[Senate Hearing 107-690]
[From the U.S. Government Publishing Office]
S. Hrg. 107-690
HIGH-TECH MEDICINE: REACHING OUT TO SENIORS THROUGH TECHNOLOGY
=======================================================================
HEARING
before the
SPECIAL COMMITTEE ON AGING
UNITED STATES SENATE
ONE HUNDRED SEVENTH CONGRESS
SECOND SESSION
__________
POCATELLO, ID
__________
JULY 2, 2002
__________
Serial No. 107-28
Printed for the use of the Special Committee on Aging
U. S. GOVERNMENT PRINTING OFFICE
81-855 WASHINGTON : 2002
___________________________________________________________________________
For Sale by the Superintendent of Documents, U.S. Government Printing Office
Internet: bookstore.gpo.gov Phone: toll free (866) 512-1800; (202) 512-1800
Fax: (202) 512-2250 Mail: Stop SSOP, Washington, DC 20402-0001
?
SPECIAL COMMITTEE ON AGING
JOHN B. BREAUX, Louisiana, Chairman
HARRY REID, Nevada LARRY CRAIG, Idaho, Ranking Member
HERB KOHL, Wisconsin CONRAD BURNS, Montana
JAMES M. JEFFORDS, Vermont RICHARD SHELBY, Alabama
RUSSELL D. FEINGOLD, Wisconsin RICK SANTORUM, Pennsylvania
RON WYDEN, Oregon SUSAN COLLINS, Maine
BLANCHE L. LINCOLN, Arkansas MIKE ENZI, Wyoming
EVAN BAYH, Indiana TIM HUTCHINSON, Arkansas
THOMAS R. CARPER, Delaware JOHN ENSIGN, Nevada
DEBBIE STABENOW, Michigan CHUCK HAGEL, Nebraska
JEAN CARNAHAN, Missouri GORDON SMITH, Oregon
Michelle Easton, Staff Director
Lupe Wissel, Ranking Member Staff Director
(ii)
C O N T E N T S
----------
Page
Opening Statement of Senator Larry E. Craig...................... 1
Panel I
Dr. Beth Hudnall Stamm, Research Professor and Director of
Telehealth, Institute of Rural Health, Idaho State University.. 3
Wallace Whitehead, Former Postmaster, Lava Hot Springs, ID....... 7
Alice Ennis, Director of Home Health, Saint Alphonsus Regional
Medical Center, Boise, ID...................................... 9
Demonstration by Marilyn Richards, Certified Wound Care Nurse,
Saint Alphonsus Home Health.................................... 11
Tom Hauer, Director, Telehealth, North Idaho Rural Health
Consortium, Coeur D'Alene, ID.................................. 13
Dr. Bruce Miewald, Attending Psychiatrist, Kootenai Medical
Center, Medical Director of Child and Adolescent Psychiatric
Clinic: and Medical Administrator of the Outpatient Residential
Youth Service, North Idaho Behavioral Health................... 15
Mary Hendrickson, Sandpoint, ID.................................. 17
(iii)
FIELD HEARING ON HIGH-TECH MEDICINE: REACHING OUT TO SENIORS THROUGH
TECHNOLOGY
----------
TUESDAY, JULY 2, 2002
U.S. Senate,
Special Committee on Aging,
Pocatello, ID
The committee met, pursuant to notice, at 5 p.m., in the
ISU Media Distance Learning Center, Room 66, Idaho State
University, Pocatello, ID, Hon. Larry Craig presiding.
Present: Senator Craig.
OPENING STATEMENT OF SENATOR LARRY CRAIG
Senator Craig. I would like to call this meeting and
hearing of the Senate Special Committee on Aging together. I
want to thank you all very much for coming out this afternoon.
This is a first and a very unique hearing that we are holding
here in Pocatello and on the campus of Idaho State today
because it is not only being heard here, and we have testifiers
here for the record today, but also we will take testimony from
people in Boise and in Coeur d'Alene.
I think if you look at the screen behind me now you will
see people in Boise. Then we will also be tied into Coeur
d'Alene, to a conference room in the medical center in Coeur
d'Alene. We are doing this first and foremost to demonstrate
the capability our State now has and is developing and
enhancing in telemedicine.
As most of you know, I grew up in rural Idaho. I was
telling someone with a local television station here that I
grew up on a ranch. The nearest doctor was 50 miles away.
So rural health in Idaho has always been a challenge. But
it becomes increasingly so as we lose some of our small
hospitals in our communities, as health care begins to
regionalize, and as our citizens grow older and want to stay in
their small communities and be safe in those small communities
and at the same time find themselves at a stage in their life
where their need for health care rapidly increases.
As many of you know, I was once Chairman and am now the
Ranking Member of this Special Committee on Aging in the
Senate. We spend a good deal of our time looking at the Federal
programs that are provided for seniors today and what can be
done to enhance overall health care for our seniors.
My staff director is with me today who works on my behalf
in that committee, Lisa Kidder, who handles health care on that
committee. Also some of my personal staff is with me today
along with Francoise Cleveland of my Pocatello staff and some
of my folks both from Boise and from Washington.
One of the opportunities I have had in working with the
facility here at Idaho State and in my capacity on the
Appropriations Committee in the Senate is to look for
opportunities and help facilitate grants that have been able to
expand the capability and the capacity here in Idaho for
telehealth. We have been able to do that in a variety of ways
both here at Idaho State and in north Idaho over the last
several years that rapidly accelerates our ability to bring
this kind of health care system to the seniors of our State.
We have a variety of folks this afternoon who are Idaho
specialists in the field of telehealth to testify to the
committee. Also I am going to at a point in the program break
and go to the back of the room and have a health exam. Now,
last I checked, I was in pretty good health.
But what is important about the health exam that you will
see today is that this unit is the kind of unit that can now be
brought into the home anywhere in Idaho, plugged into the
telephone, and instantly you have not only the ability to
transmit information digitally, but you can transmit active
video so that a nurse can actually bring this into the home of
a senior and read their vital signs, if you will. You will see
that this afternoon.
I think that is clearly an exciting feature for our State
that we have watched grow and now with this new technology, it
is becoming real to all of us.
About a decade ago when I began to work with Qwest and
pushed them, as did the State legislature in Idaho, to wire
Idaho with fiber optics, we knew that in the future these kinds
of technologies could become readily available to our entire
State. That is now pretty much the case. Nearly all of Idaho is
wired in that regard; and, therefore, the ability to transmit
high quality is the kind of stuff you will see this afternoon
that is being transmitted on the fiber optic cable across our
State that makes this kind of telecommunication literally real-
time. Of course, in health care that becomes extremely
valuable.
