If we look at the geographical propagation of Internet use within the Belgian health care institutions, we still discover a lot of white spots and "terra incognita", according to Dr. Ing. Vanlanduyt. In order to determine and evaluate the information quality level of the existing medical sites, the HIGIS inquiry has applied three different types of criteria to assess the content, the aesthetic outlook, and the technical features of each health care site. Starting with the content, the general requirements are focused on the validity and authenticity; the authority and source reputation; the overall intention; the substantiality; the accuracy and intelligibility; the innovative and unique character; the targeted audience; and the date indication of the medical site.
The relationship between the site visitor and the Webmaster who delivers the medical information is virtual, and therefore unable to serve as a substitute to personal contact, as Dr. Ing. Vanlanduyt explicitly stressed. One should also carefully consider which use exactly is made of the information, offered by the surfing visitor to guarantee the user's privacy. For typical health care sites, the author preferably has to be a medical person, whereas the content should have a truly scientific foundation. Belgian health care Web sites tend to display an indirect validity and authenticity. The content usually is rather basic and fragmentary. A number of institutions has done some real efforts to make their site intelligible. The targeted audience consists of patients and the organisation as such. The possible use that is made of visitor references is nowhere specified though, and neither are the updates.
The aesthetic criteria are related to the organisational concept and overall outlook of the site. In Belgium, health care site construction still remains elementary. Not very much attention is paid to the general accessibility of useful information. However, as Dr. Ing. Vanlanduyt pointed out, medical sites have to be easily accessible via user-friendly navigation tools as well as a modest use of images, which usually take a lot of time to download. The navigation features are limited on Belgian medical sites and their support is unstable. There is only little use of standards with Netscape or Explorer as the most popular browsers. In a country with three official languages, being Netherlands, French, and German, the multi-lingual aspect is neglected. A part from the institutions situated in the Brussels region, most sites are set up in one language.
From a technical point of view, Dr. Ing. Vanlanduyt compared the launch of an Internet site with setting up a commercial undertaking. The site builder has to decide on the type of exploitation system. One can either hire, buy or own a Web site, depending on the fact whether one prefers to host or house a site, using the services of an external provider, or install it on a proprietary server. In the three cases, launching a new Web site implies concentrating one's attention on the possibilities and risks, the site maintenance, and the update frequency. In this respect, three criteria have to be taken into account. The integrity of the information involves the balancing between permanency and regular updating. Site integrity comes down to a rational task division and a strict upkeep. Hardware integrity addresses the issues of performance and stability. To this purpose, HIGIS has launched a second inquiry to assess the technical performance of Belgian medical sites.
As for security and privacy matters and data protection, health care sites in Belgium seldom make use of the available technologies to the surprise of Dr. Ing. Vanlanduyt. Emerging dangers are related to eavesdropping practices, falsification, and modification of identities. These risks are encountered by coding and decoding measures and the use of digital signatures, certification techniques, and authentication software. For message coding and decoding, two keys are being used, a public and a private one, allowing the two parties to apply encryption and decryption in a synchronous or asynchronous way. A message, provided with a digital signature is sent, using a private key. The message is decoded with a public key to be read by the addressed person. Certification and authentication services usually are offered by third parties.
The future will see the rise of service providers dealing with information and content evaluation, as the use of search engines to look for meaningful data becomes more difficult. In the United States, interactive health portals have already emerged to communicate with a targeted audience of care providers and patients. Content and communication elements are being combined in specific programming languages, such as Unified Medical Language System (UMLS). Despite the fact that the public health care sector in Belgium is not really present on the Internet as yet, Dr. Ing. Vanlanduyt confirmed that Web technology has definitively left its infancy. Beckoning chances lie ahead for Belgian medical sites to enter the realm of quality and accessibility.