Hospital librarians are asking how they can show their value to administration and how they can show that they are more than just the keepers of the books. The answer is to branch out and get out of the library and do something that is related to the library but is not always thought of by others. Participating with EHR team to provide information to caregivers is a great example. This webinar not only will discuss librarians, EHRs and Infobuttons, but it will also highlight successful approaches for getting relevant information into the EHR and librarians can round with caregivers to help at the point of care.
Not only is this webinar interesting but it is also FREE! So you have little to lose by attending it.
Title: Adding Value to EHRs: Librarians and Infobuttons
Time: March 19, 2014, 10:00 – 11:30 am EDT.
Course length: 1.5 hours
(description from the NN/LM NER website)
This webinar is being planned as the first in a series sponsored by the NN/LM, NER on ways librarians can add value to electronic health records.
Additional webinars are in development. The overall goal of this webinar is to give medical librarians an understanding of clinical decision support mechanisms in electronic health records (EHRs) and to increase awareness of the ways that librarians can contribute. An understanding of the ways that library resources can be integrated into clinical decision support will empower librarians to pursue this in their own institutions.
Guilherme Del Fiol, MD, PhD, University of Utah, School of Medicine will present results of a systematic review on clinical questions raised by clinicians and tools that help answer these questions by integrating EHR systems with online knowledge resources. He will also discuss how these tools are being disseminated via the “HL7 Context-Aware Knowledge Retrieval Standard” (a.k.a., Infobutton Standard) and the EHR Meaningful Use certification program.
Taneya Koonce, MSLS, MPH, Eskind Biomedical Library will share the Eskind Biomedical Library’s successful approaches for integrating highly relevant evidence into the institution’s electronic medical record, outpatient ordering systems, and online patient portal.
Lauren Yaeger, MA, MLIS, St. Louis Children’s Hospital Medical Library will talk about clinical librarianship/rounding with the patient care team, Evidence Based Medicine Quality Initiative Project with the residents, and integrating clinical decision support at the point of care.Share on Facebook
(cross posted in a lot of places)
Virtual Projects for JMLA Column by March 15, 2014
The Journal of the Medical Library Association (JMLA) Virtual Projects Committee is seeking innovative and notable projects for the upcoming JMLA Virtual Projects column. The annual column which was launched in October 2013 (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3794676/) focuses on library virtual spaces that extend the library “presence” outward to support users in their digital spaces, wherever and whenever needed.
The JMLA welcomes submissions of recent projects for the Virtual Projects column that will be published October 2014. To be considered for this column, please submit a 200 word abstract of your virtual project or a link to your project web page that describes the project and why it is innovative/notable. Send your submissions to Susan Lessick, AHIP, FMLA, email@example.com, by MARCH 15, 2014.
Some examples of virtual library projects :
- projects that demonstrate the integration of evidence and/or digital content and library services into the institution’s Electronic Health Record (EHR) as part of the treatment and care process
- projects related to providing new technologies, such as libraries providing collections and tools to support 3D printing or offering 3D services (‘makerspaces’)
- projects that improve the quality of the library’s web presence through the implementation of a new web design, feature, or tool, such as animation, user interactivity or webpage/site builders
- projects that facilitate information discovery and content delivery (e.g, use of web-scale discovery or knowledge bases)
Please consider sharing your knowledge and experiences with implementing virtual projects in your library to inspire and encourage your peers, partners, and communities!
JMLA Virtual Projects Committee:
Janis Brown, AHIP
Michelle Kraft, AHIP
Susan Lessick, AHIP, FMLA
Elizabeth Whipple, AHIP
I stumbled across this blog post a week ago and thought it was a wonderful example of the way social media can be used to better biomedical science.
The New England Journal of Medicine published an article in June on the prevention of MRSA in the ICU. The study was very large, 74,256 patients, and the results looked impressive, BUT nobody could get the stats didn’t add up. The numbers given in the published paper didn’t correlate with the Number-Needed to Treat (NNT)
A blog post on Intensive Care Network posted the following about the stats in the NEJM article:
ARE THE STATS CORRECT?
We were hashing this out in our journal club, but could not get the stats to add up.
If you can PLEASE COMMENT HERE!
The NNT’s of 54 and 181 seem impossibly small, with huge clinical implications.
