Physicians explaining surgical procedures to patients now can turn to YourSurgery.com, which depicts some 40 operations through original text, illustrations, photographs and animation designed to be understood by those as young as 12.
And since March 2000, the Web site has offered doctors a free and modifiable "Internet Informed Consent" form, patent pending, which developers believe is the first online.
Using both the educational and consent aspects of YourSurgery should result in a well-informed patient and reduced physician liability, says Pontiac, Mich., neurosurgeon Harold Portnoy, M.D., co-owner of Animation Education Group, which developed the site.
"It's a way of having patients understand their surgery," Portnoy says. "You not only teach the patients about their surgery, but the signed informed consent verifies that the patient has read the procedure, discussed it with the doctor and has no more questions. This legally assures the physician that the patient has been completely informed."
Portnoy and his business partner, computer specialist Michael Stys, launched the Web site in January 1999. It currently boasts hits in excess of 1.7 million monthly and has netted acclaim, including a Forbes.com "Best of the Web" designation.
Doctors are not charged to register with YourSurgery, nor are patients or other browsers assessed a fee. Rather, the multimedia database is supported by sponsors purchasing advertising banners costing $3,000 annually, and hospitals, clinics and group practices paying an average $10,000 per year for a co-branded version of the site.
Portnoy has invested about $100,000 and Stys just over $25,000 in Animation Education Group, with about half of the total outlay funneled into YourSurgery. No venture capital is at play, and the site has yet to realize a profit.
Sean Wieland, research analyst with Prudential Securities in San Francisco, says many e-health companies forgoing venture capital miss the big picture. "What they don't realize is that the venture capitalists get them access to business relationships and talent that they wouldn't otherwise see," Wieland says.
Stys, who puts some 80 hours each week into YourSurgery, says going it alone has worked well for the Web site. "It's better than getting venture capitalists and having it all blow up in our faces. We just rolled up our sleeves and got to work," Stys says.
"As with most dot-coms, we're in a negative phase," Portnoy says. But with revenue from banners and co-branding on the rise, he anticipates the site will turn a profit this year.
Wieland says dot-coms with revenue streams hinged on "eyeballs and banners" have a tough time making it over the long haul. "I don't believe that this kind of revenue model can sustain a public company. They need to have somebody that's willing to pay for the service they're providing. (YourSurgery) sounds like a valuable component, but it can't be a stand-alone entity. It could be an attractive acquisition target."
Stys agrees the status quo will not sustain YourSurgery long-term, but he points to a compromise between owning and selling the company: licensing the material on the site to other e-health enterprises. "We've been in negotiations with various companies. I think our niche in having the informed consent is what makes us attractive."
While the partners would consider selling outright to a bidder with an acceptable offer, licensing agreements with multiple businesses would enable them to not only generate income but maintain control over their creations, Stys says. "We can elect to stop licensing if the material is not used appropriately."
Portnoy and Stys met in 1997 at a Michigan law seminar, where they discovered a shared concern about medical advice offered over the Internet. Stys, who has degrees in architecture and engineering, had spent years reducing complicated material into digestible forms in areas ranging from accident re-creation to forensic animation, while Portnoy had long dabbled in computer programming.
Soon, the pair formed Animation Education Group, generating multimedia medical animation and presentation material for businesses such as pharmaceutical companies. After months of perusing general health Web sites for comprehensive and understandable surgical information for patients, the partners determined they would pool their talent to detail common procedures, such as LASIK and cardiac catheterization, online. "If people want to know about their surgery, it shouldn't be a struggle," Portnoy says.
Before long, the neurosurgeon was spending two to four hours daily developing YourSurgery, in addition to a minimum eight hours devoted to his practice, a schedule he maintains to this day. Many of the extra hours are spent distilling sophisticated data into basic information comprehensible to the general public, he says. "The material is so extensive, but it's so simple. A person can go to this site, and pretty much understand what they're about to undergo."
