Using online maps to address unwarranted variation in health

Writing in the Health Service Journal this week (subscription needed) paediatric registrar Dr Ronny Cheung highlights the NHS Atlas of Variation in Healthcare and in particular the Child Health Atlas as a useful tool in helping NHS commissioners reduce unwarranted variation in healthcare.

Unwarranted variation is a term associated with the work of professor Jack Wennberg who spent four decades documenting the geographic variation in the healthcare that patients receive in the United States. His assertion is that the variation occurs because healthcare is complex and there are many influencing factors. These include socioeconomic factors, differences in population age or gender and also innovation in healthcare delivery – which may lead to improvements in the quality of healthcare services delivered in one area.

Wennberg also believes that some variation is unwarranted. In other words, it should not be happening and can occur because healthcare professionals are not practising according to evidence-based clinical standards, or there is variation in clinical performance. It has also been shown that where there are high levels of healthcare provision, there are higher admission rates and more outpatient appointments.

The Child Health Atlas was devised as a way of illustrating the variation in healthcare children receive across 27 indicators of child health. It was compiled by the Child and Maternal Health Observatory and for the first time provides a visual online demonstration of variations across the breadth of child health services provided in England. You can read how ChiMat worked with InstantAtlas here. The Child Health Atlas allows users to view any of the 27 indicators at upper tier Local Authority or PCT level. The extent of the variation is considerable. For example, perinatal mortality varies twofold among PCTs in England and breastfeeding rates threefold

The intention is that clinicians, commissioners and service users will be able to identify priority areas for improving outcome, quality and productivity. The question is, now that we have the tools to reduce unwarranted variation in the shape of the Child Health Atlas, whether we will see a coordinated effort. Commissioners, local authorities (now responsible for public health) and provider organisations will have to work together to reduce variation. However, there are some who believe this in increasingly unlikely and that health and social care delivery is likely to be fragmented as a result of the Health and Social Care Act. As with so many things in healthcare delivery, it is going to be a case of having to wait and see.

InstantAtlas – making sure the right people see your hard work

Investing time and effort in developing a local information system or community information system might seem like the number one priority but there’s no point putting in the hard work if no-one knows it’s there. In December 2010 there were 255 million websites and 21.4 million were added in 2010 alone. So the valuable insight provided by your LIS/CIS is competing with millions of bytes of content. You might think that search engines will help push you to the top of the pile – especially as local information systems is a relatively niche area.

However, search engines could be working against you by ranking other sites and web pages higher than yours – even though your content may be more relevant to a particular search. The way search engines work is by indexing content with relevant tags that are subsequently picked up in searches. Search engine optimisation (SEO) optimises a web site by making sure that when it is indexed by search engines the right descriptions about the content are picked up. The ultimate aim is to increase relevant traffic and search engine ranking of the website pages.

David Carey, marketing manager, Geowise has helped customers using InstantAtlas to optimise their websites. A good example is the work he has done with Lewisham Strategic Partnership (LSP). Jeff Endean is principal policy officer, Lewisham Borough Council. He says: “Lewisham council has its own website but also hosts the LSP partnership website. We wanted to make sure that anyone typing in ‘Lewisham statistics’ would be able to see the LSP website. InstantAtlas helped us tweak small but important elements such as design, layout, keywords and tabs to make sure the site was search engine optimized. We haven’t publicised the LSP website yet but its search engine rankings show that we have already met this initial objective.”

Ben Mango, database and website consultant, was working on the LSP project for the council. He says that he knew a little bit about SEO but InstantAtlas did a thorough job in optimising the LSP site. “InstantAtlas produced a document detailing the key areas where the LSP sites needed to be optimised and how to carry this out. As well as understanding more about optimising the site, I also have a better knowledge of the tools to assess how well the site is performing.  Since the website has been optimised it is now performing much better in terms of the results from search engines for its key words.”

The results are striking:

• The Lewisham LSP website is able to compete directly against Lewisham Council’s own website for people looking online for local statistical information related to Lewisham.
• The LSP website now ranks 3^rd on Google.co.uk for ‘Lewisham statistics’, each page can target a specific keyword group e.g. Lewisham economic performance, Lewisham deprivation statistics and so on
• The LSP website ranks 5^th on Google.co.uk for ‘Lewisham recession advice’ this type of information is available and accessed considerably on their site.

David says: “The LSP’s website is relevant to the users of insight provided by the LSP and is supported by InstantAtlas server. By using Local SEO tactics we have made sure that the website is becoming a real source of information for local people and partners. There are thousands of local queries every month and applying SEO provides greater and more efficient access to match queries to your information.”

For Lewisham LSP it means that it is fulfilling its role as a driving force in setting the strategic direction for the borough. It is ensuring that partners and the public can easily access the right intelligence when they need it. SEO has provided a low cost approach to attracting local partners/public.

Implementing SEO gives organisations the ability to compete for positioning against bigger players. Lewisham Council has a domain authority of 63/100 compared to the LSP of 29/100 but the LSP can still position itself on the same page for such keywords as Lewisham statistics.

The benefit of investment in SEO is also likely to outweigh any investment in pay per click (PPC) to maintain ranking in a search engine website’s sponsors sections. InstantAtlas believes PPC is a short term approach which can be used for rapid increase in traffic but it is expensive.

It was estimated that in 2010 around $20 billion worldwide was spent on paid searches (putting a company/organisation name on the sponsored sections of Bing and Google). This provides around 15 per cent of all the clicks, which equates to 15 per cent of all traffic. On the other hand, SEO gets 85 per cent of all the clicks, and spend is estimated at around $2 billion.

From an advertising budget perspective if it costs £0.50 for each click through, then to get 100 people to come to your website for 30 days it would cost £1,500. Over a year that would work out at £18,000. An initial investment of £3,000-4,000 in SEO over the same period will give you greater access to more search queries and you are not paying for every click.

Many InstantAtlas users are working on projects to build websites of 50 pages or so and effort is directed at the development but often there is little consideration about how the pages ‘get to market’. “You can have a very impressive looking site but you have to make sure it is geared to what people are after,” says David.

Optimizing InstantAtlas Reports for Search Engines

See the video

To find out more about SEO consultancy from Geowise contact David Carey: David.carey@geowise.co.uk