Two months ago, in “The Last Big Barrier To A Rural Renaissance: Healthcare”,
I reported on a White House meeting on rural telehealth that I
participated in. On June 1, we had a follow-up conference call.
This is sort of a report on that call, intertwined with my
observations from this call about why it’s hard to get things done in
the Federal government.
First, there was some encouraging news, including these items:
White House is starting to fund research on how telehealth improves
medical outcomes, which will be important for future changes.
of changes in Federal law and market conditions, there has been such a
rapid growth of integrated health care systems that, on their own, some
are now reaching out to serve rural areas.
- In various ways,
there was agreement that telehealth is now expanding into remote patient
monitoring. This is especially good news for rural residents who may
have to travel miles even to get to a local clinic which is in turn
connected to a major medical center.
This last item also reminded me of Longfellow’s Little Girl:
was a little girl, and she had a little curl right in the middle of her
forehead. When she was good, she was very, very good, and when she
was bad she was horrid”
At the same time the Veterans Health
Administration has had its problems with waiting lists at some
facilities, it is has taken the lead in innovations, like tele-health, to bring health care to veterans at work or at home in small towns, rural areas and other places where it is difficult for the veterans to get to major facilities.
note that I’ve spent much more time with local and state government,
where with good leadership, things can get done fairly quickly, even
when major innovations are involved. Many of these governments are at
least as efficient, if not more efficient, than most large
corporations. As we’ve heard and seen many times in this election year,
the Federal government is another story.
Here then are some relevant, if not new, observations based on the rural tele-health work:
- It’s very hard to get things done even if you’re sitting in the White House.
some extent, this is built into the constitution, the system of
government, which divides power and ensures that Federal agencies almost
suffer from a kind of matrix management with multiple parties having a
say about what happens.
- And when the Federal government gets
around to doing something it needs to be very careful and thoughtful
about the rules because its impact is so outsized – part of its slowness
is to ensure it doesn’t behave like a bull in a china shop.
are millions of Federal employees to contend with, each of whom has
his/her own sense of what their public responsibility calls for. This
can lead to a silo effect where people in different departments don’t
work with each other or even know each other are working on the same
issue. As an example, psychiatrists who are encouraged by one part of
the Federal government to provide face-to-face services through
videoconferencing worry about running afoul of the concerns of the Drug Enforcement Administration about electronic prescriptions of controlled substances.
Having said all this, the White House staff should still be applauded
for continuing to push these innovative tele-healthcare services,
despite the built-in obstacles and the short time they have left.
© 2016 Norman Jacknis, All Rights Reserved