Comparative Effectiveness Research (CER) and the Librarian
The Institute of Medicine released its long awaited report, “Initial National Priorities for Comparative Effectiveness Research“. According to the IOM, COE “identifies what works best for which patients under what circumstances”. The Annals of Internal Medicine posted a really nice summary and history of this project. This includes a definition of CER summarized in 2 sentences, “CER is the generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat and monitor a clinical condition, or to improve the delivery of care. The purpose of CER is to assist consumers, clinicians, purchasers, and policy makers to make informed decisions that will improve health care at both the individual and population levels.” (Annals of Internal Medicine Vol 151 Issue 3 accessed 6/30/2009).
There are many things of interest to librarians in this whole concept. It is fundamentally what medical librarians do, and if you look at projects like FPIN and other clinician/librarian collaborations, you will see the important (critical role) that librarians will (or SHOULD) play in the CER process. What is notable in the reporting about this, is the lack of any mention about the role of medical librarians. Like the whole EHR emphasis this could have been a great opportunity for MLA to make a statement (or something). I hope that despite the lack of specific mention of the role of librarians, that most clinicians and researchers looking for the research monies that are part and parcel of this, will think about their librarian partners. It is ironic (??) that this report comes at at time when the role of hospital librarians is coming into greater and greater scrutiny. Now it is most likely true that many hospital clinicians and hospital librarians might not be playing a research role in this new emphasis, but this could still be a great opportunity to continually remind clinicians and those involved in health policy about the important role that medical librarians DO play in doing the level of research required in these CER projects.
Bibliography
- Patient-Centered Research Report Sent to Congress Outlining Research Priorities for $400 Million for HHS in Recovery Act (Market Watch)
- Report Sets Priorities for Funding Effectiveness Research (Medpage Today)
- Candidates Aplenty for Spending on Comparative Effectiveness(WSJ Health Blog)
- Psoriasis Cure Now Welcomes Institute of Medicine Report Urging ‘Comparative Effectiveness’ Research on Psoriasis, But Worries About Risk of Rationing(PR Newswire Press Release)
More Publisher Relations – Flat Pricing & Confidentiality
Economic Impact Statements Update
The Triangle Research Libraries Network (TRLN) has posted an open letter to their content providers to assist in resource negotiations during these difficult economic times. This letter reiterates the Statement to Scholarly Publishers issued by the Association of Research Libraries asking publishers to work collaboratively to, “develop creative solutions to preserve the greatest amount of content possible to meet the information needs,” of their clientele. As I work with some of our vendors I feel like part of the problem is that it seems like we aren’t even speaking the same language. We recently told all of our vendors that we were not able to handle any increases (and we feel lucky in many respects) and one of our vendors came back to us with an 8% increase (this will sound familiar as I have posted this before). They explained that an 8% increase was their equivalent of a flat quote. To them an 8% increase is the same as no increase. To quote the Princess Bride, I don’t think no increase means what they think it means.
Elsevier & Confidentiality
As if our jobs haven’t been difficult enough in these trying times, Elsevier has been up to its usual mischief. In early June (Library Journal June 11, 2009) ARL issued a statement urging member libraries from refraining in signing agreements with confidentialy clauses. This statement, is written in the hope “that more openness among libraries about analogous agreements at similar institutions will force vendors to offer more equitable deals all around.” In response (or around that time) Elsevier requested made a motion requesting a judge keep contract terms with the University of Washington out of public records. A county judge blocked this motion and in the end Elsevier claims it won’t appeal. Elsevier defends its position claiming that their ability to maintain confidentiality allows them to keep prices lower. WHAT?? They seem to believe that their needs as a corporate entity trump the right of the public to know. I don’t think we’ve heard the last of this. Although Elsevier isn’t planning on appealing at this time, it is highly possible that they will file a motion in another state hoping that courts in a different state might come to a different decision.
As I negotiated my contracts this year, Elsevier was the only vendor that insisted upon keeping the confidentiality clause. Oddly enough Elsevier is not the vendor with whom I’ve been having flat pricing issues. I have high hopes of maintaining good working relationships with all our vendors, but these economic times are proving quite the strain on existing models.
