Document:

<PAGE>   1
                                                                    EXHIBIT 10.9

We have omitted certain portions of this document and filed them separately
with the commission. These portions are marked with an asterisk (*).

                         CONTINUING EDUCATION AGREEMENT
                                     BETWEEN
                                  HEALTH STREAM
                                       AND
                              VANDERBILT UNIVERSITY

This Continuing Education Agreement ("Agreement") is entered into as of July 22,
1999 ("Effective Date") by and between HealthStream, Inc., a Tennessee
corporation with its principal place of business at 209 10th Avenue South, Suite
450, Nashville, TN 37203 ("HealthStream") and Vanderbilt University, a Tennessee
not-for-profit organization with its principal place of business at 201 Light
Hall, Vanderbilt University, Nashville, TN 37240, by and through its School of
Medicine and School of Nursing ("Vanderbilt").

         WHEREAS, HealthStream is a provider of computer and Web-based education
and training services to hospitals and other healthcare organizations;

         WHEREAS, HealthStream is a provider of Continuing Education Units for
healthcare professionals ("CEU") and Continuing Medical Education for physicians
("CME") courseware and courseware management tools delivered via the Internet,
corporate intranets and networks ("HealthStream Sites");

         WHEREAS, HealthStream has an array of distribution partners for CEU and
CME courses and other online educational courseware;

         WHEREAS, current HealthStream distribution partners include AHN.COM and
Phycor, with other relationships pending;

         WHEREAS, HealthStream has an online course library with several hundred
hours of potential CEU and existing CME courseware available for purchase
("HealthStream Courseware");

         WHEREAS, Vanderbilt is recognized internationally as a provider of high
quality education programs;

         WHEREAS, Vanderbilt provides CUE and CME courses in conventional
lecture format that might also be made available for access over the Web;

         WHEREAS, Vanderbilt has the skills, clinical expertise and knowledge
required to create educational Web-based courses for the medical community; and

         WHEREAS, HealthStream and Vanderbilt desire to enter into this
Agreement.

THEREFORE, HEALTHSTREAM AND VANDERBILT HEREBY AGREE AS FOLLOWS:

1        DEFINITIONS

1.1      "CEU Courses" - Those educational courses that have been reviewed for
         continuing education units by an institution recognized by an
         accredited professional organization.

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         Those completing the courses may receive credit toward continuing
         education requirements.

1.2      "CME Courses" - Those educational courses that have been reviewed for
         continuing medical education by an Accreditation Council for Continuing
         Medical Education ("ACCME") accredited institution. Those completing
         the courses may receive credit toward continuing education
         requirements.

1.3      "Net Revenue" - Gross revenue derived by HealthStream from sales of
         Vanderbilt Courseware less discounts and credits to customers.

1.4      "T.NAV(R)" - A registered trademark of HealthStream and is a computer
         based training product that delivers and monitors World Wide Web based
         content.

1.5      "Collaborative Course" - Those courses developed into a Web-based
         format course of study by HealthStream in collaboration with Vanderbilt
         from source materials originating with Vanderbilt or third party
         personnel.

1.6      "Vanderbilt Course" - Medical and nursing courseware and educational
         materials provided by Vanderbilt to HealthStream that have been
         converted to an HTML or other HealthStream recommended Web-based
         Formats that are substantially ready and able to be deployed for the
         purpose of providing Web-based CME or CEU courses through
         HealthStream's T.NAV system on the Internet.

1.7      "Vanderbilt Courseware" - The combined body of Vanderbilt Courses and
         Collaborative Courses submitted to HealthStream under this agreement.

1.8      "Vanderbilt Materials" - Medical and nursing courseware and educational
         materials provided by Vanderbilt to HealthStream, that is substantially
         not in a format that can be transmitted over the Internet for the
         purpose of creating Web-based CME or CEU courses and that may be in
         some or all of the following formats, including, but not limited to:
         paper, film or Microsoft PowerPoint slides, text materials, Microsoft
         Word or Corel Word Perfect-based, handouts, overheads and other
         presentation materials.

