Plummeting stock prices and industry-wide layoffs were far from evident at the eHealthcareWorld conference held recently in New York City. Many relatively new e-healthcare companies presented products with flashy, multi-level exhibits full of sound, video, and live speakers. Among the hundreds of exhibitors, we found several interesting new companies and products. Interestingly, the overall focus seemed to shift away from the consumer-based products of last year toward physician and health care system customers. This conference is considered to be the premiere showcase for the latest available Internet-based technologies for the health care industry. The show was extremely well attended, with more than 6,000 people visiting over the three-day period. Two companies founded by emergency physicians received awards at this year's show. eMedicine, founded by Scott Plantz, MD, won a Bronze award for “Best Medical Product/Supply Site with International Vision.” MDchoice.com, founded by the authors of this article, won a Silver award for “Best Healthcare Search Engine.” A complete list of awards and exhibitors from the show can be found at www.ehealthcareworld.com. This month, as we discuss some of the most promising innovations, we also will provide a brief summary of the e-healthcare landscape as it looks today. e-healthcare Models Most Internet-based e-healthcare models can be grouped into four categories: content, connectivity infrastructure, e-commerce, and point-of-care tools. In the content area, some companies provide information either on retail or wholesale. Some provide content directly to the end-user, like Dr.Koop.com, while others supply content to other web sites on a licensed basis, such as Adam.com. Many experts argue today that companies with business models who provide free content to consumers will have difficulty staying in business. Thus firms that began providing content directly to consumers have shifted their businesses to licensing this information to other direct-to-consumer sites. Similarly, as health care providers realize that their patients are turning to alternative resources to find health information, they seek to reaffirm their roles as their patients' primary source of health care needs online as well as offline. In fact, many of the conference's attendees were from the marketing and IT departments of their health care systems looking for vendors to build their web sites. Companies such as Healthgate and Wellmed help by using their investments in content development and aggregation to build turnkey web sites for hospitals, insurers, and medical groups. Healthgate has provided components, or entire web sites, to more than 600 hospitals across the country. Wellmed and DoHealth focus on providing content to managed care providers, including online risk assessments and interactive tools. Many sites focus on building CME courses for physicians, supported by the pharmaceutical industry or on a pay-per-use or subscription basisTable: The World of eHealthcareWhile many hospitals find it desirable to differentiate themselves by building custom applications for their patients, it is difficult to justify re-engineering commonly found tools such as Body Mass Index and calorie counters. Similarly, unless a provider specializes in a unique therapy or procedure, consumer-oriented content is typically the same from location to location. Therefore, teaming up with third-party content providers allows hospitals and insurers to offer more information and services on their web sites more rapidly and at a far lower cost. Content providers do not limit themselves to licensing their content to a web site, however. A company called Helios Health (www.helioshealth.com) physically provides their content and a web-enabled computer kiosk to health care providers directly in their waiting rooms. This unique offering allows waiting patients to browse online from a selected range of health web pages. The service is generally free to physicians' offices, and is supported by advertisers and investors. There is an emerging group of sites that focus on building CME courses for physicians, either supported by the pharmaceutical industry or on a pay-per-use or subscription basis. Unlike many established CME providers that have simply taken their print content and placed it online, the latest group of online CME providers has moved toward creating instruction that is interactive and multimedia rich. Medschool.com and Medcases.com build case-based courses that allow physicians to manage a virtual patient and select differential diagnoses, review test results, and answer questions. Medschool.com, founded by an internist, put on a particularly impressive display with videotaped patient interviews and a visually rich user environment. While the site mainly contains question sets for medical students, they aim to build custom interactive cases for the health care industry. Helping Physicians Communicate The companies focusing on connectivity are building an infrastructure and various interfaces designed to streamline the many processes that currently occur in health care. These companies help physicians communicate with their patients, laboratories, pharmacies, health insurers, and other physicians. In addition to the many vendors of transactions such as claims payment and coding, there were vendors that offered secure communications for physicians. Two services that stood out were Medicity and iPhysicianNet. Medicity (www.medicity.com), which won an award for Best Exhibit, presented an online community for physicians that supports electronic consult requests and laboratory results. The company seeks to work with groups of physicians and hospitals to provide an integrated online communications infrastructure. The service is free, and claims more than 6000 physician members. iPhysicianNet.com is building connectivity between the pharmaceutical industry and select physicians. The company, which withdrew its IPO filing in mid-2000, has provided more than 8000 physicians with a free computer, videoconferencing equipment, and high-speed Internet access. In return, physicians contractually agree to accept an online videoconference detail or sales call from a representative of each pharmaceutical client once a month. The company plans on adding other educational content and services to the system. Handheld Applications E-commerce companies today focus on selling medical supplies, providing tools to streamline purchasing, and inventory management. Point-of-care applications include software for medical charting, charge capture, and electronic prescription writing. Emergency physicians will likely be most interested in the handheld prescription-writing applications that are now available. Parkstone Medical (www.parkstonemed.com), founded by a group of physicians, is providing a free Windows CE handheld computer to physicians who will utilize its prescription-writing software. With the handheld machine comes a desktop PC and a printer for each office utilizing the program. The major benefit of the system, according to the company, is that physicians will be alerted to drug interactions and formulary restrictions at the time they write the prescription. The prescriptions are currently printed locally and handed to the patient, but wireless connections are reportedly coming soon. The Parkstone system is supported by investors and drug manufacturers that post flashing advertisements on the tiny screen as physicians point and click their way to a completed prescription. The hundreds of millions of investment dollars that have poured into e-healthcare seem determined to gain widespread physician adoption of technology. Previous failures have directed companies toward providing their wares to physicians at little or no cost. Despite massive investments, it remains to be seen whether e-healthcare as an industry itself will survive. The more likely scenario is that e-healthcare will ultimately be delivered by traditional health care companies with proven revenue streams. We should note that several of the companies that attended the eHealthcareWorld show earlier this year in Las Vegas were no longer in business for this meeting. Nevertheless, there has never been a better time for physicians to try new technologies, and the price appears to be right.