Subject: Computers in Medicine

From: [email-masked] (Bruce C. McKenzie)
Date: 03 Nov 1994 22:40:52 GMT

Intro to computers in medicine...___________________________________________________________________________

Filename: 
	Computers in Medicine.
From:	 
	[email-masked] (Bruce C. McKenzie).
Description: 
	Introduction to application of computers in medicine.
Keywords: 
	Resources; communication; information access; newsletters; mailing 	lists;
computer basics; informatics; presentation; decision support; 	management;
research; telemedicine; networks; education; medical 		records; care
planning; imaging; coding; audit; experimental.
Location: 
	UseNet: sci.med; OneNet: Medical Library, Medical UK.
Version: 
	1.1 (03.11.94)
Posting Frequency:
	Approximately monthly

___________________________________________________________________________

About This Document
-------------------

	This document was originally written with the aim of introducing the
application of computers in medicine to colleagues presently with little
awareness of such things. My hope is to produce a readable document in an
understandable language that you can pass on to your colleagues in an
effort to recruit them to medicine in Cyberspace. It is not meant to be a
comprehensive guide to medicine on the Internet, but a supplement to the
various database-type of documents already in existence. It also has a
slightly English focus. Ever so slightly Mac biased.

	I will post this article to sci.med (UseNet) and Medical Library/ Medical
UK (OneNet) "on occasion, and from time to time", unless anyone has any
strong objections to my doing so. Related documents I'm working on-
essentially expansions of certain resources alluded to in this one that
don't seem to be covered elsewhere in sci.med- but are not infrequently
asked about, will be co-posted at the same time. The complete set is as
follows:

	1. Computers in Medicine
	2. Medicine-related FAQs
	3. Medical CD-ROMs

	I'd like to think that this document might serve to answer the question
"What use are computers in medicine?", if not directly, then by acting as a
pointer to resources that may. It's an ever-changing discipline, and all of
us are continually learning. In this regard, I would welcome constructive
comments and suggestions for revisions, pointers to additional resources,
etc. If you have a particular expertise in one of the areas covered, please
let me know. This is a team effort. Please state if you specifically don't
wish to be acknowledged as a contributor if you do help here.

	The plan is to focus almost exclusively on what is available to those who
have email access to the Internet, and are able to read UseNet newsgroups.
This is because many people, particularly those new to telecommunications,
may elect to sign on to a bulletin board service in the first instance,
where indirect Internet access may offer a cheaper and less daunting
solution. Also, more and more boards are developing Internet gateways,
including FirstClass (TM) boards, AOL and CompuServe.

	For the professional medical user/ researcher with direct Internet access,
additional resources are well covered by "Internet/Bitnet Health Resources"
by Lee Hancock ([email-masked]; ftp2.cc.ukans.edu in the
directory pub/hmatrix, get the file medlst03.txt (or .zip)), which in
addition to databases, ftp sites, mailing lists, newsgroups etc, lists
medical gopher sites; WWW servers; Telnet access sites; and national and
international health agencies connected to the Internet. This document is a
bit over 600 kb in size.

	A smaller database called "The Medical List", about 160 kb, co-authored by
Gary Malet and Lee Hancock, emphasises resources relevant to clinical
medicine. You can ftp it from ftp2.cc.ukans.edu in the directory
pub/hmatrix, get medlst94.txt.

*** Notice ***
--------------

1. If anyone is prepared to store the latest copy of this document on their
mail server or ftp archive, let me know.

2. Note change of address from [email-masked]

Version History
---------------
 
	1.0 (01.10.94)

Copyright Notice
----------------

	Copyright 1994 by Bruce C. McKenzie. This document remains at all times
the intellectual property of it's author, and is subject to the principles
of International Copyright Law. Permission is granted to freely transmit,
distribute, and store this document electronically or otherwise, PROVIDING
THAT IT REMAINS UNEDITED. Any errors are unintentional, and any expenses or
inconveniences incurred as a consequence of their interpretation are not
the responsibility of the author. For non-commercial distribution only.
Some of this text was originally published in the periodical "Jobs for
Doctors", and parts are republished with the kind permission of MMMR Ltd.

CONTENTS OF THIS DOCUMENT:
==========================

Part 1: 
	On Stethoscopes And Modems: An Introduction To Medicine Online.
Part 2: 
	Meeting Colleagues In Cyberspace- Communication: Email; UseNet & 	
OneNet.
Part 3:
	Research Without Books- Information Access: Online Databases; Medical 	CD-
ROMs; FAQs. 
Part 4:
	And Now For The News- Medical Newsletters And Mailing Lists.
Part 5:
	A Doctor's Guide To Silicon Chips: Computer Basics For Your 		Colleagues.
Part 6:
	Retrieving Software And Documents By Email: Exactly That!
Part 7:
	Medical Informatics- What Is It?: Pointers To Papers And Mailing 		Lists.
Part 8:
	Presentation Of Information.
Part 9:
	Clinical Decision Support.
Part 10:
	Practice Management.
Part 11:
	Clinical Research.
Part 12:
	Telemedicine.
Part 13:
	Hospital Networking.
Part 14:
	Computer-Assisted Learning.
Part 15:
	Computer-based Patient Management Systems/ Medical Records.
Part 16:
	Care Planning.
Part 17:
	Medical Imaging.
Part 18:
	Clinical Audit. 
Part 19:
	Medical Coding.
Part 20:
	Experimental uses of Computers in Medicine.
Part 21:
	Acknowledgements.
Appendix I:
	Additional Internet Services: Medical Resources & Direct Access. 
	
PART 1: ON STETHOSCOPES AND MODEMS
==================================

	Today's global village is teeming with the sound of many languages.
Growing numbers of medics strive for fluency in the language of
telecommunications: here, the literate among us are discovering a wealth of
information via the telephone. Whilst the press bashes the Internet as a
source of porn in schools, little appreciated is the power of this world-
wide computer network to serve today's medical community. Wouldn't it be
great to read summaries from leading medical journals on your home
computer? Talk to multiple international experts about a particular medical
dilemma? Obtain tutorial software to improve your own knowledge about HIV,
preventive medicine, or study the epidemiology of meningitis in Africa?
Subscribe to a mailing list on diabetes, or interrogate the National Cancer
Institute's computerised database for physicians? Well, you can, armed only
with stethoscope, computer, and modem.

	A modem is an electronic device that lets computers talk with one another
over phone lines. A bulletin board is a computer set up so that people with
modems can dial-in and talk to one another, and exchange files. A bulletin
board will usually be the first port of call for those new to
telecommunications. Some of these boards are operated by doctors, and
contain files and conferences (discussion forums) for medical persons.
There is usually a nominal charge to belong to a board, aside from the cost
of using a telephone to connect to it. On these boards you may find local
doctors discussing issues, asking for opinions, and computer-assisted
learning tools.

	Aside from local discussion groups, some boards offer limited access to
the Internet. This allows you to subscribe to mailing lists, retrieve
software held elsewhere, and participate in UseNet Newsgroup discussions.
UseNet is where you will find medical data such as medical newsletters,
frequently asked questions on medical topics, postings on computers in
medicine etc. You can swap personal electronic mail or files with a foreign
colleague quickly and at virtually no cost (you make only a local call;
your message is transferred from one computer to the next in a chain
linking the continents).

