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TelehealthNews..PART I....Vol. 2 No.2......July, 1998

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Welcome to the TelehealthNews, the Internet resource for health
professionals. Please feel free to pass this newsletter onto your
friends and colleagues. Subscribing/unsubscribing information is at
the
end of this post. Website: <http://cybertowers.com/>

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SPONSOR : TIE Communications, Jerry Hodges, latest and greatest
videoconferencing equipment. <http://tiecom.com>

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TABLE OF CONTENTS
Part I
1.    Feature Article
2.    Active Telehealth Projects
3.    Politics and Policy
4.    Telehealth Updates
5.    Organizations & Companies (including Vendors)
Part II (see next email)
6.    Internet Resources
7.    Conferences and Educational Opportunities
8.    Telemedicine Opportunities
9.    Subscribing, Unsubscribing & Archives

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FEATURED ARTICLE: Videocounseling for Families of Rural Teens with
Epilepsy - Project Update by Robert L. Glueckauf, Jeffrey Whitton,
Jeff
Baxter, Janet Kain, Susan Vogelgesang, Mike Hudson, Dustin Wright
Brian
Jared & Mandy Falco; Purdue School of Science Indiana University,
Purdue University Indianapolis

Our National Institute on Disability and Rehabilitation Research
project is the first study, to our knowledge, to use interactive,
home-based computer technology to address the counseling needs of
rural, at-risk teens with disabilities and their families. The
specific
objectives of the project are: (1) to assess the differential
impact of
home-based video, home-based speakerphone, and office-based counseling
on the level of improvement, severity, and frequency of specific
problems identified by teens and their parents; (2) to assess the
effects of these three counseling modalities on the therapeutic
relationship between family members and counselors, (3) to examine
differences in adherence to intervention and in attrition rates among
families across the three conditions, and (4) to evaluate the
cost-effectiveness of home-based video vs. home-based speakerphone vs.
office-based counseling.

Ninety-five families, consisting of 95 at-risk teens with epilepsy,
ages 12 to 19, and their parents from the rural Midwest and Southeast
will be randomly assigned to 1 of 3 intervention conditions: (a) 6
sessions of home-based, videosystem family counseling (n = 25
families), (b) 6 sessions of office-based family counseling located at
the university (n = 25), or (c) a waitlist control group (n = 25).
Note
that waitlist controls are randomly assigned to either home-based
videocounseling or office-based family counseling following their
second administration of the dependent measures. In addition, families
in the home-based videoconferencing condition who do not have
access to
ISDN or 56 Switch service will be offered speakerphone counseling
(anticipated n = 20). Over the past 1-1/2 years, 39 families have
participated in our videocounseling project. The distribution of
families across the three counseling conditions were as follows:
office
(n = 10), videocounseling (n = 6), speakerphone (n = 8), for a
total of
24 families. Fifteen families dropped out of the project following the
initial telephone screening interview.

Of the 15 dropouts, 9 families were in office-based counseling; 3 were
in the home-based, videocounseling condition; 1 in the speakerphone,
and 2 in the waitlist condition. As expected, attrition was
substantially lower in home-based video and speakerphone counseling
than in the office-based condition. The inconvenience of long-distance
travel, school absences, and lost wages associated with time off work
represent major obstacles to obtaining office-based family counseling
for rural families. We also performed a preliminary analysis of
treatment outcomes and therapeutic alliance across 14 families who
have
completed the six-session counseling program.

Overall, we found substantial and equivalent problem improvement
across
all three conditions. A similar pattern was observed for therapeutic
alliance. Teens and parents reported that the quality of the
therapeutic relationship with their counselors was moderately high. No
substantial differences in therapeutic alliance were observed across
the three treatment conditions. These results are only preliminary,
but
they do suggest that the effects of telecommunication-mediated
counseling may fare well against the gold standard of face-to-face
office counseling. Over the next two years, we plan to recruit an
additional 56 teens with epilepsy and their families from the
Southeast. The project is moving to the University of Florida at
Gainesville in August, 1998, and will be housed in the new Center for
Research on Telehealth and Healthcare Communications in the Department
of Clinical and Health Psychology.

