Sacred Cows and Heretical Librarians

Last weekend I had the wonderful opportunity to be the keynote speaker for the Midwest MLA Chapter meeting.  It was a great meeting and I learned so much from so many people.  I LOVE Chapter meetings.  Ask me and I will tell you, the Chapter meeting is a great place to share and learn from other in a much more scaled back and doable scale than the large MLA meeting.  That is not to take anything away from MLA, I just think that a Chapter meeting is more intimate.

Some people at the meeting asked if I was going to post my slides from my presentation.  Yes, they are on SlideShare and I have re-posted them here.

These slides don’t have a lot of text.  So I feel there needs to be a bit of outline of what I talked about to give them some context.  So here is a brief summary of what I talked about….
Technology is disruptive.  That doesn’t mean it is bad or good, it just changes everything we do.  It could change things for the good or the bad.  An example of a very disruptive technology is the light bulb.  It completely changed the way we as society do things.  Thinking of more recent technologies, the phone is another disruptive technology.  The telephone changed how we communicated to each other.  The cell phone disrupted things again.  Not only were are we able to communicate with each other over long distances, but we can do it wherever and whenever.  The smartphone just ramped things up even more by making our phones the necessary multi-purpose tool of our lives.  We use it to communicate (text, voice, email, Twitter, Instagram, etc). We use it as our own personal computers to find information online and store/create documents. It is our entertainment center for music, movies, books, online radio and podcasts.  The cell phone (among other technologies) have changed we as a society find and share information.  It is has changed the way people find and share information in libraries.  Think of what future technologies will be like and their impact on libraries.  Think of the latest technology, Google Glass, and library possiblities.
People access library websites through their phone… OR they are bypassing the library website all together and using an app (journal app, library database app, library catalog app, etc.) to find information.  They are accessing all of this information wherever and whenever….in the cafeteria, bathroom, in bed, etc.  This change in society’s behavior requires us to change the way we do things.  We must adapt to the changes in society or we face extinction.  Other professions that are dealing with changes in society as a result of technology: US postal service, newspapers, photo journalists, etc.
My presentation was not a doom and gloom thing.  On the contrary…. I said we needed to look at these disruptive technologies as opportunities.  They provide us the opportunity to shape our own destiny.  They allow us to take our services and resources and put them together in different ways to adapt to the changes.  Think of your resources and services as Legos, each one can be put together in different positions.  If something changes or doesn’t work, change the Lego’s position or swap it out.
Swapping out Lego pieces sounds easy but it may not be as easy as you think.  Libraries need to look at the changes in society and start asking themselves some hard questions.  Are the services/resources we provide for ourselves or for our users.  We do a lot of fooling ourselves that some of our traditional services/resources are for our users when really they are for ourselves.  For example, why are we checking in print journals?  Why do we even have print journals?
We need to look at our sacred cows in our library.  We need to evaluate whether we should keep them or kill them.  We can’t just keep them because we have always kept them.  Cows (in real life and virtual) need to be fed and maintained.  If feeding and maintaining them serves a valid purpose to our users, then we should keep them.  If they don’t, then we need to kill them, or they will eat food and take up space of other resources.  I gave several examples of sacred cows.  The one that everybody seemed to latch on to was my cataloging example.  I asked the question, “Do you need a catalog or would an A-Z list suffice?”  Predictably a few catalogers freaked.  What I tried to convey…
  • If you are at a large academic medical institution or even NLM you need a catalog….BUT do you need to catalog the way you are doing right now? Could you be more agile?  Could you do something slightly different?  We are too entrenched in the way we catalog things.
  • If you are small hospital library with only a few shelves of books, you may not need a catalog.  I know it is crazy to think that, but you may not. Perhaps an A-Z list or *gasp* an Excel sheet posted online will do.  Maybe you could tag your holdings in Library Thing.
  • If you are a small hospital library with more than a few shelves of books, but nowhere near what an academic library has perhaps you need a catalog. But do you need to add anything to the catalog other than what our users care about?  Most users only care about title, author, year, edition, URL, and table of contents.  They don’t care if it is 24 inches tall, illustrated and has 246 pages.  Do you need to catalog using MeSH?
Evaluating these sacred cows may cause us to think some pretty heretical librarian thoughts.  The idea of not cataloging is pretty heretical. don’t get stuck on my catalog example.  One hospital librarian at the conference mentioned they did something pretty heretical, they stopped doing research and providing articles to people who were going back to school. She told them they needed to get their research help and articles from the library of the school they were attending.  She said it was a pretty heretical thought to her staff at the time.
Wikipedia’s definition of heresy: “Heresy is any belief or theory that is strongly at variance with established beliefs or customs.”  Long established customs may not be what we need now as our society changes with technology.  In order to evolve we need to look at our services and question our long established services and see if they are really needed or helping us go forward.  If not, why are we doing them?
In sum we need to look at the sacred cows and start thinking heretical librarian thoughts.  We need to always keep trying and never give up.  Let’s not be afraid of failure, failure just tells us what doesn’t work.  We need to know what doesn’t work, to know what does.

