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Health Care Providers Discover Advantages of Internet Access

"I access all of the National Library of Medicine databases through the Internet, as well as doing most of my other online searching and interlibrary loans," Rauch said. "One time I had someone in the library looking for genetic information related to Tourette's Syndrome and I was able to successfully use a genetics database to help him. . . . I don't think I've ever been in an environment that is as information rich as the Internet."

Merle West Medical Center is one of a growing number of health care organizations using the Internet. Currently, the NorthWestNet community includes a dozen such organizations, ranging from major medical research institutions such as Fred Hutchinson Cancer Research Center, the University of Washington (UW), and the Oregon Health Sciences University (OHSU) to smaller sites such as Merle West Medical Center and the Alaska Native Medical Center in Anchorage.

Merle West is one of seven community hospitals in the Northwest that gained Internet access through the "From Bench to Bedside: Research and Testing of Internet Resources and Connections in Community Hospital Libraries" project, a National Library of Medicine grant-sponsored program implemented by NorthWestNet and the National Network of Libraries of Medicine-Pacific Northwest Region (NN/LM-PNR). This program was established initially to allow smaller medical centers located in rural areas to expand their information access in a cost-effective manner. Now, many of the individuals who have Internet access at program sites are saying they couldn't imagine doing without the Net.

Sherrilynne Fuller, coordinator of Health Sciences Systems Integration at the University of Washington and the principal investigator for the "From Bench to Bedside" program, said the success of creating demand for Internet access among the program's medical clinics has shown that such computer networking could be another valuable information tool within the health care community.

"At the time the pilot connections project was funded two years ago there was only one community hospital which had access to Internet resources in the Northwest and almost none in the rest of the United States," said Fuller. "Thanks to the efforts of librarians at each participating institution, and NNLM/PNW and NorthWestNet staff, word of the value of Internet connectivity spread like wildfire. Nationally, the interest in our project and findings has been enormous.

That success has also helped fuel increased interest from other health care providers, said NorthWestNet Director of Member Relations Tony Naughtin. Two recent additions are Kaiser Permanente in Portland and Group Health Cooperative in Seattle, two of the largest Health Maintenance Organizations in the Northwest.

"Health care information resources are abundant on the Internet," Naughtin said. "If we can empower organizations on the provider side of health care to locate and use these resources, then we've fulfilled the mission we set for ourselves more than two years ago to begin bringing those providers online."

One of the main attractions that NorthWestNet offers to any health care organization, but particularly the smaller ones where budgets often have to be stretched in creative ways, is the access to information resources that come as a standard part of NorthWestNet membership, Naughtin said. That means the money that originally went to access a database such as Medline could be used for other things instead.

For many sites, just the ability to send and receive e-mail has been as important a driving factor as either access to bibliographic databases or the potential use of such high- tech applications as tele-radiology. Dan Azevedo, director of Information Services for Kaiser Permanente said that although his organization will take advantage of online library access, bibliographic retrieval services, and electronic medical information, the ability to exchange e-mail in a quick and efficient way is itself a major advantage of the Internet.

Azevedo said that besides the wide e-mail access to government agencies and university medical centers, Internet access could eventually be the "glue" that ties the nationwide Kaiser Permanente regions together in a ubiquitous communications web, and improves the sharing of information between the organizations.

With nearly universal Internet access at major medical research institutions around the country, the clinical setting has become the new growth area for Internet connections in health care and health sciences. Marilyn Goebel, a medical librarian at Group Health Cooperative, said word of mouth about the Internet has begun to make its way through her organization, especially the utility of e-mail, despite an effort to keep the project low- key while computer support staff work out the technical challenges in supporting a TCP/IP network.

"There's been great interest among physicians," Goebel said. "They've been calling in and asking when they will get access, because they want to be able to exchange e-mail with other physicians."

Some rural clinics have seen less demand, in part because the technology is so new. Susan Long, medical librarian at Kalispell Regional Hospital in Kalispell, Montana, compared the process to the introduction of fax machines. She said that the medical library had been using a fax machine long before others at the medical center, with many wondering about its utility. However, at some point a critical mass of external fax users, including vendors, was reached. Acceptance of the technology then seemed to happen almost overnight. She expects a similar growth pattern for the acceptance of the Internet among its non-traditional users, with the demand for access increasing as a critical mass of users in this profession is reached.

"People are now seeing references to the Internet in newspapers and magazines, as well as within their own work setting," Long said. "These references make it more real to them."

For Lee Woods, a speech/language pathologist in Klamath Falls, the Internet is already a reality. Woods, who serves Merle West Medical Center and other agencies in town, said the greatest benefit has been the chance for self-directed, continuing education and the ability to communicate with others who share the same professional interests. Many medical professionals in rural areas such as Klamath Falls may be the only ones practicing their specialties, so the chance to discuss clinical issues with others becomes very important.

"This may be more obvious to those of us who have little or no contact in our daily work with other specialists in the same field," Woods said. "I work out of an office in my home quite often, and using the modem to connect with the hospital or with library resources on the Internet when I need the answers is great."

NorthWestNet Executive Director Eric Hood said Woods' experience was exactly the kind of result that the grant program was supposed to produce: "One of the primary motivations for the grant was to see if we could enable communications for clinical practitioners in geographically isolated areas. If you look at places such as Coeur d'Alene, Idaho or Kalispell, Montana, it's fairly difficult for practitioners to engage in professional contact outside of their very small local communities. Internet access can play a critical role in reducing professional isolation."

Although electronic communication has been an important first step for many health care organizations, the long-term vision is to do much more. Online repositories of medical records and electronic medical teaching tools are just some of the ideas currently being considered.

"We believe this is just the beginning," said Sherrilynne Fuller. "We must now work toward providing easy network access for individual care-givers in their offices, clinics and classrooms for 'point of need' answers to critical questions, and to find ways to ensure that as patients move from hospital to hospital that their medical records move with them. Moreover, because medicine is a very visual science, we need to be able to package images, text and voice for rapid dissemination and retrieval."

Hood echoed those beliefs, and added that interest in health care networking will increase as the promise of more sophisticated applications evolves into reality.

"As higher end applications such as medical imaging mature there will be more interest in them," said Hood. "There are a number of applications in development and use today, such as Digital Anatomist (an electronic anatomy teaching tool developed at the University of Washington), but they are not yet widely distributed. One of the things I think we'll hear at the FARNET conference (see accompanying article [in NorthWestNet NodeNews, May 1994]) is that there is a significant need to go past just e-mail to the delivery of real-time, graphically-based collaboration tools."