The use of public key infrastructure (PKI) and digital certificates is slowly gaining ground as the concept of legitimate internet business takes hold in the public mind. Interestingly, the use of the new secure online e-commerce systems is already starting to broaden out from the confines of big business, such as government, finance and corporates.

One small Melbourne business called eClinic, which has a staff of 10, is pioneering the use of PKI and digital certificates to deliver pathology results and drug samples to doctors online. The business now services about 860 doctors with pathology results online, up from 200 in March this year. The system was launched in a trial phase in December 2000, and the website went live in January this year. The site is located at www.eclinic.com.au

As an aggregator of medical services, mainly for doctors in Victoria and South Australia, eClinic has so far delivered in total about 400,000 medical results electronically, and the volume is currently running at about 75,000 per month, according to co-founder Saurabh Mishra. The doctors who receive the results are all users of the Gribbles Group pathology laboratories, which has marketed the concept to about 8,000 of them.

Mishra says another 115 doctors are also registered with the service to receive drug samples from four pharmaceutical companies which have agreed to fill orders for a limited range of drug samples through the eClinic website.

Convincing doctors to use the service when sensitive privacy issues are paramount in terms of confidential medical records is a major hurdle in the e-health area, Mishra says. "The first question we get asked is how is the info protected?" he says. "So we've got to use a best of breed solution, so we can say: 'This is as good as it gets.'

"But it's not so much the technical issue, it is perception that is the biggest hurdle. So using PKI has made a lot of difference to doctors' perceptions."

Mishra says the rollout of digital certificates free of charge to doctors was expensive but worthwhile. "eClinic right now has the most extensive PKI customer base of any health organisation at the moment. That's a pretty big achievement for us.

"The 860 doctors interface with us using a digital certificate that we've issued to them. That number compares very favourably with any other organisation or peer in Australia."

Mishra says the PKI investment was significant. "There is a barrier to investment in all of this and it is the front investment on the PKI. It costs a lot to come in and try rolling out certificates to a large number of doctors. But to us, it is a cost of doing business. "PKI was a very good bet. It was expensive to implement, it certainly wasn't the cheapest thing to buy and roll out. But I would do it again if I needed to."

Partner eSign is developer and manager of the PKI system adopted by eClinic. eClinic and Gribbles have had to upgrade the internet browsers used by some doctors to versions that support 128-bit encryption and digital certificates.

eClinic also simplified the registration and installation process, so that participating doctors could have a choice of installing the digital certificate themselves, in a process of about half a dozen steps, or having a representative from Gribbles come to their practice and do it for them.

For doctors who do not have computers or internet access, or need to upgrade their systems, eClinic has established deals with IBM (for hardware) and Optus (for ISP services) to offer competitive rates to clients.

The eClinic website cost between $750,000 and $1 million to set up, according to Mishra.

About $2 million in funding has been raised so far, from venture capital firm Capital Creation in May 2000.

More Funding Needed

"We're actually now going around and looking for the next round of funding, another $1 million," says Mishra. "That will more than likely get us past the break-even point, which we expect sometime next year."

The idea for eClinic was conceived in 1999 by Sanjiv Puri, Mishra's fellow co-founder and executive director. Puri then worked for Gribbles and he had the idea of delivering results to doctors electronically.

Puri approached Mishra, who was then working as an e-business consultant for IBM.

"We both worked out that the idea of pathology results online alone was not going to set the world on fire," says Mishra. "It had to be a broader offering than that. So we did a lot of research, asked a lot of doctors what kind of online services they would like to receive and put together a package of services."

He says the concept is to be expanded to more doctors nationally, to other countries, to other pathology and drug firms and possibly to the delivery of other services, such as prescriptions online, so that patients do not have to wait for their orders to be filled when they visit the pharmacist but just pick them up immediately.

Another new service is to be launched by eClinic this month, called MYREP. It is an extension of eClinic's drug sample ordering system, where doctors will be able to expand their ordering to more interactive and content features from drug companies, such as clinical papers.

Overseas expansion is also on the horizon for the near future. "With Gribbles, the huge positive for us is that they have operations in an increasing number of overseas countries, such as Malaysia and soon in India. They are going to look at us to do things there, so that's a very, very good international expansion opportunity."

Mishra says eClinic has three or four smaller independent competitors in Australia and New Zealand, plus other large medical aggregators such as Mayne Nickless to contend with.

"It has been a very tough environment in which to run a small business," he says. "I'm looking forward to breaking even."