Health On the Net Foundation

Last updated
Health On the Net Foundation
Company typenon-profit non-governmental organization
IndustryHealthcare
FoundedSeptember 1995
Headquarters
Geneva
,
Switzerland
ProductsCertification, health search engine and education
Website https://www.healthonnet.org/

Health On the Net Foundation (HON) was a Swiss not-for-profit organization based in Geneva which promotes a code of conduct for websites providing health information and offers certificates to those in compliance.

Contents

In September 2022, Health On the Net website pages included the advisory text "HON is no longer updated and will be permanently discontinued on December 15, 2022. Despite all our efforts, it is no longer possible to maintain it. We thank you for your understanding." As of March 2024, their domain names are unactive.

Foundation

In 1995, 60 participants at an international health conference agreed to form a permanent body to promote the dissemination of accurate health information through technology. [1] Health On the Net was founded under the auspices of the Geneva Department of Employment, Social Affairs and Health. It holds consultative status with the Economic and Social Council of the United Nations (ECOSOC) and a special relationship with the World Health Organization (WHO). The French National Health Authority appointed Health On the Net in 2007 as its official body to certify health websites based in France.

As a "Liaison A" to the International Organization for Standardization (ISO) Health Informatics Technical Committee (ISO/TC 215), Health On the Net contributes to the elaboration of standards developed by the committee.

Health On the Net offered an array of tools and services, including the HON Code of Conduct and its certification process; the Khresmoi and HONselect search engines; Provisu.ch, a database of health information on eye diseases, accessible by those with poor or no vision; and Santeromande.ch, a database directed towards French speakers in Switzerland and France, providing health information and a directory of registered health professionals and organisations.

Certification

The HONcode Logo HONcodeLOGO.png
The HONcode Logo

HON Foundation issued a code of conduct (HONcode) for medical and health websites to address reliability and usefulness of medical information on the Internet. The principles of the HONcode are: [2]

  1. Authority – information and advice given only by medical professionals with credentials of author/s, or a clear statement if this is not the case
  2. Complementarity – information and help are to support, not replace, patient-healthcare professional relationships which is the desired means of contact
  3. Confidentiality – how the site treats personal and non-personal information of readers
  4. Attribution – references to source of information (URL if available) and when it was last updated
  5. Justifiability – any treatment, product or service must be supported by balanced, well-referenced scientific information
  6. Transparency of authorship – contact information, preferably including email addresses, of authors should be available
  7. Transparency of sponsorship – sources of funding for the site
  8. Honesty in advertising and editorial policy – details about advertising on the site and clear distinction between advertised and editorial material

Each principle also had a Web 2.0 component in order to address the evolution of the Web in terms of information provision, including social media use. [3]

HONCode is not designed to rate the veracity of the information provided by a website. Rather, the code only states that the site holds to the standards, so that readers can know the source and purpose of the medical information presented. The HONcode is voluntary, [4] which means that webmasters and information providers apply for HONcode certification. Following this, the website is reviewed by a specialized team of health and legal professionals. The HONcode certification is dynamic and is renewed yearly according to site compliance. The first year of certification is free of charge. However, the new recertification process, started in 2014 when the foundation's government sponsors required the foundation to develop its financial independence, requires a financial contribution from the sites requesting recertification. The fees are as follows: €50 for non-profits with little visibility, €160 for sites with high visibility, and €325 for commercial websites. Visibility is determined by the website's Alexa ranking. [5]

In 2020, there were currently more than 8,000 HONcode certified websites, including WebMD, Everyday Health, Drugs.com, and Healthline. The HONcode has been translated into 35 languages. [6] It is the oldest and the most used code for medical and health-related information on the internet. [7]

Research in 2015 showed that the HONcode is an indicator of reliability of health information. [8] [9] Additional studies demonstrate that websites using the HONcode quality standards are more reliable than those that do not. [10] [11] [12] Additionally, the HONcode has been identified as an indicator of accuracy. [13] Certified health pages have a statistically representative higher quality score than health websites that were not certified, with one going so far as to say that "the results of their analysis have shown a quality score that is statistically superior for HON-certified sites proving that even if it is imperfect, this label remains a coherent and trustworthy tool.” (Translated from the French: “Les résultats de notre analyse ont montré un score de qualité statistiquement supérieur pour les sites certifiés HON prouvant que, même si imparfait, ce label reste un outil cohérent et fiable.") [14]

Limits and criticism

The HONcode only applied to a website's editorial processes and details, not to the actual published contents. The term "certification" can be misleading to the general public, as it can imply that the contents of the website are trustworthy, reliable or otherwise independent. [15] However, because the certification process is based on both self-declaration of adherence to the principles and assessment by a HONcode expert verifying that this is the case, it is not possible for a site to be initially certified if it does not meet the HONcode principles.

