Category Archives: 2013-2014

MLA 2014: Top Tech Trends

SharePoint

  • virtual communities via digital environments
  • increase in social features / Facebook-like
  • calendar of trainings across professionals, also IDs gaps
  • built their own SharePoint as closed system for the team
  • “shareholder buy-in to use SharePoint is really difficult” but focus on champions

Infographics

CDC The New (Ab)normal

VIVO

  • Weill Cornell Medical College installation
  • “business intelligence” – marketing, external reporting, competitive intelligence, performance tracking
  • VIVO – open source, semantic researcher profile system
    • performance monitoring – what are people up to?  ex: want a monthly report of all publications of authors
    • ex: Melbourne Research Windows
  • VIVO dashboard example

3D Printing and Medical Libraries

  • Presentation slides – PF Anderson’s
  • Able to print bioabsorbable materials, among other things like living cells, concrete, sand, and more – example
  • Biofabrication
  • 3D used a lot in surgery for models — in one case, cut surgical time by 1/3
  • biodrugs – 3D printing drugs in Subsaharan Africa
  • Awe-inspiring story about a kid printing a hand using library makerspace
  • Yeggi – search engine for 3D printable models

Late Breaking Trends

  • Gartner hype cycle – mapping of trends

Gartner Hype Cycle (2013)

  • Citizen Science
  • Wearable technology – FitBit, Nike Fuelband, etc — even Whistle for dogs
  • Mobile health  – Kinsa thermometer
  • SXSW Interactive – one location to discuss and learn about health sciences and mobile tech
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Open Forum: Futures Task Force

  • Provide more year-round activity (CEs, etc) outside of just the MLA annual meeting
  • Move more of the MLA business activity online and outside of the MLA annual meeting
  • Current Section and SIGs structure is too bureaucratic –> replace with Working Groups or Caucuses
    • Working Groups = communities of interest, produce work products (white papers, position papers, standards) – set its own agenda and activities
    • Caucuses (placeholder name) = led by convener and offer peer2peer networking, education, sharing
  • Potential new positions in MLA board staff
    • Data curator/analyst – survey development, metrics, meta-analysis of data already gathered
    • Instructional designer – help CE instructors
    • Innovator in residence (1 year appointment – grant funded? Rising Star?)

Questions/Responses Stemming from the Audience

  • MLA as a “professional home”
  • MLA members are more likely to also be ALA members than SLA members, based on previous membership surveys
  • No student chapters of MLA –> how to pull in more students?
  • Open call for papers instead of just having Sections define themes –> the masses agree, as this would allow hot topics to have a presence at meetings instead of waiting for the right staged opportunity

Other Entertaining/Interesting Tweets

MLA 2014: EdTech: We Build It – Do They Come?

Must-Have Web Browser Enhancers for Biomedical Researchers

  • Bookmarklets
  • Mendeley’s Web importer

Embedding Screencasts for Information Literacy in Evidence-Based Graduate Nursing Education

  • ADDIE Model of Instructional Design
  • Berk, RA, 2009 – “edit unmercifully to a maximum of three minutes”
  • Psychological pricing  – have videos come in at 1:59 because it sounds less than 2:00
  • Embedded videos into LMS but videos are hosted on YouTube
  • Lends itself to flipped classroom setup – can send class reminders
  • YouTube Analytics: viewers watched 68% of video one, 72% of video two

Designed Locally, Accessed Globally: Building a Better Evidence-Based Practice Tutorial

  • Enhance 5 step process
  • Expand discipline-specific coverage
  • More exercises
  • Links to patient education materials
  • Re-defined audience as University of Minnesota
  • Team members: liaison librarians (all 6) and instructional designer
  • Used Articulate Storyline
  • New site: https://www.lib.umn.edu/apps/instruction/ebp/ 
  • Responsive design
  • Return visitors can go back to where they left off
  • More accessible in HTML5
  • Able to embed into LMS modules
  • Creative Commons license to encourage reuse
  • Same amount of traffic Q1 2014: ~15k sessions
  • 1 direct reuse request
  • Future directions:
    • learning analytics based on heavily used pieces, skipped pieces
    • integration of modified Fresno test
    • patient ed/health lit module
    • free vs subscription example articles
    • use good articles AND the bad articles so you can see the gradations

