able, examples and evidence of their impact are cited. Nonetheless, a great deal is still unknown about the benefits, costs, and intended and unintended consequences of the dramatic changes in care delivery that are unfolding.

Applications at Home and in the Community

ICT offers many new opportunities for rural residents to access health information, communicate with the health system from home for clinical and administrative purposes, and manage their chronic conditions more effectively. Likewise, rural individuals residing in community-based long-term care and assisted living facilities and the providers who care for them can greatly benefit from the ICT applications that will enable them to better coordinate care and health information across settings.

Enabling Access to Health Information

The Internet has enabled instant access to health information and resources on the Web, including medical journals, clinical guidelines, and databases encompassing the world’s knowledge about conditions and diseases, as well as specially crafted patient-oriented materials, decision support tools, and online communities where patients can interact. However, the quality of information available on the Internet is highly variable (Berendt et al., 2001; Griffiths and Christensen, 2000). There are reliable sites that screen information carefully and organize the content to best meet the needs of consumers; examples are the National Library of Medicine’s MedlinePlus and the Mayo Clinic website (NLM, 2004a; Mayo Clinic, 2004). Through partnerships between information providers and health care professionals, patients can be directed to quality sites by means of “information prescriptions” that can be filled at home for those with computer connections or at local public libraries (ACP, 2003; CIT, 2004). It is important to keep in mind that, as discussed earlier, low levels of health literacy and math skills in the U.S. population make communicating health information challenging. Indeed, an estimated one-half of the population likely experience difficulty understanding most health-related materials (IOM, 2004).

Communicating with the Health System

As patient and provider access to the Internet has grown, signs of a shift from face-to-face and telephone communication to e-mail and other



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