Everyone Wants to do a Systematic Review

It isn’t your imagination, more and more people are writing and publishing systematic reviews. In a recent research letter from JAMA Internal Medicine, Assessment of Publication Trends of Systematic Reviews and Randomized Clinical Trials, 1995 to 2017, the authors noted the rate of growth in published systematic reviews was ginormous. I know ginormous is not a technical term and the authors would not use it in a publication like JAMA Internal Medicine, but when the rate of growth is 4676% I think the word ginormous is appropriate.

The systematic review is the new little black dress on the publishing runway, everybody must have one dahling.

But not all systematic reviews are created equal. The JAMA Internal Medicine study did not look at the quality of these systematic reviews. It just looked at the number of publications across 18 medical and surgical areas that made it into PubMed and were indexed as systematic reviews. Many systematic reviews do not meet basic standards. (Why are we calling them systematic reviews then?!) Melissa Rethlefsen reports in the Journal of Clinical Epidemiology. 2015 Jun;68(6):17-26, systematic reviews that included librarians or an information specialist as a part of the process were more likely to be reproducible and meet specific search standards.

So, it would behoove people who want to do a systematic review to contact a librarian to help. That is a good thing. Unfortunately, it seems too many people don’t understand what is really needed to do a proper systematic review. They just want that little black dress, and they want it now.

Librarians are not only drowning in the requests for systematic reviews, but the pool is continually filling with people who refuse to understand the requirements for a systematic review, or they are delusional about the commitment in time and effort needed to do one. Librarians are continually trying to lower the water level through education, but those educational methods are not hitting home with the right people.

I have seen librarians post information sheets online detailing the process. I know some librarians require forms and “contracts” to be fully filled out prior to discussions. Yet there still are those who are surprised by search results in the thousands (even though they were informed this is typical and they need to go through them) and ask for fewer results. There are systematic review searches that the librarians spend days creating that are languishing in systems like Covidence or DistillerSR never to be revisited by the requestor.

It isn’t that librarians don’t want to do systematic reviews, they don’t want to waste their time (often several days) on something that goes nowhere or is of such poor quality they need to ask that their name be removed from the paper. So they continue with their education efforts, guiding researchers to on how to do a proper systematic review or suggesting different types of searches as appropriate.

However, I feel this approach is a little bit like the librarian sticking their finger in the leaking damn. It isn’t until somebody repairs the damn will the leak actually stop and prevent the flooding of poor systematic reviews.

Publishers, faculty, researchers, and authors need to step up and help repair the leak.

  1. Publishers need to make it very clear to authors the criteria needed for a systematic review and anything that doesn’t meet the criteria will be immediately rejected. Some publishers are good at this, many are not. We have over a 4000% increase in published systematic reviews, clearly some publishers are not that strict.
  2. Faculty need to stop assigning systematic reviews as a summer project to their students. Assigning how to learn the methods or requirements to conduct a systematic review is entirely achievable for the summer. Telling students, residents, and other junior researchers to do a systematic review over the summer is not.
  3. Researchers and authors need to have a reality self check. We are not lying when we say a proper systematic review typically takes 12-24 months. You will not be the one who is “different” and can get it done in 4-6 months. You will also need at least 3 colleagues who have same time, opportunity, and dedication as you do because you need at least 3 reviewers (including yourself) to minimalize reviewer bias.

A quality little black dress is something that you will come back to and use as often as the need arises. A good systematic review is something that people can utilize to form policies, treat patients, and base recommendations. Unfortunately, a poorly done systematic review is worse than ill fitted, poorly stitched, little black dress made out of cheap material. Poorly done systematic reviews not only waste time but it flood the databases and do little to improve policy or treat patients. But hey, you got that little black dress published and it is now on your CV, so who cares if we pull a thread and it all falls apart. You don’t need to be the Ralph Lauren of systematic reviews, but you also shouldn’t be Amazon version either.

**Quick edit/update**
After posting this, I started thinking we librarians need to start being more assertive when somebody wants a “systematic review” without knowing or wanting to put in all of the work of actually conducting a systematic review. In addition to educating them, we have to remember to say No. It is hard to say no, librarians don’t like to say no. Perhaps we should also say no.

*Disclaimer* The authors in the JAMA Internal Medicine cited above are from my institution and one of them is my librarian co-worker.

