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EDITOR‘S CHOICE

The Internet :
Its Role in Medicine and Healthcare
Suman Kapur*

The information technology revolution is being in such areas as patient care, medical and
described as the most important development in health education, and research. This evolving
the history of humankind since the industrial technology includes the electronic medical
revolution. Characterised as ‘The Third Wave’ by record, the Internet with its e-mail, WWW (world
Alvin Toffler, in his book of the same title, it has wide web), and file transfer capabilities. There
the potential to change the ways of man and is an urgent need to integrate this technology
society beyond the wildest of imaginations. into a total information system for the clinician
in the new century and the new millennium.
The computer, invented initially to process
information, slowly grew into a storehouse of Electronic mail has the potential to enhance the
information. It then became sophisticated and professional relationship both between
ever more powerful and got hooked to others physician and patient, and among physicians
of its kind to form a formidable network. This of the same and different specialities. There are
network further acquired the capability of distinct advantages of communicating via E-
distributing electronically processed information mail: It is faster than all other forms of mail
to all and sundry, overcoming every conceivable services. It can be exchanged across time zones.
form of barriers, including geographical and It is not dependent on the presence or absence
political. Today, it is a global collaborative of both the sender and the receiver at the two
medium and a rich resource of information of ends at the same time. It is less expensive than
all kinds – science, technology, research, all other means of communication like sending
education, and commerce. Through a host of a fax or making a phone call. E-mail is the most
emerging tools and protocols, it enables person- useful resource extending the avenues of
to-person, computer-to-computer, or person-to- learning to an international audience through
computer communication. news or list-server groups. Associations,
departments, educational sites, organisations,
Welcome to the fast growing and exciting electronic
peer-review scientific journals, and Medline
world of wonders, that is the INTERNET!
database web pages of prime interest to
With continuing advances in information and healthcare providers have been developing at
communication technology, the applications of an amazing pace. The WWW provides an all-
computers in medicine have increased rapidly, in-one medium for image, sound, and video.
and have the potential to revolutionise WWW is the best method of electronic
healthcare. And, the Internet, with its powerful publishing and many magazines and
penetration and scalability, has become an newspapers are available on the Internet.
increasingly popular medical information Further developments of technological advance
resource. By re-architecturing the workplace nurturing our interests will consist of on-line
around computer-based technology, doctors, journals, telemedicine as well as advances in
researchers, and other healthcare providers are health screening and assessment, international
creating a new vision of work and organisation chatting, computer-based training and
* Head, Department of Neurochemistry, education in different fields of medicine, and
Institute of Human Behaviour centralisation of cyberspace information into
and Allied Sciences, New Delhi. database search sites.
Internet, which allows instant transmission of text of all the developments taking place in his field of
and graphics and permits talking via computers, interest despite the phenomenal growth of medical
is the ideal medium for sharing medical expertise. journals. In 1997, the number of entries in Index
It can serve to save precious human life; help Medicus exceeded seven million. With the advent
treatment in difficult and complicated cases by of the Internet, information resources (on-line
seeking expert opinion on the Net and overall, databases, CD-ROM producers, full text
facilitates an exchange of ideas. This could well documents of various societies and the commercial
lead to valuable innovations and discoveries. agencies, news groups, directories, individual
home pages and corporate resources) are now
Interactions in the cyberspace will also help the
open to one’s finger touch. Literature search can
doctors in India, especially those practising in
be done on databases such as MEDLINE, EMBASE
smaller cities, towns, and rural areas and who
and BIOSIS as well as on other Web sites in no
therefore, often feel isolated, to keep in touch with
time. Healthcare professionals can also get
new developments. They can become members
information on health workers, societies and
of information groups and search through free
hospitals, healthcare companies, and on
information databases on the Internet. Most of
healthcare management and policy. On an
the journals published in other countries take a
exploratory browsing of the Net, they can query a
long time to reach remote places in India and are
database for known references or retrieve an
also very expensive. These can be now accessed
exhaustive list of relevant material to review the
for a nominal fee on the Internet without any
available literature or pull up a list of first quality
unnecessary loss of time.
recent references to answer a particular question2.
A survey by the Royal College of Surgeons of A large amount of information on patient care,
Edinburgh has shown that health surfers, including education, and support is available. Most health
doctors, are the biggest measurable group of net sites have traditionally been information-based
users. “A quarter of the material on the Internet is and the Net (Internet) is, for example, the best
now health-related, and about a third of web way to find a self-help group for any disease. It’s
surfers are searching for health information,” says also a huge source of details on individual
Dr. Harry Brown, author of “Netlines” in the British diseases, no matter how obscure, and is
Medical Journal1. Healthcare professionals can increasingly being used by patients as a way of
retrieve plenty of information on such subjects as locating the best hospitals and doctors. Names of
AIDS, emergency medicine, geriatrics, some of the medicine-related Indian and
orthopaedics, rehabilitation, preventive medicine, important international websites are given in
public health, rural medicine, transplant medicine, Tables I, II, and III.
and travel medicine – all available on the many
web sites. Healthcare professionals can also Changes in healthcare delivery and the explosion
become a part of the various discussion forums of health information available on the Internet are
of their interest and can exchange their experience. already affecting primary healthcare practice in
Information on higher education in medical America. Briggs and Early3 have reviewed how
sciences and job opportunities in different hospitals recent developments in the technology of the
and research institutes can also be found on the Internet affect the way healthcare is provided. They
Internet. refer to the growth rate in Internet access and all
the improvements in performance resulting from
Healthcare is an area that generates a wealth of new technologies, in particular in the areas of
information in the form of journals, reports, telemedicine and in communication between
conference proceedings, etc. It is difficult for a patient and healthcare professionals. Modern
healthcare professional to keep himself abreast information technology not only affects the delivery

