Pioneering Web Portals for Health Information
Submitting InstitutionHeriot-Watt University
Unit of AssessmentComputer Science and Informatics
Summary Impact TypeSocietal
Research Subject Area(s)
Information and Computing Sciences: Artificial Intelligence and Image Processing, Information Systems
Summary of the impact
Scotland's Health On the Web (SHOW) was the first Healthcare Information
Network of its kind and was developed in an EU project between 1996 and
1999. The original aim was to develop ways of exploiting the Web to
provide trustworthy and authoritative health information in a way that was
easy to find. The resulting system was adopted as the major vehicle of NHS
Scotland for providing healthcare information to public and professionals.
Serviced by a specially appointed team, it currently supports around 400
sites, and in recent years usage has been high, averaging around 50
million website hits per month.
The Database/Knowledge Base Research group was a major research group in
HWUCS, engaged in a wide range of research into databases from the early
1980s until it transformed into the PUMA lab after RAE 2008. Some of our
early research was focused on problems relating to distributed databases,
and included work done on linking heterogeneous medical databases [1, 2].
We were also partners in one of the first EU projects developing
telemedicine systems (1989-90) and in several subsequent projects, e.g.
After the Web was made available for general use in 1993, usage began to
grow and websites to proliferate. At that stage, search facilities were
very crude and the notion of a web portal did not exist. The ease with
which a website could be created resulted in a significant proportion of
the health information being of questionable quality and it was difficult
for the uninformed user to know where to look for information and which
sites to trust. This coupled with the huge size and anarchical
organisation of information on the Internet was creating difficulties for
users in finding relevant and reliable health information quickly.
This was the motivation for developing Healthcare Information Networks,
and led to our participation in the EU project CHIN (Co-operative Health
Information Networks) from 1996 to 1999. Prof. Williams was the PI at
HWUCS and collaborated with Dr George Venters of Lanarkshire Health Board.
Gavin Venters was RA on the project.
The specific role of HWUCS in this project was to develop a Healthcare
Information Network (HIN) for Scotland which would address the following
(a) Trust. By providing access to a connected set of trusted sites, a HIN
should remove the problems arising from websites offering healthcare
information of questionable quality.
(b) Usability. Web search engines were still at an early stage of
development and finding specific information or a relevant website was
still a challenging problem. Thus contributing websites needed to be
systematically organised with some structure imposed on their
contributions to enable users to find the required information rapidly.
(c) Scale. A HIN needs to be sufficiently large scale to provide the
wealth of information needed to make it useful. In our case it was aimed
at both the public and medical practitioners in Scotland, and provided
information on available healthcare services together with educational and
reference material on a wide range of health topics.
To achieve this we had to gain the confidence and support of the major
healthcare organisations in Scotland. Working with them we developed a set
of acceptable guidelines and structures which obtained a balance between
the autonomy of individual participants and the structure needed for
consistency and for efficient and effective operation. A set of user
guides was produced to assist website developers in the different
organisations, providing advice on style and layout to fit these common
structures and produce a common look and feel. We also created a tool to
assist developers in generating compliant websites, and were responsible
for creating and maintaining the overall portal linking the various
The outcome of the research is reported in [4-6].
References to the research
(2) M.H.WILLIAMS and J.HU, Making heterogeneous medical databases
interoperable, Computer Methods and Programs in Biomedicine, 43,
275-281, DOI: http://dx.doi.org/10.1016/0169-2607(94)90080-9
(1994) - invited update on our MIE 93 paper.
(3) M.H.WILLIAMS, B.MAHR, G.VENTERS and D.LUTZEBACK, A Framework for
Telemedicine services, Proc. Eleventh Int. Congress of the European
Federation for Medical Informatics, Eds. A. Reichert et al, Freund
Publishing, 430-434 (1993).
(4) M.H.WILLIAMS, G.VENTERS, G.VENTERS and D.MARWICK, Developing a
Health Care Information System for Scotland, Proceedings of Medical
Informatics Europe '99 (MIE99), Ljubljana, P. Kokol et al (eds.),
IOS Press, pp. 125-128 (1999).
