An Introduction to Cyberspace for Medical Professionals BY Sheldon Chang, MSPT Physical Therapist

Since the boom of the Internet, the previously obscure field of medical informatics is beginning to gain in visibility. Medical Informatics is the use of computers to spread medical information as applicable to research, medical education, and improving patient care. [2] Informaticians do not work solely on Internet applications, but applications based on Internet technologies (especially telehealth and telemedicine) are the current hot spot and should continue to be so. Many of the more innovative and better resources on the Internet developed for medical professionals are the work of medical informaticians.

Many of healthcare's administrative, research, educational, and clinical tasks are going to computers and eventually to an integrated model where clinical care will meet with decision support information on demand, human processing in administrative tasks can be minimized and data from electronic charts can be quickly processed for outcome studies. [2] Standards and technology implementations for electronic patient record need to be developed. Technological and sociopolitical issues surrounding the creation of universal access of health and medical information on a universal basis will need to be addressed. [2]

The Virtual Hospital provides an electronic library of information including patient education material, multimedia textbooks, and drug interaction information.

Informatics will play a heavy role in providing the underlying infrastructure to build the healthcare model of tomorrow on. There is much work to be done.

The chief administrative body of medical informatics in the United States is the American Medical Informatics Association (AMIA). The medical Internet, like the rest of the Net, has no central control, but if any one group were to be identified as being head pioneers of developing medical resources in Cyberspace, it might be the AMIA's Internet Working Group (IWG). Early on, the AMIA IWG was behind a number of standard setting medical information sites on the Internet such as the University of Iowa's Virtual Hospital and the Oncolink cancer resource. They also maintain the premiere peer-reviewed collection of website hyperlinks, the Medical Matrix.

Another group in informatics deserving of mention is the Society for Internet in Medicine, which was formed at MEDNET 96, The European Congress of the Internet in Medicine, an international conference of developers, researchers, and users of Internet medical applications. MEDNET 97 expanded its scope the following year and included the rest of the world to its Congress of the Internet in Medicine.

The Virtual hospital of the University of Iowa was founded in 1992 as a public service designed to improve access to authoritative health information for both patients and providers. It's library of information boasts a collection of over 350 peer-reviewed books and booklets from 160 authors of the University of Iowa. All information on the Virtual Hospital is in fully digitized form and features some offerings like their Illustrated Encyclopedia of Anatomic Variations that are only available on-line. [55] Their Iowa Health Book is exemplified by it's collection of over 300 patient education modules on a wide variety of health and medical issues and also includes a database of links to outside sources of patient education that has been peer reviewed by the hospital.

In the United Kingdom, the Electronic Libraries Programme (eLib) is funding numerous pilot projects to discover the academic research libraries of the future. Among other things, the eLib initiative examines methods of document delivery, creates hybrid libraries of print and electrons, funds licensing for electronic journals, and investigates copyright issues raised by digital medias. [10] The eLib initiative also created the Organizing Medical Network Information project whose purpose is to serve as an authoritative starting point to health and medical information on-line in the UK and the rest of the world.

In the United States, $42 million dollars of funding from the National Institutes of Health will go into pilot telemedicine projects [51] in a variety of settings ranging from the urban to the rural with a wide range of population groups. Projects include efforts in using the Internet in rural areas for specialty consult, improving outcomes in an urban trauma center through continuous telemetry of vital signs from equipped ambulances, effecting health and wellness through on-line information resources, and utilizing a central database of electronic patient records through the WWW. [51]

Going through pages and pages of endless information on-line to find what you're looking for not only wastes time, it can quickly result in burn-out from information overload. [44] Too much information can be as much of a problem as too little information. Smart agents are programs that monitor a user's on-line activities to compile an "interest or activity profile" for that user. From continued observations of the user's on-line preferences, the agent can scan for information to suggest or help the user determine what resources during a session on the WWW best match the profile data. [15] High powered search engines such as HotBot and Infoseek incorporate smart agent methods into compiling search results. They know that certain key words together tend to have a higher relevance than others and will rate the relevance of one piece higher than the other.

Some see smart agents as a developing technology that can save time by helping its users select the most relevant information and prevent information overload.

As usage of the Internet around the world continues to grow, the network infrastructure needs to continue to improve in bandwidth to carry the traffic. Right now, one of the greatest impediments to practical use of the Internet is speed (or rather lack of it). An increasing prevalence of bandwidth hogging multi-media applications on the web also adds to speed woes. [19]

Speed can also be increased by increasing the efficiency of transmissions through improved data compression methods. Progressive Networks' "Real Player (Audio and Video)" and Vivo Software Inc's "Vivo Active (video) Player" were able to bypass hardware limitations of insufficient connection speed by improving data compression to allow for "streaming" audio and video to be viewed real-time (after a pre-loaded beginning segment) as it downloads over 28.8Kbps modems. Streaming video works, but still tends to be nagged by abrupt interruptions (over 28.8K connections). Streaming audio works more reliably (also at 28.8K) and is increasingly being used to mirror or perform "radio" broadcasts for access anywhere in the world. Without further advancements in hardware technology, improved data compression is unlikely to be enough to allow teleconference applications over a wide geographic area. It may take some time before the network infrastructure improves enough to reliably use videoconference.

ISDN lines, with connection speeds of up to 128Kbps were once though to be the answer to high speed personal and small organization Internet connections, but high prices, unreliable service, and developments in high speed alternatives to ISDN lines have made ISDN a bust so far, but ISDN may redeem itself yet. At the very least, businesses have found that several ISDN lines used simultaneously work effectively to perform teleconferences coast to coast in the US and is cheaper than flying a bunch of suits in first class.

56Kbps modems are hardly news anymore. It's practicality was previously tarnished by two competing standards of similar technology that were incompatible with each other. That war is over, the products are now compatible, they're now affordable, and most major Internet Service Providers provide 56K access at no extra cost. The only catch is that they're still limited to speeds considerably lower than 56Kbps due to limitations of the existing copper wire telephone infrastructure and bottlenecking of bandwidth elsewhere on the Internet. [18] 56K modems will bring about some speed improvements with standard modem connections to the Internet. The improvements just won't be as drastic as might be anticipated.

In January 1998, Intel, Microsoft, Compaq, and a number of large US telephone companies announced plans to develop technology to improve the data carrying capacity of the existing copper wire telephone infrastructure. The group aims to develop modems by Christmas of 1998 that are able to provide simultaneous voice and data transmissions and would be able to reach speeds of a T1 Internet connection (1.5 Million bps). [19] The technology sounds promising and has been in various stages of development for a few years, but delays kept the announced technology a product of fantasy in the past.

Radio stations broadcast over the Internet. Phone calls are made without a telephone. Your cable TV company also wants to provide you with Internet access--so does your telephone company. Voice messages can be delivered to an e-mail account. Faxes can be sent on-line. TVs provide Internet access. All of these things have happened and suggest that talk about a future of video on demand and unified media may not have been so far fetched after all.

Already cable TV network companies in select areas are offering high speed Internet access through cable TV networks in addition to cable TV programming and telephone service through one digital connection. In 1998, digital TV sets and digital VCRs should be on the market and eventually replace their analog counterparts. Television, unlike computers, enjoys wider usership across the socio-economic spectrum. Integration of the more universal medium of TV into the more exclusive medium of the Internet, may be the ticket that helps brings the Internet into widespread societal usage.