Table 4.

Advantages and Disadvantages of the 3 Key Mechanisms of the Health Information Quality Initiatives

Mechanism	Advantages	Disadvantages
Codes of conduct	Usually developed by broad-based participation Create useful stakeholder consensus Amenable to sector-specific interpretation Can be updated as necessary with relative ease Can be implemented by any organization, large or small Create synergy between corporate objectives and ethical environments	Implementation is by a nonbinding pledge Open to abuse Potential for misinterpretation of principles Require non-specific organizational change that is difficult to measure Difficult to measure utilization by Web sites and citizens Difficult to measure effectiveness
Third-party certification	Provides independent validation and revalidation Can be objective Forces organizational change in terms of ethical culture, audit, and accountability Forces provider education Clear criteria that are consistently applied; but, criteria can be quite clear, without being well-considered and defendable Relatively easy to measure utilization (in the case of fee-for-service programs) Can be used as a quality differentiator	High cost to providers Exclusion of smaller and other deserving providers due to cost or required organizational change User indifference (don't know, don't care) Provider ambivalence (don't care, can't do) Enforcement relies on withdrawal of accreditation; this has a weak impact Labor and resource intensive in the case of manual review and certification (eg, MedCERTAIN and OMNI)
Tool-based evaluation	Consistency of process	Semblance of objectivity User indifference Difficult to measure utilization by Web sites and citizens Difficult to measure effectiveness Narrow "expert"-only participation in developing the questionnaires that underlie the tool False sense of security Difficult to maintain currency Difficult to establish validity