Clinical Problem Solving on the World Wide Web

Slide 1:Clinical Problem Solving on the World Wide Web

J. Ben Davoren, MD, PhDClinical Architect for Information Technology, VHAAssistant Clinical Professor of Medicine, UCSF

Slide 2:Finding Clinically Relevant Information on the Web - The Issues:

TIME VOCABULARY CONFIDENCE IN QUALITY KEEPING UP TO DATE

Slide 3:Dealing with the Issue of TIME: Strategies for Efficient Web-Browsing

First: Using Integrative Literature Sites General Topics Specific Organ Systems or Disease Entities Second: Using the National Library of Medicine MEDLINE Other Health Science Databases Third: Using Professional & CommercialMedical Specialty / Subspecialty Web Sites Last:Using Major World Wide Web Search Engines or Meta-Engines

Slide 4:Integrative Literature Sites on the Web General Topics in Medicine

The Cochrane Collaboration International Collection of Regularly Updated Systematic Reviews DARE (Database of Abstracts of Reviews of Effectiveness) National Health Service Centre for Reviews and Dissemination at the University of York, England HSTAT (Health Services Technology Assessment Text) Agency for Health Care Policy & Research / US Preventive Services Task Force Practice Guidelines National Guidelines Clearinghouse AHCPR, AMA, and AAHP consortium of Practice Guidelines

Slide 5:Integrative Literature Sites on the Web Specific Disease Entities

Cancer The National Cancer Institute: CancerNet Heart Diseases The American Heart Association / American College of Cardiology Infectious Diseases Centers for Disease Control

Slide 6:MEDLINE - Preferred Sites

UCSF: HealthSTAR (formerly Melvyl) GALEN II (Web Version of HealthSTAR) National Library of Medicine: PubMed (MEDLINE + PREMEDLINE) Internet Grateful Med AIDSLINE AIDSDRUGS AIDSTRIALS BIOETHICSLINE ChemID DIRLINE HealthSTAR HISTLINE HSRPROJ OLDMEDLINE POPLINE SDILINE SPACELINE TOXLINE

Slide 7:Medical Specialty Web Sites - Third Line Locations for Medical Information

Sites Set Up for Searching Medical World Search CliniWeb Hardin Meta Directory MedHunt

Slide 8:Medical Specialty Web Sites - Third Line Locations for Medical Information

Sites Set Up for Medical Updates Medscape InteliHealth Doctor's Guide to the Internet

Slide 9:Medical Specialty Web Sites - Third Line Locations for Medical Information

Professional Organizations & Journals American College of Physicians American Medical Association New England Journal of Medicine (MMS) American Society of Clinical Oncology

Slide 10:Finding Clinically Relevant Information on the Web - The Issues:

TIME VOCABULARY CONFIDENCE IN QUALITY KEEPING UP TO DATE

Slide 11:Dealing with the Issue of VOCABULARY - mapping your terms to somebody else's

MeSH : The Medical Subject Headings of MEDLINE Hierarchically arranged structure of terms for every conceivable topic, allowing the assignment of individual journal articles to the most specific terms possible. Allows searching with maximum sensitivity by picking more generic "grandfather terms� Allows for maximum specificity by picking more specific nested terms, along with a short list of subheadings (e.g. "drug therapy" or "diagnosis").

Slide 14:Dealing with the Issue of VOCABULARY - mapping your terms to somebody else's

UMLS : The Unified Medical Language Structure Thesaurus An electronic Rosetta Stone used in PubMed to map terms or combinations of terms to the most likely MeSH term(s) and MeSH subheadings. Helps one use the highly specific nomenclature of MeSH without having to know the nomenclature in the first place.

Slide 15:Dealing with the Issue of VOCABULARY

MeSH is used not only at the NLM and other MEDLINE sites, but is also used: to index Integrative Literature Reviews at the DARE Web Site to index other Web sites at the CliniWeb and Medical World Search Web Sites UMLS is used at PubMed and also at the Medical World Search Web Site.

Slide 16:Finding Clinically Relevant Information on the Web - The Issues:

TIME VOCABULARY CONFIDENCE IN QUALITY KEEPING UP TO DATE

Slide 17:Dealing with the Issue of QUALITY - The Principles of the "Health On the Net" Code

1995: an international group of interested parties met in Geneva to create guiding principles for accountability of Health-related Information on the Internet. They created the voluntary "HON" principles, which many healthcare-related sites display. In addition, they created a searchable Web Site at which other sites which publicly subscribed to their principles would be indexed (MedHunt).

Slide 18:The HON Code

1. Advice provided will only be given by medically/health trained and qualified professionals unless a clear statement is made. 2. Site designed to support, not replace, the relationship that exists between a patient/site visitor and his/her existing physician. 3. Confidentiality of data relating to individual patients honours or exceeds the legal requirements of privacy where the Web site is located. 4. Where appropriate, information supported by clear references to source data and, where possible, have specific HTML links to that data. 5. Any claims relating to performance of a specific treatment will be supported by appropriate, balanced evidence. 6. Designers of the Web site will provide information in the clearest possible manner and provide contact addresses. Webmaster will display his/her E-mail address clearly throughout the site. 7. Support for Web site will be clearly identified. 8. If advertising is a source of funding it will be clearly stated.

Slide 19:Issues of Quality - Beyond the HON Code

Guiding principles for assessing the reliability of information at Web sites are the same as for the rest of Evidence-Based Medicine: a concise question appropriate control groups assessments of generalizability Professional Organizations create and review their own Web sites, but Academic Institutions often do not The Web sites of Journals, Individuals, and Institutions usually reflect the same quality as the original product

Slide 20:Real World Searching Step One -Beginning with the Integrative Literature Sites

Cochrane & DARE AHCPR National Guidelines Clearinghouse American Heart Association / American College of Cardiology CancerNet Centers for Disease Control

Slide 21:Real World Searching Step Two - MEDLINE and the MeSH Terms

PubMed at the National Library of Medicine

Slide 22:Real World Searching Step Three - Professional Organizations

American College of Physicians American Society of Clinical Oncology

Slide 23:Finding Clinically Relevant Information on the Web - The Issues:

TIME VOCABULARY CONFIDENCE IN QUALITY KEEPING UP TO DATE

Slide 24:Keeping Up To Date using the Internet

Scanning on-line journals as they are published New England Journal of Medicine Annals of Internal Medicine JAMA BMJ The Lancet e.journal (www.edoc.com)

Slide 25:Keeping Up To Date using the Internet

Scanning Professional Organization Sites, especially ones that provide frequent reviews of new information American College of Physicians - ACP Journal Club and Evidence-Based Medicine JournalWatch American Medical Association Reading Medical News Updates Medscape InteliHealth Doctor's Guide to the Internet My Yahoo (build your own newspaper)

Slide 26:Summary

Efficient Web Searching for Clinical Information Requires an Organized Strategy Others are working to index the information you want in useful ways The Issues of Time Utilization, Medical Vocabulary, and Reliability of information are less of an impediment than in the past - if you know where to look The Web is quickly becoming the instantaneously-updated library it has always had the potential to become http://itsa.ucsf.edu/~davoren/DavFile Ben.Davoren@med.va.gov