INTRODUCTION:

In a broad, conceptual definition, telemedicine is "the use of telecommunications technologies to provide medical information and services(1)." The Internet is a commonly used and inexpensive wide-area telecommunications technology which can provide medical information or services. Two of the most frequently used tools on the Internet are world-wide web (WWW) browsers and electronic mail (email). Email discussion lists are a common mechanism whereby interest groups may exchange information resources quickly and efficiently among a large body of participants. We have studied the use of email discussion lists by anesthesia providers as a form of cost-effective telemedicine. Further, we conclude that email discussion groups may act as virtual colleagues for medical practitioners.

ANESTHESIOLOGY DISCUSSION LIST:

Anesthesiology Discussion List is an international discussion group comprised of anesthesia and critical care practitioners. The list was formed in May, 1993 and has over 1000 members. New members are added to the list at a rate of two to three per day(2). We performed a content analysis on one month of messages from this discussion list(3). We analyzed a number of variables, including time stamps, email addresses and points of origin, general message content, knowledge sources, and keywords. Of these variables, the general message content was further subdivided into subtypes of "clinical," "administrative," or "non-clinical." We then classified its general content as a question, response to a previously asked question, both a question and answer, or neither question nor answer.

Five hundred thirty nine consecutive messages were contained in the digest we analyzed. Of these, 78 were questions for the discussion group, 387 were responses, 36 were both questions and responses, and 38 were neither. Two hundred ninety one messages had a clinical focus, 112 were administrative, and 136 had no clinical focus. Knowledge sources found in each message included personal experience, literature quotes, standards, and hearsay. Over 75% of the messages posted to the discussion list related to the daily practice of medicine.

A VIRTUAL COLLEAGUE:

In an extension of our previous study, a digest consisting of 635 messages was analyzed in a similar manner. We found 70 clinical questions asked by 56 practitioners. We developed a questionnaire, sent to these practitioners by email, asking a variety of questions about the reasons the practitioner submitted his or her question to the discussion list. Twenty eight practitioners responded to the survey and follow-up reminders. Of these, we found a group of 9 respondents who rated the quality of responses from the discussion list highly, were likely to use the list for future questions, and were more likely to use the list than their colleagues for consultation. These respondents were primarily private practitioners from small groups or solo practice. Academic practitioners and those from larger practices tended to rate the quality of responses from the list highly, were likely to use the list for future questions, but preferred to use their practice colleagues for a primary c! onsultation resource.

CONCLUSIONS:

Among a group of anesthesia practitioners who use Internet resources for telemedicine, we have discovered evidence suggesting that practitioners who work alone or in a small group are likely to use an email discussion list as a virtual colleague. These practitioners cite international diversity, exposure to academicians, and discussion of new discoveries not found in texts or current journals as benefits to belonging to such a list. While this research has focused entirely on one specialty of medicine, we find a body literature supporting the premise that colleagues and consultants are the primary information- seeking resources of health care professionals.