Jon Brassey TRIP Database and Public Health Wales July 2012

Transcription

1 Jon Brassey TRIP Database and Public Health Wales July 2012

2 Worked in information support for nearly 15 years, started and continue to run ATTRACT ATTRACT answers clinical questions for primary care health professionals within Wales Also worked on other, non-welsh Q&A services and between them have answered 10,000+ Qs Process similar across them all: Question asked Optional clarification step Search undertaken Evidence identified Answer written

3 a global clinical search engine, > 60 million searches Index from multiple sources arranged by evidence type (e.g. systematic review) Algorithm designed to return the best available evidence based on 3 main factors: Year of publication Publication score Text score Users indicate over 70% of searches on TRIP (used for patient care) actually helps Significant impact on global patient care

4 My interest is in getting robust answers to genuine clinical questions Unfortunately, clinical research (both primary and secondary) does not appear focussed on supporting clinical practice Usefulness medical information = (relevance x validity)/ work (Slawson & Shaughnessy, 1999)

5 Primary research HIRU s EvidenceUpdates Critical appraisal >50,000 articles from 110 premier clinical journals Those that pass the critical appraisal stage are passed to a network of clinicians to assess for clinical relevance and newsworthiness How many pass?

6 Secondary research Analysis of 358 dermatology Q&As How many answered by a single SR? 20% answered exclusively by secondary evidence Acne better, with 45% answered by secondary sources Psoriasis most frequently asked about, yet 10 th most common consultation, yet <10% answered with secondary evidence

7 Lots of answers looking for questions

8 Lots of clinical research Relatively little high quality, clinically relevant content How to find high quality, relevant content? Problem compounded by noise of poor quality research Search is problematic: 100 clinicians Pain

9 Despite attempts to evolve search into something more human friendly, there's still a big hole there. As useful as Google is, it doesn't answer questions very well TechCrunch blog I don t want all these getting me on the way to the answer...search engines should be replaced by answer engines. Steve Wozniak, co-founder Apple

10 Search is defined by Google Search does not directly answer questions Search is unintelligent Search isn t the answer, it s part of it but there s little debate There s a lack of research around clinical search

11 DUETs 1 of the 4 main wastes in research is choosing the wrong questions for research. This requires better engagement with end users of research (Chalmers and Glasziou, Viewpoint in Lancet 2001) Estimates 85% waste, tens of billions of investment lost Prioritise effectively and reduce avoidable waste in the production and reporting of research evidence

12 Move away from the search paradigm. Look at better ways of improving information support for clinicians If using search make it as intelligent as possible e.g. TRIP is developing an adaptive search Q&A is one possible way forward. After all clinicians want answers to their clinical questions why not spoon feed them?

13

14 Next update to TRIP users will be prompted to login. If people do this we hope to analyse usage patterns. Can we boost results based on prior individual behaviour? Can we boost results based on similar users behaviour? Attempting to make search intelligent.

15

16

17 To date the evidence based world has spent lots of time on methodology, let s redress the balance and make relevancy and findability an equal part of the triangle Squeaky clean, get our own house in order Ultimately, it s giving robust answers to real clinical questions