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TeleHealthNews

Vol. 1 Issue 1

Welcome to the first issue of TeleHealthNews, an Internet resource for health professionals. Please feel free to pass this newsletter onto your friends and colleagues. Subscribing/unsubscribing info is at the bottom. If you would like more information than found here, check out our website at: CyberTowers

This issue is brought to you by Imagelink, a videoconferencing hardware development company. For more information about how your organization can benefit from videoconferencing tools, please contact Tom Fitsimmons at: 303-708-1280.

Table of Contents

1. Feature Article(s)
2. Politics and Policy
3. Terminology (Equipment and Jargon)
4. Active Telehealth Projects
5. Equipment and Internet Connection
6. Internet Resources
7. Telehealth Articles, Books, Journals, Reports
8. Conference and Education
9. Organizations & Companies
10. Internet Lists
11. Telemedicine Opportunities
12. Subscribing and Unsubscribing

FEATURE ARTICLE: Behavioral Telehealth
Editorial by David Nickelson, Psy.D., J.D.
(Adapted from a post to the Telehealth Discussion List)

One of the challenges facing the development and implementation of telemedicine is the delineation of a consistent set of terms to define the services being used. The following article by David Nickelson, Psy.D, J.D. suggest that the adoption of the names telehealth and behavioral telehealth are sufficient to describe the myriad of practices involved under telemedicine, while providing a consistent language that will facilitate comprehensive development of the field as a whole -Joseph M. Rudolph, M.A.

Telehealth and behavioral telehealth are the only new terms we need; they define the medium in which the traditional profession, whatever it is, is practiced. All other "tele-" terms work against acceptance of this new method of practice, and do not accurately reflect that we are simply practicing our named professions much as we always have, only with the addition of technology that overcomes distance.

One of the more fundamental problems facing the development of telehealth is defining just what telehealth is. Telehealth is the use of telecommunications and information technology to provide access to health assessment, diagnosis, intervention, consultation, supervision, education, and information to under served populations, isolated practitioners, and individuals separated by distance. Behavioral telehealth is simply the application of telecommunications and information technology to provide the behavioral health aspects of these services to the very same populations. They are blanket terms that apply any technological effort to supply information or care, from email and Internet searches at 2400 baud, to real-time, full-color video and stereo audio teleconference hookups via mobile satellite. Telehealth, and the definition provided, is both more inclusive and more accurate than a number of the somewhat problematic definitions recently proposed. The National Institute of Medicine (IOM) has defined telemedicine as "the use of electronic information and communication technologies to provide and support health care when distance separates the participants." The federal Joint Working Group on Telemedicine (JWGT), operating under the direction of the Office of Rural Health Policy (ORHP), in the recent Department of Commerce report "Telemedicine: Report to Congress," defined telemedicine as "the use of electronic and information technologies to provide clinical care." That same JWGT report defines telehealth as "a diverse group of health related activities, such as professional education, community health education, public health, and administration of health services."

These definitions pose a number of concerns. The IOM definition of telemedicine is extremely broad, and a reasonable interpretation of the functional scope of the definition seems to include any type of support or provision of health care services, including non-medical services such as behavioral assessment and intervention, or similar services delivered by non-medically trained providers. Therefore, the broad term telehealth a actually provides a better fit with the range of technology and applications that the IOM definition encompasses.

The JWGT definitions are also non-inclusive. While the JWGT definition of telehealth squares functionally with the IOM definition of telemedicine, the JWGT definition of telemedicine is troubling. The JWGT defines telemedicine as "providing clinical care." Functionally, the JWGT therefore defines "clinical services" as "clinical medical services" --inaccurate for two significant reasons. First, the broad range of clinical services provided in the evolving health care system are not solely focused on medically-based or disease -based theory, models, or interventions. Second, the term as defined does a great disservice to the bulk of the providers who currently supply most of the services on these systems, particularly in rural areas -- advanced practice nurses, social workers and other non-physician providers. Perhaps Senator Kent Conrad (D-ND), the leading congressional supporter of the development of telehealth networks, said it best in his introductory remarks to a special telehealth edition of the North Dakota Law Review (Conrad, in press):

