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.
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.
I just got 5 iPads back from my IT department so we will be circulating them fairly shortly. This has been an interesting process. I know there are many academic medical libraries that are circulating iPads, but to my knowledge there are very few hospital libraries that are circulating iPads that CAN ACCESS the hospital’s secure WiFi network.
My project is to allow all* caregivers to check out an iPad so that they can use one device to do there job (EMR, labs, etc.) and library research at the point of need whether it is at the bedside or cafeteria, it doesn’t matter.
(*We will loan iPads to any main campus employee who is in good standing with the library and is not a temporary, visitor, volunteer or rotating student.)
While I have been working on this project, I have solicited information from many people and I want to thank everyone for their thoughts and advice. Here is a post listing many places I consulted and the information I found. I used a lot of that information so that I wouldn’t have to recreate the wheel. However, all institutions have require their own little tweaks to the system, ours is no different. I have decided to list the things I have personally learned that might be slightly different than what others have done, so that others might be able to learn from my experiences.
- GET IT INVOLVED! -OK that is a bit of cheat because a lot of librarians mentioned this, but I can’t stress this enough in the hospital environment. Most of what I learned is because of IT.
- Zenprise - It is a mobile device management system that makes them “business-ready” (or in my case hospital ready), keeps content secure while balancing enterprise needs and user experience. It can work with BYOD (Bring Your Own Device) institutions or institutions that provide the device. Our IT department configured all of the devices using Zenprise and is able to automatically push out institution apps. I have experimented with the iPads and it appears that users can still load their personal apps on to the devices. However, I was warned this might make some institutional apps act wonky. Since I can’t get into every institutional app (EMR as an example), we will learn whether people can load their personal apps on the devices.
- Extra Costs- The iPads aren’t cheap, but we also had to factor in the costs of our share of the Zenprise license and the software CALs (Client Access License). Without the CALs then the iPads would not have the necessary apps and software that caregivers use to treat patients or conduct buisness online. For example: If you want access to your institution’s Outlook you might need a Microsoft CAL.
It all depends on how your institution handles these type of institution wide programs and licenses. It is another reason to make sure you are working with IT. Because those extras can add significantly to the cost of the iPad
- Buying Apps – Our iPads iTunes accounts are not associated with a specific a credit card. Individuals and institutions can do this by following Apple’s directions. I am not sure how ours were set up since IT set them up. I “think” IT did something very similar to Apple method and used Zenprise to manage it all.
I have usernames and passwords for the devices so I can ”buy” more free apps as needed and install on them them on each device. If I want them added globally, I can email my IT rep so that they can be added to their profile.
If I want to buy fee apps then IT recommended that we buy iTunes gift cards and redeem them to buy apps. I am not sure if this their work around until they are able to figure out a method for institutional department purchasing through iTunes. I am sure there are lots of hoops to jump through from both Apple and the institution to purchase apps through iTunes.
- Circulation – There as many iPad circulation policies as there are libraries. We decided to have them circulate for 1 week (no renewals initially) with $10/day late fees. Since our users are employees of the institution we theoretically have a little more power to get the iPads returned, fees collected, (and hopefully never) replacement costs collected. I am told that IT can track the devices and lock them using Zenprise. I hope we never have to use that option but it is nice to know if somebody has an iPad overdue for weeks and weeks.
We are trying to walk a fine line regarding circulation. We understandably want them to have some restrictions but we don’t want the restrictions to be so tight that they inhibit usage. So we might be changing some policies as needed.
- WiFi vs Cellular- The circulating iPads are WiFi only. We bought 2 iPads with cellular iPads for librarians to use if they are somewhere where they cannot get a WiFi signal. The cellular data is off. It will only be turned on using the library credit card as needed. Both AT&T and Verizon allow you to buy a specific amount of data for a month (shortest amount of time period) without a contract or the need to continually buy data each month. Since our iPads are new, we have no idea if we will need the cellular feature or not.
- Advertising – We created a image to go on our new library page (which will launch later in June) that has a series of 4-5 rotating images at the top of the home page. It will be linked to the libguide about the iPads. We have several table top signs that will be displayed through out the library. We also have a brief story published in our Education newsletter. Our institution does not allow mass emailing to employees and they have taken steps to make it very difficult to it.
- Survey – I will create a one page after use survey for people to fill out when they are using the device or when they return it. It will be basic and is intended to see how people are using the device and asking if they will be willing to participate in a longer library iPad future survey. I will have one in paper but I am toying with the idea of creating an online one using Survey Monkey and having the survey saved as an app on the device. I am not sure if people would think to “use” the app to take a survey.
This is what I know so far. We haven’t started circulating them, but when we do I will post more about what I have learned.
