Non Governmental Organization Quality of health related information on the Web 1 Health On the Net Foundation: assessing the quality of health Web page all over the world Antoine Geissbuhler, MD, President Celia Boyer, Executive Director

2 Cartoon by Peter Steiner has been reproduced from page 61 of July 5, 1993 issue of The New Yorker, (Vol.69 (LXIX) ) The New Yorker, 1993 Information quality on the Web…

3 Outline Health website certification The HONcode database Search engine technologies of HON Collaborations Research and development

4 Importance of the Online Health and Medical Information * ** French National Health Authority *** pewinternet 2007 Internet is a mainstream media 1,403 million users worldwide connected in 2008* Importance of medical information on the Internet 1,200 million results for the search term, “health” on Google One in five patients are looking for health information online** 46 million results for the search term, “health blog” on Google Patients with chronic diseases more likely to use internet before making treatment decisions***

5 Why should Health Information on the Internet be Quality Controlled? BUT …. Just 15% of health seekers say they “always” check the source and date 53 % health information seekers report that the health information they found had an impact on their own health care or the way they care for someone else: 58% decision on how to treat an illness or condition. 55% changed their overall approach to maintaining their health 54% lead them to ask a doctor new questions or to get a second opinion from another doctor. 35% say the information affected a decision about whether to see a doctor. PewInternet Online health 2007

6 Created in 1995 under the auspices of the Geneva Ministry of Health and Social Affairs ‏ Mission: to guide Internet users by highlighting reliable, comprehensible, relevant and trustworthy sources of online health and medical information Since 1995, HON has been tackling the major obstacles of Internet usage: the overwhelming quantity of information and the uneven quality of health information available online Non Governmental Organisation

7 … specific for health websites… applicable for all sites Various initiatives for controlling the quality

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9 The HONcode Sponsorship Clearly distinguish advertising from editorial content Authoritativeness Complamentarity Privacy Attribution Justifiability Transparency Financial disclosure Indicate the qualifications of the authors Information should support, not replace, the doctor- patient relationship; Audience Respect the privacy and confidentiality of personal data submitted to the site by the visitor Cite the source(s) of published information and dating of medical and health pages Site must back up claims relating to benefits and performance Accessible presentation, identities of editor and Webmaster, accurate contact Identify funding sources

10 The Web publisher submits a request to be certified and to obtain the right to display the HONcode seal The Web publisher fills in an online questionnaire The HONcode review team conducts a thorough evaluation of the website According to findings, website is: certified certified under condition to modify/add some statement on the website not certified If certified, a unique HONcode seal is granted Each website is re-evaluated each year The certified website is integrated into the database of HONcode certified websites, HONcodeHunt HONcode certification protocol

11 The HONcode database: HONcodeHunt + 7,000 sites 118 countries 34 languages English: 51% French: 15% ; 830 HAS-HON German: 9% Italian: 7% 1,400,000 web pages certified in Google.com The HONcode team: 8 MDs, 2 medical students, 1pharmacist, 2 licensed lawyers and 1 biologist Examples: ClinicalTrials.gov HealthInsite.gov.au Health-EU Portal The National Urban League MEDLINEplus.gov PubMed Stop-tabac.ch sprechzimmer.ch patientenleitlinien.de Hospital 12 de Octubre Sociedad Argentina de Pediatría Diabetes Netzwerk Deutschland onmeda.de/ Santemagazine.fr eurordis.org

12 Last HONcode certification activity

13 Search engine of HONcode certified sites

14 Active HONcode seals in Google (and Yahoo)

15 Collaborations

16 HON certification Government-level collaboration in France: HONcode is the official international standard for quality of health websites in France since November Intended for ALL the health Web publishers Voluntary initiative For the citizen For health care providers, pharmaceutical and the eHealth industries

17 The French National Health Authority (HAS) chooses HON for the certification of French health websites Article L de la loi n° du 13 août relative à l’assurance maladie : La Haute Autorité de santé est chargée d’établir une procédure de certification des sites informatiques dédiés à la santé, et des logiciels d’aide à la prescription médicale ayant respecté un ensemble de bonnes pratiques.«À compter du 1er janvier 2006, cette certification est mise en oeuvre et délivrée par un organisme accrédité attestant du respect des règles de bonne pratique édictées par la Haute Autorité de santé. Décret n° du 26 octobre 2004 relatif à la Haute Autorité de santé Article R La Haute Autorité de santé détermine les règles de bonne pratique devant être respectées par les sites informatiques dédiés à la santé et les logiciels d’aide à la prescription médicale pour lesquels la certification mentionnée à l’article L est demandée. Elle définit les modalités de cette certification. The French bill , 13th August 2004 regarding the health insurance, has mandated the HAS to define a certification procedure for health websites: the HAS chooses HON for the certifying French health websites

18 International activities Partnerships with: The World Health Organization Google Local representation in: Mali, South Africa, Spain In a globalized world, HON aims to preserve local identities; therefore we think globally and act locally, establishing regional representations respecting social and cultural identities.

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20 Regional services Provisu (visual conditions) Regional service: SantéRomande (directory for the French speaking Swiss) Toxicology Health topics:

21 Research and Development

22 Specialised search engine

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24 Is quality of m-Health applications a problem? Application stores for windows mobiles and iphone offering access to medical software for mobile devices * Health benefits: efficiency, effectiveness and easy access to services and resources (“convenient medicine”) Cost-effectiveness very high (low cost medical innovation) What about the quality of m-health applications? Privacy and security of personal healthcare information Trustworthiness of the health and medical information offered No verification nor certification of applications that can be found on applications store HON tackles new Internet challenges by proposing a solution: the HONcode certification of mHealth applications * PocketGear, AppleStore

25 Conclusion Active for over 13 years Educate citizens to efficiently use the medical information Automatic tools developed in order to support human expertise and tackle the large number of existing Web pages 2001 eEurope Quality Criteria for Health Web sites is based on the HONcode principles Collaboration with Google-Coop for Health Collaboration with the French HAS to be the official certification body for all French health Web sites Adherence to the HONcode enhances a website’s overall quality “More than just a mouse click: Research into work practices behind the assignment of medical trust marks on the World Wide Web” Adams SA, de Bont AA. IJMI 2006