What is a website?

A website can be anything from a single web page of text to the $2.5 million all-singing, all-dancing multimedia experience of IBM's showpiece 'Eternal Egypt'.1 What they have in common is that they are written in HTML (or one of its variants), are stored on a web server and are viewed over the Internet by a web browser.

Why create a practice website?

There are many different reasons for creating a practice website, the most common reason being to promote the services of the practice. This may be aimed at the practice's existing patient base or it may be more geared towards attracting new patients. Your website could be a patient's first experience with the practice. Some sites may want to emphasise patient education, certain dental products or treatment philosophies. Online appointment booking has also become a popular service. But remember that the web is a 'pull' medium as opposed to a 'push' medium; people still have to actively seek out your site.

Do-it-yourself or outsource?

There are four main ways of creating a practice web site:

1. Write the site from scratch yourself. This entails a fair bit of work learning about HTML and multimedia presentation. The good news is that there are thousands of sites on the web that have been designed to guide you through this process, most of them written by educational establishments. There is a wide range of software which can be used to write web pages:boxed-text

  • Notepad (this text editor comes bundled with Windows and is all you need to write simple pages in HTML)

  • Word (which will 'translate' most straightforward Word documents into HTML documents with a moderate degree of success)

  • Free or non-expensive authoring programs, such as AceHTML Freeware,3 Coffee Cup's HTML Code/Visual Editor4 ($49) or NetObjects Fusion5 ($200). Some programs concentrate on the HTML code behind the design while others are more like desktop publishing software and keep the code out of sight

  • Professional authoring packages, such as Macromedia's Dreamweaver6 will do everything very well, but has a steep learning curve (and costs almost £400).

2. Use a website content management service to create your own simple site online. One drawback is the lack of templates suitable for a dental practice. Many of the American sites have designs that are very outdated. A UK site that has excellent templates that can easily be adjusted for dental use is MoonFruit7 (Fig. 3). You can trial the SiteMaker software for free for 14 days. It is also excellent value for money; the lite version costs £26.99 a year and allows you to create one web site with an unlimited number of pages, up to a maximum of 40MB. I have created a demonstration site8 which, using existing text and images, took about 90 minutes to create

Figure 3: A screenshot from the Moonfruit website.
figure 3

It shows one of the stages involved in creating a website using their online tool, SiteMaker

3. Use a dental website design company to build a site for you based upon a selection of different designs. They would also normally find you a suitable domain name and host the site for you. Minor text updates are often included in the package (see Table 1 for details)

Table 1 This table shows details of the services provided by various website design companies who create sites for dental practices. Information was taken from each companys website and was correct on 16th March 2007

4. Use a web design company to produce a bespoke website from scratch. If you require a unique look to your website with the very latest technological 'bells and whistles' then this may be the best option. Prices will vary enormously depending on your requirements (see Table 1 for details). A computer student wanting to supplement his/her university grant may well charge less than a professional web design company, but at the end of the day, you get what you pay for. Just remember the quote from John Ruskin, the 19th century critic and author: 'It is unwise to pay too much, but it is worse to pay too little. When you pay too much you lose a little money – that is all. When you pay too little, you sometimes lose everything, because the thing you bought was incapable of doing the thing it was bought to do. The common law of business balance prohibits paying a little and getting a lot – it cannot be done. If you deal with the lowest bidder, it is well to add something for the risk you run. And if you do that, you will have enough to pay for something better.'

Bring the content together

Before you can start creating a website you need to gather all the information that you want to include on the site. This normally takes the form of text and images. Aim the content at the sort of end-user you have in mind and think of the sort of information that they would want to find from your site. Keep in mind that the estimated reading age of the UK population in general is about 9 years.

Many companies will be happy to base your website on the information contained within your practice information leaflet; provide them with the original digital text and graphic files if you have them.

Most people have access to a digital camera or will be able to scan some existing photographs. Use an image-editing program, such as Picasa,9 Irfanview,10 Paint Shop Pro11 or Photoshop Elements12 to make the necessary adjustments to the images. Do an Internet search on the terms 'image optimization' to find out how to create images that will load faster from your website. There are many websites that provide free images for personal non-commercial use. For images to be used in the practice, try one of the free-to-use stock photography agencies (who normally just require that credit be given to the photographer) or purchase either royalty free images (once purchased, they can be re-used in different projects without paying an additional fee) or rights protected images (where you pay for each project in which the image is used). Details of such websites appear in the next chapter.