Please try it yourself; look at Table 3. Frequency and Rates of Outcomes during the Baseline and Intervention Periods, According to Study Group
With bloodstream infection from any pathogen, the Group 1 (standard care) number of events per 1000 patient days is 4.1. With Group 3, the number of events is 3.6 per 1000 patients days. Even taking change from baseline into account and assuming these NNTs have been calcuated AFTER randomization, between Group 1 and Group 3, we get nowhere close to their NNT’s.
PLEASE have a go and see if you can match their NNT’s.
IF you can’t there is a serious problem, with practice changing implications.
It’s too late to write letters to the NEJM, so a robust discussion in a peer reviewed forum seems a good way to go.
The authors of blog post intention was to discuss the problem in “a peer reviewed forum” and according to them “there was lots of insightful commentary from around the globe.”
The fact that they were able to discuss problem with others around world is big but not unheard of, more and more scientists are discussing issues online. To me the biggest thing is that the paper’s lead author, Susan Huang engaged in a discussion with the social media reviewers with a “prompt and gracious reply” agreed the published calculation was an error and showed “true scientific and academic integrity by contacting the NEJM as soon as there was a suggestion that the stats were incorrect.” NEJM responded by publishing an correction to the paper.
It is very cool how scientists discussed online a paper’s validity and work together to essentially provide world wide peer review. However, what I find even cooler is that the author was engaged with the social media process AND a respected journal addressed and responded to the findings. This is an example of everything that is right with social media and professional communication. It will be interesting to see if we will see more of this type of world peer review in the future especially now that PubMed Commons can also foster this kind of scientific inquiry and discussion.
NEJM is a big journal with lots of very smart authors contributing papers that are subjected to very peer reviewers, but still there can be mistakes. World peer review via social media could help improve the process. One question I keep wondering is, if we have this type of world peer review, could this cut down on the academic fraud that sometimes eludes the careful eyes of publishers’ peer reviewers? What would have happened had Wakefield’s fraudulent study linking vaccines and autism (published in 1998) been published today? Would that paper have had a chance to make it the general public’s consciousness and be as unfortunately influential as it still is today?
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American Libraries Live will be hosting a panel discussion on the challenges and changes within the libraries for the near and distant future. It is Thursday January 9, 2014 at 2:00-3:00 Eastern. It is FREE to register and “attend” the discussion.
David Lee King, digital branch and services manager at the Topeka & Shawnee County Public Library will lead the panel which also includes:
- Marshall Breeding, Library Technology Consultant, Speaker and Author
- Buffy Hamilton, Librarian at Norcross High School in metropolitan Atlanta, Library Technology Writer and Speaker
- Bohyun Kim, Digital Access Librarian at Florida International University Medical Library
- Joseph Murphy, Director of Library Futures, Innovative Interfaces
Register for this episode so you get email reminders at http://goo.gl/1p5dpV .
Preregistration is not required to attend. You can also attend by simply going to the site at the time of the event. If you’re unable to attend live, it will be recorded and available at http://www.americanlibrarieslive.org shortly afterwards.
Innovative Interfaces is sponsoring this episode. AL Live is the popular free streaming video broadcast from American Libraries, covering library issues and trends in real time as you interact with hosts via a live chat and get immediate answers to your questions. With the help of real-time technology, it’s like having your own experts on hand. Find out more, including how to catch upcoming episodes, at http://www.americanlibrarieslive.org .
Future 2014 broadcasts will be:
- February 13: The Library Website
- March 13: E-Books: The Present and Future
- April 10: Copyright Conundrum
Sounds interesting. While they don’t have an medical librarians, I’m sure there will be something that will also apply to us. Since our ILS is an Innovative Interfaces system, I am curious as to what Joseph Murphy of Innovative has to say. I often think integrated library systems including Innovative’s are overly complicated and fail to address typical user needs. I am also interested in the March 13th E-Books discussion but I fear this will be more public library related and less related to the unique mess the medical publishers have created.
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Join us tomorrow for what is sure to be a lively discussion on killing sacred library cows on #medlibs this Thursday at 9pm Eastern.
