The World Wide Web can be a tremendous resource for you and your patients if you know where to look. Here's your guide.
Fam Pract Manag. 2001 Apr;8(4):23-28.
If you're like many of your physician colleagues, you probably use the Internet occasionally – to check stock prices or weather forecasts, to e-mail family or friends, or to purchase books or gifts online. Why? Using the Internet for such purposes was probably fairly easy to learn, and it offered convenient, immediate value. Odds are, you're willing to use the Internet in your medical practice, too – if doing so is equally convenient and beneficial. The key is finding Web sites that offer quick, easy-to-use information and services.
The Web sites described in this article do just that, offering a variety of resources for professional development and continuing medical education, for educating and helping your patients, and for finding a job and referencing clinical data. Though quite varied in the services they provide, these Web sites do have several common characteristics: All are easy to use and free of charge (except where noted). All are helpful for family practice. And many of these Web sites were developed by physicians to solve problems they know you face.
Millions of people use the Internet each day to simplify tasks such as researching stock prices and purchasing gifts.
Physicians can use the Internet to simplify practice-related responsibilities as well.
There are more than 25,000 health-related Web sites to help physicians find a new job, earn CME and help their patients with special needs.
Web sites that help you help your patients
There are numerous Web sites available today to help educate patients about important health care topics and assist them in getting the care they need. While not all of them can be listed in this article, the following Web sites address three unique and important areas of concern among many patients and their physicians:
Rx expenses. Many physicians are concerned about poor patient compliance that often occurs when patients cannot afford to purchase needed medications. At www.rxassist.org, a site sponsored by the Robert Wood Johnson Foundation, you'll find information on over 100 pharmaceutical manufacturers' patient assistance programs, including programs that offer free prescription medications for eligible patients. The Web site's database can be searched by manufacturer name, medication (branded or generic name) or therapeutic class and displays each company's program criteria guidelines along with step-by-step application instructions. When available from the manufacturer, actual application forms are posted online for the patient or caregiver to complete as required by the manufacturer. You can also download a sample letter for use in certifying a patient's need for assistance.
Another Web site designed to give low-income patients access to medications they cannot afford is located at www.needymeds.org/. This site also posts drug information by manufacturer, drug name or category, listing over 900 medications from 145 companies. The Web site provides information on how to enroll in the charitable programs, policies regarding refills and limits, and procedures for dispensing. The site is co-operated by a physician and is primarily funded through sales of The Needy Med$ Manual.
A different approach for addressing medication access is offered by www.pharmapath.com. This Web site is hosted by Health Strategies Network Inc., a health information technology company that helps physicians and patients secure reimbursement for pharmaceutical and biotechnology products. The site is intended to help restore physician prescribing authority and improve patient access to leading-edge therapies. It posts free, customizable form letters for use by physicians to document medical necessity or appeal a denial of coverage. The Web site also provides reimbursement information about specific medications, describing the documentation that health plans are likely to require. All data, analysis and opinions contained on the site have been independently researched and developed by the company's medical and editorial staff, not the site's pharmaceutical and biotechnology sponsors.
Eldercare information and services. Health care is the second most frequently searched topic on the Internet, and senior citizens are the fastest growing segment of Internet users. Not surprisingly, then, many Web sites now offer health-related information and services for the elderly and their caregivers. One of those Web sites, www.roseplace.com, is designed to help people find the right type of care for themselves or their family members. It provides fact sheets that explain various care options, including home care, assisted living care, continuing care, skilled nursing care, respite, adult day care and hospice care. Over three million senior care options can be viewed through the site. Also included are tips on what to look for in a facility and questions to ask when visiting a care community.
Multilingual patient education. Many physicians today serve patients whose primary language is not English. If you fall into that category, several Web sites offer patient education resources in non-English languages. A particularly extensive collection of copyright-free multilingual patient education materials regarding immunization and vaccination is available at www.immunize.org. The site offers materials in Arabic, Armenian, Cambodian, Chinese, Farsi, Hmong, Japanese, Korean, Laotian, Portuguese, Romanian, Russian, Samoan, Somali, Spanish, Tagalog and Vietnamese. All of the materials are reviewed for technical accuracy by the Centers for Disease Control. The site also provides immunization updates, guidelines and answers to difficult questions.
