Apps – Page 2 – Krafty Librarian

Read QxMD: Another Journal App for Your iPad

Recently I have been more atune to medical apps because I am in the process creating a libguide featuring medical apps. From what I can tell, there are three main apps out there that try and provide full text access to institutional journals subscriptions via the iPad. They are Browzine, Read, and Docphin.

Last week I reviewed Browzine, today I am going to review Read by QxMD. Next week Alison Aldrich, will provide a guest post about Docphin. (I usually try to use all of the products reviewed on my blog, but in this instance Docphin doesn’t work with the way my library provides off campus access and they don’t provide access to free journals. So, I can’t try it. Alison has graciously agreed to try and write a guest post about it. -Thank you Alison!) If possible, I will take the reviews and try and compare the three apps against each other.

Read is produced by QxMD which makes several medical apps. It is founded by “medical professionals” and is dedicated to “creating high quality, point of care tools for practicing health care professionals.” They are partners with Cardio Exchange, Society for Vascular Surgery, Vascular Study Group of New England, American Academy of Family Physicians, and the Canadian Society of Nephrology.

It is also important to note their app is free and is available for the iPad as well as the iPhone (did not see an Android version). Their site promotes “seamless automatic one-tap access to full text PDFs available” for a lot of universities (full list scroll to bottom) including Johns Hopkins, Harvard, Washington University, and Yale. Despite advertising the institutions using Read, they do not include information on their website for librarians to add their institution. You have email them to add your institution, according to a tweet from QxMD .

After you download the app you are asked to create an account by adding information about your profession, specialty and institution. I find asking for profession and specialty to be annoying but I realize this is for their usage stats. If your institution is not listed you can still use the app but you will get a warning that you will only be shown free papers (Take note because this will be confusing later on).

Since my institution isn’t listed (it wasn’t listed for Browzine either, so we have a pretty equal comparison) I proceeded anyway without adding my it.

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Next you are asked to select the specialties you would like to follow. I chose Family Medicine because I know a few titles off the top of my head that are Open Access and would have free PDFs.

Once you select a specialty you are then asked to select journals to follow. The first set of journals are ones within the specialty then you are presented with an A-Z list of all journals. After selecting the journals you are also presented with a list of “collections” to follow. It appears they only have NEJM collections (which are subscription based and NOT free).

If you are paying attention to my screen shots and with the fact that my institution is NOT subscribed you will notice that there are an awful lot of listings for non-open access titles. For example: Almost all of NEJM’s stuff is available to only to paid subscribers. While Annals of Family Medicine and the journal Family Medicine are free and have no embargo period on their most recent issues, that is not the case with the rest of the journals. American Family Physician and Family Practice are not free and have an embargo on the current 12 months.

Personally I find this to be an area that has great potential to be very confusing to users. If the first screen says “By not selecting an institution you will be shown only free papers,” then as normal average person (not somebody who understands nuances institutional subscriptions, free Open Access articles, and embargo periods, which most doctors don’t) I would expect that everything I see from the first screen forward would be free. In other words since I told the app I don’t have an institution AND it told me I will only be shown free papers, then I would expect the app to be smart enough to only show free journals or papers. Instead, I am able to see free papers and subscription papers side by side, only when I click on them do I realize whether they are available. (If it isn’t available I get message indicating I can’t download the PDF)

Now you might be saying, well this whole mess is pointless if your institution subscribed to Read. No it isn’t pointless. In fact, I think it gets even messier, because no institution subscribes to every journal. There will be occasions where a user is logged in as your institution and selects a journal that your library doesn’t subscribe to (but is available on Read’s list). The average user doesn’t know what the library subscribes to and will become frustrated when they tap to read the full text of an article and it can’t download the PDF. Who do you think they will call when that happens? The following discussion plays in my head even now, “But it is listed on Read and your library is listed Read, so why isn’t it available?”

A listing of all possible journal titles that isn’t synced to a library’s holding list nor has the ability to only show free article for those not affiliated with an institution is confusing. Doctors don’t know what articles are free and what aren’t without trying to first get the PDF.

After you are done selecting the journals you are presented with a very helpful guide explaining your screen lay out. This is necessary because there is a lot going on.

The display is set up similar to a Flipboard style of browsing, showing “Featured” articles by default. There is no clear explanation as to what determines an article to be “Featured.” As I mentioned I selected these specific journals: Annals of Family Medicine, Family Medicine, American Family Physician and Family Practice. However, the bottom right article is from the European Heart Journal which I didn’t pick. (Sorry it is the journal is very faint, I couldn’t get it any darker.) I am not opposed to having featured articles, I like the idea because it allows people to become aware of articles outside of their normal journals. But, I would like to know where they get featured articles from. Is it based on a rating system or something else? (My guess is it based on their algorithm they mention in a comment on iMedicalApps.)

Tapping Journals at the top bar allows you to flip through the articles within your selected journals. The Collections tab just allows you to view the NEJM Collections (which currently are the only collections available and are not free). The outline icon (underlined in yellow on image below, next to the star) is the Topic Reviews button. It allows you to browse through “1000’s of outstanding topic reviews” which are organized from broad to narrow subjects Again it is important to note that not all of the articles listed as topic reviews are free.

