Characteristics of personal health records: findings of the Medical Library Association/National Library of Medicine Joint Electronic Personal Health Record Task Force

Objectives:

The Medical Library Association (MLA)/National Library of Medicine (NLM) Joint Electronic Personal Health Record Task Force examined the current state of personal health records (PHRs).

Methods:

A working definition of PHRs was formulated, and a database was built with fields for specified PHR characteristics. PHRs were identified and listed. Each task force member was assigned a portion of the list for data gathering. Findings were recorded in the database.

Results:

Of the 117 PHRs identified, 91 were viable. Almost half were standalone products. A number used national standards for nomenclature and/or record structure. Less than half were mobile device enabled. Some were publicly available, and others were offered only to enrollees of particular health plans or employees at particular institutions. A few were targeted to special health conditions.

Conclusions:

The PHR field is very dynamic. While most PHR products have some common elements, their features can vary. PHRs can link their users with librarians and information resources. MLA and NLM have taken an active role in making this connection and in encouraging librarians to assume this assistance role with PHRs.

Highlights

• A variety of personal health records (PHRs) exist with some tied to medical health records and others offered as standalone products.
• Librarians can be connected to PHR users through inclusion of an assistance statement in PHRs.
• PHRs offer librarians another means of providing consumers with quality health information.

Implications

• PHR user support is a new role for medical librarians.
• Medical librarians need to be proactive in their communities to educate consumers about PHRs.
• Given the dynamic nature of this market, medical librarians should make a concerted effort to stay abreast of trends in this area.

     

Development of a clinical information tool for the electronic medical record: a case study

Question:

What is the process of developing a clinical information tool to be embedded in the electronic health record of a very large and diverse academic medical center?

Setting:

The development took place at the University of Pittsburgh Health Sciences Library System.

Method:

The clinical information tool developed is a search box with subject tabs to provide quick access to designated full-text information resources. Each subject tab offers a federated search of a different pool of resources. Search results are organized “on the fly” into meaningful categories using clustering technology and are directly accessible from the results page.

Results:

After more than a year of discussion and planning, a clinical information tool was embedded in the academic medical center''s electronic health record.

Conclusion:

The library successfully developed a clinical information tool, called Clinical-e, for use at the point of care. Future development will refine the tool and evaluate its impact and effectiveness.     

A validated search assessment tool: assessing practice-based learning and improvement in a residency program

Objective:

The objective of this study was to validate an assessment instrument for MEDLINE search strategies at an academic medical center.

Method:

Two approaches were used to investigate if the search assessment tool could capture performance differences in search strategy construction. First, data from an evaluation of MEDLINE searches from a pediatric resident''s longitudinal assessment were investigated. Second, a cross-section of search strategies from residents in one incoming class was compared with strategies of residents graduating a year later. MEDLINE search strategies formulated by faculty who had been identified as having search expertise were used as a gold standard comparison. Participants were presented with a clinical scenario and asked to identify the search question and conduct a MEDLINE search. Two librarians rated the blinded search strategies.

Results:

Search strategy scores were significantly higher for residents who received training than the comparison group with no training. There was no significant difference in search strategy scores between senior residents who received training and faculty experts.

Conclusion:

The results provide evidence for the validity of the instrument to evaluate MEDLINE search strategies. This assessment tool can measure improvements in information-seeking skills and provide data to fulfill Accreditation Council for Graduate Medical Education competencies.

Highlights

• The University of Michigan MEDLINE Search Assessment tool can be used to assess search skills in residency education.
• Five elements were identified as critical elements in the development of an effective MEDLINE search strategy: inclusion of all search concepts, appropriate use of Medical Subject Headings, appropriate use of search limits, successful combination of all concepts, and search efficiency.

Implications

• This validated assessment tool can serve as an effective means to measure improvements in residents'' information-seeking skills and provide data to fulfill Accreditation Council for Graduate Medical Education competencies.

     

The Emerging Informationist Specialty: A Systematic Review of the Literature

Purpose:

A systematic literature review was conducted to synthesize what is known about informationists, highlight program models, and suggest areas for future research.