Information on 24 health topics, including AIDS, cancer, heart disease and stroke, can be found in both English and Spanish at www.noah-health.org. The Web site is hosted by the New York Online Access to Health (NOAH) organization, whose mission is to provide high-quality, full-text health information to consumers.
Two additional patient education Web sites that offer multilingual materials are www.drpen.com and www.familydoctor.org.
HOW “FREE” COMMERCIAL WEB SITES MAKE THEIR MONEY
You know the old expression “There is no such thing as a free lunch”? Well, technically, there's no such thing as a free Web site either. Although you may not have to pay directly to access a Web site's services or information, you can be sure the site is generating revenue. Knowing how they make their money may help you evaluate their motives – and their content. Here are some of the most common revenue streams:
Sales of products or services. A well-known example of this approach is www.amazon.com. Millions of people have visited the Web site, selected a book, provided credit card information and purchased it online.
Transactions. Some Web sites generate income each time an automated transaction occurs. For example, each time people buy or sell items through www.ebay.com, basically an online garage sale, the company receives a fee for handling the transaction.
Subscriptions. Some Web sites require users to pay for access to the information and services available through the site. For example, you may pay $20 per month for unlimited use of a Web site from which you can view, download or print any information posted on the site.
Advertising. In the television world, networks allow the public to view their programs for free, and they generate revenue through commercials. Some Web sites follow a similar model, allowing users to view information for free, while they make money by selling advertising space on their pages.
Affiliate links. Some Web sites make money when their visitors click on a link to another site and then make some sort of purchase. For example, if you're visiting a Web site, see an Amazon.com icon, click on it, link to Amazon and then purchase a book, the original site that linked you to Amazon might receive a commission from the purchase you made.
Licensure of content. Some Web sites post copyrighted information which is free to their visitors, but they also license and sell their content to other Web sites who want to post their information. This is a frequent practice among online publishers of articles, databases, research studies and other syndicated information.
Data mining. Some organizations sell data about the people who visit their sites, with or without the individual's knowledge. For example, while visiting a Web site you might be asked whether you'd like to be able to check your e-mail messages through your phone. You say, “Yes,” and your answer is sold to a Web-phone vendor. You knowingly provided the data. In another example, owners of a Web site might sell a report listing the type of browser most commonly used by its Web site visitors. You didn't realize information about your browser was being collected and sold. This can be a very lucrative way to generate income, but it is controversial due to issues of privacy and data ownership rights.
Physicians today are better equipped to practice evidence-based medicine than ever before, thanks to the increasing availability of clinical data whenever and wherever it is needed. Clinical reference data that is stored electronically and accessible via the Internet is more portable than printed reference manuals and much more up to date. You are probably already familiar with invaluable online resources such as GratefulMed (igm.nlm.nih.gov) and PubMed (http://www.ncbi.nlm.nih.gov/pubmed), which provide access to clinical research articles, and the National Guideline Clearinghouse (www.guidelines.gov), which provides access to a variety of evidence-based clinical practice guidelines. Here are two additional tools:
Drug reference data for use on palm-top computers. Palm-top computers (or PDAs, personal digital assistants) have rapidly become popular among physicians because of their portability and ease of use. A free drug reference database for use on Palm-compatible PDAs can be downloaded from www.ePocrates.com. The software, called qRx, was designed to help physicians prescribe appropriate drugs and reduce pharmacy callbacks and medication errors. It provides information on indication-specific dosing, adverse reactions, contraindications and drug interactions for over 1,600 commonly prescribed medications. When you “sync” the PDA in its cradle, the Web site's AutoUpdate feature alerts you to new drugs that have been released, indications that have changed or drugs that have been recalled. Several other companies also offer drug reference databases and medication management systems, but with well over 100,000 registered users, ePocrates is clearly the market leader. (Palm-top computer users will also want to check out ePocrates' newly released qID, an infectious disease application.)
