Abstract. This paper reports selected results from two comprehensive evaluation studies of the Information Prescription (or "Information Rx") Program implementation conducted from 2002-05 by the American College of Physicians Foundation (ACPF) and the U.S. National Library of Medicine (NLM). In this Program physicians are provided with Information Prescription pads, analogous to pads used to prescribe medications, that are used to direct patients to the MedlinePlus web site and its contents that are applicable to a patient's health condition. The results describe the Program's potential to enhance patient education and interpersonal communication from physician and patient perspectives. The findings suggest once physicians adopt the use of an information prescription, they perceive they are providing an additional clinical service that enhances patient education and interpersonal communication. For physicians, participation in information prescription may improve patient communication, encourage information seeking, and lessen the number of poor quality Internet searches that patients frequently self-perform and bring to a doctor's office. Similarly, once patients receive a recommendation from a physician to seek health information on the web, patients may be more comfortable with health seeking on the Internet and discussing their findings with their doctor. The conclusions of the two evaluation studies imply an Information Prescription fosters a dialogue between providers and patients, helps patients use the Internet more effectively and seems to favorably impact patient education. As the medical community and patient advocacy groups continue to emphasize the importance of evidence-based information as the gold standard for accepted care, it can be expected that informatics tools such as Information Rx will come to play an increasingly important role as a vehicle to help identify and access high quality health information on the Internet.Perceptions of the Internet as a source of vital health information and a resource for patient education, communication and empowerment are changing. In 2000, Shactman [14] found physicians resisted turning to health information on the Internet as a strategy to improve patient interpersonal communication and education. Three areas of concern were identified: the anticipated time demands of emails from patients, lost time in patient visits to discuss information from unknown or dubious sources, and the unreliability of much of the health-related information posted on the Internet.Five years later, Wofford, Smith and Miller [16] note physicians' reservations are changing rapidly. They predict the use of health information from the Internet will become an integral part of patient office visits and education. The computer:

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There are many obstacles that urban youth experience in pursuing health careers, but the benefits of diversifying the classroom and workforce are clear. This is especially true today as educators and policymakers seek to enhance underrepresented minority students’ access to health careers, and also achieve the health workforce needed to support the Affordable Care Act. The creation of student pipeline programs began more than 40 years ago, but success has been equivocal. In 2008, Mentoring in Medicine (MIM) conducted a research project to identify how students learn about health careers; develop strategies for an integrated, experiential learning program that encourages underrepresented minority students to pursue careers in health; and translate these into best practices for supporting students through their entire preparatory journey. Six focus groups were conducted with educators, students, and their parents. The inclusion of parents was unusual in studies of this kind. The outcome yielded important and surprising differences between student and parent knowledge, attitudes and beliefs. They informed our understanding of the factors that motivate and deter underrepresented minority students to pursue careers in health care. Specific programmatic strategies emerged that found their place in the subsequent development of new MIM programming that falls into the following three categories: community-based, school-based and Internet based. Best practices derived from these MIM programs are summarized and offered for consideration by other health career education program developers targeting underrepresented minority students, particularly those located in urban settings.

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Background The transition to a largely Internet and Web-based environment for dissemination of health information has changed the health information landscape and the framework for evaluation of such activities. A multidimensional evaluative approach is needed.Objective This paper discusses one important dimension of Web evaluation—usage data. In particular, we discuss the collection and analysis of external data on website usage in order to develop a better understanding of the health information (and related US government information) market space, and to estimate the market share or relative levels of usage for National Library of Medicine (NLM) and National Institutes of Health (NIH) websites compared to other health information providers.Methods The primary method presented is Internet audience measurement based on Web usage by external panels of users and assembled by private vendors—in this case, comScore. A secondary method discussed is Web usage based on Web log software data. The principle metrics for both methods are unique visitors and total pages downloaded per month.Results NLM websites (primarily MedlinePlus and PubMed) account for 55% to 80% of total NIH website usage depending on the metric used. In turn, NIH.gov top-level domain usage (inclusive of NLM) ranks second only behind WebMD in the US domestic home health information market and ranks first on a global basis. NIH.gov consistently ranks among the top three or four US government top-level domains based on global Web usage. On a site-specific basis, the top health information websites in terms of global usage appear to be WebMD, MSN Health, PubMed, Yahoo! Health, AOL Health, and MedlinePlus. Based on MedlinePlus Web log data and external Internet audience measurement data, the three most heavily used cancer-centric websites appear to be www.cancer.gov (National Cancer Institute), www.cancer.org (American Cancer Society), and www.breastcancer.org (non-profit organization).Conclusions Internet audience measurement has proven useful to NLM, with significant advantages compared to sole reliance on usage data from Web log software. Internet audience data has helped NLM better understand the relative usage of NLM and NIH websites in the intersection of the health information and US government information market sectors, which is the primary market intersector for NLM and NIH. However important, Web usage is only one dimension of a complete Web evaluation framework, and other primary research methods, such as online user surveys, usability tests, and focus groups, are also important for comprehensive evaluation that includes qualitative elements, such as user satisfaction and user friendliness, as well as quantitative indicators of website usage.