1.9      "Third Party Materials" - Those non-Web-based format materials
         delivered to HealthStream from various third party sources that form
         the basis for a course of study.

1.10     "Vanderbilt Pervasive Materials" - Those Vanderbilt Materials whose
         depiction in Collaborative Courses is substantially identical to their
         depiction independent of the Collaborative Course.

1.11     "Third Party Pervasive Materials" - Those Third Party Materials whose
         depiction in Collaborative Courses is substantially identical to their
         depiction independent of the Collaborative Course.

1.12     "HealthStream Packaging" - Those graphic, navigation and computer coded
         elements added to Vanderbilt Materials and/or Third Party Materials to
         comprise a Collaborative Course. HealthStream Packaging is not said to
         include Vanderbilt Pervasive Materials or Third Party Pervasive
         Materials, as these materials are organized and packaged for display
         without substantial modification.

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1.13     "Vanderbilt Certification" - Certification of courses for CEU or CME
         credit by Vanderbilt and branded as Vanderbilt certified courses under
         the auspices of Vanderbilt's arrangements with the ACCME and other
         professional educational quality assurance organizations.

2        TERMS AND CONDITIONS

2.1      Courseware Development. Vanderbilt shall, at its option, develop and
         provide to HealthStream Vanderbilt Courses and/or Vanderbilt Materials,
         which HealthStream will sell to a variety of medical professionals
         (e.g., physicians, nurses, Allied Health professionals) for educational
         credits via online usage at Web sites hosted and/ or managed by
         HealthStream.

         2.1.1.   HealthStream will develop, at its option, the Vanderbilt
                  Materials into Web ready courses.

         2.1.2    All Vanderbilt Courseware will be subject to Vanderbilt
                  editorial board approval prior to distribution by
                  HealthStream. Vanderbilt editorial board approval shall not be
                  unreasonably denied.

         2.1.3    It is the intent of the parties to identify and develop at
                  least ten (10) courses in each year during the term of this
                  agreement.

         2.1.4    HealthStream acknowledges that Vanderbilt anticipates
                  providing CEU and CME in novel ways that use information
                  technology to support various learning styles and distribution
                  of learning across the education-work continuum. This
                  Agreement is intended to apply making conventional CEU and CME
                  material available via the Web, not to those novel education
                  strategies and programs.

2.2      Compensation. HealthStream will pay to Vanderbilt the following
         royalties:

         2.2.1    Collaborative Courses. For Collaborative Courses, HealthStream
                  shall pay to Vanderbilt * of Net Revenue derived from the
                  sales of Collaborative Courses.

         2.2.2    Vanderbilt Courses. For Vanderbilt Courses, HealthStream shall
                  pay to Vanderbilt * of Net Revenue derived from the sales of
                  Vanderbilt Courses. Nothing herein shall require Vanderbilt to
                  produce or deliver to HealthStream, medical courseware.

         2.2.3    Payment Schedule. Royalty payments shall be made by
                  HealthStream to Vanderbilt thirty (30) days after the end of
                  the month of the initial course purchase.

2.3      Access to Courses by Vanderbilt Personnel. HealthStream will allow
         Vanderbilt faculty, fellows, residents, students and staff access to
         its Vanderbilt Courseware free of charge. All other HealthStream
         courseware shall be available for purchase by Vanderbilt faculty,
         fellows, residents and staff. HealthStream will compensate Vanderbilt
         for courseware purchased by Vanderbilt faculty, fellows, residents,
         students and/or staff by means of either one of the following methods,
         at Vanderbilt's option: (i) pay Vanderbilt *

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         * of all Net Revenue for HealthStream Courseware purchased by
         Vanderbilt faculty, fellows, residents, and staff; or (ii) provide
         Vanderbilt faculty, fellows, residents, and staff with a * discount on
         the cost of HealthStream Courseware.

