Health and the Web: UK Experience

Health and the Web:UK Experience

Professor Sir Michael RawlinsChairman, National Institute for Health and Clinical Excellence

AndProfessor 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

Effecti

vene

ss in

prac

tice

Cost e

ffecti

vene

ss

The “virtual” InstituteNICE

AppraisalCommittees

TechnologyAssessment

Groups

InterventionalProcedures

Specialist advisors

Collaborating Centres

(clinical guidelines)GDGs

PDGs(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

Hits

per

mon

th

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

Uni

que

visi

tors

per

mon

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

Visi

tor s

essi

ons

per m

onth

Current in May 2006

Page requests: 6.2 million200 Gigabytes

E-mail newsletter: >35,000 registeredE-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

Deliberative democracy

Citizens council (2005)

Societal preferences (2)

What is needed:• Broader representation (n=300 or 3000)• Retaining the deliberative element

Could the web help?

For more about NICE….

www.nice.org.uk