A Plan for Evaluating Research Data Management Instruction Methods for Medical School Students

  • objective: find most effective method for teaching RDM to medical students
  • cohort study to evaluate 5 different approaches (already have 5 existing learning communities)
    • 1 workshop
    • Multi-workshop
    • Flipped classroom
    • Synchronous webinar
    • Asynchronous webinar
  • 66% want data mgmt training
  • 50% would take an elective course on data mgmt (nursing school said 84% yes, med school reported less than 45%) — question of perceived value
  • 57.15/100 – average familiarity wtih data mgmt activities
  • 41.09/100 – average awareness of data mgmt best practices
  • GSBS score themselves higher than GSN or SOM
  • answer: no single method is most effective
  • PIs and faculty advisors are sources for support when grad students have questions — target audience to reach

MLA2014: Research Survey Design for Librarians

Planning for Effective Survey Design

  • Steps in effective survey design
    • purpose
    • problem statement
    • research questions
    • survey design
  • link between your purpose and problem statement
  • appropriate research questions — dictates type of data you need to collect and inform the methodology that you use
  • Sample
    • Is there a sampling frame (existing list)?
    • Probabilistic (greater chance to generalize results to larger population) vs non-probabilistic (limited generalizability – ex: snowball)
    • Stratification of the population
  • Instrument – your own? modified with permission? developed by someone else?  Pilot testing is essential!
  • Survey items – match to research questions
    • closed vs open questions
  • Common question pitfalls
    • double-barreled – don’t ask 2 things in 1 question
    • leading/biased
    • leaving out a choice

20140519-142441-51881206.jpg

  • reliability (consistent and stable over time) and validity (is it measuring what its supposed to measure)

Managing Bias in Survey Research

  • dog whistle politics to get certain reactions from people using keywords or names – names of key individuals (ex: Sotomayor, Scalia), verb choice (ex: follow vs interpret), priming
  • common forms of bias on surveys (these are the top 5, but there are probably 80-100 examples out in the literature)
    • purpose of study
      • possible solutions
        • inductive analysis
        • peer review
        • lit review
        • focus groups
        • community-based participatory research
    • study population (largest bias area)
      • convenience sample bias
      • selection bias
      • Grove et al 2004 offers diagnostic statistical methods to detect
      • possible solutions
        • broaden scope of recruitment
        • intensive recruitment of underrepresented population strata
        • alternative communication methods
    • reactive effects
      • pre-conditioned due to recruitment process or consciousness of study participation (“Hawthorne Effect“)
      • possible solutions
        • seems to be diminishing due to growing habit of being observed via social media
        • decreases over time
    • self-report bias
      • stigmatized topics (ex: obesity, substance abuse, etc)
      • possible solutions
        • assume third-person perspective
        • observable behavior
    • data handling
      • see a statistician early in the process
      • can avoid by concealing the identities before statistician does the analyses

The Value Study: An Example of CBCR Survey Design

  • Is survey the best method for our research?  Is the most common method in medical library field
  • Community based collaborative research is research conducted by and for those most directly affected by the issue, condition, situation or intervention being studied or evaluated
    • form of participatory action research
  • Advantages of CBCR
    • yields better data
    • buy-in
    • local jargon
    • meet community needs

 

Interesting/Entertaining Tweets From Other Sessions

MLA2014: Architects of the Future: Managing 21st Century Resources

Combining Resources, Combining Forces: Regionalizing Hospital Library Services in a Large Statewide Hospital System

  • *While not a hospital librarian, this was a helpful session to learn more about the other members in NAHRS and their potential information needs.  I’m an incoming board member of NAHRS, so this fell more into service-related knowledge development rather than job-related*
  • Regional email shared for requests
  • Shift from print to digital for equitable resource access regardless of location
    • 80% print reduction in first year — no real resistance
    • multi-site licenses were complicated to develop — cost increase
    • 20% budget decrease also occurred over time, but the shared project didn’t reduce access
  • Standardize policies, procedures, and statistics
  • Tech improvements
    • single website, create mobile site, improve remote access, launch discovery tool
  • “Marketing orientation” (Robinson, 2012)
  • 25% increase in lit searches
  • 6% in doc delivery
  • Reduced print subscription titles from 240 to 20 for in-library browsing