	Like UseNet Newsgroups, OneNet conferences are a collection of electronic
mail messages relating to particular topics. These conferences are carried
by a large number of bulletin boards worldwide. There are several OneNet
medical conferences, and these are primarily "question and answer" forums,
typically lay people asking about a diagnosis and a physician giving free
advice.

	Today, you can buy a modem for less than 100 pounds. Think of the time
saved if you don't have to go to the medical library, since someone has
done the hard work summarising the latest key papers, commenting on them,
and posting them to you twice a week via your telephone! So you have to
give a case presentation on ovarian cancer?: mail a request for a review
>from  America and read it next morning. Speaking of which, I've got a case
presentation to prepare...

Useful Contacts and Reading:
----------------------------

Andy's Clinic Bulletin Board: Medical Forums, UseNet, OneNet. Manchester,
0614399429 or 0614390617 (modem). 

CompuServe: PO Box 676, Bristol BS99 1YN, 0800 289378.

Demon Internet: Full Internet access. Enquiries to 081-349 0063. 

The Internet Starter Kit for Macintosh by Adam Engst, Published by Hayden
Books, ISBN 1-56830-064-6 (pretty verbose).

The Big Dummy's Guide to the Internet, at ftp.eff.org in the directory
/pub/Net_info, get the file Big_Dummy (Now called EFF's Guide to the
Internet, contact [email-masked]??) 

Global public health and the information superhighway. Laporte R. BMJ 1994:
308; 1651-2.

PART 2: MEETING COLLEAGUES IN CYBERSPACE- COMMUNICATION
=======================================================

	The previous part hopefully persuaded you to buy a modem and join the
online community in Cyberspace, the "Electronic Frontier". Whilst there are
many tools to aid navigation of the Internet, electronic mail (email) is
the most widely available, and can serve most of your needs whether you
have direct Internet access, or access via a bulletin board (BBS).

Email an Individual or Institution:
-----------------------------------

	Everyone on the Internet has a unique email "address", usually something
like "[email-masked]". Here, my own address, "brucem" is my
name; "andyclin" is the site name (a BBS in this case); "exnet" is the
service provider; "com" means a  commercial organisation. Sometimes an
address will have something like ac.uk (UK academic site) or co.au
(Australian commercial site) on the end. This lets you know where your
colleague is located. Once you have addressed your message, type your
request and "post it" down the phone. There is no list of doctors with
email addresses, but it is easy to come across those that have by reading
UseNet and OneNet medical conferences. In addition, you can use InterNet
email to contact doctors on other networks such as CompuServe and America
Online (see The Internet Services FAQ by Kevin M. Savetz, posted
periodically to the UseNet group "news.answers"). Want to talk to the
public?: email the Guardian newspaper at [email-masked] (see
Michael Johnson's "Media on Internet list", [email-masked]).

	I recommend learning about Internet email by joining a BBS with Internet
access. BBSs running graphical interface software (FirstClass (TM)) are
beautifully simple to beginners, for Macintosh or Windows users. Plus, it's
cheap and there are plenty of people online willing to help you. A list of
American medical BBSs is available from E Delgrasso at [email-masked].

Medical Usenet Newsgroups:
--------------------------

	Usenet is one of many forms of Internet traffic: in this case postings
>from  people to a "newsgroup" on a particular topic- such as medicine. The
online community is very altruistic and posting a message to one of these
conferences usually elicits a rapid reply. 

	The newsgroup "sci.med" is a very busy group on general medical topics,
with questions and answers appearing on topics such as the quality of
doctors, new therapies, uncertain diagnoses etc. These conferences are open
to the public, not just doctors- but our contribution is strongly
encouraged. There are a number of sub-newsgroups available within sci.med,
including sci.med.aids; sci.med.nutrition; sci.med.occupational;
sci.med.radiology; and sci.med.telemedicine (using telecommunication
technology for medicine, education, & information access). Other relevant
newsgroups include: alt.support.arthritis ; alt.education.disabled ;
alt.recovery ; misc.emerg-services ; misc.handicap; talk.abortion; and
talk.politics.drugs

OneNet Medical Conferences:
---------------------------

	OneNet conferences are based somewhere in the chain of FirstClass BBS's
around the world. Any BBS which caries the conference mirrors the contents
at all other sites such that if a new message is posted on one BBS it
appears in the same conference on all the BBS's. Pat Plummer
([email-masked]), OneNet Medical conferences moderator, has designated
these conferences as follows: "Medical"- a general discussion/non-file
area; "Medical Library"- for posting of informational text files and
messages (limited to 52K total message + file). This is also a conference
created for the posting of notices for conferences and symposia worldwide
so as to not take up bandwidth in the general Medical discussion area; and
"Medical Software"- for discussion of software that is medically related as
well as for posting of files up to 300K. In this part of the world, we also
have "Medical UK".

	Now you're ready to introduce yourself to your colleagues and patients
online. Remember that many modems can also support fax: useful for sending
diagrams, or getting your CV in on time. You may be interested in a mailing
list on medical telecommunications, called MEDNETS, at
[email-masked].

PART 3: RESEARCH WITHOUT BOOKS- INFORMATION ACCESS
==================================================

	It's your turn to give a case presentation? There are several options for
finding medical information open to the computer-literate doctor: online
databases; CD-ROM; frequently asked questions (FAQs); mailing lists; and
floppy disk. 

Online Medical Databases
------------------------

	Many facilities are available to you through electronic mail without your
requiring a direct Internet connection (see Resources, below). The National
Institutes of Health can be reached by email at ftp.cu.nih.gov. The
National Library of Medicine has an online image library at ftp
nlmpubs.nlm.nih.gov.

	As an example, say you need to give a talk on breast cancer: enter the
CancerNet database in Maryland USA. CancerNet lets you request files on
treatment; patient information; supportive care ; cancer
screening/prevention; drug information; fact sheets; and CANCERLIT
citations and abstracts. There is no charge for the service unless your
service provider charges for use of email.  Send email to
[email-masked] with "help" in the body of the message if you
want the contents list; to receive a Physician's Database Query statement
on breast cancer, send cn-100013 in the body of the message (a code
obtained from the contents list). Easy.

CD-ROM
------

	Standing for Compact Disk Read Only Memory and based on audio CD
technology, these disks can store the equivalent of 200,000 pages of text.
The Oxford Textbook of Medicine is available in this format, as is the
British Medical Journal. For further listings, see the document "3.Medical
CD-ROMs", by Bruce C. McKenzie ([email-masked]) which is posted
on occasion to sci.med.

	The most widely known CD-ROM database in medical circles is Medline, a
digital version of the increasingly heavy printed Index Medicus. A service
allowing remote searching over the phone is offered by the British Medical
Association: you need only a computer, modem, telecommunications software,
and BMA membership. See below (in this Part).

