B. Opportunities and Challenges for the NII

Principal Author:

Sharon M. Lipp

Additional Contributors:

Arati Prabhakar--Presider
Jim Flyzik--Government Information and Services
Barry Gilbert--Health Care
Bud Hyduk--Manufacturing
Daniel Schutzer--Financial Services
Connie Stout--Education (K-12)

1. Introduction

The task of setting an R&D agenda for the National Information Infrastructure can be approached in several ways, which in turn can lead to different views of the research agenda. The research and development recommendations in this report were driven by the perceived needs in various application areas. Thus, at the symposium from which the report was generated, a plenary session involving presentations by experts in five major application areas set the stage for the technology-oriented sessions that followed. It should be emphasized that these five application areas are only representative of a wide range of applications that will be available in a fully realized NII; important benefits will be seen in other applications as well.

The five application areas represented in the plenary session were health care, education, manufacturing, financial services, and government information and services. Sections 2 though 6 below outline some of the stated needs and requirements in each of the five areas. Section 7 then summarizes those requirements for each of the topics that are addressed in the agenda recommendations (Section C).

2. Health Care

There is much in the press about Health Care Reform. There are many different ideas about the problems with the health care system and many proposed solutions to these problems. One area of consensus is that reform is needed. Issues in the forefront of health care delivery that require solutions include the escalating cost of delivering high-quality health care, inadequate access to primary and specialty care by segments of both rural and urban America, and the duplication of expensive facilities due to the inability of the infrastructure to enable the sharing of these facilities.

The NII can begin to address a number of the above issues. In particular, the NII offers opportunities for outreach to geographically underserved regions and for reducing costs of information-intensive aspects of health care, such as access to patient records and automation of processes associated with record keeping, test results, prescriptions, insurance and billing.

2.1 Outreach

Video-mediated face-to-face contact between individuals involved in the delivery of health care services, i.e., between patients, medical technicians, physicians' assistants and physicians, has been demonstrated. Physicians have demonstrated that after an initial familiarization period, they can work well together without the need to be in one another's presence. Patients have also found remote consultations with physicians not to be overly intimidating, even for individuals who have no familiarity with modern communications technology.

The largest barriers to the use of the present satellite communication-based systems are the high start-up costs and Earth station support, and the inability to achieve timeliness. The technology presently allows only a few facilities to be outfitted with appropriate equipment to support telemedicine-based consultations, and hence these facilities must be scheduled in advance.

For NII-based telemedicine to demonstrate its full merit, it must be as easy to establish telemedicine consultations of all types, when and as needed, as it is to place voice calls today with "plain old telephone service." This requirement is complicated by the fact that physicians and other health care providers are and must be mobile, not only within the hospital, but also in rural areas. The medical services and applications available via the NII must be available to all sectors within the medical community--from the rural clinics to the large medical centers. That is, the communications services must be ubiquitously available with very fine granularity. There must be the ability to "dial-a-bandwidth" so that users can request the services and resources they need, when they need them, and pay only for what they use.

2.2 Lower-Cost Medical Information Access and Management

Health care is extremely information intensive. Each year, Americans undergo 23 million surgical procedures and make approximately 636 million visits to doctors' offices for ambulatory care.[1] Each of these visits and procedures generates medical and financial data such as X-rays, EKGs, patient bills, etc. Today the information is stored in paper files and/or on computer disks at the sites that delivered the services. There is no easy access to or sharing of information between physicians or laboratories unless they are located within the same medical facility.

The concept of "smart cards" and on-line retrieval, which the NII could provide, allows for the sharing of medical histories, test results, X-rays and the like, independent of the location of the patients and their medical records. The integration of handwritten physicians' notes, laboratory results, X-rays, etc. into an electronic medical record will require addressing a number of technology problems such as managing incompatible formats and heterogeneous data repositories, search and retrieval, security, etc. Substantial legal and social issues must also be addressed, but such issues are beyond the scope of this report.

As the reliance on electronic data increases, the need for reliable, robust and available systems becomes imperative. Access to patient information must be transparent and independent of the patient's physical location. The patient record should follow the patient around. The systems must be able to access information from different repositories scattered across the entire country and even the world. The NII-based applications must be as easy to use as placing a telephone call using "plain old telephone service." User friendliness and tolerance for human errors are a must. The engineering details must be hidden from the health care provider.

