Network: Appointment with the cyberdoc

Virtual consultations, online surgery and instant access to internation al journals could soon transform the medical profession. By Mike Hewitt
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Indy Lifestyle Online
Today, the workload of GPs is so heavy that many are forced to deal with patients on an assembly-line basis. Unless you have something vaguely intriguing such as necrotising fasciitis or a touch of Ebola, your average consultation, diagnosis included, is not likely to last much longer than the time it takes to drop your trousers and cough.

The main problem is that a large part of a doctor's working day is taken up with research, compilation of case notes, and basic administration. This is where a new online service - recently launched in Germany and expected to be available in the UK within the next couple of months - could help.

Health Online Service (HOS) overcomes the reluctance of many health professionals to use the Net. Basically, it is a doctors-only version of CompuServe or CIX. As such, physicians can log on, confident that they are not going to be besieged by hypochondriac techno-nerds seeking an online acne cure. The new service features the usual forums, e-mail, conferencing, databases and online journals, but all organised by, and for, physicians. And it is free, so long as you have the necessary medical initials after your name. If you do not, but are still curious, there is limited access over the Internet at http://www.hos.de/&quot.

The company behind it all, German publishing giant Burda, is not acting out of pure altruism, however. Its extensive market research established what anyone who has ever looked at the ranks of BMWs in the reserved sections of hospital car-parks already suspected - doctors are doing very nicely, thank you. So HOS, as well as "delivering the world's collective medical knowledge directly to the doctor's desktop", seeks to relieve him of some of his disposable income.

Much of the service's financial backing comes from organisations such as online banks, travel agencies and shops. Major drug companies pay for pharmaceutical advertisements to roll, continually, along the top of the screen. Even if a physician skips, say, from a conference to e-mail, and then to a database, the adverts will pursue him relentlessly, like some virtual Inland Revenue inspector. For a minimal fee, however, they can be turned off.

But HOS is not just a virtual snare for cash-rich medics. Many doctors believe it is set to transform the way in which their profession functions.

Helmut Wilimzig, a Munich-based doctor, says: "I used to spend several hours every week just going through medical books and journals doing basic research - time that could otherwise be spent with my patients. HOS gives me access to dozens of databases and international medical journals. I can now get this sort of information in seconds. Medline, for example, has more than 7.8 million articles abstracted from 3,700 journals. The information is updated with 31,000 new items each month, so I can be sure I'm getting the very latest."

There are also hypertext links from the databases directly into drug companies' Web sites. If a specific medication is mentioned in an article, doctors can retrieve all the information on the drug with the click of the mouse - including how effective it is, whether there are any side- effects and what happens if it is taken with other drugs - before deciding whether to prescribe it. They can even order it online. Having done so, they can then upload details of its success, or otherwise, for others to see.

HOS could, in time, eliminate the need for people to travel long distances to see specialists. X-Rays, CT scans, video images, and case notes would simply be uploaded into the network from the patient's local clinic. A few seconds later, consultants based anywhere in the world would be able to view the results and make diagnoses.

One significant development along these lines took place in late March, with HOS's first live transmission of a surgical operation - the repair of a torn ligament. Over the course of the 90-minute operation, still pictures were transmitted, one per minute, over the Net, along with text explaining what was going on and why. Simultaneously, participating physicians worldwide were invited to e-mail any questions they had to a team of surgeons observing the event in Stockholm. The system was overloaded with doctors trying to view the procedure, so HOS has since posted a summary for those who were unable to log on.

All these virtual consultations and their reference details are automatically logged by the system, as are routine functions such as the updating of patient records. To ensure confidentiality, all the online data is encrypted using DEC's "military strength" 786 character encryption-key software. So far, HOS is the only application to be awarded an export licence by the United States for this security technology.

Doctors' practices wanting to use the system might have been stretched by the hardware requirements a couple of years ago. The front-end software runs under Windows 95, which means participating doctors will need their own computers with the horsepower to cope. The recommended minimum specification is a 90Mhz 486 or Pentium with 16 Mbytes of RAM, a 500 Mbyte hard disk, and a V34 modem. Today, that level of kit is approaching entry-level, and is available at a discount from Dixons.

In any case, Burda has discovered that most doctors are already equipped with a computer. Those who are not, or who need to upgrade, should make savings of up to 10 per cent in their overall budgets - more than enough to pay for the hardware. In Germany, HOS has made agreements with a number of suppliers - most notably DEC and Hewlett Packard - to install, train, and fully maintain PCs at doctors' premises on a sale or lease option.

The HOS project, which has taken more than two years to come to fruition, was unveiled in Cannes in February, and immediately attracted a great deal of interest from physicians in the US and Great Britain. Currently, most users are German, reflecting HOS's origins. If, as Burda hopes, the system lives up to its hype, tens of thousands of physicians worldwide will have signed up by the end of the decade. By necessity, the flavour, and the lingua franca, will be English.

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