Disclaimer

Unabridged version of article recently published in GPNet Magazine May 2001.

Personal perspective:- Nene Valley Medical Practice Website 

It was 1998 when I decided that the practice should have its own website. It was an eventful year during which a new partnership of 4 had arisen, looking after 8400 patients in an urban area to the West of Peterborough. We were working from rundown seventies built premises but had many new ideas and were full of enthusiasm to develop the Practice. New premises were on the horizon, and a new Emis system allowed us to develop as a paperless practice. With so many changes we needed to communicate more efficiently with our patients and so the idea of the website grew. 

My first experimentations were with free webspace and Microsoft Word, which allowed documents to be saved as html. However once I realised how easy it was to put a few pages together I purchased Microsoft FrontPage to begin more serious construction. My Partners were easily persuaded to allow the purchase of commercial webspace and a domain name and soon the first website was under construction. 

Looking back it is easy to see ones mistakes and how a website should really be constructed. However I view the path I followed very much as an essential learning curve. Initially I worked very much on the run. Pages were constructed without much planning. When new pages were written I went back to the old ones to add hyperlinks. This process is not efficient and not to be recommended! 

Taking the view that a website for the practice is like a glorified practice information leaflet I attempted to include as much information as possible. Ideas came to us as the site began to grow. We started a practice newsletter and included its contents on the site each month. Whilst we felt we had increased the communication it was at this stage very much one-way traffic. What was really needed was a view of what patients themselves would desire from a truly interactive site. 

At this point we allowed ourselves to become accessible by email. This was the key to having easy communication. ‘Forms to email’ on the website for the first time allowed us to include a patient registration page, feedback forms and eventually repeat prescription request forms. We instigated a vacancies page and were pleasantly surprised to find we had received an application letter and CV by email within one day of advertising the position of practice nurse. 

Once we felt the site was sufficiently complete we started to advertise our website address. Having a website is very nice but not much use if no one is aware of it. Fortunately this coincided with our change of premises so we were able to include the website address on all the leaflets distributed to patients informing them about the impending move. Our new letterheads also included the address. Patients were encouraged to keep up to date with development of the new premises on the website. At the time of the move a detailed map and all the new phone numbers and contacts was posted on the site. Whilst ensuring as many patients as possible were aware of the site we also then proceeded to register it with as many search engines as possible. 

On occupying the new premises it was felt the website deserved a complete overhaul. Surfing the net has made me realize that website redesigns are important in maintaining an interest in revisiting sites. I was also aware that sites needed to look slick, but that simplicity and speed of download are probably more important than fancy graphics or Flash downloads which can lead to delay and frustration. Planning the full content of the site prior to publication was deemed essential and allowed the design of one simple template from which all pages would be developed. 

  In my surfing travels I was by now keen to use more html code and java in my pages. I liked to try and find out the little tricks behind elements of pages and would frequently look at the source code to try and work out how certain effects had been achieved. Pages could look so much more professional and up to date by displaying the current date.  Live news feeds and weather updates could be imported through associate schemes such as that offered by Moreover.com and The Weather Channel. However what I considered to be the real gem of a find was a site by the name of BrainJar.com. This offered useful ideas and samples of code which by its terms and conditions it was happy for others to use. It was from here that our dropdown menu was developed. In a short time after site publication we were receiving many enquiries about the dropdown menu. I don’t profess to know all the ins and outs of its design but it is simple to use from a surfers point of view. On moving the mouse over the main headings a dropdown menu appears listing subheadings, each of which is a link to the relevant page. The use of this menubar means the pages are not cluttered with numerous links and all pages have the same template so the user is able to navigate quickly and easily. 

By now we were already offering patient registration, feedback, and repeat prescription requests by forms on the site. Feedback from our patients had been extremely positive and requests for registration were coming in from distant geographical areas, demonstrating the use of the Internet by inquisitive potential patients moving to a new area. Interestingly many of these registration requests were at times more convenient to patients such as evenings and weekends. We even had a patient register with us on Christmas Day! 

It was clear our next step should be to offer online appointment booking, but to do this would need the use of Active Server Pages (ASP) and so we had to upgrade our webspace from a Unix to an NT Server to facilitate this. We are still developing this facility determined if possible to do it all in house without any use of commercial services.

We envisage having an Access Database with available doctors appointments, sitting on the server, which can be updated remotely by a receptionist each day. The website will allow patients to query this database by the use of ASP, and if they choose to book an appointment the database will be updated and we will be informed by email. Because there is no connection between the database and the Emis system, the available appointments online are blocked until the day before, at which point any remaining appointments are removed from online availability and offered as urgent appointments conventionally.

To make such a system more secure, less open to abuse and at the same time not infringing patient confidentiality it would be possible to include on the database a list of dates of birth and corresponding Emis patient numbers. Patients booking appointments would then only need to enter their dates of birth and Emis numbers as identifying factors. The practice would then be able to verify a likely genuine request and no true identifying data would have been sent over the Internet. Of course patients would need to be aware of their Emis number but this is available on repeat prescription forms. Otherwise it could be issued at the time of registration or directly at the request of a patient. 

At present all form to email information is sent to us by unencrypted email. We have a disclaimer available to patients on every page and patients are aware of the security issues. It is possible in the future we will switch to encryption. Certainly we will have to if patients start to choose to discuss matters of health directly with us by email, which we do not currently encourage, although that is not to say it does not yet happen! 

The future of our site is seen potentially as being a local health information portal with access to topical health news and a library source of practice based information and self help leaflets. We envisage integrating more with local health services and pharmacies and there is the possibility of offering health related shopping on line, which will be explored further. Funding of the site and further developments may be aided with advertising, this being an extension of what is already done in our practice information leaflets. We will aim to be topical, useful and accessible, and will continue to look for new ways in which we can offer improved innovative services for our patients. 

Steve Walker

steve@nenevalleysurgery.org.uk 

Practice Website Address: www.nenevalleysurgery.org.uk