Section III

REFERENCES and RESOURCES

TABLE OF CONTENTS

A. APPENDICES

APPENDIX 1
a. Rural Hosptials with Telemedical Programs/Projects
b. University Hospitals withTelemedical Programs/Projects
c. Pediatric Hospitals with Telemedical Programs/Projects
d. Other Hospitals with Telemedical Programs/Projects
e. Primary Care Facilities
f. Veterans' Affairs Facilities
g. Mental Health Progrmas
h. Long-term Care Facilities
i. Home Health Care
j. Prisons

APPENDIX 2
California Telephone Companies

APPENDIX 3
FUNDING SOURCES
Private
State
Federal

APPENDIX 4
LEGISLATIVE INITIATIVES
State Initiatives
Federal Initiatives

APPENDIX 5
Text of Senate Bill (SB)1665

APPENDIX 6
Text of Senate Bill (SB) 2098

APPENDIX 7
Glossary of Terms

B. TELEHEALTH TELEMEDICINE SOURCES AND RESOURCES

INFORMATION SOURCES
Associations and Organizations
Journals
Books
Internet Sites
Telehealth Internet Sites
Reference Sources
Telemedicine Internet Sites
Telemedicine Resources and Services: Organizations
Telemedicine Glossary
List of Major Telemedicine Reports

A. Appendices

Appendix 1

Telemedicine Sites In California

a. Rural Hospitals

b. University/Teaching Hospitals

c. Pediatric Hospitals

d. Other Hospitals

e. Primary Care Clinics

f. Veterans Affairs Facilities

g. Mental Health Programs

h. Long-term Care Facilities

i. Home Health Care

j. Prisons

Private

State

Recognizing the difficulty that small and rural health facilities have in obtaining financing for their capital needs, the California Health Facilities Financing Authority developed the HELP II Program in 1988 to provide low cost loans. In addition to paying for studies, surveys, construction, remodeling or purchase of facilities, the loan program will also pay for the purchase of new equipment. For many small facilities this will help meet the start up purchase costs of telemedical equipment.

The terms of the loans are very reasonable. The loan minimum is $25,000 and maximum of $300,000. There is a low fixed interest rate that is subject to change. As of the date of the report this interest rate is 3 percent. The maximum loan term is 10 years. To be eligible for financing, an applicant must have received non-profit status and qualify as a health facility under the Authority's enabling legislation - Section 15432(d) of the Government Code.

More information about the HELP II PROGRAM can be obtained by writing:

The California Health Facilities Financing Authority
915 Capitol Mall, Suite 590
Sacramento, CA 95814
Phone: (916) 653-2799
Fax: (916) 654-5362

Federal

Contact:
1/800-382-5873 (voice)
(703) 696-3813 (fax)
pa95-04@arpa.mil (e-mail)
http://www.arpa.mil/baa

Will fund: The Department of Defense; National Inst. of Standards & Technology; NASA; Department of Transportation; and the National Science Foundation.

Contact:
Armand Checker, Office of Mental Health Director;
(301) 443-9001 (voice)

Contact: Mrs. Frances Johnson, Program Officer;
(301) 496-4221 (voice)
(301) 402-0421 (fax)
frances_johnson@occshost.nlm.nih.gov (e-mail)

http://www.nlm.nih.gov/funding/funding.html

Contact: Peter Clepper, Program Officer;
(301) 496-4221 (voice)
clepper@hlm.nih.gov (e-mail)

Notes: Will fund domestic nonprofits and for profits where telemedicine may represent a significant, but not major, project effort.

Contact: Paula Geeler;
(301) 594-1364 (voice)

Will fund: Universities, foundations, nonprofits

Contact: William England;
(410) 786-0542 (voice)
(410) 966-5515 (fax)

http://www.hcfa.gov/ord/ordhpl.html (WWW)

Contact: Steve Downs;
(202) 482-2048 (voice)
(202) 501-5136 (fax)

http://www.ntia.doc.gov/activ.html (WWW)

Will fund: State and local governments and nonprofit entities

Contact: Eileen Holloran;
(301) 443-0835 (voice)
(301) 443-2803 (fax)

eholloran@hrsa.ssw.dhhs.gov (e-mail)

Contact: 1-800-287-3863 (recording) (voice)
(301) 926-9524 or (301) 590-3053 (fax)

atp@micf.nist.gov (e-mail)

http://www.atp.nist.gov (WWW)

Contact: Northwest Area: Jerry Brent, Director (202) 720-0803 (voice); (202) 205-2921 (fax).
Southwest Area: Ken Chandler, Director, (202) 720-0800 (voice); (202) 205-2921 (fax)

Will fund: An incorporated organization, partnership, Indian tribe or trial organizations as defined in 25 U.S.C. 450 (b) and (c); or other legal entity which operates or will operate one of the following: school, library, regional educational laboratory, hospital, medical clinic, college, vocational training facility, other educational institution, medical center, or rural community facility.<1>

Appendix 4

State Initiatives

Reimbursement

Effective January 1, 1997, private health insurance and managed care plans are required to integrate telemedicine into their existing reimbursement policies and procedures. This is a flexible approach which allows private payers to phase in telemedicine reimbursement and treats telemedicine in a similar manner as traditional face-to-face care. California's Medi-Cal Program is also required to have a telemedicine reimbursement policy in place by July 1, 1997. Face-to-face contact between the healthcare provider and the patient is no longer a requirement.

Confidentiality

All medical information transmitted electronically during the delivery of health care via telemedicine must become part of the patient's medical record maintained by the licensed health care provider. All existing regulations regarding access, use, disclosure, confidentiality, retention of record contents, and maintenance of health information in patient records will now apply.

Informed Consent

As a patient protection measure, all health care providers will be required to obtain verbal and written consent from the patient (or the patient's representative) prior to the delivery of health care via telemedicine. Informed consent is not required when the patient is not involved in the telemedicine interaction, such as when provider to provider consultation is talking place, in emergency situations, or for patients under the jurisdiction of the California Department of Corrections.

Physician Licensure

At the request of the Medical Board of California, the bill would clarify existing law regarding consultation across state lines. Health care practitioners outside of California who do not hold a California license to practice medicine may only provide consultation to a licensed California practitioner. This interstate consultation is allowed when the out-of-state practitioner does not have ultimate authority over the care of the patient.

The second telemedicine bill to pass the Legislature and be signed by the Governor this year is SB 2098 (Kopp), which was sponsored by the Medical Board of California. This measure allows the Medical Board to develop regulations to implement a telemedicine registration program for out-of-state physicians. With this program in place physicians, surgeons, and podiatrists could provide medical care across state lines without the involvement of a California physician. After the regulations are developed, the Medical Board are required to obtain legislative approval in order for the program to be implemented.

Federal Initiatives

The 104th Congress of the United States was active in the promotion of telemedicine through the introduction of 15 bills, five in the House and ten in the Senate, related to the technology. In summary, these bills related to:

• Reimbursement: establishing policies for and promulgation regulations related to reimbursement by federal programs.

• Access: support for universal access to telecommunications (Telecommunications Act of 1996) with emphasis on rural communities.

• Promotion: grants to support implementation and effectiveness studies; grants for equipment; and grants under the Healthy Mothers, Healthy Children Act of 1995.

