Journal of Medical Systems, Vol. 16, Nos. 2/3, 1992
Synapse Health Resources Online Robin K. Meter
The University of Nebraska Medical Center maintains the Synapse Health Information Network to provide timely clinical and library resource information to health professionals across Nebraska and surrounding regions. The system is in over 115 sites across Nebraska and surrounding regions and maintains over 320 network users.
BACKGROUND The University of Nebraska Medical Center, a major unit of the University of Nebraska, serves Nebraska through its programs in health professions education, research, patient care and community service. To provide health education and patient care information to isolated rural regions of the state, a comprehensive health information network was developed (Synapse Health Resources Online). The network is in it's third year of operation. Synapse's main objective is to provide health care information and communication in a timely and efficient manner to regional physicians, especially those rural physicians in Nebraska and eastern Iowa. It is expected that improved access to health care information and communication will translate to improved quality of care for health care recipients in Nebraska and the surrounding region. In addition, this type of data infrastructure is crucial to the concept of providing distance learning opportunities in a multidisciplinary curriculum.
COMPUTING
ENVIRONMENT
UNMC's set of health information data are housed on a variety of assorted IBM and other mainframe systems. Synapse utilizes the Crosstalk Mk. 4, version 2.0, communication software package to facilitate connection to the different mainframe systems. Special scripts have been developed with Crosstalk to provide menu-driven navigation through a front-end AT&T data switch (ISN) to various computer systems on campus. In From the University of Nebraska Medical Center, 600 South 42nd St., Omaha, Nebraska 68198-5030. 91 0148-5598/92/0600-0091506.50/0
© 1992 Plenum Publishing Corporation
92
Meter
addition, Synapse is also available utilizing the Microphone II product for use with the Macintosh.
SYNAPSE HEALTH RESOURCES ONLINE The University of Nebraska Medical Center resources available online via the Synapse network include:
Statewide Electronic Mail (IBM PROFS) Synapse participants have e-mail capabilities with each other and faculty and staff at UNMC. In addition, since UNMC is part of the Nebraska state government system, Synapse participants can also use e-mail to contact state and local Departments of Health, the Nebraska Department of Social Services, state legislators, and the Nebraska Governor's Office. Over 4500 individuals have addresses on the statewide system. The PROFS system is also interfaced to BITNET and Internet.
Multispecialty Bulletin Boards UNMC has developed a series on bulletin boards for Synapse users that allow users to share ideas and participate in ongoing dialogue with other members of their profession or specialty. In addition, access to Bitnet's discussion groups is facilitated through Synapse.
File Transfer Services Synapse allows both binary and text file transfers.
UNMC News and Information Most campus activity rosters and newsletters are made available online to Synapse users. In addition, the campus activity and academic calendar are kept online to allow for more efficient scheduling of activities.
Health Information Databases Synapse allows access to the following health-related databases: 1. Community Physician Opening Database (CPO). The CPO database was developed jointly by UNMC and the Nebraska Office of Rural Health. The database provides information on communities currently recruiting physicians, what specialties are being recruited, and the appropriate contact information within each community. 2. Online Ordering from the McGoogan Library of Medicine. Most library materials can be ordered online. In addition, general reference questions and computer search requests can be facilitated and sent to library personnel. 3. Drug Information Service. Synapse has developed an online drug information service for network participants. Questions concerning drug identification, adverse effects, dosage and other topics can be facilitated via Synapse. A user composes and
Synapse Health Resources Online
93
categorizes his or her question and sends the request to a series of sites where pharmacy faculty members retrieve, research, and answer the questions. Answers are returned electronically or phoned immediately if the answer is needed for immediate patient care. 4. Nebraska Organ Retrieval Information System. This database walks physicians through the process of organ retrieval. Clinical and legal issues are discussed. In addition, a general inquiry option is facilitated between the Synapse user and the Nebraska Organ Retrieval System headquarters. 5. Patient Education Materials Database. This database allows the user to browse through a listing of patient education materials available from UNMC and then order appropriate materials online. 6. Physicians with an Interest. These physicians can also access UNMC's patient information system to continue to track the care of a patient referred to UNMC. Information such as radiology and laboratory reports and discharge summaries are provided through the Synapse network.
