of the State University of New York at Buffalo and the Roswell Park Memorial Institute. The network will serve several purposes, such as continuing education for physicians and the health-related professions, public education, administrative communication, consultation with experts, and contacts among blood banks. It will assist both the physician and community hospital in either the rural or urban environment in having at their fingertips the latest advances in the diagnosis and treatment of heart disease, stroke, and cancer. Particular emphasis will be placed upon involving rural hospitals in this program thereby improving both their didactic and restorative function.

2. Coronary care information coordinators, direct cost-$127,544

This project will test a training technique for providing qualified nurses who will be required to staff developing coronary care units in the Region. Approximately 80 nurses will be selected from all parts of the Region for a combined academic and clinical course. It is planned that the nurses receiving this training will return to both rural and urban hospitals for the purpose of providing a diagnostic and didactic function. While the program will be housed at the medical center, the community hospitals of this region will be the benefactors of the project. Since there are few nurses trained to work in coronary care units, particularly in the rural environment, special attention will be paid to attracting nurses who will return to the community hospital.

WISCONSIN REGIONAL MEDICAL PROGRAM

The Wisconsin Program began its operational activities on September 1, 1967 when it became the first Regional Medical Program to be awarded a combined planning and operational grant. Currently funded with $630,147, about one third of which is for operational activities, the operational staff numbers 20. About one-third of the staff are physicians, another third are allied health personnel, and the last one third are supportive and other type of personnel.

Approximately 20 hospitals are involved in the current phase of the Program. Eleven of these hospitals are directly involved in the operational projects. Five are represented in the Regional Advisory Group and the remaining are represented in planning subcommittees. As the program develops additional activities during the next few years, it is anticipated that many additional hospitals will be involved.

1. Study program for uterine cancer therapy and evaluation, direct cost-$40,100 This pilot project is designed to review and evaluate current radiotherapy for patients with uterine cancer. In its first phase it will involve information exchange and dosimetry standardization. Hospitals at Marquette and the University of Wisconsin will be connected to a central, computerized data bank in Milwaukee which will compute radiation classes. When the necessary computer techniques are developed, it is projected that the central facility will be linked to other hospitals outside the Milwaukee and Madison areas with similar treatment programs, and the long-term result will be to improve local medical capabilities for the treatment of all uterine cancer patients in the Region. 2. A pilot demonstration program for pulmonary thromboembolism, direct cost$84,600

In this project a center is being established at Marshfield Hospital in Marshfield, Wisconsin, for demonstrating diagnostic techniques and the available therapy for pulmonary thromboembolism. The project has a continuing education component which will reach physicians from many hospitals in the Region. This will involve a 24-hour consultation service, the preparation of a movie on the topic, and special training sessions for groups of physicians.

The project will demonstrate a comprehensive program which will encompass diagnostic, preventive, therapeutic, and rehabilitation procedures for patients, postgraduate education, a rapid transportation system for patients from Northern sections of the state, and cooperation between the clinic and other hospitals and medical schools in the State.

3. Telephone dial access tape recording library in the areas of heart disease, cancer, stroke, and related diseases, direct cost-$18,950

This feasibility study will be carried out by the University of Wisconsin which will record and store short, 4-6 minute, tapes on various aspects of treating patients with the three diseases. Any physician anywhere in the

Region can dial the library at any time and request a tape relevant to a problem in which he is interested.

4. Nursing telephone dial access tape recording library in the areas of heart disease, cancer, stroke, and related diseases, direct cost-$18,800

This feasibility study, similar to the one above, will establish a central tape library with information recorded on nursing care in emergencies, new procedures and equipment, and recent developments in nursing. Nurses from any hospital in the region will be able to call at any time to have a tape played to them.

5. Development of medical and health related single concept film program in community hospitals, direct cost-$33,250

This education feasibility project involves ten community hospitals in its first phase. Fifteen films on procedures and techniques used in treating heart, cancer, and stroke, will be developed. Projectors and the films will be installed in the hospitals for use by physicians and other health personnel at their convenience as a continuing education device. After four to six months the materials will be relocated in ten additional hospitals.

TELEVISION, RADIO AND TELEPHONE NETWORKS FOR CONTINUING EDUCATION

OPERATIONAL PROJECTS

I. Albany Regional Medical Program

Two-way radio communication system-Direct cost, $144,100

This project will expand an existing two-way radio network to include 57 hospitals and 24 high schools. It will provide continuing education for physicians and allied medical personnel. It will also provide information and education programs for administrators, members of boards of trustees, voluntary health agencies, adult education classes, and selected civic groups.

II. Intermountain Regional Medical Program

Network for continuing education in heart disease, cancer, stroke, and related diseases-Direct cost, $243,000

The objectives of this program are to develop a communications network between patient-care and research institutions to encourage liaison between health care personnel in the area. The currently existing two-way radio system, including 11 hospitals in 7 communities in or near Salt Lake City has been expanded to 10 additional remote hospitals to serve as one link. This system will be expanded to additional hospitals in response to physician requests. Closed circuit TV and use of KVED (University of Utah education TV) is also planned. This may establish the community hospital as the focus of continuing education.

