Category Archives: General

Med-Tech Innovation Conference 25-26th April 2018

Report by Stephen Ayre, Library Services Manager, George Eliot Hospital, Stephen.ayre@geh.nhs.uk

I recently attended the Med-Tech Innovation Conference at the Ricoh Arena in Coventry. As the main focus of this event was medical devices, it was out of my previous experience. What particularly interested me was the horizon scanning.

Karen Taylor spoke on the November 2017 Deloitte report The future awakens: Life Sciences and Health Care Predictions 2022. Deloitte’s six predictions for 2022 are:

1             Quantified self

Individuals will be better informed about their conditions. They want best treatments and to stay healthy. They are becoming true consumers. This trend is facilitated by the Internet of medical things. An example is OurPath for diabetes management.

  1. The culture in health care is transformed by digital technologies

Smart technology will make hospitals more efficient to better monitor patients and reduce length of stay, leading to smaller hospitals and fewer beds. First government funded digital hospital opened in 2017.

Patients know best: patient. Controlled health records systems are being developed.

Drones will deliver medicines; robots will diagnose.

  1. The life sciences industry is industrialised

Pharma are using machine learning to develop drugs, leading to faster development and cheaper drugs. Real-time inventory management with hospitals will become possible. Digital contract management will emerge.

  1. Data is the new health care currency

There has already been a vast increase in data. Artificial intelligence (AI) will be used to analyse it. Only 0.5 of data is ever analysed. DeepMind Health is being used to monitor vital signs for deterioration. Other applications:  genomics, & using data to control costs.

  1. The future of medicine is here and now

Preventive, predictive, personalised, participatory medicine has already started e.g. CAR T-cell therapy: precision medicine, Combination therapy is being looked at for dementia (No new dementia drug since 2003).

  1. New entrants are disrupting health care

Companies like Apple, Amazon are creating systems. Philips, what was once a lighting company, is emerging as a health company. UK model more resistant to new entrants, but in places like China new systems can be built from scratch, e.g. partnership with IBM for tackling cancer.

Another interesting presentation was from Max Jones of General Electric on the development of artificial intelligence. He presented a Gartner hype cycle on emerging technologies for 2017.

There is a shortage of radiologists in the UK, with a 17% vacancy rate. There is a 4% error rate and more pressure leads to more errors.  AI may provide a solution: it is predicted that AI will be able to read mammograms and chest X-rays by 2020. By 2027 CT of the head, chest and abdomen, MR of the head, knee and shoulder, and ultrasound of the liver, thyroid and carotids will be automated, and within 15 to 20 years nearly all imaging will be interpreted by learning algorithms.

Already Visual Vitals can tell your vital signs by videoing your face and comparing it with a databases. Another system (CliX Enrich can interpret notes from doctors and assign them to patients (discharge letters and handover notes are more informative than hard data). The BVI App can calculate body volume index from photos.

Humans plus machines is the way forward. Humans need to do best what AIs can’t do.

There was a note of caution from Mike Hannay of the Academic Health Sciences Network. Spreading of innovation is hard when there is resistance, e.g. smoking was proved to be harmful in 1954, but smoking rates still high decades later. The average uptake of health innovations is 3.5%. Many clinicians are focuses on immediate survival, Trusts on immediate costs. Compare this to spread of smartphones.

Debbie Chinn of NHS Digital spoke on “Clinical risk management for health informatics.” There is a need for education and training and guidance to underpin standards and regulations. On e-LfH there is Clinical Risk Management training. They have produced a Digital tools library.

Christian Subbe of Bangor University talked about increasing safety. Safety 1 looks at errors. Safety 2 looks at things that went right. Safety 3 looks to create redundancy in networks, e.g. giving data to patients who have a direct interest in safety, like pilot in plane.

Liz Ashall-Payne of Orcha spoke about the Mobile health landscape. Thera are more smartphones on the planet than toothbrushes. There are currently 326,000 health apps, with 5 million downloads per day. Of these, 28% cover mental health, 16% diabetes, 11% heart. The major blockers to wider adoption are awareness, accessibility and trust, e.g. Suicide prevention app promoting suicide. Prank apps; ratings of apps can be gamed. 50% of apps have fewer than 500 downloads. 2/3 of apps zombie apps, I.e. Not maintained. Orcha analyses and categorises apps. Orcha creates local targeted app library, e.g. Lancashire STP, Salford Royal FT. Professional recommendations are key to promoting use. Orcha match apps by conditions, technical preferences, features, demographics. Gaps in the market are childhood obesity and bullying, and the next thing needing to be tackled is interoperability.

This was a conference that is outside normal librarian networks, but was valuable for the insight it gave. It struck me that the rise of Artificial Intelligence is something that Librarians as a profession need to face. If an AI can interpret medical images and notes, then surely an AI will be able to do literature searches. A question to ponder: what is our specific human contribution as librarians?

