Reflections: Lessons Learned and Lessons Forgotten
As we close out our 29th year, let us reflect on these past three decades and the lessons we have learned, and those we have forgotten or perhaps chose to forget. In 1993, no one, well except perhaps, Steve Jobs, had any idea what an iPhone was or for that matter what Internet Protocol (IP)-based videoconferencing was. We had some cell phones, personal digital assistants, BlackBerrys, etc., and some of us began to use the emerging internet and the infant World Wide Web for telemedicine. But few individuals thought we would be where we are today. There were naysayers all around.
NASA had been using telemedicine for several decades; the U.S. Department of Defense was beginning to invest in telemedicine through the Medical Advanced Technology Management Office (MATMO), and eventually, the Telemedicine and Advanced Technology Research Center (TATRC); the National Library was investing and discussions began about creating a federal Joint Working Group. There were no discipline-specific journals or professional associations in this field. One might even say were we in the dark ages of telemedicine. Not so fast!
This is where the true believers became engaged. Using their history, personalities, and sheer determination, they, and some of us, forged the future we now live in. The American Telemedicine Association (ATA) was established and several of our colleagues approached Mary Ann Liebert of Mary Ann Liebert, Inc., Publishers about creating a journal on telemedicine. The idea of the Telemedicine Journal emerged. Over the years, periodicity grew from 4 issues per year to 10 per year to our current 12 issues per year. The journal is now known as Telemedicine and e-Health. The ATA and the journal were challenged in getting up and running, but the wise investment in time and money has paid off.
Today, the ATA is engaged in policy formulation in Washington, DC, is engaged in the development of guidelines for practice, is engaged in other professional societies, conducts annual conferences and symposia that highlights the tools of our craft, and provides a venue where individuals can share the results of their research. Our journal is where these research results and guidelines are published for a wider audience worldwide.
We have either taught students or have been students ourselves. This often requires us to write reports, policies, scientific research articles for publication in peer reviewed journals, and perhaps even legislation. This is where a high-impact journal becomes a critical tool. As I have said before, you can look back a few years and gain an understanding, or you can reach way back and have a more complete discernment of what has transpired.
Those early years of the journal saw a steady stream of submissions, which required significant editing by Dr. Rashid Bashshur. By the time Dr. Ronald Merrell and I became the editors in 2005, the submissions began to increase. For example, during Dr. Mark Goldberg’s stint as editor, there were three volumes (1–3) with 12 issues and 1,017 pages. During Dr. Bashshur’s eight years as editor, eight volume (4–11) and 3,604 pages were published in four and then six issues per year. When Dr. Merrell and I took the reins in July 2005, the issues expanded from six to 12 over a 15-year period, with 15 volumes, 147 issues, and 14,301 pages through March 2020. From 2005 to 2019, the average submissions to the journal were around 200, with slight increases each year.
The turning point for telemedicine occurred with the pandemic; the average submission is now way above 600 per year. Submissions come from all over the world with the United States in the lead, but with significant contributions from Brazil, China, and South Korea. The quality of the submissions continues to climb such that I turn down more excellent papers than I would like, which is why the publisher created our open access sister journal, Telemedicine Reports.
Other tools that were developed in part because of our efforts in telemedicine is the aforementioned IP-based videoconferencing and the exponential increase in bandwidth worldwide. What I heard in 1994 about the internet, web-based telemedicine and videoconferencing, not only made me and others double down, it was a paradigm shift from the old “dedicated” telemedicine suite to more mobile and computer-based systems that could be easily adapted.
While an entire issue of this journal could be devoted to the lessons learned, the important point here is that we have already blazed the trail we are all walking on. Telemedicine and e-Health can serve as a journal of sorts, recording for posterity what worked and what did not. The future is unknown, perhaps not as much as it was 30 years ago, but nevertheless, it is moving faster than ever before. So when you begin to refine your telemedicine and telehealth experiences, reflect on the past and review what has been done already.
What Is in This Issue
This issue contains a significant number of original research articles mostly from the United States and others from Brazil, China, and Jamaica. There are five that focused on COVID-19 as well as other important topics. I have noticed an increase in submissions concerning disparities this past year or so; the first original research article in this issue addresses disparities among Medicare beneficiaries in Arkansas. Other clinical areas include Veterans care, Sickle Cell disease, psychiatry, retinopathy, mental health, technology—including smart phones for spine surgery—and opioid disorder. Each of these provide a foundation for all of us to not only learn from, but also to consider, modifications or updates to what we are doing.
On behalf of all those who have served on the editorial board from that very first issue to the present, I share my thanks and appreciation to each of you for contributing and keeping this journal at the forefront of telemedicine and telehealth worldwide. Writing is not easy and editing is even harder. So share your work and help our discipline to grow!