Sunday, 24 October 2010

An Information Revolution...without libraries?

The Department of Health’s Liberating the NHS: An Information Revolution consultation document was published on Monday this week (18 Oct 2010) and lays out a strategy for the way the NHS should manage information in the future. As Andrew Lansley quite rightly states in the Foreward of the document, “we must not lose sight of the primary purpose of information in the health and care system: to ensure that every patient and service user receives high quality care” (p3). All well and good but the term “information” in this document is somewhat nebulous, used as an umbrella term for everything from patient records to health websites to audit to evidence. Furthermore there is no mention of libraries or library services anywhere in the document apart from a reference to the “Indicators for Quality Improvement library” (p36) which I for one have never heard of.

While the bulk of An Information Revolution is concerned with patient records and the flow of medical data there are certainly a number of areas where libraries are involved or could be involved. Section 4.6 states “in order to grasp the opportunities offered by the information revolution, clinicians and care professionals need to be able to access the best evidence (including international evidence) of outcomes, interventions and risks. Evidence needs to be user-friendly, up-to-date and available at the point of care, to inform discussions with patients and service users…Individual professionals, teams and organisations need to be supported to access information of this kind, which can make all the difference in ensuring safety and effective outcomes” (p36) Ummm, yes – do they not realise that this information is already being provided by hundreds of NHS medical libraries across the country every day? There is a short paragraph dedicated to NHS Evidence, described as a service which “is an important addition to commercially provided data services (which are often subscription-based and aimed at particular specialist audiences)” again ignoring the fact that such subscriptions are usually paid for by NHS library services on behalf of their users.

The document strongly supports better access to medical information for patients, which of course is laudable, but takes a rather simplistic view of what is a very complex subject. The emphasis on the internet as a channel for medical information is very obvious but is fairly silent on the subject of information literacy and evidence-based medicine. The three criteria for effective information is that it should be:
- informing, so that they know it is comprehensive and can be trusted;
- engaging, so that they are willing and able to use it; and
- empowering, so that they know how it can make a difference (p11)

How about authoritative, evidence-based, reliable?

The document states that “for some time now, people have been using the internet to explore a diagnosis after (or before) they visit their doctor” (p10) quoting a study of patient use of the internet which showed 11% of patients for neurology outpatients at the Walton Centre for Neurology and Neurosurgery in Liverpool in 2001-5 accessing the internet prior to clinic attendance. 11%?! It’s hardly statistically significant is it? The document also mentions “the role of websites such as ‘Mumsnet’ in generating new ways of sharing insights and information – including health information – is having a lasting effect on our society. Carers, patients, service users, care workers and clinicians are increasingly able to access forums to discuss the issues that matter to them, and offer support from others with experience of their condition” (p10) and exhorts that “the NHS, local authorities and care providers should be responding to and supporting these new approaches” (p11). Now I have been on a few of these forums in my time and have found them pretty useless to be honest, mainly involving somebody complaining they have a strange rash, followed by a slew of respondents all saying they have something similar but nobody knowing exactly what it is or how it should be treated.

Libraries, both medical and public, are extremely well-placed to provide authoritative, reliable information to patients. Many libraries already do and even more would be willing to do so. Why is this not mentioned in An Information Revolution? It may well be that “information cannot be seen as something that is the sole responsibility of the specialist” (p39) but why not harness the knowledge and experience of information specialists such as librarians and avoid reinventing the proverbial wheel?

Finally, I did have to laugh at the statement on page 14: “Whilst any associated costs will need to be met within the Department of Health’s Spending Review settlement, there will be no additional central funding to pay for the information revolution…Whilst there will inevitably be costs, which could fall centrally and/or locally, the information revolution should, ultimately, pay for itself.” Not surprising really that the government thinks good quality information can be produced on the cheap, but it makes the whole document ring rather hollow.

I shall definitely be responding to this consultation document and hope many other medical librarians will as well. After all, there is not going to be an Information Revolution in the NHS without us!

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