I’m a Different Librarian Now

I first became a medical librarian 20 years ago. I was bright eyed and bushy tailed ready to learn everything I could about medical librarianship. Naturally over the 20 years I changed as a librarian, I became more confident, specialized in certain aspects of medical librarianship…essentially evolved.

However, I think the biggest change that I have experienced is the change in my librarian-ness when I became director of my library. I remember when I was hired I was told I will need to learn to let go of some things because the things I needed to do as director would fill those spots. Intellectually I understood this, but I don’t think I realized how much I would have to let go until I attended MLA and the whole slew of other librarian meetings that happened in Cleveland this year

As I walked the exhibit floor talking to vendors, I spoke to some great people at companies telling me how their product does this or how they’ve improved things. As I talked with these people I started to really realize that I was not the right person for them to be talking to. Yes, I make the final decisions with purchasing, but I have found that I am just not using these products as I once did.

I still do searches. We get a lot of search requests so every librarian on staff steps up and does a lot of searches. But I don’t do systematic reviews. Five years ago I would have jumped at the chance to do them and learn everything I could about doing them. Now, I just don’t have time to do them and I give them to one of the librarians who do them. I don’t edit web pages or test products as much as I would like to. Honestly, I had to go to one of my LibGuide librarians to remind me how to a certain thing in our guides.

As I look back, the transition has been a little weird to me. I don’t have the time I once had to investigate things. It is no longer my job to be the expert on library things. My job is to make it so my co-workers can be the expert in library things. That means I do everything I can to make it so they can do their jobs. My job is to be the expert at running the library. That is a big switch.

You can take all of the leadership and management classes from MLA and AAHSL (and I encourage everyone to do so) but until it happens, you really don’t understand how things change. I am forever grateful to my library friends and peers for sharing their knowledge and letting me pick their brains. Without that camaraderie, the switch to library director would have been more difficult. Librarians a great group of people who share. I hope as I continue to grow and change and be a different librarian that I am able to share with others and give back as much as others have given to me.

Don’t be afraid of change, of moving to a different job, role, or path. It will be different, but that isn’t necessarily bad, it can be quite good.

We Don’t Understand How Our Users Find Information

I had the unique pleasure to be the moderator for the McGovern Lecture at this year’s Medical Library Association Meeting. You must login w/ your paid meeting registration to watch. If you didn’t go to the meeting you can get a virtual registration to watch (scroll down to econference rates)

The McGovern Lecture traditionally is one person who give a lecture on a topic of importance to health sciences librarianship. This year the lecture featured 4 speakers (an Academic Hospitalist, a Professor of Physical Therapy, a Family Medicine doctor, and a Director of Nursing Research) all speaking about how they find information to stay up to date in their areas of specialty.

Each one of them used the library. Each one of them loved their librarians. Each one of them professed that they get the most up to date information in their specialty from Twitter. This was mind blowing to almost every librarian in the audience. These professionals use Twitter to connect across the globe with others (mentors, friends, experts in the field). They have a very curated list of people they follow on Twitter, so that they receive tweets specifically targeted on topics of interest in their field. If somebody they follow tweets about a good article, they get it. Its a bit like the old commercial when EF Hutton talks they listen.

We have all known that caregivers consult each other when faced with questions or staying up to date. In the past these people were usually in the same place of employment or geographical area. Now, with Twitter there are no boundaries for professional networking and consulting.

What also shouldn’t come as a surprise is these people mentioned that they get the articles in the easiest way possible. Sometimes that is the library, sometimes that is not. One person said if they can’t find it easily at the library, “there are other methods to get the article” implying less kosher methods. As I mentioned this should come as a no surprise, we (librarians and publishers) suck at getting people hooked up to their entitled articles and professionals don’t have the time nor patience to deal with our sucky methods. RA21 is not the answer either. RA21’s proposed method is still more complicated and more clicks than getting something from SciHub or ICanHazPDF.

If you are a librarian or somebody who works for a publisher or information provider, I highly recommend watching this lecture. It really illuminates what our patrons do in real life to get information, and it isn’t what we think they do. I also think people at NIH and NLM need to really watch this to see that front line caregivers never mentioned MedlinePlus as a resource to give their patients information until librarians in the audience asked. The speakers listed every CHI resource BUT MedlinePlus. Perhaps NLM may need to re-focus on hospitals and providers as the people who provide CHI information in addition to NLM’s efforts to connect to public libraries.