Tapping the star allows you to select articles as your favorites which you can tag with your own words or from a pre-selected list for easier retrieval. Below tagged an article Family Medicine, and while I was starting to type another word the auto suggest popped up. The auto suggest while dynamic is a bit limited and I’m not sure where they are getting the rather long terms/descriptions. It appears they are either journal article titles and/or topic review subjects.

IF you have a subscription, downloading the article is very easy, you just tap on the title and it tries to download the PDF. You can email the PDF (if you have access), tweet it, share it on Facebook, add a comment, star it (which saves it as a favorite), or rate it with a thumbs up or down. If you can’t download the article you get the message “Paper could not be downloaded” and you are encouraged to either view the citation in PubMed or Add Proxy. If you don’t have access to the full text you can still email the citation, tweet, Facebook it, comment, star it, or rate it.

Finally users have the ability to directly search PubMed while within Read. This would be useful if you read an article on a specific topic and you wanted to quickly search PubMed to see if there were other articles on the same topic. However the search is so limited, it would just be better to use PubMed app you already have on your iPad or go to PubMed using your iPad browser. I did a quick and dirty search on heart attack. I have no idea what algorithems it uses when searching the text word heart attack but I get completely different results when searching PubMed directly. (I looked both within relevance and publish date, neither of which seemed to be close the the PubMed results.) I searched using the MeSH term myocardial infarction and got similar puzzling results.

Finally, there is an issue regarding timeliness. While Read displays the current issue for some journals, that is not the case with all journals. For example the current issue for the Annals of Family Medicine (a free Open Access Journal) is January/February 2013, yet the most recent issue displayed on Read is the November 2012 issue. The same is the case for Family Medicine, and The Journal of Family Practice. This is a problem within what I call the core journals as well. While BMJ, JAMA, JACC, and NEJM have the current issue available Lancet is two issues behind. Since many of the journals are current this could be an issue as to when their software hit the journal sites, perhaps it just needs tweaking with certain journals. When many of the journals have the most current issue, it can be difficult to try and discover the ones that don’t. Kind of like find an needle in a haystack but the need moves, because the software does eventually get the most recent issue.

(I don’t remember noticing this within Browzine because their display was slightly different so I wasn’t as aware of the timeliness of the citation as I am within Read. I will have to double check how timely Browzine is.)

The good news is this app is free to users and free to libraries who want to make their journals available. However, those libraries without straight forward proxy servers might have difficulty registering with Read. They would really need to contact QxMD to see if the two systems work together. Doctors who like the idea of Flipboard for their medical journals will be happy with the display and function of Read.

According to the comments made by Read on an iMedicalApps review, they feel their algorithmic curation of the literature is perhaps the greatest strength of Read. “Rather than simply relying on our users to tell us which journals they want to read, we use a combination of machine learning, semantic analysis, crowd-sourcing and proprietary algorithms to figure out which articles our users should likely be reviewing.” I think it is matter of personality as to whether doctors end up liking Read’s selections based on their algorithms or whether they prefer a different method of selecting/reading their articles. However if Read’s algorithm determines what users should likely be reviewing then I have to wonder why their algorithms chose editorials, not articles, to display on the first Read page for JAMA. Are JAMA editorials more important that articles?

I think Read has a lot going on with it and a lot of potential but I am concerned about the fact that it only contains a few of the BioMed Central and PLoS titles which are Open Access and possible confusion regarding what is available full text and what isn’t. In theory I know doctors shouldn’t care whether an article is full text, if it is relevant they should find a way to get it. However, theory doesn’t always work in reality. I have seen more doctors ignore relevant articles because they weren’t full text or they couldn’t figure out how to get the full text. I have doctors who won’t click an order it button to order an article (FOR FREE) from our library because they don’t want to deal with it. I think there needs to be a better way for Read to work with institutions so that doctors clearly know what journals are available to them and what aren’t. Doctors assume that if they input their institution then what they see is what the institution gets, which is not always the case.

The Future of ePub Browsing

Sunday I got an email from my county library, Cuyahoga County Public Library, about their new online journal platform called Zinio. Zinio is a company that allows my public library to provide access to many of their magazine subscriptions on to my iPad (as well as other devices) in an easy to read format.

Here is a screen shot of the magazines that I selected to have on my iPad to read, all courtsey of my Cuyahoga County Public Library card.

I was also in the process of finding apps for our medical library’s libguide. I sent a tweet out asking for suggestions and some people including Third Iron responded. Third Iron is a company that produces the product Browzine. Their company which is has many executives with library degrees or significant library experience, works to make online journals available in an easy browsing experience for the online user.

Tuesday I spoke with Kendall Bartsch about Browzine, what it does and how it might work for our library. Browzine is very similar to Zinio. Where Zinio is magazines, Browzine is scholary publications and with its share, email, download, features, (not available in Zinio) it quite frankly blows Zinio out of the water.

Browzine allows people to browse scholarly publications and read the table of contents to the recent issues of journals. It works with various publishers such as Springer, Wiley, AMA, Nature, etc. It also works with Open Access publications. Users download the free Browzine app (currently iPad only but they are working on Android). When they login to Browzine it asks them to select their library. If their library has a subscription to Browzine they can login and access their library’s subscriptions via the iPad.

