Call it computer karma, but while the Internet has found new ways of infecting our computers with viruses, it is also being used as a tool to cure human viruses. Doctors use the Internet as a valuable source of medical information. It’s updated more often than journals and textbooks, which can become outdated during the time it takes to edit them.
Many Web sites are designed for professional medical use, and some of these are search engines for medical journal articles.
DynaMed, an online clinical database based in Columbia, takes the premise one step further. Doctors type in a search for any medical topic from acne to Zollinger-Ellison syndrome, and DynaMed finds the most relevant and current information from more than 400 medical journals in categories such as diagnosis, prognosis, treatment and risk factors.
Brian Alper started the database 10 years ago when he was in medical school in Philadelphia and now operates the system in Columbia. Unlike a normal search engine, the database has only one hit per entry, which contains all pertinent medical research on the topic as determined by systematic surveillance of the research literature.
“The entries are focused on what is clinically important, what patients care about, morbidity rate, mortality rates, hospitalization rates,” said Alper, a research assistant professor at MU’s Department of Family and Community Medicine.
“We update it every day,” Alper said, “Because it is organized in an outline and comprehensive, you find the whole story. We’re the only system that puts the pieces together and is updated daily.”
Until two years ago, the database was free to all physicians. Now, subscribers use a “pay or play” method of payment. Doctors can either author or review topics for the database or pay $200. The prices are $150 for a licensed health care professional in training and $100 for a student of a health care profession who has not yet obtained a license. The service remains free to physicians working in developing countries.
“We think doctors are busy here, but over in developing countries they have even less resources,” Alper said.
DynaMed can also serve as a valuable resource for physicians in rural towns to access more information for diagnosis and treatment of conditions normally cared for by a specialist.
“Think of those living in areas where there’s not much except for a gas station and a Dairy Queen,” said Linda Zakarian, a research assistant for DynaMed. “If you end up with an uncommon medical problem, you may be fortunate to find a medical doctor, let alone someone familiar with the appropriate protocol.”
Alper recalls when a patient with rheumatoid arthritis, who would normally go to a rheumatologist, was able to go back to the family doctor. The doctor used DynaMed and was able to get the patient the proper treatment.
Dan Vinson, a professor of family and community medicine at MU, uses wireless laptops to consult during patient visits .
“If someone comes in with an herbal medication I’ve never heard of that they saw on the “Today” show and asks, ‘Should I be taking this?’ I do a quick Google search,” Vinson said.
Vinson not only uses DynaMed, but he is also a contributor, often peer-reviewing journal articles and teaching the online database program to third-year medical students. Vinson encourages his medical students to teach the system to the physicians in rural town practices where they go for on-site training.
Jeff Belden, a clinical associate professor at MU’s Department of Family and Community Medicine, saw a patient who had a blood clot in her leg that traveled to her lung and became a pulmonary embolism. “Five years ago, she would have had to check into the hospital to be treated, but on DynaMed, I read a summary of research confirming it is safe and equally effective to treat people at home.”
Belden said that while physicians are interested in online tools like DynaMed, they should choose a reference with a style that meets their needs.
“It’s similar to if someone tells you to go see this movie. It may work for them, but maybe it’s an action movie and you don’t like action movies,” Belden said.
Al Alper, DynaMed user support coordinator, estimates DynaMed serves around 4,000 subscribers, including hospitals, medical schools and nurses. Those who aren’t medical professionals are not encouraged to use the system.