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Home > About > Content Selection Policy and Procedures

1. Introduction

1.1 Web Site Goal is a gateway consumer health information Web site from the United States government. The goal of the Web site is to improve consumer access to selected health information from government agencies, their many partner organizations, and other reliable sources that serve the public interest. also links to human services organizations and other sectors that can influence health, such as agriculture, environment, labor, and transportation.

1.2 Consumer and Professional Information

The content of is structured around organizations, specifically their role as providers of consumer information on health and health-related topics. Many of the organizations in offer both consumer and professional information, so professionals are finding the Web site a convenient resource for client education and cross-disciplinary Web browsing. Other organizations are using it as a Web referral source for information on topics outside their areas of specialty. Professional-only information resources may be selected for

1.3 Credible Organizations

In the selection process, each organization is reviewed to establish its general reliability and credibility, as well as its ability to respond to inquiries from the public. Once an organization is selected, its traditional contact information, direct Internet links (if available), and an abstract describing the organization and its information and referral services are entered into the database.

1.4 Selected Individual Resources

One or more of an organization's Web-accessible information resources (Web) also may be selected and abstracted separately, also with a direct Internet link, to simplify consumer access. Web resources include individual documents and other information resources such as news releases, fact sheets, journals, newsletters, directories, bibliographies, Internet resource lists, databases, online discussion groups, and health risk assessments. The organization sponsoring an individual Web resource is identified so the user has the option of reviewing the source of the information. Given the frequent changes and crosslinking that are common on the Internet, cannot verify the accuracy of specific Web resources.

1.5 Structured by Topic

The central feature of is a searchable topic index supported by the database of abstracts and links. The index provides user-friendly searching on over 1,000 topics. For the most popular topics, also assembles frequently asked question documents or guided tours to the most pertinent organizations and Web resources in the database. (Agencies represented on the Steering Committee collaborate on projects that focus on popular topics.) Other resources, such as health-specific Internet indexes, libraries, commercial health news media, etc., also are linked from if they are useful to the average consumer.

1.6 Initial Selection of Content

The initial collection of organizations and Web resources for, as well as the initial topic index or thesaurus, was derived from two primary sources--the health and human services information and referral database DIRLINE, maintained by the National Health Information Center (NHIC), and the existing Web sites of the federal agencies and other organizations listed in DIRLINE. Through this approach, the traditional selection processes used by federal agencies and information clearinghouses to identify appropriate non-federal referral sources were brought to bear on the selection of content.

1.7 Federal Clearinghouse Procedures Used

Since 1979, information staff at NHIC have identified organizational sources of health and human services information for use in its public referral functions, DIRLINE, and publications such as National Health Observances and Federal Health Information Clearinghouses. Over 50 other federal health and human services information clearinghouses have similar, time-tested procedures for identifying resources for inclusion in their own referral databases and publications. The Steering Committee of also participated in defining the characteristics of the organizations and resources that would be included.

1.8 Characteristics of Organizations Reviewed

The organizational characteristics commonly assessed in these selection processes include--

  • Nature of the organization
  • Nature of the information and services offered by the organization
  • Indicators of service area/capacity of the organization to respond to inquiries
  • Quality of the information and services provided
  • Reputation of the organization in the information and referral community
  • Sources of support

1.9 Selection Process Adapted to Internet

Since the launch of in April 1997, the traditional NHIC content selection process has been adapted to accommodate suggestions received from other federal agencies, other organizations, and consumers who are using the Web site. The basic considerations outlined in 1.8 above have been expanded to include a broader range of organization and resource types, as well as greater consideration of technological barriers to consumer access. This document represents the consensus of the Steering Committee on permanent selection criteria and procedures.

2. Oversight and Management

2.1 HHS-Developed, Government-wide Service

The Web site has been developed by the Department of Health and Human Services (HHS), in collaboration with other federal agencies. The project is coordinated by the Office of Disease Prevention and Health Promotion (ODPHP), with the active participation of a Steering Committee composed of representatives of the federal agencies whose information is included in and non­federal consumer health information specialists, librarians, and others actively engaged in the provision or use of online consumer health information. The online service falls within the larger scope of HHS's public information activities, and its oversight and management structure reflects the government-wide nature of the service.

2.2 Steering Committee

The Steering Committee meets monthly and provides general guidance for the development, maintenance, and improvement of the site, including the topic index or thesaurus. In addition, the Committee is actively involved in the selection process. Member agencies may nominate organizations and Web resources; they also are be called upon to participate in the development of topics or the evaluation of organizations and Web resources that fall within their areas of expertise. The Committee as a whole reviews all recommendations for additions to and deletions from the database and oversees special efforts on popular topics.