Browzine is a very new company, they have quite an impressive list of libraries who are either trialing the product or have a subscription, including Welch Medical Library, Medical University of South Carolina, Northwestern, and Washington University. If your library doesn’t have a subscription to Browzine, or if you want to try it out and play with it you can still download the free app and select Open Access titles which enables you to view the table of contents and PDFs of the open access publications and journal articles.

There are a ton of Open Access titles and if your library subscribes to Browzine then there are a ton of publisher titles that users can access. With that large of a number of journals it would get tedious to scroll through or search for your favorite journals that you like to keep up with. That is why you are able to save those journals in your own personal library shelf. So when you access Browzine you can go directly to that shelf instead of searching through a bunch of other journals.

Here is a screen shot of Open Access titles in Biomedical and Health Sciences -Medical Science. If your library has a subscription your library’s name is where Your Library Identity is and your list of journals will be more than just the OA titles. (Note: there are MANY OA journals, the picture below is just a small slice from the OA Biomedical & Health Sciences -Medical Sciences category.)

Here is a screen shot of my “favorite” journals that I like to read. (Pretend I am doctor or researcher who likes to read these scholarly publications.)

Here is a screen shot of the table of contents for one of my favorite journals. The yellow inbox indicates I have saved that article on my iPad.

Here is a screen shot of the PDF of an article from the TOC and the options for emailing, saving, sharing, etc.

Browzine is compatible with iAnnotate (a popular PDF annotating app) and DropBox and Box as well as other programs.

To say I was blown away was an understatement. Finally now after all these years, people will be able to browse the table of contents easily AND connect to the article via the library’s subscription in an extremely easy way. The concept of my own personal bookshelf is great. The ability to export the articles is essential and thankfully is easy to do with Browzine. Currently Browzine does not provide notifications when a new issue is available, however that is a feature that they are adding shortly. When that does happen, users will see a little red bubble with a number next to their journals.

As cool as Browzine is, they don’t work with every publisher yet. (Publisher availablity list here.) Also Browzine won’t work with database provided journals. So for example, journals you get full text through CINAHL aren’t going to be available through Browzine. Perhaps that may be why LWW is not on Browzine? (LWW requires institutions to access journals through Ovid.) However, for databases like ClinicalKey, which is an Elsevier product and has all Elsevier journals, one has to wonder if that will be in Browzine or if it will be considered a CINAHL (ClinicalKey and Browzine are both so new who knows). If it is considered a CINAHL then that would be a shame since some libraries may look at ClinicKey as their Elsevier journal provider.

While Browzine currently only does journals, I can see where this type of easy access can be applied to ebooks. eBooks suffer from much of the same silo content problems as ejournals. Each publisher has their own way of displaying and providing access. You have to bounce around from provider to provider to view the ebook on your iPad (or even your laptop). There is no easy way to find and access ebooks for medical libraries. Most of our users don’t know how to find ebooks. They sometimes check the catalog, but even then that is only a brief snapshot of some of the titles available. PMC titles and other ebook collections aren’t always in the catalog because you are either waiting for the MARC records from the provider (in the case of large aggregators like Clinical Key with hundreds of titles) or you are simply unaware of the latest title that was added to the online collection.

If we could get our ebooks to display like Browzine displays ejournals, I will jump for joy and quite possibly stop my ranting on the inaccessibilty of ebooks in the medical library.

Unauthorized Copies of Medical Texts on Apple Apps Store

I am on vacation this week so I have also been taking a bit of electronic vacation as well with the blog. But I ran across a post earlier this morning and thought….”Wow I have to blog about this!”

The post is on iMedicalApps.com, “Are unauthorized copies of popular medical textbooks being sold in Apple App Store?” While reviewing “Human Anatomy Pro for iPad” by YoDevApps LLC, Tom Lewis noticed striking similarities between the Human Anatomy app and the Gray’s Anatomy for Student App/textbook. Yet, there was no mention of this in the original iTunes description and upon further examination, Tom noted that all the images and words were direct copies of the original text of Gray’s.

Tom emailed (June 10, 2012) YoDevApps LLC for explannation of the “similarities,” and basically Evans Ben (YoDevApps), in a poorly worded and spelled email, told Tom there are similarities to Gray’s as well as other texts because he consulted the text when creating his app.
Yet this is not limited to Human Anatomy Pro and Gray’s. Tom discovered there were several titles that appeared to have a lot in common with well established medical texts. They are:

Illustrated Medical Dictionary (Similar to Dorland’s illustrated Medical Dictionary)
Principles of Internal Medicine (Similar to Harrisons Principles of Internal Medicine)
Clinical Medicine (Similar to Clinical Medicine by Kumar and Clark)
Principles of Anatomy and Physiology (Similar to Essentials of Anatomy and Physiology)

On the iMedicalApps site Tom provides screen captures of images from the YoDevApps iTunes page and compares them to the other textbooks. When making the comparisons, Tom used both printed editions of books (Kumar and Clark) and other ebook editions (Harrison’s via Inkling). The images are identical.

Obviously as Tom indicates, these apps raise a lot of questions about proper licensing and distribution of copyrighted material. Since the content appears to be heavily borrowed, it also makes it extremely difficult to trust the developer on content accuracy which is essential for medical apps.

iMedicalApps recently contacted publishers (of the original texts) and Apple regarding situation and will update their article when they have a response from those involved. As of 6/12/2012 Elsevier has responded and is “initiating action”.

