In 1998, Jakob Nielsen, PhD, hailed by the New York Times as the guru of Web-page usability, wrote, “The Web is simply not that suited for advertising.”1 He also predicted that content would become self-optimizing. In his defense, it should be noted that Nielsen was right far more often than he was wrong. Since then, the Internet has developed both hugely successful paid programs (search-engine management) and what Nielsen called free, self-optimizing programs in the form of search-engine optimization (SEO). Each has its advantages. Both require a commitment of time and personnel, and both require constant attention. The chief advantage of SEO is that it can be done for free (as long as you do not include the cost of your staff time) or for an initial investment that pales in comparison to the cost of pay-per-click advertising. Today, Web sites must be actively engaged in a formal SEO program in order to remain viable and visible. The Process SEO is the process by which a Web site maximizes visibility and search results by manipulating its content in response to the various search-engine criteria. George Grant, CEO of Connected Marketing, a Los Angeles-based SEO company, says, “SEO is all about free, organic marketing. SEO is the critical component of inbound marketing. Right now, search traffic is dominated by Google, Yahoo!, and MSN, with most of that coming from Google. The reason it’s so critical is that it’s free traffic, and once you get it to work, you get a really great return on your investment.” That return is driven, in part, by unfavorable perceptions of the paid results returned by a search engine, typically via banners near the top of the page and towers, which are on the right. Most people searching are more likely to click on an organic (unpaid) result because of the perception that the paid results are not informational, but are intended only to sell something. “Organic search is one of the most trusted areas of online marketing,” Grant says. “About 60% of people searching for something are going to go to an organic search before a paid result, simply because they trust it.” Grant knows that SEO is not free if someone has to pay to manage the program, but it is clear that the investment difference between an organic program and a pay-per-click program is vast, and that the results are comparable (or even better for the organic program). Grant says, “The paid results have offered the perception to the user that they will be manipulated—that it’s more salesy. Not only are people more likely to click on organic results, they are more likely to convert.” Online, a conversion event may be not only a sale, but a request for information, a newsletter signup, or a visit to parts of a site beyond the home page. The Elements of SEO According to Grant, the important elements of SEO are both on-page factors and off-page factors. “On-page factors are having the great title and meta data descriptions and meta key words that show up on Google,” he says; the title is the headline of the search results and the metadescription is the text (20 to 25 words) below that headline. “These are like ads,” Grant continues. “One mistake that people make is that they don’t spend any time creating proper titles and metadescriptions, and as a result, they have junky ads. When they see themselves coming up on Google along with everyone else, it is not compelling, and no one clicks on their ads.” Grant says, “Your site and your on-page options are about the outside world and have to be treated as though you are writing an ad, because you are.” For even greater results, Grant notes, remember that it’s not only what you say, it’s how you say it. “It is also important to build quality on the Web site: quality content and quality links. It’s all about quality. The reason that one site ranks better than another is because Google views it as higher quality,” he says. Blog It Blogs can boost organic results and are easy to build and maintain, yet very few radiology Web sites have blogs. “A blog is becoming mission critical,” Grant says. “It is your voice in the online community. If you are a business, you want to build your voice in the community, and a blog makes it really easy for you to publish interesting, topical things.” He continues, “Many Web sites are brochures, where someone has taken a printed piece and put it online. That is so 2006. A brochure Web site is static; it has no life. A blog gives a Web site life and dynamics. It changes the content and lets you talk about things that are current. The Web is not a place where you just post a brochure.” Grant notes that there is persistent skepticism about the value of blogs. There are also many businesses without the time or resources to make regular blog contributions. He says, “If you are not willing to (or can’t) do a blog, then you need to refresh your content as often as you can. The more topical your content is, the more valuable it is. There is a time value to the information, and that topical content helps make your site more successful.” Grant continues, “Today, Web sites must be more than brochures, and tomorrow, Web sites will include social media, video, and rich Internet applications.” In social media, Grant includes the personal interaction afforded by networking sites such as Facebook and MySpace. Videos will move beyond the company-centered Flash® versions that play on a few radiology Web sites to YouTube opportunities with the ability to reach far beyond Google’s organic results. The YouTube factor is already on the rise: A recent YouTube search for radiology yielded 554 results, nearly all of them informational. The practices of marketing an imaging center and marketing products to imaging centers are now dominated by online campaigns. Patients searching for imaging services are using key words that focus on geographical references. For example, where people once used Google with radiology as the search term, they are now searching for radiology plus Chicago (or wherever they happen to live or work). That, too, may change; “Everything is changing constantly,” Grant says. What is clear is that the proper execution of an SEO program is best left to professionals. Their attention to the constant changes benefits an already smart strategy.