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Introduction:

My topic is Medical Information on the Web sites in Taiwan, the present and future status. I hope the experience in Taiwan would be of some help to the people who are promoting health education on the Internet.

The introduction of the medical Web sites on the Internet has changed the healthcare ecology and physician-patient relationship. Medical knowledge now becomes the knowledge to be understood not only by medical professionals, but also by patients themselves who may join in making decisions for their own well-being. Thus, the availability of accurate, appropriate and high-quality health information on the Internet becomes extremely important.

Medical or health science is a special field of knowledge solely dealing with the human lives. It affects the life and death of human beings, therefore there should not be any room for carelessness or mistake. A guideline of high standard of accuracy and credibility should be strictly followed. Proper public policies and measures are essential for efficient use and development of the medical Web sites on the Internet.

Taiwan is an island country. It has population of 23 millions. Now, 5 years after the introduction of the Internet in Taiwan, there are six millions of people using Internet. Presently, the general public can rapidly obtain medical information concerning the prevention and treatment of diseases as well as other health care issues on the Internet.

The education of medical knowledge or information on the Internet can be classified into two groups: 1) for medical professionals, 2) for general public or consumers.

Presently in Taiwan, the medical Web sites for professionals are mainly created and maintained by medical schools, research institutions and various medical associations. These institutes use Information Technique as research tools, for the development of medical information technique, and in the creation of professional Web sites. For, today's topic is medical information websites, I would like to talk only about the third item -- professional Web sites.

Professional Web sites:

There are 13 medical schools, 12 medical centers, and 5 medical associations engaging in creation of medical professional Web sites. An evaluation was carried out on their planning and performance of these Web sites. The establishment of guidelines and documents on 19 major intrinsic diseases was completed by the Formosan Medical Association and the Ministry of Health. The Health-research information network has been established by National Institute of Health, which provide global biomedical database for the medical professionals and the public. And, consensus for the diagnosis and treatment of 8 major malignancy in Taiwan has also been established by the cooperation of special medical associations. Recently the Web sites of the oldest medical journal (The Journal of Formosan Medical Association) began to provide full-text of all articles. Although a few of these Web sites have high quality of contents, lacking of satisfactory medical information and performance were still noticed in other Web sites. Improvement in planning and coverage of their contents are much to be desired.

Consumer (CHI) Web sites:

As for the consumer health information (CHI) Web sites in Taiwan, they can be classified into six categories by their developers: 1) individuals, 2) general hospitals, 3) professional societies, 4) disease-oriented associations, 5) government health administrative agencies and 6) commercial corporations. A total of 40 of these Web sites were selected for evaluation. A breakdown list of these Web sites is shown on the slide.

Standard of Evaluation:

The quality of their contents was studied on seven aspects. These were accepted rather widely as the standard of evaluation on the Net. The Web sites were evaluated on the authority, accuracy and credibility of their contents by these seven criteria. The seven criteria are: 1) authority: whether the information was provided by medically qualified professionals; 2) authorship: whether author's name and attribution was shown; 3) sponsorship: whether the support for the Web site was clearly identified; 4) contact route: whether the way to contact with the authors was shown; 5) whether the career of editors was shown; 6) disclaimer: whether the disclaimer which clearly notify the visitors that the information provided is just for general common usage and not for specific person; 7) Timing: whether the date of posting and updating was shown.

Results of Evaluation

As a result, we found that, of the existing CHI Web sites, only few meet all 7 of these criteria. Besides, I have noticed some questions and flaws in these Web sites. 1) interactive Web sites, 2) warning and disclaimer, 3) easy access, 4) accuracy and visual appeal, 5) misplaced, broken and obsolete hyperlinks, 6) the level of the contents of CHI, 7) search engine and categorized medical directories:

1) Interactive web site:

Interactive Web sites that provide direct and immediate responses to inquiries are welcomed in Taiwan. These Web sites are operated by enthusiastic volunteer doctors and are very difficult to be maintained for an extended period of time, as it takes lots of efforts for doctors to maintain them with their spare time. All these doctors have their regular work and duty to do. The legitimacy of recommendation has been questioned because the doctors who provided the comment or suggestions have not examined the patients directly themselves.

2) Warnings and disclaimers:

Although visitors are warned in disclaimers that the information provided on the Web site is only general medical knowledge and may not be applicable to an individual case. However, it is doubtful that the general public really understands the implication of such disclaimers. Especially, in Taiwan people believe that doctors must give any medical information in free for helping others. They did not take into consideration that doctors should also make their living.

3) Easy access:

Easy access: a few high quality CHI Web pages are hidden so deeply under their homepages so that they are difficult to be accessed. Visitors can only reach them by chance. It is important that these sites should clearly direct visitors to the whereabouts of these specific CHI pages on the site.

4) Accuracy and visual appeal:

CHI site deals with matters of life and death. Therefore, its contents must be accurate and easily understandable by the general public at the first search. It should also avoid those graphical contents which usually slow down the access time. Thus a cleanly designed site that makes optimal use of simple HTML must be most suitable.

5) hyperlinks:

Misplaced, broken and obsolete hyperlinks are not uncommonly noticed in the classified directory Web sites. It may be due to the fact that new Web developers usually did not check for the validity of hyperlinks. It is important that webmasters should always be committed to updating the links as frequently as possible.

6) Level of contents

The level of the contents of CHI: different visitors may have different understanding on the same content. Some one who is just surfing without a particular object on the Net may find an article too difficult to understand and bothersome. On the other hand, others who are searching for a specific article may find it very useful and satisfactory. Therefore, at least two different levels of writing for the same heading are needed.

7) Search engine and categorized directories:

For searching disease names, search engine is very convenient for people who use English or other alphabetical languages. However, for Chinese language users, the ideographic Chinese characters are usually arranged by simplicity, and searching with search engine is cumbersome. In Taiwan, a disease is usually categorized by the clinical department to which it pertains, and a similar categorization on Web sites may facilitate understanding by the general population in Taiwan. Furthermore, frequently seen diseases could be grouped in one category. For effective and vital use of CHI Web sites and pages, a popular medical directory and well-designed search engine are essential.

Conclusion:

The medical schools, research institutions, medical associations and government health administration authorities should encourage and assist the creation and maintenance of Web sites for professional education. The construction of a high-quality CHI Web site relies upon the experience of the developers, the quality and quantity of medical information provided to the webmaster, and the existence of a credible party and standard instrument for evaluation of the contents.

In order to make the medical Web sites the impulse of promoting national health and prevention of disease, I would like to recommend the follows: Hospital administrators should encourage their staff to supply information resources and assist them if they are unfamiliar with Web sites authoring; A conspicuous sign to the health information pages needs to be arranged for visitors, and changes of URL should be minimized. Finally, government agencies and authoritative medical societies should include the construction of CHI Web pages as a criterion for accrediting a teaching hospital, offer financial sponsorship and awards to individuals, institutions, and communities that maintain high quality CHI Web sites, and establish standards for rating the Web sites.

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