I *do* like that DICOM files are anonymized as they are uploaded. DICOM tags are cleared and…

• The year and month are not modified
• The day is set to the first of the month
• The time is set to midnight

The patient’s birth date is set to January 1, 1970

I’ll say this much: If I kept a digital personal health record in an online service, I’d want to be able to view DICOMs in it with this kind of tool. Google needs to buy these guys or build a comparable tool. Maybe that’s what they and IBM can work on next.

_______________
Feed-only Footer:
Know of something I should blog about? Please let me know!

If you prefer, you can leave me a voicemail here: (315) 876-9574

HealthVault appears to be Microsoft’s offering in the field of patient-created personal health records.

When it’s your job to protect your family’s health, you need every advantage. Imagine if you had a way to collect, store, and share the health information critical to your family’s well-being.

HealthVault is the new and FREE way to do just that.

Imagine controlling the flow of your health information. Whether you need to search the Web for the most up-to-date treatments, catalog existing health records, receive test results, or monitor current physical readings — HealthVault gives you the control you need.

I like that they put a short version of their privacy policy on the front page:

Our Health Privacy Commitment
1. The Microsoft HealthVault record you create is controlled by you.
2. You decide what goes into your HealthVault record.
3. You decide who can see and use your information on a case-by-case basis.
4. We do not use your health information for commercial purposes unless we ask and you clearly tell us we may.

To read our full Privacy Statement, click here.

The other day, I mentioned a class of sites/services that includes SugarStats, ReliefInsite, and Fertility Friend – sites that help patients track data that is of diagnositic or therapeutic value to the patient or the patient’s healthcare providers. Wouldn’t it be great to have a free PHR service that included an optional module for each of these purposes?

_______________
Feed-only Footer:
Know of something I should blog about? Please let me know!

If you prefer, you can leave me a voicemail here: (315) 876-9574

Benjamin Fry, Jim Warren. Navigation in internet-based personal healthcare records: for consumers who think. electronic Journal of Health Informatics, 2007; 2(2): e7.

Full text PDF (requires free registration)

Abstract

Internet-based personal healthcare records (PHRs) are designed to be created and maintained by individual healthcare consumers, based on their own understanding of their health conditions. Based on historical hypertext systems and working from a series of consumer use cases, we examine the options for end-user navigation in PHR systems. A prototype Internet-based system to support four paradigms of navigation – document-centred, node-centred, path-centred and graph-based – has been implemented. The system supports PHR organisation and annotation, as well as discussion of contents among stakeholders (e.g., doctor and patient). The architecture demonstrates the integration of existing packages on the client and server ends, including use of the widely-installed Adobe Acrobat. The system is intended to provide some of the appropriate tools for the upand-coming variety of health consumer who wishes to be an active participant in their own healthcare, who wishes to understand and contemplate their health record. Both user interface and architectural design aspects are offered as concept templates for PHR system implementation.

_______________
Feed-only Footer:
Know of something I should blog about? Please let me know!

If you prefer, you can leave me a voicemail here: (315) 876-9574

Hard to tell a whole lot from these little snippets…but it looks and sounds kinda’ cool, doesn’ t it?

“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,
   or
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)¹. 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”² and “Web 2.0″³ or “Library 2.0″⁴ 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.⁵ 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.⁶ 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?⁷

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.

The Wall Street Journal Health blog mentions that Google VP Adam Bosworth (whose interest in health information I’ve previously posted about here, here and here) spoke today at the World Health Care Congress in Washington D.C.

Bosworth…said patients should have online access to all of the electronic health information that exists about them, whether it’s contained in doctors’ files, billing databases or prescription record.

…

David Williams, a blogger and health-care consultant who was there….speculates that Google wants to be the one to offer consumers this information, in the form of an electronic health record.

But Bosworth didn’t spill any specifics. Williams told the Health Blog this afternoon that the exec would only say that Google’s health project is “in the queue.”

[via]

This makes me sigh and fret.

I know that the integration of information tools into our hospital’s EMR system is absolutely essential, but haven’t gotten far with this yet. The CIO did agree to link to the library’s portal from the EMR (Eclipsys Sunrise Clinical Manager), and that’s great because it makes the library’s resources accessible to any clinican with an internet connection and an Active Directory account for a our network- but it isn’t enough. There are too many steps between the identification of a need for clinical information based on a patient’s chart and the retrieval of that information. Clinicians won’t use tools they find inconvenient.

I’m not immediately finding a lot of literature to use as a guide, either. Before I submit a call for advice to MEDLIB-L, I thought I’d post it here first. Any thoughts? Any favorite articles on the topic? Anyone who has integrated tools with Eclipsys Sunrise Clinical Manager?

• Via BHIC
  Electronic Health Records Still Not Routine Part of Medical Practice, Says New Study
  Full Report
  Executive Summary
• Via Clinical Evidence, Searching Tidbits, and Other Minutiae
  Health information technology in the United States: the information base for progress
• DigiCMB: But it is not all playing around … : Consumer health & Education & Clinical and Research
  Guus van den Brekel talks about Second Life Medical Library

This is because our CIO and VP of I.S. wanted our EMR’s “fat” client to be available from any location. To accomplish this, our I.S. department set up access to the EMR using Microsoft Terminal Services. All I had to do was build the Medical Library’s portal and demonstrate its usefulness to the CIO, and he added it as a tool launchable from inside our EMR. The clinicians can log into the portal with just their active directory user ID and password (which they use every day on-site).

Chris B. asked to hear more about how our I.S. department accomplished this- so I asked our CIO, Mitch Rozonkiewiecz for some details. Mitch said it was fairly straightforward and a fairly inexpensive solution to making the EMR more accessible (that happened to benefit our library, too).

Chris, Mitch said that if your library is interested in doing something similar to allow greater access to your library’s digital resources and your I.S. department isn’t sure where to start looking at this as a solution, he would be willing to discuss it with your I.S. department and share the benefit of his experience.

If that’s something you (or anyone else) would like, please email me at david [dot] rothman [at] gmail [dot] com, and I’ll put your I.S. folks in touch with our I.S. folks.

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.