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channel. For instance, one of educational pilot projects, which was initiated by Korea ... Classes Opened and Students Registered at Seoul National University Virtual. Campus ... Another NGI project initiated by NIH is Real-time Telemedicine.
Policy Implications for Social Impact of Emerging Technologies: Next Generation Internet Application Services in South Korea

Junseok Hwang Assistant Professor School of Information Studies, Syracuse University Syracuse, NY, USA [email protected] Jooho Lee School of Information Studies, Syracuse University Syracuse, NY, USA Ji-Hong Park School of Information Studies, Syracuse University Syracuse, NY, USA

Abstract What this study raise the most important question for the Next Generation Internet (NGI) is not how the technology for NGI application service will be changed, but how the impact of NGI application service will change our life and implicate key policy makers. To reach this research goal, this research was conducted primarily to understand and analyze the impact of Information and Communication Technologies (ICTs) use in education and health care in Korea and further to suggest policy implications for the Next Generation Internet. The research methods were related literature reviews such as Social Informatics, and Internet application services as to Education and Health Care. From the analysis of Education and Health Care application service based on the social impact perspectives, this research found that Education and Health Care application services in Korea had considered ICTs as a simple context so that some policy gaps were founded between human and ICTs. To fill it up, this research suggested critical further researches.

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1. Introduction The Internet becomes an essential infrastructure to integrate the information and communication technologies (ICT) used in various applications such as education and health care as well as in electronic commerce. In Korea, the government plans the establishment of the Next-Generation Internet (NGI) networks by 2005 and an increase of the portion of Internet users to 60 percent of the population, thus laying the groundwork for digital economy. The NGI infrastructure, aimed at boosting the average data transmission speed from today’s 33 Kbps to 33 Mbps, is expected to support info-tech venture business. According to Korea Times (2001), the government will inject 93.1 billion won into the development of backbone networks, expanding the coverage into remote areas while strengthening the high-speed network gears to increase the base of online users. With connecting universities and national labs with high-speed networks and promoting experimentation with next generation of networking technologies, NGI will support new application services such as distance education, health care, scientific research, national security, and environmental monitoring. Recently, National Computerization Agency (NCA), an agency of Ministry of Information and Communication, recommended seven core NGI application service areas such as distance learning, digital library, digital government, virtual cooperation, telemedicine, virtual research lab, and Video on Demand. These new applications could have profound effects upon professional practices and values in various fields as illustrated vivid vignettes in NGI planning documents (Kling, 1998). Of the various application services, Education and Health Care application services could widely impact almost all the people’s life. That is the reason this research chose these application services. What this study raise the most important question for the NGI is not how the technology for NGI application service will be changed, but how the impact of NGI application service will change our life and implicate key policy makers. This research focuses on two application service areas such as Education and Health Care to answer the following research questions: (1) What is the social approach for new technologies? (2) What are currently happening in education and health application service areas in South Korea? (3) What are social impacts of the education and the health application services in South Korea? (4) What could be policy implications based on the social perspective for the NGI application services in South Korea? Responding to above research questions, this study wraps up policy implications for NGI practitioners.

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2. Internet Application Services: Education and Health Care From 1995, some of pilot projects ranging from distance education to telemedicine were conducted on the line of National Project such as Super Highway Information and Communication Network Project (SHICNP) in Korea. This section introduces the application services conducted in education and health in Korea.

2.1 Education Distant learning started decades ago in the form of correspondence courses that were conducted by some colleges. But as ICT develops and the Internet becomes more pervasive, the concept moves into the mainstream education, not remaining a complementary education channel. For instance, one of educational pilot projects, which was initiated by Korea National Open University (KNOU) from 1995 to 1997, connected the head office of KNOU to 12 local community centers to build the system which can transfer the education information of video, text, and audio files. This project expected this system to support the distance lecture and learning so that might enlarge the educational opportunities and develop the quality of education (NCA, 1999). Web-based distance education, especially, has been largely expected for its cost-effectiveness and quality improvement (Lawhead, 1997; Baer, 1998; Jung and Rha, 2000; Kaczmarczyk, 2001). Table 1 described that enormous time and money has been invested in designing and implementing an ICT-based infrastructure since SHICNP conducted along with the directions such as diffusion of the ICT and pilot projects in order to achieve goal of distance learning using Internet,

