The Future of the Hospital Librarian

I saw some interesting comments on MEDLIB-L not too long ago:

“I do not think MLA, HLS, its officers, certainly not academic medical center librarians, understand that hospital libraries have ten years of life left,” writes the anonymous commenter. The commenter appears to hear the Joint Commission and others saying, “Let technology provide us with the information we need,” instead of relying on librarians.

The commenter continues:

How many IT people you know who use libraries? I know one PhD student who is excited that some paper she has written has been asked to be published in some obscure “journal” in the IT field. Frightening! Down right scary. I am old enough to be leaving the work where the techie future picture is not a pretty one for me. Where idiots with ear plugs and i-pods think they know what life is about. God save us, everyone.

This post is a reply to the anonymous commenter (who I’ll call “Nonnie”) and those who share his/her views. I can’t promise that my views will be the same in six months, but this is how I’m thinking lately.

Nonnie, I think you’re absolutely right about one thing: Hospital libraries as we know them may not exist in a decade or two. However, I don’t see this in the same dark way that you appear to. I think they’ll still exist, but will be significantly different.

As I see it, the job of the hospital librarian has been primarily to utilize expertise in the application of information tools to either:

  1. Find and/or evaluate health information for clinicians,
  2. assist clinicians in the use of tools for finding and/or evaluating health information,
  3. teach clinicians how to use the tools effectively so that they can find and/or evaluate health information for themselves.

What’s changing now at an incredibly quick pace is only the tools themselves as they become increasingly digital. The mission and the role are exactly the same.

The question becomes: How do hospital librarians set about to manage this change and continue to be invaluable to a hospital?

First: The hospital librarian must recognize that this challenge is NOT unique to hospital libraries (or libraries generally)

This very same kind of change is having its way with a LOT of other professions.

Putting aside the way information technologies are transforming other kinds of industries, lets look at a few changes just in healthcare:

  • Physicians are faced with CPOE in hospitals and increasing pressure to implement EMRs in their own practices.
  • Hospital nurses are transitioning to EMRs that manage nursing workflow and make patient charts completely digital. Drugs are frequently dispensed from stations that are really networked computers. Computer literacy is quickly becoming a requirement of the nursing profession.
  • Hospital Environmental Services Departments now have to manage their own databases of Material Safety Data Sheets.
  • Hospital HR departments have to care about the export formats of their HR software and whether their chosen carriers can parse their export files. Time clocks are almost entirely computerized and someone in HR has to be a systems admin.
  • Hospital Staff Development departments have to manage and record in-service activities digitally.
  • Hospital foundations and development offices absolutely must utilize one of several donor/donation database management software options.
  • Account management and patient financial management have been transformed by computers and communications with insurance carriers are largely on-line now.
  • Many hospitals are utilizing sophisticated software to help manage their purchasing and inventory with more efficiency and at lower costs.
  • How about the variety of kinds of systems issues faced by Health Information Management departments? Imagine what changes they’re facing as hospitals convert to EMRs.
  • How about the challenges faced by Radiology departments as they must become masters of PACS systems?

Where computers used to support healthcare, they’re now essential, elemental parts of it.

Hospital librarians need to let go of the idea that the challenge they face is unique (or even unusual) and get on with learning the new skills. This profession is not a special sort of victim and dealing with technological change shouldn’t be new to librarians. When my mentor first had to learn to put the telephone handset into a special cradle to dial up a distant computer and execute queries with a highly specialized syntax, I don’t think she complained about having to learn these new skills. I think she was excited about what this new technology could do for her library. It is now our turn to get excited about what new technologies can do for our libraries. Hospital libraries should be the first department facing and mastering these challenges so that they can help departments that aren’t so fortunate as to be staffed with information professionals.

Second: The hospital librarian must become a technologist

Wait! Come back! It isn’t as scary or difficult as it sounds!