Methods:

Articles retrieved through database searching were reviewed for relevance. Informationist case reports were identified and coded according to an attributes checklist. Data from other retained publications were synthesized under broad themes. The few research studies found were reviewed for level of evidence.

Results:

Of 113 papers reviewed, the study identified 7 classic and 8 emerging informationist programs. Two major models are apparent, clinical and research, with priorities differing according to program maturity. The literature synthesis also brought together current thinking about informationist qualifications; practice roles; setting characteristics; education and training; organizational, programmatic, and service provider success factors; and challenges and barriers. Program outcomes to date are reported, and future research topics suggested. Specific findings will assist informationist program planners.

Conclusions:

While the informationist concept remains in the early adopter stage, it appears that domain knowledge, continuous learning, and embedding (working in context) are essential to success. The need for librarians to transition to greater specialization and libraries to emphasize customized service was underscored. A research agenda focused on information management, dissemination, behaviors, and economics is proposed.

Highlights

• After years of emphasizing the generalist librarian, health sciences librarians must become more specialized, paralleling the health care environment in which they work.
• An embedded informationist is more likely to achieve credibility, acceptance, and sustainability than an impersonal information service provided at a distance.
• Subject expertise is essential for the informationist.
• Model informationist programs with the greatest stability are library funded.
• Because informationist programs are inherently targeted to small groups, multisite studies are necessary to achieve robust evaluation.

Implications

• A library starting an informationist program should review existing models, identify local needs, set program objectives, and then select the most appropriate approaches for its users.
• Programmatic emphasis should be placed on both technical and service excellence.
• Organizational commitment is needed for knowledge integration into practice and for the informationists'' lifelong learning.

     

Current status of information literacy instruction practices in medical libraries of Pakistan

Objectives:

The research explored the current practices of information literacy (IL) instruction in medical libraries of Pakistan.

Methods:

A semi-structured questionnaire was mailed to the head librarians of all 114 academic medical libraries in Pakistan. It investigated the types of IL instruction provided, topics covered, methods of delivery and assessment, level of integration in the curriculum, and level of collaboration with teaching staff.

Results:

The study revealed that 74% of the respondents had offered some types of IL instruction in their institutions during the previous year, ranging from library orientation to research-level skills. IL instruction is typically only offered to new students or first-time library users or on demand. A majority of the respondents developed IL instruction programs without faculty involvement. Librarians were primarily responsible for offering IL instruction in medical institutions. Face-to-face instruction in computer labs or lecture halls and individual instruction at reference desks were identified as the most common IL instruction delivery methods. The data indicated that oral feedback, written feedback, and searching in a computer lab were the most popular assessment methods that medical librarians used.

Conclusion:

IL instruction activities in medical libraries of Pakistan are in their infancy. Medical librarians also lack systematic approaches to IL instruction.

Implications:

Medical librarians need to develop educational partnerships with faculty for integrating IL instruction into the mainstream curriculum.     

Copyright information queries in the health sciences: trends and implications from the Ohio State University

Objective:

This paper presents the results of data gathered on copyright questions asked at an academic health sciences library.

Methods:

Collected data include questioner''s status or discipline, the subject of the questions, the types of activities that the questioners were engaged in, the communication mode, and the length of time it took to answer the questions.

Results:

Overall results showed most questions were about permissions. Staff asked the most questions, followed by faculty and students.

Conclusions:

Copyright education is needed at universities, and further analysis of queries will determine the direction of the education.     

Expanding roles in a library-based bioinformatics service program: a case study

Question:

How can a library-based bioinformatics support program be implemented and expanded to continuously support the growing and changing needs of the research community?

Setting:

A program at a health sciences library serving a large academic medical center with a strong research focus is described.

Methods:

The bioinformatics service program was established at the Norris Medical Library in 2005. As part of program development, the library assessed users'' bioinformatics needs, acquired additional funds, established and expanded service offerings, and explored additional roles in promoting on-campus collaboration.

Results:

Personnel and software have increased along with the number of registered software users and use of the provided services.

Conclusion:

With strategic efforts and persistent advocacy within the broader university environment, library-based bioinformatics service programs can become a key part of an institution''s comprehensive solution to researchers'' ever-increasing bioinformatics needs.     

