| Health |
TOP Update: Vol 3, No. 3 |
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Telemedicine increasingly is accepted as a way to bring medical care to people in rural areas that don't have enough doctors. But a TOP-supported project in Kansas City, Kansas, is showing that it may be equally helpful in urban areas. In the process, the project is shedding new light on whether doctors and nurses can deliver the same quality of care electronically as they do when they see patients in person.
Tele-Kidcare, as the project is known, uses video conferencing technology to link doctors at the University of Kansas Medical Center with school nurses' offices in 11 nearby elementary and secondary schools. Besides talking with kids and their parents, doctors can engage in real-time audiovisual conversations with school nurses and other school officials. And with help from the school nurses using electronic stethoscopes and otoscopes, they can listen to heart and lung sounds and examine ears, noses and throats.
The project arose from a recognition that geography isn't the only barrier to medical care for low-income families. Many children in inner-city neighborhoods of Wyandotte County, Kansas, are not receiving adequate medical care even though they live near the University of Kansas Medical Center. Some families may hold back because they don't have health insurance; fully one-third of the families served by Tele-Kidcare lack insurance. Other families may be overwhelmed by the everyday demands of their jobs; the median household income in the county is 16 percent below the state average, and many of the county's low-income parents cannot take paid leave from their jobs to tend to sick children. There also are language barriers; Wyandotte County has a large Hispanic population, including many people who do not speak English. And there may be cultural factors as well. "The University of Kansas is a big, confusing place," notes Kathy Archer, the school nurse at M.E. Pearson Elementary School. "I'd be intimidated trying to find my way around it myself, especially if I couldn't speak English."
If families don't come to the medical center, officials at the University of Kansas reasoned, then the medical center would have to come to them. And the best place to find children is school. While it would be impractical for doctors to travel to each school in the area, video conferencing made it feasible for them to visit numerous schools electronically.
By all accounts, the project is working. Tele-Kidcare was honored this year by Models That Work, a public-private campaign that identifies new and improved primary and preventive health-care delivery sites. And the state of Kansas was sufficiently impressed to allocate $250,000 to expand the project to three additional sites during the coming year.
Gary Doolittle, director of the Center for TeleMedicine and TeleHealth at Kansas University Medical Center, says low-income parents find it easier to come to the school nurse's office than to the more imposing medical center. "The nurse knows their kids and their kids' siblings," he says. "This is a trusted mechanism for these families to enter the health system." Children are more comfortable seeing the doctor via the nurse's computer, too. "Kids are not afraid of the doctor in the nurse's office," says Archer. "It is one of those comfy places; I don't give out grades or do discipline, I don't have a waiting room and I don't give shots."
Archer is convinced that fewer children are falling through the cracks of the health-care system now that the telemedicine project is in place at her school. Previously, when she saw a child with a medical problem, all she could do was refer the child to a doctor. She had no way of ensuring that the parent would follow up. But now, the consultation occurs in her office (parents are asked to sign consent forms, and are urged to come to the school for the sessions). What's more, kids generally see the doctor almost immediately after the nurse detects a problem. By contrast, it usually takes a day or more to schedule a visit to a doctor's office.
Some skeptics doubt that doctors can deliver the same quality of care via telemedicine than they can through traditional face-to-face consultations, but doctors who have used the Kansas system say it actually has some advantages over office visits. "I can get a better view of what I'm interested in than I do in person because it's magnified by the computer," says Pam Shaw, a pediatrician who has used the system to treat children for ear infections, strep throat, rashes and other such afflictions. Drs. Doolittle and Shaw see a particular advantage in using telemedicine for psychiatric consultations. When a child with behavioral problems is referred to a psychiatrist, the doctor typically visits just the child and the child's parents. But Tele-Kidcare makes it easy for the psychiatrist also to hear from the child's teacher, the nurse, the school psychologist and others who can present a more complete picture of what is happening in the child's life. In the process, all these people also can learn in the process how they can contribute to finding a solution. Despite such advantages, telemedicine still isn't universally accepted. In Kansas, for instance, health insurers will only cover telemedicine visits in areas officially designated as having a shortage of physicians. Telemedicine projects like Tele-Kidcare could change that. But to do so, they will have to demonstrate that they can match traditional office visits both in effectiveness and cost. There is reason to believe they can make a strong case; experts widely agree that earlier detection and treatment generally produces better results and reduces the number of serious cases that wind up in emergency rooms, where treatment is very expensive.,br>
Tele-Kidcare is currently engaged in an economic analysis that could shed light on the relative cost of telemedicine. At the same time, doctors are conducting formal studies on the effectiveness of Tele-Kidcare in treating kids with acute medical problems, Attention Deficit Hyperactivity Disorder (ADHD), and depression. The results of these studies are eagerly awaited and will be closely watched. More information about Tele-Kidcare can be found on the project's World Wide website: www2.kumc.edu/telemedicine/telekid.htm. | ||||||||||
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When a powerful thunderstorm suddenly burst over portions of
Pittsburg County in Oklahoma one day last fall, Brent Young was
prepared. Young, the county's emergency management director, had
been watching detailed radar images on his computer that showed
the storm swelling to the west. The Oklahoma Climatological Survey
at the University of Oklahoma in Norman, which provided the radar
information, soon reported that the storm was dumping rain at a
rate of six inches per hour. Young could tell from the storm's
intensity and direction that a particular bridge in his jurisdiction
soon would be threatened by rising water. So he alerted the county
sheriff, who promptly put up barricades to ward off traffic.
Several hours later, the 100-foot wooden bridge was washed downstream and
crushed, but thanks to the timely precautions, nobody was hurt.
Young is part of an innovative project that is putting real-time
weather information into the hands of local emergency officials.