Table 1. Budget Allocation for ICT diffusion into Elementary and Seconda ry School (Unit: Million Dollars) 1997 1998 1999 2000 Sum Central 2.18 2.38 2.56 5.38 12.5 Government Local 24.2 15.3 16.4 30.0 85.9 Government Private 2.42 1.81 1.64 1.03 6.88 Sector Sum 28.8 19.49 20.6 36.41 105.25 Source: 2000 Educational Informatization White Paper

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As a result, of the 10, 447 public schools including elementary, middle, and high school, 4,168 (40%) schools built the inter-school network system as of the end of 1999. 494,477 computers for students and 179,183 computers for teachers were diffused as of the end of 1998. Of these computers, 465, 389 pentium computers were pervaded. Although many computers had been diffused through the public schools, only 33.8% schools use the dedicated line to connect Internet. Furthermore, almost all schools with Internet connection network have 256 kbps bandwidth, which results in bottleneck problems when connecting at the same time (Internet White Paper, 2000). Korea is one of the strongest in the world in the infrastructure for higher education. With more than 4 million subscribers to high-speed Internet service, the country communication infrastructure is stronger than any other country. As of 2000, for instance, there are 13 cyber universities, which are spearheaded by major universities, that will be up and running from March in this country. Table 2 shows that the number of cyber-education programs run by Seoul National University Virtual Campus (SNUVC) is rapidly growing, along with that of the students taking advantage of them.

Table 2. Classes Opened and Students Registered at Seoul National University Virtual Campus 1998 1998 1999 1999 2000 2000 Spring Fall Spring Fall Spring Fall Classes 4 10 16 17 24 40 Opened Students 917 1000 900 1000 1500 2000 Registered Source: 2000 Educational Informatization White Paper

2.2 Health Care The explosive impact of the Internet will continue in health care as well as education, entertainment area. In the future, when NGI would be completely implemented, people could enjoy the medical benefit from remote health care system. Patients could meet famous medical doctors without regional limitations through video communication technologies supported by high broadband networks. Life-long health record of patients would be kept through the health care system. Radiology Consultation Workstation (RCWS), currently being implemented by NIH (National Institute of Health) in United States as a NGI Initiative, is a prototype to support radiological treatment using ATM medical networks. By analyzing patients’injuries through -4-

high -resolution screen and interactive communication system among the doctors, doctors can share their opinions and arrive decisions without location hindrances. Another NGI project initiated by NIH is Real-time Telemedicine. Medidas, Inc., a medical information firm in Korea provides “Health Korea” (www.healthkorea.net) sites where users or patients can get health consulting in the 20 medical areas such as internal medicine, pediatrics, and 23 special clinics such as obesity clinic from over 100 medical doctors. It was opened in June, 1998 and number of its members exceeds 60,000 (NCA Report, 1999). In July, 1999, a remote medical treatment center was opened in the Seoul National University. The first telemedical treatment was performed in Korea Telecom (KT)’s medical room. Korea Telecom employees can communicate with medical doctors in Seoul National University Medical School through real-time video communication systems. The medical doctors can remotely hear patients’heart beat and inspect patients’ears or eyes through telemedical devices. After the treatment, patients are provided with remote prescription on the screen with which patients can get medicine in a near drugstore or by delivery (NCA Report, 1999). The Ministry of Health and Welfare tried medical demo services such as remote reading of X-Ray and Supersonic Wave film. The service was first launched in November, 1994 and ended in February, 1998. The main problem was reluctances that the related organizations had in accepting services and some remote medical regulations and laws. The development of remote operational robots that have high sensitive sensors transmitting touching senses to operational doctors is emerging. The Tele-Robotics and Control Laboratory in Korea Advanced Institute of Science and Technology (KAIST) has developed minute remote operational robots since 1996. However, it has not been verified that users are to use this system without hesitation in reliability and security (NCA Report, 1999).

3. Social Informatics Perspective Social informatics is the multidisciplinary study that examines the design, uses, and effect of information and communication technologies (ICTs) ranging from institutional, social, and cultural contexts (Kling, 2000). In this part, we briefly review traditional socio-

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technical approaches, and then emphasizes the capability of social informatics perspectives to guide this research. The increasing interwoven social life with computing these days highlights the potential value of socio-technical approaches.

