health and the web: uk experience professor sir michael rawlins chairman, national institute for...
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Health and the Web:UK Experience
Health and the Web:UK Experience
Professor Sir Michael RawlinsChairman, National Institute for Health and Clinical Excellence
And
Professor of Clinical Pharmacology, Newcastle upon Tyne
Scope
1. Healthcare and the Web: UK Overview
2. NICE and the Web- Developing guidance
- Disseminating guidance
UK overview: general
1. Information- Public
- Professional
2. Communications - Between professionals
- Between professionals and patients
3. Research- Clinical trials
- Patient monitoring
UK overview: the NHS
Primary care- Health records
- Prescribing
- Hospital appointments
Secondary care- Patchy
To provide professional staff with advice on:
• securing the highest attainable standards of clinical care for National Health Service patients
• promoting and sustaining the public health
NICE’s Purpose
NICE: setting standards
For clinicians:• Use of individual health technologies
• Management of conditions
For public health professionals:• Single interventions
• Programmes
Effect
iven
ess
in p
ract
ice
Cost e
ffect
iven
ess
The “virtual” Institute
NICE
AppraisalCommittees
TechnologyAssessment
Groups
InterventionalProcedures
Specialist advisors
Collaborating Centres
(clinical guidelines)
GDGsPDGs
(Public health)
Public healthinterventions
CollaboratingCentres
(public health)
Developing NICE guidance
Critical features:• Clinically/scientifically robust
• Inclusive
• Transparent
• Independent
Disseminating NICE guidance
Predominantly web-based:• Full guidance
• Short forms of guidance
• Supporting evidence base
Monthly page requests
0
1000000
2000000
3000000
4000000
5000000
6000000
2000
-6
2000
-9
2000
-12
2001
-3
2001
-6
2001
-9
2001
-12
2002
-3
2002
-6
2002
-9
2002
-12
2003
-3
2003
-6
2003
-9
2003
-12
2004
-3
2004
-6
2004
-9
2004
-12
2005
-3
2005
-6
2005
-9
2005
-12
2006
-3
Months
Hit
s p
er
mo
nth
Monthly unique visitors
0
20000
40000
60000
80000
100000
120000
140000
160000
180000
2000
-5
2000
-7
2000
-9
2000
-11
2001
-1
2001
-3
2001
-5
2001
-7
2001
-9
2001
-11
2002
-1
2002
-3
2002
-5
2002
-7
2002
-9
2002
-11
2003
-1
2003
-3
2003
-5
2003
-7
2003
-9
2003
-11
2004
-1
2004
-3
2004
-5
2004
-7
2004
-9
2004
-11
2005
-1
2005
-3
2005
-5
2005
-7
2005
-9
2005
-11
2006
-1
2006
-3
Months
Un
iqu
e vi
sito
rs p
er m
on
th
Monthly visitor sessions
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
1000000
2000
-1
2000
-4
2000
-7
2000
-10
2001
-1
2001
-4
2001
-7
2001
-10
2002
-1
2002
-4
2002
-7
2002
-10
2003
-1
2003
-4
2003
-7
2003
-10
2004
-1
2004
-4
2004
-7
2004
-10
2005
-1
2005
-4
2005
-7
2005
-10
2006
-1
2006
-4
Months
Vis
ito
r se
ssi
on
s p
er
mo
nth
Current in May 2006
Page requests: 6.2 million
200 Gigabytes
E-mail newsletter: >35,000 registered
E-mail updates: up to 6,000 per day
Visitors
56.3%43.4%
Disseminating NICE guidance
Limitations:
1. Short formats• How short?
• For what purpose?
2. Patient formats• Access?
The future?
1. Developing the evidence?
2. Disseminating the guidance?
3. Discovering societal preferences?
Evidence development
1. Web-based approaches to clinical trial registries
2. Web-based approaches to conducting clinical trials
3. Web-based approaches to developing and maintaining registries
4. Web-based access to results of clinical trials
Disseminating guidance
Professionals:• PCs, hand-helds
• E-mail alerts
• Format(s)
• Revisions/updates
• Self-learning modules (CPD)
Patients, families, carers• ??????
Societal preferences (1)
NICE’s Citizens Council:• Stratified random sample
– age and gender
– socio-economic status
– ethnicity and disability
– geography
• Thirty members
• Cross-section – not representative
Delibera
tive democra
cy
Citizens council (2005)
Societal preferences (2)
What is needed:• Broader representation (n=300 or 3000)
• Retaining the deliberative element
Could the w
eb help?
For more about NICE….
www.nice.org.uk
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