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Pioneering health care organizations are saving money and gaining greater control of their networks by trading their PCs in for thin clients. But the devices are far from pervasive in health care.

Frustrated by high costs, many organizers of community health information networks are tuning to low-cost, easy-to-implement Internet technologies and protocols. Of the 22 broad network initiatives still under way, about half are either planning to build intranets or incorporating Internet technologies on some form.

Many providers are turning to information technology to improve the supply procurement process as well as reduce supply utilization. These providers are saving money and time by using such technologies as EDI, the Internet, bar coding, purchasing cards and automated supply stations.

A satellite network and other technologies enable Apria Healthcare Group to tie together sites across the nation and improve service.

A Massachusetts hospital uses live surgical scenes, an interactive survey and other measures to build interest in its Web site. It's also using Internet technology for its growing intranet.

The struggles of some high-profile CHIN initiatives have damaged the reputation of community networks. But proponents believe that integrated delivery systems and the Internet will aid their cause in the long run.

Before providers, payers and others sign up to share data through community health information networks, they're asking for proof that savings will far exceed the cost. The fate of the CHIN movement may hinge on the evidence.

Electronic prescription systems address many of the ills in the current paper-based system of getting drug orders from physicians to pharmacies. This new automation application shows tremendous potential for saving time and money and reducing the chance for medication errors. But many hurdles must be overcome before electronic prescribing is widely used.

The Big Three automakers long have wanted Michigan health care providers to give them outcomes data so the care companies could gauge the cost-effectiveness of the care their workers get in the Detroit area. At first, the car companies saw the fledgling Michigan Health Management Information System as the way to finally get the data they've wanted. Eventually, though, after long discussions with other network participants, the carmakers opted to scale back expectations, agreeing that the network should focus first on moving administrative transactions between health care purchasers, payers and providers.

Competition between community health information networks already is brewing in several cities. Some say that competition could speed network development and keep costs in check. But others worry that competition could dilute anticipated CHIN benefits.

The current proliferation of enterprisewide information networks developed by integrated delivery systems wasn't foreseen when the community health information network concept was spawned. Now, many are wondering how enterprise networks will mesh with CHINs and whether there will be needless and expensive duplication of services.

Six Iowa hospitals that don't have a common owner are banding together to form a health information network using a software system that they couldn't have afforded individually. The network will provide easy access to electronic records throughout a broad, rural area.

On-line claims adjudication would provide the virtually immediate, paperless determination of who owes what to whom for the delivery of health care services. Proponents point to the potential cost savings from the elimination of paperwork and increasing efficiency. But skeptics question whether physicians will use the service. They say that the growth of capitated managed care plans could eliminate the market for on-line claims.

After months of uncertainty, the seven regional Bell operating companies have divided into two camps: those that provide only the infrastructure for health care networks, and those that offer infrastructure along with other networking features, such as systems integration and central data repositories. In their quest for health care market share, the Bells face a number of obstacles. For example, they can't provide long-distance service, and they face restrictive rate regulations. In addition, increased interest in cable TV and wireless communication ventures has led some of the Bells to downsize their health care ambitions.

In an effort to cut costs in the paperchoked workers' compensation insurance system, states, insurers, employers and third-party administrators are testing new electronic data interchange applications. Proponents say EDI will not only reduce administrative costs, but also will speed the flow of information so that workers can receive proper care sooner and return to work faster. Two groups are developing standard electronic formats for workers' compensation transactions to simplify the conversion to EDI.

Supply expenses and the related administrative costs are a big-ticket item for America's hospitals. As a result, more materials managers are investigating the use of EDI to cut overhead costs and minimize the need to keep huge stockpiles of supplies. In fact, some envision a day when the routine ordering of supplies will no longer be necessary. But getting there won't be easy. First, hospitals must make small, incremental steps toward automation. And these steps may be the hardest because they involve creating a new way of doing business.