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  • 1. WHAT IS THE INFORMATIONIST? PAMELA C. SIEVING, MA, MS BIOMEDICAL LIBRARIAN and INFORMATIONIST NATIONAL INSTITUTES OF HEALTH LIBRARY BETHESDA, MARYLAND USA
  • 2.  
  • 3.  
  • 4. WHAT IS AN INFORMATIONIST?
    • HISTORY of A NEW IDEA
    • CURRENT STATUS
      • WHY ARE INFORMATIONISTS NEEDED?
      • WHAT WILL THEY DO?
      • WHERE WILL THEY COME FROM?
    • FUTURE CHALLENGES AND OPPORTUNITIES
  • 5. THE EVOLUTION OF A NEW SPECIALIZATION
    • Gertrude Lamb 1972
      • “ And Now, ‘Clinical Librarians’ On Rounds” ( JAMA 1974; 230:521)
  • 6. THE EVOLUTION OF A NEW SPECIALIZATION
    • SCURA: CASE-RELATED USE OF THE MEDICAL LITERATURE: CLINICAL LIBRARIAN SERVICES FOR IMPROVING PATIENT CARE. JAMA 1981; 245:50
    • LAMB: A DECADE OF CLINICAL LIBRARIANSHIP ( CLINICAL LIBRARIAN QUARTRLY 1982; 1:2)
    • VEENSTRA: A CLINICAL LIBRARIAN PROGRAM IN THE INTENSIVE CARE UNIT ( CRITICAL CARE MEDICINE 1992; 20:1038)
    • GIUSE: ADVANCING THE PRACTICE OF CLINICAL MEDICAL LIBRARIANSHIP ( BULLETIN OF THE MEDICAL LIBRARY ASSOCIATION 1997; 85:437)
    • SCHACHER: CLINICAL LIBRARIANSHIP: ITS VALUE IN MEDICAL CARE ( ANNALS OF INTERNAL MEDICINE 2001; 134:717)
  • 7. THE EVOLUTION OF A NEW SPECIALIZATION
    • Davidoff and Florance 2000
      • “ The Informationist: A New Health Profession?” ( Annals of Internal Medicine 2000; 132: 996)
  • 8. GOALS OF CLINICAL LIBRARIANSHIP
    • IMPROVE PATIENT CARE
      • “ Deliver patient-specific information in a timely,
        • cost-effective manner” (Veenstra & Gluck, 1992)
  • 9. GOALS OF CLINICAL LIBRARIANSHIP
    • IMPROVE PATIENT CARE
    • INCREASE INFORMATION-SEEKING SKILLS OF HEALTH CARE PROVIDERS
      • “ By example and by direct teaching, the clinical librarian could upgrade the information seeking behavior of the health professional by sharing with him the librarian’s skills”
        • (Lamb, 1982)
  • 10. GOALS OF CLINICAL LIBRARIANSHIP
    • IMPROVE PATIENT CARE
    • INCREASE INFORMATION-SEEKING SKILLS OF HEALTH CARE PROVIDERS
    • CONTRIBUTE TO EDUCATION OF HEALTH CARE PROVIDERS
      • “ Clinicians who are actively assisted by clinical librarians are able to gather information from a wide selection of medical publications rather than relying only on memory or the advice of a few colleagues.” (Schacher, 2001)
  • 11. GOALS OF CLINICAL LIBRARIANSHIP
    • IMPROVE PATIENT CARE
    • INCREASE INFORMATION-SEEKING SKILLS OF HEALTH CARE PROVIDERS
    • CONTRIBUTE TO EDUCATION OF HEALTH CARE PROVIDERS
    • ENHANCE STATUS OF MEDICAL LIBRARIANS
  • 12.  
  • 13.  
  • 14.  
  • 15.  
  • 16.  
  • 17. THE INFORMATIONIST: THE LOGICAL NEXT STEP?
