Personal computers (PCs) started as machines built by geeky enthusiasts in the 1970s, but became widely commercially available in the 1980s. In the first years of the 21st century, computers have become commodity items. PC prices have fallen steadily while computing power has increased exponentially. Until a few years ago, considerable thought had to be given to buying a PC in balancing price, capability, and upgradeability. Now, even the most inexpensive PCs and laptops available at large electronics stores or online can readily handle basic computer needs.

A computer and its operating system alone would not be able to accomplish very much. Additional software is needed to perform basic tasks, such as word processing. Although standalone programs of productivity software are available, they are typically obtained in suites with all components somewhat integrated, allowing consistency of use across programs. Microsoft Office has become the most commonly used office suite, but a variety of competitors exist, including the free, open-source, LibreOffice (www.libreoffice.org). Most institutions prefer to have all employees use the same program for ease of exchanging information, but most of these programs can convert between the most common formats. Online “cloud” versions of these applications are also available—they are discussed below.

Spreadsheet software (e.g., Microsoft Excel, LibreOffice Calc) is designed primarily to manipulate numbers, not text. Spreadsheets are extremely useful to healthcare epidemiologists for calculating rates and doing basic statistics. The column and row structure of spreadsheets also allows them to be used as simple databases, such as a line-listing for an outbreak investigation. Spreadsheet software can also make graphs for visualization of data, such as run charts of infection rates over time. These graphs then can be imported into a word processing document or slide presentation for distribution to others. Such graphs are easy to make, and by helping staff visualize the data, make for far more compelling discussions.

Desktop relational database software (e.g., Microsoft Access, LibreOffice Base) is not included in many basic editions of office suite software, but may be available in more extended or “professional” editions. Although in some respects more difficult to use than other desktop computer productivity software, database software can offer healthcare epidemiologists significant advantages over other methods of storing data, such as using spreadsheet software. For example, if blood culture data are being stored as part of a study, if a given blood culture has >1 organism, then in a spreadsheet, either a number of columns need to be included (e.g., “organism_l,” “organisms_2”) if data from a given culture are all to be included on one row, or a number of separate rows need to be used to record the information from a single culture. Both alternatives may introduce difficulties in subsequent data retrieval and analysis. A relational database, however, would allow the information to be structured in a manner that avoids these issues.

Because most office productivity software can be used at a basic level without any special training, the benefits of formal training are frequently under-appreciated. Various levels of training classes may be offered by larger organizations or may be available at local community colleges. Online training or structured textbooks provide additional alternatives. The time and expense spent on training will be returned many times in productivity gains. In particular, database software requires some training to use it appropriately. An excellent introduction to databases at a conceptual level (not tied to any particular program) is Database Design for Mere Mortals (2).

Although a stand-alone PC can bring a huge productivity boost to a healthcare epidemiology department, the potential utility of the computer increases significantly when it is networked to other computers. The PC then is no longer limited to data that have been entered by hand or files brought to it on some form of solid media. Instead, the PC can now share information with other computers at high speeds. Essentially, all hospitals now have networks that connect the computers in their various departments together. These networks, in turn, are typically
connected to the Internet, providing an electronic connection between the hospital and the rest of the world.

The Internet is really a network of computer networks (3), Precursors to the Internet began as a research project in the late 1960s sponsored by the U.S. Department of Defense’s Advanced Research Project Agency (DARPA). The Internet as we know it started on January 1, 1983 (4), and has grown exponentially in the intervening decades.

For many people, the World Wide Web (“the Web”) is synonymous with the Internet. The World Wide Web started in 1990 as a research project at the European Organization for Nuclear Research (CERN) (5). The purpose of the Web is to provide access to online documents (Web pages), including an easy mechanism for one page to refer to another. These pages can be viewed with software called Web browsers. Since its inception, the Web has grown beyond simple text to include images and multimedia presentations and allow downloads of files of various types.

For healthcare epidemiologists, the Web provides a wealth of resources. Many professional organizations have Web sites that provide news, guidelines, and links to other resources for both members and nonmembers. Examples include the Society for Healthcare Epidemiology of America (SHEA, www.shea-online.org), the Association of Professionals in Infection Control and Epidemiology, Inc. (APIC, www.apic.org), the Community and Hospital Infection Control Association—Canada (CHICA—Canada, www.chica.org), the Hospital Infection Society (HIS, www.his.org.uk), and the International Federation of Infection Control (IFIC, www.theific.org). Government organizations such as the Centers for Disease Control and Prevention (CDC, www.cdc.gov) provide a wealth of resources including guidelines, information on specific diseases and outbreaks, and reference materials. State and local health departments may also have Web sites that provide valuable information on local issues. The Web also provides easy access to information from companies regarding their products. Literature searches of the U.S. National Library of Medicine’s MEDLINE database can also be conducted on the Web using the PubMed system (www.pubmed.gov).

