Increased discussion and interaction amo …

Increased professional discussion and interaction amongst healthcare professionals is a very positive result of the availability of blogging software and social networking venues. Naturally, there are possible ‘adverse effects’ of communication that is detailed, public and in which patients might be discussed, or products pushed. A recently-published paper in the Journal of General Internal Medicine by Lagu et al finds that violations of patient privacy and product endorsements are two undesirable byproducts of medical blogging.

Lagu et al state that most established medical bloggers make an effort to veil their own identity and protect patient privacy. It is rare for a blogger to violate a patient’s privacy outright–the more common ‘grey area’ is a blogger giving some details about where they work and what they do, so that they are identifiable to colleagues and the public. This could endanger a patient’s privacy (my own thinking is that someone could piece together some details of who the patient is or what condition(s) a known person has, especially if they know a bit about the healthcare professional and/or the patient).
Their outlook is positive and they believe that more established bloggers are setting a good path for newbies to follow.

“A voluntary movement by medical blog authors toward self-regulation regarding patient privacy, transparency, anonymity, and patient respect is taking shape.”

I wonder if, in the near future, we can expect the BMA (or the CMA, over the ocean) to set out guidelines on medical blogging? And what about the many other colleges and associations for nurses and specialists?

Lagu et al found that 31% of the 271 healthcare blogs identified contained 1 or more product endorsement. These are not adverts of the variety that move and flash (and can be easily removed by my browser)–no, they are often written into the blog. Any sensible blogger will realise that making paid promotions (which many of these are) completely compromises their credibilty, and in this case, the blogger’s professional reputation. The researchers could not actually tell if the endorsements were paid, or if they were just things the blogger found effective, as most blogs did not declare competing interests (and they should!).

I am astounded by the many new names tha …

I am astounded by the many new names that the government has for the various schemes to ‘accredit’ information, and/or assign the ‘right’ information to the right person at the right time (maybe to keep the ‘rogue’ information of Knol and wikipedia at bay?).

Two initiatives come to mind–the Department of Health Information accreditation scheme, and the Information prescriptions project. The IP project has as its task to provide “everyone with a long-term condition or social care need” an information prescription. They’ve run a substantial pilot project in 2007 with twenty general sites (each linking to clinics or surgeries).

One thing I find slightly disheartening is that these pilots are apparently being run independently of any professional informaticist(s). At only one point does the delivery plan document mention community access points such as a library, but in the main, the services is not basing itself around libraries. It is being supported by PALS (Patient Advice and Liaison Service) and their website does not trumpet any kind of specialised training, just that some employees are NHS staff and some are volunteers.

Is anybody else concerned about outsourcing information provision to volunteers and other untrained folk, or am I just being a snob? While the promise of information accreditation is soothing (in my eyes), it sort of gets undone by not staffing these projects correctly, and I think that information professionals lose out. I am making a bit of an assumption that the lack of any mention informatics support means there wasn’t any. Belatedly, I saw something about literature searches being done, so maybe there is also an issue about informaticists not shouting loud enough about what we doing. Anyway, let us hope there is some sort of ongoing role for informaticists in the accreditation scheme, as the details (according to their Q&A sheet) have yet to be worked out.

Medpedia, the NHS, Knol and restaurant reviews

So, everyone’s talking about Medpedia. Well, when I say everyone that’s a tiny exageration. But I am aware of three people in the last few days, and that’s near enough everyone in my book. Here’s what it’s all about:

“In association with Harvard Medical School, Stanford School of Medicine, Berkeley School of Public Health, University of Michigan Medical School and other leading global health organizations, the Medpedia community seeks to create the most comprehensive and collaborative medical resource in the world. Medpedia will serve as a catalog, database, and learning tool about health, medicine and the body for doctors, scientists, policymakers, students and citizens that will improve medical literacy worldwide.”

And as if Harvard wasn’t enough, our very own NHS is getting involved. According to the Guardian “the entire NHS library is to be loaded up on a wiki site called Medpedia.” Does that add to the authority of Medpedia? Of course it does – fancy having to ask.

Google, not wanting to be out of the news for more than a second, are also getting in on the wiki act; they are launching Knol, Google’s “answer to Wikipedia”. Unlike Wikipedia, Knol has authors with “names, faces, and reputations”. Users can rate and comment on ‘Knols’ (individual, topic based entries on Knol) and give them stars, and you can suggest changes to the author, but the author remains the owner of the content. It’s not the open, anyone-can-edit, Wikipedia model.