However, it was possible for a certified site to change its content such that it no longer meets the certification criteria. While website owners are required to inform HON of any fundamental changes to their website during periods between certification and recertification, this is not always the case. Thus a site may be listed as certified when it no longer is. This is addressed at latest during the recertification process, or earlier if HON is notified that the site no longer meets certification standards. The HONcode is considered a useful guide and for some it provides the best overall guidance compared to other tools, [16] but in the end the reliability of the information is also dependent on the information provider.

The HONcode principles themselves are subject to criticism, with some experts indicating they are not adapted to modern Internet usages [17] [ citation needed ] and do not follow their own rules. [18] [ citation needed ] In response to those limitations, one previously certified website has decided to no longer display the Health On the Net logo. [19]

Yet greater awareness of the HONcode and its certification process was needed, with the authors of one study highlighting the need “to broadcast the relevance of HON certification so that creditable medical health information could be published online”. [20]

HONcode misuse

In 2000, a journal article raised a number of problems with the HONcode logo, indicating that consumers may mistake it as an award or interpret it as an indicator for assessed information. [21] Other issues with the HONcode logo were discussed in the Journal of Medical Internet Research , a peer-reviewed eHealth journal. [21] Websites that are not in compliance with HONcode can continue to display the seal, as Health On the Net Foundation (HON) has no means of forcing the offending webmaster to remove the certification seal. However, as the certification seal is active and dynamic, [22] leading to a page on HON servers with the date of the certification's validity and the status of certification in real time, the link from websites will lead to the page showing that the site is no longer in compliance (i.e., that it is either being reassessed or the certification has been revoked). This is indicated in real time. It is, however, possible for the site to retain the logo without the click through. Thus, users should be aware that if the seal is not clickable, the site is no longer in compliance and is misusing the logo.

Consumer protection advocate Stephen Barrett has been a strong supporter of the HONcode and has made efforts to improve compliance with its rules and to expose those who misuse it. A 2004 special supplement to The Washington Post provides coverage of his views on the subject, including suggested improvements and his criticisms of many named misusers. [7]

The HONcode relies on noncompliance being reported by consumers. In cases of suspected fraudulent websites or of misuse of the HONcode, HON advises internet users to alert Quackwatch or HON itself through the complaint mechanism on the HON website: "If you come across a healthcare Web site that you believe is either possibly or blatantly fraudulent and does NOT display the HONcode, please alert Quackwatch. Of course, if such a site DOES display the HONcode, alert us immediately." [23]

Other problems with the application of the HONcode principles are that HON does not have a means of verifying many of the principles, such as credentials (medical or otherwise) as stated on websites displaying the logo, or that copyright or confidentiality is not violated by webmasters.[ citation needed ]

Related Research Articles

<span class="mw-page-title-main">Health informatics</span> Computational approaches to health care

Health informatics is the study and implementation of computer structures and algorithms to improve communication, understanding, and management of medical information. It can be viewed as branch of engineering and applied science.

eHealth describes healthcare services which are supported by digital processes, communication or technology such as electronic prescribing, Telehealth, or Electronic Health Records (EHRs). The use of electronic processes in healthcare dated back to at least the 1990s. Usage of the term varies as it covers not just "Internet medicine" as it was conceived during that time, but also "virtually everything related to computers and medicine". A study in 2005 found 51 unique definitions. Some argue that it is interchangeable with health informatics with a broad definition covering electronic/digital processes in health while others use it in the narrower sense of healthcare practice using the Internet. It can also include health applications and links on mobile phones, referred to as mHealth or m-Health. Key components of eHealth include electronic health records (EHRs), telemedicine, health information exchange, mobile health applications, wearable devices, and online health information. These technologies enable healthcare providers, patients, and other stakeholders to access, manage, and exchange health information more effectively, leading to improved communication, decision-making, and overall healthcare outcomes.

