Publishing a compact disc.

When your members need a professional query answered immediately, what do they do? Ask a colleague, pick up your association's reference to me, call your information department, or turn on the modem? Any of those options probably takes several minutes--at best--to provide an answer or delivers limited information. Now picture a member turning to a personal computer, typing a few key words, and getting the answer on screen in only a few minutes. It's not magic. It's CD-ROM.

Compact disc-read-only memory, or CD-ROM, is a technology meeting the educational and informational needs of a number of association memberships nationwide. At the American Academy of Dermatology (AAD), Schaumburg, Illinois, our first venture into CD-ROM technology was publishing DermInfodisc. The compact disc is similar to an audio CD but with digitally stored text, color images, graphics, and even audio and video. One CD can hold more than 500 megabytes of data--comparable to the amount of data 400 floppy disks can hold. To make use of all this information, the CD includes software known as a search engine. This allows a computer equipped with a CD player (a CD drive) to quickly retrieve any data according to criteria the user specifies for each search.

What that means for DermInfodisc is that one CD offers nearly instant access to four dermatologic data bases and assorted other data bases. It also includes the last three years of the Journal of the American Academy of Dermatology (the years before 1990 were not available in an electronic format), with full text plus color images and graphics, and the index of JAAD's first 10 years. We'll add another year with each new CD edition. The CD-ROM also has a series of educational exercises for dermatologists to assess their own skills and knowledge through interactive self-assessment.

AAD traveled a long road to DermInfodisc, but found the effort worthwhile. Your association may also find that this is the road to the future of information access and to increased member education and satisfaction.

Committing to technology

More than 10 years ago the academy made a strategic commitment to become technologically oriented. Dermatologists are typically solo practitioners, so an easily accessible resource for diagnostic, therapeutic, and pharmaceutical reference is essential. Photo images are very important here. With our nonprofit research arm, the Sulzberger Institute for Dermatologic Education, AAD began a long-term collaboration with the National Library of Medicine, Bethesda, Maryland, investigating the image reproduction capability of various electronic media.

In particular, a team of NLM staff and AAD volunteer members compared CD-ROM, laser disc, and other digital computer technologies with the quality of 35-millimeter color slides, the unsurpassed standard for dermatologic images. As the hardware and software capabilities for CD-ROM improved, CD-ROM began to look like the most effective technology for our product needs. About five years into this research, we were ready to begin CD-ROM development.

In the meantime, though, AAD started members out on the high-tech road with DermInfonet. In the early 1980s, DermInfonet started as a series of subscription-based on-line dermatologic data bases accessible by, modem. At its peak, the program had 1,200 subscribers among AAD's 7,000 national (and another 3,000 international) members. Eventually, members found modem access cumbersome and long-distance charges prohibitive. The academy decided to revise the service and convert DermInfonet to a series of data bases purchased individually on floppy disks. In this format, DermInfonet has proved to be more functional and user friendly--although it's not practical to deliver images on floppies and it is time-consuming to, use several floppy-disk data bases at once.

Assessing feasibility

An important consideration in beginning a CD-ROM publishing program is to assess your membership's interest in and access to electronic media. The academy first polled its members five years ago. At that time, 8 percent of those polled indicated having access to a CD-ROM player and computer. Two years later, the number had increased to 17 percent. Last year the number of respondents with access to CD-ROM was more than 20 percent, and another 5 percent indicated they intended to purchase a CD-ROM player in the next year.

An exact formula for making a cost-effective choice is difficult. AAD is committed to technology-oriented education regardless of the numbers. But, since about 70 percent of our members already use personal computers for word processing and research and CD-ROM is becoming more available and less expensive, the academy is confident that its investment in CD-ROM products is wise and will reap notable gains.

Much of this needs and feasibility assessment is conducted at the association by the AAD Task Force on Technology Evaluation and Applications. This group also tests the product for useability.

AAD offers training at the annual meeting. In on-site computer labs, staff and volunteers work with users from beginner to advanced.

