Networking Health Prescriptions for the Internet (2000) / Chapter Skim
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6. Conclusions and Recommendations
6. Conclusions and Recommendations
Pages 235-268
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From page 235... ...
Administrators must be sure that bill payment and enrollment information is not corrupted as it crosses the Internet. Without proper security protections, use of the Internet to transmit medical records could make personal health information more susceptible to breaches of confidentiality and loss of integrity.
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From page 236... ...
For example, in the clinical care domain, care providers already use the Internet to search the professional literature for information on particular diseases or to examine evidence-based practice guidelines for managing a particular disorder. As ongoing projects demonstrate, the continued research, development, and deployment of Internet applications will allow care providers to more routinely access electronic medical records held by an affiliated health care organization or to interpret medical images (such as mammograms)
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From page 237... ...
However, when these technical characteristics are combined with factors such as the distributed nature and economic structure of the health industry and the constraints of operating in a health care environment, it can be seen that health does occupy a distinct, if not unique, position. Solutions to problems of authentication and QOS, for example, must scale sufficiently to support the activities of numerous independent health organizations and hundreds of millions of potential users.
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From page 238... ...
Sending periodic or hospit reports on health conditions to a care provider. Clinical care Remote medical Transfer of medical Remote and virtual Practice consultations records and images surgery (a long- Searches between clinician (e.g., X rays, MRI, term possibility professio and patient or CT scans)
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From page 239... ...
formulary. Access to published Videoconferencing Security to ensure confidentiality literature and research among public and integrity of laboratory reports results as well as health officials and other public health epidemiological data.
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. Transmission Static File Transfer Remote Control Informati and Retrim Professional Distance education: Accessing electronic Simulations of Accessing education either real-time medical records from surgical procedures.
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Sufficient bandwidth to accommodate large numbers of transactions from a single educational institution or to support access to remote scientific and clinical simulations. Ubiquity of access for students in remote clinical rotations and to support educational applications in the home.
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The need for data protection and access control is acute in health applications because some personal health information is extremely sensitive. Not only can loss of confidentiality cause embarrassment and social stigmatization, but personal health information can affect an individual's employment and insurance coverage, especially for people with private insurance or who work for self-insured organizations.
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From page 243... ...
Health care organizations must be assured that the network will be available almost around-the-clock if they become dependent on using the Internet for accessing electronic medical records, for remote monitoring of patients, or for clinical decision support. Payers and administrators will also demand high levels of availability if they are to use the Internet instead of private networks for important transactions.
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From page 244... ...
Because the health industry is highly decentralized and individual care providers' offices may need to interact with a number of different managed care organizations, insurers, and other care providers, inter-ISP mechanisms will be important for health applications. The challenge of providing QOS in a health environment is further complicated by the extremely variable QOS needs of individual health organizations over time.
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From page 245... ...
As the amount of health-related information on the Web increases, patients become more actively involved in maintaining their health: seeking information related to specific ailments or topics of interest, discussing medical problems with peers in online chat groups, e-mailing care providers with questions regarding symptoms or treatments, assessing their health, scheduling appointments with care providers, and maintaining their own health records online. These actions are reinforced by a number of fundamental factors in the nation's health care system, including greater consumer choice in selecting among alternative health plans, concerns about the quality of care provided by health care organizations in an increasingly competitive environment, and pressures to shift the site of care away from the provider location and to the consumer's location and to shift from unilateral to shared approaches that bring patients into the decisionmaking process.
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From page 246... ...
Networking capabilities are not the only technical impediments to many health applications of the Internet. For example, there is great concern regarding the quality of health information on the Internet and the inability of many consumers to assess adequately the credibility of information provided on different sites.
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Remote medical consultations (to rural medical clinics or the home, for example) will demand medical instruments (e.g., stethoscopes, blood pressure monitors, and respiration monitors)
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A number of difficult public policy and regulatory issues constrain the adoption of Internet-based health applications by health organizations and consumers. Some of these issues are specific to the health sector; many others extend beyond the health sector but require the health community's active participation in their resolution.
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Concerns over the security of personal health information continue to dampen consumers' enthusiasm for Internet systems that share such information. The Department of Health and Human Services has promulgated draft regulations governing privacy and security of electronic health records, but these provisions have yet to be finalized and will not cover all exchanges of information among the many kinds of organizations that collect, process, and distribute health information.
