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mto the problems which confront many mental institutions in this country today. Mr. CALLAHAN. Thank you, Dr. Wittson. Mr. Chairman, do you care to ask any questions of Dr. Wittson? Senator NELSON. I thank Dr. Wittson very much for taking the time to make this valuable presentation to the committee. I do not have any questions.

Mr. CALLAHAN. Thank you very much, Dr. Wittson. Your participation is very much appreciated. Dr. WITTSON. Thank you. Mr. CALLAHAN. Goodby. Dr. WITTSON. Goodby. Mr. CALLAHAN. Mr. Chairman, this is an appropriate time, I believe, to demonstrate two new communication services which we believe promise to open up new opportunities for the medical profession.

One is Touch-Tone service and the other is Picture-Phone service. I will discuss Touch-Tone telephone service because really in the traditional use, for people to talk to people, Touch-Tone service is different only in that it employs electronically generated tones instead of electrical pulses in the dialing function. I will demonstrate.

(Whereupon Mr. Callahan demonstrated the Touch-Tone feature described.)

Mr. CALLAHAN. This feature becomes very important, however, after the call is dialed, and the called station answers. Whereas, the electrical pulses of the dial phone do not pass through the telephone network after the call is connected, the Touch-Tone signals do. Therefore, Touch-Tone makes it possible to communicate not only verbally but with anything which can interpret the Touch-Tone signals—a business machine or computer, for instance.

I will demonstrate how this capability makes it possible to retrieve information from a tape library with no attendant assistance.

It will be apparent how this capability will serve medical tape libraries such as the University of Wisconsin's as the number of tapes in the library and the volume of calls becomes sizable.

Touch-Tone phones can also carry on a dialog with computers equipped with voice answer back capability. I will demonstrate this by calling a computer at the Bell System Data Training Center in Cooperstown, N.Y., and performing some mathematical problems.

The added capability of man-to-machine communication provided by the Touch-Tone phone, coupled with its very low cost, and the nearly universal nature of telephone service, I believe, offers exciting new opportunities to the medical profession.

(Whereupon, Mr. Callahan demonstrated as described.)

Senator NELSON. How does this system differ from what Dr. Meyer presented ?

Mr. CALLAHAN. Only that it makes it possible for a physician or anyone who has Touch-Tone telephone service to dial into a tape facility any time of the day or night and select programs at random from the storage location. There is no need to have an attendant.

Senator NELSON. All it eliminates is the conversation with the librarian; is that correct?

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Mr. CALLAHAN. Yes; the need to maintain someone on duty at all times. In the beginning of such a system, it doesn't make much difference economically. But as traffic grows and the number of tapes to which access is available continues to increase and runs into hundreds and ultimately into thousands, possibly, then this ability to select any one of those tapes at random becomes very valuable.

The second application of Touch-Tone phone service I would like to demonstrate relates to the computer demonstration we had earlier. As you are aware, Mr. Chairman, computers today have the ability not only to generate signals to a teletypewriter to type out information, they also have voice-answer-back capability or can be equipped with voice-answer-back capabilities so they can in effect converse by telephone with a human being.

In order to demonstrate this feature and the ability of the TouchTone telephone to communicate with a computer, I would like to demonstrate how you can do some simple mathematics with the computer and the Touch-Tone telephone.

I will call the computer at the Bell System Data Training Center in Cooperstown, N.Y.

(Whereupon, Mr. Callahan demonstrated to the subcommittee the computer technique described.)

Senator Nelson. What is the purpose of this? I mean what particular aspect of it, the mathematics aspect ?

Mr. CALLAHAN. As an actual fact last year, under the auspices of the IBM Corp. and New York Telephone, some high school students in New York City used the Touch-Tone telephone and a computer to do their mathematics homework.

Senator NELSON. Very practical.

Mr. CALLAHAN. The student sets up the problem, and instead of having to go through all the trouble of working it out, he sets up the problem and puts it into the computer. If he did it right, the answer will be right. So what it does, with the computation capability of the computer, it will relieve from professional people the necessity of doing the burdensome labor of mathematical calculations.