RA21 Hospitals Library Working Group & Survey

When RA21 was brought to my attention I was concerned because it was coming from a lot of publishers and vendors familiar with their world and the world of large academia but completely unfamiliar with the medical and hospital world.

In my post Medlibs Needs RA21 on Their RADAR, I briefly described RA21 and some of the concerns I had with moving towards this method of authentication and I was extremely concerned that the people talking about it hadn’t the faintest clue about library resources, usage, and IT in the hospital and academic medical world.

While I still have a lot of concerns about RA21 I am pleased to announce the creation of the RA21 Hospital/Clinical Access Working Group.  Their objectives are to “survey, identify and define the use cases/problems for accessing licensed resources from within a hospital/healthcare system that are involved with RA21 adoption and are related to RA21’s authentication use cases.”

In an effort to understand hospital and medical library authentication issues and needs they have created a survey  https://www.surveymonkey.com/r/RA21_Survey of 20 questions that they would like any librarian serving in a hospital or health care institution or academic health care institution to take. (If you participate you can also enter into a raffle for an Amazon gift card.) *The survey closes March 1, 2019!!

I encourage every qualifying librarian to take this survey so that the working group has a clearer picture of the issues and needs regarding access to information.

The working group was started in July 2018 and the website says it will complete its work by the end of February 2019. Hmm…. I hope they plan to continue their work.  If they continue, I hope they will include some non-vendor people on the working group from medical libraries familiar with IT issues. The co-chairs are from the vendor community and while I am sure they are lovely people, they are not in the library dealing with IT and hospital policies and restrictions.  The RA21 team does have some people from large academic institutions, but is still very vendor heavy and has no representation from the medical or hospital community.

Librarians and Publishers Working Together: MLA InSight Summit 2

The second MLA InSight Summit was held in Chicago in September.  I am on the Insight committee, the group that is working to put on a good program and produce deliverables to both librarians and publishers.  I also was the moderator for the September summit. (Gabe Rios moderated the first one and Jerry Perry is going to moderate the third summit.)

The summits are intended to be a space where librarians and key figures in the publishing and vendor world work together to try understand users (researchers, clinicians, students, nurses, etc.).  It is not a place to talk about pricing, sales, or budget blaming. It is a place to discuss the issues of our users impacting all of us and how we can take steps to improve things.  Because let’s face it, if our users stop using us (either of us) we are out of business.  The librarians who attend are a diverse group of librarians who represent different perspectives and health sciences libraries.  The publishers who attend represent small and big STEM publishers and vendors.

I wanted to wait until Elizabeth Ketterman (Library Director of the William E. Laupus Health Sciences Library at East Carolina University) and Sean Pidgeon (Publishing Director for Science and Medicine and Oxford University Press)published their summary of the of second session.  Guest Post: MLA InSight – How to Buy Whisky is a very good post that describes some of the issues we discussed.

Ketterman and Pidgeon list the most prevalent concerns and challenges we (librarians and publishers) are facing and that were discussed and explored.

They were:

  1. Patrons do not understand the value of the services provided by the library. (and I would say by natural extension publishers)
  2. We (librarians and publishers) have a poor understanding of how our users find content and interact with one another online.
  3. We seem to be helpless targets for pirates.
  4. Predatory publishers are taking advantage of a shifting Open Access Landscape.
  5. It is challenging to conduct rigorous and reproducible research in the biomedical sciences.

No surprise, I have several thoughts on those 5 issues and I plan to write about those things at future date.  The main thing I want to convey with today’s post is that both librarians and publishers came together to work their way through some of these problems. Did we solve them all on that day back in September? No, but we all certainly learned a lot more about those things than before the summit.

For example, after hearing from several different users (researchers, doctors, physical therapists, etc.) we learned that many of them just don’t give a damn about all of the special unique customization features that publishers (and some libraries) provide to people who create accounts and login to their sites.  I was sitting at a table with a person from a major publisher who actually said to everyone at the table, “We have spent all this time, effort, and man power on customized and personalized features that we just rolled out. Now I am thinking we wasted a lot of time and should have been looking at ways to better direct people to the content without logging in.”

That kind of information along with the collaborative effort to work together on things impacting both of us made the summit worth attending.  This was just the second summit, there are more good things to come that we can learn from.

