eMedicine

eMedicine is an online clinical medical knowledge base founded in 1996 by Scott Plantz MD FAAEM, Jonathan Adler MD MS FACEP FAAEM, a computer engineer Jeffrey Berezin MS. The fundamental concept was to create a large repository of professional level medical content that could be both updated and accessed continuously to assist in clinical care and physician education. The eMedicine website consists of approximately 6,800 medical topic review articles, each of which is associated with one of 62 clinical subspecialty "textbooks". Pediatrics, for example, has 1,050 articles organized into 14 subspecialty "textbooks" (Pediatric endocrinology, genetics, cardiology, pulmonology, etc.); the emergency medicine volume has 630 articles and internal medicine is near 1,400. If the remainder of the specialty textbooks (e.g., Neurology, Orthopedics, Ophthalmology, etc.) are added to the total 6800+ articles were created in eMedicine. In addition, the knowledge base includes over 25,000 clinically multimedia files (e.g., photographs, imaging studies, audio files, video files). To create this online content over 11,000 board certified healthcare specialists (95%+ physicians, 95%+ US based) were recruited and managed in a first generation, proprietary learning management system (LMS). To provide some perspective on the amount of content that was created it is estimated that, if hard-copy printed out, it would total over 1 million pages.

Each article is authored by board certified specialists in the subspecialty to which the article belongs and undergoes three levels of physician peer-review, plus review by a Doctor of Pharmacy. The article's authors are identified with their current faculty appointments. Each article is updated yearly, or more frequently as changes in practice occur, and the date is published on the article.[1] eMedicine.com was sold to WebMD in January, 2006 and is available as the Medscape Reference.[2]

History

Dr. Plantz, Dr. Adler and Mr. Berezin evolved the concept for eMedicine.com in 1996 and deployed the initial site via Boston Medical Publishing, Inc., a corporation in which Plantz and Adler were principals. Over a period of 1.5 years the Group Publishing System 1 (GPS 1) was developed that allowed large numbers of contributors to collaborate simultaneously. That system was first used to create a knowledge base in Emergency Medicine with 600 contributing MDs creating over 630 chapters in just over a year. In 1997 eMedicine.com, Inc. was legally spun off from Boston Medical Publishing. With growing traction as a revolutionary online healthcare publishing company eMedicine attracted angel level investment from Tenet Healthcare in 1999 and a significant VC investment in 2000 (Omnicom Group, HIG Capital). All investor companies held seats on the eMedicine Board of Directors.

Several key individuals made early investments in the company. These Co-Founders included Richard Lavely, MD JD who led recruitment and execution for the Internal Medicine volume and Julie Bohlen MBA who ran editorial operations for many years and became a board member. Later Ms. Bohlen, along with the other founders, played a key role in developing eMedicine Health the 600+ article consumer health reference. In 1997 the decision was also made to broaden the scope of eMedicine to effectively all medical and surgical specialties and eventually the aforementioned eMedicine Health initiative. With this gigantic expansion Co-Founders Nicholas Lorenzo MD MHCM CPE DABPN and Anne Bueltel Lorenzo BS invested in and joined the company. Ms. Bueltel Lorenzo ran production operations for many years and with Dr. Lorenzo was stationed in the Omaha eMedicine office. Dr. Lorenzo held multiple senior executive roles in the company including Chief Publishing Officer, was a member of the Board of Directors, Project Editor-in-Chief, Senior Vice President, and was the Founding Editor-in-Chief of eMedicine Neurology.

Several years were spent creating the tables of contents, recruiting expert physicians and in the creation of the additional 6,100+ medical and surgical articles. The majority of operations were based out of the Omaha NE office. However, eMedicine was one of the world's first virtual companies with key staff in multiple offices around the country including Omaha NE (Publishing and later corporate office), St. Petersburg FL (original corporate office), Syracuse NY (technology office), and Boston MA. With increasing web traffic and notoriety eMedicine developed a multi-product sales and marketing strategy. Pharmaceutical sponsorship sales were led by Laz Cabanas BS, Senior Vice President, and healthcare institutional sales were led by Dennis Carson MBA, Senior Vice President. Revenue increased exponentially as a result of the completion of the professional level content, innovative sales and marketing strategies (e.g., Laz Cabanas popular web sponsored microsite strategy), and development of the second generation LMS known as GPS 2.