2.3 Membership of the Steering Committee

  • A representative from the consumer health information (CHI) and/or communication staff of each cooperating federal agency or service
  • A representative from the Web management staff of each cooperating federal agency or service
  • Non­federal CHI specialists, librarians, and others actively engaged in the provision or use of online consumer health information

2.4 Committee Chair/Project Manager

The Office of Disease Prevention and Health Promotion (ODPHP) chairs the Steering Committee and coordinates the development and management of ODPHP staff manage day-to-day operations of, including contractual support through NHIC.

2.5 Contractor Support

Contract staff at the National Health Information Center (NHIC) provide the daily support to maintain, operating in accordance with these policies and procedures. NHIC staff also identify potential new organizations and Web resources through monitoring of key Internet information indexes and announcement sites, and also monitor existing Web sites for currency, making recommendations for action to ODPHP. NHIC staff consolidate user feedback from the Web site itself and respond directly to routine inquiries from the public. Weekly summaries of user feedback and all sensitive inquiries are forwarded to ODPHP for review. The site indicates that staff cannot respond to all comments and suggestions, but actual requests for information (as opposed to comments about the site) are processed by NHIC's existing information and referral staff.

3. Selection of Organizations and Web Resources

3.1 Nomination staff at NHIC and ODPHP will identify new organizations and Web resources through established selection procedures. The Web site also offers users an opportunity to recommend an organization or resource for consideration. The Steering Committee, other collaborating federal staff, and cooperating public and private organizations may nominate organizations and resources for inclusion in as well. Staff from all federal health and human services information clearinghouses will be invited to review for content and balance and also to nominate new organizations and Web resources for inclusion.

3.2 Breadth of the Collection

The range of organizations and Web resources included in the collection must be broad enough to ensure that consumers will perceive the service to be both useful and unbiased. Because many organizations produce information for both consumers and professionals, and many consumers are seeking more detailed information on topics of concern to them, will inevitably include both consumer and professionally oriented information.

3.3 Types of Organizations Included will include organizations providing information and/or referral services for each topic in the index. These organizations will be selected primarily from:

(a) Government and non-commercial organizations, including--

  • U.S. government agencies.
  • National voluntary, nonprofit, and professional organizations,
  • Universities, other educational institutions, and libraries.
  • Organizations partnering with government agencies to provide information to the public and other public-private partnerships.
  • State and local government agencies offering information services useful beyond their boundaries.
  • Patient support and advocacy groups, including self-help groups.
  • Foundations.

(b) Certain commercial organizations that offer substantial and free Web resources as a public service, such as--

  • Commercial news Web sites featuring health information news.
  • Online journals and newsletters.
  • Large indexes and bibliographies of information.
  • Web resources or services not available from a government agency, such as physician or health care facility locators.

Note on Marketing and Advertising: Both nonprofit and for-profit organizations selected for should clearly distinguish between information and services offered at no or low cost and products and services marketed directly and at a commercial rate. The presence of advertising will not automatically disqualify an organization or Web resources ( for example, a nonprofit might link to a corporate sponsor's Web site, or a commercial site might feature advertising on its site, but not in the Web resource specifically selected), but policies regarding advertising will be considered. Some commercial sites may have licensed significant content from nonprofit or educational institutions (Mayo Clinic, National Health Council, and Johns Hopkins University all have licensing arrangements). Also, any organization or Web resource will be excluded from if its Web site's presentation or content would lead a reasonable consumer to infer endorsement of products or services by the U.S. government. Organizations need not have an Internet presence to be included in; those with more traditional information and referral activities will also be included.

3.4 Characteristics of Organizations Evaluated

The organizational characteristics assessed in the selection process include the following. The primary source for evaluation shall be the published information about the organization (primarily its Web site, since that is what users will see) and input from the members of the Steering Committee.