At the annual meeting I will be helping to moderate, the Innovation & Research Practice Immersion Session 4, “Disorienting Dilemmas: Transforming the Librarian’s Understanding of How Today’s Health Professionals Discover and Use Information Resources Outside the Library Setting,” by Jeff Williams and Martin Wood. Monday May 5, 2019 from 4:30-5:55pm. Jeff’s presentation at the second summit was so revealing that I highly encourage librarians and vendors at MLA to attend his and Martin’s presentation on Monday.

I am also looking forward to the 3rd Insight Summit.  I hope that we can take the knowledge and information from Summits 1 and 2 and continue to build upon them other and create change together.  That is why I feel it is important that we get as much representation from librarians AND publishers for the next summit.

Publishers who have sent somebody please talk to Dan Doody to get an understanding of what is involved.  Publishers who sent somebody but didn’t feel it was worth attending again, ask yourself this question, “Did I send the right person?” Most likely you didn’t. Those publishers who are forward thinking and sent the right people (those high enough up in the company who are leaders in change) seem to have gotten the most value out of the summit.  Those who sent the local sales rep really missed out, and didn’t see the value because the information and message didn’t to the change agent.

Librarians who would like to attend talk to previous attendees or Gabe, Jerry and myself. We can tell you what it was like. We aren’t looking for any specific librarian position (director, collection development, systems, etc.). We are looking for a diverse group that are engaged, making changes, and willing to take that information and disperse to the library community.

We have only just begun. I think of the Summit 1 as a small little snowball rolling down the mountain. My hope is that with each summit the snow ball grows producing an avalanche of change.

*Here are more articles about the previous InSight summits:

 

Your Cell Phone and Searching PubMed: Full Text May Not Work

Wow time flies when you are having fun, or staring at the screen of your cell phone.  Did you know it has been over 10 years since the first iPhone was released?

According to an article in Computerworld “Nine of 10 healthcare systems plan significant investments in smartphones and secure unified communications over the next 12-18 months.”  (April 4, 2018) More and more hospitals systems are providing cell phones to their care givers and integrating their usage into their workflow (access the EHR, lab results, pharmacy orders, etc.) The cell phone is the individual’s portable computer. An older (2013) report stated 74% of their surveyed physicians used a smartphone for professional purposes which included using diagnostic tools, drug information, and reading articles. Back in 2013 they stated the most often used app on a tablet was an app for medical journals/newspapers/magazines followed by diagnostic apps. In 2017 the Physicians Practice 2017 Tech Report, shows that reading journals on a mobile device is still very popular. In this survey it was the second most reported activity physicians did when using their smartphone at work.  Looking up drug information was first, reading articles was second and looking up diagnosis and treatment information was third. Of the responding physicians, 64% reported using mobile technologies for reading journals online (slide 12). The need to read articles on a mobile device has remained important to physicians over the years.

Not surprisingly medical libraries have been adapting to this for some time. Many libraries have optimized their websites to be more mobile friendly. Lots of libraries have web pages or libguides dedicated to mobile apps (just a few examples: HSLS University of Pittsburgh, Becker Medical Library Washington University, Health Sciences Library UNC) The demand for reading journal articles on mobile devices is big. Browzine and Read by QxMD are the two main apps for reading journal articles online.

Our patrons rely upon full text information being available. They want to access the full text of an article quickly and easily. Why do you think Sci-Hub got so popular? Science reported “many users can access the same papers through their libraries but turn to Sci-Hub instead – for convenience rather than necessity.” Given this information, it is important that access to the library’s full text article be easy to access when searching the literature databases, regardless of the device used. So it surprised me the other day when I was struggling to help a physician access the full text of an article when they were using PubMed on their cell phone. We tried everything, but it always resolved out to the publisher (not always the way we own the article). It did not use not our Outside Tool that we set up.  I even tried finding a way tap the link that says go to full website. No dice.  We could not access the library’s subscribed journal article in PubMed on the cell phone. Surely I was missing something obvious.  Surely NLM has figured out away in 2019 to connect physicians to their library’s full text collection while searching PubMed on their cell phone.

Well I was wrong. I reached out to NLM and a person from the MEDLARS Management Section responded they “don’t currently offer a way to populate library links (via Outside Tool or LinkOut for Libraries) on the mobile PubMed site. If the URL to the publisher happens to activate IP authentication on the publisher end, your users will get access via your subscription.” Basically that means IF your user is ON your IP range AND you get the article from the publisher (not via consortia, full text database, or other means) THEN your user can get access. That is not good. Even on campus, a lot of articles are inaccessible. Off campus…well nothing is available.

