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BY: THOMAS C. LAWRY

In 2002 steady but pervasive change continued to reshape the way health care consumers use the Internet. For one thing, a majority of Americans seeking health information went online to find it.¹ And nearly four in ten of those who sought online health information later discussed what they found with their physicians.²

Today most hospitals have websites. Many, however, are neither keeping up with the health care consumer's growing expectations nor taking advantage of opportunities the Web offers to extend the hospital's mission into the community. But astute health care leaders recognize the shift in Web trends. They take advantage of the shift by transforming their sites, which originally functioned as online brochures, into strategic online services that address the needs of Web-savvy consumers. Along the way, these leaders are finding that such moves, by supporting their organizations' strategic and operational goals, make them more competitive.

Here are five recent leading trends that health care leaders should note and take advantage of in 2003.

Websites Can Influence Consumer Preference
Although the habits of health care consumers have been much studied, very little research has been done on the use of hospital websites. However, a new study by the Endresen Institute provides specific data on, first, who uses hospital websites and, second, the impact such sites have on health care consumers.

The Endresen Institute study shows that consumers do use hospital sites.³ The level of use varies by region. Higher use is seen in the nation's western and north central regions; for example, more than half of all consumers in these regions indicated that they had accessed their local hospital's website.

What, from a consumer's perspective, constitutes a great hospital website? The features most valued include those that enable the consumer to look up detailed information on medical conditions, ask questions about nonurgent health care issues, and be directed to credible websites sponsored by nationally recognized health care experts. Of the consumers surveyed, 96 percent said that if their local hospitals had such features, they would use the website.

When asked whether such a site might influence their hospital preference, 73 percent said that it would to some degree affect their decisions. The study concludes that hospitals with great websites can anticipate making a strong positive impact on consumers' thinking.

Besides creating a positive preference, a hospital website can also leverage and extend the basic mission of the organization. In the past two years, 11 million Americans who helped a loved one deal with illness said their use of the Internet played a crucial role in that experience. Another four million said that the Internet helped them cope with major illnesses of their own. 4

A site that provides the information and services that health care consumers find valuable will also help the facility attract new patients and reinforce the loyalty of old ones. Hospital leaders should evaluate their current website from a consumer's perspective. Does it provide detailed information about a health condition? Does it explain the organization's services and programs in detail?

It's a Women's World Online
Women have always played key roles in health care decision making. Today more women than men make use of the Internet. According to one estimate, the ratio of female to male users is three to two.⁵ The average woman who goes online regularly is married, in her thirties, and a member of a household with a higher-than-average income.⁶

Hospital leaders should note that 90 percent of the women who use online services also consider themselves to be their family's primary health care decision maker.⁷ Seventy-two percent of women who go online have sought out health information, as compared with 51 percent of the men who do so.⁸

Contrary to conventional wisdom, women who are mothers on average now spend more time online than teenagers do. And those mothers who have the least amount of free time—that is, single mothers and those with three or more children—go online more often than others.⁹ Eighty-eight percent of all mothers who are Internet users have done so seeking health information.¹⁰ This fact should interest any health care organization wanting to serve families. Busy women turn to the Web because it saves time and is convenient. Hospital leaders should keep this in mind when thinking about website design.

A hospital website is most likely to attract the attention of those women who are seeking information pertaining to an issue affecting them or family members. Hospitals should pay close attention to the needs and preferences of women when developing online information and services. Indeed, they should consider creating a special site section that provides in-depth information geared to women's needs.

Physicians Embrace the Web
Almost half of U.S. physicians report that the Web has had a major impact on the way they practice medicine.¹¹ The Internet's rising influence on clinical medicine has, among the 78 percent of doctors who use the Web, sparked an increase in both the frequency of use and the amount of time they spend.

The amount of time that the average physician uses the Web has jumped from 4.3 hours a week in 1997 to about 10 hours a week today. Although younger physicians tend to use the Web more than older ones, the number of older doctor-users is increasing. In 2001, 65 percent of doctors aged 60 years or more used the Web, compared with 43 percent the year before.

Incidentally, physicians specializing in obstetrics/gynecology and internal medicine tend to provide more online services than other specialists do.