The Health Information Literacy Research Project

Objectives:

This research studied hospital administrators'' and hospital-based health care providers'' (collectively, the target group) perceived value of consumer health information resources and of librarians'' roles in promoting health information literacy in their institutions.

Methods:

A web-based needs survey was developed and administered to hospital administrators and health care providers. Multiple health information literacy curricula were developed. One was pilot-tested by nine hospital libraries in the United States and Canada. Quantitative and qualitative methods were used to evaluate the curriculum and its impact on the target group.

Results:

A majority of survey respondents believed that providing consumer health information resources was critically important to fulfilling their institutions'' missions and that their hospitals could improve health information literacy by increasing awareness of its impact on patient care and by training staff to become more knowledgeable about health literacy barriers. The study showed that a librarian-taught health information literacy curriculum did raise awareness about the issue among the target group and increased both the use of National Library of Medicine consumer health resources and referrals to librarians for health information literacy support.

Conclusions:

It is hoped that many hospital administrators and health care providers will take the health information literacy curricula and recognize that librarians can educate about the topic and that providers will use related consumer health services and resources.

Highlights

• Health care providers responded positively to a health information literacy curriculum offered by librarians and to related resources and services, namely MedlinePlus and the information referral system known as Information Rx.
• Participation in a curriculum increased health care providers'' knowledge of health information literacy, awareness of available consumer health information, and referral of patients to the library for additional assistance.
• Librarian involvement in health information literacy increased the profession''s visibility and perceived value.

Implications

• Consumer health information services and resources offered by librarians can improve the health information literacy skills of health care providers and their patients.
• Training by librarians can increase knowledge of the importance of health information literacy and usage of MedlinePlus and Information Rxs.
• Hospital-based administrators and health care providers can be champions in support of health information literacy and consumer health information services offered by libraries.

     

Time to rethink the role of the library in educating doctors: driving information literacy in the clinical environment

Question:

Can information literacy (IL) be embedded into the curriculum and clinical environment to facilitate patient care and lifelong learning?

Setting:

The Australian School of Advanced Medicine (ASAM) provides competence-based programs incorporating patient-centred care and lifelong learning. ASAM librarians use outcomes-based educational theory to embed and assess IL into ASAM''s educational and clinical environments.

Methods:

A competence-based IL program was developed where learning outcomes were linked to current patients and assessed with checklists. Weekly case presentations included clinicians'' literature search strategies, results, and conclusions. Librarians provided support to clinicians'' literature searches and assessed their presentations using a checklist.

Main Results:

Outcome data showed clinicians'' searching skills improved over time; however, advanced MEDLINE searching remained challenging for some. Recommendations are provided.

Conclusion:

IL learning that takes place in context using measurable outcomes is more meaningful, is enduring, and likely contributes to patient care. Competence-based assessment drives learning in this environment.     

Information-seeking behavior and the use of online resources: a snapshot of current health sciences faculty

Objective:

The research assesses the information-seeking behaviors of health sciences faculty, including their use of online databases, journals, and social media.

Methodology:

A survey was designed and distributed via email to 754 health sciences faculty at a large urban research university with 6 health sciences colleges.

Results:

Twenty-six percent (198) of faculty responded. MEDLINE was the primary database utilized, with 78.5% respondents indicating they use the database at least once a week. Compared to MEDLINE, Google was utilized more often on a daily basis. Other databases showed much lower usage.

Conclusions:

Low use of online databases other than MEDLINE, link-out tools to online journals, and online social media and collaboration tools demonstrates a need for meaningful promotion of online resources and informatics literacy instruction for faculty.

Implications:

Library resources are plentiful and perhaps somewhat overwhelming. Librarians need to help faculty discover and utilize the resources and tools that libraries have to offer.     

The effectiveness of the practice of correction and republication in the biomedical literature

Objective:

This research measures the effectiveness of the practice of correction and republication of invalidated articles in the biomedical literature by analyzing the rate of citation of the flawed and corrected versions of scholarly articles over time. If the practice of correction and republication is effective, then the incidence of citation of flawed versions should diminish over time and increased incidence of citation of the republication should be observed.

