Both communications technology and a management structure to coordinate participants are necessary elements of a network. Currently, the necessary coordinative mechanisms and the resources to establish and operate a health care computer network are not available. Those in the health care field must, as a result, look to other established networks for data transmission.

Internet is a loosely organized confederation of federal, regional, and local networks that are used by researchers and educators for electronic mail, software and data file transfer, graphics and image file transfer, remote computer access to supercomputers and other specialized research instruments, and remote access to computerized databases.7 An estimated 1 million researchers are active users of the academic networks that are connected to Internet. It does not, however, provide users with uniformity in the type and quality of service; furthermore, despite its size, Internet does not yet reach the entire research and education community (Gould, 1990a).

Federal sponsors and academic participants envision continued evolution of Internet until it becomes a user-friendly, unified high-speed research network with nationwide coverage. The Federal Networking Council8 plans to transform Internet into a full-fledged National Research and Education Network (NREN) in three phases. The final phase calls for an operational national network with gigabit-capacity trunks and for transition of the network from government to commercial operation (Gould, 1990b).

The NREN is being built to support "communication and resource sharing among institutions and individuals engaged in unclassified research and scholarly pursuit" (Gould, 1990b:1). As such, it is a model for the kind of infrastructure needed to transmit patient record data routinely. Given the


In 1969 the Defense Advanced Research Projects Agency (DARPA) established an experimental network to demonstrate the potential of computer networking based on packet-switching technology, which allows many users to share a common communications channel. During the 1970s, DARPA sponsored several additional networks and supported the development of a set of rules and procedures (called the Internet protocols) for addressing and routing messages across separate networks. In the 1980s, DARPA sought to separate the operational traffic and administrative burden of military research and development (MILNET) from that of general academic research needs (Internet). Since 1985, the National Science Foundation has been responsible for coordinating the development of Internet. Funding for operations comes from five federal agencies involved in operating research networks and from universities, states, and private companies that operate and participate in local and regional networks (Gould, 1990a).


The Federal Networking Council includes representatives from DARPA, the Departments of Energy and Health and Human Services, the National Aeronautics and Space Administration, and the National Science Foundation (Gould, 1990a).


Senate Bill S. 1067 (High-Performance Computing Act of 1990) authorized the expenditure of $95 million over three years by the National Science Foundation for research, development, and support of the National Research and Education Network (National Science Foundation, 1990).

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