Over the past few years,
the availability of orthopaedic journals and textbooks on CDROM has enormously advanced
the acceptance of electronic media in our profession. Many of us now grasp the advantages
that have been realized in beginning to exploit the added dimensions that electronic media
can provide. As interesting as this transition from textbook to CDROM has been, we are
poised to make a similar leap that will prove to be more profound in the implications of
how we deal with information. The leap I am referring to is the migration of electronic
information services out of our "physical" possession and onto the global
information cooperative known as the Internet. I would venture to say that most
orthopaedists were probably not convinced of the utility, nor ready to utilize the new
technology of CDROMs when they were first released. To some, the CDROM merely represented
a seemingly bottomless vessel for the storage of textual information - a very thin book if
you will. But quickly it became apparent that the true benefits that the CDROM brought
were the ability to search, the ability to add multimedia elements AND the lowered storage
requirements of the physical media. Many of the early proprietary mechanisms to
"read" and "retrieve" information from a CDROM collection were
cumbersome and slow, to say the least. One had to be "trained" to use what was
once a simple book, easily accessible to all. The CDROM flourished because of the unique
ability to aggregate and search an entire collection of information resources - within the
limits of the capacity of the physical media. CDROM versions were certainly not less
expensive (although I still don't know completely why.) But, the evolution of electronic
media was merely just beginning. The arrival of two things created a situation where the
unique capabilities demonstrated by early CDROM based electronic media could be leveraged
to far greater advantage. One of those two things was the emergence of open standards for
handling the storage, retrieval, and display of electronic information - primarily the web
browser and all the plug-ins that have been developed to support that software technology.
The second was the emergence of a dependable, global public transport system for
information - the Internet. Today, we are presented with an opportunity to provide access
into an unlimited amount of orthopedic resources - provided the economics can be worked
out. Some of the benefits that electronic distribution provides are rather obvious,
similar to the easily recognized benefit that the CDROM could hold more information in a
smaller space. But many of the implications of electronic access are for more profound.
Let's review a few of the more obvious benefits. Electronic distribution has the ability
to nearly eliminate distribution costs for information. Nothing physical needs to be
duplicated nor transported. There are obviously costs involved in the creation of the
intellectual content, but no "physical" duplication needs to be performed -
except at the discretion of the enduser of the information resource. Since nothing is
physically reproduced until the time it is needed, maintaining electronic information
resources in the networked paradigm means that every resource can be constantly updated
and the content revised. There is no point where the intellectual content is necessarily
committed to physical media. Some may find this lack of physical permanence threatening -
get over it - or print out a copy for yourself. The concept that somehow published,
printed material is either more accurate or more permanent is simply an illusion - nothing
more. Incorrect published material is just as wrong as incorrect electronic information,
but it is more persistent.... The lack of physical media results in the ability to
eliminate excess inventory. There is no physical inventory that needs to be stored - nor
become outdated. True, there is the need for storage of the information, but like the
CDROM, the capacity seems bottomless. The electronic representation of the intellectual
inventory can be duplicated infinitely and be moved to a new location in the blink of an
eye. Physical permanence has been replaced by "backups". But, the truly profound
implications of the "digitalization" of our information needs center more around
the potential to change the way we acquire, organize and consume information to serve our
needs as orthopedists. The Internet has resulted in the creation of a "virtual
space" with the ability to house an unlimited volume of information resources - all
accessible via a single point of contact. That single point of contact is your connection
to the Internet through your web browser. The resources you will be able to access from
that single point of contact are dependent primarily on economic issues. The first
challenge is to pursue the migration of our traditional sources of information into
electronic form and to develop mechanisms that traditional publishers are comfortable with
for distributing their intellectual property via the Internet. The second challenge is to
develop new ways to utilize the unique properties of the networked information delivery
system. Each of these challenges is being actively addressed on many fronts. Imagine, for
a moment, that instead of choosing to purchase two or three textbooks (or CDROMs) for your
personal library this year, you were given the opportunity to access a comprehensive
library of information whenever you needed to, wherever you were, as long as you had
access to "webtone" (trendy geek term for access to the Internet). What would
that be worth? Could publishers be persuaded to aggregate their information resources and
allow customers to incrementally purchase only the information needed using a pay-per-view
concept? Is this better served by providing a subscription model? Or is some other
economic solution on the way? The networked information paradigm is really about
de-coupling the physical media from the content. One of the most compelling benefits of
this approach is that it allows the information seeker to be free of organizing physical
media and "outsource" the organization of all information needs to a third
party. Why worry about where you put that CDROM on knee surgery? Just remember the address
of one website... This alone separates the notion of a CDROM and a similar networked
collection in a subtle but extremely profound way. One point of contact into a
comprehensive resource creates an incredibly powerful tool that is much greater than the
sum of its parts. A reliable transport mechanism exists, the software exists, the
potential benefits are compelling - the barriers are primarily economic. We, as
orthopedists and consumers of orthopedic intellectual property, are now faced with the
opportunity to facilitate and enable the evolution to a networked electronic delivery
mechanism - just as we did for the CDROM revolution. This will require that we, as
consumers, support the embryonic network-centric information products that try and exploit
these benefits. The decision is a leap of faith, in some ways, that the benefits that will
accrue from the transition will prove compelling. I think we have a similar situation to
the emergence of the CDROM, where the benefits of electronic distribution will prove too
compelling to ignore. Give the concept some thought....
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to Appendix I
Guide to the Internet
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