Search Engine Optimization
Search Engine Taste Test
Every time I post about the budget situations, I have the need to do a follow-up post about something less stressful. I have had a note on my white board for a couple of weeks to revisit search engine optimization for our site. Once upon a time we had put meta tags on our public pages to enhance search engine optimization. At the time that worked and then Google changed its alglorithms and that was the end of that. I had saved my emails from that project and came across the one from our web developer where he described the ever changing landscape of search engine optimization. (I’m trying to see how many times I can use that phrase in this posting). At any rate, as I was searching for inspiration for today’s posting I came across the Search Engine Taste Test posting from the Closed Stacks blog. Try it, you might be surprised by the results.
I wish I could figure out a way to conduct a similarly “blind” comparison between Point of Care Products. Up to Date has been so branded that its hard to conduct any objective studies amongst the differing Point of Care products. As money becomes tighter and tighter, we really are going to seriously justify the increasing expenditures for these expensive POC products and it would be really excellent to have some sort of objective comparison.
Shrinking Budgets: The Good, The Bad, and The Ugly
The Good: Building Collections in Difficult Economic Times
Joseph Esposito recently wrote a posting to the liblicense blog on Building Collections in Difficult Economic Times. In this posting he discusses testing on demand services. This hearkens to library school discussions about just in time vs. just in case collection development. When I was in school these discussions seems oh so theoretical, now they are frighteningly real. Why do I call this “The Good”? Well, partially because I was wanting to hold my title together and this was the closest thing to good that I could find. I have been advocating an on-demand model for several years, and have even been in casual discussions with some of our vendors about trying to develop a model that would work better for our consortium. A better model for us is definately skewed more towards demand rather than towards size or potential use. Very small hospitals (under 100 beds) tend to do ok in the current pricing model because most vendors look at them as throw aways, but mid size hospitals can really be hurt because their bedsize often makes them look bigger on paper than their resource use would ever play out. The liblicense discussion does an excellent job of outlining the challenges. I’m not an optimistic person by nature, but if we can emerge from these economic difficulties with some new models that might not be a bad thing (or I should say it might be a good thing).
The Bad: Disappearing Hospital Libraries
The Krafty Librarian beat me to the punch as I was going to revisit the impacts of shrinking budgets on the future of hospital libraries. For those of you following my blog, you will remember my posting about the Vital Pathways document(and if you don’t I did provide this handy link back). I have also been posting about evolving library roles such as embedded librarians and clinician/librarian collaborative projects. I totally agree with everything the Krafty Librarian wrote in her blog about the disappearing hospital librarian.
I particularly resonated with her statement about being, “amazed and saddened by the ones who provided wonderful services with limited budgets and resources yet all of a sudden found their job reduced or eliminated. But for each of those super librarians I unfortunately run into, I also run into librarians who seem to be stuck in a time warp and are running a 1980 library in 2009 and wondering why their budget is cut every year.”
The Ugly: Replacing Hospital Librarians with Electronic Resources
Hospital libraries had begun closing even before the beginning of the current economic down turn. One of our consortial member hospitals closed their library. The institution got rid of the print collection, took the physical space, and eliminated the library staff. They did, however, keep their electronic resources. Here is an interesting statistic, once this hospital closed its library (the physical library space and by eliminating the librarian position), the usage statistics of the digital library by hospital staff significantly declined. This was even after factoring in the librarian’s usage. If we believe (which I HOPE we all do) that hospital libraries are “pivotal to the success of all health care organizations,” then the fact that resource usage declines after the loss of the professional librarian seems to make it more critical to save not only access to resources but also to the professionals who shepherd and guide resource access.
I recently had a frightening conversation with a hospital administrator who asked me why they still needed a library since they had recently purchased a subscription to a Point of Care resource (a very expensive POC resource). This administrator informed me that this resource was the only one their clinicians were using anyway and when given a choice between having access to this POC product and keeping the library most of the clinic staff chose the POC product. This is a very “ugly” possibility that many of us intentionally ignore. Its as if we are afraid that if we raise the possibility that it will come true. Its the 300 pound elephant in the room. Until we can come to terms with these POC products and can figure out how to sell our services in light of the overwhelming popularity of these products, we are going to be having this conversation over and over and over again.
