Using the Internet for
Patient & Physician Web-education
& Health Promotion

The Third Annual World Congress on the Internet in Medicine

Using the Internet for Patient & Physician Web-education & Health Promotion (EP #11)

Kirsti A. Dyer, MD, MS1; Cole D. Thompson MA2
Ololade Reis, MD3; Sandra Romer4

Affiliation: 1-4Journey of Hearts & The Medical Oasis

E-mail Addresses:

Table of Contents

Key Words
Internet, Website, Patient Education, Medical Education, Web-education, Grief, Loss, Bereavement, Depression, Primary Care, Health, Physical and Mental Well-being.

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In the United States it is estimated that 70% of patients with depression present to their primary care physicians, often with mixed symptoms and complaints. Furthermore, physicians fail to diagnose depression in more than 50% of these patients. [1] Time constraints limit the typical primary care office visit to 15 minutes or less, compared with 30 minutes for a typical visit to a mental health specialist. Compounding this is the fact that medical patients typically present with a variety of somatic complaints: fatigue, insomnia, pain, and gastrointestinal symptoms, which require a thorough evaluation to exclude potentially serious medical disorders, before diagnosing depression. Consequently, the underlying depression is unrecognized and undiagnosed. [2

Unrecognized acute loss or unprocessed long-standing grief can also mimic many medical conditions. Complicating this picture is that depressive manifestations and symptoms of distress are part of the normal reaction to grief. A grieving person may experience chest pressure, palpitations, stomach pains, backaches, panic attacks, or increased anxiety. Unrecognized, unprocessed and untreated a person's grief response can create considerable additional anguish. Grief can lead to functional impairment, decreased productivity--both personal and professional, strained relationships, clinical or situational depression, and an increased risk of suicide. [3]

It appears that the trends for treating depression in the United States are shifting. Formerly depression was considered a condition to be treated by mental health specialists. But depression is rapidly becoming the responsibility of primary care physicians with few if any provisions for the additional time, screening resources, or additional training needed to address this new requirement in primary care. [4] Unfortunately, too, many insurance companies are placing restrictions on the number of office visits to non-mental health specialists that are allowed to individuals within a health care plan.  Yet these are the often the same patients that continue to return to the clinic, office, or the emergency room with vague somatic complaints, requiring expensive, often unnecessary re-evaluations for their somatic depressive or anxiety symptoms, consequently increasing health care costs. [3,5]


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Background Discussions
The idea to create the Journey of Hearts website originated after many informal discussions with several other primary care, internal medicine and emergency physicians. During these discussions several concepts became apparent. Collectively, we were seeing more people in office and emergency room visits who were dealing with depression, stress, or grief, with less time to spend per patient. Many of us felt that there was little else to offer medically once the major medical problems were ruled out. These patients often were unwilling or unable to seek further mental health evaluation or counseling due to a variety of reasons. Their reasons included: time constraints, inability to obtain transportation, unwillingness to accept mental health referral, the limitation of mental health resources in rural communities, the costs associated with receiving counseling, and the social stigma of a diagnosis of depression, grief or anxiety.

Added to the increasing number of stressed, anxious and depressed patients being seen was the lack of preparation and information we had received during medical school and residency training for treating some of these borderline medical, borderline psychiatric disorders. The issue of grief and loss, in particular, was one that was generally relegated to ancillary staff--clergy, nursing, social workers or counselors. Yet, many of us as physicians realized that we needed information and resources to help our patients deal with these issues, when for whatever reason, they were coming to us, not the ancillary staff, for this type of support. We recognized that unprocessed depression and stress were impacting many of our patients, our friends and our colleagues, both personally and professionally. The upshot of these discussions was realizing we needed a resource to which we could refer patients, friends and colleagues for information, resources and support in dealing with the issues of grief and loss.

An Idea Emerges - A Website
Our suspicion that unprocessed grief could and did significantly impact people was confirmed as we watched the world-wide grief response [and the Internet response] to the deaths of Princess Diana and Mother Teresa in August 1997. This was the final piece to crystallize the idea. The resource we needed to created was a website. By October 1997 we launched the Journey of Hearts website that would serve as an educational resource, an adjunct to medical treatment, a "prescription for a virtual hand holding."  The underlying concept was to create a site that would combine medicine, colors, and images, be informative and interesting while providing reliable information and resources for those dealing with a loss. It was important to include images and color as a significant component in the design of the site, so as to have a resource that could be experienced visually, without having to read the words, thus benefiting those in the early or severe stages of grief.

