03/11/97
RMIUG Meeting Minutes - How the Internet
is Changing the Medical Profession
The March 11th, 1997 meeting featured
a panel presentation/discussion on how the
Internet is irrevocably changing both the
Medical Profession and Consumer's approach
to Health. Dan Murray MC'ed the meeting
and Alek Komarnitsky was the minuteman.
Approximately 60 people attended.
Dan started the meeting at 7:00 sharp
(as usual! ;-) and thanked Intermind (http://www.intermind.com)
for sponsoring the meeting and paying for
the room rental from NIST. They also donated
a number of T-shirts which were passed out
to folks who came the furthest ... and also
at the end in a drawing. There were a number
of announcements from the audience:
- Skip Hawk (skip@winningevents.com)
announced the Spring, 1997 Rocky Mountain
Internet Expo that will be held on March
21 & 22 at the Colorado Convention Center,
14th & California Streets in Downtown
Denver. Show hours are 9:30am to 7:30pm
on Friday, March 21st, and 9:30am to 5:00pm
on Saturday, March 22nd. There are 5 acres
of Exhibits, 200+ Exhibitors and 120 Seminars.
The first Cyber Casino will be there and
will have an Internet Blackjack tournament.
All attendees are invited to the CYBER
AFTER HOURS Business Networking Party
which is on Friday from 5:30 to 9:30.
Network with your peers, as well as Expo
Exhibitors & Sponsors. Music, entertainment,
free food & drinks. For more information,
see http://www.winningevents.com
(Note: Look for the RMIUG booth! ;-)
- Steve Senator (sts@senator.org)
announced the operation of a Public Domain
Name Service at http://soa.granitecanyon.com.
This will provide free primary or secondary
DNS service at no charge.
- There was an job announcement of a
company looking for two PC programmers.
Looking for folks with Computer Science
Degree, C/C++, Clipper or D-Base a plus.
Salary is $30-50K. Send your resume to
PDI, Suite 340, 1536 Cole Blvd, Golden,
CO 80401 or FAX to 232-3073
Dan asked the audience few questions:
1/4 are first-timer's to RMIUG, most from
Denver/Boulder. farthest people away are
from C-Springs/Fort Collins. About a 1/4
are in the health care field ... a few physicians,
mostly mainstream, one holistic. A few people
have done work on a health-related Web Site.
Almost all have used the Net to research
health-care stuff, mostly for themselves,
but a lot of also done for other people.
Most use the Web, a handful use Usenet News
and Email lists. Almost all said they would
use the Net for health-care stuff. A few
people have taught their health care provider
how to use the Net! ;-)
At 7:15, Dan introduced Sandra McCray
(sandra.mccray@colorado.edu) who
is the Executive Director of Colorado Healthnet.
In addition to an extensive background in
the legal profession, she has been actively
involved in the medical arena, especially
after getting a kidney transplant in 1994
and two total hip replacements in 1995.
It is these last two events that motivated
her to create Colorado HealthNet.
Colorado HealthNet (http://bcn.boulder.co.us/health/chn/)
is a site with a wealth of information about
health issues - mostly chronic illnesses.
Sandra started putting information on the
WWW about some maladies that she was familiar
with ... but over time, people have liked
the site so much, they have volunteered
additional information. She originally did
all the work herself ... but recently got
the help of a Web guru.
She demo'd the Diabetes Center which is
representative of other stuff listed on
the site. It cross-references other things
such as kidney problems, overweight, diet,
and other related conditions. There are
references local education and treatment
centers, late-breaking centers (new drugs/treatments/etc.).
Links to other sites are present, but hopefully
only those with real, up-to-date information.
There are no chat rooms and no desire/plans
to provide that service, since there is
too much misinformation spread in these.
Instead, they have pen-pals: you sign-up,
create a profile, give your Email address,
and allow others to form support groups
(outside of the Web Page). There is a Q-A
section for each area which has a volunteer
doctor that allows folks to send questions,
and they respond with answers. Colorado
Insurance Commissioner is also available
on-line to answer questions about that stuff.
Chronic health problems are the biggest
medical problem (46% of folks have 'em ...
but they account for 76% of costs), but
not much has been done about information
dissemination. She has three "secret" projects
going on ... stayed tuned to future stuff.
