Cutting Muscle and Bone

One of our favorite movies is Raising Arizona.  We can sit back and watch it any time and we often quote movie lines to each other when it fits a situation.

In Raising Arizona, Nicolas Cage plays  H.I. “Hi” McDunnough and has quite a few interesting expressions and quips. One has been on a loop in my brain lately.  It one that in the first few minutes of the film. “These were the happy days, the salad days as they say, and Ed felt that having a critter was the next logical step. It was all she thought about.” A few moments later, Hi’s voice says, “Our love for each other was stronger than ever, but I ‘preminisced’ no return of the salad days.”

Sometimes I wonder if there were ever a salad days in medical libraries.  I know medical libraries had budgets, the money just wasn’t falling from the sky.  However, it seems these last few years medical librarians have seen their budgets continually cut.  Even “lucky” libraries who have had a flat budget for the past few years, are being told to cut their budget by a percentage.  Those are the lucky ones. They have weathered the storm well until now. Hospital reimbursement from the ACA are impacting the hospital budget, they are seeing less reimbursement.  Less reimbursement means less money, less money means they are cutting budgets.

Yet as hospital library budgets have been cut, the cost of resources have continually increased.  Depending on the vendor it could be anywhere from the rate of inflation to a 75% increase.  Librarians have done their best to watch all of their resources and cut anything that is under performing.  Journals that cost more per use than ILL fees…gone. Databases that don’t have a certain cost per use…gone.  Resources that up their prices to align with competitors because the competitor is more expensive…gone  If medical libraries were a steak, they would be the leanest toughest piece of leather on the plate. There is no fat left.  There is no chef’s steak sauce to compliment the “unique” flavor.

So what happens when you have trimmed the fat?  You trim the muscle and the bone.  The cuts in medical libraries have caused librarians to cut things we would never have cut 1-2 yrs ago. Guess what…We have now cut all of our under performing resources. We are now cutting products based on price alone.

Of course, what else can you do when you don’t have the money?  Donors like to fund projects they could put their name on, not operating budgets or resources that are annual.  A bake sale ain’t going to work. Yet the prices of resources continues to rise. Vendors have told me about the “VALUE” of their product and how important it is.  Big flipping deal.  I know it is valuable, I wouldn’t be talking to them if it wasn’t. Don’t talk to me about value.  But they persist, as if hammering me about the “VALUE”  will magically cause me to find money to pay for their 30% increase.  My answer: My car is a value to my job and my life.  But, if it breaks down and my family budget cannot pay for repairs or a new one, I have to take the bus.  Do I want to commute 1 1/2 hours each way via public transportation every day? Hell no, but if that is all I can afford that is what I do.

If I can’t afford your “VALUED” product, I am going to make do without it.  Sorry, but it could be the most valuable thing on the face of the planet but if I can’t buy it, I can’t buy it.

I know of a few great medical librarians, who are looking for new jobs out of librarianship.  They aren’t looking because they were laid off (although there are those too).  They are looking because they see no future in medical libraries.  The shrinking budget (even in well funded institutions) and rising cost of resources makes them feel like they can’t do their job.  Some question whether the rise in costs will inevitably force libraries to shift the costs to the institution as a whole. Thus the shift of the product’s cost to another cost center.  What will happen when that happens for every resource, in the library?  Don’t laugh, at 15%, 20%, 30% price increases when faced with a 3%, 5% or 10% budget cut, the pot of resources gets smaller and smaller.

It would be interesting if there was a survey where librarians could anonymously mention what percent their budget was cut and list the resources they cut as a result.  They don’t have to list costs.  Just the percentage they lost in their budget and the products that were dropped as a result.  I know the resources cut will vary by institution, but it would be interesting to see if there was a pattern.  What things people are holding onto until the bitter end?  What type of vendor cannibalizing is happening within the library?  Not only will it be interesting to see what products are eating the other, but what two (or more) products from the same company are eating each other.  For example: Does a rise in the cost for UpToDate effect LWW titles purchased?  Does a rise in the cost of AccessMedicine effect AccessSurgery (or other Access database)?  It could be any resource or vendor.