Education on Grief and Loss
Journey of Hearts combines medicine, psychiatry, poetry, prose and images to provide resources and support for anyone who has ever experienced a loss. Out of concern that the Journey of Hearts site was viewed primarily as site for the public and not professionals, The Medical Oasis was created as a separate section of the site, designed to help health care professionals. This second 'portal' debuted in October 1998 to provide education and rejuvenation for those health care providers who work in settings impacted by grief and loss. It provides a resource for the information on grief that we found lacking during our training.

We utilized many of the underlying concepts of self-help groups providing useful information, sympathy, validation, and personal mastery to their members. [6] At the same time we did not want visitors to the site to be potentially disillusioned or damaged by those with "virtual factitious disorders," an unfortunate new result of the growing number of on-line support groups. Individuals are masquerading as being desperately ill, dying, experiencing seizures, or grieving an imaginary loss, in order to gain sympathy, attention and nurturing from the group. [7] To minimize the potential of patient pretenders, we have elected to not have on-line live 'chat rooms' or threaded discussion groups. The content of visitor comments placed on the site and the guest book is carefully monitored

In creating Journey of Hearts and The Medical Oasis we utilized the advantages of a website ( 1) that make it ideal as adjuncts for patient and physician education. We also recognized that a website serves as an ideal communication tool for those with a variety of limitations (Table 2) and a way to potentially reach those home-bound for a variety of reasons.

Table 1
 Advantages of a Website for Patient and Physician Education
  • A website is accessible at any time, day or night, when friends and family may not be. 
  • A website can be accessed from home, when a person is ready, enhancing receptivity and retention of material. 
  • Information on a website can be updated immediately. 
  • The ease of updating information allows for creating "What's New" sections to encourage repeat visits to a site. 
  • The Internet "levels the playing field" making the same information accessible to those in different socioeconomic groups and geographic locations.
  • A website can be accessed by patients to clarify, enhance, and reinforce information presented in an office visit. 
  • A website can be experienced in a variety of ways-- through colors, sounds, and images in addition to content on the site. 
  • The Internet can reach those in rural communities, both patients and physician. 
  • There are no state, national or international boundaries on the Internet, enabling connecting those who have similar experiences, or expertise in a particular area,  through out the world to share information and support. 
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Table 2
The Internet:
An Ideal Communication Tool for those with Limitations
  • Physical - wheelchairs, bed confinement, deformities 
  • Situational - environment (natural disasters), rural communities, transportation limitations 
  • Primary Caregiver for Family member - child or adult 
  • Phobias - social, environmental, fear of crowds, people 
  • Psychiatric - panic, anxiety attacks, depression 
  • Emotional - depressed, distraught, grief-stricken
  • Financial - free access to information on the Internet, allows for those without the resources to see a counselor to find some self-help resources and information on-line
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These websites help to bridge the gap in treatment--in the transitional area between medicine and psychiatry. This area is one that has been long neglected by the medical field, relegated to nursing, clergy, social workers, counselors or psychiatrists. Transitional Medicine combines the best of medicine, psychiatry or counseling, and complementary therapies to provide resources and support in the transition period in going from loss to eventual healing; it also recognizes that the mind can and does play a significant role in both the healing and the illness processes.

The education topics on the site include: What is a Loss? What is a Significant Life Change? What is Grief? How Long will I Grieve? Am I Really Depressed? as well as many articles, stories and poems written by those who have survived losses. The site provides information for those trying to support friends through the process including How can I help someone who is grieving? and Being a Supportive Friend. Also included are several interactive screening questionnaires for depression and stress assessment, as well as information on suicide and how to recognize those at risk for suicide. The site is linked to the Samaritans for anyone who might find the site and be feeling suicidal.

Medical Web Resources for Loss
In constructing our site, particularly the medical resource section, we wanted to provide reliable, credible information. With an amount of information equivalent to 800 novels (each 400 pages long) being posted to the Internet each day, it is a daunting task to sift through and find good reliable information. [6] The extensive resource listing was compiled so as to have a referral base for a variety of losses. The Medical and Resource List is compiled of 90 sections relating to topics of loss and over 275 resources or links to various organizations or other websites sites. Some were suggested by colleagues, others were found in medical journals or other medical sources. Many were suggested by members of the Alliance of Healing Hearts, those who have helped contribute to the creation of these sites. By providing extensive resources and links to obtain knowledge it is hoped that some of the fear of the unknown will be alleviated e.g. as with a new diagnosis of diabetes, leukemia, heart disease or Alzheimer's. It is our belief that understanding a situation, a condition, or a disease allows for a sense of calmness from knowing what is going on, or what to expect, rather than continuing to fear the unknown.

