THE BACKGROUND

There has been considerable debate about the variable quality of health information on the world-wide-web and its impact on public health. Several studies have evaluated the quality of medical information on various venues of the Internet such as the World-Wide-Web (Eysenbach et al.,2002), newsgroups (Culver et al., 1997) and email consultations (Eysenbach and Diepgen, 1998a; Eysenbach and Diepgen, 1998b; Sandvik, 1999). As the number of health related websites continues to grow, and information technology and consumer health informatics are becoming integral parts of modern public health concepts and national health care policies in developed countries (Eysenbach, 2000), implications of Internet information for public health are widely discussed (Coiera, 1998; McLeod, 1998).

While central authorities to regulate, control, censor, or centrally approve information, information providers or websites are neither realistic nor desirable, public health professionals are interested in making systems available that direct patient streams to the best available information sources. National governments, medical societies, and health professionals have recognized their responsibility to help users to identify "good quality" information sources and to guide consumers and patients to the best available medical information on the web. Medical organisations and governments have begun to develop national gateways (Healthfinder.gov, NHSDirect/NeLH), portal sites and other forms of infomediaries such as seals of approval ("kitemarks") in an effort to help consumers to locate trustworthy information resources.

MedCERTAIN (MedPICS Certification and Rating of Trustworthy Health Information on the Net), a joint project of the University of Heidelberg, Germany, the ILRT and FINOHTA co-funded under the European Union's (EU) "Action Plan for safer use of the Internet" from 5/2000 until 02/2002, established a fully functional demonstrator for a self- and third-party rating system enabling consumers and professionals to positively identify and select high quality information.

The MedCERTAIN approach combined aspects of consumer education, helping and stimulating information providers to implement best practice guidelines, encouraging self-labeling by information providers, external evaluations and monitoring. To obtain a "level-1" MedCERTAIN transparency mark, the information provider has to disclose certain information in a standardised, computer readable format using the "Health Information Disclosure, Description and Evaluation Language" (HIDDEL, formerly known as medPICS) expressed in XML/RDF. The same language can be used by gateways to express opinions (annotations) of evaluators about other sites.

As the number of health related websites worldwide has been estimated as being around 100,000 (Eysenbach et al., 1999), complete coverage by a single third party evaluation body is impossible. Instead, a collaborative approach has to be promoted, whereby different rating services/organisations use comparable standards and a common metadata language.

This is the approach of MedCIRCLE, a collaboration of European health subject gateways and rating services using the HIDDEL vocabulary to ensure interoperability of rating services and to guide consumers to high quality health information sources on the Internet.

References

Coiera E. (1998). Information epidemics, economics, and immunity on the internet. We still know so little about the effect of information on public health [editorial; comment]. BMJ 317, 1469-1470.

Culver JD, Gerr F, Frumkin H. (1997). Medical information on the Internet: a study of an electronic bulletin board.
J Gen Intern Med 12, 466-470.

Eysenbach G, Powell J, Kuss O, Sa ER. (2002). Empirical studies assessing the quality of health information for consumers on the World Wide Web: A systematic review. JAMA 287, 2691-2700

Eysenbach,G. and Diepgen,T.L. (1998a). Evaluation of cyberdocs. Lancet 352, 1526.

Eysenbach,G. and Diepgen,T.L. (1998b). Responses to unsolicited patient e-mail requests for medical advice on the World Wide Web. JAMA 280, 1333-1335.

Sandvik,H. (1999). Health information and interaction on the internet: a survey of female urinary incontinence. BMJ 319, 29-32.

Eysenbach,G. (2000). Consumer health informatics. BMJ 320, 1713-1716.

McLeod,S.D. (1998). The quality of medical information on the Internet. A new public health concern [editorial]. Arch Ophthalmol 116, 1663-1665.

Eysenbach,G., Sa,E.R., and Diepgen,T.L. (1999). Shopping around the internet today and tomorrow: towards the millennium of cybermedicine. BMJ 319, 1294.

(Last update: 2002-07-03)