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symptoms, the pediatrician on call asks to have a quick look at the baby. Rosa turns on the set, while Juanita sets up the health kit. Rosa establishes an encrypted session with the server and reserves a suitable level of bandwidth for a videoconference, using the "bandwidth wizard" on the server. When the connection is complete, Rosa selects the "habla Español" option for simultaneous subtitles, so her mother can communicate directly with the doctor, and pages the doctor. Remembering a recent news item about a rash of respiratory problems in this neighborhood, the pediatrician links to the local public health department e-channel to check on specifics. While waiting for the doctor to finish her research, Juanita scans the index of the HMO's self-help library and downloads two items, Las Syntomas de la Asma and El Gripe y su Niño, for later reading.

These scenarios require advances in technology, organizational capabilities, and public policy in order to become commonplace in the future. The first scenario requires dependable bandwidth on demand, authenticated remote access to patient records, and widely accessible Internet-based collections of resources like the multimedia series. It also requires cross-border licensing arrangements and health care reimbursement policies that cover this kind of service. The technical requirements for the second scenario include cable modems, reservable bandwidth, encrypted server access, digital instruments, and instantaneous language translation. The nontechnical requirements include a health plan that supports home telemedicine and online access to Spanish-language consumer health information. Most features of these scenarios exist now but are not widely available or easily accessible to those who may need them. The expanded capabilities for health care outlined in these scenarios could be achieved in the near future given action on some of the recommendations outlined in this report. Even more exciting are the applications that could be imagined if the nation were to begin to use the Internet to its full potential in health applications.

1 These scenarios were first described by Valerie Florance of the Association of American Medical Colleges in a public briefing to release a prepublication version of this report. Because of the interest they generated, they have been included here.

President's Information Technology Advisory Committee (PITAC). 1999. Information Technology Research: Investing in Our Future, National Coordination Office for Computing, Information, and Communications, Arlington, Va., February 24. Available online at <>

Working Group on Biomedical Computing, Advisory Committee to the Director. 1999. The Biomedical Information Science and Technology Initiative, National Institutes of Health, Bethesda, Md., June 3. Available online at <>break

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