Appendix 3-D. AHRQ Linking Policy

## Introduction

Hyperlinks allow users to move from concept to concept in a nonlinear
fashion. This is a technology used to structure and navigate the World
Wide Web.

Most often referred to simply as links, this simple Web function permits
associative references to other sections within Web documents, other
documents and files on a Web site, and other Web sites and Web-based
resources.

Links can be **internal**---that is, established to materials contained
on a single Web server and resident to that Web site. Links can be
**external**---that is, point to materials that are resident on other
Web servers or applications that are maintained by outside entities.

## Requirements

### Internal Links

Internal links do not create any liability issues because the materials
are on the same server. However, these links serve as one method of
navigation within a site and they should facilitate use of a Web site,
not confuse or disorient users so that they become \"lost in
cyberspace.\"

As part of creating a navigation architecture that allows the user to
maintain orientation, be consistent in the use of hypertext links in
lists and the level of the target for these links to subcategories of
information.

Hypertext links placed within content should direct users to more
detailed information, but clearly indicate where the target of the link
is located with a brief description of what that link contains. For this
reason, it is better to have links to other materials at the end of
sections rather than buried in the middle of paragraphs.

### External Links

External links to other Web sites constitute an \"implied endorsement\"
and create a business advantage for the linked sites. Therefore, the
Office of Management and Budget (OMB) requires Federal Agencies to do a
risk assessment of external links from their sites.

For AHRQ-funded resources, potential links to external sources need to
be assessed against Department of Health and Human Services (HHS) and
AHRQ linking policies and criteria.

If a site can make a case for deviating from these policies, then the
specific review and selection criteria must be justified and posted on
the Web site for full disclosure.

Before establishing links to external sites, check on the linking
policies of those sites. Even if the sites do not require permission to
establish a link, you should notify Web sites of your intention to
establish a link as a courtesy because your links will drive traffic to
the other sites and create demand on their servers.

Outside Web resources may link to Agency resources, providing the link
is not displayed in any way that would imply an endorsement by the
Agency of a specific commercial product or service. Each AHRQ-funded Web
site should have a page that discusses the \"Linking In\" policy and
provides a 25-word descriptor for the site with key words that other
sites can use when establishing the link.

### AHRQ Policies and Criteria 

Criteria for selection of external Web links are explained in
accompanying AHRQ documents on linking policy, criteria, and evaluation.
It is best to take a conservative approach to external linking as the
Agency cannot appear to recommend sites which are incompatible with its
scope and mission. Principle requirements include:

-   Links should be limited to other Federal agencies (particularly
    other HHS agencies), non-profit organizations which partner with
    AHRQ for specific projects, and other selected non-commercial Web
    resources, such as State and local government resources or
    educational institutions.

-   Links to other Web-based resources should only be established if
    they are specifically referenced in AHRQ Web documents and directly
    relate to the Agency mission and outputs. Even these need to be
    evaluated against several quality and risk-assessment criteria.

-   Linked sites should not conflict with any Federal policies or
    regulations.

-   Links to commercial sites which market products or services are
    generally not appropriate nor are links to sites which charge for
    information. However, this does not exclude notices of the
    availability of publications by public agencies or non-profit
    organizations that charge for the publications or notices of
    conferences and meetings which charge a registration fee, providing
    these are directly related to the Agency mission and initiatives.

The Office of Communications and Knowledge Transfer (OCKT) reviews links
for any AHRQ Web-based resources maintained internally and housed on
AHRQ servers for compliance with the Agency policy and selection
criteria. For contractor-maintained servers, it is the responsibility of
the contractor to assess links and post only those links which meet
selection and evaluation criteria.