  • 18. PUTTING THE CONCEPT INTO PRACTICE
    • MLA Philadelphia Regional Chapter
    • Oct. 2000: The Medical Informationist and Other Roles for the Librarian in the 21st Century ( Journal of the Medical Library Association 2002; v. 90)
    • MLA/NLM conference 2002 at NIH in Bethesda
  • 19. 2002 INVITATIONAL CONFERENCE GOALS:
    • FACILITATE NATIONAL DISCUSSION
    • DERIVE CONSENSUS DEFINITION
    • DEVELOP RECOMMENDATIONS FOR ACTION IN
      • CLINICAL DOMAIN
      • RESEARCH DOMAIN
  • 20. ATTENDED BY
    • ACCREDITING ORGANIZATIONS
    • HEALTH & MEDICAL ASSOCIATIONS
    • HOSPITALS & HEALTH SYSTEMS
    • LIBRARY ASSOCIATIONS
    • LIBRARIANSHIP EDUCATORS
    • NLM
    • NATIONAL NETWORK OF LIBRARIES OF MEDICINE
    • PRACTICING INFORMATIONISTS & CLINICAL LIBRARIANS
  • 21. WHY DO WE NEED CLINICAL INFORMATIONISTS?
    • INFORMATION IS SCATTERED; NOT WELL INDEXED
    • ELECTRONIC SEARCHES ARE COMPLEX
    • THE LINK BETWEEN INFORMATION AND PATIENT CARE IS OFTEN MISSING
    • CLINICAL LIBRARIANS HAVE PROVEN THEIR VALUE AND ARE MOVING BEYOND OLD LIMITS ON THEIR WORK
    • PHYSICIANS HAVE LIMITED INTEREST AND EXPERTISE IN SKILLS NECESSARY FOR GOOD RETRIEVAL
    • IMPORTANCE OF USING PHYSICIAN’S SKILLS and TIME APPROPRIATELY
  • 22. WHAT DO INFORMATIONISTS DO? (What is a librarian doing here, anyway?)
  • 23. WHAT DO INFORMATIONISTS DO?
    • “ ROUND” WITH PATIENT CARE TEAM (physicians nurses, dieticians, pharmacists, therapists, students)
  • 24. WHAT DO INFORMATIONISTS DO?
    • “ ROUND” WITH PATIENT CARE TEAM
    • RESPOND TO EXPRESSED INFORMATION NEEDS
  • 25. WHAT DO INFORMATIONISTS DO?
    • “ ROUND” WITH PATIENT CARE TEAM )
    • RESPOND TO EXPRESSED INFORMATION NEEDS
    • ANTICIPATE INFORMATION NEEDS
  • 26. WHAT DO INFORMATIONISTS DO?
    • “ ROUND” WITH PATIENT CARE TEAM
    • RESPOND TO EXPRESSED INFORMATION NEEDS
    • ANTICIPATE INFORMATION NEEDS
    • INDIVIDUALIZED, POINT-OF-NEED INSTRUCTION
  • 27. WHAT DO INFORMATIONISTS DO?
    • “ ROUND” WITH PATIENT CARE TEAM
    • RESPOND TO EXPRESSED INFORMATION NEEDS
    • ANTICIPATE INFORMATION NEEDS
    • INDIVIDUALIZED, POINT-OF-NEED INSTRUCTION
    • CONTRIBUTE TO KNOWLEDGE BASE
  • 28. WHERE WILL WE FIND THE CLINICAL INFORMATIONIST?
  • 29. WHERE WILL WE FIND THE CLINICAL INFORMATIONIST?
    • IN THE CLINIC
  • 30. WHERE WILL WE FIND THE CLINICAL INFORMATIONIST?
    • IN THE CLINIC
    • ON ROUNDS
  • 31. WHERE WILL WE FIND THE CLINICAL INFORMATIONIST?
    • IN THE CLINIC
    • ON ROUNDS
    • AT MEDICAL CONFERENCES
  • 32. WHERE WILL WE FIND THE CLINICAL INFORMATIONIST?
    • IN THE CLINIC
    • ON ROUNDS
    • AT MEDICAL CONFERENCES
    • IN MEETINGS
  • 33. WHERE WILL WE FIND THE CLINICAL INFORMATIONIST?
    • IN THE CLINIC
    • AT ROUNDS
    • AT MEDICAL CONFERENCES
    • AT MEETINGS
    • NOT IN THE LIBRARY SO OFTEN !?!!??