Senator NELSON. How would you use that in medicine?
Mr. CALLAHAN. May I defer that question to Dr. Meyer?

Dr. MEYER. We spend a fair amount of time doing physiological calculations. The one that drives me mad is the calculations that we were following of cardiac catheterizations where we calculate the flows and the resistances across valves or in holes in the heart and various physiological data like this. We get a certain amount of data and then it has to be processed in several different ways. Now, there are many, many types of uses where things are reduced to numerical figures, where physiological data is reduced to numbers and must be manipulated in the form of numbers to come out with some understanding, some understandable type of result. This is the type of thing that we would use it for in medicine.

Senator NELSON. All right.
Mr. CALLAHAN. Thank you, Dr. Meyer.

The impact of Touch-Toné telephone, Mr. Chairman, in medicine or in any other profession we believe is not very clear. It is a new service and like all other communications services it is going to have to stand the test of time and have an opportunity for people like Dr. Meyer and university people to begin to use it and to experiment with it

. So that is why I say it has great potential, promise, but not such I that we can document it.

As I said, another new service is Picture-Phone and that really isn't a new service because although it is in operation commercially between Chicago, New York, and Washington, D.C., it is in such limited availability, and will be certainly until the seventies, that it

would be more appropriate to describe it as a forthcoming service I rather than a new service.

But looking to the future it seems that Picture-Phone service even 1 has greater–far greater-implications than Touch-Tone because besically it is a Touch-Tone telephone, with the added dimension of vision. It will be able to do all the things Touch-Tone telephone can do. Not only will we be able to talk to other people, but we will be able to see each other while we talk. And as Touch-Tone telephone has the capability of talking to business machines or computers, so will the - Picture-Phone have the capability of talking to a computer. The computer will be able to answer either in the voice mode or with a picture presented to the viewer.

I think the best way to appreciate Picture-Phone is to use it. I will call you on the Picture-Phone set, Mr. Chairman.

(Whereupon, Mr. Callahan demonstrated Picture-Phone for the subcommittee.)

Senator NELSON. What is the value of this as a medical matter?

Mr. CALLAHAN. That's another question that I would like to defer to Dr. Meyer if you don't mind. May I demonstrate, before Dr. Meyer comments on that, on a second application of Picture-Phone. In addition to its ability to show each other's face, I would like to simulate a call to a computer and show the computer answer back. We are not equipped to do the demonstration from the caucus room to the Bell Telephone Laboratory computer in New Jersey. I will use slides to simulate the responses. So if you don't mind, Senator, I will say goodby on our Picture-Phone now and hang up.

(Whereupon, the demonstration with Picture-Phone was concluded.)

Mr. CALLAHAN. By using the Touch-Tone buttons of the PicturePhone set, we could call a computer. It would answer us with a message presented visually on the Picture-Phone.

(Whereupon, Mr. Callahan demonstrated the system described.) Mr. CALLAHAN. That concludes the demonstration of the capability that Picture-Phone will offer when it is available beginning in the seventies. If you now, Mr. Chairman, want to hear anything further about the medical implications of this from Dr. Meyer, perhaps he may comment.

Senator NELSON. I do not have any more questions.
Mr. CALLAHAN. Thank you.

Finally, then, Mr. Chairman, we would like to discuss briefly a concept for a drug information system about which you have evidenced considerable interest and a subject with which this subcommittee is particularly familiar.

A subject with which this subcommittee is particularly familiar is the need for an effective communications system for drug information, including continuing education for physicians and pharmacists, as well as for alerts on adverse reaction and recalls. The need to quickly reach the large number of people who need to know and still restrict the information from the general public presents a real challenge in planning and developing a system at reasonable cost. A drug recall, for example, should alert 286,000 physicians, 55,000 pharmacists, 22,000 nursing homes, and over 9,000 hospitals, or a minimum of 375,000 locations. Furthermore, we understand that recalls occur on an average of two to 10 times a week. The Food and Drug Administration is considering a plan which would capitalize on the universal, yet discrete nature, of the telephone network. Initially, the national news services also would play a key role in the plan.

