Computer Coverage Nets Capacity Crowds

Reflecting today's surging interest in computers and what they can do for mental health professionals, it was standing room only at many of the 19 computer-related presentations offered at the American Psychiatric Association's 149th annual meeting, more than triple the number included at last year's convention.

In papers with titles like "E-Mail, the Internet and the Borderline Personality," industry-supported symposia such as "Helping Technology Help People: Computer Programs That Transform Clinical Practice" and numerous workshops, psychiatrists and other mental health professionals taught their colleagues how to choose and use everything from software to hardware to Internet surfing tools and sites.

And in the massive exhibit hall, more than 30 booths were computer-related, including the APA with its just-launched web site; CME LLC. with its seven-month strong Mental Health InfoSource web site; the American Psychiatric Press with its four-disk Electronic Library; and Voice Input Technologies, with SpeechWriter, a new product that allows psychiatrists to dictate patient notes directly into their computers.

Most of the computer workshops- held in a room with a computer connected on-line and a monitor projected onto a large screen- were chaired by Steven E. Hyler, M.D., associate professor of clinical psychiatry at Columbia University College of Physicians and Surgeons.

At the beginning of one day's series, Hyler asked attendees to raise their hands if they'd ever been on the Internet. After about half did, he said that psychiatrists as a group are generally "computer phobic."

"Perhaps these fears are based on unfortunate experiences they had with computers during the formative stage in their academic development," he said, making a segue into how the Internet was conceived in the 1970s by the U. S. Department of Defense as a tool to ensure communication in the event of thermonuclear holocaust. He noted that today the Internet has 30 million users worldwide who connect to it via their computers and telephone lines, with many surfing it via the graphical interface of the World Wide Web.

Hyler said one of the most crucial reasons for psychiatrists to be on the net is for discussion of current topics, like late-breaking news from pharmaceutical companies, managed care issues and health care reform. Also, the net permits remote access to resources such as libraries and is useful for personal networking.

Hyler was followed by Robert S. Kennedy, M.A., director of computer operations in the department of psychiatry at Albert Einstein College of Medicine, and Thomas Kramer, M.D., associate training director at the University of Arkansas Medical School, who together and individually have with no pay taught hundreds of psychiatrists around the country about new computer technologies and how not to be afraid of them.

"When we started doing this about three years ago, there were only a handful of sites for psychiatry," Kennedy said. "Now there are thousands."

In this rapid-paced and highly informative session, they distributed a 52-page "Computer Survival Guide" and went on to review and demonstrate computers connecting to other computers in all variations and iterations. Included in the discussion were modems, fax/modems and telecommunications software, and a demonstration of an Internet search for documents including the word psychiatry, which yielded more than 9,000 different references. The pair also noted the net's utility for teaching courses- thereby eliminating the need for paper- and showed attendees a web-based anatomy course at the University of Arkansas. <http://anatomy.umas.edu>

"You can use the web to walk through a house, hospital, store or somebody's head," said Kramer.

Next, Robert C. Hsiung, M.D., assistant professor of clinical psychiatry at the University of Chicago, discussed and demonstrated his psychopharmacology tips' World Wide Web site, an innovative integration of electronic mail, discussion lists and the web. This site consists of practical prescription tips culled from messages submitted by more than 1,000 members of an ongoing psychopharmacology Internet discussion list. From those messages, Hsiung selects, edits, indexes and converts to hypertext markup language for the web. The result: a highly practical and up-to-date knowledge base that supplements a physician's own clinical experience and the research literature.

"This is a quicker way to disseminate information than waiting for journals," he said. "It's a way to stay on the cutting edge of the field."

It's also invaluable for patients to educate themselves about medications, he added. "Patients print things out and take them to their psychiatrist," Hsiung said. "It's also very valuable for friends and family members of patients."

Showing the actual site to workshop participants, Hsiung, who provides the service free of charge, showed its master index on which users can click on general subjects, drugs or medical problems. He then showed sample message strings relating to SSRIs and other drugs.