External links must be clearly delineated as such and a brief
description should be provided about the content of each linked
resource. The link URL can be transparent to the user, but keep in mind
that providing the specific URL for the linked resource has greater
utility for the user when the Web pages are printed and subsequently
referenced. Be consistent in the conventions that you use to designate
external links. See external link disclaimer below:

![](media/image1.png){width="6.850694444444445in"
height="2.047222222222222in"}

Once links are established, they need to be re-assessed on a periodic
basis to ensure that the links are still valid and that the linked
resources continue to meet selection criteria.

These principles may not cover all possibilities and circumstances.
Specific cases that present new issues must be evaluated on their merits
in keeping with the goals and mission of AHRQ.

### Additional Portal Links

The General Services Administration (GSA) requires that all federally
funded sites in the government domain provide a link to the GSA portal,
FirstGov, from the home page of the funded site. These site are, in
turn, indexed through the FirstGov portal.

AHRQ also has reciprocal links established with two health portals
funded under HHS auspices: healthfinder® and MEDLINEplus®, both of which
provide information on diseases, conditions, and wellness issues, and
other consumer health information and decision tools.

There may be other E-Government initiatives for portals where incoming
or outgoing links will need to be established depending on the purpose
and content of the Web-based resource.

## Tools and Resources

### AHRQ Web Site External Linking Criteria

AHRQ Web Site External Linking Criteria summarizes selection and review
criteria for external links from the AHRQ Web site.

**Selection Criteria**

Active links to sites external to AHRQ Web resources can only be made
to:

-   DHHS and other Government agency Web sites.

-   Non-profit organization Web resources that reflect the outputs of
    specific projects or conferences of AHRQ with official partners
    (specific URL, not Home Page).

-   Non-commercial resources that are specifically referenced in
    AHRQ-generated Web documents (specific URL, not Home Page).

**Review Criteria**

-   External links should only be established to sites or Web-based
    resources that are directly related to AHRQ\'s mission and outputs.

-   External links must not present conflicts with official Agency, HHS,
    or other Federal policies or regulations.

-   Links to external resources cannot imply endorsement of a specific
    commercial product or service (Title 44 USC).

-   Linked resources must be in compliance with the Americans With
    Disabilities Act and other accessibility guidelines as directed by
    the Department of Justice.

-   Linked resources should not contain inappropriate or questionable
    materials that jeopardize the Agency through associated liability,
    potential embarrassment, or political ramifications.

-   Content is accurate, scientifically sound, balanced, and current
    (pages show updates).

-   Sources of all content are specifically identified and references
    are provided for health and scientific claims.

-   The sponsoring organization(s), aims, and sources of support are
    clearly identified.

-   Biases or conflicts of interest from advocacy positions, marketing,
    or sources of financial support are explicitly acknowledged.

-   Privacy and confidentiality matters are clearly addressed, and
    registration is not required.

-   Contact information and feedback exist for both content and
    technical issues.

-   The design, reading level, and navigation tools are appropriate for
    the intended audience and do not present barriers to users.

### External Link Evaluation Checklist

The External Link Evaluation Checklist is an evaluation document that is
used to assess potential external links. Copies of these assessments
should be kept on file for the life of a project to show that you
performed due diligence in selecting and evaluating external links and
to address any challenges to the linking policy of your Web site by
outside entities.

For examples of \"Linking In\" policy pages that could serve as models,
check the following:

-   AHRQ Web site. Go to: http://www.ahrq.gov/news/weblink.htm

-   TalkingQuality Web site. Go to:
    http://www.talkingquality.gov/general/weblink.htm

-   healthfinder® portal. Go to:
    <http://www.healthfinder.gov/aboutus/linking.asp>

> For examples of \"Selection Criteria\" policy pages on Web portals,
> check the following:

-   healthfinder® portal. Go to:
    [http://www.healthfinder.gov/aboutus/selection.asp](http://www.healthfinder.gov/aboutus/selection.asp )

-   National Women\'s Health Information Center. Go to:
    http://www.4woman.gov/about/select-s.htm

-   National Guideline Clearinghouse. Go to:
    <http://www.guideline.gov/about/inclusion.aspx>