Medicine-related FAQs
---------------------

	FAQs are usually linked to UseNet newsgroups, and comprise the answers to
questions most often posted to these groups. Many are written by
enthusiastic lay people but nevertheless well referenced, and answer the
questions relevant to patients. Examples include: Diabetes from
[email-masked]; Power lines & Cancer from [email-masked];
Miscarriage from [email-masked]; Tinnitus from [email-masked];
Depression from [email-masked]. Many FAQs are made available on UseNet,
and many are archived at rtfm.mit.edu. For further listings, see the
document "2.Medicine-related FAQs", by Bruce C. McKenzie
([email-masked]) which is posted on occasion to sci.med.

Floppy Disk
-----------

	Bibliographic information is also distributed on smaller capacity and
relatively cheap diskettes, such as the Clinical Medicine edition of
Current Contents.

Mailing Lists
-------------

	Previously we introduced the concept of electronic mail. These messages
can also be sent to automated computers, which will execute a specific
request, such as finding a file, and mailing it back to you. See Part 4 for
details.

Resources:
----------

US Government Databases available via the Internet relating to Health and
Medicine: us-govt-net-pointers/part2,3,&4 from [email-masked].

Internet/Bitnet Health Resources by Lee Hancock at
[email-masked]; ftp2.cc.ukans.edu in the directory
pub/hmatrix.

The electronic information revolution and how to exploit it. JJ Cox, KJ
Dawson & KEF Hobbs. Br J Surg 1992; 79: 1004-10.

British Medical Association Medline Service:
--------------------------------------------

This section has been written by Jane Rowlands, BMA Librarian on Janet at
[email-masked].

	The BMA Library is now able to offer free, remote access to the full
Medline database, dating all the way back to 1966, as a benefit of BMA
membership. 

	To access the database, directly, or via the Library's own internal
network which provides further access to our Library catalogues, you will
need a PC, modem and communications software. The only charges incurred
will be your own telephone costs. We also now have a link onto the Joint
Academic Network (JANET). 

	We can provide a list of recommended software (the most successful being
pcAnywhere - remote version for DOS, or Versa Term for Mac's). Your modem
must be Hayes compatible. The fastest speed at which the service can be
accessed at present is 9600. The slowest speed we would recommend is 1200
baud and this must run in both directions.

	The Library has purchased a CD Plus PlusNet2 system which stores the
database on hard disk (6 gigabytes) and presently allows access from 20
remote users simultaneously so they may carry out their own searches.
Results can be printed or downloaded at the receivers end - using XModem or
more recently Kermit data transfer protocols.

	Medline indexes the world's leading periodical literature, covering all
aspects of medicine. It currently contains over 8 million records, taken
>from  around 3,700 different journals from 70 different countries. Over 70%
of these have informative abstracts. The database is extensively indexed
using standard keyword terms (MeSh Headings) and subheadings highlighting
more specific aspects of these terms for very thorough interrogation of the
database.

	The PlusNet2 system interface is extremely friendly and will allow you to
search using menus or in command (professional) mode. There is even a
facility that will help to match your own words to appropriate MeSH
Headings. The database will be updated every month. The system will run 24
hours a day, 7 days a week. Help will be available between 9.00am and
5.00pm each week day on the telephone number given below.

	For further details, and to sign up to take advantage of this new service
please contact JANE ROWLANDS at the BMA Library. Telephone 071-383 6224.

(Note: Open to BMA members only. On contacting the London Office Librarian
they will send you a pack containing logon procedure, modem number,
settings, and an application form. Charges are nil except standard phone
company charges for a call to London. The host is a PC running PC Anywhere
Remote software. Requirements are a PC-compatible or Mac, modem, phone
jack, comms software (PC Anywhere or other DOS software preferable; Windows
software will work, as will any Mac comms package supporting VT100
emulation- such as ClarisWorks or ZTerm)) - BM.

The National Library of Medicine Medline Service (USA):
-------------------------------------------------------

	Accessible via the Internet (email to [email-masked] for information).
Not much use to those of us on the European continent and without a direct
Internet connection. However, for your interest, aside from the cost of an
international call and the approx. $US 17 per hour service charge, you
could access the service as you would a BBS with a dedicated program called
Grateful Med. There is also another dedicated package available called
Loansome Doc, available in PC-compatible and Mac versions, that lets you
request copies of papers from participating libraries. To satisfy your
curiosity about these programs, email [email-masked].

PART 4: AND NOW FOR THE NEWS- MEDICAL MAILING LISTS AND NEWSLETTERS
===================================================================

Medical Mailing Lists
---------------------

	Mailservers are computers set up to answer and send email automatically.
Mailing list discussions are based at a specific computer site. Some
regular articles and newsletters are also distributed in this way, such as
"Journal Watch". Most mailing lists are moderated by the listowner, but
some will accept other's edited contributions.

	To subscribe to a mailing list you simply send a message to the mailserver
with a specified command. Each list is posted as a personal email message.
In order to subscribe to a list, you need to know the name of the list and
the address of the mailserver.

	A Listserver is an automated computer acting as a mailserver for Bitnet.
Bitnet is one of the academic networks that uses different protocols than
UseNet to distribute mail. This information is also sent to your mailbox so
it is similar to subscribing to a Usenet mailing list. Email addresses
ending in ".edu" indicate that the particular Bitnet site is connected to
the Internet. If an address doesn't end in ".edu", you have to address the
server by adding ".bitnet" to the end (from Internet).

	Conventions for subscribing to a list vary, but a common way is to send
email to "listserv@(the site name)", with the message "subscribe (list
name) (your name)". Where you don't have a listserver address, try "(list
name)-request@(the site name)", the Unix format. Sometimes you'll get mail
back telling you the idiosyncrasies of a particular mail server: many don't
follow convention. Study the following example mailing lists and
newsletters:

Computers in family medicine: FAM-MED, at gac.edu.
	email to [email-masked]; subscribe FAM-MED yourname

Medical informatics: NIBNEWS
	email to [email-masked] - a personal address - and ask to
subscribe

Chronic fatigue syndrome: CFS-L, at list.nih.gov	
	email to [email-masked]; subscribe CFS-L yourname

Medical News: MEDNEWS, at asuacad.bitnet		  
	email to [email-masked]; subscribe MEDNEWS yourname	

Psychiatry: PSYCHIATRY, at mailbase.ac.uk
	email to [email-masked]; subscribe PSYCHIATRY yourname

	Further listings can be found in "The Medical List" at ftp2.cc.ukans.edu
in the directory pub/hmatrix; get the file medlst94.txt, by Dr. Gary Malet
and Lee Hancock. Your best bet is to obtain such a database and follow the
instructions!

Medical News in UseNet
----------------------

	Most of the items in UseNet newsgroups are not that newsworthy, but
Journal Watch, a medical literature survey, certainly is
([email-masked]). It's surely a great way to stay "generally
informed", since the Massachusetts Medical Society  has done the hard work
picking out the key articles from a range of journals, summarising them,
and pointing out their deficiencies. That's a lot of time saved in the
library scanning the general journals- and a regular supply of up-to-date
information. 

	Also posted to this conference biweekly is "The Health Info-Com Network
(HICNet) Medical News Digest", from David Dodell D.M.D ([email-masked]);
and the AIDS Daily Summary and Morbidity and Mortality Weekly Report from
the CDC.