Government Shutdown and Hospital Libraries

Medical librarians were asking questions yesterday on Twitter and on Medlib-l about the impact the government shut down will have on medical library operations.  Will PubMed be up? What about Docline?

There was some uncertainty.  Alisha Miles has summed up the latest information (that we know of) in a blog post.  PubMed, NLM, Docline, and MedlinePlus websites all have notes (click on links to see the images of the notes) regarding their status during the government shutdown.

Of course being librarians we are focused on how it will impact library services, to get a perspective of how it will impact health care and hospitals check out the Forbes article, “Government Shutdown Hits Research, Teaching Hospitals, Residency Programs.”

As bad as it is, we might consider ourselves somewhat lucky.  At least the websites and backbone service programs (PubMed and Docline) we use are up.  There are other sites and industries that are not.

Alisha pointed out on her blog that ERIC (eric.edu.gov screen shot) is down. And while this tweet got a snort of laughter out of me, NASA’s website is down and redirecting to http://usa.gov (screen shot).
sarcasticrover

The White House website is down, but interestingly the Senate and the House of Representative‘s websites are up.  I am refraining from making a bevy of sarcastic comments about essential government services right now.

**Update**
Vanderbilt’s Eskind Medical Library has a REALLY good list of what is up and what isn’t.
http://www.mc.vanderbilt.edu/diglib/news/2013/10/federal-resources-affected-by-government-shutdown/

Congrats to the New Leadership Program Fellows & Mentors

Congratulations to the fellows and mentors chosen for the 2013-2014 NLM/AAHSL Leadership Fellows Program.

According to the statement posted on the MLA-LMS listserv, “the NLM/AAHSL Leadership Fellows Program prepares emerging leaders for director positions in academic health sciences libraries. The program provides a combination of in-person and virtual learning experiences for fellows and offers the opportunity to work collaboratively with the cohort of participants. Fellows are paired with mentors who are academic health sciences library directors and will visit the libraries of their mentors.”

More information about the program is available at
http://www.aahsl.org/assets/documents/2013/2013-2014_nlm_aahsl_lfp.pdf.

Although I haven’t seen a non-academic librarian accepted in a while, the program isn’t limited to just academic librarians.  Hospital librarians and librarians from other library environments can and should apply if  they have a “strong interest in pursing a directorship in academic health sciences libraries.”

2013-2014 NLM/AAHSL LEADERSHIP FELLOWS PROGRAM

Debra R. Berlanstein

Associate Director, Hirsh Health Sciences Library
Tufts University

Mentor: Thomas G. Basler

Director, Libraries and Learning Resource Centers
Chair, Department of Library Science and Informatics
Medical University of South Carolina

Renée Bougard

National Network of Libraries of Medicine Outreach Librarian
National Library of Medicine

Mentor: Pamela S. Bradigan

Assistant Vice President, Health Sciences
Director, Health Sciences Library
Ohio State University

 Tara Douglas-Williams

Division Head for Information Services/Library Manager
Morehouse School of Medicine

Mentor: Barbara Bernoff Cavanaugh

Associate Director, Health Sciences Libraries, and Director, Biomedical Library
University of Pennsylvania

 Deborah L. Lauseng

Assistant Director, Academic and Clinical Engagement Taubman Health Sciences Library
University of Michigan

Mentor: Anne Linton

Director, Himmelfarb Health Sciences Library
George Washington University

 Alexa Mayo

Associate Director for Services
Health Sciences and Human Services Library
University of Maryland

Mentor: Christine D. Frank

Director, Library of Rush University Medical Center

Dongming Zhang

Associate Director for Advanced Technologies and Information Systems
Welch Medical Library
Johns Hopkins School of Medicine

Mentor: Gerald J. Perry

Director, Health Sciences Library
University of Colorado Denver

What is the Biggest Thing in Medical Libraries

A few weeks ago over dinner and drinks my public librarian friend and I got into a very interesting and lively brainstorming discussion about the biggest “things” that have or will hit libraries. The conversation was all over the place.

