This issue of Critical Care Nursing Quarterly is devoted to telemedicine. Telemedicine is the utilization of audio, video, and information technologies to provide improved or otherwise unavailable medical care from remote or off-site locations. Ninety percent of the world's population has wireless coverage. Five billion people worldwide have cell phones. In this issue, the reader is provided with a potpourri of means to improve health care with mobile technologies. Remote telepresence has been applied to many fields: psychiatry, dermatology, ENT, and even primary care. It has been used to monitor and mentor surgical procedures performed half a world away. It can be used to facilitate consultations or family meetings. While this issue is primarily dedicated to critical care utilization, the reader will also be exposed to a wider gamut of applications.

Intensive care unit (ICU) beds comprise approximately 10% of hospital beds across the country. Whether it is the "graying of America," or changes in health care availability, or ever more complex medical interventions, utilization of these beds is expected to increase. The Agency for Healthcare Research and Quality and Leapfrog have indicated improvement in survival and quality of ICU care when intensivists are involved in the management of critically ill patients. Yet, there is a shortage of physicians with intensivist training. Telemedicine is a means of expanding availability of such expertise. Similarly, there is an ever-increasing shortage of experienced ICU nurses. Telemedicine can provide a means of mentoring novice nurses and bringing that greater level of experience to the bedside.

Critical care is a multidisciplinary field of medicine. The authors of the various sections have a wide array of credentials to reflect this philosophy.

Yeo et al begin by providing the evidence base for the efficacy of telemedicine. While seeming to have burgeoned in a brief period of time, telemedicine has actually a long track record spanning several generations. Rufo, in her section, describes the hurdles required to overcome to make a "cultural transformation" to achieve acceptance of telehealth. She emphasizes that acceptance of new technology within hospitals requires a process of planned change.

The next few sections deal with various clinical experiences and utilization of telehealth, from Curry's introduction of the reader to the world of social networking to improve communication through Rincon's demonstration of her hospital's experience of highly effective implementation of tele-ICU, especially with improvement of sepsis identification and management. Joseph et al present their experience applying mobile technology to a regional trauma system. While not necessarily focusing on the ICU, the section of Meyers et al deals with their experience in establishing a statewide network in Nebraska-one of the largest, most comprehensive, and longest established systems of providing telemedicine in the United States.

Davis et al deal with establishing a newly defined area of the CCRN-E, in which nurses achieve the expertise to function more effectively in this developing field. Such certification becomes even more important as the nurses' role increases in such platforms as the e-ICU.

Rogove's section addresses the key issues needed to determine the "how to" factors that go into deciding what type of system to actually implement telemedicine for your ICU.

The final section by Reynolds, Bander and McCarthy is an overview of the various systems available for tele-ICU in existence today and what is soon to be available tomorrow. Remote systems vary from the fixed, hardwired approach to a moveable platform brought from bedside to bedside. They also describe different staffing systems both for physicians and for nurses.

In this issue of Critical Care Nursing Quarterly, we have hoped to bring you information about where we have been, where we are now, and where we may be going with telemedicine applied in critical care. We sincerely hope to have satisfactorily met this aspiration.

-Joseph J. Bander, MD, FCCM

Issue Editor