Trip Database Blog

NHS Evidence was created to replace the NHS’s National Library for Health.  I was disappointed when it was released as it appeared little more than a clone of TRIP.  I was hoping for something more innovative to help support clinicians better and also to push the search agenda along – there is nothing like robust competition to stimulate innovation.

I have undertaken a number of Freedom of Information requests and have found out some interesting facts (click here to see the requests and responses).

What I found is as follows:

• The budget for NHS Evidence in 2010/11 is £24,438,000
• The number of searches this year is 15,811,716 (based on the average monthly figures for February to April 2010 multiplied by 12)
• This means a cost per search of 154p

By comparison, this is how TRIP stacks up:

• The budget for 2010/11 (for our search engine) – £45,000
• The number of searches this year is 8,058,648 (worked out using the same figures and method as above.
• This means a cost per search of 0.56p

Therefore, each search on NHS Evidence is 276 times more expensive than TRIP!

Why I raise this is not to rubbish NHS Evidence, although the figures are unflattering.  It’s more a feeling that it highlights the limitations of search.  Is this the law of diminishing returns?  Is search really the answer to clinical uncertainty?  I’m increasingly convinced that search is not the solution, irrespective of how much money you throw at the problem.

I’d love to have any comment on the above, are my conclusions sound?  Do the figures add up?

Answering clinical questions is at the heart of the TRIP Database.  We’ve been answering clinical questions for over 10 years and answered well over 10,000.  Most of these questions have been answered using a standard methodology:

• Receive and clarify the question
• Conduct a search
• Read and appraise the articles
• Write and answer
• Post answer on the website

This can frequently be time-consuming and therefore relatively expensive.  Search systems, even the TRIP Database, doesn’t answer questions – it returns articles that may help the clinician answer their question.

There are alternate models of answering questions and from the research evidence the most consistent source of answers for clinicians is their own colleagues.  But, there are half-way houses and my current favourite is facilitated by a service called StackOverflow which is a Q&A service for those involved in IT.  The company behind StackOverflow have recently been increasing the availability of the underlying software to power other Q&A systems and this was featured, today, on the ReadWriteWeb blog. 

One of the first non-IT uses for StackOverflow that I was aware of was GasExchange, a Q&A service for anaesthesia (check it out, it’s great).  It’s been running for many months and has an active community.  I’d love to see this sort of thing happen for other specialities – including primary care. 

I spend a lot of time pondering how best to serve up the results on TRIP.  Currently all results are merged with the ability to filter the results by category (systematic reviews, guidelines etc).

But, there are clearly different types of content:

• Research evidence – systematic reviews, synopses, guidelines, primary research etc.
• Background knowledge – eTextbooks.
• News
• Patient information

The mock-up below (click to enlarge) shows a way of making this distinction clearer.  Let me know what you think!

TRIP has become increasingly interested in improving access to the best available evidence for the developing world (see our crowdsourcing initiative).  In launching the initiative I’ve managed to meet a number of interesting people. 

Yesterday I had the pleasure of meeting the editor of the Africa-Health journal who’s knowledge and experience of the issues facing health professionals in the developing world was impressive.  We talked about a number of potential new projects but as ever funding is an issue.

I recommend readers of this blog, especially those in the so-called ‘developed world’ to spend some time reading the journal – it highlights the issues facing health professionals in these areas and gives a sobering perspective.

Excelencia clinica (ec.net) was launched in December 2008 as a collaboration between TRIP, the Spanish Ministry of Health and the Iberoamerican Cochrane Center.  ec.net was a bilingual (Spanish:English) clinical search engine modelled on the TRIP Database.

Our contract to work on ec.net finished yesterday and the work is now being carried out in-house.  It has been a great experience working with the Iberoamerican Cochrane Center (our main point of contact) and it has been a pleasure seeing the site grow and to develop. 

We wish them well for the future and hope the growth of ec.net continues.