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The American Academy of Dermatology on the World Wide Web

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(3) The American Academy of Dermatology on the World Wide Web

Thomas L. Ray, MD, Iowa
Daniel W. Collison MD, New Hampshire

Dermatology Online Journal, December 1995
Volume 1, Number 2


On July 27, 1995, at the summer Academy 95 meeting, the American Academy of Dermatology (AAD) officially revealed to its membership the AAD Home Page on the World Wide Web (WWW). President Rex Ammonette announced during his presidential address that the Academy had returned to the "online" world of electronic communications. Through the development and launching of a new dermatologic information resource, the AAD continues to serve three major groups: 1) the public, 2) skin disease patients and advocacy groups, and 3) dermatologic professionals world wide, via the Internet and the World Wide Web. Building on the foundation of the original Derminfonet, a pioneering dermatologic modem based online resource for AAD members in the 1980's, the Academy has transformed Derminfonet into an authoritative and responsible source of dermatologic and skin related information for the world.

The idea of such a resource began many years ago in the minds of several individuals. The actual substantive creation of the AAD Derminfonet WebSite began only recently. Through discussions on communications in skin disease research, John Grupenhoff, Ph.D., an AAD consultant in Washington D.C. on political and congressional issues, proposed in a January 23, 1995 memo to Dr. Lowell Goldsmith, the President of the Society for Investigative Dermatology, the development of an "electronic network" to be called "Skin Net". He proposed that it be a server based World Wide Web site, to serve "skin disease researchers, patient advocacy organizations and the dermatology community generally". And he further suggested the possibility of funding through the National Institutes of Health (NIH) and specifically the National Institute for Arthritis, Musculoskeletal and Skin Diseases.

Discussions on this topic were held by interested individuals on the Mississippi paddle wheel riverboat Natchez during the February 4 - 9,1995, Annual Meeting of the AAD in New Orleans, Louisiana. Initial resolves from these enthusiastic but brief deliberations were the creation of a Telecommunications Task Force under the Computer Technology Committee. The Task Force consists of Drs. Walter G. Larsen, Chairperson, Daniel W. Collison, Scott M. Dinehart, Stephanie H. Pincus, Thomas L. Ray, and Lawrence E. Rosenthal, AAD Staff Liaison. Two and a half weeks later, through the efforts of Lawrence Rosenthal, a grant proposal was submitted to the NIH, meeting a March 1, 1995 deadline. Because of the speed of development, members having e-mail and Internet/WWW connections carried most of the work load.

As many net-surfing dermatologists can attest, dermatologic information was making its way onto the Internet from a variety of lay and professional sources. Some information was offered responsibly, and some irresponsibly; some information was factual and some was not; some information was offered in the spirit of generosity and some was self-serving. Thus there arose an acute need for responsible, knowledgeable, and authoritative resources on the Internet for the public and medical communities seeking reliable information on skin diseases and their management.

Recognizing that the time was urgent, the committee initiated efforts to assemble databases of existing, and yet to be developed, resources from within the Academy and its membership. Furthermore, immediate sources of start-up funding were needed to develop and launch the AAD WebSite, prior to the "pay dates" of potential NIH funding. A "launch" date of July 25, 1995, coinciding with the Academy 95 Summer meeting in Chicago, was chosen.

The committee drafted and submitted a limited start-up proposal to AAD Secretary, Dr. Darrell Rigel, and seed moneys were procured. Following the lines of the NIH proposal, and through negotiation efforts by Lawrence Rosenthal, the committee selected a commercial Internet service provider, UUNET Technologies, of Fairfax, Virginia. With offices in Chicago, UUNET was the first commercial Internet service, and provides reliable, accessible, and secure networking solutions for numerous organizations of all sizes, including Fortune 500 companies. UUNET's robust IP backbone connectivity across the country and internationally, plus multiple broad bandwidth connections (45 MBps) in Chicago, provide optimal service and system redundancy to satisfy the diverse users of the AAD WebSite.

Production of custom page designs was contracted with a commercial enterprise, ICONIX, a design production facility in Bethesda, Maryland. Using advanced technology in new media products and services, Iconix provides quality design, illustration, programming and site setup in order to achieve clarity in on-line communications, while maintaining a user friendly interface.

Working through Leo Mullin and with designer Tricia Gellman of Iconix, a home page design and layout was agreed upon with little difficulty. By good fortune and coincidence, Tricia is the daughter of Dr. Arnold Gellman, a dermatologist and member of the American Academy of Dermatology. Tricia's expertise provided the Task Force members with numerous successful solutions, especially as the launch date approached.

