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ealth care-related ventures like Medscape, WebMD, and Dr.Koop.com are dominating the big, breaking stories in health care.

This is partly because the Internet and the World Wide Web are becoming more popular: Business Week has estimated that Internet usage is doubling every 100 days. But more important, Internet health care ventures are big news because the public thirst for health care information seems unquenchable. While headline news is the most popular search conducted by Internet users, information about health care is a close second. In fact, last year almost 22.3 million adults - 40% of American adults online - sought health-related information on the Internet.

Increasingly, the health care resources available over the Internet are critical to patients, to the new health care "consumer," to health care providers, and the rest of the health care industry. Yet, in this rapidly expanding environment, only a few of the major academic health centers - such as Mayo Clinic, Cleveland Clinic, and Johns Hopkins - have a web presence dedicated to providing a broad range of information and other health-related services.

Now Emory Healthcare is preparing to launch its first full-fledged entry onto the Internet. After more than a year of planning, Emory is moving quickly to make its web address an important and helpful site for patients and others when it goes live in early 2000. The new Emory HealthWeb will offer a mix of wellness and health information for consumers, medical resources for clinicians, an interactive personal health manager for patients and nonpatients, and a referral mechanism designed to boost Emory's patient base. Sporting a standardized look and greatly expanded content, the site will eventually allow consumers to link easily to other Emory health-related sites.

Cardiologist Randy Martin can be credited with having the initial bug at Emory for things web. Back in 1995, Martin would convene a group of physicians for monthly meetings to discuss what Emory Healthcare's website should look like. Their ideas helped build the foundation upon which Emory Healthcare's marketing department is now developing a new web presence.

"Emory Healthcare needs a website to be in the game," says Marketing Director Una Newman. Beyond consumer and clinician demand for Internet-based health care information, Newman reports that insurers are taking a keen interest in these sites as well and use them to compare the capacities of different health care systems. "An academic health center of this size must have a website to promote its strengths to an ever-widening market," she says.

Realizing the Emory system needed to pull together ideas, people, and websites into a unified effort, Newman got web momentum going several years ago - first participating in Martin's visionary meetings and then convening outside webmeisters to talk about what kind of website made operational and financial sense.

From five companies in which Emory expressed initial interest, a local company, Third Millennium Communications (3MC), peopled by ex-IBMers, got the nod and immediately set about doing comparative studies. This process revealed that Mayo, for example, spent $3 million on its "initial build." For that substantial sum, it was saddled with a system in which the web company - not Mayo Clinic itself - must perform all updates, resulting in annual costs to Mayo of $1.8 million.

Though entering somewhat late into the web game, playing cyber catch-up now may prove to Emory's advantage. Technology has come a long way since Mayo developed its website, when only programmers could handle content updates. By contrast with Mayo's deep-pocketed approach, 3MC recommended that Emory Healthcare develop a software-based web system that will allow continuous updating by personnel of individual departments. In this way, the functions of adding, changing, or deleting will be managed at relatively low-cost - considerably less than Mayo's annual web maintenance tab - and, simultaneously, consumers will receive timely and relevant information. Emory Healthcare's web system is being built on an industry-standard Oracle database that allows for powerful search mechanisms to be deployed throughout the site.

Emory Healthcare needs a website to be
in the game and promote its strengths.

-- Una Newman, Marketing Director

Users of the Internet service Yahoo can select Mayo Clinic's Health Oasis, which has attracted a good bit of attention as a source for health care information. The Cleveland Clinic's website provides valuable information regarding its services and procedures, but its greatest effectiveness is in marketing to consumers within the clinic's geographic location. As for Johns Hopkins, its site, intelihealth.com, offers timely, comprehensive information that is well presented and easily accessed by a national and international audience.

One recent trend among sites is to offer patients the option of customizing their own web pages. These sites can include the capacity to enter a range of secure information on a particular patient's medical history, current health condition, and prescriptions as well as built-in links to additional, relevant data. Such sites can be equipped with email-response capability and provide summations of office visits. These innovations can provide an important new level of assurance and feedback for patients in a managed care environment in which physicians are often forced to communicate in 12-minute increments. "Anything that could extend this contact - indirectly but substantively, as the web can do - has tremendous potential," says Bill Bornstein, director of clinical development for Emory Healthcare information services.

Many basic science departments, clinical sections, and centers within the Woodruff Health Sciences Center already have taken the initiative to create websites. But these lack consistency in look, feel, and content. And Emory Healthcare last year sponsored a portion of the American Medical Association's consumer health information site. A web user deploying that link today would arrive at the Woodruff Health Sciences Center page, which provides a brief overview of health care at Emory.

Local competition presently seems to be confined to the north Georgia market. One such example is the website of Northside Hospital, which specifically targets the consumer.

The point is that everyone is trying to figure out how to create as much of a rich and interactive consumer/patient interface as possible. One way to do that is to offer net services such as a personal health adviser to engage consumers so they want to come back to update their health information. It's a way of creating loyalty to Emory, not selling care, the experts say. When the patient wants care, he or she will call for an appointment.

