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Ann Thorac Surg 1996;61:1603-1604
© 1996 The Society of Thoracic Surgeons
Division of Cardiothoracic Surgery, East Carolina University School of Medicine, Greenville, North Carolina
Thoracic surgeons are changing from a posture of watching managed care and governmental agencies adjust the destiny of patient care and medical education to a proactive stance, attempting to help mold the future of health care. In many situations our interest peaked very late in the game. Just as changing clinical practices have begun to revolutionize care patterns for our patients, the exponentially expanding information age promises to make an even greater impact on medical education, clinical service, basic research, and communications in the 21st century and will perhaps render a more powerful impact than industrialization made on the latter part of the 19th century. Communications and dispersion of information have become watchwords of our time. Within the past year the Internet has become a household word. However, most physicians remain unfamiliar with the term or have not fantasized the potential spectrum of this polydendritic communications web.
The anlage of Internet was initiated in the early 1970s from an overlay of military and National Science Foundation computer networks. The subsequent communications system originated much like lymphatics, developing many collaterals with alternate routes of connectivity arranged randomly between central computer servers. Since then multiple networks now interlink a truly international communications network, or worldwide web, that now virtually has universal public access. In many circumstances the challenge now has become optimal deployment and utilization of this resource as issues of security, moral responsibility, privacy, and freedom of speech are of great concern to most who now seek benefit from this new form of communications.
Medicine and surgery are changing at a flux rate that we can believe barely. To address these changes surgeon specialists must become more adept at communication, public expression, organization, global leadership, and the development of proactive action plans for the future. To do this we need instantaneous communication and rapid access to the worldwide knowledge base. Formerly separated by academic walls and sector differences, we remained isolated but for medical meetings, journal reading, local conferences, and operating room chat. Now it seems both the challenge and professional responsibility for thoracic surgeons to rise to master what really is a new literacy. This is befuddling to most of us who have done well in the old paradigm of Osler's masterword-work-hard work combined with strategy and implementation. With the millennium change, so must we change in this arena. The risk is electronic illiteracy, which could be as debilitating as an insult to Broca's area, impairing interpretation and expression. It seems prudent for surgeons to make the leap rapidly and tap into the wonderful network of knowledge and communication. Though seemingly advanced, the Internet is an embryo with future potential beyond belief. But even now we can leap from the Countway library at Harvard ...to `Old Bodley' at Oxford ...to the National Institutes of Health ...to the Cardiac Surgery Research Laboratories at the University of Toronto ...to the Karolinska in Stockholm ...to professional medical organizations ...to my friend in Novosobirsk ...to the Virtual Hospital at the University of Iowa-all within a few minutes by the stroke of the keyboard and mouse. Computed tomographic images, patient care guidelines, educational material, grant information-there is more than you will ever believe unless you take the leap. There are news groups with direct communication and information sharing among individuals interested in a variety of medical and nonmedical subjects. For many of us at the half century mark and older, the task may seem formidable, but it assuredly is less ominous than the advances we have made in video-assisted and minimally invasive thoracic surgery in the last few years. Nearly every hospital or university has the informatics resources to get novices "on-line."
Simultaneously, our profession has developed a need for near-immediate transfer of educational and research information as well as interpersonal communications. The need is expanded more rapidly with our ever-decreasing time increment formerly devoted to surgical education. Clearly, for us to keep our knowledge base timely, surgeons must adapt and embrace the current information technology that either is or will be available to us shortly. Thoracic surgeons always have been first to develop and achieve a high degree of technologic skill whether it be video-assisted surgery, transplantation, or open cardiac operations; however, many of the same individuals seem passive regarding preparation to use the information sources soon available. Computer literacy has or will become almost a necessity for the surgeon. Whether through CD-ROM disks of a surgery text, the Grateful.Med link to the National Library of Medicine, or simple E-mail, computer access will become synonymous with information availability. In the next 10 years the difference between a surgeon who has a basic knowledge of computer access to information and one who lacks this facility will be similar to the coachmaker who would not yield to the model T Ford because there were many problems with the early car. You will be able to get there, but others will have come and gone before you can "saddle-up."
