This Week's News 7-11 June 2010

7

Govt to recruit 1,000 health workers
New Vision, Uganda

09/06/2010

By Barbara Among and Mary Karugaba
THE Government is to recruit 1,000 health workers this financial year, according to the Background to the Budget. Finance minister Syda Bbumba will read the Budget this afternoon.
She is expected to emphasise the continued development of infrastructure, enhancement of production and productivity in the agricultural sector and the promotion of actions that will create employment.
The budget will be read amid pressure from expenses of the upcoming elections and increased cost of public administration due to rising number of districts.
The Government also needs to find ways of raising more revenue.
“However, as the donor aid continues to decline, any significant increases in overall spending will have to be backed up by increased domestic revenue mobilisation efforts,” the paper said.
The report indicated that the money available for the Government to spend this year is sh7 trillion, compared to sh7.3 trillion last financial year.
About 73% or sh5 trillion will come from domestic revenue, while 31% or sh2 trillion will be got from donors.
“Donor aid during the 2010/2011 financial year is projected to decline by 1.4%,” the report stated.
In the past, the Government increased revenue through adjustments of tax rates or the introduction of new taxes. However, to match increased competitiveness and regional integration, the option of adjusting tax rates is limited.
Efforts to increase domestic revenue will focus on making improvements in tax administration, building a culture of tax compliance and enhancing public confidence through improved service delivery, according to the ministry officials.
“One of these is to consider reforming as well as streamlining the structure of the current tax system to improve the efficiency of the tax collection system, with a view of expanding the tax base,” the ministry said in the report.
A number of systems have been developed to curb tax evasion, reduce revenue leakage and simplify compliance. These include improved taxpayer services and IT supported revenue management, mainly for monitoring and control.
The high level of budget financing this year is also due to the need to provide additional resources for clearance of pension arrears and enhancement of salaries of selected cadres.
This will be guided by the recently-launched National Development Plan.
Apart from the provision of peace and security, the Government will ensure continued investments in physical infrastructure, social services and raising the productivity and returns to agriculture
Priority areas will include education with a sh1.3 trillion budget, agriculture, roads and energy unlike last year, where roads and energy took the lion’s share.
The works ministry will receive sh900b, down from last year’s sh1.2 trillion due to poor absorption capacity.
To address the chronic shortage of drugs in health centres and drug theft, sh109b, meant for medical supplies, will be channelled through the National Medical Stores out of a budget of sh638b.
The agriculture sector, which performed poorly in the last financial year, is to receive sh356b from sh321b; most of it to be channeled through the National Agricultural Advisory Services (NAADS).
The report noted that the cash crops, which include coffee, cotton, tea, cocoa, tobacco, sugarcane and horticultural exports declined due to the global financial crisis, drought in 2009 and sporadic rains.
To solve the problem of power shortage, the Government plans to focus on renewable energy and also construct several small hydropower dams, in addition to the Bujagali dam, expected to generate 250MW.
The economy grew by 5.8% in the 2009/2010 financial year, a decline from the 7.2% achieved in 2008/2009. It is, however, projected that this year, the economy will grow at a rate of 8.4%.
The main factors that led to a slowdown in the growth included the changing climate and the consequent natural disasters, external influence and the reduction in exports to Southern Sudan.
The industry and service sectors continue driving economic growth.
The good performance in the industry sector was mainly due to a recovery of the growth in the construction sub-sector, which had witnessed a slowdown amid high costs of construction materials in the previous year.
The manufacturing sector also contributed to the growth of the industrial sector.
The posts and telecommunications and financial services performed best in the last financial year.
The posts and telecommunications sub-sector registered a growth rate of 30.3%, compared to 19.8%in 2008/09. In 2009, there were a total of 12.1 million mobile phone subscribers.