Adjunctive Therapies Incorporated into the Website Design
A variety of different adjunctive therapies have been included in the information compiled within the site. Many of these adjunctive therapies are now recognized within the established medical communities as helpful, healing modalities.
(Please click on the hyperlinks to get more information)

The therapeutic impact of color and images is apparent from the moment a visitor reaches the site. The main pages for each site set a certain mood. On the Journey of Hearts page the visitor is greeted with our version of 'CyberSpace' with a dark midnight purple sky, planets aglow and twinkling stars in the distance. The background on The Medical Oasis site transitions from a calming shade of blue to an energizing shade of yellow, while a photograph of a Hawaiian Island serves as the image of the Oasis. The overall design of this main page is to create a calming place of respite and refuge, to refresh, restore and re-energize. In other sections of the website specific colors and images have been very deliberately selected. Yellows were chosen as the predominant color of the Emergency Pick-Me-Up up page and balloons as the dominant image. The Condolence & Sympathy and the Loss, Change & Grief sections were done in soothing, calming hues of blues and/or purples to help those in the early stages of grief. The section on Transitional Medicine has been designed in vibrant turquoise, blue, fuchsia, and pink to portray the colors described in a Transformation poem.  This conscious emphasis on color therapy appeals to and helps many of the visitors and colleagues who comment that color and images are some of the most therapeutic elements of the website. One visitor related that she experiences the site while sitting in a dark room, stating, with hand to heart, that "The site touches me here."

Establishing Guidelines
In constructing our websites, we wanted them to be recognized as a reliable medical resource website, not one of the many health care sites sponsored by a drug company, managed care organization, or other savvy online health entrepreneur. [8 To provide credibility for our site we created our own internal guidelines established from the two main sources JAMA [9] and the Health on the Net Foundation. [10]
In keeping with these combined guidelines, our websites the site provide information on:

It is well known that the commercial publishers have been slow to embrace the Web. The official reason given is concerns over protection of their intellectual property, but the more compelling reason is the difficulty in charging for their publication materials when much of what is currently on the Web is free to users. [14] For articles we had already published, we were able to obtain permission to include most of these articles on the site. We had more difficulty in obtaining permission from medical journals for other non on-line articles that would have been useful for the site. Additionally, most all of the authors approached graciously granted permission to use their articles, stories, poems, or quotes. Those who did not grant permission, their works were not included.


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Start-up Costs
Once the decision was made to create a website, there were several initial, unavoidable costs and fees, such as the registration and activation of the URL's with our service provider and the two years licensing fees with the InterNIC. The other major investment was that of Corel PHOTO-PAINT 8, which was our photograph and graphic program of choice, since we already had WordPerfect and experience with the earlier versions of Corel PHOTO-PAINT. A way to get software for graphic manipulation is with The GIMP (GNU Image Manipulation Program). This is a freely distributed piece of software suitable for such tasks as photo retouching, image composition and image authoring. GIMP is written and developed under X11 on UNIX platforms, so is an ideal 'free' tool for those with some computer background skills. We hope to eventually start utilizing The GIMP for our websites.

We invested in the O'Reilly Dynamic HTML: The Definitive Reference Book for another $40.00 to learn more HTML. The HTML Writers Guild is only one of many different on-line resources for obtaining information on HTML. Helpful areas on this site include HTML Resources and Useful URL, making investing in a HTML book an optional cost.

Our total start-up costs were around $400.00, but with using free software for to create graphics and on-line HTML instruction, this cost could have been reduced to around $200.00 Maintaining two URL's runs $30.00/site/month. The only other major cost has been a great investment of time.