The funding model is unsustainable for hospital libraries.  Time will tell whether the reduction in reimbursements from ACA will make shifting the library resources cost to another department in the hospital unsustainable.  Who wants to take on another department’s cost for a product when they are also rquired to cut a certain percentage out of their budget?

In my Sacred Cows and Heretical Librarians post I mentioned we need to think evaluate our sacred cows.  At the time I meant services or how we do librarianship, but we probably need to apply the same principle to our resources.



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1 comment - What do you think?  Posted by KraftyLibrarian - October 16, 2013 at 11:00 am

Categories: Other Medical Library Stuff   Tags:

Thomson Reuters Frank Bradway Rogers Information Advancement Award

(reprinted with permission)

Do you know someone who has developed an application, tool or interface to help deliver medical information to their clients?  Perhaps the technology fits the definition of meaningful use?   Maybe you know of an innovative way that a library or informatics center is using technology to better serve a specific group of people.  If so, consider nominating a colleague for the Thomson Reuters/Frank Bradway Rogers Information Advancement Award. Technological advances for this award are considered both on their merit, and the extent of their impact.

The award is presented annually in recognition of outstanding contributions in the application of technology to the delivery of health sciences information, to the science of information, or to the facilitation of the delivery of health sciences information. The award is sponsored by Thomson Reuters. The recipient receives a certificate and a cash award of $500.


Deadline for applications is November 1.
Complete information and nomination forms can be found at

If you have questions, please contact Terrie Wheeler, Jury Chair, terriewheeler58[atsign]yahoo[dotcom]

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Be the first to comment - What do you think?  Posted by KraftyLibrarian - October 14, 2013 at 10:33 am

Categories: MLA Events/News, Other Medical Library Stuff   Tags:

Sacred Cows and Heretical Librarians

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.

