PROMOTIONAL AND INFORMATIONAL WEB AND INTERNET

APPLICATIONS FOR THE PHYSICIAN PRACTICE

The Internet is the proverbial elephant described by a group of blind observers from a variety of different directions. Descriptions vary from every perspective. The Internet can be described by the same person, from the same perspective in different fashions on different days. Incorporating it as a tool in a physician's practice demands a process that requires the practice to first define the tool and, secondly, to describe the problem to which the tool should be applied.

This monograph is an attempt to define the ways in which the Internet might be used to address some common problems found in a medical practice and, depending upon the practice, allow some web adventuring as well. This monograph only addresses the promotional aspects of the Web, the ones which are important to consumers. Other perspectives include the applications of the Internet for research, claims verification, data storage, back office support functions, communications, linkages with formal networks, affinity programs, business support functions, etc. The perspective that is most important in the first phase of development is the one from which the consumer views the practice, using the Web as a filter.

First of all, there are differing facts which relate to consumers and practices and the Web.

1. There is a certain segment of the population which is becoming more web-focused and using it in some way in decision-making. These people are probably younger and have more disposable income than other segments of the economy and, therefore, would be considered to be a desirable patient population. Some analysts claim that the senior population is also becoming more we-enabled and is accessing the web for information on a more frequent basis.
2. Some people use the Web to find information about a determination (or buying decision) they have already made. They are looking for verification or for rankings. These are “web checkers.”
3. There is a segment of the population which makes its buying decisions based upon the Web and the information posted by vendors and others. These are the “web shoppers.”
4. Some people need background information on disease and treatment options (not practice selection). These are the “web researchers.”
5. There are some people who realize the need for a dimension of service obtainable only through the Internet, and they seek businesses that have that capability. These are the “web communicators.”

Once classified, the consumers can be defined by the services they are seeking on a web page or through the Internet, and the practice can determine what it feels its doctors can provide for the patients who are web savvy.

"Web checkers" want to see the practice website and confirm hours, or get a map or understand more just by reading through whatever the practice has out there as an electronic brochure. They are comparing the website to the others they browse through daily as they check out retailers and other service providers that they patronize. They may already know the doctor they want to see if that doctor or practice is recognized in the realm of Web information, or ranked by many (or any) of the relevant physician recognition sites.

The “web shoppers” are either looking for information or they are checking the site (and the doctor) against other vendors and information sources. This means the site must be “discoverable” through the normal Web browsers or via another reference site.

The “web researchers” are looking for content. They may or may not be patients, but they definitely are interested in what is known about a disease process or a treatment. They find the site (and return) based upon the content, connections with other search engines, and the value of the updates to that content.

The “web communicators” see the site as a tool, and they seek to use it to communicate with the practice about appointments, lab tests, information, questions, etc. To them, the Internet is a tool they want to use to deal with practices that know how to apply this tool to patient service.

Practices, it seems, have taken a random path to reach these groups. There are no right answers, only ones which are better (today) than those offered by competitors. Certainly, every practice needs an Internet strategy, and the following listing might help in that initial discussion which, hopefully, may lead to a full planning session.

Components of the Web offering:

1. The opening page contains a “welcome to the practice” with name, doctors, locations, phone numbers, hours, etc. This is a surrogate for the yellow pages in an electronic form. Effective openers will be easily found (many links to a variety of titles) and will have all of the content displayed in one frame of a standard browser. It will load fast and have simple and meaningful branches to other pages within the site. It will avoid a busy or cluttered look, and it will not have commercial banners, ads or streamers. The page might have a language selection button (English, Spanish, etc.), and it will boast a secure sign-in for patients (if the site is going to be allowing e-mail).
2. The secure sign-in should identify patients of the practice as “special” with unique access to some services not available to casual site visitors.
3. The site should be easily readable and printable from all of the common browser tools in current use. The site should not require downloading of additional software for a technological boost to view the site better.
4. There should be a plain statement that the practice respects the privacy of the patient and does not send any identifying “cookies” or share any kind of information or demographics with another entity. HIPAA regulations and patient confidentiality should be referenced strongly.
5. In order to appear technologically current, the opening page should have an alert or a streamer of some kind which highlights a current announcement, an important link, or something which is timely and significant. This is to demonstrate that the practice always has some important item which is current and that it has a technologically updated web design.
6. The top page should also have caveats, indemnifications, patient acceptance of responsibility (for using the information), etc. This might be requested/confirmed as a patient goes into a site with whatever might be construed as medical advice.
7. The “drill-down” buttons should have a professional look and feel, and they should direct the patients simply and in a fashion which allows immediate access to other tools and references. Do not use blank pages or “under construction” excuses. Do not use a button if there is no content. This is the opening of the portal to your website, not an outline of a “work in progress.”