Categories: iPad Tags:
Previously I reviewed two apps (Browzine and Read) that help users view and read journals on the iPad. There are two additional apps that I will be profiling on this blog. Docphin and DocWise are similar journal apps for the iPad. Thankfully Alison Aldrich has agreed to test and review Docphin (below) and Joey Nicholson will be reviewing DocWise. My hope is to get all of the reviews posted then later try and do a comparison chart of the products.
So without further ado, her is Alison’s review of Docphin.
Review of Docphin
by Alison Aldrich
Earlier this month, Krafty reviewed Browzine and Read, two journal reader applications for iPad. Today I’m writing about Docphin. Docphin is of similar ilk to Browzine and Read but with a few interesting differences.
The “phin” in Docphin stands for personalized health information network. Docphin was founded in 2010 by some entrepreneurial physicians looking to address that all-too-familiar information overload problem. Docphin users customize their experience by choosing the journals and news sources from which they would like to receive updates.Sounds like an RSS reader, right? Docphin attempts to add value over something like Google Reader by suggesting sources based on specialty, simplifying access to full text, and making it easy to comment on and share sources via social media channels.
Access to Docphin is restricted to those with email addresses at one of approximately 100 U.S. academic institutions that have requested activation. Activation is free and does not necessarily involve anyone from Docphin communicating with the library, so you may have access to Docphin without knowing it. Check by entering your university email address.
Once your institution is on board, signing up for an account is straightforward. Enter your level of education (attending, fellow, resident, medical student, or other) and between one and three medical specialties of interest to you. Docphin suggests news feeds based on your selections, but you have the final say over the sources you choose.
An important note: Docphin does not cover every journal. It draws content from around 250 journals, so about 5% of the journal titles indexed in PubMed. A Docphin representative explained to me in an email message that journal titles were selected after consultation with hundreds of practicing physicians, including Docphin’s official team of Ambassadors, about what would be the highest impact titles in each specialty.
In addition to journals, Docphin also draws content from about 250 twitter feeds, many from organizations (publishers, government organizations such as the CDC, AAMC, etc.) and a few from individual physicians. There are a handful of mainstream news media feeds available, too.
I set up my profile to watch four internal medicine journals, two public health journals, and news feeds from ABC and the New York Times. My home screen looks like this in a regular web browser:
Back to the regular web version, in the right column, I see articles that are trending among Docphin users right now. Clicking a journal title smoothly overlays this screen:
I have the option to view the article (this prompts me for my proxy server login), share the citation via social media, like it, comment on it, or mark it as a favorite. I have the option to create my own keyword tagging scheme to keep the articles I tag as favorites organized.
From my home screen, clicking to the Search tab allows me to search by keyword within all of Docphin’s Journals and News collections, practice guidelines from the National Guidelines Clearinghouse, UpToDate, News, Images, and Videos. The UpToDate search does not prompt me for a proxy server login.
Docphin sends regular email alerts about new content from the sources you chose. Email alerts can be turned on and off under Privacy Settings.
Things I Like
The interface is clean and navigation is smooth.
For the journals it covers, Docphin works quite well with my institution’s proxy server as long as our subscription access is direct from the publisher. The system breaks down when it comes to journal content we get through a third party vendor such as EBSCO or Ovid. Those articles were unavailable to me through Docphinfrom off campus.
I like the integration of Twitter feeds and trends data. Docphin does well to acknowledge these alternative modes of information discovery.
I also like that mainstream media feeds are included. I don’t know many residents who have time to catch the evening news. Docphin could help them stay a step ahead of what their patients are hearing and reading.
Things I Would Like To See
Right now, Docphin can only be accessed through a web browser or an iPhone app. There is no iPad-optimized Docphin application yet, although one is coming. An iPad app will make it much easier to interact with Docphin PDFs on the go.
I would also like to see a collection development policy of some sort.It’s difficult to get a global sense of what Docphin covers because journal titles and Twitter feeds are siloed into lists by specialty. I would like to see a master list of journal titles somewhere.
Docphin does cover a number of open access journals, and of course abstracts are freely accessible. Why not open up this level of content to those outside of registered institutions? This seems like a strategic decision, I’m just not sure what’s behind it.
In many ways, Docphin reminds me of another social scholarship website making headlines lately: Mendeley. Both work with proxy servers to simplify full text access. Like Docphin, Mendeley attempts to encourage discussion around individual articles and to expose metrics about who’s reading what. Granted, the discussion part has not exactly caught on yet. There are many, many articles and few discussions. Still, I like the idea of a discussion platform that is independent of publishers—sort of a universal online journal club.
I have been impressed with Mendeley as a PDF and bibliographic citation management tool. These features combined withDocphin’s newsfeed personalization capabilities would make for a very unique product I think.
