Throughout history those with access to knowledge had power. Therefore, historically the transmission of and access to knowledge has been carefully controlled. Even as early as 2,000 B.C. the Sumerians located the first schools and libraries in the great temples of their great cities. The Sumerians had two types of temple schools: the writing school, where reading and writing were taught, and the house of wisdom, where higher education (including linguistics, theology, magic arts, astronomy, mathematics and medicine) was imparted to the elite.

Education has not changed much since that time. Today, the distinguished centers of higher learning are physically located within universities and other institutions, each with its own faculty, student body and library to house the knowledge. As in the past, those wishing to gain knowledge and wisdom must still come to these centers of learning. Those wishing to refresh or renew their education must return to them. As in the past, large numbers of potential students are excluded from the best universities; in fact a measure of the eminence of an institution is its exclusivity. The computer is quietly beginning to remove the barriers of access to knowledge.

We are entering the early stages of a far-reaching change in the way knowledge is collected, stored, studied and circulated. The computer and telecommunications are revolutionizing our relationship to knowledge. Books and classrooms will not be replaced, but they will be enhanced and augmented by computer access. For the first time since the Sumerian era, any individual anywhere will be able to retrieve information almost the moment it is generated and interact with both students and masters via a computer and modem. Many services are available now to facilitate this access to knowledge.

For those in the medical professions, as early as 1965 the National Library of Medicine made its database available via computer through the Medical Literature Analysis and Retrieval System (MEDLARS). In the recent past, the North American Presentation-Level-Protocol Syntax (NAPLPS) was developed to allow the encoding of visual and textual information (videotex) in order to facilitate the transmission of graphic and textual material to microcomputers. Hospital laboratories are being networked directly to physicians' offices (e.g., Clinical Information Network Center by Distributed Medical Diagnostics). And finally, telepathology and teleradiology networks (remote microscopic or radiologic examination via video or satellite link) are being developed that will connect outlying pathologists and radiologists to centers of diagnostic excellence.

These emerging services and technologies will have a great impact on us all. This effort is an effective and exciting means to widen educational opportunities and thus break the Sumerian mold. In the future, the mark of an institution's greatness will not be in the size of its library but the comprehensiveness of its networks. All members of our community, wherever they are, will have access to the knowledge base that is created and collected at our institutions of higher learning. All practitioners will be able to interact with experts in a timely fashion to answer questions and solve problems. And finally, all members of our society can share in better health care because physicians will have vastly improved access to knowledge.

Written September 16, 1987

Copyrighted by Harvey Kliman, Yale University

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