Trip Database Blog

Search engines can be strange things. They are principally there to help users, with a gap in their knowledge, gain the information they need. This information may be a phone number, address, opening times, drug interactions.

Needless to say my interest is in clinical uncertainty.

Imagine if search engines were never invented and someone sat down to design a tool that would answer clinical questions. Would anyone really suggest that someone types in a few related terms, hits ‘search’ and then gets presented with 10-20 results that may have the information they’re interested in? It’s laughable really. This is further complicated by the fact that most of the clinical questions we’ve been involved in have needed more than one reference to answer. In our analysis of 350+ dermatology questions the average number of references used was 2.2.

So, the information is in disparate locations and hidden in a mass of other paragraphs (typically the information required is a paragraph or two located somewhere in a document with perhaps 100 paragraphs).

To my mind the ideal solution would be a user, typing in their full question (e.g. what are the causes of raised vitamin b12? as opposed to raised b12) and then they receive a brief response straightaway.

As far as I can tell this is a long way off (although I have seen some half-decent attempts recently). The Q&A services that we run (e.g. TRIP Answers) is another approach but it’s relatively labour intensive. I quite like the approach that Aardvark is using which uses humans to answer the questions. As this wikipedia article states:

“Aardvark is a social search service that connects users live with friends or friends-of-friends who are able to answer their questions. Users submit questions via email or instant messenger and Aardvark identifies and facilitates a live chat or email conversation with one or more topic experts in the asker’s extended social network. Users can also review question and answer history and other settings on the Aardvark website.”

My business partner at TRIP (Chris) a GP says he already knows many of the answers to the questions we receive. He’s always said that if he knows the answer he could return the response in 5 minutes (as opposed to the 60-120 minutes for a relatively easy Q&A for an information specialist).

Perhaps the Aardvark approach is the future – couple people with uncertainty with people who likely know the answer. It requires goodwill, but there’s plenty of that about!

Every now and then, when visiting a familiar website you find a new link and it reveals a wealth of new information.

I’ve been regularly visiting the Canadian Towards Optimized Practice (TOP) website when I noticed the link to Clinical Q&A. This has two sections ‘Tools for Practice‘ and ‘Briefcases‘ which I thought would be a great addition to TRIP (we already link to their clinical guidelines). Shortly after an e-mail to the site I end up discussing all things evidence with the head of TOP – Mike Allan. The short-term outcome was an agreement for TRIP to point to the Tools for Practice and Briefcases. To that end I have just added the Tools for Practice to the site and these will be searchable by the start of next week (at the latest).

After talking about it for a while now we’re getting close to launching the new feature on the site. It’s not really got a name, but it’s about crowdsourcing the identification of evidence suitable for low resource settings.

Very soon (in the next week or so) a new link will appear below each search result ‘Low resource’ and registered users will be invited to click on if they think the article is suitable for a resource poor setting. If a document receives more than one click from separate people it’ll qualify for inclusion in a subset of documents in TRIP. At the same time as the link appears below each result a tick box will appear in the results categorisation area (the box on the right-hand side of the results where users can select systematic reviews, guidelines etc) which will allow a user to restrict results to only those documents suitable for low resource environments.

A relatively simple concept, funded by BUPA, that we hope will bring great benefit to users from poorer settings.

The programming has been done and all we require now is to finalise the publicity around the project (to ensure the maximum number of people hear about it) and then we’ll launch.

Another TRIP milestone is just around the corner 🙂

We launched in early October and in just over 15 weeks we have attracted 4,000 registered users to TRIP via our My-TRIP offering. This is how long it has taken each 1,000:

• First 1,000 – 15 days
• Second 1,000 – 24 days
• Third 1,000 – 31 days
• Fourth 1,000 – 37 days

There are many advantages to signing up to My-TRIP and these revolve around keeping up to date with the latest evidence, recording your use of TRIP for CPD/CME and proof of learning and access to the TRIP/doc2doc forum. Also, searching TRIP while registered means we pay a proportion of advertising income to Medecins Sans Frontieres/Doctors without Borders and HIFA2015. For a full list of the advantages of signing up see our list of key features.

So, if you’re not registered, do it now – it’s a powerful tool and it’s free!

I’m currently evaluating a website for a large NHS organisation. I don’t feel I can divulge their name – so apologies if that negatively affects the post.

In the past TRIP has been evaluated using a number of different methods. The first major method was carried out by the Centre for Evidence Based Medicine which resulted in the following publication Using the Turning Research Into Practice (TRIP) database: how do clinicians really search? More recently, when we were internally testing the new TRIP Database site the wonderful people at Minervation did some usability testing, which involved videoing a number of people trying to do tasks on TRIP.