**External Link Evaluation Checklist: Selection Categories**

Is the Web resource that of a ***government or nonprofit*** sponsoring
organization in any of the categories below covered under the External
Linking Policy? \_\_\_\_\_Yes \_\_\_\_\_No

Please select as appropriate:\
   \_\_\_ HHS agency Web site or resource.\
   \_\_\_ Other U.S. Government agency Web site or resource.\
   \_\_\_ Nonprofit partner of AHRQ.\
   \_\_\_ Non-commercial Web resource specifically cited.\
   \_\_\_ State or local government agency with information useful
beyond its borders.\
   \_\_\_ University or other educational institution.\
   \_\_\_ Public, medical, or special library.\
   \_\_\_ National voluntary, nonprofit, or professional organization.

***If yes, skip to Nominating Criteria. If no, proceed to next selection
category.***

Is the Web resource that of an ***other than non-profit*** sponsoring
organization in any of the categories below covered under the External
Linking Policy, which warrants consideration assuming evaluation
criteria are met? \_\_\_\_Yes \_\_\_\_No

Please select as appropriate:\
   \_\_\_ Foundation with a corporate sponsor.\
   \_\_\_ For-profit organization involved in a public-private
partnership, CRADA, other grant or contract with AHRQ.\
   \_\_\_ Patient support or advocacy group.\
   \_\_\_ Commercial organization offering free Web resources as a
public service.

***If yes, skip to Nominating Criteria. If no, proceed to next selection
category.***

Is the Web resource that of a sponsoring organization that falls into
any of the ***automatic exclusion*** categories listed below?
\_\_\_\_Yes \_\_\_\_No

Please select as appropriate:\
   \_\_\_ Partisan political orientation.\
   \_\_\_ Marketing or advertising site of a company, product, or
service.\
   \_\_\_ Commercial search engine site.\
   \_\_\_ Bias, agenda, or purpose contrary to the public good.\
   \_\_\_ Undetermined sponsorship or affiliation.

***If yes, stop here. This resource cannot be considered for an external
link.***

**External Link Evaluation Checklist: Nominating Criteria**

Enter the name of the sponsoring organization:

     

Provide a brief description of the nature of the organization, its
stated purpose, and sources of support:

           

Enter the URL (and title) of the Web site or specific Web resource being
considered:

       

Describe the nature of the information and services offered by the
organization at this URL:

               

Describe its relevancy to an AHRQ Web resource, project, information
collection, or constituency group:

               

Does the site or information resource provide a contact for Web site
management and electronic policies? Please list name, title, and contact
information (e-mail, phone, fax, and/or mailing address).

               

**External Link Evaluation Checklist: Evaluation Criteria**

Is the organization and its sources of information and funding clearly
identified on the Web site or information resource? \_\_\_\_\_Yes
\_\_\_\_\_No \_\_\_\_\_Undecided

Does the Web site clearly distinguish between information and services
offered free and products and services marketed at a commercial rate?
\_\_\_\_\_Yes \_\_\_\_\_No \_\_\_\_\_Undecided

Would the presentation or content of the Web site lead a reasonable user
to infer endorsement of products or services by AHRQ? \_\_\_\_\_Yes
\_\_\_\_\_No \_\_\_\_\_Undecided

Can you determine any originator qualifications or quality assurance
mechanisms for the site? \_\_\_\_\_Yes \_\_\_\_\_No \_\_\_\_\_Undecided

Can you determine the following based on the material presented in the
Web resource?

-   Authority (author/publisher/credentials)? \_\_\_\_\_Yes \_\_\_\_\_No
    \_\_\_\_\_Undecided

-   Accuracy (verifiable source/reviewed)? \_\_\_\_\_Yes \_\_\_\_\_No
    \_\_\_\_\_Undecided

-   Objectivity (balanced/biases)? \_\_\_\_\_Yes \_\_\_\_\_No
    \_\_\_\_\_Undecided

-   Currency (release date/update)? \_\_\_\_\_Yes \_\_\_\_\_No
    \_\_\_\_\_Undecided

Is there potential for political sensitivity or embarrassment to the
Agency as listed below?

