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JAMA NetSight: A Guide to Interactive Medicine - October 21, 1998

(JAMA. 1998;280:1365-1366)

A Physician's Guide to Creating a Web Site

Richard Peters, MD, PhD; Robert Sikorski, MD, PhD

A physician in a small medical practice convinces his colleagues to fund the creation of a World Wide Web site that will be used to publish a quarterly newsletter for the practice's patients. The site also will provide information about the practice and its services. Armed with a basic knowledge of Hypertext Markup Language (HTML), the physician builds a small site over a few weekends' time. The site quickly becomes popular with patients, and the other physicians in the group decide to expand the site's capabilities to allow more patient-physician interaction. As practicing physicians become more comfortable with using the World Wide Web as a clinical tool, an increasing number may find that they can use a Web site to showcase information about themselves, their skills, and their practices. Some physicians may choose to use such a site to enhance their relationships with patients, creating a virtual link for a number of well-defined uses.

Because this issue of THE JOURNAL is dedicated to the subject of computers and the Internet in medicine, we thought it appropriate to offer a list of 10 tips for physicians who might be interested in building their own Web sites.   These suggestions are based on our own experience in creating Web sites for ourselves and others and advising academicians and practicing physicians alike on how they might adopt digital technology to improve patient care and research.  

Have a Clear Goal

Potential Web site developers should be sure of their reasons for building a site. Is it to increase the visibility of a practice? As a personal Web page?   For entertainment? It's best to have a single mission in mind. Building a site that tries to meet too many goals will confuse visitors. Once the goal is clearly articulated, gathering and maintaining content that delivers a cohesive message will be much easier.

Do Some Homework

Many physicians who decide to build a Web site might wish to hire a professional. Before doing so, some self-education on the basics of Web site design and construction can be helpful. Such background can ensure that conversations with Web page designers and site architects will result in an effective and satisfying product and help keep costs down. A number of Web sites provide information about these issues, including the HTML Primer from the World Wide Web Consortium,[1] and tutorials offered by the technology publisher Ziff-Davis.[2,3]

Get Some "Net Sense"

Developing Net sense can help to determine what type of content would work best on a site. Physicians considering e-mail contact with their patients might wish to consult American Medical Informatics Association guidelines on this subject.[4] Physicians' sites likely will attract unsolicited e-mail from patients other than their own. Dealing with these inquiries could be problematic.[5] Offering information that could be construed as "medical advice" may raise questions about liability.[6] Personal information posted on a physician's Web site could become available to millions of viewers worldwide, and posting e-mail addresses could lead to unwanted e-mail marketing or "spam."[7] It is helpful to spend some time reviewing other medical Web sites with an eye for garnering ideas about what works and what doesn't.

Organize, Organize, Organize

Before turning on a computer to create a site, developers should sketch out an organizational structure using a low-tech medium—paper. The time spent doing so will greatly assist in future site maintenance. For example, all graphics files might be kept in the same computer folder or directory, making intrasite links easier. If a physician has limited time to devote to maintaining and upgrading the site, time spent organizing early will save precious time later.

Find a Host and the Right Tools

Most Internet Service Providers (ISPs) offer Web site hosting as part of their online access agreements and provide several megabytes of server space. Physicians considering sites larger than that may find support from commercial hosting sources. After selecting a host, developers should consider purchasing software tools that should serve most amateur Web site developers quite well. One necessary program, available from different manufacturers, is one that can transfer files between the developer's computer and host ISP. In addition, developers may want to use an HTML editor to create the coded Web pages themselves. Several easy-to-use products are available for both personal computer and Macintosh platforms. New versions of the popular word processing applications (such as Word and WordPerfect) also offer users the ability to save their documents as HTML pages.[8]

Consider the Source (Code)

Whether publishing one Web page or a complete site, developers should consider the type and version of the Web browser that they expect most of their viewers will use, since different generations of browser software can cause the same site to appear and function very differently. As HTML currently is in its fourth iteration, developers have more options for manipulating the look and style of their sites; however, not all browsers will be able to read the latest generation of HTML code.

