1997 Partnerships for Networked Consumer Health Information Conference

Transcripts of Plenary Sessions and Breakout Sessions

Post Conference Workshop B: "Health Communications and the Web Workshop"

Thursday, April 17
9:00-12:00 PM

Speakers: Elaine Bractic Arkin, Health Communications Consultant, Arlington, VA

Jim Healy, Vice President, Porter-Novelli, Washington, DC

Jeff Finn, School of Communication, American University, Washington, DC

Cori Vancheri, Consultant, National Cancer Institute, Silver Spring, MD

Rick Stout, Prospect Associates, Rockville, MD

Kathy Kranzfelder, M.S., Chief Health Information Projects Section, National Institute of Diabetes, Digestive, and Kidney Diseases, Bethesda, MD;

Joel Kahn, M.D., President, Intellihealth, Bluebell, PA

Arkin: As we all know, putting information on the Net has a large effect on budgets, human resources, and other factors. We want to look at how we position this information as a tool. It is a tool that breaks down sometimes, and one that must work with support. We must consider who we are reaching and with what information. How do we design communications? Our purpose today is to look at these issues strategically. We have deliberately set up this morning's session informally and asked our speakers to be brief so there will be time for questions. There is a lot of expertise in the room, as much on one side of the podium as the other. So hopefully, there will be some informal sharing. Please feel free to interrupt.

Jim Healy is the Vice President of Porter-Novelli and has been working online since 1992. We are delighted to have him here to share his marketing information with us this morning.

Healy: Porter-Novelli is a public relations agency here in Washington, and some of our clients include the National Cancer Institute (NCI) and the National Institute of Mental Health (NIMH), with whom we've worked on various campaigns.

"The Right Tool for the Job: Health Communications and the World Wide Web " [overhead title]. I've been with Porter-Novelli for 5½ years. We started working with NCI, providing graphics and digital photos online, without the use of traditional separations. Today we have transitioned to the World Wide Web. I want to talk today about using the right tool to develop a quality product.

Let me first give this idea a sense of context. We have reached a point now where we are bumping heads and dealing with a lot of seeming contradictions. The World Wide Web is 7 years old. The first browser was created 5 years ago. Netscape is 2.5 years old. Explorer is 1.5 years old. Basically, the World Wide Web is new technology. And I want to emphasize that -- that this is technology -- a tool. And a lot of people are using it. At last count, there were 50,000,000 North Americans on the Net. And that's up from 28 to 30 million in October. The media constantly remind us of this growth, and we do feel a sense of urgency to keep up.

In the first 4 months of last year, there were 40,000 stories published in the media that included the word "Clinton." Yet there were 90,000 with the word "interactive." Is this amazing? It's certainly good for me as a media person. This cover of Wired magazine in April is an example of its benefits to the media -- the graphics focus on the growth of media formats. Radio messages managed to reach 60 to 70 percent of homes in the course of 15 years. You can see a steady climb, a peak, and then a leveling off or reaching of critical mass. So you see, the Internet is experiencing a similar pattern according to this standard penetration curve.

What does this mean, and what does this say about what we are doing? This is a new medium, but that doesn't change the fact that we should work with it. It is a fast penetration. That's my message really. That the growth of this technology is fast, but not unusual.

What opportunities are available? Over 11 million homes are connected. Seventy nine percent of all corporations have web sites, and an additional 37 percent are wired. There will come a time when all the appliances in your home will be on the Net, even your light bulbs. Your light bulb will be on the Net with the electric company logged in, so when you flip the switch they will receive a signal to turn on the power. We are on the Net to the extent that a critical mass of people is reachable.

My initial advice to you is to measure. You must start thinking in terms of establishing parameters for your success. The tracking tools are there. You can measure the success of your progress. So that you may learn from our experiences, I'll tell you about several web projects we worked on.

