The West Virginia School
of Osteopathic Medicine may be the country's most rural medical school,
but the information highway of the world is now just keystrokes away.
With the current expansion in the school's computer system, WVSOM staff,
faculty, students and area rural physicians can access information not
only in WVSOM's system but in databases located around the world.
Country Road to the Information Highway
WVSOM's computer system now includes a connection
to the Internet, in-house databases, various medical resources and the
WVSOM library's holdings. The Internet -- the multi-purpose, on-line
network that allows access to hundreds of databases (including card
catalogs and literature abstracts) and electronic mail -- is the part
of the system that Mary Francis Bodemuller, WVSOM's library director,
seems most enthusiastic about. "It's scope is amazing," she
says. "You can use libraries and databases all over the world through
Internet."
As a leading figure in its development, Bodemuller
has been marketing WVSOM's system since late last year. Periodic newsletters
and tip sheets that offer pointers on how to use the system are available
for patrons. These patrons include not only faculty and staff on campus,
but also off-campus physicians, medical staff and students at Learning
Resource Centers (LRC).
Dr. Arnold Hassen, a Physiology professor and
director for professional development at WVSOM, is the chairman of the
Learning Resource Center Committee, which manages and oversees the operations
of LRCs, the rural medical information centers in West Virginia. He
is also WVSOM's representative on SHINE--the State Health Information
Network.
"The Learning Resource Centers house several
computers, fax machines, photocopiers and some resource materials,"
Dr. Hassen says, adding, "The centers are also a central location
to conduct meetings, discussions and workshops."
LRC computers are equipped with word processing
and spreadsheet applications, and the ability to access outside information.
"You can connect with the system and get information, for example,
about clinical updates or from a drug resource database. You can also
get into a program called US HealthLink, which contains information
about diagnoses, drug interactions and more," Hassen explains.
Helping Rural Physicians and More
The Kellogg Program's Rural Health Initiative
(RHI) and LRCs address an issue vital to the improvement of West Virginia's
health care--giving better access to information to rural physicians
and other health care professionals. Computers have a major role in
this objective, which WVSOM's computer system is growing to meet.
WVSOM's service will become the third connection
on a statewide medical information network, with Marshall University's
Ruralnet and WVU's Consult computer services. "Each service has
individual characteristics," Hassen says.
All three are on an umbrella menu on Internet.
To use WVSOM's system, a patron would select it, then get a WVSOM services
menu with choices differing from the other two school's services. "We
are trying to not have repetitive programs out of each school,"
Hassen says. "We don't want to create a competition for market
share. The three schools have been working well together on this.
"We put together a network which allows anyone
with access to it to take advantage of an information bulletin board,
e-mail, information in databases anywhere in the world, and to conduct
literature searches using the Grateful Med application," explains
Hassen. Grateful Med is the operating system that supports the Medline
research database.
The LRC computers have access to the network,
but a single doctor's office can have access as well. "One of them
can be stand-alone (a computer with a modem), sitting in a doctor's
office," Hassen says.
According to WVSOM's Director of Computer Services,
Al Akers, "The hardware required to use the services is mainstream."
He explains that most of the work is done by the host computer at WVSOM.
"All the requirements of running the Internet system are in the
mainframes on campus. You connect to our machine and your computer is
a window looking into ours."
The system is accessible from IBM-compatible computers
or any other machine that can emulate an IBM-style keyboard. Other requirements
are a low baud rate modem (1,200-2,400 bps), free connecting software
and free of charge registering at the WVSOM library.
To enter some databases, registration and dues
are required. "There may be a cover charge," Akers says. "With
some you're allowed to log on, but you're prevented from accessing everything.
They will tell you that you must register and/or pay a charge to get
in. Others you can't find until you register and/or pay. Many databases
are listed only in government or trade journals, so only those who need
them will tend to find out about them."
For on-line, inter-library book loaning, another
significant service offered, patrons fill out an on-screen form and
leave it in the system for WVSOM library staff to expedite. Books may
be loaned from WVSOM or many libraries around the world. This service
is intended for rural physicians who cannot easily reach a resource
center like WVSOM, and it is useful for WVSOM faculty looking for information
beyond the school's library. Other libraries may require postage payment
up front for a book to be shipped, and WVSOM may pass that cost on to
the patron. "If we have to pay," Akers says, "we may
transfer at least part of the cost to the patron or we may not."
In all cases, return postage is paid by the patron.
How Doctors React to the Internet
No matter what the costs of services are, it appears
that using computers as information tools in health care today is vital
and will be more vital in the future. Still, some prefer to stay off
the information highway.
Hassen sees a wide disparity between users and
those who are uncertain about the system and computers in general. "What
we find is that in small practices doctors are using the system after
five or six, when their office is closed," he says. "They
do a lot of their work in the evening. During the day, doctors may not
use the system, but they may ask someone else in the office to look
something up for them.
"Physicians who do use Internet are excited
about it and they use it all the time," Hassen says. "Those
who don't use computers sometimes are unnerved, even intimidated by
them. But the only reason to not be part of the system is if a doctor
feels he or she doesn't have time to learn the system or to use it during
the day," Hassen says, noting, "The long-distance charges
required to reach the system may also be a deterrent." But this
is not a big roadblock.
"A local call is a local call," Hassen
says. "Outside the area, it tends to be expensive. But once on
a node, the phone charges aren't high."
A node is any one of many service bases (which
can be thought of as information outlets) on the network, such as WVSOM.
"The long distance charges are something
we are very sensitive to," Hassen says. "We are finding cheaper
ways to connect to the system."
Overcoming a Handicap
The Kellogg Program is only three years old, and
the network is growing steadily, as time and money permits.
"We're continually building on what's already
here," Hassen says.
Today, West Virginia's rural structure is considered
a handicap to health care providing, but with the onslaught of computerization,
it may be less of an issue. "The key idea is," Hassen says,
"with the Internet, doctors in rural communities can be as well-connected
as they would be if they were sitting in an office at the Mayo Clinic."