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From page 250... ...
To help the health community experiment with new networked applications, these testbed networks must be deployed with the technical capabilities to support a range of high-end health applications, such as medical consultations at a distance, remote control of research equipment, surgical simulation, and collaboration among researchers and clinicians. The networks are expected to be deployed with bandwidth that can support a wide range of health applications,
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From page 251... ...
protocols would allow further experimentation with virtual private networks among health care organizations involved in the NGI program and would allow further testing of the ability of the protocol to scale sufficiently to support effective interchanges of information among health organizations. The use of IPSec across the Internet could allow secure communications between fixed sets of health organizations and permit the transfer of health records among affiliated care providers or the exchange of payment, enrollment,
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Recommendation 1.2. To ensure that the Internet evolves in ways supportive of health needs over the long term, the health community should work with the networking community to develop improved network technologies that are of particular importance to health applications of the Internet.
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For many health applications, however, it is conceivable that consumers will send as much information into the network as they retrieve from it (home-based remote medical consultation is an example)
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It could also itself play a more aggressive role in establishing contact between the health community and the networking community. It could speak for the health community in conveying needs to networking researchers and in reaching out to ISPs, presenting health care as a cutting-edge example of a peer-to-peer application that demands networking capabilities beyond those now being deployed (e.g., QOS throughout the network and symmetrical forms of broadband access for residential use)
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should support biomedically motivated basic research in information technology and view it both as important information technology research and as fundamental biomedical research" (PITAC, 1999~. It is not possible to identify in advance all areas in which the health community needs to become engaged, but the analysis in this report identifies the following topics as pertinent preliminary areas of inquiry: · Validation of online information.
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· Improved audit capabilities. Additional work is needed to develop tools for reviewing audit logs that health care organizations could compile on accesses to electronic medical records.
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Demonstration and Evaluation of Health Applications of the Internet Continued experimentation and evaluation is a central component of efforts to understand better the kinds of health applications that may become more widespread across the Internet and the technical capabilities they demand. By demonstrating health applications such as distant consultation, remote control of experimental equipment, and online access to electronic medical records, members of the health community will have a better opportunity to examine their relative costs and benefits, the business models needed to support them, and the kinds of organizational policies that are needed to govern their use.
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, but should try to facilitate information exchange among limited sets of organizations, whether for clinical care (e.g., exchanges of medical records, the sharing of clinical guidelines, or remote consultations between an urban medical center and several remote clinics) or administration (e.g., payment of claims)
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From page 259... ...
Health organizations will adopt health care applications of the Internet largely on the basis of their ability to improve the quality of care and reduce its costs. Deployment of needed infrastructure will be motivated by the development of business models for supporting the applications and paying for network services such as QOS.
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Recommendation 2.4. Public and private health organizations should experiment with networks based on Internet protocols and should incorporate the Internet into their future plans for new networked applications and into their overall strategic planning.
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Addressing Educational Needs In order for the Internet to achieve its full potential in health applications, not only must it provide adequate technical capabilities, but health organizations also must be capable of adopting it. Health organizations will need the internal capability to envision ways in which the Internet could support their missions and to design, develop, and implement systems that fulfill those visions.
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From page 262... ...
Educational programs could go a long way to overcoming institutional resistance and helping workers to better use such systems. Academic health organizations and professional associations have important roles to play in educating the health community at large about the potential benefits of Internet-based systems in health care.
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Impressions of supply and demand tend to be based on anecdotal evidence about the demand for graduates of existing programs. All health organizations will be affected by the Internet and will need to develop competencies to work with it.
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Addressing the policy issues that are raised in this report will require strong leadership from federal health agencies. Not only does DHHS need to ensure that concerns and needs of the health community are reflected in attempts to address policy issues such as intellectual property protection, privacy, and access to the information infrastructure, but it can also help to ensure greater coordination of the efforts of federal health agencies in these areas.
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Continued dialog between the information technology community and the health community will be central to ensuring that the Internet evolves in ways that meet the ever-changing demands and specialized needs of the health sector and to ensuring that the Internet will support the health of the nation.
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Health Care Financing Administration (HCFA)
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1999. Information Technology Research: Investing in Our Future, National Coordination Office for Computing, Information, and Communications, Arlington, Va., February 24.
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2. The Agency for Health Care Policy and Research was recently renamed the Agency for Healthcare Research and Quality (AHRQ)
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