Developing a website for your practice

Think of the number of times you, your family and friends access the Internet. You use the Web to make travel arrangements, make purchases, download music, share information with friends and relatives and find information on topics that interest you.

Yet many medical practices have yet to establish a presence on the Web. If your patients are online, why aren't you?

Neil Baum, MD, author of Marketing Your Clinical Practice, writes, "Your website might be the first impression your patient has of your practice, the way you treat patients, and your attention to detail. If you have built a user-friendly, interactive website, this becomes a way to build trust and enhance the patient-physician relationship."

The purpose of this article is to remove the mystery from website development. It addresses the following topics: types of practice websites, setting goals, selecting a vendor, developing content material, tips for getting noticed and methods for monitoring site traffic.

Practice website basics
Many medical practices regard their websites as a second door to their offices that also offers improvements in efficiency, cost savings, increased visibility and improvements in revenue cycle management.

Depending on the capabilities you choose to offer through a website, you can provide basic information to all users and also give current patients the ability to use the website for both administrative and clinical functions. This interactive feature, called a patient portal, allows patients to request appointments and prescription refills and view lab and other test results. They may download forms and
either return them to the practice electronically or bring them to their next appointment. They may pay bills online, receive email reminders about appointments and preventive care, and access health information. Now that payers such as Blue Cross Blue Shield of North Carolina are reimbursing physicians for electronic or "e-visits," physicians may be paid for providing online advice to existing patients, subject to planspecific requirements.

Prospective patients can use your website to learn about the services that you provide and about your practitioners and administrative staff. Patient testimonials can tell them how other patients perceive your practice. Referring physicians can see what care you provide and what insurance you accept.

Setting up and maintaining a website takes time and money. The cost, however, may be less expensive than advertising in the Yellow Pages, which, let's face it, doesn't produce the results it once did now that people have the Internet. These days, patients' fingers are more likely to walk across the computer keyboard than through a cumbersome paper phone book.

Set your goals
If you're interested in establishing a practice website, start by setting goals. Look at the sites of other practices in your specialty and in your community. Some provide information only. Other websites function as interactive patient portals, but are significantly more costly to establish. Decide what's right for your practice before you make decisions about budget, vendors and site content.

If you are happy with your existing practice logo and printed brochures, they may be a good jumping off point for your website's look and feel.

When I opened Satinsky Consulting in 2002, I started with my logo and print materials and created a website that was consistent with them. I wanted to reinforce a clear and simple message with repetition. Three different people collaborated on the design, content editing and programming of my corporate website.

Some experts argue that the Web is a totally different medium and recommend starting fresh with the help of an experienced Web developer. "Some of the advantages of starting with Web design include selecting colors that reproduce well both on the Web and in print," said Alice Saunders of Finishing Software. "The implications of vertical and horizontal logos and taglines on the masthead of a website differ from print material, since space may be more limited." Information that has been specifically written and organized for the Web sometimes produces better copy for print material as well, Saunders said.

Who will build the site?
Some practices may have the in-house expertise to create and maintain a website, but most medical practices prefer to outsource the job to one or more vendors with proven skills and track records of developing attractive, functional sites for their clients.

If your practice uses a marketing consultant, he or she can likely recommend a Web developer and help you with decisions about how to proceed. If you want to go directly to Web vendors, go with the knowledge of what you need and communicate your requirements clearly.

Whatever your preference, you need website design, content editing and programming -- three different skills. Some Web design companies do everything, but others do not. In such cases you will need a team of people with complementary skills. Vendors who do not provide the full range of services you require should be able to recommend additional expertise to get the job done. Experienced vendors likely will have established partners who work with them.

Selecting a vendor
Before you select outside help, look at other websites. What look do you like? Do you want videos, case studies, a before/after photo gallery or other enhancements? Try navigating around websites you like to see how information is organized and displayed. In some cases you can find the name of the Web developer on the bottom of the home page. Contact colleagues and professional associations
whose sites you admire and ask for their suggestions.

In my experience, there are good reasons to select a vendor that specializes in creating websites for medical practices. Examples are Medfusion, Early Design Group and Mednet Technologies . These companies know the medical practice industry and the unique requirements of certain specialties. Partnership arrangements often give them the capability to integrate their patient portal right into other products such as practice management systems (PMS) or electronic health records (EHR).

An effective way to get comparable bids is to develop a concise but thorough Request for Proposal (RFP). Please see the accompanying box (below) for a list of the areas that a good RFP should cover.

