BY: MARY ANN STEINER
Uncle Louie celebrated his 92nd birthday in the hospital this year. The festivities were pretty paltry, and my uncle seemed unusually withdrawn and disconnected. Once he was home again, it was clear why he had been so resigned and out of it: He was missing his computer.
He plays his favorite games and crosswords with a special keyboard because of hand tremors. His hearing is so compromised that it is frequent visits to Facebook that enable him to keep up with the four generations he cares about. More important than the social and entertainment value the computer provides is access to a level of control in his health care. In front of the screen and equipment at hand, he sends updates to doctors and nurses, orders medical supplies and tracks his data in ways the hospital wouldn't allow. Thanks to technology, he is engaged and proficient.
Miraculous, perhaps, that a man in his 10th decade uses technology to stay healthy at home. Or, as articles in this issue describe, that a young woman in the recesses of Appalachia receives excellent cardiac care via virtual access to an urban cardiologist; that an oilman suffering anxiety disorder in northwestern North Dakota is treated by a psychiatrist across the state; that a mother with a high-risk pregnancy in one of Chicago's more dangerous neighborhoods is being monitored 24/7 without having to leave her house.
I went scrambling to the Gospel's healing miracles to find connection with the promise of telemedicine, only to conclude that there really isn't anything miraculous about these developments. The evolving adaptation of technology to the business and mission of health care is closer to the messages of Jesus' parables, which often have more to do with stewardship (the distribution of talents to the three servants), always being prepared (vestal virgins preparing for the bridegroom), the transition of assets (old wine in new wineskins) and the risks of investing everything for what is most valuable (the pearl of great price).
Much as the parables rely on common images from the visible world to illustrate truths about the spiritual world, the heroes and heroines of telemedicine are less the visionaries than the strategic planners, nurse collaborators, physician champions and technologists whose skills are exceeded only by their perseverance.
We went back and forth between titling this issue "Telemedicine" or "Telehealth." It goes against all our predilections for consistency to have those words appear alternately as the authors used their preferred terms in the different articles. It's not just a matter of vocabulary. The space between "telemedicine" and "telehealth" may be the difference between description and aspiration.
According to the Health Resources Services Administration, telehealth suggests the use of technologies and telecommunications to support not only long-distance clinical care, but also patient and professional health-related education, public health and health administration. Telemedicine, on the other hand, refers to the practice of remote clinical services. Telehealth is more compatible with the goals of population health and the spirit of collaboration among patient, physician, home health nurse and health coach. Telemedicine is still attached to a medical model, although an expanding one.
There is no doubt that telemedicine is both the method of the moment and the wave of the future. It is the inside track in the route to the "triple aim," which is to provide better care to more people at lower costs. But whether telemedicine truly becomes telehealth depends on a level of collaboration described in Alan Pitt, MD's excellent article that opens this issue. That kind of collaboration will challenge the authority, autonomy and flexibility of communities, providers and practitioners at every level, not to mention the individuals and families who need care or seek healthier lifestyles.
For this issue, we've decided to go with the title of Telemedicine, hoping that by the next time we cover this topic, we truly can call it Telehealth.
Best wishes for a blessed and wonderful new year from your friends at Health Progress.