Telehealth Now and Then: A Northwest Perspective

Jere Retzer, retzerj@ohsu.edu

Oregon Health & Sciences University

April 19, 2023

Disclaimer

All views expressed in this presentation are those solely of the presenter and he doesn’t know much!

About the Northwest

Big/diverse• House-calls rarely happen• Largely medically underserved – losing obstetricians, others due to malpractice

• Drive/fly hours to see specialist – or go without

Independent• “Fate-sharing” usually considered a bad thing

Mostly on the network “edge”

A Sampler of current activities

Lariat/BRINOregon AHECDistance Education for nursing and Medical Informatics

Telemedicine projects in CardiologyRural Health EducationArgentina brain trauma trainingORPRN – AHRQ Medication listVisions of remote surgery ….

The state of telemedicine today

Most projects fail to be sustainable

More effective at demonstrating technology than medical care

Why is telemedicine so unsuccessful?

Insurance reimbursement – making progress in Oregon

Independent culture

Cost of dedicated connections & poor quality available on the Internet

Northwest communities largely on the network edges

Life on the edge

Problem: the lack of local connections between networks is a barrier to applications that need high quality within region

Example: historically, connections from OHSU to Portland Community College (PCC) via Sacramento, San Jose, Seattle, 20-30 ‘hops’

Poor quality even across town

A regional issueFeb 2003 DSL

Lincoln City to Intel in Hillsboro via Dallas, Texas, Chicago, Seattle

Sometimes talking to the phone company can fix

Solutions

Regional exchanges

Communities of interest – future TAO

Local Health Information Infrastructures

An Engineer’s View of the Internet

Law of Network Effects:“the value of a network grows as the square of the number of users.”

Both quality & connectivity important

Source:Caida.org

Metcalfe, Robert, “The Internet After the Fad,” Remarks at the University of Virginia, May 30, 1996

National/Local Health Information Infrastructures

NHII• Improve healthcare through IT• 100,000 accidental deaths per year?• Administration 25% of healthcare cost, $1.6 Trillion industry

Focus is on LHII• Most care is local• Relationships are local• View: solutions will be local

Oregon Health Information Infrastructure (OHII)

Need + opportunity spurs intense competitors to work together

“Information technology will be the key driver of change in the US Healthcare system in the 21st century.”

-Tommy Thompson, Secretary HHS

An opportunity for Internet2

Internet2 created to enable advance networking and applications

•Needed because commercial Internet didn’t•Works because it flattened the network and cares

about quality across networks•Next phase of network applications predominantly

local – connections between people

Internet2 should extend to LHIIEngage Internet experts to develop & facilitate common tools, middleware to connect LHII – “LHIItools.org?” (see sourceforge.net to see how open source projects work)