Many’s the GP that has lamented the invention of the internet as yet another terrified patient comes into the consulting room with a print off and an outlandish self-diagnosis.

But there’s more to the internet than dodgy medicine as a raft of new websites launched over the course of this autumn are hoping to prove.

In October 2007, NHS Choices got a major upgrade with a whole host of new functions. Boots teamed up with the BMJ Publishing Group to provide the public with access to the BMJ Knowledge library of evidence based medicine.

Lloyds Pharmacy also launched a website, this time working with to provide the clinical content but adding an electronic prescription service for people on regular medication.

Meanwhile, in theUS, Microsoft pipped Google to the post with the launch of HealthVault, a secure website that allows users to store and share their health records using a free online service.

Let’s start with what the NHS hopes fervently will be the gold standard: NHS Choices. It got off to a rocky start in June this year when a ‘soft launch’ of the new site – built on the old site – got a bumpy landing. The data was wildly out of date and inaccurate and the site got a drubbing.

Come October 2007 and Dr Foster’s Intelligence, which won the£10m a year contract to run the new site, was ready to relaunch. A new look front page and a host of whizzy new tools were unveiled to HSJ just before it hit the net.

Beverley Bryant, the chief information officer for the Department of Health and programme director for NHS Choices, explains why the DoH is keen to get NHS Choices right.

‘Information is absolutely key to a number of policy areas,’ she says. ‘How can you make a choice if you don’t know what’s out there? How can you give up smoking if you do not understand how addiction works?’

Traditionally, information has been protected. For example, the National Electronic Library for Health was until recently available only to clinicians.

‘That’s very paternalistic,’ says Bryant. ‘It says we know best and the public don’t know. But patients are turning up with Google searches about conditions that have frightened them half to death and are not based on clinical evidence.’

The NHS, she says, can be an additional channel for giving information and to that end NHS Choices has a range of new tools, improved navigation and smarter searches (See box).

But, says Tim Kelsey, chief executive of Dr Foster’s Intelligence, this is only part of the story. It may look like a website now but in time it will be much more powerful.

‘This is not about having a corporate magazine,’ he says. ‘It’s about the NHS itself figuring out that a large part of its solution will be networks of virtual care.’

Heady stuff. His argument runs like this: the NHS is not going to increase productivity or produce enough efficiency savings to maintain current services levels. So instead it needs to improve health outcomes by giving information to people.

‘I want a world where you can get your lab results electronically. You do not need to see a doctor. People will end up seeing a doctor more often when it’s right, not when they do not need to.’

But before then, there is the scorecard to get right. This is the bit where patients choose: a GP, a dentist, where they want to go for their first out patient appointment and their elective treatments.

What do they need to make this choice? Accurate basic information about addresses, telephone numbers and doctors names, for sure.

A major decision pushed through by Ms Bryant was to farm out much of the routine information to providers. GPs can now update their own information and trusts have similar responsibility to check their data.

But there is another level of data. What about clinical outcomes?

‘The clinicians are driving the content,’ Mr Bryant says firmly. The clinical advisory group is currently (although it’s not clear for how long) chaired by Professor Sir Bruce Keogh, now the NHS medical director.

But Alan Plunkett, managing director of Dr Fosters Intelligence, sees another way this could develop. ‘We want to create an opportunity for feedback from users.’ Eventually, patient feedback could lead to the holy grail of patient-developed outcomes.

NHS Choices is hoping also to bring in outside websites, to become, in Ms Bryant’s words, a ‘house of brands’, a bit like Selfridges where Dior and Clinique have their outlets inside the named store.

To this end, discussions are underway with Boots and Lloyds Pharmacies, each of which has launched new web sites with health news and A to Z searches of evidence based medicine.

The new askBoots website is clearly aimed at consumers, pitched as a partnership of two trusted names (Boots and BMJ) co-operating to provide a service. ‘We know that people are becoming more health aware and are proactively managing their health,’ says Nicola Lewis, head of Boost online. ‘We also know that they feel empowered by the internet.’

Trusted maybe. Dynamic? Not really.

Likewise Lloyds Pharmacy website is pretty passive at present. Even its electronic prescription service turns out not to be electronic at all. ‘Actually it’s a telephone service,’ says head of marketing Chris Frost. ‘When we did the market research for this we found that people wanted the convenience of e commerce, so getting things delivered to them when they want them, but want to talk to a person about something as important as a prescription.’

But Mr Frost, a pharmacist by training, has a wider vision. Lloyds already does blood pressure checks, diabetes checks, heart health checks and a smoking cessation service.

He says: ‘Longer term I want to see people being able to access all patient medical and records of tests they have done in store.’

And this future vision is where theUKstarts to catch up with theUSwhere health on the web is way ahead.

Microsoft’s HealthVault portal is one example. It was launched in theUSin October with 40 health care providers, healthcare device manufacturers and patient advocacy groups signed up.

In essence, it allows users to store and share their medical histories, immunisation details, and data from devices monitoring biometrics such as glucose and cholesterol levels.

It has a dedicated vertical health search engine to enable easy navigation and organisation of users’ health data.

The theory is that users will be able to download medical information, such as laboratory results or x-rays, from the web sites of their healthcare provider. They will also be able to directly download data from HealthVault-compatible digital health monitors and devices, and store the data on their personal health record.

Individual users will then be able to provide access to some or all of their PHR to their doctor, family member or carer through a secure email invitation.

Currently it is only available in theUSwhere Microsoft is busy persuading healthcare providers to develop HealthVault compatibility.

Patient-led websites are also much more developed. The award winning is among the best of the bunch. Here patients with long-term conditions write health diaries, with a variety of sophisticated online tools to help.

It looks like a sort of health with patient profiles, descriptions and graphs plotting symptoms against time and medication.

The future, it seems, is here. Is the NHS ready to grasp it?


New times, new tools

The new NHS Choices website promises to be a very different animal from the much derided version launched in the summer.

The front page will have a daily video and lead users to sections on choice, health promotion advice and the A to Z health encyclopaedia.

In essence, it brings together:

  • the National Electronic Library for Health, providing up to date, evidence based health information to the public
  • over one million bytes of data in the trust scorecard that allow patients to compare NHS trusts
  • the NHS directory of services that spells out what’s on offer, where and when.

The new tools will help patients make sense of this, making the website usable.

For example, GPs will now have a ‘My Space’ facility where they can post up to 16 pages of information, including videos and pictures.

New search tools mean that when a patient searches for ‘heart attack’ the website will also pull up related medical terms such as myocardial infarction.

A Behind the Headlines service takes the top health news stories and subjects them to a review by health evidence specialists Bazian. An analysis of the story, sometimes with a comment from NELH director Sir Muir Grey, appears on the NHS Choices website within 24 hours.

The website has an editorial team of 25.

Pilot tests are already underway of locally adapted front pages with a facility to send key messages to targeted groups by SMS.

Future developments include opening up the site to other information providers, for example the voluntary sector, and making NHS Choices a ‘house of brands’.

There are also plans for a function that allows patients to put in information about themselves and receive personalised health information tailored to their situation.