State initiatives to promote telemedicine.

OBJECTIVE To identify states that have played a key role in promoting, developing, and supporting telemedicine initiatives aimed at improving access to basic health care and to characterize the range of actions and policy-making roles taken by the states. METHODS State agencies involved in telemedicine initiatives and state-funded telemedicine programs were interviewed by telephone. An informal case study approach was used with a standard, open-ended questionnaire. Twenty-seven states were contacted in early 1995. RESULTS Sixteen states have been active in telemedicine development since 1989, with the level of activity expanding considerably in the last 2 years. Some states, particularly Georgia, Kansas, Texas, South Dakota, and Louisiana, have well-developed programs. Policy actions taken by the states in support of telemedicine differ considerably. They include planning and coordination, development of networks, more limited program development, funding, building a telecommunications infrastructure for telemedicine, and regulatory support and clarification. A wide array of funding sources has been used, including state tax dollars and state-earmarked federal monies and regulatory judgments. The level of funding by the states has also varied, ranging from less than $100,000 to tends of millions of dollars. CONCLUSION There are varied roles and policy actions that states have assumed in promoting and supporting telemedicine development. States are investing considerable dollars and effort in telemedicine and appear likely to continue this activity in order to promote its development and improve access to health care.