2.4      Reporting. HealthStream will provide Vanderbilt, at no cost to
         Vanderbilt, with monthly reports of all Net Revenue generated from
         Vanderbilt Courseware and all Net Revenue generated from HealthStream
         Courseware purchased by Vanderbilt faculty, staff, fellows, students
         and residents.

2.5      Vanderbilt Consulting. Vanderbilt faculty may elect to develop content
         architecture for HealthStream for the development of online educational
         courses. Should HealthStream elect to utilize this content
         architecture, HealthStream will compensate Vanderbilt for such
         Vanderbilt developed content architecture on a fee-for-service basis,
         to be negotiated on a case-by-case basis. At its sole discretion,
         HealthStream may elect not to utilize Vanderbilt developed content
         architectures.

2.6      Vanderbilt Staff Restrictions. Under no circumstances shall Vanderbilt
         faculty, fellows, residents, students and/or staff author conventional
         CEU and CME courseware with HealthStream personnel or any of
         HealthStream's subsidiaries, outside of this Agreement. HealthStream
         will not be prohibited from contracting with those Vanderbilt
         affiliates who are not closely aligned with Vanderbilt.

2.7      Advertising and Sponsorship Revenues. From time to time, HealthStream
         may generate revenue through the sale of advertising on HealthStream
         Sites.

         2.7.1    Vanderbilt Contracted Advertisements and Sponsorships.
                  HealthStream shall compensate Vanderbilt * of all Net Revenue
                  generated from advertisements sold and contracted by
                  Vanderbilt for Vanderbilt Courseware on HealthStream Sites.
                  Vanderbilt contracted advertising and sponsorship sales will
                  conform to parameters established by HealthStream.

         2.7.2    HealthStream Contracted Advertisements and Sponsorships.
                  HealthStream shall compensate Vanderbilt * of all Net Revenue
                  generated from advertisements sold and contracted by
                  HealthStream for Vanderbilt Courseware.

         2.7.3    Vanderbilt Review. Vanderbilt shall have the right to review
                  and refuse all such advertising associated with Vanderbilt
                  Courseware that is placed on HealthStream Sites.

2.8      Third Party Content. At HealthStream's option, Vanderbilt may review
         and make recommendations to online content originating from other
         sources and Vanderbilt may elect to review said content for accuracy,
         provide recommendations for changes, and provide Vanderbilt
         Certification. HealthStream will compensate Vanderbilt for these
         reviews on a fee-for-service basis negotiated on a case-by-case basis.

2.9      Payment. Royalty payments made by checks shall be made payable to
         Vanderbilt University and sent to Mr. Stephen Todd, Assistant Director,
         Financial Management, P.O. Box 30195, Nashville, TN. 37241-0195. All
         reports required under this Agreement shall be sent to: Mr. Stephen
         Todd, Assistant Director, Financial Management, CC-2102C Medical Center
         North, Nashville, TN.37232-2220.

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2.10     Distribution Partner Approval. HealthStream will remove Vanderbilt
         Courseware from a HealthStream Site upon notification by Vanderbilt.
         Objection to a HealthStream Site by Vanderbilt will be limited to those
         objections based on a reasonable determination that said distribution
         partner is unsuitable to carry the Vanderbilt brand.

3        LICENSE

3.1      In consideration for the above, Vanderbilt grants HealthStream
         worldwide, exclusive Internet rights as the host and marketing agent
         for Collaborative Courses developed with HealthStream during the term
         of this agreement. Vanderbilt grants HealthStream worldwide,
         non-exclusive Internet rights as the host and marketing agent for
         Vanderbilt Courses during the term of this agreement.

3.2      Course Ownership and Copyright. Vanderbilt shall retain all ownership
         and copyright interest for all Vanderbilt Courses. HealthStream and
         Vanderbilt shall have equal ownership and copyright interest for all
         Collaborative Courses. Ownership and copyright interest in Vanderbilt
         Materials components of Collaborative Courses shall rest exclusively
         with Vanderbilt. All copyrights assigned herein shall survive the term
         of this agreement.