ClariNet News
-------------

	ClariNet offer commercial read-only newsgroups consisting of articles
written by paid reporters, distributed in Usenet form. The groups
pertaining to health are: clari.biz.industry.health; clari.tw.health; and
clari.tw.health.aids. Email [email-masked] to get more information or
[email-masked] to subscribe. There are special subscription rates for
educational institutions, overseas customers and bulletin boards. 

PART 5: A DOCTOR'S GUIDE TO SILICON CHIPS
=========================================

	Perhaps you've been reading this document and warming to the idea of
buying a computer so you can join us in Cyberspace? Here are a few
considerations to ensure your cheque book has given informed consent.

The microprocessor
------------------

	This is the computer's frontal cortex- where it's "calculating power" is
seated. Macintosh computers (Macs) use Motorola chips (microprocessors).
IBM compatible computers (PCs) use Intel chips. Windows (TM) is a graphical
interface borrowed from the Mac for PCs running the operating system called
DOS (the interface you use to give instructions to the computer). DOS is
still there in the background, but you don't have to deal with it much.
PowerPC and Pentium chips are newer developments.

Clock frequency
---------------

	All chips "think" at a particular speed, measured in MHz. A chip running
at 33 MHz thinks more slowly than a chip running at 80 MHz. 

Random Access Memory (RAM)
--------------------------

	It's all very well having calculating power, but to show it off you need
to be able to remember lots  of information at once. RAM is like a count of
neurones in short term memory: the more RAM you have, the more numbers you
could remember simultaneously to work on bigger sums. 

Hard disk drive
---------------

	In addition to having a good short term memory, you need to be able to
shelve what you've learnt in order to retrieve it latter on. A hard disk is
like long term memory- you can store a lot more in it, it takes longer to
retrieve the stored item, and it's more difficult to interrupt than data in
short term memory. 

Floppy disk drive
-----------------

	A floppy disk is a portable storage disk that is "read" by a floppy disk
drive. The most common disks in use today are high density 3.5" floppies.
They store 1.44 megabytes of data, about 240 copies of this part of the
document you are reading.

Keyboard & Mouse
----------------

	A computer keyboard resembles that of a typewriter. A mouse consists of a
ball used to "point" a cursor around the screen, and a button used to
"click" on something to select it.

Monitor
-------

	There are a number of types of monitor, including Trinitron, liquid
crystal, EGA, VGA, Super VGA. In terms of clarity of image and size of
display, you get what you pay for.

What do you want the computer to do?
------------------------------------

	The most important thing in buying a computer is choosing software that
will do the job. Many home users will buy an integrated package because it
offers several functions at minimal cost. They often consist of a word
processor (writing letters, reports), spreadsheet (accounting, numerical
data entry), paint module (freehand or bitmapped graphics), drawing module
(object-oriented graphics), database (storing related data), and
communications module (to talk to other computers). If you have specialist
requirements, such as a certain statistical package, buy your software
first and then a machine to run it.

What hardware will run the software you need?
---------------------------------------------

	A PC runs DOS or Windows programs. A Mac can also read and write PC floppy
disks, and an emulator is available (from Insignia Solutions) that will let
you run DOS or Windows on your Mac. Each platform has it's devotees: if the
software you want is available for both, go to a supplier and compare the
machines side-by-side, and talk to an advocate of each platform. 

Do you want a portable or desktop machine?
------------------------------------------

	A portable (laptop) has advantages: it can go where you go. You can get
the same power in a laptop as you can in a bigger desktop machine. However,
portability creates engineering difficulties, and you have to pay for the
genius of those who solve such problems. 

PART 6: RETRIEVING SOFTWARE AND DOCUMENTS BY EMAIL
==================================================

	This section describes the steps involved in finding and retrieving
software or documents by email. First you have to locate the file you want.
Archie is a database system that lists files held on a large number of 
global FTP (File Transfer Protocol) sites. You can then obtain files stored
at these sites using an email gateway, without direct access . This ftpmail
facility is present at some sites, working like a mail server i.e. you send
an email request to an automated host which then sends you the file. 

Finding a file using an archie mail server
------------------------------------------

	Send a message to [email-masked] with "help" in the body of
the message for a list of commands. As an example, if I wanted to find a
file called "anatomiser", I might send the following message to
archie.doc.ic.ac.uk (the name of all archie servers is archie):

	To: [email-masked]
	<body of message>
	prog anatomiser
	quit

The "prog" part asks archie to scan it's database for any mention of the
string "anatomiser".  The  "quit" tells the server to ignore bits that the
gateway tacks on to your message.  

The following (edited) message was sent by archie in reply: 

	Host rigel.acs.oakland.edu  (141.210.10.117)
	Location: /pub2/macintosh/appl
      FILE    -rw-r--r--   24704 bytes  00:00 17 Apr 1990  anatomiser.sit

As you now know the location of the file, you are ready to ask an ftpmail
server to fetch it for you.

Getting a file using an ftpmail server
--------------------------------------

	For a full list of commands send a message "help" to [email-masked].

Encoding:

	Email can only be sent in ASCII mode (the standard character set). Binary
files (non-textual data) must be downloaded in binary mode, requiring a
direct connection. Most Mac archive sites have "encoded" their application
files with BinHex, a program that converts binary data into ASCII. Such
files will end in the suffix ".hqx". Applications from other platforms are
usually encoded with the Unix program UUEncode, ending in the suffix ".uu".
You can ask the ftpmail server to convert non-encoded files into ASCII
before sending them. Encoding makes the file about 20% larger.

Splicing:

	The ftpmail server cuts data into 50 Kb segments which are received as a
series of message attachments. If the retrieved file is in parts, you will
need to download all the attachments and splice them together using a text
editor, word processor, or an application such as Stuffit Deluxe or
UUParser. Be careful to keep the pieces in the right order and do copy the
"begin" and "end" lines if you do this manually.

Decoding:

	Once you've reassembled the file you need a program which will "decode"
this ASCII information back into a binary file. Stuffit will decoding both
BinHexed and  uuencoded files.

Decompression:

	You should normally now be left with an ordinary binary compressed file,
perhaps a Stuffit (.sit) or Compact Pro (.cpt) archive. Running these
utilities to decompress the data will leave you with a usable file.

Example:

	You can use [email-masked] for ftp-by-mail. The following example
instructs the server to logon to the site "rigel.acs.oakland.edu", change
to the directory "/pub2/macintosh/appl", and get the file "anatomiser.sit"
after encoding it to ASCII.

	To: [email-masked],InterNet
	<body of message>
	open rigel.acs.oakland.edu
	cd /pub2/macintosh/appl
	uuencode
	get anatomiser.sit
	quit

Medical Software Repositories
-----------------------------

	Example medical software sites are listed below (from Internet/Bitnet
Health Resources by Lee Hancock). To get a directory listing, email the
particular ftp site as in the following example:

	To: [email-masked],InterNet
	<body of message>
	open ftp.uci.edu
	dir
	quit

To get the contents of deeper directories, you can use the "cd" change
directory command before "dir" to modify your original message.

