a national strategy for telemedicine and e-health

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243 TELEMEDICINE AND e-HEALTH Volume 13, Number 3, 2007 © Mary Ann Liebert, Inc. DOI: 10.1089/tmj.2007.9982 Editorial A National Strategy for Telemedicine and e-Health A S THIS EDITORIAL BEGINS, our nation is once again in the grips of dealing with a terri- ble tragedy. The senseless act that unfolded on April 16, 2007, at Virginia Tech University in Blacksburg, Virginia, reminds us of how frag- ile life is. Our thoughts are with the victims, their families, and the university, which ex- tends to all of us as members of an open and free society. A familiar story of chaos in the relative ab- sence of precise information emerged. It is not to say that somehow the technologies that we utilize and incorporate in our daily lives, let alone our medical practice, could prevent such events; it instills in us the need to be better pre- pared for dealing with disasters. This region of Virginia is not accustomed to the kinds of med- ical emergencies that were a direct outcome of the tragic events of that day. If you take away the large metropolitan areas of our nation and their coordinated emergency medical response, the response in more rural areas to such events, which comprise a significant portion of the United States, is not comparable to those larger areas. It is not insignificant but it is insufficient and could be overcome quickly. If such a dis- aster became much larger, would our health- care system be able to deal with such calamity? It was only a short time ago that Katrina rolled ashore, wreaking havoc for millions of people and overwhelming our fragile infra- structure. Our systems were inadequate to re- spond and in many ways continue to be so. Communication, information, and consequent timely response to mollify the disaster simply were not up to the task. It is once again time to consider the creation of a national strategy for telemedicine and e-health. Such a strategy could be of tremendous value for healthcare delivery, education, and response to calami- tous events. Both the Clinton and Bush administrations have called on the community to develop elec- tronic medical records, wire libraries for greater access to educational resources, embrace tech- nology, and integrate it in our lives. There is even a National Health Information Technol- ogy Coordinator within the U.S. Department of Health and Human Services—Dr. Robert M. Kolodner. Many industrial giants also look internally and externally at what they may do for their employees and their extended families. At the recent Health Information Manage- ment Systems Society (HIMSS) meeting in New Orleans, LA, there were more than 900 com- panies exhibiting their products and services. The HIMSS mantra is “Transforming Health- care Through Information Technology.” Dur- ing the recent American Telemedicine Associ- ation (ATA) annual meeting in Nashville, TN, there were several hundred vendors as well. In each case, they were showcasing their compet- ing technologies, all of which enable—or at least contribute to the perception of—better healthcare delivery and management. These products and services are provided through es- tablished and growing markets to whomever is capable of purchasing them. The underlying problem is that no national strategy exists that links everything together. Imagine if there were all manner of compa- nies in the 1860s and 1870s that decided to build their own railroads. Although they may have worked well together, it would have been an entirely different matter had not the gov- ernment set a precedent. A lot was done by in- dividual companies. However, the government

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Page 1: A National Strategy for Telemedicine and e-Health

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TELEMEDICINE AND e-HEALTHVolume 13, Number 3, 2007© Mary Ann Liebert, Inc.DOI: 10.1089/tmj.2007.9982

Editorial

A National Strategy for Telemedicine and e-Health

AS THIS EDITORIAL BEGINS, our nation is onceagain in the grips of dealing with a terri-

ble tragedy. The senseless act that unfolded onApril 16, 2007, at Virginia Tech University inBlacksburg, Virginia, reminds us of how frag-ile life is. Our thoughts are with the victims,their families, and the university, which ex-tends to all of us as members of an open andfree society.

A familiar story of chaos in the relative ab-sence of precise information emerged. It is notto say that somehow the technologies that weutilize and incorporate in our daily lives, letalone our medical practice, could prevent suchevents; it instills in us the need to be better pre-pared for dealing with disasters. This region ofVirginia is not accustomed to the kinds of med-ical emergencies that were a direct outcome ofthe tragic events of that day. If you take awaythe large metropolitan areas of our nation andtheir coordinated emergency medical response,the response in more rural areas to such events,which comprise a significant portion of theUnited States, is not comparable to those largerareas. It is not insignificant but it is insufficientand could be overcome quickly. If such a dis-aster became much larger, would our health-care system be able to deal with such calamity?

