Cinicians are constantly bombarded with information. The paradox is that although they may feel overwhelmed, it can prove difficult to locate a specific piece of data when it is needed.
A study undertaken in East Anglia showed that 22 general practices received and retained a total of 855 different guidelines.1 If future use is to be made of them, they would require careful indexing and storage.
Turning to the internet can make the problem worse. Web-browsers frequently return search results of vast numbers of irrelevant, out-of-date or inaccessible sites, leaving the busy clinician suffering from information overload and acute frustration.
The National electronic Library for Health (NeLH) is a key part of the NHS Information Strategy – Information for Health. It aims to harness the best of internet technologies to provide easy access to the best in current knowledge and improve health and healthcare, patient choice and clinical practice.2-4
The Primary Care National electronic Library for Health (NeLH-PC) is the first and largest of the virtual branch libraries of the NeLH and is available on NHSnet/GPnet at:
with an internet demonstrations site without some of the proprietary elements at:
The NeLH-PC has been developed by the specialist Primary Healthcare Informatics Team at St George's Hospital Medical School, London. For the past 3 years, they have been running the Doctor's Desk Project (internet demonstration site at http://drsdesk.sghms.ac.uk).
The NeLH-PC is funded by the National Health Service Information Authority, and the Doctor's Desk Project by NHSE Research & Development Directorate – South Thames.
The Doctor's Desk Project3 has delivered access to information, electronic communications and telemedicine via a single web-browser. This unique experience within the team has led to its selection to develop the NeLH-PC.
The NeLH-PC has developed an innovative approach to bring knowledge and know-how to the clinician's desktop. Its design is based on a 'Use-Spec' (user specification) developed in the first 6 months of the project.
There are a growing number of connections to the NHSnet. More than 97% of health authorities are now connected, as well as an increasing number to GP surgeries through the GPnet Project4 – now renamed GP-Connect. This has created a secure environment for primary healthcare professionals to access key services such as electronic mail, clinical discussion boards and specialist sites such as the Primary Care Library.
The NeLH-PC enables users to access key information with the confidence of operating within this safe environment. ISDN (fast digital phone line) connections that link GP surgeries to NHSnet should ensure fast access times to material within the NHS Intranet – including NeLH-PC.
The separate internet site enables users who do not have NHSnet connections or are away from their normal workplace to access the majority of information contained within the Library.
Between March and September 1999, the NeLH-PC Development Team held a series of meetings with a wide cross-section of primary healthcare professionals to discover what was really needed to make the Library a useful tool for clinicians. The Use-Spec developed has been used to define a library structure to meet users' needs.
The majority of those consulted wanted a simple site with sufficient content to answer those questions that arise in primary care. Indexing and rating of information sources was considered vital if the sites contained clinical information. Most felt that they might occasionally use the site during consultations, but would be more likely to refer to the Library at the end of clinical sessions when in 'learning mode'.
A search tool that provided the right volume of review material was considered vital. In the long term, clinicians would like the Library to be integrated with their clinical system delivering context-specific information.
The NeLH-PC has been developed around three 'views' rather than a conventional single home page. This enables users to have customised collections of resources to meet their own differing needs. The three views of the Library are navigated between, using the dropdown menu in the bottom left of the screen.
- Home – the library view
This view has information organised into categories much like a conventional library (see Figure 1, below). Categories have labels such as books, journals and references. Specific content includes clinical evidence, the Red Book, DVLA standards and patient information leaflets on a variety of topics.
|Figure 1: Home/library page of the Primary Care National electronic Library for Health|
- The people view
This view links to sites for all members of the primary healthcare team. An extended definition of primary healthcare professional has been used, with those included ranging from GPs and practice nurses to pharmacists and chiropodists.
The primary care group (PCG) People Finder from Health Service Planner provides a mechanism for locating people and organisations within PCGs. It also contains information on individual PCG health priorities committees and areas of particular interest.
- The health improvement view
This view contains guidelines and tools to help the practice of evidence-based medicine. It contains links to the National Service Frameworks and cancer referral guidelines.
Further special collections are planned, and anyone interested in setting up a collection for a specific subject area should contact the NeLH-PC Development Team at St George's Hospital Medical School (tel 020 8725 5661 or email: firstname.lastname@example.org).