The STEM Club in the North East of England

Working in partnership to support the work of the Sustainability and Transformation Partnership

The publication of the NHS Five Year Forward View and the subsequent arrival of Sustainability and Transformation Partnerships (STPs) signalled an attempt to change relationships between NHS providers and commissioners, moving away from a competitive marketplace towards closer partnership working.

In the North East of England, a group of staff from NHS Library and Knowledge Services, Commissioning and Public Health are looking to do the same. The Sustainability and Transformation Evidence Mobilisation Club (or STEM Club) is an informal group of colleagues working to support the mobilisation of evidence within the healthcare system.

We are trying to achieve this aim in two ways:

* By making links to work streams within the North East and Cumbria Partnership (and potentially beyond)

* By providing both virtual and real (in person) opportunities to connect as a group and understand who is working on what, making effective use of our collective knowledge and insights

A small group of STEM members has been meeting for over a year now and we have started to make links between work stream leads and library and knowledge staff. So far, a number of LKS staff have been involved in working on number of topics including:

* Frailty

* Maternal choice in perinatal care

* Physical exercise in preventive healthcare

We held our first full meeting of the STEM Club in March 2018. We used the name Club as the group has no formal governance arrangements as such. The event was attended by staff from LKS, Public Health, Commissioning and HE. A number of members of the group are from Yorkshire and Humber and we are happy to welcome colleagues from outside the North East. We were genuinely surprised at the level of enthusiasm in the room. There was a huge amount of interest in the work that has been done so far and a shared commitment to continuing with this approach. A few key challenges and affirmations came from the day:

* STEM is a “bottom-up” movement. This is genuine partnership working between colleagues with a shared interest in evidence mobilisation.

* We need to be responsive to the pace of work at a system level and be able to “share as we go”.

* We also need to be open to accessing and using a range of different types of evidence and knowledge (including tacit knowledge).

We are thinking about how we can share more widely regionally and nationally and we would be very interested to hear from others who have been working with their STPs locally.

The librarians who have been involved in the work are happy to share their experiences with you: Kirstin Himsworth County Durham and Darlington NHS Foundation Trust Claire Masterman County Durham and Darlington NHS Foundation Trust Dor Wilson Gateshead Health NHS Foundation Trust

You may also want to contact your Regional LKS Lead to find out more about working with STPs:

David Stewart  (North)

Ruth Carlyle (Midlands and the East)

Helen Bingham (South)

Louise Goswami (London & KSS)

Joanne Naughton
NHS Library and Knowledge Services Development Manager – North East

What goes up, comes down and stays roughly the same?

 

In this blog I would like to give an overview of the collated activity data that you have been submitting to your regional Library and Knowledge Service Leads. I will look at some of the trends in the hope of starting a discussion about what the trends might mean.

High level overview

In the three years since the 2014 publication of Knowledge for Healthcare, library and knowledge services staff have:

  • Supplied 6.2 million items (books, reports, articles)
  • Handled 3.7 million enquiries
  • Trained 513,000 NHS staff
  • Supported 97,000 expert searches

The breakdown by year is shown below:

  2012-13 2013-14 2014-15 2015-16 2016-17  
supplied 2.1m 2.2m 2.7m 1.8m 1.7m items
handled 1m 1.2m 1.3m 1.2m 1.2m enquiries
Trained* 140k 153k 174k 176k 163k staff
supported 32k 31k 32k 32k 33k expert searches

* includes user education and user induction totals

What is collected?

The Health Education England Regional Library Leads and their predecessors have routinely asked you for data on among other things the following:

  1. Enquiry services – providing answers to questions
  2. Information consultancy – expert search services
  3. User education – training users
  4. User induction – ensuring they know what is available to them
  5. Document supply – books, copies of articles etc.
  6. Current awareness services – keeping up-to-date

The data provides a rich picture of the ups and downs of some of the activity that you NHS library and knowledge services staff undertake to enable your users access the evidence they need to support their work, studies or research.

What does the data show?

1. Enquiry services

A key part of our role as library staff supporting NHS staff and learners is in answering queries from your users.  These take two different forms: procedural /directional enquiries and Information resource related enquiries.

Procedural enquiries e.g. “How do I join?”, “What are your opening hours

Directional enquiries e.g. “Where can I find this book?”,  “Where is the copier?”

Information resource related enquiries e.g. “Where can I find a copy of the Hippocratic oath?”, “How do I search for..?”, “What have you got on..?”, “Can you show me how to..?”.

The split of the categories has remained relatively steady over the years with an average of 61% of enquiries being procedural or directional. The total number of enquiries is steadily dropping off from the highest level in 2014-15. Can we assume our users are more skilled at finding the answers for themselves or can you suggest another reason for this decrease?

