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Users’ preferred
Users’ preferred interactive e-health tools
e-health tools on hospital
web sites
215
Edgar Huang
School of Informatics, Indiana University, Indianapolis,
Indiana, USA
Chiu-chi Angela Chang
College of Business Administration, Central Michigan University,
Mount Pleasant, Michigan, USA, and
Poonam Khurana
School of Medicine, Indiana University, Indianapolis,
Indiana, USA

Abstract
Purpose – Healthcare is becoming an important part of people’s online content consumption, with
people searching for information on diseases or medical problems, treatments or procedures, particular
doctors or hospitals, or about parking. This paper aims to investigate what users deem essential on
patient-oriented interactive e-health tools on hospital web sites.
Design/methodology/approach – The findings are based on 242 patients/users from diverse
backgrounds in a purposive sample. A modified Delphi technique was used in two rounds of survey to
collect and analyze data.
Findings – The respondents highly desire core-business tools, especially access to medical records
and lab results, while discounting hospitals’ efforts to connect to social media. Hospitals’ e-health
implementation on their web sites has greatly lagged behind the users’ needs for interacting with
hospitals online. It is concluded that, while continuing to provide traditional functional tools, hospitals
should expedite their development in providing core e-business tools and emerging functional tools in
order to accomplish multiple objectives, including service, education, and marketing.
Research limitations/implications – Hospitals’ e-health development efforts have been behind
the users’ expectations at large. Future research should explore whether such lagging has resulted
mainly from the lack of technical know-how, lack of funding, and/or lack of vision on the
administrative level.
Practical implications – The paper provides solid empirical evidence for US hospitals to
(re)consider how to prioritize their efforts in implementing e-health online so as to build a user-centric
web site.
Originality/value – Most US hospitals have implemented some form of e-health online to serve their
patients/users, but rarely have researchers studied such efforts. As a result, hospitals have had little
evidence to gauge their implementation success. This is the first empirical study that investigates from
the patient/user perspective the usefulness of various interactive e-health tools online.
Keywords Healthcare new media, Healthcare information technology, E-health, Hospital web sites,
Interactivity
International Journal of
Paper type Research paper Pharmaceutical and Healthcare
Marketing
Vol. 6 No. 3, 2012
Introduction pp. 215-229
q Emerald Group Publishing Limited
Healthcare is increasingly becoming an important part of people’s online content 1750-6123
consumption (Romano, 2003; Shaman and Pralgever, 2004; Taylor et al., 2005). DOI 10.1108/17506121211259395
IJPHM According to the 2002 PEW Internet Project survey, the online healthcare content that
6,3 people search for most were “specific disease or medical problem (63 percent), certain
medical treatment or procedure (47 percent), a particular doctor or hospital (21 percent),
and experimental treatments or medicines (18 percent)” (Taylor et al., 2005, p. 33). In
2004, when people were using a hospital web site, 33 percent looked for hospital
information, 19 percent for medical information, 18 percent for other health
216 information, 14 percent for a physician, and 9 percent for directions or parking
Information (Taylor et al., 2005). It is clear that interactivity can greatly help with such
tasks and more. While many interactive e-heath tools are scattered on many hospital
web sites today (see Table I for examples), it is not clear what users perceive as highly
necessary and useful. Thus, this study was conducted to investigate what are the

Interactive tools Adoption rates (%)