The Task Force agreed that the Home Page should have four domains:

  1. Public and Patient Information Domain, to include:
    • Patient support group listings, initiated by the Dermatology Nurses Association and maintained at the University of Iowa Dermatology Home Page.
    • Patient information pamphlets, from existing, updated brochures developed by the AAD's Pamphlets Task Force.
    • Patient advocacy group home pages.
  2. Professional Information Domain, to include Academy news, calendar, existing electronic educational resources, e-mail list services, and links to academic institutions, and existing dermatologic and medical resources on the WWW.
  3. About the Academy Domain, to include the organizational chart, the Academy vision and mission statements, the Academy goals, and other project information. Periodic messages, announcements and white papers are envisioned.
  4. Professional Organizations Domain, to include the home pages of dermatologic societies, associations and foundations affiliated with the Academy, or generally serving dermatology.

Actual page content included selected pre-existing databases from other Academy electronic products and databases, including items on the CD-ROM Derminfodisc. However, every item had to be re-written into hypertext markup language (HTML), reviewed and edited, in order to get them onto the AAD Home Page and the WWW. These included a Dermatologic Meeting Calendar (maintained at the University of Iowa), e-mail lists to Dermatology List Servers, links to available academic departments, a dermatologic Drug Reaction Database created by Dr. Jerome Litt, maintained on a server at the Dartmouth-Hitchcock Medical Center, a searchable Dermatology Lab Test database located at the University of Rochester Medical Center - Miner Library, and other medical and dermatologic resources. The two largest items requiring intense efforts by the committee were the Patient Information Pamphlets and Patient Support Group list. The former required conversion to electronic formats, review and updating. The latter had fortunately been started by the DNA, but needed updating and addition of WWW and e-mail links to support group home pages, where they existed.

These tasks were addressed by the authors, working collectively, but remotely, in our respective dermatology departments in Iowa City, Iowa and Lebanon, New Hampshire using e-mail, gopher, ftp, and WWW resources for the most part (rarely, if at all, resorting to FAX or telephone calls). The process required considerable "self-education" of the authors along the way, climbing the "learning curve" to master the Internet and WWW transfer protocols and languages. Fortunately, many of the resources are readily available on the Net and the Web through ftp archives, and helpful advice, suggestions and detailed directions were offered from several colleagues, including Dr. Art Huntley (UC-Davis) who was in Israel at the time, Dr. Rhett Drugge (Stamford, CT), Ken Weiss (UC-Davis) and Andreas Bittorf (Erlangen, Germany).

First steps were a "hardwire" (Ethernet) connection to the Internet, learning about TCP configurations and IP addresses, and picking a browser (ultimately Netscape). Subsequently, the phenomenon of finding every WebSite development resource available on the Net created the uncanny but indelible impression that this project was actually assembling itself. At every step, resources seemed to point through hypertext links to other helpful resources or files for downloading. In short order, the tools for constructing a WebSite were in hand. For those interested, starting points included directions from the Web 66 Project and the Classroom Internet Server Cookbook designed for the K- 12 classroom. Knowing that grade school students have routinely gone online added considerable confidence to our enthusiasm for this project.

Initial development of a prototype WebSite began in Iowa during May, 1995, running an Apple Power Macintosh 8100/100 (PowerPC 601+ RISC CPU at 100 MHz) with MacHTTP 2.2 World Wide Server software. Following detailed and fool-proof (they had to be) Web 66 Directions and writing rudimentary HTML Web Pages using The Eight Minute HTML Primer, we created the first tangible results - a working WebSite and testbed for the Academy Home Pages. Expansion and sophistication evolved through assistance garnered from Netscape's "CREATING NET SITES" pages. Page concepts were posted and tested between the authors and other interested observers. Appearance and functionality using the different available graphical browsers were also assessed. The server software was subsequently upgraded to WebSTAR 1.2.

The process of transcribing the patient information pamphlets, or "PIPs" as they came to be called, was typical of the page content development, HTML conversion and editing.