The new Emory HealthWeb is being designed primarily to provide patients, referring physicians, and others within Emory's catchment area with an easy-to-use site by which to get key and useful information about Emory Healthcare physicians and programs (see site map). While Emory Healthcare has strong name recognition and has highly regarded research facilities, quality care, and respected specialties, the new website will try to make it easier to do business with Emory Healthcare as an institution. Having a unique, informative, and user-friendly web presence - one that incorporates features and functionality far exceeding that of its local competitors - could play an important role in the future success of Emory's clinical enterprise.

Moreover, Newman firmly believes that technology can actually personalize the relationship between a health care provider and its patients by overcoming distance. The potential seems unlimited. "People meet today on the web and even get married," she says. "If technology can do that, then we should be able to use it to bring Emory closer to its patients where they live and work."

• Patient education, including archived and regularly updated information about diagnoses, procedures, and medical terminology
• Wellness and health information
• Easy-to-find information within a vast resource base
• Education on Emory Healthcare physicians and health care programs, particularly specialty resources geared toward consumers and referring physicians
• A personal health manager - a tool for individuals to record and self-manage their family's health information
• A foundation platform for future enhancements in electronic interaction between the health care consumer/patient and Emory

These precepts resulted in the following proposals:

The all-important interface. This is where websites are made or broken. The graphic design of the Emory Healthcare web presence will appeal to a largely female audience, since studies have shown that far more women than men search for health-related information on the web - and that women make the majority of health care decisions for their families. Overall, the site should put a human face - and voice - to the people of Emory. This will be achieved through the Virtual Doctor, a concept that involves incorporating a photographic image of a doctor, nurse, or other Emory Healthcare staff person onto a strategically placed page, along with a text or audio message to the consumer. This message can be anything from a short welcome to a more detailed discussion of the quality care available at Emory.

Microsites. In the long term, every clinical department and center will have a dedicated microsite within the Emory HealthWeb. In the short term, 10 clinical groups are targeted for the initial development phase:

• Cardiology
• Center for Late Life Depression at Wesley Woods
• Ear, nose, throat
• Emory Hospitals
• In vitro fertilization
• Ophthalmology
• Orthopaedics
• Radiation oncology
• Transplant, both solid organ and bone marrow
• Urology

The decision to begin with this group was based on both their readiness with content and their preparedness to handle the increased patient load that may result. Another 15 to 18 clinical areas will be developed during the first two years. Web pages for all remaining sections and clinical areas will be added by the third year.

Wellness and health information. In this realm, a comprehensive medical library/dictionary will allow users to search for medical terms, diagnoses, treatments, and procedures.

Personal health manager. This tool will allow Emory Healthcare to build a relationship with health care consumers. First, visitors to the site will be granted a secure area in which to record and manage their family health history and vital health indicators (weight, blood pressure, cholesterol, body-mass index). All aspects of the personal health manager will be protected for consumers via user IDs/passwords and encryption.

As this feature is developed further, it will be possible to create a generic wellness plan based on a consumer's age, weight, body-mass index, diet, and exercise. Eventually, the hope is that the website will provide more direct tie-ins to the clinical enterprise, including e-mailÐresponse capability, online scheduling, and online lab results. Patients will be able to print out their own medical histories to take to new physicians or mail in advance of a visit, find out how to participate in clinical trials, keep immunization records, be reminded via e-mail of necessary shots, and schedule appointments online.

Referring physicians. Here the goal is to provide more support to the referring physician, leading to more patient referrals. Such support eventually will take the form of online Q&A response, online scheduling, and online status and follow-up recommendations. Basic information will include how to make a referral, CME credit information, seminars, and special physician-only services, such as access to patient results and medical resources.

Believe it or not

"Before Leslie's evaluation tool, health-related websites could only be evaluated subjectively by health educators and other health professionals," says Susan Butler, her adviser in the department of behavorial sciences and health education. "The rating form objectively scores credibility, and that's crucial for consumers when their health is at stake."

Given the sometimes-legendary wait times of Emory patients, the logical question is: "Why do anything to increase patient volume?" The answer, says retina surgeon Tony Capone, a member of the website advisory committee, is a fundamental business tenet: "If you don't grow, you die." Thus the efforts by Emory Healthcare to look at ways to serve current patients more efficiently as well as streamline practices to get new patients in faster.

But Una Newman cautions that wait times and a department's capacity to handle patients are not necessarily correlated. For instance, there is a 30% no-encounter rate at Emory, a figure that represents both no-show patients and doctors called away for emergencies. While those involved with scheduling acknowledge need for improvement, the areas that will go online first will be those that can handle the increased volume, such as cardiology and orthopaedics.

Another goal is to bring all existing Emory Healthcare web pages under a single, corporate identity. In the new schema, each department's web presence will work according to a common navigational scheme. A master database template will cover the breadth of content possibilities for any department. This setup allows each department to control the amount and the pace of its incorporation into the web. In addition, departments will have the option of incorporating text, audio segments, video clips, and animated graphics.

