Advances in information technology (IT) since 1970 have led to significant changes in the nature of library services provided in health sciences settings.
Reference assistance is now available through e-mail exchanges and through online chat sessions at many institutions, especially academic health sciences centers. Training on the selection and use of information resources is now available through online tutorials and has been integrated as part of the content of distance education courses provided online. Perhaps a more fun- damental impact of IT on library services has been the recognition of li- brarians as expert searchers with the education and background needed to perform advanced searches and, in many cases, evaluate and synthesize the retrieval as part of the patient care provided by a clinical team. The ready availability of information online, with many publishers providing free full- text access, has enabled users to obtain much more information independent of library services than was possible three decades ago. This has prompted librarians to focus on communicating the value of their services in terms of specific contributions to the larger organization.
A. Online Reference
It is now commonplace for libraries to provide reference services through e-mail communication with users. OCLC’s QuestionPoint is one product that has been used in health sciences settings to manage e-mail reference services (Markgren et al., 2004). More than two-thirds of inquiries handled by NLM’s Public Services Division in fiscal year 2004 were from off-site users, the vast majority received through e-mail (National Library of Med- icine, 2005). Library staff at the University of California at Davis have reported their experience with providing reference service through online chat sessions (Jerant and Firestein, 2003). Online reference service provided asynchronously through e-mail or in ‘‘real time’’ through online chat sessions also offers the potential for collaboration among libraries (Chowdhury, 2002;
Lindbloom, 2004).
B. Education Services
Scherrer and Jacobson (2002) note the decline of mediated searches in the 1980s, complemented by a steady increase in the number of training sessions provided at academic health sciences libraries in the 1990s. Education pro- grams in hospital and academic health sciences libraries have evolved sub- stantially beyond orientation sessions and search skills workshops. Librarians now routinely pursue opportunities such as liaison services and serving on curriculum committees in health professional degree programs. Librarians are also often called on to provide instruction related to the practice of EBM for medical students and residents. Instructional content developed by librarians has been made available in online formats, such as tutorials de- veloped at Johns Hopkins University’s Welch Library (Sheffieldet al., 2005) and the online tutorial on information management provided as part of the PHPartners.org site (http://phpartners.org/tutorial). NN/LM’s National Training Center and Clearinghouse (http://nnlm.gov/train) also maintains a database of educational material that can be used for instruction on health information management.
Two major bodies in medical education have recently highlighted the importance of education in the area of information management. The report of the Association of American Medical Colleges’ (AAMC’s) Medical School Objectives Project, released in 1998, highlights the importance of instruc- tion in the areas of informatics and information management, noting as one objective that, ‘‘the medical school must ensure that before graduation a student will have demonstrated y the ability to retrieve (from electronic databases and other resources), manage and utilize biomedical information
for solving problems and making decisions that are relevant to the care of individual patients and populations’’ (Association of American Medical Col- leges, 1998). In a similar vein, the Accreditation Council on Graduate Medical Education developed a set of general competencies for medical res- idents, announced in 1999. Related to practice-based learning, these com- petencies include searching for, evaluating and applying evidence from knowledge-based resources to patient care (Accreditation Council on Grad- uate Medical Education, 1999).
C. Clinical Information Interventions
In addition to a stronger focus on training, the ‘‘disintermediation’’ of in- formation seeking brought about as a result end user searching technologies since the 1980s has also led librarians in health care settings to adopt new roles as part of a clinical team. The first ‘‘clinical medical librarian’’ service program was developed by Gertrude Lamb at the University of Missouri at Kansas City (Lamb, 1982). Davidoff and Florance significantly advanced the idea of clinical information interventions when they proposed the idea of an
‘‘informationist’’ who possesses the information management and subject area expertise needed to retrieve relevant information and evaluate and synthesize it in a way that supports decisions related to the care of specific patients. The idea of the informationist is ‘‘to make the critical link between the huge body of information hidden away in the medical literature and the information needed at the point of care’’ (Davidoff and Florance, 2000). This role has recently been expanded to include information interventions related to pop- ulation health in the public health domain. The potential for expert search services to improve patient care has been suggested by studies that have compared the quality of the searches performed by end users and librarians (McKibbon and Walker-Dilks, 1995;Wildemuth and Moore, 1995).
D. Hospital Library Services
MLA’s Hospital Library Section promotes hospital librarianship in a variety of ways, perhaps most significantly with its development of the ‘‘Standards for Hospital Libraries.’’ Most recently updated in 2002, these standards outline the roles of libraries in health care organizations and highlight the link between knowledge-based information and specific functions of the hospital, including clinical care, patient education and continuing profes- sional education. These standards are routinely used to support hospital librarians’ requests for additional institutional support. Evidence of what may be a decline in institutional support for hospital libraries in recent years
is the diminishing number of hospital librarians. In 1996 the Hospital Library Section of MLA had a peak of 1606 members. In 2002 the section’s membership was reported to have fallen by about 20% (Wolfet al., 2002).
Hospital librarians’ interest in ensuring access to knowledge-based in- formation resources on the Web has led to conflicts related to institutional firewalls maintained by hospital IT staff. In the interest of the security of a hospital’s network, its IT staff may limit access to Internet-based information resources. To address this challenge, the NN/LM appointed the Hospital Internet Access Task Force in May 2003 with the charge of articulating strategies for hospital libraries to promote access to Web-based resources from within their institutions while simultaneously collaborating with their IT colleagues to preserve the security of the hospital’s network and computer- based resources. Based on extensive data collection, including interviews with 47 librarians, the majority of the task force’s recommendations address issues related to communication and training (Holst, 2005). Also among the recommendations was the suggestion that technology-related standards be included in the hospital library standards maintained by MLA’s Hospital Library Section.
E. Value and Contributions of Library Services
Responding to the apparent decline in the number of hospital libraries in the United States and the reported under-funding of many academic health sciences libraries, MLA sponsored a study of the value and contributions of library services. With reports published in 2002 and 2004, this study by Abels, Cogdill and Zach (2002, 2004) resulted in a taxonomy of library contributions to the organizational missions of hospitals and academic health sciences centers, known as Contributions of Library and Information Services (CLIS) taxonomy. This study also identified specific indicators a library may use to measure the contributions of its services to the mission of its larger organization. Building on the first report of the study by Abels, Cogdill and Zach, the health sciences library at Capital Health System in Trenton, New Jersey, gathered and analyzed data related to outcomes of library use and linked these outcomes to the mission of the hospital system (Cuddy, 2005).
Contributions to patient care are among the four mission-level elements of the CLIS taxonomy. Clear evidence of the potential contributions of library services to patient care came to light in the late 1980s and 1990s with studies of the impact of mediated searches. Among these, a study led by Marshall surveyed the recipients of mediated search services in hospital set- tings and found that 80% reported that they probably or definitely handled
some aspect of patient care differently as a result of the searches (Marshall, 1992).
Potential contributions associated with the library as place are also in- cluded in the CLIS taxonomy. Citing an earlier study of usage patterns of library buildings since 1995,Lindberg and Humphreys (2005)conclude that,
‘‘Despite ubiquitous access to electronic informationythe ‘library as place’
is still highly valued and heavily usedyUsers flock to library buildings and spaces that are attractive, centrally located, technologically current, and ar- ranged to meet the needs of groups as well as solitary users.’’Ludwig and Starr (2005) suggest that there will be growing divergence in how libraries as places are used, with institutional needs influencing their design.