In the United States, the public is accessing the Internet to provide information and deliver services, and to interact with citizens, business, and other government agencies (Bimber, 1999; Pardo, 2000; West, 2003, 2004). As with any change between citizen-government interactions, e-government is accompanied by speculation on its impact to both citizen and government. E-government capability of continual service delivery can make government efficient and transparent to the public (Norris, 1999; West, 2003), and more responsive to public needs through fast and convenient communication options (Thomas & Streib, 2003). It permits quicker material update than traditional distribution methods (Pardo, 2000). However, other literature suggests e-government will not live up to these prospects. A separation exists among citizens that use and do not use the Internet. This separation is based on a number of factors, including inequalities in Internet access “digital divide” and technological skills, along with psychological and cultural barriers. Literature extensively shows the differences in United States Internet use to fall along important socioeconomic and demographic factors, such as age, race, education, and income (Mossberger, Tolbert, & Stansbury, 2003; Neu, Anderson, & Bikson, 1999; Pew Internet & American Life Project, 2003c; U.S. Department of Commerce, 2002; Wilheim, 2000). E-government may create inequalities in the delivery of government information and services. Telehealth is a specific form of e-government aimed at improving the accessibility and quality of healthcare, and reducing service costs (Schmeida, 2004a). It relies on electronic information and telecommunication technology innovation (H.R. 2157, 2001). As nations contend with expensive healthcare, the promise of better healthcare service delivery at a reduced cost has made teleheath an increasingly attractive policy option in the United States and internationally. Telehealth advancement greatly reflects the dramatic changes in the telecommunication industry. In the 1990s, we witnessed considerable advancement, such as the use of digital technology—interactive video and Internet. Interactive video, for example, can link doctors and medical students afar improving medical education. Rural citizens can interact with specialist(s) through interactive video rather than traveling great distances for a medical consultation. The Internet can bring health related information into the home for better healthcare decision-making. Telehealth can be conceptualized as both an administrative reform policy and regulatory policy. As a hybrid policy type, it mostly exhibits the characteristics of administrative reform, such as e-government (McNeal, Tolbert, Mossberger, & Dotterweich, 2003; Schmeida, McNeal, & Mossberger, 2004) driven by the goals of cost reduction and increasing efficiency, paramount to telehealth adoption and implementation. Administrative reform policy does not involve the direct and coercive use of government power over citizens and are therefore associated with low levels of conflict (Ripley & Franklin, 1980). Regulatory policy, on the other hand tends to be politically salient among citizens as well as controversial among the actors within the policy community. Traditionally, those interests who are regulated have been important players in the policy process. Important telehealth players are physicians, nurses, pharmacists, and health insurers. Since telehealth straddles both administrative and reform policy areas, it is difficult to predict the actors that will play the greatest role in assisting or impeding its implementation. Execution of regulatory policy is highly volatile and controversial with shifting of alliances and players. However, administrative policy innovations are low salience, and as some regulatory policies it involves technical issues, often driven by professional networks and elected officials.
HIPAA, HIPAA, Hooray?: Current Challenges and Initiatives in Health Informatics in the United States
