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Suggested Citation:"Index." National Research Council. 2000. Networking Health: Prescriptions for the Internet. Washington, DC: The National Academies Press. doi: 10.17226/9750.
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Index

A

Access controls, 64-65, 145, 157-160, 242-243, 256, 302

Adrenoleukodystrophy, 328

Aetna U.S. Healthcare, 60

Agency for Healthcare Research and Quality (AHRQ), 120, 223, 228, 229, 234 (n. 25), 255

Agora, 311

AIDS, 55 (n. 12), 60, 95, 103, 313

Alternative medicine, 60

American Medical Association, 155-156

American Medical Colleges, 261

American Medical Informatics Association, 14, 22, 261, 307

American National Standards Institute, 85

Anatomy, 48, 102, 108, 114-115, 244, 296, 300, 306, 307-309, 315, 317, 320, 329, 331, 332

Anonymity, 167-173

anonymous e-mail, 169-170

anonymous data, 172-173

anonymous payment, 172

protected Web browsing, 170-172

Association of American Medical Colleges, 130 (n. 30), 261

Asynchronous transfer mode, 39, 56 (n. 19), 72, 117, 134, 163-166, 272, 281, 290, 331

AT&T, 172

Audio, 31, 50, 100, 104, 105, 106, 157, 164, 220, 280, 285, 286, 288, 290, 293, 294, 296, 327, 332. see also Video and teleconferencing

Authentication, 17-18, 63-65, 70, 145, 253, 279, 297

biometric, 18, 55 (n. 13), 279

certification authorities, 151-152, 155-156, 253

encryption and, 151-153

protocols, 150, 151-156

remotely controlled medical devices, 69

token-based, 17-18, 83, 84

Availability (network and system), 9, 11, 15, 24, 40, 45, 87-88, 93, 122, 124, 144, 160-162, 191, 237, 242-244

defined, 10

digital divide, 14-15, 71, 125, 195, 209, 210, 211, 245-246

e-mail between patients and providers, 63, 70

in consumer health applications, 63, 70, 87-88, 124

in professional education, 107-108

in public health, 101

see also Data security; Intellectual property; Privacy; Ubiquity of accessbreak

Suggested Citation:"Index." National Research Council. 2000. Networking Health: Prescriptions for the Internet. Washington, DC: The National Academies Press. doi: 10.17226/9750.
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B

Backbone networks, 11, 41, 42, 49, 50, 78, 134, 135-137, 140, 253, 284, 299, 331

Very high performance Backbone Network Service (vBNS), 49, 51, 115, 116, 284, 294, 299

Balanced Budget Acts, 92, 219, 220-221, 224

Bandwidth, ix, 6, 9, 11-12, 39, 41, 51, 123, 132-134, 240, 244-245, 252-253, 289, 305

cable modems, 12, 18, 34, 39, 40, 49, 67, 132, 163-166

costs of increases, 135, 166-167, 209

defined, 10, 39

digital subscriber line services, 132, 164, 165, 166

for administrative and financial applications, 93

for biomedical research, 110, 111, 121-122, 123, 240-241

for clinical care, 72-73, 75, 77-79, 82-83, 87, 88

for consumer health applications, 61, 65, 67-68, 69, 71, 280

for e-mail between patients and providers, 63

for emergency care, 133

for home care, 67-68, 71, 267

for images, 73-74, 77-79, 80, 123, 134, 136, 162, 164, 240, 244, 272, 288-289, 301-302

for patient records, 65, 82-83, 320-321

for professional education, 104, 105, 107, 123, 126, 240, 281, 282, 290-291, 297-298

for public health, 100

for video and teleconferencing, 11, 73-74, 100, 132-133, 240, 244, 290

integrated services digital networks (ISDN), 74, 287, 288, 289, 290, 304

local loops, 61, 162-167

National Health Alert Network, 99-100

Next Generation Internet, 16, 49, 250-251

overprovisioning, 137, 138-139

private networks, 43

reconfigurable, 18, 164, 253

satellite telecommunications, 166-167

Very high performance Backbone Network Service (vBNS), 49, 51, 115, 116, 284, 294, 299

Biomedical research, ix, 1, 2, 3, 5, 16, 57, 108-123, 255, 306-307, 319

bandwidth needed, 110, 111, 121-122, 123, 240-241

clinical trials, 55(n.2), 120-121, 328

collaborative research, 118-120

data access controls and, 110-111, 122, 159, 316

databases, 109-112, 240-241, 295-298, 331-332

Digital Anatomist, 307-309

MEDLARS, 33, 55 (n. 5), 135

MEDLINE, 3, 33, 37, 55 (n. 5), 103-104, 109, 110, 215, 295, 301, 307

pathology image data system, 314-315

private sector, 109-110

digital images, 211, 245-246

expert systems, 227, 228-229

patient records, 65, 169, 173-174

publication of results, 116-118, 215-217, 238; see also Intellectual property; MEDLARS; MEDLINE

remotely controlled equipment, 5, 113-116, 240

simulations, 112-113, 118, 320

technical requirements, 6, 8, 108-123, 159, 240-241, 255

Biomedical Teleimmersion, 316, 325

Biometric authentication, 18, 55 (n. 13), 279

Blue Cross/Blue Shield, 89

Breast cancer, 55 (n. 12)

telemammography, 48, 78, 79, 142-143, 236, 244, 272-273, 324, 332-333

Bureau of the Census, 172-173

C

Cable modem technologies, 12, 18, 34, 39, 40, 49, 67, 132, 163-166

Cancer, 55 (n. 12), 62, 300-301, 305-306, 322, 325-326, 328-329

National Cancer Institute, 120-121, 273, 300-301, 305, 322, 324, 325-326

telemammography, 48, 78, 79, 142-143, 236, 244, 272-273, 324, 332-333

Cardiology, 30, 66-67, 73, 74, 128, 158, 266, 272, 273, 275, 280, 285, 286, 287-288, 289, 291, 302, 304, 327-328

Centers for Disease Control and Prevention, 95, 96, 99-100, 225, 264, 312-313break

