RURALNET West Virginia's Rural Medical Computing Network The Marshall University School of Medicine Marshall University Rural Physician Apprenticeship Program Kellogg Foundation Community Partnerships West Virginia Rural Health Initiative WHAT IS RURALNET? RuralNet is a computerized network designed to connect West Virginia's medical community with the rapidly expanding world of online health care resources. By way of modem dial-in to a minicomputer located at Marshall University's Computer Center (a Digital Equipment Corporation VAXServer 3100 Model 90), RuralNet provides its users with access to the Internet, the global conglomeration of computer networks which links more than 11,000 subnetworks and over 20 million users. This connectivity allows users to send and receive electronic mail and to retrieve information and utilities from resources all over the world, including the National Library of Medicine, the National Institutes of Health, the National Cancer Institute, the National Science Foundation, the Food and Drug Administration, the Federal Office of Rural Health Policy, and several major medical schools and their libraries. The health care related resources available on the Internet are growing every day. Additions are made to RuralNet at least once and sometimes several times per week, giving users greater and greater access to online information (see "RuralNet Health Care Resources," below). HISTORY OF RURALNET RuralNet began as the means of electronically linking those involved with Marshall University School of Medicine's Rural Physician Apprenticeship Program (RPAP), a project designed to encourage the retention of West Virginia's medical graduates. The Department of Academic Computing installed a centralized, menu- driven software interface (written by Robert Boag of Marshall's Computer Center) on the user accounts to provide user-friendly access to the online resources. The RPAP students were provided with notebook computers and would use RuralNet to send and receive electronic mail with their campus faculty and to submit the electronic case records of their patient visits. At the time of RuralNet's origin the Internet had not yet experienced the exponential growth of the early 1990s and health care related resources were scant. Electronic mail and CD-ROM literature searches from the Marshall University Health Science Library comprised the bulk of RuralNet's early usage. When Marshall University School of Medicine became involved with the Kellogg Foundation Community Partnerships grant to create learning resource centers (LRCs) in rural health centers around the state, the need for electronic access to and from these clinics became clear. Building on the RuralNet model developed for the RPAP program, the Department of Academic Computing expanded RuralNet to encompass a broader slate of electronic resources, including access to the Food and Drug Administration, the National Institutes of Health and the National Cancer Institute. When the learning resource centers of the West Virginia Rural Health Initiative (RHI) were established along the lines of the Kellogg LRCs, RuralNet again was selected to provide the electronic links among the project's members. In recent months the Internet has seen both an exponential growth and the development of more user-friendly search and retrieval techniques. The growth of health care resources has matched that of the Internet as a whole, and more electronic resources become available almost daily. In recent weeks RuralNet has added access to an online, searchable version of the 1989 Report of the Task Force on Preventive Services, to the Federal Office of Rural Health Policy and to specialized servers in the fields of nursing, pharmacy and dentistry. The Department of Academic Computing continues to support the growing number of RuralNet users and will continue to seek new utilities to add to RuralNet's menu of resources. RURALNET HEALTH CARE RESOURCES Users of RuralNet have access to most of the medical applications available on the School of Medicine's computer network, including Compact Disc (CD-ROM) literature searches of Medline (a bibliography of biomedical research journals) and CINAHL (a bibliography of nursing journals) by title, author or keyword. In addition, user's can run some of the School of Medicine's clinical applications and educational software, such as academic reviews in anatomy, physiology, biochemistry and other fields. Internet electronic mail access puts RuralNet users in contact with computer users around the world, some of whom share an interest in or involvement with health care. Thousands of topical electronic discussion lists provide forums for dialogue and the exchange of information, opinions and experience on topics ranging from hospital computing networks to public health to family medicine. RuralNet also offers access to a variety of library card catalogs, including the James E. Morrow Library at Marshall University, the West Virginia University and West Virginia Public Libraries, the National Library of Medicine, and hundreds of research and university libraries around the world (see "RuralNet Library Resources," below). RuralNet users can also access information and utilities from many federal agencies and medical education institutions: [Figure showing Main RuralNet menu deleted in ASCII file] Assistive Technology Equipment Database The University of Texas maintains a database of vendors of assistive technology equipment for disabled persons. Users can search based on equipment type or location of vendor to find possible sources of