3.1 Standard Tool Model Approach Standard Tool Model (STM) approach has been to consider technology as “hardware” such as equipment, machines, and instruments that humans use in productive activities, whether industrial or information devices. “Technological access refers to the physical availability of suitable equipment, such as computers that are of adequate speed and equipped with appropriate software for a given activity” (Kling, R., Crawford, H., Rosenbaum, H., Sawyer, S., Weisband, S., 2000).

3.2 Socio-Technical Approach In contrast to the Standard Tool approach, this seeks for optimal combination of human resources and technical systems. “Socio-technical networks refer to the interactions between people, organizations, institutions, and a range of technologies in rather intricate heterogeneous arrangements in which what is “social” and what is “technical” cannot be readily isolated in practice” (Lamb, Sawyer, Kling, 2000). If a technical system is treated separately from organizational and social issues, the result may be such a system as functions well but does not appropriate for its users. The development of organizational structures and policies to achieve organizational objectives would be counterproductive if it did not consider the possibilities and constraints of the technical system which will provide the tools to do the job (Eason, 1988). For example, the video-phone was not widely adopted. Main reason was people’s preference for visual privacy at home. Even in offices, many people who have videophones or desktop video communication facilities veil their cameras, or spend much time on cosmetic arrangements for their appearances and desktops before answering video phones (Austen, 1998).

3.2.1 Traditional Socio-Technical Approaches The two best-known socio-technical approaches are the Social Shaping of Technology (SST) and the Socio-Technical Systems (STS). The focus of SST perspective lies on large-scale socio-technical groups. SST researchers examine how social contexts shape emergent technologies. Bijker (1995), for -6-

example, uses a socio-technical framework to discuss the development of a wide range of dissimilar technologies, such as bicycles, the origin of plastic, and other innovations. The STS approach emphasizes interactions with various technologies in workplace. STS researchers have focused on developing socially sensitive, ethical, and humane methods for technology design (Kling, R., 1996). In doing so, STS researchers have developed concepts and evaluations for use in the analysis of organizational structures and in the diagnosis of workplace discontinuities (Moldaschl and Weber, 1998) Even though the focus of neither approach lies on ICT development and use, in the sense that ICTs are one of cases of “technology,” both approaches have been helpful to understand the use of ICTs and the socio-technical network. Quintas (1994) has used the SST approach to inform his analysis of software engineering innovations. Orlikowski and Gash (1994) have also used SST concepts to interpret the development of information systems within an organization. Their study merges Bijker’s concepts with organizational change theory as they examine complex “artifacts” and complex “users.” Their analysis exposes the recursive nature of changes in technology frames and technological artifacts as complexity increases, and begins to point out the need for a more well-integrated socio-technical network approach.

3.2.2 Social Informatics Perspective The social informatics (SI) foundation provides a multidisciplinary perspective. It is the interdisciplinary study of the design, uses and consequences of information technologies that takes into account their interaction with institutional and cultural contexts. SI research focuses on the social consequences of the design, implementation, and use of ICTs over a wide range of social and organizational settings (Kling, R., 1996). Social informatics is a problem-driven research domain that begins with an assumption that ICTs and the social and organizational settings in which they are embedded are in a relationship of mutual shaping (Bijker, 1993; Kling, 1996) This discussion of social informatics helps to emphasize a key idea: ICTs do not exist in social or technological isolation. The cultural and institutional contexts in which they are embedded influence the ways in which they are developed, the kinds of workable configurations that are proposed, how they are implemented and used, and the range of consequences they have for organizations and other social groupings. Social informatics perspectives provide a rich set of conceptual insights to guide current and future examinations of ICT use in socio-technical networks (Kling, 2000). -7-

However, the growing ubiquity of ICTs and the globalization of network phenomena challenge existing socio-technical interpretations.

Internet has many possibilities that have huge impact on societies and it also consolidates its shape affected by society (International Telecommunication and Economy Institute, 1997). In the view of Social Informatics, the following chapter investigates the current situations in education and health care Internet application service areas. It introduces elearning and virtual classroom initiated by United States’National Information Infrastructure (NII), and a remote medical treatment center in South Korea.