You may have heard of the National Chicken Cooking Contest controversy. We did a page for the National Broiler Council. They were basically used by Tyson's and Purdue -- strong-minded chicken companies -- for lobbying at the U.S. Department of Agriculture (USDA) and to facilitate their marketing efforts. We asked ourselves, "What is our marketing position?" Make it simple. "Eat chicken." It's at http://www.eatchicken.com. We had a budget of $25,000 for the year. We've gotten notice from the press about the site; the Washington Times mentioned it. We used a diner theme. There is a recipe database with more than 500 recipes. You can search by chicken part, even by dark or white meat, etc. The recipe database is easily updated. There are "tidbits" on the front section, "quick facts" about chicken. Every time you go in you see a new quick fact, and the page looks refreshed. This is a marketing tactic too -- it gives the media something to write about.

In another example, we did a page for the Snack Food Association. It's received more than 16 million hits in circulation. Then there was the marketing of Viractin -- a cold sore treatment for Scherring-Plough. The manufacturer has found that 90 percent of all who try the product buy it. We set up the site to take you right to a free sample. Users are asked a few questions, such as their age, what brought them to the site, etc. Twenty five to thirty thousand people have now requested a free sample. We have their addresses, ages, and their past purchases. Again, we have utilized this site to employ a marketing tactic. And the free samples are a key tool. The URL is set up to be the equivalent of an 800 number. For Viractin, it's <www.coldsores.com.> That URL alone has generated some press. The site has received coverage on syndicated news and was part of the tag line of a speech recently given at an Internet conference. The opening line was, "Do we really need a cold sore site?" The client was thrilled.

For NIMH, we've been assisting in development of the Anxiety Disorders site. We started with a situation analysis to determine who's out there and what opportunities are available. We found that there are "content providers," professionals, and other health care people. The response we got was that NIMH doesn't have to make many changes, just improve on its present resources. They needed to see themselves as a content provider.

And there are more large businesses becoming involved. AT&T had a health site that looked very promising, but they took it down after 6 weeks. Time-Warner is focusing on health.

NIMH already has credibility because of its name. So we thought we should let them dictate the terms of content distribution. Most professionals are connected at work, so human resource people are good individuals to target. Let them know how they can provide this information to their employees.

In closing, I want to go back to my earlier statement -- measure, measure, measure. In addition, don't forget to budget. Most sites will require thousands of dollars just to get them running. Then you have to account for maintaining them, and that can get into hundreds of thousands to a half million. Advertising budgets are staying low, and that's important. Let me emphasize the value of the web site. It is a communications tool that supports marketing strategies. Companies are looking at utilizing the web to change how they run their businesses. 3M, for instance, is working on getting its suppliers on the web and making a shift in business strategy.

Planning is crucial. Seventy two percent of businesses have had problems with both finances and human resources. Lack of management and lack of colleague appreciation for the work that has gone into setting up the sites have been frequently mentioned. That's it.

Audience: Have you analyzed web use among organizations that aren't private, such as public health agencies, hospitals, and smaller organizations?

Healy: No, but they are coming online. There is a universe out there. At the Office of Cancer Communication, there is information on this. It's not like publicly traded companies, though, where almost everyone has a page now.

Audience: You speak of this information system as one tool. How can we use it to maximize the use of other tools?

Healy: Start with looking at your objective, and link up all the technology that supports your communications strategy. Use a migration strategy. Ask, "Can these solutions be transferred to the web?" Look at what works. Run it in parallel with your other tools, but plan to transition over within a few years.

Audience: But what about tools that won't transfer? How do we support other "non-migratable" services? For instance, with cancer information, we put a lot of information on the web. But people need someone to help them interpret the information.

Healy: Well, at some point you have to draw the line with regard to use of the web. You can't replace interaction and dialogue. Ultimately, people must see the doctor as the next or final source of information. I'm generalizing here. But once diagnosed, people are not going to the web.

After diagnosis, people want to talk to someone. We have found that there are seven basic demographic sections in the population. Fifty percent of the population will never buy a computer.

