NLM launches effort to link hospitals, clinics

In what could be one of the largest civilian telemedicine efforts to date, the National Library of Medicine this week will launch a program to determine how high-speed telecommunications networks can support the electronic exchange of health care data.

NLM will issue a request for proposals for its health applications for the National Information Infrastructure (NII), a program that would award up to a dozen grants to link hospitals, clinics, doctors' offices, medical schools, universities and public health groups to the nation's high-bandwidth supercomputer network. The program will explore how the NII can be used to electronically deliver medical records, share clinical research and allow physicians to consult with one another and diagnose patients over long distances.

NLM expects to make $15 million to $20 million available to hospitals, medical centers, medical schools and health maintenance organizations that have operational telecommunications networks. Proposals will be due May 22, with awards expected by the end of fiscal 1996.

Federal health professionals view the project as an important step toward establishing a national, electronically delivered health care system.

"This will help determine what could be the health care system of the next century," said Michael Ackerman, assistant director for High-Performance Computing and Communications at NLM.

Federal agencies, including the departments of Defense, Health and Human Services and Agriculture, have been testing the efficacy of telemedicine applications for years.

Wendy Carter, director of library programs at the Veterans Health Administration, said the Department of Veterans Affairs would not provide funding for the program but will encourage VA hospitals to apply for grants.

The USDA has asked for $100 million in its fiscal 1997 budget to finance grants and loans for the construction of telemedicine facilities and systems to serve rural areas.

The funds would expand the USDA's Distance Learning and Medical Link grant program, a telemedicine program managed by the Rural Utilities Service. From 1993 to 1995, RUS received 353 applications seeking nearly $111 million, but only $27.5 million was awarded. The money went to rural schools and health care providers in 39 states to buy encoding and decoding devices, specialized cameras and video monitors, video switches, microphone mixers, computers and local-area network equipment.

NLM's program would be about the same size. Dena Puskin, deputy director of the Office of Rural Health at HHS and chairwoman of the governmentwide Joint Working Group on Telemedicine, said she had not yet read NLM's RFP but added it would likely be one of the larger civilian efforts to date and would complement much of the current telemedicine projects. But NLM's effort would take a broader view by including urban areas and by using the NII to establish a new health care delivery system, which could conceivably lead to the health care industry investing hundreds of millions of dollars in telecommunications networks.

"Right now, no one is taking the lead" in telemedicine, said Bob Pinto, national account manager for health care at PRC Inc. "At least NLM is taking the initiative, and I applaud that."

Greg Woods, who, as a member of the senior staff of Vice President Gore's National Performance Review, works on the NII, said, "This looks terrific. The idea is to sort out what the NII is going to make possible and how to redefine how the health care system works. The potential is tremendous."

Two-Goal Vision

Through the contract, NLM plans to accomplish two goals. First, NLM plans to test the security and confidentiality of medical records—including images such as X-rays, MRIs and CAT scans—sent over the networks and stored in databases.

"If we can't convince the public that their medical records are secure, then this will never become a reality," Ackerman said.

Second, NLM plans to evaluate telemedicine's cost effectiveness, the impact on health care quality and access to health care, including the effect on a community's or region's overall health. NLM also will try to determine if the federal, state or local governments, the private sector or a combination of those entities should pay for the telecom infrastructure.

"That will give us hard data to determine if telemedicine is economically feasible and medically sound," Ackerman said.

NLM will award the contracts with an eye toward equal representation of geographic areas—rural and urban—and toward different medical disciplines. The funding, which has yet to be determined by HHS, is part of the government's High-Performance Computing and Communications program.

The RFP is scheduled to be posted by April 18 on NLM's Web site at http://www.nlm.nih.gov/.