So what are other librarians suggesting to their patrons?  Our patrons use Browzine to keep current with their favorite journals and they love it. But what do you suggest for people who search for articles on a topic? Are you still encouraging them to use PubMed from the cell phone even though access to full text articles will be difficult and frustrating for them? Are you suggesting other sites or apps for searching MEDLINE? What about Ovid MEDLINE? Or is this question pointless because everyone searches Google, gets frustrated accessing the full text  and runs to Sci-Hub?

I am very interested in hearing other librarians’ thoughts on what mobile apps or mobile friendly sites they use to search MEDLINE that preserves the library full text linking. Leave a comment.

 

Interesting SciHub News

Wow it has been a while since I have published. Hopefully, I won’t have that kind of blogging break again.

As librarians we all know there are many ways to get scientific articles, some are legit while other methods are illegal. SciHub is one of the illegal methods.  For those of you who haven’t heard of SciHub, think of it as Napster for scientific articles. Alexandra Elbakyan, participated in research forums where scientists asked each other for research papers.  Elbakyan created SciHub as an automated method to share those papers. The process made it easier for people without access to paywalled papers or difficult to find papers to download them.  Sound familiar? Napster was founded by Shawn Fanning and Sean Parker as a peer to peer sharing service “for music enthusiasts to download copies of songs that were otherwise difficult to obtain.”

As with Napster there seems to be an anti SciHub group (which obviously includes the publishers) and a pro SciHub group who want easier access to materials that are hard to obtain or they don’t want to pay for.  As an individual it can be very easy not to care about the publishers who are profit driven making money on the backs of poor researchers and academic institutions struggling to deal with publisher price gouging rate increases.  While it is easy to think that way, there are many layers to the problem that has led us to this SciHub situation. Publishers, libraries, users, changes in society, technology, politics, and money are all to blame for the evolution of SciHub.

Until recently Elbakyan has been basically untouchable by the U.S. and European courts. While there have been several lawsuits that have gone against her and SciHub, she lives in Russia and has said she plans to ignore the lawsuits. Blocking SciHub doesn’t work either, it switches domains and mirror sites.  It is kind of like playing online Whack-a-Mole, you hit one site and another pops up elsewhere.

Well it seems as if things in Russia might be changing.  According to an article in Chemistry World, SciHub is now blocked in Russia following a Russian court ruled against the site.  Moscow City Court ruled the site should be blocked in Russia following complaints from Elsevier and Springer Nature over intellectual property infringement.  As a result of the ruling, several Sci Hub and Library Genesis domains are now inaccessible by Russian internet service providers.

An article from TorrentFreak.com says “Sci Hub is no to blocking efforts” and probably has other domains “up its sleeve.” TorrentFreak says those other domains can be targeted by rights holders and Elbakyan is encouraging users to “use tools to circumvent Internet censorship – which you can search for in Google or by using the bot in Telegram.”

So it looks like Elbakyan and Sci Hub may be touchable in Russia after all. I don’t think Elbakyan is a hero nor a villain. My hope is that through all of this Sci Hub  evolves like Napster did. Napster is now into the on-demand streaming business. Even if we aren’t using Napster directly as our streaming service, many  are using the pieces of Napster and don’t realize it.  The iHeartRadio All Access app is powered by none other than Napster. It took a Napster to bring about changes in online music. Hopefully Sci Hub can be the catalyst to bringing change to the scientific online paper world so that more papers are easily available and legally.

 

 

Predatory Publishers

A recent article in The Guardian “Predatory publishers: the journals that churn out fake science” reported on an investigation (in collaboration with German broadcaster Norddeutsher Rundfunk) into predatory publishers and fake science.

According to the article more than 175,000 scientific articles have been produced by the five largest “predatory open access publishers”  and 5,000 scientists at British universities have published in predatory publications in the last 5 years.  The article mentions that many of the researchers were “exploited by the publishers, who aggressively seek new business from academics who don’t know their reputation.”

Predatory publishing has been on the minds of librarians for quite some time, I often feel like it is old news.  Unfortunately, I think is still new news to many researchers and STEM authors.  I can point to examples of clinicians looking to publish a paper who didn’t even understand the difference between open access and traditional access.  In their mind a journal like NEJM appears open access to them because they are able to access it freely using the library subscription.