Not only is this whole thing interesting from a copyright standpoint, but it reminds us that we must be careful regarding medical apps. Any developer can throw something up on the App Store and have it look reliable.

Libraries Loaning iPads

A few weeks ago I sent out an email to MEDLIB-L asking for librarians who are circulating iPads to contact me off list to answer some questions. I was really killing about 3 birds with one stone. Not only did iMedicalApps want me to write a story about libraries loaning iPads, but I wanted to investigate the idea for our library, and I wanted to share the information for others on this blog.

A lot of librarians got back to me and I want to thank everyone who responded.

Here are some links about current library loaning projects:

Setting Up A Lending Program -Tips and resources for setting up an iPad lending program. Nova Southeastern University Health Professions Division Library
iPad on loan: a project of the CMB UMCG – Background information, finding medical apps, and information on how to add bookmarks to iPad browser (check the side bar for a lot of information). University of Groningen Central Medical Library
Setting up a library iPad program: Guidelins for success– Full text article in ACRL News by Sara Thompson at Briar Cliff University
Continuing the converstation: Integrating iPads and Tablet Computers into Library Services – ALA Tech Source article by Daniel Freeman.

Sampling of library policies:

Duke http://www.mclibrary.duke.edu/services/ipad
KOC University http://library.ku.edu.tr/technology_lending
University of California Irvine http://libguides.lib.uci.edu/content.php?pid=71488&sid=529255
University of Chicago https://itservices.uchicago.edu/page/techbr-equipment-lending-terms-and-conditions
University of Utah (iPad, Xoom, Kindle, Nook) http://campusguides.lib.utah.edu/EcclesMobileDevices
Virginia Tech http://www.lib.vt.edu/artarch/ipad-policy.html
Wake Forest http://zsr.wfu.edu/about/policies/technology-ipad
ZweigBibliothek Medizin in Münster, Germany What to consider when borrowing English Translation

Sampling of general apps loaded on iPads:

Adobe Photoshop Express
Apple’s iWork apps (Pages, Numbers, Keynote)
Box
DocToGo
Dolphin Browser
DropBox
Elements
Evernote
GoodReader
Google Search
iAnnotate PDF
iBook
Kindle
Nook
PDF Expert
QuickOffice
Penultimate
Podcasting 4 Education
Print Central for iPad
Sekai Camera for iPad
Skype
Whiteboard HD

Sampling of medical apps loaded on iPads:

3D STem Cell Simulation & Strain Tool
AHRQ ePSS
AIDSInfo HIV/AIDS Glossary
BrainPro
DailyMed
Davis’s Drug Guide
Dragon Dictation
Epocrates
Eponyms
Embryo
Eye Chart Pro
GeneIndex
Health Hotlines
Human Anatomy!
Improve Bleeding Risk Tool
Improve VTE Associative Model
Inkly
iMuscle
iPharmacyPro
iRadiology
iTriage
LactMed
LexiComp
MedCalc
Micromedex
MedPage Today
Mobile REMM (Radiation Emergency Medical Management)
Molecules
Muscle & Bone Anatomy 3D
NEJM This Week
NeuroMind
PEPID
Skyscape Medical Resources
WISER

Sample of medical library type apps loaded:
(Some overlap with above list. I think some maybe bookmarks not necessarily apps)

AccessMedicine
Annals of Oncology
Annual Reviews
Chest
Clinical Pharmacology
DailyMed
Diagnosaurus
DynaMed
EBSCOHost
First Consult
Health Hotlines
LactMed
LexiComp
Mary Ann Liebert Journals
MDConsult
Medscape
Micromedex
Natural Standard
PLoS Medicine
Procedures Consult
PsychOnline
PubMed (unclear whether PubMed Mobile or for Handhelds)
PubMed Clip
RefWorks Mobile
Science Direct
StatREF!
Skyscape Medical Resources
VisualDX

Summary:

Loan Rules
Loan rules vary from a few hours to a few days. Most libraries reset the devices to factory standards for security and privacy reasons. Although a few librarians have reported that some apps “remember” despite this and are looking into more. I was unable to find many hospital libraries that loan out iPads.

Secure Network and EMR
Additionally few hospitals or medical school responded that their iPads were also able to access the EMR. Mayo Clinic’s iPads can access the EMR as well as the devices used by residents at the NSU residency program at Palmetto Hospital. As we are looking into our own iPad program we discovered that our devices must have specific Microsoft Client Access Licenses (CALs) to software necessary to access the secure network (and the EMR). For us, the CALs add quite a bit to the cost of the iPad, about $200 more. You pay per device. So each regular 16 GB WiFi only iPad3 that normally costs $499 ends up costing $799 once you factor in the cost of the CAL’s and AppleCare+ (2 yr insurance on the device for $100). We feel it is essential to get on the secure network so the extra cost of the CALs is something we have to plan for. Working with IT has been essential in this process, without them we would not have known of the requirement to get the iPads on the secure network. While the cost of the CALs was a surprise, I am glad we had IT help so that it was a surprise in the beginning/planning stages not after we bought them.