"I have become increasingly convinced that the term "telehealth" is the more accurate description of this field than "telemedicine." Survey after survey shows health care entities all over the country use a vast array of telecommunications technology to supply a full range of health services. In many rural communities these systems are operated by a wide range of health care professionals, including nurses, psychologists, social workers, and other non-physician providers. The term telehealth encompasses this broad range of technology, services, and providers without drawing artificial and potentially harmful distinctions that will only slow the development of integrated, multi-use systems. It is in that spirit that I have adopted and use the term telehealth."

Telehealth technology is just another tool to practice what we already know how to do: undertake our professions within our scope of practice and the dictates of our ethics. If in our judgment we are outside of those boundaries when providing a telehealth service, then we have a professional duty (not a "tele-duty") to decline to provide those services. In a nutshell, telehealth is doing what we already know how to do (e.g. psychological services, social work, psychiatric services, counseling, etc.), but through a new means.

POLITICS & POLICY
Summary by David Nickelson, Psy.D., J.D.

As the application of telecommunication grows so do the legal, financial, and political issues involved with managing such a field. This is increasingly difficult when the application of such technology is being used to provide something as important as health care. The growth of the telecommunications industry and the growing use of telehealth applications make it increasingly important to stay abreast of the changes in federal funding for projects, changes in legal statues affecting such things as interstate licensure, and who is working for and against these projects.

On May 7, 1997, the FCC ruled on the Universal Service recommendations of the Advisory Committee on Telecommunications and Health Care regarding rural health care providers. The FCC released a 900+ page order including sections on distance learning and education. The FCC recently also put up a "Health" section of its website, dedicated to telehealth telecommunications. This is a great example of how interconnected health and communications are going to become in the evolving health care marketplace and the variety of organizations involved in the provision of telehealth.

The FCC provided that all public and private not-for-profit health care providers located in rural areas would be eligible to receive universal service support, not to exceed a total cap on expenditures from the Universal Services fund of $400 million. This bill will provide funds to help rectify cost disparities in internet access between rural and urban providers. For example, rural providers may be funded for telecommunications capacity up to and including a T-1 line, at rates comparable to those paid for similar services in a the nearest urban area, (more than 50,000 residents). Other examples are the provision for distance-based charges and toll-free connection to an Internet service provider or reimbursement for providers that lack toll-free access to an Internet service provider. The latter clause allows the lesser of $180 or 30 hours of Internet access at local calling rates per month.

Editors Note: As of June 27, Southwestern Bell and a small cellular provider each filed requests for temporary restraining order on implementation of the FCC Order, pending a review of filed claims for preliminary injunctions on the Order, in separate federal circuit courts. These restraining orders have likely been granted pending a meeting to combine the requests into a single circuit court, which will then rule on the merit of the preliminary injunction claims. It is not thought that these claims will harm the substance of the Order, but will certainly slow implementation.

For more information the complete FCC Order is available on-line at: http://www.fcc.gov/ccb/universal_service/fcc97157/

Terminology (Equipment and Jargon)

As the world of telecommunication technology develops so does the equipment and the language. This section will be used to help health and mental health care providers better understand the equipment and the terminology surrounding this exciting field. If you have definitions or questions about definitions please e-mail us at telehealthnews@cybertowers.com

Active Telehealth Projects

This section will provide both a listing of active telehealth projects as well as reviews of such projects. It is hoped this will facilitate the collaboration of researchers and practitioners as the field develops. If you have a project you would like included or reviewed in the next issue please e-mail us as telehealthnews@cybertowers.com

Equipment and Internet Connection

CyberTowers Professional Center, Telehealth Office

Comparative Reviews: In depth comparisons of Hardware, Software and Internet Tools

New Technology Registry for Mental Health - Free on

TopClass, free demo, adopted by the State University of New York Server software for Web Based Training

WebCT, University of British Columbia, Software to Develop Web Based Training/Courses

