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A Lean Librarian

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The picture above is what one wall in my office currently looks like. I know you are jealous of the 1970′s wallpaper and asking why I would obstruct its beauty with notes. Have I gone ‘postal?’ Not yet.

This is actually my way of working through a lean process to make changes to our current order set development process. I have been working on how to incorporate the new electronic system we have to create order sets into the current process of building order sets on paper.

But let me take a step back and explain how I, a medical librarian, got involved. I have been involved with clinical informatics, EMR training, order set development, EBM research, etc. I am very fortunate as a medical librarian to have such an active role but I also think it is a perfect fit for many medical librarians and more could be involved with these processes.

Think about it. Many medical librarians are organized, detailed oriented (think of complex searches & cataloging), understand how to structure systems (librarians code websites and work with meta data), ability to use or make the tools available work, etc. I have also noticed some librarians have a keen eye for seeing the big picture.

You have no time you say? I completely understand. I am a solo hospital librarian who supports 3 hospitals, multiple residency programs, coordinates CME, and currently I have no volunteers. I am not trying to brag or say look at me. I am just trying to show that I understand the time issue. I have had to completely re-evaluate the library and what the top priorities are for the library and my institution. Yes I still do all the normal library stuff: licensing negotiations, ordering & checking in journals, 10+ research requests a week, article request, Docline, etc. What I don’t do is check the mail everyday. Research request take longer to complete than I would like but it is a juggling act. It also means I sometimes work late, come in early and once or twice have worked on Saturday (which is one reason this blog has suffered and I apologize to my readers). It is all sacrifices I am willing to make for the time being because I know how important this is to my institution.

I have learned a great deal over the last 18 months or so. Besides it has also drastically increased library usage across the board. I haven’t really promoted the library in a year due to the workload yet I am constantly getting calls for research or being asked to present. I have become part of the team and others see I am a team player. Without making some sacrifices and stepping outside the library this would not have been possible. I want to show other librarians, especially solos, that it is possible. And I want to learn about how others are involved.

Before I posted this I actually asked other librarians if any are involved with their institutions EMR, CPOE, or order set development. Sadly I could not find anyone else. If you are involved please post a comment below.

Back to the picture above. What am I doing besides trying to replace the beautiful wallpaper? It involves incorporating new technology, EBM practices, automation, and other things into our order set development process. Most institutions have a process in place to review and develop order sets, ours just needs a little tweaking to account for some new technology.

Since I have been the primary person researching and building the order sets in the new system, I was assigned the task of reviewing the development process. Of course this is being reviewed by clinical informatics … yes even in the state it is now on my wall.

Posting this on the wall was actually part of the plan. I needed a way to easily see the entire process without squinting to see it on a computer, and a way to easily move pieces. I had to see the big picture to know how it all works together. Putting it on the wall has also allowed me to easily work on it between other tasks and not forget about it. I have even had people in my office walking through the process together.

So doing this ‘old school’ has been very beneficial to me even though I really wanted to just start developing the process on the computer. Taking time to reflect has really helped. Today it will move from the wall to the computer. I admit I will miss it.

Are there projects that you have worked like this? Do you think there are benefits to this type of process? Are you involved with order sets, EBM, COPE, or EMR? Are you a Lean Librarian?

 
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Posted by on January 6, 2012 in statistics

 

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WIIFM IFTTT

So I have had this in the draft box for a while, and the recent mention of it at a conference as well as a post by AaronTay reminded me that this was in the draft box along with countless others.

The post on IFTTT was also delayed as I figured out how it worked or if it worked for me. I have been using it on a trial basis for several weeks and I do not think I have even thought of all of the possibilities. This is the best part about IFTTT– the infinite possibilities.

So what is IFTTT?

Sounds great but what does this mean? How do you put the internet to work for you?

IFTTT is just like it sounds, If this then that. So if this happens then do that. It is a very basic tool that is extremely easy to understand, at least the basics are easy.

What have I used it for? Well as I said previously I have not explored all of the features. I have used it mostly for weather alerts so I am not stuck out in the rain when I am biking. IFTTT is reliable… the weather man on the other hand is iffy at best. **Note: tomorrow’s forecast for Columbus, Georgia, is snow. What?!?!**

I have also used it to automatically send tweets to new followers. It is a nice way to say Thank you to new followers without exerting too much effort.

I am trying to work out a way to send a auto thank you to new followers on my blog. If anyone has done this please let me know.

I have also been trying to find a way to autopost to Google+. @ericschnell shared this tweet with me:

@ericschnell: @alisha764 See http://t.co/ZC7aDdcz and http://t.co/Oipq3spl Odd solution using G-Voice / Gmail / IFTT, but works

I am not sure if I like this solution. I do not like the idea of using SMS or email to update Google+. I am hoping Hoot Suit makes this possible soon as I heard a rumor it might. I thought with the release of the API Google would release an RSS feed but it seems Google is walling things off instead of opening them up (more on this soon in a Google Reader update).

Another item I am looking at trying is when I star items in Google Reader to sens it over to WordPress as a draft post. My only issues here is I do not know of you can post a draft or if you can use multiple Google Reader accounts.

