BUSINESS

Information driveway: Physicians create inexpensive Web sites offering health data to patients

Despite the failures of big-bucks health sites, people continue to look for medical information online. Some physicians have learned to use the Web to their advantage, saving their patients -- and themselves -- time and money.

By Tyler Chin, AMNews staff. Sept. 9, 2002. Additional information

Many of the companies that tried to make big money by offering health information on the Internet are dead, but the demand for their product appears to be greater than ever.

In July, Drkoop.com Inc., a company once valued at more than $1 billion, was sold for a paltry $186,000, joining a long list of online consumer health information companies that have either vanished or become mere shadows of their former selves. Despite attracting a bevy of visitors to their sites and supplying high consumer demand for online medical information, these companies have failed to make money.

The reason for this is simple: Their business model doesn't work. Turns out consumers aren't seeking one trusted site; more often than not, they want to take whatever ailment they're interested in and look at every site they can that's devoted to it. It also turns out no one needs to spend millions of dollars to develop a Web site. For a few hundred dollars, or less, anyone can put up a health site.

That low-cost reality and the knowledge that consumers want health information online are leading some physicians, including Hernando, Miss., internist Robert R. Meacham, MD, to create inexpensive practice sites offering patients what they say is high-quality information. For a while, at least, the Internet is going to be a place where health information runs unfettered.

"There's all that information out there and so much of it is not reliable," says Dr. Meacham, who got a free site last year from Medem Inc., founded and financed by the AMA and other specialty and state societies. "For patients who are using the Internet, who see that I have a Web site, there's the hope that they will use my site to get [reliable] information."

Whatever the source of information, a huge number of consumers go online for health information and the struggles of individual health-content companies will not change that, observers say.

"There's been a growth over last three years in people going online for health information and I don't see any signs of that going down," says Susannah Fox, director of research at Pew Internet & American Life, a nonprofit organization that researches the impact of the Internet on health care and other segments of society.

About 62% of Internet users, or 73 million American "e-patients," went online in 2001 for health information, up from 52 million in 2000, according to Pew Internet. On any given day, 6 million e-patients go online for health information.

As a result, "online health is alive and well," says Tom Ferguson, MD, editor of an online consumer health information journal and a Pew Internet consultant. "More people are going online and the people that are already online are going online more [for health information]."

The problem, from a business standpoint, is that content providers give away their information to attract consumers to their sites, and no one has figured out how to make money from that traffic.

"It's not easy making money in the health care services market, and business models that are predicated on simplistic ideas of generating revenue are doomed to fail," says David Francis, managing director of the Nashville, Tenn., office of Jefferies & Co. Inc., an investment banking and institutional securities firm. "Health information is so widely available that consumers simply aren't willing to pay for it. They don't want to pay for it and they don't have to pay for it because there are so many free resources available both online and offline."

Waving the Web banner

Some of those resources are now being offered directly online by physicians who see Web sites as a tool they can use to improve their efficiency and help patients take better care of themselves. About a third of the physicians who use the Internet have Web sites and 35% of them put up their sites to provide patient education, according to the recently released "2002 AMA Study on Physicians' Use of the World Wide Web."

Dr. Meacham says posting health information online is a time-saver because he doesn't have to repeatedly say the same thing to patients who have the same problem. It also lets him give better and more complete information to patients.

"I've had at least two or three cases where I've come out of the patient room, gone to my Web site and printed a page for the patient because I knew the hard copy did a better job of explaining something that I was trying to explain [verbally] to the patient," Dr. Meacham said.

He is so sold on the benefits of using the site as a patient education tool that he has hung up a banner and small posters advertising the address of the site inside and outside his office.

So far, no patient has asked him to recommend good health sites. When patients hand him a printout or mention something that they found online, Dr. Meacham says, "I just go through the whole spiel, saying 'Well there's lots of stuff out there and not all of it is good. Go to my Web site and I guarantee that any link you find there is good and valid.'"

On occasions when patients ask questions that are not addressed on his site, Dr. Meacham will research the matter online at home and then e-mail patients, saying what he found and where.

Over the past year or two, he says he has noticed that patients are doing a better job of finding good information on the Web.

"In general, I think their ability to discern between quality information and questionable information has improved ... and more and more people have gotten comfortable with and knowledgeable about the Internet," Dr. Meacham says. "I've seen much less crazy stuff being presented to me than I used to."

