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quality of service that health care applications demand. But it does not stop with recommendations on technical requirements. It also discusses the policy and organizational issues that must be resolved to make the health community more capable of adopting Internet applications in both the short and long term. The capabilities the Internet offers to consumers, care providers, public health officials, health care administrators, and researchers promise to reshape the landscape of the health sector. Accommodating these changes will require actions within individual organizations and across them, enlisting the support of technologists, practitioners, legislators, and the general public. This chapter, accordingly, makes recommendations in areas ranging from identification of the needed technical capabilities of the Internet to specification of the organizational and policy issues that constrain its use in health applications. The recommendations are targeted at policy makers, the networking research community, researchers in health-related fields, health care administrators, and managers of health-related organizations. Taken together, the recommendations aim to provide guidance both on short-term measures that can set the process in motion and on long-term and continuing needs in communications, information technology, and health care.
The Internet can support a wide range of applications in consumer health, clinical care, health care financial and administrative transactions, public health, professional education, and biomedical research. The networking capabilities needed to support these applications are not unique, but they do reflect distinctive characteristics of the health environment.
In each of the domains examined by the committee, the Internet could be used to facilitate communications among parties in ways that can improve quality and efficiency. For example, in the clinical care domain, care providers already use the Internet to search the professional literature for information on particular diseases or to examine evidence-based practice guidelines for managing a particular disorder. As ongoing projects demonstrate, the continued research, development, and deployment of Internet applications will allow care providers to more routinely access electronic medical records held by an affiliated health care organization or to interpret medical images (such as mammograms) sent to them from a remote mammography center. They will be able to offer remote medical consultations to patients in rural areas or to adjust settings on remote dosimetry equipment or pacemakers without establishing fixed, dedicated connections between sites. They will increasingly participate incontinue