8

Deputados satisfeitos com nível de execução dos PIP em Namacunde
Angola Press

10/06/2010

Namacunde - Parlamentares do círculo provincial do Cunene à Assembleia Nacional manifestaram-se, quarta-feira, satisfeitos com as infra-estruturas em Namacunde, província do Cunene, construídas e recuperadas no âmbito do Programa de Investimentos Públicos e intervenção municipal.
No fim da visita de fiscalização em algumas obras, o coordenador do grupo, Elias Satioyamba, manifestou-se agradado pelo desempenho da administração na recuperação e construção das várias infra-estruturas sociais, garantia do desenvolvimento da localidade.
“Ficamos muito satisfeitos com o que acabamos de constatar. A recuperação do município é um facto e a Administração Municipal pode contar com o nosso apoio para melhoramento das condições da vida da população, visto que ainda falta muito por fazer”, disse o parlamentar.
Quanto as preocupações do executivo local, como a problemática da distribuição de água potável, carência de médicos, professores e a degradação da estrada que liga Namacunde à Ondjiva, entre outras dificuldades, afirmou terem sido registadas e serão canalizadas às entidades competentes.
Durante dois dias em Namacunde, a comitiva visitou as obras de construção de residências para funcionários públicos, na sede da circunscrição; deslocou-se a aldeia de Omakutu, onde manteve encontro com as autoridades tradicionais, enquanto na comuna do Chiedi esteve na Administração local, no novo Centro de Saúde e na escola de Okadweya.
O administrador municipal, Lúcio Ndinoiti, considerou esta visita um estímulo na prossecussão do propósito da criação de condições para o bem-estar do cidadão.
Localizado a 36 quilómetros da cidade de Ondjiva, o município do Namacunde integra duas comunas e 26 aldeias, com uma população estimada em 145 mil e 689 habitantes.

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Asia & Pacific

1

FOCUS: Indonesia health workers master Japanese to work in Japan
Kyodo News, Japan

09/06/2010

BANDUNG, Indonesia

Since August 2008, there have been only two Indonesians of 570 healthcare workers working in Japan that have passed national examinations and become certified nurses.

But that does not stop many other pre-departure candidates in Indonesia from struggling to master Japanese and fulfill their dream to work overseas for better salaries.
This Week in the West Java capital city Bandung, once dubbed a ''Paris Van Java''' for its many art-deco Dutch colonial buildings, 115 nurse and caregiver candidates, carefully selected from about 500 applicants, started their first day of Japanese language training.
Two other candidates were allowed to skip the training as both have mastered the language to an adequate degree, having once worked in Japan.

Taking place at the Indonesian University of Education, the candidates will be trained in the language for two months by 13 native Japanese speakers assisted by 20 Indonesian Japanese teachers.

Upon the completion of their study in Bandung, another four months of training will be held from Aug. 7 in Toyota in Aichi Prefecture for nurse candidates and in Yokohama for caregiver candidates.

This new policy in the training program is expected to give the candidates more time to adapt to Japanese culture and society before they start working.

The previous year, the training was divided into four months in Indonesia and two months in Japan and done only by native Japanese speakers.

According to Hideaki Otani, spokesman for The Association for Overseas Technical Scholarship, this year the number of healthcare candidates -- 39 nurses and 78 caregivers -- is much lower than in 2009 and 2008, which were 362 and 208.

The decreasing number is due to the slowdown in Japanese economy, said Otani.

Asked about their confidence to pass the tough national examination in Japan to become registered nurses, many of the candidates expressed optimism.

''I will do my best. I will struggle so hard by keeping learning until I finally pass the examination,'' said Siska Aditya, 27, who has two-and-a-half years experience as a nurse in Jakarta.
Another nurse candidate, Mulyati Purnama, 25, said she believes everyone has to be optimistic because all they want is to become professional and dedicated healthcare workers.
''So we are not supposed to afraid of the tough test, all we have to do is to keep struggling,'' Purnama said.