4        OTHER CONDITIONS

4.1      Term and Termination.

         4.1.1    The term of this Agreement shall be four (4) years and shall
                  commence on July 22, 1999 and terminate on July 21, 2003.
                  This Agreement may be extended for additional one year terms
                  by mutual written assent signed by the parties hereto.

         4.1.2    If, for any reason, either party fails to satisfactorily
                  fulfill in a timely or proper manner its obligations under
                  this Agreement or breaches any of the promises, terms or
                  conditions of this Agreement, and having been given reasonable
                  notice of and opportunity to cure any such default and not
                  having taken satisfactory corrective action within the time
                  specified by the non-breaching party, the non-breaching party
                  shall have the right to terminate this Agreement by giving
                  written notice to the breaching party of such termination at
                  least fourteen (14) calendar days before the effective date of
                  such termination. Further, either party to this Agreement
                  shall have the right to terminate this Agreement without cause
                  by giving written notice to the other party of such
                  termination at least thirty (30) calendar days before the
                  effective date of such termination. For termination of any
                  type, any other provision to the contrary notwithstanding, the
                  breaching party shall not be relieved of liability to the
                  non-breaching party for damages sustained because of any
                  breach of this Agreement. Fees due under Section 2 and
                  copyright and intellectual property provisions of Section 3
                  survive termination.

         4.1.3    The parties warrant they are duly licensed under the relevant
                  laws of their States and agree to abide by all applicable
                  state and/or federal laws and regulations governing the
                  licensure of its operations. The parties further agree to give

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                  prompt notice in writing to the other party in the event of
                  institution of proceedings for suspension or revocation of its
                  license, and to notify the other party in the event of any
                  suspension or revocation of its license within twenty-four
                  (24) hours of its occurrence. This Agreement will immediately
                  terminate upon the revocation or suspension of licensure of
                  either party. Further, either party, at its sole discretion,
                  may terminate this Agreement in the event the other party is
                  given official notice of the institution of proceedings to
                  suspend or revoke its licensure.

         4.1.4    In the event that either party shall become insolvent or make
                  a general assignment for the benefit of creditors, then, at
                  the option of either party, this Agreement may be terminated
                  immediately by either party and be of no further force and
                  effect upon notice of such termination.

         4.1.5    In the event that either party sells all or substantially all
                  of its assets, there is a sale of a majority ownership of
                  either party, or there occurs a material change in the
                  management or ownership of either party, this Agreement shall
                  terminate or continue at the mutual written consent of the
                  remaining parties.

4.2      Indemnification

         4.2.1    HealthStream warrants that its performance of this agreement
                  will not violate or infringe upon the rights of third parties,
                  including but not limited to property, contractual,
                  employment, trade secret, proprietary information and
                  non-disclosure rights, or any United States trademark,
                  copyright or patent right. HealthStream will, at its own
                  expense, defend any suit or proceeding brought against
                  Vanderbilt based on a claim that the HealthStream Packaging
                  infringe upon any copyright, patent, trademark, trade secret,
                  or other intellectual property right, provided that
                  HealthStream is notified promptly in writing and given full
                  and complete authority, information and assistance for the
                  defense of such suit or proceeding. HealthStream may, at its
                  option and expense, either obtain for Vanderbilt the right to
                  continue using the Vanderbilt Courseware containing said
                  HealthStream Packaging free of any claim of infringement or
                  modify such HealthStream Packaging so that affected Vanderbilt
                  Courseware is not subject to a claim of infringement.

