Two years on from Topol: Preparing ourselves for the Digital future

Two years have passed since publication of the Topol Review so it is timely to ‘take stock’. Why not take 5 minutes to review how emerging technologies are impacting on health and on NHS knowledge services?

Chaired by digital guru Dr Eric Topol, the Review anticipated the impact of technologies such as Artificial Intelligence (AI), machine learning, digital medicine and genomics on the functions and roles of the current and future healthcare workforce.  This Spring Health Education England (HEE) brought together authors of the report to reflect on changes since 2019. Prof. Lionel Tarassenko chaired a meeting with some of the Review Board, while I led a fascinating roundtable discussion with the clinical fellows who worked on the report.

The Review was well supported by knowledge specialists and knowledge managers as they considered the existing evidence base, scanned the horizon and managed the work. Thanks are due to the expertise of the team at Surrey and Sussex Healthcare NHS Trust led by Rachel Cooke, and our own HEE Knowledge Management service, managed by Emily Hopkins.

Citizens and patients at the centre: the importance of health literacy

The Topol Review placed the needs of patients and the public at its centre. The recommendations emphasise the importance of public health education initiatives and of working in collaboration with voluntary groups and information providers.

HEE’s national knowledge and library services team has since developed a suite of health literacy resources. Have you completed the e-learning programme produced in partnership with public health colleagues within HEE and with NHS Education for Scotland? Health literacy awareness training, including a “train-the-trainer” programme, has been delivered to NHS knowledge and library staff across England and this provides a foundation for the next stage.

Working with organisations which provide information and are able to support citizens develop information skills, Ruth Carlyle is leading a significant initiative to build a sustainable health literacy partnership. Over the next five years we will be working in partnership with public libraries, prison libraries, with pharmacists and with education libraries.

Adopting new technologies in health knowledge services   

The opportunities flagged by the Review are reflected throughout Knowledge for Healthcare 2021-2026,  particularly in relation to our work on resource discovery, led by Helen Bingham.

Using AI to enhance access to evidence

AI is helping to improve the search experience and reduce the time it takes to summarise and synthesise evidence.  Products like Yewno Discover, EBSCO’s Knowledge Graphs and 2Dsearch can help searchers to visualise and construct complex searches, navigating volumes of knowledge to retrieve information. This can make advanced and expert searching more accessible to the novice user. For knowledge specialists, these products can help to save time, act as a prompt to include additional search terms and help with communicating search strategies to end-users.

AI and machine learning are also showing promise in the field of systematic review and evidence synthesis. Recent work by Jon Brassey et al[i] shows that machine learning can effectively identify, assess and collate research findings to produce evidence maps, pointing to time-savings in synthesising evidence

HEE is supporting a trial of Yewno Discover with the University Hospitals Derby and Burton NHS Foundation Trust to explore how staff and learners might benefit from an AI-based approach to searching. Examples of other work in the field include the use of the RobotAnalyst tool by NICE and the MetaVerse tool by Public Health England. A trial of the IRIS AI system by MerseyCare NHS Foundation Trust, to read all Open Access papers, added depth to the search for clinicians and researchers.

Integrating evidence into the clinical workflow

There are significant opportunities to improve the accessibility of evidence through direct integration with clinical workflows.  HEE subscribes to the BMJ BestPractice clinical decision support tool for all NHSW staff and learners in England.  A recent study[ii] has shown that integrating BMJ BestPractice into wider clinical decision support system can improve consistency of diagnosis and reduce average stays from 7 days to 6 days. BMJ Best Practice and HEE are collaborating to promote the integration of BMJ Best Practice into electronic health record systems to ensure that practitioners have access to the evidence at the point of need.

Developing as a specialist workforce

The Review recommended an increase in the number of knowledge specialists to meet the demands of the NHS as a knowledge-based industry. Knowledge for Healthcare 2021-2026 emphasises the importance of workforce planning and development for our specialist workforce.

In the light of the Topol Review the team has put a lot of thought into how best to enable healthcare knowledge specialists, librarians – everyone in the team – to build their knowledge and enhance their skills to deliver the digital future. Dominic Gilroy leads our workstream on workforce planning and development and again, it is timely to share our progress.

Policy recommendations

HEE has approved several new policies to support the Topol recommendation, not least establishing a recommended minimum staff ratio. This is a key action by HEE to enable individual organisations to identify and address the risk that they may have insufficient capacity to maximise the benefit of knowledge specialist roles to inform the spread of innovation.

