CAH to CAH: EHR implementation advice to critical access hospitals from peer experts and other key informants.

UNLABELLED: The US government allocated $30 billion to implement electronic health records (EHRs) in hospitals and provider practices through policy addressing Meaningful Use (MU). Most small, rural hospitals, particularly those designated as Critical Access Hospitals (CAHs), comprising nearly a quarter of US hospitals, had not implemented EHRs before. Little is known about implementation in this setting. Socio-technical factors differ between larger hospitals and CAHs, which continue to lag behind other hospitals in EHR adoption. OBJECTIVE: The main objective is to provide EHR implementation advice for CAHs from a spectrum of experts with an emphasis on recommendations from their peers at CAHs that have undertaken the process. The secondary objective is to begin to identify implementation process differences at CAHs v. larger hospitals. METHODS: We interviewed 41 experts, including 16 CAH staff members from EHR teams at 10 CAHs that recently implemented EHRs. We qualitatively analyzed the interviews to ascertain themes and implementation recommendations. RESULTS: Nineteen themes emerged. Under each theme, comments by experts provide in-depth advice on all implementation stages including ongoing optimization and use. We present comments for three top themes as ranked by number of CAH peer experts commenting - EHR System Selection, EHR Team, and Preparatory Work - and for two others, Outside Partners/Resources and Clinical Decision Support (CDS)/Knowledge Management (KM). Comments for remaining themes are included in tables. DISCUSSION: CAH experts rank the themes differently from all experts, a likely indication of the differences between hospitals. Comments for each theme indicate the specific difficulties CAHs encountered. CAH staffs have little or no EHR experience before implementation. A factor across themes is insufficient system and process knowledge, compounded by compressed implementation schedules. Increased, proactive self-education, via available outside partners and information resources, will mitigate difficulties and aid CAHs in meeting increased CDS requirements in MU Stages 2 and 3.

Comparing frequency of content-bearing words in abstracts and texts in articles from four medical journals: an exploratory study.

BACKGROUND: Retrieval tests have assumed that the abstract is a true surrogate of the entire text. However, the frequency of terms in abstracts has never been compared to that of the articles they represent. Even though many sources are now available in full-text, many still rely on the abstract for retrieval. METHODS: 1,138 articles with their abstracts were downloaded from Journal of the American Medical Association, New England Journal of Medicine, Lancet, and the British Medical Journal. Words were extracted from the articles and their abstracts and the frequency of each word was counted in both sources. Each article and its abstract were tested using a chi-squared test to determine if the words in the abstract occurred as frequently as would be expected. RESULTS: 96% of the abstracts tested as samples of the article they represented. CONCLUSION: In these four journals, the abstracts are lexical, as well as intellectual, surrogates for the documents they represent.

Creating local bibliographic databases: new tools for evidence-based health care.

The Internet has created new opportunities for librarians to present literature search results to clinicians. In order to take full advantage of these opportunities, libraries need to create locally maintained bibliographic databases. A simple method of creating a local bibliographic database and publishing it on the Web is described. The method uses off-the-shelf software and requires minimal programming. A hedge search strategy for outcome studies of clinical process interventions is created, and Ovid is used to search MEDLINE. The search results are saved and imported into EndNote libraries. The citations are modified, exported to a Microsoft Access database, and published on the Web. Clinicians can use a Web browser to search the database. The bibliographic database contains 13,803 MEDLINE citations of outcome studies. Most searches take between four and ten seconds and retrieve between ten and 100 citations. The entire cost of the software is under $900. Locally maintained bibliographic databases can be created easily and inexpensively. They significantly extend the evidence-based health care services that libraries can offer to clinicians.

The Missouri planning grant for the education and training of health sciences librarians.

The planning grant at the School of Library and Informational Science (SLIS) at the University of Missouri has two aims: (a) developing a model curriculum for health sciences librarianship at the master's level and (b) developing materials that can be delivered by alternative instructional methods. To accomplish the first aim, the faculty will investigate the possibility of offering courses in other disciplines, such as health care administration, educational technology, adult education, and medical sociology. In addition, the SLIS faculty will investigate the development of new kinds of placement for the students' practicum experience. To reach the second aim, the SLIS faculty will investigate alternative means of delivering both graduate and continuing education. Three instructional modalities will be evaluated. Some material will be delivered via satellite broadcast, some material will be made available via the World Wide Web and some will be presented in an intensive seminar. The outcome of the planning grant will be two distinct plans. The first will be a plan for the curriculum in health sciences librarianship at the master's level. The second will be a plan for offering instruction through alternative methods, both for graduate education and for continuing education.

Retrieving research studies: a comparison of bibliographic and full-text versions of the New England Journal of Medicine.

It has been established that subject searches of medical full-text databases obtain higher recall than subject searches in a bibliographic database. In this study we attempted to determine if the same rule might apply when searching for a non-subject parameter such as study design. A simultaneous search of bibliographic and full-text records from the New England Journal of Medicine provided data on the number of items retrieved by each kind of search. Filtering strategies were created for 5 different study types: randomized controlled trials, other clinical trials and prospective studies, cohort studies, longitudinal and follow-up studies, and multicenter studies. The point of the study was to compare the numbers of items retrieved from the bibliographic database, MEDLINE, and those retrieved from the full-text version of NEJM, and to examine the unique access points available in each file. For all the study types the full-text file retrieved a larger number of records than MEDLINE, most of which were retrieved because of methodology terms found in the text but not in the title or abstract. In MEDLINE, descriptors and publication types, two value-added fields supplied by indexers, retrieved 11-89% more than title and abstract alone.

Retrieval from full-text medical literature: the dream & the reality.

While the retrieval of the full-text of a document might seem to end all the hassle of using traditional retrieval systems, the results of the MEDLINE/Full-Text Project indicate that retrieval from the current full-text databases of biomedical journal literature does not match the dream. During the first phase of the project the researchers learned that searching the full-text databases resulted in the retrieval of a significantly larger number of relevant documents than MEDLINE. However, the full-text databases also resulted in a large number of non-relevant documents. Currently the researchers are focusing on how to search these databases to continue retrieving the large number of relevant documents but without so many non-relevant items.