Health On the Net Foundation
|non-profit non-governmental organization|
|Products||Certification, health search engine and education|
Health On the Net Foundation (HON) is a not-for-profit organization founded in 1995 under the auspices of the Geneva Department of Employment, Social Affairs and Health and based in Geneva, Switzerland. This came about following the gathering of 60 of the world's foremost experts on telemedicine to discuss the growing concerns over the unequal quality of online health information. The unanimous conclusion of this gathering was to create a permanent body that would, in the words of the program, "promote the effective and reliable use of the new technologies for telemedicine in healthcare around the world". The HON Foundation became one of the first organizations to guide both lay users and medical professionals to reliable sources of health information in cyberspace.
The mission of the foundation is to guide the growing community of healthcare consumers and providers on the Internet to sound, reliable medical information and expertise. In this way, HON seeks to contribute to improved health care through patient empowerment and better informed health professionals.
Health On the Net 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 offers users an array of tools and services to meet their health information needs, including: the HON Code of Conduct and its certification process; Khresmoi and HONselect search engines, which provide access to trustworthy websites and support groups, medical images and terminology, journal articles and news; Provisu.ch, a database of reliable health information on all eye diseases and accessible by those with poor or no vision through its variability of letter size and audio version; Santeromande.ch, a database directed towards the French-speaking public of Switzerland and neighboring France and providing reliable health information and a directory of registered health professionals, medical centers, hospitals, medical associations and federal organizations.
HON Foundation issued a code of conduct (HONcode) for medical and health websites to address reliability and usefulness of medical information on the Internet. 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, 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. It is the oldest and the most used ethical and trustworthy code for medical and health-related information on the Internet.
The principles of the HONcode are:
- Authority – information and advice given only by medical professionals with credentials of author/s, or a clear statement if this is not the case
- Complementarity – information and help are to support, not replace, patient-healthcare professional relationships which is the desired means of contact
- Confidentiality – how the site treats personal and non-personal information of readers
- Attribution – references to source of information (URL if available) and when it was last updated
- Justifiability – any treatment, product or service must be supported by balanced, well-referenced scientific information
- Transparency of authorship – contact information, preferably including email addresses, of authors should be available
- Transparency of sponsorship – sources of funding for the site
- Honesty in advertising and editorial policy – details about advertising on the site and clear distinction between advertised and editorial material
Each principle also has a Web 2.0 component in order to address the evolution of the Web in terms of information provision, including social media use.
There are currently more than 8,000 HONcode certified websites, covering 90 countries. The HONcode has been translated into 35 languages. It is used to sensitize web publishers to the need for quality information and to create awareness among health professionals in order to help them guide their patients to trustworthy health information.
Research has shown that the HONcode is an indicator of reliability of health information. Additional studies demonstrate that websites using the HONcode quality standards are more reliable than those that do not. Additionally, the HONcode has been identified as an indicator of accuracy. 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.")
Limits and Criticism
The HONcode only applies 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 infer that the contents of the website are trustworthy, reliable or otherwise independent. 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 is 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, 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 and do not follow their own rules. In response to those limitations, one previously certified website has decided to no longer display the Health On the Net logo; another site warns visitors not to trust certified websites.
Yet greater awareness of the HONcode and its certification process is 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”.
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, introducing a further bias favoring disguised commercial websites instead of benevolent and scientific communities.
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. Other issues with the HONcode logo were discussed in the Journal of Medical Internet Research, a peer-reviewed eHealth journal. 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 active and dynamic , 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.
The HONcode relies on the user’s sense of civic responsibility. 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."
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.
- 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 . PMID 15249267.
- "HONcode: Certification for Websites with Web 2.0 elements". www.hon.ch. Retrieved 2016-05-24.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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 . PMID 11751805.
- 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.
- Eysenbach, Gunther (2000-01-01). "Towards ethical guidelines for e-health: JMIR Theme Issue on eHealth Ethics". Journal of Medical Internet Research. 2 (1). doi:10.2196/jmir.2.1.e7. PMC . PMID 11720926.
- 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 . PMID 23671523.
- As of January 2016; the principles were last updated in March 2010.
- "HONcode: Principles - Quality and trustworthy health information". www.hon.ch. Retrieved 2016-05-24.
- "Prescrire - Qui est Prescrire - "Non merci..." - Prescrire n'affiche plus le HONcode". www.prescrire.org. Retrieved 2016-05-24.
- Corriher, Sarah C. "The Health Wyze Report - The Health Wyze Report". healthwyze.org. Retrieved 2016-05-24.
- Note that independent reviews state that Health Wyze is not considered a safe site itself (http://review.easycounter.com/healthwyze-scam-report and https://www.rxstars.net/healthwyze-reviews-an-unpopular-website-that-published-detailed-reports-on-pharmacy-industry/)
- 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 . PMID 25599071.
- "Health On the Net (HON): About the HONcode re-assessment payment process". www.hon.ch. Retrieved 2016-05-24.
- 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). doi:10.2196/jmir.2.2.e13. PMC . PMID 11720932.
- 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
- "How to be a vigilant user" Health On the Net Foundation, accessed 8 April 2009.