The project, known as OK-FIRST (Oklahoma's First-response Information
Resource System using Telecommunications), has been operational only
since last fall, but already it is drawing rave reviews from local
officials.
"OK-FIRST is the best thing to come along since
electricity," says Kary Cox, the director of emergency management in
Bartlesville, OK.
The Oklahoma Climatological Survey launched
OK-FIRST to open a bottleneck that was jamming the information
superhighway. On one side, the National Weather Service and a
network of state radar stations known as Oklahoma Mesonet were
producing more — and better — meteorological data than
ever before.
But in Oklahoma, as elsewhere, little of this information was
finding its way into the hands of public safety officials in time
for them to use it to protect lives and property, notes Dale Morris,
assistant director of OK-FIRST. With a 1996 grant from TOP, the
OCS set out to link 32 civil defense offices,
850 fire departments and 700 law enforcement agencies to this rich
lode of information. OCS provided computers and basic training in
how to interpret meteorological data. The local agencies got
Internet connections via OneNet (a communications network operated
by the Oklahoma State Regents for Higher Education) and OLETS
(the Oklahoma Law Enforcement Telecommunications System).
As a result of the project, local emergency officials now can watch
radar images track storm systems as they occur. They can retrieve
data showing rainfall, potential hail and flooding hazards, and
current wind speed and direction virtually anywhere in the state.
They also can tap into a wealth of data to assess fire dangers —
including indices showing how intense fires will be if they erupt
and how they might spread given wind speed and direction, humidity
and temperature.
Emergency managers are very enthusiastic. "It
definitely has been an asset to our city," says Galen Kitsch,
director of emergency management and emergency communications for
the City of Moore, OK. In the past, Kitsch depended on commercial
broadcasters for weather reports, which often weren't sufficiently
timely or didn't focus on his town. Now, Kitsch gets whatever
information he needs whenever he needs it. When the weather gets
bad, he alerts public-works officials so they know when and where
extra road crews might be needed. He also notifies officials whenever
heavy rains threaten to place extra demands on the city's
waste-water treatment facilities.
The biggest pay-off from OK-FIRST
may come during the summer months, which bring thunderstorms and
tornadoes. In the past, the typical emergency-preparedness official
in Oklahoma relied for information on a telephone connections to the
National Weather Service and "spotters" who would go out in the
field and report where storms were moving. Now, rather than wait for
storm warnings from the weather service, local managers can see
radar images at the same time NWS personnel view them. Terry
Durborow, emergency management director for the City of Miami,
OK, says the system gives him a 30- or 40-minute head start when
storms threaten his town. "I can make better preparations," he
says. "That makes the difference between flying by the seat of your
pants and being able to be on top of the situation."
OK-FIRST hasn't
eliminated the need for spotters. But with radar images to guide
them, public safety officials can deploy spotters exactly where they
are needed. They also can warn spotters to get out of the way when
storms start bearing down on them. In addition, local officials say
OK-FIRST also helps them decide when not to call out spotters or
order citizens to evacuate areas threatened by bad weather; that
helps preserve good relations with spotters, who almost always are
volunteers, and with families, who may resent being rousted from
their homes unnecessarily.
National Weather Service officials are
among OK-FIRST's biggest fans. They say local officials now make
fewer calls to the federal agency for routine information and
weather updates, freeing weather service officials to concentrate
on the most pressing problems and to give more attention to local
officials who face the most serious weather problems. "The old
adage, `A picture is worth a thousand words,' really applies," says
Steven Piltz, warning coordination meteorologist in the weather
service's Tulsa office. The NWS currently is developing its own
new system for communicating with emergency managers, and Oklahoma
will be a test site. "OK-FIRST is showing us the way," says Jim
Purpura, warning coordination meteorologist for the NWS in Norman,
OK. More information about OK-FIRST can be found on the project's World Wide website: radar.metr.ou.edu/OK1/OK1.html. The OCS web site is www.ocs.ou.edu. | ||||||||||
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Lifelong Learning and the Arts |
TOP Vol 1, No. 3 |
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Last year, a group of public broadcasters joined forces in a new
kind of network that "cybercast" radio programming the likes of
which Americans rarely, if ever, get to hear anymore. Broadcasting
may never be the same. For six weeks, the group of 19 broadcasters
treated their audiences to radio dramas featuring actors like Walter
Matthau and Lauren Bacall, a five-part series of cowboy poetry and
western music emanating from the Rocky Mountains, and performances
by Hawaiian singing sensation Keali`I Reichel.
Listeners could hear newscasts by a Seattle satire company called
Rewind, tune into the National Black Arts Festival in Atlanta, or
hear the 16th annual early music festival from Utrecht, Holland.
They could listen to the United States Air Force's 24-voice Singing
Sergeants chorus in Washington, DC, or go live to the Minnesota
State Fair where Garrison Keillor interviewed Minnesotans on what
it takes to be a native of that state. They could hear jazz at
festivals in Virginia and Philadelphia, or listen to world music
performances by a Russian bluegrass group, a traditional Irish
female band and Spanish musicians.
All this and more came to people's households via a medium that
blurs the lines between radio and television. The audience
"listened" with their computers — in the process receiving not
only sound but accompanying graphics, text and links to related
Internet websites. What's more, unlike traditional broadcasts,
these programs are still available to anybody with a computer and
Internet connection.
Artsfest was produced by the Global Public Telecommunications
Network, a group of 19 public broadcasting stations assembled by the
Soundprint Media Center in Laurel, Maryland, with a grant from
TOP. The Corporation for Public Broadcasting provided funds to help
create the programming. The goal: to assemble a national audience
for grassroots cultural offerings that rarely reach the public via
the mass media.
