National Library for Health

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Knowledge is the enemy of disease Sir Muir Gray
NKS

• National Library for Health
• Angie Clarke Head of Service
• angie.clarke_at_institute.nhs.uk

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The origin of the National Knowledge Service

• UK culture when something goes wrong
• We have a Public Inquiry eg
• Kennedy Report 2002 which was a
• Public Enquiry into Childrens Heart Surgery
  Bristol Royal Infirmary 1984 - 1995
• Higher than average death rates and damage to
  young children undergoing heart surgery
• Kennedy Report http//www.bristol-inquiry.org.uk/
  
• Key factors were
• Poor quality of information
• Poor communication
• Poor training
• Lack of standards, and
• Failure to put the patient at the centre of
  care

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The origin of the National Knowledge Service
(continued)

• As a result
• The UK Secretary of State for Health announced
  the creation of the
• National Knowledge Service in 2002
• To support the delivery of high quality
  information for patients and staff

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The National Knowledge Service is responsible for

• Planning knowledge management
• Describing knowledge needs in 2011
• Working on the principle that
• "The future is here. It's just not evenly
  distributed."
• William Gibson
• What will be in general use in 2011 can be seen
  somewhere already today

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Current Knowledge Status
Knowledge is like water, clinicians and
professionals and patients need clean clear water
for good health. Muir Gray NKS

• What we have
• What we want
• How we will manage it

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National Knowledge Service why its needed

• There are a significant number of knowledge
  providers
• Department of Healths guidance and knowledge
  base, including
• Care Service Improvement Partnership and the
• Public Health Observatory
• NHS Institute
• National Institute of Health and Clinical
  Excellence (NICE)
• National Patient Safety Agency
• Medicines and Healthcare Products Regulatory
  Agency
• NHS RD Programme
• Health Protection Agency
• Information Centre for Health and Social Care
• Health Care Commission
• NHS Direct New Media
• Social Care Institute of Excellence.
• Knowledge has to flow between all parts of the
  NHS organisation
• http//www.nks.nhs.uk/cko.asp

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The NHS Institute for Innovation and Improvement
supports the NHS to ? Transform healthcare for
patients and the public by ? Rapidly developing
and spreading new ways of working ? New
technology and world class leadership.
Learning
Leadership Development
Priority programmes that help drive the NHS
reform agenda
Product and technological Innovation (NIC)
Service Improvement
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NHS Organisation and Knowledge Management
The best current evidence is where all the
government departments work together to produce
guidance in a manner which is useful to
clinicians. Muir Grey NKS
Chart Source NHS Choices About the NHS
http//www.nhs.uk/aboutnhs/howtheNHSworks/Pages/Ho
wtheNHSworks.aspx
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National Knowledge Service

• Information system as a supplement and extension
  of the human memory, delivering knowledge where
  and when it was needed
• J A Muir Gray 2006 NKS

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Functions of the National Knowledge Service

• National Library for Health
• The National Library for Health...aims to be
  the best, most trusted health related knowledge
  service in the world
• Responsible for the organisation and gathering of
  knowledge
• Provide the technical standards and solutions for
  knowledge to be delivered - where and when it is
  needed
• Either as a result of
• Pulling the information (direct search)
• Pushed to them (RSS or blogs)
• National Library for Health - http//www.library.
  nhs.uk/

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Functions of the National Knowledge Service

• Best Current Evidence Service
• Responsible for the
• Production, and
• Procurement (ie from others) of the evidence that
  both
• Clinicians and patients need
• Clinicians need evidenced knowledge to ensure
  robust clinical judgment for every patient in
  every part of the NHS
• Patients need evidenced knowledge as Patients
  share responsibility for managing own health
  Expert Patient
• Best current knowledge - http//www.nks.nhs.uk/be
  stcurrentknowledge.asp

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Example of an Evidence Service