YourSurgery's home page offers visitors options of anatomical regions: head, neck, chest, abdomen, pelvis, back and limbs. Clicking on one of the regions pulls up a list of operative procedures, and choosing a particular procedure opens a description of the surgery and its associated ailment, symptoms, basic anatomy of the area, pathology, related diagnostic methods, alternative surgical options, possible complications, post-operative care, innovations in techniques and, in some cases, animated video.
The Web site is not cluttered with intricate anatomical features or complex concepts. Words which might be unfamiliar, such as "laparoscopic" and "fusion," are defined. To assure clarity, Stys runs new procedures by his 8-year-old nephew before adding them to the expanding site. "The whole concept here is to put it in a layperson's terms," he says.
Brian Stone, 12, logged onto YourSurgery to read up on hip replacement, a surgery his best friend's brother is expected to undergo. Stone says the definitions were clear and the pictures helped explain the procedure.
Stys says YourSurgery is intended to enhance, not impinge upon, the doctor-patient relationship. Each procedure page advises patients to take a print version to their physician.
"We're not trying to supersede your doctor," Stys says. "We're interested in providing the patient enough ammunition to ask their doctor the right questions."
Although disseminating surgical descriptions to the public was the singular goal in establishing YourSurgery, Portnoy says, an unanticipated benefit evolved early this year. "It became apparent that it could be used in another manner, part of the informed consent process."
Traditional consent forms lack a detailed depiction of the impending surgery, Stys says. "The one-page informed consent most hospitals give doesn't let people know what to expect. Education is the precursor to being informed. Informed consent has to be informed." The medical information already available to the public on YourSurgery was therefore amended with the Internet Informed Consent so doctors can be guaranteed, in writing, their patients fully grasp upcoming surgery.
Now, Portnoy relies on the Web site's dual offerings in his own practice, printing three black-and-white synopses of the appropriate operation for each surgical candidate. "(The patient) can go to the Web, if he wants it in full, living color."
Then the patient initials each page and signs copies of a completed informed consent, also printed from the Internet. One package goes in the office chart, one goes to the hospital and a third is sent home with the patient.
Privacy is addressed, Portnoy says, because data entered into the form electronically is not stored. "It's going nowhere. The patient's name never leaves the doctor's computer. When the doctor finishes printing it out, it disappears."
More than 300 physicians have registered online to use the consent form, though there has been no direct marketing to doctors to date, Portnoy says. Along with others logging onto YourSurgery, the registered doctors apparently have discovered the site through word of mouth, hospitals using co-branding, mentions in publications and links from other Web sites such as the National Library of Medicine's MEDLINEplus.
The biggest hurdle facing YourSurgery is the computer-shy physician, Portnoy says. While most medical school graduates of the past 10 years are comfortable riding the technological bandwagon, he says, many others hesitate to jump aboard.
Portnoy anticipates upcoming HIPAA requirements will increase the ranks of computer-savvy doctors. "For physicians, the acceptance of computers and the Internet as a part of their everyday practice will soon become mandatory. We hope that YourSurgery.com will in some small way aid that effort."
Harold D. Portnoy, M.D.Born: May 19, 1932
Education: B.S. in chemistry, Wayne State University, Detroit, 1953
M.D. from Wayne State University College of Medicine, Detroit, 1956
Internship at Grace Hospital, Detroit, 1956-57
Residency in general surgery at Grace Hospital 1958-59; and neurological surgery, 1960-64
Professional: Certified by American Board of Neurological Surgery, 1966; Medical staff appointments, including attending at St. Joseph Mercy Hospital in Pontiac, Mich., 1965-present; and attending at Crittenton Hospital in Rochester, Mich., 1966-present
Academic appointments: include clinical professor of medical physics at Oakland University, Rochester, Mich., 1983-present
Awards: include March of Dimes Humanitarian of the Year, 1992; Medical Illness Research Association's Pat Elwell "Above and Beyond" award, 1999
Published works: more than 70 articles; designed computer programs for AppleWork; president and editor of YourSurgery.com, Jan. 1999-present
Linda Boone Hunt is a Prescott, Ariz.-based investigative reporter and feature writer.