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Recommendations for Evaluating Online Resources:
Advice for Healthcare Consumers - Part 1

Healthcare consumers (the public, patients) in ever increasing numbers are turning to the Internet for medical and health information. The Internet has the potential to be an excellent resource, providing healthcare consumers with information previously unavailable to them.  However, it also has the potential of exposing the public to an unprecedented, unregulated volume of unreliable, misleading, even harmful information on health and illness. The challenge for medical and healthcare professionals is to help patients determine the web resources that might be beneficial to them. [1]

The number of websites offering health-related resources grows every day. There are more than 20,000 websites online devoted to medicine, healthcare and a wide variety of "health" topics, originating from diverse sources—medical, health, personal, and commercial. Online health consumers can access websites related to health, on-line support groups, chatrooms and websites devoted to a specific disease, pharmaceutical sites, alternative health sites, medical products, and online practitioners or consultants. An estimated 5 million Americans are going online daily looking for health information and advice. Healthcare consumers may understandably be confused where to find reliable medical information on the Internet. [1-3]

This article provides some general criteria, guidelines and useful tips to help healthcare consumers search for and evaluate information on the Internet. Also included are who to contact for reporting Internet health fraud, or the unlawful sales of medical products over the Internet.

Evaluation Criteria for Websites [4-6] Printer Friendly Version 
When evaluating websites, the healthcare consumer should keep 5 criteria in mind: Accuracy, Authority, Objectivity, Currency and Coverage.
1. Accuracy
  • Is the information reliable and error-free?
  • What is the purpose of the document and why was it produced?
  • Is there an editor or someone who verifies/checks the information?
  • Are references cited?
  • Can the information be verified in other sources?
  • 2. Authority

  • Who publishes the site?
  • Who is sponsoring the site? Is the publisher separate from the sponsor?
  • What institution publishes the site ?
  • What type of URL is the website? .gov, .edu, .com, .org?
  • Is the author qualified to be writing on their subject(s)?
  • Is there a way of contacting the author?
  • If the page does not include a signature or indicate a sponsor, is there another way to determine its origin?
  • 3. Objectivity

  • Does the information presented show a minimum of bias?
  • Is any potential bias acknowledged?
  • What are the goals/objectives for the site, articles?
  • What opinions (if any) are expressed by the author?
  • Is the page or site promoting a particular viewpoint?
  • Are there advertisements on the site?
  • If site is interactive, is the user informed about how information will be used?
  • 4. Currency

  • Is the information dated?
  • When was the page last revised or updated?
  • How current are existing links? Have some expired or moved?
  • 5. Coverage

  • What topics does the site cover?
  • What does this site offer that cannot be found elsewhere?
  • Is the information presented cited correctly?
  • Are there references for more information?
  • Is the material presented appropriately for the target audience?
  • Do the existing links strengthen the material or just embellish it?
  • Are the pages a balance of text and images, or it is all images?

  • Check List for Websites [7] Printer Friendly Version 
    In addition to the evaluation criteria above, Kaiser Permanente recommends looking at the following questions when evaluating health and medical websites. When assessing websites does the content appear to be…
    The information presented seems to be based on sound, accepted medicine or science.
    The sources for each topic are noted on the site.

    Source of the information is clearly stated.
    Sources are from published reports and/or health care professionals with credentials.
    Groups and/or individuals who support the site (financially or otherwise) are clearly identified.
    Site provides links to other sources of health information.
    Information on the site appears to be balanced.

    CheckEasy to understand?
    The information on the site is easy to understand.
    The site explains any medical words or terms that are unclear.
    Articles on the site are well-written.

    CheckEasy to use?
    The site opens easily and downloads quickly on the computer.
    It is easy to navigate without getting lost.
    It is easy to find the information on this site.
    The site provides a table of contents or site map to find information/sections.

    The site provides balanced information on all the topics it covers.

    CheckHelpful, especially for making health decisions?
    The information given on this site helps users understand treatment options.
    The information given on this site helps users make decisions about their health.
    The information given on this site does not make the user frightened.
    The site gives users suggestions for "next steps."
    Users can use the information from the site in their daily life.

    The information on this site is interesting.
    This site is pleasing to view.

    The site provides dates that indicate when information for each topic was created and last updated.
    The dates for sources used on the site are easy to find.
    All sources used on this site are dated. 

    10 Things to Know about Evaluating Medical Resources on the Web [8]
    The National Cancer Institute offers the following questions for healthcare consumers to consider when visiting a new site that can help in evaluating health information online.
    1. Who runs this site?
    Good health-related website make it easy for users to learn who is responsible for the site and its content. The identifying information should be placed either directly on the page or no more than a link away. Check page headers and/or footers.

    2. Who pays for the site?
    The source of a site's funding should be clearly stated or readily apparent. The source of funding e.g. government, organization, drug company can affect what content is presented, how the content is presented, and what the site owners want to accomplish on the site.

    3. What is the purpose of the site?
    This information can often be found in the "About This Site" page that appears on many sites. The purpose of the site should be clearly stated and should help users evaluate the trustworthiness of the information.

    4. Where does the information come from?
    Many health/medical sites post information collected from other sites or sources. If the person or organization responsible for the site did not create the information, the original source should be clearly labeled.

    5. What is the basis of the information?
    The author(s) of material should be identified. In addition, the site should include the evidence that the material is based on. Medical facts, statistics and figures should have references e.g. an article in a medical journal. Also, opinions or advice should be clearly distinguished from evidence-based information (based on research results).

    6. How is the information selected?
    Larger sites may have an editorial board that selects and reviews information. Some indication should be made as to how site information is selected and whether it is reviewed by a qualified expert before posting.

