Informationist and Informationist and Expert Searcher: Expert Searcher:

Critical New (Old) Roles Critical New (Old) Roles for Health Sciences for Health Sciences

Librarianship?Librarianship?

Gary D. Byrd, Ph.D.Gary D. Byrd, Ph.D.

University at Buffalo (SUNY)University at Buffalo (SUNY)

An Outline for this TalkAn Outline for this Talk

►Patient-Centered Librarianship: from Patient-Centered Librarianship: from CMLs to InformationistsCMLs to Informationists

►Expert Searching: from Intermediaries Expert Searching: from Intermediaries to Educators to Search Consultantsto Educators to Search Consultants

►Knowledge Management: from IAIMS Knowledge Management: from IAIMS to Decision Supportto Decision Support

►Research QuestionsResearch Questions ►Training ImplicationsTraining Implications

Patient-Centered Patient-Centered LibrarianshipLibrarianship

►Evolving Paradigms:Evolving Paradigms: Clinical Medical Librarians Clinical Medical Librarians

(Clinical Librarians)(Clinical Librarians) Measuring the Impact of Hospital Measuring the Impact of Hospital

Library Search Services on Library Search Services on Patient CarePatient Care

InformationistsInformationists

CML ServicesCML Services

► Integrate library resources and expertise Integrate library resources and expertise into the clinical, patient care settinginto the clinical, patient care setting

►Overcome time, cost and expertise barriersOvercome time, cost and expertise barriers►Adjunct members of patient care teamsAdjunct members of patient care teams► Improve librarians’ understanding of Improve librarians’ understanding of

patient care context of questions, patient care context of questions, information needsinformation needs

►Potential to better anticipate information Potential to better anticipate information needsneeds

CML Service RolesCML Service Roles

► Providing research assistance for clinical Providing research assistance for clinical facultyfaculty

► Providing requested articles & bibliographiesProviding requested articles & bibliographies► Selecting, summarizing, abstracting articles Selecting, summarizing, abstracting articles

based on observed (anticipated) needsbased on observed (anticipated) needs► Educating students, residents, others on Educating students, residents, others on

teamteam► Providing information to patients & familiesProviding information to patients & families► Promoting use of traditional library servicesPromoting use of traditional library services

Factors in CML Successes & Factors in CML Successes & FailuresFailures

►Acceptance of librarian as team memberAcceptance of librarian as team member►Medical, clinical knowledge of librarianMedical, clinical knowledge of librarian►Librarian’s willingness to assume CML Librarian’s willingness to assume CML

rolerole►Frequency of team requests and service Frequency of team requests and service

usesuses►Costs of personnel and other resourcesCosts of personnel and other resources►Budget sources available to support Budget sources available to support

servicesservices

CML Evaluative StudiesCML Evaluative Studies

►Only 35 from 1974 to 2001Only 35 from 1974 to 2001 Mostly Mostly descriptivedescriptive (5 used controls) (5 used controls) Usually Usually single, active programssingle, active programs (5 more general) (5 more general) Most used Most used actual program dataactual program data (1 secondary, 1 (1 secondary, 1

simulated)simulated) Data collection methodsData collection methods: use statistics (20), : use statistics (20),

questionnairesquestionnaires (13), (13), surveyssurveys (10), (10), interviewsinterviews (9) (9) Service aspects studiedService aspects studied: : effect on userseffect on users (30), (30),

program functionsprogram functions (21), (21), program developmentprogram development (12), (12), costscosts (8), library effects (2), need (1) (8), library effects (2), need (1)

Impacts studiedImpacts studied: : patient carepatient care (31), (31), educationaleducational (21), (21), library serviceslibrary services (11), research (4) (11), research (4)

Results of CML StudiesResults of CML Studies

► Atypical studies:Atypical studies: Positive recollectionPositive recollection of previous services (1977) of previous services (1977) Programs discontinuedPrograms discontinued due to budget and staff due to budget and staff

shortages (1980)shortages (1980) Review of reported Review of reported benefits & problemsbenefits & problems (1974-84) (1974-84) Dept. chairs & librarians Dept. chairs & librarians mildly receptivemildly receptive to CML to CML

concept (1990)concept (1990)► Single, active program studies:Single, active program studies:

Weighted average--Weighted average--perceptions of positive impactperceptions of positive impact : :►<600 users & <400 “uses” included in these <600 users & <400 “uses” included in these

studiesstudies►UsefulnessUsefulness, quality of information (12 studies) , quality of information (12 studies)