134 Journal, Indian Academy of Clinical Medicine  Vol. 2, No. 3  July-September 2001
of healthcare, but also can significantly influence seek, and virtual health shops offering a multitude
the doctor-patient relationship. of health supplements.
Increasingly, the Internet will be used to convey While Internet technology has dramatically
more ‘real-time’ information. A physician improved the access to health material, the biggest
practicing in a remote village can now consult a shake-up is taking place in the General Physician’s
specialist sitting at any distance by providing him clinic. Doctors can key their patients’ symptoms
all images and data on-line, thus eliminating the into a computer and receive an instant diagnosis.
risk involved in and save the time and money spent In several rural areas of the UK, doctors are using
on travel. ISSN-based technology to enable a medical

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


Topic Name of the website
Indian Medlars centre http://indmed.delhi.nic.in
Indegene, India’s Premier Health Portal http://www.indegene.com
JAPI : Journal of Association of Physicians of India http://www.japi.org
Association of Physicians of India http://www.japi.org/API.
Journal of Indian Medical Association Online http://www.jimaonline.org
T B India http://tbindia.info.nih.gov/project1.html
All India Institute of Medical Sciences http://www.aiims.edu
http://www.pugmarks.com/aiims
BITE-IN http://www.bitin.com
DISHA http://www.netfx.net/disha
Institute of Speech and Hearing http://www.speechfoundation.com
National AIDS Control Organization http://www.nic.in.naco
Public Health India http://education.vsnl.com/publichealthtoday
Leprosy Projects http://www.foundation.novartis.com/
leprosy_india_gra
Schizophrenia Research Foundation http://www.xmission.com
Journal, Indian Academy of Clinical Medicine http://www.indegene.com/jiacm
Useful site for practising physicians http://www.md.consult.com

Health sites are also becoming interactive. There consultant to examine patients 120 miles away.
is the new virtual checkup for women at http:// Such technology will mean that, in 20 years’ time,
www.allhealth.com/virtualcheckup where one has many patients will no longer need to travel to see
to just key in a few personal factors such as blood a specialist. Diagnosis will be made in their family
pressure, cholesterol level, lifestyle details, and doctor’s clinic, by a consultant examining them
family profile. Virtual Check Up also has sites that with the help of video images and remote sensors
will assess individual risks for osteoporosis and that can relay data on blood pressure, heart rate,
heart disease. Other health sites are already and other vital signs. The Net is also set to allow
offering heart monitoring and cancer risk doctors to change the way they treat patients. It is
assessments, opinions on best prescriptions to anticipated that doctors will be able to use a DNA