4. Analysis of Internet Application Services in South Korea

4.1 Education The explicit goal of distance learning using ICT has not been accomplished even though it has a great potential to decrease educational costs and improve educational quality. This research believed that Social Informatics could explain partially this unexpected phenomenon. Distance learning using Internet needs huge initial and maintaining costs such as development, delivery and student costs (Lawhead, 1997). Social Informatics will be very helpful to understand redundant and unexpected costs in developing and delivering distance learning using Internet. Huge investments on ICT hardware and software for education have already sunken in public and private sector as mentioned at the previous section. However, an assumption that ICT is tool and context surrounding ICT is simple has been causing unnecessary costs during developing and implementing web-based education systems. For instance, Baer (1998) argued that improving productivity by reducing instructional cost has played a lesser role following reasons: ?? Existing courses cannot simply be transplanted onto the Internet ?? Enthusiasts usually discount the amount of human support needed for effective PC-or Internet-based learning ?? Research universities have had little incentive to reduce instructional costs since they represent a relatively small percentage of overall operating costs -8-

?? Government funding for higher education is often based on student on campus attendance ?? Faculty may explicitly or implicitly resist changes they believe threaten their jobs or academic roles

Growing concerns with cost-effectiveness have paid attention to some scholars since Virtual University Trial Project initiated in South Korea (Jung and Rha, 2000). Jung and Rha (2000) maintained that KNOU which has initiated a project on evaluating cost-effectiveness of virtual education reported that the average cost per students in a 16-week web-based course for 30 students is $434, whereas a typical 16-week distance education TV course for 1,000 students costs $80 per student. Distance learning using Internet has been approached with an assumption that ICTs are tools, not socio-technical network. For example, Pang, etc. (1999) argued that the education fields could make a decision on the user-centered procurement and deployment of ICTs in order for education institutions to catch up with rapidly changing technologies and to meet the needs of education fields. Also, administrative people are needed in maintaining ICTs after its implementation. Kazmer and Haythornthwaite (2001) explored 17 students’ involvement with the distance learning program and found that their satisfaction with the distance program enlarge with increased involvement with the learning community whose are friends and families. A great many young adults still prefer the face-to-face instructions and social interactions they can get in offline campus, even though it costs more tuition than a distance learning program does (Baer, 1998). Because ICTs and infrastructures are sociotechnical systems since technical capabilities depend upon skilled people, and administrative procedures and social capabilities are enabled by simpler supporting technologies (Kling, 1992). The context surrounding ICTs are complex, not simple. Previous researches confirmed that ICT planning based on STM has overlooked various social settings (Jung and Rha, 2000; Kazmer and Haythornthwaite, 2001). Policy makers have made an assumption that dominant users such as teachers and students are willing to utilize ICT once it diffused among educational institutions. However, lacking of understanding complexity of skill levels, needs, interactions and legal environments became the pivotal failure factor for enhancing educational quality using ICT, given frequent and proper use of ICT among teachers and students gives the foundation for improving quality of education (Chen, 2001; Song, 2001; Kazmer and Haythornthwaite, 2001). For instance, Table 3 shows that 202 (48.1%) teachers -9-

working elementary and secondary institution has been utilizing educational software very rare (10 %) in their class for one semester (Song, 2001).

Table 3. Ratio of using educational software for one semester 90 % 70 % 50 % 30 % 20 % Elementary School Middle School High School Sum

10 % 107 31 (13.2) 45 (19.1) 42 (17.9) (45.5)

Sum 235 (100)

2 (0.9)

8 (3.4)

3 (3.0)

7 (7.1)

4 (4.0)

10 (10.1) 29 (29.3) 46 (46.5) 99 (100)

4 (4.6)

3 (3.4)

6 (6.9)

9 (10.4)

9 (2.1)

18 (4.3)

41 (9.8)

64 (15.2) 86 (20.5)

15 (17.4) 49 (56.9) 86 (100) 202 (48.1)

420 (100)

This study also found that lacking of operational knowledge on educational software (21.4%), proper educational software (20.0%) and necessity of it (18.0%) are main reason why teachers at the elementary and secondary school do not use educational software. Cyber universities and virtual institutions have regarded ICT contexts as simple. It has been conducted based on a few key terms and demographics such as Koreans' unbeatable education fever, increasing the Internet users, and supporting technologies. With combining these key elements with demographics, distance learning seems to gain its intended goals to promote life-long learning, which is necessary to compete internationally and enjoy a healthy democracy. However, ICT contexts surrounding distance-learning programs are not simple. Cyber university students in Korea, for instance, cannot have same benefits as offline campus students. The current military policy in South Korea did allow those who registered cyber universities to postpone joining a military service which is a mandatory for all Korean male, although the Education and Human Resources Development Ministry has endorsed nine cyber university degrees since 2001. Whereas, the current military law allows offline-campus students to put off the military service up to eight years. These conflicts mainly resulted from the lack of institutional procedures to fill the policy gaps between offline and online education.

