Potential
Having your own Web site offers new options for advertising, accessibility to patients and referral sources, custom patient information, and an outlet for creative energies. An example of a well designed private practice site is that of the North East Wisconsin Center for Surgery and Rehabilitation of the Hand (http://www.newhands.md), which is elegant, informative, and easy to navigate.

Most existing hand surgery web sites are a brochure or advertising format, but this may change as the on-line technologies for customer relationship management (CRM) systems mature. CRM refers to a computer based system which allows a business to organize and distribute information within the business in order to facilitate service to the customer.  As the practice of medicine moves toward an organized business model of customer service, web enabled tools which are designed for business contact management will become more applicable to the practice of medicine.

An ideal medical CRM system might be set up as follows: an office has a fully electronic practice management system which includes medical records, digital images, patient accounts, prescriptions, coding, scheduling and literature access based in one office.  In addition, the practice has a Web site through which peripheral offices can access the entire system. Through this web site, patients can learn about the physicians, check insurance participation, browse patient information materials, securely fill out a new patient history questionnaire, query the system for their next appointment, check their billing status, settle their accounts on line, submit requests for prescription refills, and request information. The physicians in turn can access any portion of the system at any time securely from any Web enabled device (computer, phone, wireless handheld) to review their office or surgery schedule, patient information (notes, images and scanned Xrays), and other information. The site also acts as a data entry portal for any number of other physicians to enter data for collaborative on-line studies.

Current Reality

The technology for such a system exists, and similar systems exist for nonmedical businesses (68), but have yet to be implemented as such for medical offices. Medscape is developing a web enabled electronic medical record system, currently called Medscape Encounter (46). Confidentiality issues are frequently blamed for lack of current use, but such issues were solved long ago in the business sector to handle secure on line financial transactions. The real impediments are inertia and development. The inertia is in physicians who have been slow to embrace new technology for practice management and customer service. The development problem is in companies which typically first develop profitable large scale systems for a large corporations before the technology filters down to smaller users. The typical physician group is still small and disorganized compared to profit focused telemarketing industries such as managed care, which embraced this technology years ago (9). Despite this, it is simply a matter of time before a working system as described above will be both available and affordable to a small medical practice. Helpful introductory guides to the internet for physicians are listed in Table 6.

Should you consider having your own web site? Definitely. Do you need to have your own web site?  Not yet - unless you have a specific task that you would like to accomplish by its presence. Buyer beware: there is a cottage industry of companies who claim expertise in medical web site design, but there are no clear qualifications or certifications for the task. Some of these services are overpriced and marginally competent, relying on the legendary bankrolls and internet ignorance of physicians. A practical recommendation is to wait until at least one of the physicians in the group has some internet browsing experience, and then only go with a web design company that has proven experience in the medical web field that can be confirmed with other physician clients. What can you do with a web site right now? Two current applications are advertising and patient interaction.