integration (discussed in Chapter 2), for example, to take existing codes in multiple languages (e.g., Fortran, C, Lisp, Excel) and integrate them into a single, distributed system.

Both in crisis management and in manufacturing, critical decisions are made from composite systems involving humans, computers, and information systems. In crisis management, the emphasis is on intuitive judgment making with incomplete information. Manufacturing also requires good judgment for decision makers, but it represents a more classic decision support context that supplies engineers with information targeted very precisely at well-defined questions. These decisions need to be made by collaborations of geographically distributed engineers. This implies a need for collaboratory systems that link people and the information they need to make decisions.

Computing and communications increasingly affect health care in many different forms. Among those discussed in the workshop series were direct patient care, medical research, development of new medical technologies, and management of financial and other aspects of health services. Health care will continue to be administered by a diverse collection of providers working in a very large number of geographical settings. The health care system in the future likely will be characterized by (1) integration of widespread databases; (2) digitization of most health care data modalities (e.g., x-rays, magnetic resonance imaging (MRI)), allowing their transmission across networks; and (3) increased application of telemedicine. Health care providers will need to discover and access information from many sites in order to be able to put together a comprehensive description of a patient's medical history. Although perhaps to a lesser extent than in crisis management, there are significant variability and unpredictability in both the types of information that must be obtained (text records, handwritten notes, medical imagery) and their location. For example, an integrated health care information infrastructure will be able to give providers ready access to an accurate and detailed account of a patient's medical history. Networked access could compensate for the current, almost complete lack of access to patient medical records in some kinds of crises, such as large natural disasters. At the same time, however, the infrastructure must protect the security and confidentiality of personal information.

Medical decision support systems are increasingly used to help providers identify and evaluate different diagnostic workups and treatment plans. The ability to easily obtain large sets of longitudinal patient records will greatly facilitate the ability to carry out meaningful comparative analysis for clinical care

Front Matter (R1-R14)

Overview and Summary (1-7)

Application Needs for Computing and Communications (8-54)

Technology: Research Problems Motivated by Application Needs (55-98)

Summary and Findings: Research for National-Scale Application (99-138)

Bibliography (139-142)

Appendixes (143-144)

A Workshop Series on High Performance Computing and Communications (145-155)

B Background--HPCCI and NII (156-157)

C Acronyms and Abbreviations (158-160)