As patients increasingly use the Internet to make health-related decisions, more and more community oncologists are integrating Web sites into their practice. A Web site sends a strong message that a practice is technologically current and helps distinguish it from the competition. It helps ensure that patients receive accurate information. It can reassure and orient newly referred patients. In addition, by better connecting patients and their families to the practice, a Web site can improve the overall cancer treatment experience.
Web sites may be strictly informational—providing information such as the practice history, staff biographies and photographs, and disease-specific content. Or they may be interactive—including downloadable forms and the capacity to manage appointments and even pay bills online. The more comprehensive the site, the greater the potential for improved patient flow, lower administrative costs, and enhanced patient satisfaction.
Patients with cancer and their families are not the only ones logging on. Community physicians often pay a virtual visit to an oncology practice before referring patients. “And during times of recruitment, we found that younger fellows were rating us on our Web site (nmcancercenter.com),” says Barbara McAneny, MD, CEO, New Mexico Oncology Hematology Consultants, Ltd (NMOHC), in Albuquerque, New Mexico.
Figure 1.
Barbara McAneny, MD
Before NMOHC had a Web site, patients noted the deficiency. “Some would even come in with information from other cancer center sites,” McAneny says. “Given our increasingly competitive market, we recognized the need to provide a service that patients clearly desired.”
Determining how much to spend was not easy. With some NMOHC partners understandably reluctant to fund initiatives that even hint at advertising, the original budget was small. Yet, lacking a partner with the expertise or interest in designing and maintaining the site, the practice had to outsource the project. They chose cancerconsultants.com for content that seemed to be at the right level for their patients. “Then the market determined the budget,” McAneny says.
Even after a site is up and running, the task is not complete. Web sites require regular review and revision to meet the needs of established and prospective patients. “Content must be changed to reflect new events,” McAneny says. “Also, from time to time, sites benefit from a redesign, if only because they get stale, and Web design ‘fashion’ changes.”
Getting Started
When considering a Web site, physicians should evaluate other practice sites for visual appeal and desirable features. They also may want to seek input from Web-savvy colleagues and patients. Contact information for Web site developers can be obtained from the copyright on a site's home page or through colleague recommendations.
With an outline in mind, there are several ways to proceed:
Do the entire project in-house. This assumes the organization has staff with Web site development proficiency, editorial skills, and sufficient time to maintain the site.
Hire a Web site developer. This approach tends to produce a more attractive, comprehensive, and easy-to navigate site. However, it still requires staff to supply content and act as Web master.
Hire a full-service oncology-focused Web site development firm. This option shifts the burden of developing the site, supplying content, and maintaining the site away from the practice while still allowing the practice to have the final say. “At the end of the day, an all-in-one service costs the practice less than either of the other two options,” says Charles Weaver, MD, founder and CEO, Cancer Consultants.com, based in Ketchum, Idaho. The firm, whose Web address is the same as its name, has developed and maintains sites for more than 150 practices. “With thousands of pages of licensed cancer-related educational content and user-friendly applications (such as a dictionary of oncology-related terms, cancer drug profiles, and a daily news service), it's impossible for any practice to match the quantity, quality, and timely updates of content of a firm like ours.”
Full-service oncology-focused Web site developers typically update educational content on physician sites on a continual basis. Practices that maintain their own Web site, such as New Hampshire Oncology Hematology (NHOH), can subscribe to a syndicated cancer news service to achieve the same result. “We have taken this approach for the newest version of our Web site (nhoh.com) because constant advances in oncology make it difficult to keep current otherwise,” says Frederick M. Briccetti, MD, who practices with NHOH.
Even practices that outsource the development of their Web site need to be able to revise it at will. A professional may be most suited to handle major changes, but staff members should have the training and tools to make basic insertions and deletions.
Managing Liability Issues
The January 2007 guidelines for online communication by the eRisk Working Group for Healthcare remind physicians of their responsibility for online information they provide. To minimize liability, physicians may want to outsource content development and site review to professionals with expertise in Health Insurance Portability and Accountability Act (HIPAA) compliance.
Santa Monica Hematology-Oncology Consultants (SMHOC) is a four-physician practice that selected Medfusion, a healthcare Web site developer based in Raleigh, North Carolina, to design its site (smhoc.net). On the advice of the practice attorney, it prominently displays a disclaimer regarding patient use of medical information on the practice site or linked sites, and a description of the patient confidentiality safeguards that are provided through a secure portal for online interactions.
Practice Web sites that provide a standard e-mail address must disclose that the e-mail is not secure and therefore is not to be used to communicate health care information. “Standard e-mail between a physician and patient carries the potential for liability because there is no control over who reads it, especially when a patient uses a business e-mail address,” says Steve Malik, founder and CEO, Medfusion (medfusion.net). “The major risk to the physician more than justifies the relatively minor expense of securing patient-physician communication.” Practices that develop and maintain their own interactive Web site also can incorporate a secure portal for e-mail correspondence to conform to HIPAA regulations.
Recommendations
A Web site can offer substantial benefits to the community oncology practice and the patients and families it serves. However, practices need to prepare to invest time and energy, as well as dollars, into understanding the process of developing and maintaining a site. Here are some suggestions from oncologists who have a practice Web site:
Understand the scope of the project before choosing a Web site developer
Consider employing experts to achieve professional results
Outsource writing the medical content to experts in HIPAA compliancy
Include interactive features (eg, a “button” for patient input) to help engage site visitors
Incorporate patient and staff newsletters into the site
Review and revise on a regular basis
The Oncology Practice Web Site: One Perspective
Marilou Terpenning, MD, who practices at Santa Monica Hematology Oncology Consultants (SMHOC), refers to their educational and interactive Web site (smhoc.net) as a labor of love. “I just knew it would help our patients who were searching the Web on their own to have ‘clean’ resources and not misinformation.”
Figure 2.
Marilou Terpenning, MD
A brief training period prepared Terpenning to serve as Web master for the noninteractive functions (eg, uploading new photographs). “Although any of several web developers could have built our site for a moderate fee, we would have had to keep going to them for updates, which occur frequently,” she explains. “The ability to make revisions as needed incurs a much smaller expense in the long run.”
A welcome e-mail invites new patients to register and submit their health questionnaire online. Even before the first visit, new patients and their families can access the site's educational resources, such as up-to-date syndicated cancer material. Patients can communicate with the practice by e-mail through a HIPAA-compliant secure portal. The site's newest feature is an interface with SMHOC's practice management/electronic health record system, which automatically makes patients' communications part of their electronic health record. “Who would not want an interactive site, which is the standard in every other industry,” Terpenning says. “Patients would expect their doctors to be at least as up-to-date electronically as retailers and financial institutions.”
Direct and indirect savings within the first year of operation offset the cost of the interactive site. Automated patient reminder calls during the last 3 years resulted in a direct savings of 0.5 receptionist full-time equivalent, and help to fill appointment vacancies more efficiently. “Indirectly, we save much physician and nurse time spent educating our patients. Our site's educational resources permit complex discussions to be shared with families who live at a distance and, consequently, help us realize a marked decrease in phone calls. With approximately half of our new patients completing our health questionnaire online, we save at least 10 minutes per new patient per physician. And our recently introduced physician portal will save time for us and our referring physicians, as they communicate with us and track patient care,” Terpenning explains.
Note: The American Society of Clinical Oncology does not maintain a relationship with or endorse any Web site development firms mentioned in this article.