One of the most exciting developments of the Web is the explosion of educational opportunities. Many universities offer online classes, and it is possible to earn an advanced degree from a respectable institution through web-based learning. There is also an abundance of noncredit, but free educational sites. One example is the Supercourse, a Web-based set of >5,000 lectures in epidemiology (available at www.pitt.edu/˜super1/) hosted by the University of Pittsburgh. Other universities are making their classroom materials available online for noncredit use, for example Coursera (coursera.org) sponsored by Stanford, and edX (www.edX.org) sponsored by Massachusetts Institute of technology (MIT) and Harvard. Besides universities, other start-up companies offer similar classes, bringing in some of the best university professors from around the world to do individual courses (e.g., Udacity [www.udacity.com]).

Some hospitals and other organizations block or severely limit access of employees to the Web. Healthcare epidemiology and infection prevention programs can make a strong argument for having relatively unfettered Web access to do their jobs correctly. This typically requires going through a formal request process.

Electronic mail, or e-mail, is probably even more popular than the World Wide Web in terms of total number of users. Sending files as attachments in an e-mail has become a preferred method of sending data from one person to another. In addition, e-mail can serve as a means to alert healthcare epidemiologists to significant issues in a timely fashion. Organizations (e.g., SHEA and APIC) send e-mail alerts to their members when warranted. Healthcare professionals also can sign up for alerts and updates on terrorism and emergency response from the CDC at emergency.cdc.gov/coca/subscribe.asp. In addition, the CDC’s Division of Healthcare Quality Promotion has a Rapid Notification System for Healthcare Professionals that sends out e-mail alerts related to outbreaks and product recalls. The sign-up page is at www2a.cdc.gov/ncidod/hip/rns/hip_rns_subscribe.html.

E-mail “list-serv” software allows e-mail to be sent to many persons by sending an e-mail to a particular e-mail address. This facilitates group discussions via e-mail. Popular e-mail groups for healthcare epidemiologists include ProMED-mail (sign up at www.promedmail.org), which is sponsored by the International Infectious Diseases Society, and the Emerging Infections Network (request sign-up information from ein@ uiowa.edu), which is sponsored by the Infectious Diseases Society of America (IDSA) and the CDC. Because of the rise of unsolicited commercial e-mails (termed “spam”), many institutions have “spam filters” in place to reduce the influx of these nuisance messages. Unfortunately, these filters may filter out legitimate e-mail. List-serve-mails, in particular, may be filtered out as “bulk e-mail.” Local information systems personnel should be consulted to determine what steps are needed to ensure that desired e-mail reaches the recipient.

For more extensive analysis than can be done with a spreadsheet, a healthcare epidemiologist could use general-purpose statistical software. A wide range of programs exists, from basic statistical packages included with some statistics texts to expensive, very complex programs that can perform even
the most esoteric analysis. Widely used statistics packages include SAS, SPSS, and Stata. Many other very capable commercial programs are available. R (www.r-project.org) is an open-source general-purpose statistical package. EpiTools (available from cran.r-project.org/web/packages/epitools/index.html) is a set of tools for use with the R statistical package designed to add functions of use to epidemiologists. Although some of these programs allow for some form of direct data entry, they really are designed to import data that was entered using another program (e.g., a database or spreadsheet). Thus, using these programs for routine healthcare epidemiology use takes some effort. A user who is facile with a given program may choose to do basic analyses in that program. For the most part, these statistical programs are overkill for most healthcare epidemiology programs and are used primarily in research settings or by facilities that have dedicated statistical analysts.

Some programs occupy a middle ground between the general statistical software packages and more fully developed surveillance programs. They provide more support for data entry and management than general-purpose statistical programs, while providing more flexible statistical analysis than most specialty infection prevention/healthcare-epidemiology software packages. The primary downside is the considerable work that would be necessary to set up specific functionality that comes “ready-made” with healthcare epidemiology specific software. The benefit is the ability to design in the specific functionality the user desires.