Hot Financial Mess

On July 14th my fellow librarians and I spoke on the webinar, Facilities and Personnel Management While Your Library is Closed, Open, Reopening or Somewhere In-Between. In that webinar one of the things I briefly touched up on was library budget and the impact from covid-19.

Well, brace yourselves medical librarians and library vendors, because 2020 and 2021 are going to be a hot mess financially. So when we say we have no money, please know it is worse that the library has no money. We have no money means our funding agency, our institution and/or state literally has no money.

The only way I can easily discuss it is to break it into two parts, hospitals and universities/colleges. Many had financial problems prior to the pandemic. But all have been impacted financially by the coronavirus but in different ways.

There had been a shift in recent years where smaller rural or urban, less profitable hospitals have been either bought by larger systems or were closed due to several financial reasons. So the idea that some hospitals have been losing money hasn’t been new. But now with the coronavirus even large previously financially healthy hospital systems have seen losses in the hundreds of millions to billions of dollars.

To sum up the articles listed above, and many others like them, major hospital systems are losing a lot of money due to the coronavirus. Smaller hospitals that were on financially unstable ground have been devastated financially. The AHA estimates that the net financial impact over a 4 month period will be $36.6 billion. Lost revenue from cancelled surgeries, additional costs associated with purchasing PPE, drug shortage costs, wage and labor costs, have all compounded to make it so EVERY hospital in America is losing a lot of money.

The hospitals have second problem related to COVID-19. As millions of Americans lose their jobs they lose their healthcare benefits. That means as people lose their health insurance they won’t be going to doctors, clinics or the hospitals for procedures. They will put it off. And if these unemployed people are in one of the 13 states that did not expand Medicaid under the ACA, that means those unemployed can’t even get health insurance under Medicaid. This translates to even less procedures and money for hospitals at a time when they need it.

University and Colleges:
Like hospitals, there has been a downward financial trend for some universities and colleges that was related to the shrinking number of high school students entering college. The generation following the millennials is significantly smaller. Many colleges had hoped to supplement this downward demographic trend with international students. However, that became problematic as a result of government policies.

The authors of the article, “A Crisis is looming for US colleges – and not just because of the pandemic” and researchers from The Hechinger Report, used financial data from 2009-2018 and identified more than 500 colleges or universities with warning signs of financial stress, prior to the pandemic. Ohio and Illinois have most institutions in financial jeopardy. Many of the state institutions have NOT climbed back to funding levels prior to the 2008 Great Recession. *Note this data is PRIOR to the coronavirus, the pandemic has exacerbated these 500 colleges financial woes AND has cause financial losses to the rest who are/were financially sound.

Again to summarize the articles above, the coronavirus is impacting more than just revenue from tuition dollars. Colleges and universities were faced with spring room and board refunds. If students cannot return to campus and must do elearning, colleges must still pay the heating, electrical, and other maintenance things that student housing dollars paid for. Disillusioned with spring elearning, many students are reluctant to continue paying tuition to their institution, and electing to do a gap year or get pre-requisite course at their community college for less money.

Then you have sports. Because the NCAA basketball tournament was cancelled, schools and conferences that participated in the tournament lost 62% of $600 million to be dispersed to the schools and conference. If football is cancelled (and it is looking more and more like it will be) that is a possible $4 billion in revenue that will be lost. You may think well that is less money the institutions have to shell out to support sports at the expense of academic and if you are, you are missing a big piece of the financial pie. That is hundreds of millions of dollars that were being distributed to schools that is suddenly gone. Yet the schools are still on the hook for student athlete scholarships, heating, electricity, maintenance of the facilities. IF the school is not one of the 23 public NCAA athletic programs that is considered self sufficient, then that loss of financial support is a double whammy.

What this all boils down to is hospital and academic medical libraries are in a significantly worse financial position than they were in recent years. I am not a financial analyst but I would venture to say that it will be worse than the 2008 Great Recession. It is estimated that roughly $200 billion will be lost from states by June of next year. It is unlikely there will be much support from the state either.

