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As published in
Dermatology Business Management
written by
Aaron Dalton
Dermatology Associates of Kentucky has had a website since 1997, long before many other practices had gone online. In 2002, the practice won a Golden Triangle award from the AAD for its website. Dr. Davey spoke with DBM about the lessons he’s learned over the last seven years on the Net and the ways he hopes to make his practice’s website even better in the years to come.
- Having a site since 1997 is quite farsighted of your group! What made your practice decide to create a site so long ago? What was the site like back then and what are some major ways in which it has evolved since?
I decided back in 1997 that our practice should have an Internet site because I believed everyone would have to have such a site within five years. As it turns out, I was incorrect, because everyone does not even have one now.
Nonetheless, the Internet site has proved its worth as another way to market the practice. You can use a newsletter to market your practice or do interviews on TV, radio and in newspapers, and you can have an Internet site to complement or substitute for these other avenues.
Our first site was primarily a "brochure site" – we took brochures that we would ordinarily hand out in our practice and we put these brochures on the Internet. Most of the content was – and still is – Word files that were transferred into HTML. We used a couple of different programs – Front Page and Dreamweaver – to put the content on the Web. And we hired a group of individuals from the University of Kentucky’s arts and graphics department (both students and employees) to help us with the programming and design of the site. We got lucky with our original site because these people did such a wonderful job with our site design that we still use some elements from the original site in the site that exists today.
We still have a piece of animation on our site that this original team designed for us. They had designed a Mohs brochure for us and we just asked them to animate the brochure. As a clinical professor at the university, I clearly had the advantage of having access to the university’s resources.
The major change between the first and second versions of the site was really the way in which the site was designed. We worked to make the site flow more easily for visitors seeking specific pieces of information.
Also in the interests of helping visitors to locate information as quickly as possible, we added a search function to the second version of the site. A third-party provider called Atomz (www.atomz.com) handles this search function at no cost to our practice.
- What are your plans for the third overhaul of the site? What are your plans for audio/video with the next version of the site? Are you at all worried about people with narrow bandwidth or old media players being unable to access some content?
As we think of the third version of our site, we’re looking at making the information flow even better. We’d also like to make the site more visual. We’ll have before-and-after photos in the surgical sections of the site, for example.
We would like to put more audio and video files on the site. For example, I’ve recorded a "Dialogues in Dermatology" presentation on accreditation and I’d like to put that audio file on the academic section of the site for other doctors to hear.
In terms of other video materials that could go on the site, we’d like to put a video of our practice office building – the largest freestanding dedicated dermatology facility in the country – on the front page of the site. We already have this video that we created in conjunction with the architects when we built the building, so all we’d have to do is put it on the site to let site visitors virtually walk through the building and see what it is like to be a patient at our practice.
Although we’re looking to add a lot of multimedia files to the site, we haven’t seen any bandwidth problems that we know of. When we were building the site, we used functions in Front Page and Dreamweaver to see how long it would take the site to load at different connection speeds. We set ourselves a limit of 30 seconds in which time the homepage had to load at the slowest (56K) modem speeds. Our thinking was that site visitors – especially the younger MTV-generation visitors – would get bored and give up if it took the home page longer than 30 seconds to load.
Speaking of Dreamweaver, I went and took a class and learned how to use this Website authoring software with the idea that I would make minor changes to the site as needed, but it really hasn’t worked out that way. Based on my experience, I’d suggest that a practice should have a dedicated individual on staff – perhaps someone in a secretarial role – who has the responsibility and skills to perform some site updates and maintenance.
Site maintenance also means keeping content fresh and up-to-date. Your site content is extremely important. If it’s not fresh, no one is going to want to be a repeat visitor to your site. Luckily for our practice, Dr. Anir Dhir is a wonderful writer who wrote most of the text in the cosmetic section of the site. So we didn’t have any problems on the content creation side of the site, we just needed outside help from a design and maintenance perspective.
- Having a website for seven years now, you must have hit a few pitfalls along the way. Please share some of the lessons you’ve learned to help our readers benefit from your experiences.
When it came to our design and maintenance needs, we actually ran into some problems because we use a Linux-based Apache operating system rather than a Microsoft system. Among other reasons, we had chosen a Linux-based system to avoid the viruses associated with Microsoft operating systems.
This decision to use Linux hurt us later when we were looking at Content Management Systems (A Content Management System is a piece of software that helps website owners or managers update site content easily and quickly - DBM). One problem was that Plone, the Linux-based CMS that we found, was expensive. Another problem was that our IT consultants did not know Plone well enough to make a commitment to support us if we did choose it. So we didn’t end up implementing Plone or any other CMS, and that has made it very hard to make any major updates to the site.
- Why is a Content Management System so important to you?
Right now, we have our IT contractors handle site updates, but eventually we want to move the maintenance and updates of the site to within our practice. I’d like to have a dedicated individual use a program like Front Page or Dreamweaver – which are cross-platform programs that work equally well with PC, Mac, Linux and Microsoft – to frequently refresh the content on our site.
I’d like to simplify the site update process so that our practice could have a 24-hour response time to any major dermatologic or medical story. For example, if someone in the medical community suggests that antibiotics may be linked to breast cancer – as was recently suggested – we would have our practice’s response to that item on the site in a very timely manner. Essentially, we would just want to have the information on the site be as current and timely as possible.
Our current group of IT consultants will make small changes to the site using HTML, but we cannot do a big content overhaul ourselves without the CMS. So our experience with trying to maintain and update our website has taught us the importance of having a designer/developer who will stay with a site beyond the creation phase.