4.2 Health Care Most of current NGI medical initiatives are based on tele-medical technologies such as real-time video communications using ATM medical networks, the remote reading devices of X-Ray and Supersonic Wave film, and the minute remote operational robots, which are mentioned in the Internet Application Services section.

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Telemedicine, treating patients by "remote control," has acquired a distinctive attention. It is popularly associated with a future Utopia of computers, modems, cyberspace and the transmission of information, especially high-resolution images, instantly over long distances. A doctor can sit at a screen and direct another, hundreds of miles away, on how a procedure should be performed. If a complication occurs, he can zoom in and, thanks to highdefinition pictures, advise what should be done. If he doesn't know, he can contact doctors worldwide via the Internet to see if they have the answer. In addition, tele-medical services could lessen patients’waiting time, labors and money. Medical treatment could be customized according to each patient’s medical history, which, as a result, improves the quality of services. It also increases medical accessibility in medically disadvantaged areas with keeping medical sustainability. However, it has several problems to solve. First of all, social economic problems and regulation problems. Patients’privacy problems, licenses for doctors, and medical insurance charges are included. In tele-medical services, it is essential process to digitize patients’ personal medical information, which could cause security and privacy problems. Another problem could be costs for implementation of the medical systems and the medical services. Most R&D projects on telemedicine imply that health care is illness-oriented. It is argued that most negative aspects of institutionalized medical care are propagated into telemedicine applications, or even threaten to take alarming dimensions: for instance, home patient remote surveillance and massive screening of medical records could easily become the problem rather than the solution. Since telemedicine is socially useful, a major shift is required in order to avert negative social implications. The emerging comprehensive concept of health emphasizes the well-being of the individual, the total health environment, consciousness raising, and community involvement can provide a socially and technically sound alternative model of heath care (Veneris, Yannis, 2000). Wherever telemedicine is operated, the video interfaces using websites or whatever it would be, should be easily interactive to insure reliability and they should offer relevant and helpful information, while remaining sensitive to cultural expectations. This demands not only superlative software engineering but an understanding of the requirements of particular communities. Such hybrid perspective of the engineering view and the social view is not easily found in the current NGI medical application initiatives. Most medical websites merely provide information on diseases, symptoms and probabilities through and are, therefore, unsatisfactory. And they do not provide a means by which the ordinary person can communicate satisfactorily. The “Health Korea” (www.healthkorea.net) - 11 -

site which was mentioned before uses real-time telemedicine consulting, however, it also has some aspects overlooked. Computer systems including telemedicine systems, however wellprogrammed, lack human skills. By tone of voice, body language or whatever, patients are able to communicate what ails them to their doctors. A vague malaise could portend some serious condition, or it may simply mean a contretemps with a spouse. It takes a kind of spiritual antennae to determine which it is. Experienced doctors have these feelers. As yet, no software engineer has been able to build these into a machine. Public policy is a major factor in health provision. It is argued that health policies should take a much wider view (Veneris, Yannis, 2000). For example, the narrow medical response to lung cancer would be a method of therapy. The broader policy would start from therapies and extend beyond, to antismoking lifestyles and related intervention programs, as well as to the impact of smoking reduction for the tobacco production complex. Related to the policy issues, telemedicine is hardly advancing in Iowa, U.S. and other rural areas. Despite progress in technology, other problems plague long-distance rural health care. States will not put up the money to fund it. Insurance providers drag their feet when it comes to reimbursements. Licensing and liability issues abound. And people living in rural areas just do not accept it (CNN, Jan. 11, 2000). This tension between policy and practice has telemedicine players frustrated and questioning the long-term survival of telecommunications-based health care. Even programs in Georgia, where a great deal of effort has been put into the statewide infrastructure, are on the edge. According to CNN report, Lori Eubanks, telemedicine coordinator for the Phoebe Putney Memorial Hospital, Albany, Ga., says telemedicine has been great for indigent residents in rural counties surrounding the hospital, but she worries about how long the hospital’s clinic consults with the Medical College of Georgia in Augusta will last. She states that the state of Georgia needs to help with the high costs that are associated with the telemedical services. It is mainly because insurance companies do not want to involve themselves in the unverified market. The hospitals and the clinics are bearing it on their own, and it is still very expensive. She also says if this problem is not solved, a lot of hospitals, possibly even hers, will drop it (CNN, Jan. 11, 2000).

