Systematic Review of

Hospital Websites

Valid Medical Resource or Just

Another Marketing Tool?

Barry Little, M.D.

Systematic Review of
Hospital Websites

Objectives
Methods
Results
Discussion
Summary

Objectives

Determine whether regional hospital

websites provide viable health & medical
information
Critique usability, content and quality of
regional hospital websites
Discuss the future of hospital websites

Methodology: Content &

Usability

Identification of sites via HospitalWebUSA

Initially #55 sites found in Kentucky
Duplication of sites/website templates,
consolidated into one site
One hospital without a website
Total of #39 sites reviewed

Review was based on two main

components: content and usability

Methodology: Content
Evaluation Checklist
(Y/N)
1.
2.
3.

4.
5.

Patient educational material

Interactive
Links to educational
material/references
Maintenance
Certification

Methodology: Usability
Score (0-5)

5 highest, 0 lowest
Minus 1 point for each of the following:

Third party advertising

Distracting graphics/sound/animation
Poor readability (fonts too small, illegible)
Poor layout (too busy, color mismatches)
Technical (slow to load, dead links,
navigability)

Results: Educational
Material

No distinction made
between level or quality
of material

54% (21) of sites did not

offer any educational
material within site

Websites that did

contain material was
often commercially
created material
(canned)

Results: Interactive

Criteria: real time

interactivity - such as online
scheduling, self registration,
self diagnostic tools, bill
payment

Vast majority of sites (82%)

lacked any interactivity

Primary interactive items

were financial in nature bill
payment, bill review, etc.

Results: External Links

Primary criterion was

presence of links to
recognized medical
authorities (CDC, WHO,
Mayo Clinic, PubMed)

56% of sites did not offer

external links to educational
material, support groups,
search engines, etc

38% of sites had neither

online or external links to
educational material

Results: Maintenance

Majority of sites (85%)

were well maintained

Disparity

Criteria:

Primary - actual date of

last update listed
(uncommon)
Secondary all links
functional, dates for
upcoming or recent events
accurate, no glaring
outdated information

Results: Certification - vs
Merit Badges

Only one hospital (2.5%)

listed any Internet
certification (HON)

Several sites advertised

JCAHO credentialing or
other awards (US
News Top 100, JD
Powers, Solucient, etc)

Results: Usability Score

Most sites were moderate-high quality in terms of

usability
Common problems were poor layout/readability, lack
of maintenance, distracting graphics

Results: Incidental
Findings

Oddities

Recipes
Weather reports
Notice of narcotic restrictions

Niceties

Medication record (downloadable)

Personalized health record
CarePage patients can create their own website,
exchange email/post messages, keep family/friends
updated on condition (site is certified by TRUSTe)
Provider links to decision support

Discussion

What is the actual business model for

hospital websites?

Most function as static electronic brochures

Advertising primary function
Patient education/medical information low priority
Little direct e-commerce, delivery of online service
Poor interactivity; One way street on the
information highway
Hospital centric versus Patient/consumer centric

Discussion cont.

What might the future hold for hospital

websites?

Optimist
Interactive portals for both patients and physicians
Services available online teleconsulting,
counseling
Educational & diagnostic tools
Foundation for National & Regional Health
Information Organizations

Discussion Future of
Hospital Websites
cont.

Pessimist
Clintonomics: Its all about the economy stupid
Healthcare dollars for most hospitals are becoming
increasingly scarce, operating margins smaller
each year
Robust internet presence luxury item that has little
return on the investment dollar
Healthcare service unique: does not easily lend
itself to other service models (hotels, restaurants,
airlines, etc)

Discussion Future of
Hospital Websites
cont.

Realist
Internet has been one of the largest forces for social,
economic change in history; medicine is not immune
Smaller operating margins = unique ways to generate
revenue
Delivery of service via the internet will only increase,
not decrease, in spite of the uncertainties as to how
Stay away from the leading (bleeding) edge of
internet technology but when the time comes, know
how to use it to your advantage.

Summary

Hospital websites currently fail to meet

consumer educational needs

Most sites have moderate-high usability but

lack of interactivity & viable content, making
them less relevant

Ultimate role of hospital websites unknown;

successful evolution may ultimately hinge on
ability to reinforce need to revisit site
(commercially viable)

References:
1) Gruca T, Wakefield, Hospital websites benchmarking americas best hospitals Journal of
Business Research 5759(2002) 1-7.
2) Smith D, A survey and evaluation of hospital websites, Masters research paper, Kent State
University, submitted May, 1997.
3) Wyatt J, Sullivan FR, eHealth and the future:promise or peril? British Medical Journal 2005;
331; 1391-1393.
4) Fulda P, Kwasik H, Consumer health information provided by library and hospital webistes in
the south central region, Journal Medical Library Association 92(3) July 2004, pp 372-375.
5) Jain T, Barbieri R, Website quality assessment:mistaking apples for oranges, Fertility and
Sterility, Volume 83, Issue 3, pp 545-547.
6) Hagland M, What's in a Web site? Years into the Internet revolution, hospitals continue to
struggle with their online presence. Healthc Inform. 2006 Jul;23(7):14.
7) Hospital Web Sites Disappoint Visitors
http://www.forrester.com/Research/Document/Excerpt/0,7211,39846,00.html
8) Zingmond DS, Lim YW, Ettner SL, Carlisle DM, Information superhighway or billboards by the
roadside? An analysis of hospital websites, West J Med. 2001, December; 175(6): 385-391
9) Hernandez-Borges AA, Macis-Cervi P, Gaspar-Guardado MA, DeArcaya ML, Ruiz-Rabaza A,
Jimenez-Sosa A, Can examination of WWW usage statistics and other indirect quality indicators
help to distinguish the relative quality of medical websites?
J Med Internet Res 1999:1(1):e1
10) Boyer C, The health on the net code of conduct for medical and health websites,
Computers in Biology and Medicina, Vol. 28, Issue 5:603-610
11) Randeree E, Rao HR, E-health and assurance:curing hospital websites, Int. J Electronic
Healthcare, 2004, Vol. 1, No. 1:33-46
12) Goldwein JW, Benjamin I, Internet-based medical information: time to take charge, Ann
Intern Med 1995 Jul 15;123(2):152-153