Networking Health Prescriptions for the Internet (2000) / Chapter Skim
Currently Skimming:
1. Overview and Introduction
1. Overview and Introduction
Pages 27-56
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Already the Internet is beginning to influence the health sector by forging new relationships among stakeholders and improving access to health information. Its application in the delivery of health care, maintenance of public health, 27
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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)
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For example, although many would agree that the Internet will enhance the role of the consumer in health care, the future of specific applications, such as remote medical consultations or online access to patients' medical records, is more difficult to discern because of the range of technical, organizational, and policy issues to be resolved (as detailed in later chapters of this report)
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A live image of the pediatrician appears in a video window. Alice transmits an authorization code to the pediatrician enabling her to access Charlotte's medical record from the online repository in which Alice and Bob maintain all their family medical records.
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While her doctor is finishing up another appointment, the nurse takes Charlotte's vital signs and adds the information to her electronic medical record, which is accessed from the computer in the examination room. Shortly thereafter, the doctor enters the room, reviews Charlotte's vital signs, examines her, and provides a diagnosis.
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From page 32... ...
The electronic system also supports paperless billing, which could speed payment for services and reduce error and loss as information proceeds through the system of reviews and approvals. The system also allows easy, but protected, access to the patient's medical record to give the care provider more complete information when making a diagnosis and plan of treatment.
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Families would have to be trained to properly use the system and the home medical equipment, such that care providers could be assured of receiving valid information remotely. Health plans would need policies on payment for remote consultations and on care providers' access to the electronic patient record.
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34 NETWORKING HEALTH: PRESCRIPTIONS FOR THE INTERNET health-related Web sites running as high as 10,000 or more (Benson Foundation, 1999~. Health-related Web sites allow consumers to search for information on specific diseases or treatments, pose questions to care providers, manage chronic diseases, participate in discussion groups, assess existing health risks, and purchase health-related products.
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Web sites geared to health care professionals allow them to access the professional literature, consult with colleagues electronically, order medical supplies, or communicate with insurance companies.7 Biomedical researchers use the Internet to access online databases of journal articles and scientific information. Organizations involved in the provision of health care, whether individual hospitals, managed care plans,8 or integrated delivery networks (IDNs)
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Remote medical consultations remain a novelty practiced by a few institutions, typically over dedicated networks, for a small subset of their patients and with support from external financial grants. Most public health offices remain unconnected to the Internet and there
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Research has also demonstrated the positive effect of information technology applications in several other areas of health care. However, the ability of the Internet (as opposed to private networks)
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The benefits to care providers may be more difficult to measure, especially if healthy patients demand fewer health services in the long run. Further slowing adoption of the Internet by health organizations are uncertainties about the technical capabilities needed to support health applications.
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Real-time, interactive applications demand low latency so that users can interact with each other easily. Many interactions, such as telephone conversations or control of remote devices, become unwieldy if round-trip latencies (i.e., across the network and back)
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Such systems stand in contrast to private networks, such as those used by financial institutions, which may have broad geographic reach but strict rules regarding membership. Applications that
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Many of these differences stem from the public character of the Internet (Box 1.3) , which carries aggregated traffic from numerous parties, whereas private networks interconnect a limited number of sites using dedicated transmission links that are not shared with any other users.
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For these reasons, the Defense and Energy Departments, the banking industry, and other sectors have developed communications networks that are separate from the Internet. And yet, the distinction between public networks such as the Internet and private networks is blurred by a number of factors.
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When security and QOS are important and the relationships between communicating parties are sufficiently well known in advance, private networks are likely to be chosen. Accordingly, health organizations continue to use dedicated networks to transmit sensitive patient information, share large image files, and submit claims for reimbursement.
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With improved security and QOS, the Internet might become preferable to private networks in almost all cases. The Internet may prove to be an ideal technology for use by willing health care organizations to simplify and standardize processes and collaborate more effectively with one another.
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The government's Next Generation Internet initiative and projects sponsored by the private-sector University Consortium for Advanced Internet Development (UCAID) are attempting to develop advanced networking technologies and applications and deploy them in testbed networks that link a limited number of sites and allow early experimentation with advanced applications.
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demonstrate the feasibility of a national breast imaging archive and networking infrastructure to support telemammography, and (4) create a personal health record that can be integrated with more traditional sources of clinical information for patient use in the home, at work, or at school (see Box 1.4 for examples of these projects and Appendix A for a complete listing of NLM project awards)
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48 NETWORKING HEALTH: PRESCRIPTIONS FOR THE INTERNET NGI. Researchers at NASA's Ames Research Center, for example, are developing a system for sharing high-resolution, three-dimensional medical images in real time for purposes of collaborative diagnosis and surgical planning.20 NSF is supporting work to provide psychological services over a distance to deaf patients, to develop digital video resources for teaching and learning the life sciences (using materials that reside at
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The NGI initiative's other testbed will be built on DARPA's SUPERNET, a network composed of a variety of high-speed technologies and testbeds, enabling researchers to collaborate and experiment with advanced networking technologies and applications in a diverse, highcapacity, wide-area environment. It will use wave-division multiplexing technology (WDM)
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The goals are to provide a high-availability backbone network to support the demands of the advanced research applications being developed by UCAID members; a separate network to enable the testing of advanced network capabilities (for example, QOS, multicasting, and security and authentication protocols) prior to their introduction into the application development network; and a separate network capability to conduct networking research, including the design of an alternative network capable of advancing both the Abilene network and the general state of the art.25 Internet 2 member universities have committed more than $70 million per year in new investment on their own campuses for the Internet 2 project, and corporate members have committed more than $30 million over the life of the project.
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Deploying Enhanced Internet Technologies Although they are structured as programs with a limited number of participants, the NGI and Internet 2 initiatives are intended to serve as launching points for enhancement of the public Internet. Both programs have a stated interest in transferring new technical capabilities to the public Internet once the technologies are developed and demonstrated to be robust.
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From page 52... ...
The first part of the chapter focuses on applications of the Internet in the provision of health care, addressing topics such as consumer health, remote consultation, and the transfer of medical images for diagnostic purposes. The next parts of the chapter explore Internet applications in areas such as public health, health care finance and administration, and biomedical research.
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On-Line, Inc. to Promote AT&T WorldNet Internet Connectivity to Healthcare Providers," News release.
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1998. Next Generation Internet Implementation Plan, Second Printing.
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Most managed care plans now pay care providers some form of discounted fee for services rendered, although some still pay a fixed fee based on the number of patients enrolled in their care.
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19. The term "telemedicine" refers to the delivery of health services when distance separates the care provider and patient (see Institute of Medicine, 1996~.
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