So don’t be surprised if librarians are saying they don’t have any money. They don’t. Now is the time for vendors and librarians to work together to weather this financial storm. Both must be willing to negotiate renewal costs and think creatively. Consider multi-year agreements that have 0% renewal or a cut in price, that can gradually increase in subsequent years. Understand that some very well used resources may still need to be cut. Even if every library resource had 0% renewal price for 2021, but the library has a 20% budget cut, something will have to get cut. Librarians, work with your administration to help them understand if a multi-year agreement is beneficial. Vendors, I am not asking you to go bankrupt (that doesn’t help you or us) but please start thinking out of the box as to how we both can financially afford to be in business together, which might mean less profit in 2021. BTW deferring a full price bill that is due Jan 2021 for April 2021 is NOT help. Our budgets are set for the WHOLE year, so if I don’t have the money to pay your bill in January, I sure as hell won’t have it in April.

We are in for a hot financial mess for 2021 and 2022. Let’s all try to figure this out together so that we have something to build from in the future.

Things I’ve Learned Managing a Library During this Crisis

First I want to recommend Zach Osborne’s post “Hospital Librarianship during the COVID-19 Pandemic” as a really good description of what it is like right now as a hospital librarian. I couldn’t have expressed it better.

I also want to share some of the things I have learned during this time. I think the easiest way is to just do a list.

  • Some key library infrastructure systems do NOT work from home.
    • We found both our ILS (Innovative Interfaces) and Illiad do not allow for us to do back office work (set up accounts, catalog, order articles, etc.) when we aren’t on our institution’s IP range.
      • VPN isn’t the answer because our IP is still our personal Internet Service Provider not the institution’s IP address.
      • We had to create a frustrating work around and that limits the number of people who can get into the systems. But at least it is a work around.
    • NOT everything is available online!!! I can’t stress this enough. There are articles that healthcare people need from the 1990’s that aren’t online.
      • These are older articles on antivirals, ventilators, triage, etc. that are VERY MUCH needed by frontline personnel, researchers, and administration during this pandemic.
      • This is especially difficult to deal with since the National Library of Medicine and many academic medical libraries are not providing ILL’s to these type of articles because they have nobody in their libraries. I feel sick to my stomach that we can’t get people these needed things at this time.
  • Don’t worry about the books. Shocker, a librarian is saying this.
    • Contact your ILS to see if you can set autorenewals for all outstanding items.
    • IF you charge fines, waive them during this time.
    • Establish a procedure for handling returned books. Because people will try and return them now, and they will return them eventually when this is all over.
    • Post signs on your website, book return, and library doors for patrons not to worry about returning and fines.
  • Let staff take their computer monitors, mice, docking stations home so they can be as comfortable working online as possible.
    • Create a document stating the employee has your permission to take the listed items to use as they work from home and they understand that these items must be returned when they return to work on campus.
  • Document everything you can, you never know when and what you will need. Think of how you can show your library’s value during this time if/when there are budget cuts later as a result of the crisis.
    • It is especially important to track any searches, document deliveries, projects, help that you did specifically related to covid-19.
      • This might be difficult if the requestor doesn’t say it is for covid-19 or if it doesn’t have covid-19 in the title. But it is safe to assume topics on ventilators, ARD, antivirals, intubation, and triage can’t be counted. Another “hidden” topic is the larger topic of internal medicine, many people are brushing up on internal medicine as they are reassigned to those floors, so look at those a little closer.
  • Be flexible in your new work space and take breaks and encourage your co-workers and staff to do the same.
    • Nobody sits at their desk at work all day. They walk to meetings, lunch, talk to co-workers, retrive things from the printer, etc. So don’t sit at your home desk all day. Get up, take a quick walk, chat with a co-worker.
    • I can’t remember where I heard this, but make it a goal to reach out to at least 5 people each day (no your pet or the people in your house do not count). It is too easy accidentally socially isolate yourself.
    • Remember nobody is perfect, everybody is having struggles too.
  • Finally do what is right for you, your staff, your library and institution.
    • This means that there isn’t one right way to staff a library during a pandemic. It all depends on balancing your institution’s rules and safety.
      • Some libraries will need everyone to work from home.
      • Some will have a split staff.
      • Some will close the space to patrons but have staff come in.
      • Hospitals may have different staffing rules.
      • Colleges may want the space to be open to students so they can spread out and study/work, but the library staff work remotely.