Developing a product

As you evaluate publishing with CD-ROM, keep in mind the cost and time factors. This type of project needs considerable lead time for development. Consider, for example, whether the material you might publish (data bases, existing print publications, instructional material, and so forth) exists already in some electronic format, such as on your word-processing system or on magnetic tape. If not, conversion--by optical scanning, for instance--will cost more time and money. AAD spent five years developing and refining two prototypes with our vendor's help.

Related to time is cost. CD-ROM technology is expensive, and AAD had help. A new data base we'll include on the next edition of DermInfodisc, for instance, is "REACTION," a reference for skin reactions to various pharmaceuticals. Funded by a grant from our Sulzberger Institute, a member converted his published hard-cover book to an electronic format, so AAD had practically no up-front development costs. Similarly, we hope to fund a CD-ROM "Library of Dermatology" with a grant from the National Institutes of Health, Bethesda, Maryland. This product will include all of DermInfodisc plus a complete dermatology textbook, an encyclopedia of dermatology, and 1,500 clinical photos. Do investigate opportunities for similar industry grants or relationships with appropriate groups.

Gathering material in electronic form for a CD is one expense. Pressing the master is another. Creating the original that you reproduce costs between $1,500 and $3,000. Now that AAD is through its research stage and moving into annual production, we budget $15,000-$22,000 a year for new editions of DermInfodisc.

Contracting with a vendor

Your best development option relates to your choice of vendor as well. You will need to contract for the physical production of the CD-ROM. For example, AAD (with the assistance described above) spent money up front to create the material included on DermInfodisc. A contractor produced the CD-ROM. In this arrangement, AAD earns profits from sales and the vendor earns royalties for the use of its search engine (the CD software).

Our recently released second project has a different scenario. The Dermatology Multimedia Teaching File contains 175 brief research presentations, with audio recordings and slides, culled from talks at our 1993 annual meeting. Practitioners can search the CD by topic, key terms, and author. In this case, our contractor-publisher put up about $100,000 over one year to collect the material and create the disk. AAD collects royalties for use of our material, while the publisher profits from sales (and pays for marketing).

Choosing a vendor for our CD-ROM projects was similar to any contractor search. We collected names from a number of production companies that advertise in computer magazines and asked for references from associations that had done similar projects. After narrowing the choices to four, we invited those firms to make presentations to a joint member-staff committee at our annual meeting. This group considered each firm's track record (although the technology is so new many have not been around long) and product. AAD's basic criteria for evaluating CD-ROM products are cost and useability. Currently, our for-profit service subsidiary has the contract to produce DermInfodisc, and our long-time journal publisher will produce the multimedia CD.

Keeping your options

This is a publishing venture, so copyright is an issue, as are assignment of royalties, duration of contract, and so forth. Have an attorney work with you, and allow up to six months the first time you work out a contract.

One final issue to consider is the possible obsolescence of hardware and software. The rate of technological evolution is difficult to keep pace with. At the moment, CD-ROM technology may be superior to laser disc or other options for our members' needs. However, in the future a new technology might prove better and require a costly and time-consuming conversion to the new or revised medium. Kodak, for instance, is promoting a photo CD; this device is much simpler than a CD-ROM player and could replace the slide projector as the standard for presentations.

The best you can do to keep up is to read the computer publications and watch for what's coming. Most media convert to other formats, so be sure anything you publish is in some electronic medium and systematically archive the original data so that it is easy to retrieve.

HIGHLIGHTS

* BEFORE BEGINNING A CD-ROM publishing venture, determine your membership's interest in and access to electronic media.

* ALLOW SUFFICIENT LEAD TIME for developing a CD-ROM product. Consider, for example, whether the material you plan to publish already exists in electronic fom--if not, plan in more time and money for conversion.

* INVESTIGATE opportunities for industry grants to defray costs.

The CEO's Role in New Technology Development

The chief staff executive is a key player in bringing any innovation to the association, and new computer technology is no exception. The chief executive has four jobs in this venture.

1. Speak to and for the membership.

Articulate your vision of CD-ROM use--its advantages for members---and publishing prospects. Be aware that there is still plenty of technophobia about, and computer literacy is nowhere near 100 percent in most groups. You will also have strong member advocates of the new technology, and you need to be sure their ideas are not too far ahead of the greater membership.