The technology to send audio messages over the Internet has existed
for some time. But GPTN was designed to overcome two problems that
make it difficult for local programmers to reach a broader audience
with this new technology: the lack of adequate capacity to deliver
audio programming to large numbers of "listeners," and the
difficulty of finding a national audience for the kind of local
offerings featured during Artsfest. Because audio data requires
substantial bandwidth, the public radio partners that joined GPTN
each could transmit only 50 to 100 streams of audio at any given
time. So GPTN created "mirroring" software that enables stations
to duplicate their programs on each other's servers. Any time a
particular server is experiencing such high traffic that it has
no more capacity, users are automatically switched to other servers
on the network. With this system, GPTN could deliver 800 streams of
audio simultaneously during Artsfest.
And that was with just 10 "hub" stations. The capacity of the
network could grow exponentially if the roughly 450 public radio
stations around the country all joined. And it could get bigger
still: television stations and any number of non-broadcasters such
as schools, libraries, public-interest groups, or other like-minded
institutions also could join the network either as original
programmers or transmission hubs.
Since each of the public broadcasting participants is well-known
in its community, the network also enabled participating stations
to find receptive listeners far beyond their traditional geographic
territories. "We showed that very small communities and very rural
communities can be equal players when it comes to providing public
access and distribution of programming," says Moira Rankin,
president of the Soundprint Media Center.
Rankin noted, for instance, that WOUB AM/FM, a small radio station
in rural Athens, Ohio, is using the network to become a hub for
statewide news services. Similarly, WABE-FM/TV in Atlanta used the
network to "broadcast" an African-American arts festival that was
keyed to the 1996 Olympics, offering the world a different
perspective on an international event than what was available over
the mass media.
For the listening public, this new technology promises to bring
much more diversity in programming. Currently, high costs force the
conventional mass media to emphasize programs that will attract
large numbers of listeners. But Internet-based audio programming is
far less expensive; to join the network, a station would need a
server that could cost as little as $5,000 or $10,000 and a T-1 or
even a lower-capacity transmission pipeline. As a result, Rankin
sees opportunities to bring audiences radio programming they rarely,
if ever, hear — such as radio drama, new singer-songwriters,
regional musicians, more jazz, folk and ethnic music; poetry, and
other kinds of specialized programming.
But will people "listen" to their computers? Soundprint added
text, graphics and Internet links to its Artsfest offerings partly
because it assumed that most people still expect to use the Internet
visually. According to Rankin, the results were encouraging.
"Listeners" typically stayed with programs for 20 to 25 minutes, she
says.
Soundprint currently is exploring how to follow up on its
Artsfest success. But as yet, the network has not yet moved beyond
its experimental status. Production costs remain a difficult issue.
Moreover, the network needs some kind of coordinating body if it is
to become more permanently established. Rankin says Soundprint is
willing to play that role. Stay tuned.
Artsfest's archives can be found at
www.artsfest.org.
Soundprint's website is
www.soundprint.org.
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| Health |
Vol. 2, No. 1 |
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The middle-aged mother of three had a straight-forward question, but
the answer could profoundly define the future for her entire family.
Her husband had been diagnosed as having Huntington's disease, and
she wondered whether her children, all in their 20s, also would
suffer the affliction.
She turned to NetWellness, an online service
based in Ohio that offers users an opportunity to consult experts
about a wide variety of health questions. Soon, a response to her
anonymous query appeared from Anne Matthews, director of genetic
counseling and family studies in the Department of Genetics at Case
Western Reserve University's school of medicine.
The incurable
disease, which typically manifests itself in middle age and is
associated with loss of motor control, psychological changes and
dementia, is inherited and there is a genetic test for it, Matthews
said. But, she added, whether to take the test is a very difficult
decision that depends on each individual's circumstances. Matthews
then referred the woman via hyperlink to the Huntington's Disease
Society of America, whose website explains, among many other
things, the pros and cons of undergoing genetic testing for the
disease.
"This is a good way for us to get to the general public and
educate them about issues like these," says Matthews, one of a
growing number of doctors, nurses and other health-care professionals
who respond to questions from the public in a popular NetWellness
feature called "Ask an Expert." NetWellness, a partnership between
the University of Cincinnati, Ohio State University and Case Western
Reserve, is using computer networking to bring together medical
experts and the general public in ways that enhance health. In the
process, the project is addressing two issues that mar the emergence
of the Internet as an important new tool for promoting health: the
threat of information overload and the uncertain quality of much
information available over the World Wide Web.
With NetWellness,
experts at the three universities filter the information
and present it in packages that the lay public can both
understand and trust. As USA Today put it last August, "The value
of consumer health information on the Web increases a good bit
with the addition of NetWellness."
It is, by now, widely
recognized that the Internet has put almost unimaginable amounts
of information at the fingertips of the general public. There
are at least 10,000 health-related websites, and Medline,
the National Library of Medicine's premier online database,
contains citations and abstracts from over 3,900 biomedical
journals published in the United States and 70 foreign
countries. But much of that information is of little use to
everyday people. A recent Medline search for Huntington's
Disease, for instance, turned up 4,421 documents, including
many with titles such as this: "Atypical Rigid Form of
Huntington's Disease: A Case with Peripheral Amyotrophy
and Congenital Defects of a Lower Limb."
NetWellness offers
its readers plenty of information — including 25 electronic
books licensed by publishers, 340 health magazines and journals,
as well as access to Medline and other outside databases. But
the 1994 TOP grantee is decidedly more user-friendly. Under
"Health Topics," users can find easily readable sections on
specific diseases or conditions, as well as broader health
issues ranging from aging to women's health. They can click on
"Hot Topics" to read reports directly from scholars at the
three sponsoring institutions; recent entries include an essay
by the co-director of the Cincinnati Drug and Poison
Information Center debunking "dangerous misconceptions"
about over-the-counter drugs, and the findings of a survey by
the University of Cincinnati Institute for Policy Research
showing serious gaps in public understanding of risk factors
for stroke.
