Dr. Lindberg and scholarly publishing.

Donald A.B. Lindberg M.D., Director of the U.S. National Library of Medicine (NLM) from August 1984 to March 2015, had a remarkable vision for NLM's scope, goals, and function. This vision resulted in many external partnerships and initiatives with the publishing industry, commercial and non-profit, journal editors, and professional organizations. These partnerships ranged from ongoing collaboration and dialogue, such as the NLM Publisher's Committee and the International Committee of Medical Journal Editors (ICMJE). to the more practical, such as the creation of HINARI and the Emergency Access Initiative (EAI). Dr. Lindberg fostered partnerships outside the NLM to expand the use and reach of Library resources, including MEDLINE and ClinicalTrials.gov to support innovations in the processes that build them, and to improve the quality of biomedical journals. Dr. Lindberg also encouraged the use of technology to enhance medical information and supported the early development of fully interactive publications. Attitudes that contained a measure of skepticism and distrust faded as collaborators came to have a better understanding of both NLM and their partners. This chapter discusses these relationships and accomplishments that NLM achieved working with publishers and other creators and disseminators of medical information under Dr. Lindberg's leadership.

The persistence of clinical questions across shifts on an intensive care unit: an observational pilot study.

How do clinical questions emerge and move toward resolution in the intensive care setting over the course of 24 hours? In a 20-bed surgical intensive care unit in a large, tertiary-care teaching hospital, informationists shadowed clinicians for 2 48-hour periods to record questions, noting when they were asked and whether they were answered. Thirty-eight percent of 112 recorded questions remained unanswered. Some unanswered questions persisted across shifts, and clinicians' information-seeking behaviors changed over time. Clinical information services can be improved and integrated more fully into clinical workflows based on a fuller understanding of the life cycle of clinical inquiry.

Does providing prescription information or services improve medication adherence among patients discharged from the emergency department? A randomized controlled trial.

STUDY OBJECTIVE: We determine whether prescription information or services improve the medication adherence of emergency department (ED) patients. METHODS: Adult patients treated at one of 3 EDs between November 2010 and September 2011 and prescribed an antibiotic, central nervous system, gastrointestinal, cardiac, or respiratory drug at discharge were eligible. Subjects were randomly assigned to usual care or one of 3 prescription information or services intervention groups: (1) practical services to reduce barriers to prescription filling (practical prescription information or services); (2) consumer drug information from MedlinePlus (MedlinePlus prescription information or services); or (3) both services and information (combination prescription information or services). Self-reported medication adherence, measured by primary adherence (prescription filling) and persistence (receiving medicine as prescribed) rates, was determined during a telephone interview 1 week postdischarge. RESULTS: Of the 3,940 subjects enrolled and randomly allocated to treatment, 86% (N=3,386) completed the follow-up interview. Overall, primary adherence was 88% and persistence was 48%. Across the sites, primary adherence and persistence did not differ significantly between usual care and the prescription information or services groups. However, at site C, subjects who received the practical prescription information or services (odds ratio [OR]=2.4; 95% confidence interval [CI] 1.4 to 4.3) or combination prescription information or services (OR=1.8; 95% CI 1.1 to 3.1) were more likely to fill their prescription compared with usual care. Among subjects prescribed a drug that treats an underlying condition, subjects who received the practical prescription information or services were more likely to fill their prescription (OR=1.8; 95% CI 1.0 to 3.1) compared with subjects who received usual care. CONCLUSION: Prescription filling and receiving medications as prescribed was not meaningfully improved by offering patients patient-centered prescription information and services.

Dr. Lindberg and Scholarly Publishing.

Donald A.B. Lindberg M.D., Director of the U.S. National Library of Medicine (NLM) from August 1984-March 2015, had a remarkable vision for NLM's scope, goals, and function. This vision resulted in many external partnerships and initiatives with the publishing industry, commercial and non-profit, journal editors, and professional organizations. These partnerships ranged from ongoing collaboration and dialogue, such as the NLM Publisher's Committee and the International Committee of Medical Journal Editors (ICMJE). to the more practical, such as the creation of HINARI and the Emergency Access Initiative (EAI). Dr. Lindberg fostered partnerships outside the NLM to expand the use and reach of Library resources, including MEDLINE and ClinicalTrials.gov to support innovations in the processes that build them, and improve the quality of biomedical journals. Dr. Lindberg also encouraged the use of technology to enhance medical information and supported the early development of fully interactive publications. Attitudes that contained a measure of skepticism and distrust faded as collaborators came to have a better understanding of both NLM and their partners. This chapter discusses these relationships and accomplishments that NLM achieved working with publishers and other creators and disseminators of medical information under Dr. Lindberg's leadership.

