UpToDate, Algorithms and NICE Standards

An interesting article in Forbes (NHS readers be aware – IE6 hates Forbes) describing UpToDate as “Medicine’s Killer App”.  It identifies some of the reasons that clinicians are so fond of what is essentially a textbook and adds an interesting perspective on some of the previous discussion around this product.

The UpToDate article is one of a series of four with the most interesting article for me being about Standards and practice.  This is well worth a read for considering how guidance may and may not be adopted and when considering the Quality standards under development at NICE.

NICE’s plans for the specialist collections

I noticed today a tender notice from NICE outlining their broad plans for the specialist collections. Here is an abridged version:

“Today, NHS Evidence provides access to 30 collections of specialist evidence content, the ‘Specialist Collections’. In April 2011, NHS Evidence will launch a redesigned and improved specialist evidence service. As well as the technical developments, topic coverage will be extended and greater emphasis will be placed on quality assurance and standardisation of processes and products across topic areas. The current Specialist Collection service is contracted out to 21 distinct organisations (with an overall headcount of approx. 80 staff). The contracts for these services are due to end on 31.3.2011. In order to achieve the quality, consistency and standardisation objectives listed above, NHS Evidence are aiming to rationalise the provision of the core service to three Clinical Hub Centres. One of these will be in-house and Manchester based. The other two will be contracted out. The purpose of this tender is the provision of the service of these two Clinical Hub Centres from 1.4.2011. Each contracted out hub will cover 8 to 10 speciality areas. Key activities of each centre will include hand-picking content from sources routinely ingested by NHS Evidence, searching and identifying content from specialist sources, tagging resources / allocating to an agreed taxonomy, identifying entries for UK DUETs (UK Database of Uncertainties about the Effects of Treatment), preparing and programme managing Evidence Updates on selected key topics within the hub’s remit (there are currently over 60 Evidence Updates in total across all specialist collections, but this number is likely to increase). Managing and quality assuring the activities of each hub will be part of the service.”

There you are then. Make of that what you will. Nervous times for all involved, no doubt. Presumably the Kings Fund will go for one, given that they already manage three of the current specialist collections. Maybe a consortium up in Oxford (Oxford Radcliffe/CEBM)? They have their hands on a few. The University of Surrey currently manage three. The universities of Southampton, Sheffield and Warwick all have experience, as do a few London teaching hospitals (e.g. Royal Free). Any thoughts or inside information from anyone out there?

**Update 9th July**

It has been suggested that idle speculation about who might go for these Hubs is unhelpful, and that given people are stressed because some might lose their jobs etc. that it should best not be discussed. It is also noticeable that, apart from co-blogger Danni (thanks Danni!), there have been no comments made on the post, even though our stats suggest it has been viewed quite a number of times. I suppose I have four things to say:

1. I’m just delighted when people other than my Mum read my posts
2. We rarely get too many comments anyway *sigh*
3. I’m a chatty blogger who likes to idly speculate. I also find it difficult to finish off blog posts. Ending after “… (e.g. Royal Free)” seemed a bit abrupt. I therefore lazily tapped out “Any thoughts or inside information from anyone out there?” just to round off the post in classic blogging style with a meaningless “what do you think” kind of way. I certainly never thought that I would get much response, let alone “Yes, I am a representative of organisation X, and we’re going for it”!
4. I am aware that jobs will go, but also that new jobs will be created. I would never make light of the nervousness that we all feel during this time of uncertainty – for better or for worse, none of us have a job for life any more, and we all suffer from job anxiety. I apologise if it seemed to be in bad taste to speculate. However I do maintain that it is a topic of interest to a wide range of people, both inside and outside the NICE/specialist libraries axis, and that it’s right and proper that it is a point of discussion. Of course people on the inside will already have been speculating for a while, and will be much much better informed than I – they also would not start tapping out their inner thoughts on a forum such as this! But there are also people on the outside who are nevertheless interested in what’s going on, and some would be interested in speculation as to what’s going to happen next; and, I would suggest, why wouldn’t they be?

Basically, good luck to anyone who’s going for it, and double good luck for anyone whose job might be affected by it.

NHS Evidence (boo) vs Guidelines Finder (hurrah)

I haven’t really got into NHS Evidence yet, so maybe I’m missing something, but it all seems something of nightmare.

I want to look for guidelines, as you do, if you’re a medical informationy whatnot thingy. Let’s say I was looking for lower back pain and related conditions. The search “Low back or lower back or spinal pain or back ache or backache or Spondylolisthesis or scoliosis or Sciatica or “Spinal stenosis” or Lumbago” gave 1320 ‘guidelines’ (i.e. using the Guidelines filter) in NHS Evidence, 208 of which are apparently from NICE. This is silly. There’s no way that there are 1320 guidelines out there, or 208 NICE guidelines. In fact, when I look through a few of the results many of the hits were duplicates or ‘empty’ references. Do I really want to spend my time going though 1320 hits for a handful of useful guidelines. No, is the answer to that.

Now then, if I searched with the same terms in the good old fashioned Guidelines Finder (now a ‘specialist collection’), I get 47 hits. Forty seven useful and relevant (for the most part) hits, something I can quickly browse though and extract the few guidelines I actually want. Perfect. Does the job.

