For 6 years, the Rouen University Hospital (RUH) information system has been connected to the Internet.

The main goal of the advanced technologies use at RUH is to disseminate the right information and knowledge to the right end-user: therefore, we developed several projects following this objective:

• CISMeF, Catalogue and Index of French-Speaking health resources since 1995
• Virtual Library, which includes Medline and 90 full text electronic journals in English and French since 1997. Every department library is connected to the Internet
• French Medical Virtual University, consortium of 7 medical schools (Grenoble, Lille, Marseille, Nancy, Paris, Rennes, Rouen)

In January 2000, a Patient Internet Cafe (PIC) at RUH was implemented to permit a free and "infomediated" Internet access at the main cafeteria of the RUH to patients, their families and friends. This paper is intended to evaluate the PIC use during a five month period.

Since October 1999, the RUH has been participating in a yearlong European project EVS-PIC (European Voluntary Service -Patient Internet Cafe). This project is part of the " Multilateral and Third Countries project " of the DG XXII of the European Commission. The original idea for the PIC project came from the members of the European Office of the World Health Organisation (WHO), and notably from the network of " Health Promoting Hospitals ".

The objective is the setting up and evaluation of a PIC in 9 European hospitals:

• Prien am Chiemsee and Koblez, Germany.
• Bruck an der Mur and Vienna, Austria.
• Rouen, France.
• Letterkenny and Dublin, Ireland.
• Milan, Italy.
• Ustrom, Poland.

The idea is to develop a hospital Internet Cafe, which is open to patients, their families and to the general public (the Netizens).

The PIC at RUH was opened in January 2000. It is situated in the reception area of the main building, near the main cafeteria, thus a strategic position where the patients and their families can freely have access to the Internet. Kathrin Böer and Inès Sanchez, two young volunteers of EVS, have been responsible for getting it up and running. Stefan Darmoni, Advanced Technologies Manager, and Pascal Garel, Assistant Director in charge of International Relations are supervising the project. The CISMeF team, and in particular Magaly Douyère, were in charge of training the volunteer supervisors in the necessary Internet skills. A questionnaire containing 12 questions was designed to evaluate the project and the level of interest it has generated. It has been systematically filled in by the users of the PIC.

147 visitors filled the questionnaire during the period of January to June 2000 representing 101 working days (average of 1.45 per working day). The overall number of visits during this period is 385 (average of 3.81 per working day).

The visitors were: patients (35%, n=51), relatives of patients (24%, n=35), friends of patients (18%, n=27), and others (hospital employees) (23%, n=34). The age of the visitors was: under 15 years in 1% (n=1), between 15 and 19 years in 11% (n=16), between 20 and 24 years in 22% (n=32), between 25 and 29 years in 22% (n=32), between 30 and 34 years in 10% (n=15), between 35 and 39 years in 14% (n=21), between 40 and 44 years in 8% (n=12), between 45 and 49 years in 3% (n=5), between 50 and 54 years in 5% (n=7), between 55 and 59 years in 1% (n=1), 60 years and more in 3% (n=5) of the cases. The percentage of the female visitors was 34% (n=50).

Most of the visitors had already used the Internet (68%, n=100). Among them, 43 visitors had access to the Internet at home, 30 at work, and 17 elsewhere. Internet was used once a day by 48 visitors, once a week by 24, once a month by 13, and less than once a month by 6 visitors. These visitors found their first use of the Internet difficult in 12 cases, average in 58 cases, easy in 21 cases and very easy in 9 cases.

The main uses of the Internet at the PIC were for searching for general information (40%, n=58); sending and receiving E-mails (20%, n=30); searching for medical information (18%, n=27); using other tools (14%, n=20); Usenet, Listserv , or Chat rooms (5%, =8); and search engines (3%, n=4).

The visitors needed the help of the volunteers in 70% of the cases (n=102).

This help was considered very helpful in 90 cases (88%), helpful in 10 cases (10%), and average in 2 cases (2%). None of them found this help to be bad or very bad.

A large majority of visitors (86%, n=127) said they would return to the PIC, 4% didn’t know (n=6) and 10% said they wouldn't (n=14).

The PIC at RUH is not a quantitative success as only 0.4% of the 1,000 daily visitors and patients passing through the Cafeteria area showed interest. When implementing this PIC a higher rate was expected - between 3 and 5%. The marketing strategies were evidently not strong enough. After a regional TV interview about the official opening of the PIC, the number of the daily visits tripled within two weeks.

Overall the PIC at RUH is a qualitative success, as a lot of PIC visitors returned to it during their stay or visits to RUH because the average number of individuals per working day is 1.45 and the average number of visits is 3.85.

Another positive aspect of the project is that at RUH, the main objectives of the PIC have been fulfilled:

* promotion of the Internet tools, especially Email and the Web, for the RUH patients, their families and friends.

* improvement of patient education by giving access to quality documents, which are indexed in the CISMeF database and available on the Internet. The PIC is already a part of the virtual library available at RUH.

* contribution to patients' quality of life during their hospitalisation. This was notably achieved by creating electronic links between patients and the outside world.

Two results of the questionnaire were astonishing: (1) This PIC situated in an University Hospital was not frequently used for searching health information (only in 18%). When implementing this PIC, it was expected that a vast majority of searches would be about health. It seems that the visitors were more inclined to use the Internet Café as a means of distraction from their daily routine and not necessarily for research purposes. (2) Approximately a quarter of the visitors were hospital employees who were too shy or not allowed to use the Internet in department libraries Some results were expected as similar to polls: two thirds of the visitors were male, aged between 20 and 40.

The qualitative PIC success is mainly due to the two volunteers: 70% of the visitors needed their help. Among these visitors, nearly 90% considered the volunteers help as very important.

In conclusion, the main proof of the PIC success is the fact that at RUH the service will also be available next year.