But Mariana, 27, who has 5 years of experience as a nurse, including in emergency rooms and intensive care units, said the Japanese authority has to adjust the rules for registering foreign nurses such as non-Japanese-speaking Indonesians who have been selected among hundreds of capable and qualified nurses.

''If needed, the test can be conducted in English, as long as it is made to evaluate the competency of the nurses themselves,'' she said. ''If that could not happen, I beg to the hospitals that will hire us in Japan, 'Please do not leave us alone, please guide us, please teach us, so that we can pass the national examination,'' Mariana said.
The head of Indonesian National Nurses' Association professor Achri Yani has urged flexibility in Japan's national nursing examination to enable more Indonesians to pass the exam and get work in Japan.

==Kyodo

2

Alleged breach of Red Zone security
Daily Times, Pakistan

04/06/2010

By Vidya Rana
ISLAMABAD: As many as 15 women were injured and many fainted Thursday, when police resorted to baton-charge and tear gas shelling to disperse protesters representing different associations including All Pakistan Leady Health Workers (LHWs) Association and All Pakistan Teachers Mahaaz, holding a demonstrations in front of the Parliament House to demand regularisation of their services and revised salary package.
A peaceful protest turned violent when an all-men mob emerged and tried to breach the security of Red Zone. Police swiftly responded with baton-charge and heavy tear gas shelling to disperse them.
“We were only providing security to female protesters and had no intention to use force until a group of men tried to breach the security of Red Zone, a high security area. Magistrate on-duty allowed the police to disperse them,” said Deputy Commissioner Aamir Ali.
Aasia, an activist of LHW Association, told Daily Times that they had not collaborated with any other association or political party to hold the protest demonstration.
“Suddenly a group of angry men stormed in and after that there were clouds of smoke. Lady police baton charged some female protesters too,” she said.
Pakistan Muslim League-Quaid (PML-Q) leader Marvi Memon was also present and actively supporting the protesting women. However, few protestors were highly critical of her role.
“She (Marvi) is trying to highjack our event. It was not PML-Q who motivated us and neither was there any one who made logistical arrangements for us. I am unable to understand why some politicians are trying to take advantage of this event,” said Aasia.

On the other hand, Memon said there were some people who attacked the protesting women but police did not stop them.

“They (police) waited until those people reached the high security zone, and then the police started violence. We all had to run for cover here and there,” Memon said, adding, the prime minister had promised to solve the issue of LHWs but so far has not acted accordingly.
Earlier, around 2,000 LHWs were holding a peaceful protest to demand regularization of their services and increase of salaries from Rs 3,000 to Rs 7000 in line with the new labour policy announced by the prime minister.
Naseem Akhtar, a lady health supervisor, leading Faisalabad zone, said she had brought 13 busses of the workers to stage the protest.
“We are paying Rs 250,000 on account of busses fare from and to Faisalabad by pooling in Rs 600 by each health worker. Even those who could not make it to Islamabad on Thursday had contributed this amount,” said Akhtar.
Similarly, Farhat Jabeen, another lady health supervisor and senior vice president of LHW Association from Rahim Yar Khan said they had paid Rs100,000 as fare to hire the busses.
“The government can’t achieve one of the Millennium Development Goals without the success of public health programme which employs over 150,000 workers. This programme has many positive aspects. It not only provides confidence to these workers but has also reached millions of women across Pakistan in raising awareness of family health,” said Jabeen.
Najma Nawaz from Sialkot, who joined this programme in 2009, said she got salary for only two months since joining. She wondered why the government was recruiting more female workers when old employees were not being paid.
It is pertinent to mention that during the last Senate session, Health Minister Makhdoom Shahabuddin had informed in a written reply that presently, 110,000 LHWs were working across the country, while another 10,000 would be recruited next year and 10,000 by 2014.
The National Health Programme was started in 1994 and since then its workers have been on contractual terms.
Despite a message from the Federal Health Minister for negotiations to end the on-going protest, the LHWs refused to call off the agitation and continued sit-in amid rain and storm till the filing of this report.

