High-Tech Medical Internet Site Offers Journal Articles, Drug Database, Guidelines

OB/GYN News, Oct 15, 1999 by Kathryn Demott

By the end of this year, physicians nationwide will he able to subscribe to an Internet Web site developed by Stanford University researchers that provides speedy access to point-of-care medical information.

Without ever leaving the patient's side, doctors will be able to type in a diagnosis or specific medical question and receive up-to-date journal articles, drug database listings, and treatment guidelines. That combination of resources, coupled with the prestigious Stanford name, makes the site unique.

For the past 2 years, approximately 1,500 physicians and students at Stanford have been test-driving the site, known as the Stanford Health Information Network for Education (SHINE). But until now, they've been its exclusive users.

With the formation of an Oakland, Calif.--based company called SHINE Inc., the university now has a hand in a separate business entity that will begin providing SHINE to doctors outside the Stanford community. The university, which invested an undisclosed amount in SHINE Inc., will continue to support the site's content and design.

For example, Stanford researchers are working to incorporate SHINE seamlessly into electronic medical records so that physicians will be prompted to look at items in the medical chart for which there are new findings in the literature.

Stanford researchers also expect to design the capability to search by visual images. For example, they envision a day when physicians will be able to take a digital picture of a patient's skin lesion, scan it into the site, and search the Web site by images rather than by language, said Dr. Ken Melmon, a professor of medicine and associate dean for postgraduate medical education at Stanford, who developed the SHINE concept.

This fall, SHINE Inc. will begin testing a preliminary version among two or three yet-to-be-chosen institutional users. The site will then become widely available starting in December.

Users will be charged a subscription fee, but SHINE Inc.'s interim president Naomi Fried declined to say how much that will be. Once the preliminary testing is complete, "we'll have sense of what the market will bear," she said.

The plan is to sell the service initially to institutional users, such as hospitals or HMOs, rather than to doctors directly. In time, however, subscriptions will be priced within reach for individual physicians, Ms. Fried said.

No matter what, SHINE Inc., would like to avoid going the advertisement route in order to maintain the site's objectivity, she said. Drkoop.com, a site run by former Surgeon General C. Everett Koop, has come under fire recently for blurring the lines between objective medical information and advertising.

Still, it remains to be seen how much the use of SHINE will actually influence the course of care. Formal studies on SHINE'S effects on clinical decision making haven't been done, said Tom Rindfleisch, who as the director of the Lane Medical Library oversaw the rollout of SHINE on the Stanford campus.

In total, SHINE contains 15 sources of information. Seven journals are offered in full-text format, although hundreds more are available in abstract form through PubMed (Medline), for which SHINE is a gateway The site also enables users to search the medical textbook Scientific American Medicine, several practice guidelines, primary care teaching modules, and Micromedix, a drug database.

Yet despite its relatively small size, SHINE has been able to tackle about 85% of the questions posed by Stanford doctors, said Dr. Melmon. Right now, the majority of the questions are about drugs, but a fraction are also about specialized fields of medicine such as hematology and oncology.

The site, which was conceived to answer questions from primary care physicians, will eventually contain more specialty information.