Information partnerships building a health gateway—Health<i>Insite</i>

HealthInsite1 is a gateway website managed by the Australian Government Department of Health and Ageing. It aims to provide Australians with access to reliable health information by linking to resources on information partner websites. Potential partners may either self-nominate, or may be invited to apply for partnership following recommendations from stakeholders or the HealthInsite Editorial Team. Partner websites undergo a quality assessment process2 that includes final approval by the HealthInsite Editorial Board. The partner organisations then sign a formal deed of agreement with the Australian Government. There are no fees and each partner takes legal responsibility for its own site. The HealthInsite Editorial Team of four librarians is responsible for the day-to-day management of content for the site, supported by technical, policy and communications staff. The HealthInsite Editorial Board is an advisory body of health professionals, consumers and health informatics experts that meets three to four times per year. It participates in quality assurance processes, advises on content priorities and facilitates linkages with stakeholders. The number of partners has grown gradually since the site was launched in April 2000. Currently there are 70 partners including Australian government and State government agencies, research organisations, peak bodies (community-based organisations that represent a health services sector), support groups and commercial organisations. As a collaboration, HealthInsite provides access to over 10 000 resources on partner sites, ranging from short articles for consumers to major government reports and systematic reviews. HealthInsite also links to and maintains informal relationships with four major health gateways: NHS Direct Online3 in the UK; MEDLINEplus4 and healthfinder5 in the US; and the Canadian Health Network.6 Partners agree to maintain their resources in accordance with the HealthInsite Publishing Standards.7 These standards were developed with reference to a wide range of local, national and international recommendations. They cover four areas: quality of information, authentication, technical issues and accessibility. HealthInsite partnership agreements include a commitment to quality through an agreed set of standards, as set out in the HealthInsite Publishing Standards. In practice, implementation of those standards sometimes requires compromises to be made. When a quality issue is identified, it is not always easy to make changes promptly. Partner organisations have competing priorities and most websites have tight budgets. Often the technical side of site management is outsourced and the contractors may not understand the range of quality issues. Changes may be deferred until a general site upgrade is done. Given these constraints, HealthInsite sometimes has had to review the importance of particular quality requirements and make compromises. Our top priority has been the quality of information, as ensured by the partner's own quality assurance procedure. In other areas we give some leeway to partners but aim for a commitment to continuous improvement. Maintenance of a website is a major cost, often not fully appreciated when a site is launched. There are both technical and content aspects. It is important for sites to keep up with web technology. Furthermore, there is a perception that any site more than 2 years old will look old-fashioned. Websites tend to go through regular costly upgrades and facelifts, leaving less in the budget for content. HealthInsite must be on the alert for proposed partner site upgrades so that we can encourage the partner to check against HealthInsite quality requirements. Content maintenance means adding new resources, reviewing older resources, and updating where appropriate. There is a consumer expectation that health information on the Internet will be up-to-date. Yet there is a limit to how often partners can review their resources. One of the most common tasks for HealthInsite has been persuading our partners to protect themselves by putting clear and accurate dates on their resources. HealthInsite metadata8 is compliant with the Australian Standard, AGLS9, which is based on the Dublin Core metadata standard.10 Each field in the HealthInsite specification is important for current or potential search and navigation functionality. Partners need to keep up-to-date metadata records on their own sites, so that HealthInsite can harvest the details of any updates to resources. This ability to keep our metadata up-to-date is a key feature of HealthInsite, but the wide range of differences in the way partners operate their websites has to be managed. Establishing a metadata workflow for each of our partners has been a challenge and once again some compromises have been required. These are usually worked out through one-on-one negotiation with partners. It is useful to compare metadata with traditional library cataloguing because the level of indexing is similar. Compared with the well-established prescriptive cataloguing codes (AACR and MARC), the Dublin Core is very flexible and the use of the different syntax codes (HTML, XML and RDF) is not yet firmly established. For HealthInsite this means that some partners will not follow our specification exactly and we need to keep adjusting our harvester software to accept variant metadata. This is one of the reasons why it has been very useful to have an in-house technical team. At the content level, metadata might be created by authors, publishers, webmasters or web designers rather than well-trained cataloguers. There has been a false assumption that metadata creation is easy. Some of our partners have librarian assistance and/or have very homogenous sites and so are able to create good basic metadata records. HealthInsite provides considerable assistance for smaller sites and those with more complex web resources. HealthInsite also undertakes the subject indexing for nearly all partners. Partners can copy their metadata records from HealthInsite and then paste into their own pages. It was originally thought that partners would value having full metadata records that met an Australian standard. However, many partners do not need our full records for their own purposes. It has recently been decided to allow partners to maintain shorter records on their own sites, while a full record is maintained in the HealthInsite database. In the first stage of development of HealthInsite, priority was placed on building the gateway technology. Since then a lot of work has been invested in encouraging organisations to become information partners and in supporting them to meet the HealthInsite Publishing Standards. Communication with partners and potential partners is mostly done on a one-to-one basis by email or telephone, with occasional visits. Broad training sessions held in partner cities were not cost effective. However, a quarterly partner e-mail update helps with general information. One of the difficulties with irregular contact is that partner staff and priorities can change without us being aware. As a result, the HealthInsite team sometimes needs to provide additional support to rebuild an understanding of HealthInsite and the partnership with the organisation. Fortunately the staffing of the HealthInsite Editorial Team has been very stable. HealthInsite needs to continually expand and develop topic coverage so that it remains attractive to users. Partnerships are crucial to HealthInsite's development and there is a need to keep building on the base of high-quality partner sites to provide access to a wide range of health information. A stage has been reached where it is felt that closer co-operation amongst partners would be beneficial. One possibility is to establish a virtual partner discussion forum to encourage information sharing and to ensure more regular contact. Closer co-operation will enable us to work with partners to fill gaps in gateway coverage and avoid duplication of areas well covered. There is also a need to develop closer relationships with State and Territory government portals to provide access to their directories of health services information, which is consistently one of the most requested types of information for HealthInsite users. Overall, our experience has shown that it is not only possible to manage a large, complex, co-operative Internet gateway like HealthInsite, but that with good will and hard work the partnership can continuously grow and adapt to meet the needs of the partners, the managers and the users of the site.

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