Traditional functional tools

Online search 66.6
Interactive map 60.8
Finding a physician 56.7
Contact us 46.1
Interactive calendar or event finder 42.8
Virtual tour 8.6
Core e-business tools
Paying bills online 40.2
(Pre)registration online 19.4
Making a doctor’s appointment or communicating with a doctor online 15.3
Accessing health record, medical record, and lab results 10.1
Refilling prescriptions online 9.7
Patient support tools
Interactive patient education or health risk assessment 47.0
Patient caring and support through CarePages, blog, or chat room 16.2
Visitor-related tools
E-card or e-mail for a patient 28.2
Online nursery for viewing/purchasing baby photos 27.7
Online flower/gift shop 9.3
Public relations-related tools
Presence on social media, such as Facebook and Twitter 35.7
Online caregiver recognition 3.9
Emerging functional tools
ER wait time 5.6
Interactive cost estimator 3.5
Site or application for mobile devices 2.0
Online service menua 11.0
Personalized accounta 10.7
Table I.
Interactive tools on US Notes: a These are interface designs that promote some of the interactive tools; percentage
hospital web sites (by calculations are based on 712 sampled hospitals that had a web presence
category and feature) Source: Huang and Chang (2012)
patient-oriented interactive e-health tools on hospital web sites that users deem Users’ preferred
essential. e-health tools
Studies have found that, by enhancing customer attraction, delivering service, and
facilitating transactions, a hospital can turn its web site into an essential marketing
tool to influence and assist users in their healthcare decision-making (Catallo, 2008;
Nguyen et al., 2004; Song and Zinkhan, 2008; Taylor et al., 2005). Hospital online
marketing is best implemented when providing users with the ability to interact with 217
the hospital system and encourage consumer involvement (Buckley, 2007; Peters, 2006;
Wylie, 2006). E-health – “the combined use of electronic information and
communication technology in the health sector for clinical, educational, research,
and administrative purposes, both at the local site and across wide geographic regions”
(Mukherjee and McGinnis, 2007, p. 350) – is highly based on the interactive online
technology so that all its functions, such as e-billing, e-payment, e-prescription,
e-supply, and e-records, are made possible (Varshney, 2009).
Today, hospitals that settle with traditional “read-only” information fed from glossy
brochures and flyers are way behind the technology curve (Randeree and Rao, 2004).
Catallo (2008, p. 24) argues:
Online marketing instead must incorporate more interactive, customer-controlled capabilities
that serve to attract new patients who logically expect to “converse” online with hospitals in
the same manner that they do with schools, financial institutions, and other major service
providers in their lives.
After the e-health concept was introduced at the turn of this century (Mukherjee and
McGinnis, 2007) and as the Web 2.0 technology, which is characteristic of interactivity
and multimedia, has become increasingly mature, new interactive e-health tools have
begun to emerge on some hospital web sites, where users can schedule an appointment
with a physician, view their own medical records, pay bills, reorder prescriptions,
choose and buy new-baby photos, generate patient greeting cards, send flowers to
hospitalized loved ones, and so on (Catallo, 2008). Palomar Pomerado Health in San
Diego, assisted by its partner Cisco Systems, went as far as moving the whole hospital
to Second Life, a wholly interactive virtual environment, to explore the hospital of the
future (Zensius, 2009). After analyzing the data regarding the implementation of
patient record system in all nonfederal hospitals in the nation, Dave Garrets, president
and CEO of HIMSS Analytics, said, “This [e-health] is the most transformational thing
a hospital will ever do” (Nye, 2009, p. 11).
The findings of this study will provide empirical evidence for strategic planning for
e-health development on US hospital web sites. Specifically, this study aims to answer
the following two research questions:
RQ1. What interactive e-health tools do users perceive as the most useful to them?
RQ2. Are hospitals focusing on providing the e-health tools that users want most?

