Karen Dahlen, Project Consultant
Elaine Martin, Director
New England Region NN/LM Lamar Soutter Library
University of Mass...
Why This Project : Goals & Technology
Relationship to National /State Initiatives
Selected Resources Tied to Sources of Ev...
Unequal access to trusted library resources
 Public Health Departments have lost
in-house libraries, budget, and staff
 ...
Competencies Defined By
PHF/Council on Linkages


Analytic/Assessment Skills
›
›
›



Policy Development/Program Plannin...
Maryland DHMH Health Initiatives










Health Disparities(sexual minorities)
Preventive Services ACA*
Routine HI...








Identify core, useful, trusted e-resources to State
Departments of Health to improve evidencebased practice.
...
IT authentication provides direct access
to full-text;
 SharePoint (Web application) is utilized
to manage access when st...
Objective


Scientific literature in systematic reviews



Scientific literature in one or more journal articles



Pub...







Incorporate system strengths of existing government
agencies: NLM, CDC, NAL.
Partnerships with libraries and ...
Overall Project Plan
Resources & Tools Currently Being Tested
Partnerships & Digital Libraries in Place
Training Agenda/Tr...




To identify “core” trusted
library resources available
directly through a digital library
interface. identified thro...
State

Public Heath Department
Partners

Hospital /Academic Library
Partners

AK

Alaska Division of Public Health (AKDH)
...
Factors Influencing Rule
(Collective Data)







Number Attending Training
Number Responding to Journal
Survey Monkey...
NLM Databases: PubMed, Toxnet + ASABE
 NAL’s Information Centers (Water Quality/Food Safety)
 CDC’s New Repository
 Coc...
Single Titles (14) – Societies +















Health Affairs
American Journal of Tropical Medicine &
Hygien...
NLM’s PubMed, PubMed Central, Toxnet +
NAL’s Information Centers





Food and Nutrition Information Center (FNIC)
Foo...











Rapid access to a comprehensive array of peer-reviewed
articles.
Direct access to full text without go...
Information Need Related to Work Task
HI, AK, HI, IN, MA, MD=1514
1200

1119

1000
800
600
400
200
0

851

643

819

718

...
Connecticut Department of Public Health

Arkansas Department of Health
Alaska Division of Public Health

Hawaii State Department of Health
Functionality

--Search web for full-text–
symbol: paperclip
--Create Groups, e.g., just vaccines
--Ability to Search mult...













Journal SurveyMonkey (baseline data)
Enterprise Licensing (cost effectiveness over time)
Vendor sta...
Use of Resources & Cost Efficiencies
New Resources & Preliminary Data
Training: Content & Summary
Lessons Learned & Outcom...
NEJM Use by 15 PHDs

Public Health May 2011Department Apr 2012

Jan 2013July 2013

8000
6000
4000
2000
0

May 2011-Apr 201...
Total Use by Each PHD
PHDs
MDPH
CT DPH
KY DPH
ADH
MDHMH
Maine CDC
VDH
WI DPH
RIDH
AK DPH
CDPHE
NH DHHS
BPHC
HI DPH

Total
...
Title
BMJ

Use of Journals added in
May, 2013
 Represents 8 different
publishers
 Journals contain topical
interest of p...
Total Use=632

22 Documents Sept 2013
N=23






Formulated literature searches
Evidence-based guidelines
Systematic reviews
Review of best practices
Public Hea...
Training Topics – Day 1



Welcome & Overview
Public Health Leadership

Training Topics – Day 2



Review of Digital Lib...
STATE

PHD

Trainings

Attendance

Maryland

Indiana

Hawaii

Nutrition
Specialist (2)

State
Epidemiologist

Education
Co...
Journal Title

# Uses

Cost
Per Use

Replacement
Cost

Cost of
License

Am J Tropical Med & Hygiene

410

$1.58

$4,510

$...
May 2011 – April 2012; Cost=$18,384

May 2012 --- April 2013; Cost=$12,241
ILL

DD

Total

2

20

22

154

90

244

Massac...
Direct Access to Articles
Alternative Article Delivery

Contract Year

Total #

Amount

May 2012-Apr 2013

15

200,352

Ma...


Better Understanding of the Culture
› Relationships – of workforce: variance in skills and

knowledge, variance in topi...
Work with the “Built Environment” to provide
a sustainable model for all Public Health
Departments.
 Continue to Promote ...
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Digital Access to the World's Literature: A Blueprint to Integrate Evidence with Practice

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Lamar Soutter Library Director Elaine Martin and Consultant Karen Dahlen introduce a digital public health library initiative that supports national and state public health departments. Success stories and next steps to build a sustainable digital library model for all public health department is covered.