Partnering with Postdocs: A Library-Hosted “How To” Series Taught by Postdocs

  • Postdoc Talks – teaching opportunity, provide feedback on teaching, letter of acknowledgement, and record presentations with option to post on university’s iTunesU –> clear incentives for postdocs to want to participate
  • “How-To” (NOT a seminar)
  • Had a team of editors to edit recordings
  • Topics (as decided by presenters) ranged from how to prep a CV (7 attendees), how to process histology images in Photoshop (5), CRISPR (13), ethical considerations for scientific image manipulation (10), UNIX for Biologists (4)
  • Outcomes – minimal cost, reduce librarian instruction burden, provide scholarly & career support for underserved population
  • Future things to fix
    • Advertising to get speakers and attend talks
    • More guidance on talk title development
    • No abstracts for talks
    • confusion about postdoc talks being ONLY for postdocs, not for anyone in the community

How a Health Sciences Librarian Creates a Different Approach to Library Instruction

  •  previous model was just the one-shot –> move to more embedding
  • not one size fits all
    • physically embedded in F2F
    • F2F and online presence in LMS (Desire2Learn)
    • online session + LMS followup module
    • LMS only presence
  • Challenges
    • time
    • communicating with faculty and students, continual
  • Faculty report students turning in higher quality work
  • More students seeking help through multiple methods – they like the choice for the method best for them
  • Grad students to use the discussion forum more, undergrads are more email, drop-in based

 What’s Most Important? Emerging Technologies in Medical Libraries

  • adopt Horizon Report info
  • Think Tank reports
    • CORE-E
  • 3D printing and learning analytics – only overlapping concepts among 10 think tank reports
  • lots of potential roles for #medlibs – checkout the slides on MLAnet
  • Did the work with a Google+ community
  • 4 subgroups: Libs + Publishing, Communication & Ed, Human Body, Disaster/Risk/Public Health
  • Technologies will change but hopefully the subgroups change less

Other Interesting/Entertaining Tweets From Other Sessions

MLA 2014: Vendor Negotiation Strategies and Open Data

Using the meeting as an opportunity to learn something altogether new to me, I’ve started with exploring a vendor negotiation strategies session but eventually got bored and migrated to open data.

Vendor Negotiation Strategies

Speakers: N. Bernard (Buzzy) Basch, Elizabeth Lorbeer, Brad McCracken (Elsevier)

  • You gotta ask questions – is the person you’re working with entitled to negotiate?
  • Be honest — with vendors and with users
  • Where does the magic 5% come from for vendor increases, regardless of inflation?
    • Buzzy: the EBSCO report
      • the demand for writing has increased dramatically in the last 10 years
      • so much of the information purchased doesn’t get used
    • Brad: Multi-year agreement deals
    • Elizabeth: She’s argued for different percentages, even for 0% for some years

Multi-year Institutions

  • Elizabeth: Tends to work with 3-5 budget models

 

Open Data Initiatives and Trends

  • UCSF data workshop series – Megan Laurance
    • Research Data Repository Landscape & Ecosystem
    • Why Share Data?
    • Why reuse public datasets?  Use Cases!
    • Deep dive on one data repository
    • 45 min data reuse exercises
  • focus on research workflow, not data mgmt workflow
  • remember to take advantage of a captive audience – before, during, after the workshop — more content/exposure info
  • Attendance outcomes: Postdocs biggest groups, faculty the smallest.  Faculty, although smallest in number, provided greatest exposure
  • End session feedback identified learned items such as Awareness, Hands-on Practice, and Links to Resources
  • Working to partner with postdocs to have them do some trainings in the future, also partner with others in the UC system

Data, Libraries, and the 1K Challenge – Jackie Wirz et al.