Let me now turn to our witnesses. We're going to ask them
in giving testimony this afternoon to talk about their
relationship to this program and what it offers. Also I will be
asking a few questions of them. As I say, you will hear
testimony from two witnesses here, one in Boise, and two in
Coeur d'Alene.
Our first witness is really--I doubt that Dr. Beth Hudnall
Stamm wants to be called a pioneer, but she is. She truly is a
pioneer in Idaho's telemedicine area. She is Director of the
telehealth facility here at Idaho State. We are using that
facility this afternoon for this hearing and demonstrating it.
So Beth has done a marvelous job in working across the State,
but also in bringing resources to Idaho State University to
head up this program.
So Doctor, let me turn to you to offer your testimony.
STATEMENT OF DR. BETH HUDNALL STAMM, RESEARCH PROFESSOR AND
DIRECTOR OF TELEHEALTH, INSTITUTE OF RURAL HEALTH, IDAHO STATE
UNIVERSITY
Dr. Hudnall Stamm. Thank you, Senator Craig. Senator Craig,
members and staff of the Senate Special Committee on Aging, and
your personal staff, we are honored to have you here
with us tonight. We are very excited that the Special
Committee on Aging has chosen Idaho for this field hearing on
telehealth. We are also appreciative of the support that you
have given us to make telehealth happen in Idaho.
My name is Dr. Beth Hudnall Stamm, and I am a Research
Professor and Director of Telehealth at the Institute of Rural
Health at Idaho State University. I am also the principal
investigator of Telehealth Idaho, a state-wide telehealth
project funded by the Office for the Advancement of Telehealth
at the Health Resources and Service Administration of the
Department of Health and Human Services.
As you know, tonight we have connected three regions of our
State for tonight's hearing. As we progress through the
testimony tonight, we will virtually travel across our State.
Let me begin here in the southeast corner. I will begin by
providing an overview of telehealth and share with you
information about Telehealth Idaho and about our Senior Health
Mobile. Mr. Wallace Whitehead, who is here with us, formerly
the Postmaster in Lava Hot Springs, will share his experiences
as a consumer of services provided through the Senior Health
Mobile.
After our testimony tonight and you have asked us the
questions that you would, we would invite you to come out to
the yard and to enjoy ice cream to kick off the Fourth of July
weekend. We thought that would be an appropriate thing. We also
have the Senior Health Mobile parked outside. We would invite
you and all of the other participants to view and come through
the Senior Health Mobile.
The first thing I would like to do tonight is to define
telehealth. People ask that often.
According to the Office for the Advancement of Telehealth,
telehealth is the use of electronic information and
telecommunication technologies to support long distance
clinical healthcare, patient and professional related health
information, public health, and health administration.
Telemedicine, which is a subset of telehealth, refers to the
use of telecommunications to provide clinical care at a
distance.
The application of technology to telehealth is nearly
limitless, but it can generally be categorized into two types--
store-and-forward technologies or what we call asynchronous
technology, or real-time technology which is what we call
synchronous technology.
Store-and-forward technology allows one party to collect
and manipulate information and then send it to another person
who can then look at that information at their convenience. It
is similar to sending an E-mail. Of course privacy concerns
mean that we do not do it exactly the same as sending an E-
mail, but it would be like sending an E-mail with an
attachment.
The second type of activity, synchronous activity, is what
we are doing here tonight. In that case a patient may be in one
place and a provider in another. Other than the telephone,
viewing of health information such as on the web is the most
common telehealth activity. According to studies in 2000, about
37 percent of Americans have viewed health information online
at least three times in the past year.
When considering applications that involve two or more
parties, asynchronous or store-and-forward applications are the
most common. Synchronous applications where a patient would be
in one place and a provider in another are an important part of
what we do, but actually a small percentage of the overall
activities.
At this point I would like to shift from technology to
talking about the older rural residents of the United States,
and particularly of Idaho. Statistically older rural adults
have more health risk factors than their urban counterparts.
This resident may be a man, but is statistically more
likely to be a woman. She is dependent, at least in part, on
the public sector for her health care. She has access to fewer
resources for independent living, and she is one of the growing
number of older rural residents who form a disproportionate
share of the rural population. As you know, her economy is
fragile, often dependent on retirement income rather than on
production economy to keep their businesses open.
If she is a rural woman, she is more likely than her urban
counterparts to have been exposed to a traumatic event. She
also has an ongoing problem with access to care because she is
served by fewer and less highly trained health
professionals who are often reimbursed by Medicaid at lower
rates. She is likely taking psychotropic medications prescribed
by someone not trained in their use.
Access to healthcare is more difficult for Idahoans than
almost any other people in the United States. U.S. federally
designated physical, mental/behavioral, and oral health
profession shortage areas cover 73 to 93 percent of our State.
Idahoans face many health care challenges including severe
work force shortages, difficult geography and climate,
inadequate infrastructure, and isolation.
These factors make it difficult for patients to get care
and difficult for providers to provide care. For example,
providers in rural areas often face working conditions that
induce negative consequences such as burnout and compassion
fatigue that can lead to high turnover and increased risk for
medical error.
Telehealth is one way we can address these challenges. We
can increase the number of providers we have through new and
upgraded education. We can extend the providers that we have
through telehealth through case conferences, supervision,
consultation, and home health. We can also preserve our
existing professional work force through increased quality of
life, and reduce the negative effects of care giving by
providing them with professional support.
Telehealth Idaho seeks to improve Idaho health care access
through its health care work force. The project has three
parts--the Telehealth Idaho Toolbox which is an online
professional health resource center that includes virtual
program centers; we also have an Integrated Care Center for
consultation, supervision, case conferencing and home health.
The third area that we work in is educational
telecommunications which uses the existing telecommunications
resources to reach 50 of Idaho's 202 towns with the kind of
technology we are using tonight.
One of the projects we extend our existing providers with
is the Senior Health Mobile. This mobile health van is a
collaborative project of the Idaho Rural Health Education
Center of Mountain States Group and the Kasiska College of
Health Professionals here at Idaho State University, and the
Idaho Area V Agency on Aging.
The Senior Health Mobile travels around southeast Idaho and
performs health/functional assessments, identifies imminent
needs, and offers short-term intervention. The project, which
won the 2001 Governor's Award of Excellence, provides care for
seniors and also importantly provides training for students.