Suggested Citation:"Index." National Research Council. 2000. Networking Health: Prescriptions for the Internet. Washington, DC: The National Academies Press. doi: 10.17226/9750.
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Certification authorities, 151-152, 155-156, 253

Chat groups, ix, 5, 60, 191, 192-193, 196, 238, 261, 290. see also Support groups

Chronic illness, general, 13-14, 34, 55, 58, 60, 191

home care, 68

risk factors, 3, 31, 34, 58, 59, 60, 95-96, 274, 288

Cities, see Urban areas

Clinical care, 2, 55 (n. 2), 55 (n. 11), 57, 71-88, 120-121

and e-mail, 62, 261, 262

patient/provider exchanges, 14, 22, 37, 62-64, 66, 70, 189, 192, 197, 248, 279

bandwidth needs, 72-73, 75, 77-79, 82-83, 87, 88

data security, 65, 68, 82-84, 88

expert systems, 227, 228-229

latency needs, 81-83, 87-88, 124

Next Generation Internet, 48, 319

organizational factors, 182-184, 188, 189, 192, 195, 196

remote consultations, 6, 8-9, 16, 17, 18, 20, 30-33, 36, 57, 71, 72-76, 88, 220-221, 228-229, 236-237, 238-239, 244, 247, 258, 266-267, 280, 285-286, 288-289, 292, 323

standards/guidelines, 5, 14, 22, 57, 238-239, 275, 278

technical requirements, 4-5, 71-76, 87-88, 238-239, 246, 258

see also Diagnosis; Emergency care; Hospitals; Primary care physicians; Patient records; Specialists

Clinical trials, 55 (n. 2), 120-121, 328

Collaboratory for Microscopic Digital Anatomy, 114-115

Collections of Information Antipiracy Act, 218

Community Health Information Technology Alliance (CHITA), 90, 91, 309, 311-312

Comprehensive Telehealth Act, 224

Compression technology, 72, 77, 78-79, 80, 114, 115, 116, 129, 272, 286, 288, 290, 315

The Computer-Based Patient Record, 204

Computed tomography (CT), 4, 65, 72, 78, 134, 164, 238, 274, 300

Computer Science and Telecommunications Board, 1-2, 144, 173, 229

Conference on Fair Use, 217

Confidentiality, see Encryption; Privacy; Security

Consumer Assessment of Health Plans Survey, 90

Consumer health, 2-3, 27, 35, 37-38, 57, 58, 71, 152, 235, 245-246, 262

alternative medicine, 60

availability of access, 63, 70, 87-88, 124

bandwidth needs, 61, 65, 67-68, 69, 71, 280

chat groups, ix, 5, 60, 191, 192-193, 196, 238, 261, 290

data security for, 61, 63, 64-65, 68, 70-71, 238-239, 249

e-commerce and, 9, 10-11, 35, 60-61, 63, 71, 85, 168, 179-182, 310

e-mail, patient/provider exchanges, 14, 22, 37, 62-64, 70, 189, 192, 197, 248, 279

foreign language speakers, 119-120, 266-267

latency needs, 62, 69-70, 279

organizational factors, 9, 10-11, 179-182, 183, 191, 195

primary online activities, ranked, 61

quality control, 2, 14, 61-62, 246-247, 255-256, 292

remote consultations, 6, 8-9, 16, 17, 18, 20, 30-33, 36, 57, 71, 72-76, 88, 220-221, 228-229, 236-237, 238-239, 244, 247, 258, 266-267, 280, 285-286, 288-289, 292, 323

risk factors, 3, 31, 34, 58, 59, 60, 95-96, 274, 288

support groups, ix, 5, 60, 61, 196, 238

technical requirements, 4-5, 6, 8-9, 66-68, 69-71, 238-239, 245-246

Web sites, 9, 10-11, 59-62, 64-65, 69, 190, 196-197, 216, 256, 262, 277-280

pharmaceutical companies, 60, 71, 189, 221

see also Clinical care; Data security; Home care; Insurance; Managed care; Privacy; Records of patients; Telemedicine; cross-references under Demographic factorsbreak

Suggested Citation:"Index." National Research Council. 2000. Networking Health: Prescriptions for the Internet. Washington, DC: The National Academies Press. doi: 10.17226/9750.
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Copyright, see Intellectual property

Cost and cost-benefit factors, 8, 13, 37, 179-180, 184, 185, 186-187

administrative, 89, 91-92, 97-98, 279

bandwidth increases, 135, 166-167, 209

clinical trials, 120-121

data security, 144, 279

demonstration projects, 257

digital images, 211, 245-246

electronic publishing, 216

e-mail, 62, 63-64

integrated delivery networks (IDNs), 35-36

integrated services models, 140-141

managed care, 59, 184

medical imaging, 77, 79, 186

organizational factors, 59, 179-180, 184, 185, 186-187, 194-195, 196

patient monitoring and home care, 66

patient record sharing, 81-82, 144

price of Internet services and PCs, 209-210

private networks vs Internet, 44-45

professional education, 282-283

property, urban areas, 210-211

publication of biomedical research, 216

public health surveillance and, 97-98, 101-102

remote consultation via private networks, 74

remotely controlled devices, 76

spot market purchase of health care, 191-192

telemedicine, 184, 204, 287, 302, 303

Cryptography, see Encryption

CT, see Computed tomography

D

Defense Advanced Research Projects Agency, 46, 47, 49, 51, 250, 300

Demographic factors, see Educational attainment; Geographic factors; Language factors, human; Rural areas; Socioeconomic status; Urban areas

Demonstration projects, 15, 19-22, 250, 257-261

Internet 2, ix, 1, 50-51, 52

National Library of Medicine awards, 314-333

payment methods, 221

private sector, 20, 260-261

scalability of protocols, 16-17

testbed networks, 2, 16, 17, 20-21, 28, 47, 250-252, 259, 283-284, 323, 326-327

see also Next Generation Internet

Department of Agriculture, 212, 215

Department of Commerce, 33, 209-210, 212, 225, 226

Bureau of Census, 172-173

Department of Defense, 20, 21, 24, 43, 161, 221, 223, 225, 226, 258, 259, 264, 299

