Since ancient times patients have traveled in search of best medical treatment [1]. Health-tourism website's time line indicates that if patients' financial and physical conditions allow they tend to travel for better treatment [1]. According to Mukherjee and McGinnis [2], the authors define in ‘International Journal of Pharmaceutical and Healthcare Marketing’, Mukherjee and McGinnis define e-health as “the combined use of electronic information and communication technology in the health sector for clinical, educational, research, and administrative purposes, both at the local site and across wide geographic regions” [2]. Many people seek for hospital information via hospitals website [13]. The hospital website is a gateway for indirectly experiencing each hospitals medical service in advance. People search for medical information on particular doctors, treatment procedures, disease or even information on catering and parking services in hospitals. Especially patients who are planning to have treatment abroad tend to rely on collecting information through websites. Gallant et al. [4] stated that institutional trust can be obtained, users can gather information and select a hospital or a healthcare specialist through hospital websites. Moreover, perceived usefulness and visual elements of a website contribute to building users' trust.

In the previous study on Middle Eastern patients' satisfaction with services and revisit decisions, a statistically significant difference was shown between online and offline information retrieval. Patients or families who retrieved medical information online showed more satisfaction. In terms of reliability, online website users scored 4.62 points, while offline users scored 4.13 points (t = 3.5, p < 0.01) [5]. This shows that people tend to rely more on information provided online than on information provided offline. However, not all hospital website contain enough information to meet the patients need. Moreover, searching and comparing each web-sites is a burdensome process for patients. A study of Huang and Chang [6] showed that most hospitals only implement traditional functional tools on their websites, which only include online search, interactive maps and a tool to find a doctor. On the other hand, online e-health tools were hard to be found. These included pre-registration (19.4%), making a doctor's appointment (15.3%), accessing medical records and lab results (10.1%), and requesting for prescription refills (9.7%). Various tools can be used to evaluate websites. However, only few studies compared hospital websites by using users' preferred interactive e-health tool. In addition, previously compared and analyzed hospitals were mainly hospitals located in the United States. Huang and Chang [7] also shows ‘interactive e-health tools’ are more likely to help users' easily understand whether the website is patient oriented. With a simple use, this tool can reflect the amount of tools related to ‘patient engagement’, ‘patient participation’, and ‘patient empowerment’. This tool was selected to understand the determinants and outcomes of successful implementation of patient oriented web sites. By using the patient-oriented interactive tools the website users can easily analyze each website and collect information. This e-health tools can be used for patients who are in stage of choosing the hospital. In other words, this can be the first step which can help patients select the most suitable hospital.

The purpose of this study is to compare the functional tools of the websites of four hospitals located in four different countries providing healthcare services to UAE patients. The study presents the results on how they differ in patient-oriented interactive tools on their websites. The four selected hospitals are the leading hospitals who treat UAE patients as international patients. Specific details is describe in the method. The investigation of four best practice cases in hospitals helps us understand the determining factors for the outcomes of patient-oriented interactive e-health tools on hospitals' websites.

In this study, four hospitals' websites were evaluated by using patient-oriented interactive tools. Huang and Chang [7] states that there is a gap between what interactive e-health tool users' desire to see on hospital websites and what is offered in reality. However, there are similarities all four hospitals have in common is that they treat UAE government sponsored patients. Previous research shows how hospitals embraced e-health and applied interactive e-health tools on their websites. Study of Huang and Chang [7] shows how hospitals embraced e-health and applied interactive e-health tools on their websites. Comparing the result of interactive tools among four websites traditional functional tools. Seoul National University Hospitals and Cleveland Clinic contain almost all items of the traditional functional tools. The website engagement model distinguish four level of characteristics of patient engagement [13]. Subsequently, traditional functional tool is the least engaging more of a one-way flow following a brochure-style format. All four hospitals contain more than half of the tools listed in the traditional functional tools. Patient support tools, can refer to ‘The Collaborative Website’ stage which is the third level of the website engagement model [13]. Seoul National University Hospitals and Cleveland Clinic contain all items for patient support tools while Clinique Valmont and Medical Center of the University of Munich lack of such items. The most distinguishing part was found in the emerging functional tool which contains detailed items regarding ER waiting times, interactive cost estimator, site or application for mobile devices. Only Cleveland Clinic contained all items regarding the information above. Patient support tools, can refer to ‘The Empowered & Engaged Website’ stage refers to the forth level of the website engagement model [13]. This level includes fully developed mobile connection and interactive real-time database [13].

Applying interactive e-health tools sets an objective view for e-health strategy and vision for the hospitals conveying information through the website. The use of ‘e-health tools’ will increase the ‘patient engagement’, ‘patient participation’, and ‘patient empowerment’.

First, in the case of ‘patient engagement’ classifying hospital websites indicates how well the websites can engage the patient users. Secondly, in the case of ‘patient participation’ encouraging and drawing website users' participation can empower patients and family members to involve in care [13]. Third, in the case of ‘patient empowerment’ can be effective for patient's user as well as the hospital itself. In the hospital website users' perspective, the tool mentioned in this article can be effective in choosing the hospital's for medical treatment. As interactive e-health tool is informative and simple to use, UAE patients who tend to travel abroad can easily classify information from the website [14]. On the other hand, in the hospitals perspective the e-health tool can assist hospitals in evaluating their current website. Moreover, point out potential shortcomings, and serve as an aid in developing a plan to improve the website to step forward.

In addition to approaching hospitals that implement patient-oriented interactive tools, it is necessary to conduct in-depth interview with hospitals' website developers and the administrators. Out of the four hospitals, only Cleveland Clinic Abu Dhabi relies on its parent's system, while the others mostly rely on their own. An assistant manager in Cleveland Clinic mentioned that, in addition to patients, the target group of the website users included the general public who are interested in health information. Website should attract people seeking for health information and promote mutual communication. An administration officer in the public relations department in Medical Center of the University of Munich mentioned that standardizing the website to match international standards was an issue. An analysis of the opinions of medical staff and understanding consumers' needs are required for successful establishment of the hospital website.

However, this study has some limitations. First, it analyses only a limited number of cases – four websites of hospitals that treat UAE patients. Second, the results could be biased because of a small number of evaluators. Third, the spectrum among the four cases are too wide because the compared group range from clinic to tertiary hospital. Moreover, hospitals are from diverse geographic areas with different cultural background. In previous study, Jeddi et al. [15] mentioned information are among the most important factors affecting the tendency of patients to use a website. Therefore, conducting a study based on a larger sample of hospitals focusing on the factors related to patients could increase the reliability and credibility of the findings.

While there are challenges remaining, the study above shows different methods of approaching hospital's website. The four best-practice hospitals that treat UAE patients were examined above. Applying interactive e-health tools sets an objective view for e-health strategy and vision also for the hospitals conveying information through the website. To support this statement, Huerta et al. [14] conducted a research in 2016 in the United States and found out improving website complying with internet industry standards, specifically optimizing search engine performance can maximize the potential power of the Internet to engage and inform patients. Web-based consumer engagement will eventually improve health information accessibility for patients and website users [14]. Interactive e-health tools can be applied not only for specific countries such as UAE but also for countries with medical system applying ‘Referring Patient Abroad’. Although the contents of this paper is specified to the UAE government referred patients, as the tool is formative and simple to use, Korean medical consumers can also use the interactive e-health tools as a gateway of approaching hospital information.