Evaluating information prescriptions in two clinical environments.

OBJECTIVE: The research sought to evaluate whether providing personalized information services by libraries can improve satisfaction with information services for specific types of patients. METHODS: Adult breast cancer (BrCa) clinic patients and mothers of inpatient neonatal intensive care unit (NICU) patients were randomized to receive routine information services (control) or an IRx intervention. RESULTS: The BrCa trial randomized 211 patients and the NICU trial, 88 mothers. The BrCa trial showed no statistically significant differences in satisfaction ratings between the treatment and control groups. The IRx group in the NICU trial reported higher satisfaction than the control group regarding information received about diagnosis, treatments, respiratory tradeoffs, and medication tradeoffs. BrCa patients posed questions to librarians more frequently than did NICU mothers, and a higher percentage reported using the website. Questions asked of the librarians by BrCa patients were predominantly clinical and focused on the areas of treatment and side effects. CONCLUSIONS: Study results provide some evidence to support further efforts to both implement information prescription projects in selected settings and to conduct additional research on the costs and benefits of services.

AMIA Board White Paper: AMIA 2017 core competencies for applied health informatics education at the master's degree level.

This White Paper presents the foundational domains with examples of key aspects of competencies (knowledge, skills, and attitudes) that are intended for curriculum development and accreditation quality assessment for graduate (master's level) education in applied health informatics. Through a deliberative process, the AMIA Accreditation Committee refined the work of a task force of the Health Informatics Accreditation Council, establishing 10 foundational domains with accompanying example statements of knowledge, skills, and attitudes that are components of competencies by which graduates from applied health informatics programs can be assessed for competence at the time of graduation. The AMIA Accreditation Committee developed the domains for application across all the subdisciplines represented by AMIA, ranging from translational bioinformatics to clinical and public health informatics, spanning the spectrum from molecular to population levels of health and biomedicine. This document will be periodically updated, as part of the responsibility of the AMIA Accreditation Committee, through continued study, education, and surveys of market trends.

Working towards the informationist.

Current information is a critical component of good healthcare. In this article we offer a definition of a new health professional, the 'informationist', whose function it is to ensure evidence-based health practice. We describe the literature and discussions that led to the proposal of this new role, and offer a description of the steps being taken to further elaborate this career. In particular, we describe efforts at Johns Hopkins to train informationists and informaticists and to offer services that lead to the integration of these and other information professionals into clinical care, public health and research.

A short history of the William H. Welch Medical Library.

The William H. Welch Medical Library was founded in 1929 with the merger of three libraries, namely, the library of the School of Medicine, the library of the School of Hygiene and Public Health, and the library of the Johns Hopkins Hospital. Engendered by the dreams of Johns Hopkins University bibliophiles, such as founding Hopkins physicians William Osler, William Stewart Halsted, Howard Kelly, and William Henry Welch, the library flourished and expanded. At the same time as the founding of the central medical library, the Institute of the History of Medicine collection was established in the Welch Library building, with William H. Welch as its first director. Innovative leadership led to many exciting projects, such as the Welch Indexing Project, which was a prototype for the National Library of Medicine's medical subject headings, and the establishment of a laboratory for research into the application of information technologies to knowledge management. The Welch Library enters the 21st century as a dynamic library committed to the continuing delivery of information services, as well as ongoing research into the development of library services for the coming 100 years.

Outcome measures in clinical information systems evaluation.

Systems developed through informatics methods can be evaluated at different levels, depending on the purpose of the evaluation. A key class of measures useful in relating information systems to the quality of patient care is benefit or out-come measures, which reflect differences in the health or welfare of the patient that result from the system being utilized. A framework for describing evaluation measures is presented, definitions are discussed, and the results of a literature review are presented to indicate outcome measures used in medical informatics over several decades. The conclusion suggests that more attention should be given to the standardization of terminology and to outcome measures and methods.

Applying evidence in practice: a qualitative case study of the factors affecting residents' decisions.

Patient care based on best available evidence is increasingly viewed as the hallmark of good quality medical diagnosis and treatment, yet its uptake is often slow and uneven and the reasons underlying the slow diffusion of evidence-based guidelines remain elusive. The authors report a qualitative study conducted at a major US teaching hospital which sought to discover the reasons why an evidence-based anticoagulation guideline appeared to be applied irregularly, with problematic results. Using a theoretical framework derived from Rogers' work on the diffusion of innovation, this article describes the ways in which a group of residents evaluated and applied evidence in the context of caring for their patients. Future work in evidence-based practice can benefit from a greater emphasis on studies that use multi-method, qualitative designs to explore the complex ways in which people interact with information and the changes that ensue from its use.