But what, then, if you’re reading a ‘knol’ on Evidence Based Medicine and you think hang on, this is rubbish, I could do better than this. Well, you can just write and submit your own ‘knol’ on Evidence Based Medicine. After time, there will therefore be two, three, four, ten, four hundred and seventy seven ‘knols’ on Evidence Based Medicine – all vying for the readers attention. How to sort? Well, you can sort by authority, or by how many stars other users have rated different knols.

What do you think? While this anyone-can-post and anyone-can-rank approach might be OK for restaurant reviews, I’m not so sure it’ll help people get the best health care information. Is it not going to just be the mess of the web all over again? In fact, come to think of it, I never look at anyone-can-post restaurant reviews on the web any more precisely because they are so biased, contrary and, ultimately, totally unhelpful. Would I be an insufferable elitist if I argued for the return of the expert? Well, maybe I’ve not understood the model precisely – let’s wait and see what happens…

Oh, and while we’re on Wikis, don’t forget DrWiki of course. The good Dr seems to have been around for ages, compared to these upstarts.

Cuil – it’s not Google

Cuil, pronounced ‘cool’ is a new search engine from a couple of ex-Google engineers. It looks beautiful. Gives rubbish results though. *Sigh* the hunt for an alternative to Google goes on. Maybe it’ll get better…

Capita beats Dr Foster to run NHS website

In a £60m-£80m contract to develop the NHS website over the next few years, Capita has beaten Dr Foster to the NHS Choices contract – read all about it here. Capita said they would be “ensuring innovative engagement with citizens and clinicians”.

What is the point of management?

Do you often wonder, when sitting though the latest interminable meeting, just what the point of management (and managers) is? Here’s a nice definition in two sentences from Paul Levy’s blog (though it comes from a colleague of his, Stuart Rosenberg):

“The only role of management is to create an environment where people left to their own devices and unsupervised are most likely to engage in behavior that advances the goals of the organization. That means that people have the training, equipment, space, motivation, pay, understanding of expectations, sense of fulfillment and joy, and all the other things that will ensure that their behavior, the only thing that counts, is what we desire for the organization.”

One of the comments to the blog is even shorter and to the point, in describing what Robert Townsend thought his main (senior) managerial role was the comment author paraphrases “…his main job was to get people what they needed, carry water for them, and get out of the way.”

Marvellous. If only. (Though I should point out that my management is, of course, exemplary.)

It’s not just EB this, EB that, you know…

An interesting blog post on how “Information therapy goes beyond evidenced-based info“. The authors suggestst that “… people have health and health care-related information needs about so many things that have nothing to do with the best evidence-based health information”, for example where can I get the procedure done, is it covered by my insurance/NHS/my PCT, who should I go and see and how do I get there, what are other people’s experience of living with this condition etc. While these examples are all from the patient’s point of view, I suspect that we can learn something from this whether we’re supporing clinicians, commissioners, managers… whoever. For example, we’re doing some work for the commissioning sector at the moment, and they don’t just want to know the evidence for intervention A or B, but also information about who provides services (which PCTs, acute care trusts etc), whether incidence/prevalence of a condition is changing, what are the costs involved, what other supporting services might be needed. So it’s not just “evidence-based” info. That’s not to say that we info folks necessarily know all the answers, but we’re as good as anyone else in finding out, don’t you think?

New PubMed features – video available

Unlike Danielle, I’ve not been on holiday – but do seem to have been awfully busy. Anyway, just to let you know that if you wish to see a little (approx 30 mins) video on the new PubMed features I discussed in an earlier post – that is the new automatic term mapping process, the citation sensor, and the beta Advanced Search page, then you can go here and take a look at it. It probably remains that the most important thing for a searcher to be aware of is the need to keep an eye on the ‘details tab‘, so that you know what’s going on…

Health Libraries Group (HLG) Conference Update

I’m back, sort of, after 2 weeks of vacation, traveling about with my younger sister. Today I attended the second day of the HLG Conference in Cardiff, Wales. I wanted to give you a bit of an update of the highlights.

A question for discussion–who here likes parallel sessions? Today’s conference had 2 sets of them–one mid-morning and one post lunch. That means, I have missed a total of twenty-five presentations. This is torture–how can one be a proper information professional and accept being forced to miss that much excitement? I understand that the point is to offer us more choice, but it ends up not working as the presentations are clumped together, making it necessary to sprint to another room if there are “competing interests”.