3

IDS funding falls likely to increase burden on care providers
Ohmy News, South Korea

08/06/2010

Masimba Biriwasha
The dip in funding levels for HIV and AIDS programmes will undoubtedly put paid years of progress in the response to the epidemic in sub Saharan Africa. Reduced funding will not only cause more deaths, but also in more offloading of responsibility to poor and marginalized communities. Persons in need of care will increasingly have to resort to already over-burdened community and home based care providers, mainly women and girls.
Given that the financial drawback for AIDS programmes is occurring at a time when two million people are still dying each year in sub-Saharan Africa due to the disease, the consequences for will be drastic particularly at community and familial levels.
“The donor turn-around will not make the patients in need of life-saving treatment go away. On the contrary, it is likely to increase the numbers of people in urgent need of care and will negatively impact their family, community and the health care system. In the end, the cost of inaction will be far higher than that of action,” states a recent report by Medecins Sans Frontieres titled, “No Time to Quit: HIV/AIDS Treatment Gap Widening in Africa.”
According to the report - which analysed funding patterns in eight Africa countries - there are worrying signs that donor commitment needed to sustain and increase the current momentum in the fight against HIV and AIDS is waning.
External funding of HIV and AIDS programmes has been the cornerstone of the response to the epidemic in most parts of sub-Saharan Africa, increasing the availability of life-saving medication to many people. The availability of ARVs, in particular, has seen a reduction of people dying from preventable life-threatening diseases. But this has also meant that in poor communities care providers have seen an increase in workload as they are the frontline in the provision of care and counseling to persons living with HIV and AIDS.
Volunteer care providers, the vanguard of HIV and AIDS care at community level, will have to face additional challenges in the context of diminished HIV and AIDS financing. Already, care providers are having to make-do with little to no resource. In fact, care providers are invisible in the global AIDS infrastructure. Yet, they are key to enabling people living with HIV and AIDS to lead lives of good quality, helping them with psychosocial support and towards lives of economic well-being and develop of their families and communities.
While there is no doubt that substantial and sustained investment is urgently required to continue scaling up treatment, it must also be pointed out that the needs of care providers ? disproportionately women and girls ? need to be recognized in funding mechanisms.
Governments in sub-Saharan Africa need to develop and implement policies that ensure appropriate recognition of the work carried out by care providers, the majority of whom are women, allocation of resources and psychological support for caregivers as well as promote the involvement of men in the care and support of people living with HIV and AIDS.
In conclusion, there is a need to influence financing for the work being done by poor and marginalized care providers as well as empower them to know and claim their rights.

10

No end in sight to Queensland Health wages fiasco
The Courier-Mail, Australia

07/06/2010

Janelle Miles From: The Courier-Mail
IN 19 years with the Queensland Nurses Union, assistant secretary Beth Mohle has never dealt with a "disaster" as big as the state's payroll mess.

"The magnitude, the scale of the disaster, is just not comprehended by government, (or) by a lot of people," she said.

