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

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



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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 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

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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 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

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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 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

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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 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

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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 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

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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 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

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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 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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Page 352 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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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 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

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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 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

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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 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

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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 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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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 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

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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 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