Methods:

This is a bibliometric study using citation analysis and statistical analysis of pairs of flawed and corrected articles in MEDLINE and Web of Science.

Results:

The difference between citation levels of flawed originals and corrected republications does not approach statistical significance until eight to twelve years post-republication. Results showed substantial variability among bibliographic sources in their provision of authoritative bibliographic information.

Conclusions:

Correction and republication is a marginally effective biblioremediative practice. The data suggest that inappropriate citation behavior may be partly attributable to author ignorance.

Highlights

• The citation of flawed articles occurs at a rate nearly equal to that of corrected versions.
• The practice of correction and republication is only marginally effective and does not prevent the continued citation of flawed articles post-correction, with the analysis finding only a slight reduction in the citation of flawed articles after publication of the corrected version.
• Neither MEDLINE nor Web of Science consistently alert users when dealing with corrected and republished literature.

Implications

• The practice of correction and republication would be more effective if prominent sources of bibliographic information were more consistent in providing users with information about the status of corrected and republished articles and the existence of post-publication modifications to the literature.
• It is incumbent upon the scientific community to raise the profile of post-publication changes to the literature to prevent the wasteful and potentially tragic consequences of scientists and medical professionals applying flawed information. Failure to do so will surely result in a reduction of public trust in the reliability of the scientific literature and its users.

     

Eliminating traditional reference services in an academic health sciences library: a case study

Question:

How were traditional librarian reference desk services successfully eliminated at one health sciences library?

Setting:

The analysis was done at an academic health sciences library at a major research university.

Method:

A gap analysis was performed, evaluating changes in the first eleven months through analysis of reference transaction and instructional session data.

Main Results:

Substantial increases were seen in the overall number of specialized reference transactions and those conducted by librarians lasting more than thirty minutes. The number of reference transactions overall increased after implementing the new model. Several new small-scale instructional initiatives began, though perhaps not directly related to the new model.

Conclusion:

Traditional reference desk services were eliminated at one academic health sciences library without negative impact on reference and instructional statistics. Eliminating ties to the confines of the physical library due to staffing reference desk hours removed one significant barrier to a more proactive liaison program.     

Mapping the literature of health care chaplaincy

Objective:

This study examined citation patterns and indexing coverage from 2008 to 2010 to determine (1) the core literature of health care chaplaincy and (2) the resources providing optimum coverage for the literature.

Methods:

Citations from three source journals (2008–2010 inclusive) were collected and analyzed according to the protocol created for the Mapping the Literature of Allied Health Professions Project. An analysis of indexing coverage by five databases was conducted. A secondary analysis of self-citations by source journals was also conducted.

Results:

The 3 source journals—Chaplaincy Today, the Journal of Health Care Chaplaincy, and the Journal of Pastoral Care and Counseling—ranked as the top 3 journals in Zone 1 and provided the highest number of most frequently cited articles for health care chaplaincy. Additional journals that appeared in this highly productive zone covered the disciplines of medicine, psychology, nursing, and religion, which were also represented in the Zones 2 and 3 journals. None of the databases provided complete coverage for the core journals; however, MEDLINE provided the most comprehensive coverage for journals in Zones 1 and 2, followed by Academic Search Complete, CINAHL, PsycINFO, and ATLA. Self-citations for the source journals ranged from 9% to 16%.

Conclusions:

Health care chaplaincy draws from a diverse body of inter-professional literature. Libraries wishing to provide access to journal literature to support health care chaplaincy at their institutions will be best able to do this by subscribing to databases and journals that cover medical, psychological, nursing, and religion- or spirituality-focused disciplines.

Highlights

• Health care chaplaincy is a broadly inter-professional field that draws from and contributes to medical, nursing, psychological, and religion or spirituality literature.
• Two of the three source journals were sponsored by professional chaplaincy organizations.
• Journals and books were cited with almost equal frequency.

Implications

• For full coverage of the health care chaplaincy literature, librarians should consider searching in databases beyond MEDLINE, for example, CINAHL and Academic Search Complete, to assure comprehensive coverage.
• Health care chaplaincy researchers and educators considering publication will find the study useful for identifying relevant journals from related disciplines.