Developing content material
Presumably you have looked at other websites before you began your own project and have some idea of the topics that you want to cover on your own site. At the very least, you will want visitors to your website to learn:

• Who you are (name, mission, goals)


• How to contact your office (phone, fax, email)


• How to find your office (driving directions, map, parking)


• Hours when your office is open


• Availability of appointments and walk-ins


• Who provides clinical and administrative services (pictures and biographical information on physicians, other clinical staff, key administrative staff)


• What services you provide (names and brief descriptions)


• What insurance plans you accept


• Information on medical conditions that you frequently treat


• Link to your practice newsletter if you have one


• Current news on you and your practice


• How you comply with HIPAA (download Notice of Privacy Practices)

Tips for getting noticed
Setting up your website is only half the challenge. Once it's up and running, you want to make sure that people access it. Here are suggestions for maximizing Web traffic:

• Include your website address on all correspondence, including but not limited to letters, postcards and bills.


• Post signs in your office encouraging patients to use your website.


• Put a computer with access to your website (but not Internet shopping) in your waiting room so patients can explore your website while they are waiting to be seen.


• Involve your patients in website promotion by asking for suggestions and offering prizes for ideas that you select.


• Create and customize listings in online directories and phone books. For example, the Google Maps local business listings appear in Google searches, making them very valuable.


• All links back to your website will improve your search rank, so create listings for your website wherever people look for services online. For example, maintain listings with Yahoo, Superpages, Merchant Circle, HealthGrades and Vitals.


• Encourage patients to write reviews in Google Maps listings and other directories.


• Update your site regularly. Google can determine the last time you updated your site. If your site is "stale," your search ranking will suffer.

Conclusion
So what's the right type of website for your practice? Do you even need one at all? How will you accomplish the project? The decision is up to you!


The author wishes to thank: Robert G. Jones, MD, Impact Orthopaedics; Lynette Mutter, Business Development, Talon for Healthcare; Manish Patel, Avance Care; Vikas Patel, MD, North Carolina Dermatology Associates; Richard Pedersen, Medfusion; Don Rosenblitt, MD, The Lucy Daniels Center for Early Childhood; and Alice Saunders, Finishing Software.

References
Baum, N. and Kenkel, G. (2004). Marketing Your Medical Practice. Sudbury, MA, Jones and Bartlett Publishers.
Brown, P.A. (2008) "Website as Online Patient Service Center and Strategic Investment." Group Practice Journal, October, pages 44-48.
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HARNESSING THE POWER OF THE WEB: WHAT OTHERS HAVE DONE

IMPACT ORTHOPAEDICS
Dr. Rob Jones opened Impact Orthopaedics in Raleigh in mid-2008. His website, www.impactorthopaedics.com, contains comprehensive information about the services that he provides and about the background and experience of both clinical and administrative staff. Right now, patients can download financial policies, a Notice of Privacy Practices and forms to fill out prior to their appointments. The patient portal aspect of the site gives Dr. Jones the flexibility to add additional interactive features at a later date should he decide to do so.

NC DERMATOLOGY ASSOCIATES
Dr. Vikas Patel opened his new dermatology practice in March 2009. His website, www.ncdaskin.com, offers basic information and downloads. Dr. Patel plans to add a patient portal that will integrate into his EHR system. With the portal, patients will be able to pre-register prior to their visit, thus eliminating paper registration. Dr. Patel used a freelance Web designer to help with design. Two features are built into Dr. Patel's site. One is Search Engine Optimization (defined in RFP box below) and the second is a Web analytic tool that provides information to help the practice understand user behavior.

AVANCE CARE
Avance Care is a paperless primary care practice with one site in Morrisville and plans to expand to two other locations. Information technology has been a priority since day one. Patients can go to www.avancecare.com and click on quick links that take them to new patient registration and appointment requests, established patient appointments and an online patient satisfaction survey. Other sections of the home page offer health information and a live (i.e. on-line) chat with the receptionist to discuss appointments, walk-in policies and waiting time. The results of the patient satisfaction survey, which are very positive, are posted right on the site. Avance Care believes the features on its website help the practice keep its overhead low and manage more efficiently.

