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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






To fine or not to fine? That is the question…

In the SWIMS Network we’ve recently put fining for overdue items under the spotlight.  We’ve been looking into whether SWIMS Network library services charge fines or not, and their reasons, and also trends in library fining generally. 

 Here’s why we did that, and what we found out. 

 In March 2020 we went live with replacement regional library management system. A new system needs a lot of configuration, and with limited capacity available we need to decide priorities for the work.  Most of the configuration work benefits all library staff and end users, and so this is our highest prioritybut some libraries request local configuration requirements.  One of these is management of fines, as a small number of our libraries charge fines for overdue items. 

 It became clear that configuring the system for fines management would require a fair amount of work, which prompted us to review library fining generally.  We carried out a survey of our 29 library services.  How many libraries charge fines?  What are their reasons?  Have any stopped recently, and if so have they noticed any consequences?  We also looked at literature reviews on the subject. 

 A literature review carried out for the BASE Patch1 in the West Midlands in 2019 didn’t find any particular trend in health libraries; however it did reveal a trend away from charging fines in both public and higher education libraries 

 An update to that review carried out by the Health Education England Knowledge Management team in 20202 confirmed this trend away from library finingThe review summarised a number of arguments in the literature for not charging fines: 

  • they are discriminatory from a socioeconomic angle 
  • they are unnecessary membership barriersand  
  • they are bad for reputational risk especially if seen as income generation (even if there is re-investment in resources).  

The review concluded that it is hard to see a case for them.  

 These arguments were also reflected in the results of a 2020 survey of libraries in the SWIMS Network.  Reasons not to fine or to stop fining also included: 

  • they can jeopardizcustomer relations and staff can feel uncomfortable imposing them  
  • they incur administrative burden and cost including of having a cash register 
  • they may deter people accessing resources they need  
  • they may be seen as some kind of fee to use the service so actually encourage users to keep items longer 
  • they may not be in line with trust guidelines 
  • with increasing use of cashless payments – especially in light of coronavirus – there is a barrier to collection for libraries without the necessary technology 

 Reasons to fine included: 

  • they encourage people to return their books in good time so that they circulate 
  • they generate some income 
  • historical reasons (unspecified! 

 Both libraries which fine and those which don’t mentioned the need to consider alignment with other services in the locality, including higher education libraries. However, a further consideration with regionally-shared NHS library managements system like ours – which enable users to easily move between library services as they move between employers – is the administrative complexity involved where users with outstanding fines move to libraries which don’t fine. 

 Neither the literature reviewnor the survey provided any concrete evidence for the benefits of fining, either on stock circulation or user relations.  In terms of impact on stopping fining, one comment from the SWIMS Network survey stands out: 

 “Along with letting people eat in the library, it’s one of the best things we’ve ever done 

 We would be interested to know if colleagues in different parts of the country have differing views on this question! 

 Jenny Toller 

Library and Knowledge Services Development Manager, South West and South East (Thames Valley and Wessex) 


Becoming digital champions

Library and Knowledge Services (LKS) at Nottinghamshire Healthcare sits within the Health Informatics (HIS) department. I’m fortunate that I am a member of the Senior HIS Management Team, which means I am strategically placed to advocate the skills and services of LKS within ICT. I realised that this had obviously worked when the Head of Digital Services (IT) asked if the LKS team would become Digital Champions for the Trust and support the role out of MS Teams across the whole Organisation during the pandemic.

If you have not come across this before, Digital Champions support digital inclusion through sharing their knowledge and experience to help others develop their digital skills. You don’t have to be an IT guru to be one, but what is important is being motivated to help others at their own pace, and most importantly admitting when you don’t know the answer but will find out!

As a member of the Digital Workplace Project Group, responsible for enabling our Trust to work more digitally, I knew the plan was always to roll out teams using a Digital Champion network within both clinical and non-clinical teams across our Organisation. However, COVID forced our hand. The roll out we had been planning was changed from months to days. The Teams pilot, which LKS had been part of, had to be upscaled to the whole Trust in record time.  The LKS team would become the Digital Champions for the entire Organisation to take the additional pressure away from our IT Support Service.

There was no remit of how this support should be delivered but COVID meant that we must deliver support virtually. A dedicated inbox was created to manage enquiries, although we also responded via telephone, MS Teams and email depending on the complexity of the enquiry, enquirers preference and the implied digital literacy level of the enquirer.  We applied the same level of customer service that we use in LKS to respond quickly and answer enquiries directly to keep the business of the Organisation moving.

Based on the frequently asked questions we were receiving we created an MS Teams support page hosted on our Intranet. We created short visual support materials and provided frequent updates to the ever changing functionally of Teams.  This enabled us to signpost to key guidance and encourage independent learning across the Trust. We began hosting weekly ‘Drop in Sessions’ to cover the basics of MS Teams, giving staff the opportunity to see demonstrations and ask questions, as well as providing sessions for individual teams if requested. Due to the success and high demand we now offer daily ‘Drop in Sessions’. We write communications for the daily Chief Executive staff bulletin and weekly Line Managers update highlighting any changes or new functionality and signposting to the help section if a query has been raised several times recently.  We created an MS Team consisting of the Digital Champions and IT Support Service to facilitate knowledge sharing and problem solving. We are now adopting a more strategic level approach to aid adoption across the Organisation by approaching Managers directly, gaining an understanding of their information needs and selling the benefits of using teams and suggesting appropriate tools they could use with their teams.

At project level I have been involved in all aspects of the rollout and decision-making process, including governance and permission settings. Our Microsoft partner recognised the importance of having a Knowledge Manager involved at this level and the enhanced benefits this can bring.  I have been able to argue for the functionality I believe the business needs, including the upgrade of Communities (Yammer), so we can pilot this tool for Communities of Practice. I am the critical friend representing the user point of view, constantly reminding that digital literacy skills vary across the Organisation, and one training style does not fit all. Personally, as a relatively new manager it has been a fantastic learning opportunity to be centrally involved in a project at such scale and to work so closely and learn from our Senior Project Manager.

We made the decision from the onset that we would be transparent about who the Digital Champions were to raise the profile of the library across the Organisation. This may have been considered risky, but I wanted to showcase to our Trust what LKS can do, and we may never have this type of opportunity again. Although I haven’t got any metrics to substantiate this, I believe this has been effective. We have had some fantastic feedback, and colleagues appreciate our swift response to queries and our excellent customer service. Our “can do” attitude has built stronger relationships within not only IT but also with other services across the Trust, where I’m hoping “from little acorns mighty oaks grow”.

Our involvement in Digital Champions will continue whilst the project group work to develop what the long-term support for MS Teams and wider O365 tools will look like for our Trust. In the short- term we are looking to knowledge share and offer further training to volunteers within local teams across the Trust to grow the Digital Champions Network further.

At the beginning we were all apprehensive about taking on this role and moving out of our ‘library comfort zone’, but we knew we had the skills to do this, even if we were still developing the knowledge. All of us have found Digital Champions hugely rewarding as well as challenging at times! Most importantly we can see the difference we are making supporting our colleagues to change their working practices to continue to deliver services in these difficult times.

Samantha Roberts
Head of Knowledge Services
Nottinghamshire Healthcare