Creating Pages for the Websites
The earliest version of the Journey of Hearts website was made with Corel WordPerfect 7 HTML authoring tool. This tool severely limited the available font options both the size and style. There are no existing live pages from this stage of the site currently on the web. We purchased the much hyped Hot Metal authoring tool (another $50.00) which creates pages based on their standard templates, but were unable to easily or quickly determine how to use this program so it was abandoned. Hot Metal also created, now permanent problems with other existing programs already on the computer. Searching for a better authoring tool, we downloaded Netscape Navigator with their Composer tool for free and have used this as the primary authoring tool since.
The web pages are created visually in Netscape Composer and then the fine-tuning of the HTML code is done in Notepad or Write programs. The majority of images from the site are created in Corel PHOTO-PAINT 8, from the stock photographs from Photo Gallery 5,000 Vol. 1 & 2 from Media Graphics, and many of the newer ones are photographs that we have taken and developed onto disc by Longs Drug Photo Developing. Those images we have obtained from other sources have been credited on the site to the artists.
The Medical Oasis was created entirely after switching to the Netscape Composer.
The overall goal in authoring webpages was to emphasize content, color and downloading time. We have tried to create pages quickly accessible by the majority of browsers, and  de-emphasized the slow JAVA applets, which leave you waiting to load the images. Since visitors to the site are grieving with little left for extra patience, the pages were created to display text and color quickly and fill in the colors as a person is reading.

Additional Internet Features Utilized on the Sites
Many of the additional features incorporated into the site are from a variety of 'free resources' (except for their advertising banners) available on the Internet. We opted to utilize these resources rather than developing our own, giving us more time to emphasize the content rather than the CGI programs within the site.

One of the key lessons learned in this process of designing the websites was that the best means for creating the pages and for disseminating news of its existence (more below) were free. Almost without exception, the software HTML authoring tools, listing services, and registering (see more below) that were paid for were disappointing.
In researching articles for this paper, we looked for those that could be accessed on-line for 'free,' and that had links which could be included within the context of this electronic paper. The October 21, 1998 paper issue of JAMA arrived fortuitously, during the week we were looking for articles. This issue was dedicated to Computers in Medicine and looked at several aspects of how Computers and the Internet are impacting medicine.

Announcing the Sites
This was one area where the site promising free services or free promotion had little affect. We discovered that there were other many free ways of announcing and promoting the site.

Scripting or Programming Languages
The primary scripting language use to author the majority of pages was HTML. To create the interactive pages (Wakefield Depression Questionnaire, the Stress Assessment Quiz, and the Search Engine for the site) we utilized Perl programs using CGI (Common Gateway Interface) methods. We have recently included a small amount of Java script to liven up the opening pages of The Medical Oasis. Creating programs to search for broken links and globally updating information were also done in Perl. UNIX is the operating system used by the service provider for reliability and performance, so it required learning some basic UNIX commands and basic ftp was utilized to transfer files from our computer to the server.


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Overall Site Links - Journey of Hearts & the Medical Oasis

A Website for anyone who has ever experienced a loss.
A Place for enhancing physical and mental well-being.
A place of refuge, relief and respite to refresh, revive and restore weary travelers.
A web resource for anyone in the health 
care profession who deals with loss.
Site Statistics

Journey of Hearts Website is being used around the clock.
Figure 1
© 1998 WebSideStory, Inc. Graphics & Statistics used with permission. Labels added for clarification.
To Associated Text

Statistics for Subscribers to the Journey of Hearts E-mailing List
Figure 2


Figure 3

Figure 4

 Pie chart graphics created with Corel WordPerfect®7.
To Associated Text

Occupations of Members on Journey of Hearts E-mailing List
Table 3
Not Employed
College/University Student
K-12 Faculty
Executive/Senior Management
Customer Service/Support
College/University Faculty
K-12 Student
Total Respondents .
To Associated Text

Types of Losses Experienced by Visitors to Journey of Hearts
Table 4
Categories of Losses Percentage
Psychiatric Disorders
Environmental Factors
Past Loss - Undefined
Chronic Loss
Significant Life Changes
Total Losses .
To More Associated Text

The Statistics for the Categories of Losses experienced by those visiting Journey of Hearts were compiled from several sources:

