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Elaine Martin, Director New England Region NN/LM Lamar Soutter Library

University of Massachusetts Medical School

NLM Board of Regents MeetingSeptember 10, 2014

Public Health Information Access Project: “Digital Library for Public Health”

Access to Scientific Literature Improves Evidence-Based Public Health Practice

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BackgroundProblem Statement

Limitations of Early Projects

PHIA Goals

Basic Model

Partnerships

Partner Input

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Many public health departments have limited or no access to published literature.

There is an increasing emphasis on evidence-based public health practice.

Problem Statement

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Time-limited: Short-term access to print articles supplied via document delivery limited to 6-12 months;

Utilization constrained: Access to the number of articles limited (e.g., no more than 10 per person);

Cumbersome: Access restricted to walk-in traffic; many spent hours going to libraries and photocopying articles;

Distant: Research libraries, in many cases, are miles/cities away from Public Health Departments;

Indirect: Student help or faculty adjuncts working in Public Health often used to access library resources.

Limitations of Earlier Efforts to Improve Public Health Information Access

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Multi-year demonstration project, intended to:

Identify knowledge resources that are core, useful and evidence-based to improve public health practice.

Promote seamless access to and reinforce understanding of usefulness of PubMed, e-books, other databases, resources from national agencies.

Integrate technology and human systems to support PH access to knowledge resources.

Identify cost-effective and sustainable models for providing PH information access on ongoing basis.

Public Health Information Access Project (PHIA): Goals

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Basic Model

Identify “core” trusted library resources available directly through a digital library interface; identified through benchmarking, direct requests, wish lists, and searches.

Resources not directly available are subsidized through participating National Network of Libraries of Medicine (NN/LM) Members.

Digital Library PHD

Site

Alternate Article

Delivery via Libraries

Timely Information in Support of

Evidence-BasedPublic Health

Practice

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PHIA Public Health Departments and

Library PartnersState Public Heath Department Library Partners AK Alaska Division of Public Health Univ of Alaska (Anchorage) Medical LibraryAR Arkansas Department of Health Univ of Alabama Medical Sciences LibraryCO Colorado Department of Health &

Environment Poudre Valley Health System Library , Univ of Colorado

CT Connecticut Public Health Department Univ of Conn Maynard Stowe Library HI Hawaii Department of Health Univ of Hawaii Medical LibraryIN Indiana State Department of Health Ruth Lily Medical Library, Indiana UniversityKY Kentucky Department for Health Univ of Kentucky Medical Library

ME Maine CDC Maine Medical Center Library MA Boston Public Health Commission Univ of Massachusetts Soutter Library MA Massachusetts Public Health Department Lemuel Shattuck Hospital Library MD Maryland Department of Health &

Mental HygieneUniv of Maryland Health Sciences Library

NH New Hampshire DHHS New Hampshire DHHS Library RI Rhode Island Department of Health Rhode Island Hospital/Lifespan LibraryUT Utah Department of Health Univ of Utah, Eccles Health Sciences Library VT Vermont Department of Health Univ of Vermont Dana Medical Library WI Wisconsin Department of Health

ServicesUniv of Wisconsin, Ebling Library of the Health Sciences

WV West Virginia Bureau of Public Health West Virginia University LibrariesWA Washington State Department of Health Univ of Washington Health Sciences Library

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For what purposes do you need access to journals or other evidence-based resources? High-frequency: info to stay abreast or to provide info

to others—◦ Education, clinical guidelines, conference materials/

presentations, speeches, press releases Also frequent: program and policy development; grants

Less frequent: budget, legislation, program evaluation

To which journals or resources do you wish you had access? Answers used to inform common licensed core of

PH literature for digital libraries

Entry Queries to PH Departments re:Expected Needs and Wishlists

Resources Available through the Digital Library

Digital Library Examples

Digital Library Resources

Full Text Journals Currently in Digital Library

Licensed Databases that Supplement PubMed Search

Publicly Available Resources: NLM, CDC, NAL

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Digital Library Pages –Customized with Common Core

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Licensed (Full Text) Journals: “Core PH”

Licensed databases

Publicly-available resources

Locally-identified resources

Digital Library Resources --Overview of Content

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Journals (Full Text) Currently in Digital Library

Journal Packages

American Society for Nutrition (3)American Society of Microbiology(12)American Thoracic Society (3)Annual Reviews (9) BMJ Journals (6)Elsevier (7) Maney (2) Mary Ann Liebert (14)Nature/Palgrave/MacMillan (3)Ovid (LWW) Titles (8) Oxford University Press (27)Sage (13) Springer (19) University of Chicago Press (5) Wiley Journals (9) – 2 open access

Single Titles (13) American Journal of Tropical Medicine & Hygiene

Health Affairs

International Journal of Tuberculosis

Journal of Agricultural Safety

Journal of Exposure Science & Environmental

Epidemiology

Journal of Food Protection

Journal of Public Health Policy

Journal of Studies on Alcohol & Drugs

Journal of Wildlife Diseases

New England Journal of Medicine

Pediatrics (American Academy of Pediatrics)

Public Health Reports

Scandinavian Journal of Work,

Government -Produced Journals (5) Emerging Infectious Disease Environmental Health Perspectives Journal of Agricultural Health & Safety Morbidity & Mortality Weekly Report (MMWR) Preventing Chronic Disease Total=160

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Licensed Databases Supplement PubMed Search

E-Books

Vendor Collaborating with PHIA to Offer Identified E-Books:

