Health Portals: An Exploratory Review


A lack of health services has long been the thorn in the side of many communities, especially rural and regional communities. The high costs of treating ever growing chronic and complex conditions in traditional settings, where rural allied health services providers are non-existent and doctors are already overcommitted, are prompting a shift in focus to more efficient technology driven delivery of health services. Moreover, these days it is also increasingly unlikely that health professionals will encounter patients who have not used information technology to influence their health knowledge, health behaviour, perception of symptoms, and illness behaviour.

Advances in Internet technologies offer promise towards the development of an e-health care system. This article will postulate whether portal technologies can play a role facilitating the transition to such e-health care systems.

This article aims at reviewing the literature to present to the reader the barriers and opportunities out here for effective health portals. However, the article does not intend to provide a one-fits-all technical/content solution, only to make implementers and developers aware of the potential implications.


Many rural and regional communities lack the range of allied health services that are readily available in metropolitan areas, and many rural doctors who are already overcommitted, provide services that an allied health professional could readily provide (Department of Health and Ageing, 2004). The Australian Institute of Health and Welfare data shows that death and disability from chronic disease is higher in rural and regional communities, including Indigenous people. Coronary heart disease, asthma and diabetes are the biggest killers. Participants in the Regional Australia Summit highlighted chronic disease as a major menace (Department of Health and Ageing, 2004).

This state of affairs is already prompting a change in the health care system to focus more on preventive medicine and health care away from the traditional settings (Yellowlees & Brooks, 1999). According to Yellowlees and Brooks (1999), there are three major drivers for this change:

• The economic imperative to restrain health care costs

• Increasing consumerism, and the evolution of the “informed patient”

• Changes in communication technology, and the evolution of the Internet

Portals and health

The benefits of Web portals in aggregating information from multiple sources and making that information available to various users is well known; more importantly, they can provide the services of a guide that can help to protect the user from the chaos of the Internet and direct them towards an eventual goal (Tatnall, 2005). More generally, however, a portal should be seen as providing a gateway not just to sites on the Web, but to all network-accessible resources, whether involving intranets (within an organisation), extranets (for special partners of an organisation), or the Internet (Tatnall, Burgess, & Singh, 2004). In other words a portal offers centralised access to all relevant content and applications (Tatnall, 2005).

The literature on health portals tells us that the Internet offers a significant amount of health information of varying quality. Health portals, which provide entry points to quality-controlled collections of Web sites, have been hailed as a solution to this problem (Glenton, Paulsen, & Oxman, 2005). However, it has been demonstrated that the information accessible through (government run and funded) health portals is unlikely to be based on systematic reviews and is often unclear, incomplete and misleading. Portals are only as good as the Websites they lead to (Glenton et al., 2005). However, irrelevant information could easily be filtered using a number of frameworks that can be used to evaluate the quality of Web-located health information. For example, Sellito and Burgess (2005) have developed a set of affirmative response evaluation features identified across four quality categories: currency/authority, accuracy, objectivity and privacy. And they are used as the basis for determining the fundamental quality of Web-located health information (Sellitto & Burgess, 2005).

The consumer and health information

Increasingly, consumers are accessing health information via the Web (Thompson & Brailer, 2004). It has been estimated that 6.4 million Australian adults—almost half the adult population—accessed the Internet during 2000 (Gretchen, Berland, Elliott et al., 2001). This is not just an Australian phenomenon. In the United States, 52 million Americans access health or medical information on the Web (Fox & Fallows, 2003).

The existence of health portals has made life easier for the people that need this information. However, the quality of portal interfaces as well as the portal content has many times been in doubt (Bamidis, Kerassidis & Pappas, 2005). Using popular search engines may be aesthetically appealing and easy to use, but they often provide inaccurate information (Sutherland, Wildemuth, Campbell, & Haines, 2005). What is clear however, is that while most consumers still use word-of-mouth as a primary information source for health care decisions, the use of Internet information is increasing (Snipes, Ingram, & Jiang, 2005). In Australia, for example, more Internet users search the Web for information on depression than any other health condition (Lissman & Boehnlein, 2001). This is not surprising given the high level of disability associated with depression in the community and the fact that the Web provides a convenient, anonymous means of obtaining information about the problem (Cain, Sarasohn-Kahn, & Wayne, 2000). However, much of the depression information on the Web is of low quality and originates in the United States (Jadad & Gagliardi, 1998).

