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mere geography

Telemedicine capability exceeds
mere geography

The Rochester area enjoys a special position in the delivery of health care. There is a wealth of medical skill in this area, and we have more good medical institutions than do most comparable communities. Telecommunications technology, like other technologies, is having a real impact here.
“Telemedicine” is a relatively new term. A comparable term, “telehealth,” also is gaining some currency. However, telecommunications has been a critical component of health care provision for years, from the early establishment and expansion of answering services to the more recent introduction of new transmission services that can send digital images of things like X- rays and CAT scans to specialists who may be thousands of miles away.
Physicians participate in remote consultations in part only because they trust that the image that is sent over wires for review by a colleague will be as detailed and accurate as the image they hold in their hands. The growth of this activity confirms that trust.
The chairman of the Federal Communications Commission boasts of a computer- technology conference he attended this winter in which a medical-examination room in San Jose, Calif., was linked to East Carolina University via the Internet. Conference participants were invited to seek medical examinations from 3,000 miles away, and a hundred or so did. What was startling was the extraordinary result that emerged. Some 15 of these hundred were found to have serious, previously undiagnosed medical problems, including diabetes, hypertension and an eye tumor.
This invites a number of questions. What is the real potential of telecommunications in health care? Maybe we have not even scratched the surface. While many anticipate that rural, inner- city and homebound people can benefit greatly from telecommunications technology, there is far more potential here than that. If time is life as well as money, telecommunications can increase the percentage of lives saved in many areas, from trauma centers to routine contacts.
Can equipment that is underused in some health care facilities be linked to facilities without such equipment, to assist patients and economically benefit both facilities? If telemedicine exchanges can be encouraged for patients that have recognized medical problems, what is the potential for preventive health care?
Locally, the bricks and mortar of a St. Mary’s or a Genesee hospital could be supplemented by–or sometimes give way to–a network of small, community- based facilities in which telecommunications provides the unifying medical vision. As distance becomes increasingly meaningless nationwide, there is no reason why the specialized cancer-treatment capabilities of a Strong Memorial Hospital cannot be exported to either northern Kentucky or northern Ontario.
Conversely, there is no reason why one-of-a-kind input from a Duke or Johns Hopkins university cannot complement the unique TLC that one gets at Park Ridge or Highland.
A number of these initiatives already are under way around Monroe County. More broadly, can U.S. medical expertise (including Rochester expertise)–already sought out in many emergent situations around the world–become established as a broader service sector in which our medical knowledge is exported to other countries via technology? I think that is inevitable. As our population ages, health care spending is expected to continue to rise, to roughly 18 percent of GDP within the next eight years.
There are activities under way that have been successful in controlling some of this growth, but there also is some recent evidence that the leveling trends may have been temporary and that the low-hanging fruit in medical cost control has been plucked.
Can telemedicine help address some of the remaining opportunities, too? To me, the Internet’s greatest value is as an information resource. Despite whatever gripes one has about government, our government’s initiatives in making key information available online is a remarkable confirmation of what democracy can deliver. Health information is no exception. Look, for example, at the federal government’s Healthfinder site (www.healthfinder.gov) for a multitude of ties to consumer health information.
There already is significant evidence that in some areas of the country tele-medicine can save dollars. Many Midwestern practitioners are using telemedicine time to replace windshield time for consultations. Even if a patient has to go to a remote facility to establish the connection, the savings potential is real. Accessible data bases of diagnostic resources can lower the learning curve for practitioners who have limited exposure to certain medical conditions, can reduce the likelihood of errors and can expedite treatment. All of this results in lower costs.
The legislation enacted last year also is beginning to have some impact on the role of telecommunications in health care. Last year, Congress bundled health care-related issues under the broad “universal-service” umbrella, and mandated that federal and state regulators consider the extent to which specific telecommunications services can promote the public health. These regulators also were empowered to adjust their policies over time to ensure that emerging special services needed by health care providers can be covered by universal-service policies.
Most of the focus of the new law in the health care area is on rural health care delivery. Public and non-profit providers of health care in rural areas are ensured that the rates for telecommunications services they need will be reasonably comparable to the rates that are charged for those services in urban areas. To achieve that, a carrier that faces unusual cost differences in providing service to rural health care providers will be permitted to seek financial support to cover that difference.
Finally, as services change, these regulators also are authorized to establish rules that enhance access to advanced telecommunications and new information services for health care providers, and to define circumstances in which rural health care providers can get further assistance.
A comprehensive report from the secretary of commerce on patient safety, health care delivery, quality and efficiency–and a number of other issues related to telemedicine–was filed with Congress at the end of January. The specific policies in this area are expected to be established this coming week, with some additional targeting to take place later in the year.
The January report will be a major source of information for these decisions. The FCC also gathered input from participants in telehealth programs in 35 states, and from providers with more than 900 telemedicine sites.
At least two actions are likely to occur. One is a leveling of long-distance charges for access back and forth among the defined set of rural providers: hospitals, community health centers, rural health clinics, local health agencies, and teaching hospitals and medical schools. The second is a program designed in some way to promote Internet access for health care-related activities. In addition, one can expect that there will be pressure to establish standards for equipment used in telemedicine.
Over time, this will contribute enormously to cost savings. And don’t think that these standards will be limited to pure telecommunications equipment. There is no reason why an MRI machine or a kidney-dialysis machine cannot also be a communications device. There also is no reason why standards will not emerge for administrative mechanisms–promoting things such as secure medical-file transfer–so that physicians can more efficiently deal with billing, insurance companies and employers’ health plans.
I count the time for this activity in terms of months, not years. The real arbiter of costs here will be the health care facilities themselves. It would be a real mistake if the discounts or other cost support that medical facilities receive was merely redirected into heating oil or roof repair. The saved dollars need to be used in doing what Congress intended: building better networks for the users of medical services, and ultimately improving the public health.
(Martin McCue is corporate vice president of planning and legal services for Frontier Corp.)


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