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5. Conclusion: Policy Implication s

The main reason a telephone has shaped its current function and social role is placed on social environments that were also affected by the previous ICTs such as telegraph. According to social informatics perspectives, ICTs are shaped from social contexts and they influence socially on the environment where ICTs are implemented and used. In this paper, it was assumed that the Internet development was mainly influenced by its social contexts that was shaped by the previous ICTs, telecommunication services. In this point, it is a critical point to investigate the most advanced Internet application services now being implemented in order to forecast NGI application services. Internet has many possibilities that have huge impact on societies and it is also consolidating its shape affected by societies. The NGI seems to provide more effective and flexible application services using the broadband networks. When NGI application services would be fully implemented, it would also deliver impacts on the societies. The Internet application services in education involves problems such as the lack of previous bottom-up needs analysis. It causes application services to overlook specific requirements that are changing according to its social contexts. The Internet application services in health care imply problems in the area of security, privacy, social economy and government regulations, and interfaces between patients and ICTs. In order to understand the context surrounding ICTs and human and to suggest the implication to the policy makers, more in depth and empirical researches are needed. Based on the result of analysis, some further studies can be suggested: First, this research found that when ordinary people such as teachers and students use ICTs, they need an administrative person to assist them, which requires bottom-up needs analysis on specific ICTs before the technological implementation. As Kling indicated (2000), Standard Tool Model saw the politics as bad or irrelevant to ICTs. If politics are central and even enabling for ICTs, this finding allows the future researchers to study how the ICTs context changes the organizational structure and power shift in Education institution. Second, this research found that there is different policy between online education and offline education. This different policy could be barriers to impede the development of distant education, even though the NGI technologies are evolving to eliminate the current concern about the Internet technologies. Further studies could be conducted to identify what else barriers are impeding current distance education, and how to remove or fill the gap along the equality line of offline educations. - 13 -

Third, the privacy and security problems are one of critical issues in tele-medical services. Since tele-medical services are based on remote examining, consulting and control system, screening of personal medical records and potential remote surveillance can be problems. In addition, due to the lack of emotional transfers only allowed in actual human and human interaction, a patient’s vague symptom transferred by video communication systems could mislead the diagnosis. Patients’emotional and cognitive reactions to tele-medical services and patients and computer interaction in the aspect of privacy and security should be studied. Based on these user studies, privacy and security policy should be implemented afterwards. Fourth, Costs for tele-medical services are very high due to the lack of insurance support and its policy. The high cost problem in Georgia, U.S. case implies that insurance companies are reluctant in participating in the tele-medical services because of its uncertainty, risks, and reimbursement problems. In case a medical accident happen while using telemedical service system, who is responsible for it, the doctor or the system? If the responsibility is put on the system, should a medical insurance company make reimbursement? In addition, in the current exhausted financial situation of the national medical insurance in South Korea, is it possible to implement tele-medical services which would require more insurance finances. Further studies should start at such social and policy issues to solve these questions. NGI promises to be a profound advancement in the nation’s telecommunications infrastructure. The high bandwidth capabilities of the NGI can support promising applications for Education and Health care. While NGI is a critical enabling technology, policy makers need to consider how the Internet has affected the current social environment and how these environments would affect on NGI application service. The critical point is human, in other words, people around the NGI application services. Whatever applications would be implemented, they should be human-centered. It is desirable to conduct detail bottom-up needs analysis as well as social context analysis. The values that NGI would create in the future could be diminished or even be lost if the primary concern is considered as technological, and if policy makers underestimate the social influences of the new technologies.

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