III. Kansas Regional Medical Program

Health sciences communication and information center-Direct cost, $77,900 This project is engaged in conducting studies to determine the feasibility of establishing communication linkages vital to education, service and research programs. Specific studies to be undertaken are a physician communication system, TV teaching, electronic linkages, and Medlars search capacity. Linkages will be established at hospitals in Great Bend, Pittsburg and Kansas City.

IV. Washington-Alaska Regional Medical Program

Central Washington-Communication system for continuing education for physicians-Direct cost, $18,181

This project is designed to bring the medical resources of the University of Washington to physicians and community hospitals in Yakima, who in turn will act as consultants to surrounding smaller communities through seminars and conferences, educational TV, other audio-visual instruction; and exchange of teachers and practitioners. It will also connect internists in Central Washington to Yakima cardiologists via EKG telephone hot-line, to permit quick analysis (starting with 5 community hospitals). Three general hospitals in Yakima involved are: St. Elizabeth's, Yakima Valley Memorial, and New Valley Osteo

pathic. Nine other community hospitals to be reached initially are located in Ellensburgh, Moses Lake, Othello, Toppenish, Prosser and Sunnyside.

Southeastern Alaska-Postgraduate education-Direct cost, $27,062

This program will help improve communication between Seattle Medical Community and University to alleviate problems of the isolated physicians in southeast Alaska cities and communities: Juneau, Sitka, Ketchikan (3 largest). As in Central Washington several methods will be used such as telelectures, consultant services, seminars and the EKG hot line to hospitals in Juneau, Sitka, and PHS Native Hospital at Mt. Edgecumbe and Ketchikan community hospital. Two-way radio conference and slide presentation-Direct cost, $8,445

Six pilot programs on heart, cancer and stroke topics to be transmitted via two-way radio-telephone slide conferences, to physicians and hospital staffs on topics selected by a panel of physicians, starting with 20 hospitals in Washington are underway. It will explore potential for continuing network series with local and remote regions.

V. Western New York Regional Medical Program

Two-way communications network-Direct cost, $170,519

A two-way telephone communication network will link over 40 hospitals of Western New York and Erie County, Pennsylvania to the Continuing Education Departments of the State University of New York at Buffalo and the Roswell Park Memorial Institute. The network will serve several purposes, such as continuing education for physicians and the health-related professions, public education, administrative communication, consultation with experts, and contacts among blood banks.

Mr. ROGERS. I notice you said in the North Carolina program there were some coronary care units. How many coronary care units? I want to know what is happening to the hospitals.

Now, how many hospital administrators or people involved in the actual administration of hospitals where services are delivered? How many are on your national council?

Dr. MARSTON. One, Dr. J. T. Howell, of the Henry Ford Hospital. The executive director of the American Hospital Association, Dr. Edwin Crosby, is also a member, so this is 2 out of 12 directly representing the viewpoint of hospital administration.

(The following information was received by the committee:)

DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE STATEMENT ON HOSPITAL ADMINISTRATORS PARTICIPATING IN REGIONAL MEDICAL PROGRAMS

1 Boards of directors of the 14 new organizations formed as the coordinating agencies for their programs.

HOSPITAL ADMINISTRATORS ON REGIONAL MEDICAL PROGRAM STAFFS

Approximately 40% of the regions have established a Division of Hospital and Facilities Planning. These are, as a rule under the direction of a hospital administrator.

EXAMPLES OF HOSPITAL ADMINISTRATOR PARTICIPATION IN RMP

Georgia

In Georgia, each hospital in the region was encouraged by the Georgia RMP to appoint a local advisory group to work with the Program to advise on local needs

and problems and to serve as the liaison group between the Georgia Central Regional Medical Program office and the local community. To date, 121 hospitals have appointed local advisory groups out of the total 178 hospitals in the region. These represent 90% of the general and limited services hospital beds in the region. These groups consist of a physician, a hospital administrator, a nurse, and at least one interested member of the public.

Connecticut

In Connecticut, four Advisory Conferences have been established to aid the Advisory Board in its work. These four conferences consist of: (a) the Presidents of the Boards of Trustees of the hospitals of Connecticut; (b) the Chiefs of Staff of these hospitals; (c) the Administrators of these hospitals; and (d) representatives of over 50 "health" agencies of Connecticut. Directors of Medical Education from Connecticut hospitals have also been invited to meetings of the Advisory Conferences.

Albany

Part of the Albany operational program is concerned with the equipping of hospitals with two-way radio equipment. The Regional Medical Program personnel have visited the non-participating hospitals and discussed with the administrators and members of the staffs the advantages of joining the radio network. The number of hospitals involved in this network increased by 50% in the first year, bringing to 36 the number of participating hospitals.

