Effective use of the Internet for Enquiry Answering

Guidance for Medicines Information Services

Effective use of the Internet for Enquiry Answering v1.11

Date of preparation: December 2005

Date of review: December 2007

Introduction

The purpose of this document is to provide an introduction to the use of the Internet as a resource for enquiry answering in medicines information. It will provide basic information for using the Internet, warnings for use, tips for effective searching to produce accurate and relevant results and guidance on assessing the quality of what is found from searches.

It is not intended as a guide to using the websites included in the “UKMi Essential Resources List for MI Services”. It is also not a comprehensive guide to the Internet, nor a detailed discussion of quality issues relating to the Internet.

Internet Basics

Before using the Internet it is helpful to understand some basic terminology and nomenclature.

Terminology
  • Internet browser = software used to view the Internet e.g. Internet Explorer.
  • URL (Uniform Resource Locator) = website address e.g.
  • Home page = first page of a website, akin to the front cover of a book.
  • Favourites/bookmarks = websites or web pages saved in a folder for quick and easy reference.
  • Surfing = following links from one web page to another. Not an accurate way of finding information, especially health information.
  • Domain names = part of the URL, indicating country of origin or type of organisation (see below).
Nomenclature

Domain name - Country (at end of URL)

  • .uk = UK
/
  • .au = Australia

  • .ca = Canada
/
  • .fr = France

  • .de = Germany
/
  • .za = South Africa

NB. This is not the case for the USA.

Domain name - Organisation

  • .nhs = National Health Service
  • .com = commercial enterprise
  • .edu = educational institutions
  • .gov = Government departments or agencies
  • .net = internet service companies
  • .org = not for profit organisations
  • .co.uk = commercial enterprise (UK)

Internet Health Warnings

When using the Internet, it is important to remember the following:

  • The Internet is not owned by anybody or any organisation.
  • There are no restrictions on what is put onto the Internet and by whom (apart from technical know-how).
  • The Internet has no regard for geography. It can be just as easy to find information from the UK, as it is to find information from abroad.
  • The Internet is not a peer-reviewed source (although some individual websites might be).
  • No UK body currently actively checks health information on the Internet.
  • The Internet is an easy forum for distributing rumours and hoax information (“Internet Health Fraud”).

Searching the Internet

There are a number of ways to find information on the Internet.

  1. Visiting a known website by entering the URL in the address field of an Internet browser.
  2. Using a search service.
  3. Using a search engine.
  4. Using a metacrawler or special service.

Search Services (Directories)

e.g. Yahoo!

Search services are categorised listings or directories of websites (they do not include individual web pages). The websites are categorised manually. They are good for general or commercial information but often miss websites for non-profit organisations such as the NHS. They are used by either browsing through the categories and sub-categories to find the information required, or they can be searched like a database.

Search Engines

e.g. Altavista, Google

Search engines are best thought of as databases of websites (or web pages) that have a search facility (like Medline) on the home page. The websites or web pages are included automatically. They generally have much broader coverage than search services and are useful for obscure information or research type activities. They may however, retrieve items of little or no relevance to your search.

Metacrawlers & special services

e.g. Dogpile & Ask Jeeves

Metacrawlers are software programmes that simultaneously search a number of search engines. They generally retrieve a large amount of information, but the search engines that are included are often small or obscure.

Special services vary. The most well known is Ask Jeeves. This allows users to search using natural language in the form of a question (e.g. “where can I find….”).

The following techniques will help obtain the best results.

Searching techniques

A. Operator expressions

  • Boolean terms AND and NOT are not necessary. Google will automatically link a series of words using the operator AND. The order that the words are entered will affect the results displayed. The term OR can be used in Google by typing OR between the words you want to link.
  • You can force Google to link words that you want to search for together using ‘+’. This can be useful if it is a common word, which Google would normally ignore.

It is important to note that there must be a space before the ‘+’ but not after it.

  • Ask the search engine to exclude a word using ‘-‘. This is equivalent to NOT.

It is important to note that there must be a space before the ‘-’ but not after it.

  • Ask the search engine to search for a string of words in the exact order you want, or a phrase, by using quotations.

E.g. “Obsessive Compulsive Disorder”

B. Location expressions

It is possible to limit the search to a particular website using the expression ‘site:’ prior to the domain.

E.g. mmr site:dh.gov.uk All results will be from websites containing this domain.

It is important to note that the only space should appear before the word site.

Searching Tips

For more tips on searching the Internet see Appendix 1 and the ‘About Google’ part of the Google website ( Advanced searching options are also available in Google - use the ‘Advanced Search’ link on the website.

Place in search strategies

To a large extent the place of the Internet in search strategies will depend on the reason for using the Internet.

The Internet may be used to access a known resource e.g. the BNF, eMC, Fridge database, Medline etc. in which case its place in the search strategy will depend on the resource being accessed (i.e. primary, secondary, tertiary).

Quality on the Internet

As discussed in the Internet Health Warnings section above, as easily as you can search for accurate information you can search for inaccurate information. Not all information sources are therefore equally valuable or reliable. In comparison to traditional textbook information, there is a lack of publisher input associated with the Internet, and hence lack of editorial review and adherence to standards. Therefore, it is important for Internet users to apply the same critical evaluation skills that would be applied to a book or clinical paper to on-line Internet information sources.

There are four levels of quality:

Level 1 - bibliographic databases, including Medline & EMBASE.

Level 2 – includes evaluated subject gateways such as OMNI (see below).

Level 3 – general search tools e.g. Altavista or Google.

