How Does Technology Affect Our Ability to
Address the Health Concerns of Our People?

By Stacey L. Ecoffey

  The advancement of technology not only affects our ability to address the needs of Native educational systems, it influences our capacity to operate effective tribal governments. As Native people, our adeptness at speaking the same language as our counterparts in state and federal governments is critically important so that we may continue to have our needs met effectively. Even though tribal leaders may feel consumed with the many numerous issues that face them, it is in everyone's best interest that we continue to keep ourselves aware of technological advances. Oftentimes in Native communities, the thought of access to the Internet, teleconferencing, or telemedicine is the least of many people's worries. To make sure Native communities are able to survive through the next seven generations, it is important that we try to advance Native systems and services to our people by using modern technology as much as possible.

Technology affects delivery of health services. Technology influences every aspect of health care delivery, from the time a patient enters the hospital until he or she checks out. For an example, we can examine the effect technology has on medical records within the Indian Health Services (IHS) Resource and Patient Management System (RPMS). The RPMS is a semi-computerized medical record system, tracking key data like medications, diagnosis, visit dates, lab and X-ray results. Some of this data must be entered from paper copies. If the system had the ability to be totally electronic, the need for a paper record would be eliminated, thus decreasing prescription and transcription errors. Also, computerizing the entire system would better suit the field clinics and services performed by the Public Health Nursing, and Community Health Representatives programs.
Currently, the Public Health Nursing program may not be able to access a field clinic patient's record. The clinic may be unable to access a telephone line to log into the hospital records. Similarly, Community Health Representatives (CHR) doing home visits cannot connect with the Indian Health Service's RPMS system to properly record their findings or communicate the needs of the patients they visit. The consequences of the inability to communicate information effectively could prove catastrophic to patients.
This information, not only important to the patient's medical record, also plays a vital role in the RMPS system. This system is crucial to the IHS funding process because it provides statistics about health care needs. The government allocates funding based on statistical analysis provided from this program. If information is not properly recorded, funding could suffer. The National Indian Health Board (NIHB) estimates that what is now a million- dollar third-party reimbursement system could potentially become a billion-dollar business, theoretically expanding health care revenues by nearly 100% in certain communities.

The Benefits of Telemedicine
Many Indian communities could also benefit from telemedicine. Often specialists ranging from psychiatrists to dermatologists are not available at IHS clinics. The use of telemedicine increases patients' ability to receive consultation from these specialists. The use and advancement of telemedicine communication also increases and assures provider access to the most current information.
Many tribes are unable to send representatives to Washington, D.C. every time there is a Congressional hearing or a public meeting. In turn, health concerns of all of our people may not be effectively addressed if only a few of our tribal leaders are able to attend such meetings. Tribes are restricted by the lack of funding to travel to such events. Most recently the U.S. Senate Committee on Indian Affairs has been providing live broadcasts of their hearings via Web broadcast (www.senate.gov/~scia). Indian Country will now be able to listen and keep up-to-date with the legislative process. This could lead to interactive broadcasts. Yet how many of our tribal communities actually have access to the Internet to view such things?
A vast number of the health policy issues affect our local tribal leaders. One NIHB project, funded by the Administration for Native Americans, brings videoconferencing capabilities to remote local area health boards . This provides tribes with training opportunities on the latest health related topics and brings them up-to-date on legislative and policy-related issues. The Tribal Management Capabilities in Health and Human Service Delivery project enhances govern i n g capabilities of the NIHB, area health boards, and inter-tribal organizations and tribal governments through strengthening management capabilities in health and human services delivery.
This project plans to bridge the digital divide through distance learning and videoconferencing. Not only will the project provide training opportunities to Area Health Board s and the tribes that they serve, it will eventually provide regularly scheduled updates on health policy, including advising tribes with the latest updates on current health-related legislation. The opportunities of the project's distance-learning program will enhance access to tribal health programs and allow them to take part in the telecommunication "boom."
How technology affects the health concerns of our people revolves around the economic stability of tribes and the prioritization that Congress puts on Indian appropriations. Our ability to advance and address the health concerns of our people, through basic infrastructure or advancements in technology, depends on tribes' economic stability. Without economic stability we continue to live in poverty, lack basic infrastructure and in general, live in unhealthy communities. Improved technological capacity enhances economic stability. Technology advances our ability to communicate with mainstream America and gain what we can to strengthen our future. We should want to live among healthy people in an information-rich community filled with culture. We cannot afford to remain "information starved."

Stacey L. Ecoffey, MSW, Oglala Lakota, is project coordinator for the National Indian Health Board in Denver, Colorado.