Computers, the Internet, and the Practice of Medicine: Title and subTitle BreakA Call for Papers

Computers in general and the Internet in particular have revolutionized many aspects of our lives. Although some have criticized medicine for being slow to embrace these tools to their full advantage,¹ medicine is being transformed. Interregional and international communication, methods of practice and practice management, even the patient-physician relationship—all have been affected. Monumental change lies ahead.²

The Internet, and particularly its user-friendly subset, the World Wide Web, is an increasingly popular means of communicating information to physicians, other health care professionals, and their patients.^{3 - 4} For some physicians, e-mail permits the informal, personal contact with patients and families that a home visit used to provide.⁵ The Web is being used to study disease,^{6 - 7} to educate, train, and certify physicians,^{8 - 9} and to inform and even counsel patients.¹⁰ Patient data can be transmitted instantaneously to physicians and researchers at the next hospital or around the world.¹¹ But concerns about this medium challenge its promise. The Internet is a source not just of information but of misinformation.^{12 - 14} Its value as a patient care resource and professional educational tool is only starting to be tested rigorously. Concerns about patient confidentiality in a digital world abound.^{15 - 16}

Can the Internet improve the way physicians learn and communicate with their patients and each other? How should the patient-physician relationship evolve to exploit the seemingly unlimited and often unfiltered clinical information available to patients? Will physicians take on an enhanced role as counselors and educators in the face of so much information and misinformation? Can the Internet be an effective, useful public health and clinical research tool?

THE JOURNAL raised many of these questions in an editorial last year,¹² one goal of which was to raise the level of discussion about how to help this medium fulfill its potential of becoming much more than a vanity press and cyberspace toy. To address these and many other questions, an issue of THE JOURNAL in late 1998 will be devoted to the use of computers and the Internet in medicine. We invite submission of manuscripts that examine the effect of the Internet on the patient-physician relationship and the use of the Internet for teaching and consulting, including its effectiveness compared with other methods of communication, and the potential consequences of such an approach for patients, physicians, health care systems, and academic medical centers. We encourage submission of systematic studies of the quality of medical information available in various online venues, including methods of quality assessment and improvement, and ways in which physicians can work with patients to harness the power of the Internet to make better-informed health care decisions.

Beyond the Internet, how should computers be applied in medicine? Should every patient record be transformed into a digital file, linked to laboratory data and individualized recommendations based on clinical practice guidelines, with supporting references online? How can patient confidentiality be ensured? We invite studies addressing the effectiveness of online patient databases in improving care, the optimal structure of such databases, and the consequences of such a shift in practice. Does telemedicine enhance or hinder the consultative and teaching role of the physician? How can computers provide information on the relevant advances in clinical medicine in "real time" to educate the physician when the next patient enters the physician's office or even to educate the patient long before the visit?³

We invite.sgminal research papers on these subjects, as well as systematic reviews and cohesive commentaries. Submitted manuscripts are subject to our usual rigorous peer review process; acceptance for publication cannot be guaranteed. Papers received by April 1, 1998, will have the best chance of acceptance. We look forward to publishing the state of the art—and science—in this far-reaching and fast-moving field.