University of Michigan Macintosh Archives Section. Site address
mac.archive.unich.edu, directory /mac/etc/medical. The mirror site at
src.doc.ic.ac.uk would be better choice.

University of California Medical Education Software Repository is a ftp
site for the collection of shareware and public domain software. The site
address is ftp.uci.edu, and the directory /med-ed/mac (or /msdos).

University of North Carolina mirror, sunsite.unc.edu, for public domain
medical software. The subdirectory of interest is pub/medicine, which
contains public domain software for IBM-PCs. The original site is
ccsun.unicamp.br, same directory.

Documents by FTP
----------------
You can get a listing of FAQs held in the sci.med archive (or any other
newsgroup for that matter, substituting sci.med for the newsgroup holding
your interest) by sending a request to [email-masked]:

	open rtfm.mit.edu 
	cd /pub/usenet-by-group/sci.med
	dir
	quit

PART 7: MEDICAL INFORMATICS: WHAT IS IT?
========================================

	Medical informatics is a term that encompasses many things. Parsons
defines it as "the information science that optimises the computer
analysis, storage, retrieval, and transfer of patient and health-care data"
([email-masked], in: NYS SUMMARY on [email-masked]) .
According to Greenes and Shortliffe, it is "... the field that concerns
itself with the cognitive, information processing, and communication tasks
of medical practice, education, and research, including the information
science and the technology to support these tasks." (see reference below).
They go on to illustrate this in saying that "A physician can be expected
to make use of a broader range of functions of a computer, eg, to obtain a
list of current patients, to enquire about and review laboratory or
radiology results of particular patients, to enter orders, to enquire about
the adverse effects or interactions of medications, to consult a
differential diagnostic aid, to perform a bibliographic search, to send
electronic mail to a colleague, to save interesting cases in a personal
database, to perform statistical analyses of research data, to write a
manuscript, or to prepare slides or graphics for presentation and
publication."

	Now that's going to scare some people. When it comes to clinical
information systems, many more will have concerns about their safety. See:
Are clinical information systems safe? Smith MF. BMJ 1994: 308; 612.

	The following abstracts are from several recent review articles covering
this field:

	The electronic information revolution and how to exploit it. Cox JJ. 
Dawson KJ.  Hobbs KE. British Journal of Surgery 1992; 79(10):1004-10.
"Medical information is increasingly stored in electronic format, enabling
faster and more flexible access to the literature. Online, compact disc and
floppy disc databases are widely available. The origins and development of
these different database media are described. The strengths and weaknesses
of each, and the ways in which they complement each other, are examined.
Ease of access to medical information can result in data management
problems; the role of bibliographic software in ensuring full exploitation
of the electronic information revolution is therefore emphasised".

	Medical informatics in the intensive care unit: state of the art 1991.
Clemmer TP.  Gardner RM. International Journal of Clinical Monitoring &
Computing 1991-92;  8(4):237-50.
"Intensive care medicine requires timely, accurate, and integrated patient
records to provide the highest quality patient care. Computerized patient
records offer the best method to achieve these needs. The expectations of
society for medical progress through increased use of computers is
growing... We are on the frontier of some exciting times in the next decade
as computers become commonplace in the clinical care process rather than an
unusual event." 

	Medical informatics: an emerging medical discipline. Council on Scientific
Affairs and Council on Long Range Planning and Development of the American
Medical Association. Journal of Medical Systems 1990; 14(4):161-79.
"The use of computer technology in medicine is no longer the domain of only
a few "gadget" happy high-tech aficionados. The rapid pace of medical
progress and the increasing demands on physicians' time mandate that
mechanisms be developed to deliver the tools of contemporary information
management directly into the hands of all practising physicians.... Most
users of medical information, physicians included, have not crossed the
threshold into the electronic/computer era of information acquisition,
distribution, and assimilation. The continuing development of the physician
as a computer user will create a more efficient work environment for the
physician while at the same time improving patient care". 

	Medical informatics: the substantive discipline behind health care
computer systems. Lincoln TL. International Journal of Bio-Medical
Computing 1990;  26(1-2):73-92.
"The computer is rapidly becoming an interactive workstation for medical
research and for clinical decision-making and it has become a preferred
instrument for communication and documentation throughout health care.
However, when the attempt is made to use the rigid conventions of
information processing to impose order on the characteristically volatile
and unpredictable phenomena encountered in the clinical setting, deep
seated logical issues are uncovered. This challenge has generated the new
field of Medical Informatics, one major goal of which is to formulate
computer logics that can properly relate the idealised descriptions of
disease, the rules for medical practice and the general guidelines for
health care to the intricate diversities encountered in the care of
individual patients". 

	Medical informatics. An emerging academic discipline and institutional
priority. Greenes RA.  Shortliffe EH. JAMA 1990; 263(8):1114-20.
"Information management constitutes a major activity of the health care
professional... After many years of development of information systems to
support the infrastructure of medicine, greater focus on the needs of
physicians and other health care managers and professionals is occurring--
to support education, decision making, communication, and many other
aspects of professional activity. Medical informatics is the field that
concerns itself with the cognitive, information processing, and
communication tasks of medical practice, education, and research, including
the information science and the technology to support these tasks. An
intrinsically interdisciplinary field, medical informatics has a highly
applied focus, but also addresses a number of fundamental research problems
as well as planning and policy issues. Medical informatics is now emerging
as a distinct academic entity...". 

On the Internet
---------------

	A number of mailing lists cover the field of medical informatics, such as
AMIA-37, IMIA-L, MI-EDUC, and MI-STDNT at [email-masked], and MEDINF-
L, available on request from [email-masked].

	NIBNews is a newsletter about medical informatics from the Centre for
Medical Informatics in Brazil, at [email-masked]. The following
editorial, entitled Creative uses of networking in Medicine, is cited from
Vol. 1 - No. 10 (March/April 1994) by Renato M.E. Sabbatini
([email-masked]):

	"The explosive growth of Internet (it has been said that the number of
users connected to the net is increasing at the rate of 5% per month !) has
spawned a similar increase in the number and variety of ways and means of
generating and accessing information. Buzzwords such as Gopher, Veronica,
WAIS, WWW, etc., indicate new accession mechanisms to the mind-boggling
treasures of information lying to be harvested in the Internet.

	One of the most interesting developments, already pointing towards the day
when all the main Internet backbones will be built upon ultrahigh speed
lines (the "data highway"), is on-line hypermedia access. The World Wide
Web (WWW) and a graphics-oriented program named Mosaic, are breaking new
paths in this direction. In health care applications, Mosaic permits access
to multimedia information about patients, illustrated medical electronic
textbooks, virtual multimedia journals, medical image repositories, etc. In
Health Sciences education, Mosaic and similar products can be used as
universal informational tools for students, as demo devices for teachers,
etc. Entire virtual libraries and even virtual universities will be
implemented, as soon as real-time video and sound becomes available in the
net...."

	HSPNET-L ([email-masked]), moderated by is D.F. Parsons MD
([email-masked]; [email-masked]), covers a broad range of
medical informatics topics, such as computerized medical records; networks;
Internet security; telemedicine applications; teleradiology; family
practice networking; and the usefulness of Internet for hospitals.

