Date: Feb. 23, 2000
Contacts: Bob Ludwig, Media Relations Associate
Kathi McMullin, Media Relations Assistant
(202) 334-2138; e-mail <>

Significant Technological Barriers Remain for Providing Health Care on the Internet

WASHINGTON -- While tens of thousands of health-related Web sites can be found on the Internet, tapping its full potential for health services and the biomedical sciences will require more advanced technical capabilities, says a new report from the National Academies' National Research Council. The health and information technology industries must begin to work more closely together to ensure that the Internet's capabilities evolve in ways that support a range of activities including providing health care, monitoring public health, and bolstering biomedical research.

"The kinds of technical capabilities that health care and biomedicine need from the Internet are not unique," said Edward H. Shortliffe, chair of the committee that wrote the report and professor and chair, department of medical informatics, Columbia University, New York City. "But the operational demands of health care applications create distinctive requirements and must be considered in computer network design and implementation. The kinds of security, reliability, and quality of service that are necessary for physicians to use the Internet more routinely can go beyond those needed for e-commerce. Advances are needed in all these areas before we see physicians retrieving medical histories of emergency room patients on a more regular basis or doctors monitoring homebound patients using medical devices that send data over the Internet. Organizational and policy issues also must be addressed."

For the Internet to be used widely and effectively in the health community, the report identifies four areas that should be addressed: research, development, and deployment of technologies needed to support health-related applications of the Internet; demonstrations and evaluations of health applications on the Internet; educational programs to help health organizations and their employees adopt Internet applications and develop effective policies for doing so; and efforts to resolve policy issues that impede use of the Internet for health applications.

The health community should ensure that new networking initiatives, such as the federal government's "Next-Generation Internet," have the capability to support health and biomedical applications. Required mechanisms include quality of service -- for guaranteeing the availability of network capacity when needed (such as for remote video consultations) -- and more effective technologies for validating the identities of online users engaged in confidential electronic transactions, the committee said. These technologies should eventually be deployed throughout the Internet to serve the highly decentralized health care industry. The National Library of Medicine could play an important role in working with the private sector to ensure that these capabilities are widely available.

Further, the U.S. Department of Health and Human Services (HHS) should fund pilot projects that link multiple organizations to the Internet to exchange health information, the committee said. Health care organizations have been hesitant to explore such activities because of uncertainty around the reliability of the Internet to deliver health-related services, the size and cost of distributed information systems, and the legal aspects of controlling these systems. Evaluations of demonstration projects would provide the health and information technology industries with more accurate information for developing strategic plans that incorporate Internet-based programs. In addition, government, industry, and professional associations should work together to educate the health care community about how the Internet can benefit them, the report says. Educational outreach programs can be effective in creating a more receptive audience for new technologies.

Federal agencies that operate large programs for providing or administering health care, such as HHS, the Department of Veterans Affairs (VA), and the Department of Defense (DOD), should take the lead in harnessing Internet technologies, the report says. The Health Care Financing Administration, the arm of HHS that manages Medicare and Medicaid, is testing the viability of the Internet for filing claims securely and could set the standard for secure exchange of health information. The VA could use the Internet more extensively for sharing medical records among its health centers. DOD already has a sizable telemedicine program to provide health care to military personnel, but it does not make use of the Internet.

Demonstration programs, however, are no substitute for continued efforts to resolve policy debates that could impair the ability of organizations to adopt Internet applications. Regulations governing the protection of electronic records containing personal health information have yet to be finalized, and rules for reimbursing doctors for remote medical consultations are still being evaluated. These and other issues, such as professional licensure across state boundaries and liability concerns, must be addressed to assure that the Internet achieves its full potential in the health sector.

The report was sponsored by the National Library of Medicine. A committee roster follows. The National Research Council is the principal operating arm of the National Academy of Sciences and the National Academy of Engineering. It is a private, nonprofit organization that provides advice on science and technology under a congressional charter.

Read the full text of Networking Health: Prescriptions for the Internet for free on the Web, as well as more than 1,800 other publications from the National Academies. Printed copies are available for purchase from the National Academy Press Web site or at the mailing address in the letterhead; tel. (202) 334-3313 or 1-800-624-6242. Reporters may obtain a pre-publication copy from the Office of News and Public Information at the letterhead address (contacts listed above).

Commission on Physical Sciences, Mathematics, and Applications
Computer Science and Telecommunications Board

Committee on Enhancing the Internet for Biomedical Applications:
Technical Requirements and Implementation Strategies

Edward Shortliffe* (chair)
Professor and Chair
Department of Medical Informatics
Columbia Presbyterian Medical Center
New York City

Russ Biagio Altman
Associate Professor of Medicine (and Computer Science by courtesy)
Stanford University Medical Center
Palo Alto, Calif.

Patricia Brennan
Moehlman Bascom Professor
School of Nursing and College of Engineering
University of Wisconsin

Bruce Davie
Cisco Fellow
Cisco Systems
Chelmsford, Mass.

William Detmer
Adjunct Assistant Professor
Department of Health Evaluation Sciences
University of Virginia

Valerie Florance
Project Director
Association of American Medical Colleges
Washington, D.C.

Andrew Friede
Physician Executive
Cerner Corp.

Mark Frisse
Vice President
Clinical Information Services
Express Scripts Inc.
Maryland Heights, Mo.

John Glaser
Vice President and Chief Information Officer
Partners Healthcare System Inc.

John Huffman
Chief Technology Officer
Stentor Inc.
Menlo Park, Calif.

Isaac Kohane
Informatics Program
Children's Hospital, and
Associate Professor
Department of Pediatrics
Harvard Medical School

Carl Landwehr
Senior Fellow and Acting Director
Information Security Center
Mitretek Systems Inc.
McLean, Va.

Daniel Masys
Director of Biomedical Informatics and Associate Professor
University of California School of Medicine
San Diego

Jane Sisk
Department of Health Policy
Mount Sinai School of Medicine
New York City

Thorsten Von Eicken
Assistant Professor
Department of Computer Science
Cornell University
Ithaca, N.Y.


Jerry Sheehan
Senior Program Officer

* Member, Institute of Medicine