Public Health Information Access Project presentation to the NLM Board of Regents, Septermber 2014

1. Public Health Information Access Project:
“Digital Library for Public Health”
Access to Scientific Literature Improves Evidence-Based
Public Health Practice
NLM Board of Regents Meeting
September 10, 2014
Elaine Martin, Director
New England Region NN/LM Lamar Soutter Library
University of Massachusetts Medical School
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2. Problem Statement
Limitations of Early Projects
PHIA Goals
Basic Model
Partnerships
Partner Input
2

3.  Many public health departments have limited
or no access to published literature.
 There is an increasing emphasis on evidence-based
public health practice.
3

4.  Time-limited: Short-term access to print articles supplied
via document delivery limited to 6-12 months;
 Utilization constrained: Access to the number of articles
limited (e.g., no more than 10 per person);
 Cumbersome: Access restricted to walk-in traffic; many
spent hours going to libraries and photocopying articles;
 Distant: Research libraries, in many cases, are
miles/cities away from Public Health Departments;
 Indirect: Student help or faculty adjuncts working in
Public Health often used to access library resources.
4

5. Multi-year demonstration project, intended to:
 Identify knowledge resources that are core, useful and
evidence-based to improve public health practice.
 Promote seamless access to and reinforce
understanding of usefulness of PubMed, e-books, other
databases, resources from national agencies.
 Integrate technology and human systems to support PH
access to knowledge resources.
 Identify cost-effective and sustainable models for
providing PH information access on ongoing basis.
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6.  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
Network of Libraries of
Medicine (NN/LM) Members.
Digital
Library
PHD Site
Alternate
Article
Delivery via
Libraries
Timely
Information
in Support of
Evidence-
Based
Public Health
Practice
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7. State Public Heath Department Library Partners
AK Alaska Division of Public Health Univ of Alaska (Anchorage) Medical Library
AR Arkansas Department of Health Univ of Alabama Medical Sciences Library
CO Colorado Department of Health &
Environment
Poudre Valley Health System Library , Univ of
Colorado
CT Connecticut Public Health Department Univ of Conn Maynard Stowe Library
HI Hawaii Department of Health Univ of Hawaii Medical Library
IN Indiana State Department of Health Ruth Lily Medical Library, Indiana University
KY Kentucky Department for Health Univ of Kentucky Medical Library
ME Maine CDC Maine Medical Center Library
MA Boston Public Health Commission Univ of Massachusetts Soutter Library
MA Massachusetts Public Health Department Lemuel Shattuck Hospital Library
MD Maryland Department of Health &
Mental Hygiene
Univ of Maryland Health Sciences Library
NH New Hampshire DHHS New Hampshire DHHS Library
RI Rhode Island Department of Health Rhode Island Hospital/Lifespan Library
UT Utah Department of Health Univ of Utah, Eccles Health Sciences Library
VT Vermont Department of Health Univ of Vermont Dana Medical Library
WI Wisconsin Department of Health
Services
Univ of Wisconsin, Ebling Library of the Health
Sciences
WV West Virginia Bureau of Public Health West Virginia University Libraries
WA Washington State Department of Health Univ of Washington Health Sciences Library 7

8. For what purposes do you need access to journals or
other evidence-based resources?
 High-frequency: info to stay abreast or to provide info
to others—
◦ Education, clinical guidelines, conference materials/
presentations, speeches, press releases
 Also frequent: program and policy development; grants
Less frequent: budget, legislation, program evaluation
To which journals or resources do you wish you had
access?
 Answers used to inform common licensed core of
PH literature for digital libraries
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9. Digital Library Examples
Digital Library Resources
Full Text Journals Currently in Digital
Library
Licensed Databases that Supplement
PubMed Search
Publicly Available Resources:
NLM, CDC, NAL
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10. 10

11.  Licensed (Full Text) Journals: “Core PH”
 Licensed databases
 Publicly-available resources
 Locally-identified resources
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12. Journal Packages
American Society for Nutrition (3)
American Society of Microbiology(12)
American Thoracic Society (3)
Annual Reviews (9)
BMJ Journals (6)
Elsevier (7)
Maney (2)
Mary Ann Liebert (14)
Nature/Palgrave/MacMillan (3)
Ovid (LWW) Titles (8)
Oxford University Press (27)
Sage (13)
Springer (19)
University of Chicago Press (5)
Wiley Journals (9) – 2 open access
Single Titles (13)
 American Journal of Tropical Medicine & Hygiene
 Health Affairs
 International Journal of Tuberculosis
 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
 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
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Total=160