Appendix 5

Text of Senate Bill (SB)1665

BILL NUMBER: SB 1665
CHAPTERED 09/25/96

BILL TEXT
CHAPTER 864

FILED WITH SECRETARY OF STATE SEPTEMBER 25, 1996
APPROVED BY GOVERNOR SEPTEMBER 24, 1996
PASSED THE SENATE AUGUST 23, 1996
PASSED THE ASSEMBLY AUGUST 19, 1996
AMENDED IN ASSEMBLY AUGUST 5, 1996
AMENDED IN ASSEMBLY JULY 7, 1996
AMENDED IN ASSEMBLY JUNE 20, 1996
AMENDED IN SENATE MAY 23, 1996
AMENDED IN SENATE MAY 15, 1996
AMENDED IN SENATE APRIL 15, 1996
INTRODUCED BY Senator Thompson
(Principal coauthor: Senator Leslie)

(Coauthors: Senators Alquist, Costa, Johannessen, O'Connell, Polanco, Sher, and Watson)
(Coauthors: Assembly Members Bustamante, Caldera, Machado, Mazzoni, Napolitano, and Woods)

FEBRUARY 21, 1996
An act to amend Section 2060 of, and to add Section 2290.5 to, the Business and Professions Code, to amend Sections 1367 and 1375.1 of, and to add Sections 1374.13 and 123149.5 to, the Health and Safety Code, to amend Section 10123.13 of, and to add Section 10123.85 to, the Insurance Code, and to add and repeal Section 14132.72 of the Welfare and Institutions Code, relating to telemedicine.

LEGISLATIVE COUNSEL'S DIGEST
SB 1665, M. Thompson. Medicine: telemedicine.

Existing law provides that the Medical Practice Act does not apply to any practitioner when in actual consultation with a licensed practitioner of this state, and would prohibit the practitioner from opening an office, a place to meet patients, and from receiving calls from patients within the limits of this state.

This bill would instead provide that the act does not apply to any practitioner located outside the state when in actual consultation either within this state or across state lines with a licensed practitioner of this state, and would also prohibit the out-of-state practitioner from having ultimate authority over the care or primary diagnosis of a patient who is located within this state.

Existing law provides for the licensure and regulation of physicians and surgeons and other health care professionals and provides that various actions constitute unprofessional conduct. Existing law also regulates health care service plans, disability insurers, and nonprofit hospital service plans and requires each of them to provide certain prescribed benefits. Existing law provides that a violation of the provisions governing health care service plans is subject to criminal sanction. Existing law establishes the Medi-Cal program which provides for health care services for individuals who meet certain financial eligibility criteria.

This bill would enact the "Telemedicine Development Act of 1996" by imposing several requirements governing the delivery of health care services through telemedicine, as defined. It would require a health care practitioner, as defined, prior to providing health care services through telemedicine, as defined, to obtain the verbal and written consent of the patient, and would provide that the failure to do so would constitute unprofessional conduct. This requirement would not apply when the patient is not directly involved in the telemedicine interaction, with a specified exception. The bill would impose various requirements in regard to the provision of, or payment for, telemedicine services by health care service plans, disability insurers, and, until January 1, 2001, the Medi-Cal program.

Existing law establishes procedures regarding the maintenance of a patient's medical records and for the patient's access to medical records.

This bill would state that it is the intent of the Legislature that all medical information transmitted through telemedicine be maintained as a part of the patient's medical record. The bill would also provide that it should not be construed to alter the scope of practice of any health care provider or to authorize the delivery of health care services in a setting or in a manner not otherwise authorized by law.

By changing the definition of a crime applicable to health care service plans, this bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

This bill would incorporate additional changes in Section 10123.13 of the Insurance Code, proposed by SB 1478, to be operative only if SB 1478 and this bill are both chaptered and become effective on January 1, 1997, and this bill is chaptered last.

THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

SECTION 1. The Legislature finds and declares all of the following:

(a) Lack of primary care, specialty providers, and transportation continue to be significant barriers to access to health services in medically underserved rural and urban areas.

(b) Parts of California have difficulty attracting and retaining health professionals, as well as supporting local health facilities to provide a continuum of health care. As of June, 1995, 49 counties received federal designation as having medically underserved areas or populations.

(c) Many health care providers in medically underserved areas are isolated from mentors, colleagues, and the information resources necessary to support them personally and professionally.

(d) Telemedicine is broadly defined as the use of information technology to deliver medical services and information from one location to another.

(e) Telemedicine is part of a multifaceted approach to address the problem of provider distribution and the development of health systems in medically underserved areas by improving communication capabilities and providing convenient access to up-to-date information, consultations, and other forms of support.

(f) The use of telecommunications to deliver health services has the potential to reduce costs, improve quality, change the conditions of practice, and improve access to health care in rural and other medically underserved areas.

(g) Telemedicine has been utilized in one form or another for 30 years, and telemedicine projects currently exist in at least 40 states.

(h) Telemedicine will assist in maintaining or improving the physical and economic health of medically underserved communities by keeping the source of medical care in the local area, strengthening the health infrastructure, and preserving health care-related jobs.

(i) Consumers of health care will benefit from telemedicine in many ways, including expanded access to providers, faster and more convenient treatment, better continuity of care, reduction of lost work time and travel costs, and the ability to remain with support networks.

(j) Telemedicine does not change the existing scope of practice of any licensed health professional.

(k) It is the intent of the Legislature that telemedicine not replace health care providers or relegate them to a less important role in the delivery of health care. The fundamental health care provider-patient relationship can not only be preserved, but also augmented and enhanced, through the use of telemedicine.

(l) Without the assurance of payment and the resolution of legal and policy barriers, the full potential of telemedicine will not be realized.

(m) This act shall be known as the "Telemedicine Development Act of 1996."

SEC. 2. This act shall not be construed to alter the scope of practice of any health care provider or authorize the delivery of health care services in a setting, or in a manner, not otherwise authorized by law.

SEC. 3. Section 2060 of the Business and Professions Code is amended to read:

2060. Nothing in this chapter applies to any practitioner located outside this state, when in actual consultation, whether within this state or across state lines, with a licensed practitioner of this state, or when an invited guest of the California Medical Association or the California Podiatric Medical Association, or one of their component county societies, or of an approved medical or podiatric medical school or college for the sole purpose of engaging in professional education through lectures, clinics, or demonstrations, if he or she is, at the time of the consultation, lecture, or demonstration a licensed physician and surgeon in the state or country in which he or she resides. This practitioner shall not open an office, appoint a place to meet patients, receive calls from patients within the limits of this state, give orders, or have ultimate authority over the care or primary diagnosis of a patient who is located within this state.

SEC. 4. Section 2290.5 is added to the Business and Professions Code, to read:

2290.5. (a) For the purposes of this section, "telemedicine" means the practice of health care delivery, diagnosis, consultation, treatment, transfer of medical data, and education using interactive audio, video, or data communications.

(b) For the purposes of this section, "health care practitioner" has the same meaning as "licentiate" as defined in paragraph (2) of subdivision (a) of Section 805.

(c) Prior to the delivery of health care via telemedicine, the health care practitioner who has ultimate authority over the care or primary diagnosis of the patient shall obtain verbal and written informed consent from the patient. The informed consent procedure shall ensure that at least all of the following information is given to the patient verbally and in writing:

(1) The individual retains the option to withhold or withdraw consent at any time without affecting the right to future care or treatment nor risking the loss or withdrawal of any program benefits to which the individual would otherwise be entitled.

(2) A description of the potential risks, consequences, and benefits of telemedicine.