assistive technology. Continuing Health Care Education Schedules The continuing medical and nursing education schedules for the state's institutions are posted to RuralNet and accessible to its users. Food & Drug Administration BBS The FDA BBS posts notifications of drug approvals as well as news releases, enforcement reports, current information on AIDS, selected articles and summaries from the FDA Consumer magazine and FDA Federal Register, text of FDA speeches and testimony of the FDA Commissioner and Deputy, veterinary medical news and announcements of upcoming FDA meetings and import alerts. CancerNET Data Listing ("Physician's Data Query") The National Cancer Institute maintains its Physicians' Data Query, a set of up-to-date, approved physician's treatment protocols for all types of cancer as well as patient education documents written in lay terms. This online set of documents is keyword-searchable and information can be retrieved and printed directly through RuralNet. National Center for Biotechnology Information The National Center for Biotechnology Information archives the files that comprise GenBank Release 80.0, in the GenBank flatfile format. These files are also available on the "GenBank: Flat File Format" CD-ROM. At the National Library of Medicine, sequence entries are created by specialized indexers in the Division of Library Operations. Over 325,000 articles per year from 3400 journals are scanned for sequence data. They are supplemented by journals in plant and veterinary sciences through a collaboration with the National Agricultural Library. These records join the direct submission data stream and submissions from the European Molecular Biology Laboratory (EMBL) Data Library and the DNA Database of Japan (DDBJ) for incorporation within a relational database, GenBank. The database is converted to various output formats including the Flat File and Abstract Syntax Notation 1 (ASN.1) versions. Nat. Lib. Med. ET Net -- Educational Technology Sponsored by the Educational Technology Branch of Lister Hill National Center for Biomedical Communications and developed to aid health science educators who face a dearth of information on health science courseware, ET Net serves as an online computer conference network that links developers and users of interactive technology in health care education. The Nursing Network (NVN) -- fee based service National Videotex Network, a commercial network access provider, maintains a Nursing Forum providing electronic communication among professional and student nurses as well as informative news releases and job listings. Univ. of Pennsylvania MEDINFO The University of Pennsylvania's School of Medicine has a detailed medical information service, MedInfo, accessible via the Internet. MedInfo contains information on the University of Pennsylvania's academic programs, biomedical library, and calendar of events. In addition, MedInfo archives the Health Info-Com Network (HICNet) Newsletter and various clinical alerts of interest to health care professionals. Eng. Language Query Engine for AIDS & Epilepsy Info CHAT is an experiment in English-language information retrieval technologies developed by Industry Canada. Well- suited to patient education, CHAT allows users to phrase standard English queries to retrieve information online. For example, a relative of an epileptic patient would be able to get answers to questions without having to understand much about computer information searches and retrievals; he or she could simply type: "Should I attempt to wake an epileptic if he or she is unconscious following a seizure" and receive an answer to the question. Health Care Related Gopher Servers Developed at the University of Minnesota, home of the "Golden Gophers," Gopher is a search and retrieval utility that allows users to navigate the Internet and to retrieve resources with an easily used menu-driven interface. In recent months Gopher has become the method of choice for accessing internet resources, and a large number of medical institutions have developed their own Gopher servers. The following gopher servers are available from RuralNet: [Figure showing health care gophers deleted from ASCII file] Once connected to Gopher, RuralNet users can access any of the growing number of Gopher servers on the Internet. The list of medical Gophers currently available includes: 1. National Health Security Plan 2. AIDS Related Information 3. American Physiological Society 4. Anesthesiology Internet Gopher (SUNY) 5. Arabidopsis Research Companion 6. Artificial Intelligence in Medicine 7. BIOFTP EMBnet Switzerland 8. BIOSCI Archives Gopher at net.bio.net 9. Baylor College of Medicine Genome Center 10. Biology 11. Brookhaven Nat Laboratory, Protein Data Bank 12. CAMIS Ctr for Adv Med Informatics Stanford 13. CAOS/CAMM Center in the Netherlands 14. CHAT (AIDS database) 15. Caenorhabditis Genetics Center (CGC) 16. CancerNet Information 17. Chemical Substance Fact Sheets 18. Comp Epidemiological Data Res (CEDR) 19. Computational Bio (Johns Hopkins Univ) 20. Computer Assisted Molecular Modeling 21. Computer Assisted Organic Syntheses 22. Cooperative Human Linkage Center (CHLC) 23. DNA Data Bank of Japan, Nat Inst of Genetics, 24. Drug Info and Util Center U of Tenn Memphis 25. EMBL sequence search in Basel 26. EMBNet BioInformation Resource Switzerland 27. EMBnet BioBox Finland 28. EMBnet BioInformation Resource EMBL 29. EMBnet Bioinformation Resource (France) 30. Encyclopedia of the Mouse Genome 31. Food and Drug Admin, BBS 32. Food and Drug Admin, Elect Bulletin Board 33. GRIN, Nat Resources Program, USDA-ARS 34. GenBank at Intelligenetics FTP Archive 35. Genethon (Human Genome Res. Ctr, Paris) 36. Genome Project (via Welchlab/John Hopkins) 37. Grants and Contracts NIH guide to 38. HANCOCK Med Res on the Internet 9/93. 