TABLE ES.1Primary Technical Challenges and Limiting Technical Factors in Selected Health Applications of the Internet

Class of Application
Real-Time Video TransmissionStatic File TransferRemote ControlInformation Search and RetrievalReal-Time CollaborationPrimary Technical Challenges
Application Domain
Consumer healthRemote medical consultations to the home, office, or wherever the patient is located.Accessing personal health records online. Downloading educational videos. Sending periodic reports on health conditions to a care provider.Remote control of patient monitoring equipment.Online searching for health information or self-assessment guides. Looking for a doctor or hospital.Collaboration with care providers. Participation in chat groups and support groups.Protection of sensitive patient information from breaches of confidentiality and from corruption. Ubiquity of access so that all health care consumers can be reached at the location at which care is needed. Tools and policies for validating the quality of online information.
Clinical careRemote medical consultations between clinician and patient or between two clinicians.Transfer of medical records and images (e.g., X rays, MRI, CT scans).Remote and virtual surgery (a long-term possibility being examined by the defense and space communities).Practice guidelines. Searches of professional medical literature.Consultation among care providers, such as for surgical planning, which may involve manipulation of digital images.Access to sustained bandwidth and low latency for remote consultations and collaboration. Security of clinical records. Network reliability. Ubiquity of access for care providers.
Administrative and financial transactionsVideoconferencing with real-time sharing of documents.Payment of services, enrollment of patients, quality reviews, etc. Large medical records and images may be transmitted in support of some claims.N/AConsumer access to information about health plans, participating practitioners, eligibility for procedures, covered drugs in formulary.N/ASecurity to ensure confidentiality and integrity of records. Network reliability sufficient to support regular use for business transactions. Standards for data exchange and definitions of data elements.
Public healthVideoconferencing among public health officials during emergency situations, such as chemical or biological attacks by terrorists.Incident reporting. Collection of information from local public health departments and laboratories. Surveillance for emerging diseases or epidemics. Transfer of epidemiology maps or other image files for monitoring the spread of a disease.N/AAccess to published literature and research results as well as epidemiological data. Delivery of alerts and other information to practitioners or other health workers.Videoconferencing among public health officials during emergency situations, such as chemical or biological attacks by terrorists.Security to ensure confidentiality and integrity of laboratory reports and other public health information that may contain personal identifying information. Network reliability. Security from information warfare or attacks on the network's physical infrastructure.
Professional educationDistance education: either real-time transmission of lectures or on-demand streaming video with integrated graphics. Real-time consultations with experts about difficult cases.Accessing electronic medical records from remote clinics. Downloading sets of reference images or prerecorded videos of lectures.Simulations of surgical procedures. Virtual environments for exploration of three-dimensional environments.Accessing reference materials and course materials.Virtual classrooms. Distributed collaborative projects. Distributed discussions.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.
Biomedical researchVisual feedback from remote instrumentation. Online conferences. Collaboration among distant researchers.Transferring large data sets between computers for high-speed computation and comparisons. Reviewing results of remote experiments. Searching archives of three-dimensional medical images.Controlling experimental equipment, such as electron microscopes.Searching remote databases and professional literature.Collaboration among researchers. Peer review. Interactive virtual conferences.Sufficient bandwidth to support rapid transfers of large sets of data for distributed simulations. Low latency to accommodate remote control of equipment.
Limiting Technical Factors
Availability of sustained, predictable, high-bandwidth connections to many locations, including rural health clinics and patients' homes (to support remote consultations).Authentication of source and recipient of information. Security of personally identifiable information in transit across the network and in storage at either end of the network. Availability of sustained high-bandwidth connections for transfer of large, time-critical files.Network latency and bandwidth. Ability to obtain guaranteed bandwidth for predictable periods of time.Tools for locating information of interest and for determining the quality of retrieved information. Means of allowing anonymous searches.Sustained access to high-bandwidth, low-latency networks for collaborations involving real-time video or manipulation of images. Multicast protocols to make more efficient use of networking resources.

From: Executive Summary

Cover of Networking Health
Networking Health: Prescriptions for the Internet.
National Research Council (US) Committee on Enhancing the Internet for Health Applications: Technical Requirements and Implementation Strategies.
Washington (DC): National Academies Press (US); 2000.
Copyright © 2000, National Academy of Sciences.

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