Having said that, I did enjoy my day at Cardiff City Hall. These are some highlights of all of the sessions I have attended:

1. Dr. Tony Jewell’s very visual presentation on public health (a nice break for sore eyes);

2. Michael Heinrich’s talk on indigenous uses of herbs and plants, and the usefulness of this information to current research on drugs;

3. Sir Muir Gray’s podcasts on trying to ‘green’ healthcare, the walking campaign, and creating a common language as a means of preventing misunderstanding (unfortunately, Muir wasn’t there in person);

4. Gerry Maclean’s roadmaps to reconcile local developments in NHS education with national ones in Scotland;

5. Marina Waddington’s inspiring tale of leading her library’s initiative to provide evidence-based help with the creation of local hospital guidelines at the Royal Free Hospital–and the challenges with this (if anyone knows of a system to share guidelines so that each hospital doesn’t have to start from scratch, please let us know);

6. Lina Bakhshi’s informative presentation on the role of the Information Scientist in developing NICE guidelines;

7. Kate Wheadon’s description of Metalib, a system to allow searches by topic, rather than database–this can include searching multiple databases;

8. Kieran Lamb’s descriptive study of 84 blogs, which informs us that very few of us use either tag clouds or graphics, and that most folks blog weekly or 2 to 3 times per month (so now I don’t feel so bad…);

9. Sam Martin’s elegant survey of home workers and managers and her description of the advantages (increased productivity, being there for sick sons or daughters) and disadvantages (social isolation, being ‘out of the loop’) of home working. Wise advice: try to get out of the house at least once!

10. Joan Lomas’s and Hannah Price’s presentation on getting the right journals for the East of England NHS libraries;

11. Jean Ryan’s successful plan to start a journal writing club at the Glan Clwyd Hospital, with helpful tips to inspire us to do the same;

12. Jane McHugh’s report on what tools work best to change clinical behaviour–she found the most evidence for reminders, followed by continuing medical education, and outreach education. Combinations of interventions worked better that interventions consisting of only one component;

13. Andrew Booth was urging us to contribute our comments (200-250 words) to the Health Information and Libraries Journal by 31st July;

and,

14. Alan Fricker spoke about his work in trying to develop a public health policy for CILIP. Their wiki is located here. He has invited us to contribute to it, edit it, and get involved in this ongoing process.

Hopefully, I come across something parallel to what I have written, giving me the condensed version of the first day. And, what with parallel sessions and all, I would like to hear from people who went to listen to different sessions than mine.

Making a Bigger Difference – Guide for Commissioners

The NHS Institute for Innovation and Improvement has recently published Commissioning to make a bigger difference.  I was quite optimistic about the blurb in the Commissioning Bulletin, which begins: “How do we know that what we plan to do will lead to a service innovation or make a bigger difference? These guides illustrate methods and tools to help NHS teams answer this question.”

I was hopeful that one of these methods and tools might be to begin with a search for high-quality research evidence.  And indeed, literature searches are mentioned on page 44: “If you do not know what typical best practice is in other contexts, find out. You can do this via a literature search or by simply asking colleagues and others who you think might have a broader perspective.” 

Better than nothing, I suppose, although the idea of “simply” asking colleagues rather goes against the basic premise of evidence-based practice, which is that the beliefs of individuals, even eminent ones, are often overturned by looking at large-scale, up-to-date research. 

Anyway, at least there is recognition of the place of literature searching, except that we then come on to who should be doing these searches.  In an example of how to use this framework, a provider/commissioner team decide to assess an innovative idea compared with traditional care and “the GP on the team suggests that she will do a literature search so that they can compare their work with best practices around the world in the hope that they might get further ideas for local innovation.”

There is no mention of the words “library”, “librarians” or “information specialists” in this 96 page document on evidence-based commissioning from the organisation that hosts the National Library for Health.  Why not?  Why should any PCT Chief Execs, commissioners, or GPs take the Hill Report seriously when it is not supported by the very organisation that published it? Why is it that NHS librarians have to be constantly knocking on doors to make their pressence known?  Not only are we likely to be more skilled at searching than most GPs, but our time costs massively less.  Strongly recommending the use of library professionals in commissioning decisions would be a win-win situation for PCTs and the NHS as a whole, and yet there is next to no official recognition of this from the top. 

I’m aware that as librarians we sometimes have a tendency to rail ineffectually at perceived injustices, but I really would like an answer to these questions from someone at the Institute.  I’ve posted this message on the Primary Health Libraries Group and am hoping that someone may direct it to the authors of the guide.  I’d also be interested to know whether anyone else sees this as a concern.