Abstract
I just returned from New Orleans and the 2025 American Telemedicine Association (ATA) Nexus. It seemed to me that the event is getting smaller in both attendance and the number of vendors. Nevertheless, it was a great time to visit with friends, and colleagues, make new acquaintances, and, of course, see what new—if any—technologies are available for us to use. Many of the individuals I spoke with were engaged in some form of telemedicine and telehealth but were not 100% sure what technology to use in their project or clinic. My personal comment has always been—keep it simple! Do not overengineer it!
As an emeritus professor now, I can engage with all kinds of disciplines and make critiques without the fear of retribution or challenges to the old guard’s promotion and tenure criteria. So here it goes: engineers will develop some awesome, can-do-all technology, often without the user or clinician involved. This was the foundation for my NASA book with my former boss, Dr. Richard Williams, the NASA Chief Health and Medical Officer. 1 In this book, we addressed the challenges and potential outcomes of engineers, life scientists and physicians who impact—in my case at the time—the astronaut. This model could be applied in any situation. Great innovation makes it off the drawing board, into a working model, and eventually into a sales pitch. But is this really what the customer needs or can afford?
There is no doubt that what we have all seen on the exhibit floor could add value, but at what cost. To illustrate, I will use a different example related to new windows for my home. Recently, my wife and I decided to replace some of our windows. The sales representative demonstrated cost efficiencies and promised a potential savings of 35% on the utility bill. The total cost was in excess of $100k, and it would take 57 years to realize the total cost savings. Buying an amazing telemedicine capability can save money and enable better care and perhaps better workflow. But you have to do an analysis and determine what you really need.
Sometimes there are unseen issues with design. It was not thought of, or the right person(s) were not in the design phase. To illustrate, here is another example. An engineering colleague has proposed drones to deliver pizza. I am sure this is not just at my academic institution. I asked him about the human experience, and he was somewhat perplexed. The scenario I painted was a neighborhood of 500 houses. About 50% were indoors watching the Super Bowl in early February. The other 50% were outside enjoying the warm sunshine. Of those watching the game, 25% decide to order pizza to be delivered at halftime. Those who are outdoors hear the noise of 125 or more drones delivering pizza. The sound would be as noisy and annoying as a horde of dragonflies or locust. The engineer had not considered this.
My point with these examples is sometimes the wolf is in sheep’s clothing. It looks like a grand idea. It works flawless on the demo, but once it is placed, there are unforeseen challenges. I recall hospitals installing roaming robots and surgical robots only to be eventually pushed into a corner.
Now, I am not denigrating technology or innovation. I am simply stating that you need to be vigilant and informed as to your customer needs, your needs, your budget, etc. This is why it is of vital importance to have a needs assessment done as part of your business plan.
Many of the early vendors at the ATA Conferences no longer exist. They were no longer funded by government contracts, perhaps did not evolve their technology or modify their approach, or simply lost business. This year marked my 31st year of attending the ATA conference. It has changed a lot over the decades, as have telemedicine and telehealth. Digital health is more relevant now than ever before. The ATA recently acquired the Digital Therapeutics Alliance, which reinforces the continued evolution of our discipline and our work.
So, when assessing your needs or improvement, review what is available both in products and, I dare say, the evidence. Telemedicine and telehealth capabilities stand on the evidence and experiences of all of us, not just on the technology that is for sale.
What Is in This Issue?
This issue contains several reviews and original manuscripts that reinforce the application and integration of telemedicine and e-Health across the United States and the world. This wide variety of submissions comes from Brazil, Germany, Hungary, Iran, Japan, South Korea, and, of course, the United States. Each brings rich and innovative approaches to clinical applications as well as interesting frameworks.