Insurance Medical Directors and the Internet
Keith T. Clark, MD
Updated June 2001
Address email to keith.clark@westernsouthernlife.com
Some tips and tools for using the
Internet
Typical Projects
Obtain images for
presentations
Search the
medical literature
Search the
Internet
Find current
information on AIDS
Download
the Guide to Clinical Preventive Services
Obtain information from
the U.S. Census
Medical Sites by Type
Organizations
Universities
Government
Commercial
Other Sites
Interesting
Sites
Some tips and tools for using the
Internet
- Adobe Acrobat is a viewer used by many sites
for documents.
- Optimum times to use the Internet
- Best overall time is usually early morning
till about 11 a.m. Eastern Time
- Government servers are very busy from
midmorning to 5 p.m. Eastern Time
If you have trouble with response time
It can be one of several things
- Your ISP (Internet Service Provider)
- This is the service you connect
to, e.g. America Online, etc.
- If it is busy, you may see slow
response
- Your modem connection
- The faster the better
- 28 K is minimum
- Several ISP's are beginning to
support the 56K (actually 53K) standard
- If your company has high speed
access use it instead of your modem
- The internet is busy
- Peak times are lunchtime and
evenings
- The server you are attached to is busy
- Even if the rest of your
connection is fast, if the server at the other end is busy with
multiple users your response time is going to be slow
- You are downloading lots of graphics
- Graphics are usually large files
- If the site has a text only
version, try to navigate using text only
- This will usually speed up
your connection
Typical Projects
Obtaining
images for presentations.
- Good News
- There are many medical images available via
the Internet and more are becoming available.
- They can be readily copied and pasted.
- Although copyright must be observed, images
are generally royalty free.
- Bad News
- Images are large files and take a long time to
download.
- Many images must be reviewed before finding
appropriate images of reasonable quality.
- You can spend a lot of time looking for images
that can be found elsewhere.
Sites
The
Virtual Radiological Case Collection
University of Pittsburgh's Dept of Pathology
Dermatology
Online Atlas English version
- This link sometimes fails. Use
this link for a Yahoo search that will usually give this site as the
first hit
- At Univ. of Erlangen in Germany
- English menu available
- Very large collection of high quality (by
internet standards) dermatology images
- Search by alphabet or ICD-9 code
Loyola's Structure of the Human Body
- Anatomy course
- Includes anatomical images and
radiological as well
- Cross Sectional Anatomy viewer uses images
from Visible Human Project
Visible Human Project
- Superb images
- Excellent web resources for anatomy
listing
Harvard's "The Whole Brain Atlas"
- Normal anatomy and pathology with mri's
and ct scans
- Superb site
- Recommendation
- If you can find the image and have access subject to copyright laws, the
internet is quick way to get high quality images
- Otherwise, flatbed scanners are pretty reasonably priced
Search the medical
literature.
Free sites
- Physician Online
- Medscape
- PubMed is a search engine for
the archives of the National
Library of Medicine PubMed gives you access to over 600
million citations. You can't access the full text of the article, but most have abstracts
that are concise summaries of the articles. And this service is not easy to use. You will
have to spend some time learning to search, but it is very powerful.
- Provides access to Medline via Pubmed and Medline and
as well as multiple other databases. Their
differences are outlined here.
- Internet Grateful Med
is being phased out
- PubMed has
been recently upgraded with menu driven limits, etc.
- Overview
of Pubmed
- Also has links to molecular biology databases of DNA/protein
sequences and 3-D structure data
- Using Pubmed
- Example search term: journal of insurance medicine
- Other search fields for journals with links
- New England Journal of Medicine Link
- JAMA Link
-
Journal of the American Medical Association
- Lancet Link
- Tips
- If you plan to use this any, invest an hour in the help
section
- Make use of the limits function
- Description
- Use limits to set time span, abstracts only,
language, etc.
- Make use of the history function
- Description
- The history function allows you to create very
complicated queries
- E.g., show me all the articles about hepatitis
in JAMA and the New England Journal of Medicine in
the last 5 years published in English with an
abstract
- Do this by creating a separate query for
JAMA, New England Journal of Medicine and
hepatitis
- Combine them in two steps using the history
function
- First using 'OR' for the journals
- Then combine that using 'AND' with
"hepatitis"
- Now add limits, e.g., 5 years, English,
articles with abstracts only: about 50 hits
- For fee sites
- Paperchase
- Full access for $150 per year.
- Why pay for a service?
- Paperchase has an intuitive language
front end.
- Searching is faster and easier and
requires less training.
- Search the Internet
- Search Engines
- Yahoo
- Main page has simple search
- Yahoo advanced search
- Display up to 100 hits
- Use Boolean logic: and, or
- Yahoo has sites that are
manually indexed.
- Each site is reviewed for
content and assigned to a category.
- This helps to limit the
number of "hits".