• SCHIN (The Sowerby Centre for Health Informatics
  Newcastle)
• Clinical Knowledge Summaries (CKS) are concise
  summaries on
• How to manage almost 500 clinical situations
  (scenarios) commonly encountered in primary and
  first contact care
• These are underpinned by detailed up-to-date
  clinical knowledge on acute and chronic
  conditions, and disease prevention
• So whether you need a quick overview or the full
  text on a topic, CKS can help
• SCHIN - Certification by the British Standards
  Institute (BSI) of International Standard ISO
  90012000

• SCHIN http//www.cks.library.nhs.uk/search/0/schi
  n

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Information Overload

• Per Year
• 10,000 new diseases and syndromes
• 3,000 medications per year (Harvard Business
  School, 2002),
• Per Day
• 1,260 new clinical articles,
• 80 new Primary Care Guidelines and
• 55 new clinical trials every day (Bandolier,
  2007)
• Map of Medicine - http//www.mapofmedicine.com/

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Functions of the National Knowledge Service

• National Decision Support Service
• The Support Service Refers to the National
  Library for
• Guidelines
• Protocols
• Care Pathways
• Map of Medicine
• Tools and Rules
• National Library will be working with NICE to
• Develop tools and resources to support clinical
  decision making
• Decision Support - http//www.nks.nhs.uk/decision
  support.asp
• Map of Medicine - http//www.mapofmedicine.com/
• NICE - http//www.nice.org.uk/

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Challenges

• Expanding need for knowledge
• Shrinking finance
• Rapid digitisation
• Expanding Continuing Professional Development for
  all health and support staff
• Personalisation of this resource to meet
  individual/local needs
• Contributing to the Patient Pathway (1st visit
  outcome), and
• Reducing Organisational Risk
• More competition
• Complex networks
• Information overload

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Direction of travel

• Always Available
• Digital, paper and strategically, NLH librarians
• Local NHS libraries in
• Hospitals
• Trusts, and
• Universities
• Via the web
• At work, home or on the move
• NLH services will be available and embedded in
  the systems staff and patients use on a daily
  basis

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Direction of travel (continued)

• Integrated with intermediate services
• The library will be available as part of a
  variety of other services, including
• General search engines
• Google - Microsoft
• The NHS Common User Interface
• 40,000,000 development effort by Microsoft
  free to the NHS
• Customised MS Office and Windows for health so
  that everyone sees the same
• User interface for clinical systems that can be
  used by software developers
• Map of Medicine
• Information resource that visually organises the
  latest evidence and best practice guidelines into
  382 patient pathways
• Infobutton services
• Button on the computer desktop direct to NLH
• Can be customised for areas of interest

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NLH Customer Base

• Stakeholders
• National Library for Health - 1,250 Health
  Librarians other staff
• Strategic Health Authorities (SHAs)
• Deaneries (postgraduate medical training
  Drs, Dentists, Ophthalmologists)
• Trusts
• Key partners eg
• Social Services
• Museums, public Libraries and Archives (MLA)
• Higher Education Institutes (HEI) - Collages and
  Universities
• NHS-HE connectivity for students, researchers
  and teachers
• Enables secure anytime, anywhere access by
  medical, nursing and allied profession students,
  clinical teachers and researchers
• NHS and Higher Education Organisation
  http//www.nhs-he.org.uk

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User design experienceThe process

• LBi were commissioned to report on how people use
  the NLH for searching
• They carried out an On-line Survey
• 5 User groups identified
• Nurses / Midwives / Health visitors
• Consultants / Doctors /General Practitioners
• Allied Health Professionals
• Managers
• Librarians
• In-depth interviews with a sample of all these
  groups
• at their place of work
• looking at how they used the internet and NLH in
  particular
• qualitative interviews, not quantitative
• From this they built up personas, based on their
  style of searching this was not related to their
  roles
• The personas will be used to inform current and
  future developments

