EHR and Librarians – pt 2

It just feels a bit chaotic, this scramble to figure out how to work with the EHR’s implementation initiatives. Adam and I were meeting today to finalize our presentation for National AHEC (on using social networking to support GME) and when we were discussing our conclusions I realized that many of the things we are doing to support GME (especially in primary care settings) are quite pertinent. There are 3 main library roles or core functions (as we are calling them in ADL land) that can work in support of EHR implementation.

• Information Retrieval
• Filtering through masses of information
• Evaluating for quality and authority
• Information Organization
• Information Access
• This stems more towards the traditional elements of providing direct pathways into licensed content. the difference being that instead of providing access to journals, books, databases that in these cases librarians might be providing deeper linking to the article or chapter level

The tricky part is how to best apply these skills in the context of EHR implementation. The people who are working EHR implementation that the role of the librarian must be seen as a necessary efficiency rather than as a luxury. Many people with whom I have discussed EHR implementation look at me a bit quizzically and say, “well we are so busy just getting these implemented that we won’t be ready to think about resource integration and linking for a couple of years.” This type of conversation is a golden opportunity to offer to help filter through much of the pertinent news and definitions and deadlines emerging in the field of EHR implementation. This is an ideal time to offer to help organize the piles of forms and documentation. We mustn’t assume that the librarians role in EHR implementation is obvious to the professionals handling the implementation. We must prove our value and be willing to do everything (even if we think that filtering and condensing news is a bit “beneath” our skill level) we are asked – to provide any kind of assistance that we can.

And just because I can’t resist … I don’t think changing our name to informationists will magically make our EHR target audience more visionary when it comes to the role of the librarian in the implementation.

Embedded Librarians and What’s Up with the Informationist Name (sigh)

I was going to continue my posting on librarians and the EHR, but this article caught my eye, and since I had been writing about embedded librarians, this seemed more topical. USA Today writes about the embedded librarian program at Johns Hopkins Welsh Medical Library in its article, “Embedded Librarians: Johns Hopkins Ahead of the Curve” (Steve Kolowich: USA Today, posted 6/9/2010, accessed 6/9/2010). This article discussed plans at Johns Hopkins to completely do away with its physical building by 2012. They are moving to librarians embedded in the departments, and being part of research teams. Claire Twose, Johns Hopkins informationistn says “being on the ground with researchers — sharing spaces, attending meetings, casually bumping into them in the hallway — allows librarians to develop a better understanding of what the researchers need, while the researchers learn more about what sorts of assistance the erstwhile librarians can offer.”

This article presents a nice balanced view by presenting some of the limitations of this model. Limitations include money (it can cost quite a bit to add enough librarians to be distributed rather than centralized). This model also has limitations in terms of different needs for different types of libraries. I also have to wonder about the role of the library as a physical gathering space. A library building may no longer need to be a house for books and print collections but our library is heavily used as a group study, networking, meeting, communal space. Yes this type of space doesn’t need to be staffed but it is an important function that a campus would still need to fill. Librarians as teachers also need classroom space. Again classrooms are found in other buildings, but on our campus, most classrooms are heavily used and would be difficult to books for library instruction. None the less despite these cautionary notes, as my blog readers will note (all 2 to 4 of you) this is a route I’ve long been envisioning.

My biggest disagreement (another pet peeve of mine) is changing the name from librarian to informationist. Nancy Roderer Library director at the Welsh Medical Library advocates the term informationist rather than librarian. According to USA Today, “Roderer did not invent the term, but she prefers it to “librarian,” which she says evokes envoys from a faraway building rather than information experts whose skills are applicable anywhere.” I respectfully disagree. I have done a very unscientific but wide ranging and casual poll of many people ranging from doctors to engineers to students to lawyers and guess what not one of them knew what an informationist was but most guessed it had something to do with fixing computers. People can adapt to changing roles for librarians better than they can adapt to some made-up word that has no meaning and is almost laughable. I doubt that lawyers sit around saying maybe we should change our name to something more relevant like litigationist. Or doctors discussing changing their name to healthists. Before I end my digressionary (as long as we’re making up words) tirade let me make one last plea, embrace who we are and trust that people understand that jobs change over time. I mean we no longer except doctor’s to leech us.

For my previous discussion of embedded librarians see my June 2009 posting on Embedded Librarians

The Role of Libraries in EHR Implementation: Challenges (the first in a series)

There is a lot of buzz lately about getting EHR’s into primary care practices. Many sessions at MLA focused on libraries and their institution’s EHR implementation. At a casual glance it seemed like many of those were about hospital implementation. The sessions at MLA all focused on the many challenges librarians faced in getting involved in their institution’s EHR implementation. In terms of primary care practice implementation; I’m guessing take those challenges and multiply them by some significant number.

What are the challenges facing librarians as they try to carve out a niche in implementing EHR’s in primary care settings?

1. Unlike many (but not all) hospital settings, most primary care practices don’t have an existing relationship or an expectation of a relationship with a medical librarian. In order to work with implementation, librarians may have to develop new relationships/
2. The process of implementing an EHR in a primary care setting is in many cases overwhelming the practices and just getting the bare bones minimal implementation up and running in many cases will tax the practices leaving little or no time for adding the library/resources component. Librarians might need to practice watchful waiting to judge when the practices are slightly less stressed.
3. There are economic factors at work. In cases where practices don’t currently have subscriptions to resources, there will be added costs for adding library resources. Figuring out how to pay for these resources may call upon librarian’s creativity.
4. There are a lot of unknowns about the federal mandate for this implementation. This creates an atmosphere of chaos (which is too strong of a word) and uncertainty. This is a whole new world an often we as librarians don’t know what role to advocate

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As medical librarians choose to move forward it will be important to understand the challenges if getting our feet in the door of primary care practices. Understanding these challenges can help develop plans.

Stayed tuned for my next installment … covering possible roles for librarians