Audience: To what extent are there programs out there that are truly interactive? I've been trying to set up one for the Food and Drug Administration, and it's been hard to find something that is truly interactive, as opposed to simply informational.

Healy: We do know that users look at an average of 4 to 5 pages of a given web site. Web users’ habits correlate to what we see with TV viewing habits -- and it is because of viewers’ habits that producers develop 30-second commercials. You have to be aware of this. I was looking at Microsoft Netmeeting; it's interesting stuff, and I had the guy talking to me over the computer. I'm saying, "Wait, I've got you on the phone." Don't use something just because you can. Look at <www.amazon.com>, the bookseller. It works because the guy can sell books; it's effective for the product. Again, you have to use the right tool for the job. Does the web meet users’ needs? Don't put on something no one will use. Thanks.

Thank you, Jim. He will stay for questions. We asked Jim for the overview, from a communications perspective. Now we're going to look at how to narrowly target an audience, and we've chosen to focus on older adults, a growing population, as an example. Jeff is Journalist-in-Residence at the School of Communication at American University. He'll talk about his association with the SPRY Foundation.

Finn: Thank you. Let me start by asking, What do Dizzy Gillespie and information anxiety have in common? I was listening to this on the radio. So someone said to Dizzy Gillespie, "Mr. Gillespie, I love your music, and I wonder how you know what to put in it." His response was that he'd spent 25 years trying to figure out what to leave out of his music.

We face the same challenge in determining what to put on the web. We try to put so much in, and our users can suffer from what a psychologist recently coined as "Information Fatigue syndrome." We need to look at what is essential. Going back to older Americans, those over 85 years old are the fastest growing segment of the over-65 population. Who are they, what are their health concerns, and how do we use our technologies to meet their concerns?

In determining what is essential for these older people, we must first determine who they are. One thing we know is that they are not a monolithic group. They are very diverse. No single factor can explain their response to marketing efforts. You must segment the market.

I've been talking to my own mom about this. She just turned 75. Her husband is 92 and in great health. I've asked them, "What are your concerns?" The response is always the same: "I don't want to be a burden to my children. I want to be independent and economically stable." What kind of information do we get to these people? One thing is sure -- in addressing how to meet their needs, we must keep in mind that we have abandoned the model of the frail, vulnerable, over-65-year-old. We have a much less paternalistic image of them.

People have tried to use relatively new distinctions of young-old, middle-old, and old-old at 65-74, 75-84, and 85+, respectively. But even these categories don't work anymore. My stepdad has just published his biography. He teaches and plays the harpsichord. Age is not the same determinant of lifestyle and health that it used to be. Eighty percent of people over 65 are fully functioning and healthy. You see other morbidity’s when you get into the seventies. So what are these peoples’ concerns, and how do these concerns vary?

Health care priorities and considerations change as one gets older. Nursing home residents don't care about quality of care, but about quality of life. If someone knocks on the door before entering, that's considered good care. Quality of life supplants care. We spent a lot of time looking from the medical side, but with older people, there are other considerations. You have to take into account psychosocial, spiritual, and emotional issues. We have to think about giving information that is not just medical.

With the aging of the population, we do expect an increase in chronic conditions. Considering that 80 percent of people don't manage these conditions well, how do we use the information? Also, care will be given by informal caregivers more and more. So you are not just dealing with an individual and a single condition. Sometimes you are dealing with a couple who has been together for 50 years. You're dealing with the relationship. Or maybe the daughter is involved and strongly objects to how something is being handled. So you are dealing with family dynamics. What information you give and how you give it will vary.

With many decisions, different family members are involved, especially with chronic conditions. In 3 years, one in five people will be giving care to an older adult.

