American College of Physicians: Internal Medicine — Doctors for Adults ®

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CD-ROM-speedway to medical info

Medical titles go beyond words with high-tech sights and sounds

From the March 1995 ACP Observer, copyright © 1995 by the American College of Physicians.

By Edward Doyle

As an attending physician in the University of Alabama-Birmingham's emergency room, Jerome Carter, FACP, sees everything from simple cuts and bruises to broken bones and heart attacks. To keep on top of it all-and to give his residents and interns expert advice-he relies on one of computing's newer technologies, the CD-ROM.

With just a few keystrokes on his computer, Dr. Carter, an assistant professor of medicine and health services administration at the university, can tap into the text of countless medical textbooks and years' worth of medical journals. Whether he is looking for information on how to diagnose a difficult disease or treat an unusual patient, he has the answer almost immediately. "When I'm in the emergency room and I have my CD-ROM," Dr. Carter explained, "I'm likely to look something up on nearly every other patient because it only takes a few seconds."

Like Dr. Carter, physicians everywhere are beginning to discover that CD-ROMs' ability to store and search vast amounts of text--up to eight years of journal articles on a single disk--helps them keep current when it comes to medical literature. And as CD-ROM technology becomes both faster and cheaper, physicians are discovering that more advanced applications await them--such as earning CME credits via computer.

For now, however, reference CD-ROMs like those that Dr. Carter uses in the emergency room are most popular among internists. SAM-CD, for example, the electronic version of Scientific American Medicine that contains text and color images, is popular among internists (particularly those in academic environments) who use CD-ROM.

Charles Barr, ACP Member, director of medical informatics and assistant professor of internal medicine at Michigan State University, said he likes SAM-CD, particularly when he works with residents. "The Scientific American Medicine CD-ROM is nice because it is updated frequently and it is relatively comprehensive, so it is well-tailored to internal medicine residents," he said. "Plus, you can be sure that you can find what you're looking for relatively quickly."

Find it fast

Finding information fast is probably the biggest advantage of CD-ROM titles such as SAM-CD. "Books aren't that great for finding particular pieces of information," explained Dr. Carter, who has written a chapter on CD-ROMs for ACP's upcoming guide to medical computing. "If I were looking for something in a textbook of medicine, I'd be flipping through pages and searching through the index for much longer."

If a broad-based CD-ROM isn't quick enough, there are even more narrow titles that can make searching for information even faster. Internist Jeremy Holtzman, MD, assistant professor of medicine at the University of Minnesota, often uses a CD-ROM database of abstracts from journals related to health services research. Doing searches on this CD-ROM is faster than using a more general database like Medline (which is available on CD-ROM or online), he said, because of the CD-ROM's focus. "It's more narrow so I don't get as much junk when I'm searching."

But there is also a place for more broadly focused CD-ROM titles, say internists who use CD-ROMs. Stat!-Ref and Maxx, for example, are two fairly generic titles that are popular with internists. Dr. Carter said he likes using these broader titles when he sees patients who fall outside the bounds of traditional internal medicine. "In an office setting where I'm seeing patients with gynecological problems and I have pregnant women referred to me for follow-up medical problems during pregnancy," Dr. Carter said, "I tend to rely a lot on Stat!-Ref for its ob-gyn text."

More multimedia

Until recently, CD-ROMs such as SAM-CD--text-heavy products that contain only a limited number of pictures--have been the most common offering for physicians. But as CD-ROM technology matures, physicians are being introduced to titles that go beyond simply searching the text of journals and textbooks.

For example, PrimePractice, a new CD-ROM from Mayo Clinic, is packed with sound, photographs and even video images. Animated sequences allow physicians to examine and treat a virtual patient on their computer. Users can shine a flashlight in a patient's eye or listen to a heartbeat on an animated model of a patient that can be rotated 360 degrees. After diagnosing and treating the patient, physicians are told what Mayo physicians would have done in similar circumstances. Users can earn up to 40 CME credits a year by subscribing to the CD-ROM.

Providing CME credits is also the focus of the CD-ROMs produced by GeoMedica, the physicians' computer network that is an offshoot of Lifetime Medical Television. GeoMedica's CD-ROMs resemble Lifetime's cable television programming, but with a difference: The CD-ROMs allow viewers to mold the contents of each show to meet their own needs. GeoMedica viewers watching a segment on heart disease, for example, can get more information on a drug by stopping the CD-ROM and requesting additional footage, or they can see the text of journal articles used to create the segment.

This move toward more interactive, graphically oriented CD-ROMs comes from improvements in the technology itself. When CD-ROM was first introduced in the early '80s, single-speed drives were fairly slow; to view a color image from a CD-ROM, users would often have to wait while the image was transferred from the CD-ROM drive to their computer screen. Today, however, there are double-, triple- and even quadruple-speed CD-ROM drives that run graphics-packed titles with lightning speed. In addition, the prices of CD-ROM drives have plummeted; a good quadruple-speed drive costs just over $300, and most double-speed drives are priced in the $100 range. (CD-ROM equipment for the Macintosh is priced slightly higher.)

But is it for you?

Despite such technological advances, CD-ROM users say that the technology will not solve all physicians' information needs. While Dr. Holtzman uses a CD-ROM to search for health services abstracts, he said that he still prefers to search Medline the old-fashioned way: via a traditional computer and Grateful Med, the searching software created by the National Library of Medicine. "With the CD-ROM," he explained, "you only get one or two years of abstracts on each disk. (Medline contains the abstracts of hundreds of journals for each year.) If you want to search a number of years, you have to keep putting CDs in and out of the computer."

And Michigan State's Dr. Barr noted that while his medical CD-ROMs offer a fair amount of depth, he said they do not come close to the level of detail found in specialty medicine textbooks. "If you're searching for something on cancer or hepatitis or GI disease," he explained, "you can often get a whole chapter in a subspecialty text, where with Scientific American on CD-ROM you'll just get a section of a chapter. There is a tradeoff between quick access to something and the level of depth it provides."

So how do you know if CD-ROMs are for you? Carol Albright, an information management consultant in St. Paul, Minn., suggests analyzing how you get information. "If you're in an urban area and your method of searching Medline is asking the hospital librarian to find something for you," she explained. "I would question whether you would really want to spend your money on CD-ROM."

But Ms. Albright said there is an even simpler way to determine whether CD-ROM will help your practice. "If you are already taking time to refer to a textbook, if you have that information-seeking habit," she said, "then CD-ROM will probably add some value to your practice."

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