cis.upenn.edu (really linc) is off the sir for a period unknown) mail will be difficult till it come199309151658.AA04188 () eff org

[Dave Farber <199309151658.AA04188 () eff org>]

                 is increasing four times faster than the number of
                 doctors.


         These problems will not be solved without comprehensive
health care reform.  Better use of information technology and the
development of health care applications for the NII, however, can
make an important contribution to reform. Experts estimate that
telecommunications applications could reduce health care costs by
$36 to $100 billion each year while improving quality and
increasing access.  Below are some of the existing and potential
applications:


1.       Telemedicine:  By using telemedicine, doctors and other care
         givers can consult with specialists thousands of miles away;
         continually upgrade their education and skills; and share
         medical records and x-rays.


         Example:  In Texas, over 70 hospitals, primarily in rural
         areas, have been forced to close since 1984.  The Texas
         Telemedicine Project in Austin, Texas offers interactive
         video consultation to primary care physicians in rural
         hospitals as a way of alleviating the shortage of
         specialists in rural areas.  This trial is increasing the
         quality of care in rural areas and providing at least 14
         percent savings by cutting patient transfer costs and
         provider travel.


2.       Unified Electronic Claims:  More than 4 billion health care
         claims are submitted annually from health care providers to
         reimbursement organizations such as insurance companies,
         Medicare, Medicaid, and HMOs.  Moreover, there are 1500
         different insurance companies in the United States using
         many different claims forms.  The administrative costs of
         the U.S. health care system could be dramatically reduced by
         moving towards standardized electronic submission and
         processing of claims.


3.       Personal Health Information Systems:  The United States can
         use computers and networks to promote self care and
         prevention by making health care information available 24
         hours a day in a form that aids decision making.  Most
         people do not have the tools necessary to become an active
         and informed participant in their own health care.  As a
         result, far too many people (estimates range from 50 to 80
         percent) entering the health care system do not really need
         a physician's care.  Many improperly use the system by, for
         example, using the emergency room for a cold or back strain. 
         Many of those who end up with serious health problems enter
         the health care system too late, and thus require more
         extensive and costly therapy.  Michael McDonald, chairman of
         the Communications and Computer Applications in Public
         Health (CCAPH), estimates that even if personal health
         information systems were used only 25 to 35 percent of the
         time, $40 to $60 billion could be saved.  


         Example:  InterPractice Systems, a joint venture of Harvard
         Community Health Plan in Boston and Electronic Data Systems,
         has placed terminals in the homes of heavy users of health
         care, such as the elderly, pregnant women, and families with
         young children.  Based on a patient's symptoms and their
         medical history, an electronic advice system makes
         recommendations to HCHP's members about using self care,
         talking with a doctor, or scheduling an appointment.  In one
         instance, "an 11-year old who regularly played with the
         terminal heard his father complain one day of chest pains
         and turned to the system for help; it diagnosed the symptoms
         as a probable heart attack.  The diagnosis was correct."


4.       Computer-Based Patient Records:  The Institute of Medicine
         has concluded that Computer-Based Patient Records are
         critical to improving the quality and reducing the cost of
         health care.  Currently:


         o       11 percent of laboratory tests must be re-ordered
                 because of lost results; 


         o       30 percent of the time, the treatment ordered is not
                 documented at all;


         o       40 percent of the time a diagnosis isn't recorded; and


         o       30 percent of the time a medical record is completely
                 unavailable during patient visits.








                          CIVIC NETWORKING
                TECHNOLOGY IN THE PUBLIC INTEREST




         The benefits of the NII extend far beyond economic growth. 
As the Center for Civic Networking observed, 


         "A country that works smarter; enjoys efficient, less costly
         government, guided by a well-informed citizenry; that
         produces high quality jobs and educated citizens to fill
         them; that paves a road away from poverty; that promotes
         life-long learning, public life and the cultural life of our
         communities.  This is the promise of the National
         Information Infrastructure."


         The NII could be used to create an "electronic commons" and
promote the public interest in the following ways:


1.       Community Access Networks:  Grass-roots networks are
         springing up all over the country, providing citizens with a
         wide range of information services.  The National
         Information Infrastructure should  expand a citizen's
         capacity for action in local institutions, as it must honor
         regional differences and the cultural diversity of America's
         heritage.


         Example:  The Heartland FreeNet in Peoria, Illinois provides
         a wide range of community information to the citizens of
         Central Illinois 24 hours a day.  Topics covered include 113
         areas of social services; a year long community calendar;
         the American Red Cross; current listings from the Illinois
         Job Service; resources for local businesses; and local
         government information.  Experts in all fields from law to
         the Red Cross to chemical dependency volunteer their time
         and expertise to answer questions anonymously asked by the
         public.