-   Political point of view? \_\_\_\_\_Yes \_\_\_\_\_No
    \_\_\_\_\_Undecided

-   Political commentary or satire? \_\_\_\_\_Yes \_\_\_\_\_No
    \_\_\_\_\_Undecided

-   Advertising or fund-raising? \_\_\_\_\_Yes \_\_\_\_\_No
    \_\_\_\_\_Undecided

-   Controversial information? \_\_\_\_\_Yes \_\_\_\_\_No
    \_\_\_\_\_Undecided

-   Unsubstantiated claims? \_\_\_\_\_Yes \_\_\_\_\_No
    \_\_\_\_\_Undecided

-   Profanity or sexual content? \_\_\_\_\_Yes \_\_\_\_\_No
    \_\_\_\_\_Undecided

Are there any potential legal complications as listed below?

-   Copyright protection? \_\_\_\_\_Yes \_\_\_\_\_No \_\_\_\_\_Undecided

-   Licensing agreements? \_\_\_\_\_Yes \_\_\_\_\_No \_\_\_\_\_Undecided

-   Registration for access? \_\_\_\_\_Yes \_\_\_\_\_No
    \_\_\_\_\_Undecided

-   Tracking/user profiles? \_\_\_\_\_Yes \_\_\_\_\_No
    \_\_\_\_\_Undecided

-   Privacy concerns? \_\_\_\_\_Yes \_\_\_\_\_No \_\_\_\_\_Undecided

Is the material presented technologically accessible to the majority of
users (compatible with older Web browsers and text browsers used with
assistive devices to accommodate disabled users)? \_\_\_\_\_Yes
\_\_\_\_\_No \_\_\_\_\_Undecided

Are additional links, LISTSERV, or chat options ***directly
accessible*** from the proposed Web resource URL being linked to the
AHRQ site? If so, Please briefly describe below:

           

Would any of these accessible links present problems if evaluated in the
same context as the direct link? \_\_\_\_\_Yes \_\_\_\_\_No
\_\_\_\_\_Undecided

If yes, please explain below:

               

**External Link Evaluation Checklist: General Comments**

                               

**Recommendation:** \_\_\_\_\_Include link \_\_\_\_\_Exclude link
\_\_\_\_\_Further evaluate

**Reviewer:** Name
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Date
\_\_\_\_\_\_\_\_\_\_\_\_\_\_

## 

## References and Authorities

### AHRQ Web Site External Linking Policy

The AHRQ Web Site External Linking Policy summarizes the issues,
principles, and selection criteria that apply to the AHRQ Web site.
Under its current policy, AHRQ links only to:

-   Other HHS agencies.

-   Other Federal agencies.

-   Non-profit organizations that are official partners on specific
    projects or conferences.

-   Non-commercial Web resources that are specifically referenced in
    AHRQ-generated Web documents.

**Issues**

The following issues affect the external linking policy:

-   Under basic guidance from OMB, Federal agencies are expected to
    conduct a risk assessment before providing external links from their
    Web sites.

-   Links to other sites are viewed as both an implied endorsement and a
    conduit to traffic, providing a business advantage for selected
    sites.

-   Given the ephemeral nature of the Web, content can frequently change
    on linked resources.

-   Web sites with external links must be regularly monitored for dead
    links or changed links.

-   Resources are required to determine potential links, review and
    evaluate them, establish agreements between sites, and maintain and
    update links.

**Principles**

The following principles apply to the external linking policy:

-   Selection criteria as established are to be followed for
    recommending links.

-   Review criteria as established are to be followed for evaluating
    links.

-   Disclosure language that addresses the policy, selection, and review
    criteria must be posted on any Web site that has external links.