I know it seems a bit overwhelming but now is also the time to start planning the reopening of the library and resumption of services. Create a brainstorming document where you can list the things you need to think about when you do reopen.

Here is what is on my reopening list so far:

  • Do we need to limit the number of people in the library (including staff)?
  • Does staff need to wear masks? What about patrons?
  • Should we mark off where people should stand waiting/talking to someone at the front desk?
  • Thinking about making “Use Another Computer” or “Use Another Desk/Chair” signs to post at every other spot.

I hope this is helpful and everyone is staying safe.

Working From Home During a Pandemic

It has been a while since I have last posted. My blog had been hosted on LISHost and after many years Blake decided to move on so I had to find a new host. I transferred my blog to the new hosts, Libchalk, at the end of February. Then in March the coronavirus hit and the time to blog disappeared.

I decided my first post back would be a little bit about what we are doing at my library and a totally shameless plug for MLA’s “Join the Covid-19 Conversation: Managing Remote Workers and Work” hosted by Ellen Aaronson, AHIP, Mayo Clinic Libraries, and yours truly on Tuesday 4/14/20 1:00pm eastern time.

Here is brief run down of what we are doing at my library:

  • The library is sort of closed. The space is closed to everyone except 4 library staff who are answering phones, setting up library accounts, and ILLing our print collection to our healthcare teams as well as to other libraries in need.
  • The rest of the library staff, including those who work in our community hospital libraries, are working from home doing searches, answering LibChat, setting up online resources, ILLing online stuff, as well as other things.
  • I know our team is making a difference as we have provided info (searches, articles, and ebooks) on things directly related to Covid-19 to our doctors, nurses, researchers, administration, and to state officials.
  • I have been communicating with staff via email, text, Microsoft Teams, and through LibChat. I have been communicating with other medical librarians via Twitter A LOT. And I have to say the medlibs on Twitter have been super helpful.

While things have been serious, it is important to also to keep your sense of humor. My card table desk, overlooks my street and I feel like I am now a part of the neighborhood watch as I see everyone walking their dog, families trying to wear their kids out on tricycles, and everyone getting Amazon deliveries. I recently learned that a local brewery was delivering beer to homes because I saw their bright green car pull up to a neighbor’s house. I made a mental note to call them later for a delivery.

I feel my card table office is in a way better location than my husband who is in the basement. But he seems to have better quiet spot than I do. When he shuts the door the kids seem to leave him alone. When I shut the door it seems like it is an invitation for the kids to come in talk to me when I am on Zoom. That is why I often take my Zoom meetings (especially with my bosses) while sitting in my car in the driveway. The mail person has walked by me several times while I have been in the car on Zoom. She must think I am crazy.

Our MLA discussion on Tuesday will focus on some of the things we have been doing to make things work while keeping in mind that we are not just working from home. We are at home during a crisis trying to work. To make it more of a discussion and less of lecture, feel free to ask Ellen and me questions about what we are doing library related or just what we are doing to deal with the craziness of managing work from home during a pandemic. I look forward to “seeing” all of you online.

The ILS and the Future Needs of Libraries

ALL current ILS products suck.

There are several reasons why they suck, but the bottom line is that they fail to serve the modern needs of library which have drastically evolved.

OhioLINK and Ithaka S+R just released the white paper, “It’s Not What Libraries Hold; It’s Who Libraries Serve: Seeking a User-Centered Future for Academic Libraries” detailing the needs of libraries for systems going forward. *note* I served on the committee that helped formulate this paper.

Please note, we originally struggled with using the word ILS. Because the ILS we need now and in the future cannot be the ILS as we know it. But coming up with a name is difficult because what we really need is a true integrated library system, so what else do you call it? Think of the current ILS as Model T and the future ILS is a Tesla. The original Model T didn’t have windshield wipers and you had to crank to turn it on. The Tesla plots your course and will self park. They are both cars. They both served the needs of the population at the time. Can you imagine a Tesla on the unpaved roads of past? Likewise can you imagine commuting in a Model T every morning on the highway (in the winter in Ohio)?