At the heart of the NeLH-PC is a meta-evidence search engine developed by Dr Adrian Brown. This is specifically designed to identify key review literature for primary care and delivers a limited number of highly relevant hits in response to any search. If this search does not provide sufficient information, the search term is automatically carried forward into the Medline database of controlled trials. This avoids the need for duplicate data entry.
The NeLH-PC is very much a dynamic project using the latest technology to deliver an unprecedented range of information without tiresome passwords, registration or any other obstacles for users. From the earliest stages of the pilot, feedback from users and other interested groups has been actively sought. The development of the Library reflects the feedback received.
New features and links are constantly being developed, tested and added to the site. The Library now features a 'My NeLH-PC' option that enables users to create a personalised collection of their favourite links. The Development Team welcomes suggestions for links; we have been delighted by the response received from content providers keen to get involved with the Library.
The comprehensive indexing and rating of links with NeLH-PC is one of its major strengths. If the information contained within a site is not logically and methodically indexed, then attempts at locating and retrieving the desired data will ultimately be unsuccessful.
As Anne Oatley, the NeLH-PC Project Librarian, says: "With over 300 links and more being added daily, users need guidance round this volume of information. The indexing of the site gives users additional data that helps them gauge what will be useful to them. Every entry has a full abstract and indexing terms drawn from MeSH, to give searchers multiple routes to what they need".
The abstracted information on each link contained in the Library is easily accessible by a single mouse click on the 'i' button next to each entry.
These summaries enable users to locate quickly the exact information they need, without the trouble of constantly going back to menu options. The abstracts contain links that enable users to send either detailed or quick feedback on the site.
The detailed feedback option allows users to send their comments on the abstracted summaries and the general usefulness of the site direct to the Project Development Team.
There is also the opportunity to comment on the percentage rating scale awarded to each link within the Library. This is a very quick and easy process which asks the user to state whether he/she thinks that an individual link within the Library is 'underrated', 'correctly rated' or 'overrated'. Thus the team can quickly identify any areas whose usefulness to the primary healthcare professional has been incorrectly assessed. The rating scale used takes into account feedback received.
The rating of all the content within the NeLH-PC is of prime importance. The success of the Library rests wholly on the usefulness of its content. The team has developed a system of rating websites to ensure both consistency and objectivity in the scores awarded.
Since it first went quietly on-line within NHSnet in November 1999, the NeLH-PC has evolved further, providing a valuable portal for the primary healthcare professional.
The NeLH-PC concentrates on content of UK and European origin, ensuring that it is of the highest possible relevance to those working in the NHS.
An information sheet, setting out the key features of the NeLH-PC, is also available (see Figure 2, below).
|Figure 2: Information sheet on the Primary Care National electronic Library|
|For further information on the NeLH-PC, contact: |
NeLH-PC Development Team,
Division of General Practice,
St George's Hospital Medical School,
London SW17 0RE
|Tel:||020 8725 5661|
|Fax:||020 8767 7697|
- Hibble A, Kanka D, Pencheon D, Pooles F. Guidelines in general practice: the new Tower of Babel? Br Med J 1998; 317: 862-3 (URL: http://www.bmj.com/cgi/content/full/317/7162/862).
- Secretary of State for Health. The New NHS – modern, dependable. London: HMSO, 1998.
- Burns F. Information for health. An Information Strategy for the Modern NHS 1998-2005. A national strategy for local implementation. Birmingham: NHS Information Authority, 1998. (URL: http://www.nhsia.nhs.uk/strategy/full/contents.htm)
- Muir Gray JA, de Lusignan S. National electronic Library for Health – Information in Practice. Br Med J 1999; 319: 1476-9 (URL: http://www.bmj.com/cgi/content/full/319/7223/1476).
- de Lusignan S. The Doctor's Desk. One vision of how to deliver the future information and communication needs of general practice. Journal of Informatics in Primary Care, May 1998: 19-22 (URL: http://www.schin.ncl.ac.uk/phcsg/informatics/may98/may7.htm).
- NHSnet – the benefits to general practice. NHS Information Authority. Document Reference 200-IA-239.