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


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

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

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

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

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

CML Service Roles
  • Providing research assistance for clinical
  • 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

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

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
  • 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)

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
  • lt600 users lt400 uses included in these
  • Usefulness, quality of information (12 studies)
  • Patient care impact (12 studies) 65

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

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

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

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
  • Nationally recognized standard curriculum
  • Still librarian, but hybrid steeped in the clinic
  • Not concerned with survival of librarianship, but
    the survival of patients

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

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

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

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
  • Time-shared, network access made search dialogs
  • Systems to encourage end-user searching
  • Expert concept shift (ca 1980) from mediation
    to just searching
  • Implication anyone can learn to be an expert

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

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

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

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

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
  • An institutions own knowledge store plus links
    to external knowledge

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

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

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
  • Accessible, current, known limitations,
  • Cognitive limitations
  • Clear, readable, succinct, non-redundant, focused
  • Constrained by stress, time pressure, limited
  • Easily and quickly located (used, understood),

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

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

Medical Informatics is Strategically Focused
  • An ambitious research agenda
  • Improving patient care via the electronic health
  • 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)

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

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

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

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

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?

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

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
  • All the above?

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

  • 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

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

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

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

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

  • 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!

Thank you
  • Questions?