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Subject: [ihc] States Seek Emergency Medical Compacts
States develop technology to share medical
expertise
By Kathleen Murphy - September 2004
Arizona doctors can
provide medical services to patients more than 2,600 miles away in Panama
through a state-funded program that uses videoconferencing and digital
technology. But consultations for patients in neighboring states are rarely
allowed.
"We can consult in Panama, but not Utah," said Sandy Beinar,
associate director of the Arizona
Telemedicine Program. Most states prohibit out-of-state physicians from
practicing unless licensed in the patient's state, even in an emergency.
If there were a bioterrorist event such as a smallpox outbreak or
anthrax attack, states could legally share fire trucks and helicopters but not
medical expertise. But in a world reshaped by the 2001 terrorist attacks, states
are beginning to change that and, for the first time, consider interstate
compacts that lay the groundwork for medical professionals to cross state
borders.
In both the Midwest and the South, regional alliances are being
forged to develop agreements and the technological know-how to share medical
expertise in emergencies.
Ten Midwestern states, led by Nebraska Gov.
Mike Johanns (R), are making arrangements to share medical personnel and
communications capabilities. The alliance would include Iowa, Kansas, Missouri,
Montana, North Dakota, South Dakota, Wyoming, Colorado and Utah.
Separately, 16 governors working through the Southern Governors' Association
(SGA) have been trying since shortly after the airplane and anthrax attacks in
2001 to develop an interstate emergency medical response system that project
leaders hope is the beginning of a "national health highway system."
The
SGA project relies on telemedicine, which uses communications and information
technology to deliver health-care services over long distances. States such as
Texas have used telemedicine to treat inmates, and Alabama is starting to use it
for tracking Medicaid patients' blood-pressure readings.
Southern
governors want to use telemedicine to connect medical expertise to a point of
need, for example to allow medical experts to diagnose anthrax or smallpox from
afar.
Even with today's advances in digital technology, making online
medical connections can be difficult. The SGA tested a network this spring to
link state health departments, the Centers for Disease Control, and telemedicine
programs in Florida, Kentucky, Missouri and Virginia. It took three months to
secure network permissions for making an online connection that lasted 15
minutes -- not the type of response time sought by governors during a
bioterrorism event.
"The demonstration tested the capabilities of the
region for an immediate response to such an emergency and found them cumbersome
and lacking," an SGA progress report said
Coordinating high-bandwidth
connections between state computer systems (in a point-to-point T1 connection)
proved tricky, said Lee Stevens, SGA's legislative director for health, human
services and education. Computer security concerns and reluctance to open
"ports," the numeric Internet gateways, required intense negotiation between
participants, Stevens said.
"The irony is that it would be much easier
to practice internationally than across state borders," said Dr. Jay Sanders of
the Global Telemedicine Group, an SGA project leader. The demonstration showed
states could achieve a connection, but the system would be unusable in an
emergency because the communications' quality was lacking, Sanders aid.
Sanders has proposed that SGA seek private grant funding to establish
the technical protocols on a multi-state basis. He advocated expanding the
concept of the Emergency
Management Assistance Compact (EMAC), the agreement that routinely enables
emergency resource-sharing among states, to include virtual medical response.
SGA is expected to consider the issue at its annual meeting set for
Sept. 12-14 in Richmond, Va., where Gov. Mark Warner (D) will preside as
chairman. Warner has said the telemedicine project "can really make a
difference."
The Midwestern governors are working out agreements to
share lab space and workers, using $200,000 in federal funds granted to Nebraska
to fight bioterrorism. The agreement would include the creation of a Mid-America
Demonstration Center for Public Health Preparedness at the University of
Nebraska Medical Center.
Both the Southern and Midwestern interstate
medical agreements are expected to tackle issues of liability, licensure and
reimbursement. The result will be that interstate medical consultations
happening now sporadically -- after special licensing and approvals -- could
occur more easily under the agreements, project leaders said.
Reprinted
with permission from Stateline.org.
Kathleen
Murphy
Ed Dodds
dodds@e-dodds.com
<e-dodds.communications/>
615. 429. 8744 cel | tel
508 . 632 . 0370 fax
ed1dodds aim
49457096
icq
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