Clinician Access to library resources while “off campus”

Got a great question via email from a medical librarian reader:

Many of my doctors who are more tech savy want the information delivered to themselves “off campus” via email, RSS, etc. However, we since they are off campus most of the journal full text links (IP access only) are unaccessible to them. Have you figured out a way around this or do you have a really good line explaining this to them?

There are, I think, many different ways of meeting this challenge. All have strengths, all have faults, and every medical library is different. I’m far from expert on this topic, but here are a few methods in descending order of my preference:

  • Terminal Services Portal:
    At CGH, we have a web-based portal (using terminal services) through which clinicians can access our Electronic Medical Record system with any internet-connected computer, and our VP of Information Services agreed to add our library web portal as a link from the EMR. Any traffic from this is seen as coming from inside the hospital’s network, preserving the use of IP authentication. I’m very happy with this solution, and hope that the increased accessiblity to library resources will help be cause for further development of our library’s web portal.
  • VPN:
    Before the EMR portal was set up, clinicians were granted VPN (Virtual Private Network) access to the hospital’s network (some still use this), so that all of their internet traffic was routed through the hospital’s network and proxy, so IP authentication was/is preserved, and the user can access all the same resources he/she might use while “on campus.” I like this solution less than the portal (see above) because many users found it difficult to complete the initial set-up of their VPN connection and because it was difficult for me to provide support to help solve these problems over the phone or by email.
  • On-demand document/reference delivery:
    Although it is far from ideal, our library works hard at helping clinicians understand that there are multiple avenues through which they can make document delivery, literature search, or reference requests. The users who have adopted the use of feeds or emails for their current awareness needs are reminded as often as possible that they are absolutely welcome to email their requests to the library if this is most convenient for them, and filters have been set up to alert library staff wuickly and loudly when new requests come in via email. I’m not thrilled with this solution, but at least good feed entries from journals or PubMed, when forwarded via email to the library, have all the needed information to help the library quickly find and deliver the needed literature.

I agree with the person who emailed the question that constant access to full-text resources is most ideal, but believe that it is the library’s responsibilies to make user requests as convenient as possible for the user to submit- even in circumstances that are miles from ideal.

Hope that helps a little! If you’d like more information on how CGH set up its terminal services for the EMR portal, let me know. I may be able to get some detail and reccommendations from our IS department.

9 thoughts on “Clinician Access to library resources while “off campus”

  1. Another barrier to off-campus access to resources – cost. I’m thinking of UptoDate – seen the price on remote access to that lately? We can set up just about anything else, but this is a popular one we just haven’t been able to swing.

  2. Hi Rachel!

    Actually, the first two options above fixed exactly that problem for us. As long as traffic was going from the hospital’s proxy to UpToDate, the access isn’t “remote,” but clinicians are able to access it from off-site.

    Best,

    -David

  3. For us VPN and the portal won’t work. In our case, doctors can go into the hospital’s intranet page (via VPN or the portal) to get to the EMR, check lab values, etc. but IT made it so they (the doctors) can NOT get out to an outside resource/web page. So the doctors are able to use the internal resources they need, but the proxy server blocks them from using outside resources such as Ovid, e-journals, etc.

    That is why we (the library) are seriously looking into Athens to provide off campus access to our resources to our doctors. For an extremely reasonable fee (1000 users=$1500, 1001-2000 users=$2750, 2001-5000=users $4000) will make it so all of my users have access to my electronic resources off campus. Additionally, each users only has to remember their own username and password. They don’t have to remember 1 for Ovid, another for StatRef, another for MDConsult, and so on. Their one username and password activates access to everything. The nice thing is that you can set user permissions as well. For example, You have medical students who leave in one year, you can set it so their account expires in one year. You have nursing students who have certain databases licensed only to them and not the rest of the hospital, you can set it so that only your nursing students can get access to those databases.

    I do not own stock in Athens (wish I did), I do not work for them and I have no financial interest in them. I just set up a trial to their program and I will let you know how that works. Sorry this is long, but I thought I would offer them up as another method for providing access to off campus resources.

  4. Hi Michelle-

    I’d be interested to know the rationale of your I.T. department in allowing clinicians VPN access, but not allowing them to access pre-approved clinical (extranet) sites from inside your hospital’s network. Offhand, I can’t think of a reason why the expense of Athens should be neccessary in the context that you have described.

    -David

  5. Our IT department will NOT purchase or assist in maintaining an EZ Proxy server…. out of the question….

    We utilize VPN downloads for our offsite users, but it is a difficult one-time set-up…..

    We have been able to work with some of our vendors to “set-up” off-site access, meaning once our users “log-into” our Portal and then they are authenticated into some of our resources, Ovid, StatRef, NEJM to name a few, and although this is successful it does not work for proxying every single journal title…..

    I am interested in hearing more about how CGH set up its terminal services for the EMR portal… I think this is something we should be offering but are not it.

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  8. Our university IT would not set up a VPN or a “real” proxy server and that is why I had to set up ezproxy in the library. All ezproxy requires of the end user is to login with the correct credentials.

    Ezproxy, from http://www.usefulutilities.com is not a proxy server. It does not require a server. For a hospital you could run it on an old pc. Ezproxy rewrites url’s on request. IT people think that all of the user’s home internet traffic is now going to be going through their network and cringe. You need to explain to them that ezproxy rewrites the URL’s only on web pages for specific domains that you add to the configuration, and only for people that are authenticating against the ldap, or active directory or email system that they are already providing. It is a cheap and effective way to make the doctors and managers very happy.