A recent sprinkling of seed grants by an agency of the U.S. Commerce Department provides examples of the types of electronic network capabilities the federal government is trying to foster in the healthcare field.
The roster of successful grant recipients also demonstrates the broad range of locally significant projects already in the works as healthcare institutions and public health agencies seek to provide efficient medical care regionally.
The Commerce Department's National Telecommunications and Information Administration last month awarded $24.4 million for 92 projects in 45 states that will connect public institutions to a "national information infrastructure." The grants went to schools, hospitals, libraries, social service organizations, museums, and state and local governments.
Among the grant projects were 10 that seek to tie a region together through community health information networks or telemedicine services, or that advance the organization of public health prevention and monitoring efforts.
A total of $3.5 million in grant money went to the 10 projects, about a third of the total cost of the projects (See chart). Project size ranged from less than $300,000 for a CHIN in Idaho to $2.6 million for a project in New York City to coordinate care for tuberculosis patients.
Project specifics.Here's a Commerce Department rundown of the 10 projects, which are either planning efforts or actual demonstrations:
Planning for a CHIN to serve the Magic Valley region of southern Idaho and northern Nevada. The CHIN would integrate and automate the clinical functions of six hospitals, 200 physicians in their offices, and public health and other ancillary-care professionals. The organizer is the Boise (Idaho) State University Center of Health Policy.
Among the services envisioned for the CHIN are electronic capture of patient encounter information, integration of providers' clinical information systems, "expert" system software to provide alerts to clinicians and telemedicine technology to serve remote areas.
Development and demonstration of a "starter package" of tools for the Internet-part of the international information infrastructure-that may be used as the technological underpinning of a CHIN. The University of Michigan Medical Center in Ann Arbor will test components on its physician referral network to demonstrate remote collaboration.
Components will include encrypted electronic mail, an interface that converts computerized discharge summaries to e-mail messages and a means of electronic data interchange to send patient data.
A medical conferencing network linking physicians in rural or remote areas with resources in urban areas. The Commonwealth of Pennsylvania will develop the network as part of the Pennsylvania Rural Health Telecommunications Network.
The project will rely on a new generation of high-speed, high-capacity telecommunication links and desktop video equipment for the personal computer. Rural physicians will be able to consult physicians at three tertiary-care facilities and also gain access to medical libraries and databases. Partners in the project include the governor's office and the state department of health.
A network connecting eight hospitals in southwestern Oklahoma to bring telemedicine to rural physicians and other clinical professionals.
Comanche County Memorial Hospital in Lawton will combine efforts with First Health West, a rural HMO, to implement provision of cardiology, radiology and lab support services; patient and financial information management tools; and continuing education and technical support to isolated medical professionals.
A link among emergency departments at the state's four teaching facilities and five remote hospitals to provide teleconsultations during emergency situations. The governor's office in North Carolina is spearheading the project and using a developing high-speed, high-capacity telecommunications network called the North Carolina Information Highway.
Partners are the Bowman Gray, Duke University, East Carolina University and University of North Carolina schools of medicine.
A demonstration of information systems and links that coordinate careto tuberculosis patients. The Columbia-Presbyterian Medical Center, New York City Department of Health and Visiting Nurse Services of New York City will collaborate in unifying the providers involved.
The project will use automated decision-support systems, interactive wireless handheld computers and other developing technologies to keep track of patients in their homes, in physician offices and in the hospital.
Objectives include ensuring that appropriate protocols for TB are followed, developing an infrastructure that could be used in the treatment of other diseases and demonstrating how electronic medical records can meet high standards of privacy and confidentiality.
An effort by the St. Louis University School of Public Health to develop an integrated immunization information system as part of a five-year plan to raise and maintain the immunization rates of children younger than 2. Project partners are the Missouri Department of Public Health and the St. Louis County and city of St. Louis health departments.
A project to extend the Georgia Information Network for Public Health Officials to nearly half of the 196 community-based public health clinics operated by county health departments.
The state network also would be connected to another network that serves the public health and preventive medicine residency program at the Morehouse School of Medicine in Atlanta, and with the Georgia Interactive Network for Medical Information, which serves clinicians in 56 Georgia hospitals.
Integration of multiple statewide and local networks into the Michigan Public Health Information Network.
The Michigan Association for Local Public Health, in partnership with the Michigan Department of Public Health, will connect scattered local-area computer networks using an existing statewide network, update and move the current statewide teleconferencing system to the statewide electronic network, add e-mail and file transfer to the conferencing system, and enhance access to public health data systems.
Planning to improve surveillance and data systems of the City-County Health Department of Oklahoma County, Okla. Objectives include enabling users to interconnect among different networks; creating new interconnections and capabilities; and establishing a common database of demographic and geographic information that can keep track of health risk factors, disease studies, and efforts to control disease and promote health.