Medicare benchmark data. At www.carescience.com you can access a free benchmark database of Medicare morbidity and mortality statistics. The database, called CaduCIS, was licensed exclusively to Care Management Science by the University of Pennsylvania. It can be used to compare severity-adjusted clinical and administrative data regarding lengths of stay, complications and many other factors, analyzing outcomes by diagnosis or procedure. The public information is freely accessible to medical professionals but does require registration.
PRIVACY VS. PERSONALIZATION
Many Web sites now offer a high degree of personalization, which has its pros and cons. For example, when you register and log on to a site, you may see a message such as, “Welcome Dr. Smith.” Some Web sites track your interests by asking you a few survey questions or recording topics you previously viewed from their sites. This profile of your expressed or apparent interests is then used to customize the information and services presented to you on future visits to that Web site.
Some Web sites are even more proactive. They e-mail you when information matching your profile becomes available. For example, www.e-skolar.com, a commercial site sponsored by Stanford University, will notify you when new articles are published on topics you've previously researched through their site. Additionally, some recruiting Web sites will notify you when job openings are posted that match the qualifications listed in your resume.
Great news, right? Not everyone agrees. In order to personalize information and services for you, an organization must maintain a profile about you – your interests, buying habits, demographics, etc. Some see that as a risk for invasion of privacy and, thus, won't give Web sites permission to collect, store or use personally identifiable data.
It's important to understand, however, that data is often collected about your Internet surfing habits without your even being aware. This is accomplished through “cookies” sent between your computer and the Web site's computer. You can turn this feature on or off, or at least instruct your computer to alert you when a cookie is being sent, by clicking on the Tools menu, then “Internet Options,” then the security tab and finally clicking on the “Advanced” category (in Microsoft's Internet Explorer) or (in Netscape Navigator) by selecting “Preferences” under the Edit menu, then choosing the “Advanced” category. In most cases, these “cookies” are harmless, but it doesn't hurt to know when they are occurring.
Professional development resources
Keeping up with professional obligations associated with the practice of medicine can be time consuming and costly. Whether you're requesting privileges or reading medical literature, using these convenient Web sites can save you time and money.
Family-practice-specific sites. If you're looking for a Web site with practical information on a variety of topics targeted specifically to family physicians, there are several resources available. One is the AAFP's Web site (www.aafp.org), which can point you to policy papers, continuing education materials, practice management advice and more. Another valuable site is www.familypractice.com, which is sponsored in part by the American Board of Family Practice.
Credentialing and accreditation. HCPro.com sponsors a suite of Web sites to help you comply with burdensome regulations. For example, at one of the specialized sites, www.credentialinfo.com, you'll find short articles and full “white papers” on the credentialing and privileging process. You can even download sample policies, procedures for delineating clinical privileges and forms for requesting temporary privileges. Another of HCPro's specialized sites, www.accreditinfo.com, offers tips and news updates regarding ambulatory facility accreditation, including how to meet the Joint Commission on Accreditation of Healthcare Organization's most problematic standards.
Journal abstracts via e-mail. Keeping up with the growing volume of important medical literature can be a real challenge. Rather than subscribing to dozens of medical journals and then feeling the stress of watching them pile up unread, you can set up a free, automated system to have abstracts of articles on topics of interest to you e-mailed weekly to your attention. Not only does this approach ensure you're notified about new articles of interest, but it eliminates your need to browse articles for which you don't have an interest.
One of the abstract e-mail services, www.medjet.net, was developed by physicians. They wanted colleagues to have information delivered directly to their e-mail boxes at no charge and without the need for inconvenient passwords. The Web site offers over 200 journals, categorized into collections by specialty. For example, the “family practice” collection includes American Family Physician (AFP) and the Journal of Family Practice. You can sign up for as many journals or collections of journals as you wish. To activate the service, simply visit the Web site and select medical journals from which you'd like to receive updates. You'll then receive a weekly e-mail with titles of the most recent articles and quick access to abstracts from all journals you've selected.