-   OCKT reviews recommendations and makes final determinations on
    appropriate links.

-   OCKT negotiates linking arrangements, addresses requests from
    external sources, and responds to challenges on linking decisions.

-   OCKT provides oversight and periodic re-evaluation of linked
    resources (at least on a quarterly basis).

**Selection Criteria**

A number of general guidelines for evaluating the quality of health Web
sites have been published, and AHRQ has been involved in several
public-private collaborations that have addressed this issue.

Existing criteria that are broadly accepted include:

-   Content is accurate, scientifically sound, balanced, and current
    (pages show updates).

-   Sources of all content are specifically identified and references
    are provided for health and scientific claims.

-   The sponsoring organization(s), aims, and sources of support are
    clearly identified.

-   Biases or conflicts of interest from advocacy positions, marketing,
    or sources of financial support are explicitly acknowledged.

-   Privacy and confidentiality matters are clearly addressed.

-   Contact information and feedback exist for both content and
    technical issues.

-   The design, reading level, and navigation tools are appropriate for
    the intended audience and do not present barriers to users.

Additional criteria that affect AHRQ as a Federal Web site and agency of
HHS:

-   External links should only be established to sites or Web-based
    resources that are related to AHRQ\'s mission.

-   External links must not present conflicts with official Agency, HHS,
    or other Federal policies or regulations.

-   Links to external resources cannot imply endorsement of a specific
    commercial product or service (Title 44 USC).

-   Linked resources must be in compliance with the Americans With
    Disabilities Act and other accessibility guidelines as directed by
    the Department of Justice.

-   Linked resources should not contain inappropriate or questionable
    materials that jeopardize the Agency through associated liability,
    potential embarrassment, or political ramifications.

### Criteria for HHS External Web Site Selection 

Criteria for HHS External Web Site Selection provides guidelines for
policy development and practical application of best practices for
linking HHS-sponsored Web sites to external Web sites and resources. A
number of general guidelines to evaluate the quality and reliability of
health information Web sites have been published. The following
guidelines combine criteria from several external sources
(http://intranet.hhs.gov/#external#external) and existing guidelines
(http://intranet.hhs.gov/#existing#existing) with considerations
relevant to HHS agencies whose missions include a public information
component determine which information should be included in their HHS
Web sites. These criteria can also be used to narrow the field of
candidate sites for links to avoid information overload for users and
reduce link maintenance.

Agencies should build upon these guidelines with examples specific to
their own sites to develop operating procedures. Those procedures should
recognize that no Web site is likely to meet all criteria. However,
criteria provide appropriate guidance for staff to use in assessing the
communication needs and the relative risks and benefits of linkages for
their specific Web sites.

A.  On-line health information providers or sources should meet the
    following core criteria to be included in or linked to from an HHS
    Web site.

    1.  Content is accurate, scientifically sound, balanced, and
        current.

    2.  Sources of all content are specifically identified.

    3.  References are provided for health and scientific claims.

    4.  Site indicates that content is updated regularly (pages show
        dates).

    5.  Qualifications of persons or organizations providing any medical
        or health advice are clearly presented; trained professionals or
        an advisory board oversees such activities.

    6.  Information provided is designed to support, not replace, the
        patient/provider relationship and appropriate disclaimers are
        present.

    7.  A privacy policy statement is prominently displayed. Minimum
        elements of a privacy policy are discussed below.

    8.  Sponsoring organization(s), aims, and sources of support are
        clearly identified.

    9.  Biases or conflicts of interest resulting from strong advocacy
        positions, marketing or advertising, or sources of support are
        explicitly acknowledged.

    10. Marketing information and advertising are presented in a manner
        that would allow an average user to clearly distinguish between
        commercial content and other information presented.

    11. Contact information and a feedback mechanism for both content
        and technical issues are available.

    12. Design, reading level, search tools, site navigation, and
        interactive components are appropriate for the intended audience
        and do not present barriers to users.