What we know is that seniors are not technophobic. Seniornet in California has set up 70 learning centers nationwide. At SPRY Foundation, with the Retirement Living Forum, we've found that a maximum of 4 percent of online users are older adults. It's a small population, but the rate of growth is twice that of the rest of the population. It's happening. Kids are trading up and giving away their computers to their parents. Families have this in common. There is a lot of intergenerational interaction going on across the country. For older people, this is the 20th Century equivalent of pen pals -- it's about community, not facts. We had lots of libraries on the site. We had set the system up to operate as one-stop-shopping where you could get all the information you needed. And it was used, but what we found more was that people wanted to talk with each other.

I have been concerned about isolation. Does this promote it? It's something to think about. We know that older people will go on. But, also, they want a "hi-touch/hi-tech" mix. We have found in setting up active Q and A sessions with an invited expert, that if we advertised the sessions as a live chat at a specific time, people didn't come as readily as if, say, there was a month of Q and A beforehand, where people could build a level of trust with the information source. Then they would come to a live chat with the National Heart, Lung, and Blood Institute, Social Security, etc. People were much more receptive if there was this build-up. It's good also to build indirect alliances, i.e., with family members. The work site is a good place to reach adult offspring. Or people can approach trusted sources in communities, like information referral systems. Ask how to get the trust of elders, and access the community through this intermediary.

Also, when you are looking at budgets and maintenance costs, what are you doing to maintain credibility? This is the most expensive, but I think most important thing. Additionally, you must keep the information out in front of people -- keep it constant. There are lots of sites to link with as well. Joyce Post at the Philadelphia Geriatric Center has a list of older adult sites.

Finally, I'll end with a line from Peggy Lee: "As good as it is, is that all there is?" We need to think more creatively about how we use this resource. We must ask who are the people involved with the decisions, and we should also determine if we should do something just because we can. Thanks.

Audience: As the daughter and mother of surfers, I see that we all ask, "How can I trust what's there?" With ads -- commercial sites -- how do we help assure the quality of information? I am especially concerned when I think about older adults and how easy it would be for someone to sell them a piece of swampland over the Internet. What is our responsibility?

Finn: There was an article in JAMA yesterday about the quality of information out there. Of course there are some who see this information system as the last bastion of freedom. I think we have to educate people about what is credible. We put up some health care financing information from the Health Care Financing Administration and compared it to a Department of Health and Human Services site. All the seniors saw the word "finance" and immediately said, "Oh, they just care about my money." They went for the site with the words, "human services." These are big issues without easy answers. Thanks.

Arkin: Thanks Jeff. It is practical for us to have guidelines on determining credibility. Everyone should make sure they are on Joyce's list.

Let's use this opportunity to share some of the good work that is happening. Kathy Kranzfelder at the National Institute of Diabetes, Digestive, and Kidney Diseases (NIDDK) at the National Institutes of Health (NIH) will tell us what's happening there.

Kranzfelder: Hello. At NIDDK one of the things we do is support biomedical research.

The web has been in use for a long time at NIH, but many independent users were accessing it before the institution as a whole. We did not have a great page at first, not that well designed. The National Library of Medicine had somewhat the same beginning. It was really the "techies" who started it all.

I am a public affairs specialist and director of three national health information clearinghouses. We make brochures and fact sheets, and we disseminate them via a contract. We work with a lot of content. Walter Stuart has been very instrumental. There was a lot of fear at first about the Net. Some parties really wanted to test a lot of the systems and information first. After good functioning and good feedback, we now have a much better site.

We first submitted the page and had 500 hits a day. That was good then. We did it with an Apple SE -- those ones with the tiny screen. DCRT wired us with a dedicated router.

From the beginning, NIDDK made the decision to use this as an information dissemination tool. The technology would not be a central force in determining content, just a tool. Walter also learned HTML, the language used to enable information to be read on the web. He learned it in a very raw fashion and taught us. Tony Dove, our editorial assistant, was enlisted too. Since then, we just put up the content. While I make no apologies for it, we need to do a makeover. From what we are learning from our e-mail, people are liking it and using it. So we are going to go to a graphics designer. We are going to do a new page. I think at this point I need to bring a committee in. I have talked to the intramural, which are the on-campus people. And the extramural are off-campus scientists. I have been lucky because I have had an easy group to work with.

