System Structure

"Proponents of telemedicine are only one of a number of groups that are interested in using a modernized telecommunications system to perform their function. The configuration of the system will be driven in part by considerations related to those other services, not solely by the telemedicine function. We need to find ways to interweave and design telecommunications into the very fabric of the medical care problems, rather than to paste it on as an afterthought or try to appliqué them in some fashion. I'm vastly encouraged that ways will be found to weave in the telecommunications structure as long as we on the regulatory side make sure that the opportunities are available at a reasonable cost."
--Kenneth Gordon

Meeting the Need

"Telemedicine has to fit into the real world--it has to be needed. There are many levels of technology,
but you have to look at what is appropriate for the situation and the area."
--Margaret Houston, M.D.

"We are looking for technologies that fit the affordability function and the need function.
The future of telemedicine lies in some of the lower-tech approaches and distributive approaches."
--Dena Puskin

Cost-Benefit

"I always come back to this as an elected official: Who's going to pay for all this? I don't think you're going to sell elected people these days on spending more money just because there will be better medical care or higher value added. You've got to convince these people that costs are going to go down or at least stay the same. I think you've got to give specific examples over and over again of how you can get better care and spend less money."
--Randy Johnson

"These new technologies require our rules on reimbursement, licensure, and liability to stretch. We need more research on the value of these technologies and, as the results of that research become available, we can decide how those rules should be changed to accommodate them."
--Leo Whelan

Using the Technology

"Here's an analogy: You are a farmer who is used to practicing agriculture with a horse and a plow. All of a sudden, you're given a huge John Deere tractor with a whole set of equipment and a harvester combine. Now the question is--are you going to be more productive this year than you were last year? The answer is probably no because you knew how to farm with the horse and plow, and you didn't have to worry about fuel expenses and oil changes and mechanical expenses, and where you are going to put that tractor, and maybe even having the tractor run over people."
--Douglas Perednia, M.D.

Compartmentalization

"How global do we become in our accounting methodologies for the care we deliver? We have talked about where different "pots" of money reside. One of the things that is always involved in the health care debate is: "Who's `pot' of money are we dealing with?" Depending on how global we want to be in our cost accounting--let's say we want to include transportation costs (or the lack thereof)--we might say that these systems are very efficient right now because we don't have to have somebody hop a plane or take eight hours of their day to travel from rural Oregon to Portland to get their care. But we don't do that; the costs are compartmentalized."
--Eric Tangalos, M.D.