The security of the patient data/information must be addressed within several domains:

Further technologies specifically needed for the health care industry include:

2.3 The Need for Proven Technologies

The health care industry cannot be on the leading edge of the NII technology drivers. What are "production systems" to some applications may be considered by the health care industry as prototypes. The trust and confidence of both the patient and the physician must be built over time with particular concern for privacy and reliability. The ongoing concern for malpractice suits may slow the acceptance of NII-based technologies until the technologies are proven.

3. Education (K-12)

While a doctor from the 1890s would be at a loss in the operating room of the 1990s, a teacher from the 1890s would be totally at home in today's classroom. The use of textbooks (with a six-year life cycle), a talking-heads (didactic) delivery approach, blackboards and field trips still form the basis for the classroom experience. Historically, classroom walls isolate both teachers and students from other teachers and students. Within existing education systems, the infrastructure that industry/business takes for granted is not in place. Many schools have only one phone line into the building. Thus, teachers do not have phone lines to their classrooms. Over the last several years, computers have become more pervasive in the classroom. However, the computers that are in place are often not linked, and if they are, it is usually only to share a printer or file server. A large percentage of schools have cable installed in the classrooms because cable companies have offered free connections in order to win franchises in the community. However, cable connections currently provide only video and one-way communication.

The NII will offer many exciting opportunities for elementary and secondary education. For example, children move from school to school; having applications and information follow the student will provide for continuity in the child's learning process. Furthermore, access to student records that include examples of work highlighting the child's progress and capabilities will enable teachers to tailor their education programs. Other substantial benefits will include transitioning from:

The transition from the current infrastructure to NII technology in elementary and secondary education must take into account (and in some cases use to advantage) available resources, current educational reform efforts and the fact that more than 16,000 school districts requiring access to the infrastructure are in rural areas of the United States. Furthermore, security is a key issue. This is most obvious in the case of student record confidentiality. Another concern is that children are very creative and incredibly talented when it comes to finding ways to explore places they are not supposed to be.

Specific technologies and requirements needed by the education (K-12) application include:

The NII will facilitate the re-engineering of the whole learning process. As was observed by Connie Stout, the education panelist, "It's hard to know what [new applications] people will want until they have the opportunity to experience the technology in real applications." Experience over time will help shape the needed applications and services. However, educational systems cannot invest unless they share their investments. The education system should think about the whole community; it can become a community resource by addressing applications in areas such as lifelong learning, adult education and job training.

4. Manufacturing

Traditionally, information infrastructures have supported corporate functions by improving the efficiency of activities such as payroll and word processing. Now the shift is toward improving business performance by increasing the effectiveness of product development, delivery and support. The value of the NII to manufacturing is in increasing manufacturing's ability to meet customers' needs. One of the driving forces is reduced cycle time from concept to delivery. Manufacturing must address its customers' needs for timely availability of products. Another change is the evolution to on-line production (lot sizes of one) to meet a customer order.

To remain competitive in this rapidly changing environment, manufacturing (large, medium and small) must move to the concept of "virtual corporations"--linking manufacturing directly with its customers, suppliers, vendors and subcontractors. The integration of the entire enterprise--development, engineering and manufacturing processes into the manufacturing infrastructure--is the challenge.

The infrastructure should allow for design teams that are geographically dispersed to work together and for expansion of the design team to include customers independent of location. On-line design changes to address a production problem, design alternatives, substitution of parts/material, etc. can be done in "real time" with all of the parties involved.

The current infrastructure is meeting some needs. However, manufacturing applications severely stretch the capabilities. To fulfill the requirements for manufacturing, the infrastructure must be capable of supporting:

For the NII to be widely deployed within manufacturing, companies that participate in the network must see economic value for their customers.

5. Financial Services

The heart of financial services is people receiving and spending money. When one talks about financial services, one must include accounts and transactions, deposits and withdrawals, commerce, loans and credit, billing and payment, and money and other financial instruments. Today's approaches include credit cards, cash, stocks and bonds, and prepaid cards. None of these work very well in an NII context as currently implemented.