Literature review
From the technological perspective, Wickramasinghe et al. (2005) reiterated the
importance of implementing e-health and highlighted such challenges as meaningful
collaborations with healthcare recipients, efficient strategies and techniques to monitor
patterns of Internet use among consumers, and better understanding of the balance
IJPHM between face-to-face and virtual interactions. At the same time, they acknowledged
6,3 that e-health encompasses more than just Internet and medicine and that culture is
another factor that can greatly impact e-health implementation. That is, “e-health is
more than a technological initiative; rather it also requires a major paradigm shift in
healthcare delivery, practice and thinking” (Wickramasinghe et al., 2005, p. 333).
Blattberg and Deighton (1991) define interactivity as individuals and organizations
218 communicating directly with one another regardless of distance or time. The importance
of interactivity in online presentation for marketing purpose has been most effectively
conveyed by the flow theory, which has been developed by multiple scholars over time
(e.g. Csikszentmihalyi, 1975; Ghani and Deshpande, 1994; Hoffman and Novak, 1996;
Pace, 2004; Trevino and Webster, 1992; Webster et al., 1993). Flow represents “a state of
consciousness where a person is so absorbed in an activity that s/he excels in performance
without consciously being aware of his or her every movement” (Finneran and Zhang,
2005, p. 82). According to Hoffman and Novak (1996), telepresence – simulated perception
of direct experience – occurs in a flow experience and it has two components: interactivity
and vividness. Many studies have demonstrated the role of vividness, often represented
by a multimedia presentation, in such a flow experience (e.g. Akagi, 2008; Huang, 2009;
Huang, 2010; Johnson, 2007; Poller et al., 2009). Interactivity, on the other hand, facilitates
a seamless sequence of responses that characterize network navigation so that the flow is
made intrinsically enjoyable, accompanied by a loss of self-consciousness and
self-reinforcing (Novak et al., 2000). In the flow experience, interactivity, together with
vividness, causes increased learning, perceived control, an exploratory mindset, and
positive experience (Hoffman and Novak, 1996).
A few studies provide examples regarding the relevance of interactivity on web site
effectiveness. In an experiment examining interactivity and vividness on web sites,
Coyle and Thorson (2001) found that perceptions of telepresence grew stronger as
levels of interactivity and levels of vividness in web sites increased. In addition,
respondents who saw sites high in vividness developed more positive and more
enduring attitudes toward those sites. Further, based on the observation of world-class
web sites, Wylie (2006) suggests that enhancing interactivity, customization and the
use of rich media, among other techniques, makes a web site more engaging. Lin (2007)
demonstrates that interactivity, site design, informativeness, security, responsiveness,
and trust all bring about customer satisfaction with a web site.
Empirical studies regarding hospital web sites and their users are rare. Hermann
(2002), in an experiment involving 80 patients, assessed whether new media are suitable
for conveying basic information to patients and analyzed the merits of using
computerized animation to illustrate a difficult treatment process (the progressive steps
of a thyroid operation) in comparison to the use of conventional flyers. The study found
that understanding of and subjective knowledge about the surgical procedure and
possible complications, the degree of trust in professional treatment, the reduction in
anxiety, and readiness for the operation, were all significantly better after watching the
computer animation than after reading the text. In addition, patients who had only read
the text had a significant improvement in parameters after an additional exposure to the
video animation. Hermann (2002) concluded that preoperative surgical information could
be better delivered by presenting the operative procedure via computer animation.
Gallant et al. (2006) employed a mixed method of usability testing and in-depth
interviews to investigate what content and interactivity users preferred on hospital
web sites. They used a high fidelity prototype of a hospital web site to test 30 Users’ preferred
participants during five consecutive days by applying a think-aloud protocol. In e-health tools
addition, through three themes – targeted health information, selecting a physician,
and seamless information, the researchers attempted to find out how a hospital web
site could boost personalization through interactivity. The study concluded:
First, institutional trust conveyed through a Web site is highly important to users when
selecting a hospital, a physician, or a healthcare specialist. Secondly, visual elements and 219
perceived usefulness of the Web site can contribute to establishing trust for users. A third
point to consider is Web site users want personalized information geared to their health needs
presented in a seamless and easy-to-use manner. Fourth, quality information enhances the
credibility of the Web site and the reputation of its representative organization. Finally, the
need for user-centric design in the development of hospital, healthcare, and medical Web sites
is needed if hospital Web sites are to become a widely adopted form of interactive technology
for healthcare (Gallant et al., 2006, p. 20).
In a pioneering study that assessed the current state of e-health implementation on
hospital web sites, Huang and Chang (2012) conducted a content analysis on a
representative sample of 764 US hospitals and identified 21 interactive e-health tools in
six categories (see Table I) on their web sites. In addition, they also investigated
whether a site had an online service menu to promote such tools or had a patient portal
to provide users a secure and personalized environment to use the hospital’s core
business tools. The study found that the average number of interactive tools on a
hospital web site was 5.6. The maximum was 18, seen on Sharp.com. Of the hospitals,
66 percent had implemented traditional functional tools, such as online search,
interactive maps, “find a physician,” and “contact us.” In contrast, the adoption rates of
core e-business tools, such as paying bills online, (pre)registration online, making a
doctor’s appointment, accessing health record, and refilling prescriptions, were
significantly less (17 percent). According to the study, larger hospitals had
implemented more interactive e-health tools than smaller ones; hospital networks
had implemented more interactive e-health tools than independent hospitals. The 21
identified tools and the findings from Huang and Chang’s study will be compared with
the users’ perceptions revealed in the current study.

