October 1996 Bulletin

How orthopaedists can tap Internet

Hardware, software open door to vast storehouse of data

by Steven E. Fisher

Steven E. Fisher is administrator of Midwest Orthopaedics and principal of Evans Fisher and Associates, both based in Chicago.

A.C. Nielsen recently released a study showing that one in four Americans now has access to the Internet at home or at work. This article is intended as a primer to assist orthopaedic surgeons to familiarize themselves with the Net.

The Internet is a network of thousands of computers located throughout the world that communicate with one another at very high speeds and low cost. These computers are linked in such a way that information can be transmitted to and received by users with relatively few limitations on the kind of equipment and software the users possess.

In the Internet environment, the term "information" is very generic, encompassing simple text like this article, databases, images/photographs, motion pictures, animation, computer programs and even sound. Commercial hyperbole notwithstanding, never before has so much information been available to so many so quickly.

Services available on the Internet fall into two broad categories: communication and information retrieval. The communication is via electronic mail and electronic bulletin boards. Information is available from any of the so-called "web sites" authored by thousands of organizations. These include public agencies such as the U.S. Census Bureau, not-for-profit associations such as the Academy, large and small businesses and even individuals.

Communication and information retrieval are not separate and distinct from one another. For example, it is easy for Internet user A to attach data or a photograph to an e-mail message sent to Internet user B. The sending of even a simple e-mail message without an attachment results in the ultimate retrieval of information by someone.


People who want to gain access to the Internet need to acquire both hardware and software. First, the hardware. In general, any relatively new computer will do, but only the newer "486" or "Pentium®" models will permit the user to gain access to pictures and sounds.

The user needs a modem, which is short for modulator/demodulator. A modem permits the user's computer's signals to be transmitted via phone to the larger computer that serves as the "gateway" to the Internet. Modems are categorized in terms of the speed with which they can transmit information. For the best results, a user should acquire a modem that transmits at least 14,400 baud; ideally, it should be 28,800 baud.

A user must have a phone line to connect to the outside world. This need not be a dedicated line, but it helps if it is.


In order for the user's computer to "understand" (as opposed to just "hear") the gateway computer, certain software must be installed at the user's end. The specific type of software needed depends on the user's expectations about the formatting and appearance of information received. This software is typically provided by the Internet Service Provider (ISP) and does not require purchase by the user.

To locate information on the Internet with a minimum of inconvenience and confusion, the user will need additional software called a "browser." Browser software is available at low cost (approximately $50) from any number of sources; often it can be downloaded free by contacting the web site of its creator. Browsers work in different ways, and choosing one over another is a matter of personal preference. Popular browsers include Netscape's "Navigator" and Microsoft's "Explorer."

A user also will need to enter into an agreement with an ISP that has direct access to the Internet. There are many different ISPs and they vary in terms of price and service. Some merely allow
the user to access the Net. Others offer so-called "value-added" services, such as proprietary news and shopping. Examples of ISPs include America On-Line, Compuserve, NetCom, Sprint and MCI.

Orthopaedic surgeons will find many benefits in gaining access to the Net.

Other benefits of the Internet will materialize or intensify in the not-too-distant future. There is no reason, for example, why operative notes cannot be submitted to payers electronically along with Health Care Finance Administration forms to accelerate payment. The payment itself also could be executed electronically. As more and more information is placed on-line, opportunities for synergy among medical researchers and practitioners will increase dramatically.

Orthopaedic surgeons and groups who establish their own web sites will realize substantively improved visibility for themselves in what is an increasingly competitive environment. At a very minimum, a web site should describe the practice and the subspecialties and interests of physician principals. Additional features might include an on-line newsletter, patient satisfaction questionnaires and a mechanism whereby a person can request an appointment. The most sophisticated sites will have "hot-links" to related web sites, perhaps including physical therapy offices, rheumatology practices and so forth.

According to the A.C. Nielsen study, there was a 50 percent growth in Internet access between 1995 and 1996. It is virtually certain that applications of all kinds will continue to burgeon. Orthopaedic surgeons should position themselves to participate in the Internet.

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