their goals. Health care systems and the new media tools that maintain them,
must adhere to objectives consistent with the primary goal.

The evaluation framework consists of the primary health goal, health
care system objectives--access, quality and cost management, and charac-
teristics of new media tools--interactive, seamlessly connected and user
driven. Each chapter in this book provides a unique perspective on the goal,
the benchmarks for success, and new tools to meet these objectives.

The book's final chapter serves as a counterweight by questioning whether
the information infrastructure envisioned by the private and public sectors
will provide the fertile ground needed for new health media systems to
flourish. Together, the first and last chapters are intended to help us be
critical observers as well as participants in the evolution of health care and
its new media tools.

Almost one year from the day the Clinton administration first announced its
health care reform plan in September, 1993, it was proclaimed dead in
Washington, DC. But a year's worth of reform rhetoric and legislative
infighting has left two important legacies--greater consensus on our goal
and an expanded universe of stakeholders.

During the national debate, conservatives and liberals, corporate execu-
tives and public servants, providers and citizens, came significantly closer to
a shared vision of the purpose of health care systems. That is, to improve the
mental and physical health of everyone at an affordable cost ( Field, Lohr, &
Yordy, 1993). What was once a low income issue has become a growing
concern for many Americans, regardless of economic class. Consensus on
this goal is the first step toward its achievement.

Even after its efforts failed in the fall of 1994, the Clinton administration,
along with states and private health care organizations, has forged ahead
toward changes in the American health care system. And changes will
doubtless be confirmed by future administrations. Quite apart from the
success or failure of federal legislative efforts, progress is very much alive
and gaining momentum in many states and private health care organiza-
tions. ( Anders, 1994; Flower, 1994; Sands, 1994; Sckolnick, 1994; Senate
Committee on Finance, 1993; Tallon & Nathan, 1993). Morgan summarizes
the dynamics of health care reform after the 1994 federal legislative attempt:

Together, the pressures on state budgets and business bottom lines are chang-
ing medical care on a level hardly envisioned when Clinton unveiled his
proposals. . . . States' embrace of "managed care" mirrors a transition that is

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