Docphin is worth a look, and another look once the iPad app is released. The developers have been quite successful at growing the business through their networks of newer physicians and medical students. Your physicians and medical students need to understand, though, that while Docphin is an excellent current awareness tool, it is not the place to go for a comprehensive literature search due to its limited journal coverage and limited search functionality.
For further reading:
An interview with Docphin co-founderMitesh Patel: http://www.imedicalapps.com/2012/08/questions-mitesh-patel-docphin-medical-journal-tool/
Another Q&A with Mitesh Patel: http://www.healthtechinsights.com/emerging-health-technology-spotlight-qa-with-mitesh-patel-of-docphin/
Recently I have been more atune to medical apps because I am in the process creating a libguide featuring medical apps. From what I can tell, there are three main apps out there that try and provide full text access to institutional journals subscriptions via the iPad. They are Browzine, Read, and Docphin.
Last week I reviewed Browzine, today I am going to review Read by QxMD. Next week Alison Aldrich, will provide a guest post about Docphin. (I usually try to use all of the products reviewed on my blog, but in this instance Docphin doesn’t work with the way my library provides off campus access and they don’t provide access to free journals. So, I can’t try it. Alison has graciously agreed to try and write a guest post about it. -Thank you Alison!) If possible, I will take the reviews and try and compare the three apps against each other.
Read is produced by QxMD which makes several medical apps. It is founded by “medical professionals” and is dedicated to “creating high quality, point of care tools for practicing health care professionals.” They are partners with Cardio Exchange, Society for Vascular Surgery, Vascular Study Group of New England, American Academy of Family Physicians, and the Canadian Society of Nephrology.
It is also important to note their app is free and is available for the iPad as well as the iPhone (did not see an Android version). Their site promotes “seamless automatic one-tap access to full text PDFs available” for a lot of universities (full list scroll to bottom) including Johns Hopkins, Harvard, Washington University, and Yale. Despite advertising the institutions using Read, they do not include information on their website for librarians to add their institution. You have email them to add your institution, according to a tweet from QxMD .
After you download the app you are asked to create an account by adding information about your profession, specialty and institution. I find asking for profession and specialty to be annoying but I realize this is for their usage stats. If your institution is not listed you can still use the app but you will get a warning that you will only be shown free papers (Take note because this will be confusing later on).
Since my institution isn’t listed (it wasn’t listed for Browzine either, so we have a pretty equal comparison) I proceeded anyway without adding my it.
Next you are asked to select the specialties you would like to follow. I chose Family Medicine because I know a few titles off the top of my head that are Open Access and would have free PDFs.
Once you select a specialty you are then asked to select journals to follow. The first set of journals are ones within the specialty then you are presented with an A-Z list of all journals. After selecting the journals you are also presented with a list of “collections” to follow. It appears they only have NEJM collections (which are subscription based and NOT free).
If you are paying attention to my screen shots and with the fact that my institution is NOT subscribed you will notice that there are an awful lot of listings for non-open access titles. For example: Almost all of NEJM’s stuff is available to only to paid subscribers. While Annals of Family Medicine and the journal Family Medicine are free and have no embargo period on their most recent issues, that is not the case with the rest of the journals. American Family Physician and Family Practice are not free and have an embargo on the current 12 months.
Personally I find this to be an area that has great potential to be very confusing to users. If the first screen says “By not selecting an institution you will be shown only free papers,” then as normal average person (not somebody who understands nuances institutional subscriptions, free Open Access articles, and embargo periods, which most doctors don’t) I would expect that everything I see from the first screen forward would be free. In other words since I told the app I don’t have an institution AND it told me I will only be shown free papers, then I would expect the app to be smart enough to only show free journals or papers. Instead, I am able to see free papers and subscription papers side by side, only when I click on them do I realize whether they are available. (If it isn’t available I get message indicating I can’t download the PDF)
Now you might be saying, well this whole mess is pointless if your institution subscribed to Read. No it isn’t pointless. In fact, I think it gets even messier, because no institution subscribes to every journal. There will be occasions where a user is logged in as your institution and selects a journal that your library doesn’t subscribe to (but is available on Read’s list). The average user doesn’t know what the library subscribes to and will become frustrated when they tap to read the full text of an article and it can’t download the PDF. Who do you think they will call when that happens? The following discussion plays in my head even now, “But it is listed on Read and your library is listed Read, so why isn’t it available?”
A listing of all possible journal titles that isn’t synced to a library’s holding list nor has the ability to only show free article for those not affiliated with an institution is confusing. Doctors don’t know what articles are free and what aren’t without trying to first get the PDF.
