Beam Me Up: Telecommunications Can Improve Health Care Access for the Underserved
In 1998, the Friends of the National Library of Medicine (FNLM) sponsored a workshop focusing on issues, barriers and opportunities facing the wide-scale application of telecommunications technologies to improve health and access to care for underserved populations, including children and the elderly, the working poor, the disabled, and rural and inner-city residents.
- The one-day workshop entitled, "Bringing the Benefits of Telehealth to Underserved Populations: Barriers and Opportunities," took place on April 29, 1998, at Georgetown University in Washington. The 79 participants came from government, academia and the private sector.
The Robert Wood Johnson Foundation (RWJF) supported this project through a grant of $54,060.
Despite more than 25 major public policy studies identifying national issues relating to telemedicine, little attention had been paid to the unique circumstances encountered by special populations for whom the use of new and emerging telecommunications could increase access to quality health care services.
At the time of this grant from RWJF, several telecommunications projects were already underway with special populations. Included among them were a teleopthalmology program for high-risk inner-city populations in Los Angeles, Calif.; internet-based outreach projects for seniors in their homes; and remote cognitive therapies to assist the disabled with rehabilitation and the activities of daily living.
Although some policy issues, such as affordable rates for rural areas under new Federal Communications Commission (FCC) procedures and Medicaid reimbursement mechanisms for telemedicine, were slowly being addressed, these and other policy issues needed to be more fully examined in terms of the health care agenda for underserved populations.
This grant from RWJF supported a one-day invitational workshop entitled, "Bringing the Benefits of Telehealth to Underserved Populations: Barriers and Opportunities," that took place on April 29, 1998, at Georgetown University in Washington, D.C. It was conducted by FNLM, a nonprofit organization formed in 1986 to support and to promote awareness of the National Library of Medicine (NLM), the world's largest depository of biomedical and health sciences information. Joining FNLM and NLM in organizing and running the workshop was the Center for Public Service Communications (CPSC), an Arlington, Va., consulting firm specializing in telemedicine.
The workshop was held in cooperation with the US DHHS Office of Disease Prevention and Health Promotion, and in conjunction with the NLM's Third-Annual HII98 Conference. Both the second and the third of the HII conferences were supported by RWJF under grant ID#s 028943 and 030953. See Grant Results on these two conferences.
The 1998 workshop was the third in an ongoing series of workshops that complemented the HII conferences by focusing on particular issues with regard to the implementation of new information technologies for improved access to health care services. It was designed to help educate representatives from key public policy and constituency organizations and to bring the topic of telehealth for the underserved to national attention.
The project director has stated that holding the HII conference and this workshop together significantly enhanced the substance of both meetings, through utilizing the same content experts for both venues and allowing the invited workshop participants to attend the conference. Seventy-nine individuals from government, academia, and the private sector attended, including 15 representatives from underserved communities, whose travel was paid for by the grant.
The workshop focused on the following set of issues:
- Economic considerations, which act as disincentives to providing competitive telecommunications services in both rural and urban areas as well as for distinct populations with particular needs.
- Education and training that are needed by clinicians, allied health practitioners, telecommunications providers, and the public regarding the availability and benefits of promised services.
- Opportunities for community leadership in providing services to the underserved.
Workshop presentations by federal policymakers, clinicians, and representatives of academia and nonprofit organizations serving at-risk groups were organized to address the following topics:
- Demographics, major risk factors, and unique characteristics of the populations.
- Health care access and telecommunications technology issues.
- Public and private sector policy issues.
- Programs and applications impacting underserved populations: capacity-building initiatives.
Through their discussions of these issues, the participants identified 10 broad themes that they believed needed to be addressed:
- A broader definition of telehealth to include a wide range of both technologies and potential applications.
- A better definition of "underserved" populations to include rural as well as inner-city residents, the elderly, the disabled, many minorities, and those particularly at-risk for some conditions or diseases.
- Empowerment of individual members of at-risk groups so that they may better understand the potential that various technologies hold for them.
- The need to overcome disenfranchisement of groups so that appropriate technologies may be developed in consideration of their unique needs, including better interfaces.
- Sharing of information in "real-time" so that advances in technology may be instantly available to special groups in consideration of their needs.
- Thinking "outside the box" so that technology development and the needs of users may be meshed more closely from the onset, before technologies are deployed for the general public.
- Leveraging existing resources so that users may take better advantage of existing federal, state, and private sector development efforts as well as those of the communities in which special populations reside.
- Obtaining community "buy in" so that telecommunications projects for at-risk populations may be proactively supported by leaders and organizations that may bring to bear additional resources.
- The need for more data to support the evaluation of telecommunications efforts so that better information may be developed regarding costs, quality, and outcomes.
- A shifting paradigm with regard to health care professional education and training, so that professionals of the 21st century will be better equipped to use emerging technology tools in the delivery of care and services for special populations.
