Sep 21

Getting ‘em to use the tools

Email from a medical librarian in the midwestern United States:

Most of my doctors don’t know what RSS is (techno babble to them) how can I get them to use it when many still aren’t using their email?

I hear this question (or a variation on this theme) an awful lot. This isn’t really a question about feeds or aggregators (though this post has some tips on how to make feeds more “pushy” for users)- what it is asking is for advice on how to convince the library’s patrons to USE its super-cool new tools and services.

Putting the problem in historical perspective
When I teach classes in my library on the use of email, I always include a section on email etiquette. As I start that section, I explain WHY we need to teach email etiquette.

Imagine a friend invites you over for dinner and a movie- you arrive at the expected time and knock on the door. When your friend comes to the door, you can see she has her cordless telephone between her shoulder and ear and is having a phone conversation. As she waves you inside, you automatically do a number of things:

  • You don’t speak to your friend or distract her from her conversation.
  • You try not to make noise that would make it hard for her to continue her phone conversation
  • While she’s on the phone in the kitchen, you busy yourself in the living room with browsing her bookshelves (you’re both librarians in this hypothetical, okay?) so that you don’t eavesdrop on her conversation.

And you do all of these things without even thinking, right? This is when I point out to my class that the telephone is a relatively new invention, and that most Americans didn’t have phones at home just a few short generations ago- and it has taken those generations decades of time time in which to evolve the consistant CULTURE and behavioral expectations around the use of telephone that would let us incorporate it smoothly into our lives. We’re so familiar with them now, that we do it without thinking.

Email, I tell my class, is much newer, and nowhere near as commonly used as telephones, so there’s no shame in not knowing the etiquette that surrounds the technology, and that’s why we teach it in class. I also point out that I believe email etiquette (and that of other text-based communication technologies) will eventually be as obvious to their grandchildren one day as telephone etiquette is to us now. (Cell phone/mobile phone etiquette, by the way, I think will never evolve- but that’s a topic for a future post.)

The point of this?
The adoption of many new technologies frequently moves a lot slower in the U.S. than does the development of the technologies themselves. That’s not a bad thing in itself (I like Neil Postman), but it needs to be accepted as a reality.

There are still clinicians affiliated with our hospital that choose not to use email. That’s fine. That’s okay. That’s their choice, and I’m certainly not going to give them a hard time about it.

Meanwhile, I’m going to keep utilizing technology to expand the breadth and depth of my library’s services and to dramatically enhance user access and ease at very low cost to our organization by using new technologies.

Some clinicians will use them right away, others won’t. But some traditionalists didn’t like that newfangled talkybox, either. Now everyone uses telephones. They might not want the newfangled technology-based services now, but they’ll be demanding ‘em eventually. I can be ahead of the curve (get users what they want before they even know they want it), on the curve (get the users what they want soon after they ask for it), or behind the curve (annoying users because their colleagues elsewhere already HAVE this stuff and we don’t). I choose to be ahead of the curve whenever possible.

While continuing to leverage technology this way, I’m consistantly trying to place these tools in front of new eyeballs.

  • I teach three orientation classes for new employees every month on using computers at our hospital. I always have a short section on using the library’s digital resources, and demonstrate a few of them.
  • I attend each meeting of the Continuing Medical Education committee to let them know what neat new materials and services the library has for doctors.
  • I regularly touch base with the nurse educators in Staff Development, and made a point of building a page in our library’s portal just to address the library needs of nurses (our hospital is not affiliated with a nursing school, and I think our library has historically underserved nurses).
  • I offer courses every month on using clinical knowledge bases. If someone wants to learn how to use these tools, I drop what I’m doing and go teach that instead.
  • I identify and keep notes on which clinicians LIKE technology and which clinicians GET technology. Both groups can be great spreaders of the library’s gospel, and will likely be pleased to be asked to trial a new product, offer feedback on library services, and tell their colleagues about the coolest stuff the library does for them.

