Databases: Push Comes To Shove
Stephen M. Pribut, D.P.M., F.A.C.F.A.S.
Today your browser is a passive accomplice to your netsurfing, but the next generation of browsers will incorporate "Push Technology". "Push" will permit you to passively receive information and files. Microsoft would like the browser to be integrated with your desktop and plans an upcoming push interface called Active Desktop. Database information, which underpins much computer use, helps make this new technology work. Lets take a quick look at databases and then return to "Push".
A database is a collection of information about specific objects organized for easy retrieval. In days gone by, the information would have been stored on 3" x 5" cards. Many still use rolodex cards, but software such as Lotus Organizer does a better job by integrating a rolodex, calendar, to do list, and notepad. Your practice management program is essentially a database management program. The patients and the information about them are fields in a database. Reports are easily generated from this information. Today multi-media receives nearly all of the press, but database applications are the real secret to many current computer applications.
In the business world, database information provides essential information that allows a company to respond to the clients needs. The Internet can present an online interface to corporate operations. Inquiries and purchases are handled efficiently without human intervention. Web surfers instantly access information and save the cost of an 800 number phone call and the time of an employee.
Federal Express uses database information to demonstrate how well they perform their service. Business users enter the package ID number and then follow it each step of the way to its final destination. This ensures the timely arrival and peace of mind that the package was received. The package tracking information is entered into their database by barcode scanning.
Amazon.com is a highly database driven on line bookstore with over 1.1 million titles, a list of which would be larger than seven New York City phonebooks. Using web ordering they have eliminated a host of sales people and have no need of a fancy store front. Here you can view online book reviews and quickly retrieve information by author, title, or category. Automated database technology is used to send e-mail announcements about books you might be interested in. This e-mail is the simplest form of "push".
Medline and other medical databases are a boon to medical professionals. The GenBank database, a portion of the Human Genome Project, was used by researchers this year to help determine the sequence of a tumor suppressor gene that inhibits the growth of both prostate cancers and gliomas. Proposals have been made for an online, ever growing database of therapeutic Cancer protocols correlated with tumor markers. Researchers could add their results to the database regularly. This rapid sharing of medical research data should expeditiously lead to health benefits.
Lets look again at Push. Point Cast is a popular Push software, used to receive news headlines, articles, sports scores and stock prices. This same technology is evolving and may now be used to send software updates. Large traditional database management companies such as Oracle are taking action to make sure they are not left out of the Internet revolution. They have begun marketing Web Servers that include the ability to create online databases using various computer languages and will integrate with "Push".
New companies and products are developing which use sophisticated methods of database analysis. Firefly ( http://www.firefly.com/ ) is partnering with several companies to use supplied personal information to allow a site to recognize you as a previous visitor and customize information presented to you. Participating sites will make recommendations on music and film based on your personal tastes. At these firefly enhanced sites you can chat with individuals of similar interest. Barnes and Nobles Online plans to offer firefly users book recommendations.
Insurance companies are developing online databases with listings of health care practitioners, pharmacists and patient lists. Some managed care organizations have placed lists of their providers on the web. Shortly, patient eligibility databases will be online. Referrals will soon be done by "smart" computer systems using online databases. Online information will ultimately include patient diagnostic tests, diagnoses and medications. The security of this information is essential. N.I.H. and the National Security Agency are coordinating the design of a secure medical information system.
Who enters questionnaire information into databases? A few years ago, in Texas, violent felons entered information returned by consumers into a database. One, a convicted rapist, then sent mysterious threatening letters to several of those who had returned the questionnaire. Is database information accurate? Sometimes information in a credit database is incorrect and then repeatedly accessed by those performing credit checks on you.
Junk mail, e-mail and phone calls result from activities as innocent as returning a warranty card or posting a USENET message. It is clear that while a company having information about you can be helpful both to the company and you, there should be limits upon distribution of non-public information. While many companies agree to limit information distribution, a high level officer of Equifax expressed that "it is not your information, it is information about you." This attitude is not likely to prevail.
With scores of companies gathering information for sale to others, our personal information is profiled, then placed on lists which are sold, shared, and disseminated without notice to, or input from us. Insurance companies contract with third party firms to investigate the physicians they empanel. Discussions are needed to debate the proper balance between privacy, freedom of speech and freedom of information. Concern for online privacy led to the Federal Trade Commission convening a recent conference to discuss methods to protect privacy. Congress is also trying to keep on top of this issue and is discussing what limits should be placed on data gathering of Internet users. Today you can netsurf but you cant hide.