  • What would you do with $1k that would improve research communication and NOT build another tool?  One-on-one  training
  • Workshops with the library, workshops with the researchers, and individual consultations
  • Data means many things to many people — great example of tomayto/tomahto
  • Working with IR and ScholComm Lib
  • Did map of library skills to research cycle
  • no one had a clue about basic data literacy, no idea of metadata, and no thought given to workflow –> aka very basic concepts is more where we are starting
  • went back to figure out how to get grad students to attend the workshop
  • motivating phrases sourced by grad students and actually attracted grad students to attend a data mgmt workshop: helps PIs and researchers, make it easier to get to graduation, easily reproducible data
  • people see the same data differently
  • detailed means different things
  • no one sees metadata
  • file mgmt is difficult — only 1 group saved the file
  • workflow varies dramatically – had no idea that workflow was unique to them

Tweets from Other Sessions of Interest

MLA 2014: John P. McGovern Lecture

Dr. Aaron Carroll, author for The Incidental Economist blog, spoke about the Affordable Care Act.  Here are highlights from the session:

  • The Iron Triangle – cost:quality:access
    • can only improve 1-2 aspects of the triangle at one time without compromising the other aspects
  • US has been stagnant with covering health care
  • PPACA
    • 3-legged stool (not that type of stool, sicko)
      • regulations: everyone should be able to get insurance even if they have a pre-existing condition
      • individual mandate: everyone needs to buy insurance, even if they are healthy
      • subsidies: provide tax credits to make the insurance affordable
  • access isn’t just about insurance — percent of people waiting 6 days or more to see doctor: US=2/3 during nights, weekends, holidays
  • “richer half of Americans are more likely to avoid care because of cost than the poor half in other industrialized countries”
  • we suck at access
  • healthcare is going to ruin us in the future
  • this is not a public-payer problem – rate of healthcare premium growth far exceeds the comparatively flat rate in employee salaries
  • regulations and limited spaces in medical education are contributing to these
  • Note to self: play with OECD data
  • JAMA August 14, 2013 – Years of Life Lost (Table 4 – Rank of Age-Standardized YLL Rates Relative to the 34 OECD Countries in 2010) <– great visual resource to demonstrate exactly how we fail in quality categories
  • States oppose Medicaid expansion for 2 reasons
    • hidden costs
    • woodwork problem – those previously eligible for Medicaid but sign up now fall into the old rates paid by the states, not the new federal expansion
  • about 1 in 3 births are covered by Medicaid and 1/3 of children in US
  • average individual policy costs $6k; 2012-2013 poverty line is about $11k – they simply can’t afford it
  • Medicaid is
  • those not expanding Medicaid forego $35bn
  • providers will still care for uninsured but get even less money
  • all reform tries to spend less money
  • health care spending is growing more slowly than almost every before
  • reform is great for the company and terrible for health care industries
  • less money is going in = big changes for us
  • medical device tax estimated to raise $30bn over a decade (2.3%) –> biggest change is that they CANNOT pass this cost on to consumers –> have to make the case for rolling out this expense on tech
  • for insurance companies, prediction models will be critical
  • networks will become more important
  • #1 thing causing physician dissatisfaction: EHRs
  • How Librarians Relate aka Our Clear Takeaways
    • adhering to guidelines is going to be key – searching & understanding the lit
    • accountable care demands more info transfer
    • there is no way for a physician to remain current without help

  •  privacy is a real issue

Other Tweets of Interest or Entertainment from the Talk

 

 

Panel 3 Informationist and Rounding Services by Libraries

Librarian/informationist rounding was pioneered in the 1970s by Gertrude Lamb.  She would go on rounds, go back to library, conduct searches, and then connect articles to patient charts (LATCh – Literature Attached to Chart service).  R01 grants by NIH provides grants for Administrative Supplements for Informationist Services in NIH-Funded Research Projects.

Blair Anton, MS, MLIS – Johns Hopkins University

  • challenge: are they asking a reason due to clinical-problem that might lead to research or is a research question with clinical implications?
  • Setting: general internal medicine, held monthly, not at patient bedside,
  • residents come up with question about patient they have seen and share question with librarian team –>later debrief comparing/contrasting evidence found by resident vs librarian
  • particular emphasis on study design during discussion
  • Impact of GIM EBM rounds
    • information literacy
    • resource selection
    • efficient use of databases
    • precision searching: high quality, highly relevant information
    • *not only our students are searching for Practice Guidelines by entering guidelines into a search bar
  • WICU Pilot study
    • observational study to record clinical questions and what happens to them
    • ~38% were not answered
    • questions persisted and morphed over the course of the shift
  • Informationist participation impacting clinical practice
    • JHU Hospital Ethics Committee
    • Education Planning Curriculum Committee
    • Nursing Standards of Care Committee
    • Pediatric Staff Development Committee (allied health – social work, speech path, etc)
    • Emergency Medicine EBM Conference
  • Value indicators
    • increased grant proposal submissions
    • increased publication rates and authorship (journal articles, book chapter and updates, guideline development and updates, comprehensive reviews, systematic reviews)
    • 41% of time spent on comp and systematic reviews, writing methods sections, and more

