Networking Health Prescriptions for the Internet (2000) / Chapter Skim
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5. Issues for Public Policy
5. Issues for Public Policy
Pages 202-234
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From page 202... ...
This chapter examines six policy issues that influence the use of the Internet in support of health objectives: the protection of personal health information, access to information infrastructure, the protection of intellectual property contained in educational and reference materials, regulatory issues associated with the electronic delivery of medical services, federal support for health informatics research, and human resources.
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From page 203... ...
These issues will need to be resolved if the benefits of the Internet are to accrue to the health community. PROTECTION OF PERSONAL HEALTH INFORMATION Technology is, to a large extent, both the cause of and the solution to concerns about the protection of personal health information.
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Numerous bills have been introduced in both houses of the U.S. Congress relating to the use of medical records and personal health information (Box 5.2)
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necessary to accomplish the relevant purpose." 3 These regulations represent a significant step forward in the protection of personal health information and should reduce some of the uncertainty regarding allowable exchanges of health information and minimum levels of security protection. Other issues remain to be addressed, however, because the regulations were limited in several ways by the nature of the HIPAA legislation.
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From page 208... ...
has been reluctant to specify and implement a unique patient identifier before a consensus is reached on the larger issue of protecting personal health information, but it is evaluating several alternatives.4 The outcomes of these initiatives will have long-ranging effects on the health care providers, payers, and delivery systems that must implement the recommendations. International actions may further affect the ways in which personal health information is transmitted over the Internet.
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From page 209... ...
and European consumer organizations agree that neither the industry self-regulation nor the safe harbor proposal would provide adequate privacy protection for consumers.6 How this issue will be resolved is unclear. ACCESS TO INFORMATION INFRASTRUCTURE The promise of the Internet in health applications is related to its ability to interconnect the diverse members of the health communitycare providers, insurers, consumers, researchers, educators, and othersin a dynamic fashion that allows the sharing of information and resources in response to changing needs and affiliations.
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From page 210... ...
Less expensive products like these could help overcome some of the existing economic barriers to Internet access. Despite these trends, the marketplace may not ensure equitable access to information infrastructure across demographic lines.
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, under the direction of the Federal Communications Commission, now operates three programs that can support Internet connections: the High Cost and Low Income Program, the Rural Health Care Program, and the Schools and Libraries Program. Each of these programs provides affordable access to modern telecommunications services for schools, libraries,
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From page 212... ...
Projects funded for 21 months or longer were more likely to have expanded to serve additional end users than were short-term projects, evidence of the need for longer-term support. Ironically, the DHHS does not, itself, have ongoing programs to ensure Internet access for care providers, consumers, or other members of the health community.
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Could the same economic principle that makes telemedicine an affordable solution for prison health care also apply to home-based telemedicine services? Greater involvement by DHHS and others in these initiatives may be necessary to ensure that Internet access programs meet the needs of all parties in the health community, including consumers.
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From page 216... ...
If implemented as proposed, the site would alter the way scientific information is exchanged among colleagues, bring biomedical research reports within easy reach of consumers, and raise additional questions about the best way for universities to manage and market intellectual property. Electronic publishing whether it be article preprints posted on PubMed Central, laboratory data deposited in international scientific databases, or a research set of health outcomes information (scrubbed of personal identifiers)
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From page 217... ...
For many years, a large group of stakeholders participated in the Conference on Fair Use (CONFU) , which sponsored discussions on topics such as intellectual property protection and copyright as applied to digital images, distance learning, educational multimedia, electronic reserves, interlibrary loans and document delivery, and in-library use of computer software.
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From page 218... ...
Without a set of clear, workable guidelines, schools that educate health professionals also are unlikely to develop electronic courses and learning resources that come up to the standards of the courses and resources available to students in the traditional classroom. The same can be said for the societies and associations that provide continuing medical and professional education to their members and health care organizations that wish to provide patient education programs over the Internet.
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. The act required HCFA to expand its coverage of telemedicine services under the Medicare program beginning in lanuary 1999, but critics contend that
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, typically rural or inner city locations that have difficulty attracting and retaining physicians and other health professionals. HPSAs are designated based on the total number of physicians practicing in a geographic area.
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At the same time, existing licensure and liability rules do not adequately cover current and potential Internet applications in the health sector. State-based liability for malpractice poses an additional barrier to widespread use of the Internet for telemedicine services across state lines.
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This practice not only raises the cost of telemedicine consultations or procedures (and all of the cost may not be reimbursed, as noted above) but also makes it difficult to implement telemedicine services in small towns that have other health professionals but lack physicians.
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From page 223... ...
FEDERAL SUPPORT FOR HEALTH-RELATED INFORMATION TECHNOLOGY RESEARCH The combined efforts of both private and public organizations will be required to ensure the robust development of health care applications of the Internet. To date, federal health agencies have exhibited uneven interest in pursuing Internet-based applications or in funding information technology research that could support health applications.
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Of the $2.3 billion spent by the federal government on computer science research in 1999, just $120 million came from DHHS, and none came from the Department of Veterans Affairs (Table 5.1~.25 The Commerce, Defense, and Energy Departments and the NSF each funded more computing research, despite the fact that DHHS's overall research budget of $13 billion exceeds the research budgets of the four other agencies combined.26 This funding imbalance provides further evidence that federal health agencies have been far less active than their counterparts in the education, defense, scientific, and library communities in pursuing initiatives related to the Internet.27 The reasons for the comparative lack of support for computer science research within the DHHS are manifold, but perhaps the underlying problem is that the department as a whole has not embraced information technology (IT) as fundamental to its mission.
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From page 226... ...
, but it assumes that computer science is a source of tools for enabling biomedical research rather than a field of intellectual inquiry worthy of further investigation by biomedical researchers. Until government and industrial research organizations see the health disciplines as a potential source of innovation for new information technologies, fundamental informatics research is not likely to emerge from the traditional biomedical sciences; instead, health informatics research probably will continue to emphasize demonstration projects and applications.
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This approach is more likely to lead to solutions that advance the information technology infrastructure in general and less likely to strand health informatics in an isolated technological corner. WORKFORCE ISSUES If governments, health care organizations, academic institutions, and professional groups need to attract more effective leaders in the strategic uses of information technology, where will they find them?
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Beyond such training programs, which would be designed to develop a cadre of researchers who operate at the nexus of health and computer sciences, initiatives could be taken to infuse some degree of informatics training throughout the health sciences curricula. Health professionals need to become part of the information culture that will define the century ahead, and their educational opportunities, in both professional school and continuing education programs, must be responsive to that need.
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Report prepared for the Department of Health and Human Services, November 24. Available online at |
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1999. Fact Sheet: Medicare Payment for Teleconsultation in Rural Health Professional Shortage Areas.
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1999. Report to the FCC: Evaluation of the Rural Health Care Program.
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At present, personal health information usually resides at the health care provider organization. For many people, there is no comprehensive health record that merges information from numerous care sites, a gap that can compromise the quality of care received subsequently.
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20. Additional information on the NLM's telemedicine programs, including descriptions of funded projects, is available online at |
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