Emerging Technologies & Evolving Library from Michelle Kraft
These slides don’t have a lot of text.  So I feel there needs to be a bit of outline of what I talked about to give them some context.  So here is a brief summary of what I talked about….
Technology is disruptive.  That doesn’t mean it is bad or good, it just changes everything we do.  It could change things for the good or the bad.  An example of a very disruptive technology is the light bulb.  It completely changed the way we as society do things.  Thinking of more recent technologies, the phone is another disruptive technology.  The telephone changed how we communicated to each other.  The cell phone disrupted things again.  Not only were are we able to communicate with each other over long distances, but we can do it wherever and whenever.  The smartphone just ramped things up even more by making our phones the necessary multi-purpose tool of our lives.  We use it to communicate (text, voice, email, Twitter, Instagram, etc). We use it as our own personal computers to find information online and store/create documents. It is our entertainment center for music, movies, books, online radio and podcasts.  The cell phone (among other technologies) have changed we as a society find and share information.  It is has changed the way people find and share information in libraries.  Think of what future technologies will be like and their impact on libraries.  Think of the latest technology, Google Glass, and library possiblities.
People access library websites through their phone… OR they are bypassing the library website all together and using an app (journal app, library database app, library catalog app, etc.) to find information.  They are accessing all of this information wherever and whenever….in the cafeteria, bathroom, in bed, etc.  This change in society’s behavior requires us to change the way we do things.  We must adapt to the changes in society or we face extinction.  Other professions that are dealing with changes in society as a result of technology: US postal service, newspapers, photo journalists, etc.
My presentation was not a doom and gloom thing.  On the contrary…. I said we needed to look at these disruptive technologies as opportunities.  They provide us the opportunity to shape our own destiny.  They allow us to take our services and resources and put them together in different ways to adapt to the changes.  Think of your resources and services as Legos, each one can be put together in different positions.  If something changes or doesn’t work, change the Lego’s position or swap it out.
Swapping out Lego pieces sounds easy but it may not be as easy as you think.  Libraries need to look at the changes in society and start asking themselves some hard questions.  Are the services/resources we provide for ourselves or for our users.  We do a lot of fooling ourselves that some of our traditional services/resources are for our users when really they are for ourselves.  For example, why are we checking in print journals?  Why do we even have print journals?
We need to look at our sacred cows in our library.  We need to evaluate whether we should keep them or kill them.  We can’t just keep them because we have always kept them.  Cows (in real life and virtual) need to be fed and maintained.  If feeding and maintaining them serves a valid purpose to our users, then we should keep them.  If they don’t, then we need to kill them, or they will eat food and take up space of other resources.  I gave several examples of sacred cows.  The one that everybody seemed to latch on to was my cataloging example.  I asked the question, “Do you need a catalog or would an A-Z list suffice?”  Predictably a few catalogers freaked.  What I tried to convey…
  • 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?
Evaluating these sacred cows may cause us to think some pretty heretical librarian thoughts.  The idea of not cataloging is pretty heretical. don’t get stuck on my catalog example.  One hospital librarian at the conference mentioned they did something pretty heretical, they stopped doing research and providing articles to people who were going back to school. She told them they needed to get their research help and articles from the library of the school they were attending.  She said it was a pretty heretical thought to her staff at the time.
Wikipedia’s definition of heresy: “Heresy is any belief or theory that is strongly at variance with established beliefs or customs.”  Long established customs may not be what we need now as our society changes with technology.  In order to evolve we need to look at our services and question our long established services and see if they are really needed or helping us go forward.  If not, why are we doing them?
In sum we need to look at the sacred cows and start thinking heretical librarian thoughts.  We need to always keep trying and never give up.  Let’s not be afraid of failure, failure just tells us what doesn’t work.  We need to know what doesn’t work, to know what does.
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2 comments - What do you think?  Posted by KraftyLibrarian - October 9, 2013 at 1:35 pm

Categories: Other Medical Library Stuff, Technology   Tags:

Government Shutdown and Hospital Libraries

Medical librarians were asking questions yesterday on Twitter and on Medlib-l about the impact the government shut down will have on medical library operations.  Will PubMed be up? What about Docline?

There was some uncertainty.  Alisha Miles has summed up the latest information (that we know of) in a blog post.  PubMed, NLM, Docline, and MedlinePlus websites all have notes (click on links to see the images of the notes) regarding their status during the government shutdown.

Of course being librarians we are focused on how it will impact library services, to get a perspective of how it will impact health care and hospitals check out the Forbes article, “Government Shutdown Hits Research, Teaching Hospitals, Residency Programs.”

As bad as it is, we might consider ourselves somewhat lucky.  At least the websites and backbone service programs (PubMed and Docline) we use are up.  There are other sites and industries that are not.

Alisha pointed out on her blog that ERIC ( screen shot) is down. And while this tweet got a snort of laughter out of me, NASA’s website is down and redirecting to (screen shot).

The White House website is down, but interestingly the Senate and the House of Representative‘s websites are up.  I am refraining from making a bevy of sarcastic comments about essential government services right now.

Vanderbilt’s Eskind Medical Library has a REALLY good list of what is up and what isn’t.

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4 comments - What do you think?  Posted by KraftyLibrarian - October 1, 2013 at 11:33 am

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MLA Behind the Scenes: How to Join a Committee

**Update** I forgot to mention that President-elect Linda Walton wrote a nice article in August 2013 issue of MLA News on tips for joining an MLA committee (members only).

Usually I try and wait a little bit between my Behind the Scenes posts to give people a chance to read about other things than just MLA stuff.  However, the deadline to join a committee is October 31st so that means I better write about it now to rather than later.