         4.2.2    Vanderbilt warrants that its performance of this agreement
                  will not violate or infringe upon the rights of third parties,
                  including but not limited to property, contractual,
                  employment, trade secret, proprietary information and
                  non-disclosure rights, or any United States trademark,
                  copyright or patent right. Vanderbilt will, at its own
                  expense, defend any suit or proceeding brought against
                  HealthStream based on a claim that the Vanderbilt Materials
                  infringe upon any copyright, patent, trademark, trade secret,
                  or other intellectual property right, provided that Vanderbilt
                  is notified promptly in writing and given full and complete
                  authority, information and assistance for the defense of such
                  suit or proceeding. Vanderbilt may, at its option and expense,
                  either obtain for HealthStream

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                  the right to continue offering Vanderbilt Courseware
                  containing said Vanderbilt Materials free of any claim of
                  infringement or modify such Vanderbilt Materials so that
                  affected Vanderbilt Courseware is not subject to a claim of
                  infringement.

4.3      Insurance

         4.3.1    Both parties shall maintain for the term of this Agreement
                  comprehensive general liability insurance, including broad
                  form contractual in a minimum amount of $1,000,000/$3,000,000.
                  The coverage shall bear an endorsement precluding cancellation
                  or reduction of coverage.

         4.3.2    Both parties shall procure and maintain for the term of this
                  Agreement professional liability insurance, in a minimum
                  amount of $1,000,000/$3,000,000 in coverage for all of its
                  personnel who may participate in this Agreement. Such coverage
                  shall be for a minimum of five (5) years following expiration
                  or termination of this Agreement and shall provide for a
                  retroactive date no later than the inception date of this
                  Agreement.

         4.3.3    Each party shall provide the other party with Certificates of
                  Insurance evidencing the above coverage. The coverage shall
                  bear an endorsement precluding cancellation or reduction of
                  coverage.

4.4      Notices. All notices or other communication provided for in this
         Agreement shall be given to the parties addressed as follows:

         HealthStream:      Mr. Jeff McLaren
                            President
                            HealthStream, Inc.
                            209 10th Ave S, Suite 450
                            Nashville, TN 37203

         with a copy to:    Mr. Robert Laird
                            Vice President and General Counsel
                            HealthStream, Inc.
                            209 10th Ave S, Suite 450
                            Nashville, TN 37203

          Vanderbilt:       Mr. Winfred Cox
                            Director of Finance and Administration
                            School of Medicine
                            Vanderbilt University
                            CCC-3315 Medical Center North
                            Nashville, TN 37232-2104

         with a copy to:    Contracts Administration
                            Medical Center Office
                            Vanderbilt University
                            605 Oxford House
                            1313 21st Avenue South
                            Nashville, TN  37232-4205

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<PAGE>   8

4.5      Media. Each party agrees it will not use the other party's name, marks,
         or logos in any advertising, promotional material, press release,
         publication, public announcement, or through other media, written or
         oral, whether to the press, to holders of publicly owned stock without
         the prior written consent of the other party. Such consent shall not be
         unreasonably withheld or delayed. Accurate statements made by either
         party as to the basic terms of this Agreement are said to have the
         consent of the other party.

4.6      Assignment and Binding Effect. Neither party shall assign, subcontract,
         or transfer any of its rights or obligations under this Agreement to a
         third party without the prior written consent of the other party. If an
         assignment, subcontract, or transfer of rights does occur in accordance
         with this Agreement, this Agreement shall be binding upon and inure to
         the benefit of the parties hereto and their respective successors or
         assigns.

4.7      Independent Contractor. Each party shall be considered to be an
         independent contractor and shall not be construed to be an agent or
         representative of the other party, and therefore, shall have no
         liability for the acts or omissions of the other party. In addition,
         neither party, nor any of its employees, agents, or subcontractors,
         shall be deemed to be employees or agents of the other party.
         Therefore, neither party nor any of its employees, agents or
         subcontractors, shall be entitled to salary, workers compensation, or
         employee benefits of the other party by virtue of this Agreement.

4.8      Written Amendments and Waiver. This Agreement cannot be amended,
         modified, supplemented or rescinded except in writing signed by the
         parties hereto.