Methodology
Because there is no fixed list of patients to represent a large patient population, coming up
with a systematic probability sample of patients is impossible. Therefore, traditionally,
almost all the healthcare-related surveys have relied on a purposive sample. To deal with
the fact, this study incorporated the method called Delphi technique – a forecasting
methodology for generating expert opinion on any given subject to find out the hows and
whys of an issue – since the Delphi technique does not require systematic random
sampling (Allen, 1978). In the Delphi technique, the term “expert” refers to someone who is
familiar with the stated problem. Since experts interviewed with the Delphi technique do
not meet face-to-face, opinion dominance, social desirability, individualistic thinking,
anecdotal experiences, guesswork, and fuzzy conclusions can all be minimized. As a
result, the focus of such communication is on real problem solving instead of who said
what. Through multiple rounds of opinion exchanges via questionnaires, certain
agreement or consensus on an issue gradually emerges.
IJPHM This study used a modified Delphi technique in terms of sample size. To overcome
6,3 the poor representativeness of a convenience sample, this study drew respondents from
multiple sources: one listserv for a university’s staff and faculty, one university class,
one listserv for patients who previously volunteered in healthcare research projects,
personal invitations to patients from two hospitals, two community organizations, and
three online healthcare forums. Snowball sampling method was applied; many of the
220 initial contacts were requested to invite other qualified respondents to join the study. A
qualified participant was defined as anyone living in the USA who was at least 18
years old and who had visited either a hospital/clinic or a hospital web site in the
preceding 12 months. Although the sample in this study is not a systematic probability
sample, with many respondents drawn from a specific geographic area, the diversity of
the backgrounds of the participants from all over the nation helped offset the
homogeneity of a typical convenience sample, such as a student sample or patients
from a specific clinic/hospital. The findings and conclusions from this study can only
be applied to these respondents, but they might hint at a pattern for a larger
population. The Delphi technique usually involves a panel of 10 to 30 experts, but the
pursuit of demographic representativeness finally brought 242 participants on board.
Data collection was conducted from June to August in 2011 in two stages. Data
collection in each stage was accomplished by an online survey questionnaire. Since the
questionnaires were designed in such a way that skipping required questions was
impossible, missing data were minimized. The survey questionnaire in the first stage
presented 21 e-health interactive tools, and each tool was illustrated by a typical, live
example from a hospital web site. The respondents were asked to evaluate the
usefulness of each interactive tool on a five-point scale with 5 being the most useful.
Demographic data were collected at the same time. In the second stage, a follow-up
survey questionnaire was sent to those first-round respondents who left an e-mail
address (almost all did). Both close-ended and open-ended questions were used for the
respondents to answer questions related to the major results from the first round of
survey. Consequently, the statistics from the first round of survey received
explanations by the respondents themselves. For the open-ended questions, after
extensive exchanges of ideas, two coders encoded the answers independently by
clustering themes in answers to each question. The average value of Scott’s Pi for the
coding of three open-ended questions was 0.86.

