Rod Ward

Information and Web Technologies
Paper given at "Solving the Jigsaw"
BCS Nursing Specialist Group Conference 23rd September 1999, Northampton

Published in ITIN 12(2) 20-22


The Internet and the World Wide Web in particular has become a key tool for all healthcare professionals to publish, obtain and communicate information to support practice.

The Internet has quite a long history but prior to 1990 had little use, certainly in the nursing field. Around 1992 the Web was "born" and increasing access was gained particularly within the UK in the higher education sector. Soon after this the mailing list nurse-uk and the newsgroup were started to use this medium for communication amongst nurses.

In 1993 when I started to look for nursing web sites I found 5  with no central index and started "Nursing & Health Care Resources on the Net". Since then there has been massive growth in all sectors.


The resources on the Internet can be divided into asynchronous and synchronous.
Asynchronous includes the World Wide Web including databases, email and mailing lists/listservs, discussion boards and Usenet newsgroups. Synchronous technologies that allow immediate "real time" communication include chat, conferencing (both text, audio and video) ICQ etc.

The World Wide Web now contains over 500 million pages of information (no-one knows quite how many) and health is the second most searched for topic. Over 100 million pages contain health related information, and over 5000 web sites are nursing focused or related, with over 100 nursing specific sites in the UK.

For a long time the UK and the rest of Europe were a long way behind North America, perhaps because phone access is not paid for "by the minute". However it is predicted that within the next 2 years, European use will catch up. Other growth areas at present are Asia and Australia. Use is still limited in Eastern Europe, the Indian sub continent, Africa and South America, however some impressive developments are taking place in these areas and they are likely to be growth areas soon.

Bibliographic databases, e.g. Medline are available free over the internet others that are charged for, e.g. CINAHL are more restricted, but use internet or intranet technology for delivery.

A very wide range of organisations (and individuals) now use the web to publish information including the Department of Health, NHS, Royal Colleges and universities. Sometimes this is purely a marketing tool, but others use this for the distribution of reports and other documents and for education.

The information available covers everything you could think of and a few that you probably wouldn't! These range from government and peer reviewed research reports to personal opinion. This raises issues of quality and usefulness. The usefulness and relevance of any information, whether on the web or paper TV etc. will depend on the purposes of the reader, perhaps it is best to remain cynical about everything you read and develop your own methods of evaluating it for your own purposes.

Various health specific search facilities and gateway sites have been created including; Nursing & Health Care Resources on the Net, OMNI, Achoo, HealthAtoZ etc. Perhaps the National Electronic Library for Health (NeLH) will meet it's objective of becoming THE UK gateway to "accredited" health information and achieve it's mission:
to provide easy access to best current knowledge
to improve health and healthcare, clinical practice, and patient choice.

Email, newsgroups, discussion boards & Usenet newsgroups provide a more interactive means of communication.

Individual email provides a quick method of communication between 2 individuals or a small group. This can be enhanced by the attachment of files which may be text, pictures, sound files or even video. Listservs (mailing lists, mailbase etc.) can enable this communication amongst a much wider group with similar interests. There are over 1000 health related mailing lists, some are highly specialised (and generally have a low volume of traffic) these may relate to specific professions, conditions or geographical areas. Others are quite general and have a higher volume of traffic e.g. Nursenet

Newsgroups work in a similar way but do not require subscription and do not fill up your email box. Out of the approximately 50,000 newsgroups over 1000 are health related.

Discussion boards on the web perform a similar function enabling an individual to post a message which can then be seen by all other users, but are often less popular as they require the user to actively look at the specific web page.

The quality of the communication with all these methods can be very variable.
Most people read listserv, newsgroup and discussion board messages but never post themselves - they are known as lurkers, the reasons for this are not clear but it seems likely that many are afraid of their thoughts and comments being attacked (or flamed) by other users.

Chat, ICQ & video conferencing provide the ability to communicate instantly with others who are online at the same time wherever they are in the world. The have the potential to overcome some of the communication limitations of asynchronous communication but require different techniques & skills. These have been used in both patient - professional and professional - professional contexts.

The NHSnet is an attempt to provide a closed intranet which uses internet technologies for on a closed network for NHS staff which may link individual trust or hospital networks for data transfer email etc. (although the NHS selection of X400 as it's email systems rather than SMTP used on the internet has led to some problems.

Minor injuries/Walk in clinics, Dermatology, Remote surgery, A&E- ambulance links, appointment booking etc. are all examples from health settings which apply some of these internet technologies. Links are being developed which connect the Electronic Patient Record (EPR), which will eventually be multimedia to knowledge sources relevant to that patients immediate care.
However in many NHS settings there are still difficulties for individuals in getting connected to NHSnet or the Internet. Even when they have the possibility of access many staff lack the knowledge and skills to take advantage of the technologies. Learning the skills will take support from employers!


As envisaged in Information for Health  clinical benefit should be achieved through better information management. To achieve this the NHS needs to take advantage of work on Internet in HE sector & elsewhere rather than reinventing the wheel.

Nurses & other Healthcare professionals need to recognise potential advantages & learn the necessary skills.

Internet technologies provide opportunities for:
· easier publication
· easier finding of information
· easier communication across geographic and professional boundaries
We all need to get to grips with the potential to enhance evidence based healthcare

There are many resources available to help, particularly books (e.g. Health on the Internet, Nurses guide to the Internet) and web sites - one which was created specifically for UK nurses and midwives is Demystifying the Internet

Internet resources mentioned.

Mailing lists

Nurse-uk mailing list
To join send email to:
 with the message: join nurse-uk [Your Name]

To subscribe, send e-mail to:
 with the message: Sub NurseNet [Your real name]

newsgroups (NB Access methods vary with your setup)

Web Sites

Nursing & Health Care Resources on the Net -

Department of Health,


Royal College of Nursing

universities. For a list of all UK university schools of nursing with web sites




National Electronic Library for Health (NeLH) -

Demystifying the Internet


Health on the Net - Dennis Anthony 1996 Blackwell Science; London
ISBN: 0-632-04072-6

Nurses' Guide to the Internet 2nd Ed. Nicoll, L.H. 1998 Lippincott-Raven
ISBN 0-7817-1435-4

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Page created: 25.9.99

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