Has Anything Really Changed in 30 Years?

As mentioned in last month’s editorial, the American Telemedicine Association (ATA) celebrated its 30th year. Over the course of these past three decades, much has changed and much remains relatively the same. This year’s meeting was held in San Antonio, Texas. On Monday morning, March 6, there was a remembrance ceremony in front of the Alamo, marking 187 years since the famous battle between the Texians and Santa Anna’s overwhelming Mexican Army. The gathering on the sacred grounds of the Alamo commemorated the battle and its after effect on Texas independence. Although not related to our quest to remember how the ATA evolved since 1993, it gave me time to pause and recognize the inherently importance of history.

The previous evening, the ATA leadership dinner was replete with history. A large number of past ATA presidents¹ were recognized both on the dais and a short video vignette. Each of these individuals provided input and direction as the Association matured. In addition, several awards were presented. The one that is most relevant was the recognition of Jay Sanders, MD, with the life time achievement award for his work in this field dating to the late 1960s. Dr. Sanders made several remarks on his personal journey. Many in attendance commented on the value of the history that was presented and how in some way made them more aware of the Association and the development of telemedicine.

In one of the very first issues of this Journal, Sanders and Rashid Bashshur discussed the challenges of implementing telemedicine.² Going back to 1976, Bashshur and Armstrong discussed a new mode of delivery of health care.³ Although I could list a litany of articles, it is important to note that the very issues we face today, while they have abated somewhat, remain a challenge. There remain those who are resistant to change or perhaps would even like to go backward.⁴ In other words, some of what we faced then, we are facing today.

A stroll through the exhibit hall at the ATA, although full of new devices and capabilities, reminded me that much of this “new” stuff is really repackaged old stuff. That is not to denigrate what was on display, but to illustrate how we need to begin thinking in different ways. For example, the standard sheet the physician uses to mark why you were being seen and the medical assistant or coder uses to process the bills for payment and put a highly functional database behind it, this makes the practice of medicine better but it is still the same. Have these evolved the practice of medicine, made it more complicated or easier? It is technology put on top of an existing problem. What if we redesigned the whole encounter? What if we fully integrate artificial intelligence (AI) and robotics? We have developed a wide variety of protocols. Can these be updated with AI?

We must learn from past successes and failures. This is our history. This is our story! When we look back at that very first ATA meeting with three Mayo sites connected (Jacksonville, Rochester, and Scottsdale) through a satellite transponder on October 3, 1993, the members voted for those first officers and the ATA was off and running. It was Jay Sanders who first told me of an individual who would serve as the executive officer for approximately 25 years, including the design of its first logo and establishing an association, which would grow into what we know today as the ATA.

There are many of you who have your own stories of your journeys through these past decades. Share them with those who are coming up behind us. They can learn a lot from our successes and failures. So yes, somethings have changed but some challenges remain.

What Is in This Issue

In this issue, the ATA abstracts, which were presented either in poster form or oral presentations during the ATA conference, are available at https://doi.org/10.1089/tmj.2023.29089.abstracts.

There are a number of excellent articles from Bangladesh, Canada, France, Germany, Italy, Turkey, and the United States. Each of these covers a wide range of clinical applications, including several on COVID-19.

We have all aged well and learned a tremendous amount. But as Doc Brown said in the first Back to the Future movie, “It’s not you Marty, it’s your kids! Somethings gotta be done about your kids.”⁵ We must pass on our history as a foundation for future generations to learn from. They are not just cool stories!