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UNT Resource magazine >> Diagnosis by Computer

Dr. Martha Dodson draws most of her patients from a transient and low-income population in Tarrant County.
      For many of them, it's an ordeal to make a single doctor's visit, so Dodson does not chance taking weeks and multiple appointments for diagnosis. To expedite things, she uses the Clinical Digital Library (CDL) at the University of North Texas. It's an Internet database that provides quick access to medical diagnosis, treatment and prevention information.
      "Sometimes researching a set of symptoms can take weeks or even months," says Dodson, a graduate of the UNT Health Science Center at Fort Worth who is completing her family medicine residency at the Seminary Drive Family Practice Clinic in Fort Worth. "With our patient population, that can be disastrous because after a limited time, I may never see a particular patient again."
      The CDL offers links to nearly 50,000 web sites approved by a panel of experts in medicine and public health, says Ana D. Cleveland, a professor in UNT's School of Library and Information Sciences and a graduate faculty member at the Health Science Center.
      The CDL was established through a collaboration of UNT's medical informatics program and the Health Science Center's family medicine resident program.
      "We know from research that physicians have a five-minute window for patient care information during a visit," Cleveland says. "We have worked to create a tool that will give information within that timeframe."
      The CDL site provides diagnostic information for an array of symptoms as well as elaborate explanations of drugs, up-to-date research and preventative medicine information. It also provides access to both public and subscription-based medical journals with the latest updates.
      "A lot of this is data you can't find in a book, because by the time it makes it into print, the information is outdated," Dodson explains.
      The CDL site also offers diagnostic and treatment procedures from medical textbooks in manageable bites so that participating physicians can quickly identify what they need, says Cleveland.

Humble beginnings
Originally, the CDL was created to offer a medical resource for rural doctors across Texas and to entice more young doctors to take rural practices, says Dr. Irvine Prather, director of the family practice residency in the Health Science Center's Department of Family Medicine. The school trains more family practice physicians for rural communities than any other medical school in Texas. It is working to address a shortage, Prather says.
According to the Texas Department of Health, 176 counties are medically underserved the number of doctors is grossly inadequate for the population and the majority of the counties are in rural areas. Federal officials say a rural doctor shortage is a national problem that's growing.
The CDL provides a way to connect rural practitioners with the same quality of information that is available to their non-rural peers.
Prather says that rural physicians often must work in unfamiliar areas of medicine because of limited access to hospitals and specialists.
      "The Internet puts them in contact with other physicians and gives them a place to seek consultation," he says.
The CDL was created in 1995 with a grant from the federal Health Resources and Services Administration to Cleveland and Prather. Recently, the University of Alabama joined the project with the collaboration of UNT alumnus Steven MacCall, an assistant professor in UA's School of Library and Information Studies.
The original idea was to train future physicians to use the Internet for quick access to medical information. The CDL serves as a filter, providing links to reputable sites.
"It combines the field of medicine with the information management practices of the medical informatics program," Cleveland says. "And it's proven to be remarkably successful."

Making the rounds
Young doctors like Dodson learn to use the CDL while earning their degrees at the Health Science Center, and they apply their knowledge while completing their residencies. When they go to their future practices, rural or urban, they are already familiar with the CDL and comfortable using it.
Within her third year in the osteopathy program, Dodson began receiving dozens of calls from Texas rural communities with offers to create a place for her to practice medicine.
She knew she would open a practice in one of these counties but was always concerned about the demands of the position.
"It's a terrifying thought to know that if someone needs a rheumatologist, I'll have to be that rheumatologist no matter how uncomfortable I feel with the subject," she says. "But I think I can handle it better now that I have the CDL. I feel comfortable using it as a legitimate source of information."
      There is a great deal of medical information on the Internet that needs to be authenticated. Each of the CDL's chosen sources is reviewed by health information professionals and experts in public health and medicine. A group of UNT students constantly updates links in this digital collection, upgrading or deleting old sources.
"The idea is to decrease the barriers for rural practices but offer the same quality an urban doctor could get from consulting a local specialist," Prather says.
"We've also discovered that the CDL isn't limited to rural use," he says.
The site is linked to and used by dozens of clinics and science centers throughout the United States, Jamaica, Guam and Australia. Currently, it receives as many as 50,000 hits a month. The library is an expanded source of information for hospitals, area health education centers, HMOs, medical clinics and other health care providers.
Each clinic can alter its interface with the site to suit individual needs. For instance, doctors at the University of West Indies clinic, who deal with numerous AIDS patients, have immediate access to current AIDS research when they open their CDL interface.

Elements of the CDL
The CDL is designed for quick reference. In the section that assists in diagnosis, a physician can list a set of symptoms and get a list of possible ailments or verify a hypothesis. Another section provides background on new drugs and new information on old ones.
A section titled "Public Health" offers links to disease control and environmental health issues. It provides the latest information on health concerns around the world so that doctors can, for example, immunize patients traveling abroad or be prepared for potential outbreaks of illness locally.
Cleveland says two of the key elements of the CDL are the "Patient/Family" and "Preventative Medicine" sections. Each lists common illnesses and health issues and offers preventative measures and practical solutions. Young doctors are encouraged to use this section to refer patients to web sites that provide health information.
"We've reached an era in which information is as useful as any drug prescription," Cleveland says. "Now doctors not only prescribe drugs, but they can prescribe URLs."
The Clinical Digital Library is located at www.cdlp.org.

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