Establishing the National electronic Library for Health.

Ben Toth, JA Muir Gray, Veronica Fraser
NHS Information Authority, 19 Calthorpe Road
Birmingham - United Kingdom

Good afternoon friends and colleagues.

The National electronic Library for Health (NeLH) is a developing digital library of evidence-based health information. Its main users are healthcare professionals but it will increasingly be open to the public in the United Kingdom.

I am very pleased to be here to tell you about this programme. I bring good wishes to you from Dr Ben Toth and Dr Muir Gray.

Our paper will review the first three years of development including the policy background; funding issues; integration with existing services; content acquisition; and access management.

The presentation will focus on a number of key challenges that have faced the NeLH. These include; funding; the skills gap in the population for whom the library is intended; content purchase and access management; links with related electronic information services such as the DNER (Distributed National Electronic Resource) in the Higher Education sector; the People's Network (public library programme); NHS Direct Online and an NHS 'Virtual Classroom' for e-learning as well as the need for links with electronic health records and other projects within the NHS Information for health Strategy, and the impact of political devolution on plans for a UK wide service.

The policy background begins with an 'Information Age' government with plans to modernise and improve all its services - including health - by using information and communication technologies. This is reflected in the NHS information strategy Information for health which was published in 1998 and updated at the start of this year. This strategy includes targets for access to the internet; online appointments booking and telemedicine. The NHS Plan, published last year, and recent government statements announce the need to extend best practice throughout the health service. National programmes will be balanced by the transfer of power and resources to the NHS 'frontline' Primary Care Trusts.

The National electronic Library for Health mission is to offer fast and easy access to best current knowledge to clinicians, managers and the public. We have used the concept of a library to illustrate access to different 'floors' for clinicians and the public.

Access to licensed content is from passwords via the Athens Management System which is widely used in higher education.

The Library has a Content Development Policy and content for the Library is reviewed by a peer review group. Current content includes Clinical Evidence; The Cochrane Library; NHS Research databases;Clinical Guidelines published by the National Institute for Clinical Excellence; Evidence Base on Call and commissioned research summaries that investigate current health news stories in the popular press.

Funding for the National electronic Library is complex.

The project team had to bid against other service priorities to establish a funding base for the NeLH. Last year some funds were made available from a special Modernisation Fund. This is a crucial year for the Library as it has to complete a full business case to convince The Treasury that this is cost effective and worthwhile for the NHS budget.

The NeLH project needs to develop clear links to electronic patient records and clinical systems projects which are in their infancy. We also need to show that we can offer effective support for National Service Frameworks for Cancer, Mental Health and other NHS priorities. This requires us to know about and work with a wide range of health policy makers and professionals.
We also see it is important to develop close links with our sister project NHS Direct Online and existing NHS library and knowledge services and the developing electronic Library for Social Care. 

NeLH has links with the higher education DNER and with the People's Network for Public Libraries, as well as other national services such as the British Library, BMA and others.

NeLH has achieved a great deal, especially since the launch of the pilot service in November last year. The range of content continues to expand and the library is actively supporting clinical governance. Virtual Branch Libraries offer access to core information for specialist communities of interest. Fast links exist to NHS Direct Online, and other key sites, and there are joint programmes with NHS and other library services.

Many difficult challenges remain. The NHS does not have a consistent, universal publishing policy for its own information. Sustained funding will not be secure until the Business Case is approved. Some NHS staff are unconfident using electronic and virtual library services. Access to internet or intranet based services is not readily available to all NHS staff. Publishers, until recently, have dealt with individual libraries or area-based consortia. National purchasing presents challenges to publishers, subscription agents, and the NHS itself. Political devolution has complicated planning and service delivery on a UK wide basis. There are many, well funded, competitors keen to capture the lead in health information provision.