13. 13

14.  E-Books
Vendor Collaborating
with PHIA to Offer
Identified E-Books:
◦ Oxford Textbook of
Public Health
◦ IoM Reports (16)
◦ Infectious Disease
Series
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15.  Morbidity and Mortality Weekly
Report (MMWR)
 Emerging Infectious Diseases (EID)
 Preventing Chronic Disease (PCD)
 Data & Statistics
 Science Clips
 Public Health Image Library
 CDC Stacks: Publications
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16. The 10% Rule
Identifying Cost Efficiencies
Complexity of Providing
Literature to PH
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17. Factors Influencing Rule (Collective Data)
 Identification of Divisions and Program Areas Utilizing Information
 Number Attending Training
 Number Responding to Journal Survey Monkey
 10 % of Total
11, 000 FTE = 1,100
Aspects that Validate Number of Users/Interest
 Number attending training and turn-aways
 Number responding to Journal SurveyMonkey
 Repeat requests for training
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18.  Annual process, not unlike process faced by
individual libraries
 Goal: Fair price, not free access
 Statistics on journal level use by state
regularly provided, used to assess 10% rule
 Statistics also help for refinement of core
journal set
 Many enthusiastic partners!
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19. Two Examples
For number of uses in a contract year: Title/Package Uses
Public Health Reports
PHIA License cost: $3085
Use 1437 uses
At cost of $11/use w/o license $14,807
PHIA cost/use: $2.14
Pediatrics
PHIA License cost: $5300
Use 12,317 uses
At cost of $11/use w/o license $135,000
PHIA cost/use: $0.43
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20. 20
What is impact on Library Partners and
Network re: article delivery?
For CY 2013, 15 sites, 1027 articles at cost
=$10,736
Key metric for project.

21. 7000
6000
5000
4000
3000
2000
1000
0
2010=2087 2011=11,194 2012=14,022 2013=14,136
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22. Training Fundamentals
Progress to Date
Newsletters and Other
Communications
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23. General Background re: finding and using:
 Formulated literature searches
 Evidence-based guidelines
 Systematic reviews
 Review of ‘best practices’
 Public health data/resources
Specific Applications:
Work through real locally-identified examples, starting
with development of well-defined, clearly-focused
questions
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24.  Training conducted by NER and/or local resource
library staff on content, use of digital library
 Almost 900 individuals trained
 Between 2-4 training sessions to date in each
established site; anecdotally: trainees training
others
 Trainee roles and specialties highly varied: eg.,
staff/management, scientist/policy analyst,
epidemiologist/lawyer
 RISK: Turnover –how to keep training, awareness
of resources high in PHDs in the face of
management and staff turnover
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25. Reliable e-Resources: PHIA Newsletter
Newsletter promotes resources related to
public health initiatives and training links.
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26. Anecdotes from
key informants:
Maryland
Kentucky
Wisconsin
Connecticut
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27. Used access to literature/information to:
 understand how other states have dealt with
allowing non-nurse mid-wives to practice, as
part of analyses addressing proposed legislation
to permit such practice in MD.
 assess potential tobacco legislation prior to
introduction.
 examine state of research regarding change in
school hours and impact of improved sleep on
students.
 develop white papers regarding cost of delivery
reforms to end-of-life care.

28.  State dentist used journals and STAT!REF in
setting up a new program through the local
health department for dental care.
Wisconsin
 Used the information provided by the Digital
Library for writing grants

29. “I wanted to pass along our experience using
resources available to us via the CT DPH
Digital Library. Here in Connecticut, we
modify our Youth Risk Behavior Survey;
this year, staff at our State Department of
Education wanted to capture information
about students experiencing housing
insecurity. We know there is health and
academic risk in this vulnerable
population. Having the resources
available through the Public
Health Information Access
Project greatly helped us find
relevant research on this topic to
better inform our survey
development workgroup.
--C. Jorge
“Great recognition for this
very valuable initiative.
Kudos and thank you. ”
Jewel Mullen, MD, MPH,
MPA, Commissioner,
Connecticut Department
of Public Health

30. What Distinguishes PHIA
From Other Projects?
Short-Term and
Longer Term
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31.  Readiness and Engagement of PHD to Participate
◦ Understanding of importance of evidence-based process
◦ Agree to team approach: to install/maintain digital library &
provide coordination and support initial training
◦ Agree to project requirements (including evaluation)
 Enterprise Licensing of Core Journals for All PHDs
◦ Provides full–text to the desktop, unlimited access for employees
◦ Offers appropriate collection development for PHDs
◦ Engages publishers, libraries and public health departments
 Creative Partnerships
◦ Builds on existing NN/LM Network relationships and enhances a
value network
 Project Supports Technology Innovation
◦ Provides buy-in to need for library resource access
◦ Seamless access directly to desktop/device
◦ Interoperable connectivity from Vendors/Publishers

32. Short-term:
◦ Review data, evaluation results, web-based training, and
partner contributions to refine model and enhance project
efficiencies
◦ Strengthen training and utilization of resources in the face of
PH/Library staff turnover
◦ Derive cost per PH user of Core and Essential PHIA Knowledge
resources
Longer-term:
◦ Expand project and identify sustainable model for all state
Public Health Departments
◦ Identify options, data to justify inclusion of other public
health organizations