To the Editor,

We read with interest the editorial entitled “Health and the Internet: beyond the quality of information,” which discussed the changes and challenges facing society in the move to eHealth. With reference to the statement “any measure of quality control would be destined to fail,” we think it important to reflect on the usefulness of having mechanisms for controlling the quality of information on the Internet.1

The concept of quality control and associated processes emerged in line with industrial development. In recent years, large changes have made quality control a prominent feature of organizations. We should also mention that there are many different levels and definitions of quality. For example, when applied to health care, the World Health Organization defines quality as “the most appropriate set of diagnostic and therapeutic services for achieving optimal health care, taking into account factors and knowledge of patients and healthcare professionals, and for achieving the best outcome with the lowest possible iatrogenic effects and maximum patient satisfaction with the process.”2 This means that physicians and indeed all healthcare professionals should offer—regardless of the form or type of health care, and therefore for services and information provided over the Internet—guarantees for that care through quality control. This should be considered a priority. In the present case, it is essential to understand the quality control of information in its entirety. Thus, the scientific principals to which the information should be held, its utility and pertinence, the target audience, legal aspects, and ethical concerns applicable to any medical activity should be taken into account in order ensure the information is appropriate for the needs of the patients, healthcare professionals, and the health system itself.

With regard to quality control of web-based information, we highlight 2 initiatives that have been in place for 10 years now. The most widespread international one is the Health on the Net Foundation, established in Switzerland in 1996. In Spain, the most widely known according to surveys3 is the Web Médica Acreditada (WMA - Certified Medical Web) program, overseen by the Barcelona Physicians Association. This program, in which the authors of this letter are directly involved, began in 1999. These initiatives offer different tools, with the overall aim of serving society and with some common objectives: an improvement in the quality of medical information and more secure user access to the network. These tools are based on the need to advise those responsible for the web pages, through a review process, about how they should offer web-based health services according to legal recommendations of the information society and ethical aspects of the profession4 and how to provide the general public with elements of health education (such as the “10 Tips for Internet Users” of the WMA), as well as to incorporate information filters to access quality webs (such as application of semantic web technology developed by the WMA).5 In addition, these initiatives encourage the active participation of the Internet community, which acts as an observatory.

Any holistic and flexible overall vision of health care and the information technologies should include each and every one of the elements available for shaping them and obtaining maximum benefit from their application. Quality control of the information available on the web is one of the elements to be taken into account if eHealth environments are to continue offering the guarantees, professionalism, and security required of them, while adapting to the needs of all those who participate in this continuously changing scene.

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Corresponding author: mmayer@comb.cat