General information for medical professionals. Another popular type of Web site is referred to as a “gateway.” Such sites typically post original articles and provide directories with links to additional online resources for a particular topic. For example, I maintain a Web site at www.eHealthCoach.com that includes hundreds of articles about using the Internet for medical practice, with thousands of links to resources on information technology in health care. Two other helpful gateways are www.medicalcomputingtoday.com and www.physiciansguide.com.
Whether you prefer to earn CME by attending live programs, by completing print, audio or video programs, or by accessing it online, the Internet can save you time.
Medical meetings and CME events. In the days before Internet access, if you needed information on an upcoming medical conference, you had to track down the sponsoring organization's phone number and call them directly to obtain the information. Today, several Web sites provide free online listings of upcoming medical meetings. Four of the most useful ones are www.physiciansguide.com, www.medicalconferences.com, www.healthstream.com/ and www.aafp.org/cme.
Online CME. Perhaps you prefer to earn CME credits online, accessing programs on virtually any topic, at any time and from any place that has an Internet connection. Not only does this eliminate the expense of travel and time out of the office, it offers the convenience of tracking earned credits online.
Medscape offers thousands of free and fee-based programs, particularly presentation summaries from medical meetings nationwide. Go to http://www.medscape.org/medscapetoday to search for online CME programs by specialty, topic, conference sponsor or date. You can complete a multiple-choice test that accompanies each program and submit it directly through the Web site. Your CME certificate will be securely posted online immediately following electronic submission of the post-test. If you prefer, you can fax or mail in your post-test, and your CME certificate will be e-mailed to you within five business days.
Online CME is also available on the AAFP Web site at www.aafp.org/cme. You'll find interactive versions of the quizzes published in AFP and Family Practice Management. You'll also see CME quizzes for recent AFP monographs, interactive versions of the AAFP Home Study audio quizzes and AAFP Home Study monograph quizzes. New interactive cases are also available for online credit.
Web sites for staffing
Many Web sites are useful for finding or filling medical jobs. Whether you are seeking an employment opportunity or want to fill an opening in your practice, staffing Web sites can save you time and money. Most Web sites allow job seekers to post resumes for free but charge employers to post openings. Despite the fees, online job postings are usually much less expensive than using recruiters or placing advertisements in print publications or newspapers.
One valuable service offered by many of these sites is automated matching of employers and candidates whose qualifications fit the requirements. Many of the sites also allow searching by location and specialty. Some will even e-mail you when a candidate or job opening matches your profile. Additional services include providing background information about prospective employers, career counseling and resume-writing services for free or a nominal charge.
Dozens of good staffing Web sites exist. For example, www.miracleworkers.com, lists over 35,000 health care job openings and has over 100,000 unique health care visitors to the Web site each month. If seeking a position, you can browse the listing of job openings or request to be notified of openings that match the criteria you specify. You can create a confidential resume and specify whether you want it posted online or sent only to potential employers of your choice. The Web site also offers tips for writing effective cover letters and resumes, interviewing with prospective employers, and negotiating your new salary.
If you're searching for a new practice administrator, consider posting the position at http://www.mgma.com/careers/. The Medical Group Management Association will e-mail your opening to all job seekers who've expressed interest in a practice of your specialty type and location.
Additional employment Web sites for physicians and other health care professionals are www.acpe.org/Careers/Index.aspx, www.ama-assn.org/apps/webad_ama/webad, http://www.aafp.org/online/en/home/careers.html?navid=careers, www.healthcarematch.com, www.hospitalhub.com, www.mddirect.com, www.medcareers.com, www.mdsearch.com, www.physemp.com, www.practicematch.com and www.therecruiter.com.
With over 25,000 health-related sites on the World Wide Web today, the diversity of sites is unprecedented and the selection can be overwhelming. This article should help you narrow your search and find the information you need.
Dr. McKenna is CEO of eHealthCoach, a consulting firm that educates medical professionals about information technology and other management issues.
Editor's note: If you have a favorite Web site that wasn't mentioned in this article, e-mail us a description at firstname.lastname@example.org.
Copyright © 2001 by the American Academy of Family Physicians.
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