As the health care industry transitions, for example from fee-for-service care to managed care, access to information will be critical to a successful transformation. Changes are driving the need to rapidly integrate information from disparate systems so that the delivery of care can be managed with greater cost efficiencies. Internet technologies are readily evolving to help solve many of these integration problems. Internet technologies are driving a network-centric approach to computing, that enables authorised users to access information anywhere, anytime, anyplace.

Ernst & Young recently conducted a study of how leading health care organizations are using the new emerging technologies, and identified four major conclusions on the current state of Internet technologies in the health care industry. (The full document, "The Role of the Internet in Health Care", may be downloaded from http://www.ey.com/publicate/health/ ) Some of the issues raised include:

• Health care lags behind other industries in leveraging the power of Internet-derived technologies.
  With a few notable exceptions, the health care industry has not been as quick to use Internet technologies nor to define and measure the value of their use.

• Security is a nonissue from a technology perspective.
  Although cited often as a barrier to expanded use of Internet technologies in health care, this study considers that security is not an obstacle technically. Making sensitive information, including patient data, accessible only to authorized health care users is not only feasible today, technology-enabled security represents a step forward in providing secure access to this information. Although one sees a lot of discussion on the issue, confidentiality concerns are not necessarily Internet-related, and exist with other means of information sharing. Despite this viewpoint, "lurking" on any of a number of electronic discussions touching this issue will make one aware that it is almost as controversial as abortion!

• Immediate value is available to those who are proactive.
  This study identified significant opportunities for health care organizations to realize value from the applied use of Internet technologies. However, executives must be creatively assertive in applying them to meet specific business priorities.

• Technology-enabled "knowledge management" is a critical success factor for surviving and thriving in the future.
  Internet technologies provide a foundation for advancing knowledge management within an organization - including the virtual organization (that is, an organization connected electronically, established for a specific purpose, and torn down when the binding force no longer exists). Business managers who realize the value of sharing information are rapidly becoming "Web developers." Intranets are being recognized as a vehicle for enabling an organization’s departments and business units to cost-effectively share information within departments and with others throughout their organization. Managing the growth and development of such a knowledge-based infrastructure will be critical for organizational success.

This approach to technology applications appears very "company-centric". Yes, to some extent it is necessary for the design, standards and infrastructure to be centrally driven, but the real value should be felt at the level of practice. For this to be accepted though it is critical that there is perceived value to those who must use the system.

In a recent BMJ article the feasibility of the British NHS computer network is examined, particularly as it moves from its initial focus on administration to support for clinical work. The author finds that it is possible to defend a large-scale health network, based mostly on economic arguments, although conditions need to be met before this becomes reality, and changes in attitudes and values are required. Actual assessment is very difficult due to lack of evidence about the costs and benefits of networks in health care. It should be noted that this system involves a variety of networks and raises the real problem of lack compatibility between systems, something that could potentially be addressed by use of Internet technology. The central concept however is that the bulk of the investment costs are incurred early on in the development of a network, and tail off as the network grows (Rethinking NHS Networking, BMJ 1998;316:1291-3, http://www.bmj.com ).

MediSwitch ( http://www.mediswitch.co.za ) is one company connecting various industry players (medical aids, clearing houses, hospitals, clinics, laboratories, doctors, pharmacists, dentists and specialists) through a dedicated virtual private heath care network so that pertinent patient information can be easily and quickly interchanged.