"I've never seen anything like this. From a risk-management perspective it's an absolute failure. And now we're paying the consequences of that failure."
Since Queensland Health brought its Sap/WorkBrain payroll and rostering system online in March, thousands of employees have been underpaid, overpaid or in some cases, not paid at all.
The problems have been so widespread, the QNU is not convinced the new system is appropriate for Queensland Health, given the complexities of its workforce.
"We think there are still system problems," Ms Mohle said.
"Our members have been living this hell for a long time."
Ms Mohle likened the fiasco to the Gulf of Mexico oil disaster in terms of the amount of time it was taking to fix.
"The critical thing is actually getting the lid on that well," she said. "It's a similar thing with the payroll system - you've got to actually get it stabilised and get it functioning and then you can try to work out everything else. But nothing is going to work until you get that sorted.
"So much of it is outside the control of so many people and everyone is just holding their breath. The consequences are enormous."
Australian Medical Association Queensland president Mason Stevenson said he had no faith the payroll problems would be fixed within the next three months.
He said Queensland Health had "grossly misrepresented" the reality of the problem.
"Most doctors continue to have inaccurate pays," he said.
"The collective anger being expressed in all major hospitals in the state is red-hot. We can confirm there has been a spike in doctors looking for new employment opportunities outside Queensland Health and it relates specifically to the payroll issues."
Queensland Health director-general Mick Reid acknowledged the frustration staff were experiencing.
"We are working very hard to address ongoing issues with payroll and, while there have been improvements, there is still work to be done," he said.
"Some staff have come forward with concerns about how receiving incorrect pay may affect their tax. Queensland Health is committed to ensuring that no staff are financially disadvantaged."