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Personas

• Proactive Searchers those who had recently been
  engaged in study or research. They used NLH
  solely for searching and expected similar
  functionality to journal websites.
• Wayfinders those who expected to be guided by
  what they saw on the home page, following links
  that they recognised. This approach to using the
  web relied on a high level of trust in content
  before exploration could take place. It has also
  been described as an orienteering approach (see
  Teevan et al , 2004). If wayfinders did choose to
  search deliberately they would expect the simple
  search to provide adequate results.
• Knowledge Managers those interested in up to
  date information and a broad view across
  disciplines. Usually familiar with the NLH site
  and all supporting information sources. Would
  tend to personalise the NLH website and use it as
  a central hub directing them to known sources
  rather using the NLH for searching. This group
  would include librarians.
• Email Searchers those who had minimal time to
  spend searching for online information and relied
  on information to be pushed to them via email
  alerts or bulletins.

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My Library

• My Library is a new feature, which allows you to
  personalise the National Library for Health (NLH)
  so that you only see the content that you want to
  see. Features include
• Search Facility the Single Search Environment
  enables you to refine your searches so that you
  only search the resources that you want to
  search. You can also save searches and results
  for future use.
• Home Library your Athens username identifies
  the library closest to your working environment
  and automatically sets it as your home library,
  with a link to their web-site. (The home library
  can be changed if required).
• Find A Library type in free text or your
  postcode, and find details of medical libraries
  close to you.
• My Links a resource, which allows you to add
  and categorise your favourite web-sites, so that
  you can make My Library your homepage. You can
  also email links to your colleagues!
• My Feeds an easy way to keep up-to-date, by
  registering your RSS (Really Simple Syndication)
  feeds on My Library, so that current knowledge
  from your chosen resources is delivered to your
  personal NLH.
• My Athens all the electronic resources
  available to you both nationally and locally are
  listed in My Library, so that you have everything
  you need in one place.

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My Library

• My Library is a new feature, which allows you to
  personalise the National Library for Health (NLH)
  so that you only see the content that you want to
  see. Features include
• Search Facility the Single Search Environment
  enables you to refine your searches so that you
  only search the resources that you want to
  search. You can also save searches and results
  for future use.
• Home Library your Athens username identifies
  the library closest to your working environment
  and automatically sets it as your home library,
  with a link to their web-site. (The home library
  can be changed if required).
• Find A Library type in free text or your
  postcode, and find details of medical libraries
  close to you.
• My Links a resource, which allows you to add
  and categorise your favourite web-sites, so that
  you can make My Library your homepage. You can
  also email links to your colleagues!
• My Feeds an easy way to keep up-to-date, by
  registering your RSS (Really Simple Syndication)
  feeds on My Library, so that current knowledge
  from your chosen resources is delivered to your
  personal NLH.
• My Athens all the electronic resources
  available to you both nationally and locally are
  listed in My Library, so that you have everything
  you need in one place.

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My Library
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The Benefits of a National Knowledge Service and
NLH

• Value for Money Good Communication Network
  Validated Knowledge
• Access to validated information, articles,
  research and networks
• Clinicians access to
• Clinical information and supported decision
  making
• Patients accessing
• Validated information and sharing responsibility
  for their health
• Managers accessing
• Information for service and workforce planning
• Workforce access to
• Support Practice, and
• Continues Professional Development
• Service delivery improvement
• Hospitals

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Clinical and Financial Benefits of Access to
Research

• Access to Research
• 80 clinicians changed their practice as a result
  of evidenced based research
• Avoided hospital in 12 of cases
• Reduced length of stay in 19 of cases
• Changed diagnostic tests in 51 of cases
• Changed drugs choices in 45 of cases
• Avoided additional tests or procedures in 49 of
  cases
• Source Bandolier
• Map of Medicine - http//www.mapofmedicine.com/

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Jargon Buster
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Contact

• Angie Clarke
• Head of Service
• National Library for Health
• NHS Institute for Innovation and Improvement
• Coventry HouseUniversity of Warwick
  CampusCoventry
• CV4 7AL
• Tel[phone]
• Email angie.clarke_at_institute.nhs.uk
• Website http//www.library.nhs.uk/Default.aspx