Wednesday, February 14, 2001

Emergency Medicine and Internet Technology: Here Today, More Coming Tomorrow

Technology has always fascinated me. I built Heathkits in my early teens and received my amateur radio license before I was 14. But I’m not you and many of you tell me that you’ve only just come into using a family computer to browse the web and only rarely do you check your e-mail. At a recent gathering one long-time colleague confided that he had only recently decided that computers were not just a fad and that he was going to have to learn to live with them.

In this space in the June 2000 issue, I presented an overview of some issues relevant to selecting an ED information system. I don’t intend to reprise that here; rather, I thought I’d share some of the sites that I’ve learned from in recent months or used as a clinical reference both in delivering care and in case review. If I’ve not included your favorite site please don’t "flame[1]" me.

The National Center for Emergency Medicine Informatics is the one site I suggest everyone in emergency medicine explore first. This site is a wonderful "home page"[2] for your favorite workstation in your ED if you don’t already have a standardized home page. Among the many fine tools on the page, "MedBot" a search tool focused on a dozen or so medicine sites pops up a friendly window for your search terms while keeping the main page visible. Another area of page offers "Medical E-tools and Calculators" including algorithms to compute GI bleed complication risk, hypernatremia treatment, and hyponatremia treatment along with a bradycardia treatment algorithm and a rash diagnosis algorithm.

When away from the ED and direct clinical care the NCEMI site still holds my interest for both its daily and weekly educational and amusing nuggets including aphorisms, eponyms, cartoons, phobias and questions. The overview of the current literature relevant to emergency medicine through the "Daily Sample" column frequently prompts me to start reading an article that I then finish in the journal that had been sitting on the pile by my desk. Many other features may appeal to individual users including the ability to customize the NCEMI homepage with your most used links.

Jeff Mann in his "Site Philosophy" describes his EM guidemaps as "quick-to-read" references that can help neophyte emergency physicians optimize their clinical practice of emergency medicine. Doctor Mann explains that, "My EM guidemaps should be seen as a supplementary informational tool - specifically designed to help you manage acute clinical problems in the ED setting. They are based on a combination of my evidence-based medical knowledge and my personal experience, and they reflect my problem-solving approach to acute medical emergencies. These ready references provide a pared down how to get through the night quick hit of practical wisdom. Don’t confuse these few dozen screens that cover selected ACLS, medical, toxicological, neuro-opthalmological and trauma topics with a comprehensive text, but when you find yourself with a hole in your brain for the evaluation of a patient with for example, diplopia, Jeff Mann ’s guidemap will help you care for the patient with just a quick read of his site.

One of the external sites that we in the Maimonides Medical Center ED use extensively is the emergency medicine on-line text, Emedicine. This commercially supported site (multi-million dollar investments by pharmaceutical and health-care advertising firms) is the home of multiple texts in many areas in medicine, but the emergency medicine text was the first one. The text chapters are well organized with a front-page folder screen allowing easy selection of top-level topic (Allergy and Immunology, Cardiovascular, Dermatology, etc.) and a frame down the left had side of the screen for sub-topic: Aneurysm, Angina, Aortic Regurgitation, etc. The chapters include prominent notice of date and time last updated. Many of the chapters I recently browsed had been updated within 8 weeks of the time I am writing this column.

Another site, EMedHome offers regularly updated content, free CME and has recently implemented a relatively inexpensive CME program in support of the ABEM Life-Long Learning and Self-Assessment program of the Emergency Medicine Continuous Certification program now required of all diplomates. The longstanding, regularly updated "database" of Adobe Acrobat documents described as Protocols, Algorithms, Sample Orders, and Guidelines remains available for download, printing, and distribution. This site has some advertiser support but explicitly asserts its editorial independence.

What if you don’t have Internet access in your ED? While wireless alternatives are available, your hospital should be importuned to support Internet connectivity from your ED as a matter of patient care. Looking up references in the hospital library, no matter how nearby is not the same thing as pondering the advice from any of these sites with the chart in your hand and the patient visible across the ED. Almost certainly you have one or more computers in the ED that could have a web browser installed and a network connection upgraded to include Internet access for negligible expense. Build a coalition of your colleagues, including nursing staff, before you approach hospital administration with your request. Point to this article as describing current practice and request basic Internet connectivity as a tool for patient care.

Today, access to clinical references over the web as described above is the routine in many emergency departments. As hospitals, even small hospitals, implement electronic medical records through the web the Internet and the web browser will likely become important tools for organizing, tracking and documenting care delivered.[3] Applications supporting scheduling and tracking of residents’ hours and demographic, education, evaluation and procedure databases have already come to the web at for example GME Toolkit from Dataharbor.

The Internet and computers are not a fad. Those of us in leadership positions who’ve yet to embrace the web, should begin exploring it at once. I’m proud of my colleagues at Maimonides who have bought home computers and typing tutor programs and have begun learning their way around the web. Just as they learned to read head CT scans long after residency, so too are they learning to navigate the web. When will you?

1 To send an offensive email message or newsgroup posting, especially one containing strong language and personal insults. Compact American Dictionary of Computer Words. Copyright © 1995, 1998 by Houghton Mifflin Company.

2 For a Web user, the home page is the first Web page that is displayed after starting a Web browser like Netscape's Navigator or Microsoft's Internet Explorer. The browser is usually preset so that the home page is the first page of the browser manufacturer. However, you can set it to open to any Web site. For example, you can specify that "" or "" is your home page. You can also specify that there be no home page (a blank space will be displayed) in which case you choose the first page from your bookmark list or enter a Web address. Compact American Dictionary of Computer Words. Copyright © 1995, 1998 by Houghton Mifflin Company.

3 An application service provider (ASP) is a company that offers individuals or enterprises access over the Internet to application programs and related services that would otherwise have to be located in their own personal or enterprise computers. Sometimes referred to as "apps-on-tap," ASP services are expected to become an important alternative, especially for smaller companies with low budgets for information technology. Definition copyright © 1996-99 by Inc.