Service providers and Health Information General practitioners (Gps)

The gap between what GPs might do (based on evidence-based clinical practice guidelines and what they actually do is wide, variable and growing. Many factors contribute to this situation. GPs are inundated with new, often poorly evidence-based and sometimes conflicting clinical information. This is particularly serious for the generalist, with over 400,000 articles added to the biomedical literature each year. Adding further pressure to the “gap” are workloads that have increased over the past decade: GPs are seeing more patients with acute and complex conditions. Rural practitioners work even longer hours, offer more medical services and perform more clinical procedures than their urban counterparts—thus facing an even greater need for up-to-date information (Davis, Ciurea, Flanagan, & Perrier, 2004).

There are four steps in incorporating research evidence in clinical decision making: asking answerable questions; accessing the best information; appraising the information for validity and relevance; and applying the information to patient care (Craig, Irwig, & Stockler, 2001). However, a study in New Zealand suggested that to make this happen, practitioners urgently need training in searching and evaluating information on the Internet and in identifying and applying evidence-based information; as well as (health) portals to provide access to high-quality, evidence-based clinical and patient information along with access to the full text of relevant items (Cullen, 2002). Many sites have been developed to help the search for quality peer-reviewed literature. These include the Cochrane Library and the U.S. National Library of Medicine’s PubMed, as well as sites offering full-text access to medical journals, such as Stanford University’s HighWire Press and (Robinson & Day, 2004). GPs can keep up to date with reliable information from readily accessible Web sites such as PubMed and HighWire Press. PubMed is part of the National Library of Medicine in the U.S. It is a useful system for retrieving clinically relevant search results. HighWire Press has a less sophisticated search engine, but is an excellent source for obtaining the full text of journal articles (Robinson & Day, 2004). However, and although increasing, access to these resources by practitioners is still low (Young & Ward, 1999).


E-health can deliver health care services and education, via a Web portal, to older persons with chronic conditions and their caregivers and enables the patient’s home to be the point of care. This growing industry is ripe for exploration by nurses who can empower the patient and caregiver to gain self-care and coping skills. Advances in information technology now make this dream a reality (Moody, 2005). However, at the American Academy of Nurse Practitioner’s Conference, it was identified that information on educational options for acute care nurse practitioner (ACNP) practice was needed (Kleinpell, Perez, & McLaughlin, 2005). Information technology skills of nurse managers and staff need to be developed in order to use information technology effectively. In order to learn in a Web-based environment, everyone needs the opportunity and access to required resources. Additionally, nurse managers’ experiences are important to promote wider utilisation of Web-based learning (Korhonen & Lammintakanen, 2005).

Web portals could help nursing staff in a number of ways; for example, health assessment skills are vital to professional nursing practice. Health assessment has traditionally been taught using lecture, teacher-developed tests, practice and live demonstration, and interactive and computer-based learning materials.

Student evaluation of these types of courses revealed that online assignments enabled them to pace their learning, thereby promoting greater flexibility and independence. Students were able to master the technical skills of working online with minimal difficulty and reported that working online was no more stressful than attending class. A most helpful aspect of the online course was the instructor-developed video that was digitally streamed online (Lashley, 2005).


International health organisations and officials are bracing for a pandemic. For example, and although the 2003 severe acute respiratory syndrome (SARS) outbreak in Toronto did not reach such a level, it created a unique opportunity to identify the optimal use of the Internet to promote communication with the public and to preserve health services during an epidemic (Rizo, Lupea, Baybourdy, Anderson, Closson, & Jadad, 2005). What was learned was that many patients are willing and able to use the Internet as a means to maintain communication with the hospital during an outbreak of an infectious disease such as SARS. Hospitals should explore new ways to interact with the public, to provide relevant health information, and to ensure continuity of care when they are forced to restrict their services (Rizo et al., 2005).

Provider education and health portals

Claire Jackson (2005), the chair of the discipline of general practice at the University of Queensland, Australia, envisioned the primary care practitioner increasingly networked with consumers, government and professional groups, such as colleges and divisions of general practice. Primary and continuing medical education needs to play a principal role in this process. Education needs a fundamental change of focus from simply delivering content to developing the ability to manage these changes. Learning to learn and learning for life should be a major guiding influence in curriculum development (Carlile & Sefton, 1998).

Portals can certainly provide practitioners easy access to these resources; however, it has been argued that student health professionals lacked the state of readiness of for Web-based learning environments. A short survey was distributed to the Medical Faculty at Sheffield and 191 valid responses were received. Only 62% of students had access to an Internet-connected computer at home. Most students (95.8%) checked their e-mail every few days or more, with slightly less (82.8%) using the Web frequently. Relevant technologies were often never used, including Internet relay chat, message forums and video conferencing. However, 66% of students had used computer aided learning packages. Future use of online continuing professional education material is likely to be limited (Stokes, Cannavina, & Cannavina, 2004). Nevertheless, various studies have shown that appropriately designed, evidence-based online continuing medical education can produce objectively measured changes in behaviour as well as sustained gains in knowledge that are comparable or superior to those realised from effective live activities (Fordis et al., 2005).