This is a great spot to learn medical
stuff ... and she recommends that you always
ask your doctor about stuff you have read/researched.
While some MD's get annoyed by this, most
are open to chatting about stuff. HealthNet's
goal is to provide YOU with the information,
so YOU can take responsibility for your
condition when you chat with your doctor.
She took a few questions from the audience
- one person asked if she got good info/stats
on the quality of various hospitals when
she got her transplant. She got various
stats, and it is on-line available for folks
to see. But hospitals initially complained
(those with lower success stats) that they
took on patients that were in worse shape
(which has some merit) ... but there is
now an agreed upon correction factor to
account for that. One person asked if there
were concerns about doctor's giving advice
across state lines. Although she's a lawyer,
she says the law is untested in this area
and there are no guarantees. Since HealthNet
is a non-profit, that should help. An audience
member commented that antiquated licensing
by state doesn't really fit/handle with
tele-medicine stuff that is coming on-line.
At 7:37, Dan introduced Kent McBride (kent.mcbride@ossinc.net).
Kent is the vice-president of Learning and
Performance for Online System Services.
He is the principal Instructor of the Medical
Internet Game and has also developed a workshop
titled The Businessperson's Guide to the
Internet.
Kent discussed how OSS is providing information
mostly geared toward the medical profession
(versus the more consumer orientation of
HealthNet). They have been using the Web
since 1995 as a means of bringing technology
to the desktop of the medical professional.
One of the main reasons they decided to
get involved was that many doctors said
they don't have time to check various places
for information, and would like a central
site to do so.
This technology is changing the way health
care information is sent out to doctors/medical
professionals. http://www.mdgateway.com
is a clearinghouse for stuff which gives
access to over 5,000 conferences and publications.
It allows easy search of stuff for medical
professionals, gets gazillions of hits,
has over a thousand subscribers, and the
numerous Email/feedback they get is that
it really works!
HealthCare Communications Group site (http://www.healthcg.com/)
includes a section that has an online Continuing
Medical Education course that consists of
12 modules, one per month, on HIV. The CME
course is funded by an unrestricted educational
grant by Roche Laboratories. Doctors use
the Web site to get all the course information,
just like as if they were getting from it
the written abstract, take the test and
get the test automatically scored. If they
pass, they forward the results to the Accrediting
Organization, and their certificate of Accreditation
is sent to them in the mail.
They also have their own set of writers
that go to Conferences that summarize things
- helpful even if you are there, since they
cover the other tracks. They have the information
available on the Web the NEXT day (typical
press stuff is 6-8 weeks out). During a
3 day conference, they had 170,000 physician-visits.
Use of Internet technology is a highly effective
way of broadcasting information.
They are working on using Microsoft technology
called "NetShow" ... makes it easy to put
a slide presentation (along with a voice
track) available on the Internet. Another
interesting project is the Interactive Patient
(http://musom.marshall.edu/medicus.htm)
which allows you to pick up a case study,
the patient then "walks in" and starting
"talking" about their problems. You, the
Doctor, then ask questions, touch various
parts of the body in order to learn about
the patient and figure out what they have.
There is a great report by Ernst and Young,
LLP, (Big Six Accounting Firm), Sponsored
by Sun, 3Com, Sprint and Sybase, titled
"The Role of the Internet in Health Care"
that is very informative - see http://www.hccybervision.com.
Using the Web, information can be sent/read
by medical professionals who otherwise might
not see it. This makes the doctors smarter
... and ultimately benefits the patients.
Kent answered a few questions from the audience.
One person asked how they make money (economic
approach). Currently funded via the pharmaceuticals,
who are anxious to get data to the doctors.
Another model is charging the doctors for
viewing. Another asked the percentage of
doctors who actually use the Internet in
their work ... Kent said the number if hard
to come by, but about 30% is what most surveys
find ... and this is growing. One person
asked about security/privacy of records,
and a lot of that is being built-in from
the ground-up on any thing that will contain
patient data. According to the Ernst and
Young survey, security/privacy is one of
the top concerns for medical professional.
One person wanted some advice on search
engines. The key is to be specific as possible,
and use compound phrases to minimize number
of responses.
