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BOX 5.1
Other Reports That Identify Policy Issues Related to
Health Informatics

Realizing the Information Future: The Internet and Beyond (CSTB, 1994). This report looked at the powerful potential of the emerging national infrastructure to ''enrich people's economic, social, and political lives . ." (p. 1). It went on to say, "Today we lack a consistent technical, legal, and business framework for the dissemination of intellectual property over networks" (p. 100). Noting the need to balance public and private interests, the report called for a fuller consideration of competing interests, particularly as they affect "decisions relating to societal equity—including access to networks and the information resources available on them" (p. 211).

Telemedicine: A Guide to Assessing Telecommunications in Health Care (IOM, 1996). Noting that "most clinical applications of telemedicine have not been subjected to systematic comparative studies that assess their effects on the quality, accessibility, or cost of health care," this report presented a framework for evaluating the practicality, value, and affordability of telemedicine. Concluding a lengthy chapter on the policy context of telemedicine, the committee noted: "The task for this committee was to develop an evaluation framework for clinical telemedicine—not to develop policy recommendations. The committee recognized, however, that policies related to licensure, malpractice, and other matters need to be considered . . . because they may affect the availability, acceptability, effectiveness, and cost of telemedicine services" (p. 115).

For the Record: Protecting Electronic Health Information (CSTB, 1997). This report looked at technical and nontechnical mechanisms and issues relating to the privacy and security of health care applications of the national information infrastructure. It led off with a chapter on the public policy context. Among other things, it said that "better protection of electronic health information will require efforts at the national level. The lack of uniform national standards for the privacy and security of health information creates particular problems for health care organizations that serve constituents in multiple states and creates additional confusion for patients regarding their rights." It then suggested that "conflicting views of data ownership and a lack of patient understanding of health data flows and of their rights to privacy and confidentiality also need to be addressed . . ." (pp. 49–50).

The Computer-Based Patient Record: An Essential Technology for Health Care (IOM, 1997). Updating and expanding the original report, published in 1991, this revised edition provides a scorecard on the implementation of the original recommendations. The original committee concluded that "computerization can help to improve patient records and that improved patient records and information management of health care data are essential elements of the infrastructure of the nation's health care system" (p. 46). The authors of the revised edition's progress report noted: "Security, privacy, and confidentiality concerns have become major barriers to widespread implementation of [computerized patient record] systems and [the] sharing [of] data. There is, as yet, no agreement on what must be done to establish the balance between appropriate use of health care data and the individual patient's rights to privacy" (p. 14).

Health Data in the Information Age: Use, Disclosure, and Privacy (IOM, 1994). This report examined the potential of health data organizations to improve health

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