How to find the good and avoid the bad or ugly: a short guide to tools for rating quality of health information on the internet * Commentary: On the way to quality

Abstract

Codes of conductCodes of conduct are defined as sets of quality criteria that provide a list of recommendations for the development and content of websites. These codes inform a process of self assessment by providers of websites and educate both providers and consumers of websites about “good” practice so that providers adhere to the codes and consumers grow wary of sites that do not. Several organisations are developing a set of quality criteria for health related websites (box), but the extent to which such codes are implemented varies. Where the code is adopted by an umbrella organisation such as national or specialty based medical associations, the associations ensure that members comply with the code and may discipline members who are not compliant (box). However, some codes have been adopted by a group of individuals whose sole purpose is to draft the code rather than to oversee its implementation (box).Organisations responsible for codes of conducteHealth Code of Ethics of the Internet Health Coalition (www.ihealthcoalition.org/ethics/ethics.html) is one organisation developing a set of quality criteria for health related websitesThe American Medical Association (http://www.ama-assn.org/ama/pub/category/1905.html) oversees the quality of several websites and disciplines providers that do not comply with its criteriaHealth Summit Working Group (http://www.mitretek.org/) from north America created a code but did not oversee its implementationeEurope Draft Good Practice Guidelines for the Health Internet (europa.eu.int/information_society/eeurope/ehealth/quality/draft_guidelines/) seeks to stimulate the development and implementation of codes of conduct in member states of the European UnionCosts and benefitsCreating codes of conduct has few costs, only an outlay for meetings to draw up the code. But low costs can affect consumers because the absence of any enforcement mechanisms may mean that the code has a limited life.(Credit: SUE SHARPLES)What doesn't workAll the major quality initiatives listed in Wilson's paper have one or more of the following limitations1: Size of the burden placed on the providers and seekers of health information Inadequate provision of credible citizen education programmes Cost of developing and maintaining quality programmes Failure to address the needs of the developing world. We expect a lot of the seekers of health information. They must learn how to critically appraise information, determine its relevance and validity of context, compare various sources of information for cross validation, and really care about quality. Some citizens manage this, but they are probably a tiny minority. So far, no vision has emerged of how the great majority might be converted. Their indifference and ambivalence will continue to be formidable obstacles. A better strategy may be to educate providers to put high ethical and quality standards at the heart of their organisations.For providers, the cost of implementing quality programmes varies from little (self certification) to enormous (third party accreditation). The important cost, however, is in the long term maintenance of these efforts.A serious limitation of the current quality initiatives is that they have originated in the developed world, most of them from English speaking countries. Though the internet's potential to improve the health of people in the developing world is enormous, so too is its potential for doing harm, particularly where regulatory systems are weak.