The movie 2001, a Space Odyssey was a one of those great classic sci-fi movies. Looking back now at the movie, we can laugh. Pan Am is no longer around, there is no Hilton on the moon and the Ma Bell was spun off. Few things remain unchanged in this world. However, change is constant in the world of e-health. Yet one name stands out as a constant: Ace Allen. Like a Buddhist Monk he calmly accepts change, he also produces change. While the majority of the telemedicine community looks for direction with a few exceptions, Ace Allen continues to go boldly where no man has gone before.

Physician, clinician, early pioneer in telemedicine, author, lecturer, entrepreneur, CEO, he pushes the envelope as we know it, and creates a new envelope to push. Dr. Ace Allen continues to define e-health and to follow a different path.

First, Dr. Allen, thank you for your time. I know you are busy with launching your newest project. Would you tell us about your new adventure?

We are developing a "cybrarian," VitalSeek, that matches people to the best online healthcare resources for their unique needs and requirements. The problem today is that, while the Internet contains by far the biggest, most widely accessible library of health resources ever developed, it is still very difficult for a health seeker to cone in on what they're looking for. They now have three choices for getting to information:

1) A search engine (Google, AltaVista, etc.). These will, indeed, find the information they're seeking. The problem is that for every useful item they turn up, they turn up a thousand not-so-useful or irrelevant or outdated items. In short, there is no good way to sort through the thousands(typically, tens of thousands) of search results, to get to what YOU want.

2) A health portal, such as DrKoop, WebMD, HealthCentral, TheHealthChannel, and many others. Most of these develop and point to their own content. While the content may be good, it is by definition only a tiny fraction of what the health Internet has to offer.

3) References from friends or from other publications or websites. These can be great--but how to find them?

VitalSeek is designed to connect people to exactly the health information, products, and services they are looking for and need for themselves or someone else. We do that by cataloging thousands of health sites and topic areas within sites, and rating them on the dimensions of quality, privacy, and usability. Through our proprietary process, which is constantly updated by our team of human coders, we have developed an unparalleled database of site characteristics and qualities. Using online queries and prompts, this "knowledge base" is then used to direct people to the resources they're looking for. We do more than just get you to the homepage of the site, however. Using a proprietary spidering and search technology, we index the content of every site that we code. As a result, we can get you to the very page-level view of what you're looking for.

How do you screen material for users?

We can screen and filter your search based on dozens of criteria. Some of these can be set by you (the end-user);others can be set by clients who brand VitalSeek to their site. Are you more interested in professionally oriented material than "lay" material? Are you looking especially for Web-based discussion groups for childhood leukemia? Are you trying to find alternative approaches to smoking cessation?

Where can we locate your site?

Site URL: http://www.vitalseek.com

Why now, with the failure of dot.com's and everyone and his brother building a Dr Seuss.com site, while your building a website service?

The more DrSeuss.com sites there are -- the richer and more confusing the library of Internet resources becomes...and the more a VitalSeek capability is needed.

Why are you doing this?

The need is great, the business opportunity is great, and no one else is solving the problem of "how to get quickly to the best information," for you.

We do not develop content, and don't ever have to worry about being "low on content," for a simple reason: there is a world of content out there already. Why develop something that many other people have already developed? Our job is to identify, sort, and sift through what is out there, and to provide a short-circuited process for getting people quickly, accurately, safely and reliably to the best resources on the Web that correspond to their needs.

Who is your target audience?

Consumers (non-professionals) first, then professionals. I must qualify this by noting, however, that over 50% of non-professionals use the Internet specifically to find professional-level information that they otherwise wouldn't have access to. Thus, we are coding professional as well as consumer-oriented sites. As a result, I believe that we'll be used by many health care professionals even before we ramp up our back office to accommodate specific professional needs.

What can consumers expect from your site?

They can expect to be connected very quickly to health resources that are best for their purposes (that is, they can be tailored to their needs, or the needs of those for whom they provide care). The result? They'll save time, they'll have more reliable information, and they'll be confident that they've found the best on the Web.

How are you going to manage the quality of your site and the content?

We've gone through an extensive, painful process to assure that our coding/rating system is fair, academically defensible, and reproducible (that is, that intercoder variability is minimized). We re-spider sites frequently, and re-review sites periodically (the interval depends on the activity of the site).

What other services will you offer to the consumer and the health care community?

We are developing so many capabilities and features it is hard to know where to start. Here are some to begin with:

1) Toward the end of the year we should have the capability of correlating clinical trial availability to the location of the inquirer.

2) Providing market research to health care organizations, associations, pharmaceutical companies, and the like. We believe we'll have unparalleled insights into people's behavior on the web (all depersonalized, of course) vis-a-vis healthcare, in terms of what they're looking for, how they look, etc.

3) Providing "Send to a Friend" capabilities, allowing users to aggregate information they've found through VitalSeek into an email packet of resources.

4) We'll also be soliciting feedback from users in order to help us identify resources we may have missed, and to get feedback about sites they've visited.

Is this an extension of your telemedicine work?

In a most interesting way, yes. My main interest over the years has been in health communications. My "first love" was cancer prevention and control, which is all about helping people access the information they need, and figuring out how to convert that information to action that impacts health. Telemedicine is about access and efficiency. Our new business, likewise, is about efficient access to healthcare to make a difference in your life and in other people's lives.

Moving on to Telemedicine, the telemedicine community is trying to catch up with the Dr Seuss.com. Can you tell me what that means to you?

