Sunday, March 11, 2007

Will 21st Century Telemedicine Come to Indiana?

Improving health care for Hoosiers is one of the most important issues facing Indiana legislators. We constantly consider how to keep our citizens safer and healthier while deliberating the costs, pondering insurance plans and struggling with adequate Medicaid funding.

This year, we also have the opportunity to dramatically improve the way medical services are delivered in Indiana.

Senate Bill 489, now before the Indiana Legislature would allow Indiana to take advantage of an offer by the Federal Communications Commission to fund up to 85 percent of the cost of providing high speed internet connections to hospitals and health care facilities throughout Indiana. But to win this prize, we must act quickly and cohesively. On this issue, all legislators, Senator and Representatives, Democrats and Republicans are united.

Imagine, if you will, doctors being able to consult specialists anywhere in Indiana while you are in the office with no need for another appointment is some other city at some later date.

Imagine doctors being able to remotely examine patients in their homes, or in an extended care facility, to diagnose routine illnesses and skin ailments without requiring the patient to come to the office or emergency room.

Imagine a surgeon or emergency room physician ordering x-rays or other medical imaging and having a radiologist in another room or even another hospital interpreting those images with sophisticated computers while the patient is being treated or having surgery.

Imagine having medical bills and prescriptions transmitted directly to their destination without delay or handling or duplicating documents.

Imagine a medical records system that didn’t require patients and providers to constantly fill out paper forms and cut down tremendously on delay and errors.

A fully integrated telemedicine system could make all of this and more happen in Indiana very soon. The good news is that the technology already exists and many health care providers are already using it. The bad news is that we don’t have the fiber optics necessary throughout Indiana, especially in rural areas, to make those goals a reality.

Senate Bill 489, if it is implemented immediately, can accomplish those goals and push Hoosier health care ahead by decades.

Indiana will only have one short opportunity to move health care technology into the 21st Century. The completed application must be submitted to the FCC by May 7 in order to qualify.[*]

This is an opportunity that must not be lost. In one stroke we can:
- Make health care services quicker and easier to deliver to patients.
- Save tremendous numbers of tax dollars and insurance premiums.
- Improve the efficiency and availability or our skilled health care professionals.

The Senate unanimously passed SB 489 and the House Health Committee also passed the bill without dissent on March 7. We believe the full House of Representatives will pass the bill overwhelmingly.

The Administration has not yet taken a position on this rare opportunity. We hope they will do that soon. Indiana must take advantage of this opportunity for the future of her citizens.


[*] For detailed information re: the Rural Health Care Pilot Program: http://www.fcc.gov/cgb/rural/rhcp.html

Saturday, January 20, 2007

2007 Online Issue Poll - Updated 1/26

Each year I send out a survey asking questions about various issues that may come before the legislature. I send out post card surveys and I also make the survey available online.
These surveys never meet the test of being statistically reliable because the respondents are only those who take the time to fill out the form.
We tally the results of the mailers and the electronic results separately.
I already have over 1000 responses as of January 26, so I thought I would share those results. I’ll try to update you from time to time.


Should Indiana taxpayers pay the approximately $100 million cost for textbook rentals which are currently paid by students and their families?
Yes - 214 (21%)
No - 823 (79%)

For many years, the General Assembly gave all public schools an annual funding increase even if enrollment dropped. The funding formula was recently changed and is now based upon the number of students enrolled in each school and each student’s special needs. In the next budget, how should the General Assembly fund schools?
- Increase funding for all school corporations regardless of changes in enrollment and the number of children with special needs - 61 (9%)
- Base funding for each school corporation on the number of students enrolled with increases for children with special needs - 401 (62%)
- Limit increased funding to about the rate of inflation - 183 (28%)

The cost to provide full-day kindergarten to all children is approximately $200 million per year. In the upcoming budget, should the state make the funding of full-day kindergarten a top state budget priority?
Yes - 229 (24%)
No - 709 (76%)

Do you support school choice?
Yes - 755 (66%)
No - 396 (34%)

Currently, municipal elections are held in odd-numbered years, when there are no other elections. Should municipal elections be held in a year when state and federal elections take place?
Yes - 698 (65%)
No - 376 (35%)

The FDA has expressed concern that a significant number of imported drugs are counterfeit and could threaten patient safety, yet many Hoosiers have saved money by ordering drugs from outside the U.S. Should Indiana allow citizens to import prescription drugs from outside the U.S.?
Yes, if approved by the FDA - 451 (58%)
Yes, regardless of FDA approval - 263 (34%)
No - 67 ( 9%)

Should the cigarette tax be increased in an effort to decrease smoking in Indiana?
Yes - 687 (65%)
No - 367 (35%)

A legislative study committee of local government is considering moving township government responsibilities (poor relief, property assessment, and fire protection) into county operations as a way to reduce operating costs. Do you favor eliminating the township level of government?
Yes - 424 (49%)
No - 445 (51%)