One of the things we are doing to extend telehealth into
the Senior Health Mobile is to put videophones on the Senior
Health Mobile. Those allow us to provide supervision to the
students, and to increase the areas of supervision for the
supervisors who travel on the van. For example, a nurse may be
accompanying the students on the van. But the students may be
in nursing, they may be physical therapy, or they may be in
counseling. So we can actually link them back to a supervisor
in a specialty area if we need that.
The other thing that I think is actually the most fun thing
that we are doing with the Senior Health Mobile is that we have
a lending library of videophones. If somebody who gets care
from the Senior Health Mobile needs follow-up, we can actually
loan them a videophone, and leave it in the community. Then the
next time the van comes by, if they don't need the phone
anymore, we pick it up.
I am sure you immediately recognize the rural ``book
mobile'' concept, but we've extended it down to technology. We
really feel excited about it because our students are able to
go with the family members into the home, help them connect to
the videophone, and then we can stay in touch with them through
a period of transition.
Thank you, Senator, for hearing our testimony tonight. I
look forward to continued exciting development in telehealth in
the State of Idaho.
Senator Craig. Doctor, thanks very much for that testimony.
I'm sitting here thinking of the application of this technology
and how it gets used in the field.
I came to the State senate in 1974 as a State senator. A
doctor in Council, ID who had been a State senator in the mid
1960's had pushed through the concept of a nurse practitioner
in an effort to reach out into rural areas where doctors were
not or could not serve, would not serve oftentimes. But the
application of that oftentimes ran into difficulties when
doctors would not back up, if you will, the nurse
practitioners.
So while it pioneered here in Idaho in an effort to
outreach to those rural communities--and it was successful and
it remains successful today--in many ways it still had the lack
of connectivity oftentimes. I'm sensing that that is in part
what this offers.
You talk about students in the field or, let us say,
certainly less than the certified skilled but being fully
monitored, or the information flowing back to a center where
the professionals are to review it and, of course, give their
advice from it.
Am I thinking about this in the right context?
Dr. Hudnall Stamm. Absolutely, Senator. Actually the
situation you described is one of the very first applications
of telehealth that I worked on in the early 1990's where we had
people who were mid-level and professionals working in small
communities scattered around, in that case the State of Alaska.
We were able to link them using telehealth, both store-and-
forward and real-time, to people who had higher levels on
expertise in a more urban area which allows the local providers
to provide care to the residents so that they didn't have to
travel away from their homes.
It would help them stay with their social support and
really build a strong network. It allows people when they
do have to travel to a city to be able to return home sooner
and really, really supports continuity of care. For people who
are aging, it supports aging in place.
Senator Craig. With your experience now and the application
of this knowledge, look forward if you will. Tell me what you
see in the future as it relates to this technology and what it
might do for us.
You mentioned a lack of skilled people. We are in a nurses
shortage both here in Idaho and nationwide. So I know
technology has always been one of those--not a substitute, but
it allows a single individual to multiply at least the
application of their talent. I sense that can be part of all of
this.
But what else might you see that being?
Dr. Hudnall Stamm. Well, one of the things that you are
probably very familiar with, being a resident from a rural
state and dealing with so much health care, is the concept of
windshield time--that amount of time that circuit riders have
to spend in the car going from patient to patient. As we build
out our technological capacity, we're able to leave the
provider in one location. They can visit virtually--they can
circuit ride virtually which really may double or triple their
ability to see patients, reducing wait time, and improving
quality of care.
We can also see, I believe, an increase in the amount of
technology that is easy, that is in the home. I appreciate the
comment about being a pioneer because that touches my heart,
and I truly appreciate that. But some of things that pioneers
do is that we mess with things that don't work very well. The
technology that we have done for years has been sometimes very
difficult.
Now it is becoming easy. When we place it in people's
homes, it is no longer a technological bafflement of how to
make it work. So it becomes a very simple thing, and I think
that is a very positive change that we are seeing in the
future.
Senator Craig. Well, I meant the term ``pioneer''. When we
talk about the different definitions of health care in settings
in national policy and we talk about frontier medicine and
those various areas, we have areas in Idaho that are outside
those definitions that do not fit. So in that case I think it
is most appropriate.
Well, thank you very much.
Dr. Stamm mentioned in her opening comments that we had
with us Wallace Whitehead. Mr. Whitehead was the Postmaster of
Lava Hot Springs and has, I think, a unique first-hand
experience to visit with us about as relates to the Senior
Health Mobile.
So Wallace, if you would please proceed.
STATEMENT OF WALLACE WHITEHEAD, FORMER POSTMASTER, LAVA HOT
SPRINGS, ID
Mr. Whitehead. Thank you, Senator, for the opportunity to
tell you my experiences with the health mobile. I thank Dr.
Beth for her inviting me to do this. I guess she did it through
Judy Robinson, which is a friend of both of us. I appreciate
this opportunity.
It's always been my experience to want to be--the program
to come that can keep people in their homes, older people, as
long as possible. I seen that happen through the senior citizen
program. Especially in Lava we've had people that have still
been working as seniors when they're 92, or 93, or 94 years
old, and staying in their own homes. This is a very important
part of that from the medical side of that to be able to keep
their health.
The health mobile started coming to Lava. They got some
excellent personnel working in that health mobile. It has been
a great opportunity, I think, for the students to be for hands
on help too. It helps them, and it helps us old senior citizens
who are needing help.
When I went and they first talked to me about having my
health assessment made, well, I kind of kept not wanting to do
it and kept kind of putting it off.
Senator Craig. You sound pretty normal.
Mr. Whitehead. I thought, ``I don't need that.'' I'm
healthy and everything. We do have a good program there, and we
enjoy it.
But they stayed with me, and they did get me to do that. As
a result of doing that, I had no idea in the world I had high
blood pressure. As I was doing this assessment, the young man
took my blood pressure. Why, it was 220.
It was a day that we had the orchestra there and playing. I
said, ``Well, OK. I will just go dance it down,'' I said.
Of course, the young man looked at me; and the supervisor,
she came over. He told her what it was. Then Judy came over,
and they all looked at me and said to each other ``do you think
we should let him dance with that high of blood pressure? He
probably should not be dancing.'' They discussed it a little
bit and decided, well, it would be OK; just dance quietly; and
you don't get carried away.
Senator Craig. So no square dances, no polkas, just the
waltzes. [Laughter.]
Mr. Whitehead. I don't know why, whether it's just the
power of suggestion; but as I did start dancing, I got feeling
kind of funny, you know. I thought, well, so I did kind of sit
down a little bit more and just listen.
