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Many of these factors, in turn, are influenced by considerations other than network performance. These include organizational competencies, changing preferences and expectations of consumers and care providers, reimbursement policies for different health services, availability of complementary technologies, and laws. The confluence of so many factors confounds attempts to predict viable future applications of the Internet in the health sector.

This chapter presents a broad overview of the types of applications that the Internet can support in consumer health, clinical care, financial and administrative transactions, public health, health professional education, and biomedical research. It draws on a series of site visits by the committee (these visits are summarized in Appendix A) and other briefings to the committee to examine applications that have been deployed and that are still in the early stages of conceptualization. The chapter attempts to assess the technical capabilities demanded of the Internet in terms of bandwidth, latency, security, availability, and ubiquity (as defined in Chapter 1). Specific technical information is presented where possible, but because of the nascent nature of many Internet applications in the health sector, often the most that can be offered is a qualitative assessment. Accordingly, a ranking scale is used to assess the importance of each technical dimension to each class of applications. These dimensions are ranked on a scale of one to four, with one plus sign (+) indicating little importance relative to the other dimensions and four plus sings (++++) signifying the most importance. The chapter also identifies organizational- and policy-level issues that will influence the way the Internet is deployed in different health applications and notes, where applicable, other technologies that must be developed to make certain applications feasible. Specific technical, organizational, and policy issues are addressed in subsequent chapters of the report.

Consumer Health

Consumer health is one of the areas that could be most dramatically reshaped by the Internet. Consumer health refers to a set of activities aimed at giving consumers a more pronounced role in their own health and health care, ranging from the development of tools for self-assessment of health risks and management of chronic diseases, to home-based monitoring of health status and delivery of care. This area is similar to public health (discussed later in this chapter) in that it aims to provide consumers with the information and tools needed to improve their health, but it is less concerned with the detection of regional outbreaks of disease and is not part of government-based reporting structures. The Internet could become a significant enabler of consumer health initiatives in that it pro-soft



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