I’m going to continue gathering statistics to help understand the usage of these POC products. The hope for me is that if we can continue to keep these POC resources yoked with other library resources, then the usage of other library resources also increases (I just need to fully analyze the data to ensure that this conclusion really is supported by the facts). As librarians we have to keep advocating for keeping library resources linked with to and from these POC products.
Disclaimer
As always these thoughts are mine and mine alone. Many statements are intentionally provocative designed to stimulate thought and discussion.
Librarian – Clinician Collaborations, pt. 2:FPIN
FPIN: Family Physicians Inquiry Network
The Family Physicians Inquiry Network (FPIN) was created approximately 10 years ago with the goal of, “making evidence-based family medicine and clinical scholarship more accessible to family physicians in clinical practice.” The most visible role of the medical librarian in this network is serving as expert searchers in creating the clinical inquiries or clinical answers. According to the FPIN webiste, Clinical Inquiries, “provide the ideal answers to clinical questions: using a structured search, critical appraisal, authoritative recommendations, clinical perspective, and rigorous peer review, Clinical Inquiries deliver best evidence for point of care use.”
The FPIN librarians are trained in the evidence methodology and all librarians, “must meet qualifications demonstrating appropriate experience and training in evidence-based medicine.” (Ward, D. The role of expert searching in the Family Physicians’ Inquiries Network (FPIN). JMLA 2005 January 93(1):88-96) To date there have been over 170 Clinical Inquiries published. The FPIN Clinical Inquiries are published in the Journal of Family Practice and American Family Physician.
The ADL and Clinical Inquiries
We have provided direct links into Clinical Inquiry citations and for our members eligible to access the full text links directly into the text in the AHEC Digital Library (ADL). To see our links login to the ADL as a guest http://library.ncahec.net, and select the Clinical Answers link from the main page. We have also classified each one in an appropriate health topic area. If you visit, for example, the ADL Allergies and Immunology Health Topic page, there is a Clinical Answers section with links to 2 FPIN Clinical Inquiries. As I write this, I think I’m going to create a direct URL into our Clinical Answers page.
References
- The FPIN Website
- Ward, D. et. al.The role of expert searching in the Family Physicians’ Inquiries Network (FPIN)JMLA. 2005 January 93(1):88-96
Update on the Hoax Article
In yesterday’s posting I pondered the liblicense posting by Mahmood Alam disclaiming the publication of any such article by Bentham Publishing. Someone later posted on the list that no one said any such article had been published, merely that such an article had been accepted for publication. I wonder why the disclosure that “the publication of an industry-sponsored journal primarily for marketing purposes by the affiliate of a major medical publisher without disclosure of commercial support or publication purpose” caused so much of a bigger furor than this disclosure? I think I understand the answer: one has to do with established publishers and impacts long established business models. The other impacts newer publishing models with impacts and ramifications that aren’t yet fully understood. For me, the acceptance of this, “hoax” article raises many more interesting questions (although don’t get me wrong the industry sponsored journal is disconcerting to say the least) than the industry sponsored debacle because it does involve something new and evolving. Until peer review and OA issues are fully understood and evolved, every controversy and discussion is an opportunity to impact policy (how’s that for lofty sounding?)
Budgets, Negotiations, and Other Resource Concerns
Economic Impact Statements
We were meeting today to discuss our journal cancellations project and someone shared the Duke University Medical Center Library’s June 2009 Newsletter where there was a brief article about their budgetary constraints. As were are grappling with the need to potentially cut $360,000 from our serials budget which could result in the cancellation of up to 250 journal titles, I was interested to read that Duke’s perceptiontion of the situation with publishers matched my own.
Pat Thibodeau writes that one of their strategies has been to ask, “publishers to keep their price increases to a minimum …unfortunately, most journal publishers are not willing to recognize the current fiscal pressures on university and library budgets and are projecting their usual increases.” In my other resources hat, we have had similar experiences with some of our vendors. One of our vendors gave us a 15% price increase claiming it was only %8 (I’m not sure what kind of math they were using). Our sales rep. smiled when we had mentioned that we had NO money for any price increase and said, but its only an %8 increase (like that was a good thing). I’m thinking to myself what part of we have no money for any increase do they not understand. Some of you might be confused when I talk about facing a $360,000 decrease and also a no increase situation; this is because I wear 2 different hats and am discussing 2 different institutions.
