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D-Lib Magazine October 2004
Volume 10 Number 10
ISSN 1082-9873
Healthcare Digital Libraries Workshop - HDL 2004
16 September 2004, Bath,
United Kingdom
Anne
Adams
UCL Interaction Centre
University College London
<a.adams@cs.ucl.ac.uk>
Patty
Kostkova
Institute of Health Sciences
City University, London
<patty@soi.city.ac.uk>
The Healthcare Digital Libraries workshop in
Bath, UK, was organised by Anne Adams of UCLIC (UCL Interaction Centre) and
Patty Kostkova of City University, London, and brought together practitioners
and researchers who were developing, designing and deploying digital library
technologies in the healthcare domain.
The increased importance of evidenced-based
medicine for healthcare professionals has raised the importance of digital
libraries in this domain. The Medical domain is a complex interaction of many
different professions producing many complex user-related issues. The majority
of workshop talks consequently reviewed different aspects of user issues in
digital library (DL) design and deployment while some presented new technical
advances. At the end of the day demonstrations of specific digital library
applications were given, which were then used and reviewed by attendees.
The day opened with an invited talk by Mike
Stein from Medic-to-Medic Ltd (owned by Royal Free and University College
London (UCL) in the UK) who demonstrated the Map of Medicine project. His talk
highlighted the importance of ascertaining appropriate clinical treatment,
because an alarming number of people have died as a result of inappropriate
medical intervention. The current UK National Programme for Information
Technology in the National Health Service (NHS) is also spending the largest
amount in one organisation in the world on IT development (including digital
libraries). The Medic-to-Medic system supports communication between general
practice physicians and hospitals. The system presents best-practice care
pathways with the potential to link into digital resources, such as the
National Electronic Library for Health (NeLH), for evidenced support.
Resulting discussions after Dr. Stein's talk revealed that 80% of the initial
development costs were spent on user requirements gathered via methods such as
focus groups. This was deemed essential to gain user acceptance of the
technology in day-to-day decision-making processes. Hospitals and Primary Care
Trusts (PCTs) also required personalisation of the application for local needs
which increased users' perceived ownership of the technology.
Three researchers from UCL Interaction Centre:
Ann Blandford, Simon Attfield and Anne Adams, presented a fascinating study of
information users (patients) and providers (NHS Direct – public oriented
health telephone enquiry service provided by the NHS, UK) and their role in
the patients "information journey". This temporal
"journey" detailed the patients' initial "information
requirements", then their need for "facilitation of that
information" and finally the support required to interpret that
information and contextualise it according to patients' specific needs. The
call centre service, NHS Direct, was also discussed, with its support in
bridging the digital divide with mediated access to digital resources. In the
ensuing discussion that followed the presentation, it was decided that digital
library designers need to understand what has initiated a user's search (e.g.,
press scares, peer pressure, specific individual needs) to better support the
user's information needs and how to support the interpretation of that
information according to a patient's specific context.
Nandish Patel (Brunel University, UK) presented
a paper on an evaluation – due to commence shortly – to understand how
healthcare professionals search for knowledge in the National electronic
Library of Infection (NeLI). (The NeLI web site is at <http://www.neli.org.uk/>.)
It is hoped that the use of deferred system design principles in the
evaluation of this site will help improve the search and navigation design of
NeLI. Previous findings revealed that NeLI has concentrated on supporting
searching actions while users preferred to browse. Also, the system does not
support personal customisation, which is causing a barrier to library uptake.
The end of Patel's talk produced a discussion of the term "rational actor
model" and the need for evaluation of natural human activity within the
social context of the clinical domain.
Patty Kostkova (City University, London, UK)
presented a report about using web log analysis to evaluate the National
electronic Library of Infection (NeLI) – a UK-based resource that brings
together the best available evidence concerning treatment, prevention and
investigation of infectious diseases. Kostkova's evaluation determined that
there has been an increase in the site's usage over the web-log period, from
January 2002 to June 2003. Many of the increases in usage patterns were
related to awareness campaigns, which supports the need for these activities.
It was interesting to note that about two-thirds of the users for this
UK-specific site are located in other countries throughout the world. However,
UK NHS-based users were more likely to return to the site, spend more time on
the site and view more site pages than other users. The discussion after
Kostkova's talk centered around the problems related to log analysis and the
need for tools that provide accurate information on who has accessed sites
(i.e., US or UK residents, hospital or GP-practice users).