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  • Tools to be designed to be usable by non-technical users. Sharepoint is often used to provide internet portal management. It also has system integration and process integration.
  • Where does evidence come from?
  • Access is built on PHD IT strengths, enterprise licensing and improved collaborations with agencies and libraries. Related to “built” environment.
  • .
  • Maintain existing partnerships
  • Journal SurveyMonkey (recommended by Maine CDC as one of first in project) to findout what journals are already being used by the public health workforce and and who owns subscriptions (personal, e.g., through membership), by Department or scattered through. Information is useful in providing a more enterprise approach to access.First survey designed to provide baseline data for both the public health department and the Project.Pre/Post Training links– identifies what resources are familiar and used – also allows an opportunity to vent.
  • Remember the graphic only depicts use by individualphds – the total is calculated in the chart.
  • Identification of what is core, useful to improve evidence-based practice. $2.23. Cost of License $22,153
  • This is a segment now provided by leadership, epidemiologist (in Maryland’s case, it was Don Shell, MD. MPH Director of the Cancer and Chronic Disease, Bureau, Maryland Department of Health and Mental Hygiene. All content areas contain same/similar objectives. Instructors include personnel from Resource Libraries, hospital libraries, RML personnel (in some cases), Project Coordinator, and selected vendors. Training runs from 9:00 am-1:00 on day 1 (longer time alloted for EndNote) and 9:00 am - 12:30 on second day. Training is combination of demo with people following along at computer; short ppt’s for introduction followed by subsequent exercise.**What resources were chosen and why;
  • Digital Access to the World's Literature: A Blueprint to Integrate Evidence with Practice

