Miles of information for medical librarians #medlibs

On Saturday, November 21, October 19, I am doing a short presentation at a diabetes conference in Columbus, GA, about using technology to help you stay healthy. I was asked to speak at the community event to discuss with attendees about the various technology available to help people stay healthy whether they are currently living with diabetes, trying to prevent diabetes, or just interested in living a healthy life.

How did I get asked? I gave a presentation to a group of nurses and nurse educators about library resources, and one of the attendees asked if I would be interested in speaking at the local diabetes conference.

It is an excellent opportunity to speak to the community on this subject. Of course, I have been given 20 minutes to talk and I have several items I want to cover:

  1. Fitness Apps
    1. MapMyFitness
    2. MyFitnessPal
    3. Fitbit, Runkeeper, Nike, or just use Moves
  2. Food Apps & Sites
    1. Fooducate
    2. Diabetic Audio Recipes
    3. Tastemade
  3. Diabetes
    1. Glooko Logbook
    2. dLife
    3. MyNetDiary
    4. BlueLoop
    5. Glucose Buddy
    6. Carb Counting with Lenny (for kids)
    7. Mysugr
    8. WaveSense Diabetes Manager
    9. Diabetic Connect
  4. Tech for fun
    1. Local library resources & apps

And of course I could not do a presentation without mentioning MedlinePlus and other NLM resources.

So these are just the main items I have been reviewing and considering presenting. I wanted to hear from the rest of you, what apps do you use to stay healthy? Recommendations for other items people would find useful? Comments about the items listed above (pros/cons)?

Again, this is a great opportunity and I am excited to talk to the community about how technology can improve their health. I will of course post my presentation online after the event for others to review.




Actually what NN/LM SE/A did was provide us with an award to be able to exhibit at COMO. Additionally, they sent us a banner to use for our exhibit. So if knowledge can take you anywhere, then yes they sent us a rocket ship.

Mercer University is presenting resources from the National Library of Medicine atCOMO (The Council of Medical Organizations) today and tomorrow. The great thing is this conference is typically attended by several public libraries. It provides us with an opportunity to network NLM resources to other types of libraries.

We are not only handing out information about these resources at the conference, but Carolann Curry is discussing with the attendees how they can obtain similar resources in their libraries and how they can become members of the National Network of Libraries of Medicine SE/A region.

So thank you to NN/LM SE/A for providing us this opportunity to conduct outreach to other libraries.  If you are attending #GACOMO please stop by booth #26 to see the NN/LM resources and Carolann!




Last night @kiwona1 and I made a special trip to Veggie Galaxy.

I can say, as I finish eating the leftover carrot cake for breakfast (hey, it has carrots… So kinda healthy), that it was outta this world good. I recommend saving room for dessert.

I liked the Reuben I had but it wasn’t the best vegan Reuben I’ve ever had. We sat at the counter and got to watch as the food was cooked and sent out. There were some items I saw that I want to try next time like the vegan Mac and cheese, and the burger with onion rings on it. So definitely something to go back and try some more items.

I will be heading out for lunch at some point today. If anyone wants to join me please send me a tweet or email. I am considering the Lucy Ethiopian Cafe and Restaurant. If someone has another veggie place they would like to try today send me a message.

Next I was thinking about a veggie outing on Sunday for lunch from 12-130. There is a small break in the schedule for me that day. Since the window is small, then I think either Veggie Galaxy or My Thia are the best options since they are so close. Let me know in the comments or send me a message on if and where you would like to go. And remember we may be trying a local veg*n restaurant but all foodies are invited to attend and enjoy a local veg*n restaurant.


The Medical Informatics Section… A group with great discussions, zombies, people who plank, the group that puts together tech trends with other sections, and the group who provides members a chance to win cool gadgets.

That’s right, if you are a MIS member then make sure to attend the MIS business meeting on Monday at 4:30 in room 203 at the Hynes for your chance to win an iPad mini! Please note you must be present to win and also must be a MIS member. Not member? Join at the meeting! As long as you join and pay dues before the business meeting then you can enter to win the iPad mini. Cost to join? $10 bucks. Yep that’s it. Just $10 to be part of the planking gadget zombies.

As we discussed HIE (Health Information Exchange) I keep going back to issues I have seen time and again. Junk in equal junk out.

“Will the real Slim Shady please stand up?”

This is what kept coming to mind every time we discussed Health Information Exchange.  But first what is HIE?


HIE is the exchange of health information across systems. If you were in an accident in New York, the hospital could pull your records from your primary care physician in your hometown in Atlanta. The information is pulled online, sent to the ‘cloud’ (virtual storage), and then comes back down in a format that will work for the New York Hospital.
There are a multitude of concerns here that have been discussed by several people in the field.