Some “go to” ideas:

1. Special “quick print” page for emergency numbers - hit print and put it on your refrigerator. (e.g., 911, fire, police, local poison help line, suicide hot line, gas leaks, etc.) The idea is that it is up to date and prints in an easily displayed format (with the practice numbers).
2. Map - how to get to us. Include printable directions from any compass point. Easy parking map? Coupon for parking (printable)?
3. Physicians and staff - who we are . Vanity pages with a head shot and an action shot for each. Do a dedicated staff page. How about the doctor’s favorite non-medical website rather than hobbies? How about each sitting at a computer with obvious web graphics on it?
4. Special assistance for the physically challenged - “We know that there may be some limitations for our patients and their families, and we want to make sure you know what we have planned to make your visit easier.” (e.g., special map, access to wheelchairs, TDD, interpreters, etc.)
5. Appointments made easy - “Complete this easy form and one of our staff members will call you with the next available suitable appointment.”
   1. I prefer to see Dr. Black or Dr. Jones.
   2. New visit, recheck.
   3. Regular hours or after hours (pull down?).
   4. At the south side office or at the east side office? In our special mall location?
   5. Morning, noon or night?
   6. Name, age, phone, best time to reach you, etc.
   7. Been here before?
6. Is the doctor running on time? This capability automatically interfaces with the internal practice management system to tell patients preparing for an appointment time whether the physician or provider is on time.
   1. "Dr. Smith began his 10:15 a.m. appointment at 10:35 a.m. Please plan accordingly.
   2. "Dr. Smith began his most recent appointment seven minutes behind schedule. Please plan accordingly.
7. Payment and plan coverage - “The practice accepts the following insurance coverages:”
   1. Medicare
   2. M-Care
   3. Blue Cross Blue Shield
   4. HIP
   5. Oxford
   6. Magellan
   7. Extenda-Care
   8. Prudential
   9. Matrix on local co-pays and deductibles?
   10. Hot line help numbers for each plan?
8. Consumer helplines and hotlines for health care issues.
9. Where we send our referrals and our patients for outside service and support.
   1. Pharmacy.
   2. 24-hour pharmacy.
   3. Oncology.
   4. Podiatry.
   5. Otolaryngology.
   6. Ambulance - emergency and non-emergency transport.
   7. What else?
10. Online help for ancillaries and hospitals (to which the practice may refer). Be sure to do your own synopsis paragraph for each and make the “links” appear standard under your presentation format.
    1. Hospitals to which we admit and their web addresses and access points and maps.
    2. Radiology.
    3. Outpatient surgery services.
    4. Physical therapy.
11. Community services and support groups - local web sources for information and assistance.
    1. AA.
    2. ADC.
    3. Visiting Nurses.
    4. Meals on Wheels.
    5. Neighborhood Patrol.
    6. The Guardian Angels.
    7. What else?
12. Online script refill service (secure e-mail for patients of the practice only). This calls for another form:
    1. Name, PIN number.
    2. Phone number.
    3. Script refill requested.
    4. Preferred pharmacy. (e.g., 24-hour pharmacy, delivery pharmacy, etc.).
    5. Best time to be reached by phone for confirmation.
13. E-mail the doctor(s).
14. Best website for health resources - recommended by your doctor.
15. Let’s talk about diet - weight loss records and charts, diet plans, recipes, etc.
16. Secure site for lab results and reports (another special site for patients).
17. E-mail newsletter linkages - the equivalent of the junk mail solicitation but to the e-community.
18. Warnings, recalls and alerts.
19. Just for fun - clever site of the month. Medical puzzles related to health and wellness. Your cholesterol IQ.
20. Bulletin boards. A health care equivalent of the “back porch.”
21. Sample streaming of operations, procedures, etc. For the eager and curious? For interactive patient education. A class for the patient who is about to undergo a procedure or operation - tested/scored and recorded on the Web.
    1. Anesthesia.
    2. How to do a home pulmonary function treatment.
    3. Tips for our patients with asthma.
    4. Diabetic foot care.
    5. Lowering cholesterol through diet.

    How about an area where patients can report (and see) progress?

    1. Charting your sugar.
    2. Weekly glucose monitoring.
    3. Pulse and heart rate check.
    4. Weight record online.
    5. Blood pressure check and report.
    6. Intake and output records.
    7. Pediatric charts for growth and achievements?

The practice can choose to serve only one group of patients, or all of them. If the idea is to try to get to the “communicators,” there is a special level of vigilance, time and technology which will necessitate a web-savvy staff person. The remaining items will also take a lot of front end work and some routine updating.

Some patients in cities where care is very well organized now get referrals to specialists over the Internet. Many are invited to qualify for their benefits online before seeing a doctor, and they are looking first at the websites provided by the managed care plans to see if there is a specialist in their plan – before seeing the primary care physician. Of course, that is the future of the Internet for insurance companies – directing care and steering patients. Hopefully, physicians will take some lead in the process and give the web savvy consumers an alternative system of access.

The bottom line is that a few of the patients are now looking to see if your practice has a web page. A few more are searching and shopping their medical care over the Web. No one knows what the effects will be on eventual selection of doctors based upon pure web marketing strategies, but it is definitely non-zero and growing. It is time for most practices to be considering and implementing a strategy which moves beyond the high school level vanity pages “under construction” for most practices.