In the early 2000s Drs. Plantz and Lorenzo also spearheaded an alliance with the University of Nebraska Medical Center to accredit eMedicine content for physician, nursing, and pharmacy continuing education. eMedicine also obtained accreditation for optometry and to a lesser extent physical therapy continuing education accreditation. These continuing education accreditations increased eMedicine's visibility and credibility in the healthcare industry and also enhanced revenue generation. eMedicine was also the recipient of dozens of healthcare professional, healthcare consumer, and internet quality awards during this time.

Over the ensuing several years, eMedicine.com and eMedicineHealth.com became widely trafficked and revenues increased markedly. In 2005, eMedicine entered into discussions for acquisition. The board of directors at the time of sale, consisting of Jonathan Adler, Jeffrey Berezin, Craig Burson, Lilian Shackelford Murray and Michael P. Tierney, unanimously recommended approval for sale of the company to WebMD. The sale was completed in January 2006 and the content is available via WebMD's Medscape site and has since been renamed the Medscape Reference.

Content now includes allergy and immunology, cardiology, clinical procedures, critical care, dermatology, emergency medicine, endocrinology, gastroenterology. genomic medicine, hematology, infectious diseases, nephrology, neurology, obstetrics/gynecology, oncology, pathology, perioperative care, physical medicine and rehabilitation, psychiatry, pulmonology, radiology, rheumatology, and sports medicine. Surgical subspecialties include neurosurgery, ophthalmology, orthopedic surgery, (ENT) and facial plastic surgery, plastic surgery, thoracic surgery, transplantation, Trauma, urology, and vascular surgery.[1]

The site is free to use, requiring only registration. More than 11,000 physician contributors from primarily in the US but also internationally participated in the creation of the articles. Novel at the time, eMedicine content could also be accessed as an e-book, and could be downloaded into a palm top device.[3]

eMedicine Firsts

A list of all the revolutionary achievements of eMedicine from its founding in 1996 until its acquisition by WebMD in 2006 would be very long. Highlights of these achievements would include the following: First significant healthcare web based publishing and education system, one of the earliest web based learning management systems (GPS 1), first web based multilevel peer reviewed healthcare professional and later healthcare consumer content system, developed first mobile (Palm system) healthcare education apps, one of the earliest web based healthcare continuing education systems, and the recruitment of over 11,000 board certified healthcare professionals who created and edited content entirely online.

Usage among specialists

In 2012 Volsky et al.[4] evaluated the most frequently used internet information sources by the public, (1) identifying the three most frequently referenced Internet sources; (2) comparing the content accuracy of each of the three sources and (3) ascertaining user-friendliness of each site; and (4) informing practitioners and patients of the quality of available information. They found Wikipedia, eMedicine, and NLM/NIH MedlinePlus were the most referenced sources. For content accuracy, eMedicine scored highest (84%; p<0.05) over MedlinePlus (49%) and Wikipedia (46%). The highest incidence of errors and omissions per article was found in Wikipedia (0.98±0.19), twice more than eMedicine (0.42±0.19; p<0.05). Errors were similar between MedlinePlus and both eMedicine and Wikipedia. On ratings for user interface, which incorporated Flesch-Kinkaid Reading Level and Flesch Reading Ease, MedlinePlus was the most user-friendly (4.3±0.29). This was nearly twice that of eMedicine (2.4±0.26) and slightly greater than Wikipedia (3.7±0.3). All differences were significant (p<0.05). There were 7 topics for which articles were not available on MedlinePlus. They concluded "Knowledge of the quality of available information on the Internet improves pediatric otolaryngologists' ability to counsel parents. The top web search results for pediatric otolaryngology diagnoses are Wikipedia, MedlinePlus, and eMedicine. Online information varies in quality, with a 46-84% concordance with current textbooks. eMedicine has the most accurate, comprehensive content and fewest errors, but is more challenging to read and navigate. Both Wikipedia and MedlinePlus have lower content accuracy and more errors, however MedlinePlus is simplest of all to read, at a 9th Grade level.

In 2012, Laraway and Rogers reported a structured review of journal articles that quoted The University of Washington Quality of Life Scale for head and neck cancer patients.

