Saturday, August 23, 2014

A Trip evidence service?

Trip is a wonderfully useful search engine, widely used and it has a great reputation and brand. We're thinking we could build on this to create a formalised evidence service. 

An evidence service could undertake a number of roles to support users (probably organisations) for instance:
  • Literature searches
  • Critical appraisals
  • Evidence reviews/synthesis
  • Clinical Q&A
  • Horizon scanning
  • Etc
We have a network of highly skilled information experts who would undertake the work.  Due to our low overheads we could provide a very cost-effective service.

I have experience in the UK where there are a large number of organisations (e.g. CCGs) that do not have timely access to timely, robust evidence to support their decisions.  This is really problematic when introducing changes to the system; how can they be evidence-based with no evidence input?  I doubt UK is atypical in this respect.  Therefore, there is a real opportunity to improve care and improve our business!

If you're interested in the service and want to help us develop our service then let me know.

Thursday, August 21, 2014

Beauty is in the eye of the beholder

Clickstream data is not widely known about.  In short it's the analysis of users clicking on websites.  We've started exploring this and the clickstream we're using is based on users clicking on particular search results. In short, if you do a search on Trip and click on documents number 2, 4 and 9 you're effectively telling us that, for your intention, they're connected.  In isolation it's arguably meaningless, but over thousands of searches you start to see structure.  I've blogged about this previously (here, here and here) but now we've got more results.

Below is the largest continuous graph/map of connected documents - over 10,000 long (click on image to expand). 

Tuesday, August 19, 2014

Recruiting for clinical trials: a role for Trip?

Clinical trials are vital if we wish to improve healthcare, as such they are an important component of EBM.  However, trials are not straightforward and one major problem can be the recruitment of enough patients to ensure the trials have enough power.  There are numerous papers on the topic (well hundreds) and below are a sample:

I raise this as Trip has had two conversations in a week with organisations involved with trial recruitment and both are very interested in working with Trip and our network of users.  Trip has around 100,000 registered health professionals, the vast majority will appreciate the need for clinical trials and therefore be sympathetic to the need to recruit patients.

So, the idea seems to be that if we are made aware of a trial, of say heart failure, we alert health professionals who have indicated an interest in heart failure (either through their registration or their search history) and are based geographically close.

Early days but it seems like a great idea.  As well as hopefully improving patient recruitment it could also help Trip's finances - win:win.

Friday, July 25, 2014

Freemium: the next stage

Earlier this week I had the first planning meeting around turning Trip into a freemium service.  Much of the current site will remain free. The premium (paid for) service will have no restrictions and will have some enhancements. 

So, here's what we're thinking:

Free service
  • no advanced search
  • limited export options
  • no images, videos etc.
Premium service
  • better exprot facilities
  • improved meta-data
  • advanced search available
  • all content types available
  • no adverts
  • various discounts from evidence-style products
  • ability to add (and share) reflective notes against each article
  • introduce the answer engine
Costings is still fluid.  I intend to have an individual subscription and an institutional one.

Individual - My aim is to suggest a monthly charge of around a cup of Starbucks coffee but people will be at liberty to reduce (or increase) the amount they pay, although there would be a lower limit.

Institutional - Various levels based on the number of individual accounts available.  In addition we intend to introduce some analytics so the institution can see how the service is being used.

It's still early days and if you have any opinions please let me know.

Thursday, July 10, 2014


We have recently been in discussion with an organisation about potentially partnering with us.  This would have brought some financial security to the site as well as allowing me to further develop some of the products we're currently working on.  These technologies being shared with the organisation. While nothing has officially been said I get the impression that it's not a priority for them - so I need to move on.

I have come to the conclusion that I cannot rely on others to support Trip and therefore we need to strike out on a 'Plan B'; which is a freemium version of Trip.  In a nutshell most of the current Trip remains free and certain enhancements are made to create a 'paid for' premium version.

The insecurity around funding is getting more than tiring - so something has to change.  We've got to work out the details (features etc) but my plan is to keep the price low - I quite like the idea of linking it to the local price of a Starbucks cappuccino (or similar).  The point being that if you value Trip you'll surly pay a monthly fee that is the same as a Starbucks (I'd welcome feedback on this point).

If we can get a regular, secure income we can properly plan for Trip.  We can enhance and roll-out some truly great products.  The vision I have for Trip is really exciting and as such I could have gone and secured venture capital funding.  But that would have changed the nature of Trip, something I'm not particularly keen on - for obvious reasons.

Tuesday, June 17, 2014

Evidence based medicine: a movement in crisis?

In January this year I was a participant at a small gathering of EBMers in Oxford, exploring the notion of RealEBM.  It was jointly organised by Trish Greenhalgh and the Centre for Evidence Based Medicine.  The participant list was Trisha Greenhalgh, Jeremy Howick, Neal Maskrey, Druin Burch, Martin Burton, Hasok Chang, Paul Glasziou, Iona Heath, Carl Heneghan, Michael P Kelly, Richard Lehman, Huw Llewelyn, Margaret McCartney, Ruairidh Milne, Des Spence and myself.  Someone – certainly not me – called it the Evidence Based Medicine Renaissance Group.

A paper has been prepared and was recently published in the BMJ Evidence based medicine: a movement in crisis?

The preamble is:

Trisha Greenhalgh and colleagues argue that, although evidence based medicine has had many benefits, it has also had some negative unintended consequences.They offer a preliminary agenda for the movement’s renaissance, refocusing on providing useable evidence that can be combined with context and professional expertise so that individual patients get optimal treatment.

And the conclusion:

Much progress has been made and lives have been saved through the systematic collation, synthesis, and application of high quality empirical evidence. However, evidence based medicine has not resolved the problems it set out to address (especially evidence biases and the hidden hand of vested interests), which have become subtler and harder to detect. Furthermore, contemporary healthcare’s complex economic, political, technological and commercial context has tended to steer the evidence based agenda towards populations, statistics, risk, and spurious certainty. Despite lip service to shared decision making, patients can be left confused and even tyrannised when their clinical management is inappropriately driven by algorithmic protocols, top-down directives and population targets.

Such problems have led some to argue for the rejection of evidence based medicine as a failed model. Instead we argue for a return to the movement’s founding principles—to individualise evidence and share decisions through meaningful conversations in the context of a humanistic and professional clinician-patient relationship (box 2). To deliver this agenda, evidence based medicine’s many stakeholders—patients, clinicians, educators, producers and publishers of evidence, policy makers, research funders, and researchers from a range of academic disciplines—must work together. Many of the ideas in this paper are not new, and a number of cross sector campaigns with similar goals have already begun (box 3). We hope that our call for a campaign for real evidence based medicine will open up debate and invite readers to contribute (for example, by posting rapid responses on

I hope you’re interested and if you need an electronic copy, just drop me a line.

Friday, April 25, 2014

Stars, favourites and saving

This is another 'how to' post - explaining how to use a particular bit of functionality on Trip.  Other posts in this series include the recent Colours and Trip

Many other websites allow users to favourite (or save) things of interest.  In Google Mail they allow you to favourite an email and in Twitter you can favourite a tweet; in both systems they use a star.

In Trip we've recognised the need for users to save favourite/interesting articles and we have adopted the same approach as Google and Twitter with the star system.  Below are images highlighting the main features of the 'star' system:
  • The top image shows you the simple way to save articles
  • The middle image shows how you can browse the starred/saved articles
  • The bottom image shows how you can find articles, after a search.  This last technique might be useful if you want to actually search for an article (as opposed to browsing).  However, it might be that you're carrying out a broad search and you may want to know if any previous articles you've read (and possibly appraised) match your particular search.