TRIP in the literature

Its always nice to see TRIP being quoted in the peer-reviewed literature. This recent systematic review (click here) used TRIP as one of the search resources.

Microsoft Health

I was expecting some big announcements from MSN yesterday. What has come out (from here) is:

Microsoft on Wednesday announced that it will offer software for use in the health-care industry—a shift toward providing industry-specific applications instead of the Redmond, Wash.-based software giant’s typical business model of supplying operating systems, software and tools for other firms to build onto

The report later reports:

The company’s first effort under the new initiative is to buy software developed by physicians and other researchers from Washington Hospital Center, a not-for-profit hospital, according to the Times. Gates Inc. will also hire two of the three doctors who created the software system, as well as 40 members of the development group, the Times reports.

The software, called “Azyxxi,” is used to cull and rapidly display medical information on patients from a handful of sources, including EKG records, X-rays and MRI scans, according to the Times.

“This represents a change in our strategy,” said Peter Neupert, Microsoft’s vice president for health strategy, according to the Times. “This is the start for Microsoft. We’re just getting started.”

Answering Physicians' Clinical Questions: Obstacles and Potential Solutions

Answering Physicians' Clinical Questions: Obstacles and Potential Solutions. Another paper on Q&A from the Ely, Osheroff (et al) stable.

I'm still puzzling over the concept of an answer....

It would appear from the above paper that an answer is judged by the doctors. I suppose the issue being, does it help remove their uncertainty. However, the removal of uncertainty has little relevance to a 'correct' answer.

So a doctor might be uncertain which drug to give A or B to a patient with condition X. The doctor finds the first paper on Medline which suggests drug A is better. So they decide to use drug A. However, 5 papers down is a systematic review that shows B is superior to A. So the doctors uncertainty has been plugged by seeing a paper supporting drug A. However, the 'correct' response (from an EBM perspective) would be to use drug B. Ironically, for the patient in front of the doctor drug A might actually work better - but that's another story!

Windows Live Healthcare

Thanks to Dean for highlighting this story.

New look

The first look at the new search results page, not quite there but nearly!

The tabs for nvigating between EBM, Medical Images and Patient Information needs alterating. Also, as the Big Five journals (JAMA, NEJM, Lancet, BMJ and Annals of Internal Medicine) are being integrated into the main search that category will be removed.

Evidence Matters

"Evidence Matters (EM) is an award-winning, venture-backed company which has created a novel knowledge management system for the medical field. " or so the blurb says.

As the subscription market gets more crowded by groups who hope to squeeze money out of health organisations I can only rejoice at our decision to move away from that particular business model. Evidence Matters has had some significant investment around $1.5 million (Canadian dollars I assume).

One of the most poignant comments for me, regarding the move to free-access for TRIP, came from Brian Alper (who heads up another subscription 'knowledge' thingy). He basically said that people are not expecting to pay for search. I tend to agree with Brian. However, who will be right - us or the venture capitalists?

Answers.com

This has a beta natural language processign feature which I've been trying out.

Is metformin safe in pregnancy? - poor result

Why do you use dexamethasone in ivf? - good result

Is a BNP blood test a good screening test for identifying heart failure? - no answers

After much re-arranging of the terms, cutting out 'bits and bobs'...

Is b-type natriuretic peptide useful in heart failure? - average answer

Often, when answering clinical questions I look for background on Google. Answers.com might be a useful place to look. I have a slight concern about bias creeping in as it's not clear how they create their answer. For instance they (answers.com) may say that drug X is useful which might then cloud my judgement. The fact that answers.com may have obtained their answer from the pharma company responsible for the drug is initially hidden.

Transparency seems to be the key.

Evidence-Based Health Care Workshop - Bad timing

We frequently receive requests for free access for conferences/workshops - we're always happy to oblige. It looks like we've received our last request before going 'free'. The Evidence-Based Health Care Workshop in Colorado has asked for free access. Bad timing as they want access from 31st July to 30th August. People attending the conference will get acquainted with the subscription version. Then, the next day (31st August) TRIP will move to free-access as well as having an overhaul of how the search system works!

We're currently waiting to receive the beta-version of the 'new' free TRIP - should be within the next week. Assuming there is nothing too badly wrong with it we'll go free as of 31st August. Why the 31st? Our web c0mpany doesn't like launching new sites on a Friday (which is the 1st September). Therefore, the free version will go live in the evening (UK time) on the 31st August - the Thursday!

Bill Gates talks health

Yep, talks, via a podcast

More on Google Health

Google preparing health portal; pitching WebMD and Intuit as partners

Web 2.0

An interesting entry on Dean’s blog about web 2.0 . Not being particularly technical I struggle with terms such as 'web 2.0'! However, following some links it appears to be a move from static web-content to content that a user can interact with and alter – if they desire. Dean's blog entry links to a EBM 2.0 brainstorm from the guy who runs the clinical cases blog.

So how can we let users improve the TRIP Database and for that matter the Q&A Services?

For Q&A I’ve often wanted a ‘rapid response’ style service (as seen on the BMJ). This allows a reader of a particular paper to raise issues. With Q&A we’re a rapid service that doesn’t claim to undertake a systematic review. I’m convinced that user input would enhance the service. The slight problem being that those that control the services aren’t as keen as me!

With regard to TRIP I see two main ways:

1) With the advent of the new TRIP algorithm we can ‘weight’ various variables (date of publication, ‘quality’ of publisher etc). I actually think Dean suggested this bit. But every time people click on a link it can be taken as a ‘vote’ for that paper. Next time that article scores more highly (i.e. returned higher in the results). This allows users to decide what sources they feel are best (as opposed to just the clinical team at TRIP). A few assumptions mixed it – some would like the title of an article and view it and think it’s rubbish. However, this could well balance out.

2) Comments. Allow users to attach comments on a particular article – things they like, clinical application etc. I think this is a great idea but not convinced it’d be well used. It could form part of my plan to create a record for each article. This could include an Amazon-style ‘People who looked at this article also looked at these….’

For user participation in search try Digg.

A web-based library consult service for evidence-based medicine

According to the paper in BioMed Central's 'Medical Informatics and Decision Making' this paper (click here):

"The LCS system is designed to provide full text evidence-based literature with critical appraisal in response to a clinical question asked by a physician who may be at a remote or rural site. "

It appears to be a type of Q&A service. Not sure about the turnaround time they aim to achieve although this is an outcome to be measured. I always wonder what 'real' impact using full-text has. On one level it adds to the robustness of the answer. However, the extent of this difference may be clinically insignificant. Also it invariably adds to costs and turnaround time.