Findings
In total, 242 respondents successfully participated in the two rounds of survey. A
typical participant was a White (74 percent) female (76 percent) with a bachelor’s
degree (43 percent), who was 46-55 years old (22 percent) and who visited a medical
institution 3-5 times (33 percent) and visited a hospital web site with a broadband
connection (94 percent) once or twice (38 percent) in the preceding 12 months.
In the preceding 12 months, 26 percent of the respondents never visited a hospital
web site for the following reasons:
.
no or little need; never thought of using it; not aware of the presence of the web
site of their frequently visited hospital (63 percent); and
.
little useful info on a hospital web site; difficult to find info; no or few useful
interactive tools; info not current (30 percent).
A few respondents said that they would rather call a hospital for any info (5 percent) or Users’ preferred
that they were concerned about the security of using hospital sites (2 percent). In e-health tools
addition, the more a participant visited a hospital, the more he or she tended to visit its
web site (Pearson r ¼ 0:459, p , 0:001).
Figure 1 lists the interactive e-health tools in the order that the respondents
perceived as the most useful to the least useful. The numbers shown represent the
percentages of respondents who considered the tools to be useful (selecting 4 or 5 on a 221
five-point scale). At the same time, the data from Huang and Chang’s, 2012 study –
specifically, the percentages of US hospitals that have implemented these tools on their
web sites – are displayed side by side to provide a context to the current data. The user
preference data and hospitals’ adoption rates of interactive e-health tools are certainly
two different things. But a comparison between the two can demonstrate where each
party’s passion is and highlight the discrepancies between users’ preferences and
hospitals’ implementation efforts.
Figure 1 reflects four major discoveries from this study. First, the respondents
highly desired access to their medical records and lab results on their hospitals’ web
sites (83.7 percent). Unfortunately, only 10.1 percent of the hospitals were providing
such a service. The discrepancy is huge. The follow-up survey shows that 59 percent of
the respondents had no such access and 34 percent of them were not sure whether they
had such access. Only 7 percent were enjoying the access to their medical records. The
respondents provided five reasons in their own words why they craved such access on
a hospital web site:

Figure 1.
User preference rankings
and hospital adoption
rates of interactive
e-health tools
IJPHM (1) It will be convenient and quick to access the information about their health for
6,3 free (38 percent).
(2) It will help track and monitor health conditions; research, remember,
understand, and verify health conditions and services; and reduce
unnecessary procedures (24 percent).
222 (3) It will be convenient to transfer records, share information, and ask for a second
opinion (18 percent).
(4) It will make users feel empowered and informed to take care of their own health
(14 percent).
(5) It will be easy to check for accuracy for insurance and other purposes (6
percent).

One participant probably best stated the reasons:

My doctor does not send me my lab values, just a comment if the levels are normal or
abnormal. I’m an RN (registered nurse) and advocate for my own healthcare. I like to keep my
information to follow trends of improvement or decline of my health status. It is a motivator
to maintain my health. Also, when seeing other specialists, I have the medical information
readily available and accurate. I don’t have to rely on memory. That is the purpose of the
electronic medical record.
Second, having a presence on social media, such as Facebook, Twitter, and YouTube,
has become a trend for hospitals in the last three years or so, and many researchers and
practitioners have promoted such a presence as a way for hospitals to market
themselves (Hawn, 2009; Jain, 2009; Terry, 2009). For example, Ackerman (2010)
suggested that “many doctors see social media as a way to strengthen the
patient-physician relationship, interact with their peers and publicize their opinions on
key issues.” Huang and Chang (2012) found that 35.7 percent of the US hospitals have
made an effort connect to their patients/users via social media. The respondents in this
study, however, showed the least interest (10.4 percent) in seeing such a tool on a
hospital web site. Again, the hospitals’ emerging passion for a presence on social media
and these users’ extreme indifference constitute a stark contrast. As a matter of fact,
these users believed that it was even less important for hospitals to have links to social
media web sites than to have an online gift shop/flower shop (16 percent). The
follow-up survey showed that 80 percent of these respondents never visited or got
information about a hospital on a social media web site.
The respondents listed three reasons why they did not like to access a hospital via
social media:
(1) Never thought of using it; no need; no interest; not aware of hospitals’ presence
on social media; would visit a hospital site directly if necessary; no specific
hospital to connect to; no interest to “socialize” with a hospital (52 percent).
(2) Not appropriate, professional, credible, or secure to interact with a hospital via
social media; privacy concern; hospitals doing nothing but self-promoting on
social media (35 percent).
(3) Having no social media accounts (13 percent).
One participant commented, “I don’t feel that hospitals are social; therefore I wouldn’t Users’ preferred
be interested in interacting with them via social media.” Another participant noted, “I e-health tools
just feel social media is not the place for my personal health issues. I do not want
everyone or at least ‘my friends’ to see what is going on unless I want them to know.”
Third, Figure 1 shows that a little more than half of the respondents loved to have a
dedicated menu (52 percent) on the homepage of a hospital’s web site so that they could
immediately see what interactive e-health tools were available. The respondents 223
actually felt an even stronger yearning for the personalized functions (61 percent) on a
secure section of a hospital web site so as to be engaged in sensitive data processing,
such as accessing medical records, (pre)registering, making a doctor’s appointment,
refilling a prescription, paying bills, etc. In both cases, hospitals had only an 11 percent
adoption rate. Again, what is offered and what is desired has yet to be aligned.
Fourth, when the users’ top ten preferred interactive tools are compared with the top
ten interactive tools provided on hospital web sites, it is found that the respondents
considered all the core business tools to be highly useful, including accessing medical
records and lab results, refilling prescriptions, (pre)registering, making doctor’s
appointment, and paying bills. None of these except for paying bills is among the
hospitals’ top ten choices. In contrast, some top interactive tools available on hospital
web sites, including patient education, online calendar, a presence on social media,
e-card, and online nursery, are not among the respondents’ priorities. One participant
commented on the calendar function, “I find that the calendar of events and classes is
often inaccurate or difficult to find.”
When these 21 tools are clustered into six categories (see Figure 2) as Huang and
Chang (2012) did, two noteworthy discrepancies between user preferences and hospital
implementation emerge. First, what the respondents needed most on a hospital web
site was the core-business tools (73 percent, the most preferred category of tools), but
the implementation rate (51 percent) was way below user expectations. In contrast, US
hospitals were largely staying on the level of implementing traditional functional tools,

Figure 2.
User preference rankings
and hospital adoption
rates of interactive
e-health tools by category
IJPHM such as online search, online maps, and finding a doctor (90.6 percent, the most
implemented category). Second, the respondents were very interested in seeing
6,3 emerging functional tools on a hospital web site, including ER wait time, interactive
cost estimator, and site and applications developed for mobile devices (46 percent, the
third most preferred category), but only roughly 9 percent of the hospitals provided
such new tools (the least implemented category). Among these emerging tools, the
224 respondents were most interested in using an interactive cost estimator (see Figure 1).
One participant wrote:
Depending on the accuracy of the “estimate,” the interactive cost estimator could become a
powerful tool in the future. Rising health care costs, coupled with an uninsured/under-insured
population, means people will be looking for ways to get the best care for the lowest cost. This
tool could even be used with the “Find a doctor” tool to compare providers, services, and costs
across hospitals/facilities (assuming other hospitals/facilities have an estimator tool).