(5) E.TAMBOURIS, M.H.WILLIAMS and C.MACROPOULOS, Co-operative Health
Information Networks in Europe: Experiences from Greece and Scotland,
Journal of Medical Internet Research, vol. 2(2):e11, doi: http://dx.doi.org/10.2196/jmir.2.2.e11
(6) M.H.WILLIAMS, G.VENTERS, G.VENTERS and D.MARWICK, Developing a
Regional Healthcare Information Network, IEEE Trans on IT in Biomedicine,
vol. 5, No. 2, pp. 177-180, DOI: http://dx.doi.org/10.1109/4233.924809
Details of the impact
By the end of the CHIN project (1999), it had grown to provide services
for over one hundred organisations in the NHS Scotland. These included all
15 health boards and most of the 28 hospital trusts as well as a number of
major NHS information providers. In so doing we had created the basis for
an effective HIN for Scotland.
At that time healthcare organisations within the NHS were accepting that
patients should take a more active role in their own healthcare. Most
healthcare institutions were producing a range of paper-based documents
aimed at patients and were quick to see the potential benefits of moving
these to electronic form and making them available via the Internet,
thereby reducing overall costs. The advantage that SHOW offered at this
time was to bring together the distributed contributions from all the key
healthcare providers in Scotland and create a single virtual healthcare
library for Scotland. In so doing one creates a huge source of information
that is accessible from any part of the country. An additional benefit is
that institutions can easily learn from each other and are motivated to
improve the information sets that they want to target at patients.
Medical practitioners were also catered for within SHOW, which included
information aimed primarily at the professional. Examples were:
- TOXBASE — an online toxicology database provided by Scottish Poisons
- TRAVAX — online travel medicine advice provided by SCIEH
- Clinical guidelines for practitioners provided by Scottish
Intercollegiate Guidelines Network (SIGN)
- Information from hospitals on new services, changes to services,
laboratory handbooks, etc.
After the initial prototype service went live in 1996, the number of
services grew steadily and the common structures evolved naturally. During
this period the rate of access to these services grew accordingly, and by
the end of the project in 1999 it averaged over 50,000 page hits per day
(over 1.5 million hits per month). In 1997 the Scottish government
recognised its importance and it was adopted as part of the IT strategy of
the NHS in Scotland in the Scottish Office White Paper, "Designed to care:
Renewing the national health service in Scotland". As a result at the end
of the project, development was taken over by NHS Scotland and became the
NHS' main vehicle for providing health information to patients and
professionals in Scotland.
One of the problems which we had identified was that of protecting access
to sensitive health information for professionals (and used passwords to
do so). However, the NHS has been able to handle this with a dual system
in which a full range of information is available to professionals within
the NHS firewall and a subset available to any user outside the firewall.
Currently the full set of websites available to professionals within the
NHS firewall through SHOW numbers over 400 (see http://www.showsupport.scot.nhs.uk/About/About.aspx)
while 289 of these are available to any user outside the firewall.
In turn the use and dependence on the site by both public and
professionals has grown steadily, and during the 2008-2013 period it has
averaged 1.7 million hits per day (50 million per month). Since the
population of Scotland is around 5 million people, this represents a
significant rate of access. This put Scotland well ahead of developments
in other countries and was regarded as a major success.
Since take over by the NHS, SHOW has been managed by a support team
within NISG (National Information Systems Group) which currently consists
of 8 personnel (see http://www.show.scot.nhs.uk/aboutSHOW/howSHOW.aspx
One of the important benefits of SHOW is its ability to reach a large
number of people very rapidly. This has been particularly useful when
emergency situations such as e-coli outbreaks have occurred. It has also
been useful in providing access to new developments such as NHS24.
Following our developments on SHOW, researchers at the National Centre
for Scientific Research "Demokritos" in Athens adopted a different
approach but used some of our developments  as a basis for a HIN for
Greece. Other HINs have been developed for different purposes such as
exchange of patient data (NHIN), public health (PHIN), etc. Note that
SHINE (Scottish Health Information NEtwork) is a later development
produced by library and information services and has nothing to do with
Sources to corroborate the impact
SHOW Service Manager, NISG, NHS National Services Scotland,
Telecommunications Consultant for NHS Scotland
The SHOW home page: http://www.scot.nhs.uk/index.aspx
About SHOW (including its history): http://www.scot.nhs.uk/aboutSHOW/aboutSHOW.aspx
An About SHOW page aimed at current and future client sites http://www.showsupport.scot.nhs.uk/About/About.aspx
The current list of SHOW sites: http://www.show.scot.nhs.uk/sites_az.aspx