In 2011, more than 80% of adults reported using the Internet as a resource for health care quality information. As a result, consumers are becoming increasingly health literate and are able to understand health analytics comparing provider performance. The 2007 Health Information National Trends Survey found that 34% of surveyed consumers used Web-based tools to make hospital and physician selections.
Based on these trends, many health system websites have begun to include tools and information for patients and visitors that are designed to create a positive organizational image and provide more useful information. In so doing, hospitals increasingly are seeking to take on the role of trusted adviser that is closely aligned with the accountable care organization model being promoted through the health reform law.
Customers' evaluations of a health system's website and, by extension, their perceptions of the facility itself will be based in part on comparisons to their experiences using other popular websites such as Amazon and eBay. If a hospital's website does not conform to or exceed a customer's expectations based on those previous experiences, customers may make inferences about facility quality that may negatively influence their decision-making process.
The competitive advantage gained from building an effective Web presence has led researchers to establish accessibility, content, marketing and technical standards that define best-demonstrated practices. A study forthcoming in the Journal of Healthcare Management assesses U.S. hospital and health system websites' performance based on these standards and identifies the top-performing systems.
Measures of Website Quality
Researchers used five scales to assess website quality:
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Accessibility Scale: The accessibility scale is an assessment of a website's ease of use for individuals with lower computer literacy levels, including those with physical disabilities that limit their use of a mouse or non-standard browser (such as mobile phones or tablet devices). Accessibility is a critical factor for reaching as many users as possible, but at-risk groups may not be familiar with access features that require higher levels of computer literacy, such as hovering over highlighted phrases to see additional information.
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Content Scale: The content scale is an assessment of a website's overall content quality. Content quality is considered high if the text is grammatically correct, relevant and updated regularly. Good content maintains effective engagement between the user and the website. The quality of the site's imagery (i.e., photos and graphics) and metadata (i.e., information about the data content in specific locations) is also assessed. Elements contributing to the content scale include individual tests of spelling, the degree to which the site adds new material and the calculated reading age of the text on the pages.
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Marketing Scale: The marketing scale is an assessment of how readily and reliably information is accessed using search engines, including the appropriateness of content to hyperlinks, the rank and popularity of the website, and other technical aspects related to search engine optimization. SEO is an important aspect of the marketing scale. As content within a page becomes more accessible to search engines, the organization's profile in online searches becomes higher. Contributing individual tests include search engine results, search placement and the use of content keywords that search engines rely on to prioritize websites.
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Technology Scale: The technology scale is an assessment of how well a website is designed, built and maintained. Technical issues affect the user's experience and therefore can have a direct impact on the overall utility of the website for making decisions. Elements contributing to the technology index's scores include website download speed, site structure, code quality and the use of cascading style sheets to organize content. The technology scale focuses purely on the performance aspects of a website without respect to its content. The major contributor to the score is the speed measure.
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Overall Score: The overall score attempts to answer the question of how good a particular website is based on the other four measures. Having this at-a-glance metric that rates the overall quality of a website as a single number enables comparisons across a number of critical areas of site presentation. The analytic engine also provides clear information about how each individual organization performs and, by extension, offers clues as to how improvements in these scores might be implemented.
How U.S. Hospital and Health System Websites Scored
The mean overall score for the health systems studied was 6.37 on a 10-point scale, indicating that hospital and health system websites have significant room for improvement. The maximum score of any facility was 8.40, achieved by the Arizona Cancer Center. This organization was also in the top five for the accessibility and technology scales.
On average, hospitals' websites performed best in the content (mean score = 6.42) and technology (mean score = 5.98) categories. The marketing scale was the third best-performing element of the websites studied (mean score = 5.96). Accessibility (mean score = 5.79) is the area where organizations have the greatest opportunity to improve their websites. Given that the issues of health literacy and disability are major factors in health care, it is critical to address accessibility issues.
A cursory review of the top 25 facilities reveals that children's hospitals and specialty facilities -- cancer facilities in particular -- performed well. One explanation for why these types of hospitals tend to build better websites is that because there are fewer of them, they may compete for customers across larger geographic areas.
The top nine hospital and health system websites are:
Given the movement toward having health systems serve as ACOs that can empower consumers, the number of poorly performing websites across all measures is concerning in the near term. Early adopters of technology will benefit in an environment in which customers use the Internet to evaluate facilities.
The Web presence of many of these organizations represents the first contact health care consumers have with the organization. If such contact fails to make a positive impression on the consumer, alternatives may be explored. In saturated markets where several organizations' services are interchangeable, a strong and well-designed Web presence can be the difference between patients taking the first step into a facility or doing everything they can to avoid it.
Health organizations should strive to standardize the quality of information presented on their websites, but they should also take care to deal with issues of accessibility, standards compliance and SEO.
Note: The complete study by Ford and his colleagues -- Timothy Huerta of Texas Tech University, Richard Schilhavy at Guilford College and Nir Menachemi of the University of Alabama at Birmingham -- will be published in the January/February 2012 issue of the
Journal of Healthcare Management .