Educational Technology & Society 2(3) 1999
ISSN 1436-4522

Harrison's Online

(Website review)

Robert Luke

Courseware Specialist
University of Lethbridge, Lethbridge, AB T1K 3M4
Tel: +1 403 382 7146
Fax: +1 403 329 2097

Aude Dufresne
Dpt de Communication, Universite de Montreal
C.P. 6128 succ Centre-Ville, Montreal, H3C 3J7 Canada
Tel: +1 514 343 7371
Fax: +1 514 343 2298
URL: http://mistral.ERE.UMontreal.CA/~dufresne/

Site URL:

Site title:
Harrison's Online

Medical Reference, Educational uses

McGraw-Hill ( McGraw-Hill Health Professions Division, 11 W. 19th Street, 2nd Floor New York, NY 10011>. publishes both the text and online version of Harrison's Principles of Internal Medicine.  The website advertises the cooperation of the text book's authors in creating Harrison's Online: The involvement of the Harrison's author team, Anthony S. Fauci, Eugene Braunwald, Kurt J. Isselbacher, Dennis L. Kasper, Stephen L. Hauser, and Dan L. Longo along with J. Larry Jameson, in Harrison's Online ensures that the data you will find here meets the same rigorous standards that have made the Harrison's textbook the most trusted single resource in the medical literature. See for a linked list of the editors and their occupational qualifications.

Best Features:
Harrison's Online is a very powerful database of what is one of the medical profession's foremost text books. It is well laid out in a concise and clear manner. Navigation is simple, aided by a stable menu in the top frame that will take the user to three tables of contents (TOC) -- Brief, Full and Topical -- as well as an Index, Contributors List, Search, Forum, Sitemap, Feedback and Help. The best overall feature of this site is its ease and speed of indexing and/or looking up references, providing access to the industry standard medical text book. Having access to several kinds of search options makes this site an excellent cross-referencing tool. That this text is an evolving and continually updated resource will be of high value to any medical practitioner. The PreTests are also very good, offering instant feedback and reading suggestions as per user results (please see below for more on the PreTests).

Worst Features:
Some of the feedback in the Forum feature of the site suggests adding a chat function to Harrison's Online, but more importantly, adding a highlight feature to returned search results would be the best way to improve this site. Highlighting where in the text your search term appears would enhance the ease and usability of the search capabilities. There are some navigation issues--for instance there is often no way to return to a previous screen other than using your Browser's Back button or going back to the start of a section through the main menu links. But as with any site of this kind, users can quickly get used to the vagaries and nuances of getting around within this system.

Objective of the site:
The objectives of Harrison's Online is to provide just in time information to medical professionals:
Harrison’s Online turns the world’s leading textbook of medicine, Harrison’s Principles of Internal Medicine, into an updated medical database that delivers the high-quality information synonymous with the Harrison’s name with the immediacy that only the online environment can provide. Harrison’s Online cuts through the glut of online medical information to give you relevant, current, and practical information that will help you diagnose and manage your next case. It aims to be an open and relevant source of information that will be consulted from a doctor's desktop while working, in order to access information quickly and easily. Since this is a commercial venture, these objectives are entirely appropriate. Users pay for yearly access according to the following scale (in US dollars): Individual user: $89 Institutional subscriptions to Harrison's Online will accommodate IP address and/or User ID/Password configurations for access. Up to 2 concurrent users: $650
Up to 5 concurrent users: $875
Up to 10 concurrent users: $1250
Up to 20 concurrent users: $2000
More than 20 concurrent users: $2000 plus $75 per user for each concurrent user over 20

Additional users can be added to any of the Institutional Packages for $75 per additional user.
Institutional access would provide teaching hospitals an excellent resource tool, if computer terminals are also made available.  I contacted McGraw-Hill for a list of institutions that use either the print or electronic versions of this text, and was given this response by Jack Farrell, Director of Marketing, McGraw-Hill: While we cannot give out sales information I can tell you that the Harrison's textbook is used in every medical center [sic] in the US and most likely the world. It has that kind of presence. Use of Harrison's Online is growing quickly among institutional users and I'd say we are among the leading online services used in this setting. A concurrent license for 20 users could feasibly accommodate a large institution, since it is not a synchronous learning tool/environment.