In past posts I have mentioned that Sections, Chapters, and SIGs are a great way to get involved within MLA and to meet, discuss, and just share knowledge with other librarians.  Committees are also another great way to get involved.  Committee are also a component of the engine that helps run MLA.  Without people’s committee work, there are many things that wouldn’t get done.  There are approximately 15 staff members of MLA for an organization of 2,500-3,000 librarians and there is no way those people can do everything.  Much relies on the MLA members to keep their organization moving forward.

One way to help keep the organization moving forward is to volunteer to be on a committee.  Each year MLA members must apply to join a committee or  committees. An online committee application is available in the members-only area (active June through October 31). The form also appears in the August and September issues of MLA News and is available through headquarters. As I mentioned, the deadline for committee applications is October 31.

According to MLA’s website: “In making appointments, the association considers the background and skills of the applicants, as well as the responsibilities and needs of the committees. A history of active participation in committee work on the local, regional, or national level is an important qualification. Recommendations are sought from current committee chairs, members of the board of directors, and program staff. Some MLA committees require combinations of skills and knowledge found among few health sciences librarians. Therefore, it is sometimes necessary to recruit certain members with unique experience and expertise to serve on specific committees. The president-elect makes final committee selections. During the president’s term, he or she names members to committees as vacancies occur.”

I have been on a couple of committees and basically the above paragraph is a really long way to say the following:

  • Current committee members looks at those apply for committee spots
    • Therefore list your whatever credentials, activities, experience you have even if it isn’t national experience.  The committee members just want to make sure you are somebody who is willing to be an active participant.
    • If you want to join a committee where your experience might helpful towards committee work. For example: people wanting to join the Technology Advisory Committee will want to list their technology experience.
  • While the paragraph states the president elect makes final committee decisions, in my experience they usually go with the committee’s picks.
  • Chairs are selected from the current committee members and usually serve for a slightly longer term than the rest of the committee members.
  • In the event that certain expertise is needed for a committee, sometimes people are recruited to serve on a committee.  The best example I can give where this happens continually is the National Program Committees.  Once the chair for the NPC is chosen by the Board, the chair works with the president elect to a local assistance chair. The LAC chair is often chosen based on the host city location.  That person has certain expertise (living in/near that city) that is required.

There are a lot of opportunities to join a committee because there are a lot of committees to choose from:

Clicking on each link will give you more information about each committee (MLA members only).

Although the Administrative and Board Committees, Executive Committee, and the Nominating Committee are listed on the committee web page, these three committees are different and don’t follow the same application and appointment process.  (See my post on the Nominating Committee.)  So that brings me to the next important bit about committees….

Members are pretty much applying to be on standing committees (as list above).  Executive and Nominating Committees are mandated by the bylaws and are different.

Ad hoc committees and task forces are appointed for a special purpose or specific study and are discharged when their tasks are completed.  So these committees are not ones that you can apply for annually, the members are appointed.  BUT…(and this is only my personal opinion) you would probably have a greater chance of being appointed if you are already active within MLA through your committee, Section, SIG or Chapter work.  Just saying.

Juries are constituted for the purpose of recommending recipients of awards, prizes, grants, and scholarships. Panels are appointed to serve as peer-review and evaluation boards for MLA’s publication and credentialing programs.  These groups are found within awards committees and other committees such as the JMLA Editorial Board.

Browse through the above list of committees and check out their annual reports to learn more about them.  Find a couple that you are interested in and apply for them.  The reason I say a couple…is because on the application you are asked to list your first, second, and third committee choices.  There are some committees (NPC comes to mind) that are very popular, so it is a good idea to have backups that you are interested in.

If you are interested in joining a committee the biggest advice I can give is to provide information in the boxes about your participation and special expertise or qualifications.  In the past I have seen some applications where people haven’t listed any information in those areas and it is very hard to choose people based on limited information.

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Be the first to comment - What do you think?  Posted by KraftyLibrarian - September 30, 2013 at 1:22 pm

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Congrats to the New Leadership Program Fellows & Mentors

Congratulations to the fellows and mentors chosen for the 2013-2014 NLM/AAHSL Leadership Fellows Program.

