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J(202) 6284888   0 FEDERAL COMMUNICATIONS COMMISSION TELEMEDICAL ADVISORY COMMITTEE  ?` 4Pages:` ` 1 through 113  ? 4Place:` ` Washington, D. C.  ? 4Date:` ` June 12, 1996 "0*"   X` hp x (#%'0*,.8135@8:0*H&H&@@ them, I assume that's mostly going to be done through electronic communications of some sort. ` `  And it seems to me what we really need at that meeting is, you know, not a finished product but a product in progress which is: Here are the things this subgroup is trying to grapple with. We have five pages of the issues we are trying to define. ` `  An options paper would be great in the sense that, you know, we have looked at this; we think there are four choices here; this is what we're talking about; this is what the issues are. ` `  And then we can use that meeting really for the subgroups to present it to the entire advisory group. And if everybody says: Great, that's the way we ought to do it, you know, terrific. If you hear a roar of disapproval, you will know that there are other opinions. ` `  And then people can go back with more direction that this is something that we can try to reach consensus on or we ought to explore two options or three options, can go back to work, come back to a meeting in September with a lot more detail, have a similar kind of discussion, hopefully a more detailed discussion, reach some kind of consensus, to the best extent we can, and then be a position to have a written report by the end of the month. ` `  So with that sort of background -- and we can do%?0*H&H&@@ it a different way, but unless we want to have a lot more meetings or -- you know, we cannot change the time frame; so that's really what we're looking at. ` `  Why don't we try to talk about these four issues and see what your reaction is. ` `  Tom? ` `  MR. SPACEK: If I -- ` `  MR. LAWLER: Tom, why don't you identify yourself and what you do. ` `  MR. SPACEK: Tom Spacek from Bellcore. ` `  If I look at the act and what it appears that the FCC needs -- I'm going to talk about this a little bit out of context of the four groups but it could very easily map in -- it seems like a critical thing we need is some definition of the minimal set of services and advanced services -- and let me just loosely throw out the word "services" -- that would be in a universal service set having to do with healthcare. ` `  And the reason I said minimal set is because, what I mean by that is there's going to be loads of advances in different places and universities that, at least initially, the idea is that they would not necessarily have to be available to meet whatever critical healthcare needs there are. So what is that minimal set of simple and perhaps advanced services that is needed? Okay. The universal%@0*H&H&@@ service set that we agree and we think that the whole country should have availability of? ` `  And the reason that needs to be done is because the -- and the bill basically says, if those are available in urban areas, then you're going to have to figure out some way of reaching rural areas and other areas with technology and so forth at an affordable price. ` `  So that set needs to be defined. It's not clear whether to define that set in terms of technological capabilities or applications. I think we need to start with applications and then do a mapping into what technological capabilities are needed to provide those applications. ` `  It's going to evolve over time. What's the set now that we want to recommend? And how to pay for all that later, that's separate from our task because there's some fund that the other people are working on. ` `  Once that set is known and agreed to, at least it's our recommendation, then you have to define or try to define what is the infrastructure capabilities -- perhaps not in terms of specific technology but maybe in terms of technology properties of those technologies -- that's required and what you would need to reach all these rural areas? ` `  And as part of that, you also need to define: What does it mean to reach rural areas in the sense that, do%A0*H&H&@@ these services -- and these may vary from application to application -- they have to be available to every hospitality, clinic, community center, doctor's office, home; or if it's sufficient for some subset of them that we define, to be available just to hospitals or just in community centers in rural areas, is that what it means? ` `  And my guess is, for some services, that will be the answer because it will be too costly otherwise. For others, maybe it has to go to every doctor's office. And, in fact, those two things need to be defined first before you can really start specifying what the infrastructure might be that's needed. ` `  So that's what I think we need to do. I'm not sure how it maps into these. And the only problem I see in timing is that, although the infrastructure and technology activities can kind of muddle a long a little bit and think about this, you really need to know what that set is before you're going to say what the infrastructure capabilities would be. ` `  MR. LAWLER: I agree with that analysis. But I also -- and I don't want to play lawyer, and I don't want us to be the lawyer for this provision precisely. ` `  I mean, for example, the telecom bill says specifically public or non-profit. You know, what does that mean for doctors' offices sitting in Montana making a%B0*H&H&@@ living? ` `  MR. SANDERS: He's not-for-profit. ` `  MR. LAWLER: If you can get the IRS to buy that -- ` `  You know, but I do think that that is the way we ought to be thinking about this. ` `  I also think this has to be dynamic in the sense of what is the set today most likely is going to be very different in a very short period of time. And that has to be built into the model, the equation, however we describe it. ` `  MS. KING: Joan King with AARP. ` `  I just wanted to bring in a consumer perspective, which is complementing what he said, that my understanding is the subsidy would only go to telemedicine; but the infrastructure would serve multiple purposes. ` `  So ultimately, there's going to be a cost that has to be picked up by other kinds of consumers of the telephone network. So I think we have to take into consideration the balancing act when we're asking for an infrastructure, where is the cost allocations going to be? How much of it will be paid back to the physicians? Or how much of telemedicine is going to be subsidized? ` `  So ultimately this is a consumer issue. Each of the committees should be looking at the costs. ` `  MR. PILLAR: I'm Bob Pillar with the Public%C0*H&H&@@ Utility Law Project in New York. ` `  I want to continue on this theme. And I want to suggest that I think this advisory board needs a little bit of guidance as to how far our mandate goes. Because if you pick up the theme that you had started with, there is a case to be made out that, for every analog central office in the country in the rural area, that in order to provide almost any of these services it has to be upgraded, becoming a digital office and have to minimally have ISDN capabilities put into the switch and the line cards that are associated with it. ` `  This is short of even the question of extending fiber plant. There are applications here that require fiber plant. Once you put in that huge investment, that investment will then be marketed for private purposes and for other purposes that would never have otherwise been brought about. So there is a case to make out why we should do it. ` `  But the cost implications of that are so profound and so dramatic, especially as you get into -- further down the line into fiber or even the switch over from analog to digital offices in any quick time frame, that we need some guidance as to whether or not we're supposed to, at this point, even take costs into account. Or do we just come back and say: This is the vision that if you were going to%D0*H&H&@@ make this widely available, here's what it takes. ` `  MR. LAWLER: Elliot, you may want to respond, but let me just say this: I don't know whether it is a part of our mission to be the cost accountants for this or not. We would be insane if we came back with a grand system