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13. e-health networks and socialtransformations: expectations ofcentralization, experiences ofdecentralizationJames E. Katz, Ronald E. Rice, and SophiaK. AcordWe subtitled our edited volume, Internet and Health Communication (Riceand Katz, 2001), “Experience and Expectations” to suggest that, by reflectingon early experiences with e-health, leaders in academic research andhealthcare planning might have more temperate expectations. In this chapter,we reverse the order of the terms, identifying not only where historicalexpectations concerning e-health have been fulfilled but also where theyhave missed the mark, and suggesting areas where additional progress mightmake the strongest contributions to public and individual health.The chapter is organized around four analytical themes, all of which stemfrom the fact that the Internet has given a large portion of the general publicand most healthcare professionals an opportunity to gain medical and healthinformation and communication resources. Anticipatory of and reactive tothe opportunity that is created by the social interaction between health informationtechnology and participant desires, (1) there has been substantialresource commitment, resulting in the creation of many useful centralizedservices (some commercial, some governmental); (2) however, despite theirutility, perceived and actual inadequacies of these services have stimulateddisparate groups to organize their own compensatory, decentralized andlocal networks of health information resources. In both centralized anddecentralized Internet health resources, though, there are still many issues tobe resolved, such as (3) reconfiguring physician/patient relationships in thelight of new technology, and (4) creating socially sensitive e-health servicesthat are also socially equitable in terms of accessibility.Each of the above four analytical themes implies both an original problem,which gives rise to specific forms of Internet use, and subsequently tocontradictions, which suggest potential, often novel, solutions. A reciprocal293