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.
Brilliant post from Nicholas Carr differentiating between situational overload and ambient overload (the comments are also worth a read). He argues against the Clay Shirky talk that advanced “It’s not information overload. It’s filter failure.”
I agree with Carr – better filters mean that rather than just finding the good stuff we find ourselves overwhelmed with good stuff. In health I find increasingly I am guiding users to places where they won’t be buried under an avalanche of interesting material about their topic. In the mean time there are still needles in haystacks – check out this video of a GP trying to locate a fact in some NICE Guidance. I wonder what they will make of the new NICE pathways promised for May of this year?
(Incidentally Shirky is speaking at the MLA in Minneapolis – wouldn’t it be great to have a something of a similar ilk at a future HLG conference!).
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:
- I’m just delighted when people other than my Mum read my posts
- We rarely get too many comments anyway *sigh*
- 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”!
- 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.
Our other Alan wrote a piece a couple of posts ago on, amongst other things, this article in the Nursing Times. Basically it’s a press release for NICE, written by an implementation advisor for said large, powerful organisation. It describes how NHS Evidence will be so very useful for nurses, and I suppose it could be argued that it’s useful because the odd nurse (not literally you understand) may be flicking through the magazine, scan the article, and go and try out a bit of evidence hunting themselves. Surely a happy outcome.
But I fear that our odd nurse will only try out NHS Evidence once, maybe even twice, but probably not a third time. Why? Well, according to an issue of the Eyes on Evidence Newsletter (more PR from NICE) the top five most frequently used search terms were 1) asthma; 2) prostate AND cancer; 3) evidence; 4) flu OR influenza; 5) breastfeeding, so we get an idea of the level of sophistication behind most searches. Let’s try the top one, asthma. 5026 hits, including 516 guidelines and 1627 drug information pieces. You get the general idea. The first ‘guideline’ is “Guidelines for the prevention, identification and management of occupational asthma: evidence review and recommendations”, a pretty hardcore 88 page PDF of an evidence review, complete with evidence tables, from the British Occupational Health Research Foundation. Not at all helpful, I would’ve thought, to our odd yet eager nurse. If s/he wanted a good review of what to with someone with asthma surely they’d just go to an evidence synthesis product, such as Clinical Evidence, CKS, Dynamed or the Map of Medicine.
The problem is that NHS Evidence’s obsession with Google means that their search engine suffers exactly the same problem as Google (too many hits) but does not have the same saving grace (that the one you really want is at the top). Plus, and this is still really the crux of my problem, I still don’t have a clue who NHS Evidence is meant to be for – neither, I think, do the people behind NHS Evidence. “All things to all people” often ends up as nothing to no-one.
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.
Fascinating article in Economist about the United States healthcare system that proves that throwing money at a system doesn’t necessarily relate to either efficiency or quality. They may end adopting compulsory insurance and some form of the QOF to remedy this. Will they set up a US version of NICE? It’s too early to tell although if they do I’d be happy to help…
What do people think of the new look? It combines a Google-esque search with a cleaner display of the content. NICE also has a new website…
Meanwhile I’ve been catching up on the twitter collective of what happened at CILIP last night. The elephant in the room being if branches and groups are delivering what people want from CILIP and CILIP aren’t interested in new technologies (or even simple things like email provision to said groups and electronic payment systems) then why shouldn’t branches and groups become independent? Funding of course is an issue but there is this thing called sponsorship and much of the running ‘costs’ are already being carried by individuals on committees setting up blogs and websites as well as events that feed into the needs of members (and naughty non-members or subscribers such as I).