that cost 400 zillion dollars and was absurd. ` `  MR. PILLAR: But if you focus on functionality and you do take the approach of what does it take to make all rural areas comparable to the urban areas where a lot of companies, out of their own business plans, will invest? ` `  MR. MAXWELL: That's not what the act says. I think this is a very important discussion, absolutely fundamental discussion. And when we were talking about the composition of the advisory committee, we could have done it a number of ways. ` `  One of the reasons why there are people who are either identified as consumer advocates or represent a consumer group is because, in fact, this is, in some ways, a kind of forum in which one says: Let's understand what's going on now, both in terms of the access to services in rural areas, what we think would be important as a society for universality of access; what does it mean for consumers across the country, because, in fact, consumers will be paying for this indirectly insofar as there are services that are subsidized, because someone's going to be paying%E0*H&H&@@ for them. ` `  So I think the discussion of cost is a very important piece, though, in forming this. And when we start to think about the definition, if we start and said, what would everybody like, that's a very different discussion than the discussion that says, what are those services that one could expect were contemplated by the people who wrote this that were essential for a healthcare provision in these areas? ` `  MR. PILLAR: That's helpful. Is there an answer to this question: What time frame, in responding to the questions you have asked us, should we be thinking in terms of? Should we be thinking in terms of the next three to five years? The next decade? ` `  Because I think you come up with different answers about what kind of technologies you might need. ` `  MR. MAXWELL: This, again, is a personal view as opposed to any institutional view. But this is, again, an act which I think was, in a lot of ways, a very, very creative act. It said: Look at what's going on now and what you think is essential now, but you should remember that you're going to have to come back to this because this will evolve. ` `  So my reaction is, I think we look at a three- to five-year horizon and then assume that, in fact, the%F0*H&H&@@ Commission is going to come back and do it again. ` `  So what we're, I think, trying to create is a foundation from which one can build and a foundation that can evolve gracefully as things change. ` `  And let me give one other sort of characteristic of this foundation. The foundation has to accommodate the fact that, while in many cases there are either not the facilities available and where provided are provided on a monopoly basis, the foundation has to accommodate the provision of competition and, to the extent that we can, incentives for competition to provide facilities and provide services in these areas which may not be served now. ` `  So I hope that's helpful. ` `  MR. PILLAR: That is. ` `  MR. LAWLER: Cindy? ` `  MS. TRUTANIC: I just have a technical question. The independent telephones companies and those companies that are in areas that were subsidized by REA, are they encompassed in this whole consideration? ` `  And are there going to be kind of different rules for them versus the other common carriers? ` `  I ask it because, as you know, there's been sort of different paths for each of them. ` `  MR. MAXWELL: I think, in general, what the act said is whatever mechanisms exist have to be competitively%G0*H&H&@@ neutral and leaves to the joint board and to the FCC a fairly substantial flexibility on how the mechanisms will provide subsidy. ` `  There was a question raised earlier whether it's going to be defined in terms of the existing carriers or whether other people would be able to come in and get the subsidy. ` `  That's clearly one of the questions that the FCC is looking at very closely. There have been different treatment of small telecos versus larger telecos. I expect that there will still be elements of differences in the treatment. ` `  But for our purposes, I don't think we need to focus on them. ` `  MS. TRUTANIC: But the impact would be, for example, in a rural community where the independent telephone company is not necessarily subject to the same rules and regulations as larger common carriers and they maybe take acts against other carriers trying to come in that may be anti-competitive, which has been -- you know, where they were not on a level playing field in the old days, today it's a different story. And it would maybe impact some of the services and things that are provided in the rural community. ` `  MR. MAXWELL: I would, again, sort of give a%H0*H&H&@@ personal view. And that is that insofar as the independent companies have to respond to this, they will be governed by the provisions of the act that says bona fide requests of a telecommunications provider have to do it; here's the subsidy mechanism. ` `  As to the questions of whether others can come in, there will be rules that will govern entry and anti-competitive behavior by the incumbent that I think will address the questions you raise. ` `  MR. LIFSON: Art Lifson with CIGNA. ` `  But we're looking at this at the margin for the most part. I mean the telemedicine piece of this, as I've listened to the discussion, is not the driver of the technology and the diver of whether a community is wired or not wired. ` `  But if it is, how can we take advantage of that technology and that community and provide support? Or is there a thought that telemedicine could become the driver of entry of new technology into a rural area? ` `  MR. SANDERS: Telemedicine is the driver. ` `  Jay Sanders from American Telemedicine Association. ` `  The reality is, we can't be looking at infrastructure and taking a look at the technology. We've got to be looking at what the needs are. We've got to be%I0*H&H&@@ defining what the rural healthcare delivery problems are and what's the functional realities and what the functional solutions to those needs would be. That will totally dictate the infrastructure that we need to recommend and the architecture that we need to recommend. ` `  I would also like to say that, given the fact that what we have to do is indirectly proportional to the amount of time that we have to do it, I'd like to underline what someone earlier stated; and that is, there are a bunch of resources that exist for the committee here that I think would be very helpful background homework, particularly a lot of the testimony that was provided by a number of us to the joint board, which specifically addressed issues such as what is the basic minimum, for instance, architecture, basic minimum infrastructure, that we need? ` `  Those comments that we made and provided were not simply our own personal views but really the collective views of the people and the organizations that we represent. And I think, I think that would be very helpful to the group. ` `  MR. LAWLER: If you could get those to us or get somebody to get them to us, we'll get them out to -- ` `  MR. MAXWELL: We have them. ` `  MR. LAWLER: Oh, actually, yes, you have to have them.%J0*H&H&@@Ԍ` `  MR. TANGELOS: I think that's a very important piece. I mean, that's the freshest piece out there right now. And I definitely want to see that. ` `  MR. LAWLER: Sure. ` `  MR. TANGELOS: The other piece besides the Council on Competitiveness is the OTA work that was done, their last work, before Congress put them out of business; but that's a very nice document as well. ` `  MR. SANDERS: As well as the Augusta Conference and the Arias Conference which dealt with these issues. Very, very comprehensive. ` `  MS. DEERING: Mary Jo Deering from Health and Human Services. ` `  There are also documents coming through the administration's Information Infrastructure Task Force Subcommittee on Health Information and Applications that would also be valuable to you. ` `  And I think what we could undoubtedly -- even though they are in draft stage -- make those available. There's one on managed care. There is one on consumer health information. ` `  Your material, of course, is already in other forums, so that's available, too. ` `  MR. LAWLER: Can I ask this: Do I hear Tom Spacek and Jay Sanders saying the same thing?