INFO-I530 (Foundation of Health Informatics)

1. INFO-I530 (Foundation of Health Informatics) The Internet Lecture #3

2. Lecture in a Nutshell • The Internet and World Wide Web • The Internet as a Technological Phenomenon • The Internet as a Social Phenomenon • The Internet as a Commercial Phenomenon • The Internet as an Enterprise Phenomenon • Communication on The Internet • The World Wide Web • Web Health Services • Rapid Dissemination of Information • EMR and Web Technologies • Dissemination of Peer-Reviewed Knowledge • Continuing Education and Decision Making • Health Information on Web for Patients • Notification Systems and the Clinical Community

3. The Internet and World Wide Web

4. The Internet as a Technological Phenomenon • It evolved out of the Advanced Research Projects Network (ARPAnet) developed by the DoD in the late 1960s. • The result of this work was a standard internetworking protocol (IP), which regulates the way in which computers communicated with each other across the network. IP operates at layer 4 (network) of the OSI model. • Initially the information transmitted across the Internet consisted of text-based electronic mail, or computer files that were shipped from one site to another. • Work that began at the European Particle Physics Laboratory (CERN) in 1989 resulted in a set of communication standards and software that provided Internet users with a simple way of creating and accessing such information. • A hypertext computer file includes links within it to other files, possibly located on a distant computer. Activating a hypertext link on a document permits a reader to view the document attached to the link (non linear space). • This expanding global collection of interconnected information sources became known as the World Wide Web.

5. The Internet as a Social Phenomenon • The Internet has been around since the 1980s, but it was the advent of the World Wide Web that triggered its public growth. • By the end of the twentieth century, the Internet was in a phase of massive expansion with monthly growth rates of well above 15%. • Associated with the growing public interest in the Internet is a brand of more extreme social futurism: cyberspace and virtual reality • A feature of the futurism associated with the Internet is the belief in a technology-enabled information society. • Digital Divide: as the population of many resource-poor nations still have limited access to the Internet.

6. The Internet as a Commercial Phenomenon • Telecommunications carriers, cable television companies and personal computer companies, believed that the Internet had the potential to wipe out their businesses. • The wealth and competitive aggression of such companies led to significant over-investment in Internet businesses, and that resulted in the 'dot com‘ boom, and bust. • Four basic Internet businesses: • Transport: refers to the industries that provide the physical networks upon which the Internet is built, and it is the domain of telecommunication, cable and wireless network operators. • Internet Providers: Providing connection into the Internet is in itself a business. This is typically how most homes are presently connected to the Internet. • Services: many diverse existing businesses can use the Internet to provide their services to a larger community of people. • Content providers: the Internet has created a new demand for information. So-called content providers, be they traditional publishers, or companies that control other forms of information.

7. The Internet as an Enterprise Phenomenon • The Internet provides a new model for the way organizations can organize their internal communication and information systems. • The technological advances that have driven the growth of the Web on the external Internet are just as applicable to these internal networks. The use of Internet technologies on an internal computer network creates what is termed an internal Internet, or intranet. • Using IP allows a uniform protocol to be used across an enterprise's network. Just as attractively, the simplicity of the Web's multimedia and hypertext makes intranet systems much easier to use, and requires less specific training of staff. • The Web model allows workers across an organization to create and locally maintain their own information services. For example, manuals and information packs can be placed online and updated without any central support being needed (hospital bed report on intranet).

8. Communication on The Internet • Information Push: messages are pushed out to targeted individuals. • Information Pull: access is based on individuals seeking toward information sources. • Peer-to-Peer Communication: when messages are sent from one individual to another. • Narrowcasting: Sending a message to a select group of individuals. • Broadcasting: widespread distribution. Newsgroups are an example of the information pull communication method. Message responses can broadcast to the public. An e-mail message is an example of a information push, peer-to-peer method that can also be used to narrowcast to multiple destinations.

9. The World Wide Web • The World Wide Web protocols are overlaid on top of the Internet, and provide a standard way for creating, finding and accessing documents. • HyperText Markup Language (HTML): A standard way in which to create multimedia hypertext documents. • Universal Resource Locator (URL): A standard way to give each document an address on the Internet so that it can be located. • HyperText Transfer Protocol (HTTP): A standard way of transferring documents between computers.

10. The World Wide Web cont. Components of Web hypertext documents can be located on different computers. These multimedia documents may contain text, still or moving images and sound recordings.

11. The World Wide Web cont. • Different ways in which one can search the information space: • Specific address: If the location of a document is explicitly known, then specifying its address (its URL) will permit a browser to directly request a document from the computer it is stored upon. • Directories: Many directory services are offered on the Web, listing documents according to categories. • Search engines: create keyword indexes of as many documents as possible. Using these indexes, a user specifies the words that are likely to be associated with the topic of interest. 'Web crawlers' automatically traverse the Web, following links from one document to the next. • The problem of making the process of search tractable becomes ever harder as the number of documents on the Web grows (Information Retrieval). • Other initiatives: ranking weight, personal software agent, …

12. The World Wide Web cont. • Publishing on Web: Data, models and views on the Web. A Web browser provides a view on to the data in a document, and interprets how to present it according the model described in HTML. • Security on the Internet: Once data (D) have been encrypted according to a code, they can be securely transported across a communication channel like the Internet To be able to decode the data, one must possess a key or code that is the model (M) used to encrypt the data

13. The World Wide Web cont. • Most of the Web's content today is designed for humans to read, not for computer programs to manipulate meaningfully. There is no easy way for a computer to understand any of the semantics of a web page. • Much effort is now being devoted to understand how web documents can be structured in a machine interpretable way that allows intelligent programs to make decisions based on the information they find as they traverse the Web. • The task for the developers of this Semantic Web is to begin to add logic to the Web, to allow intelligent programs or agents to use rules and make inferences based on the information contained in Web sites. • Since the meaning of particular words or terms varies from one context to another, the Semantic Web also envisions methods for allowing agents to use ontologies to help them understand the specific type of information that different pages might contain.

