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online discussions with other care providers to consult on particular cases, sharing medical records and images as needed.

The success of any of these applications depends on a variety of factors, including their cost-effectiveness, ease of use, and ability to improve on existing processes. While some applications are already being used in operational environments across networks other than the Internet, many represent new capabilities that have no parallel on other networks or that have not been fully implemented on a large scale, such as remote medical consultations. As a result, not enough information has been gathered to allow evaluation and comparison, and continued experimentation will be needed to explore and evaluate their true potential, their technical needs, and their real-world operational requirements. A preliminary assessment (Table 6.1) shows a diversity of technical needs, with some commonality, at least within a particular domain (e.g., clinical care, public health) or class of application (e.g., real-time video, file transfers, collaboration). Consumer applications, for example, tend to demand high levels of security to protect confidentiality; clinical applications require a combination of security (to protect confidentiality and data integrity), reliability, and QOS. Virtually all collaborative applications—regardless of whether they are in clinical care, public health, biomedical research, or other domains—demand high levels of QOS, and file transfers in any health application tend to strain technologies for authenticating the identity of communicating parties. Determining which technical capabilities health applications will demand must be viewed as an ongoing process as workers envision, develop, and evaluate new applications.

The technical capabilities demanded by a number of health applications of the Internet exceed those provided by the current Internet, but they are not necessarily unique. Applications in other sectors (e.g., defense, entertainment, financial services) also require better security, reliability, and quality of service. However, when these technical characteristics are combined with factors such as the distributed nature and economic structure of the health industry and the constraints of operating in a health care environment, it can be seen that health does occupy a distinct, if not unique, position. Solutions to problems of authentication and QOS, for example, must scale sufficiently to support the activities of numerous independent health organizations and hundreds of millions of potential users. This argues for full participation by the health care community in defining the research agenda and contributing to its resolution, as the Internet moves forward with new architectures and technical capabilities.

Conclusion 2.

Security and availability are critical technical needs for health applications of the Internet and are not adequately met by today's Internet.break

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