Appendix 2
JAMA Editorial - May 1, 1996
Bonnie I. Chi-Lum MD, MPH, George D. Lundberg MD, William M. Silberg (1996) Physicians Accessing the Internet, the PAI Project: An Educational Initiative. From the Schools of Public Health and Medicine, Loma Linda (Calif) University.
Some of us have been expecting physicians to move en masse to use that wonderful beast of burden, the computer, for several decades.[ref. 1] But, with each new wave of exciting hardware, glitzy software, and mass promotion, physicians en masse have instead shunned routine personal use of computers in their education and practice.
Of course, for decades physicians' offices and hospitals have used computers for scheduling and billing, their libraries for MEDLINE searches, their clinical laboratories for reporting laboratory results, and their imaging centers for advanced diagnosis with great success. And a number of physicians-mostly at large centers or as part of specialized professional groups like the American Medical Informatics Association-indeed are pushing the edge of the envelope when it comes to computer applications.
Yet, personal direct computer use for medical purposes by hundreds of thousands of US physicians has lagged badly behind the capability of the systems and technology. Many of our scientific colleagues in fields such as physics and astronomy are well ahead of us. One wonders why.
Part of the reason likely is access to technology. Obviously, individual physicians can buy the necessary equipment right off the shelf, if motivated to do so. But many employers or institutional settings may not be providing the hardware needed to make maximum use of the computer's potential in the work setting.
It's not as if there haven't been major national efforts to get physicians and computers better acquainted. By launching the AMA/NET system in 1982[ref. 2] the American Medical Association (AMA) was betting on the future with a major push to develop information and computer access for physicians. Many millions of dollars of losses later, the AMA pulled the plug on AMA/NET, believing that it was too far ahead of the curve to wait for use to catch up.[ref. 3]
Others have had better outcomes, such as the National Library of Medicine, which, under the leadership Donald A. B. Lindberg, MD, has pioneered computer use by libraries and physicians and has had substantial success in marketing the GRATEFUL MED system.[ref. 4]
But more work is needed, and we believe the time is ripe to launch a whole new effort to hook up computers and physicians for the benefit of both patients and the profession. What is different now that would cause us to take such a step? More than 200,000 new physicians have been graduated in the United States since AMA/NET began, most of them computer literate, and many computer ficionados; equipment and software are better, much less expensive, and easier to use. And now we have the information superhighway (the Internet) and the World Wide Web offering instantaneous free information exchange to virtually every continent in the world.
The AMA and Loma Linda University School of Medicine are pleased, therefore, to announce a cooperative leading role in the new Physicians Accessing the Internet (PAI) project to teach physicians how to use the Internet. We have compiled an outstanding and balanced advisory board of experts. They include G. Octo Barnett, MD, Boston, Mass; Greg Borzo, Chicago, Ill; Ralph Korpman, MD, Loma Linda, Calif; Thomas Lincoln, MD, Santa Monica, Calif; Gretchen Purcell, Stanford, Calif; Clement McDonald, MD, Indianapolis, Ind; Marshall Ruffin, MD, Tampa, Fla; and Dennis K. Wentz, MD, Chicago.
Under the guidance of this advisory group, we have defined the following learning requirements, which, when met, will allow physicians to access the Internet successfully.
Competency Characteristics and Behavioral Objectives
To achieve these objectives, we propose that academic health centers, hospital medical staff organizations, medical associations, national and state specialty societies, organized groups of the AMA, residency programs, medical schools, managed care companies, and interested segments of industry prepare courses to help physicians to accomplish these goals. We offer the following suggestions:
Course Curriculum
1. Introduction and description of objectives.
2. Didactic information with illustrations on the following topics:
Who will pay for this education? We believe that funding sources should include sponsoring institutions, individual participant fees, educational grants from a consortium of equipment manufacturers, software suppliers, online services vendors, and pharmaceutical and medical equipment manufacturers.
Where should this teaching be done? Everywhere. Anywhere there is a critical combination of students, teachers, equipment, and motivation. Medical students may be especially effective teachers of physicians. We expect the AMA to take a leadership role in originating training programs and will announce our specific plans as they are available.
The Internet already offers plenty for physicians to see, and specifically on the World Wide Web, which although still in its infancy is starting to offer medical content of high quality and utility for both physicians and patients.[ref. 5] [ref. 6] A number of peer-reviewed medical journals, including JAMA, already have Web sites (http://www.ama-assn.org), with many more racing to establish an online presence. One of us (W.M.S.) is New Media Editor, who supervises all JAMA, Archives specialty journals, American Medical News, and condition-specific content on the AMA Web site.
We have also launched the first in a series of condition-specific Web sites, one dedicated to information on HIV and AIDS. Made possible by a generous unrestricted educational grant from Glaxo Wellcome Inc, the HIV/AIDS site is guided by a 17-member editorial review panel and a 6-person community panel to represent the information needs of patients, their families, and caregivers, since we believe that more than half of the users of the AMA's Web site are not physicians or health care professionals.
We pride ourselves on our Web efforts to date, as well as in ownership of the PAI initiative and in putting forth this plan. But we do not "own" the national effort needed to accomplish it. This will involve hundreds and thousands of people as students and teachers. We call on all interested physicians to participate in a massive education effort for the good of their patients and their own professional well-being by developing their ability to gain new information in this manner.
References