Two years on from Topol: Preparing ourselves for the Digital future

Two years have passed since publication of the Topol Review so it is timely to ‘take stock’. Why not take 5 minutes to review how emerging technologies are impacting on health and on NHS knowledge services?

Chaired by digital guru Dr Eric Topol, the Review anticipated the impact of technologies such as Artificial Intelligence (AI), machine learning, digital medicine and genomics on the functions and roles of the current and future healthcare workforce.  This Spring Health Education England (HEE) brought together authors of the report to reflect on changes since 2019. Prof. Lionel Tarassenko chaired a meeting with some of the Review Board, while I led a fascinating roundtable discussion with the clinical fellows who worked on the report.

The Review was well supported by knowledge specialists and knowledge managers as they considered the existing evidence base, scanned the horizon and managed the work. Thanks are due to the expertise of the team at Surrey and Sussex Healthcare NHS Trust led by Rachel Cooke, and our own HEE Knowledge Management service, managed by Emily Hopkins.

Citizens and patients at the centre: the importance of health literacy

The Topol Review placed the needs of patients and the public at its centre. The recommendations emphasise the importance of public health education initiatives and of working in collaboration with voluntary groups and information providers.

HEE’s national knowledge and library services team has since developed a suite of health literacy resources. Have you completed the e-learning programme produced in partnership with public health colleagues within HEE and with NHS Education for Scotland? Health literacy awareness training, including a “train-the-trainer” programme, has been delivered to NHS knowledge and library staff across England and this provides a foundation for the next stage.

Working with organisations which provide information and are able to support citizens develop information skills, Ruth Carlyle is leading a significant initiative to build a sustainable health literacy partnership. Over the next five years we will be working in partnership with public libraries, prison libraries, with pharmacists and with education libraries.

Adopting new technologies in health knowledge services   

The opportunities flagged by the Review are reflected throughout Knowledge for Healthcare 2021-2026,  particularly in relation to our work on resource discovery, led by Helen Bingham.

Using AI to enhance access to evidence

AI is helping to improve the search experience and reduce the time it takes to summarise and synthesise evidence.  Products like Yewno Discover, EBSCO’s Knowledge Graphs and 2Dsearch can help searchers to visualise and construct complex searches, navigating volumes of knowledge to retrieve information. This can make advanced and expert searching more accessible to the novice user. For knowledge specialists, these products can help to save time, act as a prompt to include additional search terms and help with communicating search strategies to end-users.

AI and machine learning are also showing promise in the field of systematic review and evidence synthesis. Recent work by Jon Brassey et al[i] shows that machine learning can effectively identify, assess and collate research findings to produce evidence maps, pointing to time-savings in synthesising evidence

HEE is supporting a trial of Yewno Discover with the University Hospitals Derby and Burton NHS Foundation Trust to explore how staff and learners might benefit from an AI-based approach to searching. Examples of other work in the field include the use of the RobotAnalyst tool by NICE and the MetaVerse tool by Public Health England. A trial of the IRIS.AI system by MerseyCare NHS Foundation Trust, to read all Open Access papers, added depth to the search for clinicians and researchers.

Integrating evidence into the clinical workflow

There are significant opportunities to improve the accessibility of evidence through direct integration with clinical workflows.  HEE subscribes to the BMJ BestPractice clinical decision support tool for all NHSW staff and learners in England.  A recent study[ii] has shown that integrating BMJ BestPractice into wider clinical decision support system can improve consistency of diagnosis and reduce average stays from 7 days to 6 days. BMJ Best Practice and HEE are collaborating to promote the integration of BMJ Best Practice into electronic health record systems to ensure that practitioners have access to the evidence at the point of need.

Developing as a specialist workforce

The Review recommended an increase in the number of knowledge specialists to meet the demands of the NHS as a knowledge-based industry. Knowledge for Healthcare 2021-2026 emphasises the importance of workforce planning and development for our specialist workforce.

In the light of the Topol Review the team has put a lot of thought into how best to enable healthcare knowledge specialists, librarians – everyone in the team – to build their knowledge and enhance their skills to deliver the digital future. Dominic Gilroy leads our workstream on workforce planning and development and again, it is timely to share our progress.

Policy recommendations

HEE has approved several new policies to support the Topol recommendation, not least establishing a recommended minimum staff ratio. This is a key action by HEE to enable individual organisations to identify and address the risk that they may have insufficient capacity to maximise the benefit of knowledge specialist roles to inform the spread of innovation.

An updated CILIP Professional Knowledge and Skills Base

HEE worked with CILIP to revise the Professional Knowledge and Skills Base (PKSB), and with thanks to Dominic who played a key role in the working group.  Through discussion with Dr Andrew Cox, the author of the CILIP Technology Review – itself a response to the Topol report – we have ensured that key skills and competencies relating to digital technologies are included in the new PKSB which will be launched later in the year. There will also be new healthcare sector guidance as a companion to the main PKSB – to be launched early this summer.

Library Carpentry for NHS Librarians

To build the data and programming skills of NHS Knowledge and Library Specialists, HEE has joined Library Carpentry.  We will be running training courses for sixty librarians through 2021/2. There will then be an opportunity for six people who have undertaken the course to be trained to deliver the course.  Holly Case-Wyatt is leading on this partnership.

Library Carpentry workshops build software and data programming skills for people working in library and information settings. This will allow participants to automate repetitive library functions and enhance evidence by adding another angle of analysis. These skills will also enable our workforce to further support the needs of students and researchers in the NHS, may of who will need to use software within their research. The Carpentries have already reported receiving enquiries from other disciplines, including Healthcare Scientists and consultants.

How can we keep up to date?

Thanks to the HEE KM team, which produces a monthly round-up about emerging technologies in libraries, we can all follow developments in the field. Sign up via: [email protected]

We are equally grateful to the Emerging Technologies Group, co-chaired by Stephen Ayre and Hannah Wood. They scan the digital horizon and let us all know when they spot something that might impact on the information world. They have written several blogs, including: enhancing wifi connections to improve the experience of working from home, and a review of the AI for Healthcare MOOC delivered by HEE in partnership with Manchester University.  You might also check out the webinar on Virtual Reality in health libraries.

Developing a Certificate in Digital Technologies

Recognising that knowledge and library specialists need to enhance their skills for a digital healthcare system, we believe the NHS needs people who understand more about AI, Machine Learning, robotics and other technologies. More generic digital knowledge, sometimes called “computational sense” is also required to inform handling enquiries from health professionals, and to be able to signpost and advise appropriately.  In an exciting new initiative, we are partnering with HEE’s National School of Healthcare Science and Manchester University to develop a Digital Technologies Certificate that will be for all NHS staff including knowledge and library specialists.

To quote Knowledge for Healthcare: “Machine learning, Artificial Intelligence and robotics are reshaping the ways teams create, discover, use and share information. We expect the emergence of new roles and responsibilities for knowledge and library service staff working alongside clinical teams and health informaticians.”

Sue Lacey Bryant – and the team
National Lead for NHS Knowledge and Library Services
Health Education England

[i] Brassey J, Price C, Edwards J, et al

Developing a fully automated evidence synthesis tool for identifying, assessing and collating the evidence

BMJ Evidence-Based Medicine 2021;26:24-27.

[ii] Tao L, Zhang C, Zeng L, Zhu S, Li N, Li W, Zhang H, Zhao Y, Zhan S, Ji H
Accuracy and Effects of Clinical Decision Support Systems Integrated With BMJ Best Practice–Aided Diagnosis: Interrupted Time Series Study
JMIR Med Inform 2020;8(1):e16912
doi: 10.2196/16912