But that got me going to the doctor to have it checked out
and because I'd been staying away from the doctors as long as I
possibly could. I did not want to go to doctors. I had been
taking my vitamins and, you know, doing all those things. We
think we are pretty healthy.
So my wife and I, we visited a couple of friends of ours,
and she has had a lot of health problems. I kind of went along
and decided--I'd looked up in my health books and decided all
the things I needed to do to get it down.
Then we went and visited them. She had had a little high
blood pressure, so she had the machine. She took mine; and it
was, I think, 175 or something then.
So that night we decided we better go see our doctor, and
so we did. As a result he has me on blood pressure pills, and
he has run me though a lot of other sets of tests to check out
everything. I wouldn't have done that if it hadn't been for
this health mobile and if it hadn't been for these people
working with me and getting me to get a check up on my health.
Incidentally, another woman from Bancroft, by her doing
this, she found out that she had breast cancer. She had no idea
that she had it. So that was really a big help to her also.
Others that have taken that, I'm sure it's helped them,
too, their health--checking on their health and realizing that
sometimes we do need those things to help us.
The big thing I think is important, they go into the home
to people that can't get out and things like that, which is
very important, too. It's hard for--you get out there, and it's
hard for people to get to Pocatello to a doctor. Incidentally,
we do have Mike down there in the clinic, too. But even then
you stay away from it as long as you can.
Senator Craig. Wallace, I appreciate that testimony. All of
the questions I was going to ask you, you have answered. I say
that because of the idea of discovering your high blood
pressure in large part due to the health mobile's availability.
Obviously the examination you had tells an awfully important
story.
Let me also recognize Alice, your wife, who is with you
today. It is nice to have you here. Thanks for being here.
Your testimony, I think, is oftentimes quite typical of not
just men, men and woman, but I think predominately men of your
age who have largely lived their lives in a very healthy way
and have had no illnesses to speak of and do not go get
checkups, do not go do the things that they probably ought to
do--or not only probably, should do simply because they feel
well.
I know. I have a father at 84 years of age who is testimony
to very much the kind of health and lifestyle you have talked
about. Through his son and daughter's urging and a wife, he
gets his regular checkups today because as a result of one of
those urgings he discovered he had prostate cancer. So I think
that's an awareness that men must come to. That will save a lot
of lives if we do. But certainly the blood pressure.
Doctor, can they actually take blood for blood test
purposes through the mobile?
Dr. Hudnall Stamm. I am going to look to one of my
colleagues because I'm not real certain about that.
Senator Craig. Do you know if that can be done with the
mobile?
Dr. Hudnall Stamm. I am going to answer that question that
technologically it can be done. I think some of the things we
have to clear are the supervision and also the sanitation
issues around the health mobile. I do not know whether they are
doing that at this point or not.
Senator Craig. I do not mean analyze. I mean simply to
bring it in for purpose of analysis.
Dr. Hudnall Stamm. I do not know for sure.
Do you know, Mr. Whitehead?
Mr. Whitehead. I do not know for sure about that, whether
they take the blood. Then we had those health fairs. They do
that where they take blood. When I was about 72 years old, I
got diabetes and also prostate cancer at the same time.
Dr. Hudnall Stamm. One of the things that the health mobile
does do is that they work closely with the local providers.
They park at the senior center, but they work closely with the
local providers so that any services that the health mobile
cannot handle, they are able to work directly with the
providers. There have been cases where people from the health
mobile have literally walked down the street with someone to a
provider's office.
Senator Craig. Excellent. Is this the point at which I am
to have my exam? We really need to move right on to Coeur
d'Alene and Boise, but I am going to take a moment and go back
and have my blood pressure checked with this marvelous new
piece of equipment. The equipment that I am being tested on, we
are going to have a nurse back there who will explain it; but
it is the very kind of equipment that can actually be brought
into the home, plugged into a telephone receptacle or
connection and as a result, immediately sent back in real-time
to the center. So let me move back and do that.
I guess Alice is going to testify before I have my exam.
Alice Ennis, thanks for bringing me online. Alice Ennis is
Director of Home Health at Saint Alphonsus in Boise. Alice is
here, and she's going to walk me through this, I guess, at
least explain it. Then we will go with Alice's instruction to
the back of the room for this technology. Please proceed,
Alice, and welcome.
STATEMENT OF ALICE ENNIS, DIRECTOR OF HOME HEALTH, SAINT
ALPHONSUS REGIONAL MEDICAL CENTER, BOISE, ID
Ms. Ennis. Thank you, Senator Craig and distinguished
guests. Good afternoon and thank you for the opportunity to
talk about telehome care. I would like to make some opening
remarks, and then we will move into your examination that we
have all been waiting for.
Like North Idaho, telehealth's network and Telehealth Idaho
from Idaho State University, Saint Alphonsus Regional Medical
Center is dedicated to providing access to quality health care
and education using telehealth technology. With this
technology, the same standard of health care available in the
cities of Idaho is made available to the elderly and non-
elderly in the rural communities.
As part of the commitment, the Saint Alphonsus Foundation
provided a grant this past year to our home health to implement
telehome care. Telehome care will make it possible to deliver
high-quality wound care to home-bound elderly outside of the
Boise area.
To illustrate the value of telehome care, I would like to
relate the case of a real patient. Last winter a physician
referred a patient to us who lived in Centerville. The patient
required daily wound assessment and care. In addition, the home
health nurse was teaching the caregiver how to do the dressing
changes. For those 2 weeks, a nurse spent 3\1/2\ hours each day
driving to Centerville, and spent about 30 to 45 minutes on
each visit. This one patient consumed 4 hours of nursing care
per day. In addition, the patient and caregiver often voiced
their concerns about the nurse's driving to Centerville in the
winter on the ice and in the snow.
That scenario would be very different with telehome care
technology. On the first day the home health nurse would admit
the patient to service, assess the wound, start the teaching,
install the patient unit, and provide instructions on how to
use the equipment. That visit would take about an hour. The
nurse may even make a visit the next day; however, from that
point on, the visits could be done from Boise using the
telehome technology.
The audiovisual capabilities will make it possible for the
nurse in Boise to see the patient, take the patient's vital
signs, listen to heart and lung sounds, assess the patient's
wounds and even measure the glucose level in the blood if that
is necessary. The care giver can do dressing changes while the
nurse observes technique and gives instructions as needed. The
nurse, patient, care giver, and physician will agree upon the
proper balance of in-person visits and telehome care visits
based on the patient's needs.