Select and register your domain name

For a personal website it is fine to use the domain name given to you by your ISP, for example http://mysite.wanadoo-members.co.uk/paul_downes/. However, for a professional image, a dental practice should really register their own domain name, for example www.cosmeticteeth.co.uk. The registration process is very quick and easy: go to a site such as simply.com13 or 1&1,14 type in your proposed domain name to check that it has not already been taken, register the name and pay. Prices for a .uk domain are about £3 per year and about £9 for a .com address. Prices normally include website and email forwarding; this means that when a patient types www.cosmeticteeth.co.uk into a web browser, the address will automatically be redirected to wherever your pages are stored, for example to your ISP at http://mysite.wanadoo-members.co.uk/cosmeticteeth.

Create the design

Once you have a rough idea of the content, you can think about the overall design for the website. If you are using a template, then this will simply be a decision about how many pages you require and which template, colour scheme and font best suits your practice image. If you want to create a site from scratch then it is best to start with pencil and paper and draw out some ideas based on other websites (not necessarily dental) that you like the look of and you feel would work with your content. It is really no different from starting to design a kitchen with rough sketches and cutouts from magazine articles and adverts.

You can then communicate your design ideas to an outsourced web designer or start developing the first page yourself with some suitable software already mentioned.

Design the site navigation

How will people navigate around the website? This is one of the most important features of a successful website and should be paramount when designing the overall look of the pages. Most web servers require the welcome page to be named something like index.html and from this page you would create hyperlinks to other pages on the website. Some pages may be 'daughters' of a particular page, for example you may require the user to click to a page entitled 'treatment options' which would contain links to pages 'fillings', 'crowns', 'bridges', 'dentures', 'implants' etc. All pages should contain a way of navigating back to the 'welcome' page, since someone finding a page from your site by using a search engine may be directed to a page deeply buried within the site. The design and navigation of a website are the key factors in good usability (Fig. 4). In a UK online survey of 2,500 adults, in-depth interviews and in-house qualitative research, YouGov found that 83% of respondents reported ease of navigation as being the most important factor in their 'ideal' website, with 62% rating high speed and 49% rating functionality as the other key factors. Eighty percent of people surveyed rated a clean and simple overall design as their most desirable design factor with only 6% wanting innovative use of flash and multimedia options.

Figure 4
figure 4

Time spent in planning the overall design and navigation for a website is time well spent

Decide on the degree of multimedia and interactivity

All dental practice websites should contain images, but you need to decide on whether or not to include other elements such as a photo gallery, 360-degree panoramas, video, dental animation (eg Dental Zone15 web package for £25 per module), animated text and graphics, electronic welcome pack, automatic free feed of dental news items,16 blogger diary,17 web cam and speech/music. Some of these elements can make a website more attractive and interesting, but many may not be suitable for your particular practice and if done badly they can easily turn away potential users. Take into account that some people will still be using a modem connection, that users may have to download additional software in order to access the extra content and you may have to ensure that your hosting service supports these additional multimedia features.

Interactivity should include something as simple as an email hyperlink but could also include a form for prospective new patients to submit a request for an appointment, live online appointment booking, a feedback form, guest book, 'tell a friend' referral, discussion forum, a poll to a simple question, live patient support during working hours via a chat session, an online store for dental consumables, or the ability to request a regular copy of the practice newsletter to be sent by email. The same caveats apply to interactivity as they do to multimedia.

Compliance with current regulations and recommendations

Check that your proposed design and content complies with the following:

  • General Dental Council (GDC) guidance18 The GDC no longer issue their detailed Maintaining standards guidelines, as these have been replaced by their broader Standards for dental professionals. However, some things to consider when creating a website include:

  • Only use the title 'specialist' if you are on the specialist register. Do not let a web design company imply possession of specialist status in terms that could mislead patients

  • Make sure that any external links only go to websites where you can be sure that the information is correct

  • Indicate whether or not the practice sees NHS patients

  • Maintain patient confidentiality

  • If the website is to contain advertisements, ensure that the products or services promoted are not in conflict with dentistry or the principles of health care.

  • Electronic Commerce (EC Directive) Regulations 2002 19

    The main points related to dental practices include that a practice website should have details of:

  • The name and address of the practice(s)

  • The email address, telephone and fax numbers of the practice(s)

  • The name of each dentist at the practice, their professional qualifications and their country of qualification

  • Information about professional registration, including the dentist's GDC number, the address and contact details of the GDC and a link to the GDC website18

  • A reference that the dentist(s) adhere to the rules governing the profession (ie the GDC Standards for dental professionals).

