TELECOMMUNICATIONS APPLICATIONS BEYOND
TELECOMMUTING

HEALTH CARE SECTOR

The U.S. health care industry could achieve higher quality care, and better access in rural areas and to low-income populations, while reducing the country's total cost of health care as a percent of gross domestic product.

The future health system must depend to a great extent on the electronic delivery and management of health care services and medical practices, utilizing networked information infrastructure technology and applications. New telecommunications applications already beginning to be used will contribute significantly to efficiency and improved care when more widely deployed. Care will be more cost effective when based on electronic access to personal medical records, extensive and current best medical practice information, and consultations delivered by teleconference to the most appropriate location, which might be remote from the health care professional.

Care givers' access through telecommunications to timely and accurate information ensures that the combination of appropriate care and appropriate location is achieved. The model of information flows shown in Exhibit 3-3 illustrates how the health care system, like other service delivery systems, can work better when comprehensively reengineered around the National Information Infrastructure.

The information system shown in Exhibit 3-3 can be designed to let the overall performance of the medical system be measured and reported to patients and care givers. Preventive care can be included as part of services where that improves performance. The system can be designed to let patients rely more on self-help information to diagnose and treat nonthreatening conditions. Standards of care can be managed to be more consistent from one community to the next,
from urban area to rural area, and across the income spectrum.

A confidential electronic medical record-keeping system allows health care providers access to comprehensive family and patient health histories as part of the routine process of diagnosis and prescribing treatment. It will replace the cumbersome and far less complete manual record system, enable faster and more accurate diagnosis, and allow appropriate care at an appropriate location. More complete and timely information can help eliminate mistakes and the need for costly multiple medical tests that are ordered because knowledge of a patient's medical history is incomplete.

A physician, who faces the daunting task of staying current with medical knowledge that grows explosively, will use new on-line services that provide access to current medical literature about the problems diagnosed and best practice treatments.

A restructured health system could, over time, reduce health costs by as much as 25%. At current expenditure levels, savings of $200 billion per year would be realized. Major savings will result as information management practices merge with structural reforms to remove duplication and fragmentation in computer networks. Up to 40% of all hospital costs are related to the generation, storage, and transfer of information.

Significant indirect benefits will result from reform as well. Lower health costs will translate to lower labor costs and fewer jobs lost to countries with more efficient health systems. For the same reason, lower health costs will reduce the price of United States goods and services and improve their competitiveness in world markets. Expanded health care access will reduce the social cost of pain, illness, death, and loss in work productivity. Workers and their families will gain a measure
of security as employers use fewer part-time and temporary employees to avoid expensive health benefits. Since health care is a major cost of government, more funds will be available for education and other services or for deficit reduction.

A new health delivery system will produce changes in travel patterns. Exhibit 3-4 illustrates how health care system functions might be divided geographically between rural and urban locations. It also shows how some kinds of critical information are available anywhere through remote electronic database access.

Telecommunications can also expand home health care service access through new attachments to home telephone service, providing consultation and monitoring services as needed, especially to the less mobile elderly population, while reducing the number of trips to health centers. In some cases, tele-health will increase travel as a result of the system transforming to provide higher quality, very specialized services around fewer, more competent centers. Examples are national and regional centers of excellence for advanced procedures, such as open-heart surgery.




Travel patterns in health care reform are a minor consideration, however, compared to the potential in cost savings and improved care. As Exhibits 3-5 and 3-6 illustrate, medical trips per household appear to be rising again, but they are a small and shrinking component of household travel overall.

U.S. Department of Energy
Office of Energy Research
Office of Scientific Computing
Washington, DC 20585
DOE/ER-0626

Available to DOE and DOE contractors from the Office of Scientific and Technical Information, P.O. Box 62, Oak
Ridge, TN 37831; prices available from (615) 576-8401.

Available to the public from the U.S. Department of Commerce, Technology Administration, National Technical
Information Service, Springfield, VA 22161, (703) 487-4650.

Entire article available at: http://www.lbl.gov/ICSD/Niles/

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