Health Information Quality Seals

The quality of medical information available online varies greatly by source. A number of frameworks and tools exist for evaluating the quality of medical information. However, it can be challenging for most users to quickly assess the credibility of content providers.

Several organizations have developed certification programs to help readers identify sites offering trustworthy medical information. Approved sites are permitted to display certification seals. These seals indicate adherence to standards that may be used as a proxy indicator of quality.¹ They do not guarantee that specific content represents sound medical advice.

An overview of the leading certification programs follows.

HONcode

The HONcode certification program and website shut down in December 2022.

Started in 1995 by Health on the Net, the HONcode was the oldest and most widely used certification for health-related information on the internet. To earn HONcode certification, sites had to meet certain requirements in authorship, attribution, currency, reliability, balance, mission/target audience, privacy, interactivity, overall reliability.

More than 8,000 sites were HONcode certified as of 2022, including WebMD, Drugs.com, and Verywell Health. Certification was valid for one year.

Core requirements:

• Authority: Give qualifications of authors
• Complementarity: Information to support, not replace
• Confidentiality: Respect the privacy of site users
• Attribution: Cite the sources and dates of medical information
• Justifiability: Justification of claims / balanced and objective claims
• Transparency: Accessibility, provide valid contact details
• Financial disclosure: Provide details of funding
• Advertising: Clearly distinguish advertising from editorial content

URAC Accreditation

URAC provides accreditation to healthcare organizations operating primarily in the United States. Among their accreditations, URAC provides a Health Content Provider Accreditation, which certifies compliance in editorial processes, quality oversight, conflicts of interest, and linking policies.

Accredited organizations include sites such as A.D.A.M., WebMD, and Healthwise. Approximately 20 organizations are currently certified. Certification is valid for two years.

Core requirements:

• Authority: Ensures that health content authors and reviewers are licensed, credentialed, and able to critically evaluate health information
• Evidence-based: Makes no claims of therapeutic effect without competent and reliable scientific evidence
• Transparency: Provides and easily accessible conflict of interest policy for the editorial team and all authors
• Feedback: Policies and procedures in place to respond to complaints in a timely and appropriate manner
• Oversight and Controls: Establishes a quality oversight committee to apply professional and ethics guidelines as appropriate to its health content, audience and goals

Information Standard

The Information Standard seal was phased out on July 31, 2022. The Information Standard continues to operate as a set of principle recommendations to health content authors.

Developed by the U.K. Department of Health in 2009, The Information Standard certification is awarded to sites that are clear, accurate, evidence-based, up to date, and easy to use. NHS England has managed the certification process since 2013.

Certified sites are permitted to use The Information Standard quality mark. As of 2019, approximately 220 organizations were authorized to use the seal, including such sites as Patient.info, Asthma UK, and Rethink.org.

Core requirements:

• Information Production: Documented process exists for producing high quality information
• Evidence Sources: Use only current, relevant and trustworthy evidence sources
• User Comprehension: Site and information are user tested
• End Product: Product has been developed in compliance with all Information Standard requirements
• Feedback: Appropriately manage comments/complaints/incidents
• Review: Content and process reviewed on a planned and regular basis

Conclusion

While all certifications cover basic standards in authority, citations, and transparency, there remain significant differences in requirements and enforcement. For example, The Information Standard requires that certified sites regularly review and update medical content and that they cite current medical evidence. HON does not require this level of editorial rigor.

Certification seals can help readers to identify more reliable content sources. However, they should not be relied on exclusively. Knowing how to apply a basic quality framework like CRAAP or Trust It or Trash It is critical to being able to assess medical content credibility. Most importantly, readers should always confirm medical claims by checking multiple sources and consulting with a medical professional.

Related Guides:

• Evaluating Health Websites
  Assessing resource accuracy, authority, bias, currency, and comprehension.
• Critically Assessing (Specific) Medical Claims
  Questions you should ask about any medical claim.

References

1. Burkell, J.A. (2004) Health information seals of approval: What do they signify? Information, Communication, and Society, special issue on e-health, 7(4), 491-509
2. URAC Directory of Accredited Organizations. Filtered by program type to Health Web Site and Health Content Provider. Retrieved January 31, 2020.

Published: April 17, 2019

Revised: November 5, 2022