McGoogan Library of Medicine Synapse also provides access to the online card catalog of the University of Nebraska Medical Center McGoogan Library of Medicine. In addition, affiliated health care professionals can also access Mini-Medline's medical journal abstract database. UNMC's participation in Interned also facilitates connection to other library systems accessible via Internet. UNMC is currently installing a 21-deck CD-ROM system that will run off the campus network and be accessible to all Synapse users.
Medicaid Eligibility Database 1. Synapse participants have access to the Medicaid Eligibility Database developed and maintained by the Nebraska Department of Social Services. This databases lists monthly Medicaid eligibility information in addition to possible lock-in situations or third-party liability situations. 2. UNMC's connection to the state mainframe system also allows Synapse users to access the Nebraska Resource Referral System. This database is produced by the Nebraska Department of Social Services and shows resources (financial, counseling, etc.) available to state citizens. 3. Access to the Nebraska Department of Health's internal information network, Nebraska HealthNetwork, is also provided. This network contains a health news clipping service, rosters of licensed health care providers and facilities, and a database monitoring the Nebraska's Certificate of Need process. 4. A connection to the UNMC Bookstore local area network is also provided to Synapse users. Users can browse the titles of bookstore holding and order textbooks online.
QMR and Scientific American Medicine's Discotest Programs Synapse participants are also provided with a copy of the Quick Medical Reference (QMR) diagnostic-aid database developed by the University of Pittsburgh. In addition,
eight case simulations per year are provided to participants via Scientific American Medicine's Discotest program. Participating physicians can earn up to 32 credit hr per year of category one credits from the American Medical Association. The package is also
94
Meter
beneficial for ongoing training of physician assistants, nurses, and students of most health disciplines.
RURAL HEALTH EDUCATION NETWORK Recently, a major effort was undertaken at UNMC to develop the Rural Health Education Network (RHEN), which is a comprehensive, interdisciplinary program aimed at addressing the specific health care problems of rural Nebraskans including the critical shortage of health care professionals. UNMC has realigned and updated its curriculum in each of its colleges to facilitate an extended period of rural health training. It is anticipated that a period of one year will be spent in one of seven "hubs" across Nebraska. Students from each discipline will rotate out of the hub to different smaller "spoke" communities surrounding each hub during this rural training track. Synapse has been identified as the communication backbone for this statewide educational effort. Programs are being implemented with the Colleges of Medicine, Nursing, Pharmacy, Allied Health and Dentistry to facilitate each college's needs.
STATE DRUG INFORMATION NETWORK The Synapse network is about to embark on a joint effort with the UNMC College of Pharmacy to develop the State Drug Information Network. This effort will include adding personal computers in rural pharmacies across Nebraska and training local pharmacists to work with local consumers in retrieving health information from the Synapse network. The SDIN is being implemented with a grant from the Department of Housing and Urban Development. USE O F S Y N A P S E According to feedback from the rural users of Synapse, the information provided via the network is useful and timely. One physician in a remote area has remarked that the new access to CME provided by Synapse has made him feel that he is no longer a "Lone Ranger." Another physician has provided feedback on the usefulness of decision-support tools on the network. " I ' m very confident in dealing with 90% of my patients' symptoms when they are in the office. It's that other 10% that I need help on and QMR helps me get a handle on the proper path of diagnosis for these patients," says a Family Practitioner from rural Nebraska. Other input solicited from Synapse users indicates that the most popular databases include the journal article database, QMR decision-support, and Scientific American Medicine's Discotest program. The Medicaid Eligibility System is also very popular with rural clinic administrators. Two negative issues mentioned by users pertain to the lack a toll-free mechanism for accessing the Synapse network. In addition, Synapse has had repeated comments about the lack of searching time for physicians. Many physicians simply do not have the time they desire to access the system because of a hectic rural clinic schedule. Currently, the Synapse program includes over 325 health professionals from approximately 115 sites in 56 communities across Nebraska and Iowa. In addition, many campus faculty and staff members have access to Synapse. The Synapse department supports the network with 5.1 FTEs.