  • Nature of the organization--published information about government, educational, professional, nonprofit, voluntary, patient support or advocacy, research, or foundation status will be considered.
  • Nature of the information and services offered by the organization--publications, telephone hotline or other counseling, databases, bibliographies, research or clinical trial information, specific referrals to facilities or providers of services, financial assistance, technical assistance, support group activities, membership services, etc. will be considered.
  • Indicators of service area/capacity of the organization to respond to inquiries--published information about national, state, or local service; tollfree information services or individual counseling services; free or low-cost information and services; financial assistance requirements; membership requirements; stated ability to respond to information requests, whether via the Internet or through traditional information and referral service, will be considered.
  • Quality of the information and services offered by the staff will review published (primarily the Web site) information from each organization for general consistency and credibility. Federal content partners with specific expertise in content areas will be asked, as part of the general review process, to undertake a more indepth review. Organizations should provide a substantial amount of consumer health information as part of their mission, and that information should be current, consistent with basic science and recommendations of recognized authorities, and well-designed. Provision of professional information is an additional factor. Responses to test inquiries by telephone and e-mail should be professional. Staff qualifications relative to information and services provided should be appropriate, and use of an advisory board will also be considered. Specific content and/or target audience(s) should be appropriate for the collection.
  • Reputation of the organization in the information and referral staff will attempt to identify any gaps in this regard. Federal content partners with specific expertise in content areas will be asked, as part of the general review process, to undertake a more indepth review of length of time in operation, reputation in the information and referral community, direct partnership and/or referral experience of federal agencies and clearinghouses with the organization, sponsorship of significant consumer information or research activities, etc. Identification of the organization as a resource on federal agency Web sites will also be considered.
  • Sources of support--published information about grants, membership income (professional, voluntary, or support/self-help), publication sales, sponsorship, public-private partnership, government, etc. will be considered. Sponsorship and advertising policies of commercial sites will be considered.

3.5 Evolving Standards for Information Quality on the Internet

Each organization will be evaluated according to published information (primarily Web site) as to its adherence to general standards for quality of health information on the Internet, including clear identification of sources of information and funding, sponsoring organizations, staff qualifications, internal review/quality assurance methodology, and privacy practices, as well as currency and scientific accuracy. Examples of evolving standards include-

3.6 Accessibility to the Technologically Disadvantaged and the Disabled

Access to the Internet and state-of-the-art computer hardware and software are far from universal. will consider technological and design factors affecting the accessibility of organizations' Web sites in the selection process, with the goal of choosing Web resources accessible to the target audience of consumers, new Internet users, and users of public Internet access points provided by libraries, schools, kiosks, nonprofit groups, etc. These factors include-

  • Network bandwidth requirements (size of graphics and other files, including advertising, and effect on speed of access via a common dial-up connection),
  • Compatibility with older Web browsers and text browsers used in conjunction with assistive devices to accommodate disabled users as required by the Americans With Disabilities Act (use of tables, frames, audio, video, image maps, etc.),
  • Ease of navigation (clarity of design, logic of site flow, search instructions, etc.), and
  • Use of 'cookies' and other tracking technologies that profile users, which may intimidate new users, raise privacy concerns, and reduce accessibility from public access facilities.
  • Registration requirements for access.

3.7 Balance of the Collection will include organizations regardless of whether their information and referral activities are traditional telephone services or Web access to publications and databases. However, because is itself a Web-based service, consumers' expectations require that information resources produced by organizations that are selected for inclusion must be Web-accessible. Also,'s goal is to improve consumer access to information, so balance of basic introductory information resources and more sophisticated resources for further exploration will be a consideration. The total number of Web resources selected for any given topic should be the minimum number that can present a complete picture of the topic at the level of detail appropriate for's gateway role; information overload should be avoided.

3.8 Web Orientation of the Service

Format and availability will affect selection of Web resources. Information in the electronic age encompasses much more than digitized versions of traditional brochures or even bibliographic databases. The Web permits up-to-the-minute posting of information about health issues. In addition, the relatively low cost of publishing information on the Internet permits more organizations to offer online versions of their publications and frequently asked questions and answers from their members. Generally, resources are designed for the Web will be given higher priority, once basic content needs of consumers are met on a given topic.

3.9 Types of Web Resources

Depending upon the availability of suitable resources, will select Web resources in the following formats for a given topic:

  • An FAQ (Frequently Asked Questions) or similar resource to provide quick answers to common questions.
  • Digital brochures, publications, fact sheets, etc. presenting non-technical information about the topic.
  • Topical news sites and online journals and newsletters.
  • Online databases, both bibliographic and content.
  • Internet indexes or resource lists.
  • Listservs and online discussion, support, and self-help groups.
  • Interactive resources such as online quizzes, electronic public service announcements, and health risk assessment tools.

3.10 Support and Self-help Group Issues selection policy treats support and self-help groups as organizations subject to the same credibility evaluation as other organizations nominated for inclusion in Patient-run organizations should meet all criteria for inclusion; special attention will be given to the presence of an appropriate advisory board, moderation of online discussion activity by a trained professional, and use of disclaimers concerning medical advice and consultation with health professionals.

3.10 Online Discussion Activities

Online discussion activities such as listservs, patient support and self-help newsgroups and forums, and 'chat' groups can be selected as Web resources to which links directly. As with other selected Web resources, an organization already selected for must sponsor the discussion activity. will highlight such resources only after consultation with a federal agency in the role of content partner; will continue to emphasize links to larger, encompassing lists or networks, directing searchers to them for further information and referral to smaller resources. Users who visit any selected organization's Web site may access any discussion activity supported there. With regard to discussion groups not sponsored by a selected organization, provides links to the American Self­Help Clearinghouse, Mental Health Net, and other credible online sources that have evaluated such resources and added them to their own referral pools.

