A click at doctors' fingertips

MEDICAL knowledge is increasing so fast that no mere mortal can be expected to keep up with it.

GPs typically receive 28 kilos of written information every year, and an estimated 26 kilos end up, unread, in the bin. East End GP Dr Sam Everington told the Evening Standard yesterday that his daily postbag contains up to 50 letters, including some seriously weighty reading. When I received the National Service Framework for Older People, it was about 1cm thick, he says.

That needs to be read and put into practice. What happens is you end up skim-reading and trying to talk to colleagues to find out about it.

Professor John Fox, principal scientist at London s Imperial Cancer Research Fund Advanced Computation Laboratory, understands the doctors frustration.

Even the most committed professionals can not avoid gaps in their knowledge.

We need to support them.

A year ago, Fox and his colleagues set to work exploring the best ways to do just this, and the fruits of their labour a new web-site called OpenClinical has just been launched.

A main goal of OpenClinical is to demonstrate new computer-based tools which, by giving doctors access to the most up-to-date knowledge on a wide range of conditions, can support their decisionmaking. Imperial Cancer has calculated that about 16,000 lives are lost a year because the current knowledge of cancer is not being properly applied, says Fox.

There s a gap between known facts and those facts doctors have at their fingertips. Although developed in a cancer centre, Open Clinical plans to target general medical decision-making.

Part of the impetus for OpenClinical comes from the move towards evidence-based medicine (EBM), which has been making its way into medical philosophy and practice. EBM means providing care and treatment based on firm foundations of what is shown to be effective, rather than treating people through individual experience, opinion and guesswork.

But it brings with it new problems, not least distribution of knowledge. EBM has traditionally made its way to doctors via paper guidelines, books and so on, says Fox. As more evidence accumulates, we risk burying doctors under more paper that they can ever hope to read. Better systems need to be available so that they can handle the rapidly growing amount of information.

In the longer term, the OpenClinical team hopes that its technology may revolutionise our experiences of medical care. Describing a patient who visits her GP because she is worried about a breast lump, Fox says: All the information and technology is out there to assist her GP in making a highly accurate decision about whether an immediate referral for a mammogram is needed. If the answer is yes, the appointment could be made via a direct link to the relevant hospital.

The patient would leave the surgery with the appointment in her diary as well as comprehensive information about her condition.

People are increasingly taking their health into their own hands.

The NHS has launched a website (NHS Direct) for advice. OpenClinical has been created for medical professionals in particular, although anyone with access to the internet can visit the website.

openclinical is on www.openclinical.org Imperial Cancer Research Fund website: www.icrf.net NHS Direct is on www.nhsdirect.nhs.uk

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