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POLITICS & POLICY American Psychological Association, the APA Ethics
Committee revised their 1995 "Services by Telephone, Teleconferencing,
and Internet" statement on November 5, 1997
<http://www.apa.org/ethics/stmnt01.html>

The HCFA Telemedicine Report to Congress is available from the Arent
Fox Telemedicine home page:
<http://www.arentfox.com/telemedicine.html>

Health On the Net Foundation Code of Conduct for medical and health
web
sites <http://www.hon.ch/HONcode/Conduct.html>

Legislative Alert -- Digital Era Copyright Enhancement For those of
you
wanting a copyright update, addressing such online issues as fair use,
circumvention, distance learning and first sale.
<http://www.igc.org/nwu/anc/hr2281.htm>

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ACTIVE TELEHEALTH PROJECTS

The AKAMAI Project by Leigh Jerome, Ph.D. The AKAMAI Project
<http://akamai.tamc.amedd.army.mil/> is a congressionally mandated
Department of Defense (DOD) telemedicine project designed to deploy
and
assess the value of telemedicine and telecommunications
technologies in
the military's Pacific region health care system. This is for the
purpose of transferring patient medical data (text, image, and video)
among facilities and all necessary theater locations in peace and war.
"Akamai" is a Hawaiian word meaning intelligent or clever. The
prevailing AKAMAI telemedicine concept is directing telemedicine and
digital imaging operations throughout the Pacific Region, including
ship sat sea. Active telemedicine operations are currently supporting:
Micronesia,U.S. Coast Guard Ships at Sea, 3rd Medical Group and
Bassett
Army Community Hospital, Alaska, 15th Medical Group Hawaii, 121st Evac
Hospital, Republic of Korea, Madigan Army Medical Center, Washington,
and US Naval Hospital Guam as well as the Naval Hospital in Okinawa,
Japan.

AKAMAI is tasked to investigate clinically relevant applications of
emerging telemedicine related products,technologies, and services.
This
is to include using already established bandwidth to pass patient
information back and forth. Further, the project seeks to evaluate
telemedicine's impact on the health care delivery system and military
readiness. Telemedicine can help meet the needs of patients and
healthcare providers in these remote areas. The Akamai telemedicine
project is addressing these needs, enabling the generalist to consult
with specialists. The goal of this telemedicine project is to evaluate
noncritical patients and treat them without evacuating them. The
following list highlights the operation objectives of the AKAMAI
Program: Digital Radiology/Sustainment: To maintain and update MDIS
systems that are already in place throughout the Pacific Basin.

Digital Radiology at Elmendorf: To establish MDIS technologies and
equipment at the 3rd Medical Group at Elemendorf Air Force Base,
Alaska. Multimedia T-Med System: To install Multimedia Medical Systems
with communications and training to the following areas: Japan/Okinawa
Guam/Pacific Islands Korea Ships at Sea Connectivity Deployable
Telepresence Web-Paradigm Solution: To provide Store and Forward and
real time/inter active solutions that can be run on the Department of
Defense Local Area Network via the Intranet. Behavioral Health
Applications have been approved and are being expanded related to
remote, electronic evaluation and treatment opportunities.

