In 2000, a movie came out called “The Perfect Storm”, wow - almost 11 years ago now and still remembering it well! This was a sea-faring disaster film starring George Clooney, Mark Wahlberg and Diane Lane. In summary a small commercial 40-foot fishing boat, with Captain “George Clooney”, heads out of port one more time to prove they still have what it takes to bring in a respectable load of fish and make the money they need to live on. They venture out to some new waters and catch a boat load of fish but their ice machine fails so rather than wait out rough weather they decide to head back to port, through it, so the catch/cargo doesn’t spoil. To add to it all, on the way back they lose radio contact which was kinda predictable.

                The weatherman was tracking the confluence of two major storm fronts and a hurricane at which point he states, excitedly, it will create “the perfect storm” . You can probably guess that the fishing boat ended up in the middle of this massive storm and was last seen trying to ride over an enormous 100ft+ wave. Sadly but expectedly the boat overturns with boat and crew being lost. The movie ends with a memorial service for those that went out to sea but never returned.  

                So what the heck does this have to do with telemedicine today? From my observations, research and tracking there is a perfect storm brewing but rather than being negative, it could build into an enormous wave of opportunity for the advancement of healthcare.

                Besides the already existing sea of opportunity in telemed consultations being held from a local or remote practice / clinic / hospital / emergency in-field laptop to a specialist(s) or specialty hospital(s) virtually anywhere around the world there will soon be an expanded prescribed at-home and mobile patient monitoring / consultation / treatment planning opportunity.

So what are these storm fronts / pressure cells that will create this massive opportunity wave?

Let’s list some:

• Because of U.S. government legislation / incentives that push the conversion of paper medical records to digital, aka EMRs, which therefore provide ready access to / video display of electronic health records / information (HD digital x-rays. . . ).
• Registration opened on January 3, 2011 for the Medicare and Medicaid EHR Incentive Programs.
• Up to $44,000 in incentives available for non-hospital doctors / practices.
• Penalties!!! Medicare payment reductions if doctors haven't achieved "meaningful use" of an EMR by 2015.
• As CMS transitions from a fee-for-service to a health quality business model, doctors will feel the need  to improve productivity in which telemed could offer opportunities.
• Because of U.S. government legislation that pushes doctors to adopting EMRs many doctors are or will be retiring or leaving the profession causing a shortage of healthcare professionals to provide care for a growing “insured” and an older American population. “Surviving” doctors will have to find newer efficient methods to provide quality care to more.
• September 30^th, 2010 “(Reuters) - The U.S. healthcare reform law will worsen a shortage of physicians as millions of newly insured patients seek care, the Association of American Medical Colleges said on Thursday.

The group's Center for Workforce Studies released new estimates that showed shortages would be 50 percent worse in 2015 than forecast.

"While previous projections showed a baseline shortage of 39,600 doctors in 2015, current estimates bring that number closer to 63,000, with a worsening of shortages through 2025," the group said in a statement.

"The United States already was struggling with a critical physician shortage and the problem will only be exacerbated as 32 million Americans acquire health care coverage, and an additional 36 million people enter Medicare."”

• The teleconferencing technologies advancements providing better resolution over slower "dirtier" general purpose internet or wireless networks.
• Utilizing the newest ITU H.264 SVC standard: “May 12, 2010 – Vidyo®, Inc., the first company to deliver personal telepresence, today introduced VidyoHealth™, an affordable scalable telemedicine videoconferencing suite that leverages the Internet and other general purpose IP networks, for a broad range of applications such as telepsychiatry, home-health and eldercare, speech therapy, and specialist consultations. . .”
• December 2010, Skype unveiled a video-calling application for Apple Inc.'s iPhone
• Federal funds becoming available for improving broadband telehealth networks.
• March 2010, a prime example, the Federal Communications Commission (FCC) allocated $145M to telehealth projects providing high speed network linking hundreds of hospitals in 17 states. This is an expansion of FCC’s Rural Health Care Pilot Program, started in 2007.
• The hurricane of mobile devices / medical apps / plug-and-play medical devices. 
• December 2010, CTIA (The Wireless Association, Nielsen Co., International Telecommunications Union) data: 93% Americans have cellphones / wireless, 29.7% are smartphones and 90% of the global population has access to mobile networks.
• September 2010, articles published revealing 3 million doctors had already downloaded a 59p app that converts an iPhone into a stethoscope.
•  December 2010, Mobisante, an mHealth company, revealed a prototype of an ultrasound probe / peripheral connected to a smartphone and is seeking FDA approval.
• Way too many more examples to mention but additional resources are listed at:  http://goo.gl/ZEkBh
• The acceptance by consumers of to-the-home high speed networks, high definition TV / theater systems, mobile devices and V/C technologies. Technology acceptance also as “employees” in their corporate environments.
• October 2010, Cisco Umi was rolled out as its consumer telepresence offering.
• Again, December 2010, Skype unveiled a video-calling application for Apple Inc.'s iPhone, this can connect to Skype running on your home computer / laptop.
• Vidyo, Polycom, Tandberg, Oovoo, Lifesize, Webex, Google Video, and I’m sure I missed a few hundred more.

                Only a small sampling of excerpts of related newsworthy articles were presented here, to try to present all or most would just be impossible and probably boring. As you can see by what was presented and the dates of publishing, the storm fronts are developing, intensifying and converging. Technology, hardware, software, infrastructure (networks), necessity for healthcare professionals to become more efficient/improve quality and consumer accepting technology are creating an enormous wave of exciting opportunities, limited only by money and the imagination, for the consumer/patient, healthcare professional and technology services/products provider. The disaster will ultimately be for those who ignore or try to hold back the perfect storm (there still remains some issues of some insurers not paying for telemed services but that is currently under active discussion / negotiations / lobbying).

                If there are opportunities you would like to explore with me / Green Smart Consulting LLC, please don’t hesitate to contact me at pendrasik@GreenSmartLLC.com.   

                To learn more about telemedicine the American Telemedicine Association (ATA), http://www.americantelemed.org/ , is the leading resource and advocate promoting access to medical care for consumers and health professionals via telecommunications technology.