Technology Review Cruising the Information Highway: Online Services and Electronic Mail for Physicians and Families John G. Faughnan, MD; David J. Doukas, MD; Mark H. Ebell, MD; and Gary N. Fox, MD Minneapolis, Minnesota; Ann Arbor and Detroit, Michigan; and Toledo, Ohio Commercial online service providers, bulletin board ser­ indirectly through America Online or directly through vices, and the Internet make up the rapidly expanding specialized access providers. Today’s online services are “information highway.” Physicians and their families destined to evolve into a National Information Infra­ can use these services for professional and personal com­ structure that will change the way we work and play. munication, for recreation and commerce, and to obtain Key words. Computers; education; information services; reference information and computer software. Com m er­ communication; online systems; Internet. cial providers include America Online, CompuServe, GEnie, and MCIMail. Internet access can be obtained ( JFam Pract 1994; 39:365-371) During past year, there has been a deluge of articles information), computer-based communications, and en­ about the “information highway.” Although they have tertainment. Visionaries imagine this collection becoming included a great deal of exaggeration, there are some the marketplace and the workplace of the nation. In this services of real interest to physicians and their families. article we focus on the latter interpretation of the infor­ This paper, which is based on the personal experience mation highway. of clinicians who have played and worked with com­ There are practical medical and nonmedical reasons puter communications for the past several years, pre­ to explore the online world. America Online (AOL) is one sents the services of current interest, indicates where of the services described in detail. Recently, one of the the problems lie, and speculates about the future of the authors used AOL’s Internet access to obtain the latest information highway. data on management of testicular cancer. W ith a few clicks The term information highway has acquired many of a computer mouse, an engaging graphical interface interpretations, and there is ample speculation about its allows navigation through a menu of over 165 medical potential. Cable companies imagine a large number of information sources. This menu includes the National television channels and related entertainment services. Cancer Institute’s PDQ database, with a state-of-the-art Telephone companies focus on enhanced communica­ description of the management of testicular cancer. In the tion, including video images. Universities, government, same area, users can review Morbidity and Mortality and today’s online service providers advocate a collection Weekly Reports (MMWRs) from the Centers for Disease of computers that provide goods and sendees (particularly Control and Prevention, clinical alerts from the National Institutes of Health, and pressure sore clinical guidelines from the National Library of Medicine. All of this infor­ Submitted, revised, June 9, 1994. mation and much more is stored on computers around From the University of Minnesota, Health Computer Sciences, Minneapolis, Minne­ the world. AOL allows subscribers to view information sota (J.G.F., email: [email protected]); the Departments of Family Practice, University of Michigan, Ann Arbor (D.J.D., email: David.Doukas® through their connection, or gateway, to the Internet, a nm.cc.mnich.edu), and Wayne State University, Detroit (M.H.E., email: network that links a huge number of separate resources. [email protected]), Michigan; and The Toledo Hospital Family Practice Residency Program (G.N.F., email: [email protected]), Toledo, Ohio. Requests for re­ All the online services described in this paper have prints should be addressed to John G. Faughnan, MD, University of Minnesota Health their own private reference and discussion areas (medical Computer Sciences, UMHC Box 511 Mayo, Minneapolis, MN 55455 (email corre­ spondence preferred). and nonmedical), as well as access to thousands o f lnter- © 1994 Appleton 8c Lange ISSN 0094-3509 365 Ihe Journal of Family Practice, Vol. 39, No. 4(Oct), 1994 Communicating via the Information Highway Faughnan, Doukas, Ebell, and Fox net resources. There is something for everyone: family Good communications software allows the user to do as members who want to keep in touch through electronic much work as possible offline (before this connection is I mail (e-mail), physicians who want to participate in an established), which is economically advantageous, since electronic exchange of ideas on the social and behavioral online charges typically begin when the connection is aspects of family medicine, or an isolated rural physician made. Even though modems are less costly and more who wants to stay connected to a network of educators reliable than they used to be, using them can be a frus­ and other physicians—it is all possible through online trating experience. The quality of telephone connections sendees. varies, and poor quality telephone lines make high-speed We will begin with basic principles, followed by the modem communications difficult. Modems are an awk­ fundamentals and features of representative online ser­ ward bridge between the separate worlds of telephone vices. Our intent is to give readers a general understand­ and computer. Experienced computer users eagerly antic­ ing of the subject and to provide guidance for online ipate the day when true computer networks rather than exploration. voice lines are available for communications. Online services is a term applied both to the services that can be accessed by modem and also to the entities The Basics that create, maintain, and provide those services (eg, CompuServe). These sendees include reference materials, ' Computer communications is simpler than renal physiol­ communications, information, entertainment, computet | ogy or VCR programming, but it involves a few novel services, and commerce ranging from airplane tickets to concepts with which users should become acquainted. To stock options. An access provider is an organization that that end, the process is described in terms of its compo­ provides access to online sendees, but does not create or nents: the user, the user’s personal computer and com­ maintain them (eg, Internet access providers). Although munications equipment, the connection between the us­ online service providers vary significantly, ranging from er’s computer and a distant online service, and some of tiny neighborhood electronic bulletin boards to large cor­ the services that are bundled together to produce an on­ porations, they have quite a bit in common. line service. Computer communications adds a new dimension to I The user, affectionately known as wetware, interacts our ability to exchange information. Text is the most with online services through reading and typing, and by common content of an electronic message, but sound, using menus and a mouse to send directions. Typically, images, and computer files also can be exchanged. Com­ each user has one billing account, although some services munication can take place between two individuals or one allow many users to share an account. Subscribers to some message can be sent to many people. Messages may be online services can set up a family account in which each posted on public electronic bulletin boards, where they person has a private e-mail address. can reach many people. In most cases, communications A personal computer is the current gateway to online occurs across time, as with a letter, but it can also take services. Computers that run Apple Macintosh, Microsoft place immediately, as with a telephone conversation. Windows, IBM or Microsoft DOS, or IBM OS/2 soft­ E-mail functions in a manner similar to that of paper ware are easiest to use with these services. Communica­ mail. It most often consists of text sent from one person to tions software, which runs on these personal computers, another, but it is possible and easy to “ carbon copy” a manages communications hardware, and in cooperation single message to many recipients. The process of address­ with the computer, creates an interface, which enables the ing an e-mail message is usually automated by means of user to access online services. At one time, a terminal or software. Newer forms of e-mail allow audio and video teletype interface, which consisted of words that appeared attachments or computer files to be sent along with a one letter at time, was the only type of interface available. message. E-mail software can sort messages by date, sub­ Today, menus and pictures commonly help users navigate ject, or sender. E-mail is a useful alternative to telephone and work with online services. messages and paper mail. In theory, a person can retain A telephone line is usually the connection between one e-mail address throughout a lifetime regardless of the user’s personal computer and an online sendee. The residential changes, an obvious benefit in our mobile age. instrument that enables a phone to be used for computer Despite the potential of e-mail, the software provided by communications is a piece of hardware called a modem. many online services is disappointing, lacking sufficient This device translates computer signals into sounds, then addressing features and writing tools. translates the sounds back into computer signals at the Conferencing software allows many messages to be | other end. When the connection between