My twin girls are five now and for the past year or so, one of their favourite refrains has been “ask Google, Daddy”. They are at that stage when they are curious about everything. The cynicism of later childhood years has yet to creep in and each day is met with a barrage of whys, what’s that for, who invented this or where is that? Now you might think that the kinds of questions posed by a five-year-old could be effortlessly fielded without recourse to books or the internet, but not so. Over the past week alone I have had to cope with: who invented electricity? Why do you get more colds in the winter? How cold is it on Neptune? and When was the first film/what was it? Of course you may be reading this wondering why anybody would need to look up such basic general knowledge. Surely everybody knows that the temperature at the surface of Neptune averages -201°C? For me, however, I did what most of us now do when posed with such questions. I asked Google. Since Google brought in voice search on their mobile App, the girls have been able to hear for themselves how Daddy obtains his answers to their random assortment of questions and queries. It won’t be long, I suppose, before my services are redundant anyway, given that they will soon figure out how to post questions to Google themselves.
The point here is: if children at this age are already being trained to go to Google, as the default option when looking for information on subjects of pretty much any nature, then there is no immediate end in sight to the search engine’s dominance as curator of the world’s information. When my childrens’ generation, the post-millennials, get old enough to start looking for health-related information, it’s a given that their first port of call will be the internet. More than half of millennials said they search online for health information before seeing a doctor (1). It is also well documented that us GenXers (some of whom are already getting into their mid-50s) and baby boomers are increasingly turning to the internet to help manage, research and diagnose health matters.
The Dominance of Google
It was during 2002 that Google started to establish its grip on search, globally, and have retained the number one slot ever since. In the US their share of the search market has remained pretty steady at between 60-70% for the past 7 years or so (2). The only significant change in the market landscape has seen Microsoft’s Bing replacing Yahoo in the number 2 slot (Bing now has about 20% US market share, which is about where Yahoo was in 2008). In most European countries Google has maintained a market share of around 90% for many years. [China has a different search landscape with domestic players like Baidu and 360 dominating]. For European-based marketers, search marketing has meant Google marketing for as long as most of us can remember. Kids in Finland are not telling Daddy to ask Bing and Dads in Italy don’t ask Yahoo. From the Nordics to the UK, central to southern Europe, it’s Google all the way. Given the dominance of Google, outside of China at least, most discussions about search engine optimisation (SEO) centre on Google (as does this article).
So it is hard to over-state Google’s power and influence over so many facets of life. Ensuring prominence in Google’s SERPs (search Engine Results Pages) has become a holy grail for businesses and, indeed, anybody who wants to be found! Google obviously realised this at an early stage and gave customers the option to pay their way onto the SERPs with the launch of Google Adwords in 2000. The vast majority of Google’s approx $66billion revenue in 2014 came from Adwords, which itself says a lot about the value we place on prominence in Google.
However, if you don’t want to shell out for Adwords, the only other option for Webmasters (anyone who controls a website) is to convince Google that your site is worth listing in their “organic” search results; preferably on the first page; preferably at the top. Enter Search Engine Optimisation, or ‘SEO’.
Google: Algorithm Changes
SEO has changed a lot over the last 5 years, mainly because Google have made a series of major changes to their algorithm. Algorithms (as defined by Google themselves) are “computer programmes that look for clues to give you back exactly [the web page] you want”. So if you understand the details of the algorithm, and so the “clues” Google is looking for, then you will know how to build your site in such a way that Google will list it favourably on the SERPs. And therein lies the problem: Google will never release the details of their algorithm and the algorithm changes all the time. Google’s algorithm is basically their “secret source”. Their core intellectual property. The way they stay ahead of the competition and ensure that Google provides the most relevant websites (or answers) to the millions of searches and questions posted every day.
So what is Google looking for when selecting websites to list on SERPs? This question is at the heart of SEO and a whole industry of SEO professionals has grown up to help companies tailor their websites for favourable listing by Google. Nobody has the definitive answers, but Google provide lots of clues, and trial and error approaches have given us a good handle on what Google does and doesn’t like.
In the early days of Google, “PageRank” was the key measure used by Google’s algorithm. Named after Larry Page, one of Google’s founders, PageRank judges a website’s importance and relevance by the number of other sites that link to it. Back then, SEO was a fairly straightforward affair. A webmaster would simply research and select keywords (the words or phrases, describing your product or service, that you would like people using Google to find you with!), stuff their site with these keywords, both within page text and embedded in site code (HTML tags), and then get as many other websites as possible to link back to you (backlinks). So if, say, you were marketing an analgesic for Migraine, you might fill your Brand and Disease Awareness websites with references to the keywords “headache”, “Migraine”, “Migraine pain relief” and ensure that as many other sites as possible linked back to you, preferably through these same keywords. The problem for Google, who always want to serve up the most relevant, highest quality content to their customers, was that this approach took no account of the quality of the site being ranked on the SERPs. You could have a highly commercial page about Migraine products that offered users very little in the way of disease information and still be successful in ensuring Google ranked you high up the SERPs.