Department of Energy, 43, 46, 49, 225, 226, 250, 299

Department of Health and Human Services, 14, 20, 23, 24-25, 62, 86, 92, 208, 215, 221, 223, 225-227, 255, 257, 259-260, 262-265

Agency for Healthcare Research and Quality (AHRQ), 120, 223, 228, 229, 255

Indian Health Service, 20, 21, 24, 258, 259

see also Health Care Financing Administration; National Institutes of Health; National Library of Medicine

Department of Veterans Affairs, 20, 24, 221, 223, 225, 258, 259, 264

Dermatology, 73, 184, 191, 274, 285, 286, 289, 291, 302

Diabetes, 55 (n. 11), 61, 66, 68, 275

Diagnosis, 8, 37, 48, 106, 306, 321, 322, 326, 328-329, 330. see also Digital images; Specialists

Differentiated services model (diff-serv), 12, 18, 45, 137-140, 143, 151, 251, 252-253

Digital Anatomist, 307-309

Digital divide, 14-15, 71, 125, 195, 209, 210, 211, 245-246

Digital images, 5, 8, 55(n.4), 65, 71, 76-79, 82, 134, 140, 236, 272-274, 300-301, 304-305, 320-321, 323, 328-329, 332

bandwidth, 73-74, 77-79, 80, 123, 134, 136, 162, 164, 240, 244, 272, 288-289, 301-302

biomedical research applications, 114-115, 238

cost factors, 77, 79, 186break

Suggested Citation:"Index." National Research Council. 2000. Networking Health: Prescriptions for the Internet. Washington, DC: The National Academies Press. doi: 10.17226/9750.
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CT scans, 4, 65, 72, 78, 80, 134, 164, 238, 272, 274, 300

Digital Anatomist, 307-309

latency, 115-116

MRI, 4, 72, 77, 80, 113, 134, 238, 248, 272, 274, 284, 328

Next Generation Internet, 48-49, 305-306, 309, 317, 320-321, 323, 324, 326, 329, 331-333

Picture Archiving and Communications System (PACS), 76, 79, 80, 274

telemammography, 48, 78, 79, 142-143, 236, 244, 272-273, 324, 332-333

ultrasound technology, 77, 273, 284, 293, 294, 300, 306

X rays, 4, 36, 65, 74, 78, 80, 84, 113, 134, 164, 238, 244, 294

see also Video and teleconferencing

Digital Millennium Copyright Act, 217

Digital subscriber line services, 132, 164, 165, 166

Disasters, 18, 99-100, 238, 254. see also Terrorism

Discrete multitone, 164, 166

Diseases and disorders, general, ix, 30-31, 34, 57, 98, 182

surveillance, 3, 4, 8, 57, 94-99, 101-102, 238-239, 258, 312-313

see also Chronic illness; Risk factors

Distance education, 6-7, 214, 217-218, 238, 240-241, 249, 261, 266, 280-283, 289-291, 293-298, 306-307, 324

Distance medicine, see Telemedicine

Drugs, 5, 10, 32, 37, 38, 61, 182, 189, 190, 238

clinical trials, 120-121

data security, 11, 71

insurance claims for, 89

intellectual property, 168-169

online ordering, 60, 71, 189, 221

public health surveillance, 8, 97, 98

E

East Carolina University, 72-73, 76, 222, 284-293

E-Biomed, 116

E-commerce, 9, 10-11, 35, 60-61, 85, 179-182, 310

encryption, 63, 71

privacy and, 168

Economic factors, 13, 248, 298-299

market forces, 33-35, 185-186, 191-192

see also Cost and cost-benefit factors; E-commerce; Funding; Health care financing; Socioeconomic status; Underserved areas

Education, professional, see Professional education

Educational attainment, 14, 61, 195, 210

Elderly persons, 83

E-mail, 35, 169, 260-261, 286

anonymous, 169-170, 256

cost factors, 62, 63-64

encryption, 156-157, 167-168, 169, 300

latency, 39

patient/provider exchanges, 14, 22, 37, 62-64, 66, 70, 189, 192, 197, 248, 279, 300

Embryology, 199, 323, 330

Emergency care, 3, 11, 18, 26 (n. 1), 133, 210, 288, 324

data security as impediment to, 144, 159

disasters, 18, 99-100, 238, 254; see also Terrorism

patient records, 81, 83, 144, 159, 160, 206

patient transport, 321, 330

videoconferencing, 4-5

Encryption, 17, 30, 32, 40, 62, 63-65, 70, 79, 145, 147, 150-155, 325

authentication and, 151-153

bioterrorism response, 100

e-commerce, 63, 71

e-mail, 156-157, 167-168, 169, 300

firewalls, 149

home care, 68, 267

in administrative and financial transactions, 91, 172

MINDSCAPE, 302

patient record sharing, 82-83, 84, 292-293

Secure Socket Layer (SSL) encryption, 17, 63, 64, 154-155, 252

time factors, 150-151

European Union, 208-209

Evaluation issues, 15, 19-22, 193, 250, 257-261

biomedical research, 117-118

consumer health information, 61-62, 255-256

e-mail between patients and providers, 62break

Suggested Citation:"Index." National Research Council. 2000. Networking Health: Prescriptions for the Internet. Washington, DC: The National Academies Press. doi: 10.17226/9750.
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quality of information, 2, 14, 61-62, 246-247, 255-256, 292

scalability of protocols, 16-17

technical considerations, 38-41

see also Demonstration projects; Standards

Expert systems, 227, 228-229

Extensible Markup Language (XML), 85, 86, 198, 331

F

FDA Modernization Act, 120

Federal Communications Commission, 211

Federal government, ix, 20-21, 24-25, 29, 96, 202-203, 211-212, 223-227, 254-260

National Aeronautics and Space Administration, 24, 46, 47-48, 49, 221, 250, 283-284, 299, 300

