Insights · March 26th, 2012

Last week I had the privilege of presenting a keynote speech to the annual conference on the future of Telemedicine, put on the Northwest Regional Telehealth Resource Center, in Billings, Montana.

As I thought about a theme for my talk what occurred to me was that there are certain developments that always seem to be “in the future” and never quite seem to reach full application here in the present. Think nuclear power from fusion, and flying cars. Telemedicine has in many ways always been something that is going to be big, in the future. This is despite widespread experiments with and adoption of telemedicine for some basic care in many rural parts of the world, including the northwest United States.

Chatting with the resource director I confirmed that indeed as an industry or enterprise those involved with telehealth are always frustrated by the lack of more widespread adoption or support for practices that can lower costs and improve access and quality of heath care. So, I entitled my program “Thinking in the Future Tense: moving telehealth from the future to the present.”

In my remarks I explored the six future forces that I think are making it more likely that telehealth will move more fully into the present. These include:

    Income gap economics – the fact that incomes have stagnated for 90% of the U.S. population and in fact have declined by many measures, means that a premium will be placed on getting services to people at a cheaper cost that current practices.
    Health care requires it – a startling new study of sources of health insurance for nonelderly Americans shows that since 2001 those with employer sponsored health insurance has declined from 70% of the population to 53%, while the insured have increased from 14% to 20%. When health care reform actually takes effect in 2014 the total insured will improve but I do not expect improvement in employee sponsored programs, in fact I expect the reverse. This all adds up to a system experiencing a fairly rapid devolution, and in the end it will have to change more radically that currently anticipated.
    Age wave need and digital natives lead – the well known age wave as the baby boomers pass through their sixties into their seventies in the coming two decades will increase demand for health care. This population will be more technically savvy and willing to use telehealth if available. At the same time the next generation of health care providers will be the first from the digital native generation, and they will be frustrated if sophisticated tools for telemedicine are not in use.
    Tech acceleration – from more immersive and 3D communication technology more widely available, to better tools for diagnosis and treatment, the tech revolution continues.
    Quantized-self health revolution – this is just becoming known. I related to story of Larry Smarr, currently featured in Technology Review, as an early adopter of increasingly available personalized tools for monitoring and communicating your own health status. As this becomes widely adopted, it dovetails perfectly with telemedicine.
    4-P medicine – the brainchild and mission of Dr. Leroy Hood and the Institute for Systems Biology, the 4 P’s stand for medicine becoming predictive, preventive, personalized, and participatory. As a concept the 4 P’s are becoming widely accepted as appropriate goals for the future of medicine. All of these themes reinforce the value of telemedicine.

I also explored the two future forces that keep telehealth in the future:

    Political restrictions – state legislatures are increasingly interfering with telehealth, limiting the services they can provide, often for non-medical reasons.
    Achieving consistency, trust and sustainability – the telehealth industry is well aware of the barriers here. The tendency of many telehealth projects is to be treated as a trial or experiment, and getting the services into a consistent basis is a big challenge.

Following my talk a third future force was emphasized in discussion, and it is obvious and perhaps the biggest of barriers. That is the way we pay for health care in the U.S., the reimbursement system. Since we defined health care as a profit centered enterprise, the incentives of providers is toward services that generate the highest return, while for payers (insurers) the incentives are to provide as little health care as possible. Both of these limit the applications of telemedicine, literally prohibiting telemedicine providers from doing many things.

So the road from the future to the present for telehealth remains a challenging one, despite so many future forces seeming poised to speed things along. I closed by recommending that the telehealth industry leverage three forces especially. First, as digital native practitioners come online get them trained up and advocating for telemedicine. Second, learn more about and ally with the 4P medicine and quantized self health revolution.

And, just before starting the keynote one more idea occurred to me. The most important population dynamic in the country (and the world) is the movement of people to the urban areas. By 2050 some 80% of the world’s population will live in cities. The proportion in the U.S. will probably approach 90%. Yet, telemedicine is still touted as the answer to the health needs of a rural population. I urged the group to refocus on urban areas, while not forgetting the rural needs. It is in cities that the infrastructure is there, the health needs are just as great or greater, where people don’t have time to visit doctors in person and doctors don’t have time to see them anyway. It is by shifting to an urban strategy that telemedicine may finally leave the future and arrive in the present.

You can view the slides that used here via Slide Share.

Glen Hiemstra is a futurist, author, speaker, consultant, Founder of, and founder and Curator of To arrange for a speech, workshop or consultation contact

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Nikolas Badminton – Chief Futurist

Nikolas Badminton

Nikolas is the Chief Futurist of the Futurist Think Tank. He is world-renowned futurist speaker, a Fellow of The RSA, and has worked with over 300 of the world’s most impactful companies to establish strategic foresight capabilities, identify trends shaping our world, help anticipate unforeseen risks, and design equitable futures for all. In his new book – ‘Facing Our Futures’ – he challenges short-term thinking and provides executives and organizations with the foundations for futures design and the tools to ignite curiosity, create a framework for futures exploration, and shift their mindset from what is to WHAT IF…

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