According to the statement posted on the MLA-LMS listserv, “the NLM/AAHSL Leadership Fellows Program prepares emerging leaders for director positions in academic health sciences libraries. The program provides a combination of in-person and virtual learning experiences for fellows and offers the opportunity to work collaboratively with the cohort of participants. Fellows are paired with mentors who are academic health sciences library directors and will visit the libraries of their mentors.”

More information about the program is available at

Although I haven’t seen a non-academic librarian accepted in a while, the program isn’t limited to just academic librarians.  Hospital librarians and librarians from other library environments can and should apply if  they have a “strong interest in pursing a directorship in academic health sciences libraries.”


Debra R. Berlanstein

Associate Director, Hirsh Health Sciences Library
Tufts University

Mentor: Thomas G. Basler

Director, Libraries and Learning Resource Centers
Chair, Department of Library Science and Informatics
Medical University of South Carolina

Renée Bougard

National Network of Libraries of Medicine Outreach Librarian
National Library of Medicine

Mentor: Pamela S. Bradigan

Assistant Vice President, Health Sciences
Director, Health Sciences Library
Ohio State University

 Tara Douglas-Williams

Division Head for Information Services/Library Manager
Morehouse School of Medicine

Mentor: Barbara Bernoff Cavanaugh

Associate Director, Health Sciences Libraries, and Director, Biomedical Library
University of Pennsylvania

 Deborah L. Lauseng

Assistant Director, Academic and Clinical Engagement Taubman Health Sciences Library
University of Michigan

Mentor: Anne Linton

Director, Himmelfarb Health Sciences Library
George Washington University

 Alexa Mayo

Associate Director for Services
Health Sciences and Human Services Library
University of Maryland

Mentor: Christine D. Frank

Director, Library of Rush University Medical Center

Dongming Zhang

Associate Director for Advanced Technologies and Information Systems
Welch Medical Library
Johns Hopkins School of Medicine

Mentor: Gerald J. Perry

Director, Health Sciences Library
University of Colorado Denver

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2 comments - What do you think?  Posted by KraftyLibrarian - September 26, 2013 at 9:56 am

Categories: Educational Opportunities, Other Medical Library Stuff   Tags:

Quick & Dirty Way to Make a Library App

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.

LibraryApp 002


Tap “Add to Home Screen”

LibraryApp 001


Name it something short and descriptive and then tap Add.  Beware: long names get cut off.

LibraryApp 003


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.

LibraryApp 004

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.

  1. Bookmark the page
  2. Go into Bookmarks menu
  3. Click and hold on the bookmark
  4. 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.

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6 comments - What do you think?  Posted by KraftyLibrarian - September 25, 2013 at 3:23 pm

Categories: Android, iPad, iPhone, SmartPhones, Technology   Tags:

Congratulations MLA Nominations

In years past I have congratulated those nominated and I want to do so again.  Good luck to everyone.

MLA Board of Directors
Teresa L. Knott, AHIP
Gail Kouame
Heidi Heilemann, AHIP
Melissa De Santis, AHIP
Kristi L. Holmes
Barbara J. Henry

MLA Nominating Committee
Diana J. Cunningham, AHIP
Sally Gore
Kelly Gonzalez, AHIP
Amy Blevins
Laurie L. Thompson, AHIP, FMLA
Paula Raimondo, AHIP
Stephanie Fulton, AHIP
James Shedlock, AHIP, FMLA
T. Scott Plutchak, AHIP, FMLA
Deborah D. Halsted
Pamela S. Bradigan, AHIP
Jonathan Eldredge, AHIP
Meredith Ilyse Solomon
Susan Fowler
Mark E. Funk, FMLA
Heather N. Holmes, AHIP
Robert T. Mackes, AHIP
Linne’ Girouard

MLA President-Elect
Michelle Kraft, AHIP, Alumni Library, Cleveland Clinic, Cleveland, OH
Elaine Russo Martin, Lamar Soutter Library, University of Massachusetts Medical School–Worcester

I am honored and humbled to be nominated, and even considered in the same category as Elaine. Both of us have done a lot of within MLA and I know it will be a difficult to decision.  In the next few weeks, MLA News will send out bios and information about the candidates.  Make sure you read them and then vote for the people based on the information within MLA News and who you think will be best for MLA membership.


