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Healthcare services are available online from a hospital's website, which greatly enhances their efficiency and facilitates patients' interaction. Nevertheless, questions persist about the adequacy of hospital websites in meeting established criteria for effective online healthcare delivery. Hospital Online Service Index (HOSPI) is an evaluation methodology that provides a sound bedrock in the effort to standardize and expedite hospitals' website evaluation, based on four criteria: Technology Features, Content, Services, and Community Interaction. This study thoroughly examines and evaluates 159 hospital websites in Ecuador, highlighting their strengths and weaknesses. The results demonstrate that Ecuadorian websites are still in a primitive status providing only basic content and technological capabilities. They display significant deficiencies in the areas of patient care, online appointments, administration procedures, quality metrics, participation features, and media support. Furthermore, the output of the study can also be used by the research community to improve and apply the methodology in other countries and to promote the health community evaluation standards development.