Remarks to the Annual HRSA Telemedicine Grantees Meeting

Prepared Remarks of Elizabeth M. Duke, Ph.D.
Acting Administrator, Health Resources and Services Administration

Annual HRSA Telemedicine Grantees Meeting
Bethesda, Md.
January 14, 2002

Good morning.

It’s my pleasure to welcome you to Washington for this annual grantee meeting.  This is my first opportunity since I became Acting Administrator last March to speak with all of you.  I want to thank each of you for the important work you do shaping and adapting all the new technologies for the benefit of our national public health.

Your activities bring much-needed health care to many Americans and help providers in remote areas keep abreast of the latest medical advances to better serve their patients.

Telehealth and telemedicine have the potential to revolutionize health care, especially for those who live in underserved communities.

Our challenge is to keep pace.  Through meetings like this, we can share and learn from each other.  We can then begin to uncover what works and what doesn’t to ensure that the telehealth activities we design are the very best that they can be.  We discussed this at our recent management “advance,” which focused on our strategic future.  We had three educational components for the day – geomapping to enhance our knowledge of service needs, the globalization of health care, and telehealth’s contribution to our current and future mission.

At HRSA, we’ve made technology a priority in everything we do.  We’re using it to keep clinicians in isolated areas up to date ... we’re pioneering telemedicine for the provision of primary care ... and we’re developing distance learning and training programs to help our own staff around the country learn and grow throughout their careers.  We’ve brought on 50 HRSA scholars as part of our workforce plan – all of them use distance learning and are expected to help accelerate HRSA into the 21^st century.

As you know, HRSA’s mission is to improve the nation's health by ensuring access to comprehensive, culturally competent, quality health care for some of the country’s most vulnerable families and individuals.  Your commitment at the state and local level helps us in this mission and complements President Bush and Secretary Thompson’s goal to ensure greater access to quality health care for all Americans.

Less than three weeks ago, Secretary Thompson announced a new pharmacy demonstration project in Spokane, Wash., that will network with health centers and use computer equipment to dispense prescription drugs through vending machines to patients at remote health clinics.  One component of this project is the use of videoconferencing equipment that will allow a centrally located pharmacist to provide patients in remote areas with one-on-one counseling on proper drug usage.  Last week I spent a day at our Area Health Education Center in Virginia, which deals with 140 language and uses local interpreters and teleservices to provide culturally competent services to all who need them.

It is through innovative projects like this that we underscore the importance of our efforts to expand the use of telemedicine to fill in the gaps for people and communities who might otherwise go without the critical health care they need.  This is especially important in the world since September 11, with our renewed focus on ensuring public health preparedness.  Our budget priorities, our program emphasis in this new anti-terror world is one in which telehealth is an important part of our emerging future.

Now I’d like to talk about some issues that, I’m sure, are important to you—namely HRSA’s budget, the reorganization we’re going through, and our plans for the future. 

In our fiscal year 2002 budget President Bush signed just last week, we received $5.5 billion.  For our Telehealth programs, we received $39.2 million, a $4 million increase over last year’s funding.

Another of the highlights of this year’s budget is the $1.3 billion we received to support our health centers program.  This is an increase of $175 million over the FY 2001 appropriation and represents a down payment on the President’s five-year plan to create new or expand health center sites in 1,200 communities across the country and increase the number of patients served by 6 million within 5 years – ultimately doubling to 22 million.

Health center programs each year provide family-oriented preventive and primary health care services to more than 10.5 million people at 3,200 access points nationwide.  The new budget will allow us to increase the number of access points to 4,400. 

Secretary Thompson has also challenged us to find ways to improve health care access to the 65 million Americans who live in rural areas.   To meet this challenge, an HHS Rural Task Force was formed with representatives from all HHS agencies and staff offices to develop strategies that will enhance health care services in the Nation’s rural communities.  Telemedicine is an important part of that effort to provide care in the nation’s remote geographic areas.  The Secretary and I are passionate about its potential, and see 2002 and 2003 as years of great advances in this arena.  We’ve asked Marcia Brand of Rural Health to work closely with us to ensure that telehealth is spread not only throughout HRSA, but throughout the HHS community of services to our rural citizens.