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1 comment - What do you think?  Posted by KraftyLibrarian - September 23, 2013 at 4:16 pm

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Quality and Safety Concerns for Medical Apps

I just read a brief perspective article in the journal Evidence Based Medicine, “Medical apps for smartphones: lack evidence undermines quality and safety.”  It is a quick little read and it brings up some very real and interesting points which I will try to summarize.

  1. There is no official vetting system for medical apps – Some apps are blatantly wrong and dangerous, some are out of date therefore also dangerous.
  2. Lack of information and clinical involvement in the creation of the apps – There is a paucity of information regarding the creator of the app. Some apps have no physician involvement.
  3. Companies (authors specifically mention Pharma) creating apps could create conflicts of interest and ethical issues – Pharma apps could produce drug guides or clinical decision tools that subtlety push their own products.

The FDA will regulate some apps but not all.  The FDA will regulate apps that control a medical device or displays, stores, analyzes patient data (example: electrocardiogram).  They will also regulate apps that use formulas or algorithms to give patient specific results such as diagnosis, treatment, recommendation or differential diagnosis.  Finally they will regulate apps that transform a mobile device into a medical device (example: apps that use attachments or sensors to allow the smartphone to measure blood glucose).

That still leaves a ton of medical apps hanging out there in the app stores which are largely unregulated.  The article states, “Until now, there has been no reported harm to a patient caused by a recalled app. However, without app safety standards, it is only a matter of time before medical errors will be made and unintended harm to patient will occur.”  Basically it is the Wild West in the medical app arena.

There are two groups that are trying to evaluate medical apps. and the Medical App Journal review various apps directed toward medical professionals.  I take issue with the article authors who state these sites are a “good starting point for peer-reviewing apps, the current assessment criteria do not address the scientific evidence for their content, but rather matters of usability, design, and content control.”  While I don’t use the Medical App Journal as often,  I use quite often and they do more than just assess the usability and design. I have read reviews where they question the medical correctness of apps, intended audience, and have even pushed for more information regarding authorship/responsibility.  Several of their reviews questioned an app’s update schedule and updated content.  They have also investigated, questioned, and reported instances of fraud and plagiarism with medical apps.  I think iMedicalApps does a very good job in a very flooded market, but there are areas for improvement.  As with any website that relies on a large number of reporters/reviewers, there is some variance in the quality based on the reviewer.  I haven’t found any reviews that are bad, just some are better and more thorough than others.  Perhaps a little more explanation or transparency regarding how they determine the accuracy or validity of medical app might be helpful, or a standardized checklist about the things they look at.  I realize evaluating the latest UpToDate app is different compared to an app on EKGs.  UpToDate already has an established proven product where as there is more to investigate and validate with an app that isn’t a version of an already established product.

The authors believe the medical community needs to be more involved with regulating medical apps.  They suggest:

  1. Official certification marks guaranteeing quality
  2. Peer review system implemented by physicians’ associations or patient organizations
  3. Making high quality apps more findable by adding them to hospital or library collections

1.  I like the idea of having an official certification indicating quality, but there are two things that must be addressed prior to that.

First you have to get the organizations to actually take responsibility for looking at apps that are in their area of expertise. The field is already cumbersome, I am not sure many organizations are able to handle that. Although I have found that several journals have now included app reviews.  While they can’t come close to scratching the surface of medical apps, these journals often have MDs, RNs, MPTs writing reviews and evaluating the content.  Specifically I have found some good reviews in the physical therapy and nursing journals.