Indiana’s economy is becoming more service-oriented, yet the state sales tax currently applies only to the purchase of goods. This makes it more difficult each year for the state to raise as much revenue through the sales tax and could result in the need for a higher rate in the future in order to generate sufficient revenue. In an effort to maintain a strong sales tax base and lessen the need for future sales tax increases, should the legislature:
- Expand the sales tax to cover most services as well as goods, exempting medical services and raw materials used in production and use the revenue for new state programs and services, such as full-day kindergarten - 143 (29%)
- Expand the sales tax to cover most services, but reduce the rate so no additional revenue is generated - 118 (24%)
- Keep the current sales tax system - 501 (66%)

In order to complete the I-69 extension from Indianapolis to Evansville in a timely fashion, should the state fund the project by making the extension a toll road?
Yes - 492 (43%)
No - 643 (57%)

Do you favor raising the minimum age to 17 to receive a license to drive?
Yes - 778 (64%)
No - 447 (36%)

Thursday, December 07, 2006

Visions for Applications of Geographic Information Systems

If you are interested in some comments on a vision for the future of Geographic Information Systems, for video, try: http://www.indiana.edu/~gis/ford_ipod.mp4
for audio only: http://www.indiana.edu/~gis/ford_audio.m4a

Wednesday, December 06, 2006

Handling Traffic Emergencies

Handling Traffic Emergencies

For 18 years, I have driven to Indianapolis on a nearly daily basis, usually following I-69 to I-465. On Tuesday morning, December 5, there was another of the common accidents that closed the road southbound near Anderson. As I understand it, the highway was closed from about 7:15 a.m., when the accident occurred, until it was finally cleared, about noon. I came upon the stopped traffic just past mile marker 26 and it took over an hour to make it four miles to the Pendleton exit, where the traffic was being routed off.

I understand that accidents are a common and (at least for now) unavoidable consequence of traffic on our highways. At the same time, I wonder why they should result in such dramatic traffic delays when they are totally predictable.

If it were just for the frustration of losing an hour (although I have been in similar congestion that lasted more than 4 hours) I would just count myself lucky that I wasn’t involved in the accident and have sympathy for those who were. As a former law enforcement officer, I also know that there is more to do than just take care of the injured and clean up the mess. There is often an investigation that must be at least partially completed before the scene can be cleared. All of that, however, should still not result in the long delays that always seem to result.

Every driver, trucker, and passenger that came along that highway – thousands of them – lost more than an hour that morning. People missed jobs, appointments, and maybe flight connections. Some goods didn’t get to their destination on time – an important issue for factories and for connecting transportation awaiting shipping or trucks. Thousands of extra gallons of fuel were burned. Without trying to calculate a number, it’s easy to guess that millions of dollars were lost to the Indiana economy. And in spite of the accident, it appears to me that much of the delay didn’t need to happen.

Those of us in the public sector are not doing enough to plan for this kind of event. In this case, the big bottleneck was at the Pendleton exit. There was no one directing traffic there and so every vehicle had to wait needlessly at the light. There was also no additional traffic control in Pendleton, where the traffic was snarling as it tried to get through town. There were no signs at exits or on-ramps north of the accident that could have redirected traffic, even though the accident was hours old by the time I arrived. State highway trucks were used to funnel the traffic off of the interstate and to block any vehicles from making U-turns, but there was no warning that the traffic was being routed off until the driver was close enough to see the exit (not far if you are following a semi). That meant that many of the drivers were scrambling for maps as they approached the exit. I tried listening to the INDOT radio frequency (530 AM). It was inaudible but, from the few words I could hear, it wasn’t mentioning the road closure at all.

It was obvious to me, as I waited, that this is not the kind of situation that we would like to have happen on a large scale in the event of a major public emergency. If we can’t manage traffic after a single and predictable highway accident, what would happen in the event of a large disaster?

My purpose here isn’t to whine about the inconvenience. My purpose is to suggest a different approach. In an age of heightened concern about homeland security, shouldn’t we have public plans that deal with the details so that, should a larger crisis ever arise, we could respond with some sense of composure and order?

Here are my suggestions.

First, INDOT and the Department of Homeland Security should have a plan that thoroughly addresses any blockage of any section of Interstate Highway. Where will the traffic be rerouted? Who is responsible for the choke points along the detour(s)? How do we re-regulate the traffic control devices along the detours for the heavier traffic? Which highway or street departments and which law enforcement agencies should be notified and what are their responsibilities?

Second, isn’t there a better way to warn and reroute traffic before it gets into the bottleneck? How about portable signs at preceding on-ramps and off-ramps that could be quickly placed by public safety to help vehicles avoid the congestion? That would, in turn, mean less congestion and delay for those who hadn’t been able to avoid it.

