -- not as a technology, but on its way to becoming just another tool, that is woven into our daily lives.
Our mantra from the very beginning over 20 years ago is Access, Collaboration and Education. Drs. Dorsey and Topol have done a good job of discussing access. And we want to champion a broader view -- one that also includes collaboration and education.
Current attitudes about telemedicine and telehealth are problematic. The prevailing view is that data is all, singularly, important. We encourage you to think beyond this. We encourage you to expand your thoughts beyond the excellent review of Drs. Dorsey and Topol. View data as valuable to the patient only when it is personalized for that patient. Use data as a language, but use the language to communicate and collaborate.
We are committed to going farther. We are committed to using human insight, compassion and judgment to master data and create solutions. It is time to do in health care that which we do in life -- use the technology that is available to improve the lives of our patients and ourselves.