Ensuring the quality of information on the world wide
web
Speaking at a symposium on quality management of information
on the web on 4 September, Joan Dzenowagis, World Health Organization,
Switzerland, said that improving the quality of health information on
the internet is a significant challenge. There were several types of quality
initiatives globally, she added, and it was possible that WHO would become
involved in certifying and/or developing quality standards in the near
future.
Pharmacy seal of approval
Carmen Catizone, executive director, National Association
of Boards of Pharmacy, United States, highlighted the responsibility of
health care professionals in not only helping patients to use the internet
appropriately, but also in getting involved in quality initiatives. He
described one such initiative developed by the US National Association
of Boards of Pharmacy — the verified internet pharmacy practice sites
(VIPPS) programme.
This programme, together with its accompanying seal
of approval, identified online pharmacies that were appropriately licensed
and prepared to practise pharmacy via the internet in the US. As a voluntary
scheme, which was neither regulated nor maintained by the industry, VIPPS
provided consumers instant access to an independently verified database
of online pharmacies, and the clearly displayed logo on the individual
pharmacy’s web page informed patients immediately whether or not they
were dealing with a VIPPS site.
Any regulation of internet sites was difficult without
the involvement of patients, she said, but it was hoped that patients
would use VIPPS as a seal of approval, and such pharmacies were already
receiving 25,000 hits a month overall. Partnership between patients and
regulatory authorities was one way forward which could help to make the
internet a safer place for health information, she concluded.
Should health web sites be rated for quality?
The case for rating the quality of health web sites
was put by Guy D’Andrea, senior vice-president, URAC (American Accreditation
Healthcare Commission), US. Many consumers had a low level of trust in
health websites and lacked the tools to help them identify sites worthy
of their trust, he said. A URAC survey had shown that a “seal of approval”
would improve users’ level of trust in health sites, with a majority of
consumers being in favour of some sort of oversight.
A further finding of the survey seemed to suggest
that consumers would value a search engine that listed results for health
websites according to whether or not they were accredited. In other words,
any rating system would have an even greater impact if it could be built
into the search engine process, he said.
Rating was not the only possible solution to health
internet quality issues, but was a significant part of the solution. However,
important questions still remained, notably, who should administer a quality
rating system, which system should be used, and whether web sites and
search engines would actually participate.
The case against rating the quality of sites was
put by Mark Duman (United Kingdom). In relation to health, it was clear
the internet could be a force for both bad and good, he said. However,
it was not known which it did more of, and it was important to know a
little more about this before progressing with accreditation and trustmarking
schemes. Quoting Dr Tony Delamonte, (web editor of the British Medical
Journal), he said, “the onus should be on those who want to intervene
to show that their actions will result in a net improvement in human health”.
The need to improve quality of health information on the web was not in
doubt, Mr Duman emphasised, but how this should be achieved needed careful
consideration.
So, what were the issues? Certainly consumers were
concerned about the validity of health information on the internet, but
the act of approving health information — of organisations viewing themselves
as gatekeepers on what individuals should and should not see — was contrary
to concepts of patient empowerment and the desire of consumers to be more
involved in decisions affecting their health. Various organisations were
developing quality tools, but it was difficult to know which tools to
use because none was properly tested. In any case, judging the quality
of information was a complex issue, and there were various vested interests
involved.
Moreover, any attempt to rate the vast amount of
information available, even with the help of information technology, would
require so much in the way of resources as to be unsustainable.
Estimates suggested that there were at least 100,000
medically related sites on the web and establishing a quality rating system
would involve thousands of people, cost millions of pounds and involve
a huge amount of bureaucracy.
Another issue was the practicality of reviewing
information, ensuring it was up to date and preventing piracy. Deciding,
for example, on what was evidence-based was a huge task in itself, not
to mention appraising content for its readability, its usability by various
minority groups and its currency. Moreover, there was little proof to
show that the accreditation process actually worked.
Standards
One way forward, he suggested was to provide consumers
— not organisations — with the tools and skills to appraise health information
on the internet for themselves. Simple standards could be recommended
for consumers to use:
- Who were the authors of the web site and what
were their credentials?
- Was the content appropriately referenced and
sourced?
- When was the information posted and updated?
- Who were the web site owners and sponsors?
- Who were the intended recipients of the information
and was it therefore targeted appropriately?
Consumers should be educated to use more than one
source of information, and be advised that information on the web is a
complement, not a substitute for interaction with a health care professional.
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