It was only a short time ago that Katrinarolled ashore, wreaking havoc for millions ofpeople and overwhelming our fragile infra-structure. Our systems were inadequate to re-spond and in many ways continue to be so.Communication, information, and consequenttimely response to mollify the disaster simplywere not up to the task. It is once again time toconsider the creation of a national strategy fortelemedicine and e-health. Such a strategycould be of tremendous value for healthcare

delivery, education, and response to calami-tous events.

Both the Clinton and Bush administrationshave called on the community to develop elec-tronic medical records, wire libraries for greateraccess to educational resources, embrace tech-nology, and integrate it in our lives. There iseven a National Health Information Technol-ogy Coordinator within the U.S. Departmentof Health and Human Services—Dr. Robert M.Kolodner. Many industrial giants also look internally and externally at what they may do for their employees and their extendedfamilies.

At the recent Health Information Manage-ment Systems Society (HIMSS) meeting in NewOrleans, LA, there were more than 900 com-panies exhibiting their products and services.The HIMSS mantra is “Transforming Health-care Through Information Technology.” Dur-ing the recent American Telemedicine Associ-ation (ATA) annual meeting in Nashville, TN,there were several hundred vendors as well. Ineach case, they were showcasing their compet-ing technologies, all of which enable—or atleast contribute to the perception of—betterhealthcare delivery and management. Theseproducts and services are provided through es-tablished and growing markets to whomeveris capable of purchasing them. The underlyingproblem is that no national strategy exists thatlinks everything together.

Imagine if there were all manner of compa-nies in the 1860s and 1870s that decided tobuild their own railroads. Although they mayhave worked well together, it would have beenan entirely different matter had not the gov-ernment set a precedent. A lot was done by in-dividual companies. However, the government

Page 2: A National Strategy for Telemedicine and e-Health

considered the matter of jurisdiction and inter-state needs and facilitated the railroad expan-sion beyond local service to a national system.This effort eventually provided unprecedentedgrowth and a means for rapid transportationof goods, services, and information. The Na-tional Interstate and Defense Highways Act in1956 mainly addressed the need to help protectthe United States from attack. If an enemy na-tion invaded the United States, the Americanmilitary could use the highways to rush sol-diers to the scene of the invasion. This fear ofinvasion was especially prevalent during the1950s, as the Cold War gripped the Americanpeople. The highways would also provide res-idents of a city with evacuation routes in caseof a nuclear attack. This system linked a nationin a way that no other on Earth had ever done.

We have established in the United States atelecommunications infrastructure that pro-vides easy access to information, nationally andinternationally. This creates new opportunitiesfor growth and is driven by consumerism. Yet,this ubiquitous system is not governed by a na-tional policy that meets the nation’s healthcareneeds or is easily transformed to support

healthcare in time of disaster. We have writtenin the past several years about the importanceof telemedicine in disaster response. The needis there. We must act to create a robust systemthat is capable of providing support. Driven bypolicies and strategies that are crosscultural,multilingual, and are readily and easily acces-sible, telemedicine and e-health broadens ourability to respond effectively and in a timelymanner.

Each issue of Telemedicine and e-Health is anillustration and testament to those who chal-lenge the status quo. Those who dare to dream!Those who utilize technologies to push the en-velope of healthcare, whether it is monitoringinfectious disease, evaluating retinal images,monitoring those in assisted living, pursuingcapabilities for remote healthcare services, orresponding to natural or man-made disasters.This issue is no different. Embrace what is here,and help foster a national strategy to be pre-pared when the unexpected happens.

—Charles R. Doarn, M.B.A.and Ronald C. Merrell, M.D.

Editors-in-Chief

EDITORIAL244