International Circulation:  What obstacles have you found in implementing this type of patient communication method?

Alfred Bove:   The biggest obstacle right now is that we don’t get paid for it.  I’ve shown this to many physicians.  Many doctors say to me “Well I won’t make any money if I don’t have a patient come to the office.”  We have to make a major change in the thinking of the people who pay for healthcare so that they will understand that this kind of continuous communication approach is a more cost efficient way of taking care of patients and be willing to provide some reimbursement. Right now my work in this area is funded by research money.  If we can use this efficiently， patients won’t come to the office and we won’t get paid.  So the biggest impediment is reimbursement. 
The second is access.  I have worked a lot with underserved communities in inner city areas of Philadelphia and in rural areas in Pennsylvania. Access is a problem since some people don’t have computers.  We often find that people at the lowest income levels who don’t have computers at home are very interested in access to this kind of healthcare but they don’t have the money to buy the necessary machine.  They could go to a community center or a library to get access.  This is improving over time as more people get into the system and more people get used to computers.  Of the main obstacles， access is one that is getting better and reimbursement is a major one that will hopefully get better in the future.  We will have to wait and see.