39. HEALTHLINE Univ of Montana Hlth Serv 40. HOSPITALS - INFORMATION SERVICES 41. Health Sci Info Net-HSLC HealthNet 42. Hlth Sci Res. on Internet Martin et al 04/93. 43. Human Genome Mapping Project Gopher (UK) 44. IMC: Inst for Med Comp Sci (AKH Wien) 45. INN, Weizmann Institute of Science (Israel) 46. Int'l Center for Genetic Eng & Biotech... 47. International Medical Informatics Association 48. MEDICAL LIBRARIES 49. MEDICAL LIBRARY GOPHERS 50. MEDICAL SCHOOLS - INFO SERVICES 51. Med Res on the Internet HANCOCK 9/93. 52. Memorial Sloan-Kettering Cancer Center 53. Molecular Biology Databases 54. NASA Space Medicine and Life Sciences 55. NIH (National Institutes of Health) 56. NSF Center for Biological Timing 57. National Cancer Center, Tokyo 58. National Cancer Institute 59. Nat Ctr for Biotechnology Information (NCBI) 60. National Health Security Plan 61. Nat Inst of Allergy and Infect Disease (NIAID) 62. Nat Inst of Env Health Sciences (NIEHS) 63. National Institute of Mental Health (NIMH) 64. National Institutes of Health ATCC Databases 65. National Institutes of Health (NIH) 66. ONLINE MEDICAL RESOURCES (CAMIS) 67. PHARMACY SCHOOLS 68. PHYLIP phylogeny package FTP server 69. Protein Data Bank (Brookhaven Nat Lab) 70. Protein Info Resource (University of Houston) 71. Society for Mathematical Biology Digest 72. Springer Journals: Table of Contents Service 73. Unified Medical Languages System 74. Univ of Houston, Protein Information Resource 75. World Data Ctr on Microorg (WDC), Japan 76. World Health Organization (WHO) Health Care Related FTP Sites Prior to the development of easier network access methods, File Transfer Protocol (FTP) was the only method of copying a computer file (a program, a graphic image, digitized sound, etc.) from one Internet node to another. Although many institutions have since converted their archives to allow Gopher access, some valuable resources remain accessible only through FTP: [Figure showing health care FTP sites deleted from ASCII file] RURALNET LIBRARY RESOURCES RuralNet provides connections to major libraries both within the state and around the world. Users can search the card catalogs of the James E. Morrow and Health Science Libraries at Marshall University and the library at West Virginia University, as well as all public libraries around the state. Internet access connects RuralNet to the online library systems of every major research university in the United States and many around the world. RuralNet is also linked to specialized health care libraries, such as those of the University of Medicine and Dentistry of New Jersey, Johns Hopkins University, Stanford University, Yale University, McMaster University and the National Library of Medicine. Users can place electronic orders for articles from the National Library of Medicine's DOCLine service or from the Colorado Alliance of Research Libraries' UnCover system. [Figure showing library submenu deleted from ASCII file] RURALNET HEALTH CARE MANAGEMENT, ADMINISTRATION AND FUNDING RESOURCES RuralNet's connection with the Internet provides users with up-to-date information on Health Care Reform, including official federal policy proposals and announcements as well as critical discussion and analysis. Health care administration and management resources, offered by some colleges of business, are expanding and growing more detailed. RuralNet users can also access detailed listings of research grant opportunities from the National Science Foundation and the National Institutes of Health. OTHER RURALNET RESOURCES Early in the development of programs to encourage the retention of West Virginia's health care graduates it was discovered that the improvement of health care delivery is inexorably linked to the improvement of the state's primary and secondary education systems and the to economic development. Part of the mission of the Kellogg Community Partnerships, therefore, is to provide community access points for resources in K-12 education and business and economic development. In this spirit, RuralNet users can access a large number of these other resources -- such as the U.S. Department of Education, the Classroom Earth BBS for Environmental Education, the U.S. Department of Commerce, the Small Business Administration and even the World Bank -- in addition to those utilities related specifically to health care. Recent attention to the issue of health care reform has highlighted the need for health care access as well as traditional quality. In this vein, RuralNet provides access to some social work resources to facilitate the determination of whether a particular individual might be eligible for assistance programs. The social work resources on RuralNet include a Social and Family Database from the University of Pennsylvania, a database of government assistance programs and the Social Security Administration FTP archive. CONNECTING TO RURALNET In order to access RuralNet a user must have a computer account with Marshall University, which can be obtained by contacting the Department of Academic Computing at (304) 696-7310). Hardware requirements include: A personal computer A modem (2400 - 14400 baud) Telecommunications software with VT100 or VT102 terminal emulation If you have any questions, contact Michael McCarthy in the Department of Academic Computing of Marshall University School of Medicine at (304) 696-7310.