“Nonnie” seems to say that a lot of IS staffers aren’t any good at using information tools. I see some truth in this generalization. Some IS professionals I’ve met in the last seven years or so are a little like auto mechanics who don’t know how to drive. (That’s okay, by the way. Their jobs don’t require them to be experts at using or teaching particular applications.) But here’s the thing: I think that as the tools of health information management (HIM) and health librarianship become increasingly digital, the hospital departments of IS, HIM and Library Services will be strongly tied to each other, overseen by a common person in senior management (probably the CIO)Tangent: I also think that in 15 or 20 years a person with an MSLIS degree would make an excellent hospital CIO.. But since so many IS people are like mechanics who don’t know how to drive, it’ll be the role of librarians to be expert drivers and driving instructors. In my experience, librarians are frequently the best possible advocates for the needs of a hospital’s technology users. In our hospital, the library teaches computer orientation classes, teaches classes on using various computer applications (including our EMR), writes user documentation and makes house calls throughout the hospital to help users solve their computer problems. Not only do I think this will be a growing trend, I think it is a trend hospital libraries should embrace. We’re already expert at teaching people how to use information tools- who could be better equipped to perform this essential function?

At this point, some readers are wondering what about this makes the librarian a technologist. Short answer: You don’t have to be a programmer to be a technologist. Someone who is expert in using these computer tools and can teach others to use them is a technologist. There’s been a growing trend for years now in which programmers develop tools to let people who don’t know how to code (but who can understand a little bit about programming conceptually) make new applications without ever writing a lick of code. I’ve seen people who know very little about (X)HTML make useful Web pages with a WYSIWYG editor like Dreamweaver or Google Page Creator. Tools like Pipes, Popfly and Dapper (among many others) are letting users who understand the ideas make new and useful tools.

This is the reason why the famous librarian advocates of “social software”Check out everything Meredith Farkas writes, especially her new book. and “Web 2.0”Phil Bradley’s new book is an excellent, painless introduction to “Web 2.0”- it is a shame that the outrageous price they’re charging for it ($125.00!) will prevent many from purchasing a copy. or “Library 2.0”I haven’t had a chance to read Casey and Savastinuk’s new book yet- but I will. are constantly on about these technologies! They can be used to enhance your library’s services at little cost- and if you were able to earn an MLS, they are easily within your ability to learn.

Third: Hospital librarians need to change the way they talk about technology and the way they talk with technologists

Communicating with IS professionals
The best thing about being a power user (expert driver) of technologies is that you are better able to communicate effectively with IS professionals. I’ve known a lot of geeks and am even related to a couple. In my experience, the vast majority of IS professionals are incredibly generous with their knowledge and expertise when you’re willing to make the effort to meet them halfway.

When I was working as a Business Systems Analyst for a benefits data management company, I was expected to use the graphical user interface (GUI) that most other BSA’s did to get information from our databases. It didn’t take long for me to grow frustrated with the GUI’s limitations and envy the programmers for their ability to write queries which fetched exactly the information they wanted at incredible speeds. I asked a couple of the programmers what it would take for me to learn to do that. They look surprised, but were incredibly helpful in finding me some good tutorials and loaning me a good book on the topic. When I came back to them after that with questions about our company’s data model or how to accomplish a particular task, they were incredibly generous and patient, taking huge amounts of time to make sure I walked away knowing how to fish, not just with a fish in hand. They patiently explained how they structured the logic of their programs, and when I did or said something stupid, they were kind and gentle in explaining my mistake to me. Not once did they become exasperated with my questions. Not a single time.

Why were they so helpful? Partially because they were good at what they did and enjoyed sharing their expertise with someone who was genuinely interested. More importantly, they were investing in me. My understanding these things better made me easier to work with. Once they had taught me to speak a few words of “Geek,” I could explain problems I was seeing in a vocabulary that made sense to them and helped us communicate efficiently. With the knowledge they had invested in me, I was better able to help other non-programmers I worked with appreciate the challenges the programmers faced. In my experience, this sort of IS professional isn’t the exception- they’re the norm. They’ll help you- you just have to make the sincere effort to meet them halfway.

Writing about technology
Libraryfolk who write about technology need to stay caught up on how technologists write about technology and use a common vocabulary. This is essential for two reasons. First, so that libraryfolk who read LIS literature about technology can use it as a springboard to explore the larger body of technology literature outside of LIS circles. Second, so that IS professionals can be effectively shown that libraryfolk can keep up with the conversation and can make valuable contributions about the way technologies should work. If we don’t speak a common language (or at least share some vocabulary), we’ll just keep talking past each other.

Engaging with technologists outside of libraries
While we’re talking about technology, we have to be careful about how we present ourselves to technology powers. I don’t think it is advisable to tell Google they’ve lost the respect of medical librarians.Rachel, will this post suffice? Frankly, Google doesn’t have to give a rat’s whisker what medical librarians think of it. Instead of giving the impression that we’re emotionally hurt by being left out of the rush to create quality online health information search services, we should be demonstrating what medical librarians can contribute to that efforts as the only professionals on the planet whose job it is to find and evaluate health information.