  • There must be no comparison in the description of care given at the practice and at others or of skills or qualifications of dentists at the practice and at other practices

  • All changes in practice circumstances must be reflected in the website within one month of the change taking place (eg changes in dentists working in the practice)

  • Sites must make it clear when the page was last updated.

  • Disability Rights Commission (DRC)20 The DRC published a report in April 2004 entitled The web: access and inclusion for disabled people.21 Some of the suggestions include:

  • Provide a text equivalent for every non-text element

  • Ensure that foreground and background colour combinations provide sufficient contrast when viewed by someone having colour deficits (a large proportion of the country is red-green colour blind)

  • Ensure that pages are usable when scripts (eg Javascript), applets and other objects are turned off or not supported. If this is not possible, provide equivalent information on an alternative accessible page

  • Ensure page titles are meaningful

  • Use consistent navigation.

  • HON code of conduct 22

    The HON Code of Conduct for medical and health websites aims to raise the quality of healthcare information available on the web. It is a self-regulatory, voluntary certification system based on an 'active seal' concept. It addresses, among other things, the authority of the information provided, data confidentiality and privacy, proper attribution of sources, transparency of financial sponsorship and the importance of clearly separating advertising from editorial content.

  • Freedom of Information (FOI) 23

    The FOI Act was passed on 30 November 2000 and is intended to promote a culture of openness and accountability amongst public sector bodies by providing people with rights of access to the information held by them. Dental practices should have written their publication scheme by October 2003 (you can download a copy of the dental model publication scheme24). The information can either be in the form of a printed hard copy available from the practice or, more conveniently, be kept on the practice website.

Decide on a host for your site and upload the files

Many of the web design companies include hosting of the site as part of the package (although this is often just farmed out to another specialised hosting company). Another option would be to use the free web space that ISPs include as part of their membership. Both solutions have limitations on the total file size, but this is normally more than adequate for the average dental practice website. Complicated websites often require support for certain software to run and you need to check with the host as to whether or not this is available. Basic hosting suitable for small businesses costs about £4-£5 per month.13,14 Specialised hosting, which would normally include your own dedicated web server, would be overkill for most dental practice websites.

The finished website files are uploaded to the host web server using a process called file transfer protocol (FTP). Most ISPs will direct you to a web page that enables you to upload the files to your web space via the web browser. A quicker and more reliable (but not so user-friendly) way of uploading the files is to use a dedicated FTP program, such as WS_FTP.25

Announcing your web presence

There are four main aspects to getting your website known to existing and new patients:

  • The first is promoting the existence and address of the site by printed media such as leaflets, posters, newsletters, the Yellow Pages, press releases, letter headed paper, appointment cards, receipts etc

  • The second is directed towards people who are actively searching for your practice website in an online business directory, such as yell.com26 or a dental directory such as the Dental Guide.27 Many web directories will list your website for free, but it is up to you or your web design company to register your details with the most popular directories

  • The third method is to ensure that your website is ranked high on the first page of results from the major search engines. This is achieved by properly submitting details of the website and by better use of page design, HTML and meta tags. This service is offered by some web design companies and is called search engine optimisation.

  • The fourth technique is to pay for your website to appear on the first page of results in a search engine. Most search engines accept paid listings, which means that your website will appear above or alongside the list of results for the keywords that you are interested in, for example 'London', 'dentist', 'implants'. Google, one of the most popular search engines, runs a scheme called Google Adwords,28 where you only pay when a person clicks on your advert. It is possible to limit your 'advert' appearing to a certain geographical target audience. You will find a wealth of information about these issues on the Seoconsultants.com website.29

Figure 1: HTML code written in Notepad (the colours have been added simply to highlight the different sets of tags).
figure 1

Notice that most of the tags are in pairs, with the second command turning off the tag. It can be saved as a web page by using the file extension .html instead of .txt

Monitoring the website

Hosting services and ISPs normally provide statistics about the websites that they host as part of the package. These statistics normally give a report on how many pages have been visited over a period of time, the number of unique or returning visitors etc. Another way of monitoring the website is to ask new patients how they heard about your practice (eg Yellow Pages, 'word of mouth', website) and keep a monthly record.

Updating the website

Most web design companies allow you to make small text changes to the website as part of their package. Some companies offer a content management system (CMS), whereby you can make the changes yourself. If you have created your own practice website, you could buy your own CMS software to enable staff members with no knowledge of HTML to keep the site up to date.boxed-text

I will finish this chapter with a quote from Michael Dell (Dell Computers): 'Show me a business that's not on the Internet, and I'll show you a business that's out of touch with the future.'