Of course, this isn’t nearly enough promotion. I need to find the time to do a LOT more promotion of the library’s services to the clinicians it serves, and have plans that I hope to execute in the coming year that I hope will significantly increase our library’s visibility.

Proving value to the clinician

I’ve said before that I think most clinicians WILL use new technologies if it can be proven to the clinician’s satisfaction both that:

  1. The technology is easy to use
  2. and

  3. The technology will save the clinician time, money, hassle, professional error, or embarassment.

Saving the clinician money
A physician affilliated with our hospital invited me to his office to talk about a computer problem he was having, and I noticed that he had UpToDate CDs on his desk. Although it was unrelated to why I was there, I pointed out that he could use the hospital’s UpToDate from his office at no charge. He boggled, and insisted it must be difficult to access. Without touching his keyboard myself, I talked him through connecting to the hospital’s network and pulling up UpToDate. He boggled again, then cancelled his UpToDate subscription. The library had just saved his practice a small fortune. This physician now contacts me routinely, and is pretty much willing to try anything I suggest, because I’ve proven to him repeatedly that I want to make his work easier and more productive.

Saving the clinician time/hassle
An obstetric surgeon visited my library and asked me to walk her through some searches in OVID- she does this every few months to see if anything new has been published on obstetric hemorrhage. I asked her how she would like it if she could make the search happen automatically and EMAIL her when it found something. She boggled. I walked her through setting up the search in PubMed for her terms and the specific journals she cares about, and walked her through setting up the email alert or RSS feed. She asked me for written instructions on how to do this herself, and I sent them to her. I hardly ever see her physically in the library now (which is a bummer because I enjoy talking with her), but she’s getting a whole lot more use out of the library, and I’m really happy about that.

Proving the technology is easy to use
I have a favorite line for doctors who insist that a technology is too hard for them: “If you say so, Doc- but I had a bunch of LPNs in here last week who figured it out, and they didn’t even have medical degrees.” As long as I say it with a smile, a doc will give it another go. Once they’re willing, the trick, I think, is not to give ANY unneccessary information. Show ‘em what it DOES for them first, how to CUSTOMIZE it for themselves second. If they’re interested in HOW it works (they usually are), they’ll ask. If THEY ask, the learning is their idea- and they’ll be a lot more attentive and receptiveto the explanation.

Metaphors be with you
I’m also a strong believer in the power of metaphor in explaining technology to non-techie people. Here’s an example of what I mean by that- I hope to write more posts like that one in the future.

Wiser folks, please chime in
I’m hoping readers with stronger backgrounds in education and promotion will chime in- the above are just some notes on what I find is working for me.

Here’s the bottom line:
If you’ve made it easy and demonstrated the benefits and the clinician STILL doesn’t want to use it, you can’t make her/him- But you still need to get the services ready. As some forward-thinking hospital libraries will develop these sorts of services for their users, your clinicians will eventually hear about them and will eventually demand them. And you, you forward-thinking MedLib, you- you’ll be ready.

Sep 20

CGH in Healthcare Informatics

I somehow missed this when it first appeared, and only recently caught it in one of my routine searches that generate feeds for my aggregator.

Healthcare Informatics Logo

Mitch Rozonkiewiecz, our hospital’s VP of Information Services and CIO was interviewed in Healthcare Informatics about CGH’s “Digital Passport” initiatives.

It is interesting to get a good, clear look at the views and priorities of a hospital CIO- and I am hopeful we’ll find good ways to effectively integrate EBM services into our application of the EMR system.

If you’d like to see a a short demonstration of the features of CGH’s EMR, Eclipsys’ Sunrise Clinical Manager, check out this link:
http://www.cgh.org/SCM_Intro_and_overview_060609.exe

Yes, it is an executable. Yes, you SHOULD think twice about downloading an executable from an unknown source. Here’s what you need to know:

  • I didn’t create it, but IT professionals at Community General Hospital of Greater Syracuse did.
  • I have installed it on multiple machines to absolutely no ill effect. It’s just an install package for the Camtasia Player and the media it plays.
  • It is virus-free, malware-free, harmless, and can be deleted when you’re done with it.

