NCIH Evaluation Survey Response - Comments Section Summary
Health Care
General Information
Health care expenditures and employment have increased dramatically over the last decade and have reached
a point where they occupy center stage in federal and state government as well as in business and
industry. This increase has initiated a strong response to contain and decrease costs through a
combination of increased use of managed care, fee management and operational costs reductions.
The primary vehicle used in the latter focus is information technologies.
Information technologies are becoming a key factor in the
delivery, management, and cost of health care. The applications cover administration, access, and
diagnostic procedures including computer based patient records, hospital information systems,
computer aided diagnostic tools, community health information networks, and telemedicine. Cost
reduction/avoidance, quality improvements, and health services access are the primary advantages
that are the driving forces behind the growth of health care information technologies. 
Relational
databases, network communications, enterprise and wide-area networks, desk top processing
capabilities, optical storage, and video links are some of the technologies that are supporting this
growth. A recent survey of large health care institutions revealed that administrative applications are
the focus of initial implementations with staff support services, information access, and medical
procedures rounding out the implementations.
When hospital administrators were asked in this survey what applications they were currently
evaluating that would have the greatest impact the answer was community health care information
networks and telemedicine. In telemedicine the primary applications are:
- Initial urgent evaluation of patients, triage decisions, and pre-transfer arrangements.
- Medical and surgical follow-up and medication checks.
- Supervision and consultation for primary care encounters in sites where a physician is not available.
- Routine consultations and second opinions based on history, physical exam findings, and available test data.
- Transmission of diagnostic images.
- Extended diagnostic work-ups or short-term management of self-limited conditions.
- Management of chronic diseases and conditions requiring a specialist not available locally.
- Transmission of medical data, public health, preventive medicine, and patient education.
Source: Grigsby, et.al., "Analysis
of Expansion of Access to Care Through Telemedicine", Center for Health Policy Research,
Denver, CO. December 1994.
There are several telemedicine implementations that have received national recognition. These
include:
- Medical College of Georgia Telemedicine System
- Texas Telemedicine Project
- Kansas University Medical Center Cooperative
- The Mayo Clinic - Minnesota, Arizona, Florida
- East Carolina University School of Medicine -Central Prison
- Oregon Human Services Consortium RODEO NET Project
In each of these projects information telecommunications technology is the backbone of the
implementation.
