A Structured Audit Framework Your Hospital Marketing Team Can Run This Quarter

Most hospital SEO audits fail because they treat the website as a single entity. A health system is not a single entity — it is a collection of service lines, locations, physician profiles, and patient pathways, each with its own organic visibility requirements.

An effective audit separates those requirements into hospital SEO audit has [four distinct layers](/resources/accountants/seo-audit-for-accounting-firms) — technical, content and scores each one independently before drawing any conclusions about priority or investment.

• Technical Health: Crawlability, indexation, page speed, Core Web Vitals, structured data implementation, and HTTPS integrity across all subdomains and facility microsites.
• Service-Line Content: Whether each clinical program — cardiology, oncology, orthopedics, primary care, behavioral health — has sufficient page depth, condition-level coverage, and appropriate E-E-A-T signals to compete for the queries patients actually use.
• Local Pack Performance: Google Business Profile completeness, review volume and recency, NAP consistency, and map pack rank for each physical facility location.
• Analytics Configuration: Whether the measurement stack is capturing organic traffic accurately without violating HIPAA — including correct exclusion of PHI from tracking pixels, server-side event configuration, and GA4 data retention settings.

Each layer gets a score before you look at the others. A health system with strong technical infrastructure and weak service-line content needs a different response than one with excellent content buried under crawl errors. Conflating the four layers produces a priority list that fixes the wrong things first.

Note: This framework is educational guidance for hospital marketing teams. For decisions affecting patient data handling or regulatory compliance, consult your HIPAA compliance officer and legal counsel.

Technical SEO problems in health systems tend to cluster around three structural issues: large site architecture that creates crawl inefficiency, legacy CMS environments that generate duplicate content, and multi-subdomain setups where link equity does not consolidate correctly.

Crawlability and Indexation

Start with a full crawl using a tool like Screaming Frog or Sitebulb. Filter for 4xx errors on URLs that appear in your sitemap or receive internal links. For most health systems, physician profile pages and service-line landing pages are the highest-value URLs — errors here directly suppress patient-facing visibility.

Cross-reference crawl data against Google Search Console's Coverage report. A large gap between submitted sitemap URLs and indexed URLs signals either crawl budget problems (common on sites exceeding 10,000 pages) or systematic indexation issues from duplicate content or thin pages.

Core Web Vitals

Google's field data in Search Console's Core Web Vitals report reflects real patient experience on mobile devices. Largest Contentful Paint above 4 seconds and Cumulative Layout Shift above 0.25 are the thresholds most commonly failing on hospital sites, often caused by unoptimized hero images and third-party script loading from patient portal integrations.

Structured Data

Health systems should implement Hospital schema, Physician schema (using the MedicalBusiness and Person types), and MedicalCondition schema on condition-level content pages. Many audits find that structured data exists on the homepage but is absent from the service-line and physician pages where it produces the most visibility impact.

HTTPS and Subdomain Integrity

Patient portal subdomains, telehealth booking tools, and facility microsites are common sources of mixed-content warnings and HTTPS failures. These do not always affect the main domain's rankings directly, but they create patient trust signals and can suppress click-through rates on branded queries.

In our experience working with healthcare organizations, service-line content gaps are the most common reason hospital websites underperform on organic search despite having strong domain authority. The gap is rarely about total page count — it is about the depth and specificity of coverage relative to what patients search for.

How to Map the Gap

For each major service line, build a keyword inventory using a combination of Google Search Console (queries your site already ranks for), a keyword research tool, and autocomplete analysis for condition-specific terms. Then map each keyword cluster to an existing page. Clusters with no corresponding page are gaps. Clusters with a corresponding page ranking below position 20 are suppression problems — a different diagnosis requiring different fixes.

Scoring Criteria for Service-Line Pages

• Condition-level coverage: Does the service line have individual pages for major conditions treated, or only a single program overview page? Cardiology, for example, typically requires separate pages for heart failure, atrial fibrillation, structural heart disease, and cardiac imaging to compete against condition-specific queries.
• Physician attribution: Are treating physicians linked from service-line pages with full profiles? Google's quality rater guidelines specifically evaluate whether medical content is authored or reviewed by credentialed professionals. Physician attribution is a direct E-E-A-T signal.
• Patient-intent alignment: Does the page address the questions patients ask at the start of care — symptoms, diagnosis process, what to expect — or only describe the program from an institutional perspective?
• Internal linking from condition pages to appointment CTAs: Many health systems have well-written clinical content that fails to convert because the path from information to booking is broken or absent.

Score each service line on a 1-5 scale across these criteria. Lines scoring below 3 are priority targets for content investment before any technical or local work produces meaningful returns.

