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TOP'S Support for Innovations in Health Care

Information technology presents many opportunities for improving the quality of health care, lowering costs, and empowering consumers of health care. Advanced telecommunications technology can help to break down barriers of distance in rural areas, where access to quality medical care often means a long drive to the nearest big city. Telemedicine can bring the medical expertise concentrated in urban areas and at academic teaching hospitals into small rural health hospitals or health clinics.

New information technologies show great promise in creating efficiencies in health care administration and increasing the quality of care that is delivered. The health care enterprise involves many different players — hospitals, clinics, laboratories, insurance companies, public health departments, and others. These organizations have a need to exchange information efficiently, so laboratory tests are not lost and unnecessarily duplicated, so public health departments can track the spread of contagious diseases, and so physicians do not prescribe drugs that could cause dangerous interactions with other medications. Information technology can put the right information into the hands of doctors and patients at the right time. For example:

Hays Medical Center: As a result of a grant in rural Hays, Kansas, home health aides are checking up on their elderly home-bound patients using two-way video links. These video house calls are saving driving time for the home health aides, enabling them to serve more patients and allowing more elderly citizens to stay at home instead of a nursing home.

Dakota Telemedicine System: Medcenter One Health Systems developed the Dakota Telemedicine System (DTS) to connect a central hospital to the Veterans Administration Hospital in Fargo and as many as 12 remote sites in North Dakota. DTS uses teleconferencing to provide services and dedicated lines for exchanging patient records by fax. North Dakota has a predominantly rural population that is underserved by medical services, typically located in major towns or cities that may be distant. Using telemedicine, primary care providers in remote clinics can obtain immediate consultations with specialists at larger care facilities before making diagnoses or transferring patients to major facilities for treatment. Additionally, patients may consult with specialists for follow-up care from a remote site.

Tele-KidCare: The University of Kansas Medical Center's Tele-KidCare, is providing teleconsultation to children by connecting school nurses to doctors. Physicians will provide a wide array of services via telemedicine, including check-ups; acute examinations for ear infections, strep throat, respiratory problems or rashes; managing chronic conditions such as diabetes, or asthma; and telepsychiatry and telepsychology for children with behavioral and learning disorders. The project minimizes transportation and other costs to parents and provide service where children are found during the day: at school.

The Shepherd Center in Atlanta, Georgia, is using a high-speed Next Generation Internet testbed to provide rehabilitation services to patients and support for their family members and caregivers. The project is exploring emerging technologies that may have telemedicine and tele-rehabilitation capabilities. The tele-rehabilitation applications will be designed to support community re-entry after catastrophic injury; prevent or reduce the severity of secondary complications often associated with catastrophic injury; and deliver health and wellness support and advocacy assistance to people with disabilities living in the community.

Duke University, in North Carolina, is developing a networked delivery system of population-based health care, targeted at Medicaid beneficiaries. The project is a pioneering effort to create the information management resources that will be needed to coordinate the health care of disadvantaged populations on a community-wide basis. It will be a model for the type of information system that will be required to support health care delivery by multi-disciplinary teams across traditional institutional boundaries.

University of Texas, Medical Branch, in Galveston, Texas, is using information technology to link mental health professionals and service providers in a rural area to provide a continuum of mental health prevention and rehabilitation services. Professionals know that early identification and timely intervention of mental and emotional health problems can prevent or reduce violence, yet in many rural areas across the country there is a dire shortage of mental health service providers. This project will serve as a model for the use of telemedicine to address this issue. Using a combination of telemedicine and local resources, the partners in this project are developing a continuum of mental health prevention and rehabilitation services to reduce violence and consequences of victimization among at-risk populations in a rural, underserved area.

Virtual Assisted Living Umbrella for the Elderly (VALUE): The University of Minnesota is developing Virtual Assisted Living Umbrella for the Elderly (VALUE), an advanced network that will combine broadband videoconferencing and Internet access, a supportive services information portal, and physiological home monitoring to provide assisted living services to frail elderly persons living independently in their home communities.

State of Wisconsin's Department of Agriculture, Trade, and Consumer Protection is integrating Wisconsin's information systems' data into a cohesive system to promote food safety and disease surveillance. The Department is key in assuring the safety and quality of food, and the health of animals, both commercial and domestic. Integrating data into a collective database improves the Department's enforcement capabilities and inspection efforts in a way that increases the potential for early detection of impending public health problems.

Muskegon I-Net: The Muskegon Community Health Project in Michigan developed the Muskegon I-Net, a web-based case management system for health care providers so they can improve the health status of indigent persons while reducing the rising costs of uncompensated charitable health care. The goal is to improve the delivery of health care to uninsured people who do not receive Medicare or Medicaid and allow for cost-saving interventions and ensure follow-up care.

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