At 7:58, Dan introduced Dr. Thomas Kunstman
(Thomas.Kunstman@colorado.edu). Dr.
Tom is a Physician at CU's Wardenburg Student
Health Center. He is also the WebMaster
for the Wardenburg Home Page (http://www.colorado.edu/wardenburg).
Dr. Tom started off by telling us that
the new medical advice is take two aspirins
and Email me in the morning. He also mentioned
the (real! ;-) Star Trek Dr. McCoy, who
used a tri-corder to figure things out and
fix 'em ... but with the Internet, who needs
Dr. McCoy! ;-)
Current uses of the Internet in Health
Care Interactions include: Email, Mailings
Lists, News Stories, Online support groups,
Visit Web Sites, Search Web Sites, Create
Web Sites. A year ago, one patient every
two/three weeks came in with info from the
Net. Now, almost every day, they bring stuff
in ... and 80-90% of the time, they are
about right with the medical problem/solution.
Example: one person with a Kidney problem
came in with some stuff that was pretty
new ... and turned out to be a good idea
... and the patient felt a lot more empowered
about their condition.
Email can be useful (assuming your doctor
uses it! ;-). Dr. Tom uses this to stay
in touch with his patients and allow a direct
interaction (although no confidential medical
information is sent via Email). He finds
this especially helpful with his patients
... since college students are hard to reach,
and this helps a lot.
Mailing lists can deluge you with messages
... he only stayed on one for two weeks
before giving up. News stories are helpful
... lots of links to 'em (see Wardenburg
Home Page). There are lots of on-line support
groups available at just about any hour
... he has not used much at all.
Visiting Web Sites is used by a lot of
folks - there is LOTS of information out
there - but a challenge to organize things
so that people can bore down to see what
they want. http://www.achoo.com
is a helpful resource to do searches. Creating
Web Sites is also a method some folks use
... especially those who have had some exposure/experience
with a malady and make the information available
to others.
Potential benefits of Internet on Health
Care Interactions. Enhanced Communications
by cutting through various layers, no phone
tag, and some patients (college students!
;-) will use, ready/easier access to health
information. Lifescan survey is pretty cool
- asks you various questions, and then based
on those, tells you how you are doing. Internet
allows you to span space/time: a patient
was going to Argentina and wanted to know
if there was a Hontivirus outbreak (similar
to 4-corners) ... and it turned out there
WAS an outbreak going on. Internet provides
much easier access to Medline Searches (about
1/3 of audience has done a Medline search)
which allows you (or the doctor) to search
for information on symptoms that may be
perplexing. Internet gives the patient ready/easy
access to Support groups and empowers the
patient to understand what is afflicting
them. And it makes his job easier ... instead
of showing static pictures from texts/models,
Dr. Tom actually pulls up Internet Pages
when talking to patients to help explain
conditions! ;-)
Potential problems are inequities in access
(but is this an infrastructure issue or
doctor use issue), quality of information
(Some Web Sites are basically marketing
pages or people pushing their own causes).
2nd year Med student syndrome - people with
lots of information, but limited experience/don't
know how to apply. Privacy/Confidentiality
Issues are a big thing. He does not send
anything (ex: test results), but asks people
to call (is that all that much safer! ;-)
Economic issues come into play ... how are
doctors re-imbursed for their time in dealing
with patients electronically. "managed care"
(sometimes called "damaged care"). Variability
of interest in the Internet ... some providers
are not interested in all; and some patients
are interested in all if they are given
pointers to the Web. Note that there are
no restrictions to access of the Wardenburg
Web Site.
At 8;22, we then had the whole panel up
front for some group Q&A: Q: Are these tools
improving the doctor/patient relationship?
Isn't the laying of the hands on, some interpersonal
empathy important? Sandra says it should
improve things 'cause you can ask a question
for free, and get an answer back within
a week. Kent says that this technology will
allow him to do more hands-on stuff and
also allows specialists to more easily offer
advice to other areas ... Internet allows
one to span time and space. Dr. Tom says
that in the future, all physicians are going
to have to be doing this. But yes, there
will be a need for Dr. McCoy to be there
with his tri-corder! ;-)
Q: 60-85% of folks that patients see are
NOT doctors ... mostly nurses, administrivia
people, etc. How will this technology help
that area? HealthNet gets hit 3,000 times/week
... and many of these are not doctors, but
the "secondary" folks in the medical profession.
