topicThe National Library for Health — an architecture for knowledge discovery to deliveryIan McKinnell, Head of Development at the National Library for Health,
summarises the achievements of the Library in its aim to build a
modern, networked library service that links users to both digital
and physical library services, putting knowledge to work to
transform patient care and public health. What is the National Library for Health? High quality, safe healthcare requires healthcare professionals to access knowledge and the best available evidence efficiently when necessary. Providing clinicians with the most up-to-date knowledge on a treatment or illness, means that the risk of harming a patient is reduced. The NeLH, as it was originally known, was born out of the Kennedy Report, which recommended the establishment of a national knowledge service to improve access to evidence for healthcare professionals and help them to make informed decisions on patient care. The National Library for Health (NLH) [1], as it is now known, gives NHS users access to key evidence collections such as the Cochrane Database of Systematic Reviews and the NLH Clinical Knowledge Summaries, 29 specialist libraries focusing on the best evidence in topic areas from cardiovascular disease to women’s health, as well as access to the medical literature databases such as Medline and CINAHL (Cumulative Index of Nursing and Allied Health Literature). Originally, the focus of the NLH was to build a national digital portal for online resources. This later evolved into the vision of joining national digital resources with local library services. The underpinning aim of NLH is to put knowledge to work, to transform patient care and public health. The desired outcome is to build a modern, hybrid, networked library service linking users to both digital and physical library service points. The Library as a web service The National Library for Health cannot just be a website — it needs to be a web service. Although NLH has around a million users a month online, the truism still holds that your users spend most of their time looking at someone else’s screen. Our ambition is to be ubiquitous, for NLH content and services to surface within systems and screens which are part of clinician’s daily work. This means that we need to be able to push knowledge content into clinical applications such as GP record systems, laboratory pathology reports, the Map of Medicine and other health-related websites — even Google. This gives rise to the concept of knowledge as an object, which can be separated from the journal article that contains it, transformed in a format which can be re-purposed, given labels to code and identify it and pushed through clinical applications to surface on a patient record. Delivering on that concept requires a radical transformation of the way the NHS procures and packages its knowledge. It will require us to adopt and implement the principles of service oriented architecture (SOA), to transform, for example, NICE guidance from PDF documents to XML, to attach persistent and reliable identifiers (digital object identifiers) to evidence so that guidance documents do not disappear every time NICE changes its content management system. We need to develop and apply consistent terminology to code knowledge in ways that allow us to present it in relevant clinical contexts, and to solve barriers to access such as multiple log-ons across separate systems. The NLH has only started on that journey but we have already achieved the following:
NLH Search 2.0 Search facilities are at the core of delivering our vision. Historically, the library service has purchased content for its users from multiple suppliers, each coming with the publisher’s native interface and search engines. Therefore users need to learn multiple interfaces — which might change every 3-4 years with the procurement cycle. Of course, publishers want to sell their own solutions and do much to add value to their propositions. But these work in isolation and cannot be integrated into the flow of evidence described above. From April, NLH will be launching a new search, 'NLH Search 2.0', which will bring together into a single search engine health bibliographical databases from Ovid and EBSCO, online journals and eBooks, a medical images search, NHS guidelines search and the 29 Specialist Library portals built by the NLH. For the first time, the NHS will own and control its own presentation layer for the discovery and search of knowledge collections. We can now start to build our own value propositions, lead by clinicians, not publishers. We can also start work on plugging these new collections into our web service APIs and make them available beyond the website. Getting to full-text In a Google age, online users increasingly expect to get the full-text of journal articles immediately — they don’t want to find a bibliographical reference in Medline — they want the article. However, in a world where publishers charge subscriptions for online content, often linked to purchasing the paper subscription, this is not always possible. The 'last mile' as it is sometimes called is an area of frustration for library users. The trick is to link the users’ search results to available online full text which has been bought for them — either at a national level by NLH or by their local NHS library service. This is the role of the NLH Link resolver, which will hold and track all the online journal and ebook holdings for the NHS — whoever purchases them. With the arrival of Search 2.0 — anyone who uses their NLH Athens to log in can have their own personalised view of full-text holdings available to them and will see links to full text within their search results. Ultimately, this can be linked to a pay-per-view delivery service — where the NHS does not hold the journal subscription. Now that the NHS library service holds a central database of its holdings, the link resolver can be used to make those links available to other search services — for example Google Scholar or the US National Library of Medicine’s Pubmed — two resources often used by clinicians. Instead of these users being lost to the library service — we can use the Link Resolver Service to bring them back in, where they may discover added-value services available to them from NHS libraries. My Library There are over 1200 librarians working in the NHS, within some 400 plus library services. A local library can be found through the Health Library and Information Services Directory [6]. Most of these librarians are happy to help NHS staff to find information. However, users famously don’t go into libraries, or don’t have access to one. A recent survey found that nearly 60% of health researchers rarely if ever used their local library. The NLH My Library programme seeks to find ways for local library services to reach out to such users through the web. Currently, users who log into NLH are shown details of their local NHS libraries. Library managers can 'push' hypertext links into the user's My Library page and push an RSS web feed into an online knowledge update. We are currently piloting new ways for libraries to use NLH to provide personalised services to their users with three NHS areas. For example, local library staff could put together 'bundles' of useful links, web feeds, learning objects and events notices for new nursing students in their area — so that when students register for their NLH Athens password we can invite them to subscribe to such 'bundles' based on their registration profile. Why not allow users to 'ask a librarian' online? Librarians are experts at searching for knowledge in a complex information landscape and deal with queries everyday — why not do it online and create a Q&A archive? In Web 2.0 speak, that is called “user-generated content” and is driving the next stage of the internet. Next steps Progress on developing an SOA (service oriented architecture) for digital library services has been remarkable — given that there is not in fact a national NHS library service. Through collaboration and partnership we have developed, without centralised authority, clear lines of governance or control of a single budget or pool of staff. There is, however, some way to go. Standards for interoperability need to be much more detailed and comprehensive. They need to encompass a wider stakeholder group — including NHS bodies that produce knowledge or purchase knowledge outside of the library service, and indeed in other parts of the UK. There are considerable challenges in joining up knowledge discovery and delivery between the NHS and higher education. Much more work is needed on the production of knowledge within the NHS so that it is summarised and presented to clinicians in a format relevant at the point of care. We need to develop the digital library space as a place where the NHS can find and share knowledge with peers either one-to-one or as part of work-based networks. As the Director of NLH, Sir Muir Gray would say: “The future is not a destination, like Glasgow, which you travel to, nor does it just arrive, you have to build it.” Ian McKinnell, Head of Development National Library for Health. Further information
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. Please visit www.institute.nhs.uk for further information on the NHS Institute and its work. |
|
||
|
|
|||