THE WISDOC RESPONSE

THE WISDOC RESPONSE
Previous Contents Thumbnail More Concise The WisDoc Response (Design)	WisDoc is the first detailed, staged design for effecting a solution to the above - the first health information utility. Any solution to a problem of this magnitude invites the obvious rejoinder - why hasn’t someone thought of it before? Clearly there must be a considerable series of conceptual and design barriers to overcome which makes a solution so elusive. There are! And in the same way that it took very considerable time to originally synthesize them, it takes a little time to realise how the rationale for the design and all the design elements fit together. In spite of this, all of the design elements are simple and robust. The power of the solution lies not in the complexity of a few design elements but in the creative linking of many simple elements. The WisDoc Design Principles Large scale elements Consumer information site design Any consumer information site that even considers trying to generate what serious consumers want - a site that gives them real decision making information not just backgrounding - faces a seemingly intractable problem. Writing and maintaining a consumer information system from scratch - or upgrading an existing database to that level would be horrifically difficult and expensive. So no one has even attempted it - the sites have simply ignored the issue blithely saying doctors will do it in spite of a mountain of evidence to the contrary about their capacity (17 years behind the working edge), time and willingness to do so. No amount of marketing or claims of high level professorial oversight disguises this fact from serious consumers who are now the bulk of users. *The WisDoc solution is to first build the corresponding professional site and then provide a translation for consumers. This is probably the only economically feasible solution.* Professional information site design Research - accessing the current seminal research in a topic area. Of all the people who actually (and potentially) read medical research journals, only a small proportion are following very narrow esoterica - for example someone following the development of a particular drug in breast cancer treatment. The large majority (and potentially many who do not access the journals at all at the moment) are reading to be brought up to speed on the status and direction of research on a broad front - e.g. a breast cancer surgeon. WisDoc distils the up to the minute essence of the seminal defining research across the whole topic of breast cancer for this group. Research clinicians select typically some 300 research and review articles in a topic area that defines the current status of the field and maintain the list to within two weeks of original publication date. Individual topic guides to researching each area are provided. No one else is doing this. Professional text account of a topic The WisDoc professional text design is multi specialty: internal medicine surgery primary care screening and preventive care This comprehensive approach is used rather than addressing these topics from just one perspective, which is the usual text approach. The text is pitched at the highest common language level. This is the level at which a specialist would explain say the rationale for a treatment or diagnostic decision to a specialist from a different field or a primary care physician. It includes all of the information relevant to another doctor understanding the clinical process in the specialist’s area but not the detail necessary for carrying out that process. E.g. A Cardiac surgeon would explain the reasons for selecting a particular replacement valve for a particular patient and the relative risks. The explanation would not include detail such as say the suturing or placement issues for that valve. Multi level sourcing The text is generated and maintained from information selected from the 6 levels of professional information described above. Due to the ever increasing rate of research, the proportion of most relevant clinical information derived from primary research (levels 1 and 2) is much greater than say 20 years ago and WisDoc uniquely incorporates these most important levels of information into the topic. WisDoc solves the problem of the patchy background of individual clinicians by providing a full reconstruction of the whole topic. Site Design Elements 20 topics - The Core topic Selection The highly skewed distribution of disease incidence means that selecting just the top twenty in terms of frequency and severity will cover more than 90% of the major diseases in the developed world. Research Clinical Specialists provide primary data Increasingly current research is where critical clinical decision making information is located. The problem with accessing it is the volume of material and the skill level required to interpret it. WisDoc uses the medical sub group most equipped to monitor, filter, distil and comment on just the relevant clinical research. An experienced working researcher/clinician who is already performing this task for him/her self daily consults with a colleague and then makes available through WisDoc the outcome of that highly skilled process. Research Clinical Specialists - open feedback The judgement call of the primary data specialists is open up to scrutiny by specialists in the same area and feed back commentary explicitly invited on the site. In this way WisDoc can benefit both from the very fast evaluation that is provided by the primary clinicians and also from peer commentary, providing corrective balance to the first opinions and catching any issues missed. Standardising the sub-component structure of each topic Maintaining a database is made very much easier by standardizing the topic sub-components so that changes are easy to locate and to effect. Sub-components vary at widely different rates - the hot areas are usually diagnostics and treatment so usually the updating clinician will only have to focus on one sub-component of a topic rather than sixteen - most likely it will be treatment. Concise low cost newspaper style text - not a ‘coffee table medical textbook’ Traditional medical texts often contain graphics and art work and so on which is very time consuming and expensive to produce but adds little to the information value of the text. WisDoc text will be simple, concise and go directly to the point using very simple illustrations where necessary to get the essence of the information across. The focus will be on layout, ease and speed of comprehension and on being complete and up to the minute. It will have the spare