that greater coordination and a centralized database for monitoring federally sponsored telehealth programs would be beneficial.

Many rural communities and providers are actively engaged in telehealth. A 1997 survey of 2,472 nonfederal rural hospitals indicated that 30 percent (700) of rural health care organizations were engaged in some form of telehealth (OTP, 2004). A 1999 study by the Agency for Healthcare Research and Quality (AHRQ) identified 455 telemedicine projects worldwide, 362 of these in the United States, 120 of which were in rural areas. Patient volumes in these latter projects remain low given the demographics of rural areas. The AHRQ study found the most common applications to be consultations or second opinions (80 percent), diagnostic test interpretation (47 percent), chronic disease management (36 percent), posthospitalization or postoperative follow-up (28 percent), emergency room triage (26 percent), visits by a specialist (22 percent), and services in patients’ homes (14 percent) (OTP, 2004). Many of the projects included more than one application.

Technical Requirements

ICT applications depend on the exchange of data among providers, patients, and vendors. For the most part, exchanging data requires access to digital lines, along with national data standards to facilitate meaningful communication and protect confidentiality.

For the majority of health care ICT applications, especially those involving the transmission of large amounts of information for real-time interaction, higher-bandwidth digital lines are required. Telemedicine for intensive care units using two-way interactive video, for example, requires high-speed digital lines with large bandwidth (e.g., fiber optics, DSL).4 For some simpler applications, such as the transfer of still images using store-and-forward technology, a simple Internet service provider (ISP) connection over ordinary telephone lines may be adequate.

While the penetration of basic telephone service is at about 95 percent for rural households and essentially 100 percent for rural hospitals and clinics, access to higher-speed digital lines is limited. A study conducted in 2000 found that cable modem service and DSL were offered in fewer than 5 percent of towns with a population of 10,000 or less; by comparison, modem service is offered in more than 65 percent of cities with 250,000+ popula-


Bandwidth is the maximum amount of data (measured in bits) that can travel a communications path in a given time (measured in seconds).

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