(3) All existing confidentiality protections apply.

(4) Patient access to all medical information transmitted during a telemedicine consultation is guaranteed, and copies of this information are available for a reasonable fee.

(5) Dissemination of any patient identifiable images or information from the telemedicine interaction to researchers or other entities shall not occur without the consent of the patient.

(d) A patient shall sign a written statement prior to the delivery of health care via telemedicine, indicating that the patient understands the written information provided pursuant to subdivision

(a), and that this information has been discussed with the health care practitioner, or his or her designee.

(e) The written consent statement signed by the patient shall become part of the patient's medical record.

(f) The failure of a health care practitioner to comply with this section shall constitute unprofessional conduct. Section 2314 shall not apply to this section.

(g) Where the patient is a minor, or is incapacitated or mentally incompetent such that he or she is unable to give informed consent, this section shall apply to the patient's representative.

(h) Except as provided in paragraph (3) of subdivision (c), this section shall not apply when the patient is not directly involved in the telemedicine interaction, for example when one health care practitioner consults with another health care practitioner.

(i) This section shall not apply in an emergency situation in which a patient is unable to give informed consent and the representative of that patient is not available.

(j) This section shall not apply to a patient under the jurisdiction of the Department of Corrections.

SEC. 5. Section 1367 of the Health and Safety Code is amended to read:

1367. Each health care service plan, and where applicable, each specialized health care service plan, shall meet the following requirements:

(a) All facilities located in this state including, but not limited to, clinics, hospitals, and skilled nursing facilities to be utilized by the plan shall be licensed by the State Department of Health Services, where licensure is required by law. Facilities not located in this state shall conform to all licensing and other requirements of the jurisdiction in which they are located.

(b) All personnel employed by or under contract to the plan shall be licensed or certified by their respective board or agency, where licensure or certification is required by law.

(c) All equipment required to be licensed or registered by law shall be so licensed or registered and the operating personnel for that equipment shall be licensed or certified as required by law.

(d) The plan shall furnish services in a manner providing continuity of care and ready referral of patients to other providers at times as may be appropriate consistent with good professional practice.

(e) (1) All services shall be readily available at reasonable times to all enrollees. To the extent feasible, the plan shall make all services readily accessible to all enrollees.

(2) To the extent that telemedicine services are appropriately provided through telemedicine, as defined in subdivision (a) of Section 2290.5 of the Business and Professions Code, these services shall be considered in determining compliance with Section 1300.67.2 of Title 10 of the California Code of Regulations.

(f) The plan shall employ and utilize allied health manpower for the furnishing of services to the extent permitted by law and consistent with good medical practice.

(g) The plan shall have the organizational and administrative capacity to provide services to subscribers and enrollees. The plan shall be able to demonstrate to the department that medical decisions are rendered by qualified medical providers, unhindered by fiscal and administrative management.

(h) All contracts with subscribers and enrollees, including group contracts, and all contracts with providers, and other persons furnishing services, equipment, or facilities to or in connection with the plan, shall be fair, reasonable, and consistent with the objectives of this chapter. All contracts with providers shall contain provisions requiring a dispute resolution mechanism under which providers may submit disputes to the plan, and requiring the plan to inform its providers upon contracting with the plan, or upon change to these provisions, of the procedures for processing and resolving disputes, including the location and telephone number where information regarding disputes may be submitted.

(i) Each health care service plan contract shall provide to subscribers and enrollees all of the basic health care services included in subdivision (b) of Section 1345, except that the commissioner may, for good cause, by rule or order exempt a plan contract or any class of plan contracts from that requirement. The commissioner shall by rule define the scope of each basic health care service which health care service plans shall be required to provide as a minimum for licensure under this chapter. Nothing in this chapter shall prohibit a health care service plan from charging subscribers or enrollees a copayment or a deductible for a basic health care service or from setting forth, by contract, limitations on maximum coverage of basic health care services, provided that the copayments, deductibles, or limitations are reported to, and held unobjectionable by, the commissioner and set forth to the subscriber or enrollee pursuant to the disclosure provisions of Section 1363.

Nothing in this section shall be construed to permit the commissioner to establish the rates charged subscribers and enrollees for contractual health care services.

The commissioner's enforcement of Article 3.1 (commencing with Section 1357) shall not be deemed to establish the rates charged subscribers and enrollees for contractual health care services. SEC. 6. Section 1374.13 is added to the Health and Safety Code, to read:

1374.13. (a) It is the intent of the Legislature to recognize the practice of telemedicine as a legitimate means by which an individual may receive medical services from a health care provider without person-to-person contact with the provider.

(b) For the purposes of this section, the meaning of "telemedicine" is as defined in subdivision (a) of Section 2290.5 of the Business and Professions Code.

(c) On and after January 1, 1997, no health care service plan contract that is issued, amended, or renewed shall require face-to-face contact between a health care provider and a patient for services appropriately provided through telemedicine, subject to all terms and conditions of the contract agreed upon between the enrollee or subscriber and the plan. The requirement of this subdivision shall be operative for health care service plan contracts with the Medi-Cal managed care program only to the extent that both of the following apply:

(1) Telemedicine services are covered by, and reimbursed under, the Medi-Cal fee-for-service program, as provided in subdivision (c) of Section 14132.72.

(2) Medi-Cal contracts with health care service plans are amended to add coverage of telemedicine services and make any appropriate capitation rate adjustments.

(d) Health care service plans shall not be required to pay for consultation provided by the health care provider by telephone or facsimile machines.

SEC. 7. Section 1375.1 of the Health and Safety Code is amended to read:

1375.1. (a) Every plan shall have and shall demonstrate to the commissioner that it has all of the following:

(1) A fiscally sound operation and adequate provision against the risk of insolvency.

(2) Assumed full financial risk on a prospective basis for the provision of covered health care services, except that a plan may obtain insurance or make other arrangements for the cost of providing to any subscriber or enrollee covered health care services, the aggregate value of which exceeds five thousand dollars ($5,000) in any year, for the cost of covered health care services provided to its members other than through the plan because medical necessity required their provision before they could be secured through the plan, and for not more than 90 percent of the amount by which its costs for any of its fiscal years exceed 115 percent of its income for that fiscal year.

(3) A procedure for prompt payment or denial of provider and subscriber or enrollee claims, including those telemedicine services, as defined in subdivision (a) of Section 2290.5 of the Business and Professions Code, covered by the plan. Except as provided in Section 1371, a procedure meeting the requirements of Subchapter G of the regulations (29 C.F.R. Part 2560) under Public Law 93-406 (88 Stats. 829-1035, 29 U.S.C. Secs. 1001 et seq.) shall satisfy this requirement.

(b) In determining whether the conditions of this section have been met, the commissioner shall consider, but not be limited to, the following:

(1) The financial soundness of the plan's arrangements for health care services and the schedule of rates and charges used by the plan.

(2) The adequacy of working capital.

(3) Agreements with providers for the provision of health care services.

(c) For the purposes of this section, "covered health care services" means health care services provided under all plan contracts.

SEC. 8. Section 123149.5 is added to the Health and Safety Code, to read:

123149.5. (a) It is the intent of the Legislature that all medical information transmitted during the delivery of health care via telemedicine, as defined in subdivision (a) of Section 2290.5 of the Business and Professions Code, become part of the patient's medical record maintained by the licensed health care provider.