Discussion and conclusions

The two rounds of online surveys in this study have investigated the usefulness of 21
patient-oriented e-health interactive tools currently available on US hospital web sites,
from the users’ perspective. The findings based on the responses of 242 qualified
participants recruited from multiple sources have provided many valuable lessons for
hospital administrations. The findings can be readily applied to a hospital’s planning
of e-health implementation on its web site, which is an important contact point between
a patient/user and the hospital. In contrast to prior research on general user behavior
(e.g. Gallant et al., 2006; Taylor et al., 2005), this study has highlighted specific
patient-preferred interactive tools that hospitals should consider adopting on their web
sites to provide a flow experience so as to better serve their patients/users.
The study found that 62 percent of these respondents used a hospital web site from
zero (26 percent) to once or two times (38 percent) in a year while 78 percent of them
visited physical hospitals at least three times in a year. It is obvious that hospital web
sites have been very much under-used, quite possibly for the various reasons the users
stated. It was found that the more a participant visited a hospital, the more he or she
tended to visit its web site. This finding suggests that, when users have to visit a
hospital, they do like to use a hospital web site. In other words, there is a strong need
for patient/user’s telepresence on a hospital’s web site. Therefore, a hospital should
seriously consider moving some of its interactivity-based services online so that users
are interested in using a hospital’s online services.
The results from this study take on a new layer of meaning when compared with the
hospital implementation data with the same set of interactive tools in Huang and
Chang’s, 2012 study. The current data show that hospitals’ development in interactive
e-health tools has greatly lagged behind the users’ needs and expectations across the
board. What the participants needed most on a hospital web site are the core-business
tools, including accessing medical records and lab results, refilling prescriptions,
(pre)registering, making doctor’s appointment, and paying bills, but US hospitals are
still largely staying on the level of implementing traditional functional tools, such as
online search, online maps, and finding a doctor, etc., which the users do also need.
The data also show that there has been huge misalignment between what the
hospitals believe the patients want and what the patients actually want. Many hospitals
have made much effort in connecting to patients via social media, but the respondents
have shown the least interest in “socializing” with any hospital. At least, the respondents Users’ preferred
have not shown enough enthusiasm in socializing with a hospital on social media. e-health tools
Instead, the respondents showed effusive enthusiasm in accessing medical records and
lab results on their hospital web site, and they have also showed conspicuous interest in
emerging interactive tools though extremely few hospitals are providing such services.
Some scholars have argued that the mere presence or absence of certain interactive
features on a web site matters only if these features affect how consumers navigate and 225
use the site (Lee et al., 2004; Song and Zinkhan, 2008). To make a hospital web site
relevant to the patients/users and to make them willing to use such a site, hospitals
should design user-centric web sites as Gallant et al. (2006) advocated.
This study has its limitations. White females self-selected to be included in this
study and constituted the significant majority of the sample; in addition, 22 percent of
the sample was between 46-55 years old. The significant proportional change of either
group may change the results of this study.
Based on the findings from this study, here are the recommendations to US
hospitals for building a user-centric hospital web site for the future:
(1) Build a highly interactive web site. Almost all the reasons that the respondents
put forward for accessing medical records and lab results can be summarized as
providing convenience and empowering. This finding supports Reichheld and
Schefter’s argument that “the largest single segment of online customers seeks
convenience above all else. . . They want to do business with a site that makes
their lives easier” (Reichheld and Schefter, 2000, p. 110). Wylie (2006) suggests
that enhancing interactivity and customization make a web site more engaging.
Interactivity helps make a user lose self-consciousness and self-reinforcing in a
flow experience (Novak et al., 2000). Therefore, hospitals need to enhance
interactivity on their web sites by first being aware of the 21 interactive e-health
tools and then implementing as many of those as possible that the
patients/users care for. When a hospital enables its users to conveniently do
and not just watch things on its web site, the site will become much more
valuable to the users. As Catallo (2008, p. 26) pointed out, when hospitals
promote Web 2.0-style interactivity, they can “quickly establish brand images
of convenience, caring, and responsiveness for their institutions”. In this rapidly
moving and changing world where many people are short on time, the
remarkable convenience of a well-developed hospital web site that provides
what the patients need will instantly make the hospital more appealing than
competing institutions and will empower people to take responsibility for their
own health.
(2) Develop more sophisticated and emerging interactive tools. The respondents’ top
ten preferred tools fall exclusively into the traditional functional tools and core
e-business tools categories. While hospitals continue to provide traditional
functional tools and continue to explore how to connect to its patients/users via
social media, they should focus on developing core business interactive e-health
tools – especially accessing medical records and lab results – as their top
priority. At the same time, hospitals can consider implementing emerging
functional tools, including ER wait time, interactive cost estimator, and site and
applications developed for mobile devices, to cater to patients/users’
contemporary, fast-paced lifestyle.
IJPHM (3) Promote interactive tools. Once hospitals have implemented an extensive array
6,3 of interactive e-health tools, they should promote the tools to their users by
designing a dedicated interactive tools menu on the home page so that more
patients/users will do business with a hospital online. More important, more
hospitals need to create a personalized and secure web space for convenient and
carefree transactions of sensitive data and for easier access to up-to-date
226 user-specific information on a hospital web site.
(4) Customize interactivity to a specific population. The findings show that a
respondent’s sex, education, and age all had an impact on the preference of
interactive tools, whereas race did not. For example, female (vs. male)
respondents considered the features of online search, virtual tour, online gift
shop, online nursery, and a presence on social media to be more useful (all
p’s , 0:05). Respondents with higher (vs lower) education levels considered the
features of finding a doctor, paying bills online, and accessing medical records
to be more useful, but a presence on social media to be less useful (all
p’s , 0:05). In all, it is likely that a hospital may match patient population
demographics or the nature of the hospital (e.g. women’s hospital or other
specialty hospital) with the design of the interactive tools on its web site. While
the present study provides an overview of users’ preferences, individual
hospitals may further cater to their specific profile of patients/users and adapt
their web sites and provision of interactive tools accordingly. Since those
patients/users who frequently visit a hospital tend to be the ones who visit its
web site the most often, identifying this group of users/patients will be helpful
as they can provide tracking data and feedback to better the design of the web
site and its features. They can also serve as the target of word-of-mouth
campaigns to bring in more potential users to the web site.

