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Congressional Testimony

Statement of Thomas C. Dorr
Under Secretary for Rural Development

Before the House Committee on Agriculture
June 25, 2003

Mr. Chairman, Members of the Committee, I appreciate the opportunity to come before this committee to testify, on behalf of the U.S. Department of Agriculture, regarding the benefits that Rural Development's Distance Learning and Telemedicine program brings to rural Americans, while simultaneously suggesting ways in which this program might be strengthened.

USDA's Rural Development agency is becoming recognized as the Venture Capitalist for Rural America. Our mission is to increase economic opportunity and improve the quality of life for all rural Americans. This program exemplifies that mission.

The USDA's Distance Learning and Telemedicine program is administered by Rural Development through its Utilities Programs. The purpose of the program is to improve the quality of education and health care in rural America. This can be accomplished by using technology to enhance the availability of medical services and to improve access to educational materials, forums and other opportunities.

Telemedicine projects are providing new and improved health care services. They run the gamet from enhancing access to more sophisticated patient diagnostic and surgical procedures to enhanced post-operative treatment. New advancements are being made in the telepharmaceutical and telepsychiatry arenas by providing health care options never before available to many medically under-served, remote and rural areas.

Our distance learning programs also continue to provide funding for computers as well as Internet access in schools and libraries. The vast array of study options available to rural students through distance learning technologies truly brings the world to their doorstep. The value of these services to rural parents, teachers, doctors and patients clearly improves the quality of life for the residents of these rural areas.

The deployment of advanced communications technologies to rural and sometimes isolated health care centers enables them to help overcome the barriers of distance, remoteness, and time that frequently confront rural physicians and patients.

One specific example of which I am aware demonstrates telemedicine's life-giving role. Dheva Muthuramalingam was born with respiratory problems and a heart murmur in a small community hospital in West Virginia on December 30, 1999.

As a precautionary measure, and interestingly as the world stepped into the new millennium, on January 1, 2000, he was transferred to the Winchester Medical Center (Winchester, VA) for further diagnosis. Dheva was seen by an adult cardiologist. As is sometimes the case in rural areas, the appropriate specialist is not always available. While the doctor determined that Dheva had a hole in his heart - it was apparent he was exhibiting other symptoms not associated with the initial diagnosis. Further expertise was required. Hence, plans were made to transfer Dheva to the University of Virginia Hospital for further testing. Fortunately, before transferring Dheva, the doctor at UVA had the ability to review Dheva's heart ultrasound test, which was transmitted via telemedicine, and the specialist diagnosed a rare congenital heart defect requiring immediate medication BEFORE the transfer occurred! Medication was prescribed and the local Medical Center was able to stabilize Dheva for safe transport. The doctors believed Dheva would not have survived the trip if the telemedicine diagnosis had not been made.

The next day Dheva underwent successful surgery. I have seen him via a live audio/video feed last January and he is an active and happy, living testament to the benefits of telemedicine. Consultation, diagnosis and the appropriate medicinal prescription were provided via a sophisticated internet hook-up several hundred miles from the patient. This system delivered life saving medicine to the future of America - a child.

Or consider, all across the country, the many rural school systems like, Quitman High School in Mississippi, which provide multiple benefits to the community through the deployment of distance learning services. During school hours, three remote school districts are linked together to share valuable teacher resources and provide interactive curriculum.

After hours, when the schools are not using the system, it serves as a community tool, available to the residents for other life-long learning opportunities. When this technology is incorporated into the school system as a result of our grant and loan programs, we also bring it and its benefits to the entire community. For instance public health and safety officials often use a school's distance learning facilities to take "re-certification" training or to receive Continued Education classes required to maintain certification.

While our focus here today is on the benefits of distance learning and telemedicine services, in reality, the benefits often spill over into the local community and foster a better understanding of the power of the world-wide web - at home, in the office, at the factory, on the farm, as well as in our schools, hospitals, and rural health clinics.

Using a home computer, a farmer can "log-on" and run his/her business. He/she is able to plan their work day by tracking weather patterns. They might also buy or sell commodities on the open market, and all this helps them to participate in the global, digital economy where they must compete. The spouse, frequently a schoolteacher, may attend college in the evening to receive a degree in working with children with special education needs. Although this is an example of the synergism these advanced technologies create, it is not an unfamiliar example where our programs have assisted in providing access to the technological infrastructure necessary to make it possible.

These are remarkable stories, that this partnership - Congress, USDA and rural America - helps make real everyday. Further the encouraging news is that advanced telecommunications networks will enable rural communities the opportunity to become platforms for new businesses to compete locally, nationally, and globally. It brings access to risk and therefore opportunity to rural America. This opportunity may entice young people to stay, return to or move to rural areas.

Despite these successes and others like them, there are many challenges before us. In the 10 years that this program has been providing funding, $173 million has been made available to over 500 projects in 45 states and four territories.

While this is a tremendous amount of public investment - which leverages private and local investment as well - more could be accomplished. We are continually reviewing the program from an administrative point of view to see where improvements can be made within the legislative boundaries in which we operate. Most recently, we reduced the matching requirement to enable more schools and hospitals, particularly those most remote communities, to benefit from the program.

One critical impediment currently exists to funding certain telemedicine services on tribal reservations. In many instances, the health care facilities on reservations are owned by the Indian Health Services (IHS). Since IHS facilities are considered "federal" facilities, these clinics are not eligible for Utilities Programs DLT grant funding. Therefore, many Native Americans will not be able to benefit from the improved health care opportunities that the DLT grants enable without legislative amendments that will enable such funding.

One other issue needs to be pointed out. In the 10 years of operating this program, it has become clear that the demand for loans in this program is very small. Only 10 percent of the total investment has been in the form of loans. This is primarily due to the types of entities that are eligible to borrow - namely schools and health care providers serving rural areas. In most cases, schools are prohibited from entering into loan agreements because they are not able to generate revenues to repay the loan if they could.

In addition, the high costs associated with the provision of rural health care, limits the feasibility of telemedicine loans. While universities and hospitals may look to the loan program for funding to construct or rehab buildings, the 10-year required repayment period proves to be a financial burden. The paradox is that - while telemedicine offers a means to reach the most isolated and poorest residents of the country - there is not always a means for cost recovery.

In conclusion, this hearing will set the stage to facilitate an increased awareness of both the opportunities and the dilemmas of this program. As with any new technology the ingenuity of the user always develops new opportunities and demands. How to maximize them while understanding how to mitigate the costs is the challenge. I appreciate the opportunity to testify before this committee today and to hopefully bring into focus some of the rewards this program offers as well as some of the challenges it faces.

Thank you.

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