Apps
Both libraries who loan iPads and those who don’t are providing lists of mobile friendly (and tablet friendly) library apps and websites. Things are bit like the Wild West with apps and mobile sites. Some library vendors mobile friendly sites require secondary authentication (using their own personal login) despite being on institutional network. Some vendors are creating apps when really a mobile friendly site is all that is needed. Apps often require a username and password to use regardless of whether they are on institutional network. Some apps are intended for individual subscribers NOT institutional subscribers, and unless the wording explicitly states that, it is confusing.

Regarding medical apps (not medical library apps like databases), library purchase (or not) policies are varried as well. Some libraries have accounts on iTunes to buy apps in bulk, while others just load devices with free apps that people might need. Some have said that they do not buy specific medical apps because the iPads are circulated to eveyone and that would mean a lot of different subject specific apps that would need to be on the device. Some librarians also spoke about the need to constantly update the apps, especially the free apps. In order for the pre-installed library “owned” apps to be updated, somebody must log in using the library install account to update them. Some mentioned this could be time consuming depending on how many they have loaded.

Many libraries seem to allow people to load their own apps on the loaned devices. The reason is that the app follows the patron not the library. So when the library restores the iPad to factory settings the app disappears from the library device, but the patron still retains ownership and can install it on another iPad.

Other thoughts and suggestions
Start off with a few iPads then grow if/as needed.

Tie the iPads into the curriculum, load medical bookmarks/apps, or get them on the secure network, in other words make them relevant for work. One library reported they bought iPads but really didn’t have a budget for apps and most already had smartphones and laptops so the iPad was more fun than productive.

Many people said that their patrons often did a try before you buy with the library iPads. Not sure how some feel about this given how expensive of an investment the devices are, but part of me knows they already do this with our textbooks.

Barcode and label EVERYTHING! Some librarians reported their patrons trying to swap out their old frayed Apple charging cables by passing them off as the library’s cables.

Get a bag and a cover for the iPad. Cover helps protects the device while in use. The bag makes it easier to hold all of the stuff (charger, forms, etc.) for circulation AND not everyone who use the device have lab coats and it is nice to just put in a shoulder bag.

I hope this is helpful to others who currently are lending iPads and to those looking to start. Feel free to comment if you have more information or questions.

Libraries Loaning iPads

This morning I posted on iMedicalApps.com the article, “Don’t have an iPad, go to the medical library and borrow one.” There are lots of medical libraries loaning iPads out to their patrons and this post was a way to highlight to physicians some of the ways libraries are helping them get connected using iPads.

In my research I discovered that there are A LOT of medical libraries doing this, too many to list in the actual article. So in order to have a more comprehensive list of libraries loaning iPads I thought it would be a good idea to create a comprehensive list of libraries who loan them and post it on the iMedicalApps forum. So if you library loans iPads, list it on the forum with your basic rules and some of the popular apps loaded. Remember keep it short and sweet with not to much library geek jargon, we want it to be easy for docs and medical professionals to scan through and look at it.

Interested in the geeky library details? Don’t worry, I will posting in the next few days the librarian version of the iMedicalApps article. This will have the information that librarians interested in starting their own iPad loaning project will want to know about.

Harrison’s Through Inkling vs. AccessMedicine

The iMedicalApps team compared Harrison’s Principles of Internal Medicine on Inkling vs. AccessMedicine. I feel I am at a bit of a conflict of interest here. I have recently begun to work with iMedicalApps to write some posts (I am currently working on a post right now) and I agreed to moderate the Medical Librarian’s Corner of their Medical Apps Forum.

My problem is that I see at least one error in the review, another area where the author needed to be clearer in their evaluation, omissions regarding updates, and a slight bias toward student use. As a result it makes it difficult for me to read the comparison without talking back to the computer. Now I don’t have an iPad (saving up for an iPad 3 when they come out) and I don’t have a subscription to Inkling, but I have worked with Harrison’s Online through AccessMedicine extensively so I am extremely familiar with it. Since I don’t have Inkling’s Harrion’s I can’t do a comparison of the two products, but I feel the need to point out the error in the review and provide some criticisms about the review itself.

While I may be struggling with how to do this appropriately given my new relationship with iMedicalApps, I don’t have any conflict of interest with AccessMedicine, McGraw Hill or any of the Access databases. In fact I have recently been kind of critical of them for having difficult mobile access policies (require personal login even while on campus) that do more to hinder the use of their ebooks.

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Update 2/22/12 Ooops…I am wrong, I do have a conflict of interest with McGraw Hill that I should report. I am on the Library Board for Silverchair and Silverchair actually built McGraw Hill’s AccessMedicine product. I want to thank those who reminded me of that. It was never my intention to hide that information, I just was more focused on the actual product and the review and honestly forgot about Silverchair’s involvement. So I guess with ties to iMedicalApps and AccessMedicine, you could say I am equally(?) conflicted?

Despite the various possible conflicts of interest, I really just tried to expand on the orginal review of the two platforms and correct an error.
****

First, let me address the obvious error within the review. The author of the review compared the search features of the Inkling platform and the AccessMedicine platform.