National Center for Biotechnology Information, 109, 111, 117

National Center for Microscopy and Imaging Research, 114-116

National Committee on Vital and Health Statistics, 25, 264, 265

National Institute of Standards and Technology, 46, 47

National Telecommunications and Information Administration, 212

see also Funding; Next Generation Internet; Regulatory issues; Legislation; terms beginning Department of

Financial issues, see Health care financing

Firewalls, 147, 148-150

For the Record: Protecting Electronic Health Information, 204

Foundation for Health Care Quality, 91, 310-311

Funding, 51, 186, 202-203, 223-227, 254, 287-288, 303

certification authorities, 156

clinical research, 120

Department of Health and Human Services, 20, 23, 257-258

distance learning and telemedicine, 214

Next Generation Internet, 46-48

payment mechanisms, 221

remote consultations, 36, 287-288, 301

underserved areas, 211-212, 213-215

workforce study, 262-263

G

Geographic factors, 125, 195

biomedical research, bandwidth, 110

clinical care, 71, 72

Kaiser-Permanente, 275-276

payment policies, 220

professional education, 102, 203; see also Distance learning

see also Home care; Remotely controlled equipment; Rural areas; Ubiquity of access; Underserved areas; Urban areas

Government role, 27. see also Federal government; Legislation; Public health; Public policy; Regulatory issues; State government

H

Hackers, 4-5, 11, 144, 145, 203, 240

anonymous e-mail, 169-170

firewalls, 147, 148-150

viruses, electronic, 145, 160

Health Alert Network, 99, 225

Health care financing, ix, 2, 57, 88-94, 125, 186-187

payment mechanisms, 2, 10, 24, 28, 32, 44, 89-92, 186, 194-195, 219-221, 235, 264

anonymous, 172

encryption, 91, 172

integrated services model, 140-141

patient monitoring, 66-67

secured transactions, 61, 190-191, 205, 242, 243

technical requirements, 4-5, 13, 90-91, 93-94, 238-239

see also Insurance; Medicaid; Medicare

Health Care Financing Administration, 13, 20-21, 89-90, 91-92, 219-221, 225, 258, 264, 286. see also Medicaid; Medicare

Health Care Personal Information Nondisclosure Act, 206

Health Data in the Information Age: Use, Disclosure, and Privacy, 204-205

Health Insurance Portability and Accountability Act, 86, 92, 185, 205, 208break

Suggested Citation:"Index." National Research Council. 2000. Networking Health: Prescriptions for the Internet. Washington, DC: The National Academies Press. doi: 10.17226/9750.
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Health Level Seven (HL7), 84, 85

Health maintenance organizations, 89, 103, 179, 186, 195, 196, 266-267

Health Plan Employer Data and Information Set (HEDIS), 90

Health plans, see Insurance; Managed care; Medicaid; Medicare

Health records, see Patient records

Home care, 57, 66-69, 75, 76, 128 (n. 7), 196, 209, 235, 240, 258, 287-288, 290

bandwidth requirements, 67-68, 71, 267

encryption requirements, 68, 267

patient/provider e-mail exchanges, 14, 22, 37, 62-64, 66, 70, 189, 192, 197, 248, 279, 300

technological issues, 66-68, 267

time factors, 68, 70

video, 129 (n. 9)

vignettes, 29-32, 266-267

see also Telemedicine

Hospitals, 13, 188-189, 287, 290

insurance claims for, 89, 195

integrated delivery networks (IDNs), 35, 44

patient record sharing, 81-82

public health surveillance and, 97-98

see also Emergency care; Surgery

Hypertext transfer protocol, 84, 147, 261

Hypertext markup language (HTML), 86, 104, 196, 290, 295, 296-297

I

Images, see Digital images

Indian Health Service, 20, 21, 24, 258, 259

Infrastructure, see Technological issues

Insurance, 8, 11, 12, 35, 37, 44, 89-90, 186, 195, 238, 247

data security, 11, 145, 240

Health Insurance Portability and Accountability Act, 86, 92, 185, 205, 208

payment mechanisms, 2, 10, 24, 28, 32, 44, 219-221

spot market purchases, 191-192

standards for claims and payments, 92-93, 186, 219-221

see also Health maintenance organizations; Managed care; Medicaid; Medicare

Integrated Advanced Information Management Systems program, 300

Integrated delivery networks (IDNs), 35-36, 44, 79, 179

Integrated services digital networks (ISDN), 74, 287, 288, 289, 290, 304

Integrated services model (int-serv), 12, 17, 18, 45, 137, 140-141, 142, 251, 253

Intellectual property, 14, 24, 99, 168-169, 188-189, 196, 202, 204, 215-218

access controls, 159

biomedical research databases, 110-111, 249, 307

educational materials, 14, 217-218, 249, 307

pharmaceutical companies, 168-169

Internet Engineering Task Force, 12, 18, 45-46, 138, 141, 143, 153, 174, 252-253, 254