Project into the future ...see that the Internet will be able to convey not only E-mail and web pages that we find now, but that telemedicine conferences, journals, diagnostic images, historical works, research co-ventures, clinical records, and much more will traverse the world nearly instantly. If I now can visit a surgeon friend in Matsuyama, a high school ham radio buddy in Novosobirsk, and an academic surgeon in Boston as well as those who educated me at Duke University all in less than 10 minutes, it is easy to extrapolate to the future. Near--real-time duplex audio transmission now is possible between interacting sites. In time Internet communications will probably provide rapid worldwide links for telemedicine. Would it not be helpful to learn from those most expert in the field of thoracic surgery, instantly and on-line, from operating suites in London, Boston, Paris, or St. Louis? We could communicate from university to university ...to community hospital and back ...and all interactively. But there are concerns that may become rate-limiting steps that include security and privacy; hardware and software issues; loss of revenues by publications; and state, federal, and international laws. All of these will become even more important as Internet capabilities expand. Most assuredly these issues will be resolved and should not pale our interest or progress any more than the lack of cardioplegia prevented us from replacing cardiac valves.
Currently, cardiac and thoracic specialties are beginning to have a presence on the Internet. At the end of this article, a number of key Uniform Resource Locator (URL) addresses are shown as an "appetizer" guide to cardiac- and thoracic-related "web pages" or "web sites." Most university centers have evolving Internet access programs and are prepared to educate those of us who never had any computer interest earlier. For others most cities have Internet providers who are happy to establish access for you at a moderate charge. Also, the Internet can be accessed from commercial services such as America On Line, CompuServe, or Prodigy. Specialty organizations that have developed web pages include the American College of Cardiology, the American Heart Association, and the American College of Chest Physicians. Soon The Society for Thoracic Surgeons will be joining the ranks by dispersing educational and organizational information via their evolving Internet program. The National Library of Medicine and the National Institutes of Health can be accessed rapidly, with guidelines, position papers, and images available. A number of cardiovascular research groups have a presence on the Internet, including the University of Virginia, Harvard, and the University of Toronto. Washington University provides the Cardiac Compass web site, which is a "jump station" to many cardiac-related sites. The University of Pittsburgh has listed criteria for lung volume reduction surgery. Visit the Division of Cardiothoracic Surgery at New York University! The Heart Surgery Forum now provides a venue for cardiac surgery case reports and technology. The evolution is enormous, and promises to be astronomical in the future. However, we all want to access only information that is reliable and accurate. Thus, as various cardiothoracic surgical publications and forums come on-line, standards and editorial review must be included to assure exchange of only the best information along the Internet, just as we have done for our "paper" journals. Without the same standards, the educational quality will erode rapidly, and may mirror the results of excessively aggressive business and federal management of American health care.
There are secondary benefits for surgeons learning to use the Internet. Many in our specialty are not yet computer literate, and this venue will help more of us understand the instruments that will become standard for education and communications of the future. Thus, by embracing this new route, surgeons will have instant access to other areas of "computerism" including all forms of knowledge, both medical and nonmedical. We will learn to use the basic electronic tools needed to build upon for the future. Believe me, all of this wonderment is still akin to the vacuum tube stage of electronic development ...envision your office or operating room in the year 2020.
In this issue of The Annals of Thoracic Surgery, Dr Replogle [1] has announced The Society for Thoracic Surgeons' vision for the future use of the Internet for continuing education of and communication with thoracic surgeons worldwide. Clearly, the excitement of The Society promises to be transferred through his comments, and The Society will have a new powerful communications network. Think of it ...a worldwide thoracic surgery network that can narrow the gaps in our practice culture, scientific achievements, and education. Our many worldwide thoracic surgical societies and their members will become closer. The Annals of Thoracic Surgery also is pleased to announce The Annals' Web Page, which has been developed in conjunction with our publisher, Elsevier Science, Inc. At present editorial board members are listed along with the table of contents for each issue. In the future this page promises to be an information source for authors and in time will develop into a mechanism for even more rapid review of manuscripts. Also, in this issue, Dr Ferguson provides the readers with the new E-mail address for communication with the editorial offices of The Annals. We are in hopes that you will communicate your thoughts via this new information highway. So join those of us who have-with difficulty, I might add-left the coach and turned on the computer to a new world of medical education. The final result will be well worth the effort, as the Internet may represent the "phenotype" of the major mode of communication and education for our specialty as we approach the new millennium and perhaps even virtual surgery. Join me as I slowly metamorphose into chitwood{at}brody.med.ecu.edu and feel some pain, but I know that this is necessary surgery.
Footnotes
Address reprint requests to Dr Chitwood, Division of Cardiothoracic Surgery, East Carolina University School of Medicine, Greenville, NC 27858.
Reference
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