Networking Health Prescriptions for the Internet (2000) / Chapter Skim
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Executive Summary
Executive Summary
Pages 1-26
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to request a study by the Computer Science and Telecommunications Board of the National Research Council that would evaluate the technical capabilities demanded by health applications of the Internet. As the health community's primary representative in the NGI initiative and a longtime supporter of R&D focusing on health applications of informa1
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It draws on a series of visits by members of the committee to organizations that are actively designing, developing, and in some cases operating networked applications. It identifies the technical capabilities that these applications demand of supporting networks and makes recommendations regarding the capabilities that need to be deployed to enable the health community to take fuller advantage of the Internet.
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; control remote medical or experimental equipment; search for needed information; and support collaboration, in real time, among members of the health community (Table ES.1~. For example, the Internet could do the following: · Enable consumers to access their health records, enter data or information on symptoms, and receive computer-generated suggestions for improving health and reducing risk; · Allow emergency room physicians to identify an unconscious patient and download the patient's medical record from a hospital across town; · Deliver care instructions to a traveling businessperson who begins to feel chest pains while in a hotel room; · Enable homebound patients to consult with care providers over real-time video connections from home, using medical devices capable of transmitting information over the Internet; · Support teams of specialists from across the country who wish to
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Sending periodic or hospit reports on health conditions to a care provider. Clinical care Remote medical Transfer of medical Remote and virtual Practice consultations records and images surgery (a long- Searches between clinician (e.g., X rays, MRI, term possibility professio and patient or CT scans)
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formulary. Access to published Videoconferencing Security to ensure confidentiality literature and research among public and integrity of laboratory reports results as well as health officials and other public health epidemiological data.
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. Transmission Static File Transfer Remote Control Informati and Retrim Professional Distance education: Accessing electronic Simulations of Accessing education either real-time medical records from surgical procedures.
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Low latency to accommodate remote control of equipment.
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While today's demonstration programs hint at the kinds of capabilities that will be needed in the future, the evolutionary path of health applications of the Internet is unclear. Will, for instance, remote medical consultations become viable between any patient and any care provider connected to the Internet, or will this capability remain more localized in its reach and limited to patients and providers in the same health plan?
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But in communicating with Internet researchers and technology developers, the health community (i.e., all those active in healthrelated activities, such as provision of care, public health, professional education, and biomedical research) can call attention to its need for particular attributes, and it can point out the characteristics of the health sector that differentiate its needs from those of sectors such as entertainment, defense, or finance.
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For example, the exchange of electronic medical records, payment data, or prescription information demands that the identities of both the sender and recipient of the data be validated (authenticated) with high levels of assurance.
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High levels of availability are needed in mission-critical applications in many industries, and similar needs obtain in health: if insurance companies and managed care organizations are to rely on the Internet for claims processing, referrals to specialists, or checks on eligibility for particular services, they must be sure the network will be running when needed and that data will not be corrupted. But the health sector's need for high levels of network availability to and from a large number of possible locations can also be greater than in other sectors, because health, well-being, and even life may be at stake.
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The decentralized structure of the health industry makes it hard for health organizations to come up with viable business models whereby they can pay ISPs to deploy the kinds of QOS they need. Almost any solution to this problem will require the participation of the insurance companies and other third-party payers who finance health care in the United States.
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Although Internet applications have been demonstrated to improve efficiency in some applications run across enterprises, Internet technology is still fairly new and untested in health care applications, making evaluations and comparisons difficult and prompting caution in the pursuit of Internet strategies. Evaluating the costs and benefits of health applications of the Internet is made more difficult by the uncertainties surrounding the effects of Internet-based communications on relationships among the numerous entities involved in health care.
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Uncertainties over evolving federal regulations for the privacy and security of electronic health information continue to deter organizations from implementing systems for sharing health records or administrative and financial information across the Internet. Other issues, such as the protection of intellectual property contained in materials developed for educational purposes, affect a broad base of constituents, including some in the health community.
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This can be done by deploying the technologies that will soon be available for improving security, availability, QOS, and ubiquity across the Internet and by continuing to research and develop improved capabilities over the long term. Efforts must also be made to ensure that the health community's needs are relayed to the networking research community and that advances are made in complementary technologies that will enable health organizations to take advantage of the networking infrastructure.
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The health community should ensure that technical capabilities suitable for health and biomedical applications are incorporated into the testbed networks being deployed under the Next Generation Internet initiative and eventually into the Internet. As a first step toward enhancing the Internet to support health applications, the health community should push to have the capabilities described below deployed in the testbed networks being constructed under the federal government's NGI initiative.
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To ensure that the Internet evolves in ways supportive of health needs over the long term, the health community should work with the networking community to develop improved network technologies that are of particular importance to health applications of the Internet. Continued research will be needed to make the Internet even more capable of supporting health and other applications in the long term.
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Recommendation 1.3. The National Library of Medicine should forge stronger links between the health and networking research communities to ensure that the needs of the health community are better understood and addressed in network research, development, and deployment.
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Recommendation 1.4. The National Institutes of Health and its component agencies should fund information technology research that will develop the complementary technologies that are needed if the health community is to take advantage of the improved networking technologies that can be expected in the future.
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Demonstrations will serve as venues for continued identification of technical needs that the networking community can address and other problems and issues for the health community to resolve. The process will be increasingly important to the health community if it is to establish a dialog with the Internet community about evolving needs and technical requirements and if it is to leverage that dialog to grow capabilities from the confines of a demonstration to widespread deployment.
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Health organizations in industry and academia should continue to work with the Department of Health and Human Services to evaluate various health applications of the Internet in order to improve understanding of their effects, the business models that might support them, and impediments to their expansion. Work is needed to evaluate the effectiveness of different forms of Internet-based health care and to compare their effectiveness against applications run across different network infrastructures.
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The Internet promises to radically transform the provision of health care and the education of health professionals, and organizations that fail to take steps now may find themselves ill prepared when improved Internet technologies become available. To make better use of the Internet, health care organizations will also have to learn how to evaluate the benefits of Internet technologies and develop effective policies for guiding their use, just as they had to learn how to use earlier and more localized forms of information technology, an effort in which the health care system is still lagging.
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Educational outreach programs would create a more receptive audience for new technologies. Academic health centers and professional associations have unique capabilities to educate members of the health community.
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Ensuring that the Internet evolves in ways that meet the needs of the health care community and enabling the health sector to better take advantage of these capabilities will require the continuous coordination of many independent activities and stakeholders in the public and private sectors. The concerns and needs of the health community must be reflected in efforts to resolve national policy issues such as intellectual property protection, privacy, and access to information infrastructure, and specific efforts are needed to ensure that policy issues of concern only to the health community, such as licensure of care providers, payment policies, federal funding for health informatics research, and the supply of health information technology workers, are addressed.
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Additional work will be needed to identify other networking technologies of interest to the health community and to ensure that related information technology needs are met. This report prescribes the actions needed now to develop a truly healthy Internet in the future.
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NOTES 1. As an example, a large number of individuals may have legitimate needs to review a patient's medical records, making the determination of access rules extremely complicated.
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