%K0*H&H&@@Ԍ` `  I mean, you're saying we need to know what the service are that people need, that will dictate where we're going. ` `  Tom, if I hear you, you said it from a different perspective, but your conclusion was precisely the same. ` `  Is that something they we have -- you know, is there general agreement on that? ` `  MR. TANGELOS: I think, again, in looking at the act, indeed, telemedicine was specified. I mean, that is the diver. ` `  MS. PUSKIN: Another thing I want to make available to the committee is a book chapter that's going to be out on multi-use systems. ` `  I want to remind people that the act also has libraries and schools in it. And part of what we need to do is recognize that if we're looking at the needs, we're looking at -- especially if we look in rural areas -- and I know Jim and I have worked together, and a number of you -- you can't look at healthcare in isolation of looking at some of those other things. ` `  Now, we're not necessarily going to look at libraries and schools per se. But how do you build this into the context of a multi-use system? Because when you do that, you also change the cost function, or you can change the cost function very dramatically.%L0*H&H&@@Ԍ` `  So what's the driver here? Well the driver is the needs of the community. How you meet them may be in the context of looking at a variety of resources in that community. ` `  You don't want to, if you can avoid it, build separate infrastructures for schools and libraries, especially in rural areas. You want to be able to get a synergy to create sufficient demand to get that competition in there. ` `  MR. LAWLER: Isn't that -- for us, though, that's a cost issue which we are not going -- I mean, we're going to assume that some other rationale being out there is going to do that. ` `  MR. PILLAR: Bob Pillar. ` `  But the problem is that -- let's just say hypothetically that an appropriate minimal technology standalone is ISDN with some multi-plexing. ` `  Well, you look at -- and you're going to run this in a rural area in a typical location for a couple of hours a day. Clearly appropriate. ` `  But when you add in the needs of the school district, if you add in the needs of the library system, maybe other resources within that community, if they can come together and then decide that it's far more efficient from a technology and from a cost perspective to have a T-1%M0*H&H&@@ line on a closed system, private network, that's the smartest choice and the appropriate choice then for telemedicine, too, and allows for more capabilities. ` `  So it's almost like you only ignore that at your peril. ` `  MR. LAWLER: I want to come back to what Jay and Tom said, which is, if we can agree on the way to approach this, which is, let us try to define what the services are that people need, if we agree on that, we then have a place to start from and we can address the issues. ` `  If we agree on that and then we all, in our wisdom, say, that's great, we know what the services are, but it's too expensive to say, this is something we're just going to do with a flat out cost subsidy, you know, then we can have a discussion about whether other schools, libraries, other users can deal with the economics of this. ` `  But that's not a decision we will ultimately even recommend, I hope. ` `  MS. BROWN: Cathy Brown with the Department of Commerce. ` `  I'm a little concerned about what you mean by "service." I think we need, then, to back up and talk about what the functionality of the need is in order to deliver that service. Then I think we have a plan. ` `  What I am worried about, though, is that we don't%N0*H&H&@@ get technology specific. It may or may not be fiber. It may be wireless. There's functionality; there's speed; and there's kinds of things that they're going to need in the healthcare community that the schools are going to need and that the libraries want that will be built into any network that is out there. As Elliot says, when you start to look at that and look at what the needs of the community are, you then drive competition in that community. ` `  There is a caveat there that this is a subsidy not only for healthcare but for education. And then you actually start to have some reason for providers -- whether they be wire line providers, wireless providers, or cable providers -- coming in and serving a particular community. ` `  So I'm with you if what we're going to do, then, is then sort of see what the broader need is. And so I'm building on this idea. ` `  MR. LAWLER: Well, I agree with that. But I also want us to keep our focus here, which is -- ` `  MS. PUSKIN: -- healthcare. ` `  But let me just say to you that that's -- exactly. We have to focus on the needs of healthcare. But let me give you an example of how this relates. ` `  When you talk about physicians' offices or services to the home, you may not talk about in terms of advanced telecommunications services. What you may say is%O0*H&H&@@ that every community, as a basis of its rural needs, needs dial-up access to the Internet. That's the base level of service. ` `  When you do that, the implications for healthcare you can get services cost effectively to the home. That's major implications. So what you're defining is you are going to define a level of sort of functional need within the context of health implications, but it also has implications for the other sectors. ` `  MR. LAWLER: You're absolutely right. ` `  MS. PUSKIN: And if you think about it in those terms -- and that's all I was saying -- if your focus is in health, but if you think about the implications and how to build that system, you create a case that is much more acceptable for looking at this. ` `  MR. MAXWELL: Just kind of remember that the work you will be writing and providing is for a joint board of state and federal regulators who are looking across these universal service requirements, who are looking at libraries and schools and healthcare and affordability of service in general. ` `  So you don't need to solve all the problems of how this will work. Let's get your expertise focused on the healthcare piece to the extent that we have wisdom about how demand can be aggregated to be able to bring competition in,%P0*H&H&@@ to be able to make better, more effective use of the technology, that's great. And that's important. ` `  But there is a kind of integrated function which should take this contribution and add it to the contribution of others in these other areas to look at this systemically. ` `  MS. PUSKIN: Can I ask you a question about the act? Because it was raised in the context of physicians' offices and the fact that this act talks about advanced telecommunications for non-profit providers. And that's why we also -- Mary Jo's concern about the home and the evolution to residential care facilities and where this is going. ` `  If we can also, at least in the context of the rural discussion, talk about what a basic level of service, not just the health applications, to allow us to reach these other healthcare entity, is that within the scope as you see it? Because certainly it was in the scope of testimony we provided. ` `  MR. MAXWELL: Let me answer that in two ways. I think it would be a mistake for us to get into sort of a legal dialogue about what the precise meaning of the act would mean. You are advisors to a process where there will be lots of people who are going to parse the act. ` `  If there are feelings and insights in addition here about what should take place, that is perfectly%Q0*H&H&@@ appropriate to put in because, in fact, if someone said, well, it doesn't, you know -- we will interpret the law to be mean X, and that's the legal judgment. This group can say, that may be a perfectly appropriate legal judgment. We want you to think about this from a societal standpoint, and you should amend the act. And the act should be saying this because that's what it should mean for rural America. ` `  MR. SANDERS: Jay Sanders, American Telemedicine Association. ` `  I think that's very, very critical; and I really feel good