"The University of Washington Quality of Life Scale (UW-QoL) is one of the most frequently reported health-related quality of life (HR-QoL) questionnaires in head and neck cancer, and since its first publication in 1993 has been used in many different cohorts. There is a considerable amount of information to assimilate and, to date, we know of no attempt that has been made to summarise publications specific to its use in a peer review journal. The aim of this review was to systematically search published papers that report its use, identify common themes, and present a tabulated summary. Several search engines were used (PubMed, Medline, Medical-Journals.com, eMedicine), and 222 abstracts were found and hand searched. A total of 66 papers were eligible for inclusion, 21 on functional outcome, 25 on predictors of HR-QoL, 19 on development or validation of the questionnaire, and one clinical trial. The review includes a diversity of studies and a range of HR-QoL outcomes following head and neck cancer. It provides clinicians and their colleagues in multidisciplinary teams with a source of quick reference to relevant papers reporting the UW-QoL, and gives a short summary of the pertinent conclusions drawn from each paper."

What is significant for eMedicine, is that Laraway and Rogers used PubMed, Medline Medical Journals.com and eMedicine as primary sources of information.[5] This is significant because medline is the compendium of all NIH sponsored research. Emedicine is made up of articles translating the body of current research in medline into clinical practice guidelines from the perspective of each subspeciality.[1]

Cao, Liu, Simpson, et al revealed that medline and emedicine were used as primary resources in developing the online system AskHERMES.[6] Physicians were asked to solve complex clinical problems using three different sources of information: AskHermes, Google and UpToDate. Surveys of the physicians who used all three systems were asked to score the three systems by ease of use, quality of answer, time spent, and overall performance.

A 2009 study showed that "89.1% of ophthalmologist respondents accessed peer-reviewed material online, including Emedicine (60.2%)."[7]

A 2007 study showed that 12% of radiology residents used eMedicine as their first source when doing research on the Internet.[8]

A 2005 study ranking 114 sites rated it the second-highest Internet-based source of information for pediatric neuro-oncology, after the site of the National Cancer Institute.[9]

A 2002 study described the site's coverage of dermatology as "excellent and comprehensive."[10]

In 2000 an article in the Journal of Ear Nose and Throat by AD Meyers from the University of Colorado School of Medicine, Denver, CO, announced the unveiling of the ENT textbook online at emedicine.com.[1]

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References
  1. Meyers, AD (Apr 2000). "eMedicine Otolaryngology: an online textbook for ENT specialists". Ear, Nose, & Throat Journal. 79 (4): 268–71. doi:10.1177/014556130007900411. PMID 10786388.
  2. Hunt, Katherine. "WebMD acquires eMedicine.com for $25.5M". MarketWatch. Retrieved 2017-08-28.
  3. Platt, AF (2008). Evidence-Based Medicine for PDAs: A Guide for Practice. Jones and Bartlett Publishers. pp. 80–82. ISBN 978-0-7637-5476-1.
  4. Volsky, PG; Baldassari, CM; Mushti, S; Derkay, CS (Sep 2012). "Quality of Internet information in pediatric otolaryngology: a comparison of three most referenced websites". International Journal of Pediatric Otorhinolaryngology. 76 (9): 1312–6. doi:10.1016/j.ijporl.2012.05.026. PMID 22770592.
  5. Laraway, D.C.; Rogers, S.N. (2012). "A structured review of journal articles reporting outcomes using the University of Washington Quality of Life Scale". British Journal of Oral and Maxillofacial Surgery. 50 (2): 122–31. doi:10.1016/j.bjoms.2010.12.005. PMID 21239091.
  6. Cao, Yonggang; Liu, Feifan; Simpson, Pippa; Antieau, Lamont; Bennett, Andrew; Cimino, James J.; Ely, John; Yu, Hong (2011). "AskHERMES: An online question answering system for complex clinical questions". Journal of Biomedical Informatics. 44 (2): 277–88. doi:10.1016/j.jbi.2011.01.004. PMC 3433744. PMID 21256977.
  7. Somal, K; Lam, WC; Tam, E (2009). "Computer and internet use by ophthalmologists and trainees in an academic centre". Canadian Journal of Ophthalmology. 44 (3): 265–8. doi:10.3129/i09-057. PMID 19491979.
  8. Kitchin, Douglas R.; Applegate, Kimberly E. (2007). "Learning Radiology". Academic Radiology. 14 (9): 1113–20. doi:10.1016/j.acra.2007.06.002. PMID 17707320.
  9. Hargrave, D. R.; Hargrave, UA; Bouffet, E (2006). "Quality of health information on the Internet in pediatric neuro-oncology". Neuro-Oncology. 8 (2): 175–82. doi:10.1215/15228517-2005-008. PMC 1871939. PMID 16533758.
  10. Maibach, HI; Bashir SJ; McKibbon A (2002). Evidence-based dermatology. PMPH-USA. pp. 289–91. ISBN 978-1-55009-172-4.
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