         Example:  The Big Sky Telegraph began operation in 1988 as
         an electronic bulletin board system linking Montana's 114
         one-room schools to each other and to Western Montana
         College.  Today, the Big Sky Telegraph enables the formation
         of "virtual communities" -- linking schools, libraries,
         county extension services, women's centers, and hospitals. 
         Montana's high-school students learning Russian can now
         communicate with Russian students, and science students are
         participating in a course on "chaos theory" offered by MIT.


2.       Dissemination of government information:  The free flow of
         information between the government and the public is
         essential to a democratic society.  Improvements in the
         National Information Infrastructure provide a tremendous
         opportunity to improve the delivery of government
         information to the taxpayers who paid for its collection; to
         provide it equitably, at a fair price, as equitably as
         possible.


         Example:  Some of the most powerful examples of the power
         inherent in information collection and dissemination come
         from the experience of Federal agencies.  For example, the
         Emergency Planning and Community Right-to-Know Act of 1986
         established a Toxic Release Inventory (TRI), which required
         industries to report their estimated total releases of toxic
         chemicals to the environment.  The Environmental Protection
         Agency has used a variety of means for making the data
         available to the public, including a collaborative effort
         involving the agency, the nonprofit community, and
         philanthropy.  This effort involved making the TRI available
         through an online service called RTK NET (the Right-to-Know
         Computer Network), operated by OMB Watch and Unison
         Institute.


         As a result of the TRI program, EPA and industry developed
         the "33/50" program, in which CEOs set a goal of reducing
         their pollution by 33 percent by 1992 and 50 percent by
         1995.  Because of RTK NET's success, EPA is seeking to
         expand the information available on the service. 


3.       Universal access:  The NII must be used to bring Americans
         together, as opposed to allowing a further polarization
         between information "haves" and "have nots."


         Example:  As part of a recent cable franchise negotiation,
         fiber optic cable was deployed in Harlem, where 40 percent
         of the residents live below the poverty line.  New York City
         is exploring the use of interactive video conferencing
         between community rooms in housing projects and government
         offices, schools, and New York corporations.  These
         facilities could be used to teach parenting to teenage
         mothers, and promote mentoring programs between inner city
         youth and employees of New York corporations.






                         RESEARCH


         One of the central objectives of the High Performance
Computing and Communications Initiative (HPCCI) is to increase
the productivity of the research community and enable scientists
and engineers to tackle "Grand Challenges," such as forecasting
the weather, building more energy-efficient cars, designing life-
saving drugs, and understanding how galaxies are formed.


         As a result of advances in computing and networking
technologies promoted by the HPCCI, America's scientists and
engineers (and their colleagues and peers around the world) are
able to solve fundamental problems that would have been
impossible to solve in the past.  U.S. researchers will continue
to benefit from the HPCCI and the emerging National Information
Infrastructure.  Below are just a few of the ways in which this
technology is being used by U.S. researchers:


1.       Solving Grand Challenges:  As a result of investments in
         high performance computers, software, and high-speed
         networks, researchers have access to more and more
         computational resources.  As a result, scientists and
         engineers have been able to more accurately model the
         Earth's climate; design and simulate next-generation
         aircraft (the High Speed Civil Transport); improve detection
         of breast cancer by turning two-dimensional MRI images into
         three-dimensional views; and enhance the recovery of oil and
         gas from America's existing reservoirs.


2.       Enabling remote access to scientific instruments:  Because
         of advancements in networks and visualization software,
         scientists can control and share remote electron
         microscopes, radio telescopes, and other scientific
         instruments.  


3.       Supporting scientific collaboration:  The Internet has
         allowed scientists in the United States and around the world
         to access databases, share documents, and communicate with
         colleagues.  For example, one computer language was
         developed by 60 people in industry, government and academia
         over a period of 3 years with only two days of face-to-face
         meetings.  Instead, project participants sent 3,000 e-mail
         messages to each other, dramatically reducing the time
         required to develop the language.  As scientific research
         becomes increasingly complex and interdisciplinary,
         scientists see the need to develop "collaboratories,"
         centers without walls in which "the nations' researchers can
         perform their research without regard to geographical
         location -- interacting with colleagues, access
         instrumentation, sharing data and computational resources,
         [and] accessing information in digital libraries."






                    LIFE-LONG LEARNING


         Increasingly, what we earn depends on what we learn. 
Americans must be well-educated and well-trained if we are
compete internationally and enjoy a healthy democracy.  The
magnitude of the challenge we face is well-known:


         o       25 percent of students nation-wide no longer complete
                 high-school, a figure which rises to 57 percent in some
                 large cities.


         o       Currently, 90 million adults in the United States do
                 not have the literacy skills they need to function in
                 our increasingly complex society.
         