The site's target audience could be anyone in the medical profession, but there is an emphasis on attracting those doctors still in training: "Perfect for board prep or as a clinical refresher" advertises the PreTests. Further: Harrison's Principles of Internal Medicine: PreTest Self-Assessment and Review has been designed to provide physicians with a comprehensive, relevant, and convenient instrument for self-evaluation and review within the broad area of internal medicine. Although it should be particularly helpful for residents preparing for the American Board of Internal Medicine (ABIM) certification examination and for board-certified internists preparing for recertification, it should also be useful for internists, family practitioners, and other practising physicans who are simply interested in maintaining a high level of competence in internal medicine. Study of this self-assessment and review section of Harrison's Online should help to (1) identify areas of relative weakness; (2) confirm areas of expertise; (3) assess knowledge of the sciences fundamental to internal medicine; (4) assess clinical judgment and problem-solving skills; and (5) introduce recent developments in general internal medicine. The idea is very sound: use of the testing function will help those medical professionals who desire exam preparation or routine knowledge testing. Quick and easy access to what amounts to a medical encyclopedia--and an evolving one at that--will allow  medical practitioners to keep abreast of the latest research and treatments.

Domain Related Aspects:
It is more of a reference book than a learning environment, though very well done. It presents an impressive sum of information in medicine that you may search using different navigation tools: TOC, map, index, search. Though I may not judge for the interest of the content, it appears to be very complete to cover different aspects of the knowledge in medicine: Dx, Clinical studies, pharmacology, approach to patient, etc. As for the interface outside from the regular functions of the Internet (cache), there are no traces of what you have seen (even though a cookie is set) or possibility to takes notes. This makes a more systematic consultation difficult. It is not organized for teaching but to give access to information "just in time", using features of the Internet to make it much easier than a book (search, multiple hierarchies).

Educational Value:
This site has good educational value. It presents an enormous amount of medical information specifically geared to its target audience of medical professionals. Most educationally valuable is the PreTest section of Harrison's Online. These multiple choice questions provide excellent feedback. When an incorrect response is given, the user has the option of choosing either a link to the relevant chapter or the correct response with a detailed explanation. This reinforces the process of learning and the reasoning behind the right answers, a very important feature given the kind of education this service provides.

The Forum on Harrison's Online is a threaded discussion environment, a useful pedagogical device for rapid dissemination of new research and clinical data.  Also, the Clinical Trials section, which is also slated for regular updates, will provide medical professionals with timely and up to date information on the latest developments in their field.

Connectivity and Interface Related Aspects:
The site is designed well. It loads quickly even over my 28.8  modem. On my T1 line it is of course very fast. The framesets keep all information in view (no scrolling) and it has a uniform look and feel throughout.

The main page (start) is Search Harrison's Online, presumably to offer quick and efficient information searching for those physicians logging on in need of just in time data. The search is standard with an advanced search option: The maximum number of results that you will get for each part of the search (chapters/updates and figures/tables) is 75. While there may be more results available, we have limited the number returned to you in order to decrease the loading time and to provide you with the closest matches. This proviso indicates that some editorial work has been done to truncate the results. Valuing their users' bandwidth is a good consideration, but it may be better to additionally offer an open search string (like a standard search engine) in order to get a thorough search of all of their resources. Some nice search features are built in: Advanced Search
To refine your search, you may restrict it to Parts of Harrison's Online, chapter/update titles, contributors, or words in the text. The Search will include all of the chapters in the selected Part(s) of Harrison's and all of the Updates, Clinical Trials, New References, and Editorials associated with the chapters in the selected Parts.
This is a handy feature that will help those familiar with Harrison's Online and medicine in general find information fast. Harrison's Online is a medical encyclopedia that can be used like an electronic dictionary.  It also has a Subject index that cross references subject headings.

All graphics are optimized for speedy downloads, and I could locate no use of multimedia.

Overall Issues:
As a resource database this site is excellent, for the most part because its search capabilities are very robust. This service is user friendly, and the feedback in their Forum has so far been very positive. There were several annoying things about my guest account--mostly that I kept getting sent out of the Harrison's Online environment and asked to log in.  When I did so, I was sent an error message saying that I was already logged on: "Maximum connections for this account reached."  Presumably this will not be the case for a regular subscriber. I did contact their help desk and received quick and effective responses to my queries about this issue. In fact, this issue was resolved so that I was able to get full access for the two week trial period. There is also a biweekly email newsletter that informs subscribers of the latest additions to Harrison's Online. Overall, Harrison's Online is a very effective learning and resource tool.  I should think that any medical professional would find this a valuable resource.