JRSM >
Volume 95, Number 2 >
Pp. 64-67
Department of Otolaryngology—Head & Neck Surgery, Victoria
Infirmary, Glasgow, Scotland, UK
1
Department of Clinical Effectiveness & Audit, Victoria Infirmary, Glasgow,
Scotland, UK
Correspondence to: Mr Brian J Bingham, Department of Otolaryngology—Head & Neck Surgery, Victoria Infirmary, Langside Road, Glasgow G42 9TY, Scotland, UK E-mail: steven.wilson{at}gvic.scot.nhs.uk
 | INTRODUCTION |
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 TOP INTRODUCTION FIRST STEPCREATING THE WEBSITECONCLUSIONREFERENCES |
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| FIRST STEP |
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TOPINTRODUCTIONFIRST STEPCREATING THE WEBSITECONCLUSIONREFERENCES |
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| CREATING THE WEBSITE |
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TOPINTRODUCTIONFIRST STEPCREATING THE WEBSITECONCLUSIONREFERENCES |
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You do not need specialist software to design your web page. A simple text editor or word processor will suffice; but an easier and less time-consuming approach is to use one of the many web page authoring packages available.
Once you have created your pages you will need file transfer protocol (FTP) software to upload your pages. This software provides a link between the files on your own computer and your web space. It can be used both to load and to delete files from the web space.
Many of the Internet service providers now offer free web space to subscribers. Once a website is created and uploaded to web space, it is available permanently on the web to anyone with an Internet connection.
Search engines
A user of the World Wide Web would use a search engine or a directory
website to track down information. A search engine utilizes indexing software
to survey the web continuously for new or updated pages. For every website
visited the indexing agent records the full text of every page. If you submit
details of your website to a search engine, this indexing process will be
faster. The search engine software will periodically visit each website to
update its information.
Websites such as the Yahoo! Directory act as an online guide to the web. Directories create their listings from website descriptions submitted by users. A staff of editors then visit and evaluate these websites and organize them into subject-based categories and subcategories.
Below is some advice for getting your website listed in search engines:
Information
You now need to decide what information to provide on your website. Box 1
is a list of topics that we considered when designing our site, though not all
were included.
Links
Links with other websites are essential to allow patients to view similar
information that may approach a problem from a different angle or in more
detail and from a source that you would consider reliable. Links can be made
to local general practice surgeries, Royal Colleges, associated services and
specialties, specialist centres of excellence, evidence-based medicine
databases (e.g. Cochrane Library) as well as general health sites.
DIPEx2 is a library
of patient experiences—interviews on videos or audiotapes and in written
transcripts—that has recently gone online. At present this site deals
with prostate cancer and hypertension; but coverage will expand to other
areas.
| Box 1 Types of information for a website General information about your hospital and travel information Ward and staff details (who does what) Services, both general and subspecialized, available in your department Routine patient information regarding conditions commonly and not commonly treated in your department. Most of this information should be available already in pamphlet form and can be easily posted onto your site Waiting list times for procedures/operations Waiting times for clinics Current updates Support groups and how to contact them Patients' charter Ward/departmental charter A patients' experiences page Health promotion page Ongoing research in your department Frequently asked questions
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Readability
Nearly a quarter of the UK working population have a low level of
literacy3. Reviewing
Glaswegian otolaryngology outpatients
Kubba4 found that
96% had a reading level of a seventh grade student or better (an 11-year-old).
This is the reading age to aim for in most patient information. Techniques to
assess readability include the Cloze and SMOG scoring techniques, as well as
some computer based indices such as the Gunning Fogg index
Most National Health Service trusts now have quality assessment departments which can examine material before it is posted onto the website. Trial and error by patient review and audit will help improve the readability of your website. Remember to tailor your language and content to local factors.
Quality
Increasingly, patients obtain information from the Internet before the
consultation and not all this material is of high
quality5,6,7,8.
In both primary and tertiary healthcare settings, concern has been expressed
about the accuracy of such information and the way patients interpret
it9,10.