    1. 1. Karen Dahlen, Project Consultant Elaine Martin, Director New England Region NN/LM Lamar Soutter Library University of Massachusetts Medical School
    2. 2. Why This Project : Goals & Technology Relationship to National /State Initiatives Selected Resources Tied to Sources of Evidence Work Within Existing Environment
    3. 3. Unequal access to trusted library resources  Public Health Departments have lost in-house libraries, budget, and staff  Library models are in constant change; many caught in dated practices and licenses dictate access policies. 
    4. 4. Competencies Defined By PHF/Council on Linkages  Analytic/Assessment Skills › › ›  Policy Development/Program Planning Skills ›  References sources of public health data and information. Uses information technology to collect, store, and retrieve data. Utilizes data to address scientific, political, ethical, and social public health issues. Analyzes information relevant to specific public health policy issues Project Tied to Competencies  Knowledge Informatics › Improve access to trusted resources › ›  Informatics Skills › Introduce interoperable features that Public Health Sciences Skills › › › Relates public health science skills to the Core Public Health Functions. Conducts a comprehensive review of the scientific evidence related to a public health issue, concern, or intervention. Retrieves scientific evidence from a variety of text and electronic sources. directly to the desktop. Describe relationships and functionality of e-resources to core public health functions/interests. Introduce specific types of resources, e.g., coding and classification tools. › › support public health work, e.g., guidelines, calculators, connectivity to trusted public sites; advanced search capability/filters. Use of Citation Management Program to save, store & reuse information. Train on use of topical alerts as a education tool.
    5. 5. Maryland DHMH Health Initiatives       Health Disparities(sexual minorities) Preventive Services ACA* Routine HIV screening Immigrant Health Undocumented individuals under ACA Drug Resistant Disease which impacts Impact on TB, STI (plus others) Health Care Reform and Interpersonal Violence/Domestic Violence Screening/Identification Infectious Diseases Hepatitis C Virus (HCV) HIV Infections --HIV and HCV Co-Infection *ACA –Affordable Care Act
    6. 6.      Identify core, useful, trusted e-resources to State Departments of Health to improve evidencebased practice. Provide direct access to subscribed + resources through an organized “digital library” page. Promote ubiquitous access based on IP authentication and enterprise licensing. Train on resources & tools related to scientific literature review to support evidence-based practice. Monitor and update aspects of evaluation plan (data model)
    7. 7. IT authentication provides direct access to full-text;  SharePoint (Web application) is utilized to manage access when staff is located distant from main site;  NLM’s linkout technology improves connectivity to full-text;  E-Book interoperability with trusted resources saves time and energy. 
    8. 8. Objective  Scientific literature in systematic reviews  Scientific literature in one or more journal articles  Public health surveillance data  Program evaluations  Qualitative data › Community members › Other stakeholders  Media/marketing data  Word of mouth  Personal experience Subjective From: Evidence-Based Public Health, A Course in Chronic Disease Prevention Ross C. Brownson PhD
    9. 9.       Incorporate system strengths of existing government agencies: NLM, CDC, NAL. Partnerships with libraries and agencies to facilitate timely information. Resources (both licensed and freely) integrate major health findings into routine work. Resources support improved practice and nurture career pathways for the public health workforce. Training encourages use of scientific literature to support work related processes. Enterprise licensing provide cost efficiencies.
    10. 10. Overall Project Plan Resources & Tools Currently Being Tested Partnerships & Digital Libraries in Place Training Agenda/Trainings Held Ongoing Evaluation Processes
    11. 11.   To identify “core” trusted library resources available directly through a digital library interface. identified through benchmarking, direct requests, wish lists, and searches. Resources not directly available are subsidized through participating National Library of Medicine Network Members. Digital Library PHD Site Timely Information in Support of EvidenceBased Alternate Article Delivery via Libraries Public Health Practice
