technology. Whereas today's information infrastructure consists of Ethernet and the Internet, tomorrow's will consist of widespread high-speed networks and hand-held devices connected to the national information infrastructure through wireless communications protocols. Many of the technical recommendations contained in this report will become obsolete as the technical environment changes. This report cannot predict the advance of technology. Although the recommendations contained in Chapter 6 do identify a handful of technologies that will become available to health care organizations in the near future (three to five years), no attempt is made to extrapolate beyond that point. Health care organizations and policy makers at the local and national levels will have to remain cognizant of technological advances and facilitate their adoption.

Finally, this report is based largely on a review of practices used at a limited number of facilities, supplemented by reviews of existing literature. Despite its efforts to address many aspects of privacy and security, the committee cannot claim that this report is comprehensive. Many other health care organizations are likely to have developed innovative solutions for protecting electronic medical information that are not described in this report. To the extent that such solutions may be applicable to a large number of other organizations, the committee hopes that health care organizations will attempt to disseminate the results of their efforts among the rest of the community in order to ensure more widespread use of strong protections.

With these goals and limitations in mind, the committee hopes that this report will provide a better understanding of the issues and assist in reducing the harm that could be caused by inappropriate disclosure of health information.

Organization Of This Report

The remainder of this report presents the results of the committee's work, including its findings and recommendations. Chapter 2 discusses the current legal and regulatory environment for protecting health information, noting its limitations and recent initiatives under way in government and industry. Chapter 3 discusses data flows within the health care industry and describes the general types of privacy and security concerns that must be addressed. These include both the vulnerability of data held by particular organizations and privacy issues resulting from the widespread dissemination of data throughout the health care industry. Chapters 4 and 5 examine technical and organizational approaches, respectively, for better protecting electronic health information. These chapters review and evaluate practices within the health care industry (many of which were observed during the committee's site visits) and practices in



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