I know for a fact that there are a lot of medical librarians who are truly expert in seeking health information online, but so few of them are making their voices heard! One of the reasons my respect for Dean Giustini continues to grow (despite the fact that we frequently disagree) is that he makes his voice heard to technology powerhouses. Medical librarians who are expert in online searching need to demonstrate this expertise outside of the LIS community and directly in front of search professionals. Submit articles to technology journals and magazines! Submit them to medical journals (as Dean has to BMJ)!

If the value of the profession is under-rated, I think it may be partially because medical libraryfolk spend too much time talking only to each other.

Fourth: Hospital librarians must accept the reality that their work requires constant learning and development of new skills

“Nonnie” wrote:

I am old enough to be leaving the work where the techie future picture is not a pretty one for me. Where idiots with ear plugs and i-pods think they know what life is about. God save us, everyone.

The problem “Nonnie” illustrates here isn’t the changing workplace- it is the unchanging librarian.

We’re in an age where virtually no professional career path can accommodate someone who finds stagnation of skills acceptable. The UPS driver who balks at the the new tablet computer he’s required to use is silly enough, but this is so much sillier to see in an information professional. Insulting the “idiots with ear plugs and i-pods” is as ridiculous as bemoaning the demise of the card catalog, the horse-drawn carriage and the telegraph. The digitization of information tools is as inevitable as microfilm and microfiche once were, and for similar economic reasons. Librarians are already being faced with the decision to either grow their technology skills or take early retirement.See American Libraries item: Digital Transition Brings Changes to LC’s Workforce This isn’t temporary and the rate of change isn’t likely to slow down any time soon. Instead of mocking iPod users, why not explore the many ways this technology might be used to enhance or expand your library’s services?How can iPods and podcasting be leveraged in medical libraries? Here are a few examples: 1, 2, 3, 4

I think this is both the longest and most opinionated thing I’ve posted here. I’d be really grateful to hear your thoughts (good, bad or ugly) in the comments.

18 thoughts on “The Future of the Hospital Librarian

  1. David – I applaud your well-thought-out post. I totally agree with your points. Most of us have probably learned that we need to be aware of the changes that will soon come, not only in the library, but all over the hospital. We information professionals need to “stay on top” of what is going on, both in the hospital, as well as globally. We need to have the knowledge and expertise to show our patrons how to best utilize the latest technology for their benefit.

  2. Bravo! Well thought out and spot on. I have no doubt that in medical librarianship, and even most librarianship further out, that this will be the case. Luminaries such as Stephen Abram have been obliquely pointing towards this for some time now, and it’s going to be inevitable. Change or die.

  3. “This profession is not a special sort of victim and dealing with technological change shouldn’t be new to librarians.” – Yes, very good.

    I do think you’re absolutely right that librarians need to spend more time telling other people what they do, instead of each other. If Google missed us, perhaps it’s because we haven’t made it clear what we do professionally. I also think Google erred in not figuring out who does this work professionally in the first place, and I think it’s healthy for the profession to talk about being left out as a means to work toward not being left on in the future where our skills should be recognized and included.

    I do have to poke at you a little and ask if you would have used the phrase “Instead of giving the impression that we’re emotionally hurt,” if the profession were dominated by men. Ahem. All in good fun. 🙂

  4. Rachel wrote:

    I do have to poke at you a little and ask if you would have used the phrase “Instead of giving the impression that we’re emotionally hurt,” if the profession were dominated by men. Ahem. All in good fun.

    Poke away, Rachel- I can take it. 🙂

    The short answer is yes. Absolutely and without hesitation.

  5. Tangent: I also think that in 15 or 20 years a person with an MSLIS degree would make an excellent hospital CIO.

    I think an excellent CIO can be anyone who applies strong management skills in the information field. There is no reason why a person with an MSLIS degree couldn’t hold this position now. Why wait for 15 years…

  6. Regarding your first tangent, there already is a CIO of the year with a Ph.D from the Information Science program at the University of North Texas. He is also a great teacher with an awesome sense of humor. 🙂

    As a student, it’s reassuring to know I’m not the only one with similar thoughts regarding the future of the profession.

  7. Margaret-

    I have to disagree. I believe that good managemement skills are not nearly enough.