Internet Protocol (IP), 42, 49, 140, 161-162, 260-261, 291, 294, 305

Internet Protocol Security (IPSec), 17, 150, 153-154, 251-252

Internet 2, ix, 1, 50-51, 52

J

Johns Hopkins University, 60

Joint Photographic Experts Group (JPEG), 286

Joint Working Group of Telemedicine/Telehealth, 224

K

Kaiser-Permanente of Northern California, 184, 196, 274-280

L

Language factors, human, 119-120, 266-267

Latency, 9, 39-40, 123, 124, 134, 136, 240

administrative and financial applications, 93

biomedical research, 122

clinical care, 81-83, 87-88, 124

consumer health applications, 62, 69-70, 279

defined, 10, 39break

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emergency care, 133

guaranteed, 134-135

imaging, 115-116

professional education, 107, 124

public health, 100

satellite telecommunications, 167

Legislation, 58, 91, 205-208

Balanced Budget Acts, 92, 219, 220-221, 224

Collections of Information Antipiracy Act, 218

Communications Act of 1934, 211

Comprehensive Telehealth Act, 224

Digital Millennium Copyright Act, 217

European Union, 208-209, 218

FDA Modernization Act, 120

Health Care Personal Information Nondisclosure Act, 206

Health Insurance Portability and Accountability Act, 86, 92, 185, 205, 208

Medical Information Privacy and Security Act, 206-207

Medical Information Protection Act, 206

Privacy Act, 207

Public Health Service Act, 224

Telecommunications Act of 1996, 211

Triple-A Rural Health Improvement Act, 224

Licensing of health care providers, 14, 24, 105, 186, 189, 221-223, 224, 267

Litigation, malpractice, 14, 221-223, 263

Local area networks (LANs), 33, 67, 79, 80, 104, 137, 153, 154, 284

firewalls, 147, 148-150

images, 80, 301

Internet Protocol Security, 153

Local communities, 38, 312

bioterrorist response, 99-100

health care claims and payments, 90

professional education, 104

public health surveillance, 96

Local multipoint distribution system technology, 166-167

Louisiana State University Medical Center, 317-318

M

Magnetic resonance imaging, 4, 72, 77, 80, 113, 134, 238, 248, 272, 274, 284, 328

Malpractice, 14, 221-223, 263

Mammography, 48, 78, 79, 142-143, 236, 244, 272-273, 324, 332-333

Managed care, 11, 35, 95, 179, 182, 183-184, 186, 190, 191, 195, 244, 247

efficiency and cost-effectiveness efforts, 59, 89

integrated delivery networks (IDNs), 35

see also Health maintenance organizations

Medicaid, 13, 21, 89, 264

Medical Information Privacy and Security Act, 206-207

Medical Information Protection Act, 206

Medical records, see Patient records

Medicare, 13, 21, 89-90, 219-220, 223, 224, 225, 264

Medications, see Drugs

MEDLARS, 33, 55 (n. 5), 135

MEDLINE, 3, 33, 37, 55 (n. 5), 103-104, 109, 110, 215, 295, 301, 307

Medtronic Inc., 66

Microsoft Corp., 66, 210, 291

Microwave technology, 74, 166, 289, 290

MINDSCAPE, 300, 301-302, 306

MRI, see Magnetic resonance imaging

Multicast protocols, 7, 49, 50, 119, 143-144, 176, 240, 283, 284

N

National Aeronautics and Space Administration, 24, 46, 47-48, 49, 221, 250, 283-284, 299, 300

National Cancer Institute, 120-121, 273, 301

National Center for Biotechnology Information, 109, 111, 117

National Center for Microscopy and Imaging Research, 114-116

National Committee on Vital and Health Statistics, 25, 264, 265

National Emergency Medicine Information Extranet, 316

National Heart Attack Alert Program, 128 (n. 7)

National Health Alert Network, 99-100

National Institute of Standards and Technology, 46, 47

National Institutes of Health, 19, 20-21, 46, 47, 116, 120-121, 216, 223, 225, 226, 228-229, 255-257, 258, 264break

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National Laboratory for the Study of Rural Telemedicine, 74

National Library of Medicine (NLM), 15, 16, 18-19, 254, 255, 258, 263

clinical transaction standards, 84

demonstration project awards (NGI), 314-333

Integrated Advanced Information Management Systems program, 300

MEDLARS, 33, 55 (n. 5), 135

MEDLINE, 3, 33, 37, 103-104, 109, 110, 215, 295, 301, 307

Next Generation Internet, 46-47, 305-306, 314-333

public health initiative, 95

National Museum of Health and Medicine, 330

National Network of Libraries of Medicine, 95

National Science and Technology Council, 46

National Science Foundation, 46, 47-49, 50-51, 111, 225, 226, 250

National Telecommunications and Information Administration, 212

Native Americans, Indian Health Service, 20, 21, 24, 258, 259

Naval Research Laboratory, 171

Network availability, see Availability; Ubiquity of access

Network Data Express, 309

Networked 3D Virtual Human Anatomy, 315

Neurology, 73, 74, 112, 131 (n. 38), 158, 272, 274, 284, 285, 289, 308-309, 319-320, 328

Next Generation Internet, ix, x, 1-2, 16-18, 28, 46-49, 52, 291, 305-306, 312, 318-333 (passim)

authentication, 17-18

bandwidth, 16, 49, 250-251

clinical care, 48, 319

data security, 17, 251-252

digital images, 48-49, 305-306, 309, 317, 320-321, 323, 324, 326, 329, 331-333

Internet 2 and, 50-51

security, 17, 312, 317-318

telemedicine, 48, 318-319, 321, 324, 327-328, 332-333

testbed networks, 2, 16, 17, 20-21, 28, 47, 250-252, 259, 323, 326-327

video and teleconferencing, 48-49, 306

O

Office of the Future, 293-294

Onion routing, 171-172

Open Systems Interconnection model, 146

Organizational factors, 13-14, 15-16, 25, 28-29, 37-38, 58, 178-201, 204-205, 236, 244-245, 247-248, 265, 310-311

barriers, external, 185-187

barriers, internal, 187-189, 194, 262

clinical care, 182-184, 188, 189, 192, 195, 196

consumer health, 9, 10-11, 179-182, 183, 191, 195

costs, 59, 179-180, 184, 185, 186-187, 194-195, 196

data security, 38, 43, 147, 159, 203-205, 253

firewalls, 147, 148-150

information systems staff requirements, 14, 23, 196-199, 227-230, 260, 261-263, 298-299

integrated delivery networks (IDNs), 35-36

Kaiser-Permanente, 184, 196, 274-280

leadership, 197-199, 227

patient records, 82-83, 182-183

public health decision making, 98

Web hosting, 162

see also Administrative support; Health care financing; Insurance; Managed care

Overprovisioning, 137, 138-139

P

Partners in Information Access, 95

PathMaster, 328-329

Patient records, 4-5, 10, 20, 34, 57, 64-65, 70, 71-72, 80-87, 94, 194-195, 197, 236, 262, 264, 301, 320-321, 325

