Cyber Libraries Enhance Military Health Care

"DoD's health care organization is one of the largest with 8 million beneficiaries and 500 medical treatment facilities worldwide. The care provided service members and their families affects readiness and quality of life," said Army Dr. (Lt. Col.) William L. Lang. "Online medical information services represent a leap in technology that enhances both concerns."

For instance, he said, online library access can be a valuable aid to military health care practitioners at remote posts or in field locations. Reading the latest medical texts and articles is a good way to keep up with changing technology, he added, while online services can be used in places that have no libraries.

Most military medical treatment facilities are going to have some degree of access to the Internet and available online medical information libraries, said Lang, a family practice physician in the directorate of information management at the TRICARE Management Activity in Falls Church, Va.

Over the last year, he said, various individual Army, Navy and Air Force medical organizations have contracted for access to medical information on Internet sites. Depending on how the contracts are written, "you can also access the online medical library away from the military treatment facilities," Lang said.

"Let's say you have a physician's assistant working in an infantry battalion. As long as he can get to a computer with Internet access, he can obtain the medical information needed by using the appropriate password. He can expand his knowledge base and be a more effective provider."

Lang said the idea of Internet medical libraries has percolated in DoD's medical community for the past four or five years. He was involved in an informal group that researched the feasibility of a DoD-wide system of contracted online medical information services.

Also over the last year, the Army, Navy and Air Force Surgeons General asked the medical library communities, together with the Uniformed Services University of the Health Sciences (USUHS), to look into establishing "libraries of the future," which meant access by the Internet or other electronic means, Lang said. The Surgeons General oversee USUHS, the military's medical school, in Bethesda, Md.

For now, however, "We received no significant financial benefit by going to a joint-service purchase," Lang noted. Because of that, the services have negotiated their own Internet medical library contracts.

The medical information compiled by the various Internet library companies is extremely valuable, and expensive and time-consuming to maintain and keep current, he said.

"If they were to open up in general to anybody who says they're from DoD, then they've opened the gate too wide," he said. "They need to have some control over the access to the information available through their service."

At issue was how to control access at a reasonable cost and still make it easy for the health care providers who need information. This, he said, is another reason online clinical information services for the military were started at the individual medical facility level.

"Specific methods of accessing the information may vary from service to service. The companies we've been working with have been very good at coming up with access approaches that are reasonable to control," Lang said.

Frank J. Becker, an Internet library project manager at the Naval Medical Information Management Center, Bethesda, notes that Internet-based delivery of medical resources within the Navy is still primarily limited to shore organizations and ships in port. He believes the situation will improve now that the Navy and Marine Corps have announced plans for an integrated computer system in the next few years that will link every sailor and Marine no matter where they are.

While ships continue to improve their computer connectivity, he added, the Navy bought CD-ROM libraries that medical staffs can use while at sea.

Lang hasn't given up hope for a DoD-wide Internet medical library system. "But for now, the cost-benefit is doing it at the service level," he concluded.