4.9      Governing Law and Jurisdiction. This Agreement shall be governed in all
         respects by, and be construed in accordance with, the laws of the State
         of Tennessee. Each party hereby consents to the jurisdiction of all
         state and federal courts situated in Davidson County, Tennessee, agrees
         that venue for any such action shall lie exclusively in such courts,
         and agrees that such courts shall be the exclusive forum for any legal
         actions brought in connection with this Agreement or the relationships
         among the parties hereto.

4.10     Year 2000 Compliance. HealthStream certifies that it has a
         comprehensive plan designed to achieve Year 2000 Compliance of its
         systems ("Compliance Plan"). To the extent the Compliance Plan provides
         or anticipates that any systems of HealthStream will not be made Year
         2000 Compliant, such non-compliance will have no material adverse
         effect upon the timely provision of the services. For purposes of this
         section, "Year 2000 Compliance" and "Year 2000 Compliant" shall mean
         that HealthStream systems, when used in accordance with its associated
         documentation, will be capable of accurately processing, providing
         and/or receiving electronic data that contain date representation from,
         into, and between the years 1999 and 2000 and leap year calculations.
         To the best of HealthStream's knowledge at the time of signing this
         Agreement, there shall be no material adverse effect upon its timely
         provision of services under this Agreement which is attributable to its
         failure to achieve Year 2000 Compliance for all of its systems.

4.11     Entire Agreement. This Agreement constitutes the entire agreement
         between the parties hereto with respect to the subject matter herein
         and supersedes any other agreements, restrictions, representations, or
         warranties, if any, between the parties hereto with regard to the
         subject matter herein.

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<PAGE>   9
         restrictions, representations, or warranties, if any, between the
         parties hereto with regard to the subject matter herein.

4.12     Severability. If any provision of this Agreement shall be held by a
         court of competent jurisdiction to be illegal, invalid, or
         unenforceable, the remaining provisions shall remain in full force and
         effect. If this Agreement as it relates to any product(s) licensed
         hereunder shall be held by a court of competent jurisdiction to be
         invalid, illegal, or unenforceable or if this Agreement is terminated
         as to particular product(s), this Agreement shall remain in full force
         and effect as to the remaining product(s).

4.13     No Waiver. No waiver of any breach of any provision of this Agreement
         shall constitute a waiver of any prior, concurrent or subsequent breach
         of the same or any other provisions hereof, and no waiver shall be
         effective unless made in writing and signed by an authorized
         representative of the waiving party.

4.14     Headings. The Article headings used in this Agreement and the attached
         Exhibits are is intended for convenience only and shall not be deemed
         to supersede or modify any provisions.

IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed
by their duly authorized representatives and thereby become effective on the
date specified above.

FOR HEALTHSTREAM

/s/ Jeff McLaren                                            7/22/99
---------------------------------------------          -------------------
Jeff McLaren, President                                     Date
HealthStream, Inc.

FOR VANDERBILT UNIVERSITY

/s/ Winfred L. Cox                                         7/19/99
---------------------------------------------          -------------------
Winfred L. Cox                                              Date
Director of Finance & Administration

/s/ Norman B. Urmy                                        7/19/99
---------------------------------------------          -------------------
Norman B. Urmy                                              Date
Executive Vice President for Clinical Affairs

                                                                     Page 9 of 9<PAGE>   1
                                                                   EXHIBIT 10.10
                                                             (HEALTHSTREAM LOGO)

We have omitted certain portions of this document and filed them separately with
the Commission. These portions are marked with an asterisk (*).

SUMMARY TERM SHEET FOR
DUKE UNIVERSITY MEDICAL CENTER
--------------------------------------------------------------------------------

<TABLE>
<S>                           <C>
Executive Summary             Duke University Medical Center ("DUMC") and
                              HealthStream seek to enter into a global
                              partnership arrangement to accomplish a broad base
                              of business opportunities. To accomplish this, a
                              contract will be written identifying broad rules
                              and parameters for this partnership that faculty
                              can work within. Modifications needed on a project
                              by project basis may be made through work plan
                              addenda specific to individual projects.
                              Otherwise, faculty and HealthStream will work
                              within the parameters laid out in this document.