Leslie Carr (University of Southampton, UK)
presented an "extended" digital library environment for orthopaedic
surgeons. His research highlighted the importance of viewing digital libraries
as more than mere collections but rather as flexible, evolving systems. Carr's
application supported the translation of the clinicians' experimental work
into publications. The initial system he presented has dealt with the
publication issue through the implementation of a user-oriented template
generation toolkit. In the discussion following the talk, the workshop
audience brought up the complexity of issues in authoring publications and the
myriad of changing user needs with regard to different experiments and
publishers. Carr then noted that within the specific field of orthopaedic
publications, there are very restricted requirements and formats for
publishing, all of which fit very well with the elements of the current
template system he presented.
The next two presentations highlighted the
growing importance of ontological models in digital library design and
implementation. Dietrich Rebholz-Schuhmann (European Bioinformatics Institute,
Cambridge, UK) presented a paper on Whatizit, a data mining system that allows
for the fast and reliable extraction of data (e.g., gene and protein names,
mutations and protein-protein interactions) within biomedical digital
libraries such as Medline. Access to this system was presented during the
workshop via the 'Whatizit' Web interface. Rebholz-Schuhmann talked about the
novel use of curation teams, with individualized modules and solutions put to
the server and the terminology resources of the team taken into consideration.
In the discussion following Rebholz-Schuhmann's talk it was pointed out that
there was some discrepancy between the "facts" and the ontologies
developed by the curation teams. Rebholz-Schuhmann emphasized the importance
of working with the curation teams to develop relevant solutions.
Anjana Roy (City University, London, UK) also
addressed the use of formal ontological representations to effectively model
clinical conditions and disease management. She argued that this modelling of
disease treatment, control and prevention can support the integration of
evidence-based knowledge into care pathways. The use of this integration can
support the accurate management of disease and the progression of the illness
and treatment. Using the disease Tuberculosis (TB) to illustrate this
approach. Roy reviewed how the professional can access the most relevant
information at the time each decision is made. The members of the workshop
audience were struck by the growing importance of fitting digital resources to
clinicians' needs in order to quickly advert potential serious public health
problems.
In his talk, Maged Kamel Boulos (University of
Bath, UK) presented some shocking government statistics about public literacy
levels – an average of 9 years of age in the UK and even lower in the US.
Therefore, most information in digital libraries and on the Internet is not
readable by the general public. With the user of the "Flesch Reading
Ease" and "Flesch-Kincaid Grade Level formulae" the readability
of 20 website documents on diabetes mellitus was tested. Even the most
readable of sites were found too difficult to understand for the members of
the general public reading at average literacy levels. Boulos' talk finished
with some useful guidelines for information providers on what they should do
and not do to make their sites more readable. The discussion following Boulos'
talk highlighted the growing need to consider how understandable documents
are. The differing needs and reading level of various users were also
discussed.
Roger Slack (University of Edinburgh, UK)
presented some findings from observational studies of two services: TOXBASE
and The Mental Health Helpline. The findings from the studies about calls
dealing with poisons, social services and self-harming were presented with
regard to information requests and formulations, and how callers' problems
were investigated and categorized. Slack's finding pointed out the important
role of intermediaries in the delivery of recipient-designed responses. He
argued that designers should review the ways in which intermediaries in
information-providing services may be supported. In the discussions after
Slack's talk, it was proposed that there should be a move away from the logic
of information in design of these systems, to a logic that encompasses the
practicalities of information provision.
In the last presentation of the day, Bryan
Manning (European Federation for Medical Informatics) outlined a strategic
approach to the development of "joined-up" multi-agency,
multi-disciplinary Health and Welfare Contact/Advice Centers by providing
"one-stop-shop" access to patient/client services. These were
highlighted as ranging from direct "face-to-face" contact to full
e-Government functionality. The limitations of the current "customer
relationship management" and "information content management"
approaches to systems design were reviewed. After Manning's talk, discussion
focused on the use of goal-centered and cognitive process mapping methods to
digital library system design and how those methods improved digital library
functionality.
The Health Care Digital Libraries workshop this
year highlighted the growing importance of user issues in clinical digital
library design and deployment. The workshop also demonstrated how many
successful systems are being designed according to user needs and implemented
through communities that in turn felt ownership in the technology. The
importance of system flexibility and personalisation for local community needs
rather than individual needs was also emphasized.
More information about the workshop is
available from http://www.soi.city.ac.uk/~patty/HDL2004/HDL%202004%20Workshop%20Top.html
Copyright © 2004 Anne Adams and Patty Kostkova
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