  • 34. ARE WE BETTER LIBRARIANS ANSWERING QUESTIONS AT A DESK OR IN THE CLINIC?
  • 35.  
  • 36. THE TECHNICAL INFRASTRUCTURE IS IN PLACE TO SUPPORT ANYTIME-ANYWHERE ACCESS TO INFORMATION -- FLORANCE , ‘ INFORMATIONISTS, CYBRARIANS AND BEYOND’
  • 37. WHY ARE WE NEEDED??
  • 38.
    • MEDICAL INFORMATION DOUBLES EVERY 19 YEARS (WYATT: LANCET 1991; 338:1368)
  • 39.
    • MEDICAL INFORMATION DOUBLES EVERY 19 YEARS
    • IN US, AT LEAST 44,000 DEATHS EACH YEAR FROM MEDICAL ERRORS (Leape: JAMA 1994; 272:1851)
  • 40.
    • MEDICAL INFORMATION DOUBLES EVERY 19 YEARS
    • IN US, AT LEAST 44,000 DEATHS EACH YEAR FROM MEDICAL ERRORS
    • AVERAGE TIME/PATIENT IS 7-10 MINUTES IN US (National Ambulatory Medical Care Survey)
  • 41.
    • MEDICAL INFORMATION DOUBLES EVERY 19 YEARS
    • IN US, UNNECESSARY 44,000 DEATHS/YEAR
    • AVERAGE TIME/PATIENT IS 7-10 MINUTES IN US
    • MOST PHYSICIANS PERFORM <ONE SEARCH/ WEEK (HERSH: JAMA 1998; 280:1347)
  • 42. SMITH, 1996 ( BMJ 313:1062)
    • DOCTORS ARE AWARE OF INFORMATION NEEDS
    • MOST NEEDS CONCERN DRUGS AND OTHER TREATMENTS
    • OFTEN COMPLEX AND MULTIDIMENSIONAL
    • NOT JUST MEDICAL KNOWLEDGE NEEDED
    • MOST GO UNANSWERED
    • MOST CAN BE ANSWERED
    • DOCTORS ASK OTHER DOCTORS MOST OFTEN
    • OVERWHELMING INFORMATION IN DEVELOPED COUNTRIES
  • 43. ARE CLINICAL GUIDELINES THE ANSWER? CAN PDA’s DO MORE THAN PROVIDE ‘QUICK AND DIRTY’ ANSWERS?
  • 44. IMAGINE: ONE PATIENT 5 DIAGNOSES EACH DIAGNOSIS HAS 2 POSSIBLE TREATMENTS…
  • 45. NO ONE CAN IMAGINE:
    • ONE PATIENT, 5 DIAGNOSES, EACH WITH 2 POSSIBLE TREATMENTS…
    • 3,628,800 POSSIBLE TREATMENT COURSES!
    • (Welsby, Journal of Evaluation in Clinical Practice
    • 2002; 8:163)
  • 46. IN THE NEO-NATAL INTENSIVE CARE UNIT HOW MANY DECISIONS PER BABY PER DAY?
  • 47. IN THE CLINICAL RESEARCH SETTING WHAT ARE THE COSTS OF IMPORTANT REFERENCES MISSED?
  • 48. WHICH QUESTION WILL MAKE A DIFFERENCE TODAY?
