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Editorials |

A Difference Is a Difference if It Makes a DifferenceDifference

Don Eugene Detmer, MD; Karen S. Rheuban, MD
Author and Funding Information

From the Department of Public Health Sciences (Dr Detmer), School of Medicine; and the University of Virginia Center for Telehealth (Dr Rheuban), University of Virginia.

Correspondence to: Don Eugene Detmer, MD, University of Virginia, Department of Public Health Sciences, Charlottesville, VA 22908; e-mail: ded2x@eservices.virginia.edu


Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Rheuban is an (unpaid) past president of the American Telemedicine Association. Dr Detmer has reported that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;143(1):7-8. doi:10.1378/chest.12-1751
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The systematic review and analysis of critical care telemedicine programs by Kumar et al1 in this issue of CHEST (see page 19) summarizes many of the challenges facing those who seek to learn from a review of a technologic innovation in a complex health-care environment. The most obvious issues relate to total sample size (typically rather small), missing variables (universally an issue), wide variation in costs, and, as a result, questionable conclusions that may be drawn. This is not intended as a criticism of the investigators, but rather recognizes the challenges that faced them.

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