Communicating on the worldwide web dental practice websites by Nigel Knott

90 OPINION Nigel Knott DOI / X Communicating on the worldwide web dental practice websites by Nigel Knott The news media are presently filled with headline stories concerning
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90 OPINION Nigel Knott DOI / X Communicating on the worldwide web dental practice websites by Nigel Knott The news media are presently filled with headline stories concerning the security of electronic communications and the internet. The Financial Times weekend supplement FT Money devoted three pages under the title Hack attack and asked whether companies are doing enough to protect data online. 1 Substitute dental practices for companies and we have an unhappy picture of the reasons why so much sensitive personal data is going missing or being accessed without properly informed consent. Author: Nigel Knott, Dental Surgeon and CEO of Dentsure Ltd, 6 Union Road, Chippenham, Wiltshire, SN15 1HW E: Keywords: websites, communications, security, messaging, professionalism OPINION 91 Much data disappears and passes unnoticed into malign hands and is then sold on the hidden or dark web, where user IDs and identities are widely advertised. A survey of a bank by the security firm Kroll revealed that 17,000 customers all used the password Arsenal1 and 85% of these used the same password for all of their online accounts. 1 In 2014, 81% of large organisations and 60% of small businesses in the UK found their digital protection (such as it is) had been breached, 2 I wonder what the figure would be for dental practices. The issue of cybercrime and terrorism exposing the inherent security risks of s, text messaging and website use has struck a significant chord with the public, which will not have escaped the notice of a number of dental practice principals either. They should not ignore the specific risks and dangers I identified in my article in the January 2015 issue of the FDJ concerning the use of electronic communications for professional purposes. 3 Observing the letter of the law of the Data Protection Act (DPA) and understanding the mechanics of a dental practice website have now become two separate imperatives. The knee-jerk reaction of the politicians to recent world events is predictable as they career around the arena with threats of yet more regulation in the form of a snoopers charter. I have little doubt that a high-level instruction will have been issued to the Information Commissioner and his staff to get your act together. Even more certain is that the new EU data protection directive will have a hastily constructed afterburner attached before another raft of complex data protection law is promulgated and enacted before It is more than 16 years since the DPA was set in stone, when information and communications technology (ICT) was in a relative state of infancy, and it is now way past its sell-by date. The traditional practice all risks insurance policy, which in days of yore covered burglary, fire, flooding and theft, takes on a completely new dimension in the age of the computer. Big data mining, electronic burglary and cybercrime comprise a whole new ball game; another set of weapons of mass destruction has been developed that needs a new set of rules and regulations. The missing IT strategy for dentistry Where IT is concerned, dentistry has become the Cinderella of healthcare. Our medical colleagues in primary care have had very significant National Health Service (NHS) funding to digitise their practice functions and to establish the necessary electronic networks to communicate in a secure environment, and most importantly, special provisions for educating all of the practice staff in the use of the technology itself. I cannot understand why the public mouth and those who provide the necessary professional dental treatment services for it have been isolated and treated by the NHS in a way that completely ignores the integrating treatment forces of digital technology. Dentistry has no settled place in the NHS world of computerised healthcare and it has been left floundering in what remains predominantly an analogue world of empiricism. In the early days of the dotcom boom and bust, I remember travelling to London to visit the temple of technology in the Department of Health and Social Security to attend some high-powered dental IT policy meetings to discuss the future vision for digitising NHS dental services and a possible big bang overall strategy. In October 2002 An Information Technology Strategy for NHS Dentistry in the 21st Century was published by the Department of Health. 4 This document included the following proposals: 1. The overriding theme is the reintegration of dentistry in the NHS and for dental records to become more connected with mainstream NHS IT. 2. Electronic patient records including digitised radiographs will need to be transferrable (securely) between dentists and other organisations. 3. In order to achieve this vision, there must be a substantial investment in education, training and change management for dental practices. 4. A programme manager has been appointed to carry out the preparatory work needed to implement the dental IT strategy. Dentistry is no nearer to being provided with a solution to the ICT problems facing it today than when this IT strategy was published well over a decade ago. No doubt the Programme Manager whoever might have been recruited to the post at the time has now been pensioned off with a lump sum bonus for complete failure and a dereliction of duty! Nearly 15 years later, we are no further forward, apart from the promise of a new contract, and the threat that no new contract will be awarded to any dental practice that is not fully computerised and compliant with the Information Government Toolkit. Jumping through this hoop will need more than a few glasses of whisky by the fireside and/or the use of antidepressants! The gap in IT education In September 2013 the Department for Education issued computing programmes of study as part of the national curriculum for schools in England. An introduction reaches the conclusion that computing ensures that pupils become digitally literate able to use, and express themselves and develop their ideas through, information and communication technology at a level suitable for the future workplace and as active participants in a digital world. 5 Great stuff so how about the General Dental Council (GDC) recognising this fact and making some space for a formal ICT educational programme to be introduced to dental undergraduate studies plus space for a verifiable continuing professional development (CPD) module for postgraduate study too? Not one single dental hospital in the UK has a formal ICT educational structure in place to prepare 92 OPINION Nigel Knott newly qualified dental graduates to enter a digitised world of dentistry. 