WINNOV Video and Audio Boards

Internet Resources

Ethics Survey for Online Psychotherapists

Psychotherapy Finances & Managed Care Strategies

US Federal Policy Issues

Psychological Tests

More Psychological Tests

CONFERENCES & EDUCATION

Promoting Standards in Telehealth Conference
July 17, 1997, Washington, D.C. sponsored by Healthcare Open Systems and Trials (HOST) & the Federal Communications Commission in collaboration with Department of Health and Human Services Office of Women's Health, Food and Drug Administration, Federal Interagency Joint Working Group on Telemedicine. For more information Contact HOST @ 202-434-4771]

The Information Connection: Implementing Effective Technologies in Healthcare
University of Vermont

University of Vermont Continuing Education

TELEHEALTH ARTICLES, BOOKS, JOURNAL, REPORTS

A Searchable index of nearly 3000 Telemedicine abstracts is available on :

Forbes "I Got My Degree Through E-Mail."

_Telemedicine: A Guide to Assessing Telemedicine in Healthcare_ National Academy Press 1-800-624-6242

"Telephone Triage-Products, Services and Successful U.S. trends and forecasts from 1996-2002", 1-800-927-8071

"Telemedicine Report to Congress " by the JWGT

Senate Bill. 385 "Comprehensive Telehealth Act of 1997," House Bill 966 "Increased Access Telehealth Act of 1997."

ORGANIZATION & COMPANIES

Arent Fox Telemedicine & Law home page

British Health Care Internet Association

DoD-Weekly Telemed, grants, policy meetings, and new technology

FCC

Federal Interagency Council on Statistical Policy- Reports from 70 US agencies

Federal Telemedicine Gateway

Georgia's Rural Health Information Clearinghouse (RHIC)

John Mitchell & Associates

NIH

NIMH

Rural Utility Service Distance Learning Loan & Grant program, RFP

Telemedicine Information Exchange

EMAIL DISCUSSION LISTS

One source of information are internet discussion lists. These lists provide forums for discussion on a specific topic or interest area. All list names are in quotations followed by the subscription address and subscription commands for the body of the messages

"TELEHEALTH" Discussion List To subscribe send email:
TO: LISTSERV@MAELSTROM.STJOHNS.EDU
BODY: SUBSCRIBE TELEHEALTH YourName

"NETPSY" Psychological Services on the net To subscribe send email:
TO: LISTSERV@MAELSTROM.STJOHNS.EDU
BODY: SUBSCRIBE NETPSY YourName

"INTA" discussion list for the International Telehealth Nurses Association, for Nurses and others interested in all aspects of telemedicine.
To subscribe send email:
TO: LISTSERV@BCM.TMC.EDU
BODY: Subscribe itna First Name Lastname

"Mental-Health-Worker" Psych Techs with Bachelors and Below
To subscribe send email:
TO: LISTSERV@MAELSTROM.STJOHNS.EDU with this in BODY: SUBSCRIBE Mental-Health-worker Your Full Name

"Poli-Psy" Political Science of Psychology/Psychiatric To subscribe send:
TO: LISTSERV@MAELSTROM.STJOHNS.EDU
BODY: SUBSCRIBE poli-psy Your Full Name

"Hospital-Downsize" closures and downsizing of psych facilities To subscribe send email:
TO: LISTSERV@MAELSTROM.STJOHNS.EDU
BODY: SUBSCRIBE hospital-downsize Your Full Name

TELEMEDICINE OPPORTUNITIES

Do you have a job opening? Do you need a job in telemedicine? Did you hear about some Grant funding for telemedicine? This section is designed for the various opportunities for individuals or organizations in the field of Telehealth. Please send all information or requests or openings to us at: telehealthnews@cybertowers.com

SPONSORSHIPS

TelehealthNews is proud to be sponsored by companies offering telehealth communication tools. To learn more about how you can become a sponsor for this newsletter, please write to Marlene Maheu at

SUBSCRIBING & UNSUBSCRIBING

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Marlene Maheu
619-277-2772
drm@cybertowers.com




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