Editor's note: This article was written in Feb. 1993. We apologize to the authors for not printing it sooner, as the subject matter is timely. The rapidity of changes on the information superhighway is startling. There are a burgeoning number of DCs sending e-mail on the Internet and other online services. In fact, we at "DC" are being inundated with e-mail. That's good news.
Information about chiropractic on the superhighway is also greatly increasing. Currently there are two active chiropractic online networks: ChiroLink and Chiropractic Network Connection (CNC). There is another one being tested: Chiro Serve. If you access ChiroLink, you can read and/or download copies of articles that have appeared in previous issues and you can review our Computerized Chiropractic Calendar for events in your area.
If you wish to communicate with our editorial department, our America Online user name is DC Editors.
During his now-famous "Information Superhighway" speech, Vice President Al Gore warned that there must be equal access "...to avoid creating a society of information 'haves' and 'have nots'." Are chiropractors being left behind as information have nots? For many years the medical community has utilized the power of the computer for the advancement of their profession. The major information suppliers, Compuserve, Prodigy, America Online, and Delphi have medical "forums" or discussion groups for medical doctors. The MDs have access to each other by e-mail (electronic mail). E-mail gives them the ability to communicate with each other no matter where they are in the world. If an MD in Zurich has a patient with AIDS and wants to know the latest treatment protocol for pneumocystis pneumonia, he "posts" a note on the AIDS information bulletin board and within a few hours he can have 15 e-mail "letters" back with suggestions from doctors in Rhodesia, France and San Francisco.
Most of us in practice have computers that are used for billing, practice management and word processing. Most of us have modems to send "electronic claims" that, for the most part, have never materialized.
Chiropractors need to began to use their computers to communicate with one another and the rest of the world. If I have a patient with a rib problem and nothing that I try is working, I can post a note on an electronic bulletin board and get suggestions from chiropractors around the world on what I can do to help my patient. Any chiropractor with an e-mail address can communicate with any chiropractor or other person around the world with an e-mail address at no cost. If a patient of mine is moving to New Jersey and I want him to see a doctor who graduated from the same school that I did, and who uses the same technique I do, imagine consulting a chiropractic Bulletin Board System (BBS) database for a referral. We can create a world-wide referral base of all techniques and specialties.
In the '90s, information is the key to success. The information revolution is here. Do we jump on the bandwagon or let ourselves be left behind? How much political clout would we have if each one of us could write a single e-mail letter and send it to each of the members of the house, senate, and Mrs. Hillary Rodham Clinton? They all have e-mail addresses. Would our leaders think twice about cutting us a raw deal if each day they came into the office and faced 65,000 electronic messages from chiropractors around the world complaining about the treatment of chiropractors in a health care issue? Think about the "20/20" program on chiropractic. They have e-mail. If they had treated us fairly, we could have sent them thank you letters. We could have sent them 65,000 complaints that they would have received immediately.
Why not just send them "regular" mail (known in electronic circles as "snail mail") or make a phone call? I (Dr. Machado) had been doing a literature search regarding myofascial pain on MEDLINE at the UCLA biomedical library for a seminar that I would be teaching. I read Dr. Pikalov's article about Russian research on manipulation that appeared in Dynamic Chiropractic. I noticed that Dr. Pikalov had left his e-mail address at the end of his article. I wanted to know if he had any knowledge of the occurrence of myofascial pain syndrome in the Russian medical literature. I had never spoken to him and was uneasy about calling him since we had never been introduced, so I composed a short e-mail message and posed a question about the occurrence of trigger points in Russian medical literature. Within a few hours he e-mailed back a response, and thus began a discussion about computers, the future of chiropractic, and the electronic collaboration that ended in the production of this article.
E-mail is less formal and easier to respond to than regular mail or a message on an answering machine. Another author, John Seabrook, came to the same conclusion when interviewing Bill Gates, the founder of Microsoft, by e-mail. Mr. Seabrook wrote: "At the moment, the best way to communicate with another person in the information highway is to exchange electronic mail: to write a message on the computer and send it through the telephone lines into someone else's computer... e-mail allows you to meet and communicate with people in a way that would be impossible on the phone, through regular mail, or face to face..."
This article came about because of e-mail. Dr Pikalov and I have never met face-to-face, nor have we ever spoken on the phone, but we were able to collaborate by way of the information superHighway.
E-mail is just the tip of the information-exchange iceberg. A chiropractic BBS (bulletin board system) will be a repository of chiropractic knowledge for all of us. There will be live "on-line" discussion groups for philosophy, technique, students, insurance issues, workers compensation, chiropractic laws for each state, chiropractic schools, seminar presenters, advertisers, etc. (Editor's note: Every Sunday night on America Online, 9pm EST, is a one-hour Chiropractic Professional Networking Forum which allows interesting interaction between DCs like Ted Koren, Dana Lawrence, Chris Kent, and whoever wants to join in. Although it has only existed since September 1994, as many as 80 users join in the discussions. See AOL's Health and Medical Chat.)
