Since its creation in 1995 the Health On the Net Foundation has been developing solutions to respond to the Internet problems potentially threatening the health and medical domains, such as the accessibility of information (creating a multilingual medical search engine, a directory and self-help tools) and the protection of the Internet users through a third party accreditation program.

Policy Context

With no international legal framework to regulate online content, consumers urgently needed to be given the means to check the reliability and the relevance of health information, and enhanced access to information of the highest quality. Health On the Net Foundation was created in 1995 to fill this role. In 2002, recognizing the need to protect its citizens, as well as the global consumer of online health information, the European Commission took a clear position on the need to maintain high standards for online health information in proposing to Member States a communiqué on Quality Criteria for Health related Websites. HON participated actively in the development of this EU document. In 2004 the European Union “Recognises that to make reasonable decisions about what health information they will trust, or what products or services they will use, individuals need to know what standards a site employs in developing content. Health-related websites must make clear the sources which they have used and ensure that the information presented is appropriate, independent and timely. Health-related websites should also identify who is most likely to visit the site and ensure that the information presented is as comprehensible and as easily accessible as possible to all visitors including disabled persons. As some sites may be sponsored by one party and hosted by a different one, these relationships should be clearly disclosed on the site.” This reinforces the need to have a third party accrediting medical and health information on the Internet.

Description of target users and groups

Citizen, Health professionals, Web health publishers

Description of the way to implement the initiative

HON first reached a consensus amongst information providers, medical experts and consumers, to establish criteria for trustworthy health information websites. Establishing trust is crucial in any relationship between a patient and a provider of health services. This applies not only to doctors and other caregivers, but also to information providers. This approach to the promotion of best practices in eHealth would only be possible if webmasters could be motivated to voluntarily adopt the standard. The result would be access to quality information by the public where identification of such information would be through a seal or brand of trust. A neutral and intelligent third party was needed to provide this context from which the notions of trustworthiness and confidence could be derived. This is now achieved through the HON Foundation, which applies a set of criteria and awards its logo and certificate to all accredited sites. HON provides information services that enrich and bring order to vast numbers of online health and medical resources. Leading this effort is a core team of computer scientists (aided by medical specialists, editors and administrative personnel) who work with a wide range of technologies developed in-house or in collaboration with partners.

Technology solution

HON technologies manage internal and external information assets. To reach the greatest number of users, HON’s services rely on standard W3C protocols: HTML, HTTP, XML and web services which provide for the multilingual handling of documents. The recently released HON Toolbar is an application intended for all searchers of health information. The Toolbar is a multifunctional browser plug-in which performs valuable functions as the user browses a health web site, checking the site’s HON accreditation status, permitting the user to look up medical terms encountered in the text, and conducting web searches limited to the “confidence-space” of HON-accredited sites. Innovative use of ICTs also makes possible the day-to-day work of HON’s multilingual accreditation team whose members reside in several European countries. A web-based system gives platform independence to members of the team who work in various institutions, and speeds integration of new collaborators. The tool provides workflow-based access to HON databases, as well as messaging and chat facilities for team members. The HON accreditation team also makes use of an advanced version of WRAPIN (Worldwide Reliable Advice to Patients and Individuals), HON’s successfully-completed EU project (IST–2001-33260).

Main results, benefits and impacts

The mission of Health On the Net Foundation is to guide the growing online community of healthcare consumers and information providers to sound, reliable medical information and expertise. This is achieved by the following: - Thorough review of candidate sites seeking HONcode certification by a team of experts. - Annual review of already accredited sites. - Research and development of trustworthy search engines for improved quality of information. - Conducting studies to improve the understanding of access of information on the Internet and its correlation with other factors (social, cultural, lingual, etc). Innovation: - The HONcode: an Accreditation System The HONcode is an easy to understand charter made up of eight principles that are simple for any well-intentioned web publisher to implement. If all eight principles are followed and confirmed by a review team from HON, accreditation is granted and the site can display the HONcode logo. For visitors to the site, the red and black striped HONcode seal is a visual proof that the site contains quality information.HONcode is used by over 5,500 accredited websites, covering 72 countries. - Search engine and other technologies The generic multilingual robot, MARVIN, (Multi-Agent Retrieval Vagabond on Information Network), combines crawler and extraction technologies. MARVIN feeds and constantly updates MedHunt, HON's medical and health search engine and HON’s databases (conferences, HONmedia and news). - WRAPIN (Worldwide Reliable Advice to Patients and Individuals) is a set of technologies developed within the framework of a two-year EU project (IST–2001-33260). Most users find it difficult to formulate queries that are well designed for retrieval purposes. In fact, as observed with web search engines, users might need to spend a large amount of time reformulating their queries to accomplish effective retrieval. Here we propose the user to interact with the knowledge that WRAPIN has obtained during the first retrieval, proposing a list of keywords to help the user refine the query. With a more efficient sharing of reliable knowledge, WRAPIN will help the citizen/individual in making better choices on medical information available on the Web. - Multi-lingualism and Multiculturalism: All HON’s Services are offered at least in 7 European languages: Dutch, English, French, German, Italian, Spanish, and Portuguese. The HONcode is available in 32 languages. - Surveys HON conducts annual surveys to ascertain its impact on the audience, to detect trends in consumer health internet use and improve its services.

Return on investment

Return on investment: Not applicable / Not available

Track record of sharing

Promoting access to trustworthy health and medical websites, HON is one of the key partners in Google Co-op service.

Lessons learnt

Lesson 1 - Need for parallel automated services Site-by-site review, indexing, annotation and surveillance of the medical Internet by humans is probably an unrealistic goal which points to the need for automated means to verify compliance with codes of conduct or future legislation. HON research group has developed a system which automatically identifies the HONcode principles in a site in order to help the HONcode team in review process. This system contributes also to daily surveillance. Lesson 2 - Voluntary submission for accreditation During the project SanteRomande, a website pool catering to the public of French-speaking part of Switzerland, we realised that the websites’ voluntary requests for accreditations are always backed by strong motivation to improve. Ethical standards are best promoted through voluntary, constructive efforts, backed up by enforcement. Lesson 3 - Recognizing diversity in a globalizing world ”Just because someone is easier to reach does not mean they are easier to understand. The opposite, in fact, is true” (Dominique Wolton). HON has regional offices in Bamako, Mali (french-speaking Africa), Johannesburg, South Africa (english-speaking Africa), and Valencia (Spain). Lesson 4 - Education. Continuous consumer education is needed to raise awareness amongst Internet users of the various issues in accessing health information.

Scope: International, Local (city or municipality), National, Regional (sub-national)