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INFORMATION IN PRACTICE: Trisha Greenhalgh, Jane Hughes, Charlotte Humphrey, Stephen Rogers, Deborah Swinglehurst, and Peter Martin A comparative case study of two models of a clinical informaticist service BMJ 2002; 324: 524-529 [Abstract] [Full text]

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"Clinical Informaticist Service" can contribute to best practice

Vivienne F Bernath   (5 March 2002)

Informaticist services for policy-makers: different again?

Helen Thornton-Jones, Susan Hampshaw and Andrew Taylor   (6 March 2002)

"Clinical Informaticist Service" can contribute to best practice 5 March 2002
Vivienne F Bernath, Research Officer Centre for Clinical Effectiveness, Monash Institute of Health Services Research, Clayton VIC 3168 Send response to journal: Re: "Clinical Informaticist Service" can contribute to best practice	An Australian project(1) to test the feasibility of providing evidence-based clinical literature search services in two centres, using rigorous but pragmatic methods to allow for rapid answers to clinical questions, demonstrated that such services can contribute to best practice in primary care. The service dimension as highlighted by Greenhalgh et al can be enhanced by providing broad access to the information gathered by such a service while providing a model of formulating questions and answering them with the best available evidence. Questions and answers from both Australian centres are available on their websites (2,3) and a regular series of articles featuring questions handled by the services appears in the Medical Journal of Australia as "Evidence in Action" (eg this week's article on oral contraception and migraine, 4) to facilitate access to the best available evidence relevant to general practice. Cost effectiveness is one aspect of the service dimension yet to be evaluated. 1.Del Mar CB, Silagy CA, Glasziou PP, Weller D, Spinks AB, Bernath V, Anderson JN, Hilton DJ, Sanders SL. Feasibility of an evidence-based literature search service for general practitioners. Med J Aust 2001;175:134-137. 2. http://www.spmed.uq.edu.au/quest/ 3. http://www-miph.med.monash.edu.au/CCE_GPQuestion/cgi-bin/start.asp 4. Bernath VF, Clavisi O, Anderson JN. Risk of taking oral contraceptives in patients with a history of migraine with neurological signs. Med J Aust 2002;176: 237-238.
Informaticist services for policy-makers: different again? 6 March 2002
Helen Thornton-Jones, Senior Lecturer Health Services Research Department of Public Health and Primary Care, University of Hull, Coniston House, Willerby HU10 6NS, Susan Hampshaw and Andrew Taylor Send response to journal: Re: Informaticist services for policy-makers: different again?	Editor, We welcome the paper by Greenhalgh et al (1) and were pleased to see formal evaluation of two quite different informaticist services. Our own experience in facilitating evidence-supported policy-making suggests that some of the points raised apply equally to policy as to practice, though there are additional facets to consider. Our developing approach has some commonality with both projects, but is aimed at policy-making bodies, comprising a variety of health professionals and lay representatives, rather than individuals or groups of practitioners. We formed the view that a 'laboratory test service' approach would not be appropriate in policy-making, although as an academic unit we found it intuitively attractive, at least initially. We were obliged to recognise that health policy issues rarely resolve into a 'three-stage answerable question.' Often, several questions need to be tackled simultaneously since policy makers also need to consider local processes, structures, times-scales and concerns.(2,3) The outcome then is a set of options rather than an answer. Over time we have increasingly favoured an approach closer to the Basildon model. We aim to arrive at 'best accepted wisdom' by accessing authoritative sources of pre-appraised guidance (4) particularly those whose methodological approach to evidence appraisal is both explicit and systematic. We have worked closely with local policy- making bodies and have found it helpful to design dissemination tailored to each issue. The on-going close relationship between our academic unit and service departments of the local NHS has made this possible. By way of example, during recent months, we have addressed diverse questions such as the health risks from household waste incinerators, cost -effectiveness of photodynamic therapy for macular degeneration, and the organisation of antenatal screening programmes. Our experience suggests that facilitation of evidence-based policy- making should be underpinned by an acknowledgement of the complexity of policy. We therefore must accept that we may sometimes need to compromise the 'technical quality of the answers'. For example, if a decision is needed quickly it may be appropriate to base decisions on easily accessible authoritative guidance rather than a comprehensive review of all available evidence including appraisal of primary research. We feel that the adoption of a pragmatic approach such as we have described can achieve a more systematic use of evidence than is the norm in the NHS.(5) The question of whether our approach, which focuses on the service dimension produces good policy decisions needs evaluating. The approach is now mature enough for evaluation and we believe that the two dimensions of a health informatics service as described by Greenhalgh et al will prove to be an important component of the methodology. We also agree that such an evaluation requires a developmental rather than a conventional approach to research. Helen Thornton-Jones, Senior Lecturer in Health Services Research, The University of Hull. Susan Hampshaw, Research Associate. The University of Hull Andrew Taylor, Health Economist. Effectiveness Facilitation Unit, East Riding and Hull Health Authority. References 1. Greenhalgh T, Hughes J, Humphery C et al. A comparative case study of two models of a clinical informaticist service. BMJ 2002;324:524-9 2. Dopson S, Locock L, Chambers D and Gabbay J Implementation of evidence- based medicine: evaluation of the Promoting Action on Clinical Effectiveness Programme. Journal of Health Services and Research Policy 2001;6(1):23-21. 3. Lomas J. Connecting research and policy Canadian Journal of Policy Research 2000;1:140-144 4. Thornton-Jones H, Hampshaw S, Soltani H and Madhok R. Reviewing local screening programmes- a worthwhile exercise. Journal of Clinical Governance, 2002 [in press] 5. Milbank Memorial Fund. Better Information, Better Outcomes. The use of Health Technology Assessment and Cost Effectiveness Data in Health Care Purchasing Decisions in the United Kingdom and the United States, July 2000. Available from: URL: http://www.milbank.org/000726purchasing.html [accessed September 2000] Competing interests: None declared.