The explosion of new technology makes mass storage of radiographs, photographs, and journal articles possible, available to you via phone lines at home or at the office. All you need is a computer and a modem to access the chiropractic database. If the BBS becomes successful, it will be made accessible through the Internet, and will, therefore, be free of phone charges to those with access to the Internet. A chiropractor could leave a group message that would be read by every member of the BBS or could be sent to only those within a particular zip code. An advertiser could target their products to those doctors that use a particular device or service in their practice. The state boards will be able to get accurate survey information about our opinions on issues such as the infectious disease ruling in California.
This linking of chiropractors could be a great financial and political benefit. If, for argument's sake, Blue Cross or Medicare began denying our claims, we could send notes to an "Insurance Forum" concerning the issue, and find that many of us were being denied payment. Do you think that they could get away with it for long if we tracked them like that? The MDs already keep track of such things in this way. What if chiropractic schools began to use this technology to access doctors in the field to do research and to report the results electronically? A single research project could involve a 1,000 doctors and many thousands of patients, rather than a few doctors and a dozen patients. A research department could put out a message for occurrence of melanoma in the chiropractic practice and within a few days have enough information to publish a paper. If a college wanted interesting radiographs of Pott's disease for their radiographic library, they could put out a worldwide request and receive digital copies via computer for their students' use. We as a profession could make our research readily available to other health care providers via computer.
Anyone who had access to the Internet (some 25 million worldwide) could learn about chiropractic in a publicly accessible portion of our chiropractic database. There are searching functions within the Internet that will search virtually every computer in the world for key words. A search for "chiropractic" resulted in only one piece of information: the formation of the new chiropractic college in North Carolina. A search for "medical" resulted in a five minute wait and 15 pages from different computers around the world that stored information about medicine that I could connect with directly by hitting the return key. Every medical school, and most colleges, give free access to the Internet to students and faculty. Any student at UCLA can dial up the main computer from his dorm room and within seconds search through the biomedical library to see if a book is checked out or look through the collections of the Library of Congress or download CT images from a compilation of medical images in Osaka, Japan. Any medical student at UCLA can access Melvyl (a direct connection to Medline, the major medical journal database of abstracts and references) from home.
Our chiropractic colleges have not yet begun to supply this kind of connectivity. LACC will be getting an Internet connection for the reference librarian only in a few months. The reference librarian at Cleveland Chiropractic College in Los Angeles has access to the Internet, but the students do not. Life West library has access; the students do not. Our chiropractic doctors of the future do not have access to the same types of resources as the average medical student has, even though they pay roughly the same amount for their education.
Why have access? Imagine chiropractic students from Australia, England and the US comparing notes on anatomy, physiology, philosophy, technique and nutrition live on the computer. Or, a chiropractic student wants to know about a staining technique that is used to prepare specimens in histology, so he can search in international computer community for the person or persons who developed the technique and get the question answered directly. This is a current technology, not some fairy tale. The question is whether we will embrace the technology. How much does it cost to have this type of computer interaction with the rest of the world? Dr. Machado pays $17.95 per month for unlimited e-mail and full access to the Internet. Dr. Pikalov has an account with Delphi, and it costs $10.00 per month with a charge to e-mail outside Delphi's system.
Chiropractic schools that have a local area network would need one connection to integrate their entire network with the world. Chiropractic students could then access the Internet through the schools' existing computer system. The chiropractic schools can provide access in another way by purchasing a coin operated terminal that could be kept at the student union for those students without computers. These terminals cost less than two-thousand dollars and would pay for themselves in a few months. This is not recreational technology; this is a survival technology. The chiropractic school reference librarians who I spoke with are very excited about having the technology, but would like to see the students have the same access. The question must not be, "Can we afford it?" The question must be, "Can we afford not to have it?" I am compiling a list of chiropractors, chiropractic educators, chiropractic students, advertisers, seminar producers, state board members, and others involved in our profession who have e-mail. If you have an Internet address, please send e-mail to Dr. Machado at smarchado@netcom.com to be included. Please e-mail any comments. Dr. Pikalov has a database on last achievements in chiropractic research. Do you have excited news in this field? Send him e-mail at hymoswmips@dephi.com. If you would like more information on this technology, please write to us at our respective addresses. Those who do not have e-mail may reply to our regular addresses. Subsequent articles will deal with the integration of technology in the chiropractic office.
References
Dr. Andrei A. Pikalov, MD, PhD
Cleveland Chiropractic College
6401 Rockhill Road
Kansas City, MO 64131
(816) 333-8230 X283
E-mail: hpmoswmips@delphi.com
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Some doctors thrive in a personality-based clinic and have a loyal following no matter what services or equipment they offer, but for most chiropractic offices who are trying to grow and expand, new equipment purchases help us stay relevant and continue to service our client base in the best, most up-to-date manner possible. So, regarding equipment purchasing: should you lease, get a bank loan, or pay cash?
