The NCIH could save the public health system in North Carolina $783,164.94 in direct costs over the next eight years. The savings will come in additional productivity (time spent on the job), travel saved to meetings and training, and money saved on paying for substitute staff.
Direct NCIH Cost
| Initial Equipment | $ 500,000 | (grant to DEHNR from NCIH) |
| $ 250,000 | (SPH investment in 1992) | |
| Replacement Cost | $ 750,000 | (seven year average life-cycle) |
| Line Charges | $3,018,624 | (4,492 x 7 sites x 8 years) |
| Staffing | $1,960,000 | (one $35K position x 7 sites x 8 years) |
| $6,478,624 |
Direct NCIH Savings
| Time on job | $2,916,151 | (# participants x 1.5 hours x $17/hour) |
| Travel | $4,002,561 | (# participants x $35) |
| Substitute Pay | $ 343,077 | (3% of participants x $100 for substitute) |
| $7,261,789 |
Assumptions
All wages (for savings and costs) are assumed to remain constant.
Telecommunications costs are assumed to stay at their introductory rates.
10% compounded expansion of use is expected annually. (SPH has seen a greater than 35% compound increase over the past 5 years. MCNC reports a similar expansion of the usage of its network during the first 10 years.)Discussion
All PHTIN sites are training existing staff to run the facilities. Staffing costs (a $35K position at each site) are at the high end of expectations, each 10% saved in the area of staffing this highly automated network realizes a further $196,000 over the eight years.
Direct cost savings will not be seen until year 2000 due to up-front investment in equipment. This is well within the life-cycle of the equipment.
Competition and history suggest telecommunications charges will fall in real terms over eight years. (A mere 20% fall over the eight years produces a further $264,129.60 savings).Indirect cost evaluation
Beyond the direct savings are the costs of not adopting the NCIH as a mechanism for training and supporting the public health system, including the cost of maintaining an under-prepared workforce, and losing workers because of the pressures of performing in such an environment, or being hired away to other positions. If just 100 of the lowest paid workers’ performance could be improved 10% through training via the NCIH, a $300,000 return on investment per year could be achieved. This amounts to $2,400,000 over the lifetime of this evaluation. A crucial point to the success of the NCIH is its ability to give greater access to communities with the fewest educational resources.
The public health system in North Carolina is beset with turnover rates approaching 25%. Each new employee costs the system on average $20,000 to train to the required level, exacerbated by the success of the recent North Carolina economy where employment levels are so high, and workers have greater choice and movement between jobs. If the NCIH were to provide a 0.1% annual reduction effect (as one strategy among many) to this problem, $3,360,000 savings would be realized, even assuming the estimated $50,000 it might require to underwrite such training.
The indirect cost savings promises the greatest overall return, because it will contribute to the greater health of the population. A healthier population is an end in itself, but also a more productive population is able to better provide for itself and its dependents.As this experience demonstrates, there is a direct tangible benefit from the NCIH implementation in our state health care system. The availability of the statewide network can address the availability of medical care in our rural areas. As the cost for health care continues to escalate, the availability of physicians in rural areas continues to decline. A statewide NCIH can bring substantial savings to the health-care industry while increasing quality and availability.
Telemedicine is one way to address economic and demographic barriers. This approach combines telecommunications, video conferencing and medical technologies into a comprehensive delivery system. Using advanced communications technology, hospitals and medical clinics can pool talent and resources to make patient records and diagnostic information available on-line. From the high bandwidth use of computers to determine where and to what degree a cancer patient should be treated, to the lower bandwidth application of transmitting x-rays from a remote area to a teaching hospital (teleradiology), telemedicine can greatly improve the quality of health care to all residents while reducing the need for costly travel, equipment, and extensive absence from one’s family and job. This technology also cuts medical expenses by enabling doctors to confer with distant colleagues, share data or examine patients in remote locations, all without losing money to travel. It also allows medical institutions to operate effectively after downsizing by drawing on specialists everywhere.Prior to the deployment of the NCIH, North Carolina was the location for two significant telemedicine trials which employed a prototype of the network installed for the NCIH. The most widely known of the two was the VISTAnet trial. Work on the project was directed by the Corporation for National Research Initiatives and MCNC and funded by the Advanced Research Projects Agency, the National Science Foundation, BellSouth, and GTE. The VISTAnet application was a dynamic radiation therapy planning process developed at the University of North Carolina. A state-of-the-art graphics processor (Pixel-Planes 5), designed and built at the University of North Carolina, and a Cray supercomputer at MCNC in Research Triangle Park, were key elements connected through a prototype SONET/ATM network. A prototype of the Fujitsu ATM switch now used in the NCIH was employed in the network for VISTAnet. Connections to the Pixel-Planes 5 and to the Cray were at speeds of 622 million bits per second, and the network included a backbone link running at 2.48 billion bits per second.
VISTAnet allowed a radiation oncologist at UNC to develop optimum radiation treatment plans for various kinds of tumors. The Pixel-Planes 5 computer was able to generate three-dimensional representations of a patient’s anatomy in the region of a tumor. The Cray could calculate, in real time, proposed radiation dosage patterns which, through the use of the Pixel-Planes 5, could be shown superimposed on the patient’s anatomy.
The second of these two trials was the Medical Information Communications Application (MICA), a joint venture involving UNC, Fujitsu, and BellSouth. The MICA application was a remote x-ray consultation process designed to allow physicians at a remote clinic to access the expertise of radiologists at a large hospital like the one at UNC.X-rays taken at the clinic were digitized and transmitted via the prototype SONET/ATM network to an archive system located at the UNC hospital. A radiologist at the hospital and a physician at the clinic could then access the patient’s file from the archive and simultaneously view that patient’s set of x-rays on high-resolution video terminals. The consultation process was facilitated by a UNC- developed application called FilmPlane. Fujitsu TV telephones, also connected via the SONET/ATM network, allowed the physicians at each site to consult face-to-face while viewing the patient’s x-rays. MICA employed 155 million bit per second connections to the sites involved (the same speed as now employed in the NCIH).