Some of the things we discussed:

  • Budgets or Tax Proposals
  • Closing of libraries or space problems
  • Competition – Used to be book stores but who is it now?
  • Technology – 3D printers, Google Glass, ebooks, virtual reality
  • Outreach – embedded librarians, phone booth libraries, gas station out reach
  • Legislation – ACA, local issues, NIH, NSA spying
  • Staffing – Where is that giant hiring push?  Staff retire and aren’t replaced.

This discussion has been bouncing around in my head for a while and I keep thinking about the “things” (good or bad) that will affect specifically medical librarians and librarianship.

In your opinion what are the major things to to be hitting medical libraries in the near future?

Is it:

  • Afordable Care Act – Hospitals tightening budgets (and thus the library’s budget) in response to lower reimbursement
  • Meaningful Use – Promote the spread of EHRs to improve health care in the United States
  • Big Data – Its use in hospitals and biomedical research
  • Space – Change of library space from holding books to services? (Often means shrinking of library space)
  • Electronic resources- What isn’t available electronic these days!? Access and usage across devices and outside of the institution.
  • Employment – In response to some of the above instititutional issues, librarians are losing their jobs or are not being replaced as they retire or move to another position.
  • e-Science – Better known as just science within scientific community, but is heavy on the tech, data, and social side of things

I think all of those thing are going to make an impact on medical libraries. But if you had to narrow it down to one thing from the above list, or something I havne’t listed, what would be the biggest thing medical librarians must deal with on the horizon?

Please make it a discussion by commenting below and on Twitter #hittingmedlibs.

#Medlibs Tomorrow: Using Social Media for Consumer Health

Tomorrow I will be moderating the #medlibs chat and we will discuss the use of social media for patient education and consumer health.  72% of adults seek medical information online, and between 26-34% (depending on various reports) of people use social media to find health information.  The thought is the trend will continue to grow.

I will be asking these questions (I’m giving them to you ahead of time so you can think about them):

  • How are librarians using social media to provide consumer health information or patient education?
  • How do you measure the effectiveness of a social media health information campaign?
  • What are some barriers to providing patient education/consumer health information via social media?

#medlibs is a active group with lots of ideas and opinions so I am sure we will have more questions as we discuss things, but this is these are the main ones to get us started.

See you all online Thursday July 11, 2013 at 6pm PST and 9pm EST.

*Disclosure Notice*
I am writing a book chapter on this topic and this #medlibs discussion will help me with it.  I may use some tweets or reference parts of the #medlibs chat in the chapter.  I don’t want to squelch the overall fun chattiness of the group.  If I use anything I will only refer to tweets that are specifically related to the discussion topic and I will make every effort to let you know I am using your tweet.

 

Meaningful Use Stage 2: Can Librarians Help?

A colleague tweeted this article, “Are Physicians Truly Engaging with their Patients? by Nancy Finn” about physicians, EMRs and meaningful use.  According to the article, “as of March, 2013, 160,890 eligible professionals had received Medicare incentive payments and 83,765 professionals had received Medicaid incentive payments” for achieving stage 1 one meaningful use. While they were able to achieve stage 1, are they ready for stage 2? How are they changing their practice patterns to achieve stage 2?

The article states stage 2 requirements are:

  • Provide patients with their health information (via a web portal) on 50% of occasions and have at least 5% of these patients actually download, view or transmit that data to a third party.
  • Provide a summary of the care record for 50% of transitions of care during referral or transfer of patient care settings.
  • Provide patient-specific education resources identified by Certified EHR technology to more than 10% of patients with an office visit.
  • Engage in secure messaging to communicate with patients on relevant health information.
  • Make available all imaging results through certified EHR technology.
  • Provide clinical summaries to more than 50% of patients within one business day.

