Shortliffe Report marks out major barriers for providing health care on the Internet

Washington 23 February 2000While tens of thousands of health-related Web sites can be found on the Web, tapping its full potential for health services and the biomedical sciences will require more advanced technical capabilities, according to a new report from the U.S. 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", stated Edward H. Shortliffe, chair of the committee which wrote the report and professor and chair, department of medical informatics at Columbia University, New York City. "But the operational demands of health care applications create distinctive requirements and have to 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 doctors retrieving medical histories of emergency room patients on a more regular basis or physicians monitoring homebound patients using medical devices which send data over the Internet. Policy and organisational issues also must be addressed."

For the Web 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 medical applications of the Internet; demonstrations and evaluations of health applications on the Internet; educational programmes to help the health organisations and their employees adopt Internet applications and develop effective policies for doing so; and efforts to resolve policy issues that impede use of the Web 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. The mechanisms required include quality of service, for warranting the availability of network capacity when needed, such as for remote video consultations, and more effective technologies for validating the identities of on-line users engaged in confidential electronic transactions, the committee said. These technologies should eventually be deployed throughout the Internet to serve the highly decentralised health care industry. The National Library of Medicine (NLM) could play a key 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 which link multiple organisations to the Web to exchange health information, the committee stated. Health care organisations 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 offer the health and information technology industries more accurate information for developing strategic plans which incorporate Internet-based programmes. In addition, government, industry, and professional associations should work together to educate the health care community about how the Internet can benefit them, as the report outlines. Educational outreach programmes can be effective in creating a more receptive audience for new technologies.

Federal agencies operating large programmes 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, according to the report committee. The Health Care Financing Administration, the arm of HHS which 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 apply the Web more extensively for sharing medical records among its health centres. DOD already has a sizable telemedicine programme to provide health care to military personnel, but it does not make use of the Internet.

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

The report was sponsored by the National Library of Medicine. 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, non-profit organisation which provides advice on both science and technology under a congressional charter. Pre-publication copies of the report Networking Health: Prescriptions for the Internet are available from the National Academy Press. Learn more about the views of Dr. Edward H. Shortliffe in the VMW article First things first in research and funding of IT, the Internet and medical informatics.

Leslie Versweyveld

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