about that comment because one of the critical concerns that we have -- and we addressed this in our testimony -- is related to the fact that it seemed to isolate the primary provider of healthcare, and that is the individual physician. ` `  Many of us around the area who are involved in this on a day-to-day basis will tell you, even though you think of rural as the rural providers being proximate to the rural healthcare delivery system in terms of hospital, the reality is if you put a telemedicine wing on a hospital and you have a doctor who's office is literally across the street from the hospital, it might as well be 10,000 miles away. ` `  The reality is, it's got to sit on that doctor's desktop and be as convenient as the phone, and it's got to%R0*H&H&@@ go into the patient's home. And that's where all healthcare is going. It's not simply rural community. It's urban community. That's where it's happening. That's where it's got to be. ` `  So the fact that we can provide recommendations that address a very basic part of that law that basically says we're only talking about non-profit organizations, which, the way we interpreted it, that meant we could only put it in the hospital; and the actual provider of care, the individual doc in their office, is basically excluded, the fact that we can provide those recommendations is very helpful. ` `  MR. LAWLER: Perhaps a clever lawyer somewhere can interpret this to mean a doctor's office, but I'd be surprised. ` `  But there is certainly nothing that says that we can't say, this ought to be -- you know, in the future, when you figure out a way to get there, it ought to include a doctor's office and it ought to include -- you know, whatever. Home healthcare. Whatever we think it ought to include. ` `  MR. HOLUM: This is the subsidy we're talking about. I mean, the services, presumably, would be available in the community. Are we talking about -- ` `  MR. LAWLER: In theory they'd be in the community. %S0*H&H&@@ But, yes, the subsidies would be available to a primary care physician, whether you're a mile away or 200 miles away. ` `  MR. HOLUM: But not under this act. ` `  MR. LAWLER: Not under the existing law. Chuck coming up with a great legal argument. ` `  MR. SONNESTRAHL: This is Al Sonnestrahl speaking, from CAN, Consumer Action Network. ` `  You are talking about systems and mechanisms with equipment and communities and people in general. ` `  And I was just wondering if you're talking about individuals as well? For example, what if one individual who is deaf and cannot hear and is trying to communicate with a physician, there would need to be a third-party line to include interpreter services with that. ` `  Would that be subsidized under the guise of universal service? ` `  That's one example for us to consider as well, is the individual needs as well as the community needs in these systems, the needs of the program, et cetera. ` `  MR. MAXWELL: It seems to me, that that's the kind of question that the advisory group should be addressing and the kind of recommendations that are perfectly appropriate for this committee. ` `  I think the worst thing that we would do is to set a very, very narrow boundary on the discussion because we're%T0*H&H&@@ looking to you as experts, as people with knowledge, understanding, experience, and insight. And if there need to be changes in the future, then people should say that. If there are constraints that this is not thought through well, you should say that. ` `  We have a responsibility under the act; we need your guidance and don't want to say, sort of a priori, that this isn't a good comment or this is a bad idea or a forbidden notion. ` `  MR. LAWLER: Tom, you had your hand up first. ` `  MR. SPACEK: Tom Spacek from Bellcore. ` `  Tying together a few of these things, the comments from the woman from NTIA -- I don't remember your -- ` `  MS. BROWN: Cathy Brown. ` `  MR. SPACEK: Cathy. Putting her remarks together with some of Jay's comments and so forth, it seems like there's a few things that, you know, one is, defining this set of services. And when you define them, in addition, you would need to define what infrastructure might be needed, taking cost into account as best you can and not being technological specific because it may turn out that, you know, upgrading central offices in rural areas is not a possibility and maybe there are satellites solutions or something else; but at least the capabilities that are needed -- you know, would need to be definitely specified.%U0*H&H&@@Ԍ` `  One additional thought on top of that is, you know, we talked about the -- we're talking about this in the context of a national information infrastructure, which implies shared lease of resources, which are some of the comments we're talking about here, and that impacts cost. ` `  And the fact that the joint board is the one who will integrate these things, we have to worry a little bit less about that. It seems like, perhaps, in our definition of what this minimal set of services for the initial set of universal service is, in specifying those things, we should probably specify it in some sort of a priority order and even some beyond what we think should be in the minimal set. ` `  The reason being is that when the joint board gets together, perhaps through the synergies between education and libraries and so forth, they could do more or less than we initially recommended because the cost structure will take that into account. ` `  So we may want to add some things or prioritize some things. ` `  MS. DEERING: Mary Jo Deering from Health and Human Services. ` `  I have a technical question also that sort of builds on that, and it does have to do with our work product eventually. I'm sort of one of these task-oriented types that congregates and breeds in Washington I guess.%V0*H&H&@@Ԍ` `  I'm wondering whether what I'm hearing would shape our input to you in the following way: That on one hand we are to address the law as it is written and give useful guidance for doing something in the next three to five years based on the way the law is written. ` `  On the other hand, I hear a strong feeling that, number one, we need to educate them about the evolution of healthcare and make certain points about likely scenarios in the future. ` `  And then, thirdly, not so much on a temporal basis, but that there are other considerations that do not fall within the scope of the act itself that we feel they should take into account nevertheless that might result, either in the near term or the long-term, in amendments or other types of action. ` `  I mean, is that a useful framework? Are we limited to any other framework at all? ` `  MR. MAXWELL: Not that we have -- ` `  MS. DEERING: I mean, we do need to do that first piece, we need to tell them -- I mean, we must tell them the first piece sort of clean. That's really my technical question. ` `  MR. MAXWELL: There were very good comments that have been provided on the panels in front of the joint board. I think some of the comments have been very helpful%W0*H&H&@@ in the proceedings itself. ` `  I was, frankly, a little surprised that we didn't get as much information as I had hoped. And, again, this is a personal view as opposed to a Commission view. ` `  Being a creature in Washington -- and perhaps some task orientation rubs off -- where there is money, there usually is comment, if not excessive comment, on how we should get that money. ` `  Here's a situation in which a societal decision that there should be this kind of service available as a society, and yet I don't think there has been a consensus yet reached about what those service are, sort of what merits subsidy, what merits, essentially, a tax from one party to another. ` `  And so we really need to focus very much on getting that answer and getting that right in the context of these other activities that are also determined to be recipients of subsidies: schools and libraries and underserved areas, high-cost and underserved areas. ` `  So if we do that alone, we would have accomplished a great deal. If we do this in a way that it can be built upon, it's better. If we do it in a way that recognizes where maybe people have not thought