“Both AM and Inkling have search capacities, but Inkling’s is far superior. First, Inkling confines its search only to Harrison’s and it retrieves every table, figure, and text finding. AM, on the other hand, has a website-wide search function that doesn’t just give Harrison’s results but also the results from other titles in the AM library.”

This is incorrect. AccessMedicine’s Harrison’s can search only within the book. The author of this review failed to notice the drop down arrow next to the search box that allows one to search only within Harrison’s. See image below.

This a pretty obvious error. Now I admit the default for the search box is AccessMedcine (as you can see) but just clicking the arrow you can easily limit your search to Harrison’s. Perhaps AccessMedcine might want to consider making the default for the Search dependent on where the user is on the site. If the user is within Harrison’s then the default is Harrison’s. If the user is in Goodman and Gilman’s then the default is Goodman and Gilman’s. If this is possible, this would help people out.

Second, I feel the reviewer needs to be a little clearer regarding the search results within Inkling and AccessMedicine. The reviewer takes issue with the number of times the term heparin was found within AccessMedicine’s Harrison’s vs Inkling.

“Moreover, the power of the Inkling search is greater than AM’s. I retrieved 50 matches when I searched Heparin on Inkling. In AM, I only retrieved 13 matches, most of which were tables, rather than mentions of heparin within text chapters. Harrison’s is such a mammoth text that a powerful search function is essential, which Inkling provides and AM does not.

This statement implies that the reviewer only looked at the search results screen from Harrison’s and counted on the number of retrieved results. They are correct that most of the retrieved results were tables where heparin was mentioned, and only one result was where heparin was mentioned within the text of Harrison’s. However, this is kind of misleading. This implies that the term heparin was only mention once in the entire book of Harrison’s on AccessMedicine, which is not the case. When you do a search for heparin in AccessMedicine’s Harrison’s, the top result (see image below) is a whole chapter on antiplatelets and anticoagulants (Chapter 118). Yet in the reviewers own screen shots, a search on heparin in Inkling also lists mostly tables AND the most relevant information (the chapter that heparin is mentioned) is listed far down on the retrieved results. I would have thought the chapter is more relevant than the tables (and given the tone of the review, so does the reviewer) but it would seem from the Inkling screen shots that it isn’t because listing for the chapter burried below the results for tables.

The whole chapter in AccessMedicine’s Harrison’s has over 100 mentions of the term heparin (as shown in bright red circle below)

So my question for the reviewer is whether Inkling retrieved more hits because it was counting the multiple times the term heparin was mentioned in the chapter on anticoagulants OR did it find more instances of the term heparin within OTHER chapters of Harrison’s. This is kind of an important nuance when you are looking at search results. Because if Inkling’s 50 hits were all within the same anticoagulant chapter then the search feature is similar to AccessMedicine’s and the results are just presented differently. (Here is a whole chapter on heparin vs. here is where it is mentioned every single time in the chapter.) But if Inking’s search found more instances of the term heparin within other chapters of the whole book then the search features on Inkling are picking up something that AccessMedicine isn’t. Is this good or bad? It really depends. Is it picking up relevant results like the paragraph on heparin in Chapter 370 Cerebrovascular Diseases (ischemic stroke section) or is it just picking up the term where it is used briefly in a sentence and really has little relevance if you truly searching the subject heparin? It is also important to remember that Inkling’s results for heparin were not as relevant because the chapter was listed the tables.

When looking at the strength of search engines more than a mere word count needs to be discussed if we are to really understand which platform has the best search features. Relevancy is way more important than sheer number of results, look how much junk floats to the surface of some Google searches. Unfortunately this was not discussed in detail enough for us to determine whether Inkling’s search engine is really better (retrieves more relevant results).

The reviewer does correctly mention that AccessMedicine has the most updated information from Harrison’s. Updates are made continuously online through AccessMedicine, therefore a reader doesn’t have to wait for a new printing of the book. “It is uncertain whether Inkling will enable the same kind of updates.” The reviewer surmises that Inkling will update their version when the next edition of Harrison’s is available (much like a print edition schedule). However, the reviewer omitted to discuss the e-chapters within AccessMedicine’s Harrisons and whether they were available on Inkling.

There are over 50 e-chapters that according to AccessMedicine are only available online (image below just captures the last chapters with the note about the e-chapter logo).

That is A LOT of addition e-content. Some of those e-chapters are tutorials and videos but others are actual chapters not “ancillary content.”

Some chapters that are e-content only:

Primary Care in Low and Middle Income Countries
Complementary, Alternative & Integrative Medicine
Ethical Issues in Clinical Medicine
Approach to the Patient with a Heart Murmur
Mitochondrial DNA and Heritable Traits and Diseases

It is imporant to know whether Inkling’s text has these same chapters as AccessMedicine or whether it is missing chapters.

Finally, the reviewer seems to have a slight bias toward student use. The reviewer seems to dismiss the charts, tables, and PowerPoint lecture slides.

“There is also some ancillary material that the AM version gives that Inkling does not. Nearly every chapter in AM’s Harrison’s has powerpoint lecture slides that have figures and tables from the book. This is not of great importance to most students I suspect, but instructors may care.”

