The Internet has introduced a number of challenges for physicians in their daily interactions with patients. Of these, one of the most profound challenges is the availability of unreliable sources of health information on the Internet. Ask any practicing physician to explain why this availability often hinders as opposed to aiding patient education. First, the physician spends precious examination time explaining or proving to a patient why a resource found on the Internet is not reliable. The information may be inaccurate or out-of-date. In addition, some physicians are not aware of the best available Internet resource to refer patients.

The American College of Physicians Foundation (ACPF) has teamed with the National Library of Medicine (NLM) to address these challenges to make the task of educating patients easier. In 2003, the ACPF and NLM launched the "Health Information Referral Project" in Iowa and Georgia. The "Health Information Referral" or Information Rx project provides physicians with the tools and resources needed to provide patients with prescriptions for quality health information from MedlinePlus. So instead of the patient coming to a visit with information obtained from searching Google on the Internet, the physician writes an Information Rx directing the patient to MedlinePlus.

Physicians participating in the project write the patient an Information Rx on a prescription pad similar to the one used to prescribe a medication. The physician provides the patient with an information prescription at the time of diagnosis or when a medication is prescribed. Consider the following scenario: Dr. John Smith has just diagnosed his patient Josephine Doe, 45, with Type II Diabetes. Dr. Smith believes that patients who are knowledgeable about their health have the best outcomes with disease management. For this reason, Dr. Smith wants Ms. Doe to learn as much about her newly diagnosed condition as possible so he writes her a prescription for the drug Avandia and an Information Rx for Diabetes. Ms. Doe has two options for filling her information prescription. Either she can take her information prescription home to access the MedlinePlus Web site, or she can visit a branch of her local public library or a consumer health library to access the site.

Selected ACP and non-ACP members in Virginia are working with the ACPF and NLM to continue the pilot. While physicians from across the state can participate, a core group of Richmond-area and Northern Virginia physicians working with Jean P. Shipman, Director of the VCU Libraries Tompkins-McCaw Library for the Health Sciences and Elizabeth McTigue of Inova Health System's Jacob D. Zylman Health Sciences Library respectively, will provide detailed feedback to NLM and ACPF.

In January 2004, NLM sent a letter to public and health sciences librarians across the state announcing the project and soliciting input. Librarians from Virginia Commonwealth University's Tompkins-McCaw Library for the Health Sciences, the University of Virginia's Claude Moore Health Sciences Library, and Eastern Virginia Medical School's Edward E. Brickell Medical Sciences Library responded by offering in-depth MedlinePlus training sessions to public librarians in their respective regions.

One outcome of the initial pilot was that physicians did not give information prescriptions to some patients because they assumed they did not have access to computers or the Internet. This is why the Virginia pilot has among its goals exploring the role libraries can play in ensuring that all patients can fill their information prescriptions through their local library.

For more information about Virginia's participation in the project contact Jean Shipman - jpshipma@vcu.edu, Linda Watson - law6z@virginia.edu, Judith Robinson - robinsjg@evms.edu, Elizabeth McTigue - elizabeth.mctigue@inova.com, Karen Dillon - kdillon@carilion.com, or the VaCOHSL Web site http://www.cbil.vcu.edu/mac/vacohsl/informationprescription.htm.