An updated CILIP Professional Knowledge and Skills Base

HEE worked with CILIP to revise the Professional Knowledge and Skills Base (PKSB), and with thanks to Dominic who played a key role in the working group.  Through discussion with Dr Andrew Cox, the author of the CILIP Technology Review – itself a response to the Topol report – we have ensured that key skills and competencies relating to digital technologies are included in the new PKSB which will be launched later in the year. There will also be new healthcare sector guidance as a companion to the main PKSB – to be launched early this summer.

Library Carpentry for NHS Librarians

To build the data and programming skills of NHS Knowledge and Library Specialists, HEE has joined Library Carpentry.  We will be running training courses for sixty librarians through 2021/2. There will then be an opportunity for six people who have undertaken the course to be trained to deliver the course.  Holly Case-Wyatt is leading on this partnership.

Library Carpentry workshops build software and data programming skills for people working in library and information settings. This will allow participants to automate repetitive library functions and enhance evidence by adding another angle of analysis. These skills will also enable our workforce to further support the needs of students and researchers in the NHS, may of who will need to use software within their research. The Carpentries have already reported receiving enquiries from other disciplines, including Healthcare Scientists and consultants.

How can we keep up to date?

Thanks to the HEE KM team, which produces a monthly round-up about emerging technologies in libraries, we can all follow developments in the field. Sign up via:

We are equally grateful to the Emerging Technologies Group, co-chaired by Stephen Ayre and Hannah Wood. They scan the digital horizon and let us all know when they spot something that might impact on the information world. They have written several blogs, including: enhancing wifi connections to improve the experience of working from home, and a review of the AI for Healthcare MOOC delivered by HEE in partnership with Manchester University.  You might also check out the webinar on Virtual Reality in health libraries.

Developing a Certificate in Digital Technologies

Recognising that knowledge and library specialists need to enhance their skills for a digital healthcare system, we believe the NHS needs people who understand more about AI, Machine Learning, robotics and other technologies. More generic digital knowledge, sometimes called “computational sense” is also required to inform handling enquiries from health professionals, and to be able to signpost and advise appropriately.  In an exciting new initiative, we are partnering with HEE’s National School of Healthcare Science and Manchester University to develop a Digital Technologies Certificate that will be for all NHS staff including knowledge and library specialists.

To quote Knowledge for Healthcare: “Machine learning, Artificial Intelligence and robotics are reshaping the ways teams create, discover, use and share information. We expect the emergence of new roles and responsibilities for knowledge and library service staff working alongside clinical teams and health informaticians.”

Sue Lacey Bryant – and the team
National Lead for NHS Knowledge and Library Services
Health Education England

[i] Brassey J, Price C, Edwards J, et al

Developing a fully automated evidence synthesis tool for identifying, assessing and collating the evidence

BMJ Evidence-Based Medicine 2021;26:24-27.

[ii] Tao L, Zhang C, Zeng L, Zhu S, Li N, Li W, Zhang H, Zhao Y, Zhan S, Ji H
Accuracy and Effects of Clinical Decision Support Systems Integrated With BMJ Best Practice–Aided Diagnosis: Interrupted Time Series Study
JMIR Med Inform 2020;8(1):e16912
doi: 10.2196/16912






Expert Search Early Adopters pilot – searches in provider interfaces

In mid-September 2020, HEE began a pilot to understand how best to help LKS in England move from using HDAS to using provider interfaces (EBSCOhost, Proquest and Ovid – see here for further detail).

The pilot period has now ended and we’re in the process of finalising the project report. Today we’re sharing our findings from the post-switch searches that our participants carried out in provider interfaces between November 2020 and January 2021. We asked people to record data for one day of each week, and they filled in an online form for any searches they did that day. We had 296 searches captured, from quick 20 minute scoping searches to 16 hours’ worth of searching to support a large evidence review and everything in between. We think it’s a fascinating set of data and we could write many, many blog posts about it, but we’re showcasing some of the highlights here. If you have any burning questions about our findings that aren’t addressed here, please post them in the comments below and we’ll try and answer.

Pilot participants were faced with a choice when searching, as Medline is available in all three provider interfaces – Ovid, EBSCO and Proquest. As reflected in pre-switch search data it continued to be the most frequently used database, with 92% of searches using Medline from one provider or another. Ovid Medline was the most frequently used resource overall (70% of searches), with Ovid EMBASE second (61%) and EBSCO CINAHL third (40%).