Cap of SCM Demo

Sep 19

Mary C. Chimato takes Syracuse

I had a great Monday.

First, I took the day off from work so I could do some writing and get a little better organized- and got a good bit done. Then I got to have dinner, for the second consecutive night, with Mary Carmen Chimato. Even better, my boss and mentor, Wendy Tarby, joined us for dinner to dish about Medical Librarianship in the state of New York.

Ask the woman who raised me, the woman who married me, or the woman who employs me: I like smart, articulate, opinionated women. Dinner was great. When in Syracuse, eat at Dinosaur Bar-B-Que.

Mary and Wendy
Mary Chimato and Wendy Tarby

Sep 19

Sage advice from the maven

Alexia Estabrook (The Medical Librarian Maven) writes a golden little post about describing and communicating the library’s value to clinicians:

We’ve developed a script of sorts at My Place of Work. We acknowledge that physicians are the experts at diagnosing and treating patients. We then explain to them that we are experts at finding, evaluating and disseminating information. We tell them that we are here to help them by doing what we do best – finding information. This allows them to spend their time most wisely doing what they do best – practicing medicine.

Read the rest.

Also, you may wish to subscribe to Alexia’s feed.

Sep 18

New version of MDCalc available

Via Over!My!Med!Body!: This tool is new to me, but I can imagine it might really be useful.

MDCalc Logo

A wee bit about MDCalc
This site was created by a third-year medical student who got tired of having to wade through Google searches to find an easy to use, quick calculator for his medical equations. Many thanks to the multiple resources and references I’ve used to put this list together, including Medcalc, Pocket Medicine, 2nd Edition, eMedicine, and notes and teachings from my preclinical and clincal instructors.

Also worth noting, MCCalc produces results in either US and SI units.

Outside the US and use SI units? We’ve converted all our formulas to SI units and are looking for your help to validate them, so you can use them in the future!

Some of the calculations the tool performs:

Equations

* A-a O2 Gradient
* Abs Neutrophil Count
* Abs Retic Count (Retic Index)
* Age
* Anion Gap (w/Delta Gap)
* Basal Energy Expenditure
* Bayes Sensitivty & Specificity
* Bicarb Deficit
* BMI/Surface Area
* Calcium Correction in Hypoalbuminemia
* Cockcroft-Gault GFR
* Cardiac Output (Fick)
* Corrected QT (QTc)
* Corrected Sodium
* CSF WBC Correction for RBCs
* Endotracheal Tube Size for Children
* FENa
* LDL (Calculated)
* Maddrey’s Discriminant Function
* Maintenance Fluids
* MDRD GFR
* Mean Arterial Pressure (MAP)
* Oxygenation Index
* Parkland Burns
* Pedi Ins & Outs
* Sodium Deficit
* Serum Osmolality
* Stool Osmolal Gap
* Water Deficit
* Winter’s Formula

Scores

* APGAR Score
* Cardiac Risk (Framingham)
* PORT Score / CAP Risk
* Glasgow Coma Score
* MELD Score
* Ranson’s Pancreatitis Mortality
* Strep Probability Score
* TIMI Score for UA/NSTEMI
* TIMI Score for STEMI
* Well’s Criteria for PE

Sep 18

5 Reasons NOT to Choose a [particular] Technology Solution

There’s a particularly great post at TechEssence by Ellyssa Kroski:

Whether we want to admit it or not, none of us is completely objective when it comes to choosing technology, or anything else for that matter. We attempt to collect and analyze an unbiased portrayal of the facts, but there are always outside influences which affect and shape our decisions. While carefully researched recommendations by respected publications go a long way to helping us with our decisions, one arresting tale from a colleague about terrible customer service and frequent down-time will send most of us into a 180° spin. How can we make solid decisions about technology for our organizations? One way is to keep in mind some common “soft spots” that people have when making these choices.