NetWellness also gives users access to five
leading health news websites. And "Ask An Expert" adds a
personal touch, enabling users to pose questions directly to any
of 27 teams of medical specialists (an offering that soon will
grow to 40 teams). "Medical knowledge is so vast that it is
logical to specialize, but society is trying to limit public
access to specialists," says Margery Gass, associate professor
of obstetrics and gynecology at the University of Cincinnati
College of Medicine. "We give people access to specialists."
Reliability is a high priority at NetWellness. Before linking with
outside websites, teams of staffers assess them according to
criteria developed by a group of health-care providers, web
designers and consumers known as the Health Summit Working Group.
Medical experts at the three universities then evaluate the sites
that survive this test. "We place a premium on the quality of
information we provide," says Stephen Marine, associate director
of the University of Cincinnati's Medical Center's Academic
Information Technology and Libraries.
NetWellness has persuaded
many people and institutions of its value. The State of Ohio has
supported NetWellness to the tune of about $1.3 million over the
last two years, and it is expected to continue backing that
project at that level or higher in its next biannual budget. The
Ohio Public Library Information Network offers the service,
including some licensed texts that are not available to Internet
users, in library systems serving about 780 communities.
NetWellness is working with a number of schools to enlist high
school students in developing health information for teens. The
Health Foundation of Greater Cincinnati has given the project a
grant to develop a special section on health issues for minorities.
And, oh yes, the NetWellness website gets about one million hits
per month from all around Ohio, the U.S. and the world.
The web
site for NetWellness is
www.netwellness.org.
The Health Summit Working Group has a website at
hitiweb.mitretek.org/hswg/.
The Huntington's Disease Society of America's website is
www.hdsa.org/.
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Lifelong Learning and the Arts |
Vol. 2, No. 2 |
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Set aside your old assumptions about museums and schools, and about
art and technology. Zeum, a new arts and technology center in
downtown San Francisco, is rewriting the book an all four.
While museums generally have been, at most, an occasional field-trip
destination for school groups, the flashy new San Francisco
Redevelopment Agency project is developing unusually close ties to
Bay area classrooms. And while many of today's parents grew up
assuming that technology was the antithesis — perhaps even the
nemesis — of art, Zeum consciously melds the two. The
combination is highly collaborative; visitors to the facility's
exhibition gallery or its 200-seat theater can view works created
jointly by renowned artists and Bay area teen-agers. It also is
very much hands-on; rather than simply viewing other people's art
works, students create their own art using traditional or digital
easels, clay-modeling tables, a puppetry room, a fully-equipped
movie production lab or a computer lab with multimedia workstations.
If you find it difficult to wrap your mind around the concept, don't
worry. From its location atop the Moscone Center's southern
convention hall to its unique name, Zeum is breaking the mold.
Those who have seen the unique facility struggle for terms to
describe it. Laura Evenson, a writer for the San Francisco
Chronicle, put it this way: "Think the Guggenheim Museum meets
the Starship Enterprise, but on a smaller scale."
All the
pyrotechnics serve serious educational purposes. "Our goal is to
bring art-making experiences, including use of new tools and old
tools, to youth and teachers," says Marie Sayles, Zeum's education
coordinator. In the process, she says, Zeum aims both to encourage
self-expression and to teach students technology skills that will
serve them well in the job market. "This is a museum that requires
time, commitment and a serious attention span," says Laura Reiley a
writer for the Palo Alto Weekly. Zeum's founders were eager to
enhance the program's educational value by reaching directy into
classrooms.
That's where TOP entered the picture. With its assistance, Zeum and
a group of private partners established high-speed connections
between the production lab and a group of six area elementary and
secondary schools. Each school also received a "digital toolkit"
consisting of a audio-visual camera, a Hi-8 camera, a digital
camera, and a digital audio tape-recorder. Students use these
tools to collect images, sound clips and video clips from their
communities. Then, they send these materials via the Internet into
Zeum, where they produce their own movies or other art works.
Though Zeum only opened in October 1998, the TOP-supported effort already has spawned a number of school projects. High school students from one school are producing videoclips, claymation and other presentations based on the myth of Persephone and Demeter. Other high-schoolers are using digital cameras and computers to create their own CD covers. A group of middle-school students with special learning challenges are writing and illustrating stories about dreams. Fourth graders from a culturally-diverse school are collecting information on their native cultures and comparing them to their lives in San Francisco. In May, these same students plan to take digital cameras and a laptop computer with them on a week-long field trip visiting the Tuele River Indian reservation in central California; they will report back to their classmates on the school web page.
Zeum's experience has underscored some verities about education and technology. First, as Nintendo and Sony have long demonstrated, many kids have a natural fascination and comfort with technology. Second, the importance of training cannot be underestimated; Zeum started introducing its technological tools to teachers long before opening its doors to the public. Third, curriculum should govern the use of technology instead of the other way around. While Zeum initially anticipated that all students in the program would make movies, teachers have moved more cautiously, initially concentrating on less ambitious applications while building confidence.
Zeum also has demonstrated the importance of generating public
support for technology projects — especially ones that differ
from what most people have experienced. Even before opening its
doors, Zeum began operating in a "digital garage." It assembled
teams to scrutinize its proposed advertisements. It worked with
radio stations that target young listeners. In addition, it recruits
student participants in its projects from community agencies and
schools. And it pays student interns to serve as docents although,
as one might guess, they go by another name — "Zeum masters."
The project already has some enthusiastic recruits. Phil Nelson, an
elementary school teacher at Harvey Milk Civil Rights Academy,
swears by it. Besides leading his students in a Zeum project,
Nelson has organized an after-school project and is planning a
three-week summer program that will bring 60 youths to San
Francisco from all around the world to participate in workshops
about conflict resolution and cultural differences. The
international group will produce a video at Zeum's production lab.