audit capabilities, 19, 83, 159, 207, 242, 256, 297, 302

availability needs, 11, 30, 64-65, 124, 133

e-mail, incorporation into, 64break

Suggested Citation:"Index." National Research Council. 2000. Networking Health: Prescriptions for the Internet. Washington, DC: The National Academies Press. doi: 10.17226/9750.
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in emergency care, 81, 83, 144, 159, 160, 206

organizational factors, 82-83, 182-183

professional education and, 106

public health workers use of, 94

quality of service needs, 134, 164

standards, 84-86, 129 (n. 17), 186, 188

see also Data security; Privacy

Patient-Centered Access Secure Systems (PCASSO), 65

Pharmaceuticals, see Drugs

Physical fitness and exercise, see Exercise

Picture Archiving and Communications System (PACS), 76, 79, 80, 274

Pilot projects, see Demonstration projects

Platform for Internet Content Selection, 62

Policy issues, see Public policy

President's Information Technology Advisory Committee, 229

Pretty Good Privacy (PGP), 63, 150, 152, 156-157, 313

Preventive care, see Risk factors

Primary care physicians, 13, 30, 31, 61, 191, 220

certification authorities, 155-156

Prison telemedicine, 72, 76, 215, 286-287, 289, 290

Privacy, 2, 5, 15, 24, 28, 38, 40, 56, 61, 68, 153, 167-173, 186, 193, 205-206, 235, 264, 310

and home care, 68

in financial and administrative transactions, 90-91

patient records, 64, 65, 68, 82-84, 124, 242, 249, 256, 262, 279, 292-293, 300, 310, 316-317, 324-325, 332-333

encryption, 82-83, 84, 292-293

public policy, 203-209, 212, 214, 262

see also Pretty Good Privacy; Security

Privacy Enhanced Mail, 152

Private networks, 34, 41, 43-45, 74, 154, 297. see also Local area networks

Private sector, general, ix, 50-51, 264

biomedical research databases, 109-110

demonstration projects, 20, 260-261

protocols, 21-22

regulatory issues, 14, 25, 205, 207-208

see also Insurance; Internet 2; Managed care

Professional education, 2, 3, 6-7, 14, 15, 22-23, 28, 57, 102-108, 240-241, 261-263, 315-316

and intellectual property, 14, 217-218, 249, 307

availability, 107-108, 240

bandwidth needs, 104, 105, 107, 123, 126, 240, 281, 282, 290-291, 297-298

continuing education, 105-107, 322

cost factors, 282-283

data security for, 108

distance education, 6-7, 214, 217-218, 238, 240-241, 249, 261, 266, 280-283, 289-291, 293-298, 306-307, 324

graduate education, 102-105, 322

information systems staffs, 14, 23, 227-230, 261-263

latency needs, 107, 124

Next Generation Internet, 48-49, 318, 319, 322

remotely controlled apparatus, 113-114

simulations, 103, 104-105, 123, 124, 250, 293-294, 320, 329

ubiquity of access, 108, 240

video and teleconferencing, 6-7, 104, 106, 240-241, 266, 273, 280-283, 290, 291, 293-294, 297-298, 315, 325

Proprietary information, see Intellectual property

Protocols, 21-22, 34, 42, 45, 55-56 (n. 15), 244, 260-261

authentication, 150, 151-156

demonstration projects, scalability, 16-17

hypertext transfer protocol, 84, 147, 261

Internet Protocol (IP), 42, 49, 140, 161-162, 260-261, 291, 294, 305

Internet Protocol Security (IPSec), 17, 150, 153-154, 251-252

latency and, 39-40

multicast, 7, 49, 50, 119, 143-144, 176, 240, 283, 284

quality of service protocols, 12, 18, 45, 132, 135-141, 142, 143, 251, 252-253

scalability of, 16-17, 32, 48, 72, 140, 252-253, 320-321break

Suggested Citation:"Index." National Research Council. 2000. Networking Health: Prescriptions for the Internet. Washington, DC: The National Academies Press. doi: 10.17226/9750.
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security, 17, 49, 63, 150-157, 251-252; see also Encryption

Transmission Control Protocol, 39-40, 42, 136-137, 260-261

Public health, ix, 1, 2, 27, 36-37, 58, 94-102

and data security, 98-99, 101

Centers for Disease Control and Prevention, 95, 96, 99-100, 225, 264, 312-313

cost savings, 97-98, 101-102

privacy and, 169

standards for, 101-102, 186

state government and, 95, 96, 97

surveillance, 3, 4, 8, 57, 94-99, 101-102, 238-239, 258, 312-313

technical requirements for, 4-5, 100-102, 238-239

ubiquity of access, 101-102

video and teleconferencing needs, 4-5, 238-239, 100

Public Health Service Act, 224

Public key infrastructure, 17, 63, 64, 152-156, 252, 264, 275, 276-277

Public policy, 14-15, 23-25, 29, 202-234, 236, 248-249, 263-265

consumer health security, 70

data security, 151-152, 203-209, 212, 214, 225, 264

privacy, 203-209, 212, 214, 262

see also Federal government; Intellectual property; Legislation; Regulatory issues; State government; cross-references under Demographic Factors

PubMed Central, 216

Q

Quality of health care, general, 28, 191, 236

Quality of information, 2, 14, 61-62, 246-247, 255-256, 292

Quality of service (QOS), 10, 12, 15, 16-17, 19, 41, 45-46, 51, 132, 133-144, 173, 235-236, 237, 243-245, 254, 256-257, 259, 293, 297-298, 331

availability of network, 160

defined, 10, 41, 55 (n. 14)

guarantees, 18, 41, 134-135, 140, 141, 142, 253-254, 256-257

Next Generation Internet, 46, 49, 251

overprovisioning, 137, 138-139

patient records, 134, 164

private networks vs Internet, 43, 44, 45

private sector, other, 50

protocols, 132, 134-144

bandwidth, 132, 135-138

diff-serv / int-serv, 12, 18, 45, 137-141, 142, 143, 251, 252-253

QOS policy, 141-143

recommendations related to, 16-18, 251-253

research needed, 17-18, 252-253

video and teleconferencing, 133, 134

virtual overlay networks, 141

see also Differentiated services model (diff-serv); Evaluation issues; Integrated services model (int-serv); Standards