So when you have this access perception problem it isn’t hard to see how some can be fooled by predatory publishers.  Their game is more difficult to spot than the Nigerian Prince who just needs you to send him $1,000 for you to receive $10,000.  The problem isn’t just with publications. There at predatory conference promoters.  Back in May I posted about receiving an invitation to speak at a conference in China.  Considering I have been asked to speak in Ireland and other places it isn’t all that far fetched to think somebody from China would be interested.  After getting my hopes up momentarily, careful review led me to realize this was predatory conference spam mail.

I think as librarians we need to remember that there are still many authors who are unfamiliar with the concept of open access and as a result unfamiliar with appropriate open access article submission guidelines and expectations.  Lists of predatory publishers will come and go, we need to work with people to be able to better identify the red flags.  We need established publishers to step up their game and help with the education process. We need database providers to establish criteria for inclusion, rather than including any research article that was publicly funded.

Only by working as group can we have a hope at turning the tide.

 

 

The Donut Hole of Library Access

We have heard of the donut hole for Medicare prescription drug coverage where people experience a coverage gap for their prescription drug coverage.  I think there is a donut hole for medical information. There are doctors, nurses, researchers who are affiliated with an institution (but not officially part of the institution) or they are private practice who have privileges but are not employed by the hospital.  These people often fall in the donut hole for access to medical information.

There are more and more of these people as universities buy hospitals but the university doesn’t/can’t provide library resources to the hospitals.  Hospital systems are buying other hospital systems and wrongly assuming the library resources will be cheaper (bulk discount) or that they don’t have to pay for library resource because “aren’t we all just one system now that you bought us and we want what you have.”

Library resources are expensive and when met with the surprise cost (when a new system is acquired) administrators often do not understand the basics of library resource licensing and costs. Why would they?  The amount of a library’s budget is not even on their radar when it comes to the budget of the entire hospital.  Unfortunately, they want across the board cuts and the department manager must enforce those cuts. We have little data that says medical libraries save lives and save money in the long run.  What little data we do have hasn’t made it to the minds of administrators.

IMHO the donut hole of information access is growing.  I have people who call for access because they are doing research with somebody in my system. I can give the person in my system access but I can’t give the partner, who is outside of my system, access.  This is met with confusion and dismay.  This is one of the reasons ICanHazPDF and SciHub exist.

As hospital libraries are disappearing and budgets are shrinking, the donut hole will get bigger.  The perception that all is available free on the Internet still exists among many people and when hit with the reality they are flabbergasted by the true access costs causing them to dig their heels in deeper and not pay for anything.  I know of 2 hospitals that didn’t have libraries who were seeking to get library resources only to immediately scuttle the idea completely when faced with the costs. No concept of baby steps and ramp up to more resources. Nope, in their minds the costs are just too astronomical for resources they thought would be cheaper because they are tailgating onto another library.  They totally bail and go back to the idea that everyone will just get by use PubMed and Google, or maybe one expensive (but not as expensive as a whole library) point of care tool.

So, how do we stop the donut hole from growing? Pricing isn’t going down. (When does it for anything…cars, houses, etc.?) Our value is not on the minds of administrators. It will probably be a multi pronged approach requiring cooperation from both publishers and librarians.  What are your thoughts?

Medlibs Needs RA21 on Their RADAR

I attended remotely, the RA21 webinar Friday morning and it was interesting.  I hope they recorded it and will make the recording available for everyone because this needs to be on the radar of medical and hospital librarians…now. Those attending MLA in Atlanta there will be session Sunday 4-4:20 Leading Easy Access to Content: RA21 Pilots Transform Researcher Productivity and Privacy in the Hyatt Regency Embassy C.

Why should medlibs care? The publishers are looking to do away with the current method of online resource authentication, IP validation.  There is a whole slew of reasons as to why IP validation has problems, one of the biggest is piracy like SciHub.

What is RA21? The RA21 website goes into further details, but it is basically an initiative to facilitate seamless access to online resources while preventing piracy and improving authentication methods.

This is big, because right now many hospital and medical libraries use IP validation, EZ Proxy or both to authenticate users.  RA21 seeks to eliminate IP validation from your on campus IPs as well as your EZ Proxy.

There are privacy issues that concern many people. I am not going to focus on that. I am going to focus on just implementation issues in hospitals.

I don’t understand all of the technical nuts and bolts to RA21 but here is what I learned from the webinar and why hospital librarians need start paying attention.

