Universal Access

(Approved by the IEEE-USA
Board of Directors, 13 Nov. 2003)

The ability for an authorized user to access secure information from anywhere within the United States via high capacity telecommunications network is called "universal access." This access should be available ubiquitously to facilitate multi-media broadband services for optimizing the delivery of public services, such as health care.

The Institute of Electrical and Electronics Engineers-United States Activities (IEEE-USA) recommends that:

• The Federal Communications Commission and State public service commissions identify incentives that will promote infrastructure development and encourage broadband network access by under-served populations; and the deployment of high-speed advanced networks to serve low-income segments of the population and persons with disabilities, as well as communities where the high cost of network development delivery have discouraged investments.

• The Federal Communications Commission and State public service commissions cooperate with local governmental and private-sector entities to identify applications in health-care, education, library, economic development, corrections, and other areas of public concern to enable communities and network providers to aggregate demand for telecommunications networks and services.

• Contributions to universal service support mechanisms be open, explicit and competitively neutral; and all service providers in a particular area should contribute.

• The private and non-profit sectors promote development of educational and training programs to help overcome user fears of new technologies, and enhance public understanding of the value of advanced networks in specific applications, such as education and health-care.

• Universal access policies be flexible, and subject to frequent review. Technology changes extremely rapidly and regulation has not been able to keep pace.

The 1996 Telecommunications Act charges the Federal Communications Commission with establishing policies for ensuring universal access in the new competitive environment. IEEE-USA recognizes that the federal government, in conjunction with state governments, is required to continue to promote and encourage universal access for all U.S. citizens, regardless of location, disability or economic status. Interactive telecommunications access points should include schools, facilities of primary care providers, government offices, libraries, post offices, community-based organizations, and ultimately, homes.

To support the development of universal service, we offer the following observations:

• Historically, universal service has meant availability of telephone services at reasonable cost. In the information age, this definition needs modification from the model of voice-grade communication, to include the availability at reasonable cost of both access to multi-media information services, as well as networks that transport these information and multi-media services.

The universal service debate must also address the need to ensure that citizens receive the education, training and services they will require to have realistic access to these networks and services. A high degree of computer literacy will be required for members of the next generation to be functioning U.S. citizens and participants in the economy.

• Different applications may have different technical requirements. For some, two-way voice and text will suffice; for others, two-way video will be necessary. Medical applications (involving patients, health-care providers and diagnostic consultants) will require high bandwidth, two-way communication.

• Enhanced privacy, security and reliability must be part of the infrastructure if the national information highway is to fulfill its potential. These needs are especially critical and immediate in medical services.

• Legal and technical standards are essential. The federal government needs to enact a comprehensive privacy law to supersede conflicting state laws, to ensure that authorized users and consumers can safely send and receive sensitive personal information. In addition, minimal standards for system security should be defined.

This joint statement was developed by the IEEE-USA Medical Technology Policy Committee and the IEEE-USA Committee on Communications Policy and represents the considered judgment of a group of U.S. IEEE members with expertise in the subject field. IEEE-USA is an organizational unit of The Institute of Electrical and Electronics Engineers, Inc., created in 1973 to advance the public good, while promoting the careers and public-policy interests of the more than 235,000 electrical, electronics, computer and software engineers who are U.S. members of the IEEE. The IEEE is the world's largest technical professional society. For more information, go to http://www.ieeeusa.org.

BACKGROUND

The recent telecommunications law sets a goal of universal service for advanced telecommunications for all regions, but addresses access to these services primarily in terms of making these services available and affordable for schools, libraries and health-care centers. While some libraries, schools and health-care centers can serve as appropriate sites for public access, use and training, such site are not a substitute for widespread access needed by individuals in their homes. The focus of the law's implementation has now shifted to the Federal Communications Commission and the states. The Federal government must still deal with other areas affecting universal service such as privacy, health-care licensure, and reimbursement for electronic delivery of health-care services.

• Historically, the term universal service has meant the availability, at reasonable cost, of telephone service. The service in question has been a voice-grade communications connection between two users. In the information age, this definition is no longer sufficient.

Vital communication occurs between and among users and information and service providers. It encompasses not only voice but data, images and two-way interactive video communications.

The definition of universal service must also include the availability, at reasonable cost, of access to new multi-media communications and to information services. To use an analogy, it does little good to transport a person to the doors of a library or health-care center only to have that person find that obtaining the information or service within is cost prohibitive.

Therefore, IEEE-USA suggests that the term universal service must include access to both the infrastructure and to on-line information and services. These inclusions implies a need for non-proprietary information and publicly oriented services to be available at affordable cost.

• IEEE-USA volunteers who are information industry professionals are particularly aware of the high degree of computer literacy that will be required for members of the next generation to be functioning U.S. citizens and participants in the economy. The universal service debate must consider the infrastructure availability required to ensure that our citizens can receive the education and training they need.

• IEEE-USA observes that technology changes extremely rapidly and that frequent regulations and reviews are unable to keep pace.

From a technology standpoint, the current rate of change is unprecedented. IEEE-USA is aware that the rate of change will continue to accelerate in the foreseeable future. Only broad policies and frequent reviews will prevent policies from becoming obsolete.

• The critical applications for universal access include but are not limited to health-care, education, E-mail, telecommuting, information, and economic development.

In this final section, we discuss the promises and challenges of the new information technologies in the health-care arena.

Health-Care Implications

Recent shifts in our health-care system from acute care to preventive and chronic care management; the emerging managed care and capitation health delivery systems; the growth in self-care and mutual-aid groups; and the increasing emphasis on the importance of preventive care require that Americans take more responsibility for their own health.

