Shortliffe E H, Bleich H L, Caine C G, Masys D R, Simborg D W
Stanford University School of Medicine, CA 94305, USA.
J Am Med Inform Assoc. 1996 Jul-Aug;3(4):249-57. doi: 10.1136/jamia.1996.96413132.
Some observers feel that the federal government should play a more active leadership role in educating the medical community and in coordinating and encouraging a more rapid and effective implementation of clinically relevant applications of wide-area networking. Other people argue that the private sector is recognizing the importance of these issues and will, when the market demands it, adopt and enhance the telecommunications systems that are needed to produce effective uses of the National Information Infrastructure (NII) by the healthcare community. This debate identifies five areas for possible government involvement: convening groups for the development of standards; providing funding for research and development; ensuring the equitable distribution of resources, particularly to places and people considered by private enterprise to provide low opportunities for profit; protecting rights of privacy, intellectual property, and security; and overcoming the jurisdictional barriers to cooperation, particularly when states offer conflicting regulations. Arguments against government involvement include the likely emergence of an adequate infrastructure under free market forces, the often stifling effect of regulation, and the need to avoid a common-and-control mentality in an infrastructure that is best promoted collaboratively.
一些观察家认为，联邦政府应在教育医学界以及协调和鼓励更迅速、有效地实施广域网临床相关应用方面发挥更积极的领导作用。另一些人则认为，私营部门已认识到这些问题的重要性，并且在市场有需求时，会采用并改进医疗界有效利用国家信息基础设施（NII）所需的电信系统。这场辩论确定了政府可能参与的五个领域：召集制定标准的团体；为研发提供资金；确保资源公平分配，尤其是分配给被私营企业视为盈利机会低的地区和人群；保护隐私、知识产权和安全权利；以及克服合作中的管辖权障碍，特别是当各州法规相互冲突时。反对政府参与的理由包括，在自由市场力量作用下可能会出现足够的基础设施，监管往往会产生抑制作用，以及在最好通过协作推广的基础设施中需要避免“共同控制”心态。
