In Practice: The Physician’s Guide to the Internet

In late 2006, the World Wide Web topped 100 million distinct Web sites. So reported Netcraft, an Internet services company dedicated to tracking Internet usage. Just a year later that count had grown by nearly half to 142 million, and currently the Web is expanding at a rate of about 5 percent a month.

Who uses the Internet? That answer varies widely across the world, but in North America, nearly everyone. Despite comprising just 5 percent of the world’s current population of 6.6 billion, we’re responsible for 18 percent of the world’s Internet usage. On any given day, three out of four North Americans regularly hop online for a multitude of reasons, including, of course, access to health information.

Certainly, as a physician you’re finding more and more reasons to log on in support of your practice. You use Web-based billing or EMR services. You check insurance benefits. You make sure you’re complying with health regulations. You research diseases and recommend treatments. And more, much more.

Your patients are online, too. They’re investigating their symptoms on WebMD, Healthline.com, or other similar sites and in some cases self-diagnosing. They may be regularly bringing you printouts about conditions and drugs they are reading about online. Some look promising, others less so - as far as you can tell in the few minutes you’ve got to peruse the information.

Likely, you’ve got a few links from your practice’s Web site directing patients to various Web sites for additional health information. But it’s also important to talk to your patients about evaluating the health information they find online. So the more educated you are about how and where to find legitimate Web sources, the better you’ll be able to educate your patients.

Notably, no single entity owns the Internet in its entirety (although it is overseen and standardized by a number of organizations, including the National Science Foundation, the Internet Engineering Task Force, ICANN, InterNIC, and the Internet Architecture Board).

So how do you truly know what’s reliable information and what’s bogus - for your practice, your patients, and yourself? Not easily. Even back in 2001, when significantly less information occupied cyberspace, the late ABC news anchor Peter Jennings said during a Larry King Live interview: “My one great concern about the Internet - and I use it religiously, it’s the most enormously potent research tool - but I’m never quite sure if I’m talking to a goat. And that does make me a little nervous at times.”

The good news is that there are methods for checking out a Web source that can give you more peace of mind about the legitimacy and accuracy of Web sites you’re using and directing your patients to. Read on for a few tips in this regard, and a useful listing of helpful and dependable Web sites.

As a matter of fact

A Web site whose information is clearly backed up by scientific evidence scores highly in terms of reliability. “Peer-reviewed is a good catchword,” says Chuck Heidenrich, practice manager for Tucson, Ariz.-based Aung Foot Clinics.

The information presented must show that it’s supported by both an evidence-based process - legitimate research using established scientific methodologies and resulting in an unambiguous outcome - and the backing of multiple experts in that field, and “not just someone’s idea that it’s ‘cool,’” says Heidenrich.

Every single one of the 19 Web sites listed as links on Aung Foot Clinic’s Web site clearly delineates where its facts are derived from - including commercial vendors such as Hodgson Mill, which manufactures whole grain and organic foods. Aung Foot Clinic even accesses Internet information in the exam room with the patient. Access to information is tied to the patient’s record in the practice’s EMR. That way, doctor and patient can quickly tap into information that backs up a diagnosis and proposed treatment plan. “It offers us an opportunity to have a dialogue with patients,” says Heidenrich.

He believes this interaction is critical to the success of their treatments: “We need them to ‘sign on,’” he says, both in terms of the Internet and treatment compliance. When a patient sees that a piece of research is clearly evidence-based, this is more likely to occur. Does it work? Well, Aung Foot Clinics claims that its patient compliance rate runs higher than 80 percent.

Stamp of approval

“With healthcare providers, there’s a bit of a gap in understanding the standards that support a Web site,” says Claudette DeLenardo, who is director of e-health technologies at Grand River Hospital in Kitchener, Ontario, Canada.

Wouldn’t it be great if there was a way to “certify” a healthcare Web site? In fact, there is. The Health on the Net Foundation is, as described on its Web site, an “organization promoting and guiding the deployment of useful and reliable online medical and health information, and its appropriate and efficient use. Created in 1995, HON is a nonprofit, nongovernmental organization, accredited to the Economic and Social Council of the United Nations.”

In short, a HON-accredited Web site has satisfied all eight of the criteria listed in the text box below. You can search a subject on the HON Web site, for example, “dementia,” and you’ll get (at the time of this writing) the following links:

• http://www.medicinenet.com/dementia/article.htm

• http://www.emedicinehealth.com/dementia_overview/article_em.htm

• http://www.webmd.com/alzheimers/guide/alzheimers-dementia

• http://www.everydayhealth.com/resources/dementia.aspx

• http://www.webmd.com/brain/tc/dementia-topic-overview

• www.emedicine.com/MED/topic3150.htm

• http://www.healthtalk.com/alzheimersdementia/programs/

You can feel pretty secure that the information contained within these Web pages is reliable, as all of these sites must have passed the eight required criteria. You can download a free HONcode toolbar that will integrate with your Web browser so you can check any health Web site for certification.

There are other accreditation and certification organizations. One such is the not-for-profit Utilization Review Accreditation Commission, or URAC, which offers 22 different accreditation and certification programs to healthcare organizations, including one for health Web sites that is similar to the HON Foundation.

You be the judge

The fact that a health Web site displays no kitemark, or accreditation icon, from an accrediting organization does not necessarily mean the Web site is rife with clinical claptrap. Remember, there are millions of Web sites, so count on a fair number having no identified certification. But that’s OK. You can cut through the schlock and get to the good sites on your own if you know what to look for. One site, http://www.judgehealth.org.uk/, offers manuals that teach exactly how to do this. The manuals cover, in depth, what you should check on a Web site to judge whether it is upstanding, information-wise.

Judgehealth recommends that you evaluate:

• The reputation of the organization.

• Who produced the site?

• The stated purpose of the site (is it clear, easy to locate?)

• Funding sources.

• Date the site was last updated or reviewed.

• Quality of the writing (balanced, clear, grammatically correct.)

• Descriptions of conditions and treatments.

• Supporting research.

You can download the specific instructions and reproduce them or put a link to them on your Web site without permission, as long as you credit the Judgehealth organization. In addition, the Web site also contains comprehensive instructions on how to search the Internet properly - also downloadable and reproducible without permission. Consider creating a packet of these documents to give out to patients so they’ll know better how to search and how to discuss what they find with you.

To be sure, nothing is certain when it comes to the Internet, and the tools for culling the good stuff are not foolproof. The HON Web site is somewhat challenging to navigate, and out of URAC’s 670 accredited/certified organizations, only 21 are health Web sites.

“It’s a challenge for healthcare providers,” says DeLenardo. Still, taking time to carefully weigh the merits of a Web site before using it or recommending it to your patients is time well spent.

Shirley Grace, senior writer on staff at Physicians Practice, holds an MA in nonfiction writing from The Johns Hopkins University. She can be reached at sgrace@physicianspractice.com.

This article originally appeared in the May 2008 issue of Physicians Practice.