Building a global e-health information business by wearing local shoes

Brussels 25 November 2000Bill Silberg, Vice-President and Executive Editor for Medscape Inc., held a keynote lecture at the recent MedNet 2000 Congress about the opportunities and challenges of the World Wide Web as a global medical information tool for both health care professionals and consumers. One of the key issues from an editorial as well as a business point of view for the creation of an international partnership and collaboration with regard to the electronic delivery of medical content is the concept of localisation. If Web publishers do not succeed in adapting and translating their health messages to local practices and local languages, they will face a difficult time trying not to get broke and stay alive, according to Mr. Silberg.

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Starting from his own experience at Medscape, a leading provider of clinical information services, established in 1995 and which he has joined in 1999, the speaker pictured the various hurdles which wait to be overcome by enterprises that seek to generate a profit-making business in distributing medical science and health information across the Internet. Right from its birth, Medscape could enjoy the luxury of a global audience. Currently, some 2.8 million members, including 480.000 registered physicians and over 1.3 million allied health professionals throughout the world turn to Medscape for immediate access to research, news, and information to guide their practices and support patient care. Revenues are mainly based on sponsorship and advertising.

In May 2000, Medscape merged with MedicaLogic, the leading maker in the United States of electronic medical records in order to address the front-end of health care in contrast with WebMD which is focusing on the back-end via partnerships with health care payers. Today, more than 15.6 million patients have digital records hosted on Medscape systems. These figures, Mr. Silberg stressed, offer just a temporal impression since the numbers of users on the Internet change ultra-fast due to the tremendous traffic increase on the Web. The Medscape site is organised by medical specialities. Approximately 30 are currently listed. To date, two local partnerships have been established which are Medscape Italia and Medscape Japan. In both cases, the content is being delivered and translated into the local language.

During the last five or six years, Wall Street has had an enormous influence on the Internet activity in general and the electronic health applications in particular, as Mr. Silberg pointed out. The Wall Street strategy has changed three or four times since, trying to find out the best business approach when dealing with the electronic media. The latest emerging trend for companies is to search for and concentrate on business relationships which make sense in order to conquer the international market. Working with peers has proven to be a possible successful direction for mutual investment initiatives. Also, international stock exchange markets have witnessed an economical shake-out, only survived by health information providers who are willing to adapt their content to the local cultures, since medicine is always practised locally.

Mr. Silberg tried to outline the global market opportunities which is not easy at all, since large traditional media-based companies have not figured it out yet. The Internet is most popular in countries where the telecommunications infrastructure has been built out properly. Nonetheless, e-health has already shown that it can become successful in selectively wired regions as well, just as long as those regions are targeted in the right manner. Countries such as Brazil and Mexico are among the fastest growing Web-enabled nations which means that medical content in Spanish and in Portuguese has to be urgently provided for. Asia constitutes an equally increasing market, with China and Japan as forerunners. In these countries, we witness a traditional interest in alternative medicine, which is also conquering the United States.

As for Japan, Mr. Silberg explained that Web access is very expensive in this country, which explains the wide use of CD-Roms and Web phones. As it is, the delivery of critical information on handheld devices gradually becomes a hot issue in the United States as well, a phenomenon, which is responded by Medscape via an aggressive strategy. In addition to the requested respect for local cultures, health content providers should equally take into account the differences in legal and regulatory aspects of transmitting information across borders. As such, medical consumer advertising is forbidden in 95 percent of the countries but not in the United States. This consumer arena forms a problematic and somewhat disappointing item for e-commerce initiatives but the number of Web users is still likely to grow.

In turn, physicians' Web-penetration increases in likewise proportions but the technology has to be made user-friendly, intuitive, and unobtrusive. The adoption of the electronic health record grows steadily but slow, considering the fact that only a few years ago, no browser existed to access the Web. The medical sector is also reluctant to implement e-publishing, according to Mr. Silberg, so it will take time for the electronic media to gain a particular share apart from the printed media. However, some nice opportunities emerge for continuing medical education through the Web. E-publishing facilities make it possible to design low cost CME programmes for health providers although CME outside the USA is not exactly a familiar concept yet.

The killer application on the Web definitely is the use of e-mail. In Africa and India, the sanctity of the local patient-doctor relationship could be preserved by applying mailing lists to connect the two parties, as Mr. Silberg proposed. On the other hand, it still remains difficult to evaluate or monitor the health professional via the Web, and the same goes for measuring the technological behaviour of doctors. As for the information systems in the medical world, a full integration constitutes the great challenge because changes happen very slowly and the equipment is expensive. In decision taking, the ministries of health or the medical societies often are the partners to talk with and thus, business opportunities are locally dependent, as Mr. Silberg concluded.


Leslie Versweyveld

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