American College of Physicians: Internal Medicine — Doctors for Adults ®

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Are you ready to hang your shingle on the Web?

It's easy to put a practice online, but there are concerns about what information to post on the Web

From the December 1998 ACP-ASIM Observer, copyright © 1998 by the American College of Physicians-American Society of Internal Medicine.

By Jodi Knapp

When Ben Z. Krentzman, MD, first decided to place his practice on the Internet six years ago, he signed up with a site developer that created a one-page site for him. Today, the family physician in Culver City, Calif., has a site with more than 1,000 pages on obesity and the science of weight control that he created himself. Not only has the award-winning site attracted new patients, it has introduced him to peers from Singapore to Australia.

"Before my site was created, I couldn't imagine being able to hook in a telephone wire, go anywhere, look at anything and publish documents with the potential to reach millions of people all over the world at almost no cost," Dr. Krentzman said. "But the idea drew me in, and I've been addicted to the Internet ever since."

Dr. Krentzman is not alone. A growing number of physicians are putting information about themselves and their practices on the Web, building everything from basic sites that provide health information for patients to more complex sites that automatically schedule patient visits and allow chats between patients and physicians.

What's driving this growth is the number of consumers going online for health information. According to the Department of Health and Human Services, the number of people using the Internet for health information grew 73.7% between 1997 and 1998, from 15.6 million to 27.1 million.

Getting started

While some physicians like Dr. Krentzman are building Web sites by themselves, there are plenty of tools and services that allow physicians to get online with little effort—and at no cost. These days, you don't have to be a programmer or even own a computer to create a Web site. You can simply fax or mail information to specialized services that will create a page for you. (For a list of physician Web sites and resources on how to get started, see "Web resources" .)

Dr. Krentzman, for example, spent three months of an early retirement gathering information on obesity and weight control for his Web site. (To view his site, go to http://drkrentzman.com.) During that time, he also learned how to build his own site using free editing software available on the Internet. Now that his site is up and running, he spends about $17 a month and a few hours of his time every few weeks maintaining and updating it.

Most physicians, however, don't want to take a do-it-yourself approach. Christopher B. Wong, ACP-ASIM Member, a cardiologist in El Paso, Texas, wanted to advertise his practice on the Web but did not want to take the time to learn how to build a Web page himself, and he didn't want to spend a lot of money using a Web consultant.

So he turned to DoctorNet, a New York City company that builds basic, one-page Web sites for physicians free of charge. Dr. Wong thinks of his Web site, found at www.doctornet.com/dn0/CHRISTOPHER_B._WONG.htm as the first step toward the future of practice marketing. "As more and more people have access to the Internet, and people become more comfortable using the Internet as an information source, my Web site will be up there for prospective patients to see," he explained.

But perhaps best of all, creating the site cost Dr. Wong no money and little time. He simply filled out an application form indicating what information he wanted on his site, and DoctorNet did the rest. The service, which has created sites for more than 3,000 physicians in 50 different medical specialties, offers basic pages including address, contact information, hours of service and specialty information for free.

DoctorNet is able to give away free one-page Web sites by charging physicians who want more elaborate Web pages. Customized pages allow physicians to schedule patient appointments online and feature interactive bulletin boards that allow physicians to talk to patients and colleagues. DoctorNet charges between $199 and $749 a year for these high-end Web sites; annual maintenance fees run from about $20 to $100.

Salu.net in Portland, Ore., is another service that helps physicians build Web sites free of charge. Salu.net offers six different Web site designs, each of which can hold five pages of information. The company also provides generic graphics, but it does require physicians to update content on the page or links to other pages. Almost 6,000 physicians have used the service, which has been available for about a year.

Salu.net subsidizes its free services by selling ads to pharmaceutical companies. The ads are designed for physicians who log onto the member services area of Salu.net; consumers who view Salu.net's physician Web sites do not see the ads.

Customized sites

For physicians who want more customized Web sites, there are Web developers who will take care of every aspect of their Web page. Turnkey operators like Chicago-based GenneX Healthcare Technologies handle not only the technical aspects but also develop content, design the site and promote it so that Web surfers will find your site when looking for a doctor. GenneX typically charges physicians about $500 to create a basic site, according to Karen Sarpolis, MD, medical director for the organization.