When the ICOLC published their Statement on the Global Economic Crisis and Its Impact on Consortial Licenses, I have to confess that I honestly had a glimmer of hope that there might be some reason as we worked with our vendors for the coming year. In all honest 2 of our vendors have been great!! I wish I could throw more business their way; to give them a reward for their excellent business practices. I was going to write here also about the MLA News (or was it Focus) item about the ICOLC economic statement, but I had filed that email in a local folder on my computer at work. Alas I don’t keep my mlanet login information handy so have no way to get into it from home tonight (here’s a chance for me to advocate once again for MLA to change its authentication to something a bit more intuitive or user driven — allow us to set our own username/password perhaps??)
I also read with interest the UC Libraries Open Letter to Licensed Content Providers. I hope they are having a better response than the Duke Libraries and some of our consortial members are finding.
The Hoax Article
There was a bit of a buzz on the liblicense list about a hoax article that was accepted by an Open Access Bentham journal: the Open Information Science Journal (see Library Journal, “Hoax Article Accepted by “Peer-Reviewed” OA Bentham Journal“. This comes at an interesting time in the OA movement. On the heels of the “fake” journal debacle (well actually a journal paid for by the pharmaceutical industry), the calls for increased ethical standards are going to become stronger and stronger. An editor at Bentham has resigned over this hoax. The Open Access Scholarly Publisher’s Association posted on its blog about, “Publishing ethics, open access, and OASPA“.
In an interesting side bar, there has been a bit of back and forth on the liblicense list about the use of the word “prank” in the OASPA blog posting.
Despite having several articles written on this topic (Library Journal, The New Scientist, The Scientist.com, boston.com to name a few), there was an odd posting on the liblicense list from Mahmood Alam the director of publications at Bentham Science Publications where he states that such an article was not published. His exact note is as follows, “I refer to your following message. Please note that this is not correct that Bentham Science Publishers has published any such article.” I have checked the OASPA web site and blog as well as Library Journal and some of the other sites that had covered this story but have found no retractions. Maybe I misunderstood this posting on the liblicense list.
These are certainly interesting times. What is the role of peer reviews in the OA model? What are concerns about funding sources for OA journals? What is the role of OA in libraries as they struggle with budetary concerns/constraints? How will emerging budgetary difficulties impact the OA movement? There has been much written by many people far wiser in these issues than myself, and I’m not going to attempt to encapsulate all of that discussion here. I merely write here to highlight another interesting story in the world of publishing.
I would include something here about the MLA ethics statements, but as mentioned above don’t have access to the members only section of MLANET this evening.
Librarian – Clinician Collaborations
JAAPA Ask a Librarian Column
I recently came across the Ask a Librarian Column in Journal of the American Academy of Physician Assistants. This column, “addresses questions that clinicians commonly ask medical librarians, with the goals of providing information about the various resources offered by medical libraries and of promoting collaboration between PAs and medical librarians.” It is written jointly by Jim Anderson PA-NP, and Susan Klawansky MSLS, AHIP both of the Seattle Children’s Hospital. This column was inagurated in the March 2009 issue. As I have pondering the future of health sciences libraries, this seems like an excellent collaborative project to highlight the best of the future.
Ask a Librarian Topics
- AAPA – NLM Partnership
- Finding Clinical Guidelines
- Saved Medical Searches
- Swine Flu Resources
- What are good non-commerical patient education sites?
- What is the definition of a Point of Care Product
Nursing Research: Show Me the Evidence
This blog is published the the St. Joseph Hospital in Orange California. The goals of this blog are to communicate nursing research activities and to, “serve as an open discussion forum for nurses and librarians interested in evidenced based nursing”. Julie Smith, MLS, AHIP is the librarian contributor to this blog. I love this project because it utilizes newer technologies ( well if you still consider a blog a new technology) and it highlights the role of the librarian. It gives a presence to the hospital librarian that is separate from the physical space. It highlights the service and knowledge expertise that librarians contribute to a hospital’s mission. This blog has been recognized by the Online Nursing Degree Guide (ONDG).
