internet_medicine

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* Head, Department of Neurochemistry,Institute of Human Behaviourand Allied Sciences, New Delhi.

E D I T O R S C H O I C E

The Internet :

Its Role in Medicine and HealthcareSuman Kapur*

The information technology revolution is being

described as the most important development in

the history of humankind since the industrial

revolution. Characterised as The Third Wave by

Alvin Toffler, in his book of the same title, it has

the potential to change the ways of man and

society beyond the wildest of imaginations.The computer, invented initially to process

information, slowly grew into a storehouse of

information. It then became sophisticated and

ever more powerful and got hooked to others

of its kind to form a formidable network. This

network further acquired the capability of

distributing electronically processed information

to all and sundry, overcoming every conceivable

form of barriers, including geographical and

political. Today, it is a global collaborative

medium and a rich resource of information of

all kinds science, technology, research,

education, and commerce. Through a host of

emerging tools and protocols, it enables person-

to-person, computer-to-computer, or person-to-

computer communication.

Welcome to the fast growing and exciting electronic

world of wonders, that is the INTERNET!

With continuing advances in information and

communication technology, the applications ofcomputers in medicine have increased rapidly,

and have the potent ial to revolut ionise

healthcare. And, the Internet, with its powerful

penetration and scalability, has become an

increasingly popular medical information

resource. By re-architecturing the workplace

around computer-based technology, doctors,

researchers, and other healthcare providers are

creating a new vision of work and organisation

in such areas as patient care, medical and

health education, and research. This evolving

technology includes the electronic medical

record, the Internet with its e-mail, WWW (world

wide web), and file transfer capabilities. There

is an urgent need to integrate this technology

into a total information system for the clinicianin the new century and the new millennium.

Electronic mail has the potential to enhance the

professional relat ionship both between

physician and patient, and among physicians

of the same and different specialities. There are

distinct advantages of communicating via E-

mail: It is faster than all other forms of mail

services. It can be exchanged across time zones.

It is not dependent on the presence or absence

of both the sender and the receiver at the two

ends at the same time. It is less expensive than

all other means of communication like sending

a fax or making a phone call. E-mail is the most

useful resource extending the avenues of

learning to an international audience through

news or l ist-server groups. Associations,

departments, educational sites, organisations,

peer-review scientific journals, and Medline

database web pages of prime interest to

healthcare providers have been developing at

an amazing pace. The WWW provides an all-in-one medium for image, sound, and video.

WWW is the best method of electronic

publ ishing and many magazines and

newspapers are available on the Internet.

Further developments of technological advance

nurturing our interests will consist of on-line

journals, telemedicine as well as advances in

health screening and assessment, international

chatt ing, computer-based training and

education in different fields of medicine, and

centralisation of cyberspace information intodatabase search sites.


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134 Journal, Indian Academy of Clinical Medicine Vol. 2, No. 3 July-September 2001

Internet, which allows instant transmission of text

and graphics and permits talking via computers,

is the ideal medium for sharing medical expertise.

It can serve to save precious human life; help

treatment in difficult and complicated cases byseeking expert opinion on the Net and overall,

facilitates an exchange of ideas. This could well

lead to valuable innovations and discoveries.

Interactions in the cyberspace will also help the

doctors in India, especially those practising in

smaller cities, towns, and rural areas and who

therefore, often feel isolated, to keep in touch with

new developments. They can become members

of information groups and search through free

information databases on the Internet. Most of

the journals published in other countries take a

long time to reach remote places in India and are

also very expensive. These can be now accessed

for a nominal fee on the Internet without any

unnecessary loss of time.

A survey by the Royal College of Surgeons of

Edinburgh has shown that health surfers, including

doctors, are the biggest measurable group of net

users. A quarter of the material on the Internet is

now health-related, and about a third of web

surfers are searching for health information, says

Dr. Harry Brown, author of Netlines in the British

Medical Journal1. Healthcare professionals can

retrieve plenty of information on such subjects as

AIDS, emergency medicine, geriatrics,

orthopaedics, rehabilitation, preventive medicine,

public health, rural medicine, transplant medicine,

and travel medicine all available on the many

web sites. Healthcare professionals can also

become a part of the various discussion forums

of their interest and can exchange their experience.Information on higher education in medical

sciences and job opportunities in different hospitals

and research institutes can also be found on the

Internet.