Frankly, some of the telemedicine community has been way ahead of me in terms of really innovative deployments. I'm thinking of the crews at East Carolina School of Medicine, Yale University School of Medicine, the University Hospital of Troms (Norway), and the like. My frustration has not been with the "telemedicine community" at all, but rather with the slow rate of adoption by the "not-yet telemedicine community." The gears of the healthcare system in the U.S. move very slowly, and it is hard to make a business in such a cautious, risk-averse climate.

What is your prognosis for telemedicine, Dr. Allen?

It is unfolding now before our eyes, under many guises: telemedicine, telehealth, ehealth, medical informatics, multimedia patient records, remote monitoring, and so forth. However, in terms of "classical telemedicine," meaning live interactive video-consultations between patients and clinicians, I believe that adoption will continue to be slow and that deployment will occur in more limited circumstances such as rural, prison, and military health, and emergencies.

What can we do to continue to promote telemedicine in the U.S?

Per my comments above, I think that telemedicine is here to stay, and that is increasingly being recognized by entities that make a difference in the long run: insurance companies and HCFA. A problem we face is our highly fragmented healthcare system, which makes it very difficult to apply general solutions or to promote any single way of doing things. On the other hand, the fragmentation does make it easier to experiment on a "small stage." Some small programs can do things quite quickly.

There are two things that I think "telemedicalists" are obligated to do to help promote the field:

1) Join one or more of the telemedicine associations: the American Telemedicine Association (http://atmeda.org) ; the Association for Telehealth Service Providers (http://www.atsp.org); the International Society for Telemedicine (http://www.isft.org); the Canadian Society of Telehealth (http://www.cst-sct.org); and many others (you can begin your search at http://tie.telemed.org/links/organizations.asp or at http://atmeda.org/news/newres.htm).

2) Contribute to the march of progress by encouraging and doing telemedicine research. The two main peer-reviewed journals are the Journal of Telemedicine and Telecare (http://www.coh.uq.edu.au/jtt/index.html) and the Telemedicine Journal (http://www.liebertpub.com/TMJ/default1.asp).

David Balch from Eastern Carolina said that telemedicine, as we know it will disappear, meaning it will be commonplace and web based. What do you see happening?

I agree with Dave, with the exception that I think the term "telemedicine" will persist and will continue to have meaning and currency, as the clinical care-oriented aspect of distance healthcare. And yes, I think that nearly all distance healthcare will be Internet mediated.

When you look at telemedicine today, do you see the glass half full or half empty?

Half full, and rising.

Do you see any bright spots out there and what should we look for here at home and internationally?

I see many bright spots, and I think that there's a lot to learn from what's going on outside the U.S. Some of the programs I keep a special eye on (aside from my own "alma mater," the U. of Kansas School Telemedicine Program) include:

1) East Carolina School of Medicine (http://www.telemed.med.ecu.edu). They've been relentless leaders, innovators, and educators. I am especially impressed by their commitment to their rural region.

2) University Hospital of Troms (Norway; http://www.telemed.rito.no). This is an extraordinary program that impacts healthcare throughout the whole country. It is backed by the full financial, legislative, and rhetorical support of the Norwegian government (imagine that!). It is also underpinned by a national commitment that isolated rural populations have a right to the same standards of health care as anyone else in the country.

3) The Centre for Online Health at the U. of Queensland (Australia; http://www.coh.uq.edu.au). They've been publishing and innovating and deploying a wide variety of technologies (interactive video, Internet-mediated store-and-forward, remote psychiatric monitoring) for over a decade. I track other programs in Canada, Israel, the U.K., Finland, Spain, Latin America, China and Japan.

4) China: Some of these programs may be of interest and they are,

Dalian Telemedicine Ctr
Dalian, China
Contact: Dr. Li-Qun Cheng
This is a leader in the Golden Health Medical Network, which is deploying a
fairly substantial telemedicine infrastructure throughout China.

5) Japan:
Tokyo Medical and Dental University
Contact: Dr. Keiko Nakamura
She and her colleagues have been doing home telehealth deployments and
research for about 5 years.

6) Latin America:
There are deployments in Costa Rica and the Caribbean that I've been
tracking through their technology partner, ViTelNet (http://www.vitelnet.com). I've
also been tracking developments (slowly unfolding) in Peru, via my contact
Dr. Rosa Tang.

Looking out on the horizon, what you do see for telemedicine, e-health and medical informatics in 5 and 10 years from now?

I believe that distance healthcare and informatics will increasingly converge via the Internet. As privacy, security, and legal barriers are overcome, the true efficiencies of "moving information instead of people" will become very apparent. I don't know whether the movement toward this convergence will be incremental, or whether we'll reach a "tipping point" where the efficiencies become apparent to all, the barriers to deployment fall, and where adoption becomes universal. One thing I am sure of: the more explicit my prediction, the more chance I have of being wrong!

Where would you like to be in that period?

I want to be part of it!

You recently sold Telemedicine Today. Will it still be published and will you remain involved?

We sold Telemedicine Today to B2B Health Media in southern California about 6 months ago. It is undergoing a remake, and should be back on the newsstands about now. In order to protect my time in the new VitalSeek venture, my involvement with the new Telemedicine Today is minimal.

Ace, I wish you continued success and with your new challenge, please keep us informed!

Thank you, Bob. It is always a pleasure working with you and I really enjoy the TelehealthNews Letter.

Thanks,
Bob Pyke Jr.,RN,CPNP
Assistant Editor & Roving Reporter TelehealthNet News