(b) This section shall not be construed to limit or waive any of the requirements of Chapter 1 (commencing with Section 123100) of Part 1 of Division 106 of the Health and Safety Code.

SEC. 9. Section 10123.13 of the Insurance Code is amended to read:

10123.13. Every insurer issuing group or individual policies of disability insurance that covers hospital, medical, or surgical expenses, including those telemedicine services covered by the insurer as defined in subdivision (a) of Section 2290.5 of the Business and Professions Code, shall reimburse claims or any portion of any claim, whether in state or out of state, for those expenses, as soon as practical, but no later than 30 working days after receipt of the claim by the insurer unless the claim or portion thereof is contested by the insurer in which case the claimant shall be notified, in writing, that the claim is contested or denied, within 30 working days after receipt of the claim by the insurer. The notice that a claim is being contested shall identify the portion of the claim that is contested and the specific reasons for contesting the claim.

If an uncontested claim is not reimbursed by delivery to the claimants' address of record within 30 working days after receipt, interest shall accrue at the rate of 10 percent per annum beginning with the first calendar day after the 30 working day period.

For purposes of this section, a claim, or portion thereof, is reasonably contested where the insurer has not received a completed claim and all information necessary to determine payer liability for the claim, or has not been granted reasonable access to information concerning provider services. Information necessary to determine liability for the claims includes, but is not limited to, reports of investigations concerning fraud and misrepresentation, and necessary consents, releases, and assignments, a claim on appeal, or other information necessary for the insurer to determine the medical necessity for the health care services provided to the claimant.

SEC. 9.5. Section 10123.13 of the Insurance Code is amended to read:

10123.13. Every insurer issuing group or individual policies of disability insurance that covers hospital, medical, or surgical expenses, including those telemedicine services covered by the insurer as defined in subdivision (a) of Section 2290.5 of the Business and Professions Code, shall reimburse claims or any portion of any claim, whether in state or out of state, for those expenses, as soon as practical, but no later than 30 working days after receipt of the claim by the insurer unless the claim or portion thereof is contested by the insurer in which case the claimant shall be notified, in writing, that the claim is contested or denied, within 30 working days after receipt of the claim by the insurer. The notice that a claim is being contested shall identify the portion of the claim that is contested and the specific reasons for contesting the claim.

If an uncontested claim is not reimbursed by delivery to the claimants' address of record within 30 working days after receipt, interest shall accrue at the rate of 10 percent per annum beginning with the first calendar day after the 30-working-day period.

For purposes of this section, a claim, or portion thereof, is reasonably contested where the insurer has not received a completed claim and all information necessary to determine payer liability for the claim, or has not been granted reasonable access to information concerning provider services. Information necessary to determine liability for the claims includes, but is not limited to, reports of investigations concerning fraud and misrepresentation, and necessary consents, releases, and assignments, a claim on appeal, or other information necessary for the insurer to determine the medical necessity for the health care services provided to the claimant.

The obligation of the insurer to comply with this section shall not be deemed to be waived when the insurer requires its contracting entities to pay claims for covered services.

SEC. 10. Section 10123.85 is added to the Insurance Code, to read:

10123.85. (a) It is the intent of the Legislature to recognize the practice of telemedicine as a legitimate means by which an individual may receive medical services from a health care provider without person-to-person contact with the provider.

(b) For the purposes of this section, the meaning of "telemedicine" is as defined in subdivision (a) of Section 2290.5 of the Business and Professions Code.

(c) On and after January 1, 1997, no disability insurance contract that is issued, amended, or renewed for hospital, medical, or surgical coverage shall require face-to-face contact between a health care provider and a patient for services appropriately provided through telemedicine, subject to all terms and conditions of the contract agreed upon between the policyholder or contractholder and the insurer.

(d) Disability insurers shall not be required to pay for consultation provided by the health care provider by telephone or facsimile machines.

SEC. 11. Section 14132.72 is added to the Welfare and Institutions Code, to read:

14132.72. (a) It is the intent of the Legislature to recognize the practice of telemedicine as a legitimate means by which an individual may receive medical services from a health care provider without person-to-person contact with the provider.

(b) For the purposes of this section, the meaning of "telemedicine" is as defined in subdivision (a) of Section 2290.5 of the Business and Professions Code.

(c) Commencing July 1, 1997, face-to-face contact between a health care provider and a patient shall not be required under the Medi-Cal program for services appropriately provided through telemedicine, subject to reimbursement policies developed by the Medi-Cal program to compensate licensed health care providers who provide health care services, that are otherwise covered by the Medi-Cal program, through telemedicine.

(d) The Medi-Cal program shall not be required to pay for consultation provided by the health care provider by telephone or facsimile machines.

(e) The Medi-Cal program shall pursue private or federal funding to conduct an evaluation of the cost-effectiveness and quality of health care provided through telemedicine by those providers who are reimbursed for telemedicine services by the program.

(f) This section shall remain in effect only until January 1, 2001, and as of that date is repealed, unless a later enacted statute, that is enacted before January 1, 2001, deletes or extends that date.

SEC. 12. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.

Notwithstanding Section 17580 of the Government Code, unless otherwise specified, the provisions of this act shall become operative on the same date that the act takes effect pursuant to the California Constitution.

SEC. 13. Section 9.5 of this bill incorporates amendments to Section 10123.13 of the Insurance Code proposed by both this bill and SB 1478. It shall only become operative if (1) both bills are enacted and become effective on January 1, 1997, (2) each bill amends Section 10123.13 of the Insurance Code, and (3) this bill is enacted after SB 1478, in which case Section 9 of this bill shall not become operative.

Appendix 6

Text of Senate Bill (SB) 2098

BILL NUMBER: SB 2098
CHAPTERED 09/25/96

BILL TEXT
CHAPTER 902

FILED WITH SECRETARY OF STATE SEPTEMBER 25, 1996
APPROVED BY GOVERNOR SEPTEMBER 24, 1996
PASSED THE SENATE AUGUST 26, 1996
PASSED THE ASSEMBLY AUGUST 20, 1996
AMENDED IN ASSEMBLY JUNE 28, 1996
AMENDED IN ASSEMBLY JUNE 17, 1996
AMENDED IN SENATE MAY 1, 1996
INTRODUCED BY Senator Kopp

FEBRUARY 23, 1996

An act to amend Sections 803.2 and 2234 of, and to add Section 2052.5 to, the Business and Professions Code, relating to medicine.

LEGISLATIVE COUNSEL'S DIGEST
SB 2098, Kopp. Medicine.

Existing law requires every entry of judgment, settlement agreement, or arbitration award over $30,000 of a claim or action for damages for death or personal injury caused by the negligence, error, or omission in practice, or the unauthorized rendering of professional services, by a physician and surgeon or doctor of podiatric medicine or osteopath, when that judgment, settlement agreement, or arbitration award is entered against, or paid by, the employer of that licensee and not the licensee himself or herself, to be reported to the appropriate board, by prescribed persons or entities.

This bill would include awards in any claim or action alleging the negligence, error, omission, or unauthorized practice within this requirement. By requiring court clerks to make these reports, this bill would impose a state-mandated local program.

Existing law, the Medical Practice Act, provides for the licensure and regulation of the practice of medicine and podiatric medicine. Existing law requires any person who practices medicine or podiatric medicine to obtain a license from the Medical Board of California. Existing law authorizes the board to take action against any licensee who is charged with unprofessional conduct, and prescribes acts that constitute unprofessional conduct.