I have heard many people say they use IFTTT to send items to Facebook or Twitter but I do not and will not. Why?

I really still like using dlvr.it

IFTTT has channels but Dlvr.it let’s you take RSS feeds and send them to different routes. It is a little more work to set up. The great thing is you can customize each ‘route’ with filters, add additional text, and my favorite is scheduling.

See how I have set up different routes compared to IFTTT channels:

IFTTT offers channels that are not available in dlvr.it. dlvr.it is more for pushing updates or timing updates (you can also schedule future posts). The reason I will continue to use dlvr.it is for the statistics and scheduling.

IFTTT does not have these kinds of statistics. I really enjoy being able to see how effective my shared items are on the various channels. If I see there are not many clicks on a particular item then I can adjust my sharing. The statistics have really helped me improve what I share and how often. It is helping me to reduce the shared items that are just adding ‘noise.’

Speaking of noise IFTTT can create a lot! Think about using the recipe ‘If I star an item in Google Reader then post it to Facebook and Twitter.’ Now picture your typical day. If you are like me then you use Google Reader in spurts. Basically I am reviewing items between search request and other stuff. So if I had IFTTT sending my stared items then there could be 20 posts in 1 hour. Talk about a quick way to overload your followers and for people to ignore your posts.

Yes I said ignore your post. Why? Because I know if I see 5 posts from the same person back-to-back I am less likely to read all of the items. I also like seeing posts from people throughout the day not just all at once during lunch.

Dlvr.it allows you to schedule the posts and use a ‘trickle off’ feature that will keep posting new items throughout the day even if you starred all of the items during lunch or at 1am. Ok I admit it, I often stay up late blogging, reviewing Google Reader or even… sigh… doing work. But I have yet to join my fellow medlib in watching Billy the Exterminator while finishing search requests and coding late at night:

So while IFTTT is neat for some things, I think I will stick with dlvr.it for pushing updates to social media so my updates go out when most people are online and not 1am.

On the other hand, IFTTT is great for those looking for a quick fix. I have demonstrated IFTTT to several students, residents, physicians and other Healthcare providers.

If you are a student you could have SMS alerts for assignments. Or what about a teacher setting up an scheduled email alert to send out study notes or tips when it gets close to an exam. I could see physicians using it for alerting them about new results for searches, perhaps an alert for free CME, or an SMS so they won’t forget an anniversary. I set it so I will never forget boss’ day… again. (Oops!)

What have you used IFTTT for? Or do you have other suggestions? Would you use dlvr.it instead of IFTTT and why?

 
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Posted by on November 28, 2011 in statistics, Technology

 

Biased guidelines or limited study

With a huge push towards evidence based medicine with Meaningful Use, many hospitals are blindly relying on trials, guidelines and organization recommendations. Yes some hospitals are using databases which review these original references for conflicts of interest but how much do they review and how much can they review?

A new study released shows there are several conflicts of interest in authors of guidelines that are not always disclosed. If it is not disclosed then who can really judge the biasness of a guideline? Do databases? Do librarians?

“suggesting that conflicts of interest are managed well on government-sponsored panels.”

Well this is at least some good news.

I have to say as a solo librarian who spends most of the day researching for order set development and other projects– I do not have time to search each author to determine if any bias information has been left out. Who does? 

I trust certain organizations and always do a basic review of the information before recommending it. Plus I often include, when possible, multiple references on the same subject. Now I wonder if I need to do more.

I also wonder if this study holds true for other disease guidelines or if this is just a limited sampling. The study only reviewed 14 guidelines. Although the study is limited, I will look closer at guidelines biasness and I do believe it should be investigates further but I know I won’t be able to do in depth reviews to determine bias. Shedding light on the subject may help make changes wjere they are needed– the guidelines’ industry requiring full disclosure from all authors.

This sums it up best:

“What is needed is a change of culture in which serving two masters becomes as socially unacceptable as smoking a cigarette,” Gale wrote. “Until then, the drug industry will continue to model its behavior on that of its consumers, and we will continue to get the drug industry we deserve.”

References:

Neuman J, et al “Prevalence of financial conflicts of interest among panel members producing clinical practice guidelines in Canada and the United States: cross-sectional study” BMJ 2011; 343: d5621.

Gale EAM “Conflicts of interest in guideline panel members” BMJ 2011; 343: d5621.

Medical News: Guideline Writers Often Don’t Mention Conflicts of Interest – in Public Health & Policy, Ethics from MedPage Today. October 11, 2011.

 
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Posted by on October 12, 2011 in statistics

 

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10,000th article request

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On January 12, 2011, I filled the 10,000th article request since starting in this position March 2008. It was a monumental occasion for me as a solo, so I had to celebrate the event.

I gave this basket of goodies to the requestor as a thank you for supporting the library. The patron was very appreciative.

Since this request I have filled 874 article request. Perhaps I will hit the 20,000th request this year!

**Please note article request refer to in-house requests only and does not include ILL from other libraries or research request.  I passed the 500th research request last year and did not notice. Maybe I will reach 1,000 this year.

 
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Posted by on January 28, 2011 in statistics

 
 
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