89%89%►Patient care impactPatient care impact (12 studies) 65% (12 studies) 65%

Hospital Libraries & Patient Hospital Libraries & Patient CareCare

► Studies of general impact of hospital library Studies of general impact of hospital library services on quality and costs of patient careservices on quality and costs of patient care King (1986):King (1986): random, unobtrusive survey of random, unobtrusive survey of

physicians & nurses in Chicago-area hospitals; 74% physicians & nurses in Chicago-area hospitals; 74% would handle case differently with library-provided would handle case differently with library-provided informationinformation

Marshall (1990-91):Marshall (1990-91): Rochester hospitals study; Rochester hospitals study; 80% would handle case differently80% would handle case differently

Klein (1989-90):Klein (1989-90): Search services impact on Search services impact on Detroit hospital charges and length of stay; “early” Detroit hospital charges and length of stay; “early” MEDLINE searches lowered costs and patient bed MEDLINE searches lowered costs and patient bed daysdays

The “Informationist” ConceptThe “Informationist” Concept

►Davidoff & Florance (2000) Davidoff & Florance (2000) AnnalsAnnals editorialeditorial Proposed new, credentialed professional roleProposed new, credentialed professional role Combine knowledge, training and skills of Combine knowledge, training and skills of

librarian, biostatistician, computer scientist librarian, biostatistician, computer scientist and medical professionaland medical professional

Evidence-based medicine mandate to bring Evidence-based medicine mandate to bring best evidence to point of carebest evidence to point of care

Institute of Medicine reports (1999, 2001) Institute of Medicine reports (1999, 2001) mandate to reduce medical errorsmandate to reduce medical errors

CML Redux, or Something CML Redux, or Something New?New?

►Giuse (1997-98) Vanderbilt Univ. CML Giuse (1997-98) Vanderbilt Univ. CML experienceexperience Prefigures the informationist movementPrefigures the informationist movement ““Future of medical librarianship is in the Future of medical librarianship is in the

clinical realm”clinical realm” Lack of adequate CML preparationLack of adequate CML preparation Need to “assimilate the culture”Need to “assimilate the culture” Ability to interact on rounds, search Ability to interact on rounds, search

effectively, and effectively, and interpretinterpret the literature the literature

The Critical Informationist The Critical Informationist Difference Difference

(With thanks to Scott Plutchak, 2000 (With thanks to Scott Plutchak, 2000 BMLABMLA))► More than helping role of librarian at bedside More than helping role of librarian at bedside

(ambivalence of librarians and physicians)(ambivalence of librarians and physicians)► Move information management to mainstream Move information management to mainstream

of clinical practiceof clinical practice► Clinic driven & funded, not library driven & Clinic driven & funded, not library driven &

fundedfunded► Nationally recognized standard curriculumNationally recognized standard curriculum► Still librarian, but hybrid steeped in the clinicStill librarian, but hybrid steeped in the clinic► Not concerned with survival of librarianship, but Not concerned with survival of librarianship, but

the survival of patientsthe survival of patients

Expert SearchingExpert Searching

►Evolving Paradigms:Evolving Paradigms:Search intermediarySearch intermediaryEducator and trainer of end-Educator and trainer of end-user searchersuser searchers

Expert search collaborator, Expert search collaborator, consultantconsultant

Mediated Search ServicesMediated Search Services

►Combination of knowledge & skills Combination of knowledge & skills (2003 MLA Policy Statement)(2003 MLA Policy Statement)

►Knowledge areas:Knowledge areas: Subject domain, discipline, or practiceSubject domain, discipline, or practice Databases content, structure, & Databases content, structure, &

effective useeffective use Retrieval system capabilities, Retrieval system capabilities,

limitationslimitations

Mediated Search Services Mediated Search Services (cont.)(cont.)

► Skills needed:Skills needed: Clarify, refine & understand context of information Clarify, refine & understand context of information

needsneeds Find and effectively use information in all formatsFind and effectively use information in all formats Recognize personal and institutional limitationsRecognize personal and institutional limitations Apply retrieval system logic, syntax and weightingApply retrieval system logic, syntax and weighting Be mindful and reflective (use iterative and heuristic Be mindful and reflective (use iterative and heuristic

methods)methods) Use deductive and inductive reasoningUse deductive and inductive reasoning Efficiently evaluate results to fit requestor’s needs & Efficiently evaluate results to fit requestor’s needs &

expectationsexpectations Expertly process and edit results to facilitate work of Expertly process and edit results to facilitate work of

requestorrequestor Thoroughly document search processThoroughly document search process

