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which might be a nonprofit organization, the government, or a private corporation such as Verisign.

CHITA has no plans to attempt to change the Internet or its directions but rather will attempt to accommodate whatever weaknesses it exhibits with respect to information security. While asserting that businesses need to move too quickly to wait for the NGI, Mr. Bailey wondered if it would be possible to allocate part of the Internet 2 (perhaps one or two frequencies) for health care. He also would consider the formation of a separate health information network as a means of avoiding some of the security concerns associated with the Internet.

According to him, security officers in health care have responsibilities that differ from those of their counterparts in other industries. The applicable state and federal laws are different, the privacy and security concerns are greater, and health care organizations must meet requirements for successful electronic data interchange. At the same time, the health care industry is driven by economics, not privacy.

Washington State Laboratory Reporting Project

Jac Davies, representing the Washington State Department of Health, described the Electronic Laboratory Reporting System (ELBRS) project, which involves the electronic submission and tabulation of reportable events within the state, of which there are fewer than 100,000 every year. (Physicians and testing laboratories are required to report certain conditions to their county health department.)

Such reports generally are sent by regular mail, fax, or voice mail. Public health officials then are required to follow up with the doctor and patient to further investigate possible causes, paths of contagion, and so on. Often, reports are sent to the wrong county and/or are not subsequently forwarded to the state. Furthermore, different states and counties tend to have their own lists of reportable conditions, which are tied closely to local concerns (the conditions vary, for example, between urban and agricultural counties), and they have different rules for where to send the information. As laboratories (and health organizations generally) consolidate into national entities, tracking different reporting requirements has become time-consuming. SmithKline Beecham, for example, operates a number of clinical laboratories and has three or four people dedicated to tracking different reporting requirements.

Under Washington's planned system, lab reports would be sent directly to the state rather than to local health departments. The state then would process the reports and forward information down to local communities and up to the Centers for Disease Control and Prevention (CDC), as necessary. Such centralization would allow the state to bettercontinue



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