Perhaps the single biggest technological change since the first edition of the report is the rising importance of the Internet. Although the Internet dates back to 1969 when the first node of ARPANET was installed at the University of California at Los Angeles, several changes have coalesced to bring together a paradigm shift that now touches all segments of society. The World Wide Web (WWW) has transformed a research network into the fabric of a new information age. Internet service providers have made access convenient and reasonably inexpensive. As much as 50 percent of the U.S. population will have access to the Internet by early in the next century (National Research Council, 1996). It is precisely this kind of ubiquitous connectivity that enables IDS organizations to share data throughout their geographically dispersed clinical delivery sites, and even to reach the consumer or patient at home. To the extent that health care becomes dependent on access to computer networks, however, policymakers need to pay special attention to the needs of the medically underserved population to ensure that lack of network access does not further impede their access to care.
Connectivity is not the only requirement for transmitting patient data to remote sites. Confidentiality and security safeguards need to be developed and enforced. Fortunately, the requirements of business to protect electronic commerce over the Internet will drive technical solutions and policy standards, which health care applications can leverage. Technology dedicated solely to health care applications risk being orphaned due to the lack of a mass market. The market drive of consumerism must pave the information infrastructure for health care applications
Probably the most important tool that led to the domestication of the Internet was the development of software that made it easy to connect to, search, browse, and download information from anywhere on the network as if it were located on the user's personal computer. Commonly called browser software (e.g., Netscape Navigator™, Microsoft Internet Explorer™), these programs give a graphical, intuitive, and common interface to functions that locate and interact with remote data on the Internet without the user having any technical knowledge of how it is done. Browser user interfaces have become so commonplace that they are being adopted as the interface to desktop computers.
Another fundamental breakthrough associated with WWW browsers is that the software runs on almost any computer (Cimino, 1995). One of the critical problems that had been plaguing computer users since the invention of electronic computing has been the general inability of programs written for one machine to run on another machine or to use data generated by another program. Efficient and cost-effective use of computers suffered due to the incompatibilities caused