1. How do you secure the cloud? How will it be HIPAA Compliant? How do you keep it from being easily hacked and ensure only those who should be pulling your records are pulling them?

2. How do you get the different systems to talk to each other? Each system has it’s own language. Yes there is SNOMED-CT that should be the verbiage used for problem lists, but it won’t be used for tests (ok ICD9 or ICD10 will help with this one), clinician notes (nothing to help with this one yet), etc. No one calls items the same thing. Even in the same hospital there are different terms for diagnosis, diet, etc. depending on who you ask. The Dietician calls it the Consistent Carbohydrate Diet. The Nurse knows it as the ADA Diet. The nutritionist who serves the food and the patient, knows it simply as the Diabetic Diet. If there is so much inconsistency within one organization on a simple item such as diet, then how will information be sent to a cloud and come out in a readable & useable form?

3. Supposing the issues above could solve, then lets move on to a bigger issue. ” Will the Real Slim Shady please stand up?”


This is the issue I keep coming back to. Patient Identifier. Even if you can get hospitals to agree to an HIE, and even if (BIG if here) you could solve most of the issues with terminology, how in the world do you solve the issue with incorrect records being tied together? Or making sure you have pulled all the information on that patient?

If you have a savvy patient who knows all of their past medical history, and may even carry their records to each hospital visit then you don’t have this issue. This issue is caused by those patients who cannot remember what hospitals and physicians offices they have used. It is an issue for people who do not have a unique identifier. Not everyone who is seen in US hospitals has a SSN.

Another issue is not everyone wants to have their medical records linked. I know the VA just used metadata tagging so that some information could be sent and other information could be excluded based on tags.

There is also the issue of people who don’t want to have the system share information across an exchange. They don’t want to be in any system.

So why does this matter? Well what happens when you are traveling by yourself. You are in a major car wreck. Your allergy bracelet (listing your deadly allergic to __) comes off in the wreck and your ID is still intact and the responders have enough information to pull your health record. The hospital in anticipation of your arrival uses the information the emergency responders have to pull your records. The only issue is someone has stolen your ID in the past. You made sure to cancel your credit cards and other items, but you didn’t check to see if anyone had used your ID at a hospital. The most recent visit at the hospital, is by the person who stole your ID & not you. You are transferred to the hospital, where they start treating you for your wounds. They start an IV with the medication your are deadly allergic to. You start crashing. Now are you crashing due to an internal bleed or another issue? The hospital does not know. Your records shows you have no allergies so it must be something else.
This is just one scenario that keeps coming to mind. I mean just think about the episode on House (even if you don’t agree with the medicine or think this has ever happened, it could). The patient kept crashing until they figured out they had the wrong patient records.
Am I suggesting implanting computer chips in everyone? Or maybe a tattoo with information? No. I am just saying don’t think technology will fix everything. As I said other day, technology on top of a bad process is still a bad process with bad outcomes. Do I know how to fix this issue? No. I know there are several people working on the issues I mentioned above. Your hospital may even be working on these issues now just within their hospital.

What do you think? Do you think we will be able to create an HIE? Do you think it will work? What about the issues above… how would you address these issues?

Just some thoughts to ponder on a lovely Thursday afternoon.

Oh the possibilities with using Semantic Medline. The demonstration of Semantic Medline really engaged the class. I now remember why I LOVE research. You could say it was the pretty colors or just the complete cool geeky way of correlating research. I wish it would have started with the visualization first then went into the details.

So what is Semantic Medline?

“Semantic MEDLINE is a prototype Web application that integrates PubMed searching, advanced natural language processing, automatic summarization, and visualization into a single Web portal. The application is intended to help manage the results of PubMed searches by identifying semantic predications in the citations retrieved.”

And here is what it looks like:


You may not be able to see it from this still photo, but you can actually click into each color line and term to see why it was linked to the original term. This is all done based on the MeSH terms.
In addition to getting the visual image, you can also see the abstract of the article:

This allows you to look at the visual picture of the connection and then go into the details and the data of why it is connected. Now why is this so awesome besides the pretty colors and patterns?

Imagine all the possibilities and the new heights research could reach……

Think of teaching. How this can be used to help students who are more visual learners grasp what cases Alzheimer’s Disease.The professor could do the search and then lead a discussion into the specific nodes, pulling up the literature that supports why it is related to the topic. It could even go into why the literature is reliable or not.

It access an extremely rich data mine of information and extracts it into a visual presentation. It could lead to new discovers of diagnosis, treatment, management, etc.

Genetics. It can show the connection between a gene and a specific disease. For instance, obesity alters the CLOCK gene, the alterations of to the CLOCK gene have the potential to cause cancer. This can be easily shown through the visualization of the MeSH terms in Semantic Medline.