PART 8: PRESENTATION OF INFORMATION
===================================

	Computers are used increasingly in the production of handouts and slides,
and in the pharmaceutical industry and medical education, in audiovisual
presentations. 

Reading:
--------

Preparing lectures using microcomputers. Uhari M, Rantala H. Medical
Teacher. 16(1):101-105, 1994.

Twelve tips for effective electronic presentation. Crosby J. Medical
Teacher. 16(1):3-8, 1994.

PART 9: CLINICAL DECISION SUPPORT
=================================

	The British press has recently sensationalised the intention of a ICU
Consultant at Guy's in London to use a program called "R.I.P" to predict
clinical outcome, assisting in the withdrawal of life support to
rationalise limited resources. According to the media, this is a computer
that plays God. However, this will be familiar to medically trained persons
as a digitised rendering of Medical Decision Analysis, as taught at medical
school. It's all to do with maths. Basically, you navigate through a flow
diagram to arrive at one or perhaps several outcomes. Along the way, each
choice that is made (surgical or medical interventions) or variable that is
considered (eg biochemistry, ventilator settings, MAP etc) is associated
with a certain statistical probability of producing a particular outcome-
such as life or death. These algorithms can be used to compare the efficacy
of one treatment against another, or to predict from multiple sets of
variables which combination is most likely to result in a favourable
outcome measure relative to other combinations.

Reading/ Resources
------------------

AI-MEDICINE-REQUEST is a list discussing the application of artificial
intelligence to medicine eg computer-clinical decisions. Subscribe to ai-
[email-masked].

SMDM-L is the list for The Society for Medical Decision Making, discussing
decision making as it applies to clinical practice etc. Subscribe to
[email-masked].

Computer-aided diagnosis of acute abdominal pain: a multi-centre study. BMJ
1986; 293: 800-4.

PART 10: PRACTICE MANAGEMENT
============================

	The number of general practitioners with a computer in their consulting
rooms greatly exceeds those on the desks of hospital consultants. Benson
lists 10 reasons why this is so: the existence of "role models" for general
practice; the enthusiasm of GP organisations; government support; non-NHS
sponsorship; lack of funding for hospital systems; financial incentives for
GPs to closely monitor their activities; better access to terminals in GP;
data security concerns in hospitals; the existence of comprehensive coding
systems for GPs; and the simpler technology requirements of general
practice systems (The rise of clinical computing. Benson T. British Journal
of Healthcare Computing 1993; March: p 35-39). This doesn't mean that
everybody in general practice is sold on the idea (see: We don't have a
computer. Stanley PH. BMJ 1991: 303; 971-2).

	Computerised practices may use their systems for such things as
administration (patient register/ practice profile; word processor; stock-
control; salaries & accounts); age-sex registers; disease registers eg
cancer or hypertension; running preventive medicine programs such as
immunisation or cervical screening; prescribing from the practice
formulary; drug interaction notification; reviewing past medical histories;
research and audit; billing; and as an electronic reference library.

	The list FAM-MED at [email-masked] discusses the use of computers in
family practice.

PART 11: CLINICAL RESEARCH
==========================

	Computers can make life much easier for those undertaking research. The
last time when you painstakingly thumbed through Index Medicus, you might
instead have used the Medline bibliographic database on CD-ROM to survey
the literature, downloaded your search onto a floppy and read it at home.
Then, a departmental computer to select clinical cases for the study;
entered the collected data into an electronic database; used a statistical
package to perform the analysis; and had your secretary type the draft
manuscript manuscript using a word processor, ready for you to edit, run a
spell-checker, and format the text. You might use a program like EndNote
(tm) to make sure your numbered citations are matched to the appropriate
papers, and prepare your illustrations using a graphics program, importing
the data points directly from the database. 

PART 12: TELEMEDICINE
=====================

Definition
----------

Using computers and telecommunication links to remove the factor of
physical distance from the consultative process, and to augment the
dissemination of medical information to fellow professionals and the
public.

Potential Benefits of Telemedicine
----------------------------------

(Summarised from Telemedicine in New York State by DF Parsons. Get "NYS
SUMMARY" on [email-masked]).

	Specialist Selection: Terminals in shopping malls could help users to
choose the kind of specialist they should see, avoiding the expense of
seeing an intermediate specialist who may refer on.  

	Preventive Medicine Education: In providing a self-assessment of factors
influencing personal health, public terminals could suggest lifestyle
changes where necessary.

	Surveillance of Infectious Disease: An integrated public health network
could provide for physician awareness of current epidemics. Internet
gateways permit communication with the Centre for Disease Control.

	Video Teleconferencing: Potential uses include clinical consultation;
better access to specialists for under-served communities; medical
oversight; an aid to primary care in remote clinics; triage and
stabilisation assistance to rural hospitals (reducing the "time-to-
treatment"); distance teaching and training; and improving health care at
reduced cost in "closed" communities (eg prison).

	Online Physician Databases (including bibliographic information).

	Medical Record Portability: Email allows the text of patient records to be
sent to another hospital, providing rapid access to the medical records:
transmission of digitised x-rays and other medical images is also possible.

	Teleradiology: transmission of digitised images could allow radiologists
based at a medical centre to review and report xrays taken in satellite
clinics without delay or travel costs.

Existing Applications of Telemedicine
-------------------------------------

	The programme for TeleMed 94 at Hammersmith Hospital in London (Nov 3-4)
is illustrative of the range of blossoming telemedical services:
telepsychiatry (London); management of minor injuries (London/Belfast);
remote fetal scanning (London/IoW); teledermatology in prison (North
Carolina); Scottish telemedicine (Aberdeen); telemedicine for the under-
served community (Rochester, Minnesota); remote monitoring (Oxford); Kansas
telemedicine (Kansas); distance teaching of surgery (London); distance
training for percutaneous renal stone extraction (London); intercontinental
telemedicine (WellCare) and telemedicine at HCI; teleradiation therapy
(Houston, Texas); metropolitan area teleradiology (Dublin); automatic
transmission of CT images (Liverpool) and remote operation of a 3-D
workstation (London).

Obstacles to Telemedicine
-------------------------

	According to Parsons (Telemedicine in New York State, get NYS SUMMARY on
[email-masked]), the main obstacles to the growth of telemedicine
are the lack of reimbursement for time spent in teleconsultation; the high
cost of long distance connections; a "modem tax" imposed by New York State
on information distribution; and the lack of reduced charges for
educational and medical telecommunications. In addition, there is concern
about increased malpractice risks resulting from incomplete or defective
transmission of data and breaches of confidence. 

	Whilst digital compression of video images may have facilitated the
delivery of specialised care to rural America, some doctors are simply
uncomfortable with the technological nature of this approach (Investor's
Business Daily 8/17/94 A4, cited in Edupage 8/18/94 from
[email-masked]). The relative paucity of teleconsultations creates
difficulties in the assessment of cost-benefit analysis. 

Resources
---------

See the newsgroup sci.med.telemedicine or it's associated mailing list
TELEMED, at [email-masked].

HSPNET-L ([email-masked]) covers telemedicine: HSPNET-D is the
monthly digest of this list. It is moderated by is D.F. Parsons MD
([email-masked]; [email-masked]).