As I mentioned in my post on the #medlibs blog…
The library environment has changed drastically and is continuing to do so. The library of 5 years ago is different from the library today. For example, the iPhone had just been released, there were no iPads and the idea of a “downloadable” ebook had just been introduced by Amazon Kindle. There were a very limited number of Kindle and certainly not intended for medicine. Yet many of us are doing the same things we did as librarians 5, 10, 15, 20 yrs ago. We were stretched thin back then, so there is no way we can now add things to our repertoire without giving up something in return. We must look at what we do in our own libraries and evaluate whether it is necessary, whether it helps our patrons or helps us. To really evaluate our services we need to look at EVERYTHING including the sacred cows of the library. We need to ask ourselves, do we need to check in journals, catalog books, make copies, eliminate the reference desk, fuss with circulation, etc. The right answers will depend on the library. A large academic library might need to still do cataloging but does a small solo hospital library with 4 shelves (not ranges) really need a catalog system much less spend time cataloging books? Some of these ideas are dangerous and even somewhat heretical librarian thinking, but I feel we need to discuss them. For more background on sacred cows and heretical librarian thoughts check out my summary of my keynote address I gave at the Midwest Chapter annual meeting.
We need to look at, evaluate and slaughter some sacred library cows. IT makes no sense for us to spend our time doing things that are no longer relevant or used by our patrons. That isn’t to say that we should have never done them. Everything has its time and place. It might be hard to give up, but we can’t just do things because we always have. We need to think like our patrons and for many of us that means completely taking off our librarian hat and looking at ourselves from a patrons view point. That may mean we come up with answers that are uncomfortable, that borderline on librarian heresy. But that is what is needed.
This Thursday’s #medlibs discussion at 9pm Eastern will discuss the idea of thinning the herd of library services so that we can grow healthy new opportunities.
Molly Knapp (@dial_m), Amy Blevins (@blevinsa) and I (@krafty) will be moderating the discussion. As always we will be using the hashtag #medlibs but if you want to further the discussion before/during/or after the regular Thursday night time use the hashtag #moo.Share on Facebook
The iPad is the new darling of the hospital world. Depending on who you talk to, it can do almost anything. Perhaps that is why some groups are jumping into the iPad arena before they are ready. The adoption of any technology depends heavily on whether an institution has the infrastructure to support it. Here is an example of one residency program testing the use of an iPad before its hospital had the infrastructure to support it.
The article “Resident Impressions of the Clinical Utility and Educational Value of the iPad” published in the November issue of Journal of Mobile Technology in Medicine tried to determine the value of the iPad during clinical rounds and for education. The authors from Riverside Methodist Hospital gave 119 residents an iPad to use during the 2011-2012 academic year. The residents gave their opinions on the clinical utility and educational value of the iPad. The results were disappointing. “The iPad received low marks for daily clinical utility (14.7%) and efficiency in documentation (7.8%). It was most valued for sourcing articles outside the hospital (57.8%) and as a research tool (52%).” Basically residents did not place a high value on the iPad when used in clinical rounding or as an educational tool.
Yes the residents didn’t find the iPad to be useful during clinical rounding, but that is because the hospital really wasn’t ready for the iPad, or any device, to helpful during rounding.
At the time the article was written, the hospital was still writing orders on a paper based chart. Moving from paper to the iPad is quite a jump for people and hospital technology. “All resident groups reported problems with utilization of the iPad for medical documentation/progress notes.” If the hospital is still writing orders on paper based charts perhaps it isn’t the iPad to blame but the fact that the hospital hasn’t adopted writing orders electronically.
In addition to writing orders on a paper based chart, the hospital’s other infrastructure items clearly were not ready for the use of iPads. Further in the article they discuss connectivity problems and EMR access problems.
Connectivity - “All resident groups noted problems with iPad login-in and connectivity/WiFi. During the academic year 98 tickets specific for iPad set-up and connectivity issues were reported to Information Technology services.” Now the authors do mention that it was 98 tickets out of 182,000 global tickets, but when you only have 119 people using iPad, 98 tickets is not good. Anybody who has been in a deadzone can relate to the frustration of losing network access. Relying upon a network device for clinical use when you have poor connectivity (or difficult to access WiFi) is like relying on a cell phone service in the mountains after a winter storm.
EMR access – Residents were asked to recommend apps and medical tools for the iPad. “The single most frequently cited application was Riverside’s electronic medical record.” The method by which they access their EMR makes it cumbersome for somebody with an iPad to access it. “Our EHR is access via remote desktop, requiring a two-step login process.” So the device that they wanted them to test its clinical use, does not have easy access to the EMR, a major clinical application.
