None of these index pages compares in scale to the OWL/Orthogate/Orthosearch/Orthoguide database of over 3000 orthopaedic links. However several of them receive substantial attention in terms of pages linking to them from elsewhere on the Internet. All of these pages are parts of larger collections of medical and other links and will remain on the Internet in competition with Orthogate because of their intent to cover the whole of medicine.

Quality Criteria

The quality criteria which guide Orthogate are founded on the OMNI list of quality criteria ⁶⁴ . These have been accepted by the project as a whole as an ideal to strive for (Table 4). The OMNI criteria are grouped under the headings of Context Evaluation,  Content Evaluation, and Access Evaluation. We have added some general categories, the appeal of a site to the international and multilevel users of Orthogate and adherence by the site to medical ethics, particularly non-interference with existing doctor-patient relationships and the maintainance of confidentiality.

Table 4 Quality Criteria

The criteria for inclusion in the OWL list of links has always been much looser, viz. the editors' opinion that the resource would be of interest to orthopaedic surgeons and/or, patients. The above criteria are seen as a possible structure for evaluating the quality of the material referred to. It is not currently practical to apply these criteria to all 3000 sites listed in OWL. We see three levels of adherence to these ambitious standards. Material posted on Orthogate "in house" should comply with these criteria; resources which can be fully evaluated, should be posted and notified as compliant with our standards or not as the case might be. Other sites which have not been evaluated against these standards should have no comment attached. As the sites listed with Orthogate undergo review it is hoped to increase the proportion which have been evaluated. Meanwhile the criteria themselves and the practicality of applying them will be under review.
Stilberg et al ⁶¹ suggest 4 areas of concern (authorship, attribution, disclosure and currency) and the Health on the Net Foundation ⁶² promotes 8 principles as described in the HON Code. These quality standards for the Internet are compared to the OMNI  ^{63 60} criteria ⁶⁴ expanded for Orthogate in Table 5. These cover Stilberg's criteria and the HON Code principles. As might be expected in a site with a predominent concern over the value and accuracy of content, run by people whose opinion about content has some validity, there is extra emphasis on international, multilevel appeal, applicability, content and accessibility.

Table 5 Comparison between Quality Criteria of Internet sites

Relationship between ISOST and Orthogate

Construction and maintenance of a gateway site is exhausting, time consuming and expensive. With an annual budget projected in the hundreds of thousands (US$) for staff, equipment and administration, it is clear that the project cannot be financed solely from the founders. Nor, with the number of other interested orthopaedic surgeons amounting to about 100 can this group carry the costs for long. Unless this effort is rapidly recognised by the granting agencies as worthy of academic support and funding, the only viable source of funds is commercial. We envisage sponsorship and advertising on the site and some user-pay services in addition to the free gateway services. These could include provision of full text journal articles, consulting for web site construction, help with searches for orthopaedic material and the hosting of CME material. The need for large amounts of money makes it likely that venture capital would be the most likely start-up source and that in its turn means that the site must be run for profit. This aspect is in apparant conflict with the group's desire that the site be run for the benefit of the subject of orthopaedics. We felt that some conflict was inevitable but that our aims could be sustained if the Internet Society of Orthopaedic Surgery and Trauma operated as a non-profit learned society analagous to the other subspecialty societies in our speciality. ISOST would then have direction and policy control over the site but licence the running of it to a for-profit management corporation (Orthogate Inc.) The creation and delineation of these institutions has taken up a lot of time and attention but we believe that the foundation of the project (ownership of the intellectual property) must be secure before we advance very far. ISOST will have many other activities apart from directing Orthogate; papers for the inaugural scientific meeting in Febuary 1999 have already been called for.

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