The problem is the current ILS products fail to serve the needs of the current population. ILS products over prioritize the print collection (what the library owns) and fail to deliver on serving the needs of the user which has shifted beyond just the print collection. Since I am a medical librarian I see this most prominently in the medical library world. Librarians have used outside vendor products (link resolvers, discovery platforms, LMS, aggregators, etc.) to duct tape together a system to solve the needs that a true Integrated Library System should.

I encourage everyone, especially medical librarians, to read the white paper and think about the 4 main points we present that are necessary in the ILS of the future (near future IMHO).

  1. Libraries have shifted their raison d’etre from being the keeper of information to a user centered services. Unfortunately, every ILS I know of is centered around the keeping of the collections. The collections are important but they are not primary focus of libraries or users now. ILS products have not full understood that because it requires a complete reframing of the entire system. Too many ILS products are built on legacy coding and legacy structures and new versions and features are glued on. It is like taking a Model T and adding keyless entry.
  2. ILS products are still overly focused on print or physical in house collections. While we still need to keep track of that stuff, we need more help dealing with the external collections like online journals, image databanks, ebooks, music, databases, etc. Having a link in the catalog is not the answer, nor are any of the electronic resource manager modules that the ILS vendors provide. The ERMs do poor job of pulling in that information. Its as if you stuck turn signal lights on the Model T without any electricity to make them blink.
  3. Libraries are more than just where you read a book or study. Library resources are more integrated with their institution’s research, teaching, and learning. ILS products must be able to work with LMS platforms, research platforms and be able to handle the decentralized world that we live in. The report gives an awesome example of this type of unmet need that is NOW (not the future).
    “A medical researcher at the University of Cincinnati is collaborating with a colleague at Case Western Reserve University (both in OhioLINK) and with a third colleague at Oxford University, funded by a grant from the NIH. They are able to set up access and journal alerts for their joint work in three labs with multiple potential authors by seamlessly merging their respective e-resource entitlements and are able to integrate library materials and citations, their own data, and their draft publications in a common online working platform. When lab members are ready to publish, they are able to track where articles have been submitted, accepted, and where and how the Open Access provisions required by the NIH have been satisfied. The library maps seamlessly to the researchers’ workflows.”
  4. Gone are the days of reporting just your circulation stats. Librarians need data to analyze and communicate their value to their institution. Currently ILS products cannot do this in any meaningful way. “Library systems must be completely re-architected for the modern business intelligence needs of libraries & consortia.” If I reported just circ stats that just tells my administration how many times people are borrowing books. Why do they need a librarian to loan books? I need to report on ways we are involved in interprofessional education and how that impacts the educational and research needs of employees and the care and treatment of patients. Reporting on that requires a lot of work gathering data from multiple systems that don’t talk to each other. It is like asking somebody to monitor the gas consumption of their Model T to see if they can make it to the next gas station on their trip. It requires a lot of guessing and math. Hint: The gas gauge is a paint stick. You open the gas cap and look in the tank and stick a stick in to see how full your tank is.

The paper provide several key pieces of evidence supporting these 4 main points. For example:

The Primacy of Print is Past
A snapshot of OhioLINK’s resources clearly illustrates that print is smallest collection component of current libraries. In state wide consortia of 34 libraries, there are 12.6M ejournals, 9M etheses and dissertations, 7.5 ebooks, 6.3M database resources, and only .3M print that were lent within the cosorita*. Why are ILS products focused on print? *1/27 clarification as someone on Twitter mentioned the print number appears low and off. It is low, but to provide more context, that number reflects the stats for the consortial activity, ie interlibrary print lending and consortial digitally provided access. We did not go into each individual institution’s local print circ stats for this specific report.

Users Start Outside of the Library
Google, Google Scholar, and direct (going to the source like JAMA directly) are the first stop for finding information the greatest amount of time. Despite some OhioLINK libraries that have implemented discovery systems, only a teeny tiny amount of people who start their search using the library’s discovery system. Interesting for my medlib people, of the 117 OhioLINK libraries there are only 5 medical libraries. Yet, more people start their search for information on NCBI than on discovery platforms.