Maybe some students may not care about slides, figures, and PowerPoint slides, but if you have to give a presentation you probably care a lot. As a librarian at a large research medical center I can tell you this type of “ancillary material” is asked for and used more than the reviewer would think. For example I can’t tell you how many times I used to get asked about NEJM’s PowerPoint slides and how they could download them. (I am not unique, other librarians have been asked this too.) So I would say that Harrison’s slides, charts and tables are more than just mere ancillary material that only instructors may care about. I think if you are doing any research, publishing, and presenting you will be very happy to have another resource for your papers and presentations.

Now that I have pointed out the things I found to be lacking in the review, I do want to mention some of things that I feel the reviewer correctly hit on.

Note taking within AccessMedicine’s Harrison’s is not helpful and all types of users, including students, take notes. If you have created your own personal MyAccessMedcine account you can “Bookmark” chapters and items, but you really can’t take notes.

The reviewer is also correct that if you want a version of Harrison’s that is not dependent on an Internet connection then Inkling is for you. However, as hospital networks improve I see this locally loaded feature (of any product not just Inkling) to be less of an issue. The cloud is the future for information storage and retrieval. But I do recognize this is a personal taste issue, some people just like having content loaded locally.

The way AccessMedicine limits readers to view only sections at a time is frustrating and a barrier. As a result AccessMedicine’s Harrison’s Online is not an easy book to read online. Inkling’s version appears to be very easy to read online based ont he review. The reviewer correctly mentioned the reason for divvying up the book into sections was to prevent online piracy. Unfortunatly, this does little to prevent piracy and more to inhibit real usage. (People are scanning entire books and making them available online. AccessMedicine does little to prevent guests from creating a MyAccessMedicine password at a subscribing institution and using it well after they are an authorized user.) It appears from the review, Inkling’s book is much more user friendly to read in a sitting rather than the AccessMedicine version. AccessMedicine’s presentation is limits its use.

Personally, I think the decision to use AccessMedicine’s Harrison’s vs Inkling breaks down into 2 parts.

1. If you want to stay current and have the most recent information then you need to use AccessMedicine’s version. Inkling has not indicated their update schedule and AccessMedicine always updates Harrison’s. The reviewer did not mention if e-chapters are in Inkling’s version, if they aren’t then you are missing chapters.

2. If you are not as concerned about the timeliness of the information (or the possiblity of missing e-chapters) and you want an easy to read experience with the ability to take notes and read offline then Inkling’s version is what you want.

Free Web Class: Get Mobilized

Get Mobilized! An introduction to mobile resources and tools in health sciences libraries is a free, self-paced, web-based class. The class runs from February 20 – May 6, 2012 and is approved for 6 CE credits from MLA. The class will be taught by health sciences librarians working in the field with mobile device experience and is presented in 6 learning modules over the course of 6 weeks. Each module focuses on a different aspect of mobile resources in the health sciences library.

Week 1: Introduction to mobile resources by Molly Knapp
Week 2: Mobile Applications by Luke Rosenberger & Julie Gaines
Week 3: Mobile trends and issues in academic and hospital environments by Jaime Blanck & Melissa Rethlefsen
Week 4: eReaders by Suzanne Shurtz
Week 5: Promoting Mobile Resources by Amy Blevins
Week 6: Mobile site creation by Wayne Loftus

June 3 will be the absolute day to submit your workbook for credit.

Mobile Technology Webinar Available

The SCR CONNECTions webinar, Unwrapping Mobile Technology Trends for the New Year is now available in the SCR CONNECTions archives http://nnlm.gov/scr/training/webmeeting.html#Archives. The PowerPoint presentation which has a lot of great links to the references she mentions is also available on the website.

The webinar is very good for librarians new to the area of mobile devices. Emily Hurst, the presenter, discusses smartphones, tablets and e-readers. Mobile devices in libraries is still fairly new. According to Emily’s survey most of the people attending the webinar use them for education and instruction, but there were still those who don’t use it in the library. What was interesting was LSU mentioned in the chat that they use mobile devices to check off campus access. That is how the systems librarian and I use our personal mobile devices at work too. Often we are told a resource is unavailable off campus, but of course we are told this while we are work (on campus). Now when we are notified of problems either the systems librarian or I turn off wifi on our smartphone and use 3G to access the off campus server and then try and access the problem resource for troubleshooting.

Emily also described the differences between mobile sites and mobile apps. There was a brief discussion about the pros and cons for each. Emily asked the question, “Providing direct access to a specific type of data, program, or information on a mobile device is best archived with a… mobile site or mobile app?” While most of the people in the webinar answered mobile app, I feel the question was kind of a loaded one. I think the real answer is, “it depends.” It depends on how you want to use the resource, does it need to be loaded and “on” all the time regardless of 3G or wifi connectivity? If so then you need an app. How often does the information change and how robust is your computer programming skills? If your information changes quite often and you don’t have a cadre of computer programmers then you need to go with an mobile website. Finally you need to think cross platform. If all of your users have iPhones then that is great you only need to develop one app. But if your users have a variety of devices and you don’t have variety of programmers, you might consider a mobile site which can be read by any mobile device.

Two valuable resources Emily mentions are CNET’s Updates Tablets Test Results and Yale’s Mobile Device Options for Healthcare Professional. CNET’s is a listing comparing LOTS of tablet devices with each other so that people can make an informed decision as to which one they would like. The nice thing is this list is updated regularly. Yale’s is a listing of various resources (phone and tablet) and healthcare things to consider prior to purchasing a device.