about how the evolution is proceeding or have missed areas that will be critical for this to be successful, all the better. And if we can do it%X0*H&H&@@ in a way that suggests that, in the future, one should be looking at this and give people some insight about that, then it's a home run. ` `  MR. LAWLER: Doug? ` `  MR. TINDALL: Doug Tindall from UT Houston. ` `  And I hope Dr. Duke would permit me to say one more thing. ` `  Listening to this, I would like to relate a scenario that developed over the last 18 months in Houston. I'll keep it very short. ` `  We spent a very small sum of money, especially with respect to those sums of money we will probably be talking about allocating throughout this piece of legislation. And with this very, very small, insignificant amount of funds, we have learned many very valuable things that I'm not hearing in the discussion yet. ` `  First of all, yes, cost to a consumer is a very real concern; and it should be, especially for people like the AARP, for example. But I haven't heard anything about optimizing healthcare around telecommunications, because actually we'll have a net cost savings. ` `  I haven't heard that yet. ` `  As the devil's advocate, as well, I haven't -- for example, that little tiny research project that we did, we found many different areas within cardiology, trauma, and%Y0*H&H&@@ stroke that have been published from UT Houston and also School of Public Health documents that have been published from UT Houston that I think I can get for this board before the next meeting that address these costs, you know, public-service-versus-healthcare-dollars kind of thing. And I'm not hearing that in the discussion yet. ` `  Also about cost sharing, the whole idea about if you bundled education and maybe another agency together you can increase it from ISDN to T-1 but actually have a savings in installation, I submit that it's not only those. It's telecommunications companies, libraries, schools, other public safety agencies, emergency medical authorities, industry in general, the worldwide web industry, wireless telecommunications, and computers. And all of those really are -- it's just this huge maze. ` `  What we saw as a reaction of that tiny research project is that we are generating enough support within Texas that we probably will get something that we can put as far as a, quote, unquote, subsidy for rural care, at least in my opinion. This is hypothetical. And we think the state might be able to do a subsidy for rural care. ` `  We had a meeting also with some civic officials within the City of Houston, granted a much bigger pot, now you're talking urban and inter-city as well. And they are to the point that they are also justifying potential sharing%Z0*H&H&@@ and allocation of resources to us for a variety of benefits, both political and to the constituency as helping members in their healthcare needs. ` `  I think I've got the ball on the table. I could put more examples forth, but I think I got the ideas out. ` `  MR. LAWLER: Yes? ` `  MR. HOLUM: You know, I would love to begin this process and to proceed on the basis of satisfying the human needs because I think that's what healthcare is all about. ` `  But I want to express a caution at the outset. It seems to me that it's easy to say that, but it's very hard to develop a consensus on what people's needs are in the healthcare arena. ` `  I think the fact that we were unable to reform the healthcare system, in part, was a reflection of the lack of consensus on what people need as a basic minimum package of healthcare. ` `  It seems to me that there is another standard stated in the act. And that is that rural areas should have services that are reasonably comparable to what's in urban areas. ` `  So it might be a useful start to say: What do we think urban areas will have three to five years out? And then try to use that as the benchmark for what we need to get into the rural areas without spinning a lot of wheels%[0*H&H&@@ about what would be nice and desirable and even, in some sense, practical from a human needs point of view. ` `  MR. BAILEY: Hi. Bill Bailey. I'm from Southwestern Bell. ` `  That's an important point. Someone said earlier that telemedicine is moving. It's moving within the context of telecommunications. Telecommunications, over the next several years, is going to move dramatically. ` `  Today, I think everyone agrees, that typically it costs less to provide telecommunications services in the metropolitan areas than it does in rural areas. That's just a function of the density and the distance which we have to provide service to. ` `  Competition is going to, at least in the near term, concentrate in the metropolitan areas where the margins are greater. And what's going to happen is that prices of services -- and many of the prices we're talking about for services which are being utilized for telemedicine already have built into them high prices to try to keep local telephone rates low. ` `  And what will happen in the future in the metropolitan areas, those rates will come down as a result of competition. But those same forces will cause rates in rural areas to likely go up, even more than what they are now, to meet their cost.%\0*H&H&@@Ԍ` `  So we can see that there are problems today in providing telemedicine; but the structure we're doing that it in is going to be even worse for rural areas. I mean, it's going to be much more difficult to provide services to rural areas at comparable prices tomorrow than it is today. ` `  MR. MAXWELL: I think there is a potential for a little confusion. Let me just go back again to the act for a second. ` `  Again, it's on page 96 of that handout. What we are thinking about in terms of healthcare services, it doesn't provide so much guidance, but the words are the words of the act. And it is that they are necessary for the provision of healthcare services in the state. So the underlining is a definition of what the society believes is necessary, not discretionary, not what one would like. ` `  And it then goes back to sort of the telecommunication services which are necessary for doing that. So it doesn't provide much sense, but we are trying to define a kind of set that we can all agree upon are required and then go to the telecommunication services which are necessary for that. ` `  And I'm only doing that because we could spend, you know, from here to the first part of September saying what the healthcare system should be like. ` `  And I think Tom was right, we have to make a stab%]0*H&H&@@ at what is necessary in rural areas and then the services which are necessary for doing that and then look at the comparability issue for the costs involved. ` `  There is kind of logic about it which I think people were talking about, and it has to be sort of very much on our agenda. ` `  MR. DOUGHERTY: Elliot, could I just follow up? ` `  On the page before, the bottom of 94, this is where I was taking the language from, Number3, "Access in Rural and High-Cost Areas: Consumers in all regions of the nation...should have access to telecommunications information services...that are reasonably comparable to those services provided in urban areas." ` `  That's the benchmark I was looking at. ` `  MR. MAXWELL: That has to do with, in general, telecommunications services. And there is a provision overall with respect to universal service that says the nation should look reasonable comparable, there should not be a distinction. ` `  When they talk about the healthcare piece, they're talking about sort of looking at a healthcare system in which rural areas should not be distinguished or deprived in a large measure, and then go back to the services necessary to make that happen, the telecom services. ` `  This is kind of a multi-layer view of universal%^0*H&H&@@ service, one is universal service as a whole, and looking at the society as a whole. The other is just focused on the healthcare-related pieces in the rural areas. ` `  MR. LAWLER: Did somebody have a comment back there? ` `  I may have missed it. ` `  MR. ENGLAND: Bill England from HCFA. ` `  I was wondering about something that Jay said about heading down the path of who is the subsidy going to? And