1. Gould, Kathleen Ahern PhD, RN

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The year 2016 will represent one of the biggest shifts in medical care as we continue to evolve within the Internet of everything era. If you have not already transitioned to the electronic medical record, you will soon. Health care is transitioning so quickly that we can truly witness a paradigm shift occurring. This trajectory reflects new values, new knowledge, and new technology. As this unfolds, a few things are clear:


* The patient's voice is respected and revered, and their needs will drive new systems.


* Technology will continue to expand within and around health care, as medical applications will become key drivers for new technologies.


* Integrative therapies are becoming the norm as medicine and mindfulness meet-even in a world that lures us toward less personal interaction and more technological engagement.


* More patients will be treated at home. Many will manage their care through telemedicine; using remote monitoring, electronic alerts, and improved patient portals to become their own primary care manager.



As we ring in 2016, health care organizations will be embarking upon many new initiatives. Among those topics that will be on every organization's list are care transitions. Dr Jan Volland tells us we will see a major shift to virtual visits and follow-up care; and refers to a recent report by Deloitte, reporting that 1 of 6 visits to the doctor in the United States may soon be virtual.1,2


Dr Eric Topol, a renowned cardiologist, geneticist, and digital medicine researcher, adds to this vision as he writes, "We are embarking on a time when each individual will have all his/her own medical data and the computing power to process it in the context of their own world. [horizontal ellipsis]This will set up a tectonic (or 'tech-tonic') power shift, putting the individual at center stage. [horizontal ellipsis]What have been dubbed the 6 most powerful words in the English language-'The doctor will see you now'-will no longer be true."3


In 1996, the Institute of Medicine (IOM) defined telemedicine as "the use of electronic information and communications technologies to provide and support health care when distance separates participants."4 At that time, telemedicine was beginning to emerge as a network or system within limited facilities.


Today, things are quite different. Even our descriptions have matured as we now refer to this modality as telehealth, more definitively defined as the use of electronic information and telecommunication technologies to support long-distance clinical health care, patient and professional health-related education, public health, and health administration. Technologies include videoconferencing, the Internet, store-and-forward imaging, streaming media, and terrestrial and wireless communications.5


In 2012, the Health Resources and Service Administration sponsored an IOM workshop to examine how the use of telehealth technology can fit into the US health care system. The workshop summary discusses the evolution of telehealth since 1996, including the increasing role of the private sector, policies that have promoted or delayed the use of telehealth, consumer acceptance of telehealth, and current evidence base, including available data and gaps in data. The group also looked at how technological developments, including mobile telehealth, electronic intensive care units, remote monitoring, social networking, and wearable devices, in conjunction with the push for electronic health records, are changing the delivery of health care in rural and urban environments.5


We will care for patients using a different infrastructure, now possible with new tools and innovations. Applications may be introduced more quickly as older patients become more comfortable using technology, and advances in analytics help us automate the logistics of care and create predictive models that help improve care delivery.


Many innovations, first encouraged by continued pressure to reduce medical cost and improve care, have surpassed our expectations! Some things were simply not possible only a few years ago. Medicine has been digitized.


Telehealth has continued to grow in both the public and private sectors. An influx of professional journals and organizations are devoted to telehealth, with federal and private funding available to develop new applications.


The change is powered by what Topol calls medicine's "Gutenberg moment". "Much as the printing press took learning out of the hands of a priestly class, the mobile Internet is doing the same for medicine, giving us unprecedented control over our health care. With smartphones in hand, we are no longer beholden to an impersonal and paternalistic system in which "doctor knows best."3


Topol also tells us that health care will be democratized, "Computers will replace physicians for many diagnostic tasks, citizen science will give rise to citizen medicine, and enormous data sets will give us new means to attack conditions that have long been incurable. Massive, open, online medicine will spread knowledge and disseminate research in unprecedented ways. Patient interfaces will enable real-time diagnostic and management of acute and chronic conditions."3


It is an exciting time; the path forward will be complicated, but extraordinary. There will be more time for conversation and more time to listen to patients' concerns and learn about what matters to them, as they become active partners in their care. This will require extraordinary leadership and energy. Smith6 reminds us that leadership style and organization culture predict organizational outcomes. This is even more important as technology has given us unprecedented powers to change health care. Great leaders will emerge and become stronger as they lead us in this new adventure.


One theme that emerged over the IOM 2012 workshop included an emphasis on the relationship between the patient and the provider; technology should not be seen as a barrier, but something that facilitates access for more patients to interact with their providers. Similarly, the focus should be on the patient and not the technology.5


Through this transition to a digitalized medical world, the patient outcomes must continue to drive our work.


New Year' resolutions are often predictable. However, this year, we may be using new words and language that did not even exist last year. I have joined a BioBank, one that did not exist last year. I will engage in research using social networking and embrace technology that is new to me. I will join colleagues as we introduce patients and family members to new ways of managing their care. Throughout the year, I will continue to learn more about modern statistics, ways to manage and interpret big data and build predictive models toward health care improvements. Most of all, I am excited to practice mindful medicine, using alternative care techniques and the patient's voice to guide me.


The primary benefit of virtual medicine and other new modalities may be cost reduction, but the greater good may come from saving lives and improving care. As the IOM report concludes, "It is not about the uniqueness of the device or technology-it is about the way it changes people's lives."5



Kathleen Ahern Gould, PhD, RN


Editor in Chief


Dimensions of Critical Care Nursing


Adjunct Faculty


William F. Connell School of Nursing


Boston College


Chestnut Hill, Massachusetts


The author has disclosed that she has no significant relationships with, or financial interest in, any commercial companies pertaining to this article.




1. Volland J. A New Year, a Renewed Focus: Transforming Care Transitions. 2015. National Research Corporation. Accessed September 30, 2015. [Context Link]


2. Delloitte, e visits: the 21 century housecall. 2014. The Creative Studio at Deloitte, London. Accessed September 20, 2015. [Context Link]


3. Topol E. The Patient Will See You Now: The Future of Medicine Is in Your Hands. New York: Basic Books; 2015. [Context Link]


4. Field M, ed. Telemedicine: a guide to assessing telecommunications for health care. 1996. Accessed September 30, 2015. [Context Link]


5. Tracy A. Lustig, Rapporteur; Board on Health Care Services; Institute of Medicine The Role of Telehealth in an Evolving Health Care Environment: Workshop Summary. Washington, DC: The National Academies Press; 2012; Accessed September 34, 2015. [Context Link]


6. Smith C. Exemplary leadership: how style and culture predict organizational outcomes. Nurs Manage. 2015; 46( 3): 47-51. [Context Link]