This is one example of how Saint Alphonsus home health will
use telehome care technology. Telehome care will help Saint
Alphonsus respond to an increasing number of the home-bound
elderly population with increased needs and declining Medicare
reimbursement. Later this month, Saint Alphonsus home health
will launch the telehome care pilot project with a base unit in
Boise. Five patient units in the Boise area and one in Jerome
with Saint Benedict's home care staff.
The unit you have there, Senator Craig, is an example of
the patient care unit. The focus of the pilot will be patients
with wounds. These patients were chosen for two reasons. They
create a major drain on prospective payment reimbursement
because of the cost of supplies and the need for frequent
nursing visits.
Second, patients with wounds make up about one third to one
half of our patient census. With telehome care technology, we
feel that Saint Alphonsus Regional Medical Center can provide
home health services to under-served areas in the State.
Telehome care home units can be placed in any home that has
a telephone line. Wound care nurses, through a scheduled
appointment in our office, can work with non-wound care nurses
onsite to provide treatment options.
Once telehome care is established, and we have demonstrated
its value in caring for patients with wounds, we will branch
out to other specialties--oncology, diabetes, and congestive
heart failure just to mention a few.
Now for what we've all been waiting for. Marilyn Richards,
a certified wound care nurse with Saint Alphonsus, will provide
a demonstration of the user-friendly American telecare
equipment that you have there in Pocatello. Thank you very
much.
Senator Craig. Alice, thank you very much not only for that
explanation, but also what Saint Alphonsus Regional is doing at
this time and the outreach that will result from that.
So now can I go to the back of the room? All right.
Marilyn, thank you. I am wired so I can move and talk at the
same time.
DEMONSTRATION BY MARILYN RICHARDS, CERTIFIED WOUND CARE NURSE,
SAINT ALPHONSUS HOME HEALTH
Ms. Ewert-Neilson. We are going to wait for the phone to
ring; and when the phone rings, we're going to press the green
button. You'll see your picture right here. Then when they
convert it over, you'll see them, and they will see you. When
the phone rings, press your button.
There you are. It takes 30 seconds for it to convert over,
and then when this 30 seconds has completed and it is it is
just the plain old telephone system which we are connected to--
you will see their picture, and they will see yours. You can
see how many seconds have arrived with the counter is showing
us.
Senator Craig. All right.
Ms. Ewert-Neilson. Like Alice was saying, six of these will
be placed in the community, and the central station will stay
in Boise. The nurse will be able--there is your nurse.
Senator Craig. I am now on their screen.
Ms. Richards. Can you see me?
Senator Craig. Yes, I can. Marilyn, give us your full name
again and what you do.
Ms. Richards. Marilyn Richards, and I am a certified wound
care nurse for Saint Alphonsus Home Health.
Senator Craig. Wonderful. I do not think I have any wounds
today that I know of, but please proceed.
Ms. Richards. Well, I appreciate you being our patient
today. It gives us the opportunity to test the equipment. Since
we have not had an opportunity to come and instruct you in the
use of the equipment, Paula will help you, and I will as we go
along.
Senator Craig. All right.
Ms. Richards. OK. Let's start by taking your blood
pressure. Paula will help you put on the blood pressure cuff.
Tell me when you are ready.
Senator Craig. I am ready.
Ms. Richards. OK. Great. I am going to activate the remote
blood pressure, and you should feel it start pumping in a
second.
Is it working?
Senator Craig. Yes, it is now.
Ms. Richards. OK. You will be able to see your blood
pressure on the monitor there in front of you, but I will not
bring it up on my screen to protect your confidentiality.
Senator Craig. Now it's going back down, you see. How
fascinating. OK. Now that the pressure is coming off from the--
--
Ms. Richards. Can you see it on the monitor?
Senator Craig. Yes.
Ms. Richards. OK. Great. Now you can push the blue button
and take off the cuff, and that will erase it.
Senator Craig. OK. How about that.
Ms. Richards. I would like to listen to your heart.
Senator Craig. All right.
Ms. Richards. Your lungs. No one else will be able to hear
that because I will have on a set of headphones.
Senator Craig. Oh, all right.
Ms. Ewert-Neilson. Now, here is the picture for you to look
at so you can see where she would like you to place it.
Senator Craig. Yes.
Ms. Richards. You should have a card showing you where to
place it. You definitely have a heart. [Laughter.]
Senator Craig. Thank you for saying that. Some people think
I do not.
Ms. Richards. Now over to the other side. OK. That sounds
great. Go ahead and put the stethoscope away.
Senator Craig. OK.
Ms. Richards. Next we would like to have you step on the
scale, if you would like to.
Senator Craig. With or without my shoes? [Laughter.]
Ms. Richards. Nobody will know.
Senator Craig. Well, I am what is known as random security
today. My shoes have already been off at the Cincinnati
airport.
Ms. Richards. Now, I could also bring this information to
my monitor; but I will not today.
Senator Craig. OK.
Ms. Richards. OK. Thank you. The last thing we would like
to demonstrate is the ability of this equipment to do
medications.
Senator Craig. Oh, yes. OK.
Ms. Richards. You can see what I see.
Senator Craig. All right. [Holds up bottle to camera.] It's
getting readable.
Ms. Richards. Now you'll be able to read medication labels
and also do prescriptions. OK. Great. That completes our
demonstration.
Do you have any questions?
Senator Craig. Well, no, but I all of a sudden sense why a
novice or someone who is inexperienced with technology would be
willing to use this because you are here.
Ms. Richards. It is very simple to use, too.
Senator Craig. It is simple, and it is interactive. There
is actually a face and a person talking to you, and that is
probably very helpful to someone who might be a little
skeptical about the use of this kind of equipment.
Ms. Richards. I appreciate you being a patient today.
Senator Craig. Thank you. Now tell me about the use of this
technology for a wound. You mentioned that as an application of
the type of person that you are seeking out with this
technology. How would that work?
Ms. Richards. What we would have is a camcorder that we
would be able to use so we will be able to look at the wound
and what is going on. If there's an infection going on, we'd be
able to see that also.
Senator Craig. So this camera that comes with it is not the
camera that would be used to examine the wound?
Ms. Richards. No.
Senator Craig. OK. Well, thank you. I'll tie my shoes and
go back to the table. How is that?
Well, Alice, thank you very much for allowing us not only
to see that technology, but see it in action. I think that is
even more exciting.
Do you have anything further or any further comments to
make in relation to that technology.
