I'm concerned with promoting consumer access to public health care technology. The importance of an individual's lifestyle behavior is less than the variety of impacts the community has on it's members' health issues. The quality of the community's environment and living conditions has a tremendous impact on people's health. These issues aren't very much talked about, even though they are very important. We must open the issue of the community working together to solve the health problems of its people. We should try to create the kind of health information programs that the community can use effectively. We can migrate to networks where we can have community discussions and create a feeling of joint concerns on these problems. This is what our panel will address this issue today here.Jeff ... Director, Spry Foundation
What I would emphasize when trying to inform people about health care is an enormous amount of focus on dissemination. The emphasis should also be on the budget of households nationwide because budgets are shrinking. It became very clear that many people had computers but they couldn't afford online services. Instead, health care uses 3,000 referral systems to share information. It is clear that the consumers are telling us, "Give us a place to go, don't give us 50 places to go to."
The information referral system has said, "We are the place to go to in this community." What we want to provide is a schedule of local resources and credible health information to the consumer. Thus, we selected the top 24 places of quality information referrals. Some were public libraries, some were local organizations, some had few computers, and some were phone-in and online services. The greatest impact on users of the systems was the benefit that the consumer can access information directly. Particularly if they needed the information immediately, it was important that consumers could get the information fast.
It is great to have good content, but if no one knows it is there, it does no good. It is very important to let people know that the information is there and how to get it. Consumers thought that the schedule of information is great. But can the consumer get the information in a certain kind of format if they have to get it out of this data base and into that one? If the consumer is really interested in getting the information -- and needs ready access -- then I think you should provide it.
But you must know how to take the information and rework it so it is useful. There is an enormous disparity in the quality and clarity of information. I still believe that the delivery system in the community is important. Marketers of information have little understanding of the market they are entering into and who their consumers are. It is important to plan ahead. The public library system has received a large grant and are actively pursuing outreach. They are putting computers in the inner city and we have been invited in to bring the information. There are wonderful projects being pursued by the libraries. I would caution putting a lot of technology in at once, however.Lois Steele Indian Health Service
Indian Health Service is a holistic health system. It provides access for those who are eligible. We take care of people from birth until death -- taking care of vaccinations, social problems, alcoholism, sanitation and other health issues. We are scattered all over, especially in sparsely populated areas such as in Arizona.
When you look at the causes of death of Native Americans compared to the rest of the U.S., they are very different. Thus, we need a different target for our health information. A number of laws in the Indian Heath Care Improvement Act have changed the process of dissemination. In 1988, a law was formed that could have helped information dissemination to our remote areas -- if the project had been funded. The law states that there must be an automated management system of health care. The system would bring tribes online and was going to be in place for all tribes in contact with the government by 1990, but we never got the money to do it, and in the meantime federal budgets went down, so there is a lag in funding.
The closest system we have to an automation management system is the patient care component. I will pass this pamphlet on it around. We have one of the best patient care components of anywhere in the nation. We have 44,000 patients going to the patient care component. We have a law in place for the automated service and it only costs $25,000 -- but to get the network installed, you need good phone lines. We don't have them. Tucson has access, but the online service runs through old phone lines and it is very slow. Belcourt, North Dakota is nearly on the Canadian border in a remote location. The tribe there has Internet access and all the phone lines because they thought it was very important. They worked with the tribal community college to develop the project. A service in Nevada has one person who installed the hardware who was very well trained and they are online. There are other examples where remote locations have been brought online.
This is the best type of Indian health care service and we have the administration people who are trained to direct people where they need to go for information, and we distribute pamphlets that help people go where they need to -- and fast.
The administrators are from tribes and hospitals. The hospitals say that they don't have the money to provide 100% of the care needed. They only provide service for 70% of the demand for care now. They are working at 40% of the funding levels most providers use.
It is crucial that we make the small investment of money to bring the tribes online. However, it is important to note that the tribes' experience is contrary to the common belief that if we keep sending the technologically literate people to reservations, then we will get online faster. We are not going to get online faster. It does not work to keep the philosophy of "go in and get the job done," because you are entering a new culture.
We have to respect the elders, and if we send someone to the tribe to set up the online system that looks like a teenager, the elders must speak in a council first to discuss the issue of bringing the new technology to their tribe. The council has a real lack of time urgency. The present is more important than a future orientation. Those who try to set up the Internet must be able to tell Native Americans why it is important to adopt this technology.
The tribe believes that electronics are negative spirits. They may not know what evil spirits are coming over the lines. We have to have the credibility, but we have to be aware that we are talking to a different world. We've got to remember that all healing happens in a circle and goes hand in hand with healing all over the world. These basic problems of cultural communication must be dealt with. We *can* accomplish this! We just need to be aware.
Margaret Mead once said, "When you're teaching don't forget that the students you are teaching live in a different world than you do. What they know and what they believe may be very different than the teacher's world."Steve Snow, Charlotte's Web
I have a bit of a different perspective than some. There has been a lot of talk about "value" -- and that's what Charlotte's Web niche is. We are in partnership with the Department of Commerce and
We provide lots of information -- as you would expect from an provider. But our focus is on emphasizing the value of individuals as people. It's the person who has the value -- not the network, not the wires, not the technology. The person who uses this technology is what makes the technology valuable. What makes a Web page important is not the wonderful information on it, but it is important because a *person* created it.