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Telemedicine Update
Forum Explores Telemedicine's Potential
Video Link Unites Forum Participants in Washington and Rochester

In 1993, The Annenberg Washington Program introduced the Annenberg Health Communication Forum to explore the relationship between communication technology, public policy, and interpersonal communication in health and medicine. The forum, convened by Annenberg Senior Fellow Gregory Makoul, first addressed telemedicine in March 1994 at the session TELEMEDICINE AND ACCESS TO CARE: A DEMONSTRATION. During the demonstration physicians and patients at Northwestern University Medical School consulted with physicians at the Mayo Clinic via a real-time T1 cable link.

On May 19, 1995, The Annenberg Washington Program, Northwestern University Medical School, and the Mayo Clinic sponsored the follow-up forum TELEMEDICINE: BARRIERS AND POSSIBILITIES, a policy roundtable convened by Gregory Makoul and Eric Tangalos, a Mayo Clinic physician.

  • Telemedicine: Barriers and Possibilities
  • Possibilities of Telemedicine
  • Barriers to Implementation
  • Forum Speakers
  • Roundtable Highlights
  • Telemedicine-related World Wide Web Sites

  • TELEMEDICINE: BARRIERS AND POSSIBILITIES gathered six panelists to identify barriers to developing and deploying telemedicine. Via satellite, three panelists at The Annenberg Washington Program's auditorium in Washington discussed the issues with three panelists at the Mayo Clinic in Rochester, Minnesota. Government policymakers, academics, and corporate representatives participated from the audience, and Annenberg Senior Fellow Dale N. Hatfield moderated the discussion.

    Annenberg Senior Fellow Gregory Makoul began the forum by reflecting on Program Director Newton N. Minow's words to President John F. Kennedy in 1962, "Launching a communications satellite is more important than launching a man into space. The satellite launched an idea, and ideas last longer than human beings."

    Makoul reinforced the idea that, while technology from the space flights has informed the telemedicine enterprise, the key is not necessarily the technology itself but opening people's minds to new possibilities. He observed that, ironically, the myriad possibilities associated with telemedicine--simple image transmission, two-way interactive video, even robotic surgery--can be seen as barriers to its development because they make the term so difficult to define. "We first and foremost have to define the terms, define the needs, and look not only at all the sexy technologies but at the minimal technologies to meet those needs," urged Makoul.

    Douglas Perednia of the Oregon Health Sciences University offered a similar perspective: "People don't want telemedicine; they want to feel better. Unless you define your goals relatively specifically, telemedicine as a concept is too vague, and too big, and too meaningless to let you make any progress in eliminating barriers. If the people agree that what you're trying to accomplish is a good idea and that the way you're going about it will make them feel better, then you are more likely to succeed."

    In response, Eric Tangalos of the Mayo Clinic provided a basic definition of telemedicine, "Telemedicine is the delivery of health and medical services across some distance through some means of telecommunication." Armed with this definition, the speakers explored the technical, political, and interpersonal elements of telemedicine. During the forum, participants reviewed the possibilities of telemedicine and identified a number of specific barriers--some familiar and others not yet well understood. By identifying these barriers, participants accomplished the major goal of the roundtable: recognizing the obstacles--the first step toward reaching solutions.

    Possibilities of Telemedicine

    Barriers to Implementation

    Forum Speakers

    In Washington, D.C.

    Kenneth Gordon
    Chairman, Massachusetts Department of Public Utilities

    Dale N. Hatfield
    Annenberg Senior Fellow and
    Chief Executive Officer, Hatfield Associates, Inc.

    Gregory Makoul
    Annenberg Senior Fellow and
    Director, Program in Communication & Medicine, Northwestern University Medical School

    Douglas A. Perednia
    Director, Advanced Telemedicine Research Group, Oregon Health Sciences University

    Dena S. Puskin
    Deputy Director, Office of Rural Health Policy, Health Resources and Services Administration

    Eric Tangalos
    Associate Professor of Medicine and Head of the Section of Geriatrics, Mayo Clinic

    In Rochester, MN

    Margaret Houston
    Staff Physician and Assistant Professor, Department of Family Medicine, Mayo Medical School

    Randy Johnson
    Commissioner, Hennepin County (Minneapolis) Board of Commissioners

    Leo Whelan
    Legal Counsel, Mayo Foundation

    Roundtable Highlights

    System Structure

    "Proponents of telemedicine are only one of a number of groups that are interested in using a modernized telecommunications system to perform their function. The configuration of the system will be driven in part by considerations related to those other services, not solely by the telemedicine function. We need to find ways to interweave and design telecommunications into the very fabric of the medical care problems, rather than to paste it on as an afterthought or try to appliqué them in some fashion. I'm vastly encouraged that ways will be found to weave in the telecommunications structure as long as we on the regulatory side make sure that the opportunities are available at a reasonable cost."
    --Kenneth Gordon

    Meeting the Need

    "Telemedicine has to fit into the real world--it has to be needed. There are many levels of technology,
    but you have to look at what is appropriate for the situation and the area."
    --Margaret Houston, M.D.

    "We are looking for technologies that fit the affordability function and the need function.
    The future of telemedicine lies in some of the lower-tech approaches and distributive approaches."
    --Dena Puskin


    "I always come back to this as an elected official: Who's going to pay for all this? I don't think you're going to sell elected people these days on spending more money just because there will be better medical care or higher value added. You've got to convince these people that costs are going to go down or at least stay the same. I think you've got to give specific examples over and over again of how you can get better care and spend less money."
    --Randy Johnson

    "These new technologies require our rules on reimbursement, licensure, and liability to stretch. We need more research on the value of these technologies and, as the results of that research become available, we can decide how those rules should be changed to accommodate them."
    --Leo Whelan

    Using the Technology

    "Here's an analogy: You are a farmer who is used to practicing agriculture with a horse and a plow. All of a sudden, you're given a huge John Deere tractor with a whole set of equipment and a harvester combine. Now the question is--are you going to be more productive this year than you were last year? The answer is probably no because you knew how to farm with the horse and plow, and you didn't have to worry about fuel expenses and oil changes and mechanical expenses, and where you are going to put that tractor, and maybe even having the tractor run over people."
    --Douglas Perednia, M.D.


    "How global do we become in our accounting methodologies for the care we deliver? We have talked about where different "pots" of money reside. One of the things that is always involved in the health care debate is: "Who's `pot' of money are we dealing with?" Depending on how global we want to be in our cost accounting--let's say we want to include transportation costs (or the lack thereof)--we might say that these systems are very efficient right now because we don't have to have somebody hop a plane or take eight hours of their day to travel from rural Oregon to Portland to get their care. But we don't do that; the costs are compartmentalized."
    --Eric Tangalos, M.D.

    Video cassettes of the Annenberg Health Communication Forum sessions on telemedicine, Telemedicine and Access to Care: A Demonstration (33 minutes) and Telemedicine: Barriers and Possibilities (132 minutes), are available from Northwestern University Medical School's Program in Communication & Medicine, 303 East Chicago Avenue (W117), Chicago, Illinois, 60611, (fax) 312-503-0574

    Telemedicine-related World Wide Web Sites

    Telemedicine Information Exchange
    (maintained by Telemedicine Research Center)

    Telemedicine Resources
    (maintained by the University of Washington)

    Telemedicine Resources and Services
    (maintained by the University of Texas)

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