Ebook: Internet, Telematics and Health

The editors of this publication, and by extension their institutions, Pan American Health Organization, Medical Informatics Foundation of Argentina, and the European Commission, are to be congratulated on their achievement in assembling and publishing this much needed text. The importance of the undertaking is attested to by the quality of the contributions; all are eminently qualified experts in their aspects of medical informatics.

The volume is laid out intelligently and logically. It develops the theme that the state of human health is to a large extent dependent on the utilization of scientific medical information, that information technology has entered a “golden age” with the potential of making this information more widely available than ever before, and that there are already many successful applications in medical informatics from which we can learn. To be sure, there are many determinants yet to be identified. Many are attitudinal, economic and managerial in nature. Some are still technological.

Here the good news includes the growth world-wide of reliable, fast communication networks, the general warm reception of the newest improved interfaces such as the World Wide Web and its client versions, and cautious enthusiasm for the languages for application writing such as the object-oriented set. Discouraging news includes the absence of multimedia file (and patient record) systems and the users’ continuing thirst for reasonable operating systems.

Internet, Telematics and Health serves not only to document where we are today, but it contains insights into what we can expect tomorrow. Health professionals of all kinds, in many countries, who eagerly seek to apply the new communications technologies in their work will find this a useful and heartening book.

A eulogy is defined by the dictionary as a laudatory speech or written tribute, and also as a great praise or commendation, or in its strict Greek origin (eulogia) “well discourse” [1]. However, our intention is not to make an apology for a personality, but rather pay due homage to a man and his ideas, and if possible add a touch of gratitude for the personal gain that most people felt after being acquainted with him. This may help to understand why we have decided to dedicate this book to the memory of Professor Tim de Dombal.

It is becoming more and more difficult to teach medical diagnosis, as expanding numbers of students face a relatively static population of patients and teachers. A computer-based system is described which is being used in Leeds for simulation exercises in clinical diagnosis. Over thirty students have used the Leeds system. Initial student reactions and performances have been very favourable.

This paper reports a controlled prospective unselected real-time comparison of human and computer-aided diagnosis in a series of 304 patients suffering from abdominal pain of acute onset. The computing system's overall diagnostic accuracy (91.8%) was significantly higher than that of the most senior member of the clinical team to see each case (79.6%). It is suggested as a result of these studies that the provision of such a system to aid the clinician is both feasible in a real-time clinical setting, and likely to be of practical value, albeit in a small percentage of cases.

In this chapter I will give a personal vision of the relationship between information sciences, their concepts, techniques and tools, on one hand, and their relationship with bio-medicine and health, and their professions, on the other. However, before tackling the matter, I want to put the discussion into the context of a wider conceptual framework of knowledge, man and medicine. I believe that these reflections, from a humanistic and philosophic perspective, are necessary in a book that is centred in a technological revolution like the one represented by the Internet.

In today's world of high-velocity change the culture needs to learn better ways of behaving and to have a new set of responses that hold greater promise for the future. Health care reforms around the world are making change more rapid. Before health care providers can adjust to one change, they are hit with several others.

We live in a period of constant transition. We can expect rapid increases in the rate of change as the population doubles over the next few decades. One source of this change is Technology. Another source is knowledge and information. According to the book Information Anxiety, the fund of information available to the individual doubles every five years. More people, more tools, more knowledge. The future promises us more change than we have ever experienced before.

The social areas, and especially the health sector, have suffered a major impact as result of the profound social and political changes of the last decades, the ongoing process of economic globalization and interdependence, and the harsh realities of structural readjustment taking place practically in all societies.

The loss of the capacity of the State to maintain social benefits systems, the failure of the public sector in the provision of health care when faced by the explosion of the demand and the mounting costs associated with redundant and many time conflicting health care models and interventions, have all motivated governments and international financing institutions to find new strategies for the sector. Similarly, the disenchantment with the biased political discourse that dominated much of the public health arena during the `60s and `70s and the realization of the impossibility to accomplish the postulates of Alma-Ata and Health for All by the Year 2,000 have stimulated the search for alternative forms of health care and a revision of the roles of institutions and professional categories. In this context, health information systems and technology have been found to be an essential element in the effort to improve the management of services and clients and to contribute toward the overall quality of care.

The objective of Information Systems is to ensure that reliable and accurate information is available when it is needed and that it is presented in a usable form. According to the purpose for data processing, information systems can be classified in different application types. However, these categories are more or less artificial. They are all related to each other and the functionalities are not always strictly different. In each type an example of the application used in health care will be described.

Internet developed so rapidly that today it offers numerous services. The generalization of the World Wide Web (WWW) [1] as a point of access to this net has resulted in the confusion of this term. Many new users enter the world of Internet directly by WWW also known simply as the Web.

Nevertheless, there are a group of services called basic or classic, which are the base of Internet's functionality. These are electronic mail, file transfer and remote sessions or connections, all of which can be accessed through WWW but can also be used independently. A group of tools designed to search for information such as Archie, Gopher-Veronica and WAIS, tend to be presented as part of the Web. Because of their own peculiarities, it is important to know them and to appreciate what can be obtained by using them.

Technically, reference is being made to SMTP (Simple Mail Transmission Protocol) - the electronic mail protocol; TELNET (Network Emulation Terminal Protocol) - allowing the employment of PC from a remote location; and FTP (File Transfer Protocol) - permitting file transfer throughout the net.

From the very beginning these formed Internet's main services and are responsible for making its contribution relevant and, despite the development of new tools, these still continue to be principal features. Today's great advantage is that their integration is increasingly transparent thanks to the World Wide Web. Those who primarily visualized World Wide Web as Netscape or Internet Explorer have already included electronic messaging and FTP services as part of their packages.

It is very important to understand that the Web's first goal was to offer a unifying and integrated access to hypermedia documents from any given point in the Internet. Thus, and thanks to NSCA Mosaic[2] which captured its essence, the trend has been to access all of the Internet services from this window.

This window also allows users to reach the services mentioned before. (Anatomy of the World-Wide Web / by Eric Richard. -- Internet world 6(4): 28, April 1995).

People around the world access the Internet on one of two main modalities. The traditionally well established one, in universities, companies, research institutes, and in mid to large size organisations, through local area networks and servers that act as gateways to the external world. The more recent modality, and the one that is growing very fast is that of people accessing from their homes through normal telephone lines, with the help of an Internet service provider. In the first case, the end user is spared most of the often complicated technicalities involved in getting connected to Internet, and can concentrate on the contents he is interested in for his professional purposes. In the case of organisations, the main computers and networks are well structured and managed by specialists that take care of keeping the systems running, developing new applications and services, providing support to users and similar functions. On the other hand, the user at home, even if skilled in technical matters may have to cope with the possible difficulties arising from connecting to Internet, alone and without much of expert support.