ATP FOCUSED PROGRAM:

               Information Infrastructure for Healthcare

                       FY 1994 NIST Funding: $30 million
                  Total FY 1994-98 NIST Funding: $185 million

Potential for U.S. Economic Benefit

     The healthcare industry has a pivotal role in the economic health
     of the country. Medical spending is expected to top $1 trillion in
     1994, and conservative estimates figure 20 percent of today's
     healthcare costs are related to the processing of information.
     Using effective information technology systems in the healthcare
     industry can deliver substantial cost savings while also
     strengthening an important sector of our industry. On the other
     hand, continuation of today's segmented applications of information
     systems to healthcare will only move the industry further from the
     possibility for a seamless information infrastructure.

     Growth in the healthcare industry should be part of a systemwide
     approach to information systems. It should not be driven by
     isolated technology applications that provide only piecemeal
     solutions to our healthcare information needs.

     Even so, healthcare is the fastest growing market in the computer
     field. Medical software systems, for example, have uses in patient
     monitoring, financial information tracking, and analysis -- all
     increasingly important tasks as our healthcare information
     infrastructure develops. The ATP focused program can drive further
     the growth rate for both computer hardware and medical information
     systems used in the healthcare industry.

Technology Challenge

     The ATP Information Infrastructure for Healthcare program will develop
     technologies at each of three consecutive levels:

     >  technologies to form the foundation of a private-sector-driven,
          nationwide information system, including tools for enterprise
          integration, domain identification, and business process
          modeling;

     >  technologies to make such a system efficient and user friendly,
          including computerized knowledge-based systems, digital
          libraries, and natural language processing; and

     >  applications that directly meet healthcare users  needs, such as
          clinical decision support systems and consumer health
          information and education systems.

     After the five-year program is completed, and the technical goals
     are met, the nation should expect to see the capability to develop
     products that will:

     >  reduce healthcare costs,

     >  improve the quality of healthcare, and

     >  capture global market share of new and improved products and
          services.

Industry Commitment

     This focused program builds on about 36 detailed  white papers
     submitted by industry and on follow-up discussions with the
     representatives of companies and organizations in several sectors
     of the healthcare and information communities. About 400 of these
     representatives took part in a workshop to help formulate this
     program. In the past two years, major industry consortia have begun
     to address the very complex interoperability issues related to a
     national healthcare information infrastructure. These consortia
     include the Computerized Patient Record Institute, Microelectronics
     and Computer Technology Corporation's Healthcare Open System Trials
     program, and the National Healthcare Industry Consortium. Although
     member companies do research on individual technologies, ATP
     funding is needed to catalyze development of an infrastructure that
     will connect these islands of automation. The consortia and other
     players have agreed to at least match the cost of any technology
     development on the part of the federal government if they submit
     successful proposals.

Significance of ATP Funds

     Existing multimillion-dollar programs of research in healthcare
     information technology lack the coordination and integration
     necessary to share information nationwide. For example, individual
     hospitals are developing or installing their own information
     technology systems without knowing how to make sure that they will
     be connected seamlessly to the national healthcare enterprise.
     These institutions run the risk of investing huge resources in
     systems that will limit inherently the ability of others --
     including suppliers, insurance companies, and non-affiliated
     physicians -- to make the best, most efficient use of the
     information contained in those systems. Furthermore, they miss out
     on the economies of scope that a more systematic approach to
     healthcare information systems would bring.

     Today, the development of the technology needed to establish a
     national, interoperable, dynamic information system is unlikely to
     occur with current industry effort. By creating a way for the
     private-sector players to coordinate their efforts, the ATP can
     minimize the individual risk so that investments can be made in the
     technologies necessary for long-term success.

     Other government agencies are investing in information technology
     applications for healthcare, but the money flows almost exclusively
     to one of three areas: funding basic health research; low-risk,
     near-term problems directly related to the mission of the funding
     organization; or establishing small, isolated pilot projects using
     existing technology. NIST has, in fact, involved many of those
     agencies as this program has been developed to ensure coordination
     and cooperation. The ATP focused program will be unique in
     providing funding for high-risk technology development projects
     that are led by industry and designed to have a major economic
     impact on both the U.S. information technology sector and on the
     healthcare system that so desperately needs to take better
     advantage of the benefits that information technology can deliver.


April 1994