Gil-López P., et al.
sician with specialists, nurse with physician, etc.) and between
the health care professional and the patient. In Europe, especial-ly
in the military, the first field is the most common. The second
needs much more technology because the number of patients
potentially using telemedicine is huge, so millions of wearables
to record patients vitals are necessary, and strong organization
is needed, including artificial intelligence systems to process and
analyze the billions of data points that the wearables send so that
only the useful ones are received by the health care workers and
algorithms to determine where the data goes, who receives it,
and when it should be received.
Tele-health is a much wider concept than telemedicine, dealing
not only with the exchange of information for clinical use (diagno-sis,
treatment, etc.) but also for «patient and professional health-re-lated
education, public health and health administration»6,7.
When it comes to telemedicine, reality usually goes in front
of legality. Thus, although there are a lot of people already using
this technology, ethical documents of both international and na-
tional medical organizations5,8,9 recommend its use only in spe-
cific circumstances for some cases during the clinical process and
with specific requirements and legislation and guidelines and
standards, most of which are still lacking.
E-health would be considered the widest concept and is de-fined
as «in the intersection of medical informatics, public health
and business, referring to health services and information delivered
or enhanced through the Internet and related technologies. In a
broader sense, the term characterizes not only a technical develop-ment,
but also a state-of-mind, a way of thinking, an attitude, and
a commitment for networked, global thinking, to improve health
care locally, regionally, and worldwide by using information and
communication technology»10.
WHERE IS TELEMEDICINE AS A TECHNOLOGY?
Gartner, a leading research and advisory company in the U.S.,
has developed what it is called the Hyper Cycle of Emer- gent
Technologies11 that «provides a graphic representation of the matu-rity
and adoption of technologies and applications.» (Fig.1)
198 Sanid. mil. 2020; 76 (3)
This Hype Cycle establishes five phases of a technology’s life:
«• Innovation Trigger: The first phase of the cycle is the «launch»,
the presentation of the product or any other event that generates in-
terest, presence and impact on the media. At this stage there are rare-
ly usable products and commercial viability is not proven..
• Peak of Inflated Expectations: At this stage the impact
on the media usually generates unreasonable enthusiasm and ex-pectations
about the possibilities of technology. Some pioneer-ing
experiences may be successful, but there are usually more
failures.
• Trough of Disillusionment: Expectations are not met, be-
cause they are delayed, etc. Interest is being diluted and some
in- vestors are starting to fall. After the advertising boom of the
second phase some technologies are no longer in vogue and, conse-quently,
the media usually forget about them.
• Slope of Enlightenment: Although the media have already
no interest in the technology, some companies continue testing to
understand the benefits that technology can provide and explore
new practical applications. Some technologies begin to crystal-
lize the benefits they can bring and begin to be widely understood.
Technologies are improved with 2nd and 3rd generation products
and services.
• Plateau of Productivity: A technology reaches the «produc-
tivity plateau» when its benefits are widely demonstrated and ac-
cepted. Finally, the criteria for determining commercial viability
begins to become clear. The mass adoption of technology is begin-
ning to become a reality. Technology is starting to provide benefits.»
When we look at Digital Health Gartner’s Hyper cycle, we
find that Tele-health is already considered to be in the «Plateau
of Productivity»12. (Fig. 2)
So, world-wide, it is considered a well-established technology,
but that is not what we see, at least in Europe. Why? Maybe be-
cause it is growing as an exponential technology does.
TELEMEDICINE AS AN EXPONENTIAL TECHNOLOGY
Ray Kurzweil, a famous American inventor and futurist, says
that «the future is widely misunderstood. Our forebears expected
it to be pretty much like their present, which had been pretty much
like their past. The rapid growth of technology is actually acceler-
ating progress across a host of domains. This has led to unexpected
degrees of technological and social change occurring not only be-
tween generations, but within them»13.
Related to this is the concept of exponential growth of some
technologies. What does exponential growth mean?
Most likely, telemedicine is an exponential growth technolo-
gy. These technologies have a curious type of growth, compared
with the classic linear technologies, perfectly described by differ-ent
authors14. (Fig.3)
At first, they grow even slower than linear technologies,
which is deceptive and creates a feeling of disappointment, but,
at some point, there is a trigger that accelerates this growth like
an explosion, thus making it exponential. But, what will be the
trigger induces exponential growth for Telemedicine?
Probably it will be a combination of different things: cheap
and comfortable wearables (like stickers or decals that children
use) for the patients to send their vitals, improved communica-
Figure 1. Hype Cycle of Emergent Technologies. Available at:
https://www.gartner.com/en/research/methodologies/gartner-hype-
cycle.