Medical Computing and Medscape

George D. Lundberg, MD, Editor in Chief Medscape

While stationed at Letterman General Hospital as an army captain in 1963, I was assigned by my boss, to "automate the California Tumor Tissue Registry" which was then housed in the pathology department. I had no idea how to do that but I learned and did it. Thus began my long relationship with computers and medicine. Every decade since then I have predicted verbally and in print that "doctors are going to use computers big-time" and every decade I have been wrong-until the 1990s.

The first fully automated science journal was operational at MIT in 1967. Yet even today, some seem resistant to such electronic medical journals. In the mid-1980s, we at the AMA offered fully online and randomly searchable JAMA and the AMA Archives journals through Mead Data Central in Dayton Ohio. Others used BRS Saunders as an online search company. Everything but the charts, graphs and tables and no color. It was a wonderful product but it failed in the marketplace. Then about 1990, we and many others, began to offer medical journals on CD-ROM. Terrific technology that included charts, graphs and tables and color plus interactivity. I thought it was the answer. Wrong again. A transitional technology, already transitioned out.

Then came the Internet-the so-called "information superhighway." On August 1, 1995, we began the AMA's scientific and clinical offerings on the medical Internet. I stated in New York at the launch that "the Internet is the future in the present" and "the most important advance in human communication since the printing press."

We were excited and thought we were pretty early and we were. But Medscape was already there-founded in May 1995 by Peter Frishauf, a commercial publisher who imagined that the medical Internet would become very important. He was right.

Medscape has always been intended to help doctors practice medicine better by providing up to date, clinically-useful and easy to understand medical articles. It has always been free of charge to the user and has been supported by advertising and sponsorships, much as NBC and JAMA have been. It has always required registration to learn thetypes of people use it, in order to sell advertising (but never to target individuals or victimize anyone). Although intended for MDs, Medscape has always been used by more non-physicians than physicians.

Some interesting markers along the way: in early 1998 it had 30 employees, in early 1999. 70 and in early 2000, 220. In February, 1999, Medscape announced its one millionth registrant. At this writing, we count 2.2 million registrants in more than 230 countries. Included in these numbers are about 400,000 MDs, 700,000 other health professionals (including about 160,000 students) and more than one million consumers.

Medscape content is organized along medical specialty lines so that users are sent directly to their field of interest upon logging on. Physicians are very busy and they will not tolerate any computer use that wastes their time. We are keenly aware of that and do our best to make every minute useful.

Mindful of the many types of people who use Medscape, in 1999 we created special sites called Medscape for physicians, for pharmacists, for nurses, for medical students and a special site for consumers called CBSHealthWatch. As part of its Internet strategy, CBS invested heavily in Medscape in 1999, making it their medical and health information source. We are integrating radio, television and the web at this time. Of course, anyone who comes onto Medscape or CBSHealthWatch can go wherever they wish for information.

For consumers, we label the articles as "basic," meaning 5-6th grade reading level, advanced-12th grade, or "what your doctor reads." We do not require registration for "basic" but do for the other two levels. About 50 people visit the consumer site for every one who actually registers.

Medscape has strategic partnerships with AOL, the National Data Corporation and others, most especially the Beth Israel Deaconess Hospital at Harvard Medical School.

Being fundamentally a content site, we create new content, aggregate existing content, provide Category I CME(instant certificates), report next day conference summaries, provide easy searching on nine different immense data fields, including a special user-friendly subset of Medline called Medscape Select, license previously published material and host fully electronic, primary source, peer reviewed medical journals, such as Medscape General Medicine and Women's Health.

Top quality peer review is critically important for us. Each specialty site has an editorial board and there is an overarching editorial board of world medical luminaries. We have been active in leading the field in both evidence-based medicine and the creation of the ethics of the medical Internet.

There is no turning back. This is the future. It is all based not on technology but on trust. And for the next phase, we are merging with MedicaLogic of Portland, OR and San Francisco, CA, so as to blend the online health record with the best medical information, at the point of care, where it all happens. One doctor-one patient-the correct informed decisions, well documented and acted upon by patient and doctor.

Dr. Lundberg is the former Editor of JAMA and Editor in Chief, Scientific Information and Multimedia from 1982 to 1999.