Informationist and Expert Searcher: Critical New (Old) Roles for Health Sciences Librarianship?

1. Informationist and Expert Searcher: Critical New (Old) Roles for Health Sciences Librarianship? Gary D. Byrd, Ph.D. University at Buffalo (SUNY)

2. An Outline for this Talk • Patient-Centered Librarianship: from CMLs to Informationists • Expert Searching: from Intermediaries to Educators to Search Consultants • Knowledge Management: from IAIMS to Decision Support • Research Questions • Training Implications

3. Patient-Centered Librarianship • Evolving Paradigms: • Clinical Medical Librarians (Clinical Librarians) • Measuring the Impact of Hospital Library Search Services on Patient Care • Informationists

4. CML Services • Integrate library resources and expertise into the clinical, patient care setting • Overcome time, cost and expertise barriers • Adjunct members of patient care teams • Improve librarians’ understanding of patient care context of questions, information needs • Potential to better anticipate information needs

5. CML Service Roles • Providing research assistance for clinical faculty • Providing requested articles & bibliographies • Selecting, summarizing, abstracting articles based on observed (anticipated) needs • Educating students, residents, others on team • Providing information to patients & families • Promoting use of traditional library services

6. Factors in CML Successes & Failures • Acceptance of librarian as team member • Medical, clinical knowledge of librarian • Librarian’s willingness to assume CML role • Frequency of team requests and service uses • Costs of personnel and other resources • Budget sources available to support services

7. CML Evaluative Studies • Only 35 from 1974 to 2001 • Mostly descriptive (5 used controls) • Usually single, active programs (5 more general) • Most used actual program data (1 secondary, 1 simulated) • Data collection methods: use statistics (20), questionnaires (13), surveys (10), interviews (9) • Service aspects studied: effect on users (30), program functions (21), program development (12), costs (8), library effects (2), need (1) • Impacts studied: patient care (31), educational (21), library services (11), research (4)

8. Results of CML Studies • Atypical studies: • Positive recollection of previous services (1977) • Programs discontinued due to budget and staff shortages (1980) • Review of reported benefits & problems (1974-84) • Dept. chairs & librarians mildly receptive to CML concept (1990) • Single, active program studies: • Weighted average--perceptions of positive impact : • <600 users & <400 “uses” included in these studies • Usefulness, quality of information (12 studies) 89% • Patient care impact (12 studies) 65%

9. Hospital Libraries & Patient Care • Studies of general impact of hospital library services on quality and costs of patient care • King (1986): random, unobtrusive survey of physicians & nurses in Chicago-area hospitals; 74% would handle case differently with library-provided information • Marshall (1990-91): Rochester hospitals study; 80% would handle case differently • Klein (1989-90): Search services impact on Detroit hospital charges and length of stay; “early” MEDLINE searches lowered costs and patient bed days

10. The “Informationist” Concept • Davidoff & Florance (2000) Annals editorial • Proposed new, credentialed professional role • Combine knowledge, training and skills of librarian, biostatistician, computer scientist and medical professional • Evidence-based medicine mandate to bring best evidence to point of care • Institute of Medicine reports (1999, 2001) mandate to reduce medical errors

11. CML Redux, or Something New? • Giuse (1997-98) Vanderbilt Univ. CML experience • Prefigures the informationist movement • “Future of medical librarianship is in the clinical realm” • Lack of adequate CML preparation • Need to “assimilate the culture” • Ability to interact on rounds, search effectively, and interpret the literature

12. The Critical Informationist Difference (With thanks to Scott Plutchak, 2000 BMLA) • More than helping role of librarian at bedside (ambivalence of librarians and physicians) • Move information management to mainstream of clinical practice • Clinic driven & funded, not library driven & funded • Nationally recognized standard curriculum • Still librarian, but hybrid steeped in the clinic • Not concerned with survival of librarianship, but the survival of patients

13. Expert Searching • Evolving Paradigms: • Search intermediary • Educator and trainer of end-user searchers • Expert search collaborator, consultant

14. Mediated Search Services • Combination of knowledge & skills (2003 MLA Policy Statement) • Knowledge areas: • Subject domain, discipline, or practice • Databases content, structure, & effective use • Retrieval system capabilities, limitations

15. Mediated Search Services (cont.) • Skills needed: • Clarify, refine & understand context of information needs • Find and effectively use information in all formats • Recognize personal and institutional limitations • Apply retrieval system logic, syntax and weighting • Be mindful and reflective (use iterative and heuristic methods) • Use deductive and inductive reasoning • Efficiently evaluate results to fit requestor’s needs & expectations • Expertly process and edit results to facilitate work of requestor • Thoroughly document search process

16. Evolution of Mediated Searching(with thanks to Catherine Smith, JMLA 2004) • The impact of MEDLARS and MEDLINE • Traditional reference, but with “machines” • Intermediary role “born of batch processing” • Separation of expert searcher and customer • Mediation between sophisticated inquirer and idiot computer • NLM training to certify expertise & library school courses • AAHSL mediated database search statistics, up to 1992 • Time-shared, network access made search dialogs possible • Systems to encourage “end-user” searching • “Expert” concept shift (ca 1980): from mediation to just searching • Implication: anyone can learn to be an expert searcher

17. Librarians as Search Educators • NLM and Library Schools Trained Librarians • More sophisticated and user-friendly search system interfaces • NLM policy shift to encourage end-user searching • AAHSL user education statistics, 1985 ff. • Ubiquitous, easily accessible search systems • Explosion in number of online searches • Perception: librarian search expertise not needed

18. Renewed Needs for Librarian Searching Expertise • Collaboration and consultation: • To conduct systematic reviews of the literature for best evidence • To confirm complex research designs (e.g., for clinical trials) • To support basic research and grant proposals • To prevent medical errors (e.g, Johns Hopkins research volunteer death) • To overcome the illusion of the all-inclusive & comprehensive Web