I hope you all read the white paper. I know several ILS vendors have been irritated with me in the past as I have critiqued their products. However, this white paper just articulates the needs that we librarians have been saying for years, about your products. We are all riding the information highway in our Model Ts covered in duct tape with modern day accessories (which are more necessity than accessory) as Google, Amazon, and other companies and library competitors speed by us in their Teslas.

Hospital Acquistions: Problem with Libraries

According to Modern Healthcare, “Hospital megamergers continue to drive near-historic M&A activity,” the actual number of hospital mergers and acquisitions have been similar to 2018 and the numbers seem to be pretty consistent from when the merger and acquisitions “trend” hit in 2010. What is different according to the article is the amount of revenue that is part of the process. The money involved was “nearly four times higher in the second quarter of 2019 compared with the prior-year period.” No longer content with serving a specific locale (city, county, etc.) hospital systems are expanding to larger regions and into different states to diversify and expand market share.

What this article doesn’t talk about is everything that happens once these hospitals are acquired and merge. Everything from HR, GME, billing, etc. gets assimilated to the buying entity’s system. As librarians we see this every time our hospitals merge, doctors, nurses, and some administrators assume that they automatically have access to the library resources “now that we are part of your hospital.” That is not the case. Like many other librarians, I am forever explaining that our license agreements only extend to the current facilities and do not automatically allow for newly acquired institutions to be added. If the newly acquired institution wants to be added to the licenses, they must agree to pay the costs of the library resources. This blows their minds. I don’t know why, because that is same deal with EMR systems. You just don’t get EPIC for free now that your hospital was bought by a hospital using EPIC.

Nursing, Pharmacy, IT have programs and resources that they license for the institution to be used by their people. Why is it that they seem to get those added to the new institutions faster than library resources when some of resources are drug databases and nursing information tools and are often sold by the same companies that sell to libraries? It was only a few weeks ago when I was once again reciting my license speech when it hit me. Every hospital (buyer and acquired) has a CNO, Chief Pharmacy Officer, CTO, etc. Yet, due to an increase in layoffs and “retires but no rehires” (see Hospital Library Association benchmarking survey) there are very few “Chief Librarians” or any librarians at many of the hospitals. So while the two CNO’s work together to discuss address issues, costs, etc. of their two hospitals merging, the librarian rarely has a peer at the other hospital to do the same thing. Not only that, but there is no hierarchy for the librarian of the buying hospital to consult at the acquired hospital to address the issues, costs etc. of merging. Because there is no librarian, there is nobody supervising the librarian, buying/budgeting library resources, licensing them, etc. It is basically a black hole.

Can you think of this happening within any other hospital department? I’m trying… help me out.

Without my counter part at the other hospital to discuss the merger and to discuss the costs, logistics, onboarding, etc. with their boss, I am left to talk to the wall. Nobody in the newly acquired hospital knows how to handle it and plays hot potato passing along the “library stuff” to the next administrator who also doesn’t know…. all before I drop the cost bomb. So, I am left giving my license speech to doctors and nurses explaining why I can’t give them access. I become the big bad librarian, alienating potential customers.

If a tree falls in the woods and nobody is there, did it make a sound? If a hospital librarian asks about resources and services and nobody is there, do we even exist? How can hospital librarians navigate this situation? Where do you find the support for resources in a hospital system that never supported it and doesn’t have the infrastructure to create it?

The Predatory Journals: The Dandelion of Biomedical Research

For years I have complained about predatory publishers found in PubMed. The publishers entry point is through PMC. Articles submitted to PMC are searchable and findable using the PubMed interface DESPITE being from a journal that is NOT indexed in MEDLINE.

Librarians and very savvy researchers might know the distinction, but the vast majority of the people using PubMed do not know or care. If it is found in PubMed then it they believe it has passed some sort of litmus test. Librarians, ask yourself, how many times have you done a long complicated search in PubMed and then looked at the journals to try and weed out predatory journals. Several different people have questioned, criticized or stated concerns about the PMC backdoor to PubMed. However, a recent post on Scholarly Kitchen reveals things have gotten worse. Predatory journals can now be found in other biomedical databases such as Science Direct and WoS via cited references. Where PMC was the backdoor for predatory publishers to be findable in PubMed, the cited reference has become the backdoor for these publishers to be findable in other biomedical databases.