Telepsychiatry Program at the Sepulveda VeteransAdministration,
California by Walter E. Jacobson, M.D. Immediate goals are two-fold:
(1) to conduct telepsychiatry consultations and medication
evaluations/management for patients at distant sites, including the
Bakersfield V.A. OPMH, the Santa Barbara V.A. OPMH and the downtown
LAOPC, utilizing staff attendings at the Sepulveda V.A., and (2) to
link up with educational institutions and existing psychiatric/mental
health videoconferencing networks in order to exchange programs of
educational/training value, such as Grand Rounds, seminars,
conferences, lectures, colloquia, etc. Walter E. Jacobson, M.D., Chief
Resident, Department of Telepsychiatry <[log in to unmask] >

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TELEHEALTH UPDATES

Federal Telehealth Activities by David Nickelson, Psy.D., J.D.
Proposed
Rule on Medicare Teleconsultation Reimbursement:  On June 22, 1998,
HCFA posted a proposed rule outlining how it might implement
reimbursement for telehealth consultations provided to rural health
professional shortage areas.  It is critical that all interested
providers respond to HCFA about this rule within the 60 period that is
allowed.  While not all providers or geographic locations may be
eligible under the rural definition, the definitions and assumptions
that will be adopted with the final rule will likely set the limits on
what future reimbursement models will be allowed to address, and may
also be used by private insurers as a model for what they should, and
should not, provide reimbursement for.  The rule also includes a
methodology for determining the amount of reimbursement.

In HCFA's own words -- "This proposed rule would implement parts of
section 4206 of the Balanced Budget Act of 1997 by amending our
regulations to provide for payment for professional consultation by a
physician and certain other practitioners via interactive
telecommunication systems. Payment may be made if the physician or
other practitioner is furnishing a service for which payment may be
made under Medicare to a beneficiary residing in a rural area that is
designated as a health professional shortage area. This proposed rule
would also establish a methodology for determining the amount of
payments made for the consultation."

See:  http://www.tgci.com/fedrgtxt/98-16278.txt Reduced Rural
Telecommunications Rates and Toll-Free Internet Access via the Rural
Healthcare Corporation (RHCC) for discounted telecommunications and
internet connections for rural healthcare providers.  For folks who
meet the criteria, this program is an excellent way to lower the
largest overhead expense for most interactive telehealth systems. Best
information on the program, including the forms required:
http://www.rhccfund.org/ or 1-800-229-5476.

HHS - Centers for Disease Control and Prevention: Translational
Research Centers for Diabetes Control Within Managed-Care.
Availability
of Funds for Fiscal Year 1998. Invites cooperative agreement
applications for a multi-center, collaborative, diabetes translational
research initiative within managed-care settings:
http://www.tgci.com/FR/fr062998.htm#FR Doc.98-17202 Department of
Education: Final funding priorities for two Rehabilitation Research
and
Training Centers (RRTCs) under the National Institute on

