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2 . .3.4 .0.6 2 . 2 . .0.6 .3.4

Without some way to interact with the outside world, most of our programs would be rather pointless. At the very least, we need to provide input to tell the program what specific set of data we want processed (or what parameters to use in its processing), and we need some way for the program to inform us of the results. All of Ruby s input-output (I/O) facilities are derived from the class IO. The streams we normally expect in programs running under UNIX or Windows are provided as global instances of IO: $stdin, $stdout, and $stderr. $stdin allows access to the standard input stream. By default, the standard input stream is the keyboard. $stdout allows access to the

A more recent paper by Crowe [223] is also helpful in tracing the first attempts to provide telemedicine with a strategic dimension at Federal level In 1996, the House of Representatives Standing Committee on Family and Community Affairs established an inquiry into health information management and telemedicine This Committee, which published its Hecrlth On Line, report in late 1997 [224], received subniissions on a wide range of issues, including feasibility, costs and benefits, standards and service implications It expressed particular interest in rural applications, reflecting the vastness and remoteness of the Australian continent, and noted a lack of basic infrastructure on which to mount services 1996 also saw the establishment of a working party of the Australian Health Ministers Advisory Council to examine a range of issues that needed to be resolved at national level.

These issues were concerned with guidance on financing, inter-state registration of healthcare professionals, privacy and security, and equipment and reliability standards Interestingly, criteria to evaluate projects were accorded a high priority [223] More recently (1998/99), we have had the industry scoping study [4] and the report on e-health [6] commissioned by the Commonwealth Government from the Mitchell stable We introduced and referred to these studies in previous sections They are major reports intended as discussion documents to inform the strategy setting process National workshops have been used to broadcast their message The executive summary of the e-health report recommends that everyone should work with everyone else to identify and solve the problems preventing telemedicine from entering mainstream healthcare.

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If this counsel seems a little obvious then the body of the report is more substantial, giving many case studies, an up-to-date list of telemedicine projects in Australia, and international comparisons to illustrate the unstoppable rise of e-health The range of projects demonstrates the willingness of healthcare professionals to embrace telemedicine particularly in the many remote areas with which Australia is so well endowed The industry scoping study has a sharper focus and greater penetration It concludes that most people see telemedicine as a mix of technologies, markets and customers, and few industry stakeholders have a clear picture of how information technology and telecommunications will impact on healthcare over the next few years Some sections of the market (eg videoconferencing) are dominated by a few suppliers thereby restricting competition Enthusiasm and fascination with technology are no substitute for sound business planning and evaluation.

Other factors include the opportunities for exporting and selling healthcare, the limited infrastructure the lack of dialogue and partnerships between vendors and buyers, as well as the usual financial legal and cultural barriers to progress Given the picture of uncertainty that the report paints, it is perhaps unsurprising that while there is agreement that Australia needs a.