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organizations will be able to consider new applications, and new barriers are likely to arise.

Research in several areas could give health care organizations the confidence they need to move forward in using the Internet, First, research on Internet-induced changes in health care economics, organizational form, and interorganizational processes would provide guidance for organizations and patients, helping to ensure that the changes are effective and that they do not materially damage the health care system or harm the health of patients and consumers. Second model policies and procedures for the effective management of Internet-related clinical, administrative, and fiscal processes and activities would help organizations address these issues before they become problems. Third, an assessment of the Internet's capability to resolve (or not resolve) the health care system's persistent difficulties with implementing and managing older information technologies would provide guidance on the value added. Fourth, case studies of the staffing levels and skills needed to develop, implement, and support Internet-based applications could assist planning for Internet use. Poorly conceived or poorly executed change could have serious negative consequences for the nation's health care delivery system, health care organizations, and health care research and education, as well as for its citizens. All of this research is needed for developing information and guidance to promote a positive transformation of the health care industry.

References

College of Healthcare Information Management Executives (CHIME). 1998. The Healthcare CIO: A Decade of Growth. College of Healthcare Information Management Executives, Ann Arbor, Mich.

Drucker, P. 1999. Management Challenges for the 21st Century. Harper Business Press, New York.

Earl, M., and D. Feeney. 1995. "Is Your CIO Adding Value?" McKinsey Quarterly 1995(2):144-161.

Fitzgibbons, Stephen M., and Richard Lee. 1999. The health.net Industry: The Convergence of Healthcare and the Internet, Industry Report. Hambrecht and Quist Institutional Research, San Francisco, Calif., January 8.

Glaser, John P., and Leslie Hsu. 1999. The Strategic Application of Information Technology in Healthcare Organizations: A Guide to Implementing Integrated Systems. McGraw-Hill, New York.

Kane, Beverley, and Daniel Z. Sands. 1998. "Guidelines for the Clinical Use of Electronic Mail with Patients," Report for the AMIA Internet Working Group, Task Force on Guidelines for the Use of Clinic-Patient Electronic Mail, Journal of the American Medical Informatics Association 5(1). Available online at <http://www.amia.org/pubs/pospaper/position2.htm>.break



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