You know we talked about budget. We do not have a budget. We have an Apple server, which was a $10,000 commitment.

The lessons I have learned are nine nuggets of web development wisdom.

1. Learn raw HTML. This is where you take text and drop it in.
2. Learn good HTML, using all the tags properly. These tags are used by the search people.
3. Get the training. Everything that I learned was from other people.
4. Content, content, and content. If you do not have anything to say, don't say it. Don't put up gorgeous pages with nothing underneath. Also, make sure the page has room to grow and change.
5. Organize by audience needs, not by organizational charts.
6. Web publishing is still publishing. Turn over the printing to the Government Printing Office.
7. All good print design principles should still apply.
8. All good writing principles still apply.
9. Read and answer your e-mail. Use it to change your page and for feedback to the Government, which is very good public relations.

That is all I have.

I was trying to think of what I could give you to take home. I will give you my card, a newsletter that we publish, a reference library sheet, and a sheet on the top 10 design mistakes. Are there any questions?

Question: What is your web site address?

Answer: It is <http://www.niddk.nih.gov>.

Question: How many e-mails do you get a day?

Answer: I get five e-mails a day. It is not overwhelming. We are mostly referring people to the proper sources.

Vancheri: First I want to thank all of the people who helped us. I spent almost 10 years in programs to observe the needs of our audience. There are a couple of handouts out back. Please take one.

The main message is that this web site is still under development. Also, we are really taking a step approach to this. You will see the site has some graphics, since it was organized with the head person at NCI. This kind of a project needs to be a team effort, but led by the Communications Office. We took a look at who our audience is. The mass media is our audience. There are two buttons that are a split, which are supported research and referencing. Technology transfers the people working with patents and product development. The information for patients and the public in general gives them access to what the program is about.

After we made the list detailing who the audience was, we went ahead and started the site. You are going to find that your web users are looking for the same thing that the press and other people are looking for. The other thing we did as we created our site was look at what the public wanted from us. As we go through, you can see the frame set up. This enables users to go where they want to go. A negative is that it takes up screen space. If you scroll over to the right, it has welcome text and other things. The front of each page has descriptive, explanatory buttons.

If we take a look at publications, we will see some graphics. We put an 800 number on it. If we go back to communication and education resources, we find materials that are for the public. NCI has done a beautiful job creating a lot of these materials. We put them on the web so that people can download them. We also have copyrighted materials. Teachers will find that they are able to do a tutorial on the screen, and they can print it out and make a presentation to the class. If we go back home under mass medical, again we are pretty sure of the media we are looking for. All of the background statistics are on this site. This is just the introduction page, so health professionals and others can find out what is on there. It has a wealth of information, including references to our research facilities, with location mentioned. That is all I have here. Things are constantly being updated. Really organize the materials for your audience. We are evolving like anyone else. We are aware of our audience and where they are. What I am working on is a way to bring this idea of clinical research to everyone.

Question: What happens after you design it? It seems to me that the more you put on, the more funding resources you need.

Answer: The cancer network has an oversight committee with a content person who helps set this up.

Arkin: I think you wrote the content to our next session coming up. Thank you, Cori.

Stout: Sorry for the delay. Currently, we are developing web sites for the USDA and other organizations. I work with people who are trying to achieve their goals through effective technology. I see we are all on the same theme. I look at management as a whole enchilada. It is the planning, development, design, and adoption of a site. Web sites are dynamic. They require ongoing change. They are not books. They will be able to interact with this association. Another point that pertains to this technology is its implications for specific audiences. The last point is that you are the experts here. You know who you are trying to reach and what you are trying to achieve. No one ever designs a perfect system the first time. That is really the message that I would like to get across today.

Key trends are that the Internet is an emerging technology with immature, unformed, and inadequate standards, as well as security concerns. Web sites are high maintenance and costly, and social factors are more important than traditional values in determining how to meet users’ needs. I think that we are going to go back to a more traditional value.

