Editorial Milestones and Millstones—Moving Healthcare Forward
Charles R. Doarn, MBA, FATA, and Ronald C. Merrell, MD, FACS, FATA Editors-in-Chief
T
he term ‘‘milestone’’ denotes two connotations but basically means a point in a journey from one location to another location. In antiquity, the milestone was a stone obelisk or stela that demarked the distance from one point to another. These stones were used extensively in Roman roads, such as the Appian Way, as well as roads in Byzantium, with Rome and Constantinople as the center, respectively. On a journey today, we use mile markers imprinted on signs along the Interstate Highway System, all of which are directly aligned from the number one milestone, often called the ‘‘Zero Stone,’’ in Washington, DC. America’s first road, the National Road (U.S. Route 40), actually still has several stone obelisks, which were originally placed along the road in the early part of the 19th Century! In our daily lives, the other connotation of ‘‘milestone’’ is also a key tool. We reach the age of understanding, the age when we can drive, vote, have a child, become a grandparent, etc. Each of these milestones in life has a profound effect on us. The concept of a milestone is also a very important tool in program/project management. These milestones might be when a particular part of a project has been completed. For example, the entire hull of an aircraft carrier has been completed, a building has been topped off (when this milestone is reached, an evergreen tree is often hoisted to the top), or, in our healthcare world, an event has been completed, like the Affordable Care Act or the Centers for Medicare & Medicaid Services’ recognition of telehealth. Milestones are project management tools that indicate progress along a project timeline—the plan of activities to be completed over time. They provide time of reflection and gauging of progress, which can influence decision-making, budgetary control, management of resources, and managing schedules. Over the past 20 years, we have celebrated the growth of telemedicine and telehealth as an effective tool. We celebrated our first 20 years as a major milestone. Other milestones are laid out for us, such as Meaningful Use and other elements of the Affordable Care Act. Although the U.S. Congress will have a different make-up and perhaps a different philosophy for the next several years, we anticipate that it will move to improve the nation’s healthcare by including telemedicine and telehealth as fundamental tools in the delivery of healthcare. That would be a major milestone in our journey. It is of course our intent in the Journal to continue to push for the evidence that can enable not only practitioners but also legislators and policy makers to get it right. Of course, achieving a milestone requires vigilance and hard work—thus, the use of the millstone metaphor. A millstone is a
DOI: 10.1089/tmj.2015.9999
combination of two stones that are used to grind grain or other materials. One stone remains stationary (bedstone), and the other stone (runner) rotates in a circular motion, grinding whatever is placed between the stones. Although not exactly the same, they can also be called grindstones. Whether operated by a water wheel, by a mule, by an ox, or by hand, it can be a difficult task. As young students we are often told to work hard and keep our nose to the grindstone, which as we all know is hard work. Now this metaphor is not to be misconstrued here. It is not our intent to imply we are running in circles or that we are being led by mules or oxen. It is simply used to imply that our work is never finished. We must continue our research efforts and alert those in decision-making roles that we are indeed a millstone and that this work, while only just beginning, is helping all healthcare reach new milestones. Without the highly selective research outcomes reported in the Journal—your journal—we cannot achieve these milestones. Regarding the American space program, President John F. Kennedy stated the U.S. objective of going to the moon during his address at Rice University: ‘‘. We choose to go to the moon in this decade and do the other things, not because they are easy, but because they are hard, because that goal will serve to organize and measure the best of our energies and skills, because that challenge is one that we are willing to accept, one we are unwilling to postpone, and one which we intend to win, and the others, too.’’ This same ideal is expressed today as we embark on fundamental change in our delivery of healthcare and how we interact with patients. Telemedicine and telehealth are often hard to implement, but we know that the growing evidence base concomitant with consumer demand and the burgeoning innovative spirt we have enable us to accept the challenges set before us. Keeping our nose to the grindstone will result in many milestones in moving healthcare forward. Look at what has been achieved over the past 20 years!