19. Knowledge Management • Evolving Paradigms: • Integrated information management systems • Network infrastructure for seamless access • Semantic and syntactic integration • Decision support

20. Integrated Information Management • IAIMS (starting with Matheson Report, 1982) • Librarian leadership potential • Strategic planning for integrated advanced information management systems • Evolution from infrastructure and organizational issues to binding knowledge to effective action • Continuing barriers and problems: • Marking quality & authority in complex information spaces • Superficial integration (hyperlinks) vs. true integration (syntax and semantics) • Facilitating information flows across patient care, research and education missions

21. Knowledge Management • The core mission of hospitals and academic health sciences centers • Stewardship over the life cycle of health sciences knowledge • Support for the creation, storage, manipulation, dissemination & use of data, information and knowledge • An institution’s own knowledge store plus links to external knowledge

22. Binding Knowledge to Effective Action • The end goal of knowledge management • Support for effective decision-making • Decision support • Make all relevant current, accurate, authoritative health information immediately useful and usable • Support for care providers, researchers, administrators, patients, and public

23. The Decision Support Challenge • Overcoming human decision-making limitations • We tend to be risk adverse • We make decisions to satisfy needs rather than maximize utility • Our decisions determined by opportunity, availability, uncertainty about consequences, personal preferences • We all have “cognitive limitations” • Our choices are constrained by stress, time pressure, limited resources

24. Information Characteristics Needed to Compensate for These Limitations • Risk adverse • Authoritative • Satisfy need (vs. maximize utility) • Relevance, timeliness, tied to context, optimized to work goals • Determined by opportunity, availability, uncertainty about consequences, personal preferences • Accessible, current, known limitations, personalized • Cognitive limitations • Clear, readable, succinct, non-redundant, focused • Constrained by stress, time pressure, limited resources • Easily and quickly located (used, understood), inexpensive

25. The best strategies or tools to bind knowledge to effective action? • Informationist expertise in decision making settings? • Expert searching expertise? • IAIMS infrastructures and resources? • New information management technology applications? • Others, or a combination?

26. Two world views . . . • Health Sciences Librarianship (Librarians) • The service paradigm • CML, Informationist, Expert Searcher • Medical Informatics (Mostly Physicians) • The information technology paradigm • IAIMS Leader, Decision Support Applications Developer

27. Medical Informatics is Strategically Focused • An ambitious research agenda • Improving patient care via the electronic health record • A growing number of doctoral training programs • National leadership and funding • National Library of Medicine • Office of National Health Information Technology (David J. Brailer, MD, PhD)

28. The Challenge for Health Sciences Librarianship • We need-- • A more focused research agenda • Evidence-based librarianship • A clear vision for librarians’ role in the knowledge management process • A strategy for educating and training the next generation of librarian knowledge managers

29. Research Strategies • Learn from and use the research results of others (mine the literature!) • Collaborate with faculty and graduate students • Health sciences (clinical and basic sciences) • Medical informatics • Library science and informatics • Study and report on the impact of our services and resources

30. Some Research Questions • CMLs and Informationists • In what settings can they be most effective? • In-patient, out-patient, research labs, clinical trials … • What information needs can be most effectively anticipated? • Best ratio of librarian to clinicians or researchers? • Time needed to best evaluate a program or service? • What is the cost-benefit ratio for these services?

31. More Research Questions • Expert Searching • How important is recall and precision for meeting different information needs? • What characteristics of the search consultation communication process lead to successful results? • Can we measure the additional value provided by librarian search experts serving on research teams?

32. And Some More Questions • Knowledge Management • Can we use metadata standards to effectively indicate the quality and authority of information resources in databases? • In what settings and situations can decision support be best provided by an information management expert (librarian) rather than being embedded in an IT application?

33. What is Our Vision? • Univ. at Buffalo School of Informatics

34. What knowledge and skills are needed to achieve our vision? • Patient-centered librarians? • CMLs, Informationists • Expert searchers? • Intermediaries, educators/trainers, consultants • Knowledge managers? • Information system integrators, decision supporters • All the above?

35. Pharmacy Education as a Model • PharmDs now often serve as drug “informationists” in clinical settings • Major transition in education and practice roles • Deliberate process over past 30 years • Intriguing parallels with evolution in our thinking about patient-centered librarianship

36. Pharmacists • Professional training • Five-year baccalaureate degree • Work environment • Drug store or hospital pharmacy • Practice roles • Dispensing drugs and advice • Philosophy • Provision of useful drug products and services

37. Doctors of Pharmacy • Professional training • Six-year PharmD with clinical experience • Work environment • Hospital wards, clinics, HMOs, clinical research teams • Practice roles • Provide drug therapies for individuals & populations • Philosophy • The provision of pharmaceutical care

38. Health Sciences Librarians • Professional training • Masters degree, often with other training in health sciences • Work environment • Hospital or academic health sciences library • Practice roles • Develop collections, facilitate use, retrieval for individual requestors • Philosophy • Provision of health information resources & services

39. Health Informationists? • Professional training • Six-year clinical information doctorate with clinical experience • Work environment • Hospital wards, clinics, HMOs, clinical research teams • Practice roles • Provide knowledge management services for other health professionals and patients • Philosophy • Provision of health information care

40. Other Potential Training Models • Additional specialized graduate training beyond the professional degree • MD/PhD or MD/JD models • Certification of specialized knowledge and skills • Fellowship training in clinical settings

41. Conclusions • Growing recognition of the value of information and knowledge • Many competing professions interested in facilitating knowledge management • Medical informatics • Pharmaceutical sciences • Management sciences • A challenge & opportunity for us!

42. Thank you Questions?