Public health practitioners' information access and use patterns in the Maryland (USA) public health departments of Anne Arundel and Wicomico Counties.

PURPOSE: To increase understanding of the information needs and use of public health practitioners. SETTING: From June 2005 to May 2006, the library offered a course in public health information resources to eighteen practitioners in two counties, access to the library's licensed electronic resources through a tailored web portal, and consulting services. EVALUATION METHOD: We combined usage statistics from the web portal, self-report and observational data collected during training and shadowing of participants. CONCLUSIONS: The data from this project indicate that usage of licensed information resources and services is infrequent but broad ranging. A few users register at the high end of the usage range, but one use of one high quality article can have a significant impact on policy decisions. Time and competing responsibilities often constrain the retrieval and use of resources for evidence-based decision making and an informationist or power-user model may be more appropriate than training all practitioners to integrate searching into their workflow. This study indicates (i) that evidence-based public health practice requires seamless and broadly based information access; and (ii) that the currently existing patchwork does not support the level of use or take into account the time constraints of information needs for public health practice.

A comparison of the diffusion of two innovations -- a pilot study: telemicroscopy versus teleradiology.

Despite speculation that Telemicroscopy and Digital Microscopy will follow the same diffusion curves as their counterparts in the world of Radiology - Teleradiology and Filmless Radiology, no study has offered definitive evidence in support of this hypothesis. To address this gap in the informatics knowledge base, dual survey instruments were created to measure current opinions on both technologies among Pathologists and Radiologists and disseminated to Pathologists and Radiologists at two major academic medical centers.

Building user research interest profiles through a MeSH indexer.

In the information portal environment, user profiles helps librarians to better understand users' needs and build individualized services. We have used a locally developed UMLS-based MeSH indexer to process and extract MeSH concept terms from the contents of individuals' usage files on our library's portal system (MyWelch). The algorithm was also developed to refine these extracted terms and assign weights to individual terms. This process yielded a weighted MeSH term set for each individual user that can be considered to define the individual user's areas of research interest profile.

Scholarly communications program: force for change.

The changing landscape of scholarly publication and increasing journal costs have resulted in a need for proactive behavior in libraries. At Johns Hopkins University in Baltimore, Maryland, a group of librarians joined forces to bring these issues to the attention of faculty and to begin a dialog leading to change. This commentary describes a comprehensive program undertaken to raise faculty awareness of scholarly communications issues. In addition to raising faculty interest in the issues at hand, the endeavor also highlights an area where library liaisons can increase their communication with the units they serve.

Developing a UMLS-based indexing tool for health science repository system.

One of the important procedures during the operation of an Institutional Repository System (IRS) is to categorize and index the submitted digital objects. Based on current practice, human catalogers are frequently involved in this process to make accurate categorization. Funded by NLM development grant, we are developing an UMLS-based indexing tool. The tool will be integrated or plug-in into most IRS, and categorize and assign MeSH headings and keywords to text-based digital objects automatically.

Fellowship training at John Hopkins: programs leading to careers in librarianship and informatics as informaticians or informationists.

Preparing librarians to meet the information challenges faced in the current and future health care environments is critical. At Johns Hopkins University, three NLM-funded fellowship programs provide opportunities for librarians to utilize the rich environments of the Welch Medical Library and the Division of Health Sciences Informatics in support of life-long learning.

A current perspective on medical informatics and health sciences librarianship.

OBJECTIVE: The article offers a current perspective on medical informatics and health sciences librarianship. NARRATIVE: The authors: (1) discuss how definitions of medical informatics have changed in relation to health sciences librarianship and the broader domain of information science; (2) compare the missions of health sciences librarianship and health sciences informatics, reviewing the characteristics of both disciplines; (3) propose a new definition of health sciences informatics; (4) consider the research agendas of both disciplines and the possibility that they have merged; and (5) conclude with some comments about actions and roles for health sciences librarians to flourish in the biomedical information environment of today and tomorrow. SUMMARY: Boundaries are disappearing between the sources and types of and uses for health information managed by informaticians and librarians. Definitions of the professional domains of each have been impacted by these changes in information. Evolving definitions reflect the increasingly overlapping research agendas of both disciplines. Professionals in these disciplines are increasingly functioning collaboratively as "boundary spanners," incorporating human factors that unite technology with health care delivery.