MeSH. I am going to start teaching MeSH using Semantic Medline. Why? People respond extremely well to the visualization. It reminded me of why I enjoy research. It is piecing together a puzzle, and Semantic Medline pieces it together in a gorgeous data rich way. It makes me want to review terms all day long to find connections, determine if it has been written about before, and write articles. It makes me want to long to research (yes I am an odd duckling).

The only sad part is it is not available to all users yet. It is limited to those with a license to UMLS. It is also important to note that it is still in beta testing. So there are still some issues being worked out before it goes live. If you want to have access you will need to request a license to UMLS. It is free, all you have to do is complete a report once a year. So if you want to use this to teach students, do research, or just have fun with the graphics then you will need to sign-up first.
Can you imagine other ways it can be used? My head is still reeling with all the possibilities.

Of course this is all possible thanks to genius people like Marcelo Fiszman, M.D., who is also an excellent presenter. Excellent job!

This is what we learned in class today, and I mean that in the nicest way possible.

One of the presenters today, by J. Starren, discussed unintended consequences of implementing technology. He discussed how implementing new technology can interrupt or cause issues with current processes. Yes this is true. The other issue, which we have not discussed is when you implement technology on-top of a bad process only muddies the waters even more. What do I mean?

Hypothetical Scenario: Let’s say you have a process of filling out paper slips for lab for every item that is sent to lab. On this slip you indicate the specimen, patient data, and tests that need to be ran. When you implement the new EMR, you do away with the paper slips. Now only patient data is put on the specimen, and all orders are entered into the computer system screen which was built off the paper lab slip. Nursing has access to the system, so lab should too and why do nurses need this information filled out again?

It is the first day of implementation and about an 30 minutes into it when issue calls start coming in. Physicians are asking where their stat lab results are for patients and why the information is not showing up in the system. Nurses are now spending their time rewriting orders, calling lab, and some are actually going to lab. Lab meanwhile, is standing there like deer in the headlights. They have no idea what has just happened. They are trying to process orders without the information they previously received. The only person with access to the new system in lab is on vacation.

There are multiple possible issues with this hypothetical situation (I am making assumptions based on the information above):

    1. No one walked the lab process to determine if it is in fact done this way.
    2. No one confirmed the labs on the paper slip are actually orderable labs in the system.
    3. Lab was not involved in the process and now is receiving specimens without the information they were use to and do not have access to the system to look up the information.
    4. If no one reviewed the labs on the paper slip, then no one bothered to see if they could prefill specific items on the screen. IE, urine always defaults in the specimen field for Pregnancy Urine Test.
    5. No one worked with lab to create a glossary of orderable labs and what is included in each lab test.
    6. Lab was not even informed of the change.

Within 15 minutes of the first call, everyone has reverted back to paper. No worries lab had extra copies stored away in a cabinet.

Maybe I am thinking of the worse possible situation, but it illustrates what can happen when you take a bad process (not just the paper slips process but the lack of a process for making changes) and add technology onto it.

So how does this relate back to your baby is ugly? Well we discussed today how testing a system with someone you know does you know good. They will not admit when there are issues. It is the same for testing a process. You need to find an outside resource that is not involved in the process, has no ties, or influences to evaluate the process, database, program, etc.
Sometimes the best way to do this is get someone who is very resistant to change or against the idea and evaluate the process. If you are the one that designed the process, program, or other item, you may not be pleased with what you hear, but just remember it is constructive feedback. It is a little different than your baby is ugly. It is hard to hear, but you can fix the process/program.
I have had this issue lately. As I developed a process for order set development people have made suggestions for changes. I know changes are needed. I developed a process with parts that are constantly under change. So change is part of it. The issue is how it is addressed.

A stranger walks by and says your baby is ugly is actually better than you finding out your Aunt has been saying your baby is ugly every time you left the room. Why did the Aunt not tell you up front? Its hard. Some people do not take it as well. Personally, I want to hear if there are issues with a process/program so that it can improve. If I do not know the issues, then I cannot fix them. But these can be communicated in a nicer way than saying “your baby is ugly.” Constructive criticism is how you help others improve.

The other item is offer feedback to people directly instead of just criticizing. Don’t just say this is bad, I don’t want to change. Offer suggestions. Or say I am not sure how to fix this but it would be nice if..”.

All of this to say that technology will turn your processes upside. It sometimes is a good unintended consequence since it provides you time to review your processes. It can be an issue that does not go well if you do not take the time to evaluate the process and walk it in advance.


This is just something I have taken away from Woods Hole so far. I am sure as I reflect on my the presentation and my tweets I will have other take away items that I will post later.


