The Internet as Practice Extender

November 1, 1999

In the early 1960s, the Internet was born out of the idea of a "Galactic Network." By the late 1980s, technology had advanced to allow for computer-based exchange of scientific information between academic and research institutes. From these humble beginnings, the Internet has experienced explosive growth in the last five years, evolving into a powerful global information resource and new media format unto itself. Psychiatrists can now reap the full benefit of this fast-paced evolution to extend the reach of their medical practice.

In the early 1960s, the Internet was born out of the idea of a "Galactic Network." By the late 1980s, technology had advanced to allow for computer-based exchange of scientific information between academic and research institutes. From these humble beginnings, the Internet has experienced explosive growth in the last five years, evolving into a powerful global information resource and new media format unto itself. Psychiatrists can now reap the full benefit of this fast-paced evolution to extend the reach of their medical practice.

At first, the only psychiatric resources on the Internet were searchable libraries and a few journal abstracts. Today, however, a new generation of medical Internet sites has emerged that delivers high-quality content directly to psychiatrists. These sites are easy to find and navigate, and they can be used to obtain practice updates, the most current journal summaries and even continuing medical education credits.

Consumers have already taken the lead over their physicians regarding medical information on the Internet. These computer-savvy individuals are using the Internet to enhance their understanding of diseases, medications and treatments. The Internet also provides patients with the opportunity to chat about their conditions or treatments and to access patient support groups online. Now it's time for their physicians to catch up.

Let's Go Surfing Now

To get on the Internet you will first need a personal computer with a modem. You can then "dial-up" an Internet Service Provider (ISP) and log onto a personal account. The cost of both computers and Internet access has come down considerably over the last year. The most popular companies like Gateway, Micron and Dell offer personal computers for under $1,000. Some offers even include one year of free Internet access with the computer purchase.

Computers usually come with either Microsoft's Internet Explorer or Netscape Navigator installed. These programs are "browsers" for "surfing" the Internet using the World Wide Web. Programs for sending and receiving e-mail and accessing user groups are also available. Nationally available ISPs provide access to all Internet services including the Web, e-mail and user groups.

Internet 101

The World Wide Web, also referred to as the Web, is the largest and most powerful space on the Internet. It is an international network of untold millions of computers woven together with a common language called HTML, or Hypertext Markup Language. Hypertext is a multimedia file format through which phrases or images link to other files for more information. Click on these highlighted "links" in your browser and away you go to other documents, images, audio files or even real-time video.

Web addresses (annotated www for World Wide Web), also known as URLs (Uniform Resource Locators), enable Internet users to access sites on the World Wide Web. E-mail, Usenet and Internet Relay Chat (IRC) are other powerful Internet resources beyond the Web. To keep things logical, e-mail addresses and URLs were set up to end with suffixes known as top level domains. These include .edu for educational institutions, .org for organizations, .gov for government addresses and .com for commercial enterprises among others. E-mail has been referred to as "telegraphy for the masses," enabling instant electronic messaging anywhere in the world. Usenet is a massive collection of bulletin boards organized into user groups based on interests. IRC allows for real-time talking or "chatting" on the Internet. This is often used by colleagues to share information or by patients for support.

Sending and receiving important information quickly and efficiently is one of the ways e-mail is used. For instance, you can compile a mailing list of patients and/or colleagues for practice updates or newsletters. Physicians are cautioned, however, that e-mail is not necessarily confidential or secure. (Although there are ways to increase the level of security for e-mail, it is beyond the scope of this article-Ed.) Mailing lists, called list-servers, are also used by groups to communicate and share information. For example, one well-established group discusses psychopharmacology issues. On this list, doctors from around the world write questions, comments, and share experiences with medications and patient management. There are also mailing lists for patient support and communication about their experience with medications and treatment. (For a searchable index of available lists, visit CataList www.lsoft.com/lists/lists/listref.html, the official catalog of Listserv and lists-Ed.)

A few forward-thinking psychiatrists have even created their own Web pages. A personal Web page helps generate new referrals and describes your practice to patients. It also provides a vehicle for continuing education for your patients. For example, you can post your own patient information handouts and provide recommended links for visitors. A Web site is also a good place to archive copies of electronic newsletters for patients to review. (Software is available to assist both the novice and expert alike in producing their own Web site. For more information on building a site, contact your ISP-Ed.)

For Your Information

Internet sites and services can be very useful in extending the range and depth of your practice. There are Web sites for professional and patient information, medications and mental illness information, detailed searches online, and for locating and registering for professional meetings. Continuing medical education credit is also offered online at a variety of sites.

A good place to start when searching online for medical information is the large Internet portal Yahoo! www.yahoo.com, which collects and categorizes Web sites. Yahoo! has a psychiatry section at dir.yahoo.com/Health/Medicine/Psychiatry> with sub-directories for information regarding children, conferences, forensics, hospitals, institutes, journals, organizations and psychopharmacology.

There are other huge Internet portals, including Excite www.excite.com and AltaVista www.altavista.com. Unfortunately, there is a drawback to their approach: the results of a search can be long lists of other Web sites, which can be daunting when you are searching for specific facts. However, there are sites specifically for psychiatrists, with only mental health resources, up-to-date news and diagnostic-specific information.