PART 13: HOSPITAL NETWORKING
============================

	Overlapping to some extent with telemedicine, hospital networking can link
different hospitals to each other, and different hospital departments
together on the same network. Many hospitals already partake in the later
application: ward terminals are linked to computers in pathology and
radiology departments, providing access to the most recent and past results
for a given patient; juniors can get a list of their patients before the
morning rounds, using data from the admissions office etc. HSPNET-L
([email-masked]) covers all aspects of hospital networking:
HSPNET-D is the monthly digest of this list. It is moderated by is D.F.
Parsons MD ([email-masked]; [email-masked]).

PART 14: COMPUTER ASSISTED LEARNING
===================================

	Computer Assisted Learning (CAL) is an ever expanding sphere of
development, paralleling the wider availability of the necessary hardware.
Whilst CAL product development is time-intensive, it has distinct
advantages over traditional teaching methods. The wider it's use, the
cheaper the investment becomes since the expense lies with capital outlay.
It also ensures that the information is presented in the same form to all
students, eliminating discrepancies that inevitably occur in traditional
teaching (1). CAL enables active independent learning. It does this through
the following mechanisms (2):

	a. Holding the learners attention and interest.
	b. Paced at the user's individual rate.
	c. Non-threatening/ non-competitive feedback allowing immediate self-	
evaluation.	
	d. Flexibility to learn according to personal schedule/ needs/ 		
motivation.
	
	"The real educational advantage of computers is not realised in 'drill and
practice', or 'tutorial' CAL, but in simulations of 'real life' scenarios
in safe and non-threatening environments..... simulations allow learners to
experiment repeatedly in ways that may not be possible or practical in
laboratory or clinical situations" (3). "CAL design requires skills in
education, software design, programming, and the subject area which one
hopes to teach" (1). 

	The Apple Macintosh and the application "HyperCard" (from Apple Computer)
are certainly well known to many university students. A HyperCard Stack is
essentially a hypermedia document, or a medium with pointers to other
media. In such a document, if you want more information on a particular
topic you are reading about, you can often "click on it" to either read
more detail (i.e. hypertext), or see a graphic, animation, or hear a sound.

	There are a number of FTP sites that hold medical software archives for
both Macintosh and IBM compatibles, such as the University of California
Medical Education Software Repository at ftp.uci.edu.

	The Liverpool School of Tropical Medicine has written a CAL package called
the Meningitis Epidemic Case Study. It uses hypertext to examine the
investigation of a recent meningitis epidemic in Africa.  It requires an
IBM-compatible, 540Kb of free RAM,1.5 Mb hard disk space, EGA. You can ftp
it and associated files from the site ftp.liv.ac.uk in the directory
~ftp/pub/epidemic.

	There are a few mailing lists relating to computers in medical education,
such as "cocamed" at [email-masked]. You can email Grace Paterson
at [email-masked] for information.

	A new UseNet Newsgroup  misc.education.medical, according to the the Call
for Votes, will provide a forum for discussion of issues related to medical
education.

Continuing Medical Education
----------------------------

	The Bitnet list "fam-med" discusses the use of computer technology in the
teaching and practice of Family Medicine. Email paul@gacvax1 or send a
subscribe command to [email-masked]. A digested and edited version of the
messages comes out about twice weekly, and the entire archive of Fam-Med
postings is searchable using Gopher.

	Scientific American Medicine (415 Madison Avenue, NY 10017) produce
"DISCOTEST" on floppy disk containing case simulations, and the University
of Washington School of Medicine Webserver at
http://www.rad.washington.edu/ has a radiology teaching file (contact
Michael L. Richardson, [email-masked]), both of which can earn
credit for the Physician's Recognition Award of the American Medical
Association. 

References:
-----------

1. Inform '93 Workshop Report: Development and using CAL, M Doherty and S
Whitely. International Journal of Health Informatics 1993 vol 2 (4).

2. Computer Assisted Instructions: a role in teaching human gross anatomy.
RJ Welsh, RC Bohn. Medical Education 1990 vol 24, page 499-506.

3. Formative evaluation of a multimedia CAL program in an ophthalmology
clerkship. D Kaufman, S Lee. Medical Teacher 1993 vol 15 (4), page 327-
340.

PART 15: COMPUTER-BASED PATIENT MANAGEMENT SYSTEMS/ MEDICAL RECORDS
===================================================================

	Computer-based patient management systems (PMSs) may have a number of
advantages:

**Provision of a template that automatically lists standard investigations
in response to a keyword diagnosis, avoiding omission errors.
* Automatic listing of past admission dates and diagnostic coding.
**Legibility, infallible entry documentation for medico legal safety.
* Availability of help messages allowing the user to call up protocols, for
example, guiding the administration of streptokinase in MI.
* Can produce a summary of selected information from a variety of input
screens to present it as a coherent admission summary.
* Standardisation of treatment plans.
* The same notes can be available to be read by several people at once in
different sites.
* Concurrent  document compilation to generate investigation requests,
referral letters etc, which are "posted" electronically.
* Rationalisation of resources eg by providing guidelines for preoperative
investigations, reminders to consider discontinuing antibiotics after 7
days.
* Potential for computerised audit on a scale not previously achievable.
* Improved confidentiality: the system records who has seen particular
patient details.
* Rapid transmission electronically of medical details from one institution
to another.

	As always, there are potential disadvantages:

* Limitation on freehand drawings, which are often indicated.
* Hardware and software failure.
* Access limitation- will enough terminals be supplied?
* Cost.
* Conversion of existing records.
* Eye strain ,musculoskeletal complaints?
* Computer system unavailable during the backup window.

	In 1993 I was seconded for a brief time from my clinical duties to work on
the development of my hospital's Patient Management System. In my report to
the project team, I concluded:

	"We sought to elucidate what might be possible, how a computer-based PMS
might function. But now, like the dinosaur-breeding scientists in
Crichton's "Jurassic Park", we must consider again whether or not we were
so busy wondering if we could, but didn't stop long enough to ask if we
should. 

	... the key issue in presenting computer-based PMS to the medical user is
providing an indisputable incentive to use the system. Being simple
creatures, junior doctors sometimes find it difficult to see beyond their
immediate workload, and managerial concerns such event frequencies and
practice audit can appear to be of little relevance at the coal face. In
essence, we want our job to be easier, to spend less time on paperwork and
more time doing the sorts of things we dreamt we might spend time doing
when we were at medical school. So if it takes me three times as long to
clerk an acute admission into a computer, when I've another waiting,
another on the way, and two preadmissions who have both been waiting over
an hour- not to mention a half page "things to do" list from the morning
ward round- then I'm not overly excited by the idea. Medical people tend to
be a bit conservative in the way they do things. Modern medicine, we
believe, has arrived at "The Way to Clerk an Admission". Why change? Do we
need to change- have we been deluded all this time into thinking that we
were doing a reasonable job out there, grabbing disease by the horns and
wrestling it into the shape of a paper-based medical record?