Finn wonders if “a majority of physicians remain steadfast in dominating the physician/patient relationship, convinced that engaging patients in their care is a burden? Or are many of them beginning to realize that engaging the patient in their health care decisions will make health care more efficient and cost effective, and improve patient outcomes?”

The librarian in me wonders if there are ways we can help physicians meet stage 2 requirements.  I know with EPIC a physician can send a request for a librarian to provide patient education information to the patient through their portal.  I know specifically of one librarian who got a message in Epic to do that.  She logged in, provide links and contact information to appropriate free patient ed resources to the patient.  The patient got the information through My Chart and was so happy that she emailed the librarian thanking her for the information.  Another nice thing about this patient ed transaction, EPIC noted that patient education information was sent to the patient and included that in her chart for the doctor to see. 

I’m not trying to say that doctors shouldn’t help provide patient education information, but I also know that in a hospital environment things can be hectic, confusing, scary, etc. for the patient.  They may have gotten information from the doctor but not understood it or wanted more detailed information.  Using the librarian to provide patient education material through EPIC (and EPIC notes that it was provided) has got to help both doctors and patients.

Are there other ways that librarians can help doctors and their institutions meet stage 2 requirements? Please comment with your ideas.

 

Business of Hospital Libraries on #medlibs Tomorrow

Join me tomorrow April 25th for a #medlibs Twitter chat at 6pm Pacific/9 Eastern on the topic of the business of hospital libraries, hosted by yours truly (@Krafty).

The Affordable Care Act has changed the way hospitals are reimbursed for medicare patients. In the past hospitals made more money off of patients who were readmitted for things they were orginally discharged with. Now, they are penalized for readmissions happening within 1 month of discharge for certain conditions. This means that a lot of hospitals are going to be seeing losses of millions of dollars.

Where does the library stand in the face of these losses when technology has changed the way we search for things and users often search Google before asking a librarian. The librarian needs to get lean and mean and start operating his/her library like a hospital department that is responsible for achieving the specific goals of the hospital. So if the hospital’s goal is to reduce readmissions by x% then the librarian needs to figure out specifically how the library can help the hospital do that. (If your answer is I can give them more literature searches, then think again because that won’t help you keep your job because administrators think they can do that already.)

This tweet chat will discuss the various ways librarians can specifically show their worth to their own administration instead of passivley pointing to some standard or study illustrating the need for a hospital library. We will be discussing ideas of what we can do to answer our administration’s always constant question “What have you done for me lately and why should I give you money instead of another department?” The game has changed and we need to change our strategy.

If you are new to Twitter or the idea of tweet chats then I highly recommend participating using the website http://www.tweetchat.com.  Login to the site using your Twitter username and password then type in the word medlibs into the box at the top of the page next to the go button.  You will be able to follow the discussion very easily and you won’t have to worry about adding #medlibs to every post because it already does that for you. For more information about tweet chats check out this quick guide.

Librarians Take a Consumer Health Information Survey & Win

Researchers from Louisiana State University Health Sciences Center in Shreveport, LA are conducting a 15-20 minute survey to identify consumer health information services. 

The researchers hope to receive responses from public libraries, academic institutions, hospitals and not-for-profit organizations involved in consumer health information services.  The goal is to identify what services are currently offered, who is offering them and how often. 

The data may be able to assist other organizations in implementing new consumer health information services.  Organizations that participate will be entered for a drawing to win one of two $300 checks. After the survey period, 53 randomly chosen hospital librarians that complete the follow-up survey will receive $10 for their time and effort. 

This research is possible through financial support from the Hospital Libraries Section of the Medical Library Association. The survey will be open from April 15, 2013 to April 30, 2013 at 11:45 pm Pacific time. If you are willing to participate, please go to https://www.surveymonkey.com/s/2012_CHISS.

 

 

The Business of Hospital Libraries

Earlier last week people on medlib-l discussed (The  perfect library storm) closures of hospital libraries.  They are seeing a contradiction between Evidenced Based Medicine imperatives vs budget and resource demands on hospital libraries.  Some are seeing how the increase in pricing and bundling practices have caused the hospitals to “throw it back to the physicians and staff” causing libraries to close.  I interpret this statement to be that the hospitals are no longer willing to provide monies for institutional support of resources (the library) and require doctors and staff to buy their own resources.