    7. How current is the information?
    Websites should be reviewed and updated on a regular basis. It is particularly important that medical information be current, and that its most recent update or review date is clearly posted. Even if the information has not changed, it is good to know that the site owners have reviewed it recently to ensure that it is still valid.

    8. How does the site choose links to other sites?
    Websites usually have a policy about how they establish links to other sites. Some medical sites take a conservative approach and don't link to any other sites; some link to any site that asks, or pays, for a link; others only link to sites that have met certain criteria. Links to other sites do not imply endorsements.

    9. What information about you does the site collect, and why?
    Websites routinely track the paths visitors take through their sites to determine what pages are being used and how to improve the site. Some health sites ask their visitors to "subscribe" or "become a member." This may be so that they can collect a user fee or customize information for users that is relevant to their concerns. It is important to realize that "subscribing" or "becoming a member" provides the site personal information about the user.

    Credible health sites asking for this kind of information should explain exactly what they will and will not do with it. Many commercial sites sell "aggregate" data about their users to other companies. Some sites may collect, use and sell information that is "personally identifiable," such as your zip code, gender and birth date. Be certain to find, read and understand any privacy policy or similar language on the site. Don’t sign up for anything that isn’t understandable or doesn’t make sense.

    10. How does the site manage interactions with visitors?
    Websites should provide a way for visitors to contact the site owners with problems, feedback and questions. If the site hosts chat rooms or other online discussion areas, it should inform visitors of the guidelines and terms for using this service. It is good practice to spend time reading the discussion area before join, to see what the environment is like before becoming a participant.

    Tips For Health Consumers: Finding Quality Health Information on the Internet [9]
    The Internet Healthcare Coalition offers the following tips to help Internet healthcare consumers, professionals, educators, marketers and media and to evaluate the reliability of online health information and advice:
    1. Choosing an online health information resource is similar to choosing a doctor. A good rule of thumb for users is to find a website that has a person, institution or organization in which they already have confidence. Ideally healthcare consumers should seek information from several web sources and not rely on a single source of information.

    2. Trust what you see or read on the Internet only if you can validate the source of the information. Authors and contributors should be identified, along with affiliations, financial interests, and contact information.

    3. Question sites that credit themselves as the sole source of information on a topic and those that disrespect other sources of knowledge.

    4. Don't be fooled by a comprehensive list of links. There are no restrictions keeping one site from linking to another. Links to other sites in no way implies endorsement from either site.

    5. Find out if the site is professionally managed and reviewed by an editorial board of experts to ensure that the material is both credible and reliable. Sources used to create the content should be clearly referenced and acknowledged.

    6. Medical knowledge is continually evolving. All clinical content should include the date of publication, date last modified or updated.

    7. Any and all sponsorship, advertising, underwriting, commercial funding arrangements, or potential conflicts should be clearly stated and separated from the editorial content.

    8. Avoid any online physician who suggests diagnosing or treating healthcare consumers without a physical exam and consulting the medical history.

    9. Read the website's privacy statement. Make sure that any personal medical or other information supplied to the site will be kept absolutely confidential.

    10. Use common sense. Get more than one opinion. Be suspicious of miracle cures. Always read the fine print.

    Top Tips for Online Health Searching [2]

    Some tips from Dr. Tom Ferguson, pioneering physician, author, professor of Health Informatics, and researcher, author of the Ferguson Report, on online health:

    Don't search alone. Ask web-savvy friends or family members to help the first few times you go online. Even experienced web users may benefit from the help and support of friends or family members who can help extend search efforts and interpret the findings.

    The Internet is a good place to find medical and health information. Unlike print sources, the Internet can facilitate connect with online authors and experts.

    Double-check the information found online. Check several reputable sites to make sure they all give the same or similar information.

    Those dealing with a serious illness should consider joining an online support group, and look for other online patient-helpers who share your concerns. In addition, online patient-helpers with the same disease may be able to offer comfort and common-sense perspective that close friends and family members can not.

    The Net can be used to stay connected with family members and friends. Periodic e-mail bulletins can keep loved ones up dated on someone going through an illness.

    The Internet can be used to get referrals to the doctors and treatment centers needed. Disease-specific websites can be useful for finding the top specialists and treatment centers for a particular condition.

    The Internet should be to supplement face-to-face doctor visits, not to replace them. It isn't always easy to interpret what you find. A frank and open discussion with a physician may help to clear up some of the uncertainties in the information found on the Internet and help to confirm or reconsider some tentative conclusions.

    The Internet can be used to help evaluate the information and advice received at the doctor's office. Those doubting the care received may want to ask other online patients or online support group to critique the treatment. The online patient-helpers may suggest questions to raise with the doctor for the next visit.

    The information found online can be shared with the doctor. The increased knowledge may enable many healthcare consumers to become a more assertive patient. Some doctors still are not ready to become "Net-friendly" physicians. It is best for doctors and patients to work together as a coordinated team. Healthcare consumers should try to be assertive rather than aggressive. Communicate needs, express feelings and views honestly and openly, but still show respect for the healthcare provider.

    Let the doctor see how online research can be helpful to patient care. Those who have already mastered the basics of their condition(s) can let the doctor shorten the usual educational explanations. Many physicians would appreciate a good review article from a medical journal downloaded from the Internet on unusual condition—with relevant parts highlighted.

    Article Continues in Part 2.

    The Internet has the potential to be an excellent adjunctive resource for patient web- education. It also has the unfortunate potential of exposing the public to an unprecedented, unregulated volume of misleading information on health and illness. The goal for medical professionals in the next millennium will be to help sway the balance towards good, reliable medical web-information.
    Kirsti A. Dyer, MD, MS

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