Universal access to more comprehensive health information, to effective preventive care, and to health-care professionals and resources is needed to deal with these trends. Curtailed hospital stays, and the increasing percentage of the population living with chronic illness or disability, require patients and their caregivers to be able to access health-care professionals and services to manage their care at home.

Consumer Health Informatics (CHI) initiatives now empower consumers (patients, caregivers, etc.) to access health-care information and tap electronic mutual support groups. Preliminary studies suggest that CHI programs can help cut health-care costs, extend services and improve quality of life.

Telemedicine technology also makes it possible for homebound patients to receive much of their needed care electronically in their homes, with consequent savings on office visits and transportation. The development of interactive computer programs and access to two-way multimedia telecommunications services can economically reduce costly face-to-face health consultations. Electronic telecommunications can enable both consumers and providers to access a broad spectrum of information resources that guide improved decision-making.

Population-based health needs are also advanced by universal access to networked information. In a July 1995 report of the U.S. Public Health Service titled, "Making a Powerful Connection: The Health of the Public and the National Information Infrastructure," the Public Health Data Policy Coordinating Committee argued that networked information could serve the health of the public through rapid communication regarding disease or environmental risk; assessment of community health problems and needs; provision of distance education regarding prevention to residents and public health workers; identification of community health resources to residents; and data collection for public health assessment and planning.

Similarly, research has confirmed the critical impact of community health on individual health, making electronic access to community health information networks an essential component of our national health-care system.

Digital technologies that can enable a wide range of treatment modalities traditionally carried out in hospitals or nursing homes can now be performed at home. Physicians can use stethoscopes, endoscopes, electrocardiography, radiographic and sonographic equipment, and the network can carry high quality diagnostic information electronically from patients to remote physicians.

The telecommunications technologies provide consumers with new informational tools to locate and identify information tailored to their particular health status. Telecommunications also increases the sources of information that consumers can access to and share information with each other. The new technologies have the potential to provide consumers with access to multimedia information and communications in much more powerful, timely and effective formats. Medical personnel can now provide education, training and specific instructions for rehabilitative therapy, or use of equipment in the home, visually to patients and caregivers. Support groups can be facilitated through access to video communications, which can also enhance their effectiveness.

Delivery of interactive health-care information in multimedia formats greatly enhances the effectiveness and likelihood of use by individuals. Use of these systems has reduced patient trips to emergency rooms, as well as office visits and telephone calls to physicians. For many consultative and rehabilitation cases, a two-way, on-line video consultation may be either the only acceptable treatment mode or may substantially enhance the effectiveness of the treatment.

However, barriers to exploiting technological advancements for the electronic delivery of health-care do exist. Lack of universal access to advanced multimedia telecommunications systems resources and networks represents a significant barrier to maximizing the personal self-care and well-being of all residents. The current uneven, fragmented deployment of advanced telecommunications networks capable of delivering these health-care resources and services to every U.S. household constitutes the most formidable barrier to universal access to electronically delivered health-care services.

Populations, such as the poor, the severely disabled, and the chronically ill, and their caregivers stand to gain much from such access, including health-care information, and on-line advice from professionals, as well as diagnostic, consultative and mutual aid support. Low levels of computer ownership by low-income population segments point out the current imbalance of telecommunications resources although future development of more user friendly, less complex, access devices may ease this imbalance to some extent. In addition, technological advances, such as home care telemedicine, could be more easily implemented through universal home access to enlarge essential access by individuals in their homes for preventive and consultative health-care services.

Most health information technology was designed for the medical professional and is not effectively available to the lay consumer. Moreover, consumers today require a much greater scope and range of community, social and wellness information to manage their health-care needs beyond that found in medical clinical records, or in professional medical databases.

Communities have similar needs for a wide range of data capable of being aggregated and compared across communities to assess their health status.

Consumers must have access to professional medical information databases and medical assessment tools in formats adopted to their needs and concerns.

These barriers have served to limit universal access to comprehensive health-care information, restricting the consumer's ability to make decisions, practice self-care and take the preventive steps that individuals and communities may require.

A widespread assumption posits that health-care equals paid professional services. Rich, largely untapped health-care resources including the volunteer-run, on-line support networks and information services, which share scientific and practical experiential knowledge, sophisticated interactive information, and software to motivate and help modify personal lifestyle behaviors. These grassroots lay health information networks and software tools should be identified and supported, since they provide practical, culturally sensitive and competent health support and communications.

Another significant barrier to the widespread development and use of health information databases is the fear that the individual's privacy will not be protected and that the confidentiality of personally identifiable information about an individual's health will be compromised.

Universal service would also serve to breach the widening gap between the "information poor" and the "information wealthy." With shortened hospital stays, and the closings of many hospitals, disadvantaged citizens have access to fewer health-care resources. Universal access to monitoring and consultation services electronically, as well as to on-line, health-care databases and decision-support services, promises to provide practical health information and more effective access to disadvantaged populations often at highest risk for health problems.

Affordability is a major barrier to universal access, often affecting the disadvantaged, those with disabilities and the homebound most acutely. Universal lifeline and other services will be required to extend access to those who cannot pay full rates.

A final obstacle to universal access is the need for training of both users and providers in the use of the new technologies. Community centers, social service agencies and public libraries can provide needed orientation and public access to on-line health information systems for those who cannot afford them. Health-care providers can also receive continuing education training in their homes.

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Last Updated: 17 November 2003
Staff Contact: Deborah Rudolph, d.rudolph@ieee.org

Copyright © 2003 The Institute of Electrical and Electronics Engineers, Inc.
Permission to copy granted for non-commercial uses with appropriate attribution.