effectiveness and currency of a jetliner cockpit information system. Construction and maintenance efficiencies Top end primary data providers All doctors are not equal - not just in terms of how up to date they are but very importantly in terms of how difficult the task of updating is for them. The sub group of doctors who are actually fully up to the minute is a small fraction of the total of doctors. Within this group the full time clinicians have a relatively tough time of it but the university/research institution based researcher clinicians have an easier time as being on top of the literature is a significant fraction of what they do routinely. WisDoc will use these people as the primary data providers - they are very significantly more efficient at generating and maintaining clinical information than doctors generally. They are usually not the famous professors of medicine or surgery that lend their names to various textbooks. They are the leading edge clinical research sub-group who work in labs, see patients and sometimes lecture in universities. They are the people who, off the top of their heads without warning, can name the authors of forty of fifty of the current important research papers in their field. Communications specialists - Doctors can't write The running joke in medical writing is that the descriptor is like 'army intelligence' - doctors can't write. WisDoc will use writing and communications specialists to convert the 'text in the boxes' into highly accessible meaningful text in conjunction with the originating specialist. Experienced literate GPs will be used to translate the professional text to the high school level consumer text. This in turn will be 'worked' by the communications experts until it is optimally presented. WisDoc in Summary The WisDoc design is simple. But it is grounded in a very extensive fundamental reexamination of the whole field of health information both professional and community. It has many unique features as a consequence. It is modular Health topics (like breast cancer or coronary artery disease) are modularized. They are divided into 16 standardized modules like genetics, pathology, diagnostics, treatment and so on, which broadly match the natural divisions of the research literature. It is completely updated on a two week cycle On a two-week cycle, the latest research, screened from all the major medical, surgical and other health professional journals is incorporated into the relevant modular areas. Thus the whole topic area is continuously updated by a minimal reconstruction of just the relevant modular components. It is a multi-specialty text The WisDoc system performs all of the multiple medical, surgical and related text collating and journal updating for the professional, combining it into a single formatted text. A single click provides the professional with everything he/she needs to be absolutely at the forefront of any field. Community text maps exactly on professional text on the same time scale WisDoc is a tightly coupled professional and community health information system. An identical topic and module system is used for the community version. This is a one to one translation, module by module, of the professional information into high school level language. The translation is provided by doctors and communications specialists and continuously updated from the professional database on the same time scale as the professional update from the research. Additional models, diagrams and analogies are provided to support the text making it particularly user friendly. WisDoc is the first professional/community common resource So again, at a single click, a community user can access the 'lay' version of the complete up to the minute professional text. The system not only solves the information search problem for professionals and the community, but very importantly it provides for the first time a common resource. A complete, shared understanding of the issues in a common language from the same resource will make a great difference to discussion and decision making. WisDoc reinforces the doctor/patient relationship The community health information site is however intended to provide renewed support for quality doctor-patient relationships by providing a common reference because of the coupled design. The medical community will have to adapt to the newly evolving cultural circumstance where patients are routinely actively involved their own management in due course. WisDoc - the de facto net standard for health information No existing health information service, either professional or community, known to us approaches these specifications. We expect WisDoc to redefine the whole field of health information and establish the de facto net standard for a coupled doctor/patient information resource. A professional user would have available two services: An inter-specialty, medical/surgical text that is within four weeks of the publication research edge - material that was published for the first time four weeks ago in, say, the New England Journal of Medicine would appear already incorporated into the text. It will be a primary specialist text and a complete update resource all in a single text. A research data base that includes: For each domain (such as breast cancer for example) the most important research and review articles ~ (50 - 300) over the last twelve months, in abstract and full text format, selected and maintained by a field specialist up to date to within two weeks of the original research publication date. One-page guides to the idiosyncrasies of researching each health topic written by field specialists. A community user: A community user will be able to call up a broad topic such as Breast Cancer and read a complete user-friendly account of the subject, in high school level English replete with models, diagrams, analogies etc. The distinguishing features of this account will be: It is a 'one to one modular translation' by doctors and communications experts of a complete up to the minute specialist level account of the topic. It will be current to within six weeks of the publication research edge, i.e., relevant substantive information distilled by a breast cancer specialist and published six weeks ago for the first time in, say, the New England Journal of Medicine would already be incorporated into the text of the article. A table summarizing the information framework for WisDoc forms appendix A.
Thumbnail More Concise The WisDoc Response (Design)
Thumbnail More Concise The WisDoc Response (Design)
Thumbnail More Concise The WisDoc Response (Design)
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