- Using these broad themes, workshop participants presented several examples of innovative uses of telecommunications technologies for at-risk populations, including:
- Interactive video in Indiana that enables teens at risk for epileptic seizure to communicate with counselors in Indianapolis.
- Electronic kiosks in Georgia schools that make information available to children at risk for asthma.
- Telemedicine in a south central Los Angeles, Calif., housing project is used to screen and treat preventable blindness in low-income minorities.
- Bidirectional video using ordinary phone lines provides spinal-cord-injury patients with needed services from a rehabilitation center.
Following the presentations of these examples, the participants identified 25 recommendations in the following categories:
- Dissemination of Information: such as distributing results from research and evaluation studies, summarizing and evaluating current projects, exploring new ways of distributing information, and establishing information-exchange programs.
- Public Policy: such as integrating federal telehealth and telemedicine programs and policies and identifying organizations to advocate for telehealth.
- Funding and Sustaining Projects: such as ensuring sustainability of projects by funding evaluations and developing and supporting joint ventures and collaborations.
- Business and Process Issues: such as measuring benefits and costs of technology for specific applications, developing and publishing business models, and developing templates and guidelines.
- Special Needs: such as creating the possibility of telemedicine for the deaf, assessing quality-of-care issues, and extending telemedicine projects to the nursing/allied health field.
A press release was sent to more than 100 trade and popular press publications. A conference report was mailed to all workshop participants as well as to interested parties who were unable to attend the workshop. The report is available on the FNLM Web site.
AFTER THE GRANT
Another workshop occurred in 1999.
GRANT DETAILS & CONTACT INFORMATION
Workshop on the Use of Telecommunications to Improve Health Care Access for the Underserved
Friends of the National Library of Medicine (Washington, DC)
Dates: April 1998 to June 1998
Keith Krueger, C.A.E.
(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)
Neuberger N, Arnheim L, Scott JC, and Krueger K. Bringing the Benefits of Telehealth to Underserved Populations: Barriers and Opportunities, workshop report. Center for Public Service Communications, 1998.
"Bringing the Benefits of Telehealth to Underserved Populations: Barriers and Opportunities," April 29, 1998, Washington, D.C. Attended by 79 people from government, academia, and the private sector. Two Presentations, four panels, and one breakout session and report-out discussion.
- John Scott and Neal Neuberger, "Introduction."
- James Simpson, Office of the Deputy Assistant Secretary for Minority Health, Department of Health and Human Services, "Luncheon Presentation."
- "Underserved Populations: Overview of Demographics; Major Risk Factors and Unique Characteristics," John Scott (moderator); Robert Glueckauf, associate professor and director of clinical training, Department of Psychology, Purdue University School of Science; Yvonne Freeman, vice president for sciences and technology, Morehouse School of Medicine; Donna Sorkin, executive director, Self Help for Hard of Hearing People, Inc.; Robert Lorence, president, Northwest Indian College, Bellingham.
- "Health Care Access and Telecommunications Technology Issues," Neal Neuberger (moderator); James Simpson, Office of the Deputy Assistant Secretary for Minority Health, Department of Health and Human Services; Jillaine Smith, senior associate, Communications Policy, Benton Foundation; Steve Downs, National Telecommunications and Information Administration, Department of Commerce; Jim McConnaughey, National Telecommunications and Information Administration, Department of Commerce; J. Michael Fitzmaurice, director, Center for Information Technology/AHCPR, Department of Health and Human Services.
- "Addressing Public and Private Sector Policy Issues," Neal Neuberger (moderator); Elliot E. Maxwell, deputy chief, Office of Plans and Policy, Federal Communications Commission; Russell E. Morgan, Jr., president, SPRY Foundation; Paul R. Young, senior executive, American Board of Family Practitioners; Dena S. Puskin, deputy assistant director, Office of Rural Health Policy, Department of Health and Human Services.
- "Programs and Applications Impacting Underserved Populations: Capacity Building Initiatives," John Scott (moderator); Mel Blackwell, vice president for industry development, Rural Health Care Corporation; Warner V. Slack, associate professor of medicine and psychiatry, Harvard Medical School, copresident, Center for Clinical Computing; M. Anthony Graham, chief of telemedicine, Veterans Health Administration, Department of Veterans Affairs; Ann Temkin, telemedicine program manager, Crawford Research Institute, Shepherd Center; Charles Flowers, Charles R. Drew University of Medicine and Science.
- "Developing Strategies for Empowerment."
- "Discussion and Recommendations," John Scott and Neal Neuberger (moderators).
Press Kits and News Releases
A press release describing the workshop "Bringing the Benefits of Telehealth to Underserved Populations: Barriers and Opportunities" was mailed on July 1st, 1998.
"Empowering Patients, Broadening Access to Care with 'Telehealth,'" in among friends, Newsletter of the Friends of the National Library of Medicine, XII(1): 1998.
Report prepared by: Heidi Sheehan
Reviewed by: Timothy F. Murray
Reviewed by: Molly McKaughan
Program Officer: Paul Tarini