Tuesday, February 14, 2006

It's Time for a Universal Health Information Rating's System

Actually The "Rolls-Royce" of Rating's System

Last week the New York Times published a story titled "Low Fat Diet Does Not Cut Health Risks, Study Finds". It referred to an article published in the Journal of the American Medical Association (JAMA) which examined the associated health risks of a low-fat diet. Much has been said during the week about the article but what caught my eye was a comment by Dr. Michael Thun, who directs epidemiological research for the American Cancer Society. He is quoted as describing this study as "the Rolls-Royce of studies". While I'm sure most people would interpret this to mean "a very good study", it is not without its critics. The expression "Rolls-Royce" implies a very high standard, however most people do not know exactly what that range of that standard is. This is the problem with using such a descriptive phrase in an article which appears on the front page of the New York Times and is a lead article on its internet edition. We can do better and we have.

A Better Standard Already Exists

Most people are probably unaware that physicians and researchers do have standards to describe the quality of the evidence and recommendations that are used in medicine. It is a product of the evidence based medicine (EBM) movement that is rapidly becoming a more influential part of our Healthcare System. There are accepted methods to grade both the evidence and recommendations that are published. For instance, the Society of Critical Care Medicine (SCCM.org) as well as other notable medical societies frequently publish guidelines which are available on their websites. One such guideline, "Surviving Sepsis Campaign Guidelines" utilizes a modified methodology for its grading scheme. The evidence is graded best to worst (I-V) as well as any recommendations (A-E) promoted based on that evidence. What makes these guidelines particularly useful is that a reader can not only identify the source of each piece of evidence but also the standard on which to judge the strength of the evidence or recommendation. This type of ratings system is sorely lacking for the overwhelming majority of health information websites.

Is That Website You're Visiting HIT Worthy?

With more and more people flocking to the internet and using it as a source of health information, what assurances do any of us have that the information we obtain is accurate? The URAC (Utilization Review Accreditation Commission) is one that attempts to achieve a standardization process for this issue. The URAC is an organization that accredits health care organizations including health information websites. According to their website they update the standards for accreditation every three years. They require websites to: disclose sponsors and financial backers, identify how the website develops information, use evidence based information, have a quality oversight committee and maintain privacy and security standards. What having the URAC seal of approval on a website doesn't assure is that a grading of the evidence or recommendations will be provided as well. The quality of acceptable evidence can vary greatly. While URAC is a step in the right direction, bear in mind, so far they have only accredited just under 300 websites.

So Why is This Important?

In order to transition from the established paradigm of delivering healthcare to a new paradigm of delivering healthcare any prevailing source of health information must be reliable and trusted. As people seek the low cost and easy access of health information on the internet they will, in time, begin to demand that the available information is high quality and reliable. Most of these websites maintain an extensive "terms of use" that seeks to limit their exposure to liability, but as physicians discovered a long time ago with "consent forms" there is only so much you can do to hold back the tide of medical liability attorneys once there is a breach in the levee. There is an even more important reason to insist on a quality rating system for health information and that is because it can be a useful means to educate people not only on the existence of such a system but also on the widely varying array of quality that currently exists. There are simply too many snake oil salesman on the internet. There are guides on how to evaluate health information but I suspect most people choose not follow them very effectively, if at all. A simpler, more easily identifiable system is going to be needed as more and more people seek out the internet for health information.

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