Evolution of Mediated SearchingEvolution of Mediated Searching(with thanks to Catherine Smith, (with thanks to Catherine Smith, JMLA JMLA 2004)2004)

► The impact of MEDLARS and MEDLINEThe impact of MEDLARS and MEDLINE► Traditional reference, but with “machines”Traditional reference, but with “machines”

Intermediary role “born of batch processing”Intermediary role “born of batch processing” Separation of expert searcher and customerSeparation of expert searcher and customer Mediation between sophisticated inquirer and idiot computerMediation between sophisticated inquirer and idiot computer

► NLM training to certify expertise & library school coursesNLM training to certify expertise & library school courses► AAHSL mediated database search statistics, up to 1992AAHSL mediated database search statistics, up to 1992► Time-shared, network access made search dialogs Time-shared, network access made search dialogs

possiblepossible► Systems to encourage “end-user” searchingSystems to encourage “end-user” searching► ““Expert” concept shift (ca 1980): from mediation to just Expert” concept shift (ca 1980): from mediation to just

searchingsearching ► Implication: anyone can learn to be an expert searcherImplication: anyone can learn to be an expert searcher

Librarians as Search Librarians as Search EducatorsEducators

►NLM and Library Schools Trained LibrariansNLM and Library Schools Trained Librarians►More sophisticated and user-friendly search More sophisticated and user-friendly search

system interfacessystem interfaces►NLM policy shift to encourage end-user NLM policy shift to encourage end-user

searchingsearching► AAHSL user education statistics, 1985 ff.AAHSL user education statistics, 1985 ff.► Ubiquitous, easily accessible search systems Ubiquitous, easily accessible search systems ► Explosion in number of online searchesExplosion in number of online searches► Perception: librarian search expertise not Perception: librarian search expertise not

neededneeded

Renewed Needs for Librarian Renewed Needs for Librarian Searching ExpertiseSearching Expertise

►Collaboration and consultation:Collaboration and consultation: To conduct systematic reviews of the To conduct systematic reviews of the

literature for best evidenceliterature for best evidence To confirm complex research designs To confirm complex research designs (e.g., (e.g.,

for clinical trials)for clinical trials) To support basic research and grant To support basic research and grant

proposalsproposals To prevent medical errors To prevent medical errors (e.g, Johns (e.g, Johns

Hopkins research volunteer death)Hopkins research volunteer death) To overcome the illusion of the all-To overcome the illusion of the all-

inclusive & comprehensive Webinclusive & comprehensive Web

Knowledge ManagementKnowledge Management

►Evolving Paradigms:Evolving Paradigms: Integrated information Integrated information

management systemsmanagement systems Network infrastructure for Network infrastructure for

seamless accessseamless access Semantic and syntactic integrationSemantic and syntactic integration Decision supportDecision support

Integrated Information Integrated Information ManagementManagement

► IAIMSIAIMS (starting with Matheson Report, 1982) (starting with Matheson Report, 1982) Librarian leadership potentialLibrarian leadership potential Strategic planning for Strategic planning for integrated advanced information integrated advanced information

management systemsmanagement systems► Evolution from infrastructure and organizational Evolution from infrastructure and organizational

issues to binding knowledge to effective actionissues to binding knowledge to effective action► Continuing barriers and problemsContinuing barriers and problems::

Marking quality & authority in complex information spacesMarking quality & authority in complex information spaces Superficial integration (hyperlinks) vs. true integration Superficial integration (hyperlinks) vs. true integration

(syntax and semantics)(syntax and semantics) Facilitating information flows across patient care, research Facilitating information flows across patient care, research

and education missionsand education missions

Knowledge ManagementKnowledge Management

►The core mission of hospitals and The core mission of hospitals and academic health sciences centers academic health sciences centers

►Stewardship over the life cycle of Stewardship over the life cycle of health sciences knowledgehealth sciences knowledge

►Support for the creation, storage, Support for the creation, storage, manipulation, dissemination & use of manipulation, dissemination & use of data, information and knowledgedata, information and knowledge

►An institution’s own knowledge store An institution’s own knowledge store plus plus links to external knowledgelinks to external knowledge

Binding Knowledge to Effective Binding Knowledge to Effective ActionAction

►The end goal of knowledge managementThe end goal of knowledge management►Support for effective decision-makingSupport for effective decision-making

Decision supportDecision support

►Make all relevant current, accurate, Make all relevant current, accurate, authoritative health information authoritative health information immediately useful and usableimmediately useful and usable

►Support for care providers, researchers, Support for care providers, researchers, administrators, patients, and publicadministrators, patients, and public