B.  Privacy protections for personal information. A Web site\'s privacy
    policy should:

    1.  Notify users of which information is collected about them while
        they are on the site.

    2.  Explain how the information will be used, shared and protected.

    3.  Include a requirement to ask users for explicit permission to
        collect, track, aggregate, or share personally identifiable
        information.

C.  Beyond core selection criteria, HHS-specific considerations include
    the following. HHS Web sites should link to or recommend only those
    information sources that:

    1.  Are directly relevant to HHS programs, activities, communication
        goals, or target populations.

    2.  Comply with the Americans With Disability Act, and World Wide
        Web Consortium and other accessibility guidelines, as directed
        by the Department of Justice.

    3.  Provide balanced treatment of topics addressed on the Web site.

D.  HHS sites should be clear on the relationship between the HHS site
    and any linked sites. There are currently multiple means to indicate
    to users that they are accessing content on a non-HHS site,
    including disclaimers, exit notices and pop-up boxes. Technology is
    constantly changing, however, and mandating a specific technical
    solution does not always provide the highest standard of user
    protection. The technical solution to clarify the relationship
    between HHS and non-HHS content, therefore, will be left to
    individual HHS agencies and Web sites.

E.  In the case of on-line discussion forums, HHS Web sites should link
    to or recommend only those forums that use qualified people to
    moderate or regularly review the discussion for inaccurate content.

F.  HHS Web sites should not link to or recommend information sources
    that:

    1.  Conflict with official agency, HHS, or other Federal policies or
        regulations.

    2.  Include invalid or unsupported health claims or invalid or
        unsupported science.

    3.  Violate Federal or State laws and regulations governing the
        practice of medicine or the dispensing of pharmaceuticals across
        State lines or national borders.

    4.  Imply endorsement of products or services by the Department.

    5.  Allow targeted advertising by topic (for example, search on
        diabetes and get a specific drug ad).

    6.  Imply endorsement of advocacy efforts targeting Federal laws,
        regulations, or policies.

    7.  Do not disclose the nature of the partnerships and affiliations
        of contributors to the Web site and related projects.

    8.  Provide secondary linkages that lead to inappropriate content.

    9.  Require registration (anonymous use should be possible) or
        charge fees for basic information.

**External Guidelines Used As Sources for Core Criteria**

1.  Health on the Net Code of Conduct. Go to:
    http://www.hon.ch/HONcode/Conduct.html

2.  healthfinder® Selection Guidelines. Go to:
    <http://www.healthfinder.gov/aboutus/selection.asp>

3.  Evaluating Health-Related Web Sites, Emory University. Go to:
    http://www.sph.emory.edu/WELLNESS/instrument.html

4.  IHC Application Checklist, Science Panel on Interactive
    Communication and Health (SciPICH). Go to:
    http://www.health.gov/scipich/IHC/checklist.htm

5.  Criteria for Assessing the Quality of Health Information on the
    Internet, Mitretek. Go to:
    http://hitiweb.mitretek.org/docs/criteria.html

6.  eHealth Code of Ethics, Internet Healthcare Coalition. Go to:
    [[http://www.ihealthcoalition.org/ethics/ehealthcode0524.html]{.underline}](http://www.ihealthcoalition.org/ethics/ehealthcode0524.html)

**Existing Guidelines Used As Sources for HHS-Specific Considerations**

1.  Office of Management and Budget, Policies for Federal Government
    Public Web Sites. Go to:
    [[http://www.usa.gov/webcontent/reqs_bestpractices/omb_policies/linking.shtml]{.underline}](http://www.usa.gov/webcontent/reqs_bestpractices/omb_policies/linking.shtml)

2.  U.S. General Services Administration, USA.gov. Go to:
    [[http://www.usa.gov/About/Linking_Policy.shtml]{.underline}](http://www.usa.gov/About/Linking_Policy.shtml)