Level 4 – includes discussion groups and news groups.

Quality on the Internet is defined as how effectively the characteristics of a site satisfy the needs of the user.

One of the biggest problems regarding quality on the Internet is the potential for a ‘context deficit’, leading to a situation where information does not have to be incorrect to harm. This may be a result of:

  • Being able to enter a web page within a website and therefore miss out on important information such as intended audience, or country of origin.
  • Anonymity of author.
  • Health information being different in different markets. For example product licences differ between the UK and USA.
Evaluated Subject Gateways

e.g. OMNI (

Evaluated subject gateways are one of the tools available to users to help ascertain the quality of information being used. They only include Internet resources that meet predefined quality criteria. They can be thought of as high quality search engines.

Organised Medical Networked Information (OMNI) provides descriptions and links to more than 8500 health and medicine resources. It can be searched using MeSH terms.

OMNI is part of the BIOME collection of evaluated gateways, which in turn is part of the Resource Discovery Network.

Quality Indicators

At present there is no single perfect indicator of quality. As a result, an inference must be made from a collection of clues or indicators based on the anticipated use of the information source. A systematic approach should be developed to evaluate information on the Internet in the same way that it is to clinical trial papers.

The following quality indicators have been adapted from the quality criteria used by BIOME.

Context

  • Scope and intended audience
  • Authority and reputation

Content

  • Coverage
  • Accuracy
  • Currency

Format

  • Accessibility
  • Design and layout
  • Ease of use

A checklist based on these indicators has been developed and can be found in Appendix 2. The checklist can be applied to a website or Internet resource and will help to make an inference as to the quality of the information and the risks of using this for patient care.

Summary

The Internet may be used in enquiry answering as a way of accessing electronic resources or as a search tool when other standard resources have not provided sufficient information. It should be used in a similar way to other databases and searches should be performed systematically, using appropriate terminology and searching techniques to ensure accurate results.

Any information not from a recognised source should be assessed for quality before being used to influence patient care.

Further Information

Teach Yourself Tutorial

The Resource Discovery Network Virtual Training Suite includes a tutorial for pharmacists:

Reading

Wilson P. How to find the good and avoid the bad or ugly: a short guide to tools for rating quality of health information on the Internet. BMJ 2002; 324: 598-602.

Risk A, Peterson C. Health Information on the Internet – quality issues and international initiatives [editorial]. JAMA 2002; 287: 2713-2715.

Eysenbach G, Diepgen T. Towards quality management of medical information on the Internet: evaluation, labelling, and filtering of information. BMJ 1998; 317: 1496-1500.

Links

BIOME –

Resource Discovery Network –

Appendices

Appendix 1 – Signals Supplement – Tips and Tricks for Searching the Internet

Appendix 2 – Quality Checklist

Based on work and teaching by London Medicines Information Service.

Written by: Julia Sawyer, London Medicines Information Service, on behalf of the UKMi Clinical Governance Working Group.

Effective use of the Internet for Enquiry Answering v1.11

Date of preparation: December 2005

Date of review: December 2007

Appendix 1 Supplement produced with Smoke Signals; April 2004, Vol. 5, No. 4

Used with permission (adapted from original)

A service to Primary Care Pharmacists from Wessex Drug & Medicines Information Centre,

Southampton. Tel (023) 8079 6908.

Tips and Tricks for Searching the Internet

We assume you’re using Google as your search engine:

Effective use of the Internet for Enquiry Answering v1.11

Date of preparation: December 2005

Date of review: December 2007

Appendix 2 Quality Checklist

Evaluating Internet-based Information Sources

Checklist

Note: It may not be possible to answer all the questions listed below. However, a reasonable attempt should be made, so as to understand the resource before using it to influence patient care.

Name of site
Address of site

A. Context

  1. Scope and intended audience

1.1 What is the intended subject scope?
1.2 Who is the intended audience?
Yes / No
1.2.1 Is it relevant for our needs?

2.Authority & reputation

2.1 Where has the information come from?
2.2 Has an individual or group taken responsibility for the resource?
2.2.1 Are they qualified to provide this information?
2.3 Is an organisation responsible for the information?
2.3.1 Are any organisations associated with the resource?
(e.g. publishers, sponsors or funding agencies)
2.4 Is the resource well known or heavily used?
B. Content

1.Coverage

1.1 What is the subject of the resource?
Yes / No
1.2 Is the resource comprehensive?
1.3 What is the range of subjects covered?
1.4 Is the coverage adequate?
1.5 Is the information presented in sufficient detail and at an appropriate level?
Yes / No

2.Accuracy

2.1 Is the information accurate?
2.2 Has the information been edited or reviewed?
2.3 Is the information supported by evidence?
2.4 Is there any evidence of bias?
2.5 Is the information professionally presented?
(e.g. are there any typographical or grammatical errors?)

3.Currency

3.1 Is the information up to date?
3.2 How frequently is the information updated?
3.2.1 Is this frequency appropriate for this information?
Yes / No

C. Format

1.Accessibility

1.1 Are there any charges to access any sections?

2.Design and layout

2.1 Is the resource well designed?

3.Ease of use

3.1 Is the source easy to use?
3.2 Is the help information useful?

Assessed by:

Date assessed:

Comments:

PASS – Y/N

Checklist devised by London Medicines Information (Northwick Park), May 2003

Based on “Factors affecting the quality of an information source”

Effective use of the Internet for Enquiry Answering v1.11

Date of preparation: December 2005

Date of review: December 2007