This bill would authorize the board to develop a proposed registration program that would, if implemented, permit a physician and surgeon or doctor of podiatric medicine located outside this state to practice medicine or podiatric medicine across state lines. It would require the board to include prescribed requirements and procedures in the proposed registration program, and would authorize the board to include other prescribed requirements and procedures in the proposed program.

The bill would provide that upon the implementation of the proposed registration program discussed above, the practice of medicine or podiatric medicine from this state into another state or country without meeting the legal requirements of that state or country for the practice of medicine constitutes unprofessional conduct.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement, including the creation of a State Mandates Claims Fund to pay the costs of mandates that do not exceed $1,000,000 statewide and other procedures for claims whose statewide costs exceed $1,000,000.

This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to these statutory provisions.

THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

SECTION 1. Section 803.2 of the Business and Professions Code is amended to read:

803.2. Every entry of judgment, settlement agreement, or arbitration award over thirty thousand dollars ($30,000) of a claim or action for damages for death or personal injury caused by, or alleging, the negligence, error, or omission in practice, or the unauthorized rendering of professional services, by a physician and surgeon or doctor of podiatric medicine licensed pursuant to Chapter 5 (commencing with Section 2000) or the Osteopathic Initiative Act, when that judgment, settlement agreement, or arbitration award is entered against, or paid by, the employer of that licensee and not the licensee himself or herself, shall be reported to the appropriate board by the entity required to report the information in accordance with Sections 801, 801.1, 802, and 803 as an entry of judgment, settlement, or arbitration award against the negligent licensee.

"Employer" as used in this section means a professional corporation, a group practice, a health care facility or clinic licensed or exempt from licensure under the Health and Safety Code, a licensed health care service plan, a medical care foundation, an educational institution, a professional institution, a professional school or college, a general law corporation, a public entity, or a nonprofit organization that employs, retains, or contracts with a licensee referred to in this section. Nothing in this section shall be construed to authorize the employment of, or contracting with, any licensee in violation of Section 2400.

SEC. 2. Section 2052.5 is added to the Business and Professions Code, to read:

2052.5. (a) The proposed registration program developed pursuant to subdivision (b) shall provide that, for purposes of the proposed registration program.

(1) A physician and surgeon practices medicine in this state across state lines when that person is located outside of this state but, through the use of any medium, including an electronic medium, practices or attempts to practice, or advertises or holds himself or herself out as practicing any system or mode of treating the sick or afflicted in this state, or diagnoses, treats, operates for, or prescribes for any ailment, blemish, deformity, disease, disfigurement, disorder, injury, or other physical or mental condition of any person in this state.

(2) A doctor of podiatric medicine practices podiatric medicine in this state across state lines when that person is located outside of this state but, through the use of any medium, including an electronic medium, practices or attempts to practice podiatric medicine, as defined in Section 2472, in this state.

(3) The proposed registration program shall not apply to any consultation described in Section 2060.

(b) The board may, at its discretion, develop a proposed registration program to permit a physician and surgeon, or a doctor of podiatric medicine, located outside this state to register with the board to practice medicine or podiatric medicine in this state across state lines.

(1) The proposed registration program shall include proposed requirements for registration, including, but not limited to, licensure in the state or country where the physician and surgeon, or the doctor of podiatric medicine, resides, and education and training requirements.

(2) The proposed registration program may also include all of the following: (A) standards for confidentiality, format, and retention of medical records (B) access to medical records by the board (C) registration fees, renewal fees, delinquency fees, and replacement document fees in an amount not to exceed the actual cost of administering the registration program, and (D) provisions ensuring that enforcement and consumer education shall be integral parts of administering such a registration program.

(3) The proposed registration program may also provide all of the following:

(A) All laws, rules, and regulations that govern the practice of medicine or podiatric medicine in this state, including, but not limited to, confidentiality and reporting requirements, shall apply to a physician and surgeon, or a doctor of podiatric medicine, who is registered by the board to practice medicine or podiatric medicine or podiatric medicine in this state across state lines.

(B) The board may deny an application for registration or may suspend, revoke, or otherwise discipline a registrant for any of the following: (i) on any ground prescribed by this chapter (ii) failure to possess or to maintain a valid license in the state where the registrant resides or (iii) if the applicant or registrant is not licensed by the state or country in which he or she resides, and that state or country prohibits the practice of medicine or podiatric medicine from that state or country into any other state or country

without a valid registration or license issued by the state or country in which the applicant or registrant practices. Action to deny or discipline a registrant shall be taken in the manner provided for in this chapter.

(C) All of the following shall be grounds for discipline of a registrant: (i) to allow any person to engage in the practice of medicine or podiatric medicine in this state across state lines under his or her registration, including, but not limited to, any nurse, physician assistant, medical assistant, or other person (ii) to fail to include his or her registration number on any invoice or other type of billing statement submitted for care or treatment provided to a patient located in this state (iii) to practice medicine or podiatric medicine in any other state or country without meeting the legal requirements to practice medicine or podiatric medicine in that state or country (iv) to fail to notify the board, in a manner prescribed by the board, of any restrictions placed on his or her medical license, or podiatric medical license, in any state.

(D) A registration issued pursuant to the registration program shall automatically be suspended upon receipt of a copy, from the state that issued the license, of the surrender, revocation, suspension, or other similar type of action taken by another state or country against a medical license, or podiatric medical license, issued to a registrant. The board shall notify the registrant in writing of the suspension and of the registrant's right to a hearing.

(4) Section 2314 shall not apply to the registration program.

(c) This section shall not be construed to authorize the board to implement a registration program for physicians and surgeons or doctors of podiatric medicine located outside this state. This section is intended to authorize the board to develop a proposed registration program in order that it be authorized for implementation by future legislation.

SEC. 3. Section 2234 of the Business and Professions Code is amended to read:

2234. The Division of Medical Quality shall take action against any licensee who is charged with unprofessional conduct. In addition to other provisions of this article, unprofessional conduct includes, but is not limited to, the following:

(a) Violating or attempting to violate, directly or indirectly, or assisting in or abetting the violation of, or conspiring to violate, any provision of this chapter.

(b) Gross negligence.

(c) Repeated negligent acts.

(d) Incompetence.

(e) The commission of any act involving dishonesty or corruption which is substantially related to the qualifications, functions, or duties of a physician and surgeon.

(f) Any action or conduct which would have warranted the denial of a certificate.

(g) The practice of medicine from this state into another state or country without meeting the legal requirements of that state or country for the practice of medicine. Section 2314 shall not apply to this subdivision. This subdivision shall become operative upon the implementation of the proposed registration program described in Section 2052.5.

SEC. 4. Notwithstanding Section 17610 of the Government Code, if the Commission on State Mandates determines that this act contains costs mandated by the state, reimbursement to local agencies and school districts for those costs shall be made pursuant to Part 7 (commencing with Section 17500) of Division 4 of Title 2 of the Government Code. If the statewide cost of the claim for reimbursement does not exceed one million dollars ($1,000,000), reimbursement shall be made from the State Mandates Claims Fund.

Notwithstanding Section 17580 of the Government Code, unless otherwise specified, the provisions of this act shall become operative on the same date that the act takes effect pursuant to the California Constitution.

Appendix 7

Glossary of Terms

Asymmetrical Digital Subscriber Line (ADSL) - is a pair of modems on either end of a twisted pair copper line that provides asymmetric transmission of data. ADSL doesn't really refer to the line but the modems that connect the line into a high speed digital pipe.