The display is set up similar to a Flipboard style of browsing, showing “Featured” articles by default. There is no clear explanation as to what determines an article to be “Featured.” As I mentioned I selected these specific journals: Annals of Family Medicine, Family Medicine, American Family Physician and Family Practice. However, the bottom right article is from the European Heart Journal which I didn’t pick. (Sorry it is the journal is very faint, I couldn’t get it any darker.) I am not opposed to having featured articles, I like the idea because it allows people to become aware of articles outside of their normal journals. But, I would like to know where they get featured articles from. Is it based on a rating system or something else? (My guess is it based on their algorithm they mention in a comment on iMedicalApps.)
Tapping Journals at the top bar allows you to flip through the articles within your selected journals. The Collections tab just allows you to view the NEJM Collections (which currently are the only collections available and are not free). The outline icon (underlined in yellow on image below, next to the star) is the Topic Reviews button. It allows you to browse through “1000′s of outstanding topic reviews” which are organized from broad to narrow subjects Again it is important to note that not all of the articles listed as topic reviews are free.
Tapping the star allows you to select articles as your favorites which you can tag with your own words or from a pre-selected list for easier retrieval. Below tagged an article Family Medicine, and while I was starting to type another word the auto suggest popped up. The auto suggest while dynamic is a bit limited and I’m not sure where they are getting the rather long terms/descriptions. It appears they are either journal article titles and/or topic review subjects.
IF you have a subscription, downloading the article is very easy, you just tap on the title and it tries to download the PDF. You can email the PDF (if you have access), tweet it, share it on Facebook, add a comment, star it (which saves it as a favorite), or rate it with a thumbs up or down. If you can’t download the article you get the message “Paper could not be downloaded” and you are encouraged to either view the citation in PubMed or Add Proxy. If you don’t have access to the full text you can still email the citation, tweet, Facebook it, comment, star it, or rate it.
Finally users have the ability to directly search PubMed while within Read. This would be useful if you read an article on a specific topic and you wanted to quickly search PubMed to see if there were other articles on the same topic. However the search is so limited, it would just be better to use PubMed app you already have on your iPad or go to PubMed using your iPad browser. I did a quick and dirty search on heart attack. I have no idea what algorithems it uses when searching the text word heart attack but I get completely different results when searching PubMed directly. (I looked both within relevance and publish date, neither of which seemed to be close the the PubMed results.) I searched using the MeSH term myocardial infarction and got similar puzzling results.
Finally, there is an issue regarding timeliness. While Read displays the current issue for some journals, that is not the case with all journals. For example the current issue for the Annals of Family Medicine (a free Open Access Journal) is January/February 2013, yet the most recent issue displayed on Read is the November 2012 issue. The same is the case for Family Medicine, and The Journal of Family Practice. This is a problem within what I call the core journals as well. While BMJ, JAMA, JACC, and NEJM have the current issue available Lancet is two issues behind. Since many of the journals are current this could be an issue as to when their software hit the journal sites, perhaps it just needs tweaking with certain journals. When many of the journals have the most current issue, it can be difficult to try and discover the ones that don’t. Kind of like find an needle in a haystack but the need moves, because the software does eventually get the most recent issue.
(I don’t remember noticing this within Browzine because their display was slightly different so I wasn’t as aware of the timeliness of the citation as I am within Read. I will have to double check how timely Browzine is.)
The good news is this app is free to users and free to libraries who want to make their journals available. However, those libraries without straight forward proxy servers might have difficulty registering with Read. They would really need to contact QxMD to see if the two systems work together. Doctors who like the idea of Flipboard for their medical journals will be happy with the display and function of Read.
According to the comments made by Read on an iMedicalApps review, they feel their algorithmic curation of the literature is perhaps the greatest strength of Read. “Rather than simply relying on our users to tell us which journals they want to read, we use a combination of machine learning, semantic analysis, crowd-sourcing and proprietary algorithms to figure out which articles our users should likely be reviewing.” I think it is matter of personality as to whether doctors end up liking Read’s selections based on their algorithms or whether they prefer a different method of selecting/reading their articles. However if Read’s algorithm determines what users should likely be reviewing then I have to wonder why their algorithms chose editorials, not articles, to display on the first Read page for JAMA. Are JAMA editorials more important that articles?
I think Read has a lot going on with it and a lot of potential but I am concerned about the fact that it only contains a few of the BioMed Central and PLoS titles which are Open Access and possible confusion regarding what is available full text and what isn’t. In theory I know doctors shouldn’t care whether an article is full text, if it is relevant they should find a way to get it. However, theory doesn’t always work in reality. I have seen more doctors ignore relevant articles because they weren’t full text or they couldn’t figure out how to get the full text. I have doctors who won’t click an order it button to order an article (FOR FREE) from our library because they don’t want to deal with it. I think there needs to be a better way for Read to work with institutions so that doctors clearly know what journals are available to them and what aren’t. Doctors assume that if they input their institution then what they see is what the institution gets, which is not always the case.