Disability and Rehabilitation Research (NIDRR) for fiscal years
1998-1999. http://www.tgci.com/FR/fr062998.htm APA Behavioral
Telehealth
Programs: As part of my work with the American Psychological
Association Practice Directorate, I am  seeking to update the
information that I have on behavioral telehealth programs that are
underway both on the Internet and/or telephone/telecommunication
networks.  Please send you informaiton to: David Nickelson, Psy.D.,
J.D. <[log in to unmask]>

~~~

Access To Mental Health Services In Frontier America Letter to the
Field No. 4,By Dennis F. Mohatt, M.A., Deputy Director,Nebraska
Department of Health and Human Services,
<http://www.du.edu/frontier-mh/letter4.html>

Busy Signals is a FREE weekly Electronic Newsletter for TELEHEALTH
NURSES CyberHealth Consulting
<http://sunnyokanagan.com/carekit/index.html>

Frontier Mental Health Strategies: Integrating, Reaching Out, Building
Up, And Connecting Letter to the Field No. 6 by Jack M. Geller, Ph.D.,
Marshfield Medical Research Foundation; Peter Beeson, Ph.D, Prairie
Wind Productions; Roy Rodenhiser, Ed.D., Rochester Institute of
Technology <http://www.du.edu/frontier-mh/letter6.html>

Health Communication on the Internet: An Effective Channel for Health
Behavior Change? Article presents "a theoretical rationale for using
the Internet to conduct persuasive public health
nterventions...<http://www.emerson.edu/JHealthCom/>

International Telehealth Report from Wired News Net Savior Foils
Suicide <http://www.wired.com/news/>

MEDLINE: <http://www.nlm.nih.gov/databases/freemedl.html>

NIH - weekly listserv announcement containing Table of Contents (TOC)
for that week's issue of the NIH Guide for Grants and Contracts
<http://www.nih.gov/grants/guide/listserv.htm>

The Role of Rural Primary Care Physicians in the Provision of Mental
Health Services Letter to the Field No. 5 by Jack M. Geller, Ph.D. &
Kyle J. Muus, Ph.D., The Center for Rural Health, University of North
Dakota School of Medicine & Health Sciences
<http://www.du.edu/frontier-mh/letter5.html>

TIE: 3000 Telemedicine abstracts: <http://tie.telemedicine.org/>

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ORGANIZATIONS & COMPANIES

American Psychological Association News by Leigh Jerome, Ph.D.

American Psychological Association Board of Professional Affairs (BPA)
has appointed a BPA Work Group on Professional Practice Issues in
Telehealth to be chaired by Antoinette L. Anker, Ph.D.; A. Toy
Caldwell-Colbert Ph.D. and Nancy Tippins, Ph.D. will serve as the BPA
representatives; Lisa Grossman, J.D., Ph.D. has been asked to
participate as representative a\of the Committee on Professional
Practice and Standards (COPPS). Members include - Leigh W. Jerome,
Ph.D., Rob Glueckauf, Ph.D., Morgan Sammons, Ph.D., Daniel Shapiro,
Ph.D., and Norma P. Simon, Ed.D. Practice Directorate staff will
include: Geoffrey M. Reed, Ph.D., Christopher J. McLaughlin, David
Nickelson, Psy.D., J.D. and James G. "Gill" Hill. The charge of the
APA


Work Group is advisory to BPA, to make recommendations to BPA
regarding
professional practice issues related to psychology and telehealth.
These include but are not limited to issues related to licensure and
clinical standards and guidelines. The Work Group will accomplish its
work through collecting information, identifying relevant practice
issues, articulating goals and objectives for professional practice
and
reviewing developments in state and federal governments, other
professions and the healthcare marketplace. The focus of these efforts
should not be to endorse telehealth per se, but to lay a foundation
that will ensure sound information and decision-making on these issues
as they affect the professional practice of psychology.

~~~

Colorado Psychological Resources Directory of licensed mental health
professionals, features therapists by location, insurance company
affiliation, zip code, and more.
<http://pw2.netcom.com/~nbrooks7/small.html>

Practice Guideline Coalition: input to the demonstration projects
(e.g.,  supply articles or clinical evidence, recommend panel members)
and participate in the coalition building process. The PGC website is
located at <http://www.unr.edu%2Fpsych%2Fpgc>

Telehealth Association of Ontario <[log in to unmask]>

If you'd like your organization added to the TelehealthNews, send info
to: <[log in to unmask]>

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TELEHEALTHNEWS REVIEW BOARD:
Deborah Burton, M.A. <[log in to unmask]>
Rob Glueckauf <[log in to unmask]>
David Nickelson, Psy.D., J.D. <[log in to unmask]>
B. Hudnall Stamm, Ph.D. <[log in to unmask]>
Mike Terry, Ph.D. <[log in to unmask]>
Leigh W. Jerome, Ph.D. <[log in to unmask]>

Marlene M. Maheu, Ph.D., TelehealthNews Editor/Writer
<[log in to unmask]> (PSY 11921)

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Disclaimer: The accuracy of any information presented herein cannot be
guaranteed. The opinions expressed may not reflect those of SH&P,
Pioneer Development Resources, Inc.; or Marlene M. Maheu, Ph.D.
Permission is granted to reproduce or distribute this newsletter in
its
entirely only, and provided copyright is fully acknowledged.

Copyright 1998 by Pioneer Development Resources, Inc.