are private physician offices non-profit? And, of course, through our payment system, many of them probably are. ` `  But the IRS very clearly defines who is non-profit. I mean, Publication 17 tells us who public and non-profit entities are. You know, it's a list we can hold in our hands. It's fine. And I think if we try to discuss, are we going to subsidize nursing homes, are we going to include physicians' offices, et cetera, we are going to get way beyond anything that can reasonably be done. ` `  And I, first, would just like to suggest that for discussion, as it says, public and non-for-profit, that is defined and it's a fixed group of entities and we can limit what we're talking about to those entities only. ` `  And I agree, absolutely, that it's going to go to homes and it's going to go to doctors' offices. But%_0*H&H&@@ Medicare is not, for example, planning on paying for that anytime in the near future. ` `  This is an issue -- ` `  MR. SANDERS: You don't want to get into that. ` `  MR. ENGLAND: Okay. That's one constraint. ` `  The second thing is, you know, we have this market system and it does efficiently price things in urban areas and rural areas. And it's how much are we willing to subsidize where? ` `  We are trying to set an objective -- maximizing an objective function, and we're not looking at, you know, how do you constrain, what are the constraints, what do you have to give up for subsidizing here and not here? And the market does that fairly well. ` `  If we just say, we want every hospital to have two T-1 lines, every rural hospital, well, that would be wonderful. I mean, there's no way we can mandate that to happen. ` `  So I think what we need to do is to set what it is -- is it 1/4 T-1 line from one of these entities, if they are requesting it, to say, okay, that's it, let the market price it, and then you provide the subsidy or figure out a way to provide the subsidy to pay for it. ` `  MR. LAWLER: Let's do a couple of more comments, and we're not going to get into Medicare reimbursement. I%`0*H&H&@@ promise. ` `  Tom? ` `  MR. SPACEK: Tom Spacek from Bellcore. ` `  Just a comment on your comment, and maybe it's inappropriate because we are supposed to be moving forward and not debating at this point. ` `  I think what the issue is here and the purpose of this universal services subsidy issue is not that the market will set prices in these areas; but it is, perhaps, what Bill was talking about, that it's going to be very expensive in rural areas. So what is this minimal set of potential things that are needed now, and that will evolve over time? And then, what's the technological capabilities needed for that? Then it turns out, what will it cost? ` `  And by definition, if you agree, that said then, that this fund subsidizes those, you know, market forces don't create the prices for those, unfortunately; and that's the purpose of this whole deal, I guess. So it's a little different focus. ` `  MR. LAWLER: Yes, sir? ` `  MR. HOLUM: I'm very pleased with what I think is some narrowing of the focus of this discussion. I think the more focused and the narrower we can get, the more we're likely to add more value in this short amount of time that we all have to put in.%a0*H&H&@@Ԍ` `  Notwithstanding that, I think we would do ourselves a disservice if we so limited our discussion on this one point to simply the words of the statute with regards to the public and non-profit facilities. Because in that one component, I think we have to have a little broader vision in the sense of what the intent of this is. And it may be added as an addendum or an ancillary discussion with respect to what has to happen. ` `  If we don't constrain ourselves, we're going to be missing an enormous component of providing healthcare services and access to healthcare services in so many areas. ` `  MR. LAWLER: Let me try to declare, at the risk of getting tomatoes thrown at me, that we seem to have an evolving consensus on at least how we want to think about this, which is we do want to provide advise on the words of the statute. We can't change them. ` `  So we do want to provide advice. I happen to think that Tom's sort of formulation of this is a very constructive one, a good way to think about it. ` `  Beyond that, I do think we also have a consensus, that if we think there is something more that ought to happen, whether it's in rural areas or beyond rural areas, I think we ought to feel like we can say that. And, you know, that's what our job is, to give people advice. ` `  And we want our advice to be as narrowed and%b0*H&H&@@ tailored as possible. But we should not -- you know, if we think that this particular provision is great but it's only 25 percent, we ought to say it's only 25 percent. And there's, you know, a lot more we need to think about. ` `  MR. HOLUM: At the same time, I would hope that our focus would be on access to the communications system and the cost and subsidies associated with access to the communications systems as opposed to -- you know, we could go a lot of different directions in terms of what kinds of healthcare services we think are necessary. You know, we could go a lot of different directions to get out of this focus on communications. ` `  MR. LAWLER: Right. ` `  MS. PUSKIN: I think actually we can do a lot, without getting too far away, within actually the current structure of the statute to apply what we think we see the communications needs are for the healthcare system in three to five years. ` `  For example, if you look at the Universal Service Provision, which is for all consumers, which is what you mentioned earlier, one might argue that in that context is where you might put physicians's office and some other evolving institutions if you say, really in rural communities, just as in urban communities, one would expect local dial-up access to the Internet.%c0*H&H&@@Ԍ` `  If that is a basic service that's available, that is a service that goes a long way to meeting the healthcare needs of physicians' offices, facilities, et cetera; and it's within the context of what it is your expecting in the universal service for everyone. ` `  Then you say: What's that basic service that you would expect to be out there and the implications for healthcare services? ` `  Then you go and say: What are the advanced services beyond that in the context of what we said earlier? And there may be some different levels. ` `  I think a lot can be done within the context of understanding the act. You may end up advising some special things. But I think you also need to look and say, there are a lot of things out there where, in three to five years, actually the things we'll be doing in healthcare that won't require any greater functionality, in some way, in terms of the telecommunications industry, than we would expect that would be going into people homes and urban areas and, therefore, would expect in rural areas. ` `  I think you have to keep that construct so we're not -- and that may help you to address some of the issues in this act. ` `  MS. DEERING: My only observation on this -- and this is moving this forward, because I have a 1o'clock%d0*H&H&@@ conference call to make -- is, based on this emerging consensus, whether the structure of your subgroups really feeds into the final product that you want. ` `  It seems to me that they are horizontal slices, not vertical slices. And I just throw it out on the table as to whether or not there is any drafting process that might actually get us -- we've got an awful long way to go. And if we do it that way, will we have an awful lot of re-synthesis and re-packaging to do afterwards? ` `  MR. LAWLER: Right. Let me do one more comment, and then let's talk about how we go forward. ` `  Did somebody have their hand up back there? ` `  Yes. ` `  MR. BARR: It's a basic comment. Rick Barr. (inaudible) International, an end-user for two years of ISDN. ` `  A very basic request, as far as being a healthcare provider, is the issue of connectivity in rural areas. ` `  The band width is one issue. But more importantly is reliability of the service. And we fought for six months between the Arbachs and three different long-distance carriers to give us daily