    That’s so awesome. Thanks! 🙂

  8. I want to add to what David has so well stated. What is the true mission or purpose of medical librarians? It is to improve the quality of health care we all receive. If we do not strongly believe and advocate that efficient access to and use of the medical evidence base by clinicians is a key component in the provision of the highest quality of care possible then we are in the wrong business. While the change from a print based to a digitally based evidence base has drastically changed how we do this the underlying mission of improving the quality of health care by facilitating the access and use of the best possible evidence has not changed. With the print based evidence base the library (hospital and academic) had a unique role as the repository of the evidence base. No matter how large your library was a key part of the medical librarian’s job was using the available resources (space, money and staff time) to build the best possible collection of books and journals (the repositories of the evidence base) and to facilitate their access and use (catalogs and databases – mainly Medline). But the underlying goal was facilitating access and use of evidence in support of clinical research and practice. Many of us (medical librarians in the babyboomer’s cohort) were trained in building and running a library (focused on the library as a place) and we saw that as what we, as medical librarians, did.

    The ‘golden age’ of the medical library as a place was the 1970s and 80s when not only did we house the evidence base but we provided an unique service in support or use of this resource via our medicated Medline search services – you had to have you librarian perform your Medline searches for you (Greatful Med was first introduced in 1984 but end user searching did not become significant until the World Wide Web took of in the 1990s). Then, in the mid 1990s the Web exploded and the shift of the medical evidence base from print to digital began. When evidence-based medicine was first introduced by Sackett in the mid 1990’s the end users ability to build their own subject bibliographies via online versions of Medline was all that was possible. Then the next five years saw the emergence of web based versions of print based journals and books. Over the last 10 years we have seen the emergence of web based resources that are able to take advantage of the Web and that do not have print equivalents. Point of care products such as UptoDate, ACP PIER, MDConsult and Dynamed are important examples of this. Clinicans have neither the time, access or skills to efficiently evaluate the primary literature and, in the days of the print based evidence, frequently turned to text and reference books for quick answers to questions. The new web based products have gone much further by taking advantage of the technologies ability to not be limited by space and time. The new resources have few limits as to their size and are updated frequently. So where does this leave medical librarians?

    I want to go back to my original point that our basic mission is to facilitate access and use of the clinical evidence base in support of quality of care. We need to understand that this is not only our role but our expertise – whether in the training of student clinicians in how to access and use evidence or in supporting practicing clinicians practices by facilitating and supporting their use of evidence. This is the context in which I read David’s Blog. Hospital librarians have to see themselves as the leading experts in their institutions in developing and supporting access to and use of clinical evidence in the quality of care provided by the institution. This, and not the physical room(s) the library is located in is what the hospital library is. David has very apply shown the implications of this on how hospital librarians must view themselves and what they do in the era of the digital evidence base. And, if we do not believe in the importance of what we do in improving the quality of care provided by our hospitals and that we, as a profession, can do this better then anyone else in the hospital then, as Nonnie fears, traditional hospital libraries as places with books and journals and mediated Medline searches will probably not be around in 10 years.

  9. I guess, there’s yet another fact about hospitals that we frequently don’t think about. With the raging development of the information management and exchange of the data across the hospitals we being in the euphoria of how it will speed up the data processing have completely forgotten about what are that data we are working with. We have forgotten that the information we are working with is a personal health information. And the hospitals were mostly developed with a health care in mind but not the data protection. But a quick thinking allows to realize how vulnerable we are in the face of the data fraud risks. It doesn’t mean hospitals should prepare to hold the line like the military does. Usually, simple security auditing is more than enough to feel safe. No one gives the absolute protection but everyone using a network today knows that the security subject starts where the directory services become involved in the process. Hence, almost every place is now vulnerable to the threats because directory services are wrapping each businesses today and Active Directory as the typical example of such services is probably the most vulnerable now as probably the most popular service in data exchange. That’s why hospital personnel today should think about information technology much more accurately than they before. Does it mean each hospital should hire a lot of superspecialists in computer security. I guess, no. At least that’s the main quality of Windows in general and the Active Directory in particular. They are much more easily manageable then any concurrent services. I would not go very far away but give an example of what I’ve heard from my friend who is currently working as an IT specialist for one of the hospitals here. He said the found it a complex task to control the AD security with the built-in functionality because it involved too much extra programming. I guess that’s why people prefer not to think too much about security- everyone wants to save himself from an extra pain. I advised them to look at special security tools. We used a tool that allowed for active directory auditing. My friend was fairly confused against all the tools he used before because as he said they just take your time and don’t provide anything over that you have already had. I would say I had a little fear that the tool would not suit him because we work for different companies which run a completely different businesses. To my pleasure, my guide was very effective and close to week end he dropped me a letter that they deployed the tool in the network and all hospital net was now under the control. The main reason why hospitals don’t control the security is that they have no scope in this area whereas a simple look at IT market can sometimes give a quick answer. I must say that hospital personnel should not be afraid of taking information security measure as it’s now a component part of the overall data exchange and can be manageable as easy as we we now operate with an endoscope and tomography scanning.

