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consumers with information on specific diseases, therapies, and healthy lifestyles. Some sites allow consumers to evaluate risks to their health, manage chronic medical conditions, purchase health-related products, pose questions to health professionals, or engage in discussions with other consumers. These systems take advantage of the Internet's broad, public reach to engage significant portions of the online population, often with information that is specially tailored to their needs. An estimated 30 million users searched for health information on the Internet in 1999 alone, and in 1998 consumers and students—as opposed to practitioners and researchers—accounted for roughly 30 percent of the use of the NLM's MEDLINE system, which contains references to millions of journal articles (Lindberg, 1998).

Although health-related Web sites garner considerable media attention, they represent only a small sampling of the ways in which the Internet can be used in health, itself a large sector embracing health care, public health, health education, and biomedical research. Because the Internet, in theory, can link all the participants in the health community, it can be used to improve consumer access to health information and health care, to enhance clinical decision making and improve health outcomes by making better information available to clinicians on demand, and to reengineer the processes of care to make them more efficient. The Internet can also be used to improve the education of medical professionals, enhance public health surveillance, and facilitate biomedical research. In each of these domains, specific applications can be envisioned in which the Internet is used to transfer text, graphics, or video files (and even voice); control remote medical or experimental equipment; search for needed information; and support collaboration, in real time, among members of the health community (Table ES.1). For example, the Internet could do the following:

• Enable consumers to access their health records, enter data or information on symptoms, and receive computer-generated suggestions for improving health and reducing risk;

• Allow emergency room physicians to identify an unconscious patient and download the patient's medical record from a hospital across town;

• Deliver care instructions to a traveling businessperson who begins to feel chest pains while in a hotel room;

• Enable homebound patients to consult with care providers over real-time video connections from home, using medical devices capable of transmitting information over the Internet;

• Support teams of specialists from across the country who wish tocontinue



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