connectivity, which was a very, very rough start up just within a 200 mile radius of where we sit today. ` `  And I think the other issue that a consumer would%e0*H&H&@@ also need assistance along with the telecom piece is the issue of slamming. We had many instances of being switched from one long-distance carrier to the next, not being aware that it happened at the local switches; but yet we lost connectivity for three, four, and five hours. ` `  And in the practice of telemedicine, which is really a deterrent to any local clinician is that, if you don't have the connectivity, you don't have service, you can't provide what would be the rationale for why you're even in telemedicine today. ` `  I think that's a very basic premise going back to some of Jay's comments about what do the people need. ` `  MR. LAWLER: We want to try to give people a chance to eat lunch before we go up to this demonstration, so let's try to move forward from here. ` `  Mary Jo suggested that, perhaps, there's a different way to slice this. If there is, let's see if we can do that. ` `  MR. TANGELOS: Well my brain has already been thinking along the lines of what we've got here. So 2-1/2 hours, 2-3/4 hours into it, with 15 minutes to go, that's a little tough. ` `  But for the pieces that we have got lined up, I think that, just speaking from the architecture point of view, I've already got a general design that we can come%f0*H&H&@@ back at the next meeting in July, quite nicely within that framework to give the group plenty of information. It may, indeed, be horizontal. It may, indeed, be a box. But that's kind of easy to do within the time frame that we have remaining. ` `  MR. LAWLER: Tom, any contrary ideas? ` `  Or -- ` `  MR. SPACEK: Well -- ` `  MR. LAWLER: Or non-contrary? ` `  MS. DEERING: The one drafting piece which is missing here, unless it's in your first box, which it may well be, is the definition of "need of services." And to me that's a little bit cross cutting. ` `  MR. LAWLER: I agree with that. ` `  MS. DEERING: I think you may need a separate -- ` `  MR. TANGELOS: You know, you can leave that to the group as a whole, though. ` `  Again, the building blocks may be these four pieces here, and we as a committee of a whole finish the job. ` `  MR. SANDERS: And Jim Brick's committee could really address the "need" issue. ` `  MR. LAWLER: Yeah? ` `  MS. TRUTANIC: I guess what Mary Jo is saying, though, is that there may be, from each of these four%g0*H&H&@@ sections, interaction and input that everybody can do. ` `  For example, DoD is heavily doing some international telemedicine right now and in addition to infrastructure, they can give some very vital insights into the problems of providing telemedicine services. ` `  MR. LAWLER: There is no question that there is almost total overlap, perhaps with the exception of the International subgroup. ` `  MR. TANGELOS: But I'm convinced that there are pieces already in testimony that I will be getting, that there are pieces in the Council's report that I will cut and paste right into the work that we want to submit in July. ` `  MR. LAWLER: Right. ` `  Tom? ` `  MR. SPACEK: I see the International one as being able to proceed, you know, soon. ` `  Even the one that's called "Architecture," because if I read it and also hear what a few of you just said, there's a lot of equipment out there, that's your viewpoint on what's out there, the compatibility that might be needed between the equipment, among equipment and so forth. So that potentially can be some useful stuff, too. ` `  It just seems like the definition of the essential set of services now and perhaps in the future, when there is a longer list of those put in priority order, really has to%h0*H&H&@@ occur, in some sense, before you can do something useful with respect to what telecommunications capabilities are required to meet that. ` `  MR. LAWLER: Well, let me try something here; and I'll dump this on the three Chairs here of all but the International one. ` `  Is that something that the three subgroup Chairs can talk about and try to get a common language about and see if there can be a joint understanding that they can proceed on? ` `  And maybe, Jim, you can take the lead in doing that. ` `  MR. BRICK: I'd be happy to. ` `  MR. LAWLER: But, you know, you will be communicating with the other subgroups so there is some development of that jointly rather than -- ` `  MR. TANGELOS: Yeah, I'm really not uncomfortable. Let me just -- we are winding down, and let me give you an idea, if I may -- ` `  MR. LAWLER: Sure. ` `  MR. TANGELOS: -- what I would like from our group. ` `  I think a two- or three-page document from every member of my subgroup, providing with me basic information that they think is important and can be worked into a%i0*H&H&@@ document that will end up being submitted by me at this next meeting that may be 15 to 20 pages long. ` `  I think it would also be easy, with the architecture question, listing many of the conflicts that exist, many of the anecdotes that are out there. And there's nothing wrong with listing them, getting the individual perspectives from ACR, from AARP, NTIA, and going forward from that. ` `  Then I think it's the responsibility to have that information here so that we can now work up, and Lygeia can work up, and get it to the next step. ` `  So I'm more concerned with getting something forward in the next six weeks than a finished product that's interrelated and goes together and looks beautiful. That's not what I want to get to in the next six weeks. There are more practical things that I hope each member of this group will at least give me two, two-and-a-half pages. ` `  MR. SPACEK: But that suggestion -- and maybe it's what you were saying before, I'm not sure -- but if the first one, which is called "Telemedicine in Rural Areas" -- which in some sense is telemedicine in urban areas, too -- if the idea is to define this minimal set, if that group is responsible for defining the set, perhaps the Chairpeople of the other groups can view themselves as members of that first group, so we will all focus -- you know, let the%j0*H&H&@@ Chairperson of that first group be responsible for defining that set, the other Chairpeople having input to him. ` `  With respect to the "Telemedicine Infrastructure," which I would be Chairing, what we would do in addition to inputting into that, between now and July perhaps, is looking at the -- you're also asking for sort of the future vision here, too. So maybe between now and the next meeting we could focus more on that future vision. ` `  At the next meeting, once this set is sort of defined and we can agree to it, then between July and September, we could focus on the shorter term issues of what would be the telecommunications requirements to meet the agreed upon set. So we sort of do the future before the present, but that's okay. ` `  MR. LAWLER: That's fine. I also, if it's possible -- and that set will need to begin to be designed prior to our -- you know, everybody hearing about it in July. Maybe you can begin the second part of that even before that meeting. And that's really, you know, if you three can communicate on that. ` `  MR. MAXWELL: It may be useful, on the infrastructure side, to be also looking at sort of what exists today in terms of the rural infrastructure so one can say: What would need to be changed to be able to do some set which I think there will at least be input on from the%k0*H&H&@@ statements that were made at the en banc hearings in front of the joint board, which we will gather up and make sure it's available to everybody here. ` `  Let me make one other comment, perhaps a process comment. ` `  MR. LAWLER: Sure. ` `  MR. MAXWELL: I think if we don't do as much of this as we can electronically, we are nuts. People are dispersed. The subgroup, in part, because it represents the rural areas and non-urban areas as well as urban areas, people beyond the Beltway, if you -- when you hand in those contacts sheets -- there are two things. Not only phone number and fax number, but if you have e-mail, please give the address. If you have a web page, please give it because we'll make sure that these are linked up. And, to the extent that we can, I think as much of the inputs that can be shared across the groups so that people can participate as they are able to, will allow it to make much more progress. And to the extent that we can deliver things electronically, your humble staff would, I think -- such as it is -- would be much appreciated. ` `  MR. LAWLER: Let me just say, on this list, we were totally arbitrary and ignorant when we did this. You know, we looked at what we knew about people, and we put them in various subgroups.