--------------------------------------------------------------------------------

Fee for Service Projects      From time to time, Faculty and staff at DUMC have
                              need for work-for-hire and fee for service
A) Best Pricing               multimedia projects including but not limited to
                              Web sites, CD ROM creation, data base applications
B) Guarantees                 and development of online training courses.
                              HealthStream seeks to the preferred vendor to the
C) Publicizing                DUMC Faculty and staff for these projects.
   vendor status
                              In consideration of this designation, HealthStream
                              will provide DUMC with hourly pricing
                              significantly below HealthStream's normal fees
                              (see attached). Pricing assumes a significant
                              increase in projects in the next 12 months.

                              Preferred vendor status does not guarantee
                              HealthStream the work. Faculty members may utilize
                              other vendors to achieve lower cost pricing or for
                              work out of scope of HealthStream capabilities.

                              DUMC will be responsible for publicizing this
                              designation of HealthStream through general press
                              releases, newsletters, and other formal publicity
                              means of reaching DUMC faculty. HealthStream
                              provides regular visits to the DUMC campus to meet
                              with faculty interested in this opportunity.

--------------------------------------------------------------------------------

Marketing                     HealthStream will provide up to $* in internal
                              marketing on the DUMC campus to publicize
                              HealthStream's products and services to DUMC
                              physicians, faculty and staff.

                              HealthStream will provide up to $* in external
                              marketing of this new partnership.
</TABLE>

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Confidential         HealthStream/Duke University Medical Center        03/22/00

<PAGE>   2

<TABLE>
<S>                           <C>
--------------------------------------------------------------------------------

Proprietary CME               As part of this global partnership, DUMC will
Gateway/Distribution          utilize HealthStream's CME delivery system and
                              courses as its' online CME platform. Links to
                              HealthStream's site will be provided at
                              http://www2.mc.duke.edu/depts/som/docme/welcomeframe.html.
                              A unique, personalized gateway page will be
                              created for DUMC by HealthStream at no charge to
                              ensure visitors recognize this effort as a DUMC
                              product.

--------------------------------------------------------------------------------

--------------------------------------------------------------------------------

Content Development           To assist in this transition, HealthStream will
                              provide the technology and development services to
A) Live Lecture to            capture 30 live lectures, like those delineated at
   Online Courses             http://www2.mc.duke.edu/depts/som/docme/welcomeframe.html
                              (Duke CME Offerings) at no cost to DUMC. Examples
B) Didactic Courses           of how live lectures can be captured and put into
                              an online format can be seen at
                              http://cme.silverplatter.com/. SilverPlatter
                              Education was acquired by HealthStream in July
                              '99. Those products and services are provided out
                              of HealthStream's Boston office. These products
                              are provided free of charge to the physician
                              community and are underwritten by pharmaceutical
                              and medical device companies. Therefore royalty
                              payments will be based upon advertising revenues
                              received.

                              HealthStream is also interested in the development
                              of didactic courses with DUMC faculty. All courses
                              developed shall be sold through the HealthStream
                              partner web sites and royalties applied as
                              indicated below.

--------------------------------------------------------------------------------

Site Advertising              Advertising and course sponsorship is available
                              within the training site. DUMC and HealthStream
A) Revenue Sharing            shall share in all advertising revenues through
                              the DUMC proprietary site in accordance with the
                              royalty fee schedule. DUMC may offer this
                              advertising opportunity to their vendors and
                              partners. HealthStream will provide the business
                              package and contracting around the execution of
                              these advertising arrangements.
</TABLE>

--------------------------------------------------------------------------------
Confidential         HealthStream/Duke University Medical Center        03/22/00

<PAGE>   3

<TABLE>
<S>                           <C>
Ownership                     DUMC shall retain ownership of the DUMC CME
                              Courses licensed and created under this agreement.
                              HealthStream retains ownership of the Training
                              Navigator(R) system.