Ms. Ennis. My only comments are that we are very excited
about having it and anxious to get it up and running and to
demonstrate the value that it is going to be. I thank you for
the opportunity.
Senator Craig. Thank you. Dr. Beth was suggesting that we
might have made history today, that your guinea pig in this
instance was a Senator. I think that is what she was
suggesting. [Laughter.]
Dr. Hudnall Stamm. I don't think it's in the Congressional
Record anywhere else. [Laughter.]
Senator Craig. Well, thank you very much. Now we are going
to go to Coeur d'Alene.
Tom, thank you for joining us. Tom Hauer is Director of
Telehealth at North Idaho Rural Health Consortium.
Tom, are you going to lead off here with your testimony?
STATEMENT OF TOM HAUER, DIRECTOR, TELEHEALTH, NORTH IDAHO RURAL
HEALTH CONSORTIUM, COEUR D'ALENE, ID
Mr. Hauer. Yes. If I could, I would like to give you a
brief overview of what we have been doing up in the northern
part of the State, and then I will turn it over to our real
witness here who has had some experience doing this real-time,
Dr. Miewald. But first I thought I'd give a brief overview.
I'd like to first thank Beth for setting this up so that--
inviting us so we could join in. We also have other sites that
have joined us in the northern part of the State. Bonner
General Hospital in Sandpoint is also on the connection here
along with Wallace High School and Beniwah Community Hospital
in St. Marie's. So we have got quite a number of people that
are joining in just to watch today.
Senator Craig. Did you see my blood pressure, Tom?
Mr. Hauer. No, we couldn't see it very well up here.
Senator Craig. I was just checking to make sure Alice was
true to her word. [Laughter.]
Mr. Hauer. I'd take her word for it.
Senator Craig. Please proceed.
Mr. Hauer. The North Idaho Rural Health Consortium is a
consortium of five county hospitals that in 1991 formed a
group; that their group's objective was to provide a regional,
integrative approach to the delivery of rural health care; and
they joined forces to share all their objectives--or to share
their resources to try to provide better health care for rural
north Idahoans in the north part of the State.
I came on board in 1996. Five years later we purchased our
video conferencing equipment, and the objective at the time was
to provide professional education to physicians and other
health care professionals up here. That could mean weekly we
bring in a speaker to provide continuing medical education for
the physicians, and we broadcast those to our four neighboring
county hospitals so that those physicians can take advantage of
those speakers.
I also got involved in some of the trials, some of the
early clinical applications which were to provide surgical
follow-up for some surgeries where the physician or the surgeon
would need to check range of motion or simple things where they
would not need to get their hands on the patient. We have also
been doing cancer conferences which are where you have a
patient that has a tumor that is not defined easily and the
physicians can get together and discuss what's the best course
of treatment.
We've been doing those things since 1996, and in year 2000
we were approached by some of the other community groups that
were interested in seeing if telehealth could benefit their
organizations. These groups were not only the hospitals, but
some of the mental health providers locally, the school
districts, and their special services group which take care of
special service needs children, the Idaho Department of Health
and Welfare, some of our local judicial system members, and
then a school up in Bonners Ferry which is the private school
for troubled adolescents. We sat down with all these people
that have diverse needs. We said ``look, we have got this
equipment, and we have got the means to provide some of these
services to you. Let us talk about what your needs are, and let
us plan a course of action and try to see what we can do.'' So
that group had a representative from each group meet for about
a year. We analyzed our needs; we analyzed what types of
systems we had in place, what types of technology we had and
where--was the technology compatible or not; and the group then
selected two pilot programs.
This was a year ago, approximately, where we would see if
this could work clinically. The two pilot projects that were
selected were mental health and special needs children. The
mental health pilot, Dr. Miewald is going to speak to here in
the second, that was something where he is seeing patients that
he has a relationship with already.
Then the other pilot program is special needs kids, and
that is in conjunction with two of the school districts that we
are starting this pilot with. It will provide physical therapy
and occupational therapy from physical and occupational
therapists at Bonner General Hospital to two of the school
districts in the Kellogg area and St. Marie's.
So we are really excited about this, and we are also
excited with the fact that you are in a position to help us out
with an appropriation, we understand we received early this
year that will go toward making these pilot programs a reality.
So we really appreciate that and want you to know that.
I know this hearing is focused mainly on the geriatric
population in a rural setting. While our pilots do not go after
the geriatric population, I think some of the lessons we have
learned and will be learning over the next year can easily be
transferred to some of those programs. So we are excited that
Beth has brought us onboard with this statewide effort to
coordinate telehealth and that we can share some of those
things, some of our experiences and then learn from some of
their experiences in the south and southwest, southeast also.
Please keep that in mind as you're listening to Dr. Miewald as
these are some of the things I think we can go forward and
learn from.
I will introduce Dr. Miewald. He is a psychiatrist here in
Coeur d'Alene. He did his undergraduate and graduate work at
the University of Montana. This is long. [Laughter.]
He received his M.D. at the University of New Mexico. I
will not go through all of what he did in Pittsburgh, but he
has been here since 1990 working in conjunction with Kootenai
Medical Center, and behavorial health here. He is now the
attending Psychiatrist at Kootenai Medical Center and the
Medical Director of Child and Adolescent Psychiatric Clinic,
and the Medical Administrator of the Outpatient Residential
Youth Services at North Idaho Behavioral Health.
I also want to thank him because he has been a driving
force to making telepsychology a reality up here. So I'll turn
it over to Dr. Miewald.
Senator Craig. Dr. Miewald, welcome.
STATEMENT OF DR. MIEWALD, ATTENDING PSYCHIATRIST, KOOTENAI
MEDICAL CENTER; MEDICAL DIRECTOR OF CHILD AND ADOLESCENT
PSYCHIATRIC CLINIC; AND MEDICAL ADMINISTRATOR OF THE OUTPATIENT
RESIDENTIAL YOUTH SERVICE, NORTH IDAHO BEHAVIORAL HEALTH
Dr. Miewald. Thank you. Senator, I want to thank you for
two things. One is, again, what Tom was mentioning about all of
your support through the Senate to get the funding so we can
get more resources to expand telepsychiatry. I also want to
thank you for pronouncing my name right. It's one that most
people have trouble with. [Laughter.]
Tom is being a little too modest about what he and all the
other people on the committee have been doing. I kind of came
into the picture a little bit late.