A personal health record (PHR) is a health record where health data and other information related to the care of a patient is maintained by the patient. This stands in contrast to the more widely used electronic medical record, which is operated by institutions and contains data entered by clinicians to support insurance claims. The intention of a PHR is to provide a complete and accurate summary of an individual's medical history which is accessible online. The health data on a PHR might include patient-reported outcome data, lab results, and data from devices such as wireless electronic weighing scales or from a smartphone.

eMedicine is an online clinical medical knowledge base founded in 1996 by doctors Scott Plantz and Jonathan Adler, and computer engineer Jeffrey Berezin. The eMedicine website consists of approximately 6,800 medical topic review articles, each of which is associated with a clinical subspecialty "textbook". The knowledge base includes over 25,000 clinically multimedia files.

Health information management (HIM) is information management applied to health and health care. It is the practice of analyzing and protecting digital and traditional medical information vital to providing quality patient care. With the widespread computerization of health records, traditional (paper-based) records are being replaced with electronic health records (EHRs). The tools of health informatics and health information technology are continually improving to bring greater efficiency to information management in the health care sector.

An e-patient is a health consumer who participates fully in their own medical care, primarily by gathering information about medical conditions that impact them and their families, using the Internet and other digital tools. The term encompasses those who seek guidance for their own ailments, and the friends and family members who research on their behalf. E-patients report two effects of their health research: "better health information and services, and different, but not always better, relationships with their doctors."

<span class="mw-page-title-main">Gunther Eysenbach</span> Canadian hesalthcare researcher

Gunther Eysenbach is a German-Canadian researcher on healthcare, especially health policy, eHealth, and consumer health informatics.

The Journal of Medical Internet Research is a peer-reviewed open-access medical journal established in 1999 covering eHealth and "healthcare in the Internet age". The editors-in-chief are Gunther Eysenbach and Rita Kukafka. The publisher is JMIR Publications.

Online health communities are online social networks related to health. They primarily provide a means for patients and their families to learn about illnesses, to seek and offer social support, and to connect with others in similar circumstances. These online groups can be composed of individuals with illnesses, groups of medical professionals with shared interests, non-professional caregivers and family of patients, or a combination. The term "online health community" is primarily academic jargon.

Patient portals are healthcare-related online applications that allow patients to interact and communicate with their healthcare providers, such as physicians and hospitals. Typically, portal services are available on the Internet at all hours of the day and night. Some patient portal applications exist as stand-alone web sites and sell their services to healthcare providers. Other portal applications are integrated into the existing web site of a healthcare provider. Still others are modules added onto an existing electronic medical record (EMR) system. What all of these services share is the ability of patients to interact with their medical information via the Internet. Currently, the lines between an EMR, a personal health record, and a patient portal are blurring. For example, Intuit Health and Microsoft HealthVault describe themselves as personal health records (PHRs), but they can interface with EMRs and communicate through the Continuity of Care Record standard, displaying patient data on the Internet so it can be viewed through a patient portal.

<span class="mw-page-title-main">Health 2.0</span>

"Health 2.0" is a term introduced in the mid-2000s, as the subset of health care technologies mirroring the wider Web 2.0 movement. It has been defined variously as including social media, user-generated content, and cloud-based and mobile technologies. Some Health 2.0 proponents see these technologies as empowering patients to have greater control over their own health care and diminishing medical paternalism. Critics of the technologies have expressed concerns about possible misinformation and violations of patient privacy.

The Global Library of Women's Medicine is a free and publicly available resource of clinical information on women's health launched on 20 November 2008. Its purpose is to provide expert support to obstetricians, gynecologists, and reproductive health professionals.

Drugs.com is an online pharmaceutical encyclopedia that provides drug information for consumers and healthcare professionals, primarily in the United States. It self-describes its information as "accurate and independent" yet limited to being "for educational purposes only and is not intended for medical advice, diagnosis or treatment."

<span class="mw-page-title-main">Health information on Wikipedia</span>

The Wikipedia online encyclopedia has, since the late 2000s, served as a popular source for health information for both laypersons and, in many cases, health care practitioners. Health-related articles on Wikipedia are popularly accessed as results from search engines, which frequently deliver links to Wikipedia articles. Independent assessments have been made of the number and demographics of people who seek health information on Wikipedia, the scope of health information on Wikipedia, and the quality and reliability of the information on Wikipedia.

<span class="mw-page-title-main">Health information on the Internet</span>

Health information on the Internet refers to all health-related information communicated through or available on the Internet.