Third, we need information delivered quickly to the motorists. INDOT already has the radio frequency. A few portable signs asking motorists to tune in coupled with a temporary transmitter could give information on alternative routes, expected delay time, emergency phone numbers, and other important information.

I’m sure our Homeland Security folks and Transportation officials could come up with some other useful ideas to incorporate into an overall plan. Executing those plans when the need arose would not only save a lot of time and money for Hoosier motorists but would serve as great practice for larger emergencies. The problem is too common and too costly not to address. We need some solutions and we need to put them into practice.

Wednesday, June 21, 2006

$18 million wasted??

In light of Major Moves, in light of the fact that there are private companies providing the same service within 10 miles in either direction of this project, why are we spending this money?
http://www.thestarpress.com/apps/pbcs.dll/article?AID=/20060621/NEWS01/606210315/1002
Let me know what you think.
David

Tuesday, June 20, 2006

MODERNIZING HIGHWAY TRANSPORTATION


June 20, 2006

I wanted to pass along some observations about the state of transportation in Indiana.

The system in place is suffering from many of the problems of antiquation. Highways are too expensive to build and the life expectancy of our roads and bridges is embarrassingly short. I think everyone agrees that liquid fossil fuel energy sources are becoming increasingly problematic. Congestion continues to worsen. Personal injuries and deaths on the highway are a disgrace. And generally the costs of travel, in terms of dollars spent and loss of productivity are just too high.


I recognize that it is naïve to expect to have major changes of practice in the short term but I also think we have a unique opportunity with the construction of I-69, the first new construction interstate highway in the United States in several decades. I talked to some of the highway researchers at Purdue about this a year ago and they seemed anxious to explore new approaches in a number of concerns.

As you are aware, new technologies are allowing wholesale changes in thinking in a number disciplines. I would like to see the I-69 project become of model of the future in transportation. I think, properly presented, a number of federal grants could be secured to explore new concepts and, at the same time, help defer the cost of the project. With a lot of thought and a little marketing, this could be the highway of the future that would help Indiana make a quantum leap to position the state as the epicenter of economic progress from transportation, distribution and logistics.

There are certainly challenge involved with getting people to change the way they travel. Some have suggested an appeal to their sense of energy conservation. That might work to some degree but I am a firm believer that people modify their behavior in their own interests. They change because they save money or because they find the change enjoyable or convenient.

There are hundreds of ideas floating around on new concepts of transportation, but let me just offer a few:

- Consider a system of parallel rails for “piggy back” transport of trucks and autos. If vehicles could quickly and economically load onto rail cars near an onramp on one end of a long (two hours or more) stretch of highway and off at the other end for a cost less than the cost of the gasoline to make the same trip – if they could make that trip in a way that left them completely free to sleep or engage in activities they prefer to driving – if truck drivers could extend their range by not having to log the driving time for that segment – if the trip would be quicker than the drive – and if the drivers could be essentially assured of no unforeseen congestion or delays due to weather or accidents, I think many would take advantage of the service. Rails last a lot longer than roads and are less expensive to maintain. Vehicles on rails require very little law enforcement activity. Such a system would save tremendous amounts of fuel (indeed, the train could be electric or powered in other exotic ways). Safety would be greatly improved. Environmental effects would be mitigated. Fuel costs would be reduced. Travel time and frustration would be reduced. Everyone would win. The downside? It would take some investment from the state (which might be partially offset in the long run) in additional right of way and infrastructure. The motoring public would have to get used to the idea, although I would guess that the freight carriers would see the benefit quickly.

- Consider teaming with automakers to develop a system to supply electricity to automobiles in motion (similar to electric trains). Electric vehicles still have a relatively short range but, if they could get the fuel they need to travel long distances as they travel and then have a battery reserve to allow for another 50 to 100 mile range, they could eventually serve commuters who travel distances beyond their normal range and perhaps never have to be “plugged in” at home.

- Explore options for new materials and techniques in the construction of highways and bridges. Heavy truck traffic and winter weather conditions result in the replacement of highway surfaces on a schedule that has become unaffordable. There must be materials and processes that last a lot longer, that are designed for modern traffic, and that are designed for less expensive replacement when they wear out. We know that roads are going to have to be maintained and improved. Why not plan for replacement that is more economic in dollars and delays than we currently experience.

- Modern management information systems (MIS), Geographic Information Systems (GIS), Geographic Positioning Systems (GPS), Radio Frequency Identification Devices (RFID), motion sensors, and digital communications have dramatically changed air travel. It is time we applied some of the same concepts to surface transportation. Every truck that is delayed on the highway is burning extra fuel and driver time and possible keeping goods from getting to their required destination in time to avoid production loss. I don’t know if anyone has tried to calculate the cost to the economy as a whole, but it has to be astounding. Better information is available. Let’s put it to use in this century.

