Part I: World Wide Web

• Illustrate the vast array of available resources
• Present an overview of the Internet; cutting through the hype and hoopla
• Demonstrate ways to access information
• Provide the criteria for judging quality and avoiding the "fool’s gold" on the Net

II. Overview of Internet and web history

• 1960s: Rooted in the Cold War mentality, the Internet was created in the 60s as an alternative military communication system to be used in the event of a massive nuclear strike

• 1980s: TCP/IP communication protocol was agreed upon in 1983; the 80s saw the Internet used heavily in the academic and research environments

• 1990s: Birth of the web by Tim Berners-Lee at the Cern Particle Physics Lab in Switzerland; develop-ment of hypertext "point-and-click" technology

• Democratization of the web with the development in 1993 of the first browser capable of displaying graphics. NCSA Mosaic, developed at the University of Illinois National Supercomputing Center, enabled non-technical users to view a web site.

• 1997: Exponential growth continues in 1997 with the number of pages on the web estimated at 60 to 100 million and estimated by some to be doubling every four months

A. Patient Care

• Health information: diseases and diagnoses, health risks, health improvement, diet, medical procedures, medications, and more are available often free-of-charge from reputable sources.

• Location of support groups: the Net has become legendary in its ability to connect human beings of similar interests. Online support groups on virtually any condition can be located. In addition, information on local, national, or international organizations can be accessed.

• Answering patient queries: Patient education material is available from reputable sources. Media outlets, including many newspapers and broadcast sources, have web sites where you can monitor what your patients are reading, and anticipate their questions.

• Reviewing patient care options: Treatment protocols from the National Cancer Institute, American College of Cardiology, and American Academy of Pediatrics, to only name a few, are available. There are several different tools for searching the Medline database available free-of-charge, in addition to Knowledge Quest, the product offered through Allina Library Services.

B. Practice management

• Contacting health plans/providers: Allina’s HealthVillage web site will soon provide easy access to Allina’s health plan products and services for both physician and patient alike.

• Accessing government information: From the Health Care Financing Administration (HCFA) to the FDA, CDC, and NIH, more and more state and federal government agencies are distributing information, including laws and regulations, via the web.

• Patient referrals: There are databases, such as the Physician Select feature on the AMA’s web site, that can assist with locating colleagues in other parts of the country with which to consult or provide referrals.

• Medical records management: Allina is piloting the use of a completely electronic environment for its patient records at the Wright Clinic in Buffalo. The web offers other opportunities to more efficiently share clinical data.

• Issues surrounding patient confidentiality and security are of primary concern in implementation of web-based technology.

• Practice guidelines can be made available through internal networks or intranets. Allina plans to have about 200 guidelines on its site.

C. Continuing education / Career opportunities

• Upcoming professional meetings and CME courses can be located on the web. Abstracts of papers, schedule of events and speakers, and other conference information can often be browsed at a web site established just for a particular event. In some cases, online registration is even available.

• Web sites are available, sponsored among others by professional societies or journal publishers, that allow you to register and keep an electronic record of your CME credits.

• Increasingly medical publishers are offering access to their journals: some full-text and more often abstract only. Some titles are available on the Net sooner than the print version arrives. There are sites on the web that gather links to most of the major medical journals.

• Online job listings can help you search for candidates to expand your practice. Information on nearly all major residency programs are available on the web.

IV. Web basics

• The web is a portion of the Internet (the worldwide network of networks developed back in the 60s for military communication); it runs on this huge network, but is not the same thing as the Net.

• The web is an Internet tool just like e-mail and file transfer protocol. These latter two tools will be discussed in Part Two of this series.

• Various protocols or standards are necessary for the web and also the Internet to operate.

• Locally mounted software called a browser (other terms are viewer or client software) is needed to view a web page. Netscape and Microsoft’s Internet Explorer are the most popular. Browser software may differ in the speed at which it displays images and text, formats the web page on a computer monitor or off a printer, or is able to handle different file formats such as audio or video applications.

• The basic format for all web addresses is as follows

• The last part of the URL describes the type of Internet connection of the machine hosting the web site. A commercial Internet address will likely end in .com; a government address in .gov; a nonprofit or organizational address in .org; an educational address in .edu; and a military address in .mil.

A. Definition and characteristics

• Search engines are web sites that create listings or databases of other web sites based on an automated retrieval process. Directories, such as the well known Yahoo site, are also web sites containing listings of other web sites, but they rely on humans to sift through submitted web pages.

• True search engines consist of three parts:

• Search engines overlap in content, but no search engine searches every site on the web. Some have larger, more up-to-date databases than others.

• Each search engine provides different ways to search its database. Some allow for Boolean operators, or concept connectors, such as AND, OR, NOT. Others let you specify how close together you want terms to occur to one another, either NEAR or ADJ (for adjacent). Quotations marks can be used by some to specify a phrase search, such as "myocardial infarction."

• Some search engines include more than just web sites in their databases. For example, some include newsgroups and file transfer protocol sites.

• Word order matters on some search engines. Enter your most important concept first.

• Revise your query if you don’t find what you’re looking for after viewing the top 10 to 30 hits.

• The best strategy may be to choose speed and familiarity first. Investigate a couple search engines well and try your search in more than one if you don’t find what you want the first time around.

B. Medical search engines

• Increasingly, there are projects underway to develop customized search engines, some of them attached to specific clinical databases, to help medical and health professionals find the right resources.

• These specialized search tools offer searching by concept, which is a great advantage if you have a narrow topic. For more general topic searches, however, these search tools may not have large enough coverage.

• Other search tools allow you to search for a topic simultaneously in a collection of medical search engines.

A. Content

• Does the information appear to be credible, authoritative, and objectively presented? Is it relevant to your current needs? Does it appear accurate and current? Is the coverage in-depth or superficial? Is it unique? Are the links it points to useful and of high quality?

• Who developed the site? Who sponsored it? Who is responsible for maintaining it? Is the information easily verifiable? What is the purpose of the page: advocacy, informational, marketing? Is it self-evident?

• Is the site logically organized and easy to navigate? Does the overall design hinder or help your access to the information? Is the site searchable and/or interactive?

• Can you routinely access the site? How quickly does it load? Is it reorganized or does it move its web address frequently?
• The HON Foundation is an international organization dedicated to promoting quality in medical sites

VII. Summary

• The web represents a paradigm shift in information retrieval and communication technology. The breadth and depth of available resources is impressive.

• More than 20% of families are estimated to have access to the Internet.

• While the web isn’t there yet in terms of quality and ease of use, it is a valuable resource that cannot be ignored.

• Training will increase efficiency in accessing the resources that are available to help you in your practice on the web.

• Allina Library Services offers individualized or small-group training. Call 612-863-4312.