The NII will accelerate the velocity of money flow by realizing the concept of a "virtual bank." The virtual bank will allow delivery of services over public networks 24 hours a day, seven days a week, from any device, anywhere and with any bandwidth. This will allow people to do their banking at their home, their office, their car, wherever they are. It will be accessible--no waiting in lines or busy signals. It will minimize paper and manual processing.

The NII will also allow customer service representatives and financial specialists using interactive video lines to provide global assistance and individual customization and personalization of products and services. Analyses including realistic simulation and visualization of multiple futures can be made readily available. In addition, transparent third-party real-time financial services would also be available. These services will renew emphasis on long-term relationships and provide the flexibility needed by the customer.

NII financial services such as those outlined above will require the use of "digital currency." Digital currency must provide anonymous transactions with the same ease of use and flexibility as cash has today. The buyer requires assurances of privacy, yet the seller must be assured that the payment is valid. Thus, specific technologies and requirements needed by the financial community to realize this vision include:

6. Government Information and Services

Nearly everyone must interact with the government at one time or another. In many cases, the interaction is complicated, difficult, slow and may require dealing with a number of different agencies or departments.

The NII provides dramatic opportunities to improve the efficiency and ease of use of government services. Electronic government overcomes the barriers of time and distance to perform the business of government and give people public information and services when and where they want them. It can swiftly transfer funds, answer questions, collect and validate data, and keep information flowing smoothly within and outside government. Integrated electronic benefits transfer; a national law enforcement/ public safety network; intergovernmental tax filing, reporting and payments processing; an international trade data system; a national environmental data index; and governmentwide electronic mail are only a few of the applications and services that will benefit from an NII. The infrastructure will also allow the government to consolidate and modernize its data processing centers and standardize some of government's basic administrative functions, such as payroll, personnel record-keeping, management information systems, and financial and general ledger accounting. NII's implementation will thus provide substantial return on investment through increases in productivity.

The movement toward an electronic government should focus on providing effective services to the citizenry. As with industry, government should not simply automate existing practices. Instead, public officials should view information technology as the essential infrastructure for government in the 21st century--a modernization to give citizens broader, more-timely access to information and services through efficient, customer-responsive processes.

The move to an electronic government will require overcoming a number of barriers--some technology-related, some cultural, some regulatory and some legislative. The government now provides services on an agency-by-agency basis with little or no sharing of data/information across agencies. This must change. Furthermore, an incredible volume of information and information processing services must be converted to electronic form.

Government information and services must be available 24 hours a day. They must be user friendly and support a combination of audio, video, text and graphics. Behind the applications, there must be fast and efficient storage, searching and indexing techniques for information retrieval. Expert systems or agents can assist the user and will determine user eligibility for specific government services.

The technical issues that must be addressed include:

Success in implementing electronic government also depends on public confidence. Electronic government must protect the information it processes and ensure individual privacy. It also must protect national security interests, permit legitimate law enforcement activities, enhance global competitiveness and productivity for American business and industry, and ensure civil liberties. The government must define uniform privacy protection practices and generally accepted principles for information security. It also must adopt a digital signature standard and promulgate encryption standards for sensitive information.

7. Summary

The integration challenges of the NII are without precedent. We must create an infrastructure that is ubiquitous and transparent. The base technology needs of the five strategic application areas that must be addressed to move the NII from a concept to a reality include: In addition, the application areas highlighted a number of policy and market issues. A few policy issues include access that is independent of location (rural or urban), intellectual property rights and interoperability. Market issues such as low cost/affordability and the need for a global NII were discussed. These are important issues that can benefit from technology solutions such as technologies that reduce costs, technologies that allow for implementation of the intellectual property policies/laws, and wireless and satellite technologies that may address some of the global access issues. Although the policy and market issues are important, they are being addressed in several NII working groups and are outside the focus of this report.
[1] Computer Systems Policy Project, "Perspectives on the National Information Infrastructure: CSPP's Vision and Recommendations for Action," Washington, D.C.; January 1993, page 8.