Second, there is growing problem with fake certifications. If an app is created by a company or people who already don’t care about its accuracy or is a plagiarizing a product, they probably have no qualms about lifting the image of the certification and posting it on their website.  They could create their own certifications to fake (but legit sounding) orgs and post those on their app’s site too.  Official certification is a good idea and I like it but there needs to be more to it to make sure it truly represents quality.

2. I personally believe the writers at are on their way to something of a peer review system.  Right now they only have one person review an app.  While that completely makes sense from a writing perspective, perhaps they can implement some sort of peer review process where more than just one person is reviewing the app, yet still retain the one voice post for ease of reading.  Perhaps they could  reach out to a few medical professionals who are leaders in their field to review specific apps.  Thus giving the reviewed app a little bit more weight.  This along with astandardized check list or illustrating how they review the medical accuracy of an app would make the information on their site even more important and provide an excellent way of separating the wheat from the chaff.

3. An online repository of approved apps would be great.  Some hospital IT departments that have mobile device policies have this, but they seem to be only hospital type apps like Citrix or database subscription apps like LexiComp, PubMed, UpToDate, etc.  While these apps are important, there is little worry about apps like LexiComp, UpToDate, or PubMed because they were well established medical information products before their app.  Their app is just an extension of their verified product.  I don’t see a lot of  IT departments that have investigated having a pool of apps that aren’t hospital specific or from database subscriptions.  Additionally, IT would either need to rely on an outside sources like iMedicalApps or content experts within the field in that hospital to build the app pool.  IT would have no way of verifying the authenticity and validity of an app on pediatric emergency medicine.

Finally, getting hospitals to buy bulk licenses to apps is tricky at best.  With exception of a few places like Epocrates, Unbound Medicine, Inkling, and Skyscape (many of those companies dealt with institutional subscriptions before app stores….remember PDAs?) there are very few places that sell or license apps to a group of people.  The purchasing of apps was created as an individual service.  Now academic medical centers may have a foot in the door with iTunes U, but I have heard that discussions with Apple and their app store and hospitals is an “interesting” process.  The same principle applies to library repositories.  Instead of IT aggregating the apps, the library would do that.  There are a lot of library’s that already have great lists suggesting various medical apps.   But the vast majority of medical libraries have app resources guides, suggesting apps that the individual must buy.  Also just like with an IT repository of apps, the librarian must rely on sites like or their own physician suggestions to ensure they are listing quality apps.

Like I said it is the Wild West when it comes to medical apps.  That is because the whole app industry is a new frontier.  There are quality and accuracy problems with other apps in the app stores. A pedometer app with errors is not going to kill somebody, but an inaccurate medical app can.  Yes, the medical community needs to get involved in evaluating apps, but so does Apple and Google.   Right now Apple’s iTunes store feedback and ranking system while good for games, is not adequate for medical apps and can easily be subject to fraud.  Additionally, Apple is extremely tight lipped about its app store rules and regulations.  Some apps have extreme difficulty getting approved, while others fly through approval process only to be mysteriously removed later.  There is no transparency to the Apple App Store.  For example, there is no information about the app Critical APPraisal which was determined to be a plagiarized version of Doctor’s Guide to Critical Appraisal.  The app was available in the App Store July 2011.  However, if you searched today for the app, you wouldn’t be able to find it in the App Store, it simply disappeared.  Unless you happen to read the article in BMJ,, or a few other British publications, you would have no clue as to why the app was removed.  When it comes to dangerous apps, disappearing them from the App Store is not good enough. You must have transparency when it comes to medicine.


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.”


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1 comment - What do you think?  Posted by KraftyLibrarian - September 18, 2013 at 10:30 am

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Plagiarism of Medical Text in Medical Apps

In a recent post, Timothy Aungst from 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 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.”

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1 comment - What do you think?  Posted by KraftyLibrarian - September 17, 2013 at 10:46 am

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