2. Assess feasibility and profitability. The chief executive is ultimately responsible for success, so be sure your project team accurately assesses the number of members who will benefit from CD-ROM, the number likely to buy it, and the amount the association must commit to its development. Look at your possible markets. The American Academy of Dermatology (AAD) has been quite successful marketing CD-ROM to international members, for instance.

3. Create a task force. Search out the staff and members most interested in this technology and assemble a task force.

4. Smooth staff adjustment and concern. Be prepared to deal with worry among staff with a stake in print media; they may see CD-ROM as a threat. At AAD, we don't intend to eliminate print, and the chief executive officer communicates that clearly to staff. Include publishing staff in the planning process and, if possible, give them a stake in the outcome.

The Task Force's Task

To oversee our foray into CD-ROM publishing, the American Academy of Dermatology (AAD) created a member task force. For your association, look for about five technology-oriented members and include one or two appropriate staff members. Since this group will also test product useability, don't include anyone working on developing the actual CD-ROM.

With direction from the association chief executive officer, the task force's basic charge is as follows:

* Explore the products and services to which CD-ROM might apply, such as data base reference, color images, and educational modules.

* Articulate a detailed development, field testing, and production plan, including staff and budget needs for the various project phases.

* Build bridges to staff and member segments that may feel threatened by this technology.

Another way to structure this committee's work is to list questions it should be able to answer:

1. What is the extent of member interest in CD-ROM applications? How many members have the computer hardware needed to use CD-ROM products?

2. What applications that can be provided by the association lend themselves to the CD-ROM technology? Data bases do, for instance, but specialized billing system software does not. A related question is whether this a one-time effort. Start-up is the longest and most costly phase, so it is more economical to continue producing CDs.

3. Is the association leadership willing to commit to a multiple-year development cycle for CD-ROM prior to any revenue return? AAD started 10 years ago, and although it won't take you that long now, don't count on making a profit in 12-18 months.

4. How will you reconcile conflict between those who have a stake in print media and those with a stake in CD-ROM? Can yon develop a joint stake between the two groups?

5. Can this task force evaluate the project from such perspectives as content, ease of use, and research protocols? Do you have special criteria for evaluating the CD and the project?

6. Have you met with attorneys to protect your association's legal rights in and ownership of the CD-ROM product and its content? If the CD deals with some recommended procedure, have you included a disclaimer?

7. Have you established procedures for member review and evaluation of the product before it is ready for sale?

Get Your Hardware Ready

Here are the steps we took to bring staff hardware up to speed.

For users with personal computers already installed, we first evaluated two critical items: the size of the memory and the monitor. We found that 10 megabytes of memory was sufficient to run the most popular commercial CD-ROM software currently on the market. We increased existing memory as needed, upgrading in four-megabyte increments at approximately $2.50 each.

The existing monitors were evaluated for display resolution capabilities (sharpness of picture). Most CD-ROM software requires a Super VGA monitor, and this type of display is a necessity to display images. All existing personal computers were brought up to this standard at a cost of $300-$500 each.

Finally, we added a CD-ROM drive (player) to each machine. The average cost for CD-ROM units ranges from $300 to $500.

For all new machines, the academy's information services department set standards for purchase to maximize processing capabilities when working with CD-ROM software. Standards set include processor type speed, memory, and monitor resolution.

Your best option at the time of purchase is the newest processor chip available and the fastest megahertz speed. This is currently 55 megahertz. These two components directly affect the response time. As a standard, we require at least 10 megabytes of memory and a Super VGA monitor with at least one megabyte of memory on the video board. This will ensure compatibility with CD-ROM products available today and in the near future. The CD-ROM drives selected must be Multimedia PC compliant, a computer industry standard.

You may select an internal or external CD-ROM drive. Both function with the same effectiveness. Choose an external drive for personal computers with multiple diskette and cassette drives and no space for an internal drive. The approximate cost for a multimedia system with the above requirements is $2,800-$3,500 per unit.

Lawrence E. Rosenthal is deputy executive director of the American Academy of Dermatology, Schaumburg, Illinois. Thomas G. Pearson is director of education, and Susan M. Curtin is director of information systems.