What happened was I have a lot of different projects that
I'm involved with. As Tom mentioned, one of them is an
administrative position at North Idaho Behavioral Health which
is part of Kootenai Medical Center. The other part is I have
had a contract for many years to do consulting for family and
children's services through the Department of Health and
Welfare. So when I got appointed to this committee for
telehealth, it just made a lot of sense to try to expand it to
the clients that I see through family children services.
What I do through that contract is I do evaluations and
then follow-up appointments for children, adolescents for the
whole northern region. It has been a problem to have the
children and their families and case workers to have to come
into Coeur d'Alene for these follow-ups, especially in the
winter. It is often a real long drive from Bonners Ferry or the
Silver Valley. Sometimes they have to cancel or they show up
late. So what we have done is we've done really what I call
more of a pilot, pilot project to try to work some of the bugs
out of doing follow-up appointments over the telehealth hookup.
So I have seen probably a total of five or six different
individual patients. Several of them I have seen for two or
three times. So I am guessing I have probably done a total of
ten or so appointments over a several-month period since last
fall. I've seen clients from Sandpoint, from Bonners Ferry, and
from Kellogg. Though we haven't done any formal studies, that's
kind of the next step that we're trying to develop with Dr.
Stamm and the rest of the group, but informal follow-up has
been very positive.
The patients and their families and the case workers all
have been very positive in their feedback. They mostly cite how
much more convenient and safe it is not having to drive down
here. Most of the kids like kind of the cool part of the
television. They fool around with the zoom and move it around
and all that; but usually after 5 or 10 minutes they kind of
settle down and, to me, act pretty much like they would
normally act and talk as if I was seeing them live.
So the case workers who are usually distant with the
patient and the family have felt that the follow-up has been
just as helpful as it would be if it was live. The families and
the patients have all felt that they have at least--they have
told me that they have all received just as good a service as
if they had come into Coeur d'Alene and seen me face to face.
So I think the next place that we want to expand--and I
have been talking with the other psychiatrists here in Coeur
d'Alene--is to expand the number of patients that we are seeing
and then the age range. I think it is more just coincidence
that I have worked mostly with children. There is no reason why
we cannot be using this technology for all age groups. Again, I
think it would be a lot more convenient for the patients and
their families to not have to drive in.
The biggest problem--the technology is really tremendous. I
am very impressed with the quality of the sound and the picture
is very good. The biggest problem we have had is scheduling
where my schedule, the patient's schedule, the schedule for the
hookup here in Coeur d'Alene, the schedule for the remote
hookup, that has really been the major stumbling block. I think
we can work around that. We are hoping to use some of the
additional funding we have gotten to be able to buy further
hookups. I think that has a tremendous potential there.
For example, we have a lot of patients that are in long-
term residential programs here in Coeur d'Alene, but their
families are down in Idaho Falls or Saint Anthony's or
something like that. I think it would be a tremendous help to
be able to do family therapy over the television. Right now we
are probably stuck doing it over the old telephone. That is one
area that I think there is lots of potential.
That is about all the comments I had. I do not know if
anybody has any questions.
Senator Craig. Doctor, a couple of questions as it relates
to the experience you have had to date. I gather from your
testimony that you feel that this is serving your clients or
your patients adequately and as adequate as if it were a face-
to-face, in person, kind of, consultation or relationship.
Dr. Miewald. Yes, I do. We have not done any initial
evaluations. Apparently in some other States like Nebraska and
Kansas they will even do initial evaluations. But so far we
have pretty much kept it to follow-up appointments.
Senator Craig. As a provider, what has your experience been
with reimbursement through telehealth services? Any problem
with that?
Dr. Miewald. Not yet. But that is the fluke of how we have
set it up is that I have just continued to charge Health and
Welfare the same rate I would charge them if I was seeing the
patient live. So from my end, it has not been an issue.
We are trying to work with Medicaid to do a pilot project
to look at reimbursement for telehealth for Medicaid clients.
That is a concern some of the psychiatrists have raised is
whether they will be getting paid for this work or not. But for
me individually it has not been an issue so far. It has saved
the state money, I think, because, if nothing else, they have
not had to pay for the case workers to drive down, pay
reimbursement for the travel time and all that. I don't think
anybody is keeping track of that, but I think it has saved the
state a little bit of money in that way.
Senator Craig. All of your clients to date have been state
or state reimbursed?
Dr. Miewald. Right.
Senator Craig. You mentioned Medicaid. Are you sensing
there would be a problem, or is there just a necessary
procedure you feel you have to go through to identify?
Dr. Miewald. Well, my understanding is that right now
Medicaid will not pay for telehealth services. The director has
said that they will be willing to do that in a very small pilot
project here while we are gathering data on patient
satisfaction and then savings and things like that. So for
right now my understanding is we have approval for this pilot
project. It's certainly not the routine setup at all.
I also understand that Medicare will pay for telehealth;
but to my knowledge, nobody in Idaho has done that yet. So it's
actually gone through and tried to bill Medicare for that. The
rumor on the street is that that is reimbursed at Medicare
rates.
Senator Craig. I'm getting a positive response from here in
the room, so there has apparently been some experience and/or
knowledge about that.
Doctor, again, thank you very much for giving us some
firsthand experience of the kind that I think clearly in
building the record to the application of telehealth is
extremely important.
Tom, do you have anything additional you would like to add
or comments you would like to make?
Mr. Hauer. If I might, I would like to introduce Mary
Hendrickson who will be taking the lead in the physical
therapy, occupational therapy portion of this. She is up in
Sandpoint.
Mary, can you hear us?
Ms. Hendrickson. I can. Good afternoon.
Senator Craig. Mary, thanks for joining us.
STATEMENT OF MARY HENDRICKSON
Ms. Hendrickson. Thank you. This is a great opportunity for
us to be able to interface with you, sir. Let me start by
thanking you very, very much with regard to the help that you
have given us with regard to the appropriation.
This appropriation will definitely further our opportunity
to advance telehealth. We have been so fortunate in the north
here to have the bi-northern county hospital administrators
supporting Tom and I and Dr. Miewald as we have forged forward
in the effort to bring telehealth to the point that it is here
in the north. We are incredibly proud of where we have been up
to this point and where we are going now.
Because we have forged also forward in this opportunity to
bring the other community leaders involved in this project, one
of the things that we have done is to work very closely with
the school districts. We were fortunate enough to have a school
nursing grant that we did most of it through the interactive
video conferencing equipment. It was also through the Office of
Advancement of Telehealth is where that funding was
administered.
In the process of doing that, we were able to develop just
an incredible relationship with the superintendents as well as
with the school nurses; and given that opportunity, we
continued in that effort as we decided what projects we were
going to take on.