Worried that patients may be putting themselves at risk, many doctors recommend that patients visit "trusted" sites -- those operated by medical societies, government agencies and nonprofit entities. But most patients are ignoring that advice, finding they don't need to have a trusted or favorite medical site, according to Pew Internet.

American Internet users typically use a search engine and work their way through the results to find health information instead of going to a trusted site. They told Pew Internet that they are finding good health information online, are satisfied with what they find and are not harming themselves, Fox says.

"I don't see that changing in the near future ... if they are satisfied with the results, why should they change?"

Another reason most consumers do not have a trusted site is that most of them say they go online only when something comes up.

"They went hiking, got poison ivy and now want some answers about how to deal with it," Fox says. "It's sort of the idea of 'just-in-time' information."

Information therapy

While some physicians have created Web sites that patients can go to for information, some industry players are taking patient education to another level by pushing a new concept known as "information therapy."

In "information therapy," customized health information is prescribed electronically to the patient throughout the course of care, according to Donald Kemper, CEO of Healthwise Inc., a nonprofit entity in Boise, Idaho, that coined the term and licenses patient education material to hospitals, health systems and insurers. The information can be prescribed directly by physicians or automatically generated by clinical information systems, Kemper says.

For example, if a patient schedules a visit for knee pain, information about knee pain, medical tests used to evaluate it and information about knee surgery could be electronically generated and transmitted to the patient when the appointment is made on a scheduling system, he says.

Group Health Cooperative, a health system in Seattle that employs about 1,200 physicians and owns two hospitals and more than 30 primary care and specialty care facilities throughout Washington, has been using information therapy for about a year.

"It allows us to use technology to do what we've always wanted to do, which is give our patients personalized attention that is a combination of information that comes directly from their doctor and high quality evidence-based information," says Ted Eytan, MD, physician lead for MyGroupHealth, a Web portal offered to Group Health patients.

Any adult who receives care at Group Health can go to the health system's site, set up a personalized health page and securely submit questions to his or her personal physician. Doctors can then include a link to information developed by Healthwise or Group Health when they answer patients' questions, according to Dr. Eytan, a family physician.

Although it has been available since October 2001, information therapy is off to a slow start. Dr Eytan says that's partly because the hospital system has refrained from widely promoting the service to physicians, pending the installation of a clinical information system.

Once that system is installed, it will automatically generate information for the patient when the physician enters the patient into the system. "Basically, what will happen is that it will become part of the work flow," Dr. Eytan says.

Meanwhile, Dr. Eytan actively practices his own form of information therapy by routinely asking patients whether they use the Internet. Most do, he says, and so he refers them to Group Health's Web site (http://www.ghc.org/).

"I let them know we can give them comprehensive health information. I say, 'I'd like to prescribe this medication. You can read more about it on the Web site.'... Patients love it."

Dr. Eytan says he asks about Web usage because he wants patients to ask or tell him about what they found online to ensure they are getting good information.

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DRKOOP.COM INC.

IPO: $84.4 million (June 1999)
Peak market capitalization: $1.5 billion (July 1999)
Current status: Sold to Vitacost.com in July 2002 for $186,000

MEDSCAPE INC.

IPO: $52.8 million (September 1999)
Peak market capitalization: $3 billion (February 2000)
Current status: WebMD bought Medscape's portals for $10 million in December 2001

WEBMD CORP.

IPO: Note available. Healtheon acquired then-privately-held WebMD for $7 billion in May 1999.
Peak market capitalization: $20 billion (May 1999)
Current status: Still operating; now worth $1.4 billion

Sources: Jefferies & Co. Inc., Red Herring, Forbes

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Who's online?

• 62% of all Internet users, or 73 million American "e-patients," have gone online in search of health information.
• 5% of all Internet users, or about 6 million Americans, go online for medical advice on a given day.

What are they doing?

• 82% of e-patients say they find what they are looking for most of the time or always.
• 81% of e-patients start their hunt for information via a search engine such as Google, Yahoo, MSN or AOL.
• 14% of e-patients have bookmarked a favorite medical or commercial health site.

Source: Pew Internet and American Life Project

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Report, "Vital Decisions: How Internet users decide what information to trust when they or their loved ones are sick," Pew Internet & American Life Project

Baxter Clinic of Hernando, Miss. (http://www.baxterclinic.yourmd.com/)

Article, "Health e-People: The Online Consumer Experience," California HealthCare Foundation

Healthwise Inc. Center for Information Therapy (http://www.informationtherapy.org/)

Group Health Cooperative (http://www.ghc.org/web/)

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Copyright 2002 American Medical Association. All rights reserved.