Journal, Indian Academy of Clinical Medicine  Vol. 2, No. 3  July-September 2001 135
database of patients to tailor drugs for their specific complicated surgeries underway in real time
conditions and eliminate possible side effects. environment. The singer Carnie Wilson was not
The Internet has become a new platform for alone during her gastrointestinal bypass operation.
telemedicine. Cyber Medical Center (CMC), a Along with half a dozen doctors and nurses, there
project that integrates the technologies of were 52,000 people watching the two-hour
multimedia, database management, a multiple- procedure live on the Net. Apart from improving
site video-conferencing system and the WWW, is the rating (due to celebrity patients), watching
aiming to create a multimedia network system for operations could help potential patients to make
the electronic management of patients’ records, up their minds, and younger surgeons to learn
teleconsultation, on-line prescription, on-line from the vast experience of their senior colleagues
continuing medical education and information and peers. There is no more a need to visit a doctor
services on the web4. British doctors are already for estimates on the expenses for a given treatment
using the Internet to make diagnoses, carry out or corrective surgery. For plastic surgery, just scan
remote examinations, and give consultations. Soon in your picture and e-mail it along with a credit-
they will operate remotely on patients thousands card consultation fee of $ 250 to HYPERLINK at
of miles away and use virtual reality to allow http://www.celebrity or www.doctor.com/
leading surgeons without leaving their offices to personal.html which is run by a team of doctors,
consult around the bed of a patient. and back comes the advice on what work is

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


Topic Name of the website
National Library of Medicine: Internet Grateful Med Search http://igm.nlm.nih.gov
Electronic BMJ (British Medical Journal) http://www.bmj.com
New England Journal of Medicine On-line http://www.nejm.org
The Journal : Current Issue (Lancet) http://www.thelancet.com/journal
Annals of Internal Medicine http://www.annals.org
Postgraduate Medicine http://www.postgradmed.com
American Family Physician http://www.aafp.org/afp
Postgraduate Medical Journal http://www.postgradmedj.com
Hospital Practice http://www.hosppract.com
Pro COR (Conference on Cardiovascular) Health http://www.procor.org
Medscape www.medscape.com

It is possible to speak (transmit voice) in real time needed, and how much is it likely to cost.
on the Internet. Audio-conferencing programmes
One of the biggest challenges, particularly in
work by digitalising speech and then sending the
emergency medicine, has always been to bring
digital data over the Internet. Internet can thus
together the patient and the right doctors as quickly
help in arranging teleconferences at an affordable
as possible. The Net has started coming to our
cost.
rescue in such instances. In North Carolina,
Net is also impacting the way surgery is carried researchers were able to treat an airline patient
out. Cybersurgery is the latest health craze on the during journey 30,000 ft above the ground, using
Net. VRML enables doctors to actually view data transmitted live on the Internet.

136 Journal, Indian Academy of Clinical Medicine  Vol. 2, No. 3  July-September 2001
Remote sensor technology is already changing circulation and feedback, and consensus diagnosis
the way we care for the elderly. In Germany, for pathological review in clinical trials5. In the
doctors and social workers have set up a next 5 to 10 years it will be possible to build sensors
telemonitoring system where elderly people and that are almost as powerful as the entire pathology
the chronically ill and housebound are lab. The doctor can then search a database on
monitored, using a camera and a high speed the Net and look up data on other people who
telephone line. suffered from similar symptoms and immediately

Table III : Other health information sites.


Name of the site Name of the site
http://www.ayurvedic.org http://health.indiamart.com/alternativemedicine
http://www.ayurvedwebline.com http://www.indiandoctors.com
http://www.ayurvarta.com/eng http://www.indianhealthzone.com
http://www.ayurveda.com http://www.indiaspace.com/homeopathy
http://www.baidyanath.com http://www.indiayogi.com
http://www.badlani.com/Goodhealth http://www.jabalpurdoctors.com
http://www.chennaionline.com/medizine http://www.lovelight.com
http://www.classicalhomeopathy.com http://www.mdspeak.com
http://www.doctornet.com http://www.meditimes.com
http://www.doctorsaab.com http://www.po.com
http://education.vsnl.com/reikinetindia http://www.saffronsoul.com
http://www.emedilife.com http://www.sreekrishnapharmacy.com
http://www.goodhealthnyou.com http://www.thriveonline.oxygen.com
http://www.growingwell.com http://www.webhealthcenter.com
http://www.healthcarehouse.com http://www.wholehealthnow.com
http://www.healthlibrary.com http://www.yoga.indiainfo.com
http://www.internetindia.com/health http://www.yogacare.com
http://www.indiadiets.com http://www.yogasite.com
http://health.indiamart.com/kidshealth http://www.youngmaster.com

