Online Medical Services: The Second Generation
Companion NetView:
Online medical services
by Marjorie Lazoff, MD
Emergency Medicine
Philadelphia, Pennsylvania
Medical Editor
Medical Computing Today

accepted for publication in Medical Computing Today January 1999
Originally published in the January 1999 issue of Medical Software Reviews

Healtheon - WebMD - Medcast - Others

A companion NetView reviewed established medical online services for physicians and other healthcare professionals. To their credit, these established services are ever-changing; for example, Physicians' Online has a new logo and pharmacology section, MD Consult now permits whole site searches, and Medical Economics' old physician interactive Web site has been transformed into, showcasing its flagship product.

But the latest excitement comes from several well-financed fledgling companies that promise to revolutionize how physicians use the Web and computers in clinical care, practice management, and professional education. This next generation of healthcare services strives to be self-contained, comprehensive systems -- portals, in technospeak -- and seek to address everyone's needs: physicians, administrators, and patients. Many of the established medical online services are also unabashedly commercial ventures run by experienced businessmen hoping to make a fortune heading expansive enterprises. The new companies differ from them largely in the size of the investment capital, CEOs' superstar status, aggressive partnerships, competitive marketing strategies, and attention from Wall Street.

Unlike its companion NetView on established medical Web services, this is not a formal review.

Sections Healtheon
last visited January 1999

The press releases and interviews read like a maudlin TV movie: during his father's illness, a famous and business-savvy son gets a personal glimpse into medicine's disorganized information systems and sets out to develop technology to correct the health care industry's chaos. Looking to repeat the phenomenal success of his other start-ups Netscape Communications and Silicon Graphics, in 1996 Jim Clark created Healtheon.

See a description of Healtheon's technology, a "highly-secure, scalable Internet-based platform that supports high-volume mission-critical transactions, and integrates widely-distributed applications and data, using a modular, tiered, CORBA-based architecture." To insure patient confidentiality, Healtheon uses RSA encryption technology with Secure Socket Layer protocol and 128-bit length keys -- the same technology used in portions of the military and banking industry. This page links to two white papers on platform and security technology, both from September 1998, as downloadable PDF files.

Clark began by building a core of products and services targeting health plan benefits administration, such as statewide Blue Shield organizations and the Rocky Mountain Health Care Corporation. An old PR slide presentation outlines Healtheon's benefits administration plan from these early years. But stories soon emerged concerning Healtheon's technological and business difficulties, as in Healthlink's White Paper on Healtheon and Q&A with Debra Jones, public relations manager. Within the business community the early glowing predictions dimmed. Like many companies about to go public in mid-1998, Healtheon backed off after the volatility of the late summer market. Present company stock information is available on a number of online resources, such as Hoover's Online.

Recently, Healtheon has shifted its marketing strategy away from trying to attract MCO and insurance company administrators to wooing their members (patients). Although Healtheon does not accept individual subscribers, it boasts how subscribers to the organizations signed up with Healtheon can choose a primary care physician, communicate with health plans and physicians through e-mail, and receive other online health information.

This strategy has resulted in, among other things, Healtheon Consumer Services. This is a well-designed site without the typical registration demands, flashing banners, or marketing hype. Strengths include a thoughtful general medical library and an advanced health database, each consisting solely of links to other Web sites, such as top government and academic resources. Unfortunately, not all information sources, authors, or dates are identified. Users may search the general library, topical databases, or use Citeline to search the Web.

Other site features include daily health care-related articles from the New York Times, and several interactive features on wellness and nutrition. It's not clear how some features, such as weekly Zebra Cards with associated links, serve a nonprofessional audience's needs. But in general, this upscale site does a good job of siphoning off the best health information on the Web...and may well siphon off Web-savvy users from competing patient education Web sites.

Despite its rocky start, Healtheon casts a large shadow on the healthcare industry. It has not marketed its services directly to practicing physicians or small groups (yet), but it offers online demos of its group of Internet-based services, designed to "bring secure communications between patients and physicians or health plans, and the ability to create and maintain a personal electronic health record."

Sections WebMD
last visited January 1999

WebMD's mission sounds similar to Healtheon's: "to become the leading Internet-based healthcare network, offering products and services that bridge the continuum of care, meeting the needs of doctors and hospitals as well as consumers." Started in 1996 by twenty-something CEO Jeff Arnold, WebMD forms partnerships with other companies rather than developing its own technology. The impressive list of partners includes HBO & Co., Envoy Corporation, Premiere Technologies, iXL,, Thomson Healthcare Information Group, A.D.A.M. Software, and the National Jewish Medical and Research Center. A recent press release boasts of WebMD's signing a deal with electronic brokerage superstar E*Trade.

At present, this service offers online insurance eligibility verification and referrals; news, reference and research data from the Web (not original content); a "universal in box" for e-mail, voice, and fax messages; online CME; and a customized Web site for patients. Basic WebMD physician subscriptions range from $25 to $175/month. Part of WebMD's marketing strategy is to provide free computers to doctors who don't yet own one.