One of the most compelling reasons for a unified Emory Healthcare website is to reflect and market Emory's movement toward seamless integration of its many superior programs and star players. Although an "institution" in name from the start, the Emory system has traditionally been a conglomeration of individual centers of excellence, both medically and operationally. But Emory is looking for ways to more effectively compete with private sector caregivers. As an institution, Emory can harness, leverage, and publicize our biggest assets: our brain trust and cutting edge equipment, technologies, and techniques.

Capone likens the collaborative effort to putting together a team of exceptionally talented players who can work together and win while still showcasing its stars. "Take the prominence of Greg Maddux, Tom Glavine, and Chipper Jones of the Atlanta Braves. The team is our darling because it is a winner. Complementing the marketing of the team by marketing selected players gives folks a feeling that they 'know' the team, and enhances the visibility of particular strengths."

Capone also believes, for example, that it is far better for the Emory Eye Center to be known for ophthalmic excellence within a broad, well-integrated medical center than as a center of ophthalmic excellence alone. "Why? Because patients develop institutional loyalty, particularly if they have positive experiences across departments," he says. "And this is one way we can decidedly thrash our competition - if we get it right."

To test the market for Internet services, Emory Healthcare invited two groups of consumers - those aged 30 to 50 and those aged 55-plus - to view both the existing websites and the unified site proposed by 3MC. Both groups preferred the new site to the old material and did not spare their views about design, clamoring for white backgrounds and other, in their words, "necessary" features.

The surprise was that the more-mature set frequently use the web, and their principal affiliation at present is with either Mayo or Cleveland clinic. Many older patients go online to research prescription medicines that their doctors have ordered for them.

Clearly, says Newman, "We are in the presence of consumers who are savvier than ever before. One thought that must stay constantly before us as we create this website is, 'It's not about us; it's about them.' The question then becomes, What is the best way to partner with today's educated consumer?"

Emory reviewed models from several different industries. Companies such as REI seemed to have figured out something important about working with their customers. They know that building business on the web is all about building relationships with customers. "REI, for example," Newman says, "first put its recreational equipment catalog on the web, then built in interactivity so customers could order or comment on the merchandise. Now REI is branching out and helping its web customers plan their trips."

That approach translates well to health care. "We start out by providing health care information," Newman says, "then get into referrals, scheduling, or providing lab results. Patients someday may be able to handle their preadmission paperwork online and use a personal code to access their results on a secure web page. Eventually we could be recommending personalized nutrition plans, rehab, or fitness training."

Emory Healthcare is expected to fund most of the initial development of the new Emory HealthWeb system. Sections will be responsible for contributing funding and maintaining their websites over the long term, giving them both incentive as well as maximum flexibility. After the first two years, costs will be allocated to the hospitals and to Emory Clinic sections based on current volume within the Emory Healthcare website. Individual sections will be responsible for clinical content updates to the website, with overall coordination by an Emory Healthcare web administrator.

Web enthusiasts such as radiation oncologist Jerome Landry predict that better web access will reduce the time it takes patients to get into the system. "It will give patients a faster, easier way to contact Emory and give us a better way of contacting them. If patients can see my picture and what I do on our web page, they can send me a message that they're interested in coming to Emory, and we can respond almost immediately."

As a unified offering, the new website will also showcase Emory's multidisciplinary approach to diseases such as cancer, Landry says, by providing links between his department, surgical oncology, and medical oncology. "It also will provide an opportunity to call attention to our newest bells and whistles, such as the fact that we're the beta test site for intensity modulation radiation therapy, which allows us to treat tumors more precicely while sparing normal structures. The website will help us recruit patients for clinical trials and broaden our ability to attract international patients as well."

However, there is still much to do. Content must be so good that browsers keep coming back for more. "We have to stress what makes Emory stand out," says Landry. "That we're the best in cardiac care and transplantation, that we're doing something different in cancer treatment, that we're on the leading edge in treating brain tumors, and that our GI studies on pancreatic cancer are some of the best in the country . . ."

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One potentially ironic measure of the new website's success will be how big a problem it becomes for sections or departments to keep it updated and respond to inquiries, observes Capone, who says the Eye Center already has a webmaster handling such duties. "The challenge of institutional websites is learning to set limits," he says. "As more inquiries come in, the system will become stressed. The challenge is knowing when the inquiries amount to providing care as opposed to giving general information. I need to see the patient to give specifics. We don't want to deliver care or provide insurance information on the website because that information changes so rapidly that we can't possibly provide any degree of accuracy."

Newman looks forward to the more encouraging aspects of this project: providing valued and timely information that is easy to access, nurturing strong and lasting customer relationships, cultivating more repeat patient visits, and shoring up Emory Healthcare's position in the market as a premium provider system that offers greater quality of care than the competition.

"Evidence suggests that patients are more comfortable relying on academic health centers, even in an age when these centers are being tested as to whether they should remain the foundation for the discovery and creation of new knowledge regarding health care," she adds. "Emory Healthcare has a real opportunity to serve our patients well with web information that we certify as the best. That is an extremely valuable service."

Software giant Microsoft asks its consumers, "Where do you want to go today?" The hope here at Emory is that a frequent response will be the Emory HealthWeb at www.emory.org.

Susan Carini is director of publications for Emory University.