More post switch searches were carried out over multiple sessions (57%) than in a single session (43%). The time taken to complete a search varied between 20 minutes and 16 hours. As with our pre-switch search data, there were two searches captured that fitted into the systematic review category, and as their times vastly skewed the average search time they were removed from calculations for this blog post. With the remaining 294 searches the average time to complete was 3 hours 13 minutes, with most taking between 2-3 hours or 3-4 hours (23% and 21%).

Participants used many different combinations of interfaces and databases to search. The use of multiple interfaces was spread pretty evenly, with 41% using one provider interface, 39% using two and 20% using three. Where searches did use just one interface, 62% used Ovid.

We asked participants to tell us what had gone well with their search, what didn’t go so well, and what changes could be made to improve their search experience. Things that worked well included the use of reference management software for amalgamating results, the ease of use of subject headings within the provider interfaces, and using one interface – where the search is carried out in multiple databases but in a single provider interface. Things that didn’t work so well included difficulty producing outputs for end user, a perception that the whole process took a lot longer, and problems with reference management software, whether it was difficulty importing results or not being able to format references in a desired style. The suggestions for improvements to the search experience covered a multitude of elements, some related to the interfaces themselves, others around issues with reference management software, the time burden of adapting to new functionality and the extra login steps needed to access databases.

Finally we asked people to rate their search experience a star rating, where 1 is poor and 5 is excellent. The average rating was 3, with 10% rating 1 star, 18% rating 2 stars, 42% rating 3 stars, 21% rating 4 stars and 9% rating 5 stars.

The qualitative data collected about the search experience has been key in shaping the final report for the project, including recommendations for moving forward, and it will be published towards the end of April. For any questions about the project, please email

Emily Hurt
Lancashire Teaching Hospitals NHS Foundation Trust

Expert Search Early Adopters pilot – training evaluation

In mid-September 2020, HEE began a pilot to understand how best to help LKS in England move from using HDAS to using provider interfaces (EBSCOhost, Proquest and Ovid – see here for further detail:

We’re now heading towards the end of the project and are currently analysing all of the data we’ve collected so we can pull together a report with recommendations for moving forward. Today we’re sharing some of the results from our training evaluation survey – the valuable feedback we’ve collected from pilot participants will shape the way training is rolled out to the rest of LKS in preparation for migration from HDAS to provider interfaces.

Training was offered by all three interface providers (EBSCO, Proquest and Ovid). The team at University of Cambridge Medical Library also very kindly provided online training that was open to all pilot participants, regardless of geographical region. All of the training sessions were recorded and made available to those who couldn’t attend the live sessions. Of the 68 participants who completed the training evaluation survey, 93% had attended some training as part of the pilot.

When asked if the training provided meant that participants felt ready to switch from using HDAS to provider interfaces for literature searching, the responses were split pretty much equally, with 51% answering yes and 49% answering no. We asked for further detail to help clarify the issues around preparedness, as this will be key to helping staff feel confident about moving from HDAS. Those who had answered ‘yes’ said that a) the training sessions were a good starting point, and that they were ready to dive in and start practicing (38%), or b) they already had some familiarity with provider interfaces and so the training acted as a refresher (34%). The responses for those who answered ‘no’ were more difficult to categorise. There was a feeling that the training on its own was not enough, that people needed time to consolidate their learning and practice. There were also comments about the need for follow up sessions so that there was an opportunity to ask questions and share experiences after the initial sessions.

When asked what they would like to change about the training offered, 68% of participants said that the timing of sessions needed to be earlier. There were definitely slippages in the timing of the whole project, and we appreciate that the training schedule didn’t fit with the expectations of the pilot participants. We know from other comments that people needed time to process what they had learnt, to practice searching so they could increase their familiarity with interfaces and also to have a chance to come back to training if they need to. All of the sessions were demonstrations with time for questions, and 10% of participants would have liked hands on training, where there’s a chance to try a live search for yourself. However, there was a recognition that could be difficult in an online format.

There was a marked difference in the feedback for the training delivered by provider representatives and the sessions held by the University of Cambridge Medical Library. Although satisfaction levels were not drastically different, participants commented positively on the content and structure of the Cambridge sessions. Their training focussed on taking a search from start to finish in an interface, whereas participants felt that the interface providers were demonstrating functionality and features that weren’t necessarily relevant to the search process.

The next blog post for the pilot will be sharing some of the results from the data we’ve collected around ‘post-switch’ searches – those carried out in provider interfaces. Participants captured information about 296 searches, which is a fantastic resource for us to draw from.

For any questions about the project, please email

Emily Hurt, Lancashire Teaching Hospitals NHS Foundation Trust
Vicky Price, Vicky Price Consulting