Simplicity is a virtue

Back in June, these guiding principles helped the interactive specialist pharmaceutical information resource win PPA Business Intelligence Product of the Year.

The Royal Pharmaceutical Society (RPS), the professional membership body for pharmacists and pharmacy students, has been publishing information for pharmacists since 1841 – though it was only in 1988 that the RPS was granted the title ‘Royal’.

Its publishing arm, Pharmaceutical Press (PP), focuses principally on publishing independent information relating to the design, manufacture, and therapeutic use of medicines and also the professional concerns of those working to ensure their safe administration and use.

Today, PP has a comprehensive range of print and digital resources spanning more than 150 different titles drawing on RPS research and influence.

Its internationally recognised titles include Martindale: The Complete Drug Reference and Stockley’s Drug Interactions.

Its other products and services include the British National Formulary (BNF) – the bible of all the UK’s licensed medicines for the drug management of common diseases published jointly with the BMJ Group, BNF for Children, and MedicinesComplete.

Launched in 2004 to provide quick and easy access to core and specialist pharmaceutical resources at the point of care, with knowledge and guidance regularly updated, MedicinesComplete was re-launched in its current form in 2018.

Three years earlier, Jeremy Macdonald had joined from Macmillan Science & Education, where he was head of platform operations, after previously spending eleven years at Nature Publishing Group, where he was associate director, platform development.

And high on his to do list on arriving at PP as the publishing division’s Director of Technology (before his role was expanded society-wide) was to re-build the MedicinesComplete platform with the help of the 18-strong product development team he built in-house.

“Looking back, it’s still what I’m most proud of: the availability (of MedicinesComplete), the stability of it, the infrastructure of it. It sits there, is used every day by a lot of people in a real-world care setting,” he says.

“The quality of the code the team of developers put together and the AWS infrastructure hosting it – which is cloud-based – has been great.”

MedicinesComplete is now the definitive online resource for drug and healthcare information, providing instant access to more than 650,000 pages of up-to-date, quickly searchable drug information from trusted resources around the world.

With its extensive library of publications – including the BNF and Martindale, and an interactions checker powered by Stockley's Drug Interactions – it supports pharmaceutical decision-making by people working in healthcare, academia, and industry.

A subscription-based product, the platform has a mix of users.

Group subscriptions are sold to private pharmacies, such as Boots. There are larger deals with NHS Trusts and smaller ones in other healthcare related settings. Through a contract with NICE, meanwhile, other healthcare workers can access BNF without the rest of the platform’s content.

It’s very easy when building a platform like this to fall into a trap of over engineering it.

Key features

Scale of essential content and user experience are MedicinesComplete’s two key USPs, Macdonald says, highlighting a couple of features.

“One is search. Enter a drug name and you get dose information presented directly within the search results, making it fast and easy,” he explains.

“Another is our checkers. MedicinesComplete’s adverse drugs reaction checker, for example, allows the user to quickly see if they prescribe drug A to a patient how it will interact if the patient is already taking drug B.”

It’s not just about data, or functionality, Macdonald continues: “It’s also about the design – the way information is presented – and the user experience, which must be fast and simple as it is happening at the point of care.”

Regularly updating information when it needs updating and enhancing services in direct response to audience need are important guiding principles.

In 2020, for example, a new product called Critical Illness was added to the platform – initially, focused on Covid-19 care.

“We launched it in beta form in the May with a dozen or so drugs on it to support the critical care of patients with Covid, before a full launch at the end of last year,” Macdonald explains. As it evolves, it will expand beyond coronavirus treatments to offer wider critical illness care information.

As a platform, MedicinesComplete is entirely content-driven, which has posed Macdonald and his developers, who work hand in hand with PP’s product team, a variety of challenges.

“The data structure – and the meta data, and the info held within the products – is key and what drives the functionality and the presentation. The technology challenges are around how we maintain that data,” he continues.

On the platform are a number of publications, some of which the RPS owns. But third-party data under licence is also bought in. With a mix in content, multiple data sources, and a variety of data structures and types of data, the challenge is in presenting it all in a logical and coherent way.

One issue has been how best to accommodate the mix of longer-form content with practical short-form information – such as dosage, which is database-driven.

Another has been accommodating the controlled vocabularies used by manufacturers to describe a drug, its uses, and how it should be prescribed. Then there’s responding to the daily flow of new drugs licenced or withdrawn, constant clinical trials, and continuous updating of knowledge daily.

“We do use modules we will license or buy or use open-source software. But it’s been about putting it all together to create a pipeline ourselves to put all that content through because, as our content and data is unique, there is no appropriate CMS out there,” Macdonald says.

“But as we’re always adding new and maintaining existing content, it’s very much database, not journal, publishing.”

Considerable scope remains for further growth and development, he believes. But while growing numbers, including subscribers and dwell time, are standard metrics – and measures of success – the nature of MedicinesComplete means its future evolution will be very much on its own terms.

“More users is always good. This is a business information tool, there is a finite universe for it, and – as it is not for the lay person to use – the total number we could ever achieve is in a sense fixed. But while it’s good to increase numbers, it’s not the main driver,” Macdonald observes.

“We are a not-for-profit organisation. At the same time, we need to be sustainable and commercially viable. But that has to be within the context of the audiences we serve.”

When it comes to time spent on the platform, for example, as it’s a point of care tool, in and out in a second is a tick in the box.

As it’s a point of care tool, in and out in a second is a tick in the box.

Areas to work on

“But what we do need to grow is user workflows, user interaction, and user experience that allows the clinicians that use it quick, easy, and efficient access to the information they need,” he says.

Other areas with scope for expansion include tools – in particular, building on MedicinesComplete’s checkers, which are already proven to add real value – and harnessing new and evolving technologies.

Macdonald cites latest hosting and infrastructure technologies offering alternatives to running servers 24/7, which are more sustainable as they use less power, as one area of interest. Another is voice.

“In business information, the idea of asking a natural language question and hearing the answer spoken back whatever device you use is better than having to key in the name of a drug using a computer keyboard,” he notes.

“And we’re heading that way, though we are not there yet. Nor do we have how to apply it commercially yet worked out.”

Whatever the next step, however, Macdonald advocates the importance of keeping thing simple.

“It’s very easy when building a platform like this to fall into a trap of over engineering it. A couple of years in, I can see there are areas that in a perfect world we might have done slightly differently, and most would fall under the category of perhaps we could have made it simpler,” he admits.

“When the content is complex, occasionally that complexity can make you fall into thinking the system that supports it has to be complex. But this isn’t always the case.”

As for many information publishers, identity and access management remain a challenge, Macdonald continues.

“In the B2C world, the many different accounts we have can make identity management challenging – should you log in using your Facebook, or Google, or LinkedIn? In B2B, federated access adds even greater complexity,” he observes.

“How do you give an organisation access in such a way that its users can access your platform sitting at home as easily as when they are sitting in an office?”

It’s a challenge that’s not going away.

“We get it to work, it does work, but it can be complicated. I don’t have an ideal solution quite yet. But the right solution will depend on your business model. If you can keep your business model simple, that will help your access model,” Macdonald adds.

“And the same applies to your presentation, too. Look at MedicinesComplete and the user interface is very simple.”

His approach, he says, has got simpler over time.

“I believe in taking agile principles around minimum viable products and making sure we hear what the customer wants to do and deliver that, rather than overweighting it with lots of things. It’s an important lesson, I think, and one I’ve learned along the way.”