- It also limits you to the
sites that have been reviewed and to their categorization.
- AltaVista
- AltaVista advanced search
- AltaVista is catalogued using Raw Indexing
- Alta Vista was the first large
site.
- Basically all the web content on
the Internet is indexed word for word.
- Very powerful.
- Downside is that simple queries
can return tens of thousands of hits.
- Limit hits by using advanced
searching (Boolean logic)
- Example
- Simple search >>
Social security death index returns about 18,000
hits
- Advanced Search >>
"Social security death index" returns about
18,000 hits
- Advanced Search >>
"Social security death index" and cdrom returns
about 120 hits
- Advanced Search >>
"Social security death index" near "cd
rom" returns about ten hits
- The difference is the use of
quotation marks. This makes the query look for an exact
word for word match
- Other internet search engines
- Lycos
- Metacrawler
- Front end search engine that uses other search engine
- Advanced
search lets you select which engines to use
Find
current information on AIDS.
- Fantastic sets of data slides
HIV/AIDS Surveillance Report
Find current information on
experimental/investigational procedures.
- This outlines what clinical trials are (e.g., Phase I vs. Phase II)
The FDA Drug Approvals
list is updated weekly (but may not have all new drugs)
Various resources for clinical trials
Obtain
information from the U.S. Census.
U.S.
Census bureau
Medical
Sites by Type
Universities
Government
The Center for
Disease Control
National
Center for Health Statistics
- Data warehouse of health information
- NCHS
Public-use Data Files and Documentation
- down-loadable public use datafiles
- too many files to list but include cause of death, birth
data, multiple cause of death, health information (ambulatory,
hospital, nursing home), family growth,
NHANES II Mortality Study, and so on
- Federal
Electronic Research and Review Extraction Tool (FERRET)
- This project represents a collaborative effort between NCHS
(National Center for Health Statistics) and the Bureau of the
Census. FERRET system will provide full access to complex large
data sets through the Internet, allowing you access to micro-data
sets via the World Wide Web. Currently, the 1994 Underlying
Cause-of-Death File, the 1993 National Health Interview Survey and
the third National Health and Nutrition Examination Survey, NHANES
III are available via FERRET.
National Institute of Health
The
Department of Health and Human Services
Federal Drug Administration
HCFA (Health
Care Financing Administration)
U.S. Government Printing Office
- This page includes a search engine
The National Technical Information Service
- The official resource for
government-sponsored U.S. and worldwide scientific, technical,
engineering, and business-related information
- Use their search engine
- You can search for manuals,
CD-ROM's, and so on.
- Go to Federal Computer Product Center
if
you are just looking for information published electronically
Search the FedWorld FTP site
- Not user friendly but very powerful
The Office of Disease Prevention and Health
Promotion
World Health Organization
Commercial
CenterWatch Clinical Trials Listing Service
- An international listing of clinical
research trials.
- Coverage has been expanded
- Includes recently approved drugs (FDA)
Social Security Death Index
- The Death Master File (DMF) from the
Social Security Administration (SSA) contains over 68 million records
created from SSA payment records. This file includes the following
information on each recorded death: Last name, First name, SS# (State
issued), Birth date, Death date, Last residence, Lump sum payment
- Ancestry's version
- Yes, this gives you access to 68 million deaths recorded by the
SSA
- Current through April 2000 (when I checked it in May 2000; this
probably means that they had added quarterly data through 4/2000
with deaths through 12/1999)
- And they have it (through 1998) on CD
Family Tree Maker will sell it to you on
CD for $39.95
- This is the real thing. But check what year it is
current through.
- Healthtouch
Online has extensive, detailed information for more than 10,000 prescription and over
the counter (non prescription) medication. Go directly to the Drug Information page to search for
medications by name (Like most search engines, it requires accurate spelling.) When you
find the medication that you are interested in, be sure to page down. The information may
be several pages long.
- WebMD
Prescription Drug Reference
-
PDR.net has
online access to many of its publications. I have not included it in the
past because it either required a fee for much of its data or was
available only to physicians. That seems to have changed recently. It is
worth a look.
- GOODMAN law firm Investigation &
Directory Links
Other
Sites
I gave a presentation
to the Ohio Home Office Life & Health Underwriters Association
June 2000 with links of interest to underwriters. Many are covered in this
document but others are not. I updated the links in June 2001.
The Doctor's Guide
The Physician's Guide to the Internet
- Site aimed at practicing physicians
The Doctor's Page
- specifically designed for the practicing physician
The National Health Information Resource
Center (NHIRC)
A clearinghouse and communications hub for health information
systems and data
Interesting
Sites
The
Visible Human Project
National Human Genome Research Institute
- Place to go for the Human Genome Project
Virtual
Colonoscopy
- Animation of colonoscopy that requires
media viewer
- Be patient, will take 5 to 10 minutes to
download