Health Information on the Internet: A Study of Providers, Quality, and UsersBMJ 2006; 333 doi: https://doi.org/10.1136/bmj.333.7568.607 (Published 14 September 2006) Cite this as: BMJ 2006;333:607
This book—painstakingly researched and compiled over four years by an assistant professor in information management in Victoria, New Zealand—is a laudable attempt to capture thoroughly the bewildering array of global health information available on the internet and to elucidate how the internet has changed the way in which healthcare consumers and providers communicate. Inevitably, given the time it took to write, some of the information is not up to date—access to bmj.com is not universally free any more, for example.
The author argues that a paradigm shift has taken place as the internet has fundamentally changed the relationship between providers and consumers of health care. It has done this by providing access to clinical information for both groups, thus potentially enabling consumers to question as well as challenge providers, participate in decisions, make informed choices, and influence outcomes. Cullen begins by looking at where and how health information is found on the web, and who provides it (educational establishments, government initiatives, private companies, etc). She also examines barriers to using the internet (such as access problems, a lack of familiarity with search techniques, or a lack of culturally relevant content) and the factors that motivate information providers (which can range from making profits to networking to facilitating academic excellence). There has been substantial investment, and online healthcare information has some unique characteristics that affect its production and use. These include issues of regulation and quality (control), ease of dissemination, possible access from anywhere and at any time, as well as the searchable and accessible format of this information.
Examining the structure of knowledge in the health sciences (including an interesting discussion on evidence based medicine), the author highlights the differences in the format and content of print and web media. Web information may be as costly to produce as printed matter, but its dissemination incurs no cost to the provider. However, web content has necessitated new marketing ventures to increase advertising revenue and has required a rethink of subscription and reprint rates as a result of losing print subscriptions. Web content is not limited to the printed word; it can include interactive features, soundbites, videos, podcasts, online surveys, and additional data sets, and thus altogether helps the web user to become a participant, rather than just a reader.
Cullen concludes that people from many different disciplines—such as librarians, information managers, web developers, health informatics specialists, healthcare practitioners—will have to pull together and become involved in making this new technology effective and useful in improving health care through collaboration, training, and evaluation.
The book's main shortcoming, however, is that it is anything but a rollicking good read—it takes discipline and application to plough through, and its academic style, peppered with lots of citations and quotes, makes it hard to recall what you have just read, even when you have only just reached the end of a chapter. That said, it is incredibly informative, and its eight clearly labelled chapters with tables and figures, plus 22 pages of bibliography, and a carefully compiled index make it easy to for readers to locate whichever bit of information they are after.