Here is something else I’m taking away, wonderful morning walks with great views:


Today was the first day at the Woods Hole Biomedical Informatics Program. I say it was the first day but it was really a day of welcome and introductions.

Tonight we had a welcome reception where everyone introduced themselves. I learned a few interesting facts:

  1. Total number of people at this session=30
  • 17 Librarians (tied for most librarians)
  • 6 Physicians (least number of physicians)
  • 6 Administrators
  • 1 vendor

2. Each person brings a unique perspective

We have some who are just dipping their toes into Informatics, and others who have been working in the field of informatics for years. We have people who want to learn the basics to just have more knowledge, and others who want to know how to integrate this into their daily clinical life to improve patient care. There is one person (a GI fellow) with a great idea of reducing the amount of unnecessary CT scans to diagnosis GI issues using screening criteria built into an EMR system. It sounds like an intriguing idea and I am curious to learn more about the concept and if the class will help develop the concept.

I am still learning about all the people in our class and will be posting more as we move through each session. I will also tweet as much as I am able (yes @hurstejwill probably tweet more than me even though she is not here).

Tonight as we introduced ourselves we discussed why we here and what we hoped to learn. As my post earlier today pointed out, my job description has changed. I am now officially part of Clinical Informatics. I still do all of the normal library work, but I also work on informatics projects. This is one of the main reasons I am here. I want to learn more about how to accurately incorporate appropriate technology into clinical settings. I am not sure the course will go over this specifically, but I am hoping to get some basic knwoledge to take back to my organization.

Of course I will be sharing this knowledge and information gathered with all of you. If you have a question about the courses, program, items I post, etc. please leave me a comment below or send me a message on twitter.

Note: For some reason I am having issues with various features in WordPress on the iPad. It must be the questionable iOS or that this is an Apple product (kidding Apple Fanboys). I do however apologize for the issues with spacing and other items.


Qapla’! That’s Klingon for success!

It took me a while to get to this post. I wanted to wait, and then time simply slipped by me. I presented  a very short segment on April 18 for the MLA Educational Webcast Leveraging Mobile Technologies for Health Sciences Libraries, it seemed to go over well.

I want to thank MLA for doing a fabulous job with the video. I especially liked the music the MLA editors added at the end. I also want to thank my fellow presenters:Kimberley Barker, Heather Holmes, Molly Knapp, and Colleen Cuddy. It was a pleasure to work with innovators in the medical librarian field. I also want to thank the committee who selected the presenters.

Finally, just to make sure my disclaimer for the presentation was clear… I was not paid by NLM or NN/LM (except I did receive a few awards from SE/A NN/LM) to discuss their services. Although if NLM or NN/LM wants to send me a check then that is fine too. :)

I appreciate everyone’s assistance, I am glad the presentation was well received, and relieved it is over. Why?

Well, I redid the presentation several times. Have you ever watched yourself present on tape over and over again? Yeah, I am not a big fan of it either. I enjoy presenting, but I prefer to present face-to-face in a live session. It is so hard to really gauge the audience when you present virtually and it is impossible to gauge the audience when you tape the presentation. I almost redid the whole video right before it was due… but I finally let go, and let it be. Yes I stumbled a few times. The important thing is to keep going. I keep reminding myself of this every day. Just keep swimming, just keep swimming, swimming.

While the presentation was well received, I did have some questions at the end.

One of the questions/suggestions during the presentation was if/how I connect the use of apps such as cooking apps to medical information. I have done this before. For instance, if I am presenting to a group of diabetes educators then I point outFood on the Table. 


Food on the Table helps people plan meals based on what is on sale and will even help create meals for health issues, such as diabetes. It is available for free. I have demonstrated this to educators to show patients who have computer access how to use it, and for those who do not it is still a valuable tool for educators. It helps them show patients how to create meal plans and some will even create a few to provide to the patients. Providing patients with easy meals to follow, using items that are on sale (within budget), and going over the nutritional information is great at helping diabetic patients eat healthier.

This is just one example. I have a few others and will be demonstrating a few in upcoming posts including how to get rid of the paper recipe book!

@alisha764As I wrote yesterday I am presenting a very short segment today for the MLA Educational Webcast Leveraging Mobile Technologies for Health Sciences Libraries, April 18 at 1pm central.

I will be presenting with some of the outstanding leaders in the field and hopefully I can keep up!

Nikki posted about the MLA approved hashtag for the conference #mlamobiletech

If you are tweeting please use this hashtag. Also if you post a question please put ‘Q:’ at the beginning to help corral all the questions.

I will be tweeting (@alisha764) and will try to respond to questions as I am able. Answers will have ‘A:’ at the beginning. On second thought I am a little too nervous so can someone just tell me when it is over? Not to mention it is scheduled for central time which just keeps throwing me off! See you in 30 minutes!