Page 345
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
remotely controlled medical devices, 69
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
Page 346
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
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 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
National Health Alert Network, 99-100
Next Generation Internet, 16, 49, 250-251
overprovisioning, 137, 138-139
private networks, 43
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
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
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
Page 347
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
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
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
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
Page 348
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
demonstration projects, 257
electronic publishing, 216
integrated delivery networks (IDNs), 35-36
integrated services models, 140-141
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
National Library of Medicine awards, 314-333
payment methods, 221
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
Page 349
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
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
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
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
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
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
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-mail, 156-157, 167-168, 169, 300
firewalls, 149
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
Page 350
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
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
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
biomedical research, bandwidth, 110
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
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
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
Page 351
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
video, 129 (n. 9)
see also Telemedicine
Hospitals, 13, 188-189, 287, 290
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
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
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
Page 352
emergency care, 133
guaranteed, 134-135
imaging, 115-116
professional education, 107, 124
public health, 100
satellite telecommunications, 167
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
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
Internet Protocol Security, 153
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
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
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
MEDLINE, 3, 33, 37, 55 (n. 5), 103-104, 109, 110, 215, 295, 301, 307
Medtronic Inc., 66
Microwave technology, 74, 166, 289, 290
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
Page 353
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
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
digital images, 48-49, 305-306, 309, 317, 320-321, 323, 324, 326, 329, 331-333
Internet 2 and, 50-51
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
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
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
Page 354
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
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
Next Generation Internet, 48-49, 318, 319, 322
remotely controlled apparatus, 113-114
simulations, 103, 104-105, 123, 124, 250, 293-294, 320, 329
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
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
Page 355
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
Centers for Disease Control and Prevention, 95, 96, 99-100, 225, 264, 312-313
privacy and, 169
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
guarantees, 18, 41, 134-135, 140, 141, 142, 253-254, 256-257
Next Generation Internet, 46, 49, 251
overprovisioning, 137, 138-139
private networks vs Internet, 43, 44, 45
private sector, other, 50
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
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
Page 356
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
defined, 10
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 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
Page 357
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
distance education, intellectual property, 218
insurance claims and payments, 92-93, 186, 219-221
patient records, 84-86, 129 (n. 17), 186, 188
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
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
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
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
Page 358
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
encryption/decryption, 150-151
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
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
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
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
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