Many developments in science have their origins conclude and say you have – XYZ.
in science fiction, and telepathology is no The resources available on the WWW can be
exception. The concept was first illustrated in 1924 deployed as a very useful “Information for Health”
in the magazine ‘Radio News’. It was not until tool bridging the information gap and reducing
1980, however, that the first working telepathology the number of accidents and risks due to misuse
system was demonstrated. Telepathology can now or improper use of drugs6. Misuse of prescription
be used for remote primary diagnosis, remote medications is a serious problem largely due to
referral to a specialist in pathology, remote lack of information. WWW can well be deployed
teaching, remote presentation of post-mortem or to fill in this gap in appropriate and safe use of
microscopic findings, quality assurance image prescription drugs7. Within the past 10 years, a

Journal, Indian Academy of Clinical Medicine  Vol. 2, No. 3  July-September 2001 137
wealth of data has shown that diet and exercise programme called Health-Inter-Network which
play an enormous role in fighting disease. Today, aims to improve global public health by facilitating
it is well recognised that life style patterns increase the flow of health information worldwide, using
an individual’s risk for particular disease. Physical Internet technologies. Research, and sharing the
inactivity is recognised as an independent risk knowledge gained through its efforts, is
factor for cardiovascular diseases. A large fundamental to improving public health. “Valuable
proportion of the US population does not research is carried out in the developing countries
participate in regular physical activity and research and emerging economies, but researchers are
has shown that, without intervention, most people hampered by not being able to share essential
remain sedentary. American Cancer Society scientific information and communication,” says
attributes one-third of all cancer deaths to poor WHO Director-General Dr. Brundtland, “If
diet. To be disseminable, physical-activity, and researchers and scientists can read the same
dietary habit interventions must move beyond journals, search the same databases, join in the
reliance on strictly face-to-face modes and begin discussion groups, compete for the same grants
to fully use newer technologies such as the as their colleagues from wealthier countries, it will
Internet8. strengthen their own research, bring them into the
international community of researchers, and
A panel of experts from the fields of
eventually improve dissemination of their results.
neuropsychology, neurology, psychiatry,
behavioral medicine, family medicine, paediatrics, Internet – as a global cooperative network of
physical medicine and rehabilitation, occupational university, corporate, government and private
therapy, nursing, speech and hearing, computers, all communicating with each other –
epidemiology, and biostatistics met with the public can go a long way in meeting the WHO goal of
some time ago to discuss effective rehabilitation “Health for All”. As we move into the next century,
measures for persons who have experienced a and a new millennium, the Internet, as we know it
Traumatic Brain Injury (TBI). And biomedical today, should help us to define the world of
researchers and clinicians were made available tomorrow. It is however worth remembering that
the draft statement on the Internet immediately many health- and medicine-oriented sites have
following its release at the conference and were serious shortcomings with regard to quality and
later updated with the panel’s final revision of reliability of content. Some guidelines could prove
recommendations9. more useful in getting valuable feedback from
information providers and users alike, in
The digital divide in information between the
improving the quality of information at its point of
developed and the developing nations requires
production7. Till that happens and till a computer
new approaches within the field of scientific
terminal is at place on every healthcare provider
publishing for all concerned parties to work in
and medical practitioner, print journals like the
concert and solutions that neither the public nor
one you are reading now will remain indispensable
the private sector will be able to achieve on its
although JIACM has also gone on-line.
own. The World Health Organization (WHO) and
the Open Society Institute (OSI), a part of the Soros Also, remember you need to be computer savvy
Foundation network, have teamed up with leading and to a large extent you need to know exactly
information providers, ISI and Silver Platter, and what you want! Queries have to be focussed to
other public and private partners to provide access retrieve meaningful information. For a lot of
to high quality scientific information via the information lies dumped on the Internet, and
Internet, for research centers in the countries of as such may not be very reliable because there
Africa, Central Asia, and Eastern Europe. The pilot are no guidelines on what is to be on the
project is a part of a wider United Nations Internet.

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