Miles of information for medical librarians #medlibs

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?

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?

Maybe I am writing about this to encourage myself to use this new tool. After all, I have blogged about eating lunch at my desk and I get so caught up with work that by the time I get home I’m too worn out to post anything. So I apologize to my followers for the lack of post. There are several drafts sitting in my folder now waiting to be finished, and this was one of them.

iMedicalapps did a great review of Lunchmeet. I won’t repeat all of the benefits and reasons for using LunchMeet in general.

The app connects to your LinkedIn account, so you’ll need one of those first. What’s the purpose? Well LunchMeet connects users who are available or open for a lunch meeting.

But I don’t have time to set-up another app and monitor it!

Yes I can understand. I have already planned my lunch date for today …. with my desk, two computers, and an iPad. But imagine how useful this would be for meetings. Imagine at the next MLA or ALA not having to worry about trying to set-up lunch meetings. This app will help you break the ice and request a meeting with the person you’ve been dying to meet and pick their brain.

I also think this is a great app for librarians. Why? Well librarians are known for staying in their comfort zone. Not all librarians and it isn’t necessarily a bad trait but it is helpful to branch out. This app might just help you branch out to meet librarians in other types of libraries, maybe someone in the retail business that might have great marketing tips or… gasp… an IT person. I know this could be difficult for some librarians who have a love/hate relationship with IT.

These are just a few ideas. I think this is a great app for helping to really build those virtual networks. Look outside your circles too see what others might be able to offer. Think beyond your lunchmeat to the LunchMeet.

Of course for this to work LunchMeet will need to develop a strong following. And to get a big following they need to launch the android version, which is why I am not using this app..yet. I can already say this will be helpful when I am traveling but I do not see many in Columbus, Ga, using this app. People just really started using Twitter… well kind of.

What do you think? Would you use this app? Or is it a little too creepy?

GOOGLE HAS INSIGHT

Google’s latest project, that isn’t on the chopping block for now, is Think Insights.

Think Insights Homepage

According to the homepage:

Forward thinking and rooted in data, Think Insights offers you a one-stop shop for consumer trends, marketing insights and industry research. Stay updated and join the conversation: Think with Google on Google+

Besides the fact Google is offering a shiny new page with detailed statistics, I am excited to see what Google does with this new tool. Why? Well many reasons. I am curious to see how Google uses this new tool when they have retired several others. It is also a great display. Plus Google, the ultimate search engine, has an advantage when it comes to compiling research. But if you look at the research library there are two areas I am particularly interested in. The first is the technology and mobile sections: A great infographic and there are reports and videos with additional information. Seeing all of the studies on mobile and technology in one place will be great. Right now the library is not large and I hope it is expanded soon.  

Oh what a glorious day it would be to have all of the healtchare studies in one location! It would be great not to spend so much time searching for healthcare statistics reports. But will it have enough data? I do not know. Right now it is very limited in the number of items in the research library.

The average consumer consults 10.3 sources of information in the process of making healthcare decisions. (Zero Moment of Truth Study -OTC Health)

Really? I would like to see more information about this.

Next I took a look at the videos in the Healthcare Section and was a little disappointed. The videos were by, for the most part, either Google employees or pharmaceutical companies. Now I am wondering who is financially supporting Think Insights and is it biased information.

As I said, I do not know where Think Insights is going but it has definite potential for those trying to gather statistics from the internet. It is built more for marketers attempting to improve their product promotion, but that doesn’t mean libraries cannot use it.

Check out the Real Insights Finder and let me know if you think libraries could use it.

I think it could be useful for libraries trying to determine what people are using on their website and how to better market their resources. I did a quick review of one website on Think Insights:

Clicked on ThinkInsights Real-Time Insight, then “What are people clicking on” and entered MedlinePlus.gov in the Ad Planner.

Neat to see the statistics in the graphs. MedlinePlus reaches 45 million people! Unfortunately it is only 1.1% reach. Hmph.

So do you think you will use Think Insights? How? Let me know in the comments below.

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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Wal-mart just announced the launch of Vudu, its new online movie platform. The store that sales just about everything is now streaming movies.

What does it mean? Will Wal-mart increase streaming usage? Will it be able to compete with Netflix, Redbox, the newly released movies on Youtube, & others? What about Blockbuster? Or are they completely obsolete now?

Interesting news and I’m wondering if having so many players in the field will help to create a better product– not to mention a pricing war. I am also curious to see if Wal-mart’s Vudu will increase usage of video streaming. If Wal-mart becomes a major player then what about libraries? Will libraries be able to work with the big box to provide videos online to patrons?

I know some libraries have reviewed the possibility of streaming videos (I’m referring to new releases and big titles) online for library patrons; however, the cost is typically beyond a library’s budget. Some libraries do stream videos but the ones I reviewed are very limited and have a small list of titles.

Only time will tell.

On Friday I received my invite to Google Music Beta. At the exact same time I saw the update on Google’s blog about discontinuing Google Health (GH).  Coincidence?

GH was discontinued according to Google because it wasn’t having a ‘broad impact.’ Really? I think it did by getting the industry and people to talk more about patient health records, security/privacy of records, access to information and more. I previously blogged about GH including its issues.

Yes GH had issues: security/privacy, it wasn’t social and did not have a social connection (Google seems to struggle with the social part of every project), it didn’t provide fancy features, Google didn’t involve clinicians, there was no marketing, and it appeared abandoned months ago.

Despite the issues with GH I still think it was premature to discontinue the program. Right now many hospitals and healthcare facilities across the US are implementing electronic medical records as part of ARRA HITECH. It is the start of a long process. A process that ends with all systems being able to communicate and share information. GH had started the process of communicating with Beth Israeland other early adopters. GH was ahead of its time with helping organizations communicate. Did it need improvements? You betcha.

