Telemedicine:

Federal Strategy Is Needed to Guide Investments

NSIAD/HEHS-97-67: Published: Feb 14, 1997. Publicly Released: Feb 14, 1997.

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Pursuant to a congressional request, GAO reviewed the steps that the federal government needs to take to realize the full potential of telemedicine and achieve cooperation with the private sector, focusing on: (1) the scope of public and private telemedicine investments; (2) telemedicine strategies among the Department of Defense (DOD), other federal agencies, and the private sector; (3) potential benefits that the public and private sectors may yield from telemedicine initiatives; and (4) barriers facing telemedicine implementation.

GAO found that: (1) collectively, the public and private sectors have funded hundreds of telemedicine projects that could improve, and perhaps change significantly, how health care is provided in the future; (2) however, the amount of the total investment is unknown; (3) 9 federal departments and independent agencies invested at least $646 million in telemedicine projects from fiscal years 1994 to 1996; (4) DOD is the largest federal investor with $262 million and considered a leader in developing this technology; (5) state-supported telemedicine initiatives are growing; (6) estimates of private sector involvement are impossible to quantify because most cost data are proprietary and difficult to separate from health care delivery costs; (7) opportunities exist for federal agencies to share lessons learned and exchange technology, but no governmentwide strategy exists to ensure that the maximum benefits are gained from the numerous federal telemedicine efforts; (8) the Joint Working Group on Telemedicine (JWGT) is the first mechanism structured to help coordinate federal programs; (9) however, its efforts to develop a federal inventory, a critical starting point for coordination, have been hampered by definitional issues and inconsistent data; (10) in addition, DOD and other federal departments do not have strategic plans to help guide their telemedicine investments, assess benefits, and foster partnerships; (11) telemedicine is an area in which public and private benefits converge; (12) many anecdotal examples demonstrate how telemedicine could improve access and quality to medical care and reduce health care costs; (13) however, comprehensive, scientific evaluations have not been completed to demonstrate the cost benefits of telemedicine; (14) the expansion of telemedicine is hampered by legal and regulatory, financial, technical, and cultural barriers facing health care providers; (15) some barriers are too broad and have implications too far-reaching for any single sector to address; (16) telemedicine technology today is not only better than it was decades ago, it is becoming cheaper; (17) consequently, the questions facing telemedicine today involve not so much whether it can be done but rather where investments should be made and who should make them; (18) the solution lies in the public and private sectors' ability to jointly devise a means to share information and overcome barriers; and (19) the goal is to ensure that an affordable telecommunications infrastructure is in place and that the true merits and cost benefits of telemedicine are attained in the most appropriate manner.

Recommendations for Executive Action

  1. Status: Closed - Not Implemented

    Comments: The Office of the Vice President has made no comment on GAO's recommendations.

    Recommendation: The Vice President should direct JWGT, in consultation with the heads of federal departments and agencies that sponsor telemedicine projects, to propose a federal strategy that would establish near- and long-term national goals and objectives to ensure the cost-effective development and use of telemedicine. In addition, the proposed strategy should include approaches and actions needed to: (1) establish a means to formally exchange information or technology among the federal government, state organizations, and private sector; (2) foster collaborative partnerships to take advantage of other telemedicine investments; (3) identify needed technologies that are not being developed by the public or private sector; (4) promote interoperable system designs that would enable telemedicine technologies to be compatible, regardless of where they are developed; (5) encourage adoption of ppropriate standardized medical records and data systems so that information may be exchanged among sectors; (6) overcome barriers so that investments can lead to better health care; and (7) encourage federal agencies and departments to develop and implement individual strategic plans to support national goals and objectives.

    Agency Affected: Executive Office of the President: Office of the Vice President of the United States

  2. Status: Closed - Implemented

    Comments: DOD concurred with GAO's recommendation and has taken action to address issues that had been identified.

    Recommendation: Because DOD is the major federal telemedicine investor and manages one of the nation's largest health care systems, it is in the best position to help forge an overall telemedicine strategy. A first step is to develop a departmentwide strategy. Therefore, the Secretary of Defense should develop and submit to the Congress by February 14, 1998, an overarching telemedicine research and development and operational strategy. The strategy should clearly define the scope of telemedicine in DOD.

    Agency Affected: Department of Defense

  3. Status: Closed - Implemented

    Comments: DOD concurred with GAO's recommendation and has taken action to address issues that had been identified.

    Recommendation: Because DOD is the major federal telemedicine investor and manages one of the nation's largest health care systems, it is in the best position to help forge an overall telemedicine strategy. A first step is to develop a departmentwide strategy. Therefore, the Secretary of Defense should develop and submit to the Congress by February 14, 1998, an overarching telemedicine research and development and operational strategy. The strategy should establish DOD-wide goals and objectives and identify actions and appropriate milestones for achieving them.

    Agency Affected: Department of Defense

  4. Status: Closed - Implemented

    Comments: DOD concurred with GAO's recommendation and has taken action to address issues that had been identified.

    Recommendation: Because DOD is the major federal telemedicine investor and manages one of the nation's largest health care systems, it is in the best position to help forge an overall telemedicine strategy. A first step is to develop a departmentwide strategy. Therefore, the Secretary of Defense should develop and submit to the Congress by February 14, 1998, an overarching telemedicine research and development and operational strategy. The strategy should prioritize and target near- and long-term investments, especially for goals related to combat casualty care and operations other than war.

    Agency Affected: Department of Defense

  5. Status: Closed - Implemented

    Comments: DOD concurred with GAO's recommendation and has taken action to address issues that had been identified.

    Recommendation: Because DOD is the major federal telemedicine investor and manages one of the nation's largest health care systems, it is in the best position to help forge an overall telemedicine strategy. A first step is to develop a departmentwide strategy. Therefore, the Secretary of Defense should develop and submit to the Congress by February 14, 1998, an overarching telemedicine research and development and operational strategy. The strategy should clarify roles of DOD oversight organizations.

    Agency Affected: Department of Defense

 

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