Both of these important trials demonstrated the power of a high bandwidth ATM network when supporting telemedicine applications. Under an NTIA grant, ECU, Duke, UNC-CH, and Bowman Gray medical schools have each been involved in a pilot program to provide consultations in emergency medicine and radiology to physicians at rural hospitals using the NCIH.The UNC Program on Aging is using the NCIH to test a model for providing comprehensive geriatric services throughout a community including a local clinic and two hospitals in Northampton and Halifax counties.
The Department of Environmental Health and Natural Resources (DEHNR) and the UNC School of Public Health are using the NCIH to provide training to health workers through sites at health departments in Catawba, Cumberland, Jackson, Pasquotank and Wilson counties.East Carolina University Medical Center has been a leader in telemedicine and distance learning applications to hospitals and community colleges in eastern North Carolina.
The broadband capability of the NCIH brings teaching hospitals and Area Health Education Centers (AHEC) locations to the network. At present, Coastal AHEC in Wilmington is the only NCIH- connected site while three other regional AHEC sites are connected through the NCREN network. These two applications use interactive video to provide distance learning opportunities through continuing education and technical assistance to health professionals.Criminal Justice is the broad name given to applications that impact the dissemination of information contained within the databases of the Justice Department’s Division of Criminal Information, the Administrative Office of the Courts, the Department of Correction, and other state and federal databases. Also included in areas to be favorably impacted are the normal day-to-day operations of crime enforcement agencies throughout the state and new uses within the correctional system and the court system.
Because of the vehicular orientation of much of crime enforcement operations, the emerging technologies of the wireless communications are being explored simultaneously. North Carolina needs to be able to take advantage of the initiatives that will arise from the Federal Government’s National Crime Information Network (NCIN) 2000 and the state’s Criminal Justice Information Network (CJIN) initiatives. The National Crime Information Network 2000 initiative is a federally funded and driven series of initiatives which are designed to incorporate the newest technologies into crime prevention, enforcement, and operations. CJIN is an effort to electronically connect state and local databases that would make pertinent criminal history information immediately available to authorized law enforcement or court officials. These kinds of systems will give the field enforcement officer immediate access to whatever information is available. The appropriate information could literally result in life-saving facts if available.
In the court system, several states and municipalities have already entered into trial arrangements whereby court arraignments and parole hearings are held remotely through telecomputing hookups. Security is enhanced by the video arrangements in that the alleged perpetrator can be arraigned without leaving the secured confines of the detention facility. The cost of transporting inmates to each and every court appearance is also avoided.A real concern of prison management is medical services delivery and how to minimize prisoner transport prior to the need for such transport being determined. Two-way video conferencing can enable a physician many miles away to examine prison inmates and make "informed" decisions as to whether to transport prisoners to a more fully staffed medical unit. Substantial savings could immediately be realized by a reduced corrections personnel force necessary for the protected transport of prisoners.
Historically, Criminal Justice/Public Safety data transmissions have been short text messages or transactions requiring fast response times. With the emergence of graphical images such as fingerprint images or photographs, the need for bandwidth is beginning to grow. In the recent Criminal Justice Information Network study, the need to utilize the automated fingerprint identification system (AFIS) statewide was clearly outlined. Such usage will allow for the positive identification of individuals in a timely manner. Outlining the benefits for positive identification in a timely manner would require more space than this report allows.In the first steps to deploying such a statewide system, the Charlotte Mecklenburg Police Department, Mecklenburg County Sheriff’s Department, Mecklenburg County Court Services and the Division of Criminal Information (DCI) of the State Bureau of Investigation are working in partnership to build the cornerstone of our statewide system. In doing so, Mecklenburg County will actually begin populating the statewide database and move away from utilizing a separate localized system. Through this integration, the remaining counties will benefit from the additional county data and Mecklenburg will gain immediate access to the data from all other counties. This will position North Carolina to link with the Integrated Automated Fingerprint Identification System (IAFIS) which is being developed at the national level.
In support of the state system, live-scan fingerprint devices which directly connect to the system, and located around the state, will be used. Currently there are twelve such sites planning for connectivity to the system. From all of these locations around the state, fingerprint images will be electronically submitted to the system. As this volume grows, the need for an increased bandwidth will grow. This will increase even more as the integration continues to include photographs and other images. Couple this with the traditional text data, and the demand continues to grow.In preparation for this, DCI is working with STS to seek ways to realize cost savings available over the NCIH statewide backbone while meeting existing security requirements. As more and more nodes begin utilizing images and the demand for bandwidth increases, this will be expanded.
In terms of speeding crime investigation, North Carolina has been one of the leaders in cross fingerprinting technologies. That whole process must be accelerated and all of the Justice Department’s Division of Criminal Investigation (DCI) client base must have faster access.As part of the deployment of the NCIH, there is an emphasis on providing educational and training opportunities to the prison population. The Department of Community Colleges in conjunction with the Department of Correction is exploring how video can be used to provide appropriate classes. The NCIH infrastructure accommodates and encourages these efforts.
Other projects use applications envisioned for an information superhighway and will become part of the NCIH, such as video court arraignments being conducted between Greensboro county courts and the High Point jail.As part of a telemedicine project, East Carolina University (ECU) School of Medicine in Greenville provides health care to prisoners some 100 miles away, via a two-way video hookup with Central Prison in Raleigh.
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