- Under-represented groups represent 34% of the total population
- Diversity in health care work force
- Physicians: 7%
- Nurses: 3%
- Pharmacists: 3%
- No Ivy League schools are among top medical schools that American Indians, Alaska Natives, or African Americans apply
- Top medical schools for Hispanic or Latino schools are all in Puerto Rico
- Business case for diversity in science
- Birds of a feather research together — and produce research in journals with lower impact factors and less cited
- Implicit association test https://implicit.harvard.edu/implicit/takeatest.html
- 16% of NIH grant applications from black researchers succeed vs 29% from whites
- AAMC report on state of women in medicine lacked any mention of intersectionality
- Four patterns of gender bias
- Feel need to “prove” our competence
- Walking the tightrope between too aggressive vs too feminine/weak
- Motherhood penalty
- Queen bee syndrome (women who refuse to mentor the next generation)
- JHU Institutional Plan to address
- Faculty Diversity Action Plan
- Diversity Advocate
- $25M JHU Diversity Initiative
- 54 URM Faculty hired in FY15-16
- 3 women dept directors
- 3 URM dept directors
- Pipeline programs -HCOP, SARE
Monthly Archives: September 2016
MACMLA 2016: Paper Session 1
Building a Critical Mass of Systematic Review Authors and Teachers: A Collaboration between Librarians and Faculty
- What is the rate of systematic reviews for comparable institutions (those without med schools)?
- Need to meet with Deans, Directors, Faculty to determine needs
- Work with researchers on currently publishing SRs & MAs
- Interest in non-HS programs like Educational Technology, Psychology/Counseling, Statistics, & College of Liberal Arts (ex: Health Care Ethics)
- Grant from NNLM for on-campus event for training on SRs
- Created LibGuide and online community for on-going support (basic focus but decent guide usage even before official launch)
- Speakers were a combination of experts and local researchers
- Workshop topics
- Importance of SRs, process
- Breakout sessions on meta-analysis, integrating EBP into teaching
- Panel discussion on opportunities and barriers
- Librarian training
- 3 options: UofMichigan workshop, Pitt program, applied project for university conference
- Workshop attendance filled in days (n=27)
- SRs in Education
- class presentation, UG research symposium, critically appraised topics, IPE Health Research Skills course
Assessing Value of Library Services on Research, Clinical Practice, Education, and Administration
- Had done Library Values survey 5 years prior
- Benefits of informationists services (overall results, but different audiences have different rates per category)
- information search (56%)
- point of use instruction (19%)
- citation management (9%)
- publication/grant prep (4%)
- students rank coursework as the highest indicator for intended use of library resources
- What resources people used with and without informationists
- with Informationists, more likely to use more resources, and resources like CINAHL, Embase, etc
- without, more likely to use Google or Dynamed
MEDLIB 2011-2016
- 5 year analysis of content and comparison with 1997 article analysis
- as of 2016, MEDLIB-L has ~2000 subscribers (35% education domains, 23% healthcare orgs/hospitals)
One systematic review software to rule them all — NOT!
- EndNote web works terribly for researchers across different institutions
- Mendeley sinks beautifully across users but does not have as much space for PDF space (without payment)
- RefWorks crashed with large RIS file due to timeout
- SRAssistant deduplication – unsure how well it works
- **checkout expert searching listserv
- RefMan only available to Cochrane reviewers
- SRDR wonderful but clunky due to framing
- Covidence – can’t have more than 1 person assigned to an article; after 2nd reviewer, then the article moves out of the pool of review
MACMLA 2016: Using Data to Improve Clinical Outcomes — Examples and Lessons Learned from Cleveland OH
- Started with EHR in 1999 (some patients have up to 17 years worth of data in the EHR)
- Broader use with 2012 for enterprise-wide EHR adoption – starting with Meaningful Use 1 and progressed forward
- Paper health records:Hammer :: Electronic health records:Power nail gun — increased power due to tech, but also large potential for more problematic outcomes
- Case #1 of EHR’s potential – identifying the significant underdiagnosis of hypertension in children — data was available but just not applied
- Response: Put in an alert to better identify/highlight existence of data
- Baking the evidence based guidelines into the EHR (CDSS)
- 38% decrease in false positives
- 100% increase in provider recognition of abnormal blood pressure
- Answer: Alerting helps, but not the total fix
- Case #2 – Immunizations
- Over 300 immunization rules for children — how do you know if your patient has completed their schedule?
- Messaging algorithm to reach out to patients using TeleVox about immunization follow up
- Messages helped increase results by 1/4, but not a perfect fix for the other 3/4
- Number needed to message 4 people to get 1 immunized
- $5k in messaging costs led to $200k clinical revenue
- Personal Health Records
- Patients will be the biggest amount of EHR users in the future
- PHR allows for reminders, health info exchange (ex: immunization)
- Case #3 – Meeting referral drop-off between obesity clinic to specialist
- 76% referred but never seen
- So what is the actual appointment follow through within a month after referral? 48%
- Solutions: self-scheduling + giving specialists a list of patients so they know who is referred and they can take over outreach
- Moved to 61% after new interventions (6700/month initial consults = $1mil
- Case #4 – Depression Screening
- Advanced CDSS for subjective data
- Use PHQ-9
- Case #5 – Health Information Exchange
- Who is likely to have their data exchanged?
- Older people, female, African Americans, Medicare/Medicaid
- +1 mil patient records a day exchanged among those on EPIC system
- Who is likely to have their data exchanged?
- Case #6 – Longitudinal diabetes data
- Synopsis report of data overtime
Q&A notes
- Information is getting smarter to not just be one click away to Micromedex or UpToDate as a general resource, but one click away from the specific drug entry in Micromedex or UpToDate
- People in health care do not value information and its integration well into clinical practice — how do we change this paradigm? Informaticists
- What are the opportunities for librarians to offer education on informatics/EHR competencies
- Re: alert fatigue – who should the alert be going to? Is adding more info to the 15 min visit overload? What would be a better time? How actionable are these alerts that are provided in the visit?
- 100% of privacy/security is not realistic, but we need processes in place like credit reports to help manage the inevitable
Follow up readings
- All of Kaelber’s articles
- IHI Triple Aim
- The Learning Healthcare System from IOM (2012)
MACMLA 2016: Leading from the Library, Anne-Marie Deitering
In a unusual twist, MACMLA started the conference with a presentation from a undergraduate-focused librarian with expertise in qualitative research. I found her exploration of learning as a performance vs learning as mastery a great way to frame different motivations present in our students.
Continue reading MACMLA 2016: Leading from the Library, Anne-Marie Deitering