Security and accuracy of medical information on the Internet
Online posting: April 12, 1996
Published in print: June 1, 1996 (CMAJ 1996;154:1621-1622)
Re: A clinician's experiences on the Internet, by D. John Doyle, Can
Med Assoc J 1996; 154: 382–384 [full text]
I read Dr. Doyle's article with great interest. As a physician
who has personal experience with the Internet and teaches a
workshop on it to fellow colleagues, I found Doyle's article
informative and pertinent for physicians unfamiliar with this new
medium. I, too, feel strongly that the Internet will some day
become an important tool for our profession.
However, before the Internet can become an indispensable mode of
communication for physicians, two significant hurdles need to be
overcome.
The first involves the security of information transmission.[1]
Beginning Internet users need to be aware that sending electronic
mail (email) is similar to sending a post-card. During
transmission, anyone involved in handling the email message can
access the content with relative ease. Although some email
programs, such as Pegasus,[2] can encode and decode messages to
deter casual browsers, these encryption techniques cannot
guarantee the prevention of voyeurism. As a result, Internet
users should not rely on email to transmit sensitive or
confidential information, such as patient records, raw research
data or other information intended solely for the sender and the
receiver.
Second, medical publishing is flourishing on the Internet, thanks
to the ease of instantaneous dissemination of information
worldwide. However, unlike the printed medium, in which peer
review ensures the accuracy of information, the Internet has no
such mechanism.[3] As a result, discerning whether the medical
information on an Internet site is accurate and scientifically
rigorous can be difficult. It is even harder for a health care
consumer to judge which patient-targeted information sites
provide balanced coverage of the issues and do not offer harmful
advice. Consequently, the Internet cannot be the definitive
source of accurate medical information, at least for now.
Whereas technical wizardry outside the field of medicine is
required to overcome the first hurdle, our profession can
certainly surmount the second by setting up a cooperative peer-
review process to scrutinize medical information available on
line.<3> Through the global effort of our colleagues, we can
mould the Internet into a truly useful method of communication
for our profession.
Kendall Ho, MD, FRCPC
Department of Emergency Medicine
Vancouver Hospital and Health Sciences Centre
Vancouver, BC
kho@unixg.ubc.ca
References
- Lincoln TL: Travelling the new information highway. JAMA
1994; 271: 1955–1956
- Harris D, Nadeau J: Pegasus Mail, [resource on the World
Wide Web; URL: http://www.cuslm.ca/pegasus/], Feb 23,
1996
- Goldwein JW, Benjamin I: Internet-based medical information:
time to take charge. [editorial] Ann Intern Med 1995; 123:
152–153
[ The author responds: ]
Dr. Ho makes several worthwhile comments. However, I am not as
pessimistic as he concerning the role of the Internet in clinical
medicine.
Ho expresses concern about the security of information
transmission. Although it is likely true that the US Central
Intelligence Agency can decode much encrypted Internet traffic,
it is unlikely that a "hacker" would have the time, interest or
computing resources to decode random encrypted email. Indeed,
the weak security links in Internet data transmission are much
more likely to be at the transmitting and receiving ends, where
unauthorized eyes may get access to information in its original
form through more mundane security breaches. Breaches can also
occur with courier services, fax transmissions and, of course,
ordinary telephone conversations. That we should use these means,
but not the Internet, to exchange clinical information makes
little sense.
Ho's second concern, about the need for a peer-review process for
medical information posted on the Internet, is particularly
relevant. In April 1994, Dr. Keith Ruskin of Yale University, as
publisher, and I, as editor, started a peer-reviewed anesthesia
journal on the Internet (Educational Synopses in Anesthesiology
and Critical Care Medicine, available at
http://gasnet.med.yale.edu/esia/). Similar efforts are under way
elsewhere.
With respect to patient-information resources, one way of
providing reliable information would involve the development of
home pages by responsible patient-advocacy groups, such as the
Canadian Cancer Society. Indeed, many of the society's patient-
information brochures, which have already been carefully vetted
for their accuracy, could be made into World Wide Web pages with
relative ease.
D. John Doyle, MD, PhD, FRCPC
Department of Anaesthesia
Toronto Hospital
University of Toronto
Toronto, Ont.
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