GAO wants DOD to develop strategy

The General Accounting Office issued a report last month that calls on the Defense Department to help forge a governmentwide strategy for using and gauging the success of telemedicine technology in the federal arena.

The report comes at a time when federal use of telemedicine is increasing. In fiscal 1996 nine federal agencies spent at least $229 million on telemedicine projects with DOD accounting for more than half of the spending according to GAO. That was up from $183.5 million in fiscal 1994.

Telemedicine which covers a broad range of technologies can be as simple as transmitting medical records by fax or as sophisticated as using high-resolution monitors cameras and electronic medical instruments that send real-time images and data around the globe.

The technology is one that promises to save lives and money.

The problem however is that no one in the federal government has a good handle on the costs and benefits of telemedicine or how the government can best tap into the technology according to GAO.

"No formal mechanism or overall strategy exists to ensure that telemedicine development is fully coordinated among federal agencies to serve a common purpose " GAO concluded. "Although some interagency coordination occurs on an ad hoc or narrow basis (through working groups symposiums technology demonstrations and joint programs) these efforts do not provide a firm basis for technology exchange."

As a result GAO asked DOD to develop a telemedicine strategy and submit it to Congress before Feb. 14 1998. The strategy which could become a blueprint for the rest of the federal government is expected to include a definition of the scope of DOD telemedicine its goals and objectives and prioritization of telemedicine investments.

Most uses of telemedicine in DOD so far have not involved life-or-death situations although the Army reports that two years ago a doctor in Macedonia consulted a specialist in Bethesda Md. via a video link to offer treatment to a soldier who was having trouble breathing.

Most experts agree however that telemedicine saves money although how much has yet to be determined. Savings are derived from removing the need to transport patients out of the field or off ships at sea when a medical condition arises.

A spokesman for the Army Medical Research and Materiel Command said his organization sees Defense-related telemedicine projects as on target.

Despite GAO's report stressing the need for a federal strategy for telemedicine there are some who believe the state of telemedicine and the federal government is in pretty good shape.

"I think telemedicine is fine " said Michael Ackerman assistant director for high-performance computing and communications at the National Library of Medicine. "I think the government effort in telemedicine so far is real it's coordinated."

Ackerman sits on the Joint Working Group on Telemedicine which was created in 1995 in response to Vice President Al Gore's charge to the Department of Health and Human Services to report on telemedicine projects and issues.

But the group's efforts to develop an inventory of federal telemedicine projects have been hampered by factors such as incompatible agency data according to GAO.