Healthcare is an area that generates a wealth of

information in the form of journals, reports,

conference proceedings, etc. It is difficult for a

healthcare professional to keep himself abreast

of all the developments taking place in his field of

interest despite the phenomenal growth of medical

journals. In 1997, the number of entries in Index

Medicus exceeded seven million. With the advent

of the Internet, information resources (on-linedatabases, CD-ROM producers, full text

documents of various societies and the commercial

agencies, news groups, directories, individual

home pages and corporate resources) are now

open to ones finger touch. Literature search can

be done on databases such as MEDLINE, EMBASE

and BIOSIS as well as on other Web sites in no

time. Healthcare professionals can also get

information on health workers, societies and

hospitals, healthcare companies, and on

healthcare management and policy. On anexploratory browsing of the Net, they can query a

database for known references or retrieve an

exhaustive list of relevant material to review the

available literature or pull up a list of first quality

recent references to answer a particular question2.

A large amount of information on patient care,

education, and support is available. Most health

sites have traditionally been information-based

and the Net (Internet) is, for example, the best

way to find a self-help group for any disease. Itsalso a huge source of details on individual

diseases, no matter how obscure, and is

increasingly being used by patients as a way of

locating the best hospitals and doctors. Names of

some of the medicine-related Indian and

important international websites are given in

Tables I, II, and III.

Changes in healthcare delivery and the explosion

of health information available on the Internet are

already affecting primary healthcare practice in

America. Briggs and Early3 have reviewed how

recent developments in the technology of the

Internet affect the way healthcare is provided. They

refer to the growth rate in Internet access and all

the improvements in performance resulting from

new technologies, in particular in the areas of

telemedicine and in communication between

patient and healthcare professionals. Modern

information technology not only affects the delivery


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Journal, Indian Academy of Clinical Medicine Vol. 2, No. 3 July-September 2001 135

of healthcare, but also can significantly influence

the doctor-patient relationship.

Increasingly, the Internet will be used to convey

more real-time information. A physician

practicing in a remote village can now consult aspecialist sitting at any distance by providing him

all images and data on-line, thus eliminating the

risk involved in and save the time and money spent

on travel.

Table I : Names of some of the major medicine-related Indian web sites.

Topic Name of the website

Indian Medlars centre http://indmed.delhi.nic.in

Indegene, Indias Premier Health Portal http://www.indegene.com

JAPI : Journal of Association of Physicians of India http://www.japi.org

Association of Physicians of India http://www.japi.org/API.

Journal of Indian Medical Association Online http://www.jimaonline.org

T B India http://tbindia.info.nih.gov/project1.html

All India Institute of Medical Sciences http://www.aiims.edu

http://www.pugmarks.com/aiims

BITE-IN http://www.bitin.com

DISHA http://www.netfx.net/disha

Institute of Speech and Hearing http://www.speechfoundation.comNational AIDS Control Organization http://www.nic.in.naco

Public Health India http://education.vsnl.com/publichealthtoday

Leprosy Projects http://www.foundation.novartis.com/

leprosy_india_gra

Schizophrenia Research Foundation http://www.xmission.com

Journal, Indian Academy of Clinical Medicine http://www.indegene.com/jiacm

Useful site for practising physicians http://www.md.consult.com

Health sites are also becoming interactive. Thereis the new virtual checkup for women at http://

www.allhealth.com/virtualcheckup where one has

to just key in a few personal factors such as blood

pressure, cholesterol level, lifestyle details, and

family profile. Virtual Check Up also has sites that

will assess individual risks for osteoporosis and

heart disease. Other health sites are already

offering heart monitoring and cancer risk

assessments, opinions on best prescriptions to

seek, and virtual health shops offering a multitude

of health supplements.

While Internet technology has dramatically

improved the access to health material, the biggest

shake-up is taking place in the General Physiciansclinic. Doctors can key their patients symptoms

into a computer and receive an instant diagnosis.

In several rural areas of the UK, doctors are using

ISSN-based technology to enable a medical

consultant to examine patients 120 miles away.Such technology will mean that, in 20 years time,

many patients will no longer need to travel to see

a specialist. Diagnosis will be made in their family

doctors clinic, by a consultant examining them

with the help of video images and remote sensors

that can relay data on blood pressure, heart rate,

and other vital signs. The Net is also set to allow

doctors to change the way they treat patients. It is

anticipated that doctors will be able to use a DNA


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database of patients to tailor drugs for their specific

conditions and eliminate possible side effects.

The Internet has become a new platform for

telemedicine. Cyber Medical Center (CMC), a

project that integrates the technologies ofmultimedia, database management, a multiple-

site video-conferencing system and the WWW, is

aiming to create a multimedia network system for

the electronic management of patients records,

teleconsultation, on-line prescription, on-line

continuing medical education and information

services on the web4. British doctors are already

using the Internet to make diagnoses, carry out

remote examinations, and give consultations. Soon

they will operate remotely on patients thousands

of miles away and use virtual reality to allow

leading surgeons without leaving their offices to

consult around the bed of a patient.