Some very recent developments has a Pfizer-sponsored educational Web portal for GPs allows the company to track the advertisements doctors look at and the Web links they visit. Believed to be the first pharmaceutical company-sponsored portal for GPs in Australia, the My E-Portal site ( ) allows GPs to drag-and-drop links to their most frequently visited sites, and provides journal and division sites, access to continuing medical information, and links to entertainment, banking and travel sites. Pfizer can then collect information about what sites are accessed, the ads and links clicked on, and the links added to the site (Limprecht, 2005).

Electronic communication and portals

The Internet also offers a unique means of health promotion through the use of interactive tools like chat rooms, e-mail, hyperlinks and the like (Stout, Villegas, & Kim, 2001). Looking at all these is beyond the scope of this article, however, a brief look at e-mail communication will suffice to outline some of the basic issues facing the e-health care system of the future.

In a recent American study, a Web-based communication strategy (e-mail) was used to enhance communication between patients and GPs, where a Web mail address was promoted on the telephone (Spencer, 2005). An important observation from this study is that less than half of e-mails require the direct attention of the physician. This study is also supported by other similar research findings (Griffiths & Christensen, 2002). This of course has a number of ethical issues that need to be explored before going any further (Flicker, Haans, & Skinner, 2004).


The literature is full of evidence on portal’s potential use in health, but it is all compartmentalised: there are GP studies, nurses’ studies, hospital studies, patient studies, communication studies and so on. Furthermore, since the inception of the computer age, and even now with the advances in online technologies, there is ample evidence to suggest that development and implementation of these tools always lie in the realm of the technologists; where the technology is the focus of the implementation rather than the user’s outcome (Tatnall, Davey, Burgess, Davison, & Fisher, 2000).

The technical issues involving portals is well documented; however, portals are but one component of the larger Health Information System. This simple fact needs to be acknowledged and efforts for wider research into the many facets of online health users and their subsystems must be taken into account, not as neat individual groups as current research seems to place them, but as dynamic partners of a Health Information System.

It is with this fear that this article has been written, in the hope that somehow developers and implementers would take heed of the barriers and opportunities for cross-field efforts to develop workable online tools that would produce, in this case, positive health outcomes.


This review recognises the potential for Web information technologies to affect some of the uses of these technologies in the development of an e-health care system for communities. However, for every potential, there are lessons that need to be embraced before rushing to developing portal technologies; for example:

1. The lack of user training is usually apparent when new technologies are introduced.

2. The need to be able to appropriately filter information to instill consistency and confidence on users of the resources.

3. Not all GPs are yet convinced the evidence-based guidelines are the clinical future for the treatment of chronic and complex conditions. This is perhaps the biggest obstacle to an uptake of Web-based resources and treatment.

4. Health communication tools like e-mail presents an interesting challenge for clinicians, clinical treatment and ethical issues.

5. The overall message from this article is proceed with caution. The potential for portals is definitely there, and making users adopt them is perhaps the key to it.

key terms

Broadband Incentives: The Australian federal government provided incentives to cover the cost of voluntary connection and use of broadband in general practices to improve their poor access to the Internet.

Evidence-Based Medicine (EBM): Evidence-based medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research. By individual clinical expertise we mean the proficiency and judgement that individual clinicians acquire through clinical experience and clinical practice. Increased expertise is reflected in many ways, but especially in more effective and efficient diagnosis and in the more thoughtful identification and compassionate use of individual patients’ predicaments, rights, and preferences in making clinical decisions about their care. By best available external clinical evidence, we mean clinically relevant research, often from the basic sciences of medicine, but especially from patient centred clinical research into the accuracy and precision of diagnostic tests (including the clinical examination), the power of prognostic markers, and the efficacy and safety of therapeutic, rehabilitative, and preventive regimens. External clinical evidence both invalidates previously accepted diagnostic tests and treatments and replaces them with new ones that are more powerful, more accurate, more efficacious, and safer (Sackett et al., 1996).

Generalist: Refers to a general practitioner (GP) or sometimes referred to as medical doctor (MD) as opposed to specialists (cardiologist, neurologist, etc.).

General Practice (GP): Primary care is delivered by some 9,000 practices in Australia, housing some 20,000 GPs; these vary from large practices with 10-15 doctors to many single doctor practices. These are typically doctor owned and run independently as small businesses although the government has a major influence in the way services are delivered and charged.

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