Citation Contamination: References to Predatory Journals in the Legitimate Scientific Literature by Rick Anderson identified seven journal titles that fell victim to publishing junk articles or fake editor approval. He then looked for any published articles that cited and article published in these seven journals. What he found was articles published in predatory journals are indeed being cited by authors who are writing in non-predatory journals and thereby are findable in WoS and Science Direct and DOAJ.

Rick Anderson isn’t the only person to have discovered this problem. Authors of the article, Citations of articles in predatory nursing journals, in Nursing Outlook found “814 citations to articles published in predatory nursing journals. These articles were cited in 141 nonpredatory nursing journals.” The authors correctly noted that CINAHL and MEDLINE do not index predatory journals and that the prevalence of predatory journals in other databases is still small. Yet these journals are findable in PubMed (through the PMC backdoor) and other databases through the cited references backdoor, I feel it inadvertently and falsely gives these journals some legitimacy to authors.

Unfortunately, NLM has yet to adequately address the PMC problem. NLM employees responded to the CMAJ article “How predatory journals leak into PubMed” stating, “journals that apply to be in PMC undergo a rigorous assessment of scientific and editorial quality.” Really? Then why are there articles from predatory publishers even in PMC? IMHO, rigorous assessment of scientific and editorial quality means that no article published in a predatory journal should be allowed, regardless of whether NIH grants were used for the research.

Rick Anderson’s post is very recent (published Oct. 28, 2019), as of today (Nov. 5, 2019) I have not found any responses from the databases he mentioned regarding infiltration of predatory journals via cited references. Several databases have stated they have taken steps to help prevent the indexing of predatory publishers’ journals, but I couldn’t find anything dealing with the issue of cited references.

Predatory publishers have become the dandelion weed in the garden of biomedical literature. While they have not completely infested the landscape, their seeds distributed on the winds of Google, PMC, and other databases have invaded legitimate biomedical databases that researchers, clinicians and others use to share knowledge and treat patients. It will take a concerted effort by librarians, legitimate publishers, editors, and researchers to eliminate the predatory journal seeds from spreading further into the biomedical databases and invading the literature. If not, our biomedical databases will be like this.

Everyone Wants to do a Systematic Review

It isn’t your imagination, more and more people are writing and publishing systematic reviews. In a recent research letter from JAMA Internal Medicine, Assessment of Publication Trends of Systematic Reviews and Randomized Clinical Trials, 1995 to 2017, the authors noted the rate of growth in published systematic reviews was ginormous. I know ginormous is not a technical term and the authors would not use it in a publication like JAMA Internal Medicine, but when the rate of growth is 4676% I think the word ginormous is appropriate.

The systematic review is the new little black dress on the publishing runway, everybody must have one dahling.

But not all systematic reviews are created equal. The JAMA Internal Medicine study did not look at the quality of these systematic reviews. It just looked at the number of publications across 18 medical and surgical areas that made it into PubMed and were indexed as systematic reviews. Many systematic reviews do not meet basic standards. (Why are we calling them systematic reviews then?!) Melissa Rethlefsen reports in the Journal of Clinical Epidemiology. 2015 Jun;68(6):17-26, systematic reviews that included librarians or an information specialist as a part of the process were more likely to be reproducible and meet specific search standards.

So, it would behoove people who want to do a systematic review to contact a librarian to help. That is a good thing. Unfortunately, it seems too many people don’t understand what is really needed to do a proper systematic review. They just want that little black dress, and they want it now.

Librarians are not only drowning in the requests for systematic reviews, but the pool is continually filling with people who refuse to understand the requirements for a systematic review, or they are delusional about the commitment in time and effort needed to do one. Librarians are continually trying to lower the water level through education, but those educational methods are not hitting home with the right people.

I have seen librarians post information sheets online detailing the process. I know some librarians require forms and “contracts” to be fully filled out prior to discussions. Yet there still are those who are surprised by search results in the thousands (even though they were informed this is typical and they need to go through them) and ask for fewer results. There are systematic review searches that the librarians spend days creating that are languishing in systems like Covidence or DistillerSR never to be revisited by the requestor.