One of the best things about the Internet is that most of the resources are free for the asking. All you need is your own Web access. Psychiatry On-Line at www.priory.com/psych.htm is a good example of a site just for psychiatrists. This site features current articles and papers, a research roundup, and a plethora of links to other psychiatry resources worldwide. There are other subsections on this Web site for child and adolescent psychiatry and forensic psychiatry.

Commercial Sites and Services

Medscape www.medscape.com is tailored for medical professionals with original, peer-reviewed reports and journal articles organized by medical specialty. (Many sites, such as Medscape, require users to register before they can fully access the site and its resources. Registration is usually completed with an online form, which entails the user entering some basic information [e.g., e-mail address, name, password, etc.]. Although many sites are free, some sites charge for part or all of the resources offered-Ed.) Medscape offers an extensive compilation of medical conference news summaries, treatment updates, original medical texts available in electronic format, clinical research on MEDLINE and category 1 credits. If you are unable to attend a conference, Medscape even provides next-day conference summaries written by medical specialists.

Medscape's psychiatry page includes sections for psychiatric news, journals, treatment updates and conference summaries from the 1999 American Psychiatric Association meeting. The clinically focused conference summaries offer up to eight hours of free CME credit. I found the Medscape conference summaries very well-written. They included discussions of combination therapy in depression, childhood-onset schizophrenia, and new frontiers in the assessment and treatment of dual diagnosis.

Also available through Medscape are patient monographs, which can be handed out to patients for medication information and side-effect profiles. To test the search capacities, I plugged in the phrase new antipsychotics. Medscape then produced a very useful document entitled "Atypical Antipsychotics: A Practical Review."

Medcast www.medcast.com is a medical news and information subscription service designed to meet the needs of physicians. This site provides daily headlines, pharmaceutical updates and research articles for a variety of specialties, including psychiatry. Medcast features professional writers who monitor medical journals, professional organizations, and legislative and regulatory bodies to generate original content for subscribers daily.

WebMD www.webmd.com began as an Internet portal for consumer health news and information. WebMD now has over 54,000 physician subscribers. There are physician directories and condition-specific "communities" that serve as support groups for patients. WebMD has a specific psychiatric site, but it is not as robust as Medscape Psychiatry.

WebMD also features reference materials including patient education, The Merck Manual, and Diagnostic Procedures and Medical Software reviews. Literature searches and journals are online as well. Patient information handouts prepared by Clinical Reference Systems are available for behavioral health, including major psychiatric illnesses.

Professional Organizations

Many professional medical organizations have Web sites that offer membership information, news, clinical updates and meeting calendars. Popular destinations include the APA www.psych.org andthe American Medical Association www.ama-assn.org.

Utilizing the power of e-mail for dissemination of information, the APA has launched an online news service, APA On-Line News. This e-mail newsletter covers legislative developments, changes in Medicare rules, managed care guidelines, annual meeting updates and Board actions. APA members can sign up for this newsletter at www.psych.org/apamember/onlinenews.html.

The American Academy of Child and Adolescent Psychiatry www.aacap.org has a very useful listing of informative handouts called "Facts for Families." The Academy has posted these for public release and distribution of information on child psychiatry including illnesses, medications and family issues.

The U.S. government, after playing a primary role in the founding of the Internet, remains a major online presence. The National Institutes of Health Web site is located at www.nih.gov. The National Library of Medicine www.nlm.nih.gov has a nifty gallery of images from the history of medicine. In addition to making press releases, the National Institute of Mental Health www.nimh.nih.gov provides patient education programs for a variety of conditions. The NIMH Web site's Anxiety Disorders Education Program starts with a patient anecdote of what it is like to live with the disorder. This site is a good example of an Internet resource to which psychiatrists can confidently refer patients for information about their conditions.

A further demonstration of the value of the Web for drug alerts and information can be found at the U.S. Food and Drug Administration site www.fda.gov. Adverse effects of medication can be recorded at www.fda.gov/medwatch.

Mental Health Infosource

CME LLC, the parent company of Psychiatric Times, offers continuing medical education credits on its Web site, Mental Health Infosource www.mhsource.com. Informative articles are posted from current as well as previous issues of PT, Medicine & Behavior and other publications. Mental Health Infosource includes MHinteractive, where questions can be posted for experts, and Healthier You, which provides consumer information on mental health conditions. Mental Health Infosource has subsites on schizophrenia and bipolar disorder for even more condition-specific information.

Of all the Web sites I reviewed, one of the best CME activities on the Internet is at Mental Health Infosource. Progress in Psychopharmacology: Psychiatric Disorders Update is an online course that offers up to five category 1 credits. The course starts with an excellent review of basic receptor/ligand biology. The graphics that accompany the text clearly illustrate signal transduction and receptor-specific neural pathways. The review of serotonin biology and the serotonin/dopamine interaction in this CME activity is very well done. This illustrates the true potential of the Internet for continuing medical education.

Where Is It All Going?

The growth of medical resources on the Internet has been phenomenal. In the future, the Internet may be at the core of many physician-patient transactions, including claims processing, lab orders, medical record access, transcription services and even supply orders. With so many rich and informative Web sites, it is impossible to describe the abundance of psychiatric resources online. It's time for all psychiatrists to get on the Internet and experience the bounty for themselves!