Physicians are using the Internet both to gain medical knowledge and to embrace online tools that enhance patient care, such as electronic prescribing, online communication with patients, and the use of electronic medical records. Even so, doctors' use of online services still lags behind what their patients desire. According to one study, 90 percent of health care consumers using the Web say they would like to be able to communicate with their physicians online.¹² They say, for example, that they would like to be able to ask their doctors questions, schedule appointments, get prescriptions renewed, and receive the results of medical tests.

Hospital leaders, recognizing that many physicians are interested in learning how they could use the Internet in their practices, should take a leadership role vis-à-vis their medical staffs by helping them to utilize web services. They should also consider asking physicians to help evaluate the information and content provided on the hospital website.

A More Diverse Internet Community
Internet use among the nation's Hispanic population grew by 19 percent last year—a rate three times the size of the growth among non-Hispanic users.¹³ Today Hispanics constitute 11 percent of the total U.S. online population.

Internet use has also grown considerably among people who live in low-income households. In even the lowest (less than $15,000 annually), one in four people now use the Internet.¹⁴ And the growth in Internet use in rural areas has recently been so strong that it now matches the national average.¹⁵

Hospital leaders should make sure that the facility's website is designed to serve a broad audience, parts of which have special needs. They should, for example, consider putting at least portions of the site's content in languages other than English. Recognizing that lower income families are now online, they should provide information programs, services, and policies that help low-income families.

Staff Recruiting Goes Digital
The growing shortage of registered nurses and other professionals is a great threat to the nation's health care system. For example, most hospitals report that vacancy rates for RNs, pharmacists, and imaging technologists are increasing.16 Increasing as well are the costs of recruiting new professionals and of temporary staffing until these positions are filled.

As it happens, those professionals are increasingly turning to the Internet when they look for new positions.¹⁷ On an average day, more than four million Americans go online to look for a job. This represents a 60 percent increase in online job hunters in the past two years. One fourth of all Internet users who changed jobs in the past two years said it played a crucial role in their job search. Two-thirds of American women who work outside the home have used the Internet to learn about career advancement and almost half have used the Internet to find a job.¹⁸

Hospital leaders should be aware that as more people go online in search of a job, the Internet is proving to be a very cost-effective means of attracting new talent. Today the average cost of recruiting a new staff member via a website is much lower than the traditional methods.¹⁹

Leaders interested in improving their facilities' recruiting should look closely at the online recruiting centers of Fortune 500 companies.²⁰ Most of these organizations have created online recruiting centers that recognize and cater to the needs of job seekers. Most job seekers want a website to give them some sense of the organization's culture, for example. Recent graduates tend to prefer to deal with companies whose online recruiting centers have special sections for new and recent graduates. Knowing this should be useful for hospitals trying to attract graduate nurses and imaging technologists.

An effective online recruiting center can both improve recruiting and reduce recruiting costs. Hospital leaders should make sure their sites include a strong career opportunities center. This center should be designed to help job seekers understand and relate to the organization's mission and culture. And, of course, the site should also make it easy for interested job seekers to actually apply online for jobs.

NOTES

1. Healthbeat, September 16, 2002.
2. Harris Interactive Health Care News, June 11, 2002.
3. To request a copy of the study, e-mail Karen Endresen.
4. Pew Foundation, "Use of Internet at Major Life Moments," May 8, 2002,
5. Netsmart America.
6. Harris Interactive/Cyberatlas.
7. Women.com.
8. Pew Foundation, "Vital Decisions: How Internet Users Decide What Information to Trust When They or Their Loved Ones Are Sick," May 22, 2002,
9. "Moms, Hispanics Increasing Web Use," CyberAtlas, May 8, 2002,
10. "Moms, Hispanics Increasing Web Use."
11. American Medical Association, "2002 AMA Study on Physicians' Use of the World Wide Web," July 17, 2002.
12. Harris Interactive, "Many Patients Willing to Pay for Online Communication with Physicians," April 11, 2002,
13. "Moms, Hispanics Increasing Web Use."
14. U.S. Department of Commerce, "A Nation Online: How Americans Are Expanding Their Use of the Internet," Washington, DC, February, 2002.
15. U.S. Department of Commerce.
16. American Hospital Association, "Healthcare Workforce Shortage and Its Implications for America's Hospitals."
17. Pew Internet, "Online Job Hunting: A Pew Internet Data Memo," July 2002.
18. "Women Taking the Internet Lead," Business Women's Network/CyberAtlas.
19. Logos Research, 1999.
20. Logos Research, 2000, "Best Practices of Fortune 500 Career Website Recruiting."