Go Easy on the Graphics

Although the Web is still in its infancy, many sites have become extremely sophisticated in look, taking maximum advantage of the highly visual capabilities of this new medium. This capability might tempt Web novices to load their sites with colors, pictures, and other graphics. But unless the visuals truly enhance the message being communicated, piling on fancy images will only crowd the pages unnecessarily and will take a long time to appear on many users' computer screens. Images should be used selectively and should be made as small as possible while maintaining resolution, quality, and utility. Tips for optimizing image size can be found on the CNet site.[9]

Avoid "Fancy" Programming

The fast-increasing development of the Web offers developers a host of new programming tools that can dramatically enhance sites with such features as animation, audio, video, and other sophisticated applications. Although potentially appealing, such features generally are neither necessary nor desirable for amateurs. As with overused graphics, overly sophisticated programming can slow down a site substantially, especially when it is accessed by slow modems. A cleanly designed site that makes optimal use of simple HTML is impressive enough.

Back it Up

Before making any change to any file, developers would be wise to make a copy of the original file so that it is always available in the event of an error. Routine back up of the entire site weekly, rather than reliance on an ISP's back up policy, also is advisable. File transfer utility programs can make this process straightforward.

Plan Regular Maintenance

The Web is a constantly evolving medium. Content quickly becomes outdated, as can even carefully chosen links to other useful, high-quality sites. Broken links and obsolete content are guaranteed to annoy visitors and could quickly discourage their return. Developers who cannot commit to refreshing the site regularly—say, at least once a month—might be better off not building one at all.

These basic tips should help even the newest Web developer prepare for a successful first launch into cyberspace. But as is true in much of medicine, experience is the richest and most effective tool in the armamentarium of a physician who seeks to harness and exploit the Web's potential.

From Medsite Communications Corp, Boston, Mass (Dr Peters, e-mail: rpeters@tiac.net; Dr Sikorski, e-mail: rsikorski@erols.com).

Drs Peters and Sikorski are Consulting Editors for the Computers in Medicine issue.  

Corresponding author: Richard Peters, MD, PhD, Medsite Communications Corp, 123 Crane Neck Rd, West Newbury, MA 01485.


1. Raggett D. Raggett's 10 minute guide to HTML. World Wide Web Consortium Web site. Available at: http://www.w3.org/MarkUp/Guide/.   Accessed September 11, 1998.

2. O'Brien S, Beer M. Web page 101: introducing the Web and HTML.   Internet User Garage section of the ZDNet Web site. Available at: http://www.zdnet.com/products/garage/html/webpage101. Accessed September 11, 1998.

3. Dougherty AG. How to use links effectively: smart links make the difference. Internet User Garage section of the ZDNet Web site. Available at:  http://www.zdnet.com/products/garage/html/links. Accessed September 11, 1998.

4. Kane B, Sands DZ, for the AMIA Task Force to Develop Guidelines for Clinical Use of Electronic Mail and the World Wide Web. Guidelines for clinical use of electronic mail with patients (white paper). J Am Inform Assoc. 1998;5:104-111.

5. Eysenbach G, Diepgen T. Unsolicited patient e-mail on the World Wide Web. JAMA. 1998;280:1333-1335.

6. Spielberg AR. On Call and online: sociohistorical, legal, and ethical implications of e-mail for the patient-physician relationship. JAMA.   1998;280:1353-1359.

7. Sikorski R, Peters R. A privacy primer for the Web: spam, bread, crumbs, and cookies. JAMA. 1998;279:1219-1220.

8. Peters R, Sikorski R. The Web, unplugged: hardware, software, and connections. JAMA. 1996;276:1607-1608.

9. Garrigus SR. Seven top Web graphics tools. Builder.com Web site. Available at: http://www.builder.com/Graphics/GraphicsTools/?st.cn .Web.today.bl. Accessed September 11, 1998.

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