UI Researchers Make Information Gathering Easier For Doctors, Patients And Students

December 30, 1998

IOWA CITY, Iowa -- The Internet can be useful for learning more about any topic, but pouring over the enormous number of hits that any one search might produce can make even the most patient people want to throw their computers out the window.

Two University of Iowa College of Medicine assistant professors are helping to alleviate the frustration for those wanting quality information on various medical topics. The Department of Radiology's Michael D'Alessandro, M.D., has created PediatricRadiology.com and MedicalStudent.com. His wife, Donna D'Alessandro, M.D., UI assistant professor of pediatrics, has started generalpediatrics.com. The D'Alessandros' digital libraries are organized collections of links to other authoritative Internet sites that individuals may use to obtain answers to medical questions.

"To optimally practice medicine, physicians need a way to organize authoritative information," said Michael D'Alessandro, who likens himself to a curator and librarian. "To stay healthy and to live active lives, patients need the same thing."

Studies show that physicians generate one to three questions during every patient visit, but many times doctors do not look up the answers to questions unless they are critical, D'Alessandro said. Having an electronic resource at their fingertips enables doctors to find the answers while they are busy seeing patients.

Looking up the answer to a question generated in a clinical context means a physician is much more likely to remember the answer for future patients who might have the same problems, D'Alessandro said. The digital library can be a good teaching tool for medical students and residents, too. For example, in radiology, students and residents can view surgical photos of an abnormality that they identified through diagnostic imaging.

"With a digital library, you can teach the students quickly," D'Alessandro said. "You are just a couple of clicks away from the information you need. Plus, the information on the sites is more up to date than that found in hard-copy textbooks." D'Alessandro's medical student site includes patient simulations -- digitized patients and patient encounters so that the students can "see" patients. "Today, with the emphasis on fast, efficient service, the patients are out the door before students have a chance to see and evaluate real patients," D'Alessandro said.

There were obstacles that D'Alessandro had to overcome in creating the libraries. The Internet is chaotic, D'Alessandro said, noting it doubles in size every six months and that existing sites are constantly changing. There also are concerns over the quality of the information.

"How do you know what is good and what is bad?" D'Alessandro asked rhetorically. D'Alessandro's first digital library focused on pediatric radiology, his own specialty. To build it, he spent hours manually searching all the information on the Internet related to pediatric radiology. "It took hundreds of hours using various search engines and medical indexes," D'Alessandro admitted.

He isolated about 100 pediatric radiology related sites. He then had to determine the quality of the information. To be included as a link to the page, the site needed to be a creation of an established local, state, national or international commercial, education, non-profit or governmental organization. This ensured the site was authoritative, up-to-date and long-lived. The site had to be free to use, and its information must have been primarily in Hypertext Markup Language format (HTML) so that all users can view it, regardless of the search engine.

D'Alessandro then organized the information in a way that would make sense to people so they would use it effectively. He arranged it by organ system and type of text. "It's a first step to bringing order to the chaos of the Internet," D'Alessandro said.

Based on his demonstrated efforts with the original site, D'Alessandro received a grant to further improve the pediatric radiology page. He is using intelligent agent software to handle the drudgery of upgrading the site. An intelligent agent software program allows a user to teach it to do repetitive tasks.

One of the agents takes all the authoritative web sites that D'Alessandro has indexed and makes them searchable. Every month or so, it will reindex the sites. The second agent monitors the indexed sites so that anytime there is a change to a site, D'Alessandro receives an e-mail to alert him. The third agent continually crawls the Internet looking for new sites to add. The fourth agent notifies those who subscribe to it of any new, available resources.

With the grant funds, D'Alessandro also plans to redesign the user interface for the pediatric radiology site so that it also organizes information by the 50 to 100 most common pediatric problems.

D'Alessandro suspects that others are somewhere in the process of creating a digital library for just about every field of medicine, but most are early in the prototype phase.

"There are very few or none that reach our level in the integrity of information, clarity of design and the ability of its intelligent agent software," he said. "We've been lucky here at Iowa because we were early adopters and users of Internet technology. We were running at the front of the pack, and we're still out on the leading edge."

D'Alessandro also has helped to create UI Hospitals and Clinics' Virtual Hospital and Virtual Naval Hospital -- sites similar to his digital library pages that help to make the Internet a useful medical reference and health promotion tool for health care providers and patients.

"Ultimately, it's not about technology," he said. "It's about taking better care of patients. It's just another tool, like a stethoscope, that we can use to take better care of patients and allow them to take better care of themselves."

University of Iowa

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