The authors of this study suggest that residency efficiency “may be less positively impacted by the use of the iPad than previously reported.” I believe the authors are both right and wrong to make this statement. The authors clearly listed several hospital wide infrastructure issues creating barriers to online access. “Though log-in and connectivity issues were noted as a significant problem, technology support was rarely utilized. Residents often found it faster to use a computer than reporting difficulties. Additionally, electronic order entry is not available at our hospital.” Not only do these statements reveal the hospital wasn’t ready for adoption of the iPad or any tablet device, but it reflects their residents’ attitude toward their help desk and the speed at which they need things to work to get information. I think the authors would have been more accurate if they had stated, residency efficiency may be less positively impacted by the use of the iPad if the hospital is not adequately prepared ahead of time for the use of mobile devices.
To study the use of the iPad in a clinical setting when the clinical setting is clearly not ready, is like testing the use of a car in an area where there are no roads.
I look forward to reading other iPad studies where the hospital is not the barrier and we can better determine whether the iPad (or any other tablet) is of clinical value or not.Share on Facebook
Last weekend I had the wonderful opportunity to be the keynote speaker for the Midwest MLA Chapter meeting. It was a great meeting and I learned so much from so many people. I LOVE Chapter meetings. Ask me and I will tell you, the Chapter meeting is a great place to share and learn from other in a much more scaled back and doable scale than the large MLA meeting. That is not to take anything away from MLA, I just think that a Chapter meeting is more intimate.
Some people at the meeting asked if I was going to post my slides from my presentation. Yes, they are on SlideShare and I have re-posted them here.
- If you are at a large academic medical institution or even NLM you need a catalog….BUT do you need to catalog the way you are doing right now? Could you be more agile? Could you do something slightly different? We are too entrenched in the way we catalog things.
- If you are small hospital library with only a few shelves of books, you may not need a catalog. I know it is crazy to think that, but you may not. Perhaps an A-Z list or *gasp* an Excel sheet posted online will do. Maybe you could tag your holdings in Library Thing.
- If you are a small hospital library with more than a few shelves of books, but nowhere near what an academic library has perhaps you need a catalog. But do you need to add anything to the catalog other than what our users care about? Most users only care about title, author, year, edition, URL, and table of contents. They don’t care if it is 24 inches tall, illustrated and has 246 pages. Do you need to catalog using MeSH?
Recently I was talking with some medical librarians who mentioned that a lotl their medical students or residents want a library app for their phone or tablets. These librarians are either solo librarians, librarians with no programming skills, or librarians who are institutions with some restrictive IT policies. Basically they either don’t have the time, skills or permission to create an app for the library.
But there is a work around to this problem if you/they have an iOS or Android device. Its a cheat because it isn’t a true app, but it does look like one on the phone’s screen. Think of it more as a bookmarked page that looks like an app.
Follow these instructions:
Go to the web page you want to make as an “app” and then tap on the square with the arrow at the bottom of the phone screen.
Tap “Add to Home Screen”
Name it something short and descriptive and then tap Add. Beware: long names get cut off.
It appears as an app on your phone’s screen. Note the picture is of the web page you chose, so if it might be very white or boring looking. But hey it is on the phone.
I don’t have an Android phone so I don’t have screen shots, but my coworker, Kim, gave me the instructions for Android users.
- Bookmark the page
- Go into Bookmarks menu
- Click and hold on the bookmark
- Choose “Add Shortcut to Home”
As I mentioned earlier, this isn’t a true app. But I consider it a quick and dirty way of getting an app like presence on your patron’s devices.Share on Facebook
In a recent post, Timothy Aungst from iMedicalApps.com sheds more light on the trend of copying established medical textbooks and repurposing it in a medical app that they sell on iTunes. Aungst cites a recent report in BMJ, where three doctors, “Afroze Khan, Zishan Sheikh, and Shahnawaz Khan face charges of dishonesty in knowingly copying structure, contents, and material from the Doctor’s Guide to Critical Appraisal, by Narinder Gosall and Gurpal Gosall, when developing the app, representing it as their own work and seeking to make a gain from the plagiarised material.” Not only did the doctors plagiarize the text, but according to Aungst and BMJ the doctors also sought to increase their ratings within iTunes by writing reviews of their own apps without disclosing an conflict of interest.