Jonathan Hartmann, MLS – Georgetown University Medical Center

  • starting to use text mining to help with info retrieval
  • using diagnostic tools to help (DXplain, Isabel)
  • rounds are in internal medicine and PICU
  • carry iPad mini now – previously was done with mobile phone
  • NN/LM SEA Express Hospital awards to market the service
  • librarian vs infobuttons: librarian offers greater ability to respond, refine, and re-search

Terrie Wheeler, AMLS – National Institutes of Health

  • NIH Library Informationist program
  • 2011 JAMA article recognizes the contributions of these programs to medicine
  • Activities:
    • Instruction
    • Search/synthesize
    • Participate in clinical rounds (using iPads)
    • Write and edit manuscripts
  • Examples
    • Alicia Livinski, MPH, MA – Expertise: Social Media, Public Health
    • HHS Committee investigating allocation of medical resources after nuclear detonation
    • Info Intervention: literature search and analysis; working editor-in-chief of special journal supplement on topic
    • Impact: first article on this topic
    • Nancy Terry, MLS – Expertise: Public Health
    • NICHD and HHS Office of Disease Prevention and Health Promotion
    • Info Intervention: ID nutrition studies on children for birth-24 months; answering research questions for the Dietary Guidelines for Americans, 2015
    • Impact: 2015 Dietary Guidelines form the basis for federal public health food and nutrition programs – but how much money does this save? how does this impact patient health?
  • Clinical Search: Clinical Information System has links to NIHL bedside tool

Lauren Yaeger, MA, MLIS – St. Louis Children’s Hospital/Washington University

  • Positioned in the hospital
  • Involved with Resident EBM Curriculum/Resident Journal Club
    • iPass created by residents and given to librarian PRIOR to interaction, so librarian knows the context, abbreviations, etc ahead of time
  • Non-clinical rounds (ex: cleft palate and craniofacials rounds) – aim on interdisciplinary care
  • Worked on integrating library resources into EHR
    • Unless someone is standing there with the care provider and showing them how to use it, care providers won’t use EHR-linked resources

Questions

  • How is this role effective when you are a generalist and when you are a subject matter expert?
    • Subject expertise is important to service users, according to NIH project
    • General skill most needed is finding information quickly, but the subject background helps users not have to explain things quite as thoroughly, according to JHU
    • Rounding with residents tends to have questions and conversations at a more accessible level, but knowing the acronyms or nuances are helpful with searching and reviewing results, Georgetown
    • Teaching hospitals are also good environments, since the culture is teaching and introducing people
  • These services are all for the clinicians, not the patients

Panel 2 InfoButtons and Meaningful Use

Infobuttons and Meaningful Use
Guilherme Del Fiol, MD, PhD University of Utah, Moderator and presenter

  • Glycemic Management in a Patient with Type 2 Diabetes — NEJM NEJM 2013; 369:1370-1372 – case vignette
  • Clinician Info Needs
    • 20 patients a day
    • 12 info needs
    • 6 pursued
    • 4 meet
    • 4 = treatment alternatives
  • Reasons why info needs are not met
    • no time
    • doubt answers exist
    • not urgent
    • referred to specialist
    • deferred and forgotten
  • Positive impact on info seeking
  • 2-3 minutes max time spent searching
  • Implications
    • 60% of info needs not met
    • not getting better: less time, complex patients and knowledge
    • missed opportunity for improved care and lifelong learning
  • Informatics opportunities
    • efficient tools (30s-1m timeframe)
    • decision under complexity
    • EHR to become a learning environment, not just a documentation burden
    • integrate with maintenance of certification/CE
  • 1995 – release date for Columbia; 2002- Intermountain
  • Impact of Infobuttons
    • answers to 85% of questions
    • decision enhancement or learning in 62% of sessions
    • median session time: 35s
    • User satisfaction (69% to 92%)
    • Slow but growing usage (Partners Healthcare ~100k sessions/month
  • EHRs
  • Implementations
  • References