The plan would combine two well-tested communications arrangements now in use. From the viewpoint of the doctors and others authorized to receive the drug information, the plan would be similar to the University of Wisconsin tape library. They would dial into a recorded announcement using unpublished telephone numbers which would be released only to authorized professional people. To disseminate the information quickly to the local points where the announcement machines are located, teletypewriter messages would be sent to a point in each State which would in turn send it to the local announcement points. This is very much like the national law enforcement teletypewriter system which links 48 States for fast, secure dissemination of law enforcement messages.

But an important question remains. How do we notify the physicians, pharmacists, and others that there is a drug-alert message for them to receive? An approach being considered is to use the national news services and the local newspapers. When a drug alert was sent out, the newspapers could carry an inobvious signal such as an asterisk or other special mark in a specific place which would be an indication to authorized people.

If and when the system reached the point where urgent or important information was carried daily the need for a notification scheme might be obviated. For instance, it might be used for the introduction of new drugs supplementing the present detailing system or for the continuing medical education of doctors in connection with beneficial or detrimental effects of certain drugs.

The plan could be put into effect on a trial basis in selected regions without need for any capital investment and a relatively small monthly charge in each announcement location. After the plan was working for a reasonable period of time, the effectiveness of this form of communications could be determined. Further studies could then be made to decide on the value of developing a more sophisticated communications system, if needed.

Senator NELSON. Does yours relate only to the question of notification of physicians about a drug that has been recalled? Or, does your proposal also relate to the question of drug information centers in the way Dr. Meyer discussed them!

Mr. CALLAHAN. Our proposal at this time is not that specific, Mr. Chairman. The Food and Drug Administration, I believe, is concerned primarily with the dissemination of emergency information. The system, as I described it, doesn't really even require new equipment to be installed in each State.

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For instance, if in Wisconsin the University of Wisconsin were determined to be the dissemination point, then a teletypewriter presently installed at the university could be used to receive this message and the university in turn would disseminate it to points throughout the State, possibly in each county, depending on what the traffic requirement would be, so that the information could be put on a tape and each doctor would only have to make what amounts to a local telephone call to gather the information.

Senator NELSON. Does that cover everything?

Mr. CALLAHAN. Yes, sir. I would like to briefly conclude this presentation on an observation about the regional medical center program now under development.

I hope this presentation has demonstrated that communications can produce new efficiencies in many ways. Transporting a patient to a distant hospital or clinic for an on-the-spot examination and diagnosis will seldom be necessary. Pressure on the supply of beds in the large institutions will be relieved. Waiting for admission to those institutions will be greatly reduced, if not eliminated.

The problem that results from a patient's returning home from a distant medical facility to a practitioner who has not participated in the medical discussions and who may not be entirely confident of being able to provide the special treatment prescribed, which is common in psychiatric cases, will occur less frequently. The hospital of the future will rely more heavily on physiological monitoring, computer-assisted diagnosis, television viewing of patients with concurrent consultation by doctors; and distance need not be a deterrent. Much more use will surely be made of data processing and information retrieval over the communications network. These capabilities are available right now.

The communications developments discussed today show the trend | toward community and regional centers linked by communications to serve hospitals and the medical profession. In turn these local centers will have access to State, area, and specialized information centers, technical information centers, and other national resources or medical libraries. Such complexes will require coordinated voice, video, and data communications, of whatever kind is needed, for 'administration, patient care, research, and education.

This is the overall communications concept that will be an indispensable part of the regional medical programs initiated by the Surgeon General.

(The overall communications concept illustration referred to appears on next page.)

Mr. CALLAHAN. Through the use of the nationwide communications network, any of the facilities available in State, regional, or national information and resource centers and medical libraries can literally be put at the fingertips of the doctor.

Whether in his home or his office, at the clinic, the hospital, or at an extended-care facility, the doctor will be able to get the information he needs, when he needs it, in the form he wants it, by telephone, by telewriting, by television, or slow-scan television to retrieve X-rays or other photos, by facsimile to duplicate printed material, by teletypewriter for printouts or displayed on a cathode ray tube.

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