MedicineNet is an American healthcare information website launched in 1996. The website provides a medical dictionary and information about diseases, conditions, medications and general health. In partnership with Veritas Medicine, it connects site users with appropriate clinical trials.

Infodemiology was defined by Gunther Eysenbach in the early 2000s as information epidemiology. It is an area of science research focused on scanning the internet for user-contributed health-related content, with the ultimate goal of improving public health. It is also defined as the science of mitigating public health problems resulting from an infodemic.

Health data is any data "related to health conditions, reproductive outcomes, causes of death, and quality of life" for an individual or population. Health data includes clinical metrics along with environmental, socioeconomic, and behavioral information pertinent to health and wellness. A plurality of health data are collected and used when individuals interact with health care systems. This data, collected by health care providers, typically includes a record of services received, conditions of those services, and clinical outcomes or information concerning those services. Historically, most health data has been sourced from this framework. The advent of eHealth and advances in health information technology, however, have expanded the collection and use of health data—but have also engendered new security, privacy, and ethical concerns. The increasing collection and use of health data by patients is a major component of digital health.

Hixny is a not-for-profit, health information exchange (HIE) serving the Hudson Valley, Capital Region and Southern Tier of New York State. A health information exchange connects fragmented personal health information between different organizations for improved overall healthcare.

<span class="mw-page-title-main">Marion J. Ball</span> South African born American scientist

Marion Jokl Ball is a South African born United States (U.S.) citizen, scientist, educator, and leader in global Biomedical and Health Informatics. She holds the Raj and Indra Nooyi Endowed Distinguished Chair in Bioengineering, University of Texas at Arlington, is Presidential Distinguished Professor, College of Nursing and Health Innovation and serves as the Founding Executive Director, Multi-Interprofessional Center for Health Informatics (MICHI), University of Texas at Arlington. She is Professor Emerita, Johns Hopkins University School of Nursing and Affiliate Professor, Division of Health Sciences Informatics, Johns Hopkins School of Medicine. A member of the National Academy of Medicine (NAM), she is a pioneers of Informatics in Nursing and in Medicine and a founding member of the Technology Informatics Guiding Education Reform (TIGER), a global grassroots initiative that formalized in 2006 to enable nurses and later, the multi-interdisciplinary healthcare workforce in 34 countries to best make use of Health Informatics principles, methods, tools, and resources. Ball is the author/editor of over 35 books and over 200 articles in the field of Health Informatics.