    12. 12. State Public Heath Department Partners Hospital /Academic Library Partners AK Alaska Division of Public Health (AKDH) Univ of Alaska (Anchorage) Medical Library AR Arkansas Department of Health (ADH) Univ of Alabama Medical Sciences Library CO Colorado Department of Health & Environment Poudre Valley Health System Library CT Connecticut Public Health Department University of Conn Maynard Stowe Library HI Hawaii Department of Health University of Hawaii Medical Library IN Indiana State Department of Health Ruth Lily Medical Library, Indiana University KY Kentucky Department for Health University of Kentucky Medical Library ME MA Maine CDC Boston Public Health Commission* Maine Medical Center Library University of Massachusetts Soutter Library MA Massachusetts Public Health Department Lemuel Shattuck Hospital Library MD Maryland Dept of Health & Mental Hygiene University of Maryland HS Library NH New Hampshire DHHS New Hampshire DHHS Library RI Rhode Island Department of Health (RIDH) Rhode Island Hospital/Lifespan VT Vermont Department of Health (VDH) UVM Dana Medical Library WI Wisconsin Department of Health Services Ebling Library of the Health Sciences
    13. 13. Factors Influencing Rule (Collective Data)     Number Attending Training Number Responding to Journal Survey Monkey Identification of Divisions and Program Areas Utilizing Information (T=10, 124) 10 % of Total =1,012 State PHD FTE Early Users % Users ADH *695 69 10% AKDPH 525 55 10% BPHC* *650 65 10% CDPHE *600 60 10% CT DPH 400 40 10% Hawaii DPH *750 75 10% ISDH 780 75 10% Kentucky 400 40 10% MDHMH *2000 200 10% 395 40 10% *1500 150 10% NH DHHS 279 30 10% RIDH 400 40 10% VDH 350 35 10% WDPHS 400 40 10% Maine CDC MDPH
    14. 14. NLM Databases: PubMed, Toxnet + ASABE  NAL’s Information Centers (Water Quality/Food Safety)  CDC’s New Repository  Cochrane Systematic Reviews  STAT!Ref (40 e-book titles)  Global Health (Cabi)  CLSI (Clinical Standards Database)-New in 2013  ASABE Online Technical Library 
    15. 15. Single Titles (14) – Societies +              Health Affairs American Journal of Tropical Medicine & Hygiene Journal of Agricultural Safety Journal of Exposure Science & Environmental Epidemiology Journal of Food Protection Journal of Public Health Policy Journal of Studies on Alcohol & Drugs Journal of Wildlife Diseases International Journal of Tuberculosis New England Journal of Medicine Pediatrics (American Academy of Pediatrics) Public Health Reports Scandinavian Journal of Work, Government Produced Journals (5)      Emerging Infectious Disease Environmental Health Perspectives Journal of Agricultural Health & Safety Morbidity & Mortality Weekly Report (MMWR) Preventing Chronic Disease E-Journal Packages (110)            Annual Reviews (9) American Society of Nursing (3) BJM Journals (6) Oxford University Press (20) Ovid --Wolters Kluwer (2) Mary Ann Liebert (12) Maney Publishing (3) Ovid (LWW) Titles (6) Sage (11) Springer (18) + 4 University of Chicago Press (6) American Society of Microbiology (12)
    16. 16. NLM’s PubMed, PubMed Central, Toxnet + NAL’s Information Centers     Food and Nutrition Information Center (FNIC) Food Safety Information Center (FSIC) National Invasive Species Information Center (NISIC) Water Quality Information Center (WQIC) CDC Resources Related to Literature Review      Community Guide to Preventive Services CDC Journals: MMWR, EID, PCD (alpha inclusion in journal list) Science Clips CDC Stacks Data & Statistics by Topic (NCHS; FastStats; Interview Surveys)
    17. 17.          Rapid access to a comprehensive array of peer-reviewed articles. Direct access to full text without going through a library. Access to electronic textbooks and reference books. Best-practices guidelines from all states. Recorded lectures from medical schools, schools of public health, etc. Ways to save ongoing searches. Access to an image library. Access to cited references. Catalog of model public health laws.
    18. 18. Information Need Related to Work Task HI, AK, HI, IN, MA, MD=1514 1200 1119 1000 800 600 400 200 0 851 643 819 718 698 577 393 539 564 455 380 227 151
    19. 19. Connecticut Department of Public Health Arkansas Department of Health
    20. 20. Alaska Division of Public Health Hawaii State Department of Health
    21. 21. Functionality --Search web for full-text– symbol: paperclip --Create Groups, e.g., just vaccines --Ability to Search multiple databases, e.g., and e-books --Cite While you Write Feature With Word --Drag/Drop article into record --Input records manually or electronically --Records can be ordered by clicking on the field, e.g., year 18 copies provided as incentive to improve skills; save time; comply with national competency objectives.
    22. 22.           Journal SurveyMonkey (baseline data) Enterprise Licensing (cost effectiveness over time) Vendor statistical reports validate “use of resources” Monthly reports from “library partners” to measure use and identify resources to add to Digital Library Page Ongoing capture of suggested e-books, journals, and databases to enhance collection Results from Pre-Post training links Feedback from hands-on training Interviews with leaders and workforce Focus group sessions Quarterly/Annual Reports (submitted to NLM)
    23. 23. Use of Resources & Cost Efficiencies New Resources & Preliminary Data Training: Content & Summary Lessons Learned & Outcomes Enterprise Cost Efficiencies
    24. 24. NEJM Use by 15 PHDs Public Health May 2011Department Apr 2012 Jan 2013July 2013 8000 6000 4000 2000 0 May 2011-Apr 2012; N=13,173 715 406 BPHC 371 337 NH DHHS 553 316 CDPHE 754 223 7078 3112 RIDH 731 415 CT PHD 1713 1603 KY DPH 10000 792 MPHD Jan-Jul 2013; N=9823 1179 Maine CDC 12000 VDH 79 665 ADH 0 239 WI DHS 0 954 ISDH Maryland DHMH 0 178 0 520 HI DPH 0 63 0 13173 0 9823 AK DPHS Total