	Maybe. The computer-based system deserves a fair hearing. I guess a good
starting point is "who are we designing the system for?". If it's the
medical profession, what do they want? Because we can guarantee now that if
we design something they don't want, it won't get used. And the only people
sending the Health Authority Christmas cards will be the suppliers of
unused hardware, and certainly not Mr Misery, who's been told there's no
budget for his hip replacement".

	Another interesting development is that of the personal digital assistant
for the coat pocket, such as Newton, from Apple. There is a program for the
MessagePad available called "Hippocrates", portrayed by it's marketer as an
"electronic medical assistant". It is intended (say HealthCare
International) to "supplement medical practice and clinical information
management systems while reducing paperwork and administrative costs". It
is reported to be able to exchange ASCII data with larger PMSs (hospital
databases?), such as appointments, notes, prescriptions and billing- all
translated from your handwriting by the Newton (have you seen a doctor's
handwriting lately?). Anybody know if it can store your pictures too ? (see
the ASCII art FAQ!).

Reading/Resources
-----------------

CPRI-L, the Computerized Patient Records Institute discussion list from Lee
Hancock at [email-masked], may be of interest . 

The electronic medical record at HCI is described in Telecommunications,
expert systems and quality. Beard N. British Journal of Healthcare
Computing 1993. April, p 24-25. 

Patient records and computers. Shortliffe EH, Detmer DE. Ann Intern Med
1991: 115; 979-981.

PART 16: CARE PLANNING
======================

*** IN PREPARATION ***

PART 17: MEDICAL IMAGING
========================

	Most of us are already familiar with the computers in the radiology
department scanning suite. The newsgroup sci.med.radiology is visited by a
number of people in the field who see the transmission of medical images
over the Information Super-highway: the vaguely-defined successor to
today's Internet. It has been proposed that expert interpretation of images
sent via a network will improve the quality of care, and perhaps limit the
increasingly popular pastime of patient suing doctor.

	A discussion of digitised medical image formats is the file medical-image-
faq/part1 from David A. Clunie ([email-masked]), available at
rtfm.mit.edu which has a mail server, in the directory
pub/usenet/news.answers.  

PART 18: CLINICAL AUDIT
=======================

*** IN PREPARATION ***

PART 19: MEDICAL CODING
=======================

Medical Coding in the UK
------------------------

*** IN PREPARATION ***

Reading
-------

Of mice and men. Macey A, Munroe G, Beverland D, Mollan R. British Journal
of Healthcare Computing 1991; Feb: p 16-17. (Examines the influence of user
interface in clinical coding systems, using mouse input, graphics and
hypertext.)

PART 20: EXPERIMENTAL USES OF COMPUTERS IN MEDICINE
===================================================

	"RoboDoc". The stuff of science fiction? Not to be found in District
General Hospitals, but computerised surgical assistants have already had a
hand in reaming out a close-fitting bony receptacle for prostheses in hip
joint replacement surgery. Aside from robotic technologies in surgery, 
computers are being employed in treatment planning, operative simulations,
three dimensional modelling based on conventional medical imagining
techniques, and experimentally in virtual reality scenarios.

	Machines smaller than 250 microns could be injected into the bloodstream
or tissues and, under computer control, used to excise, secure haemostasis,
perform embolectomies etc. There is a paper by Merkle on medical
nanotechnology applications on the WWW at
http://king.ncb.gov.sg/jkj/nt/ntmerkle.html.

	Connecting the medical profession and health care institutions to the
Internet is an ongoing experiment. Various groups are developing medicine-
related Internet resources that utilise Gopher, WWW, WAIS, and FTP to make
available online text, graphics, and multimedia. Paralleling this
development are efforts to standardise data formats and secure it's
integrity for transmission to authorised persons only.

PART 21: ACKNOWLEDGEMENTS
=========================

	The contribution and/or assistance of the following persons is gratefully
acknowledged (no particular order):

* Mr Andrew Maskell ([email-masked]), Administrator Andy's
Clinic BBS, Manchester UK.

* Lee Hancock ([email-masked]), Education Technologist/ author
of Internet and Bitnet Health Resources, University of Kansas USA.

* Jane Rowlands (Janet: [email-masked]), Librarian, British Medical
Association, London UK.

* MMMR Ltd, publishers of "Jobs For Doctors"21 St Thomas St, Bristol BS1
6JS, UK.

* Dr Donald Parsons ([email-masked]), Editor HSPNET, New York
State Department of Health, USA.

APPENDIX I: ADDITIONAL INTERNET SERVICES
========================================

	Remembering my intention to focus on email access to the Internet, it is
nevertheless worth mentioning in brief additional services available to
those with direct Internet access. For an introduction to Internet
services, obtain "internet-services/faq" by Kevin Savetz from news.answers.
For a database of medical resources, ftp to:
ftp2.cc.ukans.edu/pub/hmatrix/medlist94.txt

Gopher
------

	Gopher is an Internet "browser". With appropriate client software, a
gopher server presents a series of menus leading to more menus, documents,
or other services to track down the info you require. There is a European
gopher at gopher.ebone.net. You can use Veronica with gopher, a program
which searches through all menus on all gopher servers for a specified
string.  An experimental MailGopher server is at the National University of
Singapore (send mail to [email-masked] with help in the body of
the message). Example: The NIH Gopher at gopher.nih.gov provides access to
library catalogues, databases, and AIDS and cancer information. 

World Wide Web
--------------

	WWW is similar to gopher in that you can browse the Internet without being
constantly logged in to a host. The WWW interface is a hypermedia page,
with text containing links to graphics, sounds, or animations. Information
on various services is displayed in one consistent interface. Example: The
Virtual Hospital at the University of Iowa at http://
indy.radiology.uiowa.edu/virtual hospital.html.

FTP
---

	FTP clients allow you to log in to a file/software archive site, with the
username "anonymous" and your email address as the password (ftpmail
servers handle this for you). Example: European mirror site of the mac
archives section at the University of Michigan: src.doc.ic.ac.uk in the
directory computing/systems/mac/etc/medical.

Archie
------

	Archie is a program that scans the archie server's database of many ftp
sites for files matching a user-specified search string, and returns a list
of file names and site addresses so you can ftp them. Aside from via email,
archie can be accessed interactively (using Telnet) or using archie client
software.

Telnet
------

	Telnet is a program run by you on your computer that controls the host to
which you are connected. Like anonymous ftp, there are anonymous Telnet
services, but usually you will need permission to logon. Example: Medline
>from  the National Library of Medicine at medlars.nlm.nih.gov.

WAIS
----
	Wide-area information servers index the contents of archive sites. WAIS is
addressed in English ("Tell me about aspirin and asthma"), and allows the
use of Boolean operators (eg AND, OR, NOT,ADJ). Making a request will
result in a menu of documents being returned, ranked according to
"relevance" as determined by WAIS. WAIS searches can also be done by email:
get the BIOSCI waismail server help file by sending the message "help" to
[email-masked].

+=====================================================+
|            Bruce C. McKenzie MB ChB (NZ)            |
|    OneNet email: Bruce C. McKenzie,Andy's Clinic    |
|    InterNet email:  [email-masked]    |
|         :-) The usual disclaimers apply (-:         |
+=====================================================+ 

end.