Copyright 2000 Federal News Service, Inc.
Federal News Service
April 11, 2000, Tuesday
SECTION: PREPARED TESTIMONY
LENGTH: 1323 words
HEADLINE:
PREPARED TESTIMONY OF JONATHAN D. LINKOUS EXECUTIVE DIRECTOR THE AMERICAN
TELEMEDICINE ASSOCIATION
BEFORE THE HOUSE
COMMITTEE ON COMMERCE SUBCOMMITTEE ON TELECOMMUNICATIONS, TRADE AND CONSUMER
PROTECTION
SUBJECT - "INTERNET CONTENT: ALL DRESSED UP WITH NO
PLACE TO GO"
BODY:
Mr. Chairman:
My
name is Jonathan D. Linkous. I am the executive director of the American
Telemedicine Association and provide these remarks today about broadband
deployment and telemedicine on behalf of the Association. ATA is a
non-profit membership-based organization, established in 1993, which serves to
promote telemedicine and resolve barriers to its deployment. The Association
seeks to bring together diverse groups from traditional medicine, Internet
online firms, academic medical centers, technology and telecommunications
companies, e-health sites, medical societies, government and others in order to
resolve barriers to the advancement of telemedicine through the professional,
ethical and equitable improvement in health care delivery.
Telemedicine
represents a marriage of advanced telecommunications technology and new
approaches to improving medical and health care at affordable rates. Be it
through telehomecare for homebound frail patients, remote medical support for
astronauts in space or the nation's military on the front lines of battle, or
access to comprehensive databases of health and medical information for
consumers over the Internet, telemedicine holds the promise of using
telecommunications in a direct way to improve the lives of all Americans. It is
not surprising that telemedicine is one of the fastest growing segments in
healthcare. Today, telemedicine encompasses a multimillion-dollar industry
including high-speed networks linking hospitals and clinics, remote patient
monitoring systems and e-health services available over the Internet. The
federal government alone will spend close to $300 million for
telemedicine over the next year. Private insurance reimbursements as well as
applications in managed care settings are also on the rise. Market reports
consistently predict a healthy and steady increase of 15 to 30 percent per year
in telemedicine investments over the next five years.
However, critical
to the growth and success of telemedicine is access to broadband networks. The
deployment of telemedical links to rural and suburban medical centers require
communications networks that are reliable and capable of handling large amounts
of data in a short time. In the very near future telemedicine will be used in
practically every part of the United States. In the Chairman's home state of
Louisiana, telemedicine is already used in: the state's correctional care
facilities, for a multispecialty program at LSU, for telepsychiatry in Lake
Charles, for ophthalmology exams for patients in rural communities out of St.
Francis Medical Center in Monroe, and for home care in Baton Rouge. Each of
these applications benefits from the availability of broadband technology.
I'd like to share two examples of how access to broadband technologies
can make a substantial difference in providing patient care: Teleradiology
allows medical clinics in a rural or suburban area to gain access to the
services of qualified radiologists. An X-ray or other radiological image is
transmitted to the radiologist for an assessment. For almost all radiology
services there are several images to be viewed of the area in question taken
from two or more angles. Two mid sized medical images sent at the quality needed
for rendering a medical opinion can easily consist of 5 megs of data. If
transmitted over plain old telephone lines with a normal 56 K modem this could
take almost two hours to transmit. If there are glitches in the line affecting
the initial transmission, it could require double that amount of time. For most
emergency situations, that amount of time to wait is unacceptable. For other
situations that amount of time is, at best, inefficient.
Transmission of
live video images of a quality that allows for an actual medical diagnosis of a
patient's condition requires broadband technology. Live video is required for
such applications as mental health consults, assisted surgery, emergency
medicine and even some pathology examinations. The standard frame rate for high
quality video (like seen on television) is 30 frames per second although lesser
quality may be employed with the use of image compression. Transmission of video
typically requires bandwidth speeds of anywhere from 128 kps to 1.5 mbs. For
most telemedicine services this requires more than just plain old telephone
service. Rural areas of the country without such bandwidth will continue to lack
access to many types of telemedical services. The alternative is either travel
by the patient and the patient's family to a distant location or simply doing
without health care.
Unfortunately, national health statistics show that
all too often patients in remote areas without adequate healthcare do not ever
get the care they need in order to remain healthy, productive citizens.
In March 1994 ATA testified before Congress about the need for rural
access to high-speed telecommunications infrastructure saying:
"Installation of telemedicine equipment serving rural communities would
be fruitless without adequate transmission lines and facilities to carry the
quality of video and speed of transmission required for many medical
consultations. A principal goal of health care reform is providing greater
access to health care for all Americans. Without an adequate communications
infrastructure, rural America will lose the opportunities it now holds for using
telemedicine to increase access to medical care."
There are broadband
issues with video teleconferencing, both in rural and metropolitan areas - but
both differ. Rural communities are limited in the availability of high-speed
communications networks and where available, have problems with reliability and
cost, whereas metropolitan areas are less affected. This problem has lessened in
recent years as more areas come on line with alternate bandwidth choices -
wireless (cellular, satellite) as well as terrestrial (cable, ADSL). Our members
have had problems in the past with various ISDN providers having different
"clock speeds" for their proprietary ISDN systems, such that connecting between
facilities was impossible or fraught with reliability concerns. This is less of
a problem now as ISDN development matures in this country. Reliability with the
Internet has been less of an issue and is more dependent on whether a user has
to compete with a small finite "pipe" coming into their work area, vs. slow
computers that make downloading information tedious. Again, this has become less
of an issue as technology improves for both hardware as well as bandwidth
availability.
A related issue is providing reliable and affordable
communications network to the home. As mentioned above, telehomecare is one of
the most promising new applications of telemedicine. While much can be
accomplished over voice grade telephone lines some applications require more
than just plain old telephone service. Deployment of high-speed networks to the
home via wireline, wireless or cable should be a priority in the development of
telecommunications related public policy.
Finally, I should mention the
program within the Federal Communications Commission that provides assistance to
rural health providers in obtaining access to broadband services. Congress
established the program under the Telecommunications Reform Act of 1996 to
provide improved broadband access by rural health centers. Although well
intentioned, this program has fallen far short of its potential and ATA has been
particularly critical of its implementation. However, recent improvements by the
FCC in the program create hope that the program can still be a major benefit to
rural America. Indeed, money for grantees is finally flowing and the potential
impact of the program on rural health is growing. ATA encourages Congress to
continue this relatively small yet very significant program.
Thank you.
I will be happy to answer any questions you may have.
END
LOAD-DATE: April 12, 2000 