This type of plagiarism is not new. In fact as Aungst states iMedicalApps.com Editor, Tom Lewis, discovered several apps in iTunes that plagiarized other works. (I wrote a brief post about Tom’s finding while I was on vacation last year.) I can see from Tom’s comment that while he never heard directly from Elsevier regarding the issue, YoDev apps LLC had all of their apps pulled from the App Store.
Copying and re-posting a book online or through bit torrents for free is so 2005. Welcome to the new world where plagiarizing can make you money. All you have to do is steal the content and sell it in an app. They are also sneakier than they were in 2005. They aren’t selling the app under the original book title, they are changing the name and trying to market it as something totally different. Hmm it seems requiring users to use personal logins to view the PDF is really working to curb copyright violations.
According to an updated BMJ article, the doctors accused of plagiarizing The Doctor’s Guide to Critical Appraisal to use in their app Critical APPraisal, have been cleared of plagiarism by the Medical Practitioners Tribunal Service.
“A regulatory panel rejected charges by the General Medical Council (GMC) that Afroze Khan, Shahnawaz Khan, and Zishan Sheikh acted dishonestly in knowingly copying structure, contents, and material from a book, The Doctor’s Guide to Critical Appraisal, when developing their Critical APPraisal app, representing it as their own work, and seeking to make a gain from the material.”
Shahnawaz Khan and Afroze Khan were also accused of dishonestly posting positive reviews of the app on the Apple iTunes Store without disclosing that they were co-developers and had a financial interest in the app. The GMC found that Shahnawaz Khan no evidence that he knew that the app, which was initiallly free, would later sold for a fee. His case was concluded without any findings. However, the GMC panel found that “Afroze Khan’s conduct in posting the review was misleading and dishonest.” Yet they considered this type of dishonesty to be “below the level that would constitute impairment of this fitness to practise.” The GMC panel said it was an isolated incident and did not believe it would be repeated in which they “considered his good character and testimonials attesting to his general probity and honesty and decided not to issue a formal warning.”Share on Facebook
I have doctors asking about all four journal browsing apps; Docwise, Docphin, Read, and Browzine (click links for reviews on each app. The reviews were either done by me or guest librarians who had access to the app). A few of the requesting doctors have used one of the above products, but it seems the vast majority of the doctors haven’t used any of the apps and are asking based on word of mouth.
The four apps are very similar. To me it is a bit like comparing PubMed vs Ovid Medline, both do the job well but differently. You also have people who prefer one over the other. One is free while the other is not.
The biggest difference is that three of the apps show the abstracts and tables of contents to almost every medical journal known to man (I over exaggerate of course). The full text is provided if the library/institution as a subscription to that journal. However, there is no clear branding or explannation of what journals the library/instituion owns because Docwise, Docphin, and Read don’t know. If a doctor views the table of contents for the Journal of Big Toe Science in Docwise, Docphin, or Read (which is not owned by the library), the doctor is denied the full text. Last time I checked, there was no clear message as to why they can’t get the full text. Docwise, Docphin, or Read didn’t say soemthing like, “Your library doesn’t subscribe to this journal therefore you can’t access the full text.” Docwise, Docphin, and Read do not know the library/institutions holding or access methods.
Browzine does know what the library/institution owns. Because the library submits the list (with access methods) to Third Iron (the company that owns Browzine). Browzine only shows those journals to doctors. There is no guessing as to whether it is available full text to the doctor. If it is in Browzine, it should be available full text.
Let’s pretend that my hospital library provided proxy access to resources. (Most hospital libraries don’t have proxy servers to provide access to journals or other resources.) I could have my pick of these apps to provide to my users. My question for librarians is: Do I list all four apps and let them decide what they want? I have a very strong feeling (based on 15 years of answering doctor’s library questions) that doctors are going to be complaining about Docwise, Docphin, or Read not providing the full text. After all, if the library recommended a product that connects users to the full text, shouldn’t everything be full text?
What do other libraries do? Do you list all of the apps and let the users decide? Do you worry that there might be confusion among the apps because they are so similar but slightly different? Do you worry that doctors might feel frustrated when they can’t get the full text? Would doctors even bother ordering the unavailable article (going outside of the app to do this) through the library?
I appreciate your thoughts and comments. Because sometimes I feel with these journal apps I am being asked to pick between Coke and Pepsi, Ovid and PubMed. I know the difference between them, but my users don’t. Does it matter?Share on Facebook