Orthogate - The
Rationale For An Internet Gateway Site In Orthopaedics
Contact Person: Myles Clough (firstname.lastname@example.org )
Discussion & Conclusion
Discusssion of our results
The sites assembled to found Orthogate are truly an impressive group, with diversity of service but a surprisingly common philosophy and outlook. We discovered as we were discussing the concept of a gateway site that we all had the following beliefs and wishes.
The foundation sites are successful as stand-alone webs managed by energetic and forward thinking individuals. With these people contributing a proportion of their attention to the group the energy and flow of ideas is vitalizing. Furthermore it seems as though orthopaedics on the Internet is small enough at the moment that virtually everyone who is interested is aware of Orthogate and supports it either in concept or with practical help. Cyberspace is so large that there may be another group working away without our being aware of it, but we beg leave to doubt. The fact that Orthogate and ISOST are international organizations of this complexity and with these aims is very encouraging for the future health of the subject.
In addition to posting the Orthogate site the project has aims to influence the orthopaedic internet in specific directions, cohesion, cooperation, high quality content and improving the availablility of all CME material. We have made progress in these other less tangible directions
The influence that project members are already having on the development of resources is out of proportion to our numbers
Yet, the central question, "is the time right to start this process?" remains unanswered. Our results show that readership of Orthogate itself, as opposed to its member sites, is very small. It is growing and the potential for exponential growth is seen in the trend so far. Yet the traffic does not warrant a claim to status as a gateway. The reasons are not difficult to find. The group's energy has gone into forming the cooperative associations and building the site, not into publicizing. Most of the links to Orthogate itself and a stunning 95% of links to ISOST are from inside the Orthogate project itself. We are in danger of talking to ourselves! By contrast, even though they are at most a fifth the size of Orthogate's, the library and commercial links pages' orthopaedic links collections (table 3) are referred to from hundreds of pages across the Internet. We need a massive effort to bring the Orthogate project and its status as a gateway to the attention of the Internet.
Other gateway sites in Medicine
Another type of gateway is offered by major organizations such as the American Academy of Orthopaedic Surgeons 42 and equivalent organizations in other nations 43-51. These sites offer information about the organisations, the meetings and publications they produce, policy statements, the web sites of subspecialty organizations and a wealth of other material. However, many restrict their aims strictly to the remit of the organization and do not provide a gateway. The Radiology Society of North America 52, American Heart Foundation 53, American College of Cardiology 54 and the American College of Rheumatology 55 are other notable North American examples which do have wider aims. The American Academy of Family Physicians 56 describes its website as "a resource for anyone interested in family practice, whether they are a patient, health care professional, government policymaker, family practice resident, or medical student".Because of their national orientation it is doubtful if these organisations would wish to construct a supranational gateway or supersite of the type Orthogate aspires to be. Part of the requirement is support from the international professional community as represented on the Internet.
The "Megasites" 57 review detailed 25 sites that provide entry to all fields of medicine, selected from 52 considered 58 . These sites are legitimate gateways but because they try to cover the whole of medicine their coverage of individual specialist areas is not comprehensive. Because of their different aims and de facto competition between each other it would be difficult to get them to combine to form the sort of unified collection which Orthogate considers necessary for the future development of medicine on the Internet. Furthermore, their broad scope makes it unlikely that the other attributes of a supersite, textbooks, authoritative databases, electronic journals and the like, will attach themselves to the gateway. The paper is interesting in a number of ways, not the least of which is the criteria they select for quality in a gateway site 59.
Strategies for quality control on the Internet
Considering that the quality of information on the medical Internet is such a concern to so many people it is surprising how few options have been proposed. The instinct to "control" the Internet and in some way to assure quality by denying access to "poor quality" runs up against the reality that there is no effective way to prevent people from posting or reading whatever they want. Closed webs with limited access to the Internet are perhaps the only way this can be accomplished for a limited group of users. The NHS in the UK has such a network and it remains to be seen whether good quality medical information will be available on that network or whether the best sites will be put off by the restrictions. Orthogate suggests that the best and only possible penalty for posting poor quality material is to be ignored. PLink 66 67 is a collection of plastic surgery links consciously assembled to assure patients and doctors that the information on the sites mentioned is reliable. However, it does not provide comprehensive access to pages on individual topics so readers still have to do their own searching on the approved sites.
Another formidable strategy for improving quality on the Internet is best exemplified by OMNI (Organized Medical Networked Information) 63 . This network of UK medical librarians has a set of well worked-out criteria 64 for inclusion of a site in their collection. Thus sites which are listed with OMNI have been positively vetted and a brief review is attached to each link. Unlike Orthogate the sites which do not meet the criteria are not listed. While this approach sounds highly appropriate the numbers reveal that no attempt has been made to make a comprehesive collection of all eligible sites. Indeed the process of review is so time intensive that the Internet probably grows faster than OMNI can. The total number of sites listed by OMNI for the whole of medicine is of the same order of magnitude as the OWL/Orthogate collection in orthopaedics alone. OMNI is clear that it is not attempting to offer comprehensive coverage. However, there is one concealed logical problem in this approach. If a site is not listed with OMNI is it because it doesn't meet with the quality criteria or because it hasn't been evaluated? There's no way to tell. This seriously weakens the value of the site, and the strategy. Only a combination of comprehensiveness and searching review will be effective in promoting good quality. We anticipate that the experience OMNI gains in reviewing will be of enormous value when the problem of how to provide comprehensive coverage has been solved and the two approaches can be combined. Until then we believe that searchers for information on the Internet will be attracted to the most comprehensive collections, not to those that provide the most information about quality. Whereas most professionals have been trained to evaluate information quite critically they are not familiar with searching for information; these people will go where the searching is made easiest. Patients, on the other hand, have little training in discrimination and are most in need of advice about the quality of the information they are exposed to. However, they are even less likely to visit a resource like OMNI because they wouldn't think to look for it and because they will not find what they are looking for in its index anyway. Laissez faire is the predominent attitude on the Internet along with a belief that censorship is simply a "glitch" to be circumvented. Traditional attitudes do not mesh well with that and have resulted in a number of efforts to measure quality of Internet postings. In a recent JAMA article Jadad and Gagliardi 68 concluded "Many incompletely developed instruments75 to evaluate health information exist on the Internet. It is unclear, however, whether they should exist in the first place, whether they measure what they claim to measure, or whether they lead to more good than harm."
In the free environment of the Internet
readership will go where the service is most compellingly useful. Thus any site which aims
to have influence must first capture the readership by being the most valuable resource in
its field. Our analysis is that in the current state of the Internet readers value
comprehensiveness more than they do comments of the quality of the resources. If both
cannot be provided we will aim first for the fullest possible coverage and plan to
progress towards comments on quality once Orthogate is established as an authority. Our
on-site resources amount already to a gateway, if not already a supersite; our
organization and philosophy is fitted to the task. It remains to be seen whether we can
attract the readership, the personnel and the supporting resources to sustain our vision.
The rationale for a gateway site in Orthopaedics is that there is no other practical way
to lead the transformation and take advantage of the changes in academic and professional
communication offered by the Internet.
© 1998 Author(s) Hold Copyright