Proposed Frameworks to Improve the Quality of Health Web Sites: Review

Cynthia Baur, PhD and Mary Jo Deering, PhD

In This Article


The pervasiveness of the Internet and the World Wide Web in health and healthcare raises multiple concerns about privacy, confidentiality, quality assurance, professionalism, liability, and responsible medical practice. The current Internet industry and public policy approach to these concerns is to encourage voluntary codes of conduct and industry self-regulation, in conjunction with selective government intervention in specific categories of unlawful activities, such as deceptive trade practices and illegal sales of prescription medications. Legislation has been recommended as a remedy to the problem of online violations of privacy.[1] The ehealth space has responded to public concerns by creating multiple codes of ethics/conduct, guidelines, or principles for Web-based health activities. Although the codes may have different audiences and purposes, all are being promoted to the general public as mechanisms to improve quality. They represent the most current and widely accepted guidance for developers of health Web sites. According to the creators of these efforts, code development will be followed by implementation and enforcement so that users of health Web sites will be able to identify those sites that abide by recognized quality standards. The existence of multiple codes raises questions about redundancy, gaps, and possible competition among them to become recognized as "the standard" for health Web sites, especially if seals of approval become sites' preferred method to alert consumers about policies and practices.

The U.S. Department of Health and Human Services (HHS) has articulated the importance of the Internet and interactive technologies for health improvements and the rationale for quality standards for Web sites in Wired for Health and Well-Being, the final report of the Science Panel for Interactive Communication and Health.[2] The Department's commitment to improve the quality of health Web sites is reflected in a national Healthy People 2010 objective to increase the number of health Web sites that disclose quality standards information.[3] The information that should be disclosed to users is the identity of Web site developers and sponsors; how to contact the owners/developers of a site; potential conflicts of interest or biases; explicit purpose of the site, including commercial purposes and advertising; original sources of content; how the privacy and confidentiality of personal information is protected; how the site is evaluated; and how content on the site is updated. The objective must have quantified achievements by 2004 to document progress in the area. The Department's goal is to promote the development of a consistent, comprehensive approach to the identification of high-quality sites that consumers will find reliable, valid, and easy to use.

The present article analyzes and compares the key elements of 4 private-sector proposals to improve the quality of health Web sites. In this article, as in the proposals themselves, the definition of "quality" is not limited to the quality of the information on the site but includes other elements mentioned above that bear on reliability, value, and user protections. The purpose of the analysis is not to assess the frameworks against HHS-determined criteria but to help identify components of a broad-based consensus on the fundamental elements necessary to inform and protect health Web site users. Once consensus is reached, it must be translated into mechanisms that can be effectively implemented, communicated, monitored, and measured.