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 Informationists
► Expert Searching: from Intermediaries to
Educators to Search Consultants
► Knowledge Management: from IAIMS to
Decision Support
► 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 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
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
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)
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%
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 & funded
► 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
MLA Policy Statement)
►Knowledge
& skills
(2003
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 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
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
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 knowledge
► An institution’s 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
limitations
human decision-making
 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 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
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?
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
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)
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 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?
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?
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
supporters
► 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
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
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
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
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
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
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!
Thank you
Questions?