The last technology discussed was the e-reader. The nice thing about Kindle is you DON’T have to have a Kindle, you can download the free Kindle app on your Android, iPhone or iPad. It is important to remember that e-readers aren’t just for books. Librarians might want to consider creating or selecting PDFs, Word docs, audio files, or collection of works for specific users or groups. This works especially well in outreach and education endeavors. Suzanne Shurtz and Megan von Isenburg describe using e-readers in medical education (Shurtz, S., & von Isenburg, M. (2011). Exploring e-readers to support clinical medical education: two case studies Journal of the Medical Library Association : JMLA, 99 (2), 110-117 DOI: 10.3163/1536-5050.99.2.002) and although medical students did use them at the bedside they said they were very helpful in their studies.

Mobile devices are a part of our daily lives. The largest growth in smartphones was from women and older individuals, as Emily notes this really indicates that smartphones have gone mainstream. This is a great webinar for those new to the technology in medical libraries.

Hospitals Slow on Tablet Implementation

I saw this article, “Hospitals slow on tablet implementation,” last week and posted it right away on my Facebook account with the intention of blogging about it the next day. Sigh… that was before round two (or is it three now) of sick kids.

Several things flitted through my mind when I first read the title:

Wow, Apple’s Tim Cook was a little off on his estimate that 80% of top hospitals were testing the iPad.
Ok, looks like my hospital and I are not in the minority as it sometimes felt.
Yep, same ol’ same ol’. By the time we adopt the new technology it is out of date

But after those thoughts and others left I began to wonder what is the real hold up. It can’t be that 99% of all hospitals have the same draconian IT policies. (Although my conspiracy theory friends might disagree.) Why does it seem that U.S. hospital have such wonderful advance cutting edge technologies for diagnosing and treating diseases, but when it comes to computer infrastructure, hospitals cannot keep up with technology.

So I began to look around the web to find out if anybody commented on Sarah Jackson’s post at Fierce Mobile Healthcare as to why so few hospital have done fully functional tablet systems.

Both Jenny Gold of Kaiser Health News and iMedicalApps approach the problem from the app side of things. Gold’s article blames the EMR companies that often don’t have apps for their software, thereby forcing hospitals to use third party apps like Citrix or VMware which can be clunky and slow. Satish Misra at iMedicalApps points out that even apps created by EMR companies like Epic, Centricity, and Allscripts require make their EMR apps read only making it a necessity for doctors to log on to a separate computer to make notes in the chart. To add to the “fun” many of these EMR companies like Epic and Allscripts require separate licensing for their mobile platforms. (Hmm that little caveat sounds familiar to librarians.) So what you have is all these hospitals who have spend LOTS of time and money getting themselves and EMR product and now enters a game changing product that was never envisioned 5 years ago when many hospitals were well into their EMR planning and implementation.

While EMR integration is important there are many doctors who are using the iPad without that ability. They are using them in the exam room, ER, Surgery, and especially in radiology. According to Robert McMillan of Wired, Apple has a secret plan to steal your doctor’s heart. His name is Afshad Mistri. (Although I am not sure how secret he can be when Wired does a big article on him and he is organizing invitation only conferences for medical professionals.) His goal (and Apple’s) is to get the iPad in the hands doctors. McMillan reports that it was Mistri who launched the special iTunes room for healthcare in September, and promoted it to a select group of healthcare app developers. Apple has to be careful promoting the iPad in hospitals. Step too far one way and the FDA will want to regulate it as a medical device, but don’t step at all and you don’t get it in the hands of doctors. The Wired article is a very interesting read and highly recommend it because it does a good job of illustrating just how Apple, a consumer oriented company not a company usually interested in businesses, is delicately trying to work its way into healthcare, specifically hospitals.

As much as Apple has secret fingers in the pie, trying to hook docs to the iPad, don’t forget that there are still signal issues within most hospitals. This is a big barrier to implementation. You can have all the best apps and EMR integration but if you are in a deadzone, you have an expensive brick. Ravi Nerella posted in the iMedicalApps forum, “We had issues with reception throughout our hospital (the ED was a dead zone) until one of the major cellphone carriers was allowed to place a tower or repeater (whatever it is they needed) and now we have great reception (for the specific carrier only of course) that also forced us to go with the specific carrier to provide us service.”

Just from a quick look through the Internet it seems that there is a host of reasons why 99% of the hospitals don’t have fully functional tablet systems. But from my perspective it seems to basically comes down to money (doesn’t everything). It takes some serious cash to license the app (3rd party or from the EMR company), some apps aren’t even fully functional so you aren’t saving on hardware costs by chucking the PCs. It also costs a lot of money to support the product and write hospital specific apps. Additionally they have to spend money on the infrastructure, making dead zones viable. If something wasn’t put in the budget and it is that costly to implement, it is going to take quite a while (years maybe?) to implement. The iPad is less than 2 years old. It wasn’t even a glimmer in budget lines back then. The speed of personal day to day technology has outpaced hospital budget planning processes. Quite simply, hospitals are giant cruise ships that can’t turn on a dime when the iceberg of new technology comes into sight. Let’s just hope most hospitals are not the Titanic.