3.11 Keeping the Collection Current

One of the challenges for ensuring the credibility of the Web service is to maintain the currency of the collection of organizations and Web resources. This means having the most up­to­date information about organizations and Web resources. NHIC staff will work with contacts at the cooperating agencies to identify Web resources that are revised or become outdated. In addition, Web site management software will be used to regularly analyze the integrity of the outward links from Recommended additions and deletions resulting from this activity will be handled through the same review process as new acquisitions.

3.12 'Sunset Clause'

For, which is a selective rather than an exhaustive collection of information resources, another aspect of credibility is the freshness of the selection. Web resources will be selected for for a period of 24 months, and then will be tagged to be dropped or deselected from the collection unless they have been revised or updated. Tagged items will be reviewed by NHIC staff before they are deactivated. Exceptions to this automatic deselection may be items that are unique or of exceptional merit due to format or content. Recommended additions and deletions resulting from this activity will be handled through the same review process as new acquisitions.

3.13 Deselection

All organizations and Web resources in the collection may be recommended for deletion at any time if they do not continue to meet the general selection guidelines.

3.14 Recommendations for Deselection

Recommendations regarding deletion of organizations or Web resources will be accepted through the same mechanisms as nominations for additions.

4. Review of Recommended Additions and Deletions

4.1 Basic Review Steps

All organizations and Web resources identified or nominated for addition to the database and Web site are reviewed first by staff at NHIC for compliance with the selection guidelines above. Existing resources are verified and updated on a regular schedule. ODPHP staff oversee this process and approve routine actions. Items that require additional content review are referred to members of the Steering Committee whose organizations have responsibilities in the topic area. Actions are summarized by staff each week for ODPHP and once a month for the Steering Committee.

4.2 Levels of Review

(a) First level review. NHIC staff identify organizations and Web resources that clearly comply with selection guidelines and are similar to those in the initial collection, through their own efforts and through nominations, and add those items to once the initial review is completed satisfactorily. These would include federal offices and services and non­controversial, non­commercial private sector resources and services. These additions are reported weekly to ODPHP and provided to the Steering Committee monthly. (Routine updates also fall in the first level review.)

Nominations may be rejected at the first level of review because they fail to meet the selection criteria-for example, they are (1) primarily commercial or require membership for access, (2) duplicative of existing links, (3) not current, (4) of insufficient quality, (5) present insufficient evidence of reliability or integrity of the sponsor, or (6) are technologically inaccessible to a majority of users. Rejections are included in the weekly reports to ODPHP.

(b) Second level review. Recommended additions of certain categories of organizations and Web resources and all proposed deletions are subject to second level review by ODPHP staff. NHIC staff prepare recommendations regarding organizations and resources that offer information that impinges on federal policy, regulations, or practice guidelines (mammography or dietary guidelines, for example) and refer them to ODPHP. Second level review is also required for organizations and resources providing information on topics that involve several federal offices (such as genetic testing for breast cancer, which falls within the purviews of the National Cancer Institute, the Food and Drug Administration, and the Centers for Disease Control and Prevention). NHIC staff must also refer to ODPHP all resources of merit that fall outside usual selection criteria because of size, topic, or collection balance, as well as all recommended deletions.

ODPHP reviews the nominated resources; those that ODPHP determines do not require prior review by the Steering Committee are acted upon and those that require additional content analysis are referred to the Steering Committee members with expertise in the topic or other identified content partners (third level review). Again, all additions and deletions are included in the monthly summary provided to the Steering Committee.

(c) Third level review. ODPHP staff will refer all sensitive or questionable potential additions or deletions to Steering Committee members with topic expertise and/or appropriate content partners for further review, as necessary.

(d) Web posting of information for the Steering Committee. Monthly summaries, agendas, and other information will be posted on a secure Web page for the Committee, in addition to e-mail and fax distribution.

5. Notice of Selection/Request for Update to Organizations

5.1 When inclusion of an organization or selection of an individual Web resource for is confirmed by the Steering Committee, an e-mail message (or letter, if necessary) will be sent to inform the organization. This communication will include information about, its selection policies (including the 24-month 'sunset' clause), and HHS's non-endorsement policy, as well as a copy of the database record or Web page containing the pertinent information. The organization will be asked to indicate via e-mail or in writing its (a) approval of the information included in and (b) its willingness to inform of any change in the status of the organization or Web resource.

6. Disclaimers

6.1. will include appropriate disclaimers. The disclaimer currently in use is-

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