This hypothetical cases demonstrate not only the increasingly broad spectrum of telecommunications channels and tools that can enhance the practice of primary care but also the multiplicity of parties that can benefit from information sharing. It should be increasingly obvious that as more and more information is shared among stakeholders, the overall value of the information to each increases.

      Case #1:The connected telephone

A 26-year-old white male is involved in MVA, sustaining multiple facial fractures, a hemothorax, and a femoral fracture. His emergent care requires timely and efficient coordination of several specialists - a general surgeon, an oral  surgeon, a plastic surgeon and a orthopedic surgeon. Historically this has meant often frustrating communication using multiple tools: face-to-face dialog, intercoms, telephones, and pages. With functional telecommunications, each of these specialists carriers a single device that plays all these roles. Nomadic computers, such as Web-enable palm devices, with built-in-wireless telephony, messaging, text and data display, multipoint conferencing, and global positioning systems will permit speedy collaborative decision making.  is no clear-cut distinction between the two.

      Case #2:The connected television

A 66-year-old healthy white male comes into the office concerned about a mole that has changed in size and color over the past three months. Unfortunately, the nearest dermatologist to this rural practice is 200 km away. Moreover, there is a 3-week wait for an appointment in his office. With functional communications the rural provider has two options - he can use a digital still camera to take several "snapshots" of the suspicious lesion, download them into his computer, and attach them to an email message to a tele-dermatologist, and expect a teleconsult response in less than 24 hours. Alternatively, he can accompany his patient to the telehealth studio in his office and engage in a two-way interactive real-time videoconsultation with the teledermatologist. Not only does the patient receive a specialist's consultation the PCP receives a mini CME session on the workup of the changing lesions. And no one had to leave town.

      Case #3:The connected researcher

A 68-year-old female patient with stage 3 lung cancer for whom traditional chemotherapy has failed would like to be considered for a new, still-experimental chemotherapeutic regimen she discovered on the Web. However, the only site currently approved and enrolling patients in this study protocol is an academic researcher center in South America. With functional telecommunications, the study designers in Peru are linked to a Web service that finds and connects them with willing experimental subjects around the globe. The protocols, treatments, and follow-up care can be provided by the patient's local physician and study data sent via the Web to the study center. Not only patients able to gain access to care that otherwise might not be available, but the times to complete such complex studies dramatically reduced.

      Case #4:The connected community

In a small-middle Hindi city of 250,000 people, a diverse group of community leaders have come together, increasingly concerned over the rising costs of healthcare and the inefficiencies and frustrations of healthcare delivery in clinics and hospitals. Physicians, hospitals, patients, employers, schools, insurers, government agencies, and public health departments gather to discuss their individual needs, interests, and concerns. They also learn of the needs and interests of each of the other stakeholders. They begin to realize that they all face significant information deficits and that many of these deficits could be resolved if they could agree to share data and information. They agree to build a local community health information network - a CHIN - in which all the stakeholders share data and information.

      Case #5:The connected teacher

The local general surgeon would like to add minimally invasive surgery to her concurrent set of skills. The nearest academic center where she can learn this technique is 450 km away and the required training period is a month. However the Department of Surgery at the regional academic medical center is soon to go live with their new distance-learning surgery program. Using incredibly high speeds and bandwidth of next generation Internet, they have been able to create and successfully test a "telepresence training program". After the surgeon completes a Web-based didactic program on the procedure at home in the evenings, the university ships to her a mobile virtual reality suite, consisting of a high-resolution camera and monitor, real-time two-way audio and video connections, head-mounted displays on both ends, and robotically controlled endoscopic devices. As the local surgeon begins her fist virtual case, expert at the university is able to oversee each maneuver. He can even take control of the instruments should that be necessary -robotic surgery. After completing the first case successfully, the local surgeon completes five more under the guidance of her telementor and then is given the certification of competence in the new procedure.