"This is changing everything I do in the classroom," Nelson says.
"I had students who couldn't care less about anything but now they
are so excited about Zeum."
Students are learning faster, and
parents — many of them recent immigrants — have started showing
up at school to see what has made their kids so interested, he adds.
Of course, some parents have no choice, Nelson concedes: their kids
want to be driven to school so they can arrive before the school
bus does — and thus get some time on the computer before the work
day begins. Zeum's website is www.zeum.org. Students at Harvey
Milk Civil Rights Academy eventually will present their work on the
school's website:
www.sfusd.k12.ca.us/schwww/sch505.
Laura Reiley's article about Zeum can be found at
www.service.com/PAW/morgue/cover/1998_Oct_30.ARTS30.html.
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Vol. 2, No. 3 |
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Government, business and nonprofit organizations all must work
together — but local communities must set the agenda — if
we are to close the gaping digital divide between countries. That
was the conclusion of a forum of more than 50 experts on
information and communications technology and policy, hosted by the
Commerce Department's
National Telecommunications and
Information Administration, the World Bank's
Global Knowledge
Partnership, and the
Benton Foundation.
The emphasis on partnership and local control should be familiar to followers of the TOP program. In providing grants to support domestic information-technology projects, TOP stresses that local communities are the best judges of their own needs, and therefore should design their own projects. And in striving to support projects that will survive even after their federal grants run out, TOP requires projects to find partners from various sectors as a condition to receiving funding.
While TOP only funds projects within the United States, forum participants generally agreed that those principles are equally valid in the international arena. Many also suggested that TOP projects could serve as models in developing countries just as they have helped demonstrate the uses of information technology in this country.
A number of representatives from TOP-supported projects attended
the meeting, and three — Ana Sisnett from the
Austin FreeNet,
Tom Garritano from the University of Tennessee/Knoxville's
KORRnet project, and
Ellen Burnham from the Mississippi Department of Education's
Connect2Tomorrow
project —
briefed the participants on lessons they have learned that could
be helpful to communities in developing countries.
The forum was held amidst growing awareness that access to the tools of the information age vary sharply from country to country. If the world were a village of 1,000 people, noted Larry Irving, assistant secretary of commerce for communications and information, 500 people would never have used a telephone, 335 would be illiterate, only 10 would have a college degree, and just one person would own a computer. Irving also observed that 80 percent of the world's telephones are located in just 25 countries; that means the remaining 20 percent are spread among the remaining 90 percent of the countries of the world.
The implications of this gap are growing increasingly ominous. Summarizing key findings of the World Bank's 1998-1999 report, "Knowledge for Development," Carl Dahlman, program manager at the World Bank, observed that the economy of South Korea grew by a factor of six during the past 40 years, while that of Ghana didn't grow at all. Econometric analysis shows that effective use of knowledge and information tools explains more than half the difference, he said. And that doesn't measure the importance of information to achieving other, equally important, social goals, such as improving health, he added.
Dahlman said a number of factors determine a country's ability to take advantage of information technology — including its openness to outside ideas, the strength of its educational institutions, and how well developed its information infrastructure is. But, in words echoed by a number of speakers, he said human resources — the education and skill level of people — are the "key enabler" that determine whether a country can use technology effectively.
A multi-faceted challenge requires a multi-dimensional response, speakers argued. Yet all too often, efforts to promote more effective information systems focus exclusively on technology
— and in particular, on high-tech tools just emerging in countries with advanced information systems. Roberto Rodrigues, coordinator for the Pan American Health Organization's Health Services Information Systems Program, faulted U.S. industry for promoting such technologies as teleconferencing and high-resolution image communications in Latin America, when the real need is for education. And Ron Epstein from MediaOne Group, said Americans should pay closer attention to the need for basic voice communication in developing countries rather than focusing on higher-end technologies.
At the same time, several speakers argued, it's important to recognize that information technologies are unlikely to take root unless local communities see the value in using them. Larry Forgy, work program administrator at the World Bank, for instance, argued that programs should become more "demand-driven" rather than "supply-driven." Similarly, Bernadette McGuire-Rivera, associate administrator of the NTIA, said projects should aim for "empowerment," rather than simply to provide "access."
And Steven Miller, executive director of Massachusetts Networks Education Partnership, argued that communities are more likely to embrace information technologies if they see them as a way of producing social change. "We have to stop thinking about exporting products and really start thinking about sharing organizing strategies," said Miller.
Tom Chesney, business development manager for Sun Microsystems, noted that it's not just buying and selling technology, but communities need to understand how to apply technology to their local problems in order to make technology truly relevant. Mickey Gardner, chairman of the U.S. Telecommunications Training Institute, briefed the participants on his vision of a non-profit program that has helped empower women and men from the developing world to bring modern communications to their fellow countrymen. "For 16 years, USTTI has been training engineers and managers from developing nations in courses offered free by major U.S. corporations and the U.S. government," noted Gardner, "and with the increasing need for communications training throughout the developing world, the relevance of USTTI becomes more apparent."
Marlee Norton, director of international and domestic program
development for the National Telephone Cooperative Association,
led a group of industry, government and nonprofit-sector officials
in a discussion about what they are doing to encourage the
development of information infrastructure in developing countries
— and what they have learned. Her conclusions: there are a
whole range of different technologies and models for increasing
access to information technology; it's important to know end users
and their needs; we should all address issues of long-term
financing and sustainability; and "mutual respect and dialogue
among partners generally results in better products."
As that discussion suggested, there is no single answer to the
challenge of helping developing countries enter the information
age, said Audrey Choi, chief of staff for the White House Council
of Economic Advisers and a top aide to Vice President Albert Gore.