Maryland

In Maryland, the RMP staff has devoted considerable effort to developing contacts with the community hospitals. At least 21 of the 38 hospitals in the region have been visited by the Regional Medical Program staff.

In November 1967 a three-day planning workshop was held by the Maryland RMP. Invitations were extended to all the hospitals in the region and over half of the short-term, non-federal hospitals sent one or more representatives. Those who attended expressed a genuine desire to cooperate in the planning process.

OTHER DEVELOPMENTS

Community planning committees have been organized in several other regions including South Carolina, Intermountain, and Greater Delaware Valley. These local planning committees all include hospital administrators in their membership.

HOSPITAL ADMINISTRATORS ON THE NATIONAL ADVISORY COUNCIL AND ON THE REVIEW COMMITTEE

Council:

(1) Edwin L. Crosby, M.D., Director, American Hospital Association, Chicago, Ill.

(2) James T. Howell, M.D., Executive Director, Henry Ford Hospital, Detroit, Mich.

Committee: (1) Mr. John D. Thompson, Director, Program in Hospital Administration, School of Public Health, Yale University, New Haven, Conn.

Formers Members:

(1) Mark Berke, Director, Mount Zion Hospital and Medical Center, San Francisco, Calif.

(2) Howard W. Kenney, M.D., Medical Director, John A. Andrew Memorial Hospital, Tuskegee, Ala.

Mr. ROGERS. It seems to me the thrust of this program has got to get down to that.

How about in your regional medical councils, the local ones?

Dr. MARSTON. Ten percent of those represent hospitals.

Mr. ROGERS. Should there be more?

Dr. MARSTON. I don't know the answer to that, Mr. Chairman.

Mr. ROGERS. Give us your thinking on that. I am concerned that we are not getting enough of the people involved who are meeting the patient and getting care to him.

Dr. MARSTON. The American Hospital Association is having a conference at our request in June to focus on just the problem you are bringing up.

Mr. ROGERS. I would be interested in following the results of that conference and your actions on it.

Now, what other professions are involved in these regional medical programs, and in the field? Could you give me a rundown on that? If you will let us have this it would be helpful.

Are you really tying them in-nurses, dentists, and so forth-as well as educators?

(The following information was received by the committee:)

DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE STATEMENT ON PROFESSIONAL INVOLVEMENT IN REGIONAL MEDICAL PROGRAMS

The scope of professional involvement in Regional Medical Programs is both broad and balanced, and is evident in all facets of the programs across the country. Broad professional involvement is seen in the composition of Regional Advisory Groups, planning committees, program staffs and operational activities. Such involvement reflects the essential cooperative nature of Regional Medical Programs as they work toward harnessing the multiple health and medical resources in local areas in order to help provide high quality care in heart, cancer, stroke and related diseases.

The membership of the Regional Advisory Groups, which currently totals ap proximately 1900 individuals, includes 21.9% practicing phyicians; 15.6% medi. cal center officials; 13.1% hospital administrators; 11.7% voluntary health agencies; 7% public health officials; 8.1% allied health workers; 15.3% member of the public and 7% others. Planning committees, which currently include about 2500 individuals, also demonstrate broad involvement. The membership includes: 18% practicing physicians; 41% medical center officials; 13% hospital administrators; 6% voluntary health agencies; 6.5% public health officials; 10% allied health workers; 5% members of the public, and 5% others.

In terms of participating organizations, it is estimated that over 1700 organizations are now involved in Regional Medical Programs. These include all of the medical schools, state medical societies, state heart and cancer societies, and state health departments. Almost 60% of the state nursing and dental associations are involved; about 80% of the schools of public health and state hospital associations are involved; and about 35% of the schools of denistry. In addition, many schools of nursing and other allied health professions are involved as well as a broad array of other professional organizations and institutions.

CORE PLANNING AND ADMINISTRATIVE STAFF

Reports from the Regions indicate that approximately 47% of the professional and technical planning staff are physicians. Allied health professionals including nurses, hospitals administrators, dentists, and others account for approximately 12% of the core staff. Related health professionals, including health economists, medical sociologists, statisticians, and others account for approximately 19%; general supportive staff accounts for about 16%; and "other" groups account for 6%.

OPERATIONAL STAFF

The operational staff personnel are concerned with the implementation of specific operational projects. The manpower involved in these projects comes from a broad range of specialities, including physicians (25%); nurses (8%); other allied health (10%); education and communications (5%); computer and other electronics specialists and their supporting personnel (16%); other technicians (14%); administrative and clerical (20%); and other 2%.

Dr. MARSTON. I spoke to 80 nurses in Wisconsin last night, via a telephone lecture system

Mr. CARTER. Will you yield on that?

Mr. ROGERS. Yes.