R

Realizing the Information Future: The Internet and Beyond, 204

Regence BlueShield, 309-313

Regulatory issues, 186, 202, 219-223, 248-249, 263

insurance, 56 (n. 16)

licensing of health care providers, 14, 24, 105, 186, 189, 221-223, 224, 249, 267

malpractice, 14, 221-223, 263

privacy and security, 14, 25, 205, 207-208

public health surveillance and, 98

see also Intellectual property; Legislation; Standards

Remotely controlled equipment, 3, 4-7, 20, 36, 39, 68-69, 70, 75-76, 113-116, 121, 128 (n. 7), 133, 209, 235, 236, 240, 243, 247, 253-254, 266-267, 331

Next Generation Internet, 46, 48-49, 331

Remote, Real-time Simulation for Teaching Human Anatomy and Surgery, 320

Research, 15, 29, 174, 223-227

Department of Health and Human Services, 24-25

National Institutes of Health, 19

National Library of Medicine role, 18-19break

Suggested Citation:"Index." National Research Council. 2000. Networking Health: Prescriptions for the Internet. Washington, DC: The National Academies Press. doi: 10.17226/9750.
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network availability, 161-162

see also Biomedical research; Demonstration projects; Evaluation issues; Funding; Internet 2; Next Generation Internet

Risk factors, 3, 31, 34, 58, 59, 60, 95-96, 274, 288

Robert Wood Johnson Foundation, 156, 310

Rural areas, ix, 6, 48, 72, 74, 77, 96, 103, 104, 120, 195, 209, 210, 211-212, 213-214, 215, 220, 222, 224, 236, 240, 245-246, 300, 315, 321

Rural Health Science Education, 315

S

Satellite telecommunications, 166-167, 300. see also National Aeronautics and Space Administration

Scalability, 16-17, 32, 48, 72, 140, 252-253, 320-321. see also Bandwidth

Science Applications International Corp., 65

Seattle/Pacific Northwest GigaPOP, 305

Secure/Multipurpose Internet Mail Extension (S/MIME), 157

Secure Radiologic Collaboration on the Next Generation Internet, 318

Secure Socket Layer (SSL) encryption, 17, 63, 64, 154-155, 252

Security, ix, 9-11, 15, 17, 22, 28, 29, 40, 45, 46, 123, 124, 136, 144-162, 167-173, 186, 193, 235, 237-243, 262, 310, 322-323

access controls, 64-65, 145, 157-160, 242-243, 256, 302

attribution/nonrepudiation, 146

authentication, 17-18, 63-65, 70, 145, 253, 279, 297

confidential e-mail, 156-157

cost factors, 144, 279

defined, 10

firewalls, 147, 148-150

for digital images, 79

for patient records, 64, 65, 68, 92-84, 124, 242, 249, 256, 262, 279, 292-293, 300, 310, 316-317, 324-325, 332-333

encryption, 82-83, 84, 292-293

in biomedical research, 110-111, 122, 159, 316

in clinical care, 65, 68, 82-84, 88; see also for patient records supra

in clinical trials, 121

in consumer applications, 61, 63, 64-65, 68, 70-71, 238-239

in e-mail between patients and providers, 63, 66, 300

in emergency care, 144, 159

in financial and administrative transactions, 61, 90-92, 94, 145, 172, 190-191, 205, 240, 242, 243

in home care, 68

in private networks, 34, 41, 43-44, 74, 154, 297

in professional education, 108

in responding to bioterrorist attacks, 99-100

information warfare, 4

Internet Protocol Security (IPSec), 17, 150, 153-154

network availability, 6, 9-11, 160-162

Next Generation Internet, 49

on consumer Web sites, 61, 64-65, 249

organizational factors, 38, 42, 147, 159, 203-205, 253; see also firewalls supra

perimeter control, 146

protocols, 32, 48, 72, 140, 252-253, 320-321

public health information, 98-99, 101

public key infrastructure, 17, 63, 64, 152-156, 252, 264, 275, 276-277

public policy, 151-152, 203-209, 212, 214, 225, 264

recommendations regarding, 16-17, 251-253

regulatory issues, 14, 25, 205, 207-208

rural areas, 48

Secure Socket Layer (SSL) encryption, 17

Transport layer security, 154-156

see also Authentication; Encryption; Intellectual property; Privacy

SHINE project, 130 (n. 31)

Simulations

biomedical research, 112-113, 118, 320

professional education, 103, 104-105, 123, 124, 250, 293-294, 320, 329

Smart cards, 17-18, 30break

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Socioeconomic status, 95

digital divide, 14-15, 71, 125, 195, 209, 210, 211, 245-246

Southern Governors' Association, 223

Specialists, 8, 11, 13, 76-77, 82, 182, 184, 191

consultations, 6, 8-9, 16, 17, 18, 20, 30-33, 36, 57, 71, 72-76, 88, 220-221, 228-229, 236-237, 238-239, 244, 247, 258, 266-267, 280, 285-286, 288-289, 292, 323

see also specific specialities

Standards, 186, 188, 194, 196, 238, 280, 286, 292, 310

clinical practice standards/guidelines, 4, 14, 22, 57, 238-239, 275, 278

discrete multione, 164, 166

distance education, intellectual property, 218

insurance claims and payments, 92-93, 186, 219-221

patient records, 84-86, 129 (n. 17), 186, 188

public health, 101-102, 186

quality of service guarantees, 18, 41, 134-135, 140, 141, 142, 252-253, 256-257

see also Protocols; Regulatory issues

Stanford University, 130, 131, 280-283, 329

State government, 317-318

insurance regulation, 56(n.16)

licensing of health care providers, 14, 24, 105, 186, 189, 221-223, 224, 249, 267

malpractice, 14, 221-223, 263

public health surveillance, 95, 96, 97

Washington State Laboratory Reporting Project, 312-313

Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI) Rural Telemedicine Network, 300, 302-303, 306-307

see also terms beginning University of

SUPERNET, 49

Support groups, ix, 4, 60, 61, 196, 238. see also Chat groups

Surgery, 3, 4-5, 8, 36, 71, 105, 123, 124, 238, 244, 250, 294, 316, 320, 323, 329