WebMD has entered the online consumer health market with Health and Wellness Center, a site difficult to distinguish from the dozens of professionally designed patient education sites. Its healthcare content comes primarily from mainstream database suppliers such as Johns Hopkins-Aetna/U.S. Healthcare's InteliHealth and HealthGate. Extras include the slow but visually impressive ADAM interactive anatomy program, and a condition center of almost three dozen disorders. Other features include AMA and WebMD physician search, and a wellness center with lots of information on nutrition, exercise, and alternative medical therapies. Comparing this with Healtheon's more sophisticated consumer site illustrates subtle differences in their marketing strategies, which may portend more significant differences elsewhere in these companies.

Sections Medcast
last visited January 1999

The opening paragraph in Sept 7, 1998's article from Atlanta Business Chronicle, WebMD Vs Medcast begins: "In what is shaping up as a battle of big egos and big money, two Atlanta companies are working furiously to develop products that compete for the same prime piece of real estate: space on a doctor's crowded desktop." Yet further down, even this article acknowledges the battle involves two fundamentally different products.

In early 1998, Alan Greenberg, chairman and CEO of Greenberg News Networks, launched Medcast, a private, interactive desktop application that "aims to feed doctors' appetites for health-care news, continuing education courses, announcements of regulatory changes, research findings and professional interaction." Push technology allows for information to be continually updated, and the service is delivered by closed circuitry -- not though an Internet Web site -- using a channels format. A self-described "Bloomberg for doctors," Medcast models itself after the successful business news organization and data provider by employing reporters, editors, and stringers from around the world to supply much of the core content.

Professional credibility and medical content come from its medical director, Bruce Dan, MD, past Senior Editor at JAMA; an impressive medical board of advisors; and, under corporate agreements, from medical organizations such as the American College of Cardiology and Johns Hopkins. In exchange for content, these medical organizations are provided their own channel to communicate with members and promote themselves to a physician audience. The ACC channel is scheduled to launch in the first quarter of 1999. Medcast Networks provides not only the news but also the software and terminal to access Medcast, directly challenging WebMD's free computer distribution.

For a comprehensive news story on Medcast, see the February 16, 1998, issue of the Atlanta Business Chronicle. See too Medcast's marketing-rich Web site, which includes a clever demo.

Sections Other Services
last visited January 1999 is a year-old professional resource site for all physicians and other healthcare professionals but with an emphasis on Tennesee resources. Free registration provides a virtual office: a personalized home page with access to site features along with a nice customizable daily reminder and appointment feature. InfoStat is a menu-within-menu annotated list of health and medical sites organized in part by Steven Nace, MD, known for his Doctor's Page, from which InfoStat heavily draws. In keeping with its practicing physician slant, included is a listing of physician personal home pages. Even more so than InfoStat, the articles in's Library lean strongly to practice management, managed care, and related topics. Practicing physician utilities include virtual business cards, a member directory, and ICD-9 and DRG code manuals. An annotated list of nonclinical medical texts links to More forgettable features include a poorly attended group of forums, and free e-mail to registrants is promised soon. was founded by Passport Health Communications, whose OneSource uses Web technology to transmit Tennessee patient insurance information, including eligibility for Medicaid and MCO programs, and MCO benefits, referrals, claims processing, and current formularies. It also communicates with and markets MCOs to providers, employers and members. Price vary from $50 to $435/month depending on number of transactions, after a $375/account setup fee. Passport OneSource is described as the largest such resource in Tennesee. provides a link to these services, creating for its subscribers a full-featured Web medical portal.

Last year, IT services provider Electronic Data Systems and pharmaceutical company Eli Lilly pooled their healthcare electronic network businesses to form Kinetra. Like Healtheon and WebMD, this Colorado company aims to deliver networked healthcare services to payor, physician, pharmacy, hospital, and laboratory customers. It already boasts the largest healthcare transport facility in the U.S., linking more than 200 hospitals, 96% of retail pharmacies, and several large laboratories. As described in a February 1998 press release, Kinetra introduced its new browser-based physician desktop Web tool, Odysent. Its Medline provider, Medcite, is freely available on line to registered users but be forewarned -- unless requested otherwise, Medcite will send pharmaceutical information based on your searches to your e-mail address. (Registration accepts dummy information, but this limits use of its features.)

For a discussion of how several individual hospital and small specialty companies have developed their own interactive Web sites, see the December 1998 Health Data Management's Building Interactive Web Sites. Just as the companies above have done, most incorporate databases, search engines, and e-mail and video applications for users to complete online transactions, conduct physician searches, schedule appointments, obtain referral request forms and provider directories, and communicate with physicians via e-mail. Examples of Web-based systems that include network patient charts, with and without additional services appear in Medical Records Projects.

Companies like WebMD,, along with established online medical services design interactive sites for the Web. Others, like Medcast and Kinetra, use the Web to promote themselves while employing another network technology to deliver their services to their members. In the same issue of HDM, managing editor Bill Siwicki writes the cover story, With worries galore, should health care rely on the Internet?. The article asks whether the Web's problems with universal and real-time availability and security issues outweigh its economic and technical advantages, such as independent platform and ubiquitous network structure. Internet 2 (NGI) may or may not address access and security issues. But the many specialized and comprehensive medical services and portals successfully using the Web suggests it is a fertile medium today.

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