Sunday I got an email from my county library, Cuyahoga County Public Library, about their new online journal platform called Zinio. Zinio is a company that allows my public library to provide access to many of their magazine subscriptions on to my iPad (as well as other devices) in an easy to read format.
Here is a screen shot of the magazines that I selected to have on my iPad to read, all courtsey of my Cuyahoga County Public Library card.
I was also in the process of finding apps for our medical library’s libguide. I sent a tweet out asking for suggestions and some people including Third Iron responded. Third Iron is a company that produces the product Browzine. Their company which is has many executives with library degrees or significant library experience, works to make online journals available in an easy browsing experience for the online user.
Tuesday I spoke with Kendall Bartsch about Browzine, what it does and how it might work for our library. Browzine is very similar to Zinio. Where Zinio is magazines, Browzine is scholary publications and with its share, email, download, features, (not available in Zinio) it quite frankly blows Zinio out of the water.
Browzine allows people to browse scholarly publications and read the table of contents to the recent issues of journals. It works with various publishers such as Springer, Wiley, AMA, Nature, etc. It also works with Open Access publications. Users download the free Browzine app (currently iPad only but they are working on Android). When they login to Browzine it asks them to select their library. If their library has a subscription to Browzine they can login and access their library’s subscriptions via the iPad.
Browzine is a very new company, they have quite an impressive list of libraries who are either trialing the product or have a subscription, including Welch Medical Library, Medical University of South Carolina, Northwestern, and Washington University. If your library doesn’t have a subscription to Browzine, or if you want to try it out and play with it you can still download the free app and select Open Access titles which enables you to view the table of contents and PDFs of the open access publications and journal articles.
There are a ton of Open Access titles and if your library subscribes to Browzine then there are a ton of publisher titles that users can access. With that large of a number of journals it would get tedious to scroll through or search for your favorite journals that you like to keep up with. That is why you are able to save those journals in your own personal library shelf. So when you access Browzine you can go directly to that shelf instead of searching through a bunch of other journals.
Here is a screen shot of Open Access titles in Biomedical and Health Sciences -Medical Science. If your library has a subscription your library’s name is where Your Library Identity is and your list of journals will be more than just the OA titles. (Note: there are MANY OA journals, the picture below is just a small slice from the OA Biomedical & Health Sciences -Medical Sciences category.)
Here is a screen shot of my “favorite” journals that I like to read. (Pretend I am doctor or researcher who likes to read these scholarly publications.)
Here is a screen shot of the table of contents for one of my favorite journals. The yellow inbox indicates I have saved that article on my iPad.
Here is a screen shot of the PDF of an article from the TOC and the options for emailing, saving, sharing, etc.
Browzine is compatible with iAnnotate (a popular PDF annotating app) and DropBox and Box as well as other programs.
To say I was blown away was an understatement. Finally now after all these years, people will be able to browse the table of contents easily AND connect to the article via the library’s subscription in an extremely easy way. The concept of my own personal bookshelf is great. The ability to export the articles is essential and thankfully is easy to do with Browzine. Currently Browzine does not provide notifications when a new issue is available, however that is a feature that they are adding shortly. When that does happen, users will see a little red bubble with a number next to their journals.
As cool as Browzine is, they don’t work with every publisher yet. (Publisher availablity list here.) Also Browzine won’t work with database provided journals. So for example, journals you get full text through CINAHL aren’t going to be available through Browzine. Perhaps that may be why LWW is not on Browzine? (LWW requires institutions to access journals through Ovid.) However, for databases like ClinicalKey, which is an Elsevier product and has all Elsevier journals, one has to wonder if that will be in Browzine or if it will be considered a CINAHL (ClinicalKey and Browzine are both so new who knows). If it is considered a CINAHL then that would be a shame since some libraries may look at ClinicKey as their Elsevier journal provider.
While Browzine currently only does journals, I can see where this type of easy access can be applied to ebooks. eBooks suffer from much of the same silo content problems as ejournals. Each publisher has their own way of displaying and providing access. You have to bounce around from provider to provider to view the ebook on your iPad (or even your laptop). There is no easy way to find and access ebooks for medical libraries. Most of our users don’t know how to find ebooks. They sometimes check the catalog, but even then that is only a brief snapshot of some of the titles available. PMC titles and other ebook collections aren’t always in the catalog because you are either waiting for the MARC records from the provider (in the case of large aggregators like Clinical Key with hundreds of titles) or you are simply unaware of the latest title that was added to the online collection.
If we could get our ebooks to display like Browzine displays ejournals, I will jump for joy and quite possibly stop my ranting on the inaccessibilty of ebooks in the medical library.