Nathan Hulse, PhD – Intermountain Healthcare

  • URL-based
  • primary effort on ‘developer’s side’ is to populate the right data points
  • content provided as metadata or presentation layer
  • launching PHR infobutton – this arena raises new questions regarding greater contextual question, reading level
  • Supported infobutton resources
      • local content
      • genetic home reference
      • gene review
      • Cochrane
      • MerckIndex
  • Resource selection considerations
    • clinical
    • usage patterns
      • how many hits
      • where are they originating from
      • cost per click
      • unique users
    • overall cost
    • perceived value
    • CME credit integration
    • Overlaps in content coverage
  • Achieving meaningful use
    • integrating infobuttons in multiple, overlapping systems
    • ‘documenting’ that education materials were given
    • new coverage in areas like imaging, allergies, and other domains

Consumer Health Information and InfoButtons
Leslie Kelly Hall, Healthwise

  • infobutton more contextually relevant as it is in workflow
  • provides conversation shift from where to find things to relevancy review of articles

Stratton Lloyd, BA – EBSCO Information Services

  • new model for aggregating content
    • actionable content, contextual searching, integrating into tools
    • Point of Care tools
      • PEMSoft
      • Nursing Reference Center
      • Social Work Reference Center
  • Content access via EMR/EHR
  • 2 key content sets: patient education  vs clinical reference content
  • patient ed requires significant effort in EMR system, but clinical reference does not

Overall, infobuttons are just getting on the roadmap for EHRs

Panel 1 The Role of Standard Vocabularies in Meaningful Use

The Role of Standard Vocabularies in Meaningful Use: LOINC
Clement J. McDonald, MD, FACMI
Director, NLM Lister Hill National Center for Biomedical Communications (LHNCBC)

  • average patients have 4 visits per year – 1/2 to primary care and 1/2 to specialists
  • LOINC – one of 3 NLM systems required in meaningful use (others are RxNorm and SNOMED)
    • has 6 major parts and can include up to 13 different parts
    • variables have synonyms, descriptions, links to references, data types, cardinality, and more
  • used in 157 countries, incl. national standard for 10 countries (Australia, Canada, France, Germany) and translated into 16 languages
  • has 2k most common items listed
  • web browser search/nav option
  • hospital labs must report individual lab tests and some clinical measurements with LOINC codes.  For example,
    • tests reported to public health
    • cancer tumor registry

SNOMED CT and Meaningful Use
James Case, DVM, PhD, FACMI – NLM – SNOMED

  • ID structure composed of extension item ID, namespace ID, partition ID, and check digit
  • 890k relationships
  • 777k descriptions
  • 297k concepts
  • IHTSDO – manages SNOMED and change request submissions

RxNorm and Meaningful Use
Patrick McLaughlin, MLIS – NLM

  • grew out of UMLS
  • followed HL7 drug model – based upon clinician prescribing rather than pharmacy ordering/fulfillment
  • two important driving factors: 1) improved interoperability 2) patient safety concerns
  • collection of commonly-used public and private drug vocabs (ex: Micromedex, Multum, Gold Standard, MeSH, SNOMED, VA National Drug File, FDA Structure Product Labels aka DailyMed, Anatomical Therapeutic Chemical Classification System, Medi-Span, First DataBank)
  • finding names is easy, but finding strengths is challenging
  • RXCUI (RxNorm concept unique identifier) – for what would be prescribed to the patient
  • How RxNorm is Structured
    • SCD – generic drug (~20k)
    • SBD – branded drugs (~10.5k)
    • GPCK – generic pack (multiple drugs in same pack) 333
    • BPCK – branded pack 410
  • medication standard for Stage 2 of meaningful use
    • medication reconciliation across multiple settings or care providers
    • MedlinePlus Connect – links EHR/PHR to MedlinePlus consumer health information via RXCUI match-up –> meets patient-specific information
  • need to register with UMLS for license but the license is free