As you can see, President Bush and Secretary Thompson are determined to get as much of our money as they can into direct medical services for the people we serve.  To that end, I have been directed to take a number of internal changes to make sure we save money, streamline operations, and increase our efficient delivery of services.

The change that I’m sure you are most interested in is the move of the Office for the Advancement of Telehealth and the Center for Quality, both previously housed in the Administrator’s office, to the HIV/AIDS Bureau.  This change parallels changes we’ve made elsewhere as part of my effort to build one HRSA as part of “One Department of Health and Human Services,” as Secretary Thompson has directed.  We’ve used the idea of executive agency leads for years in HHS, and I believe it is an effective way to manage.  At HRSA, the primary effort in executive agency leads was taken by my predecessor, and I thoroughly support that -- he moved women’s health from his office to the Maternal and Child Health Bureau.  I spoke at the HHS work group for women last week, and the meeting reflected the vitality of this management system as a way to emphasize program integration and establish cross-agency linkages in an important mission area.

We moved OAT to HAB to improve the office’s ability to manage grants.  From a management standpoint, it’s unwise to have operational grants handled out of the Administrator’s office.  From now on, OAT will be part of a bureau that has an established mechanism to award and manage grants.  This more efficient use of resources will allow telehealth technology to spread to an even wider group of health care providers and to be under leadership that is as passionate as the Secretary and I are about enhancing the use of telehealth throughout all our programs and substantially improving the quality of care.

OAT’s promotion of telehealth technology to educate health professionals and share vital treatment information is important to us.  Placing OAT in HAB does not mean that we are restricting OAT’s service to HAB’s traditional clients.  Rather, the client base of OAT remains its responsibility.  OAT will continue serving its telehealth customers in rural areas and wherever else they may be.

The missions of OAT and HAB coincide in another way.  HAB -- and the people with HIV/AIDS that are served by its programs -- will benefit from greater use of telehealth technology.  Few health providers are as reliant on the latest information on treatment, drug regimens and evaluations to save their patients as the professionals who treat people with HIV/AIDS.  Telehealth technology can play a decisive role in getting life-saving information to HIV care providers in their home communities and in providing consultations on HIV care to physicians and nurses in remote locations.  These services can be especially helpful for rural health care providers, many of whom are seeing more HIV/AIDS patients than ever.

This placement builds on a passion Joe [O'Neill, HAB Associate Administrator] and I and his management team share for the use of technology to build capacity and increase quality care in all settings.

All of these changes have a single impetus at their core: to further HRSA’s mission to expand access to quality health care for all Americans who need it.  We are duty-bound to take whatever actions we can that will strengthen our ability to provide more direct medical care to the people who rely on us. 

With your help, we can expand our telehealth capacity so that we make the best and broadest use of available technologies to ensure that providers in remote areas have this valuable tool available to them.  We also need to continue to look to distance learning activities to educate and train a public health workforce to serve us now and well into the future.  We must look for ways to share knowledge about best practices in telehealth, pool our expertise, and expand our relationships. Partnerships make it possible to serve more people, to serve them better and to control costs.  In short, we must continue to collaborate and coordinate in the interest of the common good -- and I will seek a more regular dialogue with this community and its leadership as a priority over the next few months.

In all that we do, the goal remains the same: to bring high quality health care to people no matter who they are or where they live.

In closing, I wish you much success on your work these next few days.  You have before you an ambitious and worthwhile agenda.  I urge you to continue to let us know what we can do to make your jobs easier and what barriers need to be overcome. 

At HRSA, our pledge to all our grantees is this: when you talk, we will listen and respond.