◦ Oxford Textbook of Public Health

◦ IoM Reports (16)◦ Infectious

Disease Series

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National Public Resources: NLM, CDC, NAL

Morbidity and Mortality Weekly Report (MMWR)

Emerging Infectious Diseases (EID) Preventing Chronic Disease (PCD) Data & Statistics Science Clips Public Health Image Library CDC Stacks: Publications 15

Managing the EnterpriseResources, Licenses, Technology

The 10% Rule

Identifying Cost Efficiencies

Complexity of Providing Literature to PH

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Factors Influencing Rule (Collective Data) Identification of Divisions and Program Areas Utilizing Information Number Attending Training Number Responding to Journal Survey Monkey 10 % of Total

11, 000 FTE = 1,100

Aspects that Validate Number of Users/Interest Number attending training and turn-aways Number responding to Journal SurveyMonkey Repeat requests for training

Enterprise Licensing: The 10% RulePrimary Aspects of Licensing

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Annual process, not unlike process faced by individual libraries

Goal: Fair price, not free access Statistics on journal level use by state

regularly provided, used to assess 10% rule Statistics also help for refinement of core

journal set Many enthusiastic partners!

Negotiation Process

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Two Examples

For number of uses in a contract year: Title/Package Uses Public Health Reports

PHIA License cost: $3085 Use 1437 usesAt cost of $11/use w/o license $14,807PHIA cost/use: $2.14

Pediatrics PHIA License cost: $5300 Use 12,317 usesAt cost of $11/use w/o license $135,000PHIA cost/use: $0.43

Enterprise Licensing of Full-Text Access Costs Less than Per Use Access

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Beyond the Licensed Journals

What is impact on Library Partners and Network re: article delivery?

For CY 2013, 15 sites, 1027 articles at cost =$10,736

Key metric for project.

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NEJM Use 2010-2013Shows Complexity of Providing Literature to PH

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2010=2087 2011=11,194 2012=14,022 2013=14,136

Training and Communication are Key

Training FundamentalsProgress to Date

Newsletters and Other Communications

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Training Fundamentals:Making the Link Between Evidence and its Relationship to Practice

General Background re: finding and using: Formulated literature searches Evidence-based guidelines Systematic reviews Review of ‘best practices’ Public health data/resources

Specific Applications:Work through real locally-identified examples, starting with development of well-defined, clearly-focused questions

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Training conducted by NER and/or local resource library staff on content, use of digital library

Almost 900 individuals trained Between 2-4 training sessions to date in each

established site; anecdotally: trainees training others

Trainee roles and specialties highly varied: eg., staff/management, scientist/policy analyst, epidemiologist/lawyer

RISK: Turnover –how to keep training, awareness of resources high in PHDs in the face of management and staff turnover

Training: Progress to Date

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Newsletter: Strategic Project Component

Reliable e-Resources: PHIA NewsletterNewsletter promotes resources related to public health initiatives and training links.

How States are Using PHIA

Anecdotes from key informants:

MarylandKentucky

WisconsinConnecticut

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Used access to literature/information to: understand how other states have dealt with

allowing non-nurse mid-wives to practice, as part of analyses addressing proposed legislation to permit such practice in MD.

assess potential tobacco legislation prior to introduction.

examine state of research regarding change in school hours and impact of improved sleep on students.

develop white papers regarding cost of delivery reforms to end-of-life care.

Maryland

State dentist used journals and STAT!REF in setting up a new program through the local health department for dental care.

Wisconsin

Used the information provided by the Digital Library for writing grants

Kentucky

“I wanted to pass along our experience using resources available to us via the CT DPH Digital Library.   Here in Connecticut, we modify our Youth Risk Behavior Survey; this year, staff at our State Department of Education wanted to capture information about students experiencing housing insecurity.  We know there is health and academic risk in this vulnerable population.  

Having the resources available through the Public Health Information Access Project greatly helped us find relevant research on this topic to better inform our survey development workgroup.

--C. Jorge

“Great recognition for this very valuable initiative. Kudos and thank you. ”

Jewel Mullen, MD, MPH, MPA, Commissioner, Connecticut Department of Public Health

Connecticut

Advancing the Project(Where do we go from here?)

What Distinguishes PHIA From Other Projects?

Short-Term and Longer Term

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Readiness and Engagement of PHD to Participate ◦ Understanding of importance of evidence-based process◦ Agree to team approach: to install/maintain digital library & provide

coordination and support initial training◦ Agree to project requirements (including evaluation)

Enterprise Licensing of Core Journals for All PHDs◦ Provides full–text to the desktop, unlimited access for employees◦ Offers appropriate collection development for PHDs ◦ Engages publishers, libraries and public health departments

Creative Partnerships ◦ Builds on existing NN/LM Network relationships and enhances a

value network Project Supports Technology Innovation

◦ Provides buy-in to need for library resource access◦ Seamless access directly to desktop/device◦ Interoperable connectivity from Vendors/Publishers

What Distinguishes PHIA From Other Projects?

Advancing the Project(Where do we go from here?)

Short-term:◦ Review data, evaluation results, web-based training, and

partner contributions to refine model and enhance project efficiencies

◦ Strengthen training and utilization of resources in the face of PH/Library staff turnover

◦ Derive cost per PH user of Core and Essential PHIA Knowledge resources

Longer-term:◦ Expand project and identify sustainable model for all 

state Public Health Departments

◦ Identify options, data to justify inclusion of other public health organizations