This email conversation is very timely.  It turns out this week I will be in Tulsa, OK teaching the class, “The Evolving Librarian: Responding to changes in the workplace and in healthcare.”  Technology changes, social changes and healthcare changes have forced hospital librarians to step back and really change the way we do things.

Personally, we hospital librarians need to start treating our library like a hospital department and not a library.  I mentioned this in my medlib-l post. I know this statment sounds odd because you might think we do that already.  I think we could do better.  I think librarians not only need to align their goals to the hospitals, but they need to make the hospital’s goals their goals.

With the Affordable Care Act, hospitals stand to lose 1% of their Medicare payments in penalties if patients with specific conditions are readmitted within 1 month of discharge.  By 2015 it will be 3%.  That is billions of dollars.  To put it in perspective, Barnes-Jewish Hospital in St. Louis will lose $2 million dollars according to Kaiser Health News. Dr. John Lynch the chief medical officer of Barnes-Jewish says they could absorb the loss this year but not over time if penalties continue to accumulate.

You better believe all of the other hospital departments in your hospital are working toward the hospital goals.  Aligning the library to demonstrate specifically (hard numbers) how it can help the hospital achieve their goals is essential.

I thought long and hard about my post to medlib-l before I sent it.  The reason was I didn’t want to lay blame for hospital libraries closing on the librarians.  I didn’t want to imply that they weren’t doing their jobs or that if they “could’a, would’a, should’a” they would still have their jobs.  That wasn’t my intent.  Although, one person responded on the list saying they found it “disheartening that sometimes when a library staff is downsized or actually closed, that a too common belief is that if  only ‘that library’ had been doing more, building a stronger case, demonstrating their worth in concrete ways, etc., etc., this would not have happened.”

Who knows what the situations were at those hospital library closures or downsizings?  However, I firmly believe if you don’t start looking at your library as a business arm of the hospital and align your goals to support the hospital achieve its goals, then you are going to have a very rough time.  Because if an institution as established and good as Barnes-Jewish is dealing with these things, then it can, and is happening everywhere.  Where do you think the library stands when the institution has to deal with a $2 million dollar loss one year? Repeatedly?  Where do you think it stands if you do not illustrate exactly with hard numbers how your department has helped prevent that loss.

I think everyone (administrators, doctors, nurses, etc.) can agree that the idea of a library is good.  But when faced with money demands, that idea  needs concrete specific support.  That support must be generated from within.  Administration doesn’t care about the library in terms of JCAHO standards. Administration doesn’t care about the Rochester study or newer updated similar published research.  Administration cares about what your library is doing now.  Those studies, standards, etc. aren’t going to change your administration’s mind, you are.  They don’t care if you give them every flipping article under God’s green earth saying that a library will save them money and help them cure every disease known to man.  Administration only cares about you, your library, what you are doing, and how it benefits them.

I am not alone in thinking that hospital librarians need to change they way they think and do “library business.”  The Mid Atlantic Region will be running a CE webinar series starting May 31, 2013, entitled “Running Your Hospital Like a Business.”  Some of the things the series will address are: writing a business plan, art of negotiation, and proving your worth/adding to your value.  All of these things are those business skills that I ran away from in college but now am kicking myself as I realize I really need them today and could’a, should’a taken a business class back then.

Oh well, time to beef up now.

 

Friday Fun: The Unofficial MLA Drinking SIG

Many who go to MLA often find themselves in the evening after the meeting going out to dinner and the bars to discuss library and non-library stuff.  I remember somebody mentioning that we met for drinks so often that we could have our buisness meetings at the bar.  After a good laugh and a few more drinks later the unofficial Drinking SIG was born. 

I want to stress it is all in good fun and completely unofficial from MLA.  There are no dues but you will probably have a bar bill.  Last year was the first year the unofficial Drinking SIG came off of the barstool and started selling t-shirts and other fun items promoting the group.  This year for 2013 a new design and new set of items is available http://www.cafepress.com/drinkingsig for you to purchase. 

Even though the SIG is not official, it wouldn’t exist without the people of who attend MLA.  So all of the profits from the SIG’s cafepress site sold will go to the MLA scholarship fund. 

Next Friday Fun post will be a guest post from Heather Holmes about the unofficial Drinking SIG.