Analog - a continuously varying electrical signal in a shape of a wave. It is represented by continuous wave forms that vary in size and number as the source of the information varies. The variations in voice, loudness or pitch that a user hears at the other end reflects differences or fluctuations in the electrical current.

Archiving - a technique to transfer data created during operations into a more permanent form. Systems range from manual backups, through periodic, automatic transfer to magnetic tape, to real-tune storage onto WORM (Write Once Read Many) disks.

Asynchronous communication - two-way communication in which there is a time delay between when a message is sent and when it's received (e.g., electronic mail and voice mail).

Asynchronous Transfer Mode (ATM) - Narrowly defined, a particular mechanism by which cells are queued and switched through a cell switch. More broadly, the entire set of protocols and equipment associated with cell based communications networks. These networks are capable of transmitting voice, data, and video traffic simultaneously using a statistical multiplexing scheme.

Audio-teleconferencing - two-way voice communication between two or more people at two or more locations.

Backbone network - a high-speed transmission facility designed to interconnect lower speed distribution channels.

Bandwidth - a measure of the information carrying capacity of a communications channel; the higher the bandwidth, the greater the amount of information which can be carried.

Bulletin Board Service (BBS) - a computer service that allows remote users to access a central "host" computer via a remotely located computer to read and post electronic messages.

Cable modem - a modem designed for use on a TV coaxial cable circuit.

Compatibility - two pieces of hardware (e.g., a personal computer and a printer) are compatible if they can operate together. Standards, published specifications of procedures, equipment interfaces, and data formats, are the key to reducing and eventually perhaps eliminating incompatibility. Suppliers that ensure that their telecommunications, hardware, and software products comply with a standard can expect those products to be compatible with the products of other suppliers that have adhered to the same standard.

Connectivity - it is helpful to think of telecommunications in terms of two questions: "Can we send and receive information between these two locations/devices/business services?" and "Can the transmitted information be interpreted and processed?" The first question relates to connectivity, the second to integration.

Digital Imaging and Communication Standards (DICOM).- A set of protocols describing how radiology images are identified and formatted.

Digital - Used in both electronic and light-based systems, digital signals transmit audio, video, and data as bits. Digital technology allows communications signals to be compressed for more efficient transmission.

Direct Broadcast Satellite (DBS) - a satellite designed with sufficient power so that inexpensive earth stations, or downlinks, can be used for direct residential or business reception.

Direct Capture - involves the capture of digital images (e.g., an MRI) so that they can be electronically transmitted. This is in contrast to an x-ray that is first made into a film and then scanned for digitization to send or store.

Dish - a parabolic antenna that is the primary element of a satellite earth station, or downlink.

Earth Station - the ground equipment, including a dish and other electronics components needed to receive and/or transmit satellite telecommunications signals. An "uplink" is used for sending information to a satellite for distribution to various earth receiving stations, while a "downlink" is used to receive such information.

Encryption - encryption is a technique for ensuring the security of information to be transmitted over a communications link. Security is achieved by scrambling the information at one end and unscrambling it at the other. Keys for scrambling the information are generated by mathematical algorithms.

Equal Access - ability to choose between the different long distance carriers. In rural areas, some local exchange carriers are still serviced by only one long distance carrier.

Facsimile (Fax) - a device which electronically transmits and reproduces documents over telephone lines.

Fiber Optics - hair-thin, flexible glass rods encased in cables that use light to transmit audio, video, and data signals.

Footprint - the geographic region on the earth underneath a satellite which is in the appropriate range to receive that satellite's information.

Freeze frame - one method of transmitting still images over standard telephone lines. A single image is transmitted every 8 to 30 seconds. This is also referred to as slow scan.

Full duplex - a communication channel over which both transmission and reception are possible in two directions at the same time. A standard telephone line is a full duplex system since people on either end of the connect can simultaneously speak while listening to sounds coming from the other end.

Full-motion video - a standard video signal that can be transmitted by a variety of means including television broadcast, microwave, fiber optics, and satellite. Full-motion video traditionally requires 6 Mhz in analog format and 90 Mbps when encoded digitally.

Gateway - a computer used to provide translations between different types of standards. Usually applied to computers that translate complex protocol suites, such as different E-mail messaging system. More recently, used to describe a "door" from a private data network to the Internet.

Gigabit (GB) - one billion bits of information - usually used to express a data transfer rate (e.g., 1 gigabit/second = 1Gbps). The bandwidth of optical fiber is often in the gigabit or billion-bits-per-second range.

Geostationary orbit - describes the orbit of a satellite whose position relative to the earth's surface is constant so it appears to hover over one spot on the earth's equator.

Gigahertz (Ghz) - one billion cycles per second. It is a measurement of analog signal transmission.

Graphical User Interface (GUI) - a way computers are controlled using graphic images or icons, to which the user points using a mouse.

Half duplex - a communication channel over which both transmission and reception are possible but only in one direction at a time.

Hardware - hardware broadly refers to the physical components of information technology, the computers, peripheral devices, such a printers, disks, and scanners, and the cables, switches, and other elements of the telecommunications infrastructure that connect everything together.

High Definition Television (HDTV) - an advanced television system that produces video images as clear as high-quality photography.

Hertz - a unit of frequency equal to one cycle per second.

Health Level Seven (HL7) - a protocol designed to allow different hospital and clinic information systems to exchange information in the form of messages.

Image Technology - refers to the general category of computer applications that convert documents, illustrations, photographs, and other images into data that can be stored, distributed, accessed, and processed by computers and special-purpose workstations.

Independent Telephone Company - a local exchange carrier that is not part of the Bell system of operating companies (BOCs). In rural areas, many of the independent telephone companies are cooperative.

Informatics - the application of computer science and information science to the management and processing of data, information, and knowledge.

Information Technology (IT) - is the storage, manipulation, and communication of information in audio, data, and video formats using a variety of electronic technologies.

Interface - an interface is the connection between two devices, either hardware or software.

Internet - the largest international computer network. It is a network of computer networks linking computers from colleges and universities, government agencies, institutions, and commercial organizations worldwide.

Integrated Services Digital Network (ISDN) - a digital telecommunications channel that allows for the integrated transmission of voice, video, and data; a set of protocols for high speed digital transmission.

Kilobits Per Second (Kbps) - a way of reporting the rate of transmission of digital information per second.

Local Area Networks (LANs) - data communications networks that are fairly limited in their reach DBI - e.g., the premises of a building or a campus. They are private networks that facilitate the sharing of information and computer resources by the members of a group.

Local Access Transport Area (LATA) - these are local telephone service areas created by the divestiture of the Regional Bell Operating Companies (RBOCs) formerly associated with AT&T.

Long Distance Carrier (LDC) - Also Interexchange Carrier (IEC).

Leased lines - a line rented from a telephone company for the exclusive used of a customer. May also be called a dedicated line.

Local Exchange Carrier (LEC) - a telephone company that carries local calls.

Megabits Per Second (Mbps) - one million bits per second.

Medical Informatics - the combination of computer science, information science, and the health sciences (medicine) designed to assist in the management and processing of data to support the delivery of health care.

Microwave - high frequency radio waves used for point-to-point communication of audio, video, and data signals. The microwave spectrum is generally above 2 Ghz. Microwave transmission requires line of sight transmission between sending and receiving antennas.