Also, web sites are moving from static to dynamic content and function, using push technologies such as Pointcast. The other point I wanted to make is that the theme is static content versus dynamic pages. We should move away from static pages to dynamic pages. This allows you to generate a number of pages, and it also has implementations for dynamic pages.

Just real quickly, lets discuss common problems of site management. One of the basic problems is the lack of a clear purpose or strategy. A web site is simply an electronic publication, nothing more. Web sites may be poorly architected; and there is a problem if there is no strategy for publicizing the site.

When we look at sites, these are some of the things that we feel must be done: monitoring usage and users; updating content regularly; motivating a user to return; using graphics intelligently; avoiding orphans, broken links, and dead pages; assessing and responding to changes in technology; considering use of dynamic pages; developing and implementing site maintenance and marketing plans; and using latest site management tools to reduce labor costs.

Finally, there are a number of tools used for web traffic/log analysis.(Hit List, NetTracker, Web Trends, Accrue Insite, Et Stats Pro). There are site creation and management tools (backstage enterprise, FrontPage, SynaWeb, NetObjects Fusion). And there are URL checkers and site maps (WebAnalyzer, Cyberspyder Link Test, LinkBot, SiteSweeper). Flipping to marketing and promotion, in this business, links are critical (consider general search engines and promotion web sites, and focus on health-specific search engines). Focus on your target audience; marketing is an ongoing process; traditional (nonelectronic) approaches also are useful (press release, flyers, newspaper and magazine articles, conferences, and media events).

Some key questions that you might want to consider before setting up your site are

1. Who is your target audience?
2. How do you reach them?
3. How can you make the site relevant and useful for everyone?
4. Am I satisfying the target audience's needs?

The focus on reaching the target audience is on putting the offering right in front of them. Promotion software that you can download is Submission Wizard Web Promotion Speaker.

One site that we are promoting is a new information product, and the decision to be made now is whether to develop it as a publication or a database. I would go for doing it as a database. I think that is a trend that needs to be weighed as important. It is much more difficult to convert to this format once you have the content. I inform you all that technology has gotten much better, and your users will like the product a lot more. It needs to be more appealing. Thank you.

Arkin: Does anyone have any questions for Rick?

Question: Do you have any guidelines for us?

Answer: I will tell you that it is a jungle out there and that a lot of people are trying to answer that question. I think there is going to be a lot of fallout between competitors. I think that you should stick with a major vendor or a leader in the field. Another suggestion that I have is to make sure the tool does what you want it to do before you buy it.

Arkin: Thank you Rick. Our next speaker is Peter O'Donnell.

Peter O'Donnell, President/CEO, Health Design Corporation, Berkeley, CA: First of all my presentation is going to be a little bit different. I am going to be talking about new communication opportunities using the web. Now we have a great responsibility with regard to navigation. We think that the opportunity is to become the personal shopper and to organize the health care experience. There is opportunity for a trillion-dollar health care market (50 percent for chronic conditions). There is pressure to enhance quality and drive down costs. We must consider consumer activism and technology tools. We are in a new era. Communication has always taken place last. We don't think that the user can get this information. So this is where we start, from top down to bottom up. Change presents both opportunity and risk. We are dealing with new communication tools and uncharted territory. It is a new way to communicate. Information is not communication. Interface is not what you see, and content is not just words. The challenges are to meet the need for two-way, built-in decision support; to manage uncharted territory; to deal with limited consumer research; and to understand the consumer (how do individuals learn, and what is the larger consumer environment?).

The opportunities with the technology are very personalized, confidential, community oriented, and interactive. The key is that you never need an appointment. The lessons learned are to beware of Information Fatigue syndrome, keep it simple, assure that there will be user control, and keep it personalized. The benefits to consumers are obviously that it provides access to information, supports self-management, and increases satisfaction.