A health system's aggregate local SEO score is meaningless. A flagship academic medical center ranking in position 1 for its city does not compensate for a regional facility three markets away that fails to appear in the Map Pack for any of the high-intent queries driving patient volume in that community.

Each facility needs its own diagnostic. Run each location through the following checklist independently.

Google Business Profile Completeness Audit

• Is the GBP verified and owned by the health system's marketing team — not an outdated agency login or a former employee's account?
• Are the primary and secondary categories correct? Most hospital facilities should use Hospital as the primary category, with secondary categories for specific departments where supported.
• Is the address, phone number, and website URL consistent with the NAP data on the facility's website location page and major citation sources (Healthgrades, Yelp, Bing Places)?
• Are services listed at the facility level, not only at the system level?
• Do GBP photos include interior facility images, exterior wayfinding photos, and department-specific imagery? GBP profiles with recent, relevant photos consistently outperform those with only a logo.

Review Volume and Recency

Industry benchmarks suggest that local pack visibility correlates with both review count and recency — a facility with 200 reviews but none in the past six months is at a disadvantage against a competitor with 80 reviews and a consistent monthly cadence. Audit the date of the most recent review for each facility, not just the total count.

Local Pack Rank Measurement

Use a rank tracking tool that supports grid-based local rank tracking (BrightLocal or Local Falcon are commonly used for this). Measure rank at the facility's address and at a 3-5 mile radius for your highest-value service queries. The difference between rank at the facility address and rank two miles away reveals whether your GBP is visible to patients searching from surrounding neighborhoods — a common failure point for urban health systems with dense competitor environments.

This layer must be diagnosed before you trust any data from the other three. If your analytics configuration is passing protected health information to third-party platforms — a violation that HHS's 2022 and 2023 guidance on tracking technology made explicit — then your traffic data, conversion data, and keyword data are both legally problematic and potentially inaccurate.

Educational note: The following guidance reflects general best practices. Your organization's compliance determinations should be made in consultation with your HIPAA Privacy Officer and legal counsel, not based on this content alone.

What to Check

• GA4 IP anonymization: Confirm that IP anonymization is enabled and that user-level data is not being retained beyond your policy's defined window.
• Pixel inventory: Document every third-party pixel or tag firing on patient-facing pages — appointment booking flows, symptom checkers, patient portal login pages. Meta Pixel and Google Ads remarketing tags on these pages have been identified in HHS guidance as potentially capturing PHI without a valid Business Associate Agreement.
• Form field tracking: Confirm that analytics events are not capturing form field values on appointment request forms or any page where patients enter health-related information.
• Conversion proxy configuration: If you have removed direct pixel tracking from sensitive pages, confirm that server-side conversion APIs or HIPAA-compliant proxy services are in place and producing reliable conversion data for organic traffic attribution.

Why This Affects Your Audit Baselines

If PHI-adjacent tracking has been removed from appointment booking flows — a step many health systems took after the 2022 HHS guidance — organic traffic may appear to have declined when what actually changed is your measurement scope. Auditing organic performance without understanding recent analytics configuration changes produces false conclusions about SEO effectiveness.

After completing all four layers, you have four independent scores. The relationship between those scores determines your priority order — and whether the work is feasible internally.

Scoring Rubric

• Score 1-2 (Critical): Active suppression. Crawl errors on priority pages, GBP suspensions, analytics configurations passing PHI to ad platforms. These require immediate action before any growth work produces results.
• Score 3 (Moderate): Structural underperformance. Thin service-line coverage, incomplete GBP profiles, missing structured data. Addressable with a structured roadmap over 3-6 months.
• Score 4-5 (Optimized): Competitive refinement. The foundation is in place; marginal gains come from content depth, link acquisition, and local review programs. This is the stage where specialist support shifts from remediation to growth acceleration.

When to Handle Internally vs. When to Bring in Specialists

Internal teams handle moderate scores well when the problems are content-related and the marketing team has clinical writing capacity. Technical scores of 1-2 involving site architecture, crawl budget, or structured data implementation typically require specialist access to the CMS, server logs, and Search Console history — tools and permissions that external teams often work through faster than internal stakeholders can navigate approval cycles.

Local pack scores of 1-2 for multiple facilities simultaneously — GBP suspensions, NAP inconsistencies across hundreds of citation sources, or Map Pack absences in competitive markets — are the clearest signal that the scope has exceeded what most in-house hospital marketing teams are staffed to resolve. If your audit surfaces this pattern, hospital SEO services to resolve audit findings represent a faster path to recovery than adding headcount.

The audit's job is not to produce a task list. It is to tell you honestly what you are dealing with — and what the realistic remediation path looks like given your team's current capacity.