Medical Library Association | Public Policy : Digital Millennium Copyright Act (DMCA)

Digital Millennium Copyright Act (DMCA)

MLA Letter to Copyright Office

December 7, 1998

Ms. Shira Perlmutter
Associate Register for Policy and International Affairs
Office of the Register
James Madison Memorial Building, Room LM-403
101 Independence Avenue, S.E.
Washington, DC 2055-96000

Re: Promotion of Distance Education Through Digital Technologies, Copyright Office

Docket No. 98-12

Dear Ms. Perlmutter:

I am pleased to submit this statement prepared by the Medical Library Association (MLA) concerning the promotion of distance education through digital technologies. MLA is a professional organization representing more than 1,200 institutions and 3,800 individuals involved in the provision of health care information. Health sciences librarians support distance education programs in their institutions and understand the important and critical role it plays in support of health professional education, research, and health care delivery.

As we approach the millennium, we are moving from the Age of Information into the Age of Communications—an age where geographically dispersed collaborators will be able to work together in rich ways. New digital communication tools are dramatically changing how we create, access, and disseminate information, and will continue to change this process well into the new millennium. While these new tools help us organize, share, and filter information; coordinate teams to solve problems; collect and share aggregate data; and learn from our experiences and the experiences of others, they also pose unique challenges.

One of these challenges is to promote the delivery of health education, research, and clinical care with diminishing resources while maintaining an appropriate balance between the rights of copyright owners and the needs of users of copyrighted works. In order to achieve our national "Health for All" policy goals, the Medical Library Association supports the decision to include a study on distance education as part of the Digital Millennium Copyright Act (DMCA). We believe that careful consideration must be given to the need for an exemption from exclusive rights of copyright owners within the healthcare distance education and telemedicine arena.

Health care delivery is increasingly complex; the potential for telemedicine and distance education is compelling and likely to revolutionize the delivery of medical care. A 1990 study by the Office of Technology Assessment found that physical barriers to healthcare access, difficult as they are, may be outweighed by financial barriers. Since access to healthcare and healthcare education is not sufficiently addressed by traditional approaches, it is critical that we make full use of digital technologies to improve quality and broaden access to care.

Today, according to a 1998 survey by the American Telemedicine Association, 1,032 healthcare sites are supporting telemedicine and distance learning interactions. Most of these programs started within the structure of large health care organizations (typically university-based hospitals, multispecialty clinics, or the military), but are now also used by a variety of health care provider organizations, especially rural health care providers. Most programs use about half of their aggregate network time for clinical consultations and maintaining patient confidentiality. The remainder of usage is for medical education and administration, although medical education usage is on the rise and is doubling on an annual basis.

The inclusion of an exemption from exclusive rights of copyright owners for healthcare distance education and telemedicine within the DMCA would help reinforce national health structures by improving linkages between rural district hospitals and the main national hospitals using telecommunications; help provide training and education to health-care professionals in rural areas; encourage students to be interested in providing primary care in rural and underserved areas; and improve quality and efficiency of healthcare services.

Computers and advanced telecommunications technologies facilitate these educational and patient care situations. It is the position of the Medical Library Association and the Association of Academic Health Sciences Libraries that our laws must not create technological barriers that restrict the use of distance education technology and access to information. Our libraries must be able to provide the same level and quality of knowledge-based information services to all students and faculty, regardless of where they are trained or work.

In closing, I would like to provide you with a brief description of two distance education programs that support medical professionals and students:

The George Washington University in Washington, DC, contracts with the United States Navy to provide education and training of its Independent Duty Coremen through its Clinical Management and Leadership Program for Health Sciences Professionals. Through the program, naval personnel, who provide frontline medical duty, are able "to advance their knowledge, skills, and careers without ever having to leave their duty assignments. Courses are conducted using videotape, the Internet, printed study guides and textbooks." Students may be as far away as Japan and Iceland while participating in the program, and graduation day may be the first time that the student travels to the campus.

The George Washington University is currently working with Operation Smile to bring teams of health professionals into countries such as Bosnia and Columbia to provide specialized medical care that does not exist or isn't readily available. In April, the students and faculty from GW, The School of Public Health and the School of Medicine and the Health Sciences traveled to Bogota, Colombia to participate in a telemedicine demonstration project where surgeries were televised live at the University for purposes of education and training.

In both of these programs, the Himmelfarb Library of the George Washington University Medical Center supports the information needs of students and faculty. It is not uncommon for library staff to receive a request for information over the Internet that is needed in order to effectively treat patients. It is crucial that intellectual property law not limit or restrict access to information that is used to support the education and training of students and that could impact patient care, regardless of the location of the computer work station from which the request is made or fulfilled.

The University of Arizona Health Sciences Center, Tucson, Arizona, has developed several programs that promote the practice of telemedicine and excellence in health care education throughout the state. In the near future, telemedicine will play a central role in certain educational programs by creating multi-site "virtual classrooms" for medical students and other students of the health care professions throughout the state. First and second year medical students soon will perform preclinical rotations in rural communities and keep in touch with their rural physican-preceptors through teleconferencing. During their third and fourth years of medical school, while on their clinical rotations in rural communities, students will stay in contact with faculty at the College of Medicine in Tucson.

The University of Arizona also sponsors programs that seek to strengthen disease-prevention and health-promotion efforts throughout the state. For example, the University Heart Service works with the state's Native American Communities and the Indian Health Service to address serious health problems in a comprehensive fashion, focusing on culturally sensitive prevention and health promotion activities, as well as 'cutting-edge' clinical care and prevention-based research. Other programs provide pediatric genetics services to Native American children; offer education and information resources on cancer prevention, diagnosis and treatment to the public; and conduct a mini-medical school and educational public forums on controversial medical issues.

Computer and advanced telecommunications technologies are the vital link to implementing all of these programs which provide Arizona's citizens with access to medical care and biomedical information, as well as support the education and training of health professionals.

Thank you again for the opportunity to share our thoughts. Members of the medical library community look forward to other opportunities to share our views as the dialogue on this important and timely issue continues.

Sincerely,

Marianne Puckett
Chair, Medical Library Association Governmental Relations Committee
Associate Director, Louisiana State University Medical Center Library