         The Clinton Administration has set ambitious national goals
for lifelong learning.  The "Goals 2000: Educate America Act"
would make six education goals part of national policy: 90
percent high school graduation rate; U.S. dominance in math and
science; total adult literacy; safe and drug-free schools;
increased competency in challenging subjects; and having every
child enter school "ready to learn."  Secretary of Labor Robert
Reich also has emphasized the need to move towards "new work." 
New work requires problem-solving as opposed to rote repetition,
upgrading worker skills, and empowering front-line workers to
continuously improve products and services.  All of the
Administration's policy initiatives (national skill standards,
school-to-work transition, training for displaced workers) are
aimed at promoting the transition towards high-wage, higher-value
"new work."


         Although technology alone can not fix what is wrong with
America's education and training system, the NII can help. 
Studies have shown that computer-based instruction is cost-
effective, enabling 30% percent more learning in 40% less time at
30% less cost.  Fortune recently reported that:


         "From Harlem to Honolulu, electronic networks are sparking
         the kind of excitement not seen in America's classrooms
         since the space race ... In scores of programs and pilot
         projects, networks are changing the way teachers teach and
         students learn."


         The United States has just begun to exploit the educational
applications of computers and networks.  Students and teachers
can use the NII to promote collaborative learning between
students, teachers, and experts; access on-line "digital
libraries";  and take "virtual" field trips to museums and
science exhibits without leaving the classroom.


         Example:  Headquartered in Cambridge, Massachusetts and
         funded by the National Science Foundation, the Global
         Laboratory Project links students from over 101 schools in
         27 states and 17 foreign countries, including Japan, Saudi
         Arabia, Russia and Argentina.  All over the world, students
         establish environmental monitoring stations to study climate
         change, monitor pollutants such as pesticides and heavy
         metals, and measure ultraviolet radiation.  Students share
         their data over the Global Lab telecommunications network
         with each other and with scientists to make comparisons,
         conduct analyses, and gain a global perspective on
         environmental problems.


         Example:  In Texas, the Texas Education Network (TENET) now
         serves over 25,000 educators, and is making the resources of
         the Internet available to classrooms.  One Texas educator
         from a small school district described the impact it was
         having on the learning experiences of children:


                 "The smaller districts can now access NASA, leave
                 messages for the astronauts, browse around in libraries
                 larger than ever they will ever be able to visit,
                 discuss the Superconducting Supercollider project with
                 the physicist in charge, discuss world ecology with
                 students in countries around the world, read world and
                 national news that appears in newspapers that are not
                 available in their small towns, work on projects as
                 equals and collaborators with those in urban areas, and
                 change the way they feel about the size of their world. 
                 This will create students that we could not create
                 otherwise.  This is a new education and instruction."


         As computers become more powerful and less expensive,
students may eventually carry hand-held, computer-based
"intelligent tutors," or learn in elaborate simulated
environments.  One expert predicted the following educational use
of virtual reality:


         "Imagine a biology student entering an immersive virtual
         laboratory environment that includes simulated molecules. 
         The learner can pick up two molecules and attempt to fit
         them together, exploring docking sites.  In addition to the
         three-dimensional images in the head-mounted display, the
         gesture gloves on his hands press back to provide feedback
         to his sense of touch.  Alternatively, the student can
         expand a molecule to the size of a large building and fly
         around in it, examining the internal structure."


         




                      CREATING A GOVERNMENT THAT 
                       WORKS BETTER & COSTS LESS


         The Vice President Gore's National Performance Review (NPR)
provides a bold vision of a federal government which is
effective, efficient and responsive.  Moving from red tape to
results will require sweeping changes: emphasizing accountability
for achieving results as opposed to following rules; putting
customers first; empowering employees; and reengineering how
government agencies do their work.  As part of this vision, the
NPR emphasizes the importance of information technology as a tool
for reinventing government:


         "With computers and telecommunications, we need not do
         things as we have in the past.  We can design a customer-
         driven electronic government that operates in ways that, 10
         years ago, the most visionary planner could not have
         imagined."


         The NPR has identified a number of ways in which "electronic
government" can improve the quality of government services while
cutting costs, some of which are described below:


1.       Develop a nationwide system to deliver government benefits
         electronically:  The government can cut costs through
         "electronic benefits transfer" for programs such as  federal
         retirement, social security, unemployment insurance, AFDC,
         and food stamps.  For example, 3 billion Food Stamps are
         printed and distributed to over 10 million households. 
         Estimates suggest that $1 billion could be saved over five
         years once electronic benefits for food stamps is fully
         implemented.


2.       Develop integrated electronic access to government
         information and services:  Currently, citizen access to
         federal government information is uncoordinated and not
         customer-friendly. Electronic kiosks and computer bulletin
         boards can result in quick response, complete information,
         and an end to telephone tag.


                 Example:  Info/California is a network of kiosks in
                 places like libraries and shopping malls.  Californians
                 can use these touch-screen computers to renew vehicle
                 registration, register for employment openings, and get