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Subject: Re: [ihc] States Seek Emergency Medical Compacts
Thanks, David, I'm inside a case of tunnel vision lately. It's good to know we are more or less on the same page wrt wider access for information and cross connecting the most cogent and current information to necessary recipients when it is most useful. I think what I am seeing are the briefest snapshots of the elephant passing by the knothole in the fence, and this seems more frequent lately. I say seems because I'm just more busy than usual, and when things ease up a bit, I imagine my focus and perspective will both improve. Ciao, Rex At 11:10 AM -0400 9/14/04, David RR Webber wrote: >Rex, > >No - I was following you and your thread OKand concur with the >notions. And certainly if you were on holiday - and you could >video-conference in your home doctor in >event of an emergency, you would definately want that. Not too >mention the reverse when you return home, or your doctor being able >to video-conference in a specialist and so on. >We'd been looking at this over in EPRforum - from the point of view >of records sharing - and digital bag management too. > >I just took a tangent completely - thinking about the whole notion >of remote support - and having watched Robin Williams in the old >movie my wife rented a few nights back! >Some controls are in there for a reason it seems! But then in a >moment of crisis and urgent need - any help maybe better than none - >and some boundaries may not be as >important.. > >Of course we take for granted now things like WebEx and Remote PC >access tools - so who am I to cast the first stone, eh? ; -) > >The lesson is that technology changes and redefines what is needed >and can be achieved - and challenges us to create the means >to use it sensibly and reliably. > >Cheers, DW >===================== >Rex Brooks wrote: > >>I'm a little slow on the uptake this morning, David, >> >>So, please excuse my lack of understanding. All I was responding to >>was the informational context of there being such programs in >>existence right now of which I was previously unaware. My >>motivation was to extend that awareness, not recommend either the >>programs or their approaches to the problem space of inadequate >>communication between and amongst the various levels of government >>responsible for healthcare information. >> >>When I said that this fits right into my work, I was referring to >>that context, again not making any recommendation but nevertheless >>needing to take into account that such programs may, in fact, >>pre-empt the establishment of more generalized communication >>channels being opened. While this article does not go beyond the >>issues of statewide jurisdictions and does not specify how such >>"telemedicine" actually works, I would probably recommend web >>services with a more complete security context than, say a regional >>coalition of states determined to make their own systems better and >>perhaps demonstrate that a "national (or in the ihc context, >>international) health highway system" is possible. >> >>Regardless, I am not quite sure what the purpose of your comment >>is? If I am failing to see something, I would appreciate having my >>attention drawn directly to that oversight, if you don't mind. >> >>Ciao, >>Rex >> >>At 9:50 AM -0400 9/14/04, David RR Webber wrote: >> >>>I'm just wondering what you do - if as you are lying on the >>>oerating table - peering into the video camera, you >>>see Robin Williams in a mask and gown smiling down at you from the >>>monitor....? >>> >>>DW >>> >>>Rex Brooks wrote: >>> >>>>Thanks, Ed, >>>> >>>>This fits right into the work I am doing building a portal to >>>>demonstrate CAP and WSRP at XML 2004. I forwarded this to the >>>>Emergency Management TC and the Medical Working Group of the >>>>Web3D Consortium. >>>> >>>>Ciao, >>>>Rex >>>> >>>>At 1:34 PM -0500 9/13/04, Ed Dodds wrote: >>>> >>>>>/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 >>>>><http://www.telemedicine.arizona.edu/>. 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 <http://www.southerngovernors.org/> (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. >>>>><http://www.stateline.org/stateline/?pa=story&sa=showStoryInfo&id=147127&columns=false> >>>> >>>> >>>>> >>>>>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. >>>>><http://www.stateline.org/stateline/> >>>> >>>> >>>>>*Kathleen Murphy* >>>> >>>> >>>>>Ed Dodds >>>>>dodds@e-dodds.com <mailto:dodds@e-dodds.com> >>>>><e-dodds.communications/> <http://www.e-dodds.com/> >>>>>615. 429. 8744 cel | tel >>>>>508 . 632 . 0370 fax >>>>>ed1dodds aim >>>>>49457096 icq >>>>>Read <Conmergence/> <http://www.conmergence.com/> >>>> >>>> >>>> >>>> >>>> >>>> >>>>-- >>>> >>>>Rex Brooks >>>>GeoAddress: 1361-A Addison, Berkeley, CA, 94702 USA, Earth >>>>W3Address: http://www.starbourne.com >>>>Email: rexb@starbourne.com >>>>Tel: 510-849-2309 >>>>Fax: By Request -- Rex Brooks GeoAddress: 1361-A Addison, Berkeley, CA, 94702 USA, Earth W3Address: http://www.starbourne.com Email: rexb@starbourne.com Tel: 510-849-2309 Fax: By Request
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