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CONCLUSION

The pilot connections project demonstrates that it is an unusual community hospital which is ready, willing, and able to establish a direct Internet connection. It also shows that the clinical utility of the Internet is not yet readily apparent in a typical community hospital. We feel this is recently beginning to change and will likely do so with increasing rapidity. When a critical mass of easy-to-use, relevant resources with obvious value to health care providers is reached, community hospitals will then have a much clearer incentive to invest in this technology. Other external factors, such as health care reform and reimbursement issues, could heighten the potential productivity gains from Internet use and further add to the incentive.

Establishing a direct Internet connection at a community hospital is a major undertaking requiring institution-wide planning and commitment. The elements needed to do this and some pitfalls encountered in the absence of those critical elements have been elucidated in the foregoing sections. The desire to use the latest technology to move large data files or transfer diagnostic images may be necessary, but is not sufficient in itself. There also needs to be an understanding and assessment of user needs, the development of a comprehensive approach toward information management, and an understanding of how information resources and communication services through the Internet are going to contribute to the mission of the community hospital.

The typical community hospital is not there yet and it will take several years of hard work to get there. It is clearly the direction in which health care needs to be moving. We are convinced that high quality, cost effective health care will not be possible without integrated information management and access to information that the Internet makes possible. We think forces from many different directions will begin to accelerate this process: as Internet- experienced health professionals enter into practice, they will bring a demand for access at their workplace; HCFA's electronic filing requirements will surely affect the computer networking decisions of community hospitals. [2] Add to this a mixture of TV cable companies, telephone companies, and other computing and communications interests and we can only guess at what changes will take place and how quickly.

One of the lessons of this project is that health care in the community setting must come to grips with the role of information in providing care. Another lesson is that the Internet is not yet a clinically useful tool. A question that is raised by this project -- and also by health care's relative lack of substantive presence in national computer networking activities -- is whether the interests of health care can be advanced effectively by the academic and research communities out of which the Internet has sprung, and which manage the networking infrastructure. Would health care be better served by a networking consortium dedicated to it as a vertical market? We think this question bears further consideration.

At no other time has the library profession faced such an opportunity as it does now. The satellite broadcast of the 1994 MEDLARS update included video clips of National Library of Medicine Director, Donald A.B. Lindberg and Vice President Al Gore stating that librarians are in positions to play major roles in the ongoing development of a national information infrastructure. [3] Steve Cisler of the Apple Library described the opportunity: "Librarians have many roles to play as users, facilitators, guides, consumers, and information providers ... no other group has the potential for feeling at home in this electronic place than we do." [4]

The need to connect community hospitals to the developing resources of the Internet continues. Librarians must develop their skills as advocates for information management, and must work to overcome the obstacles outlined in this paper.

ACKNOWLEDGEMENTS

The authors would like to thank the entire NN/LM PNR Staff, the NorthWestNet Staff, and all those who have worked hard and taken risks: Judith Bendersky, Edean Bergland, David Frinell, Cheryl Goodwin, Susan Long, Lynn Marcy, and Kathy Wagner.

RESOURCES

The pilot project librarians found the following resources to be particularly helpful in learning the language, the concepts, and the issues of Internet connections and resources:

ESTRADA, S. Connecting to the Internet: a buyer's guide. Sebastopol, CA: O'Reilly & Associates, 1993.

KROL, E. The whole Internet: user's guide & catalog. Sebastopol, CA: O'Reilly & Associates, 1993.

MARTIN, EW [et. al.]. Managing Information Technology: what managers need to know. New York: Macmillan, 1991.

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