Read the whole excellent thing. It is filled with advice that should be reviewed and heeded by both both the techno-neophyte and the seasoned geek.

Sep 18

How to: know when your organization appears in the news

I’ve found that a number of hospital employees have current awareness needs that aren’t clinical. Sure, you can set up alerts from ProQuest or EBSCO from non-clinical periodicals, but if what your users want is to know when your organization appears in the news, I’ve found the following pretty effective and completely free.

There are a number of search engines for news that can output feeds. Although I’ve usually been partial to Google News and Topix, but MSN and Yahoo have similar services, and it seems silly to leave them out, but it is a pain in the backside to find each site, run the search, and collect the feed URL. Fortunately, we have feedgit.

feedgit logo

Feedgit us a sort of metasearch (or federated search) for all kinds of searches where the search results can be outputted as feeds.

First, go to http://www.feedgit.com

Next, enter your search terms. Since I’m looking for news about Community General Hospital in Syracuse, my search string will be: “Community General Hospital” Syracuse

search terms

…now click the Search button.

Underneath the search field is a short list of popular aggregators. If you use one of these, go ahead and click the appropriate one (I use Bloglines). If ou don’t use one of these, click the orange, square RSS icon on the far right.
choose agregator

Now there should be a button next to each source of news information to be searched according to my string, allowing me to add the new feed to my aggregator with a single click!

add to aggregator

To help demonstrate the usefulness of your library to management who don’t often have need for the clinical information you regularly provide, try making these feeds available via aggregator or email (try RSSFWD or FeedBurner) to the Director of Corporate Communications, PR Director, or other management who care a whole lot about public perception.

Sep 15

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.

Sep 12

Montréal’s Jewish General Hospital Health Sciences Library Starts RSS Services

Jewish General Logo
Francesca Frati made my day a couple weeks ago by describing how she’s rolling out RSS-based current awareness services in her medical library. Francesca has allowed me to post her entire email, after which I’ll post some of my answers to her questions/concerns.

Dear David,

A little while ago you asked to hear from anyone working with RSS in a hospital library…

I’ve recently begun to develop a current awareness service using RSS technology very much like what you have been developing for your physicians. I would say we are a small library, although the Jewish General is a McGill University teaching hospital so we are academically affiliated. I’m relatively new to RSS and have been reading as much as I can on the subject and exploring options offered by various databases. I’ve also been following your extremely helpful discussion on this topic- your unwitting assistance has been much appreciated!

So far two patrons I’ve worked with before in my capacity as consultant have agreed to help pilot test the service. One is a practising family physician who also happens to be the R&D coordinator at the clinic I consult for, and the other is a researcher. As they are together engaged in studying the use of push/pull technology in clinical practice and are both what I would describe as “carefully enthousiastic” when it comes to new technology, I saw them as the perfect guinea pigs for the project.

Interestingly the R&D coordinator is convinced this will only be useful for research and not so much practice, although he does consider InfoPOEMs to be very useful in the clinical setting. I suspect that what you describe as perceived push vs pull is a key factor in his thinking. I see this as something that will need to be addressed for the service we offer to succeed. We are all interested to see how actually useful the service will be because it does seem to require active seeking- at the very least an initial effort to set up the feeds- which may be a deterrant.

To date both patrons have asked that I subscribe them to TOC as well as PubMed feeds (at the moment I am actively involved in subscribing them to various feeds and at the same time teaching them how to do it themselves- in the future I see my role as more focussed on the instruction). The researcher expressed an interest in citation alerts so I set him up using Web of Science and he has already been notified several times which has made him very happy.

In any case so far so good.