In some countries, regulatory reform is key; in others, training
should be the top priority. Overall, she said, the Clinton
administration is looking for more ways "to take knowledge we
already have and leverage it." That suggests the need for more
networking among those with experience in putting information
technology to use — both among themselves and with people in
developing countries. "How we facilitate the networks and organize
the exchanges is still up for grabs," concluded Larry Kirkman,
executive director of the Benton Foundation.
One start is the World Bank's Global Knowledge Partnership, which its director, Philip Karp, described as an informal grouping of international organizations, nongovernmental organizations, some national governments and private companies. The partnership promotes dialogue and seeks to encourage collaborative projects that help people in developing countries acquire knowledge and make better use of information technology. Among other things, it sponsors online discussions among individuals and organizations that share its vision, and it is seeking, through its website, www.globalknowledge.org, to build a database of projects. | ||||||||||
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Vol 3, No. 1 |
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Nobody said it was going to be easy. In 1997, the City of
Philadelphia set out to create a computer network that would enable
the plethora of city and nonprofit agencies to work together to
provide seamless, comprehensive services to low-income families.
The idea had a lot of momentum behind it — as it does to this
day. A growing number of policy-makers believe that consolidation,
or at least coordination, of widely disparate human service
programs is the key both to increasing the quality of services for
low-income families and to cutting the cost of delivering those
services. A TOP-supported project in New Hampshire
("Safety Net — New Hampshire") has developed a computer
network that enables diverse agencies to screen clients for each
other's benefits. And Congress enacted legislation in 1998 to pull
together diverse job-training programs into a single, "one-stop"
delivery system.
But there is a lot of hard work between having a good idea and
actually changing the way the numerous, widely dispersed agencies
that deliver human services work. "It's going to take time to
convince the social service community this is a good innovation,"
says Cy Rosenthal, a professor of social administration at Temple
University in Philadelphia and an enthusiastic supporter of
Philadelphia's Community Services Network (CSN). "For years,
they have had to rely on the sense that they had to do their own
thing in a world that didn't reward what they were doing."
The challenge may be especially great when government agencies are
involved. Bob White, project manager for a TOP-supported social
services network in northwest Arkansas (The Washington County
Community Partnership for Children and Families), says nonprofit
and faith-based agencies have been quicker to join the network
than government ones, which tend to fear they will lose power if
they share information. "A lot of the directors and administrators
of program offices in human services give lip service to change;
but when it comes down to action, they have a lapse of memory,"
White says.
Michelle Davis, manager of the Philadelphia network, believes the
Community Services Network suffered because it oversold itself in
the beginning. When the project was just getting started, sponsors
circulated a videotape showing a caseworker and a pregnant teenager
effortlessly applying online for benefits from a different agency,
even conducting a live teleconference with an official at the other
organization. In practice, Philadelphia service providers still
cannot use their network to fill out and submit applications for
different agencies. Nor can they collaborate in managing clients'
cases.
As yet unfulfilled promises from the project's early days haunt
network managers, who say their project was slowed in its early
days by shifting priorities in city government, personnel changes,
and reliance on a vendor who failed to provide what it promised.
"Our biggest challenge now is to restore our credibility," says
Davis.
Today, Davis and her team are seeking to demonstrate the value of
the project — and build trust, from the ground up. Their first
step is a redesigned website, which provides an impressive rundown
of services available throughout Philadelphia. It is hard to
comprehend just how big and fragmented the city's human services
system is — and therefore how handy a tool this database can
be. Philadelphia has an estimated 150 separate mentoring programs,
for instance. And the 18 pilot agencies currently participating in
the network — just a handful of agencies serving Philadelphia
neighborhoods — manage 112 varied human service programs
themselves.
Helping clients find and take advantage of all the services
available to them can be an overwhelming task for caseworkers,
requiring hours of time on the telephone. But the CSN website puts
the whole panoply of services on each caseworker's desktop in an
easy-to-use, searchable database. "I use it every time a client
needs services," says Waleska Sanchez, formerly an intake specialist
for the Lighthouse, a multi-service agency in north Philadelphia.
Across town, Leonte Dunbar, an outreach coordinator for the
University of Pennsylvania Educational Opportunity Center, also is
enthusiastic about the database. The center helps clients enroll in
post-secondary educational programs. Prospective students face any
number of obstacles to attending classes, from the need to find
day-care for their children to the need to arrange elder-care for
aging parents, according to Dunbar. "Whatever question or concern a student has, I can point him or her
to the website and they can find a solution," says Dunbar.
The database is just the beginning of the Community Service
Network's new push. The project also is developing tools to enable
workers like Sanchez or Dunbar to go beyond finding information to
actually helping clients apply online for services at other
agencies. Felicia Coward, executive director of Friends Neighborhood
Guild, says such capabilities would be a real boon to service
providers. "It would be wonderful if we could, in effect, provide so
many services right here in our offices," says Coward, whose agency
helps low-income families meet their winter heating needs. Clients
would benefit from one-stop shopping too, she adds. "I have seen
clients come in here, and they are treated hostilely," Coward
observes. "Then they are sent all over the place, where they have to
start the process over and over again."
Ultimately, the network would like to go even further than allowing
online benefits screening. It hopes that caseworkers in various
agencies ultimately will use the network to coordinate efforts on
behalf of clients. The first step toward such coordinated case
management, according to CSN sponsors, is simply to get caseworkers
to start communicating. To that end, the new website enables
officials in different agencies to read and post notices on an
electronic bulletin board, and to participate in chat rooms.
Bryan Anderson, chief information officer for the Mayor's Office of
Information Services, believes these small steps will start
Philadelphia moving toward a more fully integrated social services
system. "We have to build some early successes by making CSN an
information resource, a portal to other agencies, something that
helps," he says. "If you have only a blueprint, you won't get the
buy-in. But if CSN starts providing real services, if it brings
people together and starts them working together, pretty soon
we'll have them banging the door for more."