Therefore Guidelines Finder, at least for this common situation, is better than NHS Evidence. Much better. But Guidelines Finder might be under threat from the monster that is NHS Evidence. On the front page of Guidelines Finder they write: This collection is now NHS Evidence – national library of guidelines, and you will continue to be able to access all the content and features. The existing url for the collection will remain for now, but is likely to change later in the year as the specialist collections become fully integrated into the NHS Evidence portal. “Fully integrated” – sounds scary.

Now I know that NHS Evidence and the specialist collections are fundamentally different technologies, and both may have their uses, but in the age of information overload the collections rule – don’t you think? A request to NICE – please keep the specialist collections.

Eminence-based Medicine?

According to the NICE website, guideline producers should be accredited.

The draft ‘Process manual for accrediting producers of guidance and recommendations for practice: a guide for producers and stakeholders’ describes the process for accrediting producers of guidance and recommendations for practice. It provides details on the scope for accreditation and what types of guidance producers are accredited, the criteria used to perform the accreditation assessment, the main steps in the process for reaching an accreditation decision and the notification and publication process of an accreditation decision.

This draft is out for consultation until 1st May 2009 so you may wish to leave your comments before then.

I witnessed an interesting email exchange in which one person questioned whether applying the ‘seal of recognition’ to institutions rather than individual guidelines, as NHS Evidence will do, was a return to ’eminence-based medicine’ instead of evidence-based medicine.

I think the commentator has a point as, in my experience of guideline-producing organisations, guidelines vary widely based on who is working on them and their commitment to the project.  Staff turnover is a constant threat. Before all that the guideline has to be scoped. If the scope is too broad, then the workload can easily become immense, leading to extra pressure on staff. I will not remark on project management or management of any kind.

I have not yet read the consultation document, but I will, and when I do I will consider how the recommendations affect the people creating the guidelines, running the searches and writing the reviews.  At work, it was often said that a NICE-quality guideline is the equivalent of 15-25 systematic reviews, yet the entire process takes 18 months with no ‘wiggle room’ for sick leave or annual leave.

The commentator suggests that the new recommendations seem ‘rigorous if time-consuming’.  In my personal opinion, I was always amazed that only one research fellow was assigned to each guideline, given the workload. Perhaps the consultation contains guidelines for increased staffing as well?

Preserving web resources – new advisory handbook from JISC

Been a bit of a busy week in office land. Just time though to give you a little pointer to what might be an interesting and up-to-date little handbook to some of you. It’s from the Joint Information Systems Committee, more commonly known as JISC, and it “offers a wealth of tips and information for web managers, data professionals and those making decisions concerning the long-term preservation of online resources“; so there you go. JISC assures me that It “provides solutions” and gives “illustrative case studies”.

JISC also do regular podcasts, including one entitled “Library spaces for the ‘Google Generation” – how hip are they at JISC?

In case you’re wondering who are these hip, active JISC people, it’s all rather British. They exist to “support education and research by promoting innovation in new technologies and by the central support of ICT services” and are funded by, amongst others, the Higher Education Funding Council for England, the Higher Education Funding Council for Wales, the Department for Employment and Learning, the Scottish Funding Council, and the Department for Children, Education, Lifelong Learning and Skills.

Don’t say you never learn anything from me.

NHS Evidence; something for everyone, not (apparently)

In April 2009, NHS Evidence will apparently be launched. An evidence advisory committee has been set up and the service is intended to be a unified evidence base for everyone in the NHS who makes decisions about treatments or the use of resources. It will also be available for use by patients. According to NICE It will include: 1) a fast, comprehensive search function, 2) access to a resource collating information on new drugs for commissioners, 3) a home page users can personalise. Sounds very much like the National Library for Health (NLH), I thought. I then realised that it was one of Darzi’s big ideas and is planned to replace the NLH (which up until recently the NHS has been spending lots of money on). So, I looked at the briefing document to get some more idea of just how NHS Evidence will be different (and presumably better) than the NLH; it says that:

NHS Evidence will consolidate information from a wide range of sources in one central portal, with a common point of access. The service will provide easy access to information that has traditionally been difficult to find, or available only by searching a variety of different sources, such as drug approval status. Furthermore, information included in the portal will not be limited to research evidence – the service will also aim to provide users with access to tools (such as service models and local policies) that they can use to apply the evidence in their day-to day work.

NHS Evidence will apparently not generate new content, rather it will act as a point of access to information including coverage of:

1) Clinical Evidence, including guidelines, systematic reviews, other synthesised content and primary research and ongoing trials

2) Practical Support, including service guidance, tools and models, care pathways, indicators & metrics and improvement information, local examples and tools

3) Drug and Device Information, including prescribing and safety information, NICE technology appraisals, significant new drugs and devices, diagnostics and interventional procedures

4) Non-Clinical Information, including social care information (assured by SCIE), public health information – evidence and practical support

Well, it’s certainly not a miserly set of aspirations. One thing that worries me a bit is that the document says that “NHS Evidence will be designed to meet the needs of users from across the NHS, including (but not restricted to) clinicians, nurses, pharmacists and commissioners” (i.e. pretty much everyone) followed a couple of sentences later with the statement that “NHS Evidence has a clear scope and objective. It is important that the service does not seek to be ’everything to everyone”. Hmm.

Anyway, the briefing document, of course, does not mention libraries or librarians, apart from the fact that it’s replacing the NLH. And it’s going to be run by NICE. Does that mean that librarians have just lost all control of the NHS online information service? I don’t know – let’s see, it’ll be with us in five months or so.

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.