Modem - a modulator/demodulator. This device converts digital information into analog form for transmission over a telecommunications channel, and reconverts it to digital form at the point of reception.

Multimedia - multimedia is a catchall term for the transmission and manipulation of any form of information, whether it is words, pictures, videos, music, numbers, or handwriting. To a computer this is just digital bits--zeroes and ones--as it is to a digital telecommunications link that carries information in bit form. The rapid increase in computing power allows integrated patient records with audio and video clips.

Network - a set of nodes, points, or locations which are connected by means of data, voice, and video communications for the purpose of exchanging information.

Open systems - "open systems" are implicitly vendor-independent and, by extension, interconnectable and "interoperable."

Packet switching - the process of transmitting digital information by means of addressed packets which include data, call control signals, and error control information -- so that a channel is occupied only during the transmission of the packet. In contrast, data sent using modems occupies a channel for the entire duration of the transmission, even when no data is actually traveling over the lines. Using packet switching, the various packets of information can travel along different routes on the network, allowing the carrier to optimize its network capacity.

Point of Presence (POP) - the point at which an interexchange carrier's circuits connect with local circuits for transmission and reception of long distance phone calls.

Plain Old Telephone Service (POTS) - the common analog phone service used everywhere.

Protocol - a protocol is a procedure for establishing links between communication systems. Protocols are primarily concerned with three aspects of the communication process: how data are represented and coded, how data are transmitted, and how errors and failures are recognized and handled. These concepts apply to software as well as hardware.

Public Switched Telephone Network (PSTN) - the public telephone network.

Repeater - a bi-directional device used in channels to amplify and regenerate signals.

Satellite - an electronics retransmission device serving as a repeater, normally placed in orbit around the earth in geostationary orbit for the purpose of receiving and retransmitting electromagnetic signals. It normally receives signals from a single source and retransmits them over a wide geographic area, known as the satellite's "footprint."

Slow scan video - a device that transmits and receives still video pictures over a narrow telecommunications channel, such as standard telephone lines.

Standards - Standards are agreements on how to implement technologies.

Switch - a mechanical or solid state device that opens or closes circuits, changes operating parameters, or selects paths or circuits on a space or time division basis.

Telecommunications - the use of wire, radio, optical, or other electromagnetic channels to transmit or receive signals for voice, data, and video communications.

Teleconferencing - interactive electronic communication between two or more people at two or more sites which make use of voice, video, and/or data transmission systems: audio, audiographics, computer, and video systems.

Telehealth - is the use of electronic communications networks for the transmission of information and data focused on health promotion, disease prevention, and the public's overall health including patient/community education and information, population-based data collection and management, and linkages for health care resources and referrals.

Telemedicine - is the use of electronic communication networks for the transmission of information and data related to the diagnosis and treatment of medical conditions.

Terrestrial carrier - a telecommunication transmission system using land-based facilities (microwave towers, telephone lines, coaxial cable, fiber optic cable) as distinguished from satellite transmission.

Translator - a broadband network operation. A translator is a device which is located in a central retransmission facility to filter incoming microwave signals and retransmit them in a higher frequency band.

Transmission speed - the speed at which information passes over a communications channel, defined in bits per second (bps).

Turn-key system - a telecommunications system in which all components and installation services needed for operational teleconferencing have been provided by a single vendor or contractor.

Uplink - the path, or link, from a transmitting earth station to the satellite. The term is frequently applied to a transmitting earth station.

Videoconferencing - videoconferencing uses telecommunications to bring people at physically remote locations together for meetings. Each location in a videoconferencing system needs a room equipped to send and receive video.

Virtual reality - virtual reality creates an illusion of being a three-dimensional world. That world is created by the computer, and viewed through a special headset that responds to your head movements, while a glove responds to hand gestures. In a virtual room, you may, for instance, move your hand up in order to fly or tap to change the color of a wall.

Voice grade channel - a telephone circuit of sufficient bandwidth to carry signals in the voice frequency range of 300 to 3400 Hertz. This is the bandwidth of a POTS line.

Voice recognition - voice recognition refers to the ability of a computer to interpret spoken words.

Voice switching - an electrical technique for opening and closing a circuit, such as changing from one microphone to another microphone or from one video camera to another video camera, in response to the presence or absence of sound.

Wide Area Networks (WANs) - data communication networks that provide long-haul connectivity among separate networks located in different geographic areas.

Wide Area Telephone Service (WATS) - a flat rate or measured bulk rate long distance service provided on an incoming or outgoing basis. WATS permits a customer, by use of an access line, to make telephone calls to any dial-able telephone number in a specific zone for a flat or bulk monthly rate using an 800 number.

Information Sources

Associations and Organizations

American Medical Informatics Association (AMIA)
4915 St. Elmo Avenue, Suite 302
Bethesda, Maryland 20814
301/657-1291

American Telemedicine Association (ATA)
204 East 4th Street
Austin, Texas 78701
512/477-9119

California Healthy Cities Project
P.O. Box 942732, MS 675
Sacramento, California 94234-7320
Phone: 916-327-7017
Fax: 916-324-7763

Healthcare Information and Management Systems Society (HIMSS)
230 East Ohio Street, Suite 600
Chicago, Illinois 60611-3201
312/664-HIMS

Institute for Telemedicine
Part of The Center for the New West
1625 Broadway, Suite 600
Denver, Colorado 80202
303/572-5400

National Information Infrastructure Testbed (NIIT)
Part of the USC Advanced Biotechnology Consortium
1537 Norfolk Street, DEI-5104
Los Angeles, California 90033
213-342-3671
E-mail:usc-abc@helpnet2.hsc.usc.edu

Source: Healthcare Forum Journal. January/February 1995

Journals

Sources: Healthcare Forum Journal, January/February 1995; Telemedicine Information Exchange

http://tie.telemed.org (WWW)

Books

The Internet is an impressive resource for health care professionals and consumers, providing access to entire libraries or allowing users to focus in on a particular topic. However, any new tool can be intimidating. The following books may be of value to individuals embarking on the quest for knowledge about Telehealth through the Internet.

Ferguson, Tom, M.D., Health Online; Addison-Wesley, 1996.

Hogarth, Michael M.D., Hutchinson, David, M.D.; An Internet Guide for the Health Professional, 1996.

Linden, Tom, M.D. and Kleinholz, Michelle; Dr. Tom Linden's Guide to Online Medicine; Adler & Robin, Books, Inc.; 1995.

Krol E. The Whole Internet User's Guide and Catalog, 2nd Ed. O'Reilly and Associates, 1994.

Internet Sites

To assist individuals interested in further information on telehealth and telemedicine, the following World Wide Web (WWW) sites have been selected as starting points for searches. These are grouped as Telehealth and Telemedicine Resources. Following the name of the Website, the Uniform Resource Locator (URL) for the Website, is provided. Many other sources are available and can be found by using the various WWW search engines such as Yahoo, Alta Vista, Lycos, etc.. Effective words for finding additional sources include: science, health, medicine, telehealth, telemedicine, or distance learning.

Telehealth Internet Sites

Global Health Network

URL: http://www.pitt.edu/HOME/GHNet/GHNet.html

A comprehensive site produced by the University of Pittsburgh available in English, Japanese, Portuguese and Spanish. This site provides links to organizations, academic programs, Public Health resources, electronic publications, meeting, health related networks, newsletters, and available grants.