Hospitals’ e-health development efforts have been behind the users’ expectations at
large. Future research should explore whether such lagging has resulted mainly from
the lack of technical know-how, lack of funding, governmental regulations, and/or lack
of vision on the administrative level. Nevertheless, the importance of understanding
users’ needs and preferences for e-health interactive tools cannot be overemphasized.
Various discrepancies uncovered in this study serve as a practical starting point for
hospitals when they attempt to implement e-health on their web sites by providing
useful interactive features. Such features will very likely bring a flow experience so
that, through their telepresence, they user will truly learn about their own health
issues, explore solutions, meaningfully participate in their own healthcare, and gain
positive experience from a hospital web site. Taken together, hospitals cannot overlook
the opportunity to shape their relationships with their patients/users and to enhance
their reputation and credibility by adopting useful patient-oriented interactive tools;
such successful implementation will make a hospital truly stand out by serving
multiple objectives, including service, education, and marketing.

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About the authors Users’ preferred
Dr Edgar Huang is an Associate Professor from the School of Informatics, Indiana University on
the Indianapolis campus. His research articles on healthcare new media, media convergence, e-health tools
streaming media, copyright issues related to DVD ripping, online imaging, documentary
photography history, digital imaging manipulation, and the internet and national development
have been published in many prestigious journals, including Convergence and Journalism and
Communication Monographs. He has taught more than 20 different kinds of courses from online
video streaming, advanced web design, video production and editing, to media convergence, 229
research methods, and news writing at eight universities in the last 27 years. Edgar Huang is the
corresponding author and can be contacted at: [email protected]
Dr Chiu-chi Angela Chang received her PhD in Marketing from Indiana University in
Bloomington, Indiana. She is currently Assistant Professor of Marketing at the College of
Business Administration, Central Michigan University, Michigan. Her research interests include
green marketing, health marketing, prosocial behavior, and consumer welfare. She has published
in such academic journals as Journal of Business Research, Journal of Experimental Social
Psychology, Journal of Retailing and Consumer Services, and Health Marketing Quarterly, in
addition to numerous conference proceedings.
Dr Poonam Khurana is a pediatrician specialized in neonatology. She completed her pediatric
residency at Lincoln Medical Center, Cornell University, New York, and her neonatology
fellowship at St Christopher Hospital for Children in Philadelphia. She is currently an Assistant
Professor of clinical pediatrics, section of neonatal-perinatal medicine at Indiana University and
practices in Riley at Methodist Hospital in the neonatal intensive care nursery. Effective
communication in the medical setting is a passion for Dr Khurana and she has enjoyed success in
this field through the development and implementation of novel programs for effective
communication. She is the director of the American English for Internationals and the
Navigating Difficult Conversations in the Medical Setting programs; she has also served as a
team leader in the medical school’s curricular reform effort in the area of communication skills. In
her most recent venture she has expanded her interests to focus on communication between
hospitals and patients.

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