Internet. But numerous efforts are under way to address these issues as they apply to both the current and the next-generation Internet (Elhanan et al., 1996; National Research Council, 2000).

Fourth, the extraordinary advances achieved in molecular medicine in recent years will further increase the complexity of both the evidence base and the clinical decision-making process, making it imperative that clinicians use computer-aided decision supports. Molecular medicine introduces a huge new body of knowledge that will affect virtually every area of practice, and also opens up the possibility of developing individualized treatments linked to a patient’s genetic definition (Rienhoff, 2000). CDSS programs offer the prospect of applying more sophisticated forms of decision analysis to the evaluation of various treatment options, taking into account both the patient’s genetic definition and preferences (Lilford et al., 1998).

Given the potential of CDSSs to enhance evidence-based practice and provide greater opportunity for patients to participate in clinical decision making, the committee believes greater public investment in research and development on such systems is warranted. In fiscal year 1999, the Agency for Healthcare Research and Quality began a new initiative, Translating Research into Practice, aimed at implementing evidence-based tools and information in health care settings (Eisenberg, 2000a). The focus of the initiative is on cultivating partnerships between researchers and health care organizations for the conduct of practice-based, patient outcome research in applied settings. In fiscal year 1999, 3-year grants were awarded in support of projects to identify effective approaches to smoking cessation, chlamydia screening of adolescents, diabetes care in medically underserved areas, and treatment of respiratory distress syndrome in preterm infants. The resources for this program should be expanded to support an applied research and development agenda specific to CDSSs.


The Internet is rapidly becoming the principal vehicle for communication of health information to both consumers and clinicians. It is predicted that 90 percent of households will have Internet access by 2005–2010 (Rosenberg, 1999). The number of Americans who use the Internet to retrieve health-related information is estimated to be about 70 million (Cain et al., 2000). The connectivity of health care organizations has also increased. For example, between 1993 and 1997, the percentage of academic medical libraries with Internet connections increased from 72 to 96 percent, and that of community hospital libraries rose from 24 to 72 percent (Lyon et al., 1998).

The volume of health care information available on the Internet is enormous. Estimates of the number of health-related Web sites vary from 10,000 to 100,000 (Benton Foundation, 1999; Eysenbach et al., 1999). A survey conducted by USA Today found that consumers access health-related Web sites to research an illness

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