tion, and DSL is available in more than 56 percent of all cities with 100,000+ population (Allen, 2001). This aspect of the digital divide is one of the greatest challenges for rural telehealth, as well as other rural commerce.
As noted earlier, data standards5 are another important aspect of ICT requirements. To be most user-friendly, information exchanges require common standards for how the data are packaged, how systems interact, and what vocabulary is used to represent the information (IOM, 1997). When the sending and receiving systems use the same data standards, health information can flow more easily from one system to another. Telehealth applications such as the transmission of radiological images, physician order entry systems, and home care medical device monitoring systems rely on data communication standards to speed transmission and improve connections among users (typically referred to as increasing interoperability and scalability). However, poor system interoperability, limited data comparability, and the need to improve data quality and integrity have been cited as major obstacles to the electronic exchange of health information in both urban and rural settings (Lumpkin, 2000). Currently, vendors of certain imaging technologies (e.g., teleradiology) have employed a common standard (DICOM) for packaging and transmitting images in their systems, while vendors of other applications are only now beginning to incorporate the federal government’s recommended standards. Accelerating the promulgation of national data standards is one element of a comprehensive plan to facilitate the adoption of EHRs, and substantial progress has been made to this end, particularly in the past 3 years. The standards developed are international in scope and tied to the National Library of Medicine’s Unified Medical Language System.
Recent years have seen a great deal of momentum and some tangible progress toward the development of an NHII. The envisioned NHII has been defined as a set of technologies, standards, applications, systems, values, and laws that support all dimensions of the health system—personal health management, provider care delivery, population health, and research (NCVHS, 2001). More specifically, the NHII initiative is a cohesive and