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House Commitee Explores Delivery of Emerging Medical Technologies

WASHINGTON – The health and technology professionals who convened at the Gardner Carton & Douglas law offices in Washington May 18 couldn’t have picked a better time to come together. Though probably not all of them knew it, the House of Representatives that very day passed an Interior Department budget that more than restored the Bush administration’s proposed funding rollbacks for the IHS.

The House Appropriations Committee’s narrative report made the case for “telehealth” and related emerging medical technologies. In recommending a boost in spending on health facilities in Indian country, the committee filed the following observations in reference to the IHS waiting list for tribal hospitals: “At the level of funding requested in 2007, it would take 48 years to complete the facilities on the current priority list. There are many facilities that should be added to the list now and, in 48 years, all of the IHS facilities will need to be replaced or require major renovation.”

The committee also addressed the maintenance problem at IHS facilities, including hospitals: “The current IHS maintenance budget is less than half of what is required, if you apply commercial sector health care standards. Without progress on new and renovated facilities, the maintenance backlog will grow at a rapid pace from the current backlog level of nearly half a billion dollars.”

That is the lead argument for bringing telehealth to Indian country. A variety of big-picture considerations, too lengthy to revisit here, suggest the federal government will never be able to fully meet the demand for health care in Indian country. Funding saved on health facilities would find a host of other Native-specific uses. Computer and telecommunications technologies now permit physicians to provide genuine health care, often quite advanced, at any distance from the patient and at a tiny fraction of the cost of construction and maintenance for conventional “brick and mortar” facilities. Patients also save the cost of travel, a real consideration in the long-distance locales that characterize much of Indian country.

As demonstrated at the May 18 proceedings by Don Kashevarov, president and chairman of the Alaska Native Tribal Health Consortium, a powerful model of Native-specific high-tech health care from a distance has already been established.

In Alaska’s vast geography, with 75 percent of its communities unconnected by roads to a hospital and a doctor-to-resident ratio among the lowest in the nation, federal agencies have collaborated to improve health care through a “telehealth” approach. ANTHC, the IHS contribution to the project formally known as the Alaska Federal Health Care Partnership, has served patients in 41,536 cases during seven years of operation. It has deployed some 300 telehealth “carts” to more than 200 locations in the state. Medical departments accepting telehealth cases in Alaska now include cardiology, urology, pediatrics, family medicine and trauma follow-up, among numerous others.

But another theme of the May 18 meeting was that telehealth implementation must be handled with care in Indian country. Sen. Lisa Murkowski, R-Alaska, spoke by video to remind attendees that telehealth must not come at the expense of budgeting for brick-and-mortar facilities.

Dr. Adam Darkins, chief consultant for care coordination at Veterans Affairs, where telehealth has a significant presence, offered cogent advice on the challenges of implementing telehealth systems once the visionary plans have been laid and the detailed hard work has to begin. The challenges include attracting and retaining technological personnel with the right blend of talent and dedication to follow-through.

Notwithstanding all that, the time seems ripe for progress on telehealth for Indian country. A number of laws have passed Congress that relies on high-tech applications in health care, and a number of others are afoot. The IHS has excelled in its telehealth programs, the Bush administration is heavily promoting electronic health records, Gardner Carton & Douglas houses a telemedicine law center, and the private sector is on the prowl for telehealth projects to invest in.

Paul Moorehead, a partner in the Indian Tribal Governments Practice Group at Gardner Carton & Douglas, said he hopes the May 18 session will result in a loose coalition of some or all the 30 or so attendees. The coalition’s purpose would be to build momentum for Indian telehealth issues through the remainder of the 2006 congressional session, in the process positioning itself to have an impact on policy and appropriations beginning in 2007.