In our search for the best solution to Internet access we found a partner in the Virginia Health Department. The Health Department has offices located in every county in the state, all of which are networked to the main office in Richmond, which in turn has Internet access. We reached an agreement with the Health Department to use their network in return for encouraging reporting of communicable diseases, disseminating vaccination records, and providing continuing education materials to rural physicians.

As part of this project we have developed the Virginia Medical Education Network, or VMedNet, a World Wide Web server dedicated to providing useful information and Internet links that would be of interest to generalist physicians. Faculty preceptors are given a e-mail account on VMedNet and use it as their startup "home page" for their web browser. We constantly monitor Internet resources in medicine and update the VMedNet site to provide a one-stop clearinghouse for medical information on the Internet. We also provide a direct link to the Health Department where physicians may report diseases via a web form. We also provide Medline and state-wide vaccination records access to our remote preceptors.

Providing Internet access to our remote preceptors also has a strong business case. By providing our preceptors with Internet services through the University, we strengthen our reputation as an innovator and leader in medical informatics, and access to our specialty physicians for all Virginians is improved. Through the VMedNet web site generalist physicians my request consultations of our specialists. We are also working on ways to provide pathology reports and patient discharge summaries back to referring physicians via e-mail. Giving better service to our referring physicians should result in more referrals.

The educational uses of this system are two-way with medical students playing an important role. Since medical students are usually more expert computer users than physicians, we use them to help educate our preceptors and their staff in the uses of the information systems we provide. The students in turn get e-mail and web access while they are out of town.

On the other hand, preceptors can assess several university developed on-line continuing medical education programs which are delivered via the VMedNet Web server. This provides rural health care providers another option to expensive and time consuming trips to CME conferences, and also allows them to pursue CME any time they have an opening in their schedule.

Setting up this system was not easy, however. Even once there was agreement between all parties on how to proceed, there were many technical obstacles in passing Internet information through a secure Health Department network, not to mention the difficulties of setting up user verification on a state-wide system. These issues will be discussed in more detail in the presentation.

State-wide information networks like the one described above will become commonplace in the near future. They facilitate communication with students and remote faculty, can provide continuing medical education programs, and encourage referrals to the host institution.