To the Editor: In reviewing the CD-ROM containing an integrated set of Therapeutic guidelines (eTG complete),1 Mann noted that, although utility was improved, the cost was high ($220 for a first user, and $110 for each subsequent user, compared with $264 for a set of the printed volumes which could be shared within a practice).2

Unfortunately, the cost of distilling evidence-based knowledge is also high, especially for publications that require regular review and update. In addition, there are extra costs involved in electronic conversion (text to HTML), reformatting material to fit computer screens, creating expandable and collapsible tables of contents (JavaScript) and searchable indexes. There is also a need to ensure that the electronic version works with a range of common operating systems (Windows, Macintosh and Linux) and with varied and ever-changing web browsers (eg, Netscape and Internet Explorer). In short, producing electronic versions of print publications requires additional resources, stringent quality control and considerable pre-release testing.

In the near future, guideline producers face an additional technological challenge: the need to move from "static" HTML-tagged documents to "active" XML-tagged documents, in which the data elements and underlying logic are machine-readable and thus capable of interacting with the health worker and the emerging electronic medical record (computerised decision support).

These developments (and Mann's concerns) raise the question as to who should pay for best-practice guidelines, including the evolving electronic conversion. Currently, the Australian government appears to lack a coherent approach to the provision of health information, at least with respect to best-practice clinical guidelines. For example, the Federal Government currently funds revision, production and distribution of The Australian immunisation handbook3 and the Manual of use and interpretation of pathology tests.4 More recently, the government has commendably funded a national subscription to the Cochrane Library. However, the government does not fund other equally valuable resources, such as the Australian medicines handbook5 or Therapeutic guidelines.1 The latter survive solely on a user-pays market model.

It can be argued that it is time that the government adopted a more even-handed approach to stimulate the uptake of national best-practice guidelines and related services, perhaps by reimbursing health workers who subscribed to such services with practice incentive payments. This would lower the cost of practitioners acquiring national information resources, preserve the market model and assist guideline producers to meet the ongoing challenges of electronic conversion by improving their income stream.

Competing interests: KJH is a (non-remunerated) Board member of Therapeutic Guidelines Limited.