Not only are they pulling information down
... but they are volunteering information
to be put up ... and not all comes from
MD's. Kent says that an often heard question
is why limit this information to Medical
Professionals. Nurses say that this information
helps them in their dealings with patients
and doctors.
Q: Dr. Tom said 5-10% of Boulder doctors
are using the Internet - what are the barriers
to using the tools and are the young people/graduates
wanting to use it? Yes, more recent graduates
are skilled in this technology and using
it, but not all are. Biggest challenge is
time - don't want to learn a new trick.
Lots of existing doctors are from a generation
that is resistant to keyboard/computer stuff.
Also, lots of doctors don't do much desk
work, and so this is like desk work. UCD
Medical School has a new requirement that
every medical student have a computer, so
we'll see more of this. One audience member
who comes from a family of doctors says
that the biggest barrier is simply ignorance
... Web is not hard to learn, they just
need to get exposed to it. Kent said that
some older doctors are scared of it ...
but once they start seeing it, they start
using it. Another example is Kent's wife
... who was so-so about the Internet ...
until a family member became ill ... and
then she had a purpose (this is key) and
became quite proficient.
Q: Wanted to know how often Dr. Dr. Tom
used the Internet in his everyday work.
He typically uses it 3-5 times/day (varies).
Sometimes for real oddball things ... but
also to research stuff that has been in
the text for years 'cause there might be
new stuff out there that supplements it.
Q: It seems that one problem is that every
doctor has hand-written scribbles all over
the place which is very hard to read/combine
... is there a place for computerized medical
records to straighten all this out? Dr.
Tom says that although Wardenburg is looking
at technological solutions, there really
isn't one out there ... they are too slow,
hard-to-use, etc. Lots of efforts by folks
to generate acceptable computerized medical
records and some are in use, but this is
still a big issue for the medical profession
and hand-writing is often used. Sandra said
that privacy is a BIG issue that need to
be addressed - concern is stuff like King
Soopers card with all your information on
it.
Q: Is there work so that folks like fireman/paramedics
can have medical ID cards available? CU-Boulder
is working on a universal ID card to handle
stuff like this and more! ... but yes, there
are serious ethical/privacy/security questions.
Important to have the right protections
in place. Interesting enough, Colorado DMV
is working on having a database tied to
your drivers license that allows the cops
to pull up all sorts of information about
you when they pull you over (including possibly
medical records).
Q: Are their issues that the panel thinks
us the audience (computer jocks) should
be working on? There's some work with smart-AI
tools (i.e. did you really need to go to
the emergency room ... or maybe even put
this in the emergency rooms themselves).
Sandra things security/privacy issues are
a BIG issue and need to be addressed ...
since everything is going electronic. Kent
(who has kids) says that some people have
Internet access and some don't ... how do
we make sure people have access and knowledge
to use it. Physicians are very resistant
to things that make them feel less than
masterful (nature of the job) ... so it
is important that the computer software
be user friendly, not confusing, etc. ...
otherwise, resistance will be encountered.
The meeting ended at 8:50 with Dan giving
away the last of the T-shirts.
RMIUG wishes to thank Internet One of
Boulder for continued sponsorship of the
refreshments, NIST for use of their meeting
room, and XOR Network Engineering for maintenance
of RMIUG's WWW site and Email lists.
Suggestions/comments/feedback are always
welcome - please Email these to rmiug-comm@rmiug.org
RMIUG has three Email lists for its members.
Send an Email to rmiug@rmiug.org
for an auto-reply message with more information
or check out our Web Site at http://www.rmiug.org/rmiug/
Tentative schedule of upcoming RMIUG topics:
May 13: Games on the Internet
- Panel Discussion
July 8: Email Publishing and Marketing
- "Boring Old Timer or the Killer App
of the Net?" - Industry Panel Discussion
Sept 9: Local Web Content -- City-centered
Web sites coming to a metropolitan area
near you (ie, Denver)
Nov11: Financing (VC, IPO, private funding,
etc.) for Internet companies in Colorado
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