It isn’t that librarians don’t want to do systematic reviews, they don’t want to waste their time (often several days) on something that goes nowhere or is of such poor quality they need to ask that their name be removed from the paper. So they continue with their education efforts, guiding researchers to on how to do a proper systematic review or suggesting different types of searches as appropriate.

However, I feel this approach is a little bit like the librarian sticking their finger in the leaking damn. It isn’t until somebody repairs the damn will the leak actually stop and prevent the flooding of poor systematic reviews.

Publishers, faculty, researchers, and authors need to step up and help repair the leak.

  1. Publishers need to make it very clear to authors the criteria needed for a systematic review and anything that doesn’t meet the criteria will be immediately rejected. Some publishers are good at this, many are not. We have over a 4000% increase in published systematic reviews, clearly some publishers are not that strict.
  2. Faculty need to stop assigning systematic reviews as a summer project to their students. Assigning how to learn the methods or requirements to conduct a systematic review is entirely achievable for the summer. Telling students, residents, and other junior researchers to do a systematic review over the summer is not.
  3. Researchers and authors need to have a reality self check. We are not lying when we say a proper systematic review typically takes 12-24 months. You will not be the one who is “different” and can get it done in 4-6 months. You will also need at least 3 colleagues who have same time, opportunity, and dedication as you do because you need at least 3 reviewers (including yourself) to minimalize reviewer bias.

A quality little black dress is something that you will come back to and use as often as the need arises. A good systematic review is something that people can utilize to form policies, treat patients, and base recommendations. Unfortunately, a poorly done systematic review is worse than ill fitted, poorly stitched, little black dress made out of cheap material. Poorly done systematic reviews not only waste time but it flood the databases and do little to improve policy or treat patients. But hey, you got that little black dress published and it is now on your CV, so who cares if we pull a thread and it all falls apart. You don’t need to be the Ralph Lauren of systematic reviews, but you also shouldn’t be Amazon version either.

**Quick edit/update**
After posting this, I started thinking we librarians need to start being more assertive when somebody wants a “systematic review” without knowing or wanting to put in all of the work of actually conducting a systematic review. In addition to educating them, we have to remember to say No. It is hard to say no, librarians don’t like to say no. Perhaps we should also say no.

*Disclaimer* The authors in the JAMA Internal Medicine cited above are from my institution and one of them is my librarian co-worker.

I’m a Different Librarian Now

I first became a medical librarian 20 years ago. I was bright eyed and bushy tailed ready to learn everything I could about medical librarianship. Naturally over the 20 years I changed as a librarian, I became more confident, specialized in certain aspects of medical librarianship…essentially evolved.

However, I think the biggest change that I have experienced is the change in my librarian-ness when I became director of my library. I remember when I was hired I was told I will need to learn to let go of some things because the things I needed to do as director would fill those spots. Intellectually I understood this, but I don’t think I realized how much I would have to let go until I attended MLA and the whole slew of other librarian meetings that happened in Cleveland this year

As I walked the exhibit floor talking to vendors, I spoke to some great people at companies telling me how their product does this or how they’ve improved things. As I talked with these people I started to really realize that I was not the right person for them to be talking to. Yes, I make the final decisions with purchasing, but I have found that I am just not using these products as I once did.

I still do searches. We get a lot of search requests so every librarian on staff steps up and does a lot of searches. But I don’t do systematic reviews. Five years ago I would have jumped at the chance to do them and learn everything I could about doing them. Now, I just don’t have time to do them and I give them to one of the librarians who do them. I don’t edit web pages or test products as much as I would like to. Honestly, I had to go to one of my LibGuide librarians to remind me how to a certain thing in our guides.

As I look back, the transition has been a little weird to me. I don’t have the time I once had to investigate things. It is no longer my job to be the expert on library things. My job is to make it so my co-workers can be the expert in library things. That means I do everything I can to make it so they can do their jobs. My job is to be the expert at running the library. That is a big switch.

You can take all of the leadership and management classes from MLA and AAHSL (and I encourage everyone to do so) but until it happens, you really don’t understand how things change. I am forever grateful to my library friends and peers for sharing their knowledge and letting me pick their brains. Without that camaraderie, the switch to library director would have been more difficult. Librarians a great group of people who share. I hope as I continue to grow and change and be a different librarian that I am able to share with others and give back as much as others have given to me.