I was contacted by the organisation as the senior managers were concerned that the site was no longer fit for purpose. While they felt the content was great, the findability was suspect.

It’s been a great experience, we’ve really got stuck into the web-stats, got lots of user feedback and we’re seeing a very consistent picture. The results might not be a surprise to the organisation (although there will be a few strong recommendations they’re not expecting) but it should give them the evidence they need to plan significant changes to the site.

The most important lesson from the whole process – for me – is that the internet is so important for communication, regular evaluation is essential to ensure your message/output is getting the exposure it deserves.

TRIP have been using the publications from the Faculty of Sexual and Reproductive Healthcare for years. We’ve used two principle outputs, their guidance and their clinical Q&As. The latter have been produced by the Clinical Effectiveness Unit (CEU). But, the CEU had a problem.

Basically, there was a large repository of clinical Q&As but members of the Faculty were not finding the search particularly useful. So, instead of looking at previous answers they went straight to the human-powered Q&A service – which wasn’t ideal.

So, we were delighted when they approached us to help improve their search. The new search has just been launched and can be accessed via this link. For specialist information on all things sexual and reproductive health orientated, you’d be hard pressed to find a better resource.

TRIP has been interested in education for a while and the new site saw a new feature added ‘Use as CPD’. This allows a user to view an article in ‘CPD mode’; this results in the article being opened with a top bar with 3 questions:

• Why am I exploring this area?
• What have I learned?
• How will I change my behaviour?

See image below to help understand what we do!

The idea is that health professionals record their reflections on the paper and this is then stored in their educational eportfolio.

As with many innovations things started slowly but I’m now delighted to report that it’s being used heavily and it’s looking great.

What interests me is the middle questions ‘What have I learned’, wouldn’t it be great if this learning could be shared?

Having a blog allows us to communicate new TRIP developments. As such, it also acts as a ‘sort of’ diary. As we’re approaching the end of 2009 I thought that I’d look back over a very significant year.

January – we reported on the early steps of TRIP Answers and also my discovery of Wordle!

February – results of the latest survey of TRIP users & highlighting a massive increase in traffic.

March – Mentioned HIFA for the first time, discussed the 2009 upgrade to TRIP and our trademark of the phrase TRIP.

April – Swine flu resources were mentioned a lot and we also highlighted the end of the NLH.

May – Further posts on new TRIP, highlighting a proposed new logo (which most people hated so we didn’t use) and the adding of the first blog to TRIP – Clinical Correlations.

June – Announcing the TRIP Advisory Board, discussed my partial menisectomy!

July – Mention of our idea for identifying evidence for the resource poor world.

August – further discussion of our ‘resource poor’ idea and some sneak previews of the new TRIP (advanced search, medical images etc).

September – Various teasers for the new site, followed by the launch announcement and ending with an apology for the new site dying and being taken down!!!

October – Announcing our tie-in with a electronic health record system, also announcing the securing of funding for our ‘resource poor’ idea and – thankfully – reporting on the stability of the new TRIP.

November – Reporting on our work with the iPhone, announcing a few new planned enhancements to TRIP and a post about the impact of TRIP.

December – Related articles was rolled out and hitting 3,000 registered users.

Aside from the above in 2009 we had nearly 10,000,000 visits to TRIP, we forged lots of new relationships with companies and organisations as well as building on existing ones.

For me 2009 was a transition period for a number of reasons:

• We established ourselves as a stable company without the largesse of NHS funding (via the significant Q&A contract we had for 4+ years).
• We moved away from using a large company for our web-developments and started working with Phil and a separate design agency.
• We spent a large amount of our time developing the site and improving upon it.

And 2010?

• We’ll be launching our ‘resource poor’ feature on TRIP, this could have significant global benefits.
• We’ll be rolling out an overhauled TRIP Answers.
• We’ll be launching our self-test CPD modules – over 6,200 of them.

However, 2010 will be mostly about building on the work of 2009 and hopefully getting out and discussing TRIP with more individuals, organisations etc. Basically, further increasing brand awareness and traffic!

We launched in early October and in just over two months we have attracted 3,000 registered users to TRIP via our My-TRIP offering.

The first 1,000 took 15 days, the second 1,000 took 24 days and the third 1,000 took 31 days.

For a full list of the advantages of signing up see our list of key features but they revolve around keeping up to date with the latest evidence, recording your use of TRIP for CPD/CME and proof of learning and access to the TRIP/doc2doc forum. Finally, searching TRIP while registered means we pay a proportion of advertising income to Medecins Sans Frontieres/Doctors without Borders and HIFA2015.

So, if you’re not registered, do it now – it’s a powerful tool and it’s free!