As much as I love ebooks and technology, they are like a crummy loser boyfriend. Full of ups and downs that take you on a roller coaster of emotions only leaving you to love them one minute and hate them the next. Just like that loser boyfriend they have money issues and sometimes I find myself humming Joan Jett, “I Hate Myself For Loving You,” when dealing with them.
- They are available whenever, wherever, and can’t be stolen, lost, or damaged.
- Using ebooks I can provide information to patrons across the hospital at the time of need and they don’t have to come to the library.
- Many ebooks can be updated more often than traditional print books.
- The distribution of medical ebooks is STILL behind the public library model (and while the public library model isn’t that spectactular it runs circles around what we have).
- Publishers who require an ADDITIONAL logins if you are using a smart phone. It is confusing to patrons, they don’t understand why they are being asked for a password when they are on the hospital network. In this instance they don’t think of their phone any differently than a lap top. (ahem MDConsult/Elseveier)
- Many ebooks are stuck in publisher silos, can’t be searched effectively. No NORMAL person knows to go directly to StatRef to search, then AccessMedicine, then MDConsult, etc. They just know they want a book on a topic and they want to type in the topic somewhere and be presented with a list of ALL the ebooks that has their topic. Some librarians say…ah use the catalog. Ptthbbb, ever try searching for a chapter topic or something else within the content of the book in the catalog? It sucks.
- Few companies have a few book titles that can be downloaded to a mobile device but they are way too expensive because we have to BUY the book and they don’t have a circulating model plan (ala public libraries). Large publisher’s with books we need and pay lots of money for can’t be downloaded to any mobile device, they are web enabled…yeah patrons love hearing that.
- I get the idea that an online book is more expensive than in print because it can be viewed by many, but if one online title is a 1/3 of my book budget, I can’t buy it no matter how much I want to have it online.
- We all are either scraping by on less budget or a flat budget while just trying to keep current library resources that keep getting more expensive. I have no flexibility to “try” your new product. I don’t care if it is cool and it addresses a need, I can’t afford it. The price might be reasonable or it might be whack-a-doodle but I still can’t afford it without dropping something. My wish list is a mile long and it isn’t getting shorter with items that are reasonable (as well as whack-a-doodle) pricing.
Right now we are all searching for the Mr. Right of ebooks. Part of the difficulty is that Mr. Right for me might be Mr. Wrong for somebody else. But our potential boyfriends (the publishers) need to step it up considerably if they want to be Mr. Right for any library because it seems many of us are unhappy and currently settling for Mr. Right Now.
This what my patrons want (therefore this what I want):
- eBook platforms that work on lap tops AND are downloadable to a mobile device (not web enabled to a mobile device).
- We need the core chunk of titles that we are CURRENTLY buying from you, don’t increase the price so that one dinky little title is $2000 online and a established plain ol’ text (not a even a reference book) is $15,000. That my friends, is whack-a-doodle pricing. We don’t buy online books like that now, making it “downloadable” at that price is not going to change our mind or our budget.
- For example AccessMedicine, MDConsult, Ovid get your ebook platforms that we are already buying downloadable….now!
- We need the core chunk of titles that we are CURRENTLY buying from you, don’t increase the price so that one dinky little title is $2000 online and a established plain ol’ text (not a even a reference book) is $15,000. That my friends, is whack-a-doodle pricing. We don’t buy online books like that now, making it “downloadable” at that price is not going to change our mind or our budget.
- We are very open to the circulation model of ebooks. Public libraries are doing it and our patrons seem to understand that concept. This is a nice alternative to buying the title and should be cheaper than buying the title. Think of it as renting.
- We need a collection of decent titles. Not a pittance of specialty books. We need/want the Harrison’s, Hurst’s, DeVita’s, etc. We need real titles, don’t shove your Big Toe Science book in there, unless we are podiatrists we don’t want them and won’t buy them.
- Eliminate the artificial barriers for access. We do a VERY good job of maintaining proper access to our online resources (becasue your license agreements require us). We know better than you do who our patrons are and when to cut them off, so let us do our jobs and stop putting up extra logins while people are on network or proxied. If our patrons get confused, they don’t use, if they don’t use we don’t buy. Plain and simple, extra loggins affect our usage stats (negatively) and we don’t buy or drop your stuff if our usage stats go down. Remember we have wish list a mile long waiting for weakness in a product.
Some day I hope that I am able to look back at ebooks like I do at my old loser boyfriends; a phase that I had to go through in order to meet Mr. Right.
I am on vacation this week so I have also been taking a bit of electronic vacation as well with the blog. But I ran across a post earlier this morning and thought….”Wow I have to blog about this!”