Synapse Health Resources Online Robin K. Meter
The University of Nebraska Medical Center maintains the Synapse Health Information Network to provide timely clinical and library resource information to health professionals across Nebraska and surrounding regions. The system is in over 115 sites across Nebraska and surrounding regions and maintains over 320 network users.
BACKGROUND The University of Nebraska Medical Center, a major unit of the University of Nebraska, serves Nebraska through its programs in health professions education, research, patient care and community service. To provide health education and patient care information to isolated rural regions of the state, a comprehensive health information network was developed (Synapse Health Resources Online). The network is in it's third year of operation. Synapse's main objective is to provide health care information and communication in a timely and efficient manner to regional physicians, especially those rural physicians in Nebraska and eastern Iowa. It is expected that improved access to health care information and communication will translate to improved quality of care for health care recipients in Nebraska and the surrounding region. In addition, this type of data infrastructure is crucial to the concept of providing distance learning opportunities in a multidisciplinary curriculum.
COMPUTING
ENVIRONMENT
UNMC's set of health information data are housed on a variety of assorted IBM and other mainframe systems. Synapse utilizes the Crosstalk Mk. 4, version 2.0, communication software package to facilitate connection to the different mainframe systems. Special scripts have been developed with Crosstalk to provide menu-driven navigation through a front-end AT&T data switch (ISN) to various computer systems on campus. In From the University of Nebraska Medical Center, 600 South 42nd St., Omaha, Nebraska 68198-5030. 91 0148-5598/92/0600-0091506.50/0
© 1992 Plenum Publishing Corporation
92
Meter
addition, Synapse is also available utilizing the Microphone II product for use with the Macintosh.
SYNAPSE HEALTH RESOURCES ONLINE The University of Nebraska Medical Center resources available online via the Synapse network include:
Statewide Electronic Mail (IBM PROFS) Synapse participants have e-mail capabilities with each other and faculty and staff at UNMC. In addition, since UNMC is part of the Nebraska state government system, Synapse participants can also use e-mail to contact state and local Departments of Health, the Nebraska Department of Social Services, state legislators, and the Nebraska Governor's Office. Over 4500 individuals have addresses on the statewide system. The PROFS system is also interfaced to BITNET and Internet.
Multispecialty Bulletin Boards UNMC has developed a series on bulletin boards for Synapse users that allow users to share ideas and participate in ongoing dialogue with other members of their profession or specialty. In addition, access to Bitnet's discussion groups is facilitated through Synapse.
File Transfer Services Synapse allows both binary and text file transfers.
UNMC News and Information Most campus activity rosters and newsletters are made available online to Synapse users. In addition, the campus activity and academic calendar are kept online to allow for more efficient scheduling of activities.
Health Information Databases Synapse allows access to the following health-related databases: 1. Community Physician Opening Database (CPO). The CPO database was developed jointly by UNMC and the Nebraska Office of Rural Health. The database provides information on communities currently recruiting physicians, what specialties are being recruited, and the appropriate contact information within each community. 2. Online Ordering from the McGoogan Library of Medicine. Most library materials can be ordered online. In addition, general reference questions and computer search requests can be facilitated and sent to library personnel. 3. Drug Information Service. Synapse has developed an online drug information service for network participants. Questions concerning drug identification, adverse effects, dosage and other topics can be facilitated via Synapse. A user composes and
Synapse Health Resources Online
93
categorizes his or her question and sends the request to a series of sites where pharmacy faculty members retrieve, research, and answer the questions. Answers are returned electronically or phoned immediately if the answer is needed for immediate patient care. 4. Nebraska Organ Retrieval Information System. This database walks physicians through the process of organ retrieval. Clinical and legal issues are discussed. In addition, a general inquiry option is facilitated between the Synapse user and the Nebraska Organ Retrieval System headquarters. 5. Patient Education Materials Database. This database allows the user to browse through a listing of patient education materials available from UNMC and then order appropriate materials online. 6. Physicians with an Interest. These physicians can also access UNMC's patient information system to continue to track the care of a patient referred to UNMC. Information such as radiology and laboratory reports and discharge summaries are provided through the Synapse network.