- Consider designing and managing highways to allow for the foreseeable accident. Why should it be necessary to hold up traffic for hours every time there is a collision? Can’t we allow for separated parallel lanes so that blockage of part of the highway doesn’t result in total paralysis? “Local” and “Express” lanes help to separate traffic but they also provide a safety valve when delays occur. As mentioned above, congestion equals economic costs. They major arteries are built to speed traffic flow, they shouldn’t end up doing the opposite.

There must be thousands of people with better ideas than mine but it seems to me that we have an opportunity change the paradigm. Maybe we ought to think about taking the biggest steps we can.

Thanks for listening,
David

Saturday, December 31, 2005

BUILDING FOUNDATIONS FOR ECONOMIC DEVELOPMENT IN INDIANA

Hoosiers love to discuss the problems with the Indiana economy. Our Governor often points out that, “Hoosiers earn less than 90 cents for every dollar the average American earns. These losses result in diminished hope and opportunity for Hoosiers around the state and sagging revenue for state government.”

<>So what do we do about it? Can state and local government really play a role in improving the economic well-being of our citizens? Is trying to recruit companies to move here from another state to “bring jobs to Indiana” the only trick in the economic development grab bag? In order to have better jobs and higher income in Indiana, do we essentially have to take those from someone else? Or, can we find a way to produce more jobs and wealth through public policies that make better use of the resources we already have? <>

The answer is, “Yes!” There is a formula for growing jobs at home. 85 percent of the new jobs created in Indiana come from companies that are already here or are being started here. We can do it with the people and tools available to us, and here is how. <>

The solution to increasing wealth and a better standard of living is called “productivity”. Improved productivity increases wealth for individuals and for the economy as a whole. It means getting more done in less time. It doesn’t mean necessarily working harder or working longer hours. It does mean working smarter. <>

Now, working smarter comes in two broad categories. First, we must all be smarter workers. Whether we are working in a factory, providing a service, growing food, or engaged in any other economic activity, modern competition dictates that the workers who make the best decisions, get the most done with the resources they have, and maintain the best quality, will be the economic winners. <>

The second category of improved productivity comes from the use of the best possible tools. Even when we have to invest a little more to get good tools, the increase in productivity more than offsets the cost. <>

If those two principles are true, then government can help to enhance the private sector by encouraging both a better educated workforce and investments in the “tools” that make Indiana the place where the job (any job) can best get done. <>

Now these aren’t new concepts. As long as Indiana has been a state, education has been a recognized priority. Our ancestors also recognized that public utilities like water and highways were the keys to helping all Hoosiers live easier and more productive lives. <>

We are facing many modern challenges and changes, though. Ending your formal education after 12 or even 16 years is no longer sufficient to keep you productive enough to stay ahead of the competition. Hoosiers and their government need to accept, as a part of the cost of the lifestyle they seek, that they will have to continue to educate themselves throughout their working lives. Sweating over the horse drawn plow or the wood fired oven was the cost of a daily living for our ancestors. Today, the muscles of labor that provide our living are less in our arms and our backs, and more between our ears. <>

The challenges for policy makers in regard to an educated workforce are how to structure effective educational institutions, how to pay for them, and how to make them available to all Hoosiers. We must also provide leadership in encouraging people to take advantage of those opportunities. How do we increase the graduation rate? How do we get more students into programs beyond high school? How do we encourage adults to continue and expand their educations? How do we keep more of the people we pay to educate in Indiana? <>

Providing better “tools”, from a public policy perspective, means strategies aimed at both the private and public sector. We must all look for ways to encourage (or at least not discourage) private investment in buildings and equipment for increased productivity. <>

We have also come to accept that certain investments in assets valuable to all citizens are proper expenditures for tax dollars. Roads, streets and bridges, utilities, and public safety services are not just conveniences, they are necessary for economic activity. State and local government in Indiana have failed to prioritize our infrastructure needs for too long. We have to address issues like highways that are inadequate to our economic needs and sewers that don’t measure up to our environmental expectations. <>

The 21st Century has brought some new demands to our infrastructure needs. Threats of terrorism place new stresses and burdens on our productivity. We need to deal with those costs rationally and effectively. <>

Most of the world’s economic growth potential is in information technologies and intellectual property. That includes health care, business practices, communications, entertainment, and a variety of other economic activities. Unfortunately, Indiana is well behind the nation and the world in development of information infrastructures. Our lack of access to fiber optics and wireless broadband is a serious detriment to our ability to grow a modern economy. The technological tools exist. In Indiana, we don’t yet have the political will to make it happen.<>

<>The bottom line is that there is neither reason nor time for Hoosiers to feel sorry for themselves. A better future is available to us. All we really need to do is take a dose of the advice that we give our own children, “Study hard and invest your money wisely.” If we can adopt that advice as public policy, Indiana will prosper once again.