Computing for the Next Millennium Damir Sapunar Department of Histology and Embryology, Split University Medical School, Split, Croatia

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March 1999 (Volume 40, Number 3) Computing for the Next Millennium Damir Sapunar Department of Histology and Embryology, Split University Medical School, Split, Croatia

Computer technology has changed our lives, even that of physicians. In a few years time, a physician can expect to have a new tool by the bedside: a hand-held computer small enough to put into a pocket and powerful enough for all everyday activities, including highly specialized and sophisticated activities such as prevention of adverse drug reactions. The Croatian Academic and Research Network (CARNet) was crucial in bringing the benefits of the information technology to the Croatian scientists. At the Split University School of Medicine, we started the Virtual Medical School project, which now also includes the Mostar University School of Medicine in neighboring Bosnia and Herzegovina. Virtual Medical School aims to promote free dissemination of medical knowledge by creating medical education network as a gateway to the Internet for health care professionals.

Key words: computer communication networks; computer literacy; computers, personal; Croatia; education, medical

People have short memory. We often forget how dramatically computers have changed our lives. Several weeks ago I flipped through my colleague's doctoral thesis and noticed that it was written on a typewriter. I was stunned! How was it possible to write something with more than several pages without a computer and, what is more surprising, less than a decade ago? When I compare the way we do things with computers and the way we did them before their time, the change is all the more startling. One more thing comes to my mind when I think about benefits brought by information technologies – the role of the libraries. I must admit that during these past years I have very rarely visited our library (I wonder if it is still out there). When I need an article I use my credit card and visit OVID (Ovid Technologies, Inc. New York City, USA) or some other provider of access to the bibliographic and full text databases for academic and scientific research. Today almost all libraries in western academic medical centers have Internet access, and the percentage of hospital libraries with Internet connection in USA has risen from 24% in 1993 to 72% in 1997 (1). Not only do we not realize the benefits brought to us by information technologies but we have also become spoiled, asking for smaller, more powerful, and easy-to-use machines: PCs, laptops, organizers, software, e-mail utilities, Internet, etc. Of course, all physicians do not have to like computers, and rightfully ask for a more easy way to use hardware and software. I can not predict what kind of machines will be developed for the next millennium. I will just write a letter to Santa and tell him what kind of computer I want: a handheld computer small enough to fit into my pocket and powerful enough for all my everyday tasks (text processing and communication). I do not want to type on a small keyboard or to pick letters with a pen, and the machine must be powerful enough to perform voice (speech) recognition (including languages other then English). I don't want to only enter text through such voice recognition software but also to issue commands and perform tasks (remember the scene from Bladerunner when Harrison Ford explores a replicant photography). It must have a bright color display and its batteries must last at least a month. Of course, it must have a built-in wireless modem so that I can check e-mail during my vacation on a lonely beach. Such a machine should not be a toy for computer geeks but should help physicians in everyday work. One example of its potential usage in everyday workflow is prevention of adverse drug events (ADEs). ADEs are the most common type of iatrogenic injury occurring in hospitalized patients (2). Clinicians could use an information system based on handheld computers and good databases to prevent patient injury secondary to a broad range of ADEs (2). No one should underestimate the power and usability of these devices. They have a thousand times more storage capacity and speed than my first desktop. On my desktop, I would like to have a ”monster” PC with software to talk to and programs that will be so intuitive to need no help in learning. Of course, I need an Internet connection fast enough to allow videoconferencing. I would also like to change a few things about the Internet. We often hear that all information is now equidistant, and that computers erase differences between the rich and the poor (3). Unfortunately this is not true. It seems that the Internet is only a new media which will make poor become poorer and the rich all the more richer. This new business goldmine is simply making us want to buy, buy, and buy over the Internet (check Internet stocks on CNN!). Yes, there are free things on the Internet but with these sites we have serious quality problem. Most major medical journals and sites are charging for their services (my best regards to those who don't). When I look back on my wishes, they really seem very modest. They will all be fulfilled in a year or two. Real advances are beyond my imagination and they go far from endless Internet and intranet wiring, terabyte storage capacity and enormous CPU (Central Processing Unit) speed. Perhaps they may come from the development of the first neurochip, a system which connected rat embryonic neurons with an ordinary chip (4,5). That kind of future will probably erase the border between carbon and silicon worlds. Although these advancements sound spectacular, we should not overestimate the significance of information technology. Information technology revolution taught us to view the world as a global village, but even the smallest village has houses on the periphery. Unfortunately in Earth case majority of its inhabitants live on this periphery. World population, which passed 5 billion in 1987 has more than 75% in non-industrialized countries and between 1988 and 1990 about 20% of that population was estimated to have inadequate food. Undoubtedly, information technology will help us in knowledge transfer and application of scientific procedures and programs to people of developing countries but can we without second thoughts admit that these spectacular achievements will bring real benefits to their lives. But all this leaves a strong taste of bitterness, so it is best to stop think and write about it (as we all do). I also have a few wishes concerning my country. Croatian Academic and Research Network (CARNet) was started at the beginning of the 1991 war, as a project of the Ministry of Science and Technology. It was a way of seeking recognition in those difficult times, and today CARNet is a national academic computer network and the Croatian presence on the Internet. CARNet is also a testbed for research of the latest information technologies in Croatia. Although the network is based on a fast ATM (Asynchronous Transfer Mode) core, we all scream for more bandwidth (but isn't everyone around the world?). An important segment of CARNet's work are pilot projects. The objective of these projects is to explore the application of information technologies in various areas of academic activities. One of these is the Virtual Medical School (VMS) (http://www. mefst.hr/vms). It originated at the Split Medical School in Croatia and now includes the Mostar Medical School in Bosnia and Herzegovina. The project objective is to promote free dissemination of medical knowledge by creating a medical education network that will serve as a gateway to the Internet for healthcare professionals. The first step in the project development was the establishment of a group of educators who would participate in it. Their task was to develop VMS curriculum with loosely integrated lectures, elective material, case reports, digital image collections, and systems for knowledge evaluation. During the second phase, collected educational material will be organized in three segments – for students, physicians and patients. This site will also offer full access to the Croatian Medical Journal, a full text Internet edition free of charge. Several other journals will be included during the next year. At this moment the most important thing is to attract numerous users to become regular guests of VMS, i.e., to create a virtual community. The success of such a project depends on the quality of published material, and cooperation of academics, publishers, practitioners, and medical societies. Even if we fail, the project will connect people who would have otherwise probably never communicated.

Acknowledgement The Virtual Medical School project is supported by The British Council and a grant from the Croatian Academic and Research Network (CARNet).

References 1 Lindberg DAB, Betsy L, Humphreys MLS. Medicine and health on the Internet; the good, the bad, and the ugly. JAMA 1998;280:1303-4. 2 Raschke RA, Gollihare B, Wunderlich TA, Guidry JR, Leibowitz AI, Pierce JC, et al. A computer alert system to prevent injuy from adverse drug events; development and evaluation in a community teaching hospital. JAMA 1998;280;1317-20. 3 Turin L. Praise the Web. Wellcome News 1998;16:32. 4 O'Connor B. Researchers grow brain cell in neurochip. Biotech Lab 1998;3:1-4. 5 Tatic Lucic S, Wright JA, Tai YC, Pine J. Silicon culture-neuron prosthetic devices for in vivo and in vitro studies. Sensors & Actuators B-Chemical 1997:43:105-9. Correspondence to: Damir Sapunar Department of Histology and Embryology University of Split Medical School, PAK Spinèiæeva 1 21000 Split, Croatia [email protected]