Don’t be afraid of change, of moving to a different job, role, or path. It will be different, but that isn’t necessarily bad, it can be quite good.

We Don’t Understand How Our Users Find Information

I had the unique pleasure to be the moderator for the McGovern Lecture at this year’s Medical Library Association Meeting. You must login w/ your paid meeting registration to watch. If you didn’t go to the meeting you can get a virtual registration to watch (scroll down to econference rates)

The McGovern Lecture traditionally is one person who give a lecture on a topic of importance to health sciences librarianship. This year the lecture featured 4 speakers (an Academic Hospitalist, a Professor of Physical Therapy, a Family Medicine doctor, and a Director of Nursing Research) all speaking about how they find information to stay up to date in their areas of specialty.

Each one of them used the library. Each one of them loved their librarians. Each one of them professed that they get the most up to date information in their specialty from Twitter. This was mind blowing to almost every librarian in the audience. These professionals use Twitter to connect across the globe with others (mentors, friends, experts in the field). They have a very curated list of people they follow on Twitter, so that they receive tweets specifically targeted on topics of interest in their field. If somebody they follow tweets about a good article, they get it. Its a bit like the old commercial when EF Hutton talks they listen.

We have all known that caregivers consult each other when faced with questions or staying up to date. In the past these people were usually in the same place of employment or geographical area. Now, with Twitter there are no boundaries for professional networking and consulting.

What also shouldn’t come as a surprise is these people mentioned that they get the articles in the easiest way possible. Sometimes that is the library, sometimes that is not. One person said if they can’t find it easily at the library, “there are other methods to get the article” implying less kosher methods. As I mentioned this should come as a no surprise, we (librarians and publishers) suck at getting people hooked up to their entitled articles and professionals don’t have the time nor patience to deal with our sucky methods. RA21 is not the answer either. RA21’s proposed method is still more complicated and more clicks than getting something from SciHub or ICanHazPDF.

If you are a librarian or somebody who works for a publisher or information provider, I highly recommend watching this lecture. It really illuminates what our patrons do in real life to get information, and it isn’t what we think they do. I also think people at NIH and NLM need to really watch this to see that front line caregivers never mentioned MedlinePlus as a resource to give their patients information until librarians in the audience asked. The speakers listed every CHI resource BUT MedlinePlus. Perhaps NLM may need to re-focus on hospitals and providers as the people who provide CHI information in addition to NLM’s efforts to connect to public libraries.

RA21 Hospitals Library Working Group & Survey

When RA21 was brought to my attention I was concerned because it was coming from a lot of publishers and vendors familiar with their world and the world of large academia but completely unfamiliar with the medical and hospital world.

In my post Medlibs Needs RA21 on Their RADAR, I briefly described RA21 and some of the concerns I had with moving towards this method of authentication and I was extremely concerned that the people talking about it hadn’t the faintest clue about library resources, usage, and IT in the hospital and academic medical world.

While I still have a lot of concerns about RA21 I am pleased to announce the creation of the RA21 Hospital/Clinical Access Working Group.  Their objectives are to “survey, identify and define the use cases/problems for accessing licensed resources from within a hospital/healthcare system that are involved with RA21 adoption and are related to RA21’s authentication use cases.”

In an effort to understand hospital and medical library authentication issues and needs they have created a survey of 20 questions that they would like any librarian serving in a hospital or health care institution or academic health care institution to take. (If you participate you can also enter into a raffle for an Amazon gift card.) *The survey closes March 1, 2019!!

I encourage every qualifying librarian to take this survey so that the working group has a clearer picture of the issues and needs regarding access to information.

The working group was started in July 2018 and the website says it will complete its work by the end of February 2019. Hmm…. I hope they plan to continue their work.  If they continue, I hope they will include some non-vendor people on the working group from medical libraries familiar with IT issues. The co-chairs are from the vendor community and while I am sure they are lovely people, they are not in the library dealing with IT and hospital policies and restrictions.  The RA21 team does have some people from large academic institutions, but is still very vendor heavy and has no representation from the medical or hospital community.