Moving Forward As we enter our third decade of publishing outstanding work, we must be reminded of the quality and quantity of what we can publish. Like with all scientific journals, we are dedicated to comprehensive review of our collective works by our peers. Through this process we will only accept the best manuscripts, those that lead the way forward and serve our readers. We cannot possibly accept every one that is submitted, and there are a lot of great ones. We may reject far more than we accept, and we do so with our readers in mind as well as of what the field is in need. Our goal is to publish an average of 10–12 manuscripts per issue, or approximately 120 per year. Over the past few years, our submissions have been in the range of 250–300 manuscripts. Our rejection rate has been in the 40–45% range, but it will grow to 60–70%. So, as we continue to move forward, we have
ª M A R Y A NN L I E B E R T , I N C . VOL. 21
NO. 1 JANUARY 2015
TELEMEDICINE and e-HEALTH 1
EDITORIAL
set the bar higher. This takes courage and commitment, and we of course cannot do this without our reviewers. At the end of this issue, please find a note of appreciation to all of our reviewers.
What’s in This Issue? This issue reports some great research efforts from around the world. Manuscripts about smartphones, text messaging, and online services are no longer unique or limited in scope. The application of mobile devices continues to become integral within the framework of healthcare. In addition, the case study on the Veterans Affairs telehealth program1 illustrates the true power and capability of
2 TELEMEDICINE and e-HEALTH J A N U A R Y 2 0 1 5
telemedicine and telehealth for our veterans and can serve as a model for all of us. We hope you enjoy this issue, and we look forward to your great submissions. Keep your nose to the grindstone so the milestones we all hope to achieve are not a long way off but close by. Your work really makes a difference. REFERENCE 1. Darkins A, Kendall S, Edmonston E, Young M, Stressel P. Reduced cost and mortality using home telehealth to promote self-management of complex chronic conditions: A retrospective matched cohort study of 4,999 veteran patients. Telemed J E Health 2014;21:70–76.
Charles R. Doarn, MBA, FATA, and Ronald C. Merrell, MD, FACS, FATA Editors-in-Chief
T
he term ‘‘milestone’’ denotes two connotations but basically means a point in a journey from one location to another location. In antiquity, the milestone was a stone obelisk or stela that demarked the distance from one point to another. These stones were used extensively in Roman roads, such as the Appian Way, as well as roads in Byzantium, with Rome and Constantinople as the center, respectively. On a journey today, we use mile markers imprinted on signs along the Interstate Highway System, all of which are directly aligned from the number one milestone, often called the ‘‘Zero Stone,’’ in Washington, DC. America’s first road, the National Road (U.S. Route 40), actually still has several stone obelisks, which were originally placed along the road in the early part of the 19th Century! In our daily lives, the other connotation of ‘‘milestone’’ is also a key tool. We reach the age of understanding, the age when we can drive, vote, have a child, become a grandparent, etc. Each of these milestones in life has a profound effect on us. The concept of a milestone is also a very important tool in program/project management. These milestones might be when a particular part of a project has been completed. For example, the entire hull of an aircraft carrier has been completed, a building has been topped off (when this milestone is reached, an evergreen tree is often hoisted to the top), or, in our healthcare world, an event has been completed, like the Affordable Care Act or the Centers for Medicare & Medicaid Services’ recognition of telehealth. Milestones are project management tools that indicate progress along a project timeline—the plan of activities to be completed over time. They provide time of reflection and gauging of progress, which can influence decision-making, budgetary control, management of resources, and managing schedules. Over the past 20 years, we have celebrated the growth of telemedicine and telehealth as an effective tool. We celebrated our first 20 years as a major milestone. Other milestones are laid out for us, such as Meaningful Use and other elements of the Affordable Care Act. Although the U.S. Congress will have a different make-up and perhaps a different philosophy for the next several years, we anticipate that it will move to improve the nation’s healthcare by including telemedicine and telehealth as fundamental tools in the delivery of healthcare. That would be a major milestone in our journey. It is of course our intent in the Journal to continue to push for the evidence that can enable not only practitioners but also legislators and policy makers to get it right. Of course, achieving a milestone requires vigilance and hard work—thus, the use of the millstone metaphor. A millstone is a