McGoogan Library of Medicine Synapse also provides access to the online card catalog of the University of Nebraska Medical Center McGoogan Library of Medicine. In addition, affiliated health care professionals can also access Mini-Medline's medical journal abstract database. UNMC's participation in Interned also facilitates connection to other library systems accessible via Internet. UNMC is currently installing a 21-deck CD-ROM system that will run off the campus network and be accessible to all Synapse users.
Medicaid Eligibility Database 1. Synapse participants have access to the Medicaid Eligibility Database developed and maintained by the Nebraska Department of Social Services. This databases lists monthly Medicaid eligibility information in addition to possible lock-in situations or third-party liability situations. 2. UNMC's connection to the state mainframe system also allows Synapse users to access the Nebraska Resource Referral System. This database is produced by the Nebraska Department of Social Services and shows resources (financial, counseling, etc.) available to state citizens. 3. Access to the Nebraska Department of Health's internal information network, Nebraska HealthNetwork, is also provided. This network contains a health news clipping service, rosters of licensed health care providers and facilities, and a database monitoring the Nebraska's Certificate of Need process. 4. A connection to the UNMC Bookstore local area network is also provided to Synapse users. Users can browse the titles of bookstore holding and order textbooks online.
QMR and Scientific American Medicine's Discotest Programs Synapse participants are also provided with a copy of the Quick Medical Reference (QMR) diagnostic-aid database developed by the University of Pittsburgh. In addition,
eight case simulations per year are provided to participants via Scientific American Medicine's Discotest program. Participating physicians can earn up to 32 credit hr per year of category one credits from the American Medical Association. The package is also
94
Meter
beneficial for ongoing training of physician assistants, nurses, and students of most health disciplines.
RURAL HEALTH EDUCATION NETWORK Recently, a major effort was undertaken at UNMC to develop the Rural Health Education Network (RHEN), which is a comprehensive, interdisciplinary program aimed at addressing the specific health care problems of rural Nebraskans including the critical shortage of health care professionals. UNMC has realigned and updated its curriculum in each of its colleges to facilitate an extended period of rural health training. It is anticipated that a period of one year will be spent in one of seven "hubs" across Nebraska. Students from each discipline will rotate out of the hub to different smaller "spoke" communities surrounding each hub during this rural training track. Synapse has been identified as the communication backbone for this statewide educational effort. Programs are being implemented with the Colleges of Medicine, Nursing, Pharmacy, Allied Health and Dentistry to facilitate each college's needs.
STATE DRUG INFORMATION NETWORK The Synapse network is about to embark on a joint effort with the UNMC College of Pharmacy to develop the State Drug Information Network. This effort will include adding personal computers in rural pharmacies across Nebraska and training local pharmacists to work with local consumers in retrieving health information from the Synapse network. The SDIN is being implemented with a grant from the Department of Housing and Urban Development. USE O F S Y N A P S E According to feedback from the rural users of Synapse, the information provided via the network is useful and timely. One physician in a remote area has remarked that the new access to CME provided by Synapse has made him feel that he is no longer a "Lone Ranger." Another physician has provided feedback on the usefulness of decision-support tools on the network. " I ' m very confident in dealing with 90% of my patients' symptoms when they are in the office. It's that other 10% that I need help on and QMR helps me get a handle on the proper path of diagnosis for these patients," says a Family Practitioner from rural Nebraska. Other input solicited from Synapse users indicates that the most popular databases include the journal article database, QMR decision-support, and Scientific American Medicine's Discotest program. The Medicaid Eligibility System is also very popular with rural clinic administrators. Two negative issues mentioned by users pertain to the lack a toll-free mechanism for accessing the Synapse network. In addition, Synapse has had repeated comments about the lack of searching time for physicians. Many physicians simply do not have the time they desire to access the system because of a hectic rural clinic schedule. Currently, the Synapse program includes over 325 health professionals from approximately 115 sites in 56 communities across Nebraska and Iowa. In addition, many campus faculty and staff members have access to Synapse. The Synapse department supports the network with 5.1 FTEs.