Patient and Physician Web-education Links
Both of the Website were created to serve as education tools on the Internet, using a variety of different methods. The following are links to the areas on the site where more medical and traditional information can be found.
Discussion & Conclusions
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Inherent Problems in Conducting Surveys on a Website
It is difficult with a website primarily dedicated to grief and loss to be able to conduct randomized, controlled double blinded studies. Not only does the nature of the topic hinder the process, but the very reasons the Internet is so appealing--the anonymity--make it nearly impossible to design a hypothetical study surveying the random visitor to the site. A person in the early stages of grief may just be able to look around the site and absorb some of the images and the colors, but would not be in a state of mind to fill out an on-line survey. Thus, the potential sample population is biased to those visiting the site who are feeling well enough or would have the time or inclination to complete the forms. A study would be unlikely to include those who do not find the site useful, adding more biases. Those who are 'lurkers' would also not be inclined to respond, and therefore not included in any study. (Lurking is an on-line phenomenon seen particularly in the listservers, but also in groups. The term describes those who 'lurk' in the background and follow along for months reading what is posted, but not participating or commenting.)
However, recent statements made by Dr. Alvan R. Feinstein, professor of Internal medicine at Yale University, at a meeting on evidence-based medicine on clinical studies are starting to question the overall usefulness of randomized controlled trials. In this recent report on the meeting, researchers are being urged to include more non-randomized and case studies in clinical trials, traditionally the 'softer' data. Yet this soft data is the type of information that is more useful to clinicians. [13] Most of the findings that we could elucidate from the website would constitute softer non-randomized data and unsolicited 'case reports' or site comments.

Analysis of Statistics from the Journey of Hearts Website
We were able to generate some statistics for the Journey of Hearts site from several different sources and made some rather interesting observations.

As would be anticipated, the largest number of visitors to the site, with conservative estimations at over 90%, is from the United States. We are starting to see more international visitors. Based on anecdotal findings for other limited studies of using the Internet with Cancer support groups we felt that the site would be useful to people in the middle of the night. We were a bit surprised to discover that the site is being visited around-the-clock (Figure 1). Some of this constant site traffic may be from the international visitors, yet we have had many people write to thank us for being there in the middle of the night when they can't sleep--a fact demonstrated by the site hourly statistics.

In looking at the composition of those who have signed up to the Journey of Hearts E-mail Listing, numbering over 430 members since June, there were some predictable and other more surprising findings.

In looking for the common reasons why people visited the site, the overwhelming reason at 63.4% was due to some type of death with death of child, death of parent, death of friend and death of pet as the four highest reasons given in rank order (Table 4).

Other Methods for Judging the Impact of the WebSites 
Other ways we have judged the site have been based on the consistent daily traffic since getting the site linked with others and indexed by the search engines. Perhaps the greatest demonstration of the impact of the website, is in the words from the visitors to the sites. (Comments, Guestbook, Supporters) The types of losses, the depth of emotion expressed in these comments continue to be astounding. People have written messages of thanks after spending hours absorbed in the site, including several men. Others have sent glowing e-mails to inform us they are passing on the URL to all of their friends and family. We have received many e-mails from those who have experienced more distant losses, wishing the site had existed years ago when they had faced a difficult loss. There have been messages of thanks for the color and images that can be experienced and help even when a grieving person is too distraught to read.

Comments and Anticipated Medical Website Trends
Much of the appeal for these websites, Journey of Hearts and The Medical Oasis, may be the result of in part functioning as a support sites. By serving as a resource for medical and practical information as well as emotional support, these sites are providing help to patients, friends, family and colleagues. These resources, medical and non-medical, are beneficial for anyone dealing with an illness or loss and in need of some support or additional resources. Having an on-line support site is particularly helpful, for patients as well as practitioners, in this neglected area of grief and loss and stigmatized area of depression. [6,14]

With over 22,750 visitors to the site since April 1998, we have been able to reach, teach, help and ultimately impact many more people than one could do within the confines of a traditional office practice, clinic setting or emergency room. The additional benefit to a website is that it is available at all hours of the day, no appointment necessary (and for the practitioner, an ability to provide a recommended resource without being on permanent call).

We believe the success of the Journey of Hearts site is because we are providing something that is lacking in many of the traditional medical practices--the ability to really "touch" a person's heart, to reach them and connect with them. The site also provides information to help in Gaining Knowledge to Regain Control. It is our belief that "Understanding a situation, a condition, or a disease allows for a sense of calmness from knowing what is going on, or what to expect, rather than continuing to fear the unknown." Knowledge provides a way to overcome that fear and begin healing from the loss or the significant change. Knowledge helps to return a sense of control over what often seems like a random or unfair occurrence, e.g. a devastating loss, new medical diagnosis, or sudden change in life circumstances. By being able to assume control one is able to more quickly accept the life change, assimilate it and start making some decisions about what to do next.

