Telemedicine promises to improve the quality and efficiency of health care. Various forms of telemedicine, including online care on demand, virtual specialist consultation and remote patient monitoring, will help physicians deliver optimal care faster and more efficiently, while allowing patients to be engaged more directly in their own care. According to Manhattan Research, 7 percent of U.S. physicians already are using online videoconferencing to interact with patients. Telemedicine also promises to help lower costs, improve ease of use and offer greater convenience for health care providers, physicians and patients.

However, for telemedicine to realize these benefits, providers' websites and mobile site performance must be fast, reliable and consistent. A health care institution's website is truly its "digital front door," and poor performance not only can diminish patient perception and trust, but also drive them to more expensive call center channels.

Performance Improvement Tactics

What can a health care provider do to ensure strong website and mobile site performance? Here are a few tactics:

Understand performance as your end users experience it — at the browser or device level. Many health care providers still judge the performance of their websites and applications from a look inside their data center. If you examine the infrastructure of all servers using system management and monitoring tools that show everything is working and the local network is running fine, you may conclude that end users are satisfied.

Unless patients and physicians live in your data center, you can't make this assumption. There are so many performance-impacting variables beyond the firewall — content delivery networks, cloud service providers, third-party services adding features to your site (for example, online chat sessions), regional Internet service providers, local ISPs, browsers and devices. You don't know what kind of Web experience you're delivering until you're in the end user's seat.

Prioritize your most important end users, including mobile users. If your organization has a nationwide presence, knowing where most of your patients and physicians live and work can help guide decisions that can make a big difference on Web performance — for example, where to locate content delivery networks to bring content closer to end users and allow for faster content downloads.

It's nearly impossible to measure and monitor end-user performance given the volume of mobile browser/device combinations in use today, so focus on exceptional speed and reliability for the ones used most by your patients and physicians (Blackberries, iPhones, Sprint 4G, Verizon/Droid or any combination of these). At a minimum, you should make sure mobile site content "fits" and displays properly on the screens of today's popular mobile devices; there are online tools available to help you do this quickly and easily.

You may consider creating a dedicated, streamlined mobile site that delivers basic services while remaining more "lightweight" — by avoiding video, for example — so you can maintain speed. Of course, you'll need to make sure mobile users are directed automatically to this mobile site rather than the PC-based website where they're apt to experience slowness. Another alternative is to use services that detect mobile traffic by device type on your website and selectively filter and download content based on the volume and type of content the particular device can handle without sacrificing speed.

Load test early and often, along the entire application delivery chain. Health care providers need to be prepared for periods of peak traffic — such as the flu season, when people flock online. Health care providers often find it helpful to combine simulated load generated from the cloud with real-world load generation from end users' browsers and mobile devices. By combining the two, you can load-test up to millions of page views per hour and accurately parse how various end-user segments are experiencing a website or application under different load sizes. When you notice a performance degradation, you then can trace it from end-user browsers all the way back to your data center to identify the elements that aren't carrying their weight.

Set and monitor service-level agreements. Today's websites and applications include many features delivered by third-party services. Just one poorly performing service can cause an entire website to slow down, and your end users will blame you regardless of the actual cause, possibly harming your patient loyalty and brand. That's why it's critical to demand specific performance guarantees in your contracts with third parties, including periods of peak traffic. You must also monitor end-to-end application performance from the end user's perspective to identify and address any weak links. Validate service-level agreements and ensure you're getting what you're paying for.

Use industry benchmarks. You should also compare your service against industry benchmarks that showcase how health care industry leaders are performing on the Web. These leaders are defining good experiences and setting user expectations, which can help determine how strong your own website performance needs to be and provide a context for ongoing efforts to optimize performance.

Provide pertinent information to the business. With so many variables affecting performance, you need an all-encompassing view that pinpoints the causes of performance issues for your most important end users and Web pages. This view is often a consolidated dashboard that shows all the elements in a web application delivery chain.

Finally, analytics can help you correlate Web performance to desirable or undesirable outcomes. They allow you to measure the rate of abandonment along each step of an online process, such as searching for a particular physician or specialty, and estimate the number of end users having a satisfying, mediocre or frustrating experience. These analytics can help Web teams prioritize problem-solving efforts in accordance with patient and physician needs.

A Fast, Reliable Website Is Becoming More Critical

Today's patients are taking a much more active role in their medical care; they expect their health care providers to offer access to medical records and online communication with caregivers. Health care IT executives expect to invest in patient portals, physician portals and Web content over the next few years. By ensuring fast, reliable and consistent Web experiences, IT teams will play a key role in driving the transformation of health care delivery — from traditional office-based and hospital settings to the patient's home, or anywhere else, via mobile devices.

Michael Wilson, M.B.A., is the health care domain executive for Compuware Corp. in Detroit.