Enquiries by type
  2012-13 2013-14 2014-15 2015-16 2016-17
Number of procedural/ directional enquiries 603,762 733,193 796,908 745,738 699,168
Number of information resource related enquiries 418,995 452,651 491,824 474,808 460,299
TOTAL 1,022,757 1,185,844 1,288,732 1,220,546 1,159,467

2. Information consultancy – expert search services

This covers mediated searches i.e. where library and knowledge services staff undertake a literature search on behalf of users. We are experts in searching for information and doing it more quickly and effectively than our users particularly when it is a multi-faceted search or one where results cannot be found in the traditional databases. The figures have remained relatively steady over the last five years although 2016-17 shows the highest figures for this five year period. We are providing more clinical/outreach services which traditionally encourage more requests for mediated searches.

  2012-13 2013-14 2014-15 2015-16 2016-17
Total number of mediated literature searches 31,978 31,121 32,550 31,668 32,819
No. of clinical /outreach librarian services 106 113 111 104 113

3. User education

Complementing the bespoke service we provide, we also support NHS staff and learners to “do it themselves”. We train them (user education) to carry out effective and efficient searches on databases and websites by giving them the skills to narrow down their searches or broaden them as appropriate. We try to show them that “just googling it” is not necessarily the effective way to find answers.  Any thoughts on why the number of users receiving user education is now dropping after increasing each year since 2012-13?

2012-13 2013-14 2014-15 2015-16 2016-17
No. of library users receiving user education 41,301 45,576 51,814 53,594 47,425
Total number of user education sessions 20,097 22,945 26,845 27,748 24,086
Of which no. of 1-1 training sessions 14,651 15,440 18,972 16,533 15,683
Of  which no. of group training sessions 4,171 3,732 4,681 4,421 3,554

4. User induction

We also ensure they know what is services are available for them to use (user induction). We know that in many Trusts library and knowledge staff no longer have a slot at corporate inductions and have to find new ways of introducing services to new Trust staff and the figures back this up for 2016-17.

  2012-13 2013-14 2014-15 2015-16 2016-17
No. of library users receiving induction/year 98,737 107,393 121,709 122,456 115,519
Total number of user induction sessions 34,458 35,457 38,974 40,872 36,596
Of which no. of 1-1 user induction sessions 27,136 29,545 32,299 33,818 29,711
Of which no. of group user induction sessions 5,089 5,269 7,614 5,567 4,652

5. Document supply

Libraries have traditionally been seen as storehouses of printed books and journals. We now our art is sourcing items and supplying them without the requester necessarily knowing the items are not from your own stock.

Where once users relied on library staff to deliver the whole package: conduct the expert search, source and then supply copies of articles or other items – Increasingly users are doing it for themselves. Users issue and renew book loans via our self-service machines and download articles from national, regional and local e-resources or the growing number of open access journals. Downloads of chapters from books by users are also another element of self-service.  Anecdotally we also suspect our users are becoming more discerning and request fewer items or are abstracts now their key source of information?

2012-13 2013-14 2014-15 2015-16 2016-17
Total items supplied  to users 2,117,528 2,059,429 2,781,557 1,820,143 1,554,799
Total items received for users 264,369 270,138 133,551 115,551 90,498

6. Current awareness services

With information overload increasing every year, we help to lay a path through the information forest. We provide a range of current awareness service designed to alert users to new information in their areas of interest or to keep them up to date. We do this in three ways: we create, modify or contribute to someone else’s bulletins or circulate a bulletin from another supplier without any changes.

2012-13 2013-14 2014-15 2015-16 2016-17
Current Awareness Services Provided by LKS 956 961 1,046 1,134 1,215

The chart shows the number of library and knowledge services providing one of more type of current awareness service.  While the production of new acquisition bulletins is decreasing; the number of subject/topic bulletins is increasing with a significant increase in 2016-17 for personalised bulletins (e.g. from sources such as KnowledgeShare).

We also use different means to deliver current awareness:

  • E-toc alerts (electronic tables of content from journals)
  • Library blog or wiki
  • Netvibes or equivalent
  • RSS feeds
  • Social networking (e.g. Twitter and Facebook)

Perhaps most significantly while other formats of current awareness are staying steady, there have been major increases in the use of social networking (e.g. Twitter and Facebook) as a means of delivering current wwareness services with a 156% increase from 2012-13 to 2016-17.

Have you shared what you produce through the CAS portal? Why not have a look at http://kfh.libraryservices.nhs.uk/current-awareness/

Looking forward

Library and knowledge staff are certainly moving with the times and finding new ways to deliver services. From 2017-18 the HEE Leads will be asking you to report on different aspects of the services you deliver (see the 2017-18 annual statistics return). It will be interesting to see what the next five years show about how what we deliver and how we deliver it in a world of increasing automation and collaborative working.

I am also interested to see the outcome of the HEE Leadership project that is currently gathering information about what you collect locally and how you use it. The group will be developing a Statistics Toolbox to help you. Watch out for a presentation/ focus group being held near you soon.

If you would like to see more of the data for 2012-13 up to 2016-17 please download the summary file.

If you have any thought or comments on the data please add a comment to the blog.

Linda Ferguson

HEE LKS Statistics Lead

Linda.ferguson@hee.nhs.uk