Evaluating IAIMS at Yale: information access.

OBJECTIVE: To evaluate use of information resources during the first year of IAIMS implementation at the Yale-New Haven Medical Center. The evaluation asked: (1) Which information resources are being used? (2) Who uses information resources? (3) Where are information resources used? (4) Are multiple sources of information being integrated? DESIGN: Measures included monthly usage data for resources delivered network-wide, in the Medical Library, and in the Hospital; online surveys of library workstation users; an annual survey of a random, stratified sample of Medical Center faculty, postdoctoral trainees, students, nurses, residents, and managerial and professional staff; and user comments. RESULTS: Eighty-three percent of the Medical Center community use networked information resources, and use of resources is increasing. Both status (faculty, student, nurse, etc.) and mission (teaching, research, patient care) affect use of individual resources. Eighty-eight percent of people use computers in more than one location, and increases in usage of traditional library resources such as MEDLINE are due to increased access from outside the Library. Both survey and usage data suggest that people are using multiple resources during the same information seeking session. CONCLUSIONS: Almost all of the Medical Center community is using networked information resources in more settings. It is necessary to support increased demand for information access from remote locations and to specific populations, such as nurses. People are integrating information from multiple sources, but true integration within information systems is just beginning. Other institutions are advised to incorporate pragmatic evaluation into their IAIMS activities and to share evaluation results with decision-makers.

The MEDLINE experience at Yale: 1986-1996.

The Cushing/Whitney Medical Library began providing end-user access to MEDLINE in 1986 and switched to the OVID system in 1993. MEDLINE is a core service of the library, and the choice of delivery systems has had a significant impact throughout the Yale-New Haven Medical Center. This paper describes the user response to MEDLINE, discusses the effects of MEDLINE on other library services, and suggests ways in which technology, policy, and funding have influenced use. Yale's experience suggests that removing barriers in all three areas can dramatically expand the points of access, the number of users, and the amount of use with manageable effects on other library services.

Lessons learned from a pilot implementation of the UMLS information sources map.

OBJECTIVE: To explore the software design issues involved in implementing an operational information sources map (ISM) knowledge base (KB) and system of navigational tools that can help medical users access network-based information sources relevant to a biomedical question. DESIGN: A pilot biomedical ISM KB and associated client-server software (ISM/Explorer) have been developed to help students, clinicians, researchers, and staff access network-based information sources, as part of the National Library of Medicine's (NLM) multi-institutional Unified Medical Language System (UMLS) project. The system allows the user to specify and constrain a search for a biomedical question of interest. The system then returns a list of sources matching the search. At this point the user may request 1) further information about a source, 2) that the list of sources be regrouped by different criteria to allow the user to get a better overall appreciation of the set of retrieved sources as a whole, or 3) automatic connection to a source. RESULTS: The pilot system operates in client-server mode and currently contains coded information for 121 sources. It is in routine use from approximately 40 workstations at the Yale School of Medicine. The lessons that have been learned are that: 1) it is important to make access to different versions of a source as seamless as possible, 2) achieving seamless, cross-platform access to heterogeneous sources is difficult, 3) significant differences exist between coding the subject content of an electronic information resource versus that of an article or a book, 4) customizing the ISM to multiple institutions entails significant complexities, and 5) there are many design trade-offs between specifying searches and viewing sets of retrieved sources that must be taken into consideration. CONCLUSION: An ISM KB and navigational tools have been constructed. In the process, much has been learned about the complexities of development and evaluation in this new environment, which are different from those for Gopher, wide area information servers (WAIS), World-Wide-Web (WWW), and MOSAIC resources.

Navigating the Internet.

Navigating any complex set of information resources requires tools for both browsing and searching. A number of tools are available today for using Internet resources, and more are being developed. This article reviews existing navigational tools, including two developed at the Yale University School of Medicine, and points out their strengths and weaknesses. A major shortcoming of the present Internet navigation methods is the lack of controlled descriptions of the available resources. As a result, navigating the Internet is very difficult.

NetMenu: experience in the implementation of an institutional menu of information sources.

NetMenu is a program, developed at Yale, which enables straightforward access to online information systems. NetMenu has been deployed in several diverse settings within our medical center. In the hospital, NetMenu is functioning as a front-end for our clinical workstation providing access to the hospital information system, the clinical laboratory computer, a drug database and several bibliographic databases. The medical libraries are utilizing NetMenu for both medical education workstations and for scholarly information workstations. This paper describes our initial experience in the implementation, support, and maintenance of NetMenu as an institutional menu of information sources.

IAIMS at Columbia-Presbyterian Medical Center: accomplishments and challenges.

The concept of "one-stop information shopping" is becoming a reality at Columbia-Presbyterian Medical Center. Our goal is to provide access from a single workstation to clinical, research, and library resources; university and hospital administrative systems; and utility functions such as word processing and mail. We have created new organizational units and installed a network of workstations that can access a variety of resources and systems on any of seventy-two different host computers/servers. In November 1991, 2,600 different individuals used the clinical information system, 700 different individuals used the library resources, and 900 different individuals used hospital administrative systems via the network. Over the past four years, our efforts have cost the equivalent of $23 million or approximately 0.5% of the total medical center budget. Even small improvements in productivity and in the quality of work of individuals who use the system could justify these expenditures. The challenges we still face include the provision of additional easy-to-use applications and development of equitable methods for financial support.

Managing Medical Logic Modules.

A key element of IAIMS development at the Columbia Presbyterian Medical Center (CPMC) is the Medical Logic Module (MLM), designed to provide decision support to clinical users. A standard has been established for MLMs, and a number of institutions have agreed in principle to share them. At CPMC, MLMs are under development and MLMs from other institutions are being reviewed. The Columbia Health Sciences Library has developed a management system for MLMs which supports both internal development and sharing of MLMs among institutions. This paper describes the elements of the MLM management system.