  • Publishers are pushing to eliminate IP validation and the method for authentication.  This means you won’t be able to give your hospital’s IP ranges or your proxy server and have your patrons automatically access library resources (without passwords).
    • Patrons will not be able to click and access a resource simply by just being on campus.
  • RA21 will require people to validate themselves and sign into the resources.  So a doctor will click on Wiley’s Cochrane Library and be asked to login, even when on campus.
    • They mention that the doctor will only have to login once because the system will know him/her.  What doctor do you know stays in one place and uses one computer? Doctors will have to login multiple times through out the day.
  • RA21 follows the user not the user’s location. So there will need to be some database of approved users.
    • Librarians will need to maintain that. They are the one who will have to add users and delete users.
    • Some libraries are set up to be able to do this through their ILS patron database. However, other ILS systems can’t share patron database info.
    • Additionally, A LOT of hospital libraries don’t have an ILS, they still have sign out cards!
  • EVERYONE, academic medical libraries and hospitals will need something like Shibboleth or OpenAthens to be able to implement RA21.  This is not good. There are A LOT of hospital libraries who can barely afford their journals let alone OpenAthens or another product to manage online access.
  • Libraries with walk up access via their computers will have to figure out how to time out people.  The doctor is not going to logoff of a journal when they leave.

Now I am admittedly fuzzy on what authentication methods they are using.  Whether they have a database of approved users who have created their own ID and password or they have something else. Some groups seem to be talking about email addresses while other groups talk about login IDs and two factor authentication.

However, every user must authenticate. There will be no more pass throughs via IP. So every time a doctor wants to use an online resource they will have to login.  Now as many hospital librarians know, the doctors are not going to want to login to access an online resource.  I believe I heard one medical librarian say her doctors will have kittens if they had to have yet another username and password to remember just to get journal articles.  We have an online resource that contains both ejournals and ebooks within it.  The ejournal articles allow IP validation to access the PDF. The online resource used to require doctors to use a username and password to access the PDF of the books. Our doctors absolutely refused to use any of the ebooks from that product.  They didn’t want to bother with logging in. Requiring a login to view the PDF of those books impacted usage. IMHO RA21 in a hospital environment will impact usage.

What about single sign-on? RA21 keeps talking about single sign-on. Most likely hospitals will not allow us (or anyone) to tie our library login to their network login.  So there is no real “single” sign-on.  They will need to remember 2 different usernames and passwords, one to get onto the hospital network and one to get library resources. What do you think will happen?  Doctors will use the same network passwords as the passwords for the library.  That’s not good.

Hospitals tend to have extremely locked down IT environments, some hospitals more than others. I know of hospitals that can’t provide off campus access to the ejournals because their IT forbids them from using proxy access (even if it is outsourced and off site).  The folks at RA21 kept talking about working with our IT departments and it is clear that none of them have had to deal with hospital IT.  The hospital IT department does not care about the library. The hospital IT only cares about the EMR and locking everything down as tight as possible from the outside world…including medical publishers.  I know a librarian at a government healthcare agency library that routinely loses access to PubMed due to IT restrictions. Yes, a government healthcare agency library loses access to a government database because the government agency IT has things extremely locked down. So IT is not going to be on board. It isn’t in their interests which is the total security of the hospital network….not STEM piracy prevention or user experience.  This change will fall to the library staff to handle.

Now I agree that IP validation is a flawed system and we need something better.  However, I have concerns as to how it can be implemented in hospital libraries.  Not one of the RA21 Steering Committee is from a hospital library.  They are all big STEM and research and have tested it in the academic library environment.  When I asked for examples of implementation or testing in hospitals I heard nothing.  I don’t think they realize how different hospitals are.  After all, they kept presenting the idea that we can tell IT that it will be a better user experience.  IT is does not care about user experience.

I think your major hospital systems will be able to adapt.  Sure the docs will have kittens about the login requirements and usage might go down because they don’t want to bother logging in for something quick. But I really worry about the hospitals that aren’t big.  I worry about the ones with budgets that are little more than pennies.  I worry about the ones that aren’t allowed to use any outsourced resources to provide journal authentication.  I worry about the solo librarians with no contacts in IT.  How are those hospitals going to handle things?

We need to pay attention so that we can be an active partner in trying to make RA21 or whatever method for authentication something that is feasible for medical libraries.