BLUE RIDGE FAMILY PHYSICIANS
Blue Ridge Family Physicians in Raleigh had a dilemma. Patients were calling on the phone and waiting on hold for as long as thirty minutes to make appointments, request prescription refills and take care of other administrative matters. With ten providers, the practice struggled with an inefficient front office and with billing and clinical processes that had a negative impact on patient communication. Patient complaints skyrocketed, and the practice realized it needed to address all of these problems.

The practice was already well on its way to becoming a paperless practice. In 2002, it had implemented an electronic medical record system (EHR), and it had a practice website that was up and running. It sought a solution that would blend well with its other investments. Working with Medfusion in Raleigh, the practice added a patient portal to its existing website. Once patients had the ability to request appointments, pay bills, pre-register, submit health forms and renew and refill prescriptions, the telephone problem abated. The practice saved money on postage, paper and printing. Patients and staff love the new features. In fact, the practice involved both groups in contests to come up with ideas to market the new website to patients.
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Finding the right Web vendor(s): a good RFP can help
A thorough Request for Proposal can help a practice clearly state its goals for a website and help select a vendor capable of delivering the results you want. Thanks to the Foundation of the Lucy Daniels Center for Early Childhood in Cary, which shared the basic framework it used for its RFP.

• Project summary


• Proposal Guidelines and Requirements (e.g. open and competitive process, deadline for receipt, fixed price, willingness to incorporate elements of Proposal into final agreement)
  Length of the Contract Term


• Purpose, Description, and Objectives (what you want to accomplish)


• Description of website that you want (e.g. flexibility, informative, easy to maintain, safe and secure, quick loading)
  Internet Objective (e.g. create brand identity)


• Specific Strategies and Required Functionality (e.g. focus on existing and/or potential patients, resource for referring physicians, provision of downloadable administrative tools/forms, encourage patient
  communication with practice)


• Maintenance Strategy Will you or the vendor provide updates and how extensive and frequent do you expect them to be?


• Miscellaneous Related Services How will you acquire a domain name and who will be responsible for this task? How does the vendor handle Web hosting and is the hosting service HIPAA compliant? How will email be sent through the site? Who will provide technical support? What Search Engine Optimization* or Search Engine Marketing** strategy does the vendor propose?


• Design Preferences (e.g. look and feel, additional features such as photography or video)


• Technical Specifications What software or programming language will the vendor use to create the site? How will site traffic be tracked and analyzed***? Who will host the site ****and who will provide technical support if the site crashes?


• Timeline for completion


• Pricing Terms Ask the vendor to itemize pricing for various services. (e.g. acquiring domain name, hosting, design, customization, video and other special features, content management if you are not doing it yourself, monthly maintenance, price per click for some items, etc.) If the vendor offers different levels of service, request a pricing range and recommendation for the level appropriate for your organization.


• Payment Terms How much money is due up front? How is billing done once the project is underway (weekly or monthly, based on completion of project milestones)? If the vendor will provide ongoing maintenance,how will you be billed once the project is done?


• Asset Ownership Who owns the assets, such as logos and images, at the initial project completion? In what format will the vendor need these assets? What, if any, proprietary tools and techniques are being used and are essential for further development and maintenance of the site? What are the license fees for these tools and techniques and who is responsible for paying them going forward?


• Evaluation Criteria How you will measure the vendor's responsiveness to your needs

Cheat sheet for Web development lingo
*Search Engine Optimization (SEO) is a means of ensuring that the content of your site gets optimal visibility on the Web. For example, if you were a general surgeon practicing in Hickory, you would want to make sure that your practice name comes to the top of the list when people type in Hickory surgeon on Google, Yahoo and other search engines. SEO can make that happen, so ask vendors for examples of ongoing or previous SEO projects so you know how they work.

**Search Engine Marketing (SEM) is related to SEO but extends into the realm of paid advertising in the search engines. Advertising is one way to ensure that your listing appears above others, but it can be costly if there is a lot of competition in your community.

***Tracking and analytics refers to systems that allow you to get as much information as possible about your website users. For example, Google Analytics lets you measure Web traffic, path analysis, visitor trends, page views, entry pages, top pages, exit pages, length of stay per page and what browsers and platforms visitors use. These metrics can help you make changes in both design and content.

****Web hosting is a service that lets individuals and organizations make a website accessible via the World Wide Web. If your vendor provides this service, ask how frequently the server is backed up and how frequently you can expect your site to be down or disrupted because of maintenance. Who will provide technical support and security? Health care practices will want to know if the hosting vendor/company is HIPAA compliant.

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