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Conference Report


D-Lib Magazine
October 2004

Volume 10 Number 10

ISSN 1082-9873

Healthcare Digital Libraries Workshop - HDL 2004

16 September 2004, Bath, United Kingdom


Anne Adams
UCL Interaction Centre
University College London

Patty Kostkova
Institute of Health Sciences
City University, London

Red Line


The Healthcare Digital Libraries workshop in Bath, UK, was organised by Anne Adams of UCLIC (UCL Interaction Centre) and Patty Kostkova of City University, London, and brought together practitioners and researchers who were developing, designing and deploying digital library technologies in the healthcare domain.

The increased importance of evidenced-based medicine for healthcare professionals has raised the importance of digital libraries in this domain. The Medical domain is a complex interaction of many different professions producing many complex user-related issues. The majority of workshop talks consequently reviewed different aspects of user issues in digital library (DL) design and deployment while some presented new technical advances. At the end of the day demonstrations of specific digital library applications were given, which were then used and reviewed by attendees.

The day opened with an invited talk by Mike Stein from Medic-to-Medic Ltd (owned by Royal Free and University College London (UCL) in the UK) who demonstrated the Map of Medicine project. His talk highlighted the importance of ascertaining appropriate clinical treatment, because an alarming number of people have died as a result of inappropriate medical intervention. The current UK National Programme for Information Technology in the National Health Service (NHS) is also spending the largest amount in one organisation in the world on IT development (including digital libraries). The Medic-to-Medic system supports communication between general practice physicians and hospitals. The system presents best-practice care pathways with the potential to link into digital resources, such as the National Electronic Library for Health (NeLH), for evidenced support. Resulting discussions after Dr. Stein's talk revealed that 80% of the initial development costs were spent on user requirements gathered via methods such as focus groups. This was deemed essential to gain user acceptance of the technology in day-to-day decision-making processes. Hospitals and Primary Care Trusts (PCTs) also required personalisation of the application for local needs which increased users' perceived ownership of the technology.

Three researchers from UCL Interaction Centre: Ann Blandford, Simon Attfield and Anne Adams, presented a fascinating study of information users (patients) and providers (NHS Direct – public oriented health telephone enquiry service provided by the NHS, UK) and their role in the patients "information journey". This temporal "journey" detailed the patients' initial "information requirements", then their need for "facilitation of that information" and finally the support required to interpret that information and contextualise it according to patients' specific needs. The call centre service, NHS Direct, was also discussed, with its support in bridging the digital divide with mediated access to digital resources. In the ensuing discussion that followed the presentation, it was decided that digital library designers need to understand what has initiated a user's search (e.g., press scares, peer pressure, specific individual needs) to better support the user's information needs and how to support the interpretation of that information according to a patient's specific context.

Nandish Patel (Brunel University, UK) presented a paper on an evaluation – due to commence shortly – to understand how healthcare professionals search for knowledge in the National electronic Library of Infection (NeLI). (The NeLI web site is at <>.) It is hoped that the use of deferred system design principles in the evaluation of this site will help improve the search and navigation design of NeLI. Previous findings revealed that NeLI has concentrated on supporting searching actions while users preferred to browse. Also, the system does not support personal customisation, which is causing a barrier to library uptake. The end of Patel's talk produced a discussion of the term "rational actor model" and the need for evaluation of natural human activity within the social context of the clinical domain.

Patty Kostkova (City University, London, UK) presented a report about using web log analysis to evaluate the National electronic Library of Infection (NeLI) – a UK-based resource that brings together the best available evidence concerning treatment, prevention and investigation of infectious diseases. Kostkova's evaluation determined that there has been an increase in the site's usage over the web-log period, from January 2002 to June 2003. Many of the increases in usage patterns were related to awareness campaigns, which supports the need for these activities. It was interesting to note that about two-thirds of the users for this UK-specific site are located in other countries throughout the world. However, UK NHS-based users were more likely to return to the site, spend more time on the site and view more site pages than other users. The discussion after Kostkova's talk centered around the problems related to log analysis and the need for tools that provide accurate information on who has accessed sites (i.e., US or UK residents, hospital or GP-practice users).

