whole notion of what is a means and what is an end needs to be kept in clear focus.

PARTICIPANT: What impact will all of this additional information have on health care costs?

DR. DETMER: This is anybody's guess right now, because it is a very democratic Net out there. Anybody can throw out anything into the Internet. As I said, it can be noise or it can be signals. The problem is, of course, what all of that does. If it generates more demand for services that are off the wall and trivial, it does not help matters.

That is why I think we are calling for a new challenge to the health professional to try at least to figure out a way to address this new wave we are moving into, because with some of these devices I can see as much opportunity for mayhem as for improvement.

PARTICIPANT: It is unclear how education and research will be supported in a market-driven system of health care. How will all these advances in information technology be supported in medicine?

DR. DETMER: Looking at the current scope and scale of information technology in health care, we are underinvested within our industry by a factor of three compared to airlines, banking, finance, and such. Candidly, it is hard for me to say exactly what the effect of that will be, but it obviously could be profound. Health care is an information-driven line of work.

So as we scale up in information technology, there is absolutely no question in my mind that it will have a profound impact on how we organize ourselves. However, I really have not taken sufficient time to look at more of its organizational implications.

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