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payment for health care services, education of health professionals, and conduct of health sciences research could improve the quality of care and access to it as well as reduce its cost.

Despite its promise, the Internet's future in supporting health and health care is far from assured. A number of technical, organizational, and policy barriers stand in the way of its adoption by health organizations and consumers. Furthermore, although much can be done with the Internet in its present form, some health applications demand greater technical capabilities than the Internet can now provide, especially in the areas of security, reliability, and timely transmission of information. As a result, some health applications cannot be implemented across the Internet and used in operational settings without potentially threatening the privacy and optimal care of patients.

Health applications have helped motivate a number of efforts to improve the nation's information infrastructure.1 Ongoing research and development (R&D) efforts, such as those being pursued under the federal government's Next Generation Internet (NGI) initiative and the private sector's Internet 2 initiative, also hope to foster technologies that could enhance the Internet's ability to meet the needs of the health sector. These efforts will also provide testbeds for improved evaluations of the benefits of different health applications of the Internet and their technical and nontechnical requirements. But these testbeds—and ultimately the Internet itself—will not adequately support health applications unless a better understanding is developed of the technical capabilities that these applications demand.

This report explores the use of the Internet in health-related applications and attempts to delineate the technical capabilities that such applications demand. Taking a broad view of health applications, it considers uses of the Internet in consumer health, clinical care, public health, medical education, health care financing and administration, and biomedical research.2 It does not, however, attempt to predict which applications are most likely to catch on or to estimate levels of use; rather, it attempts to illustrate the types of applications that are possible and to assess the technical capabilities required for their safe, effective deployment in an operational setting.

The report also addresses organizational and policy issues that stand in the way of broader adoption of Internet technologies for health applications.3 It became increasingly apparent during the course of the study that health applications of the Internet involve systems that combine network infrastructure with other computing technologies (both hardware and software) and with end users who operate in multiple organizational contexts and are influenced by the policy environment. The close coupling among these levels makes it impossible to focus on any one level to thecontinue



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