  10. Normally I post my name, and David you can see my e-mail and so know who I am, but having received some serious criticism for this opinion, I’m reluctant to post my name at this time.

    Some hospitals in our area have closed their libraries, but none have stopped offering library services. All have outsourced to us, an academic medical library. Many smaller institutions that could not afford libraries now offer library services through us. The results: we’ve hired more librarians and more library assistants to keep up with demand.

    So what happened to the libraries that closed? They employed older librarians and library assistants who refused to keep up. Not only did they refuse to change technologically, they refused to keep current with every aspect of their careers. If you want to be taken seriously as a professional, you need to look the part, talk the part, act the part. If you have the same haircut you did when you were 14 years old, if you are wearing sensible shoes, NO ONE thinks you’re capable. That does not mean that once you’re over a certain age that you’re past it. People take Alan Greenspan and Warren Buffett’s opinion seriously, and they’re both ancient. But whether or not you like it, you have about 15 seconds to make an impression. If your appearance is outdated, if you can’t talk tech to techies, economics to economic people, marketing to marketers, etc. then you will not be taken seriously. Period.

    If you think somehow all learning should have stopped when you graduated from library school in 1977. If you are mad because your clients don’t learn “the right way” of doing things, then don’t blame me or IT if you find yourself unemployed.

  11. Pingback: » Blog Archive » Presentation: Social technology in health library practice and outreach

  12. Thought provoking stuff.

    I am currently involved in a group considering what the healthcare library / knowledge service might look like in 2011 (UK based). The idea being it is easier to get somewhere if we know where we are going. You can read the background paper on the National Knowledge Service page here

    A couple of points

    There are more uses to a hospital library than just providing clinical information. For example we support education and development for the entire workforce. This might mean doctors but it might also mean customer service, ICT, cleaners improving skills for life, senior management etc etc.

    Also the physical space is not just a repository – it is a place where things happen. People meet on neutral territory, they can concentrate and take time to think away from interruptions etc etc. We are also the easiest way for many staff to get on to the hospital network to access all our lovely e-resources or to engage in e-learning.

    I am very interested in comment 13 (unlucky for some?) particularly in what standards of service are offered to those buying in the service – is there somewhere I could read more about this?

  13. Hi Alan!

    There are more uses to a hospital library than just providing clinical information. For example we support education and development for the entire workforce. This might mean doctors but it might also mean customer service, ICT, cleaners improving skills for life, senior management etc etc

    That’s a reasonable point.

    One the one hand: Perhaps I would, in future revisions, remove the word “clinicians” and replace it with “patrons.” I also might replace “health information” with “information (mostly health information).”

    On the other hand: While a hospital library does (and should) assist with non-clinical information needs, I still think that serving clinical information needs is (and should be) the primary focus and priority of a hospital library).

    Also the physical space is not just a repository – it is a place where things happen. People meet on neutral territory, they can concentrate and take time to think away from interruptions etc etc. We are also the easiest way for many staff to get on to the hospital network to access all our lovely e-resources or to engage in e-learning.

    Amen. Absolutely. No disagreement here. Did I give the impression that I thought the hospital library’s value as a physical space was decreasing? If so, I apologize- I certainly don’t believe that’s the case.

  14. I might add a 5th point to your excellent piece, David. Hospital Librarians need to embrace the nomenclature of the information technology field and be willing to think of themselves – and call themselves – knowledge managers or knowledge services directors. It worked for medical records (now health information management). (In my own hospital, when the name changed, HIM joined the IS department and the director now has a seat at the table. “Knowledge Services” is used in the NHS libraries in the UK, and in special libraries here in the US. It’s about survival.