The Decision Support The Decision Support ChallengeChallenge

►Overcoming human decision-making Overcoming human decision-making limitationslimitations We tend to be We tend to be risk adverserisk adverse We make decisions We make decisions to satisfy needsto satisfy needs rather than rather than

maximize utilitymaximize utility Our decisions determined by Our decisions determined by opportunity, opportunity,

availability, uncertaintyavailability, uncertainty about consequences, about consequences, personal preferencespersonal preferences

We all have “We all have “cognitive limitationscognitive limitations”” Our choices are constrained by Our choices are constrained by stress, time stress, time

pressure, limited resourcespressure, limited resources

Information Characteristics Information Characteristics Needed to Compensate for Needed to Compensate for

These LimitationsThese Limitations► Risk adverseRisk adverse

AuthoritativeAuthoritative► Satisfy need Satisfy need (vs. maximize utility)(vs. maximize utility)

Relevance, timeliness, tied to context, optimized to Relevance, timeliness, tied to context, optimized to work goalswork goals

► Determined by opportunity, availability, uncertainty Determined by opportunity, availability, uncertainty about consequences, personal preferencesabout consequences, personal preferences Accessible, current, known limitations, personalizedAccessible, current, known limitations, personalized

► Cognitive limitationsCognitive limitations Clear, readable, succinct, non-redundant, focusedClear, readable, succinct, non-redundant, focused

► Constrained by stress, time pressure, limited resourcesConstrained by stress, time pressure, limited resources Easily and quickly located (used, understood), Easily and quickly located (used, understood),

inexpensiveinexpensive

The best strategies or tools to The best strategies or tools to bind knowledge to effective bind knowledge to effective

action?action?► Informationist expertise in decision Informationist expertise in decision

making settings?making settings?►Expert searching expertise?Expert searching expertise?► IAIMS infrastructures and resources?IAIMS infrastructures and resources?►New information management New information management

technology applications?technology applications?►Others, or a combination?Others, or a combination?

Two world views . . .Two world views . . .

►Health Sciences Librarianship Health Sciences Librarianship (Librarians)(Librarians) The The serviceservice paradigm paradigm CML, Informationist, Expert SearcherCML, Informationist, Expert Searcher

►Medical Informatics (Mostly Physicians)Medical Informatics (Mostly Physicians) The The information technologyinformation technology paradigm paradigm IAIMS Leader, Decision Support IAIMS Leader, Decision Support

Applications DeveloperApplications Developer

Medical Informatics is Medical Informatics is Strategically FocusedStrategically Focused

►An ambitious research agendaAn ambitious research agenda Improving patient care via the electronic Improving patient care via the electronic

health recordhealth record►A growing number of doctoral training A growing number of doctoral training

programsprograms►National leadership and fundingNational leadership and funding

National Library of MedicineNational Library of Medicine Office of National Health Information Office of National Health Information

Technology (David J. Brailer, MD, PhD)Technology (David J. Brailer, MD, PhD)

The Challenge for The Challenge for Health Sciences LibrarianshipHealth Sciences Librarianship

►We need--We need-- A more focused research agendaA more focused research agenda

►Evidence-based librarianshipEvidence-based librarianship

A clear vision for librarians’ role in A clear vision for librarians’ role in the knowledge management the knowledge management processprocess

A strategy for educating and A strategy for educating and training the next generation of training the next generation of librarian knowledge managerslibrarian knowledge managers

Research StrategiesResearch Strategies

►Learn from and use the research results Learn from and use the research results of others (mine the literature!)of others (mine the literature!)

►Collaborate with faculty and graduate Collaborate with faculty and graduate studentsstudents Health sciences (clinical and basic Health sciences (clinical and basic

sciences)sciences) Medical informatics Medical informatics Library science and informatics Library science and informatics

►Study and report on the impact of our Study and report on the impact of our services and resourcesservices and resources

Some Research QuestionsSome Research Questions

►CMLs and InformationistsCMLs and Informationists In what settings can they be most effective?In what settings can they be most effective?

►In-patient, out-patient, research labs, clinical trials …In-patient, out-patient, research labs, clinical trials … What information needs can be most What information needs can be most

effectively anticipated?effectively anticipated? Best ratio of librarian to clinicians or Best ratio of librarian to clinicians or

researchers?researchers? Time needed to best evaluate a program or Time needed to best evaluate a program or

service?service? What is the cost-benefit ratio for these What is the cost-benefit ratio for these

services?services?