The post is on iMedicalApps.com, “Are unauthorized copies of popular medical textbooks being sold in Apple App Store?” While reviewing “Human Anatomy Pro for iPad” by YoDevApps LLC, Tom Lewis noticed striking similarities between the Human Anatomy app and the Gray’s Anatomy for Student App/textbook. Yet, there was no mention of this in the original iTunes description and upon further examination, Tom noted that all the images and words were direct copies of the original text of Gray’s.
Tom emailed (June 10, 2012) YoDevApps LLC for explannation of the “similarities,” and basically Evans Ben (YoDevApps), in a poorly worded and spelled email, told Tom there are similarities to Gray’s as well as other texts because he consulted the text when creating his app.
Yet this is not limited to Human Anatomy Pro and Gray’s. Tom discovered there were several titles that appeared to have a lot in common with well established medical texts. They are:
- Illustrated Medical Dictionary (Similar to Dorland’s illustrated Medical Dictionary)
- Principles of Internal Medicine (Similar to Harrisons Principles of Internal Medicine)
- Clinical Medicine (Similar to Clinical Medicine by Kumar and Clark)
- Principles of Anatomy and Physiology (Similar to Essentials of Anatomy and Physiology)
On the iMedicalApps site Tom provides screen captures of images from the YoDevApps iTunes page and compares them to the other textbooks. When making the comparisons, Tom used both printed editions of books (Kumar and Clark) and other ebook editions (Harrison’s via Inkling). The images are identical.
Obviously as Tom indicates, these apps raise a lot of questions about proper licensing and distribution of copyrighted material. Since the content appears to be heavily borrowed, it also makes it extremely difficult to trust the developer on content accuracy which is essential for medical apps.
iMedicalApps recently contacted publishers (of the original texts) and Apple regarding situation and will update their article when they have a response from those involved. As of 6/12/2012 Elsevier has responded and is “initiating action”.
Not only is this whole thing interesting from a copyright standpoint, but it reminds us that we must be careful regarding medical apps. Any developer can throw something up on the App Store and have it look reliable.
A few weeks ago I sent out an email to MEDLIB-L asking for librarians who are circulating iPads to contact me off list to answer some questions. I was really killing about 3 birds with one stone. Not only did iMedicalApps want me to write a story about libraries loaning iPads, but I wanted to investigate the idea for our library, and I wanted to share the information for others on this blog.
A lot of librarians got back to me and I want to thank everyone who responded.
Here are some links about current library loaning projects:
- Setting Up A Lending Program -Tips and resources for setting up an iPad lending program. Nova Southeastern University Health Professions Division Library
- iPad on loan: a project of the CMB UMCG – Background information, finding medical apps, and information on how to add bookmarks to iPad browser (check the side bar for a lot of information). University of Groningen Central Medical Library
- Setting up a library iPad program: Guidelins for success- Full text article in ACRL News by Sara Thompson at Briar Cliff University
- Continuing the converstation: Integrating iPads and Tablet Computers into Library Services – ALA Tech Source article by Daniel Freeman.
Sampling of library policies:
- Duke http://www.mclibrary.duke.edu/services/ipad
- KOC University http://library.ku.edu.tr/technology_lending
- University of California Irvine http://libguides.lib.uci.edu/content.php?pid=71488&sid=529255
- University of Chicago https://itservices.uchicago.edu/page/techbr-equipment-lending-terms-and-conditions
- University of Utah (iPad, Xoom, Kindle, Nook) http://campusguides.lib.utah.edu/EcclesMobileDevices
- Virginia Tech http://www.lib.vt.edu/artarch/ipad-policy.html
- Wake Forest http://zsr.wfu.edu/about/policies/technology-ipad
- ZweigBibliothek Medizin in Münster, Germany What to consider when borrowing English Translation
Sampling of general apps loaded on iPads:
- Adobe Photoshop Express
- Apple’s iWork apps (Pages, Numbers, Keynote)
- Dolphin Browser
- Google Search
- iAnnotate PDF
- PDF Expert
- Podcasting 4 Education
- Print Central for iPad
- Sekai Camera for iPad
- Whiteboard HD
Sampling of medical apps loaded on iPads:
- 3D STem Cell Simulation & Strain Tool
- AHRQ ePSS
- AIDSInfo HIV/AIDS Glossary
- Davis’s Drug Guide
- Dragon Dictation
- Eye Chart Pro
- Health Hotlines
- Human Anatomy!