     

An extensible and successful method of identifying collaborators for National Library of Medicine informationist projects

Question/Purpose

The New York University (NYU) Health Sciences Library used a new method to arrange in-depth discussions with basic science researchers. The objective was to identify collaborators for a new National Library of Medicine administrative supplement.

Setting

The research took place at the NYU Health Sciences Library.

Methods

Using the National Institutes of Health (NIH) RePORTER, forty-four researchers were identified and later contacted through individualized emails.

Results

Nine researchers responded to the email followed by six in-person or phone discussions. At the conclusion of this process, two researchers submitted applications for supplemental funding, and both of these applications were successful.

Conclusions

This method confirmed these users could benefit from the skills and knowledge of health sciences librarians, but they are largely unaware of this.     

Making the Critical Appraisal for Summaries of Evidence (CASE) for evidence-based medicine (EBM): critical appraisal of summaries of evidence

Objectives:

Standards for evaluating evidence-based medicine (EBM) point-of-care (POC) summaries of research are lacking. The authors developed a “Critical Appraisal for Summaries of Evidence” (CASE) worksheet to help assess the evidence in these tools. The authors then evaluated the reliability of the worksheet.

Methods:

The CASE worksheet was developed with 10 questions covering specificity, authorship, reviewers, methods, grading, clarity, citations, currency, bias, and relevancy. Two reviewers independently assessed a random selection of 384 EBM POC summaries using the worksheet. The responses of the raters were then compared using a kappa score.

Results:

The kappa statistic demonstrated an overall moderate agreement (κ = 0.44) between the reviewers using the CASE worksheet for the 384 summaries. The 3 categories of evaluation questions in which the reviewers disagreed most often were citations (κ =  0), bias (κ = 0.11), and currency (κ = −0.18).

Conclusions:

The CASE worksheet provided an effective checklist for critically analyzing a treatment summary. While the reviewers agreed on worksheet responses for most questions, variation occurred in how the raters navigated the tool and interpreted some of the questions. Further validation of the form by other groups of users should be investigated.

Highlights

• Few critical appraisal tools have been evaluated with inter-rater reliability testing.
• The ways that users of evidence-based medicine (EBM) point-of-care (POC) tools interpret how to appraise an evidence summary—particularly when defining the grading of evidence, currency, and bias—may vary even when a standard evaluation sheet is used.
• The Critical Appraisal for Summaries of Evidence (CASE) worksheet had a moderate level of inter-rater reliability, similar to previous evaluative studies of critical appraisals tools.

Implications

• Medical librarians can develop tools useful for librarians, students, and clinicians to guide them in appraising clinical evidence summaries.
• The CASE worksheet can be a valuable tool to consider the quality of individual evidence summaries and to see patterns of overall quality in EBM POC tools.

     

Expanding services in a shrinking economy: desktop document delivery in a dental school library

Question:

How can library staff develop and promote a document delivery service and then expand the service to a wide audience?

Setting:

The setting is the library at the Indiana University School of Dentistry (IUSD), Indianapolis.

Method:

A faculty survey and a citation analysis were conducted to determine potential use of the service. Volume of interlibrary loan transactions and staff and equipment capacity were also studied.

Main results:

IUSD Library staff created a desktop delivery service (DDSXpress) for faculty and then expanded the service to practicing dental professionals and graduate students. The number of faculty using DDSXpress remains consistent. The number of practicing dental professionals using the service is low. Graduate students have been quick to adopt the service.

Conclusion:

Through careful analysis of capacity and need for the service, staff successfully expanded document delivery service without incurring additional costs. Use of DDSXpress is continually monitored, and opportunities to market the service to practicing dental professionals are being investigated.     

Starting the data conversation: informing data services at an academic health sciences library

Objective

The research obtained information to plan data-related products and services.

Methods

Biomedical researchers in an academic medical center were selected using purposive sampling and interviewed using open-ended questions based on a literature review. Interviews were conducted until saturation was achieved.

Results

Interview responses informed library planners about researchers’ key data issues.

Conclusions

This approach proved valuable for planning data management products and services and raising library visibility among clients in the research data realm.