Several rating tools have been developed for evaluation of health-related
websites11,12,
and key criteria include quality, reliability, accuracy, scope and depth of
content, design and aesthetics, currency of information, disclosure of
authors, sponsors and developers, authority of source, ease of use,
accessibility and availability, and attribution and
documentation11.
For help in quality development we recommend the websites produced by DISCERN13 and the Health Information Technology Institute, Agency for Health Care Policy and Research14. In refining quality we have been much helped by departmental and interdepartmental peer review, and again patient review and audit is valuable.
Advertisement
Patients need to know about your website. We provide the website address to
patients at clinics and there are posters in the waiting area. Posters have
also been sent to all general practitioners in our catchment area for display
in their surgeries. The website address is to be placed on departmental
letterheads.
Audit
Audit is an essential element of the website, with a formal commitment to
continual assessment of patients' needs, values and preferences. This can be
done via patient or general practitioner surveys, healthcare staff initiatives
and regular review of e-mail comments from website readers.
Funding
When setting up a website you need to calculate the staffing and funding
requirements. What are the possible sources of funding? Pharmaceutical
companies are often keen to participate not only because they can advertise
but also because they like to be seen to be involved in patient education.
Questions of ethics and conflict of interest can arise. Tench et
al.15 note
that over 50% of patient-oriented rheumatology websites contain advertising.
Provided that conflicts of interest are clearly stated, then it is reasonable
to use pharmaceutical funding. A possible alternative is funding from your
local NHS trust or a government agency (local, regional, national or
European). Lastly, funds might be available from non-profit organizations and
patient support groups with special interest in the area of healthcare covered
by your website.
E-mail
If you decide that your site should have an e-mail facility then a protocol
is required to establish who will review e-mails and who will respond to them.
Patients use e-mails to elicit diagnoses, confirm diagnoses, validate
treatments, seek further information regarding conditions and seek alternative
therapies16.
Initial screening of e-mails can be done by IT or clerical staff, but if so an identified member of the medical staff must be available to deal with queries. One solution to ‘cries for help’ is a standardized reply, and this is effective though impersonal17. The volume of correspondence by e-mail will often determine your departmental response. A statement regarding e-mails must be included in the site disclaimer (see next section). At present our website responds to e-mails individually. Although we did not incorporate a diagnostic service, we receive unsolicited diagnostic inquiries both from general practitioners and from patients. There are two reasons why we do not offer consultations. First, we do not think that this form of consultation adequately replaces a face-to-face encounter; and, secondly, patient confidentiality cannot be guaranteed over the Internet.
Disclaimers
Uploading information to the World Wide Web has legal implications in every
country where the web page is available. The content provider should consider
limiting these consequences by putting a disclaimer on the page. This
disclaimer should describe the limitations, purpose and authority of the
information and emphasize that the content is general health information
rather than medical advice. The disclaimer should state that only a qualified
health professional is able to advise on individual health problems, and this
advice is based on personal history and other information revealed in the
professional/patient relation-ship. It must also define any relationship and
responsibility between the original website content and links to other
sites.
| CONCLUSION |
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TOPINTRODUCTIONFIRST STEPCREATING THE WEBSITECONCLUSIONREFERENCES |
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The advantages to clinicians of setting up their own website are that they can direct patients to reliable, up-to-date and readable sources of information and thereby decrease confusion and anxiety. Patients will become more knowledgeable.
Although a website should improve certain aspects of patient care there may be drawbacks. Increased information does not seem to reduce the number of consultations and may increase individual consultation times. A website has direct costs in set-up, maintenance and staff. Patient expectations may be raised to a level higher than the service can provide. There is still little known about both short-term and long-term effects of healthcare information on public health.
We believe that the healthcare professions must come to terms with the implications of this information technology for the doctor—patient relationship. For those who aim for clinical excellence, a website will be a help rather than a hindrance.
| Footnotes |
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| REFERENCES |
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TOPINTRODUCTIONFIRST STEPCREATING THE WEBSITECONCLUSIONREFERENCES |
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  G Akram, A H Thomson, A C Boyter, and M J S Morton Characterisation and evaluation of UK websites on attention deficit hyperactivity disorder Arch. Dis. Child., August 1, 2008; 93(8): 695 - 700. [Abstract] [Full Text] [PDF]
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