  • 49. JOHNS HOPKINS DEATH SUMMER 2001
    • HEALTHY VOLUNTEER DIED
    • REACTION RECOGNIZED IN THE LITERATURE IN ’50’s
    • INADEQUATE LITERATURE SEARCH A FACTOR
    • NEW GUIDELINES ADOPTED BY JHU and MLA
  • 50. TRADITIONAL LIBRARIAN SKILLS
    • RECOGNIZE GAP IN KNOWLEDGE
    • FORMULATE QUESTION
    • SEARCH FOR RELEVANT INFORMATION
    • FORMULATE ANSWER
    • USE ANSWER TO GUIDE ACTION
    • “ SAVE THE TIME OF THE READER”
  • 51. EVIDENCE BASED MEDICINE
    • CONSCIENTIOUS, EXPLICIT and JUDICIOUS USE of
    • CURRENT EVIDENCE
    • in MAKING DECISIONS
    • about the CARE OF INDIVIDUAL PATIENTS
  • 52. GUYATT et al ( BMJ 2000; 320:954):
    • MANY CLINICIANS NOT INTERESTED IN SKILLS TO FIND AND USE BEST ORIGINAL LITERATURE
    • THOSE THAT DO HAVE NO TIME TO APPLY SKILLS
    • INCREASED USE OF FILTERED SUMMARIES IN PRINT
  • 53. CLINICAL INFORMATIONIST
    • TRADITIONAL SKILLS OF LIBRARIANS
    • TRAINING IN EVIDENCE-BASED MEDICINE
    • INFORMATION IS PRIMARY RESPONSIBILITY
    • CONTINUALLY IMPROVING THE LIBRARY’S SUPPORT OF INFORMATION NEEDS
  • 54. INFORMATIONISTS COMFORTABLY BETWEEN TWO WORLDS
    • PER DAVIDOFF AND FLORANCE:
      • TRAINED IN THE ESSENTIALS OF CLINICAL WORK AND ABLE TO FUNCTION IN A CLINICAL CARE TEAM
      • CLEAR AND SOLID UNDERSTANDING OF INFORMATION SCIENCE
      • -- PRIMARY EDUCATION MAY BE INFORMATION OR BIOMEDICAL SCIENCE
  • 55. OPTIONS FOR EDUCATION AND TRAINING OF LIBRARIANS AS INFORMATIONISTS
    • DUAL-DEGREE PROGRAMS
    • INTERNSHIPS & FELLOWSHIPS
    • CONTINUING EDUCATION COURSEWORK
    • ON-THE-JOB TRAINING
    • SPECIALIZED TRAINING PROGRAMS
    • MENTORSHIPS
  • 56. OPTIONS FOR EDUCATION AND TRAINING OF SCIENTISTS, NURSES, PHARMACISTS AND PHYSICIANS AS CLINICAL INFORMATIONISTS
    • DUAL OR COMBINED DEGREE PROGRAMS
    • SPECIALIZED TRAINING PROGRAMS ( NLM)
    • ON THE JOB TRAINING
    • CONTINUING EDUCATION
    • FELLOWSHIPS AND INTERNSHIPS
  • 57. WHAT ABOUT RESEARCH INFORMATIONISTS?
  • 58. WHAT ABOUT RESEARCH INFORMATIONISTS?
    • “ TWO HOURS IN THE LAB WILL SAVE
    • ONE HOUR IN THE LIBRARY”
  • 59. WHAT ABOUT RESEARCH INFORMATIONISTS?
    • “ TWO HOURS IN THE LAB WILL SAVE
    • ONE HOUR IN THE LIBRARY”
    • “ ASK FRANK!”
  • 60. WHAT ABOUT RESEARCH INFORMATIONISTS?
    • “ TWO HOURS IN THE LAB WILL SAVE
    • ONE HOUR IN THE LIBRARY”
    • “ ASK FRANK!”
    • RESTRICTIONS ON ANIMAL USE
  • 61. WHAT ABOUT RESEARCH INFORMATIONISTS?
    • “ TWO HOURS IN THE LAB WILL SAVE
    • ONE HOUR IN THE LIBRARY”
    • “ ASK FRANK!”
    • RESTRICTIONS ON ANIMAL USE
    • GENETIC DATABASES
  • 62. PILCH ( UNPUBLISHED, 2001): NIH RESEARCHERS NEED ASSISTANCE WITH:
    • LITERATURE SEARCHES OUTSIDE OWN AREA
    • EVALUATION FOR RELEVANCE AND QUALITY
    • APPLICATIONS OF TECHNIQUES AND KNOWLEDGE FROM UNFAMILIAR AREAS OF RESEARCH
    • RESEARCH UPDATES
    • BACKGROUND INFORMATION SUMMARIES
    • UNFAMILIAR DATABASES
      • SCIENTIFIC TRAINING AND COMPETENCE OF INFORMATIONIST MOST IMPORTANT
  • 63. CAN INFORMATIONISTS WORK WITH PATIENTS?