It seems if Google was hoping for a ‘broader impact’ so quickly then they do need to get out of healthcare, which by design moves slow. I constantly hear colleagues complain about the amount of time it takes clinical findings to get to the point of care. Yes it is a slow process and could be improved but if you move too fast there is not enough time to test. For instance efforts to reproduce the Leaven tight glycemic control study resulted in increased mortality rates in the ICU instead of decreasing mortality.

So there is reason to move a little slower in the healthcare industry. A pace it seems Google is unaccustomed to and requires quick large impact.

If Google has decided not to enter the health field then it would be great if they turned the GH code into open source so others could use it as a building block. It may not be perfect but GH was a start on the long HITECH road.

Who knew emailing the PubMed Help Desk actually… well…helps! On March 16, 2011, I emailed the following suggestion to the PubMed Help Desk:

Can “Item in Clipboard” be moved to next to the journal title and information?

I conduct searches in PubMed frequently. I use many of the features, including combining searches, advanced search, etc. Often I am frustrated when working on a long complex search to see items already in the clipboard continuing to display in the search results. After all, it takes time to review the abstracts so I don’t want to continue reviewing and choosing the same abstracts over and over when they are already in the clipboard. Yes I can combine the different searches but those pesky items in the clipboard keep displaying!

I remembered the discussions on the Medlib Listserv following the PubMed update in October 2009.  There were a few emails and discussions about items not displaying in green when an article is in the clipboard. While I found several emails lamenting the loss of the green indicator, I did not find any solutions or suggestions. A couple months later there was a short message with some cryptic information on removing items already in the clipboard from the search result but nothing else.

Well the PubMed Help Desk stated there are no plans to make any changes to the indicator “Items in Clipboard.” But that’s ok. The Help Desk provided even better information, a work around.

So lets refresh. I have been using PubMed for 3 years now. I have taken a PubMed class. I use PubMed everyday at work, even on the weekend sometimes 🙂. Even with all of this exposure to PubMed, I do not recall hearing or seeing this work around before:

Citations in the Clipboard are represented by the search number #0, which may be used in Boolean search statements. For example, to limit the citations you have collected in the Clipboard to English language articles, use the following search: #0 AND english [la]. This does not affect or replace the Clipboard contents.

Really!?!? That’s it? I did a quick search and sure enough, there it was:

PubMed Advanced Search Page

As plain as the nose on my face. All I can say is the search history may have been too long and I never bothered to hit the “More” button, or I just wasn’t paying attention.

I must have missed this somewhere in the discussions or documentation, right? Well I reviewed all of the Medlib Listserv Archives and could not find any mention of this work around besides the confusing email mentioned above. I then looked at notes from previous PubMed classes, discussions, etc.  Finally I googled it. I found a brief mention of using the #0 in one of the PubMed tutorials, but even this only mentions #0 represents clipboard in the search history. Of course I found more details in Internet Cool Tools for Physicians.  Then buried in the PubMed Help bookis the exact information the PubMed Help Desk sent.

So I post this here today to make note of this wonderful feature, and hope when someone else googles for help with PubMed’s clipboard they might stumble across this post and find it useful.  It is another step in the process, but a good step and one I will certainly be using. Proof that I always have something to learn.

A quote for fun:

The minute that you’re not learning I believe you’re dead. ~

Jack Nicholson

 

Yesterday I presented new library resources to a group of pharmacist. As we were finishing the session a pharmacist asked about PubMed MyNCBI. I showed a few features and then decided to mention PubMed Health, except PubMed Health did not want to make an appearance.

I wanted to let my patrons know about this new resource so they are not caught off guard, as many in the medical library field have been (See previous post), when they do a search on Google for a medication or disease. Yet, when I did a quick Google search for ‘paxil’ this was the result:

Figure 1: Google search result for paxil on 3.22.11

As you can see from the image above, PubMed Health was  nowhere to be found.  It was disappointing to see Wikipedia as the first result when I had been so accustomed to seeing the Google Heatlh Search box and now PubMed Health. I thought maybe this is a fluke, let me do another search (mind you this was all during the middle of a presentation):

Figure 2: Google search for zofran 3.22.11

Once again PubMed Health is nowhere to be found in the search results 🙁

Well I was bound and determined to show the pharmacist the new PubMed Health that ‘was’ appearing on ‘most’ computers as the first result in a Google search for medications and/or diseases.  I could not remember the exact website address so I did what any good librarian would do… I googled PubMed Health to no avail.

I ended up clicking on the recent article from The Krafty Librarian, which displayed within the top 3 results, to get to the link.  Sigh, it was one of those moments when you try to show something new only to have it #fail.

I know PubMed Health is still new, and these things happen. I mean different computers yield different search results in Google based on previous searches. I think it was the context in which this happened that really has me bummed about PubMed Health.  It also didn’t help that a search for “PubMed Health” could not find the home page.

Anyone else experiencing this? I know there were reports of different results from medical librarians in Canada (I believe this was mentioned by @danhooker). Is anyone else seeing different results on Google when searching for medications or disease information?

 

Update: I was using IE8 browser, with the firewalls, and on internal servers. It was the same, except for the computer, as I use at my desk (see image below for different result when searching ‘paxil.’). I think it is like T. Scott said, it is the Google algorithm that creates different results depending on previous searches. The frustrating part for me was that even googling “PubMed Health” did not yield a link to the website. Now I am wondering if I should be considered with the odd results or the fact that the pharmacist are probably using Wikipedia and other resources more 🙁

Figure 3: Google results for ‘paxil’ on my work computer.