--------------------------------------------------------------------------------

Distribution                  HealthStream will provide distribution of the DUMC
                              CME Courses through HealthStream's current and
                              future Internet and intranet distribution
                              channels.

                              DUMC will provide distribution of DUMC and
                              HealthStream's CME Courses through DUMC's web site
                              (see above).

--------------------------------------------------------------------------------

Exclusivity                   For all content authored by DUMC, HealthStream
                              retains the exclusive rights to distribute this
                              content on the Web for the duration of this
                              Agreement.

--------------------------------------------------------------------------------

Pricing                       HealthStream courses range in price, but currently
                              average approximately $10 per credit hour. DUMC
                              Faculty and HealthStream will work together to
                              determine appropriate pricing for each new course
                              developed.

--------------------------------------------------------------------------------

Distribution Fees             As a distribution partner, DUMC shall receive *%
                              of all CME course purchases through the DUMC
                              gateway site.

--------------------------------------------------------------------------------

Revenue Sharing Projects      HealthStream seeks to create, and DUMC seeks to
                              utilize HealthStream to build, projects and
A) CME Courses &              products with long term revenue potential. These
   Projects with              projects can be designated as one of two types:
   advanced fees

B) CME Courses &              A) Projects with advanced fees: In certain cases,
   Projects with              DUMC will pay to HealthStream development fees as
   no advanced fees           part of a revenue sharing project. These fees will
                              cover some or all of HealthStream's development
                              costs. When HealthStream's development fees are
                              covered, HealthStream will provide royalties back
                              to DUMC of *% of net revenues for sale of the
                              products.

                              B) Projects with no advanced fees: In certain
                              cases, HealthStream will receive no fees in
                              advance for project development. HealthStream will
                              provide its' development as part of an equity
                              stake in the product. In these situations,
                              HealthStream will provide royalties back to DUMC
                              of *% of net revenues for sale of the product.
                              Royalties will increase to *% after HealthStream
                              has recovered its' development fees. Development
                              fees will be identified at the start of the
                              project.
</TABLE>

--------------------------------------------------------------------------------
Confidential         HealthStream/Duke University Medical Center        03/22/00

<PAGE>   4

<TABLE>
<S>                           <C>
HealthStream                  As part of this Agreement, HealthStream agrees to
Sponsored Faculty             sponsor a faculty position to provide leadership
                              to the online education efforts between DUMC and
                              HealthStream. HealthStream agrees to provide a
                              maximum of $* for one year towards this
                              effort. A job description will be provided by
                              HealthStream at a later date. This position may be
                              renewed for subsequent years by HealthStream after
                              an evaluation of its' success at the end of the
                              first year.

Agreement Term                Thirty-six (36) months from signing;
                              automatically renewed for one-year periods unless
                              notification by either party provided forty-five
                              (45) days in advance.
</TABLE>

Fee for Service Development Fees

<TABLE>
<CAPTION>
Function             Usual and Customary Fees/Hour     DUMC
Fees
<S>                  <C>                              <C>

Programming                     *                      *
Development                     *                      *
Quality Assurance               *                      *
</TABLE>

Agreed to by:                            Agreed to by:

/s/ Robert Taber                         /s/ Robert A. Frist, Jr.
-----------------------------------      ---------------------------------------
Robert Taber, Ph.D.                      Robert Frist
Duke University Medical Center           HealthStream

-----------------------------------
Gordon Williams
Duke University Medical Center
10/25/99                                 10/26/99
-----------------------------------      ---------------------------------------
Date                                     Date

--------------------------------------------------------------------------------
Confidential         HealthStream/Duke University Medical Center        03/22/00

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