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tion technology (IT), NLM sought advice on which capabilities should be deployed in the NGI testbed networks and, ultimately, the Internet. It recognized that the potential for health applications of the Internet had contributed to policy discussions of information infrastructure for several years but that progress in realizing that potential had been slower than in other economic sectors. This report responds to the NLM request by examining applications of the Internet in six health-related areas: consumer health, clinical care, health care financing and administration, public health, professional education, and biomedical research. It draws on a series of visits by members of the committee to organizations that are actively designing, developing, and in some cases operating networked applications. It identifies the technical capabilities that these applications demand of supporting networks and makes recommendations regarding the capabilities that need to be deployed to enable the health community to take fuller advantage of the Internet. It also identifies additional work that is needed to develop complementary and appropriate information technologies, such as tools to help consumers evaluate the quality of the information they find on the Internet and access controls to reliably limit Internet users' ability to access resources such as patient medical records.

But the report does not focus exclusively on networking technologies, since the capabilities needed in networks are intertwined with other technical, organizational, and policy considerations. As the committee learned during its site visits, an adequate communications infrastructure is not the only prerequisite for expanded Internet use within the health community. Efforts are also needed to surmount organizational and policy impediments to the adoption of the Internet and Internet-based applications. At present, health care organizations are ill prepared to deploy Internet-based applications, because they lack information upon which to base investment decisions, face an uncertain financial environment, and have difficulty attracting the talent needed to design, develop, and implement such applications. A number of public policy issues, ranging from concerns about patient privacy to the lack of payment mechanisms for some medical consultations delivered remotely, also stand in the way of greater deployment of Internet applications. All of these issues need to be addressed if health organizations are to take advantage of the capabilities offered by an enhanced Internet.

Health Applications of the Internet

The most visible examples to date of the Internet's role in health-related activities are in the consumer domain. Tens of thousands of sites on the World Wide Web (the Web) offer information on health topics, and a growing number of companies have established Web sites to providecontinue



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