14. Web Health Services

15. Rapid Dissemination of Information • Amount of Information: As information technology has become more pervasive, the physical aspects of publication have shifted some of the act of publication closer to the creator of the original information. • Speed of Appearance and Timeliness: A corollary of the speed of publication is the rapidity with which information is now able or permitted to change. • Version Control: There is only one access point for a Web document, and it is always the current version. • Type of Information: Many healthcare publications take full advantage of the multimedia and hypertext facilities. • Permanence: Another important aspect on the Web is that our belief in the permanence of information begins to erode. • Manner of Interaction: Web resources are not necessarily passive information repositories. They can be constructed to solicit input from the reader. • Searching: The advantages of the Web is that, through the search engines and indexes that now exist, one can perform the same type of search globally. • Remote Collaboration: The Web is more permissive than many early groupware offerings in this respect, since it allows individuals to create and distribute information with little regard to its structure.

16. EMR and Web Technologies • Despite the promise of the EMR, several significant technical obstacles have hindered its widespread adoption: • As organizations grow and obtain new information systems, there arises a need to integrate these with older or 'legacy' systems which continue to function in parts of the organization. • One constant in the development of the EMR has been the running battle with obsolescence of the functional specification of these systems (when healthcare practice changes). • There are as yet no internationally agreed standards on how a medical record should be structured, or the communication protocols that should be used to share medical records between institutions. • Many of these problems may be solved by using Web technologies: • Since the Web uses IP as its basic networking protocol, it is designed to interoperate with a variety of other networking standards (HL7), and should therefore support interaction both between different components including legacy systems. • The basic Web technology is designed specifically to handle multimedia, and imposes very few requirements for document display. • The Web is also seen as a mechanism to permit patients to access their medical records directly, from wherever they may be.

17. Dissemination of Peer-Reviewed Knowledge • Speed of publication: Eliminating the need to physically print journals, and then distribute them through a postal system, reduces the time between publication and appearance of a journal. • Cost of publication, distribution and access: The elimination of printing and distribution stages makes Web publishing cheaper than paper journals. • Form of publication: The multimedia and hypertext capacity for Web documents means that research appearing on the Web can appear in far richer forms than is possible on paper. • Content of publication: A research paper can include all the data obtained during the investigation. • Method of interaction: Some journals have taken advantage of the two-way communication afforded by Internet publication to open up the peer-review process of articles to the journal's readership.

18. Continuing Education and Decision Making • All health professionals need to update their knowledge to keep up with changes in knowledge. • This activity is often called continuing professional education (CPE) or continuing medical education (CME) when specifically addressing medical needs. • It has been proposed that in the future most CPE will consist of using online information technology to answer immediate clinical questions. • The whole notion of CPE changes from one of periodic updates to a clinician's knowledge to a ‘just-in-time’ model where a clinician checks the medical knowledge base, potentially at every clinical encounter. • Studies investigating the barriers to the use of online evidence resources have identified a range of factors including insufficient training in both database searching and general IT skills. Problems with access to computers, excessive amounts of information and socio-technical views are also other barriers.

19. Health Information on Web for Patients • The general public has access to a wide variety of health-related material, often of variable quality or relevance. • It may still be the case that in some areas a higher percentage of patients than general practitioners have access to the Internet. • We must assume that patients have access to information on best practice from a variety of sources on the Internet and will demand it when it is known. • Treatments that are the most cost-effective over a population may be favored over treatments that are best in class (availability versus accessibility). • Risk of poor quality information: epidemiology in health informatics. • Official health information standards could be used to voluntarily label information and help the public make better choices. • Personal Health Records (PHR): Custom EMRs for patients

20. Notification Systems and the Clinical Community • Although publishing using Web technologies is a powerful way to disseminate information, it is a passive or 'pull' broadcast medium. • The Internet changes the way an organization is able to communicate through the distribution of information. It is often the case with publicly sensitive information that healthcare workers need to be notified in advance of the public, so that they can be prepared to deal with the consequences of such announcements. • Some rudimentary systems have already been put in place to communicate urgent public health information. Through a combination of fax, paging and e-mail technologies, it is possible to contact most people in developed countries. • Governmental bodies have developed systems for reporting adverse drug reactions. • Globally, the World Health Organization (WHO) has developed FluNet, an Internet application linking the WHO network of influenza centers.

21. Summary • The Internet and World Wide Web • The Internet as a Technological Phenomenon • The Internet as a Social Phenomenon • The Internet as a Commercial Phenomenon • The Internet as an Enterprise Phenomenon • Communication on The Internet • The World Wide Web • Web Health Services • Rapid Dissemination of Information • EMR and Web Technologies • Dissemination of Peer-Reviewed Knowledge • Continuing Education and Decision Making • Health Information on Web for Patients • Notification Systems and the Clinical Community