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North America

1

The Doctor Will See You Now. Please Log On
New York Times

30/05/2010

By MILT FREUDENHEIM
ONE day last summer, Charlie Martin felt a sharp pain in his lower back. But he couldn’t jump into his car and rush to the doctor’s office or the emergency room: Mr. Martin, a crane operator, was working on an oil rig in the South China Sea off Malaysia
He could, though, get in touch with a doctor thousands of miles away, via two-way video. Using an electronic stethoscope that a paramedic on the rig held in place, Dr. Oscar W. Boultinghouse, an emergency medicine physician in Houston, listened to Mr. Martin’s heart.
“The extreme pain strongly suggested a kidney stone,” Dr. Boultinghouse said later. A urinalysis on the rig confirmed the diagnosis, and Mr. Martin flew to his home in Mississippi for treatment.
Mr. Martin, 32, is now back at work on the same rig, the Courageous, leased by Shell Oil. He says he is grateful he could discuss his pain by video with the doctor. “It’s a lot better than trying to describe it on a phone,” Mr. Martin says.
Dr. Boultinghouse and two colleagues — Michael J. Davis and Glenn G. Hammack— run NuPhysicia, a start-up company they spun out from the University of Texas in 2007 that specializes in face-to-face telemedicine, connecting doctors and patients by two-way video.
Spurred by health care trends and technological advances, telemedicine is growing into a mainstream industry. A fifth of Americans live in places where primary care physicians are scarce, according to government statistics. That need is converging with advances that include lower costs for video-conferencing equipment, more high-speed communications links by satellite, and greater ability to work securely and dependably over the Internet.
“The technology has improved to the point where the experience of both the doctor and patient are close to the same as in-person visits, and in some cases better,” says Dr. Kaveh Safavi, head of global health care for Cisco Systems, which is supporting trials of its own high-definition video version of telemedicine in California, Colorado and New Mexico.
The interactive telemedicine business has been growing by almost 10 percent annually, to more than $500 million in revenue in North America this year, according to Datamonitor, the market research firm. It is part of the $3.9 billion telemedicine category that includes monitoring devices in homes and hundreds of health care applications for smartphones.
Christine Chang, a health care technology analyst at Datamonitor’s Ovum unit, says telemedicine will allow doctors to take better care of larger numbers of patients. “Some patients will be seen by teleconferencing, some will send questions by e-mail, others will be monitored” using digitized data on symptoms or indicators like glucose levels, she says.
Eventually, she predicts, “one patient a day might come into a doctor’s office, in person.”
Although telemedicine has been around for years, it is gaining traction as never before. Medicare, Medicaid and other government health programs have been reimbursing doctors and hospitals that provide care remotely to rural and underserved areas. Now a growing number of big insurance companies, like the UnitedHealth Group and several Blue Cross plans, are starting to market interactive video to large employers. The new federal health care law provides $1 billion a year to study telemedicine and other innovations.
With the expansion of reimbursement, Americans are on the brink of “a gold rush of new investment in telemedicine,” says Dr. Bernard A. Harris Jr., managing partner at Vesalius Ventures, a venture capital firm based in Houston. He has worked on telemedicine projects since he helped build medical systems for NASA during his days as an astronaut in the 1990s.
Face-to-face telemedicine technology can be as elaborate as a high-definition video system, like Cisco’s, that can cost up to hundreds of thousands of dollars. Or it can be as simple as the Webcams available on many laptops.
NuPhysicia uses equipment in the middle of that range — standard videoconferencing hookups made by Polycom, a video conferencing company based in Pleasanton, Calif. Analysts say the setup may cost $30,000 to $45,000 at the patient’s end — with a suitcase or cart containing scopes and other special equipment — plus a setup for the doctor that costs far less.
Telemedicine has its skeptics. State regulators at the Texas Medical Board have raised concerns that doctors might miss an opportunity to pick up subtle medical indicators when they cannot touch a patient. And while it does not oppose telemedicine, the American Academy of Family Physicians says patients should keep in contact with a primary physician who can keep tabs on their health needs, whether in the virtual or the real world.
“Telemedicine can improve access to care in remote sites and rural areas,” says Dr. Lori J. Heim, the academy’s president. “But not all visits will take place between a patient and their primary-care doctor.”
Dr. Boultinghouse dismisses such concerns. “In today’s world, the physical exam plays less and less of a role,” he says. “We live in the age of imaging.”
ON the rig Courageous, Mr. Martin is part of a crew of 100. Travis G. Fitts Jr., vice president for human resources, health, safety and environment at Scorpion Offshore, which owns the rig, says that examining a worker via two-way video can be far cheaper in a remote location than flying him to a hospital by helicopter at $10,000 a trip.
Some rigs have saved $500,000 or more a year, according to NuPhysicia, which has contracts with 19 oil rigs around the world, including one off Iraq. Dr. Boultinghouse says the Deepwater Horizon drilling disaster in the Gulf of Mexico may slow or block new drilling in United States waters, driving the rigs to more remote locations and adding to demand for telemedicine.
NuPhysicia also offers video medical services to land-based employers with 500 or more workers at a site. The camera connection is an alternative to an employer’s on-site clinics, typically staffed by a nurse or a physician assistant.
