In 1980, futurist Alvin Toffler published The Third Wave in which he described the evolution of agarian economies to industrial economies to post industrial economies (The Third Wave) and discussed the impact that transformation would have on society. Most of his predictions have come true, including the creation of what he termed "prosumers" i.e. outsourcing the production of a service to the consumer like self service check out at grocery stores, pumping your own gas and using ATM machines instead of tellers. We're not there yet, but telemedicine, I believe, will follow this trend and evolve in four stages or waves.
Stage one, which we have experienced since the inception of telemedicine in the late 1950's, has been mostly about demonstrating proof of concept and validating the notion that patients could be treated without actually seeing them face to face. Most of these efforts have been funded by grants and did not scale or achieve adoption or penetration because of obstructive laws, regulations and lack of market adoption.
Stage two, where we are now, is characterized by more widespread acceptance of telemedicine and the creation of business models that would provide an incentive to create telebusinesses. Most of these models are in closed loop systems deployed in integrated delivery networks like the VA, Kaiser or muli-site hospital systems.
Stage three will be achieved when closed systems communicate with eath other, thus creating an openly integrated nexus of telemedicine nodes such that any patient could connect to any doctor anywhere, any place at any time.
Finally, the fourth wave will be achieved when there is a shift of the center of gravity from providers to prosumer patients with the gradual disintermediation of healthcare professionals, driven by DIY medicine and commoditized medical products. The business models driving this evolution will be global and separate and distinct from sick care brick and mortar delivery to healthcare democratized delivery.
The primary barriers to the fourth wave are legal, regulatory and reimbursement obstacles based on the existing paradigms of care. As those change, so will the telemedicine ecosystem allowing the fourth wave to wash away all that preceded it. The result wil be a global care system that is democratized, commoditized and internationalized. Prepare now if you don't want to be swept away by the tsunami.