An example of Julie Smith’s contributions to the blog are the May 7, 2009 edition entitled Julie’s Pick’s from the Nursing Literature: May 09. Take a look at the blog and this article in particular to garner ideas for collaborative projects between librarians & clinicians
Coming Soon… The FPIN Project
It’s Not Just Another Statistics Rant
Clemson & the U.S. News & World Report Rankings
Inside Higher Ed recently ran a piece about a report given by a Clemson researcher detailing the steps Clemson took to improve its standing in the U.S. News & World Report rankings. (‘Manipulating,’ Er, Influencing ‘U.S. News’June 3, 2009. Accessed 6/8/2009). The U.S. News & World rankings have long been controversial, and its not my intention to get into any of that controversy here. This story does, however, illustrate another point that I have been ruminating upon. I have recently been doing a lot of thinking about the validity and utility of statistics. There is no doubt that there is much validity to statistics and there is much that they can tell us. There is also no doubt that statistics can be manipulated and spun. For me, this story illustrates some of the issues about the validity of statistics, about the basis upon which statistics are built, and about the methods that are utilized in gathering statistics. There is one very interesting tidbit in this story about manipulation of survey data by ranking other’s lower in a peer survey to boos your own rankings. Librarians spend so much time gathering stats for a myriad of reasons and I’m once again wondering about the utility of all the hours spent gathering stats. I sometimes think we need a lot more clarity about why we are counting, analyzing, categorizing etc all of our usage and other data. This story while not directly applicable does serve for me as a cautionary tale.
Yes, its another Ovid Stats Rant
I applaud the efforts of the COUNTER folks to come up with common elements to create some consistency in electronic resource stats. This is a very noble effort, but I also wonder to some extent if it isn’t also establishing some false expectations. This sort of perpetrates the illusion that any stats can be 100% accurate and comperable. It creates a bit of a false sense of security. All is right with the world because of all of our vendors are COUNTER compliant. I can rest at night knowing that no matter what vendor my stats can be compared across the board on an equal footing (sorry a bit heavy on the sarcasm doh). I’ll set that aside for now, here’s the point of this Ovid/COUNTER rant. Ovid recently “upgraded” their statistics utility. (please note this upgrade still doesn’t feature real time stats, we still have to wait for the Monday after the first Sunday of the month). The bad part about this “upgrade” is that they are changing the basis upon which they report so some numbers are going up and others are going down. This makes legitimate statistical reporting across time invalid. To help with that problem they’ve been kind enough to provide back stats using the new formulas (going back to 2007 I believe). Whoo peee!! Now I get to go back and rerun all of my old stats reports, plug in new numbers, write a report explaining why 2 years of data are now invalid and that we now need to look at these new numbers. The problem is that most people to whom I report stats aren’t going to be interested in reading an explanation as to why I’m having to report new stats. If I don’t, howeve, go back and update all of my old stats for fulltext journals I’m suddenly seeing a drop in June and for their EBM-R databases, there is a sudden increase beginning in June. For administrators who don’t bother to recheck the revamped old numbers they’ll just see either an abnormal increase or decrase. Since the most important thing we do with stats is compare them across time, it seems a bit odd to me to redo the way we calculate stats since that suddenly invalidates your data set. What I wish they would have done instead is introduced a new category of stats, left the existing stats intact and allowed us the end user and oh gosh I don’t know the customer the choice of either using the stats as calculated using old formulas or to switch to the new formulas. I really didn’t have the time blocked on my calendar this June to go back a recalculate all of my Ovid stats dating back to 2007 and then to write an explanatory report. Thanks Ovid, you guys rock (and I’m not apologizing for that sarcasm). I would prefer non-COUNTER compliant stats that are at least consistent across time, but as always no one at Ovid asked me.
It seems odd to me that at a time Ovid is raising the price of its EBM-R collection by upwards of 12%, that they are suddenly coming up with a new statistical measure that makes it look like the EBM-R databases are being used at a much higher rate than it would have appeared a month ago. Coincidence that this is happening at a time that many customers may be thinking of dropping this product due to the outrageous price increases. I’m just cynical enough to not believe in the coincidence. Especially since when we raised the issue about dropping our EBM databases, our rep just happened to mention our “high” usage of that database. Hmmmmm
Here Come the Disclaimers
Yes I do believe in gathering and reporting stats, I just think we often focus on the wrong questions.
Much of what I have written in this post has been written to stimulate thought and discussion.
All of what I have written are my thoughts along and do not express anything beyond that.