%l0*H&H&@@Ԍ` `  I think the best way to try to deal with this, if I can impose on our Chairs here, is if somebody has a great deal of expertise in another subgroup and none in the one they're in -- although, that's almost impossible -- let's try to work out a way where -- each of them needs to be covered. But what I don't want to do is get everybody saying, you know: I don't want A. I want C. And we will start all over again, and we'll end up being equally arbitrary the second time around. ` `  So if you have a particular need, let's see if we can accommodate it. I will admit to just doing it arbitrarily because we couldn't figure out any other way to do it in the sort time frame we had. ` `  MR. BRICK: If I might, please, just don't put all the lawyers in one group. ` `  MR. LAWLER: All the lawyers are in your subgroup. ` `  MR. BRICK: We need everybody together so that, you know, we hear all the stories from everybody. ` `  MR. LAWLER: I think what we tried -- there was some method to our madness. I do think we tried to spread people out, you know, in terms of expertise. You know, we tried to put as many of the rural people on the rural. You know, it was not total madness, only partial madness. ` `  MS. DEERING: Can I just ask who is here representing Ronald Coleman as Chair?%m0*H&H&@@Ԍ` `  MR. BOTTS: I am. ` `  MR. LAWLER: I talked with Ron. He's, unfortunately, out of town but is eager to participate and will be here. ` `  Joan? ` `  MS. KING: Joan King from AARP. ` `  If we're on a committee, say the "Infrastructure," and we have -- and AARP has a policy on rural healthcare, we would like to be able to make comments to that committee. ` `  MR. LEWIS: Absolutely. ` `  MS. KING: The other thing is my name appears in here with neither a phone number or a fax. ` `  How do we handle that? ` `  MR. LAWLER: In your packet, there's a blank information sheet for you to fill out which is -- and we probably have people's wrong phone numbers and wrong addresses and all that. So please, please, please fill them out ` `  MR. MAXWELL: And no one gets out of this room without turning one in. ` `  MR. LAWLER: That's right. ` `  MS. RICCIARDI: Give it to me or Thayer. ` `  MS. DeMers: Could I plead for more at least more notice than we had? I ended up paying what it would cost me for two trips out here for this trip.%n0*H&H&@@Ԍ` `  MR. LAWLER: Yes. ` `  Lygeia, how soon will we have another meeting? ` `  MS. RICCIARDI: Well, the reason that we haven't given you a date for the July meeting is that we want to structure it around a joint board meeting which has not yet been set, and that's what we're waiting on. ` `  If they take too long, we will set it -- what? Within -- we realize that you folks need more time to prepare for this. ` `  Shall we just say within say a week we'll have an answer? ` `  MR. MAXWELL: You will have a date within a week. ` `  MS. DeMERS: Right. As long as we get three week's notice, that's fine. ` `  MR. MAXWELL: Right. What we wanted to do -- the joint board had tentatively scheduled a meeting about the third week or so in July. ` `  What we wanted to do was to be able to have a meeting before that because that meeting's going to be in Los Angeles. Lots of people would not be able to get out there. So we would at least have the potential of some people able to join the joint board there so that we can keep input going in and not sort of have to run up at the end and do that. ` `  So we will commit to having a date in --%o0*H&H&@@Ԍ` `  MS. PUSKIN: Can I make a plea that you not set it for the same time as the COMNET meeting, which is in Washington, which is around the 17th -- ` `  MS. DEERING: The week of the 17th. ` `  MR. MAXWELL: If there are dates anywhere, let's say, between the 7th and 17th or so of July that don't work for you, could you feed them to -- ` `  MS. PUSKIN: That week of the 15th of July is bad. It's a pretty bad week. ` `  MR. LAWLER: That is the time frame we're looking at, between that really -- after that 4th of July week through the 20th of July or thereabouts. ` `  MS. PUSKIN: That particular week is a very, very bad week. ` `  MR. LAWLER: In September, we're talking soon after Labor Day. ` `  Isn't that right, Lygeia? ` `  MS. RICCIARDI: Yeah. We thought the third. But we can change that if that's a problem for us as a group. But that's what we're aiming for now. ` `  MR. TANGELOS: The Labor Day holiday is Monday the 2nd of September. ` `  MR. LAWLER: Yeah. We may want to -- we'll give a little time in between. ` `  MS. RICCIARDI: Oh, okay.%p0*H&H&@@Ԍ` `  MR. MAXWELL: Toward the end of that weekend is what we were thinking about. ` `  We do apologize about the time frames. ` `  MS. DeMERS: I think it was understandable for this time. I'm just making a plea for future hearings. ` `  MR. LAWLER: Yeah, you're absolutely right. ` `  Any more housekeeping things that we have not covered, Lygeia or Thayer? ` `  MS. RICCIARDI: Yeah. Just a couple of logistical things. ` `  You have in your folders a schedule for today, and it tells you that at 2o'clock we're going to be reconvening in the Dirksen Building, which is the building connected to this, in Room 106, to look at the demos which have been organized by the Congressional Ad Hoc Steering Committee on Telemedicine and Healthcare Informatics. ` `  And if they ask you, just identify yourself as either a member of or a participant in our meeting here. ` `  And then, as you will also see on your schedule, at 3o'clock, in the same building, different room, on the ground floor, Dirksen Room 50, we're going to have a press conference at which Chairman Hunt will be speaking as will Commissioners Ness and Chong from the FCC and several Members of Congress. They will be Senators Snowe, Rockefeller, Exon, Conrad, and Pressler.%q0*H&H&@@Ԍ` `  So we'll look forward to seeing you at both of those events. ` `  MR. LAWLER: And after the press conference -- and, Lygeia, correct me if this is wrong -- but after the press conference, if we can hang around for a couple of minutes, the three commissioners are just going to say a few minutes worth of, you know, thanks for doing this, here's how we look at it, in the same room, right after. And the press conference shouldn't take very long. We won't keep everybody hanging around too long. ` `  (Whereupon, at 1:00 p.m., the hearing was concluded.) // // // // // // // // // // // // //%r0*H&H&@@ԑ ? (! r   X` X VAHeritage Reporting Corporation &(202) 6284888V "REPORTER'S CERTIFICATE ă   ?X  FCC DOCKET NO. :  ?  CASE TITLE : TELEMEDICAL ADVISORY COMMITTEE  ?x  HEARING DATE : Washington, D. C.  ?  LOCATION :  June 12, 1996  I hereby certify that the proceedings and evidence are contained fully and accurately on the tapes and notes reported by me at the hearing in the above case before the Federal Communications Commission. Date: _06/12/96__ _____________________________ Official Reporter Heritage Reporting Corporation 1220 "L" Street, N.W. Washington, D.C. 20005   Greg J. Poss  ?P <! TRANSCRIBER'S CERTIFICATE ă  I hereby certify that the proceedings and evidence were fully and accurately transcribed from the tapes and notes provided by the above named reporter in the above case before the Federal Communications Commission. Date: 06/14/96__ ______________________________ Official Transcriber Heritage Reporting Corporation Greg J. Poss  ?@  <!PROOFREADER'S CERTIFICATE ă  I hereby certify that the transcript of the proceedings and evidence in the above referenced case that was held before the Federal Communications Commission was proofread on the date specified below. Date: 06/20/96__ ______________________________ Official Proofreader Heritage Reporting Corporation's0*''Ԍ Barbara Blossom