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Ophthalmology and its adnexal disciplines are in the grip of an explosion in information technology (IT), as are most branches of medicine. Not only do we have a bewildering number of published (on paper that is) periodicals, textbooks, and society (or faculty or college) newsletters to sift, select, and assimilate information from, but we now also have an increasing array of electronic sources of information.
Many peer reviewed journals (the BJO included) are now represented on the internet in world wide web (“web”) sites.1 Some of these contain full text and graphics articles whereas others offer samples of their content, or tables of contents. Inevitably, they almost always provide subscription information. Most usefully, the web sites usually provide the current instructions for authors. The internet addresses (uniform resource locators, URLs) of some ophthalmology journals are provided in Table1.
In addition to formal “publications”, there are many web sites which contain information that has not undergone peer review. Some of these web sites offer information about well established societies, faculties, or colleges. Examples of these are provided in Table 2. Others are sites of specific hospitals, laboratories, and even individual practitioners. These latter web sites are often advertisements for the services of the organisation or individual who runs the site and, as such, are publicity ventures and not necessarily rich or reliable sources of information. Web sites which are advertisements and publicity ventures for biomedical publishers, manufacturers, and traders also exist in abundance. The true nature of a web site is often not apparent until time has been expended, or wasted, in finding it and reading it.
A further type of site that can be very useful also exists. This type of site has collected information from many disparate sources, presents them in a digestible format, and provides links to more information as a starting point for the inquisitive. Web sites of this nature are found within the internet presence of some of the organisations listed in Table 2. Of these, the web site of the American Association of Ophthalmology is particularly useful in its “eye care links” section (URL: http://www.eyenet.org/eyelinks.html) which allows the viewer to search for information on a range of topic headings including mailing lists, national organisations and societies, patient information, physician resources, publications and journals, and more. Sites with a similar ethos, although less elaborate in presentation, are also maintained by individuals on a philanthropic basis. These include a web site on ophthalmic pathology (URL:http://pathology.mc.duke.edu/EyePath/EyePath.htm) and a web site aimed at UK ophthalmic trainees (URL: http://www.wp.com/ophthalmology).
The technology of the internet also provides the ability to search large databases for published information using online bibliographical databases2 3 (such as Medline, Embase, and Pubmed). Bibliographical data downloaded can then be handled by personalised, commercial, or customised bibliography programmes to manage the data on your personal computer.3 Online databases also exist covering other aspects of biomedicine such as molecular biological and genetic sequence data. The internet has also been used specifically to compile a database of ophthalmological practice and, in the process, it has been used a research tool.4
A further aspect of the internet, which is potentially useful for even the busiest professional, is the email discussion group (or “list” as they are known). Discussion groups offer simultaneous contact with many professionals in the discipline, through a single email address, allowing contact with individuals without prior knowledge of their interests, skills, or even their personal email address. The nature of the message can be very varied. Email discussion groups enable participants to consult on and discuss diagnostic problems with colleagues with special expertise; discuss the availability of patients, tissues, cells, DNA, etc for research; distribute material such as papers, minutes, reports, and data; advertise posts and fellowships; publicise conferences and seminars. As email does not interrupt work, unlike a phone call which must be answered or a meeting or videoconference which must be “attended”, it can be consulted at a convenient time. A personal secretary can handle email on a daily basis as with conventional (paper) mail and new messages or replies can be dictated for typing in the normal fashion. Successful email discussion groups exist in many areas of medicine and science and there is great potential for such groups in ophthalmology. Several groups do exist, such as the recently formed eyepathology group, covering a wide range of topic areas (Table3).
Of course, the internet and its perplexing range of possibilities is not the only aspect of IT to confront us. For years now we have been using pagers, messaging services, and mobile phones. Many of us have now tried textbooks or journals in CD-ROM format and most hospital libraries have facilities for bibliographical searches of, for example, Medline on CD-ROM. Journals are increasingly including reviews of multimedia publications among their book reviews. In clinical practice, we are taking patient photographs with digital cameras, the radiologists are giving opinions on computed tomograph or magnetic resonance imaging scans transmitted digitally down lines, and the records department is replacing your personal secretary with a computer with voice recognition software for the dictation of letters. Those preparing or reviewing contributions for journals or books are dealing with illustrations which have undergone digital image enhancement. Indeed, some journals demand the inclusion of original unenhanced pictures for review purposes. Publishers are increasingly requesting manuscript contributions directly on magnetic media such as floppy disc or zip disk.
So is this abundance of IT good for you? There is no doubt that much of these advances are potential time savers, but all too often we find them to be time wasters. The technology is such that both the hardware and software applications have steep learning curves despite media publicity to the contrary. This is confounded by the frequent refreshers required because of the constantly evolving nature of hardware and software. Changes to the machinery and programs lead to problems with compatibility with colleagues, home and office computers, your secretary’s computer, and those of your local medical illustration department or publisher. Frequent upgrading of computing capabilities leads to obsolescence of hardware and software with the attendant cost implications and redundancy or retraining of staff. However, the most critical problem some people experience is that the capabilities brought by modern IT lead to information overload in their already busy lives. This discourages some from wholeheartedly embracing the technology. For example, a search for internet sites using the phrase “ophthalmology” turns up around 10 000 “hits”—this is more likely to hinder than to help.
There are, of course, problems more specific to the medical use of IT. For example, how do you ensure confidentiality when using email to discuss a case with a colleague? Encryption technology may offer the key to this problem. What are the medicolegal issues involved in using electronic consults? How do we control the quality of information supplied electronically? This is particularly problematic if we forget that much of what appears on the internet has not undergone peer review or any form of moderation. The likelihood that electronic databases, such as bibliographical databases, are not comprehensive must be remembered. How do we ensure that we do not become victims of automated direct marketing via our computer (which can lead to a form of system overload known as “spamming”)?
Despite these drawbacks there are enormous potential benefits, not least the sheer volume of information available if we know how to harness it. Electronic mail, in addition to its use for discussion, can be used for rapid communication of discharge letters, laboratory reports, or consultation requests, for example.5 One potential use of email is that it may become a method for holding electronic conferences of peers with discussion available to all participants. Unlike a conventional conference, which requires funding and the attendance of many hundreds to be worthwhile, valuable information can be obtained through an email discussion list of appropriate collaborators. This is especially so in conjunction with associated documents or pictures made available on the world wide web. We are all aware of the contribution of IT to enhance the presentation of data, be this in publications, theses, teaching material, or verbal presentations at conferences. It allows us an air of professionalism more commonly encountered in commerce. It is clear that remote access to databases will help efficient use of time and resources. Consider the missing test result from the case record, has it been done, should it be repeated? Access to the laboratory database from the office desktop computer can resolve this quandary.
Inevitably, the future of medical IT is hard to predict—even Bill Gates (head of Microsoft) can only speculate. Medicine will probably continue its efforts to catch up to industry levels of IT use. Electronic mail is likely to remain solid, as it is the lowest common denominator of the internet and the only method of electronic communication likely to be available in most parts of the world. Technologically, there is likely to be a streamlining and convergence of TV, video, computer, and telephone formats. One thing is for sure, we are very likely to have more to read rather than less.
Guidance on medical use of the internet is available in a booklet by Pallen,6 which is a collection of articles reprinted from the BMJ, and in the regular “Netlines” features which also appear in the BMJ. Additional information for those interested in the issues raised here is available in a new bimonthy newsletter (He@lth Information on the internet) published by the Royal Society of Medicine in association with the Wellcome Trust.
A member of the eyepathology email discussion group