- What are the ramifications of working with a design/development team that does not stay to work with the practice beyond the site creation phase?
Dermatologists may find lots of designers and developers who are very enthusiastic about building the site and who are enthusiastic while they do the site, but then who simply disappear when the site is built because they aren’t interested in maintaining the site. This happened to us with the designer that we hired to build the second version of our site, so when we look to build the third version of our site we’re going to try very hard to find someone who will make a commitment to help us with the maintenance and updates to the site – or who will help us get the CMS in place so that one of our staff can handle such changes.
Along with finding a good designer, it’s also important to find a host that you think you can be happy with as the site grows and evolves. When we made the decision to switch from our first website host to a new host, the first host wiped out our website. Although the first hosting company was supposed to have backed up the site, the host actually had decided to write over the backup tapes. The end result was that we had to rebuild the site from some original design copies.
- What has been patient response to the site? What do the patients value most? Have you tried using any metrics to measure quantitatively how valuable the site has been for your practice? If so, what do these measurements show?
Patient response to our site has been somewhat slow in building. We originally gave out cards to let people know that we had a website and we would get some patients e-mailing us so we knew we had site visitors.
When patients come to our practice, we ask how they found us and have found that so far less than 10% of our patients find us through our website. But we do have some patients who drove hundreds of miles because they saw us on the Internet and thought we knew what we were doing.
So the site has more than paid for itself. There is no question about that. One surgical procedure of the type we perform in our practice can pay for the website, so we have not had any problems making the site pay for itself.
We also have a valuable tool called a Web equalizer that tells us exactly where site visitors are coming from – in what country or state they are logging on – and where they are going on the site. We can measure site activity in terms of page "hits" or in terms of information downloaded in kilobytes or megabytes. So we have a good idea of what people are interested in. Recently, many site visitors have been interested in the sections of the site that deal with AIDS and with Aldara – a new immune modulator from 3M Pharmaceuticals that has been approved for wart treatment among other applications.
So we can see what interests patients have and have talked about using this information to build an e-mail list that we could then use to send patients information – almost automatically – when we update a section of the site that they might find of interest. We have also thought about creating a quarterly online newsletter and distributing via the Internet (perhaps with our third-generation site) and/or e-mail as another marketing tool.
- Your site was honored for its informative qualities at the AAD Golden Triangle awards. Was it a big investment for the practice in time/energy to develop the information on the site and keep it current? Do all the physicians in the practice share in the responsibility of keeping content current and informative?
We sent boards of our website to the AAD Golden Triangle awards committee to show how the site would look when it was printed. Honestly, it was great fun to go to New York to receive the award at a black-tie event and also to come in first ahead of the Mayo Clinic, which is the brand name in healthcare.
Our site is informative and much of the information is in the writing, which is the biggest time investment in building a website like ours. Dr. Dhir and myself are the computer nerds in our practice and we have been doing most of the work on the site thus far, but if and when we create practice newsletters, those would be written by everyone and posted on our site.
As for dollar costs, we put up our original site with the help our friends at the university for maybe $1,500. The third incarnation of our site may cost about $2,500, but that’s just a ballpark figure. We haven’t even developed RFPs for that yet.
- Your site appears very high in search returns for "Kentucky dermatology" on Yahoo!. What steps did you take to ensure that your site would be visible to Web browsers – or did you put this work in the hands of consultants?
When we first created www.daklex.com we went to a site called Website Garage that let us submit our site simultaneously to 200 search engines (Website Garage appears to have since closed down its since Dr. Davey first submitted his website, but there are other sites and programs that promise to submit websites to multiple search engines. Many of these sites and programs now charge for their services. One site that still claims to submit your site to various search engines for free is Submit Corner – http://www.submitcorner.com/Tools/Submit/. Such sites or programs can be a part of your search engine submission strategy, but you should definitely coordinate search engine placement with your developer/designer team or even with a dedicated search engine optimization specialist. Search engine placement is too important to your site’s success to be treated casually - DBM).
Every search engine is a bit different in how it handles submissions. But search engines look for metatags, so we have a number of metatags on our homepage that are invisible to a casual site visitor. One important thing to note is that if a site has frames, the metatags must sit in the proper frame or the search engines may miss them completely.
So we basically put dermatology terms – terms like "surgery," "acne," "warts," "melanoma" and our doctors’ names – all over our homepage in the metatags. The search engines then pick up these tags and as you saw tend to rank our site highly for relevant searches. Obviously, we’re very pleased with this outcome.
- What is your advice to other dermatologists who may be trying to determine the best use of a website for their practices? What are your own plans for the future when it comes to getting the most out of your practice website?
The most important thing on any website is to make sure that the content is fresh. People won’t want to come back if the content is not fresh, so keep changing and updating the content to encourage repeat visits.
Also, get someone who is outstanding to do the site design and maintenance and then give that person the latitude to perform these roles.
In the future, we would like to have patients registering online and making their own appointments. We would also like to have a secure section of our site for notification of pathology results. From a business perspective, these kind of Internet-based systems would take patients off the phones. Even if we could get 10% to 15% of our patients off the phones it would be great for business.
We’d also like to enhance the section of our site that contains information for other physicians. We lead a continuing education course in dermatology for primary care doctors and would like to put more material related to continuing education on the site. Providing this information helps with building the relationships with primary care physicians that lead to a larger referral base.
And of course we’re in the process of developing a quarterly newsletter that would just naturally belong on our website.
There’s really a ton of neat stuff you can do on the Internet and these are just a few ideas.
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