Health care via Internet languishes; Federal expenditures to help rural facilities equal fifth of program cost


WASHINGTON -- After mounting major efforts to foster electronic commerce and connect schools and libraries to the Internet, the federal government is falling short on another ambitious cyberspace goal: using the Net to improve rural medical care.

A 2-year-old, $400 million federal program aimed at helping the United States' 22,000 rural medical facilities get high-speed Internet access did not award any money last year because of bureaucratic delays. As of July 6, $289,424 had been distributed to 68 of 452 applicants -- less than one-fifth of the annual $1.4 million cost of administering the program.

Federal policy missteps and red tape continue to pose significant obstacles to telemedicine's exploiting the stunning growth and influence of the Internet, according to the congressional General Accounting Office, some members of Congress and industry critics.

Laws restricting the practice of medicine across state lines have prevented many physicians from offering their services -- via the Internet -- to the sick and infirm in other regions.

Internet-based health care, or telemedicine -- with electronic commerce, entertainment and education -- was touted as one of the Internet's most compelling applications.

Proponents envisioned medical facilities in remote areas transmitting live video of patients over high-speed Internet lines to big-city hospitals, where medical specialists could treat patients. Neither doctor nor patient would have to travel.

While more than a dozen federal agencies, from the National Aeronautics and Space Administration to the Agriculture Department, have programs aimed at fostering the development of telemedicine, "no government-wide strategy exists to ensure that the maximum benefits are gained from numerous federal telemedicine efforts," according to the congressional General Accounting Office in a 2-year-old report on the issue that the agency said remains valid, even after creation of the federal program.

"Physicians really gain a lot using video over the Internet. The technology is there and the hardware costs keep coming down," said Richard Ferrans, chief of telemedicine for Louisiana State University's health sciences centers. "What's really needed now is some federal support."

Robert Waters, head of the Washington-based Center for Telemedicine Law, said state legislatures are redrawing a patchwork of laws restricting the practice of medicine across state lines. The California Legislature, he said, recently extended the state's Medicaid program to cover more telemedicine procedures.

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