Mustang Cat, a Houston-based distributor that sells and services Caterpillar tractors and other earth-moving equipment, signed on with NuPhysicia last year. “We’ve seen the benefit, ” says Kurt Hanson, general counsel at Mustang, a family-owned company. Instead of taking a half-day or more off to consult a doctor, workers can get medical advice on the company’s premises.
NuPhysicia’s business grew out of work that its founders did for the state of Texas. Mr. Hammack, NuPhysicia’s president, is a former assistant vice president of the University of Texas Medical Branch at Galveston, where he led development of the state’s pioneering telemedicine program in state prisons from the mid-1990s to 2007. Dr. Davis is a cardiologist.
Working with Dr. Boultinghouse, Dr. Davis and other university doctors conducted more than 600,000 video visits with inmates. Significant improvement was seen in inmates’ health, including measures of blood pressure and cholesterol, according to a 2004 report on the system in the Journal of the American Medical Association.
In March, California officials released a report they had ordered from NuPhysicia with a plan for making over their state’s prison health care. The makeover would build on the Texas example by expanding existing telemedicine and electronic medical record systems and putting the University of California in charge.
California spends more than $40 a day per inmate for health care, including expenses for guards who accompany them on visits to outside doctors. NuPhysicia says that this cost is more than four times the rate in Texas and Georgia, and almost triple that of New Jersey, where telemedicine is used for mental health care and some medical specialties.
“Telemedicine makes total sense in prisons,” says Christopher Kosseff, a senior vice president and head of correctional health care at the University of Medicine and Dentistry of New Jersey. “It’s a wonderful way of providing ready access to specialty health care while maintaining public safety.”
Georgia state prisons save an average of $500 in transportation costs and officers’ pay each time a prisoner can be treated by telemedicine, says Dr. Edward Bailey, medical director of Georgia correctional health care.
With data supplied by the California Department of Corrections and Rehabilitation, which commissioned the report, NuPhysicia says the recommendations could save the state $1.2 billion a year in prisoners’ health care costs.
Gov. Arnold Schwarzenegger wants the university regents and the State Legislature to approve the prison health makeover. After lawsuits on behalf of inmates, federal courts appointed a receiver in 2006 to run prison medical services. (The state now runs dental and mental health services, with court monitoring.) Officials hope that by putting university doctors in charge of prison health, they can persuade the courts to return control to the state.
“We’re going to use the best technology in the world to solve one of our worst problems — the key is telemedicine,” the governor said.
WITHOUT the blessing of insurers, telemedicine could never gain traction in the broader population. But many of the nation’s biggest insurers are showing growing interest in reimbursing doctors for face-to-face video consulting.
Starting in June, the UnitedHealth Group plans to reimburse doctors at Centura Health, a Colorado hospital system, for using Cisco advanced video to serve UnitedHealth’s members at several clinics. And the insurer plans a national rollout of telemedicine programs, including video-equipped booths in retail clinics in pharmacies and big-box stores, as well as in clinics at large companies.
“The tide is turning on reimbursement,” says Dr. James Woodburn, vice president and medical director for telehealth at UnitedHealth.
Both UnitedHealth and WellPoint, which owns 14 Blue Cross plans, are trying lower-cost Internet Webcam technology, available on many off-the-shelf laptops, as well as advanced video.
UnitedHealth and Blue Cross plans in Hawaii, Minnesota and western New York are using a Webcam service provided by American Well, a company based in Boston. And large self-insured employers like Delta Air Lines and Medtronic, a Blue Cross Blue Shield customer in Minneapolis, are beginning to sign up.
Delta will offer Webcam consultations with UnitedHealth’s doctor network to more than 10,000 Minnesota plan members on July 1, says Lynn Zonakis, Delta’s managing director of health strategy and resources. Within 18 months, Webcam access will be offered nationally to more than 100,000 Delta plan members.
Dr. Roy Schoenberg, C.E.O. of American Well, says his Webcam service is “in a completely different domain” than Cisco’s or Polycom’s. “Over the last two years, we are beginning to see a side branch of telemedicine that some call online care,” he says. “It connects doctors with patients at home or in their workplace.”
Doctors “are not going to pay hundreds of thousands of dollars for equipment, so we have to rely on lower tech,” he adds. The medical records are stored on secure Web servers behind multiple firewalls, and the servers are audited twice a year by I.B.M. and other outside computer security companies, Dr. Schoenberg says.
In Hawaii, more than 2,000 Blue Cross plan members used Webcams to consult doctors last year, says Laura Lott, a spokeswoman for the Hawaii Medical Service Association. Minnesota Blue Cross and Blue Shield started a similar Webcam service across the state last November.
Doctors who use the higher-tech video conferencing technology say that Webcam images are less clear, and that Webcams cannot accommodate electronic scopes or provide the zoom-in features available in video conferencing. “If they are not using commercial-grade video conferencing gear, the quality will be much lower,” says Vanessa L. McLaughlin, a telemedicine consultant in Vancouver, Wash.
Last month, Charlie Martin, the crane operator, was back in the infirmary of the Courageous for an eye checkup. In Houston, his face filled the big screen in NuPhysicia’s office.
After an exchange of greetings, Chris Derrick, the paramedic on the oil rig, attached an ophthalmological scanner to a scope, pointed it at Mr. Martin’s eye, and zoomed in.
“Freeze that,” Dr. Boultinghouse ordered, as a close-up of the eye loomed on the screen. “His eyes have been bothering him. It may be from the wind up there on the crane.”