Synchronous Optical Network equipment, 135, 146

T

Technology Opportunities Program, 212, 213-214

Teleconferencing, see Video and teleconferencing

Telemammography, 48, 78, 79, 142-143, 236, 244, 272-273, 324, 332-333

Telemedicine, 21, 47, 52-53, 56, 69, 71, 186, 189, 197, 209, 224, 235, 236, 243, 248-249, 259, 300, 321

chat groups, ix, 5, 60, 191, 192-193, 196, 238, 261, 290

Comprehensive Telehealth Act, 224

costs, 184, 204, 287, 302, 303

defined, 56

funding, 214

licensing of health care providers, 14, 24, 105, 186, 189, 221-223, 224, 249, 267

malpractice, 14, 221-223, 263

Next Generation Internet, 48, 318-319, 321, 324, 327-328, 332-333

payment policies, 219-220

prisons, 72, 76, 215, 286-287, 289, 290

private sector (Internet 2), 50

remote consultations, 6, 8-9, 16, 17, 18, 20, 30-33, 36, 57, 71, 72-76, 88, 220-221, 236-237, 238-239, 244, 247, 258, 266-267, 280, 285-286, 288-289, 292, 323

site visits by committee, 280, 284-289, 290

support groups, ix, 4, 60, 61, 196, 238

telemammography, 47, 78, 79, 142-143, 236, 244, 272-273, 324, 332-333

ultrasound technology, 77, 273, 284, 293, 294, 300, 306

vignettes, 29-32, 266-267

Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI) Rural Telemedicine Network, 300, 302-303

see also Home care; Remotely controlled equipment

Telemedicine: A Guide to Assessing Telecommunications in Health Care, 204

Telequest, 77

Teletrauma and the NGI, 324

Terrorism, 4-5, 99, 100, 101, 225, 238break

Suggested Citation:"Index." National Research Council. 2000. Networking Health: Prescriptions for the Internet. Washington, DC: The National Academies Press. doi: 10.17226/9750.
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Testbed networks, 16, 17, 20-21, 28, 47, 250-252, 259, 283-284, 323, 326-327

3Com Corp., 210

Time factors, 11, 28, 184, 240

bandwidth, impacts of increases in Internet use, 136

continuing medical education, 107

e-mail responses, 22, 63

encryption/decryption, 150-151

home care, 68, 70

image transmission, 78

see also Availability; Bandwidth; Latency

Token-based authentication, 17-18, 83, 84

Transmission Control Protocol, 39-40, 42, 136-137, 260-261

Transport layer security, 150, 154-156

Transport of patients, 321, 330

Triple-A Rural Health Improvement Act, 224

U

Ubiquity of access, 9, 12, 15, 38, 40-41, 71, 88, 124-126, 195, 235, 238, 245-246

administrative and financial applications, 94

biomedical research, 122-123

defined, 10, 40

digital divide, 14-15, 71, 125, 195, 209, 210, 211, 245-246

patient records, 65

professional education, 108, 240

public health, 101-102

underserved areas, ix, 14, 210-212; see also Rural areas

see also Bandwidth

Ultrasound technology, 77, 273, 284, 293, 294, 300, 306

UNCLE system, 295, 297

Underserved areas, ix, 14, 72, 210-212

Unified medical language system, 84-85

Universal Resource Locators (URLs), 170-171, 295, 298

Universal Service Administration Company, 211-212, 213

Universal Service Fund, 211, 215

University Consortium for Advanced Internet Development, 46, 50-51

University of California, 65, 76, 77, 272-274

University of Iowa, 74

University of North Carolina, 293-298

University of Washington, 298-309

Urban areas, 72, 96, 103, 120, 176, 195, 210-211, 220, 245-246

URLs, see Universal Resource Locators

V

Very high performance Backbone Network Service (vBNS), 49, 51, 115, 116, 284, 294, 299

Video and teleconferencing, 3, 4-7, 71, 74, 75, 129(n.10), 179, 220, 238-239, 240-241, 273, 304-305, 315, 321, 326

bandwidth, 11, 73-74, 100, 132-133, 240, 244, 290

Biomedical Teleimmersion, 316

bioterrorism response, 100

consumer use of, 30-31, 266, 288

home care, 129(n.9)

image transmission and, 78, 115-116

Next Generation Internet, 48-49, 306

professional education, 6-7, 104, 106, 240-241, 266, 273, 280-283, 290, 291, 293-294, 297-298, 315, 325

public health, 4-5, 238-239, 100

quality of service, 133, 134

see also Digital images; Simulations

Viruses, electronic, 145, 160. see also Firewalls; Hackers

W

Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI) Rural Telemedicine Network, 300, 302-303, 306-307

Wavelength division multiplexing technology, 135

WebTV, 210, 291

Western Governors' Association, 222

World Wide Web Consortium, 62

World Wide Web Electronic Medical Record System, 81-83

X

X rays, 4, 36, 65, 74, 78, 80, 84, 113, 134, 164, 238, 244, 294

XML, see Extensible Markup Language

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Networking Health: Prescriptions for the Internet Get This Book
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Consumer health websites have garnered considerable media attention, but only begin to scratch the surface of the more pervasive transformations the Internet could bring to health and health care. Networking Health examines ways in which the Internet may become a routine part of health care delivery and payment, public health, health education, and biomedical research. Building upon a series of site visits, this book:

  • Weighs the role of the Internet versus private networks in uses ranging from the transfer of medical images to providing video-based medical consultations at a distance.
  • Reviews technical challenges in the areas of quality of service, security, reliability, and access, and looks at the potential utility of the next generation of online technologies.
  • Discusses ways health care organizations can use the Internet to support their strategic interests and explores barriers to a broader deployment of the Internet.
  • Recommends steps that private and public sector entities can take to enhance the capabilities of the Internet for health purposes and to prepare health care organizations to adopt new Internet-based applications.
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