You probably know that there is a plethora of health-related web-sites out there, and they cover a wide range of subjects. Some take up lifestyle questions in general; others provide advice on how your body works or information about specific diseases. Some provide medical services. In many cases you are offered personal consultancy services by e-mail, giving you an opportunity to ask questions about your own health. Some provide consultations, and giving prescriptions on the internet is also a question currently being discussed.  

The terms used about these services are not clearly distinguished. They are referred to as guidance, counselling, health services, online health services, health web services and health-related internet services, to mention some. Other terms are also being used. However, the name is not decisive. When you are evaluating a service, you must look at its contents and make up your own mind about what sort of service this really is. Below you will find some points to keep in mind when evaluating internet health services in the light of current legislation.

Many providers of health-related services on the internet strongly emphasise that their service is not meant to replace your regular general practitioner or other traditional services. In this context it is immaterial what is said about this. What is important as far as you are concerned is the contents of the service.

There is no separate legislation for health services on the internet
The rights and duties of patients and health personnel are laid down in Norwegian health legislation, the Health Personnel Act and the Patients' Rights Act being the most important statutes. If you want to know more about these acts, you will find information at the Norwegian Board of Health's web site (Statens helsetilsyn).

We have not yet acquired much experience in applying health legislation to health-related services on the internet, so there is still a lot that remains unclear, both nationally and internationally. In Norway these questions are handled by the central authorities as well as by the Norwegian Centre for Telemedicine in Tromsø (NST). NST is also running this website.

Authorised health personnel must act responsibly - also on the internet.
All health personnel authorised in Norway are under an obligation to perform their work in accordance with the requirements of professional responsibility and diligent care that can be expected. Authorised health personnel are not allowed to offer services for which they are not qualified in formal or real terms. Whenever necessary they must refer you to, or consult, a person who has the proper qualifications. At the central level it is the Norwegian Board of Health [Statens helsetilsyn] which is ultimately responsible for ensuring that this requirement is met. "The Norwegian Board of Health in the County" has supervisory responsibility at the county level. If you have any questions, you could contact the chief medical officer in your own county to start with.

To assess an internet health service provided by authorised health personnel, you must at any rate find out what professional training the provider of the service has. The person in question must establish his or her identity properly and you must be told whether a responsible doctor, if any, gives the answer himself, or whether he or she is only accountable to the web site.

If you should have any doubt that the person offering a health service is really authorised, you may call the Norwegian registration authority for health personnel [Statens autorisasjonskontor for helsepersonell ] to check his or her credentials, at phone no. +47 21 52 97 00.

Patients have patients' rights. What about you?
It is difficult to give any clear answer to this question, but you have to be a patient to have patients' rights. According to the Norwegian Patients' Rights Act, Section 1-3 a patient is defined as "a person who contacts the health service requesting health care, or to whom the health service provides or offers health care as the case may be". Not all users of health-related services on the internet are patients. But some will be.

The following circumstances may be significant in this connection:
a) Are you consulting the web site instead of going to your regular doctor?
b) Do they offer you a consultancy service by e-mail?
c) Do they offer you individual consultations by videoconferencing or images?
d) Do you get answers to specific questions about your own health?
e) Do you get medical advice based on information on your state of health?
f) Are you offered prescriptions and/or medical certificate?
g) Is there a fee for each consultation?
h) Is the Public Health Service provider?

The more of these questions can be answered in the affirmative, the greater the likelihood that you would be defined as a patient, with the rights that follow from this.

Patient on the internet - so what?
An act on patients' rights has been passed in Norway. Literally, this act defines the rights that patients have in Norway towards the National Health Service. However, health personnel providing health services outside the National health service are obliged to act in accordance with the patients' rights act, as well.

The Act relating to Patients' Rights establishes the patient's right to health care. It also establishes the patient's right to participation, information, consent, access to medical records and to make complaints. In addition, children have special rights. If you want to know more about patients' rights in Norway, click on the Health Board's web site or here for the Patients' Rights Act in English.  

This overview might be a starting point for any questions you might want to ask providers of this type of service on the internet. 

If you feel that your rights under the Patients' Rights Act are not being complied with, you may submit a complaint to The Norwegian Board of Health in the County. Here you may also obtain any information and guidance you might need in connection with this.

Right of privacy/professional secrecy
Some of the web health sites offer services that require you to provide health data about yourself. All personal health data are considered sensitive information. This means there are special rules for how to process such data. If operating a health web site entails processing sensitive information about you and others, in principle a licence must be obtained from the Data Inspectorate. Before you provide health data about yourself it might be wise to check whether the web site has obtained a licence and whether it meets the Data Inspectorate's requirements for processing such data (see also the page about data security).

Professional secrecy is another aspect of the right of privacy. This is closely connected with the duty to observe the Data Inspectorate's requirements to data security. Inadequate data security may represent a breach of professional secrecy under national health legislation. The Norwegian Board of Health (the county medical officers) are responsible for ensuring that professional secrecy is observed. In general health personnel are under an obligation actively to prevent others from obtaining access to or knowledge of your health data. Naturally, this also applies to health personnel offering health services on the internet.

To be able to assess whether you may be confident that personal health data are being processed securely, you should demand information on how this is done.

Foreign health personnel and their services
Foreign health personnel can in principle only provide health services if they are authorised or have a licence in Norway. This is simple to check with respect to persons employed in the traditional health services, but not when it comes to providers of such services on the internet. Nevertheless, it is reasonable to assume that online health sites operated from abroad in other languages than Norwegian are operated by persons who do not have a Norwegian licence. If you choose to use such services, it is important to keep in mind that you may not necessarily enjoy the protection provided by Norwegian health legislation.

Norwegian health legislation applies to "health personnel and enterprises that provide services in Norway".  Thus, it does not apply to health personnel in other countries. They will be subjected to their own national legislation in this area. This affects your rights. The obligations of health personnel vary from one country to another.

The Norwegian Inspectorate for Social and Health Affairs has been evaluating the situation on this field for some years, and it is difficult for us to give mor spesific advice or information before they have come to a conclusion.  
 
"Everyone is thinking of himself, only I am thinking of me."  Others who are thinking of you:
Norway have passed acts that to a high degree safeguard patients' rights and establish the duties of health personnel. These acts are above all adapted to the traditional health service, although the legislation does not draw a line between these services and web services.

The Norwegian Board of Health and the county medical officers are responsible for controlling whether web health sites meet health legislation requirements. The Data Inspectorate is the regulatory agency for data security and privacy issues in general. You may contact these bodies if you have any questions or doubts about a web site offering health services or processing sensitive data about yourself and others.

Conclusion
Even though legislation related to health and protection of privacy, and the responsibilities of  The Data Inspectorate and The Norwegian Board of Health also apply to health services on the internet, we believe that you, as user of these services, must to a great extent protect your own rights. There are many reasons for this: these services are relatively new, the offers numerous, the quality varied, and in practical terms the central authorities can only follow up internet developments to a limited extent. Furthermore, the authorities depend totally on individual users taking initiatives before they can intervene in specific cases. In the meantime: Use the quality criteria guidelines to assess the health related web sites  you fint.