- Improve Bleeding Risk Tool
- Improve VTE Associative Model
- MedPage Today
- Mobile REMM (Radiation Emergency Medical Management)
- Muscle & Bone Anatomy 3D
- NEJM This Week
- Skyscape Medical Resources
Sample of medical library type apps loaded:
(Some overlap with above list. I think some maybe bookmarks not necessarily apps)
- Annals of Oncology
- Annual Reviews
- Clinical Pharmacology
- First Consult
- Health Hotlines
- Mary Ann Liebert Journals
- Natural Standard
- PLoS Medicine
- Procedures Consult
- PubMed (unclear whether PubMed Mobile or for Handhelds)
- PubMed Clip
- RefWorks Mobile
- Science Direct
- Skyscape Medical Resources
Loan rules vary from a few hours to a few days. Most libraries reset the devices to factory standards for security and privacy reasons. Although a few librarians have reported that some apps “remember” despite this and are looking into more. I was unable to find many hospital libraries that loan out iPads.
Secure Network and EMR
Additionally few hospitals or medical school responded that their iPads were also able to access the EMR. Mayo Clinic’s iPads can access the EMR as well as the devices used by residents at the NSU residency program at Palmetto Hospital. As we are looking into our own iPad program we discovered that our devices must have specific Microsoft Client Access Licenses (CALs) to software necessary to access the secure network (and the EMR). For us, the CALs add quite a bit to the cost of the iPad, about $200 more. You pay per device. So each regular 16 GB WiFi only iPad3 that normally costs $499 ends up costing $799 once you factor in the cost of the CAL’s and AppleCare+ (2 yr insurance on the device for $100). We feel it is essential to get on the secure network so the extra cost of the CALs is something we have to plan for. Working with IT has been essential in this process, without them we would not have known of the requirement to get the iPads on the secure network. While the cost of the CALs was a surprise, I am glad we had IT help so that it was a surprise in the beginning/planning stages not after we bought them.
Both libraries who loan iPads and those who don’t are providing lists of mobile friendly (and tablet friendly) library apps and websites. Things are bit like the Wild West with apps and mobile sites. Some library vendors mobile friendly sites require secondary authentication (using their own personal login) despite being on institutional network. Some vendors are creating apps when really a mobile friendly site is all that is needed. Apps often require a username and password to use regardless of whether they are on institutional network. Some apps are intended for individual subscribers NOT institutional subscribers, and unless the wording explicitly states that, it is confusing.
Regarding medical apps (not medical library apps like databases), library purchase (or not) policies are varried as well. Some libraries have accounts on iTunes to buy apps in bulk, while others just load devices with free apps that people might need. Some have said that they do not buy specific medical apps because the iPads are circulated to eveyone and that would mean a lot of different subject specific apps that would need to be on the device. Some librarians also spoke about the need to constantly update the apps, especially the free apps. In order for the pre-installed library “owned” apps to be updated, somebody must log in using the library install account to update them. Some mentioned this could be time consuming depending on how many they have loaded.
Many libraries seem to allow people to load their own apps on the loaned devices. The reason is that the app follows the patron not the library. So when the library restores the iPad to factory settings the app disappears from the library device, but the patron still retains ownership and can install it on another iPad.
Other thoughts and suggestions
Start off with a few iPads then grow if/as needed.
Tie the iPads into the curriculum, load medical bookmarks/apps, or get them on the secure network, in other words make them relevant for work. One library reported they bought iPads but really didn’t have a budget for apps and most already had smartphones and laptops so the iPad was more fun than productive.
Many people said that their patrons often did a try before you buy with the library iPads. Not sure how some feel about this given how expensive of an investment the devices are, but part of me knows they already do this with our textbooks.
Barcode and label EVERYTHING! Some librarians reported their patrons trying to swap out their old frayed Apple charging cables by passing them off as the library’s cables.
Get a bag and a cover for the iPad. Cover helps protects the device while in use. The bag makes it easier to hold all of the stuff (charger, forms, etc.) for circulation AND not everyone who use the device have lab coats and it is nice to just put in a shoulder bag.
I hope this is helpful to others who currently are lending iPads and to those looking to start. Feel free to comment if you have more information or questions.
This morning I posted on iMedicalApps.com the article, “Don’t have an iPad, go to the medical library and borrow one.” There are lots of medical libraries loaning iPads out to their patrons and this post was a way to highlight to physicians some of the ways libraries are helping them get connected using iPads.
In my research I discovered that there are A LOT of medical libraries doing this, too many to list in the actual article. So in order to have a more comprehensive list of libraries loaning iPads I thought it would be a good idea to create a comprehensive list of libraries who loan them and post it on the iMedicalApps forum. So if you library loans iPads, list it on the forum with your basic rules and some of the popular apps loaded. Remember keep it short and sweet with not to much library geek jargon, we want it to be easy for docs and medical professionals to scan through and look at it.
Interested in the geeky library details? Don’t worry, I will posting in the next few days the librarian version of the iMedicalApps article. This will have the information that librarians interested in starting their own iPad loaning project will want to know about.