    25. 25. Total Use by Each PHD PHDs MDPH CT DPH KY DPH ADH MDHMH Maine CDC VDH WI DPH RIDH AK DPH CDPHE NH DHHS BPHC HI DPH Total 1830 1256 1066 1006 741 736 660 656 572 514 486 184 178 59 High Use 13 OUP Titles Journal Title Total Clinical Infectious Diseases American Journal of Epidemiology Schizophrenia Bulletin JNCI: Journal of the National Cancer Institute ICES Journal of Marine Science The Journal of Infectious Diseases International Journal of Epidemiology Journal of Antimicrobial Chemotherapy Nephrology Dialysis Transplantation Journal of Analytical Toxicology Annals of Oncology Toxicological Sciences Journal of Pediatric Psychology 1412 513 393 343 269 259 184 156 151 128 100 98 95
    26. 26. Title BMJ Use of Journals added in May, 2013  Represents 8 different publishers  Journals contain topical interest of public health workforce  #Uses 1031 American Journal of Clinical Nutrition 450 Tobacco Control 285 Journal of Antimicrobial Chemotherapy 200 Diabetes Educator 93 Annual Review of Public Health Archives 87 The Journal of School Nursing 83 Health Promotion practice 83 Journal of General Internal Medicine 75 Archives of Environmental Contamination and Toxicology 36
    27. 27. Total Use=632 22 Documents Sept 2013 N=23
    28. 28.      Formulated literature searches Evidence-based guidelines Systematic reviews Review of best practices Public Health data/resources Training component : Development of a well-defined, clearly-focused question
    29. 29. Training Topics – Day 1  Welcome & Overview Public Health Leadership Training Topics – Day 2  Review of Digital Library Page**  Introduction to Cochrane Library & Systematic Reviews  Project Introduction  Why Evidence-Based Public Health*  Alternative Article Delivery Service  NLM’s PubMed Database  Introduction to Global Health  Introduction to EndNote 7  Introduction to STAT!Ref  Practicum Computer Lab Assignment  Review of EndNote 7  Brief Info about NIH RePORTER  Practicum Computer Lab Assignment Total of 7.0 Hours Training Two Days: Back to Back
    30. 30. STATE PHD Trainings Attendance Maryland Indiana Hawaii Nutrition Specialist (2) State Epidemiologist Education Coordinator (2) 52 Research Statistician Supervisor – Labs + (3) Asthma Coordinators(2 58 Injury Prev Epidemiologist Legislative Liaison 4 Policy Analyst (2) 3 32 Program Mgr (2) Staff Attorney Epidemiologist MPHD* NH NH DHHS 2 24 Epidemiologist Microbiologist ( 2) CO CDPHE* 5 100 Research Analyst (2) Medicare Specialist/Advis or (2) Regional Program Director Program Coordinator, SAPB RI RIDH 2 30 VT 3 46 ME VDH MAINE CDC* MA BPHC* MA 3 CT CT DPH* 5 101 KY AR KDPH ADH 2 2 46 31 Policy Advisor (2) Director of Prog Evaluation Epidemiologist (3) WI WI DPH 2 33 Psychiatric VT Genetic Counselor AK AK DPH 2 50 Director of Prog Development 68 Field Epi Director HI DPH 2 Executive Ass’t HI Tobacco Prevent Mgr IN ISDH 2 60 MD MDHMH 38 Access Services Mgr Informatics Analyst 2 Deputy Secretary 41 769 Director VSA IT Supervisor Nutritionist TOTAL 15
    31. 31. Journal Title # Uses Cost Per Use Replacement Cost Cost of License Am J Tropical Med & Hygiene 410 $1.58 $4,510 $ 650 Am J Respiratory & Critical Care Med 189 $14.28 $2,079 $2700 Health Affairs 2038 1.81 $22,418 $3690 Infection Control & Hospital Epidemiology Public Health Reports 638 658 4.69 $7,238 $3085 Intern’l J of Tuberculosis & Lung Diseases 192 5.83 $2112 $1120 Annual Review Series 595 12.60 $6545 $7500 Pediatrics 7846 .68 $86,306 $5300
    32. 32. May 2011 – April 2012; Cost=$18,384 May 2012 --- April 2013; Cost=$12,241 ILL DD Total 2 20 22 154 90 244 Massachusetts (BPHC) 9 10 19 Massachusetts (MDPH) 7 6 13 New Hampshire 0 0 0 Rhode Island 82 79 161 Vermont 54 243 297 Colorado 112 40 152 Arkansas 32 73 105 Kentucky 8 3 11 Wisconsin STATE STATE Maine Massachusetts (BPHC) 0 0 0 462 593 1055 DD Total 0 83 83 Connecticut 560 Connecticut ILL 364 924 Maine 11 8 3 Massachusetts (MDPH) 1 1 2 New Hampshire 0 0 0 Rhode Island 47 36 83 Vermont 21 191 212 Colorado 323 156 479 960 834 1794 Total Total Article Delivery Costs Via Library Partnerships
    33. 33. Direct Access to Articles Alternative Article Delivery Contract Year Total # Amount May 2012-Apr 2013 15 200,352 May 2011-Apr 2012 11 156,280 May 2010-Apr 2011 9 96,252 Total # Amount May 2012-Apr 2013 1055 12,241 May 2011-Apr 2012 1794 18,385 May 2010-Apr 2011 672 8,263 Contract Year
    34. 34.  Better Understanding of the Culture › Relationships – of workforce: variance in skills and knowledge, variance in topical › Uneven access to information  Institutional Change › Dissemination plan › IT Differences Transparency of Access  Nurtures Practice and Career Pathways  Cost Efficiencies 
    35. 35. Work with the “Built Environment” to provide a sustainable model for all Public Health Departments.  Continue to Promote Project Efficiencies  Dissemination Plan (natural turnover of personnel; retraining)  Gather data to justify access for “Local Public Health.” 

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