More Research QuestionsMore Research Questions

►Expert SearchingExpert Searching How important is recall and precision for How important is recall and precision for

meeting different information needs?meeting different information needs? What characteristics of the search What characteristics of the search

consultation communication process lead consultation communication process lead to successful results?to successful results?

Can we measure the additional value Can we measure the additional value provided by librarian search experts provided by librarian search experts serving on research teams?serving on research teams?

And Some More QuestionsAnd Some More Questions

►Knowledge Management Knowledge Management Can we use metadata standards to Can we use metadata standards to

effectively indicate the quality and effectively indicate the quality and authority of information resources in authority of information resources in databases?databases?

In what settings and situations can In what settings and situations can decision support be best provided by an decision support be best provided by an information management expert information management expert (librarian) rather than being embedded in (librarian) rather than being embedded in an IT application?an IT application?

What is Our Vision?What is Our Vision?

►Univ. at Buffalo School of InformaticsUniv. at Buffalo School of Informatics

What knowledge and skills are What knowledge and skills are needed to achieve our vision?needed to achieve our vision?

►Patient-centered librarians?Patient-centered librarians? CMLs, InformationistsCMLs, Informationists

►Expert searchers?Expert searchers? Intermediaries, educators/trainers, Intermediaries, educators/trainers,

consultantsconsultants

►Knowledge managers?Knowledge managers? Information system integrators, decision Information system integrators, decision

supporterssupporters

►All the above?All the above?

Pharmacy Education as a Pharmacy Education as a ModelModel

►PharmDs now often serve as drug PharmDs now often serve as drug “informationists” in clinical settings“informationists” in clinical settings

►Major transition in education and Major transition in education and practice rolespractice roles

►Deliberate process over past 30 yearsDeliberate process over past 30 years► Intriguing parallels with evolution in Intriguing parallels with evolution in

our thinking about patient-centered our thinking about patient-centered librarianshiplibrarianship

PharmacistsPharmacists

►Professional trainingProfessional training Five-year baccalaureate degreeFive-year baccalaureate degree

►Work environmentWork environment Drug store or hospital pharmacyDrug store or hospital pharmacy

►Practice rolesPractice roles Dispensing drugs and adviceDispensing drugs and advice

►PhilosophyPhilosophy Provision of useful drug products and Provision of useful drug products and

servicesservices

Doctors of PharmacyDoctors of Pharmacy

► Professional trainingProfessional training Six-year PharmD with clinical experienceSix-year PharmD with clinical experience

►Work environmentWork environment Hospital wards, clinics, HMOs, clinical Hospital wards, clinics, HMOs, clinical

research teamsresearch teams► Practice rolesPractice roles

Provide drug therapies for individuals & Provide drug therapies for individuals & populationspopulations

► PhilosophyPhilosophy The provision of pharmaceutical careThe provision of pharmaceutical care

Health Sciences LibrariansHealth Sciences Librarians

► Professional trainingProfessional training Masters degree, often with other training in Masters degree, often with other training in

health scienceshealth sciences►Work environmentWork environment

Hospital or academic health sciences libraryHospital or academic health sciences library► Practice rolesPractice roles

Develop collections, facilitate use, retrieval Develop collections, facilitate use, retrieval for individual requestorsfor individual requestors

► PhilosophyPhilosophy Provision of health information resources & Provision of health information resources &

servicesservices

Health Informationists?Health Informationists?

► Professional trainingProfessional training Six-year clinical information doctorate with Six-year clinical information doctorate with

clinical experienceclinical experience►Work environmentWork environment

Hospital wards, clinics, HMOs, clinical Hospital wards, clinics, HMOs, clinical research teamsresearch teams

► Practice rolesPractice roles Provide knowledge management services Provide knowledge management services

for other health professionals and patientsfor other health professionals and patients► PhilosophyPhilosophy

Provision of health information careProvision of health information care

Other Potential Training Other Potential Training ModelsModels

►Additional specialized graduate Additional specialized graduate training beyond the professional training beyond the professional degreedegree

►MD/PhD or MD/JD modelsMD/PhD or MD/JD models►Certification of specialized Certification of specialized

knowledge and skillsknowledge and skills►Fellowship training in clinical Fellowship training in clinical

settingssettings

ConclusionsConclusions►Growing recognition of the value of Growing recognition of the value of

information and knowledgeinformation and knowledge►Many competing professions interested Many competing professions interested

in facilitating knowledge managementin facilitating knowledge management Medical informaticsMedical informatics Pharmaceutical sciencesPharmaceutical sciences Management sciencesManagement sciences

►A challenge & opportunity for us!A challenge & opportunity for us!

Thank youThank you

Questions?Questions?