Dr Bruce McKenzie is now available for freelance consultancy as a clinical knowledge architect, addressing the unmet need for usable knowledge resources at the point-of-care in UK general practice. General practitioners (GPs) make more decisions in a day than a typical business executive, and these decisions cost not just money but potentially lives. It's challenging work, and you can but hope your decisions are based on good information. The problem is information overload and access to what you need when you need it: there's just too much and it's too hard to find in the context of a 10 minute consultation. As a GP for 10 years I can relate to this. I also have informatics knowledge and experience, and this puts me in a position to offer you solutions that are built the way a doctor would design them.
The fact is information doesn't become knowledge by itself. After careful needs assessment raw information must be broken down and reconstructed into a usable form as part of a design process that draws upon both the art and science of information architecture. In other words it's a creative process, but it also necessitates solid technical insight into the context in which a knowledge resource will be used.
With my primary care background, grasp of medical informatics, passion for writing, and practical experience in delivering concise clinical guidance for use at the point-of-care, I am now available for freelance consultancy as a clinical knowledge architect.
Experience in primary care
Ten years experience in several general practices in the UK and New Zealand has given me a practical understanding of the breadth and depth of primary care, and the opportunity to utilize a variety of decision-support tools. A healthy mix of team working and self-directed activity has afforded me insights into group dynamics without compromising my ability to work as an independent professional. An advocate for evidence-based practice, my most recent NHS position included a contracted weekly session on quality initiatives (including on the Quality & Outcomes Framework and RCGP Quality Practice Award preparation). As a nominated GP representative to the Priorities and Clinical Effectiveness Forum (PACEF) in North Derbyshire I shared my passionate views concerning the appropriate form of information destined for use at the point-of-care, instigating "bottom line" summaries in GP circulars and promoting quick-reference guideline flow charts supported by textual background (rather than the opposite).
Experience in medical informatics
As a web developer since 1994 I have a good understanding of evolving technologies used in the delivery of online content, appreciating their potential and recognizing their limitations. While the Diploma in Medical Informatics provides confirmation of my theoretical knowledge, I have considerable real-world experience in clinical knowledge architecture and in supporting practice intranets (2001–2006). As both an online information provider and consumer I understand that print and online media are not the same and that treating them as such can lessen the impact of your content. In the context of a consultation "less is more" when it comes to effective decision support.
What if you could adhere to national and local guidelines, stick to your prescribing and clinical formularies, ensure you do what counts for QOF, and indicate who is responsible for doing what? What if you could distil all these requirements into a single screen on your computer?
A particular interest, first realized in 2002, is the adaptation of evidence-based guidelines for use during the consultation. Much of the guidance available to primary care clinicians still comprises large amounts of textual information and suffers from poor accessibility as a result. During 2004–2006 part of my self-imposed remit was to distill and homogenize competing guidelines (NICE, NSF, PCT, etc.) into consultation-optimized flow charts, to integrate these with clinical terms and prescribing formularies, to take account of in-house resources and indicate areas of clinical responsibility, to ensure concordance with local secondary care clinical practices, to address quality indicators in the New GMS Contract, and to publish the result on a practice intranet as cross-referenced clickable image maps. This was no small task but completed for all the QOF clinical indicators; my ultimate vision was full clinical system integration (using XML for data exchange).
Experience in technical writing
Being first to the market in 1995 with the paperback Medicine and the Internet demonstrated my commitment and dedication to meeting deadlines (from proposal to shelf within 12 months is highly unusual for a medical textbook). I delivered two subsequent editions of this commercially successful title, further refining my literary abilities to Oxford standards and, in the third edition, my editorial skills. I continue writing for pleasure, often on technical subjects, via my weblog.
Creating knowledge from information needs an architect [© iStockPhoto]
What makes my service unique?
The combination of cross-domain knowledge and experience described above is itself a rarity. Furthermore, being independent yet able to work with the NHS gives me the clinical insight and technical flexibility to help you beyond the limitations of a "one size fits all" NHS informatics service. I don't have to deliver an "out of the box" solution and try to convince you that's what you need: you tell me what you want and I'll work with you to design it.
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