Table II : Some of the useful websites for physicians (International).

Topic Name of the website

National Library of Medicine: Internet Grateful Med Search http://igm.nlm.nih.gov

Electronic BMJ (British Medical Journal) http://www.bmj.com

New England Journal of Medicine On-line http://www.nejm.org

The Journal : Current Issue (Lancet) http://www.thelancet.com/journalAnnals of Internal Medicine http://www.annals.org

Postgraduate Medicine http://www.postgradmed.com

American Family Physician http://www.aafp.org/afp

Postgraduate Medical Journal http://www.postgradmedj.com

Hospital Practice http://www.hosppract.com

Pro COR (Conference on Cardiovascular) Health http://www.procor.org

Medscape www.medscape.com

It is possible to speak (transmit voice) in real timeon the Internet. Audio-conferencing programmes

work by digitalising speech and then sending the

digital data over the Internet. Internet can thus

help in arranging teleconferences at an affordable

cost.

Net is also impacting the way surgery is carried

out. Cybersurgery is the latest health craze on the

Net. VRML enables doctors to actually view

complicated surgeries underway in real time

environment. The singer Carnie Wilson was not

alone during her gastrointestinal bypass operation.

Along with half a dozen doctors and nurses, there

were 52,000 people watching the two-hourprocedure live on the Net. Apart from improving

the rating (due to celebrity patients), watching

operations could help potential patients to make

up their minds, and younger surgeons to learn

from the vast experience of their senior colleagues

and peers. There is no more a need to visit a doctor

for estimates on the expenses for a given treatment

or corrective surgery. For plastic surgery, just scan

in your picture and e-mail it along with a credit-

card consultation fee of $ 250 to HYPERLINK at

http://www.celebrity or www.doctor.com/personal.html which is run by a team of doctors,

and back comes the advice on what work is

needed, and how much is it likely to cost.

One of the biggest challenges, particularly in

emergency medicine, has always been to bring

together the patient and the right doctors as quickly

as possible. The Net has started coming to our

rescue in such instances. In North Carolina,

researchers were able to treat an airline patient

during journey 30,000 ft above the ground, using

data transmitted live on the Internet.


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Remote sensor technology is already changing

the way we care for the elderly. In Germany,

doctors and social workers have set up a

telemonitoring system where elderly people and

the chronical ly i l l and housebound aremonitored, using a camera and a high speed

telephone line.

Table III : Other health information sites.

Name of the site Name of the site

http://www.ayurvedic.org http://health.indiamart.com/alternativemedicine

http://www.ayurvedwebline.com http://www.indiandoctors.com

http://www.ayurvarta.com/eng http://www.indianhealthzone.com

http://www.ayurveda.com http://www.indiaspace.com/homeopathy

http://www.baidyanath.com http://www.indiayogi.com

http://www.badlani.com/Goodhealth http://www.jabalpurdoctors.com

http://www.chennaionline.com/medizine http://www.lovelight.com

http://www.classicalhomeopathy.com http://www.mdspeak.com

http://www.doctornet.com http://www.meditimes.com

http://www.doctorsaab.com http://www.po.com

http://education.vsnl.com/reikinetindia http://www.saffronsoul.com

http://www.emedilife.com http://www.sreekrishnapharmacy.com

http://www.goodhealthnyou.com http://www.thriveonline.oxygen.com

http://www.growingwell.com http://www.webhealthcenter.com

http://www.healthcarehouse.com http://www.wholehealthnow.com

http://www.healthlibrary.com http://www.yoga.indiainfo.com

http://www.internetindia.com/health http://www.yogacare.com

http://www.indiadiets.com http://www.yogasite.com

http://health.indiamart.com/kidshealth http://www.youngmaster.com

Many developments in science have their origins

in science fiction, and telepathology is noexception. The concept was first illustrated in 1924

in the magazine Radio News. It was not until

1980, however, that the first working telepathology

system was demonstrated. Telepathology can now

be used for remote primary diagnosis, remote

referral to a specialist in pathology, remote

teaching, remote presentation of post-mortem or

microscopic findings, quality assurance image

circulation and feedback, and consensus diagnosis

for pathological review in clinical trials5. In the

next 5 to 10 years it will be possible to build sensors

that are almost as powerful as the entire pathology

lab. The doctor can then search a database onthe Net and look up data on other people who

suffered from similar symptoms and immediately

conclude and say you have XYZ.