6 To some senior practice principals, the digital sea change in the administrative/regulatory landscape of dentistry alone presents an intolerable burden that will blow the fuses responsible for powering the surgery lights, prompting many to head for the pension exit and leaving everything in darkness. This situation does not seem to be a million miles away from the extraordinary lack of any digitised dental policy for UK dentistry, which remains in what might be described as a black hole! In the meantime, private enterprise is left to its own devices, and the great dental divide between the NHS funding budget and private sector supply widens as the burgeoning ICT influence advances relentlessly in the form of digitised clinical applications. In the October 2014 issue of the FDJ, I reported a patient treatment that included the fitting of a dental prosthesis that had been manufactured using 3D printing technology supported by the latest in computerised design and manufacturing (CADCAM) processes. 7 This fantastic technology will have a revolutionary impact on the traditional analogue methods of manufacturing prosthetic appliances, and yet where are the educational resources and the knowledge bases designed to enlighten dental practitioners of the spectacular advantages? More about this technology will be published in my next FDJ article, as the search it is not unknown for website agencies or internet service providers to register a dental practice URL themselves and then charge a fat fee when their services are no longer required and a transfer is needed for innovative ways of reducing the overhead clinical costs of primary dental care continues unabated. So what has all this got to do with dental practice websites? Quite simply, do you wish to publish details on the worldwide web of what you are doing, where you operate and how you communicate with patients electronically? If so, you will need a properly designed practice website that is fit for purpose in every sense. However, first I will make another small digression to illustrate a contrarian point of view that is rooted in a belief that the status quo of the analogue world remains very much alive and kicking. A clinical experience At Christmas, my son related to me a recent dental experience that proved illuminating. He accessed the internet to find an emergency dental service in his area, selecting one of few practice websites that provided the necessary details of immediate telephone contact and treatment costs. He ended up finding an incredibly gifted practitioner (55 years of age and a technophobe) who is not interested in advertising on the internet for new patients via an expensive whizzy website. He does, however, have a strong ethical commitment to look after anyone who is in dire need of assistance when acute dental pain strikes (not just his regulars ) and provides a minimal internet presence to announce the fact. This practitioner has a thriving private practice built on recommendation and reputation that sets exceptionally reasonable patient charges, including a fee of less than 500 for a high-class complete gold crown. While his appointment book is full, he has no intention of computerising his practice and spending large sums of money attempting to recruit new patients online his offline analogue model serves him well and his patients network his services for him. We must not ignore the fact that neither he nor his age group has had any formal education at school in computer studies, which arrived more than two decades later. What is a website? This may seem a stupid question but the answer is not as simple as you think. A website is a collection of web pages, images, videos or other digital assets that is hosted on one or several web servers accessible via the internet, a mobile phone (responsive) or a local area network. The principle components are the domain name, web host, topic or content and communication facilities Domain name The results from a trawl of dental practice websites makes it obvious that not much thought is given to the domain name itself (also known as your web address or uniform resource locator [URL]). If you are keen to give your practice the maximum exposure on the internet, you should choose your domain name carefully as it will have a major impact on internet visibility where search engine optimisation is concerned. Significant keywords (meta tags or metadata) disclose important information about the nature of your busi- OPINION 93 ness that will influence the search engine rankings of Google and others. The presence of dental, dentistry or dentist in the URL is a fairly obvious essential that identifies the vast majority of practice websites. Some web addresses can fetch serious money today as they exploit their search engine optimisation value (eg www. bristoldentist.co.uk or the generic As the technology advances and competition mounts, more attention is being focused on the inclusion of a postcode (www.dentistsw1.co.uk) to pick up website visitors in a particular area. Brevity in a domain name is a key consideration, not only making it easier to access a website but also when used in an address. I cannot understand why so many websites include so many characters in their address and anything over 30 characters (including the www. prefix and.co.uk suffix) for a web address should be avoided. Another point to bear in mind when you copy out and send s is that the more text characters that have to be entered, the greater the likelihood of a mistake, resulting in a bounced message. There is no benefit in including practice in a web address where dental is a keyword or metatag. It is vitally important to ensure that a dental practice URL is registered with a domain registrar in the name of the practice principal as the owner. It is not unknown for website agencies or internet service providers to register a dental practice URL themselves and then charge a fat fee when their services are no longer required and a transfer is needed. Furthermore, make sure the period of ownership is not allowed to expire as I have experience of a practice manager failing to renew the practice URL registration after being taken ill and a pornographic website replacing it mysteriously two days later. This unhappy event was soon followed by an from the new URL owner to pay $8,000 to buy the web address back and remove the sleazy contents! Web host The web host or computerised facility ( web server ) has the ability to publish the practice website on the worldwide web, where it can be seen and visited. This computer will have a numerical internet protocol (IP) address (eg ) assigned as being the source of the website content in order to trace the origin. This hosting facility carries the domain name (website) information linked up with the IP address that is part of the domain name system used on the internet. When you type in a web address on your web browser (Safari, Internet Explorer, Firefox etc), you will be connected to the IP address in the domain name system. The cost of website hosting has come tumbling down with the introduction of cloud hosting and is often hidden in a much larger website administration fee being charged by a web agency. It is essential to have a proper contract with the service provider that includes details of the web server security and country of domicile where your practice website is housed. Beware of US hosting facilities as many do not comply with EU safe hosting requirements. These details are important as they have an impact on the notification details that must be registered with the Information Commissioner s Office (ICO). Topic, content and security compliance The topic of dentistry is obvious but what does your shop window (website home page) look like to a worldwide audience on the equivalent of a TV screen? From a brief survey of dental practice websites, insecure data harvesting facilities that include patient referrals, contact us, feedback, complaints and unsuitable services are common and do not look professional. British Dental Journal (BDJ) classified advertisements frequently invite the submission of personal CVs online and here there is very obvious evidence of a widespread DPA electronic communications compliance failure in UK dental practices. In other words, the stakeholders responsible for the regulation of UK dentistry and its data (the GDC, the Care Quality Commission [CQC] and the ICO) are way behind the action in monitoring the explosive metamorphosis from analogue to digital services in dental practices. Google has recently stated publicly that it processes personal data from all its accounts for commercial purposes and there are numerous examples reported in the press of Hotmail and Yahoo accounts (and Sony) being subject to cybercrime and hacking. Looking at recent BDJ classifieds, 48 dental practices seeking new staff published the addresses to which applicants were invited to send their personal CVs, including and 7 Quite apart from the fact that these IP addresses do not exactly broadcast an aura of professional respectability, prospective staff will want to know their sensitive personal data cannot be accessed and shared with an internet audience. The ICO has made it explicitly clear in its Burnett practice ruling in April 2013 that practices using / websites for professional purposes must ensure they are security protected (padlocked) and that e-messaging facilities are properly encrypted. 2 The Information Commissioner himself, Chris Graham, has publicly expressed his concerns over the unlawful exposure of personal identifiable information to unauthorised third parties and called for tougher punitive sanctions to be imposed, including jail. 10 Today s news headlines give his concerns renewed significance. A specific example is cited below of a dental practitioner failing to comply with the DPA and GDC regulations. The implications were serious as not only has patient personal identifiable information (PII) been accessed but viral malware may have been widely disseminated and a phishing exercise initiated to exploit patients financially. The target of the hacking was a Yahoo account that was advertised on the practice website and the viral infection spread via a private BT internet account. This type of electronic intrusion can cause total chaos and many sleepless nights for the practice staff. 94 OPINION Nigel Knott Figure 1 received by NJ Dentsure Ltd The shown in Figure 1 was sent to an unknown number of patients who attended a London practice (as well as to other archived personal addresses) and their sensitive personal details hacked unlawfully from a Yahoo account. Dentistry is a regulated profession carrying special duties of confidentiality but it is not alone as lawyers, accountants and others are all open to similar exploitation without the necessary regulatory compliance measures being in place. Compliance problems for dental practice websites Large numbers of dental practices use insecure accounts for professional communications purposes on a regular basis, and Gmail and Hotmail seem to be the most commonly used services. Google, of course, is a regular topic of conversation as its electronic tentacles spread far and wide, and its services have displaced Hotmail from the top dental spot in the last couple of years. It is difficult to know the actual numbers as particular practice web addresses (URLs) may be used to obscure the service provider. What I can say, however, is that all dental practice websites with unencrypted electronic communication template facilities designed to harvest sensitive patient data are breaking the law. Large referral practices are particularly at risk as any online referral templates inviting other dentists to refer their patients online must ensure they provide specially encrypted website facilities. Few practices publish a privacy policy on their website to make it clear to patients and referring dentists alike that they have registered with the ICO and that their e-communications are properly secured and encrypted for professional use. Nearly 10% of 130 dental practices referred to the ICO in a recent notification survey verified by the ICO were not registered at all under the terms of the 1998 DPA. 11 Many others have registered incorrect DPA details with the ICO. In addition, ICO registration details supplied by dental practices frequently fail to take account of the fact that data transfers or data sharing online are often made outside the jurisdiction of the European Economic Area (EU) despite their ICO notification details stating that these data exchanges take place in the safe harbour environment stipulated by law. There is considerable unease at present that some hosting facilities domiciled in the US do not fulfill the EU safe harbour compliance requirements. The home page as your shop window The look and feel of your website home page and the speed of response will be the difference between a high-value new visitor staying to learn more about your practice online or disappearing to find more opportunities on the first page of the Google search list. A rapid download speed is an essential website ingredient. Music, videos and a large amount of confusing text and irrelevant pictures, t

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Jul 23, 2017
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