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HIMSS invests in telehealth as e-health wrestles with future


HIMSS invests in telehealth as e-health wrestles with futureFirst annual meeting highlights real-world appsAmid all the talk about e-health and the Internet's inevitable role in healthcare, telemedicine has been playing the tortoise to

HIMSS invests in telehealth as e-health wrestles with future

First annual meeting highlights real-world apps

Amid all the talk about e-health and the Internet's inevitable role in healthcare, telemedicine has been playing the tortoise to electronic medicine's hare (see related story, page 8). As investors and venture capitalists swooned over the financial potential of e-healthcare this year, the hundreds of telemedicine projects in place worldwide have been steadily gathering quantitative data that demonstrate how existing computer and communications technologies can improve the delivery of healthcare at even the most remote locations.

But telemedicine has long suffered from a lack of notoriety, not to mention financial backing. Broad-based adoption of traditional telemedicine has been impeded by a number of factors, including regulatory difficulties, reimbursement problems, and the reluctance of the medical community to embrace new technology.

This scenario could change, however, with the help of such organizations as the Health Information and Management Systems Society (HIMSS). Working with University of California, Davis, Health System, HIMSS cosponsored Telehealth 2000 in Los Angeles Oct. 31-Nov. 3. The three-day conference, which is expected to become an annual event, was designed to showcase innovations and practical solutions in telehealth today and to provide a forum for healthcare providers, consultants, executives, and technologists to trade tips gleaned from their real-world experiences. HIMSS organizers were inspired to cosponsor the event after a special telehealth issue of their Journal of Healthcare Information Management generated a surprising amount of response from readers, according to Rosemary Nelson, chair of Telehealth 2000 and vice chair of the HIMSS telehealth committee.

"HIMSS has done some telehealth workshops in the past on a smaller scale," Nelson said. "But we see interest in telehealth growing among our members."

Even so, the conference attracted only 280 or so attendees and a handful of exhibitors, despite some top-name speakers, well-organized workshops, and free ice cream (courtesy of Ben & Jerry's co-founder Jerry Greenfield, who gave the opening keynote address). The sessions were organized around four themes: telemedicine as a business, international and cultural issues, public policy, and operational considerations. The overriding message was that telemedicine continues to prove its viability as a means for bringing healthcare to underserved populations. Its proponents are as convinced of its inevitability as e-health's supporters are of the Internet's role in revolutionizing medicine.

"It is just a matter of time before healthcare delivery is radically transformed by teletechnology," said Dr. John Parker, who oversees the U.S. Army Medical Research and Materiel Command. "The healthcare delivery system of the future will be free of the structural confines of today."

General Parker emphasized that the U.S. Armies Medical Department is committed to supporting telemedicine and, in fact, is spending $5 million on telemedicine-specific projects this year. These projects include the Personal Information Carrier, a smart card designed to serve as the foundation for a mobile medical record; the WIN-T (Warfare Intelligence Network-Telemedicine) project; the Internet Tumor Board of the Pacific; and the Healthcare Complex Model, which is intended to facilitate the planning of teletechnology deployment.

The biggest barrier to widespread adoption of telemedicine is no longer technical but rather behavioral in nature, according to Parker. He maintains that who pays for it, and how, should be less of an issue than ensuring that the technology is used to provide care to anyone who needs it, worldwide.

"We need to realize that telemedicine is a vehicle, not an end point, and that it transcends cost analysis," he said. "The changing face of medicine is a behavioral phenomenon, and we need to use available technologies to empower others to deliver healthcare."

Still, several policy-related barriers also remain, particularly in the U.S. Reimbursement continues to be a fundamental issue, largely because so many telemedicine programs are not able to wean themselves completely from government or grant funding, according to Dena Puskin, director of the federal Office for the Advancement of Telehealth and a member of the congressional Joint Working Group on Telemedicine. The OAT alone has given out $20.5 million in grants this year and is supporting 60 telemedicine projects.

"We often ask our grantees, 'What are you going to do to sustain this program after the funding goes away?'" Puskin said. "But the truth is, certain sites will always need some funding."

She noted that the successful programs are those that are able to demonstrate that telemedicine adds value to and is consistent with current practice. Those that fail are often the result of poor planning and an inability to follow through on the "value add."

"Telemedicine isn't just consultations-it is showing expertise and providing service," she said. "Success depends on good planning, but often there is a lack of realistic assessment of need."

Proper planning and a clear understanding of the impact of new technologies, not just on personnel but on existing concrete and wire infrastructures, are critical to the success of a telemedicine installation, according to Mike Severns, director of facility services for Sparling Electronics and Consulting in Seattle. His presentation, "Integrating Technologies and Talent in Healthcare," pinpointed some of the more practical realities that are often overlooked by systems developers and even architects who are trying to plan for healthcare's electronic future.

"I believe you can build an infrastructure that can last 15 years, with good planning," he said. "But too many designers of healthcare do not understand the technology impact and infrastructure needs."

Those needs are changing rapidly, Severns said. In the not-so-distant future, hospital infrastructures will need to support wireless technologies, standards, and materials conducive to both RF and IF technologies, and the migration of many health-related services into the home.

"We need to use technology to create an environment that promotes and complements healing," Severns said.

In the long run, the Internet appears to represent the greatest opportunity for telemedicine-both traditional and otherwise-to realize its full potential. A new report from Insight Research, "Healthcare and Telecommunications, 2000-2005," argues that broadband telecommunications services for hospitals, physicians' offices, and home healthcare will account for more than 100 times more revenue than traditional telemedicine (such as teleradiology and teleconsultations) by 2003.

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