The resources available on the WWW can be

deployed as a very useful Information for Health

tool bridging the information gap and reducing

the number of accidents and risks due to misuse

or improper use of drugs6. Misuse of prescription

medications is a serious problem largely due to

lack of information. WWW can well be deployed

to fill in this gap in appropriate and safe use of

prescription drugs7. Within the past 10 years, a


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wealth of data has shown that diet and exercise

play an enormous role in fighting disease. Today,

it is well recognised that life style patterns increase

an individuals risk for particular disease. Physical

inactivity is recognised as an independent riskfactor for cardiovascular diseases. A large

proportion of the US population does not

participate in regular physical activity and research

has shown that, without intervention, most people

remain sedentary. American Cancer Society

attributes one-third of all cancer deaths to poor

diet. To be disseminable, physical-activity, and

dietary habit interventions must move beyond

reliance on strictly face-to-face modes and begin

to fully use newer technologies such as the

Internet8.

A panel of experts from the fields of

neuropsychology, neurology, psychiatry,

behavioral medicine, family medicine, paediatrics,

physical medicine and rehabilitation, occupational

therapy, nursing, speech and hearing,

epidemiology, and biostatistics met with the public

some time ago to discuss effective rehabilitation

measures for persons who have experienced a

Traumatic Brain Injury (TBI). And biomedical

researchers and clinicians were made availablethe draft statement on the Internet immediately

following its release at the conference and were

later updated with the panels final revision of

recommendations9.

The digital divide in information between the

developed and the developing nations requires

new approaches within the field of scientific

publishing for all concerned parties to work in

concert and solutions that neither the public nor

the private sector will be able to achieve on itsown. The World Health Organization (WHO) and

the Open Society Institute (OSI), a part of the Soros

Foundation network, have teamed up with leading

information providers, ISI and Silver Platter, and

other public and private partners to provide access

to high quality scientific information via the

Internet, for research centers in the countries of

Africa, Central Asia, and Eastern Europe. The pilot

project is a part of a wider United Nations

programme called Health-Inter-Network which

aims to improve global public health by facilitating

the flow of health information worldwide, using

Internet technologies. Research, and sharing the

knowledge gained through its efforts, isfundamental to improving public health. Valuable

research is carried out in the developing countries

and emerging economies, but researchers are

hampered by not being able to share essential

scientific information and communication, says

WHO Director-General Dr. Brundtland, If

researchers and scientists can read the same

journals, search the same databases, join in the

discussion groups, compete for the same grants

as their colleagues from wealthier countries, it will

strengthen their own research, bring them into theinternational community of researchers, and

eventually improve dissemination of their results.

Internet as a global cooperative network of

university, corporate, government and private

computers, all communicating with each other

can go a long way in meeting the WHO goal of

Health for All. As we move into the next century,

and a new millennium, the Internet, as we know it

today, should help us to define the world of

tomorrow. It is however worth remembering thatmany health- and medicine-oriented sites have

serious shortcomings with regard to quality and

reliability of content. Some guidelines could prove

more useful in getting valuable feedback from

information providers and users alike, in

improving the quality of information at its point of

production7. Till that happens and till a computer

terminal is at place on every healthcare provider

and medical practitioner, print journals like the

one you are reading now will remain indispensable

although JIACM has also gone on-line.

Also, remember you need to be computer savvy

and to a large extent you need to know exactly

what you want! Queries have to be focussed to

retrieve meaningful information. For a lot of

information lies dumped on the Internet, and

as such may not be very reliable because there

are no guidelines on what is to be on the

Internet.


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References

1. Internet Access Essentials, Ed Tittel E, Robbins M, APProfessional, MA.

2. Beginners guide to the Internet, Ed Aggarwal, MD, TFYTechnical publications, New Delhi.

3. Briggs JS, Early GH. Internet Developments and theirsignificance for healthcare. Med Inform Internet Med1999; 24 (3): 149-64.

4. Chen HS, Guo FR, Lee RG et al. Recent advances intelemedicine. J Formos Med Assoc1999; 98 (11): 767-72.

5. Wells CA, Sowter C. Telepathology: a diagnostic tool forthe millennium?, J Pathol2000; 191 (1): 1-7.

6. Benger J. A review of telemedicine in accident andemergency: the story so far. J Accid Emerg Med2000;17 (3): 157-64.

7. Doupi P, van der Lei J. Rx medication information for thepublic and the WWW: quality issues. Med Inform InternetMed1999; 24 (3):171-9.

8. Marcus BH, Nigg CR, Riebe D, Forsyth LH. Interactivecommunication strategies: implications for population-based physical promotion.Am J Rev Med2000; 19 (2):121-6.

9. Consensus conference, rehabilitation of persons withtraumatic brain injury, NIH consensus development panelon rehabilitation of persons with traumatic brain injury.JAMA 1999; 282 (10): 974-83.

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