References

  1. ↑ Ball, Marion J. (2006). "Better Health Through Informatics: Managing Technology to Deliver Value". In O'Carroll, Patrick W.; Yasnoff, William A.; Ward, M. Elizabeth; Ripp, Laura H.; Martin, Ernest L. (eds.). Public Health Informatics and Information Systems. Springer Science & Business Media. p. 45. ISBN   978-0-387-22745-0.
  2. ↑ "HONcode: Principles - Quality and trustworthy health information". www.hon.ch. Retrieved 1 August 2019.
  3. ↑ "HONcode: Certification for Websites with Web 2.0 elements". www.hon.ch. Retrieved 2016-05-24.
  4. ↑ Greenberg L, D'Andrea G, Lorence D (June 2004). "Setting the public agenda for online health search: a white paper and action agenda". Journal of Medical Internet Research. 6 (2): e18. doi: 10.2196/jmir.6.2.e18 . PMC   1550592 . PMID   15249267.
  5. ↑ "Health On the Net (HON): About the HONcode re-assessment payment process". www.hon.ch. Retrieved 2016-05-24.
  6. ↑ "Health On the Net, promotes transparent and reliable health information online through HONcode certification". www.hon.ch. Retrieved 2020-01-30.
  7. 1 2 Christopher Wanjek. Attacking Their HONor: Some Dispute Value of Logo Used to Verify Accuracy, Integrity Of Health Web Site Contents. Special to The Washington Post , April 20, 2004; Page HE01
  8. ↑ Nassiri, Mujtaba; Bruce-Brand, Robert A.; O'Neill, Francis; Chenouri, Shojaeddin; Curtin, Paul (2015-08-01). "Perthes Disease: The Quality and Reliability of Information on the Internet". Journal of Pediatric Orthopedics. 35 (5): 530–535. doi:10.1097/BPO.0000000000000312. ISSN   1539-2570. PMID   25254387.
  9. ↑ Bruce-Brand, Robert A.; Baker, Joseph F.; Byrne, Damien P.; Hogan, Niall A.; McCarthy, Tom (2013-06-01). "Assessment of the quality and content of information on anterior cruciate ligament reconstruction on the internet". Arthroscopy. 29 (6): 1095–1100. doi:10.1016/j.arthro.2013.02.007. ISSN   1526-3231. PMID   23582738.
  10. ↑ Laversin, Sabine; Baujard, Vincent; Gaudinat, Arnaud; Simonet, Maria-Ana; Boyer, Célia (2011-01-01). "Improving the transparency of health information found on the internet through the honcode: a comparative study". Studies in Health Technology and Informatics. 169: 654–658. ISSN   0926-9630. PMID   21893829.
  11. ↑ Nassiri, Mujtaba; Bruce-Brand, Robert A.; O'Neill, Francis; Chenouri, Shojaeddin; Curtin, Paul T. (2014-07-01). "Surfing for hip replacements: has the "internet tidal wave" led to better quality information". The Journal of Arthroplasty. 29 (7): 1339–1344.e1. doi:10.1016/j.arth.2014.01.009. ISSN   1532-8406. PMID   24559520.
  12. ↑ Elliott, Andrew D.; Bartel, Annette F. P.; Simonson, Devin; Roukis, Thomas S. (2015-06-01). "Is the internet a reliable source of information for patients seeking total ankle replacement?". The Journal of Foot and Ankle Surgery. 54 (3): 378–381. doi:10.1053/j.jfas.2014.08.012. ISSN   1542-2224. PMID   25746768.
  13. ↑ Fallis, Don; Frické, Martin (2002-01-01). "Indicators of Accuracy of Consumer Health Information on the Internet". Journal of the American Medical Informatics Association. 9 (1): 73–79. doi:10.1136/jamia.2002.0090073. ISSN   1067-5027. PMC   349389 . PMID   11751805.
  14. ↑ Paolino, L.; Fritsch, S.; Danoussou, D.; Guimaron, S.; Genser, L.; Azoulay, D.; Lazzati, A. (2014-04-11). "Les sites internet français sur la chirurgie bariatrique sont-ils de bonne qualité ?". Obésité (in French). 10 (1): 28–33. doi:10.1007/s11690-014-0446-5. ISSN   1951-5995. S2CID   160258122.
  15. ↑ Eysenbach, Gunther (2000-01-01). "Towards ethical guidelines for e-health: JMIR Theme Issue on eHealth Ethics". Journal of Medical Internet Research. 2 (1): E7. doi: 10.2196/jmir.2.1.e7 . PMC   1761845 . PMID   11720926.
  16. ↑ Wong, Lih-Ming; Yan, Hanmu; Margel, David; Fleshner, Neil E. (2013-01-01). "Urologists in cyberspace: A review of the quality of health information from American urologists' websites using three validated tools". Canadian Urological Association Journal. 7 (3–4): 100–107. doi:10.5489/cuaj.501. ISSN   1911-6470. PMC   3650761 . PMID   23671523.
  17. ↑ As of January 2016; the principles were last updated in March 2010.
  18. ↑ "HONcode: Principles - Quality and trustworthy health information". www.hon.ch. Retrieved 2016-05-24.
  19. ↑ "Prescrire - Qui est Prescrire - "Non merci..." - Prescrire n'affiche plus le HONcode". www.prescrire.org. Retrieved 2016-05-24.
  20. ↑ Chen, Emily C; Manecksha, Rustom P; Abouassaly, Robert; Bolton, Damien M; Reich, Oliver; Lawrentschuk, Nathan (2014-12-01). "A multilingual evaluation of current health information on the Internet for the treatments of benign prostatic hyperplasia". Prostate International. 2 (4): 161–168. doi:10.12954/PI.14058. ISSN   2287-8882. PMC   4286727 . PMID   25599071.
  21. 1 2 Nater, T; Boyer, C; Eysenbach, G (2000-01-01). "Debate about evaluation and monitoring of sites carrying the HON-Logo". Journal of Medical Internet Research. 2 (2): E13. doi: 10.2196/jmir.2.2.e13 . PMC   1761850 . PMID   11720932.
  22. ↑ "HONcode: Policing the HONcode". www.hon.ch. Retrieved 1 August 2019.
  23. ↑ "How to be a vigilant user" Archived 2014-05-13 at the Wayback Machine Health On the Net Foundation, accessed 8 April 2009.
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