Healthy Technology Options for State and Local Health Care Agencies

Laura Larsson gave up hope long ago that the public health nutritionists she helps train would get access anytime soon to the technology necessary to mine the wealth of health information now on the Internet. "One of the problems in public health education is that [the nutritionists] don't have computers and other equipment good enough to get on the Internet," she said. "So often we have to redo work that is already on the [World Wide] Web."

Instead, Larsson, director of information services for the University of Washington's Department of Health Services, photocopies and sends articles and excerpts from books of interest to her clients, who work as dietary counselors to the poor and other information have-nots. "What I have tried to do is reach out to these people," she said. "The technology is so far behind for the people who need it most."

Even those higher up the public health food chain are pessimistic about getting information technology into the hands of health workers. "The biggest problem is the large-scale computer needs and the fact that there is no funding," said Dil Ranatunga, director of innovation at the Washington, D.C.-based American Public Health Association, which represents 50,000 public health officials. "If you don't have the equipment, there is no point in trying to get connectivity."

But getting state and local public health professionals some help acquiring the technology they need might be closer than Larsson and other state and local government public health officials think. No less than three federal grant programs-including those sponsored by the National Library of Medicine and the Centers for Disease Control and Prevention-are now available with money specifically targeted for public health organizations in need of an IT jump-start.

In fact, while most of the funding is open to state and local health care agencies, it goes begging in most cases. "State and local health facilities have not applied," said Frances Johnson, who manages NLM's Internet Connection for Medical Institutions Program, which awards about 25 $30,000 Internet grants ($50,000 for team awards) annually to nonprofit institutions dedicated to research, education, administration or clinical care in the field of health sciences.

"We don't have state and local organizations represented on our list of grant awards, but that doesn't mean they would not be eligible or that they would not be worthy," Johnson said. Each year NLM awards the grants, and each year it distributes the money to other nonprofit health institutions because state and community health facilities repeatedly fail to apply.

But NLM's Internet Connection funds are available to state and local agencies starting an online project or seeking help to "finish the last mile," said Michael Ackerman, NLM's assistant director for high-performance computing and communications. To qualify, an agency must have the rudiments of a network in place.

"The purpose of the program is to promote access to the Internet," Johnson said. "Funds can be used to obtain router or gateway equipment or to connect a local-area network to an Internet service provider. It can be used for leased-line charges, and it can be used for Internet service provider fees."

Program dollars cannot be used to cover costs of computer peripheral equipment and other incidentals. On the other hand, the funds may be used to expand an existing network. "It doesn't support the purchase of PCs or the payment of personnel," Johnson said. "But an organization might already have an Internet connection and may want to extend that access to outlying organizations. That is another model that we would support."

Johnson offered the following advice to those public health facilities interested in applying: "An applicant should really have a local-area network in place; they really have to bring that to the table," she said. "There should also be people on-site with network experience, and there must be a proposed plan to train users to access the Internet."

In addition to offering funds to assist in information gathering and dissemination over the Internet, NLM also is working to offer funds to state and local health agencies interested in using the Internet as a medium for doctoring. To do so, the agency will launch a $5 million grant program in the upcoming fiscal year to ensure that telemedicine is represented in the federal government's "Next Generation Internet" (NGI) initiative.

The NGI program, which is still in the midst of a congressional funding debate, is an outgrowth of a 1996 NLM grant program that awarded $42 million to telemedicine programs in "rural, inner-city and suburban areas." But even though the money was available to state and local government agencies and organizations, they all but ignored the program.

"We have not yet, in all of our telemedicine funding, funded a state or municipality. They have never applied," NLM's Ackerman said. "I can say that if a state had come in with a public health services network and was interested in participating, we would have listened."

But state and local agencies will get another chance. NLM has decided to issue a request for proposals to fund telemedicine projects at the rate of $5 million annually during the next three years, even though Congress has not yet decided how much money it will allocate to telemedicine in the NGI budget.

"We've mortgaged the farm for the next three years," Ackerman said. "What we'll do is make believe we have the money for the next three years. It gives new meaning to the term 'just-in-time funding.' "

In deciding which grant applications to fund, NLM will be looking for projects that take on the current bandwidth limitations surrounding telemedicine over the Internet. "One of the things about the Internet today is that it is slow," Ackerman said. "And not only that, it seems to deliver things using a mind of its own. We are interested in techniques to show how we can leave the pipes alone but give certain signals priority over others."

State and local health organizations have an important role to play in CDC's and NLM's programs, Ackerman said. "Someone has got to represent them, and I'm not at all condemning them," he said. "But what comes to mind in terms of state and local involvement is the aspect of medicine that only state and local governments do-public health. They've got their hands full." But "NLM's job is to worry about the world's health care literature making its way to the practicing health care specialist," he added.

Elsewhere, federal money is being earmarked for projects that would help plan for the sharing of health care information between government jurisdictions. Earlier this year, the CDC, the Association of State Territorial Health Officials and the National Association of County and City Health Officials published a guide for investing in IT to create intergovernmental health care information systems.

"Public health processes such as the connection, analysis and dissemination of health statistics and disease-surveillance data cross intergovernmental boundaries, and new information technologies, such as the Internet and distributed computing, now facilitate integrated approaches," according to the guide, which added that CDC grant funds may be requested "for the purpose of planning an integrated health information system project." The CDC accepts proposals on a rolling basis.

Still, while some money is available, the public health IT landscape remains uneven. "There is a wide range of what public health departments have in the way of technology," said a spokeswoman for the Washington, D.C.-based Public Health Foundation, which represents public health care officials. "Some have very advanced technology, while others are still using rotary phones and have one computer that is used by the whole office."

Jennifer Jones is a staff writer for civic.com. She can be reached at jjones@fcw.com.