I am going to show you a before and after. This is our page, and we decided we did not like it. It was too busy, so we changed it. You have very familiar tools to use. If you are a diabetic you want to track your glucose. You can download or import this information. It is very simple, and users can put in their own comments and they can include information about other things. After you close the information, you get feedback on your entries. The file cabinet is where your information is stored. I will close by asking for questions from the audience.

Arkin: Thank you Peter. Is there one question for him?

Question: What is the span of health topics?

Answer: It goes across the board. We are developing information on senior care, HIV, and asthma.

Thank you very much, Peter.

Kahn: I have heard a number of talks about the World Wide Web. I want to get into some discussion about technology. Intelihealth was founded in February 1996. It was really founded as an outgrowth of the consumerism that everybody was talking about. It progressed to the point that consumers were not going into their physicians or health care givers, so we started with a goal of developing a consumer health tool, and we wanted to make sure it was user friendly. One of the things that was very important to us was brand credibility, quality, and authority. One of the things that Johns Hopkins provides for us is oversight. We took a different approach than a lot of organizations. We looked at distribution. Before we got a product, we got an audience. We got together with CompuServe. We went to Pointcast to get help. Of course we are on the web, and we are on other medical distributions, such as personal pages. Then we had to begin actually developing a product. We looked at different users. They want to see topical information in magazine style. But they are an audience. The Worried Well are a large audience who wants interesting, riveting information that is solid. There are people interested in specific, acute problems. They want to find the information quickly. Then you have people with specific, chronic problems. They may want to know if there is more information. These peoples’ educational levels range significantly.

So what did we do? We started collecting information sources. One of the things that we worked on is telehealth. We developed Health News for the consumer, and we also projected new material from Johns Hopkins (news, commentaries, briefs, Ask the Doctor, encyclopedia, Health Radio Minute, and allergy maps). We licensed databases.

And then there is what we consider credible, authoritative information. Government agencies certainly have this credibility. There are other organizations out there, but people do not know about them. So what do we do with this information? We try to publicize, develop, and package it. We took the news and distributed it as the consumer health news (daily e-mail). We developed an encyclopedia of information. The news that I mentioned, we now package. Health covers every demographic. The nonhealth-related sites are interested in developing a demographic. We do not feel that we should be the only health care information site. Key to making that information available to users is that you have to get it out as soon as possible. So the Healthy Home Catalog contains actual products that are for sale.

Now there are many sources of health information on the Internet. There is a real hunger for this information. There are wonderful search engines out there. But each has a different function. The method of delivery is very important. Some people read newspapers or magazines, and some people look at the web. Some people want very specific information. Please know what they are looking for. The active areas on health site are New, Medications, MEDLINE, and Ask the Doctor. What I wanted to show is our beta site. We found trends and then a dip, trends then a dip. Mondays through Fridays everybody is looking at it during lunch and nobody looks at it on the weekends. We track a lot of statistics because we want to know where our reviews are coming from. Our biggest users are people coming from America Online, then PCN which is behind corporate firewalls and other Internet service providers. Some interesting facts: most usage is during the week; and about 56 percent of the individuals we are looking at are male, and 44 percent are female. The average user age is in the 40’s. Feedback we get is usually in the form of e-mail and is about how to register.

Once you start answering questions, you start getting more questions. We discover information through our daily e-mail, and most of our comments are based on what we are being asked through this correspondence. The questions related to information about idiopathic thrombocytopenic purpura, specifically in pediatric cases. Issues relating to content dealt with navigation and finding information. There was no good consumer health index, ontology or vocabulary; and a priority among users was that the information be kept current. Are there any questions?

Question: What is the time frame?

Answer: It is different for every source of information.

Question: How are you funded?

Answer: We have an initial credit line. And the revenue sources vary. No one is sure where revenue is going to come from.

Arkin: I want to stop here. Joel will be here, and we will have several sites up during lunch. I want to thank everyone for all of the wonderful information.

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