First things first in research and funding of IT, the Internet and medical informatics

Heidelberg 20 September 1999At the MedNet'99 Conference, Dr. Ted Shortliffe, who is Professor for Medical Informatics at Stanford University, offered the audience a brief overview of the current status in the Internet research and its implications for the future of health care. The political agenda for research funding in the coming years has to include both basic informatics research as an enabler of long-term goals and support for traditional biomedical research. At present, we are facing an underinvestment in long-term fundamental research which industry is unable to sustain. It is of vital importance that the government continues to support the education and proportion of the IT workforce, and the high risk, innovative ideas. The governmental agencies are pressed by the growth of IT needs and urgently require funding for basic research and development actions in IT.


In the early days of the Internet, there was no sign of the health care sector when the ARPAnet emerged from the research laboratories in the seventies. On the threshold of the 21st century, new initiatives in IT research are generated, like the academic institutions' Internet-2 testbed, the United States government's Next Generation Internet, and President Clinton's plans for IT². This time, the biomedical community definitely searches ways to be involved in the various applications of IT research, as stipulated in the Botstein/Smarr report addressed to the Director of the National Institutes of Health (NIH). In turn, the National Research Council (NRC) has performed a study funded by the National Library of Medicine (NLM), stating in its report to be issued in November'99, that health care has no special needs but that its complexity of issues and difficult trade-offs do constitute its uniqueness.

In this regard, Dr. Shortliffe doubts whether it would be wise for the health care sector to just take over the security concepts of e-commerce which are commonly used in business today. The Presidential Information Technology Advisory Committee (PITAC), that consists of non-federal members, including experts like Steve Wallach, Larry Smarr, Sherrilynne Fuller and the key-note speaker Ted Shortliffe, has issued its final report this year on February 24th. PITAC has recommended the government to double the budget of $1,4 billion per year by 2004, as to offer wings to projects related to High-Performance Computing & Communication (HPCC), Information Technology (IT), and the Next Generation Internet (NGI). The focus should be put on increasing the fundamental research with regard to software, high-end computing, scalable information infrastructure, and similar items.

So far, the NIH has not been so much involved in getting funding for HPCC. Most of the money has gone to the Department of Defence's DARPA initiative, the National Science Foundation, the Department of Energy and the NASA. At present, there are five areas of cross-agency co-ordination, being high-end computing & computation; large scale networking; high-confidence systems including telemedicine; human centred systems such as biomedical imaging; and human resources, education and training. The Next Generation Internet has passed legislation in February 1997 and as such constitutes the official successor of HPCC. The goals are to connect universities, demonstrate new applications, and promote experimentation. The NGI architecture consists of five high-speed networks, including Internet-2, the vBNS, and its successor Abilene. The American standard for network speed is the optical carrier (OC), ranging from OC-3 or 155 Mbit/sec to OC-192 or 10 Gbit/sec.

As Dr. Shortliffe points out, the Internet has come a long way since Dr. Larry Roberts started with the concept of packet switching in the sixties. The first Telnet use for remote connection with a computer was performed at UCLA by Dr. Kleinrock. Next, File Transfer Protocol (FTP) and e-mail emerged. Dr. Vint Cerf played a major role in transforming TCP/IP into a new standard during the late seventies. After the external networks the local area networks (LANs) such as Xerox and Ethernet were developed. The next step consisted in the creation of a domain system. In 1973, science and medicine discovered the power of the Internet as a novel means of literacy (Joshua Lederberg, 1978). In the mid eighties, the NIH implemented wide-area networking. At the same time, debates started on the issue whether the network should be opened up to commercial activities.

The spectacular rise of the World Wide Web has enabled the development of HTTP and HTML. In 1989, the HPCC programme was promoted by Senator Al Gore to be chartered by Congress in the HPCC Act of 1991. For most of the HPCC agencies, the funding was authorised for the fiscal years 1992 to 1996. A National Co-ordinating Office (NCO) was created for HPCC, which initially was hosted at the NLM and headed by Donald A.B. Lindberg. This is history, the Next Generation Internet constitutes the future. All the current guidelines for further development and evolution are available at the site of the National Co-ordination Office for Computing, Information and Communications. If you like to consult the contents of the Botstein and Smarr report, you can visit the NIH Web site.

Leslie Versweyveld

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