The Health On the Net Code of Conduct for medical and health Websites

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Abstract

Internet has become one of the most used communication media. This and the fact that no constraining information publishing policy exists have created an urgent need to control the quality of information circulating through this media. To this purpose, the Health On the Net Foundation has initiated the Code of Conduct (HONcode) for the health/medical domain. This initiative proposes guidelines to information providers, with the aim, on the one hand, of raising the quality of data available on the Net and, on the other hand, of helping to identify Internet sites that are maintained by qualified people and contain reliable data. The HONcode mainly includes the following ethical aspects: the author's credentials, the date of the last modification with respect to clinical documents, confidentiality of data, source data reference, funding and the advertising policy. This article presents the HONcode and its evolution since it was launched in 1996.

Introduction

The advent of the Internet, and especially in recent years the explosion of the World Wide Web (WWW or Web), has provided professionals, but also the general public, with the access to a wealth of information. In the medical and health domain, data and information available on the Web offer to individuals (and patients in particular) the possibility to investigate nearly any topic of interest and to compare data from many different sources. Medical professionals can also use this media to obtain up-to-date information, or to exchange data and knowledge.

With the wide availability of Web server software it becomes increasingly easy to set up a Website and to publish any kind of data. Similarly, using Web browsers such as Netscape Navigator™ or Microsoft Internet Explorer™, most people can surf the Net and have access to these data. The problem is therefore no longer to find information, but to assess the credibility of the data source, as well as the relevance and correctness of a document retrieved from the Net. In many cases, no appropriate documentation is provided regarding the scientific design of a medical study, nor are studies made available that support given claims. The Code of Conduct for medical Websites (HONcode)[1]has been elaborated by the Health On the Net Foundation[2]to help unify and standardize the quality of medical and health information available on the WWW.

The first published version of the Code of Conduct, version 1.5[3], was made available in July 1996 in response to concerns expressed by a number of people involved in medicine and health care, regarding the difficulty to determine the reliability of data on the Net. Of specific concern were the validity of research data, the quality of medical advice being given on certain Websites, as well as the lack of scientific data supporting claims related to commercially available treatments[4]. Also, Webmasters do not always include all the necessary useful information (source of document, e-mail address, date of last update, …) on their Website. These omissions are in most cases free of malicious intent. Even more, discussion with these Webmasters showed that they were seeking guidelines for content presentation and were willing to improve their site by following some basic rules. The HONcode was therefore developed as a self-governance initiative that webmasters can accept or reject. By displaying the HONcode logo[5]on a Website, the owners of the site are demonstrating their desire to provide medical/health information, services or resources via the WWW that are of genuine value to the Net community and that meet specific quality standards. We hope that this approach will forestall draconian attempts at regulation by possibly inappropriate bodies.

Also, it was indicated that the HONcode would evolve according to the Net community demand. To meet requirements of the users and of the health and medical sites' webmasters, a new version of the Code of Conduct, version 1.6 was proposed[1].

In Section 2we detail the principles and the methods of evaluation of the HONcode. Then, in Section 3we describe the HONcode status in 1997 and finally, in Section 4, we present the world-wide use of this initiative and its impact on the Net community.

Section snippets

Materials and methods

A distinguished group of experts in medical informatics and telemedicine met to discuss the opportunities and risks associated with the Web at an international working conference in Geneva, Switzerland in September 19956, 7. Organisations represented included the World-Wide Web Consortium (W3C), European Community DGXIII, National Library of Medicine (NLM), World Health Organization (WHO), International Telecommunication Union (ITU), European Bioinformatics Institute (EBI), International

The HONcode

The eight principles of HONcode version 1.6 are as follows:

  • 1.

    Any medical advice provided and hosted on this site will only be given by medically trained and qualified professionals unless a clear statement is made that a piece of advice offered is from a non-medically qualified individual/organisation.

  • 2.

    The information provided on this site is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her existing physician.

  • 3.

    Confidentiality of data relating

Results

Since the launch of this initiative in July 1996, feedback from institutions, medical professionals and patients has been extremely positive. Those Web servers bearing the HONcode logo offer reassurance to visitors that the information being provided and the operating principles of the Web server meet specific quality standards. The authors believe that this initiative helps address a key prerequisite in realising the potential benefits to the medical and health communities of the Web and

Discussion and conclusions

World wide owners of medical/health Websites are aware of the need to unify the quality, to ensure that accurate, unbiased, ethical health/medical information prevail on the Internet. There is also a need to educate and continue providing clear guidance for medical/health Website managers. Additionally and from a legal perspective, it is apparent that:

  • There is a lack of common law decisions on matters relating to medical information/practice on the Web, Internet and On-line Services.

  • The ability

Summary

The growth in the number of medical and health Websites and the varying quality of medical and health information currently available on the World-Wide Web have created the need for guidelines to help homogenise the quality of such medical information. In view of the rapid proliferation of new medical and health Websites, it is often difficult for a user to identify sites offering useful and reliable information or advice. The Health On the Net Foundation (HON) has initiated the Code of Conduct

Acknowledgements

The Health On the Net Foundation and the authors express their thanks to the many people who provided valuable input to the HONcode principles and to all those participating in this initiative.

Celia Boyer received her M.Sc. in Applied Physics from Université de Luminy in 1993 and an Engineer Diploma in Computer Science from Ecole Polytechnique Fédérale de Lausanne. She is the webmaster of the Health On the Net Foundation, Geneva Hospital.

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Celia Boyer received her M.Sc. in Applied Physics from Université de Luminy in 1993 and an Engineer Diploma in Computer Science from Ecole Polytechnique Fédérale de Lausanne. She is the webmaster of the Health On the Net Foundation, Geneva Hospital.

Mark Selby is Executive director of the Health On the Net Foundation and President of the Internet Society Geneva Chapter. He has held senior executive position at Digital Equipment, Xerox and Océ. Appointed as an expert to the European Commission on Electronic Data Interchange in 1987, Mark Selby has worked extensively in the field of computer networking.

Professor Jean-Raoul Scherrer is a certified internist who received his M.D. from Geneva University Medical School in 1959. He became laureate of the Geneva Medical School for his doctorate thesis in 1965. From 1967 to 1969, he collaborated in research in physics at Brookhaven National Laboratory in New York. He became lecturer on medical informatics at the Geneva University Medical School in 1971 and a full Professor at the same medical school in 1979. He is Director of Medical Informatics at the Geneva University Hospital.

Ron D. Appel received his Ph.D. in Computer Science from Geneva University in 1997. After a post-doc at Harvard School of Public Health, and Brigham and Women's Hospital, he joined the Medical Informatics Division at Geneva University Hospitals where he is leading the Molecular Imaging and Bioinformatics Laboratory. Ron D. Appel is also member of the Executive Committee of the Health On the Net Foundation.

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