In the meantime, however, CSN must figure out how to survive. The
project's TOP grant expired last September 30, and officials
couldn't persuade the city to provide funds to continue its
operations. Instead, city budget officials told project staff
they would have to persuade social service agencies themselves
to pay for the network's continued operation. In response, CSN
has been conducting "return on investment" studies that it believes
demonstrate that the project is a sound expenditure for city
agencies. One study showed, for instance, that city-run health
centers could save more than $700,000 this year alone by screening
and enrolling uninsured children it serves in the federal Children's
Health Insurance Program (CHIP) and Medicaid. That by itself would
pay CSN's total budget for a year. But it remains to be seen whether
the city health department will agree to undertake such screening,
which could lead some of its own clients to seek care elsewhere.
Anderson, for his part, hasn't given up on the idea of persuading
city fathers to appropriate funds directly to the network. He has
one extra argument in his hip pocket: with city agencies all
rushing to build their own new computer systems, Philadelphia will
pay dearly if it fails to produce a shared database like the
Community Services Network. "If we don't build the Community
Services Network, we're going to end up with little community
services networks in dozens of agencies — and the cost will be
enormous," Anderson says.
In the last two years, city expenditures
on information technology doubled, from about $55 million to over
$100 million. If efforts aren't made to consolidate efforts, the
city's information-technology costs could approach $1 billion in
four years — a figure that would leave a lot of taxpayers and
policy makers disgruntled, to say the least. The Community Services Network's website is www.csn-phila.org. Click here to view a detailed evaluation of the Children's Alliance-New Hampshire project. The Washington County Community Partnership for Children and Families maintains a "client referral network" at www.clientreferralnet.com. | ||||||||||
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Vol 3, No. 1 |
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Emerging technologies present new opportunities for the
public-interesting networking movement, but they pose enormous
challenges as well, Gary Chapman, director of the
21st Century
Project at the University of Texas LBJ School of Public Affairs
told participants in TOP's 1999 Networks for People conference.
Chapman, the keynote speaker at the annual conference, said that
public agencies and nonprofit organizations have "all sorts of new
ways to show people how to do interesting and innovative things in
these sectors." But after describing several not-so-appealing
aspects of the information society — including growing income
inequality arising from differing access to technology, as well
as the Internet's contribution to "a vapid and commercialized mass
media culture" — Chapman urged past, current and prospective TOP
grantees to "tell people that the kind of work you're doing is an
essential part of the Information Revolution."
The two-day conference, which was held November 1-2 in Arlington,
Va., covered a range of issues. It opened with a speech by
Sen. Byron Dorgan (D., ND), who suggested that universal-service
policies such as those that have made basic telephone service
nearly ubiquitous in the United States should be extended to
advanced telecommunications services. "If we have a nation of haves
and have-nots with respect to broadband access, we almost certainly
will have a digital divide where there will be areas of the country
that will grow and have economic opportunity and others [that] will
be left behind," Sen. Dorgan said. "It will just be inevitable."
The roughly 600 participants who attended the gathering spent much
of their first day exploring practical issues that public networking
projects face: what kind of changes organizations must make so they
can take advantage of new technologies; what opportunities
cutting-edge technologies present for nonprofit organizations (and
how to pay for these new technologies despite tight budgets); how
to sustain telecommunications projects when federal grant money
runs out; and how to bridge the digital divide.
On the second day, participants saw a preview of a program the
Public Broadcasting Service aired on January 28 examining
the
digital divide, heard from a diverse group of people involved
in international projects designed to promote public-interest uses
of information technology, and observed a lively discussion among
representatives of leading foundations about their approaches to
funding information-technology projects.
In his speech kicking off the conference, Chapman predicted that
the key technologies of the next decade will include high bandwidth,
which he said will create "all kinds of capabilities" such as
real-time video-conferencing, real-time telemedicine,
high-definition "virtual reality" modeling, video-on-demand and
more. He said wireless networking will come into its own, too, and
will be a "huge boon" for nonprofit institutions — especially
schools. In addition, he said that digital television will allow
for programming that is targeted to specific neighborhoods and
for the transmission of data along with tv signals; he said
public broadcasters and community networks should form alliances to
take advantage of this "great new frontier."
What's more, Chapman predicted that technological advances will lead
society toward "ubiquitous," or "pervasive" computing — that is,
basic computing and telecommunications capabilities will come to
be vested in a wide range of appliances other than computers.
Such innovations promise to bring new efficiency and convenience to
our lives, but Chapman said current trends present substantial
challenges to public-interesting networking efforts as well —
challenges that will require creative, new thinking.
One challenge is the digital divide; Chapman argued that Americans
must come to recognize that the solution to this problem does not
lie simply in training individuals to develop the technical skills
required to get good jobs, but also in addressing the difficulties
that entire communities face. Education, training and privacy also
represent additional challenges that Americans have only begun to
address, Chapman added. Yet another challenge, according to Chapman,
is the possible spread of proprietary networks, in which
telecommunications-service providers also control content. "It is
not clear that we, as public-interest networks, will have access
to these (new) networks," he warned. "You should be talking about
open access, about public standards, about public domain and about
keeping the Internet free and open from end to end so that we (don't
get) locked out simply because we're not a lucrative partner for
the people who are delivering services to the home."
While Chapman opened the conference by urging participants to look
at the big picture, a group of leaders from private foundations
closed the gathering on a more pragmatic note, discussing what
funders are seeking today in information-technology grant
applications. In many respects, their comments echoed concerns
important to TOP.