The numerous heart-felt responses we have received to the site indicate that the Journey of Hearts site is filling a much-needed niche on the net; it is helping in to bridge the gap between medicine and psychiatry, an area of "transitional medicine."

Both sites are combination, integrative websites: part medical, part psychiatric, part art, part
literary, and part self-help resources. By bringing together these different disciplines and combining various aspects with images and color we have developed a new style of medical website, one that can be "experienced" as much as accessed for medical information. Perhaps this new style will become an example of the next medical website generation on the Internet,  taking the best of the medical resources and blending it with artistic color and images, to create websites designed for patient and physician web-education, a resource accessible to anyone with a computer. [15]

In an era of "fast-food medicine" we have created a resource where both patients and practitioners can find a place of respite and support to linger and heal their heart and soul. In a world where time is a premium and becoming more impersonal, these "healing places" provide a resource for our patients and ourselves. In particular The Medical Oasis was created as "a place of information, encouragement & relief for the dry, dark, discouraging, days of training and beyond." One of the advantages of a website is that it is always there, even in the middle of the night, as a virtual shoulder to cry on or hand to hold.

Kirsti A. Dyer, MD, MS
Cole D. Thompson MA
Ololade Reis, MD
Sandra Romer
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[1] Perez-Stable EJ, Miranda J, Munoz RF, Ying YW. Depression in medical outpatients. Under recognition and misdiagnosis. Arch Intern Med. 1990;150:1083-1088.
[2] Kroenke K. Discovering Depression in Medical Patients: Reasonable Expectations. Ann Intern Med. 1997;126:463-465.
[3] Callahan CM, Kesterson JG, Tierney WM. Association of symptoms of depression with diagnostic test charges among older adults. Ann Intern Med. 1997;126:426-32.
[4] Pincus HA, Sacks H. Depression and Primary Care. Letter. Ann Intern Med. Oct 15 1997
[5] Unutzer J, Patrick DL, Simon G, Grembowski D, Walker E, Rutter C, et al. Depressive symptoms and the cost of health services in HMO patients aged 65 years and older. JAMA. 1997;277:1618-23.
[6] Osheroff, JA. Online Health-related Discussion Groups: What We Should Know and Do. J Gen Intern Med 1997;12:11-12.
[7] Stephenson J. Patient Pretenders Weave Tangled "Web" of Deceit. JAMA;280:1297.
[8] Ferguson T. Digital Doctoring--Opportunities and Challenges in Electronic Patient-Physician Communication. JAMA 1998:280:13611-1362.
[9] Silberg WM, Lundberg GD, Musacchio RA. Assessing, controlling, and assuring the quality of medical information on the Internet. JAMA. 1997:277:1244-1245.
[10] HON Principles. Health On the Net Foundation Code of Conduct for medical and health web sites.
[11] Pies R. Cybermedicine. NEJM. 1998;339:638-39.
[12] Eysenbach G, Diepgen TL. Responses to Unsolicited Patient E-mail Requests for Medical Advice on the World Wide Web. JAMA 1998;280:1333-1335.
[13] Parker SG. Randomized Trials Seldom Much Help: Case Studies Include Useful, Soft Data. Intern Med News November 1, 1998;31:46.
[14] Hersh W. Evidence-based Medicine and the Internet. ACP Journal Club Jul/Aug 1996
[15] Shortliffe, EH. Health Care and the Next Generation Internet. Ann Intern Med. 1998;129:138-40.

Live Links within this Electronic Paper
The links within this paper were verified and determined to be working at the time this paper was submitted for on-line publication. When available the URL for the Reference article have been included and linked. These links have been provided here for those who are interested in getting more information on these topics.
The external links to commercial sites mentioned in this paper are provided for information only. We do not receive any financial reimbursement for including the sites, nor does an inclusion imply an endorsement. These links are provided as additional resources for those interested in authoring their own websites,  that were found to be helpful (or in some cases not helpful) during the construction of these websites.

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MEDNET 98 - The Third Annual World Congress on the Internet in Medicine
Electronic Poster # 11
© 1998 Kirsti A. Dyer, MD, MS, et. al. All rights reserved.
Last update 11/13/98 by Kirsti A. Dyer, MD, MS
Journey of Hearts, The Medical Oasis