The plan is to offer hospital-wide instruction sessions this fall and eventually to have our library news available as an RSS feed on our website, along with any other feeds that may be of interest to our patrons, and ‘how to’ information etc.

So far I have explored the possibilities in Pubmed and Web of Science as well as FeedNavigator at Helsinki University and BioMed Central. I haven’t been able to figure out what options OVID and EBSCO provide, if any. I would love to know about any other resources in your repertoire that could be of use to medical researchers/clinicians.

Cheers,
FF


Francesca Frati, MLIS

Information Management Consultant
Herzl Family Practice Center

Current awareness/Serials
Health Sciences Library
~~~~~
SMBD Jewish General Hospital
3755 Côte Ste.Catherine
Montréal, Québec
H3T 1E2

Phone: (514) 340-8222 Local 5929
Fax: (514) 340-7552

“The real technology- behind all our other technologies- is language. It actually creates the world our consciousness lives in.” –Andrei Codrescu

Kudos to Francesca and her organization for getting ahead of the curve and getting off to a really good, pragmatic start! I hope that a lot of medical libraries can follow your example!

Here’s a bit of what I wrote back to Francesca:

  • I think RSS is best used in a clinical setting as an SDI tool for physicians with very specific current awareness needs. For instance, I set up a feed from PubMed for a gastroenterologist on probiotics AND (“ulcerative colitis” OR “Crohn’s Disease” OR “inflammatory bowel disease”) because many of his patients had expressed an interest in probiotics as a potential therapy.

    This method, I think, helps clinicians know immediately when very specific topics are addressed in as many (or as few) journals as they want.

  • Regarding the views of your R&D coordinator: I would argue that staying up-to-date on any new developments in his/her specialty is utterly essential to clinical practice.
  • EBSCO does offer RSS feeds. I have a post planned that details how to do this. [David adds: post on creating feeds from EBSCO is here]
  • OVID, unfortunately, does not yet offer RSS feeds for searches, but I am told by my tech support contact at Ovid that they do plan to roll out this feature in the near future. I can’t wait until they do- that’ll be a tremendous help to me.
  • In addition to FeedNavigator, be sure to review MedWorm, which has a much larger directory of feeds, and a great number of pre-set aggregated feeds based on specialty or condition. Also worth checking out is Medical-feeds.com, and the UK’s NHS RSS directory. I wrote up a few short notes on these four directories here.

Have I mentioned yet that Francesca rocks?

Is your medical library rolling out RSS-based services or other Library 2.0 tools? I’d love to hear about it and feature your library’s activities here. Email me at david[DOT]rothman[AT]gmail[DOT]com, and we’ll tell the world how much you rock.

Sep 11

Must-Read Blog for Medical Libraryfolk:

There’s this blog I’ve been reading for a couple months…and I find myself constantly thinking: I wish I’d found and posted that.

It regularly contains things I don’t find elsewhere. Since I was kind of non-observant of Blog Day, let this be my belated recommendation:

Clinical Evidence, Searching Tidbits, and Other Minutiae
Blog
Feed

Just bite-sized nuggets of delicious interestingness-all the time. Look at today’s post for example.

If you read blogs about medical librarianship, add this one to your aggregator.

A brief thought for Becky: Please consider adding a link for your blog’s feed to the sidebar? It’ll make subscribing easier for a lot of folks.

Sep 11

Wikipedia on NPR (or NPR on Wikipedia)

NPRlogo on wikipedialogo

NPR’s Morning Edition did a story on Wikipedia this morning that includes a little of Stephen Colbert’s “Wikiality” bit.

Wikipedia Wins Users and Critics

Morning Edition, September 11, 2006
Wikipedia is the ever-evolving work of hundreds-of-thousands of volunteer writers and editors who range from high school students to academic scholars. This leaves the online encyclopedia open to criticism and ridicule. That doesn’t seem to stop people from using the site as a source for knowledge.

NPR provides streaming audio of the story in Windows Media or Real format.

Sep 11

Medical Interpreters