The original text content of the AAD published "PIPs" was captured electronically by:

  1. Scanning the brochure with an HP ScanJet IIcx (Dartmouth), or "sending" the brochure via a FAX transmission to a Power Macintosh 8100/100 via FAX modem (Iowa).
  2. Optical Character Reading (OCR) of scanned or faxed text with OmniPage Pro 5.0 or STF AutoOCR for the Macintosh.
  3. Preliminary proofreading and editing of OCR errors (which were many).
Parenthetically, steps 1, 2 and 3 are examples of where the increasing power of microcomputers saved a lot of rework. The PIPs did not need to be retyped, and most of the scanning, OCR and proofreading were done by one of our assistants, Louise Hawthorne, whose primary work is as a Mohs histotechnologist. We will all need to become more efficient as physicians and dermatologists in the future, and the use of microcomputers and the delegation of tasks to our assistants, no matter their official job description, is one way to do this.

Preliminary PIPs were exchanged via e-mail (usually as attachments or enclosures due to their size) for proofreading at Iowa and Dartmouth-Hitchcock. The authors wish to recognize and thank the generous efforts of dermatology residents Kendall A. Morrison, M.D. and Tiffani K. Hamilton, M.D. at the Dartmouth-Hitchcock Clinic for eagle-eyed expert assistance in proofing and editing the PIPs. Corrected text was returned via e-mail to Iowa for transcribing into HTML, with appropriate anchors and links for easy navigating. Much of the HTML editing was by hand rather than software HTML editors.

All the text, pages, databases, and formats were electronically transmitted to Tricia Gellman at ICONIX, either by e-mail or by posting the HTML pages on the Dept. of Dermatology WWW Server, for ICONIX to download from the source files. Both methods were successful. Ms. Gellman adapted the files for inclusion into the AAD Home Page layouts and formats, and corrected relative hypertext links as necessary.

The prototype AAD Home Page was first launched on an ICONIX server for review by the committee members during the third week of July, barely one week before the "official" launch date. Proof-reading led to additional corrections, revisions and redo's, which electronically buzzed between Portland, Oregon (Walter Larsen), Iowa City, Iowa, Lebanon, New Hampshire and Bethesda, Maryland. With approximately 36-48 hours to spare, the page was serviceably finished and presentable.

The final task in launching the page remained - a "live" demonstration of the AAD Home Page to the membership attending the Academy 95 summer meeting, in Chicago, Illinois. Larry Rosenthal, aided by Jim Armstrong at the AAD, obtained space in the Academy exhibits for showcasing the AAD WebSite. Jim successfully procured a Power Macintosh, a 17 inch monitor, a US Robotics 28,800 kbs modem, and arranged with UUNET - Chicago to set up a Point to Point Protocol (PPP) dial-up connection for us to use in the convention hotel. All necessary PPP, MacTCP/IP and communication software plus start-up, system, and browser applications were loaded onto a portable (La Cie Joule) 540 MB hard drive in Iowa and brought to the meeting. A functional "emulation" of the WebSite was also loaded onto the drive, "just in case" a modem PPP connection could not be established.

Setting up the demonstration was not without a glitch, as some US Robotics modem users may suspect. The first try at making the PPP connection failed. A call to the UUNET "gurus" led to a quick assessment of the problem and a successful solution. A reset of the modem dip switches brought relief and joy, and the AAD Home Page was successfully introduced "online" and "on time" to the Academy membership on July 27, 1995. Properly, the authors met at the exhibit for their first face to face meeting since starting the project. After several weeks delay, the AAD request to the W3 for URL was granted, and by late August the Home Page was finally moved from the ICONIX server to it's present location on a UUNET server.

The goals of the Telecommunications Task Force are to continue to develop the AAD WebSite, not as a parochial Academy site, but as a broad Dermatology Community site, a neighborhood where those interested in diseases of the skin and skin care can find, acquire and use reliable, authoritative and responsible information. A public service goal is part of the AAD Home Page mission, and patient support and advocacy groups are an important segment of the WebSite. Extended resources for the membership are also in the plans, with more databases, services and listings. Some of these developments will await installation of e-mail capabilities at the Academy offices, and the installation of "restricted - membership access" to proprietary databases of the Academy. Others we hope to have in place more quickly, including multimedia resources and clinical images.

The authors, a transplanted Iowan from the West and a native Iowan transplanted East, held the "Field of Dreams" conviction that "If you build it, they will come".

Derminfonet - the original dermatologic online service of the AAD in the 1980's, with the early DermRx and DermDDX databases - is in the process of being reborn. Many of the same visionary goals are being pursued - only faster, more comprehensive, more brightly colored, more dynamic, and more easily used. Derminfonet returns as the electronic database and multimedia resource for the dermatology and skin disease community.

All contents copyright© 1995.
Dermatology Online Journal
University of California Davis