Algorithm tweaks were made from the early days, but from 2011 onwards, Google started to make significant changes to their algorithm to address some of the SEO techniques designed to ‘game the system’: so-called black hat SEO. Many of these changes fell into what became known as the “Panda” and “Penguin” up-dates and the kinds of issues and sites they were principally designed to target included:
• Low quality “link farm” websites whose sole purpose was to provide backlinks to a target website that a webmaster was seeking to SEO
• Sites with too many adverts
• Unnatural backlinks, created by a target site’s webmaster (as opposed to natural links reflecting a recommendation for the site by a third party)
• Low quality / ‘thin’ content websites
• Keyword stuffing of sites with poor quality content
• Scraper sites that steal content from other sites
In 2016, after a whole slew of algorithm up-dates, the way to get your site to the top of Google is now a lot different to the way it was back in 2010. Whilst good quality backlinks from reputable sites are undoubtedly still of value, content is now very much king. And this is exactly the way Google wants it. Black hat SEO is out and white hat is in. White hat SEO is basically SEO that Google would approve of: techniques to create a well-structured, easily navigable site with great quality, authoritative, relevant content that is endorsed by other sites that command authority in their respective field.
SEO for the Healthcare Industry
The challenge for many healthcare marketers is to gain visibility within a particular disease area: visibility often meaning (quality) traffic to a medical education initiative website or a brand site. Clearly, generating traffic to your shiny new website is never going to happen without ranking well on Google’s SERPs. For a commercial organisation this can be hard. The top slots on SERPs for most medical conditions are dominated by the big authority sites, and this is probably the way things should be. www.NHS.uk/conditions frequently leads for UK searches whilst www.webmd.com, www.cdc.gov , www.mayoclinic.org , and http://www.ncbi.nlm.nih.gov/ are big hitters in the US. Patient societies / advocacy groups and medical professional bodies also regularly feature in the top 5-10 on SERPs. Authority has become a big deal in SEO and nowhere is this more important than in healthcare.
It’s hard to over-emphasise the importance of quality content for search engine optimising a medical site:
• Firstly, whilst link farms, backline campaigns and automated link-building software are definitely ‘out’ in the post-Penguin/Panda world of Google; natural, relevant backlinks from major medical authority sites are almost certainly a good thing. However, these sites will never want to link to you if all you can offer is a commercial brand site with nothing in the way of quality medical content, whether for HCPs or patients.
• A website’s bounce rate (the % of visitors viewing only one page / the number of visits in which a person leaves your website from the landing page without browsing any further) and ‘time on site’ statistics will almost certainly form a part of the Google algorithm. If Google knows that people looking for information about “migraine” don’t stay on your site for long once they have found you, they will assume you are not providing the right information and demote you on the SERPs. The way to overcome this is by offering great content that retains visitors once they find you.
• Finally, Google are getting more sophisticated in recognising well-informed and credible content, as opposed to content written purely for SEO purposes. Google are investing a lot in artificial intelligence and maybe this plays a role here.
For me, the key take-home from the above is to ensure that you enrol a credible key opinion leader (KOL) to write medical (education) information for any website you are constructing. If you don’t do this, you are going to have a very hard time with SEO. Firstly, the authority of your KOL is going to encourage back-linking from the established authority sites in your field. Secondly, you are going to end up with content that Google recognises has been written by “somebody who knows what they are talking about”. Thirdly, because your content will be good, visitors will stay on your site for longer once they find you, which again will be looked on favourably by Google.
Outside of content, there is a whole host of the things you need to get right to maximise your chance of ranking highly in Google. These include:
- Optimise HTML tags and meta-information
- Submit a site map to Google Webmaster tools
- Minimise page load time
- Browser test site and, preferably, make it responsive- for mobile and tablet
- Initiate a social media campaign around your website
- Use video content on your site.
Lots of little things you can do will collectively, and over time, help to move you up the SERPs.
My three key steps to SEO success for your new healthcare website:
1. Work with your developer to design and build a user-friendly, easily navigable, mobile-optimised site
2. Enlist one or two credible KOLs to write content for you, and have a plan to keep content regularly refreshed. Engage with organisations running authority sites for your disease area, like patient societies.
3. Work with your developer (or enlist the services of an SEO expert) to ensure you have addressed all of the little things, around great content, that together can maximise your chances of SEO success.
The key to all SEO is to think about Google’s business model. Google needs to ensure that their search engine always finds the best results for its users so they keep coming back. If you can align your sites with this objective you won’t go far wrong.
I think all medical marketers need to keep in mind that healthcare is different to many other categories of search. There is a particular responsibility on Google to ensure that unbiased, authoritative and credible sites from trusted sources are first in line when people search for information about medical conditions and symptoms. Life and death decisions can result from some of these searches. However, it is also important that the manufacturers of the medicines and healthcare products that millions of us use every day have a voice, and for our websites to be found we need to get to grips with current thinking around SEO.