For instance, Willem Scholten, executive
director of the
Gates Center for Technology Access,
said technology
should not be the driver of new projects. The Gates center, he said,
wants to fund "programs where it's not about technology, it's about
a problem in a community." Andrew Blau, program director for the
Markle Foundation,
said foundations are looking for projects that
carefully document what they do. "We don't see enough people
taking the time to build evidence showing the link between a project
and their goals," he said.
Similarly, the
AOL Foundation's David Eisner spoke of the growing
importance of collecting data that demonstrates whether projects
have achieved their goals. "New technology is forcing a more
entrepreneurial attitude in foundations," Eisner said. Today, he
explained, funders are more focused on results. The ultimate goal,
however, remains much the same — namely, to enable people to control
technology, and thereby ensure that it helps meet social needs,
rather than let technology control us.
Chapman captured the argument by suggesting that the title of his
keynote speech — "Where is Information Technology Taking Us?" —
should be revised. The real title, he said, should be: "Where Do
People Want Information Technology to Take Us?"
To view Gary Chapman's presentation to Networks for People, 1999, click here. | ||||||||||
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Community |
Networking
TOP Update: Vol 3, No. 2 |
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When Manuel Huerta, a student at the University of California at
Los Angeles, went back to the neighborhood where he grew up, he found
a gem he had never noticed previously.
Working with a team of students scouring his old neighborhood to
identify cultural, educational, economic and other community assets,
Huerta came upon the Boyle Heights College Institute, which
provides tutoring and mentoring services to neighborhood youth.
Although the institute had been operating for years, few people
knew about it, and even fewer were aware that it had so outgrown
its space that it was regularly turning away scores of students.
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"I lived here all my life, and I never knew it existed," says Huerta.
Determined to make their findings known, the UCLA students met with
Los Angeles city council member Nick Pacheco. Almost immediately, a
plan was hatched: the councilman would make his own, much larger
offices available to the institute, enabling the program to triple
the number of students it could serve.
The Boyle Heights mapping project is an outgrowth of "Neighborhood
Knowledge Los Angeles," a 1998 TOP grantee that uses geographic
information systems — databases tied to maps — to build stronger
communities. By all accounts, NKLA has been a remarkable success,
helping city government, nonprofit organizations and individuals
to change the face of some of Los Angeles' most troubled
neighborhoods. Indeed, the project has parlayed its TOP funding into
a growing enterprise, attracting new funders and spinning off new
projects that promise to expand its role in the years ahead.
NKLA began with a simple, but far-reaching premise: the process of
urban decay often begins with small, little-noticed changes. Long
before buildings become strewn with trash, defaced by graffiti or
abandoned, they run into troubles invisible to the outside observer;
their owners, either deliberately or due to circumstances beyond
their control, fall behind on tax payments or utility bills, for
instance. To get a handle on this process, researchers at the
Advanced Policy Institute of the UCLA School of Public Policy and
Social Research began collecting information on tax delinquencies,
building code violations, unpaid utility bills, and certain other
variables from disparate government databases, amassing them into a
single Internet-accessible database that serves as an "early
warning system" for neighborhood activists and government officials
combating urban problems.
To suggest the information has proven invaluable would be an
understatement. The website gets some 1,500 hits a day from
government agencies and nonprofit organizations. Community-based
organizations like Concerned Citizens of South Central Los Angeles
and the Dunbar Economic Development Corporate search the NKLA website
for tax-delinquent properties. If possible, they help the property
owners resolve their financial problems before they lose their homes.
But if necessary, the organizations try to acquire the properties
themselves and refurbish them. The NKLA website is "our
lifeblood," says Juanita Tate, Concerned Citizens' executive
director. "They are an essential part of what we do."
The value of NKLA hasn't been lost on city officials. Garry Pinney,
general manager of the Los Angeles Housing Department, says his
inspectors use the website in setting priorities for its own
building inspections. Deputy City Attorney Richard Bobb consults
the website to get a full picture of how well landlords comply
with building codes, thereby identifying property owners with a
history of neglectful behavior that warrants legal action. And
city health inspectors, aware that unpaid bills or building-code
violations can indicate other serious problems such as rat
infestations, also are known to search NKLA for clues about which
buildings they should inspect.
NKLA soon could grow even more useful. The city of Los Angeles has
contracted with the UCLA team to create a new, digital information
system for its own building inspection program. Under the new
system, inspectors will record their findings on Palm Pilots,
which they then will download into a comprehensive database. Neal
Richman, director of NKLA and associate director of the Advanced
Policy Institute, is negotiating with the city to incorporate
much of this information into the NKLA website, possibly making
the detailed inspection results available to the public. With
this information, Richman argues, individual renters and
tenants-rights organizations could track whether landlords are
meeting their responsibilities — and whether the city is
effectively enforcing housing codes.
Besides identifying sore spots in communities, NKLA is moving to
stress community strengths as well. The project recently opened "I
Am LA," a new, more positive section on its web page. UCLA students
and Power Youth, a neighborhood group in Vernon Central, have begun
surveying two south central Los Angeles neighborhoods to identify
community "assets" — everything from stores and churches to music
teachers and parks. As Huerta's experience attests, the exercise
already is helping disparate community institutions find each other
and work together. And that could be just the beginning. Melodie
Dove, the lead youth organizer for Concerned Citizens, believes the
project will help build a more positive image for the neighborhood,
enable youth to influence where new schools will be built, help
community groups determine where young children live so that their
homes can be targeted for lead abatement efforts, and much more.
NKLA director Richman sees this as a logical extension of the
original neighborhood knowledge project — but a revolutionary one.
"Up to now, we have been mapping deficits — problem properties," he
notes. "Now, we are mapping assets. And soon, we're going to map the
new infrastructure of the neighborhood. That's the kind of thing
that in the past only high-level planners could do. But now, we're
going to have kids acting as urban planners."
The Neighborhood Knowledge Los Angeles website is: http://nkla.sppsr.ucla.edu/.
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