Use and classification of health sites in Italy

1. Use and classification of health sites in Italy Paola Di Giacomo, Riccardo Maceratini Centro di Ricerca per l’Analisi dei Modelli e dell’Informazione nei Sistemi Biomedici, Università “La Sapienza” di Roma Corso Vittorio Emanuele 244 – 00186 Roma Paola.Digiacomo@uniroma1.it

2. Abstract In this paper, we describe the application of a model, based on search engine, for the recognition and classification of health sites in Italy, which could be tested in other countries Effective use of technology, in fact, has led to medical advances that have not only extended life expectancy, but also fuelled an increasingly well informed public’s desires to expect more and more from today’s healthcare providers

3. Costs reduction • Times reduction • Sharing of information and information systems (quality, security and privacy) • Business models through web technologies (such as in genomics, clinical trials and diseases management) and new market segments

4. Scenario… As a consequence of the web’s rapid, chaotic growth, the resulting network of information lacks organisation and structure and the quest for a method of finding relevant and reliable information quickly is spawning the growth of the Internet Portal Sites U.S. and European Union, Italy too, have established the importance of rules to check, the quality of health sites both for the users not professional (citizens), for their privacy and security (for example, medical records) and for the health operators (physicians and others), where the most important thing is the quality of providers contents

5. Definitions… • The health sites can be distinguished into: • health portals (sites with services and/or pharmacies on line) • documental sites and metasites (with links to other sites and/or references, for example, NIH, NLM-Medline, FDA etc.) • professional sites for health operators and citizens (mainly disease-specific for example, Medscape, Medconsult, National Cancer Association etc.) • personal medical sites (for personal physicians information about working times and addresses, procedures performed, email etc.)

6. Standards of evaluation and policies for eHealth The Health World Organization has established six principles for the use of Internet in medicine that see the advantages to find information on line (diagnoses, therapies, organizations, health societies and services) to use only with the support of physicians

7. 1997, AMA (American Medical Association) has published the principles to value the quality of information on line, which concern the identification of authors, their affilation and credentials, date and relative updates Theoretically, it’s possible an automatic filtering that doesn’t allow the access to sites of mediocre quality. Rules for the valutation of the quality of health information on line have been promulgated by the Health Information Technology Institute (HITI), but they are useful only to experts

8. PICS (Platform for Internet Content Selection) is one of the standards for the valutation of information by the authority. The european project Med-CERTAIN, mentioned below, regards the realization of the infrastructure to certify the quality of health information on line, based on Med-PICS

9. In 1996, the Health on the Net (HON) Foundation has promulgated in eleven languages, a code of autoregolamentation for the health portals • The HON Code doesn’t allow the valutation of the contents of health sites but to verify if the site has been designed with the minimal quality requirements • The sites that agree to this code exhibit the mark of HON Code

10. The principles of HON Code are: • authority • complementarity • confidentiality • attribution • justifiability • transparency of authorship • transparency of sponsorship • honesty in advertising • editorial policy

11. Materials and Methods We have designed a search engine which allows to find in Internet the italian health sites, to classify them if they are honoured HON Code or no, if they are metasites (sites with only links to other sites), personal medical sites, health portals, documental or information sites (for health operators and/or for not professional users)

12. The search engine is based on a perl script which is composed of four subroutines: • The subroutine &HTML opens the output of tag html to build the page answer to our query • The subroutine &Next computes the number of files processed and to process • The subroutine &Form allows to make a new search at the end of each page answer • The subroutine &Find allows to make a search full-text in accordance with the requirements of the problem

13. Results At June 2001, the search engine used has found 2627 italian health sites in Internet. Only 46 of 2627 sites are honoured HON Code, compared to the 48 in Germany, 120 in United Kingdom, 10 in Sweden, 65 in France, 945 in North America, 126 in South America, 23 in Belgium Moreover, the search engine has computed that about the 65% of sites presents the name and/or the email of the webmaster, the name of the sponsorship, the last update and the counter of visitors related, sometimes, to the last update

14. Health sites and tipology Personal Sites 1% Portals 13% Information Sites 41% Metasites 18% Documental Sites 27%

15. Health sites and medical domains

16. Health sites and medical domains

17. Conclusions • We have described the application of a model for the classification of health sites in Italy but it could be repeated in other countries • The results that we have obtained, even if good for us, because they prove that there is an active virtual community in Italy in the health domain, are still very preliminary and the analysis shows that there is the necessity of a common regulamentation and definition of standards for the quality of health sites, for the privacy and the security of citizens