I really enjoy it when our hospital library is asked to do some non-clinical research. It is unusual, and usualy challenging. A few months ago, I was asked to determine the language needs of the population in the hospital’s catchment area (using census data). It was a fun and interesting assignment that was completed successfully(those who asked for it were happy with the methodology and results)- but since then, I’ve sort of had language and translation needs for hospitals in the back of my mind.

Librarians who don’t work in clinical setting certainly understand the need of libraries to overcome language and cultural barriers, but nowhere is this more essential than in a clinical setting. Below is a story found in my aggregator today in which a hospital administrator talks about having sent bi-lingual employees as interpreters through cultural competance training. My understanding, though, is that a good intepreter for a clinical setting is pretty hard to find. In addition to the linguistic skills required, the interpreter should also have an extensive clinical vocabulary in both languages.

Setting aside translation needs in a clinical setting, what does your medical library do to make resources available to non-english speaking (or newly-english speaking) consumer health information seekers? This is something our library doesn’t do enough of yet, and I’d be glad to hear any suggestions.

Also interesting at CGH: It looks like we’re going to work with some students from Syracuse University on exploring the use of video conferencing equipment to provide American Sign Language translation services. I love the idea.

Sep 08

Site Review: Google Co-Op

Information World Review does a site review of Google Co-op.

Go ahead and read it- then read Dean Giustini’s notes on the Google Health Co-Op:

In this, as in many things, I think Dean Giustini is asking all the right questions.

Sep 08

Living with pain: Hunting for health online

Article from U.S. News and World Report containing more good advice (from the MLA) for healthcare consumers looking for information online:

So how can you weigh whether you’re getting good information? Check four criteria. First, who sponsors the site? Consider whether the person or organization has a stake in your taking any particular advice. Second, how current is the information? Medical knowledge grows and changes, so a recent publication or revision date is key. Third, can the source of the info be traced, and can the material be easily identified as fact or opinion? And fourth, is the site comprehensible by a general audience or are the discussions highly technical?

Other posts about consumer health info

Sep 08

Resources for teaching EBM to PAs

I sent the following to MEDLIB-L yesterday:

From: David Rothman Mailed-By: gmail.com
To: MEDLIB-L
Date: Sep 7, 2006 10:51 AM
Subject: Teaching Evidence Based Medicine

Good morning.

My library has a physician patron who has been tasked to teach a class on Evidence Based Medicine to students studying to be Physicians Assistants.

Could you please perhaps suggest some of the most important texts or resources that this patron will want to acquire and utilize in creating her syllabus and course? The patron already has Users’ Guides to the Medical Literature .

I would be grateful to have any suggestions you might have emailed directly to me at davidDOTrothmanATgmailDOTcom, and would be pleased to summarize for the list if there is significant interest.

Thank you in advance for your kind assistance and expertise.

David Rothman

Thanks very much to all who sent suggestions. These suggestions have been passed on to our library’s grateful patron, who asked that I express her thanks along with my own to you lovely, friendly, helpful people. This is the first time I’ve asked for help on MEDLIB-L, and the response was really wonderful.

I received a great number of requests to summarize for the list. I am attaching them to this blog post because MEDLIB-L does not allow attachments. (I had planned to share this information on my blog anyway.)

Please click here for the summary: Summary_Teaching EBM.xls

Also see an annotated Bibliography that could not be taken apart and added to the summary without sacrificing full attribution against the author’s wishes: ClassAnnotatedBibliography_Pappas.doc

If the MS formats cause anyone any trouble, please let me know and I’ll be glad to convert them to something else.

If anyone particularly expert in the topic would like to critique this summary and send back to me thoughts on what is really the creme de la creme in its contents, I’d welcome that.

Thanks again for your kind assistance- it is sincerely appreciated.