    • PATIENT INFORMATION CENTERS
    • WEBSITES FOR PHYSICIANS, HOSPITALS, PROFESSIONAL ORGANIZATIONS, DRUG COMPANIES
    • CYBERSENIORS
      • 34% OF U.S. HOME COMPUTER USE IS BY THOSE OVER 65 ( www.aoa.dhhs.gov/aoa/stats/profile/2001/13.html)
  • 64. CAN INFORMATIONISTS CREATE INFORMATION? SHOULD THEY?
    • META-INFORMATION
      • “ INFORMATION about INFORMATION”
    • KNOWLEDGE BASES
    • ASSESSMENT OF NEW PROGRAMS
    • WORK WITH DATABASE PRODUCERS
    • PARTICIPATE IN EVIDENCE-BASED PROGRAMS
    • ORGANIZE INTERNATIONAL and THIRD-WORLD PROGRAMS
  • 65. NIH LIBRARY INFORMATIONIST MODEL
    • CLINICAL ROUNDS
    • ASSISTANCE WITH CLINICAL RESEARCH FROM PROTOCOL TO PUBLICATION
    • CONSENSUS CONFERENCE SUPPORT
    • KNOWLEDGE BASE
    • WEBSITE DEVELOPMENT
    • EXPLORATIONS BEYOND NIH CAMPUS
    • WHO
    • COCHRANE COLLABORATION
    • INTERNATIONAL COLLABORATIVE EFFORTS TO CONNECT MEDICAL KNOWLEDGE AND PATIENT NEEDS
  • 66. VANDERBILT UNIVERSITY MODEL
    • CLINICAL LIAISONS
      • ROUND
      • FILTERED EBM SEARCHES
      • KNOWLEDGE BASE
      • CONTINUAL LEARNING
        • SEARCH AND FILTERING JOURNAL CLUBS
        • 50+ MODULES FOR STAFF DEVELOPMENT
        • FORMAL CLASSES
    • RESEARCH INFORMATIONISTS
      • PARTICIPATE ON RESEARCH TEAMS
      • EXPERT SEARCHING
      • SHARE KNOWLEDGE WITH LIBRARY STAFF
      • CONTINUAL LEARNING WITH SOME ELEMENTS AS CLINICAL LIAISONS
  • 67. OBSTACLES
    • NO ACADEMIC PROGRAMS ESTABLISHED YET
    • PERSONAL COSTS FOR ADDITIONAL DEGREE OR TRAINING
    • UNCERTAIN RECOVERY OF ADDITIONAL COSTS
    • DIFFICULTY INTEGRATING PROFESSIONALS WITH DIFFERENT BACKGROUNDS IN SAME POSITION
    • RELUCTANCE OF SOME (PHYSICIANS, RESEARCHERS ) TO GIVE UP AUTHORITY OR ADMIT LIMITATIONS
  • 68. ADDITIONAL CHALLENGES
    • NEW MODEL vs OLD MODEL of WHAT A LIBRARIAN IS
    • CONTINUAL LEARNING vs INCREASED DEMANDS ON TIME AND DECREASED FUNDING
    • TWO-TIER STRUCTURE FOR INFORMATIONISTS WITHIN A SINGLE INSTITUTION
    • WHO WILL PAY?
    • EVALUATION OF NEW PROGRAMS
  • 69. THE FUTURE
    • INCREASING ACCESS TO MORE INFORMATION
    • NEW TECHNOLOGY
    • DEMAND FOR BETTER MEDICAL CARE
    • NEED TO CONTROL COSTS
    • AGING POPULATION
    • NEW HEALTH THREATS
    • MORE ATTENTION TO ETHICS and PATIENT RIGHTS
    • BETTER-INFORMED PATIENTS
  • 70. HOW WILL WE RESPOND?
  • 71. MAKE VISIBLE WHAT, WITHOUT YOU, MIGHT NEVER HAVE BEEN SEEN. --ROBERT BRESSON, FILM-MAKER