The commerce of ideas: Internets and Intranets

Academic physicians pride themselves on their intelligent use of medical technology, their innovativeness, and their ability to market their excellence to the public. Although this pride is extraordinarily justified in the areas of clinical medicine, biomedical research, and health sciences education, academic physicians have less reason to be proud of their accomplishments in the area of information management. In years past, a lack of attention to coherent information management had few consequences so long as there were foci of excellence in clinical disciplines, libraries, core research laboratories, and selected training programs. But the widespread adoption of network-based communications has changed both the priorities of faculty and the information infrastructure necessary to maintain a competitive advantage. In the arena of health care information technology, many medical centers have chosen indiscriminate consumption over focused leadership. This essay speculates on how technologies based on the World Wide Web (WWW) may affect academic medicine through both the greater penetration of the Internet and a wider use of internal "intranets." The Internet is transforming the landscape of biomedical publishing, biomedical education, and the hospital library. The intranet is becoming a vital means of providing documents to support the administration of academic medicine and, in many circumstances, the delivery of patient-specific information. Although there is great potential for transformation, many academic medical centers have not yet fully demonstrated either the wisdom to advance a great information-technology vision or the will necessary to turn a vision into a coherent plan of action.