Our larger telehealth working committee, as we decided on
the two pilot projects that we were going to work on we looked
at something that was already funded and mandated and funded
because we knew that the State of Idaho at this point in time
Medicaid-wise was not paying for telehealth services. So we
knew that we had to take that project on separately.
So as we looked at what was already currently mandated and
funded, as what you can tell, too, from what Dr. Miewald has
testified, that we looked at psychiatric services because that
is being paid for at the state level. In addition to that--and
also because of our highest need.
In addition to that, then we looked at the occupational
therapy, speech therapy, and physical therapy needs of special
education students in the school districts. It is mandated and
funded, sir; but in addition to that, it also is an opportunity
where there is a great health shortage as far as health care
professionals and especially here in the north.
We are fortunate enough here at Bonner General Hospital in
Sandpoint to have a leader that has hired Dean Tompt who has
allowed us to hire occupational therapists and physical
therapists. We have got a full complement of rehab staff and an
excellent rehab program so we are now able, with this
appropriation funding, we will be able to put our pilot project
into full fruition, and we will be able to provide those
services to students that are down in the Wallace, St. Marie's.
This would be car-wise a minimum of a 2-hour to 3-hour drive,
and you can imagine what that is like in the winter time and
the mountainous roads.
We so far have conducted three occupational therapy and
physical therapy sessions with the students via this current
interactive video equipment. With the additional roll-around
units, things will become enormously easier plus infinitely
more expanded because of the fact that we will have the
different stethoscopes, et cetera; otoscopes, ear scopes, those
kind of things that you've kind of seen today.
One of the biggest advantages that we have found, sir, is
the peer-to-peer contact. We have one occupational therapist
down in the St. Marie's area that was on the other end helping
with the student visits, and what she found was enormous by
being able to connect with a therapist here because of the
isolation. That is one of the things that Beth has mentioned as
well.
So the benefit of the mobile interactive units, as I've
said, will greatly enhance what we are able to do here in the
north.
Again, I thank you and appreciate the opportunity to be
here today.
Senator Craig. Well, thank you very much. By my schedule
here, you are a surprise witness; but I am tickled to death Tom
has connected you in because--I mean, not only for those of us
sitting here at Idaho State University in the south because for
you to come almost instantly on screen and give us your
firsthand experience, I think, demonstrates the value of this
technology.
Ms. Hendrickson. Thank you, sir.
Senator Craig. This was going to be a three-community
hearing today; we have gone to four.
Tom, are there anymore? [Laughter.]
Mr. Hauer. I believe that Wallace High School and St.
Marie's are also listening in, but they are not going to be
speaking.
Senator Craig. Well, thank you all very much.
Tom, any additional comments before we come back to
Pocatello?
Mr. Hauer. No. I think we are finished here. Thank you very
much.
Senator Craig. Thank you. Well, let me thank all of you
here in Pocatello and in Boise and in Coeur d'Alene and in
Sandpoint for joining us today not only to get firsthand
testimony as to the application of telehealth, but to actually
see the technology function and to begin to sense how valuable
this can be to transmit to a center to the expert, if you will,
the kind of information where diagnosis or assistance can be
offered that might not be able to be offered, and then the
sheer time and distance.
I think all of us who live here in Idaho understand the
issue the mayor was talking about--the snowy roads or waking up
in the morning and knowing that you simply cannot physically
get from point A to point B because of the road conditions that
are oftentimes the case here in the winter time. So it is
extremely important. This application, I mean, just fits Idaho
so very well.
Of course, Beth, you came from Alaska with the experience
you have had up there. Of course there, it is even all the more
important from the standpoint of distance. Roads do not even
exist in some of those places that I am sure that you
experienced or provided service to. So I played a small role.
But to watch these appropriations get on the ground and begin
to work and know that they are providing real services to
people that might not otherwise have the quality of service
makes this all worth while.
As we reshape health care in States like Idaho, I think all
of us were tremendously concerned when we saw payment levels
and reimbursements either flat and, in some instances, adjusted
and/or declining and small rural hospitals closing. Many
communities were extremely fearful that we simply would not be
able to provide--have provided to those communities the quality
of health care that they had in the past. I think that is less
the case now with technology; and, of course, I'm always amazed
at the application of technology.
I was telling Dr. Beth that I was on an airplane recently
where a doctor was sitting beside me, and we got to talking. He
had just been assigned to a new program at Wayne University
Medical School, and his talent was that he had developed a new
software package that was applicable to the very technology
that we have here today. You simply move it through a computer
and through this new software package on its way into
transmission and it becomes almost fully real-time. It takes
away the slight lag time that we all experienced here today so
well that they are now using it to--Wayne University doctors
just conducted a surgery at a hospital in Los Angeles via this
technology by actually hands on and helping actually manipulate
the devices that were conducting the surgery.
Of course this doctor, as I was telling Dr. Beth, happened
to have the software package right along on his laptop and
showed me a blow-by-blow account of the surgery. It was a gall
bladder removal.
But the point is that it is all happening out there now in
a way that is certainly going to facilitate rural Idaho.
As I close, let me remind folks that we have an ice cream
social as we go out this evening to--we are going to go out and
see the van, have a chance to see that and share some ice
cream. This is going on in a couple of other locations for
those of you who attended to enjoy the ice cream.
Also I want to thank the Chairman of the full committee in
Louisiana. John is the Chairman of the Special Committee on
Aging in the Senate. We have a very positive working
relationship, and thanks to him we were able to bring this
field hearing to Idaho today.
Where is Phil? Phil, take your bow. Phil is on staff with
the Special Committee, and I want to thank you also for coming
out and helping facilitate this hearing today.
All of this becomes a record of the committee. As some of
you may know, this is not an authorizing committee; but the
special committee itself plays a very valuable role both in
hearings, investigative work, scoping, all of those kinds of
things to analyze the problems of the senior community of
America to develop the reports.
Oftentimes our material goes directly to the Finance
Committee itself which is charged with Medicare, social
security, and a variety of the health care areas that we
oversee through this committee and, therefore, then hand our
reports through to them. So this will all become part of the
record; and it enhances not only further application here in
Idaho, but my guess is it will help across the county.
So thank you all for coming out today, and a very special
thanks to Dr. Beth and the center here and the work you do.
Obviously your outreach statewide was very evident by the
contact and the relationships today. So thanks to you and your
work and the work here at Idaho State.
With that, the field hearing will stand adjourned.
[Whereupon, at 6:10 p.m., the committee was adjourned.]
-