For years, much has been made of the “digital divide” in Native America —
and with good cause. The percentage of Native homes lacking basic
telephone, Internet, wireless and related information technology is much
higher than that of the rest of America. This poses serious consequences
for Native peoples and their standard of living.

In the area of telehealth, however, there are reasons to be hopeful.
Telehealth services connect patients in remote areas with specialists in
urban centers over the Internet and are available, to one degree or
another, in all 12 administrative areas of the IHS. Telehealth is being
extensively used in two areas of the United States, namely Alaska and the
Navajo region, to provide health screenings, medical analysis and health
services.

In Alaska, some 200 tribal health facilities benefit from the Alaska
Federal Health Care Access Network while the lower 48 experience a much
lower rate of telehealth usage: only 81 of 236 tribal facilities have
telehealth activities.

Telehealth services, including ophthalmology, cardiology, radiology and
mammography, psychiatry, child abuse services and others are now in use by
tribal and IHS facilities. There are also a number of emerging applications
including home health care, pharmacy and prescription drug services; even
“robotic surgery” and virtual simulators to train physicians and other
medical personnel.

Simulation training is a little-known, but widely used, form of training
that allows students, physicians, nurses, emergency responders or other
health care workers to practice on lifelike mannequins or Web-based
applications instead of patients. One company has created a virtual
training center in which a mannequin is transported around the country in a
modified bus, thereby creating cost-effective, flexible training for rural
and remote communities.

The remoteness of most Native communities means that the use and importance
of these technologies will increase in the coming years. Thanks to friends
like Alaska’s Republican lawmakers, Sen. Ted Stevens and Rep. Don Young;
and Sens. John McCain, R-Ariz., Byron Dorgan, D-N.D. and Daniel Inouye,
D-Hawaii, as well as IHS Director Dr. Charles Grim, telehealth and
telemedicine (terms that are often used interchangeably) will continue to
revolutionize the Indian health system and improve the health of Native
peoples.

There is much yet to be done, however, especially in the area of financing
the infrastructure and hardware. Training also is needed to facilitate the
introduction and use of world-class telehealth practices to those areas
that currently do not employ them, particularly the IHS administrative
regions of California, Minnesota and Tucson, Ariz.

There are pending legislative proposals that, if enacted, will assist in
the financing and build-out and use of these technologies. In March, Inouye
introduced the Native American Connectivity Act (Senate Bill 535). One
purpose of this act is “to enhance the health of Indian tribal members
through the availability and use of telemedicine and telehealth.” The bill
would launch a block grant program in the Department of Commerce to provide
funds to tribes, tribal consortia, tribally-chartered organizations, tribal
colleges and others for a variety of activities including the acquisition
of real property, the construction of telecommunication facilities and the
development of telehealth programs. From a telehealth perspective, the DOC
is a good choice to provide management and oversight of these efforts.
Commerce consistently has been a supporter of telehealth and has sought to
address licensure issues — one of the primary barriers to telehealth — as
specified in its 2004 report “Innovation, Demand and Investment in
Telehealth.”

The report is available online at www.technology.gov/reports.htm. Since
clinicians serve both Native and non-Native communities, licensure is a
concern for all who would benefit from telehealth practices.

In May, McCain introduced the Indian Health Care Reauthorization Act (S.
1057), which, as part of the Indian Health Care Improvement Fund,
authorizes the secretary of the Department of Health and Human Services to
use funds to meet the health care needs of Indian peoples, including the
use of telehealth and telemedicine.

Congress’ pending review and reauthorization of the Telecommunications Act
of 1996 is expected to be debated in 2006. The Telecommunications Act
provides funds through the universal service fund, which encourages
telehealth in rural areas by making telecommunications rates for public and
nonprofit rural health care providers comparable to those paid in urban
areas.

For Native peoples, the universal service access programs help ensure that
consumers in all regions of the Nation have access to affordable
telecommunications services to make telephone service available in
high-cost areas or to low-income consumers; and to assist schools,
libraries and rural health care providers in purchasing telecommunications
and information services. These programs are open to all eligible
applicants, including Indians and Indian businesses.

Visit www.fcc.gov/wcb/tapd/indians/welcome.html for more information.

There is concern, however, that the universal service fund will come under
fire by the telecommunications industry once the act is open for
reauthorization. It is in the best interest of the telehealth and Native
communities to come together to protect Native and rural health care and
distance learning.

Emerging technologies hold much promise for improving the Indian health
care system, but we must first deal with the threshold issues of
infrastructure financing and development, program planning and
implementation, and training. Encouraged by Indian tribes and tribal
organizations, Congress has another opportunity to address these matters in
the remaining four months of the 109th Congress and we should continue to
be at the table to educate others about these issues.

Jackie Eder-Van Hook is the executive director of the Washington,
D.C.-based Center for Telemedicine Law. You can e-mail Jackie at
Jackie@ctl.org. Paul G. Moorehead is a partner in the Indian Tribal
Governments Practice Group of the Washington, D.C. office of Gardner Carton
& Douglas LLP. From 1997 to 2005 he was chief counsel to and staff director
of the U.S. Senate Committee on Indian Affairs.