2012 is gone, 2013 is coming. Are there any trends in telemedicine and medical collaboration that are clear? Can we look beyond the scary fog?

Three aphorisms come immediately to mind:

• Franklin Delano Roosevelt: “The only thing we have to fear is fear itself”
• Yogi Berra: “ It ain’t over ’til its over”
• Dorothy in Wizard of OZ: “Toto, we are not in Kansas anymore

Sometimes an aphorism is all we can hang on to as we look ahead into a fearful fog of uncertainty. As we ask ourselves what happened in 2012? And, what is ahead in 2013, it is difficult to find answers. Here are a few observations of events, and then a brief discussion of where all of this fits into the last 50 to 75 years as our world changes.

A few attitudes changed in 2012:

• California passed its telehealth law.
• Emailing pictures is expected by patients.
• Enforcement of HIPAA and HITECH laws increased.
• An election took place, Obamacare (Otherwise not known as the Affordable Care Act of 2012) moved forward.
• Big Data became interested in health care.
• Connectivity in the USA increased.
• Providers became busier.

A few attitudes did not:

• Store and forward telemedicine is not explicitly paid for by CMS
• EMR and EHRs were pushed into use, and costs increased.
• Technology fatigue remained.
• People still need the right care at the right time in the right place.

• It is acknowledged, by everyone both inside and outside “the system,” that health care is a mess.
  

ClickCare had some exciting moments in 2012:

• Thousands of collaborations on behalf of the patient.
• A couple of lifesaving collaborations.
• A prominent article in the NY TImes.
• Some great Blog coverage.
• A shout out from “Santa Woz” at the American Telemedicine Association Meeting 2012.
• The meeting of new friends, customers and business partners.

Can we find a larger context for what is going on in health care?

Consider this thought by C. Otto Scharmer, Theory U Leading from the Future as it Emerges. There are three global shifts of humankind worldwide.

1. The rise of a global economy
2. The rise of a networked society
3. The rise of a new consciousness, a cultural-spiritual shift.

As you read the following, and if you are old enough, remember, or young enough, study, some events that you have seen or heard about: Martin Luther King, the sexual revolution, Betty Freidan, the fall of the Berlin Wall, on-line shopping, search, social media, jet travel, a friend in a foreign country, war in far off villages. In each case, in just 25 to 50 years, a massive and common shift has occurred. And the shift focuses on the individual. 

There are many good things about these shifts, Sharmer explains, but they have also created three types of poverty: economic poverty, sociocultural poverty (a loss of inner values with a culture of materialism), and spiritual poverty (a loss of connectivity with our neighbors while we become world wide more connected). These have resulted in a backlash and a restructuring of society. Fundamentalism, human rights, feminism, struggling capitalism and failing socialism, and environmentalism. 

In the setting of health care, the backlash is in the form of regulation which is essentially distrust of one's neighbor, even if that neighbor is a healthcare provider. The backlash is also a distrust of the individual. Further, a culture of materialism is fostered by a system which declares professional courtesy or discounted service for the poor (exceptions for individuals) to be fraud. While we are connected with social media, we are also increasingly forced into silos of activity and silos of knowledge. The new cultural spiritual shift is driving people who wish to give, to justify their activity, by what they take. Giving freely is suspect because free has been monetized and no longer is free.

With a concerted effort, the good will triumph over the bad. The networked patient can become part of their own care—not by dictation of “meaningful use 2," but by the sheer ability to participate. The networked society can be augmented and nourished, not crushed and made illegal. The global economy can be recognized and engaged, not ignored and isolated.

We see providers who are members of the emerging “creative class” returning to the basics of good care and rejecting the constraints of federal initiatives. The materialism of CPT codes will be replaced by a commitment to good care. We will see patients accept illness and not accept being labeled as consumers of medical care, but rather providers. We will see problem solvers try to use technology in a way that is right and proper, not reimbursable and archaic. We see ClickCare empowering the individual patient and the individual provider to work together with each other and with colleagues to provide access to care, collaboration and support of each other, and education of healthcare students of all types. Hierarchy and rules will be broken down. The backlash will resolve and the movement toward the empowered individual will go forward.

We see a better 2013 than 2012.

Attribution and References:
Fog and Hound:
http://grizzlybomb.com/2012/01/11/bbcs-sherlock-season-2-episode-2-the-hounds-of-baskerville/

Betty Friedan:
http://en.wikipedia.org/wiki/Betty_Friedan
Schlesinger Library, Radcliffe Institute, Harvard University
http://www.nytimes.com/2006/02/05/national/05friedan.html

Theory U:
C. Otto Scharmer, Theory U Leading from the Future as it Emerges, 2009