By A K Midgley First serial rights
I have used world wide web access on my surgery desktop for some time now. One of the more useful accesses I made during a consultation was to the website of the Royal Horticultural Society www.rhs.org.uk/
The volume of information available is increasing exponentially, and therefore the proportion of it which is outside any fence we care to erect will also increase exponentially. There is a statement of this as one of the internetworking laws (ascribed to Robert Metcalfe, who invented Ethernet) and a commentary on it at www.useit.com/alertbox/
Most useful information is not held within the NHS Net, but is outside our fence, on the Internet, whether it is more conventionally useful information such as Medline searches and consensus statements from the US National Institutes of Health www.nih.gov/ papers in learned or popular journals, or pharmaceutical manufacturer's own data in their own data stores.
We are all agreed that the World Wide Web is poorly organised. This is not merely because of lack of control, since the most controlled areas are frequently the least useful to anybody outside the organisation owning them, but reflects the flip side of the simplicity of technology which allows us to have a world wide web at all - if it required agreement on complicated rules we would still be waiting - and the newness of the concept and our experience with it.
While clever network design can make up for some limitations in bandwidth, the usefulness of an isolated network will tend, inexorably, to decline steadily as time goes on. Naturally, the more money is applied to it, the better it will work.
The National electronic Library for Health in this country, and many individual or private or public projects throughout the world are attempting to help you navigate through the information jungle, or offer charts to help sail the information sea, however you like to look at it. Mapping Cyberspace offers some very pretty ways of representing our shared information space. Which one works best for you? Tell your system providers.
One way of adding value to hypertext (the web is hypertext even when it has pictures) is to mark a path through it. This path typically runs through several websites, on several computers and perhaps several continents, but it feels like a single object to a user guided down it.
Maintaining these blazed trails is a non-trivial task, but one which is valuable to the community. Vannevar Bush predicted the arrival of a class of people who would do just that, in his 1945 article As We May Think. Full text of As We May Think
Well, it could have been to look up St John's Wort, or Rose of Sharon, but actually it was to keep up the conversation with a patient who quite reasonably regards horticultural studies as important in controlling their condition. Correctly so, and no more detail here, but using the Web as intended to obtain details of where and how to pursue further studies, was helpful to the process both of us were engaged in. And at the end, I printed a couple of pages over the network to be taken away for further use.
Among the staff, friends or colleagues the Chief Knowledge Officer of a PCG or other health organisation should have, should be people who pre-browse resources for the rest.
On the purely technical level, by identifying and visiting pages that other people on the same network may later visit, the speed of the network can be increased as the next time these pages are delivered they come from the boundary cache rather than through a narrow gateway to the outside world.
But as with all navigation, and as with knowledge whether medical or otherwise, one does well to follow somebody who generally knows the way and tends not to get lost.
Locally, you need to pick out who are the scouts, the information hunters, and keep an eye on them.
Practical help and human understanding, are not what the NHS principally buys off General Medical Practice, but work better than many other approaches.
Jakob Nielsen was previously a distinguished engineer at SUN. SUN is a seriously technical company, and had matters proceeded differently we would all be sitting at networked SUN - clone computers rather than IBM - clone PCs. Nielsen is one of the world's foremost gurus on the usability of computers, focusing on the part you actually see, the interface on screen. If anyone tries to sell you a network solution, and they havn't heard of Nielsen and his bi-weekly AlertBox column, they do not know their field.
Oh, and his writing is good, readable, and doctors looking at his austere and workable pages should see that here is a useful tool being used usefully, and how to do it in medicine.
www.useit.com/alertbox/
www.sun.com/