HealthSeek

URL: http://www.healthseek.com

Healthseek offers a wide range of information for health care professional, companies, organizations, and consumers on the Internet's Healthcare Marketplace where companies market and advertise their products and services. Also links to the Healthcare Career Mart, medical equipment classifieds, and HeathSeek Postroom for discussions with other professionals.

Reference Sources

URL: http://guide.infoseek.com/IS/Cool/?health.html

An overall vehicle to begin a search for a broad spectrum of health and related topics.

Yahoo!

URL: http://www.yahoo.com/HEALTH

Yahoo! is a Web search tool that covers health topics from alternative medicine to health in the workplace.

Your Health Daily

URL: http://nytsyn.com.med/index.html

Up to the minute medical and health news provided by The New York Times. Topics are searchable by keyword.

Blue Cross/Blue Shield Association

URL: http://www.bluecares.com

A resource that provides users with a comprehensive list of reputable websites to learn about specific health topics, association, and health "entertainment" such as "Hyper Doc" link to the National Library of Medicine to learn anatomy and physiology; "Go Ask Alice" link to the Health Education division of Columbia University where consumers can participate in an interactive question and answer session; and a virtual library.

Wellweb

URL: http:www.wellweb.com

Subtitled: The Patient's Network, site provides a holistic approach to care and wellness on the premise that consumers should be informed and participate in the decisions that affect their health care.

MedAccess

URL: http://www.medaccess.com

Provides health and wellness information plus information on U.S. health system, surveys, health knowledge quizzes, newsletters, workbooks and manuals, extensive lists of physicians, hospitals, PPOs, HMOs, and nursing homes.

McMaster University (Ontario, Canada)

URL: http://www-hsl.mcmaster.ca/tomflem/top.html

A comprehensive telehealth resource plus a guide to using the WWW and the Internet.

Washington University

URL: http://www-hpcc.astro.washington.edu/scied/health.html

Health education resource with links to mental health information, Healthwise for Wellness (a resource for improving personal health) and an interactive Q & A on health topics, and the Pharmaceutical Information Network for professionals, students, and patients

California Health Information for Policy Project

URL: http://www.chipp.cahwnet.gov

Full information on a project managed by the Office of Health Planning and Development (OSHPD) and funded by the Robert Woods Foundation to provide coordination of and access to the state's integrated databases. Includes the health database inventory.

MedWeb

URL: http://www.gen.emory.edu/medweb/medweb.telemed.html

MedWeb provides bibliographies, conferences and calendars, documents, electronic publications, guides, hearings, history, informatics, legal medicine, lists of Internet resources.

Health Science Library

URL: http://www.ghsl.nwu.edu/healthweb/index.html

An academic virtual electronic library resource.

Cornell University

URL: http://www.tc.cornell.edu:80/Edu/MathSciGateway/medicine.html

A broad spectrum of resources including Discover Magazine, link to the CDC, NIH History of Medicine Exhibits, The Visible Human Project (3-dimensional visualization of the body), and nutrition resources.

Telemedicine Internet Sites

Department of Defense Telemedicine Test Bed

address: http://www.matmo.army.mil

The DOD home page for telemedicine projects contains information about meetings, projects, weekly news, and bookmarks for telemedicine related sites.

National Institutes of Health

URL: http://www.nih.gov

A home page that provides links to a number of NIH resources, including the NIH Guide to Grants and Contracts.

National Library of Medicine

URL: http://www.nlm.nih.gov

Access to all resources and links to information on specific topics and projects.

Telemedicine Bibliography

URL: http://naftalab.bus.utexas.edu/~mary/mzmtmbib.html

A telemedicine bibliography compiled by Mary Moore, Ph.D. University of Texas at Austin, lists articles, books, and reports.

Telemedicine Information Exchange (TIE)

URL: http://tie.telemed.org

TIE is a comprehensive, on-line source of information about telehealth and telemedicine. This Resource includes searchable databases of almost 3,000 bibliographical references, active telemedicine projects, products and services, legal and ethical issues, meeting, and funding

sources. This site is updated every two weeks.

Telemedicine Resources and Services: Organizations

URL:http://naftalab.bus.utexas.edu/nafta-7/orgs.html

A home page from the University of Texas at Austin, compiles documents, sources for more information and information on current projects. A companion piece, presently under construction, is Elements of Success in Telemedicine,which describes telemedicine projects in the past that have demonstrated the potential of telecommunication services to improve healthcare.

URL:http://naftalab.bus.utexas.edu/nafta-7/elemsucc.html

Telemedicine Glossary

URL:http://www.hscsyr.edu/~wwwserv/Telemedicine/glossary.html

List of Major Telemedicine Reports

a. Telecommunications: Can It Help Solve America's Health Problems?Arthur D. Little, Inc., July 1992

b. Rural TeleHealth: Telemedicine, Distance Education and Informatics for Rural Health CareU.S. Public Health Service, September 1993

c. Reaching Rural: Rural Health Travels the Telecommunications HighwayU.S. Public Health Service, Office of Rural Health Policy, November 1993

d. Telemedicine: Assessing the Kansas EnvironmentKansas Telemedicine Policy Group, November, 1993

e. The Telemedicine Initiative of the International Telecommunication Union (ITU) World, Telecommunication Development Conference, March, 1994

f. R&D for the NII: Technical ChallengesTechnology Policy Working Group of the Information Infrastructure Task Force Committee on Applications and Technology, May 1994

g. Putting the Information Infrastructure to WorkInformation Infrastructure Task Force Committee on Applications and Technology, May 1994

h. Working Conference on Telemedicine Policy For the NII - Airlie HouseHealth Information and Applications Working Group of the Information Infrastructure Task Force Committee on Applications and Technology, August, 1994

i. Analysis of Expansion of Access to Care Through Use of Telemedicine and Mobile Health Services - Study Summary and Recommendations for Further ResearchCenter for Health Policy Research, December, 1994

j. Breaking The Barriers To The National Information InfrastructureCouncil on Competitiveness, December, 1994

k. Telemedicine on the Move; Health Care Heads Down the Information Superhighway American Hospital Association, 1994

l. Global Information Infrastructure: Agenda for CooperationU.S. Department of Commerce, Secretary Ronald H. Brown, February, 1995

m. The Human Dimension of Telemedicine: Barriers to Practitioner AcceptanceCenter for Public Service Communications, February, 1995

n. Telemedicine Initiatives of the Group of Seven Industrialized Nations (G7) and the Global Information Infrastructure (GII) Conference, February, 1995

o. Common Ground: Fundamental Principles for the National Information Infrastructure, NationalInformation Infrastructure Advisory Council, March, 1995

p. Vision to Action: Info-Society 2000, A policy report of the Danish Ministry of Research and Information Technology, March, 1995

q. Working Conference on Telemedicine and the National Information Infrastructure - Augusta, Information Infrastructure Task Force, Telemedicine Subgroup, May, 1995

r. Telemedicine Action ReportWestern Governors' Association, June, 1995

s. Making a Powerful Connection: The Health of the Public and the National Information Infrastructure

t. Telemedicine: A Guide to Assessing Telecommunications in Health CareCommittee on Evaluating Clinical Applications of Telemedicine; Institute of Medicine, October 1996. Source: Scott, John and Neuberger, Neal; Center for Public Service Communications; ISSUES AND OPPORTUNITIES FACING THE FIELD OF TELEMEDICINE: A Review of Selected Policy Studies, Task Force Reports and Legislative Activities; July 1995.

Source: Telemedicine Information Exchange