D.M. Shetty, MD, an otolaryngologist in Munster, Ind., used GenneX to build a site that features directions to his practice, office hours, information about his training and links to resources on otolaryngology. (The site can be viewed at www.GenneXHealth.com/shetty.) While Dr. Shetty admitted he doesn't know how many patients have used his Web site and that the Internet doesn't replace conventional marketing tools such as word of mouth and the Yellow Pages, he said he believed it was important to have a presence online. "It is an avenue that I couldn't discount for drawing in clientele, especially the younger generation," he said.

Content

Besides listing basic information such as practice information, physicians can choose to post all kinds of other information.

HealthGate Data Corp., for example, offers more than 700 articles on various medical conditions and procedures that physicians can put up on their own Web sites free of charge. HealthGate subsidizes this service with fees from corporate users.

Putting detailed information about health conditions on your site, however, can raise some thorny issues. Although there are no hard and fast laws governing patient information that appears on the Internet, physicians are considered responsible for the information on their sites. Online veterans say that physicians should include a disclaimer on their sites emphasizing that they are not prescribing treatments but rather that patients should contact their physicians for further assistance.

Yul D. Ejnes, FACP, a general internist in Cranston, R.I., and Transitional Governor for the College's Rhode Island Chapter, has a site for his five-physician practice on America Online that contains information about the practice, links to patient education materials on the Internet and newsletters highlighting office policy and procedures. (See http://users.aol.com/renmed/RenMed.html.) The site, which costs about $20 a month to run, also includes contact information for the practice's entire staff and a link that allows patients to e-mail physicians.

The site also features a disclaimer in the patient education section advising users not to take any action without first consulting their doctors. "I use the general principles of common sense in terms of what you would or wouldn't do on the phone or outside the office or what you would do for a patient vs. a nonpatient," Dr. Ejnes said.

But because the site allows patients to e-mail physicians, Dr. Ejnes said that the practice has taken other precautions. "We've made it a point to explain that e-mail is not for urgent problems," he said. "We try to keep online questions limited to nonmedical issues such as billing or scheduling questions, or general medical questions that aren't time-sensitive." (Dr. Ejnes recommended that any physician considering setting up an e-mail response system on the Internet first read the American Medical Informatics Association's guidelines on e-mail access.)

Pat Hale, ACP-ASIM Member, a general internist in Fort Edward, N.Y., who has created several Web sites for her practice and the hospital where she works, said she, too, has been careful to emphasize to online patients that the information is not a substitute for seeing a doctor. Each site was set up for different reasons, but none is designed to diagnose symptoms or instruct patients to undergo a certain treatment. (Her practice's site is at www.glensfallshosp.org/samafe/samafe.htm.)

The site for her practice helps market its servicess and targets patient groups for new physicians. Another site that Dr. Hale has created focuses on occupational medicine, a specialty of hers, and helps patients identify and understand problems. Dr. Hale said that any treatment information on the sites is geared toward explaining in-depth treatments that have already been recommended.

Physicians agree that the Web should not replace physician-patient interaction. The Internet is best used as a vehicle to exchange information, and that's why some say physicians need to embrace this new medium.

"There will be a day when nearly everybody is hooked up in some form and if you aren't on the Internet, you will be at a disadvantage," Dr. Ejnes explained. "Being connected also serves as a marketing function in areas other than patient care: Colleagues and other medical organizations or entities see the site, which only helps to enhance our status as a practice."

Jodi Knapp is a freelance writer and editor in Exton, Pa.

Web resources

Here is a list of resources to help you create your own Web site:

  • The American Medical Informatics Association (www.amia.org) offers guidelines for online communications with patients and links to other medical computing sites.
  • DoctorNet (www.doctornet.com) builds basic, one-page sites for physicians free of charge.
  • GenneX Healthcare Technologies (www.gennexhealth.com) builds customized Web sites for physicians and other clients.
  • HealthGate Data Corp. (www.healthgate.com) allows physicians to post medical articles from its site on their individual sites.
  • The List (www.thelist.com) is a directory of Internet Service Providers, some of which help their customers develop Web pages for free.
  • Medsite Publishing (http://medsite.com) offers physicians help in setting up Web sites.
  • Salu.net (www.salu.net) offers physicians six different Web designs free of charge.

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