Hsiung said that in May 1995, the site's first month of operation, it was accessed 383 times. By July, the number reached 4,514, an average of almost 150 "hits" a day.

Following Hsiung were Tal Burt, M.D., and Waguih William IsHak, M.D., psychiatry residents at New York University department of psychiatry. The pair has worked on computer projects including the creation of a computerized patient record software (CPR) and a national computerized communication network for residents (called GRASSMITS). They also distribute a computer utilization survey to psychiatry residents nationwide and coordinate computer courses for residents and faculty at NYU.

Together, they discussed psychiatry residents' use of the Internet for education and communication.

"For many psychiatrists, the residency period represents a great opportunity to acquire computer skills in general, and Internet skills in particular," said IsHak. "This goal can best be reached through a directed educational effort integrated into the training curriculum."

Not only will computer training enable residents to keep current in their field and communicate with each other, but it will help them "become an integral part of the psychiatry political arena and join the health care debates at a time when their informed and educated opinion is most needed," Burt said.

Burt and IsHak demonstrated NYU's department of psychiatry home page, which lists links to other psychiatry departments on the web plus psychiatry links and referral telephone numbers for the general public. NYU's home page also provides a reference desk for DSM III-R disorders. And its Interactive Testing in Psychiatry (ITP) contains seven modules for psychiatrists and related professionals to test their knowledge by answering board-style questions and getting immediate scoring and annotated answers on-line. They can also earn CME credit.

Burt and IsHak also demonstrated Internet Mental Health, a free on-line encyclopedia of mental health information composed by Canadians Phillip Long, M.D., and Brian Chow, B. Sc., and Harvard's Whole Brain Atlas, where users can tour the human brain and see how diseases like multiple sclerosis affect it over time.

Next, Russell F. Lim, M.D., clinical instructor at UCLA's department of psychiatry, presented "Publishing, Therapy and Research on the Internet." He explained how the Internet enables the exchange of most forms of data, including text, graphics, video and sound among geographically distant mental health clinicians, trainees and researchers.

"Connecting to and navigating the Internet has historically required the use of complex and cryptic line commands," Lim said. "But recent development of graphical interfaces to the Internet, such as Mosaic and Netscape, has made access to its resources much easier."

Lim demonstrated the ease of using browsers and showed attendees how to use search engines- including Lycos, McKinley and others- to find useful information. He also demonstrated specific sites for clinical, research and training applications in psychiatry, including those that have requests for proposals, residency training information and continuing medical education.

Additionally, he described and demonstrated how to access InterPsych, a rapidly emerging international effort which is helping to organize psychiatric and psychological information resources.

In a discussion of e-mail, Lim said the tool is a revolutionary method of communicating that offers five distinct advantages over regular mail and telephone communication. First is speed, because unlike regular mail, most e-mail is received the same day it is sent. Second is low cost, since lengthy communications can be sent for a fraction the cost of a telephone call. Third, unlike a telephone call, a single message can be sent to many people. Fourth is convenience, as recipients don't need to be present to receive communications and can retrieve them any time.

"Also, replying to e-mail is easier than replying to a regular letter," he added. "That's because replies are automatically addressed to the sender and mailing them is accomplished with a keystroke."

The fifth advantage of e-mail is that automatic software, known as LISTSERV, can be used to receive letters and then mail them out to subscribers. The group of subscribers is known as a discussion group, and people of similar interests can correspond through regular e-mail or in real-time discussion conferences on-line using Internet Relay Chat (IRC).

"Thus participants can send questions and answers to each other instantaneously, like a text conference call," Lim explained of IRC, adding that journals can also be published on-line and distributed via subscription lists.

At the end of this day's workshops, Hyler, who is on the Media Subcommittee of the APA's Scientific Program Committee, stressed to attendees that computer phobia must be overcome.

Said Hyler: "Psychiatrists need to update their computer skills so as to make use of the wealth of psychiatry-related software and on-line information to assist with their patient care and continuing medical education."

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