DOI: 10.1089/tmj.2015.9999
combination of two stones that are used to grind grain or other materials. One stone remains stationary (bedstone), and the other stone (runner) rotates in a circular motion, grinding whatever is placed between the stones. Although not exactly the same, they can also be called grindstones. Whether operated by a water wheel, by a mule, by an ox, or by hand, it can be a difficult task. As young students we are often told to work hard and keep our nose to the grindstone, which as we all know is hard work. Now this metaphor is not to be misconstrued here. It is not our intent to imply we are running in circles or that we are being led by mules or oxen. It is simply used to imply that our work is never finished. We must continue our research efforts and alert those in decision-making roles that we are indeed a millstone and that this work, while only just beginning, is helping all healthcare reach new milestones. Without the highly selective research outcomes reported in the Journal—your journal—we cannot achieve these milestones. Regarding the American space program, President John F. Kennedy stated the U.S. objective of going to the moon during his address at Rice University: ‘‘. We choose to go to the moon in this decade and do the other things, not because they are easy, but because they are hard, because that goal will serve to organize and measure the best of our energies and skills, because that challenge is one that we are willing to accept, one we are unwilling to postpone, and one which we intend to win, and the others, too.’’ This same ideal is expressed today as we embark on fundamental change in our delivery of healthcare and how we interact with patients. Telemedicine and telehealth are often hard to implement, but we know that the growing evidence base concomitant with consumer demand and the burgeoning innovative spirt we have enable us to accept the challenges set before us. Keeping our nose to the grindstone will result in many milestones in moving healthcare forward. Look at what has been achieved over the past 20 years!
Moving Forward As we enter our third decade of publishing outstanding work, we must be reminded of the quality and quantity of what we can publish. Like with all scientific journals, we are dedicated to comprehensive review of our collective works by our peers. Through this process we will only accept the best manuscripts, those that lead the way forward and serve our readers. We cannot possibly accept every one that is submitted, and there are a lot of great ones. We may reject far more than we accept, and we do so with our readers in mind as well as of what the field is in need. Our goal is to publish an average of 10–12 manuscripts per issue, or approximately 120 per year. Over the past few years, our submissions have been in the range of 250–300 manuscripts. Our rejection rate has been in the 40–45% range, but it will grow to 60–70%. So, as we continue to move forward, we have
ª M A R Y A NN L I E B E R T , I N C . VOL. 21
NO. 1 JANUARY 2015
TELEMEDICINE and e-HEALTH 1
EDITORIAL
set the bar higher. This takes courage and commitment, and we of course cannot do this without our reviewers. At the end of this issue, please find a note of appreciation to all of our reviewers.
What’s in This Issue? This issue reports some great research efforts from around the world. Manuscripts about smartphones, text messaging, and online services are no longer unique or limited in scope. The application of mobile devices continues to become integral within the framework of healthcare. In addition, the case study on the Veterans Affairs telehealth program1 illustrates the true power and capability of
2 TELEMEDICINE and e-HEALTH J A N U A R Y 2 0 1 5
telemedicine and telehealth for our veterans and can serve as a model for all of us. We hope you enjoy this issue, and we look forward to your great submissions. Keep your nose to the grindstone so the milestones we all hope to achieve are not a long way off but close by. Your work really makes a difference. REFERENCE 1. Darkins A, Kendall S, Edmonston E, Young M, Stressel P. Reduced cost and mortality using home telehealth to promote self-management of complex chronic conditions: A retrospective matched cohort study of 4,999 veteran patients. Telemed J E Health 2014;21:70–76.