Leslie Carr (University of Southampton, UK) presented an "extended" digital library environment for orthopaedic surgeons. His research highlighted the importance of viewing digital libraries as more than mere collections but rather as flexible, evolving systems. Carr's application supported the translation of the clinicians' experimental work into publications. The initial system he presented has dealt with the publication issue through the implementation of a user-oriented template generation toolkit. In the discussion following the talk, the workshop audience brought up the complexity of issues in authoring publications and the myriad of changing user needs with regard to different experiments and publishers. Carr then noted that within the specific field of orthopaedic publications, there are very restricted requirements and formats for publishing, all of which fit very well with the elements of the current template system he presented.

The next two presentations highlighted the growing importance of ontological models in digital library design and implementation. Dietrich Rebholz-Schuhmann (European Bioinformatics Institute, Cambridge, UK) presented a paper on Whatizit, a data mining system that allows for the fast and reliable extraction of data (e.g., gene and protein names, mutations and protein-protein interactions) within biomedical digital libraries such as Medline. Access to this system was presented during the workshop via the 'Whatizit' Web interface. Rebholz-Schuhmann talked about the novel use of curation teams, with individualized modules and solutions put to the server and the terminology resources of the team taken into consideration. In the discussion following Rebholz-Schuhmann's talk it was pointed out that there was some discrepancy between the "facts" and the ontologies developed by the curation teams. Rebholz-Schuhmann emphasized the importance of working with the curation teams to develop relevant solutions.

Anjana Roy (City University, London, UK) also addressed the use of formal ontological representations to effectively model clinical conditions and disease management. She argued that this modelling of disease treatment, control and prevention can support the integration of evidence-based knowledge into care pathways. The use of this integration can support the accurate management of disease and the progression of the illness and treatment. Using the disease Tuberculosis (TB) to illustrate this approach. Roy reviewed how the professional can access the most relevant information at the time each decision is made. The members of the workshop audience were struck by the growing importance of fitting digital resources to clinicians' needs in order to quickly advert potential serious public health problems.

In his talk, Maged Kamel Boulos (University of Bath, UK) presented some shocking government statistics about public literacy levels – an average of 9 years of age in the UK and even lower in the US. Therefore, most information in digital libraries and on the Internet is not readable by the general public. With the user of the "Flesch Reading Ease" and "Flesch-Kincaid Grade Level formulae" the readability of 20 website documents on diabetes mellitus was tested. Even the most readable of sites were found too difficult to understand for the members of the general public reading at average literacy levels. Boulos' talk finished with some useful guidelines for information providers on what they should do and not do to make their sites more readable. The discussion following Boulos' talk highlighted the growing need to consider how understandable documents are. The differing needs and reading level of various users were also discussed.

Roger Slack (University of Edinburgh, UK) presented some findings from observational studies of two services: TOXBASE and The Mental Health Helpline. The findings from the studies about calls dealing with poisons, social services and self-harming were presented with regard to information requests and formulations, and how callers' problems were investigated and categorized. Slack's finding pointed out the important role of intermediaries in the delivery of recipient-designed responses. He argued that designers should review the ways in which intermediaries in information-providing services may be supported. In the discussions after Slack's talk, it was proposed that there should be a move away from the logic of information in design of these systems, to a logic that encompasses the practicalities of information provision.

In the last presentation of the day, Bryan Manning (European Federation for Medical Informatics) outlined a strategic approach to the development of "joined-up" multi-agency, multi-disciplinary Health and Welfare Contact/Advice Centers by providing "one-stop-shop" access to patient/client services. These were highlighted as ranging from direct "face-to-face" contact to full e-Government functionality. The limitations of the current "customer relationship management" and "information content management" approaches to systems design were reviewed. After Manning's talk, discussion focused on the use of goal-centered and cognitive process mapping methods to digital library system design and how those methods improved digital library functionality.

The Health Care Digital Libraries workshop this year highlighted the growing importance of user issues in clinical digital library design and deployment. The workshop also demonstrated how many successful systems are being designed according to user needs and implemented through communities that in turn felt ownership in the technology. The importance of system flexibility and personalisation for local community needs rather than individual needs was also emphasized.

More information about the workshop is available from


Copyright © 2004 Anne Adams and Patty Kostkova

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