Health Science Librarians and The Point-of-Paradigm - part 1 (guest post from Michele Matucheski)

Health Science Librarians and The Point-of-Paradigm 

Report from MLA-17 in Seattle : Part 1

By Michele Matucheski, MLA, AHIP – Medical Librarian for Ascension Wisconsin

June 30, 2017

I attended the 2017 MLA Conference in Seattle, Washington, with the generous support of a $500 WHSLA Continuing Education Travel Grant.   For a return on WHSLA’s investment, I will be posting a series of articles to share what I learned at MLA17.

As new clinical decision support and point-of-care tools have come on the market and are being integrated into the EMR/EHR, I’ve been wondering where that leaves Health Science Librarians and Library Services if Clinicians are doing it for themselves?   Are Library Services being by-passed for this more direct and integrated access at point-of-care?  Some people have even said that they don’t need anything besides UptoDate and Google.    In that wake, multiple professional Librarian jobs are being eliminated, and Libraries closed.  Where do Health Science Libraries and Librarians fit in this new world order?  Is there a new place for us in this golden age of Information?  These were just a few of the existential questions on my mind as I headed for Seattle for the 2017 Medical Library Association Conference last May.

One of the most interesting and illuminating programs I attended  was a Sunrise Seminar sponsored by Wolters-Kluwer / Ovid that offered a new model as to where Health Science Librarians and Libraries fit into the larger scheme of supporting the information / knowledge needs of medical, nursing, and health professionals today.

The program was entitled “Using Evidence to Inform Practice at the Point-of-Care, Point-of-Reference, and Point-of-Learning” by Anne Dabrow Woods. 

Now, through the magic of YouTube, you can watch the full recording of this session (51 min.).

Disclaimer : These Sunrise Seminars are a chance for vendors to show how their particular products  solve a vexing problem in the world today.  That said, Anne Dabrow featured several products from Lippincott / Wolters-Kluwer in the program.    I am not advocating for any of these Lippincott tools, nor does my company currently subscribe to any of them.  I am more interested in the overarching model of information needs that Dabrow describes.

If you don’t have the time or attention span to watch the video, consider reading the articles the speaker provided on the topic :

• Dabrow Woods, A.  Using Evidence to Inform Practice, at Point-of-Care, Point-of-Reference, and Point-of-Learning  [White Paper]

• Implementing evidence into practice.   Woods AD.   Nursing. 2013 Feb;43(2 Suppl 1):4-6. doi: 10.1097/01.NURSE.0000426539.59569.f2.     PMID:23328746.

“Health care is evolving but one thing that has remained consistent is the goal of all nurses and health care professionals to provide the highest quality care that improves patient outcomes.  Nurses and clinical professionals access and use the best available evidence at the point-of-care, the point of reference, and the point of learning, all of which have changed in recent years.   The clinical setting changes have influenced how clinicians work, access, and use information in their workflow.  Through use of case studies and clinical experiences, our keynote speaker will walk you through how the changing paradigm of health care has had an impact on clinical decision making, and how you as a Librarian can support quality care by providing health care professionals with the right information when and where they need it.”  --Abstract / blurb from the MLA17 Meeting Program (p.23)

Anne Dabrow Woods is a nurse who clearly values what Librarians offer those in clinical practice.  What fascinates me about Anne Dabrow Woods’ proposed model is that it shifts where Libraries fit into the scheme of evidence-based practice.   EBP has grown and evolved through the years, and so have the tools.  It used to be that Systematic Reviews were the pinnacle of the evidence-based pyramid, and Libraries/Librarians were the gateways to get there.  No  longer.   That top spot has been replaced by clinical decision support and point-of-care tools.  We need to evolve our Library resources and services accordingly.   According to Dabrow Woods, Clinicians access evidence-based practice content at the following points of need:

1. The Point of Care > The need-it-now moment where Providers only have 30 seconds to 2 minutes to search for an answer with a patient in front of them. Examples of tools are UptoDate, DynaMed, Nursing Reference Center, Lippincott Procedures … They need the synopses and best evidence in bulleted easy to read formats. Illustrations and videos are helpful. 
2. The Point of Reference > This was the standard approach 5-10 years ago, where information supports clinical care. But it takes longer to search for an answer this way. This is the classic Library model that covers example tools such as PubMed, CInahl, eJournals, eBooks, Cochrane, etc. Deeper info – Info for quality improvement efforts, or for updating policies and procedures. 
3. The Point of Learning > to maintain licensure or learn something new. CEUs and CMEs.

There is still a vital place for Librarians and our unique skill sets in this hierarchy especially at Point-of-Reference and Point-of-Learning. 

We still help inform the decision-makers about available tools, setting up demos, and evaluating products.

Then we help to make the tools available and accessible—part of that is integrating them wherever possible –and that includes the EHR/EMR, mobile access, intranet pages and beyond. 

We still help train people to use those tools efficiently.

We still help people find the info they need beyond those need-it-now decision-support/point-of-care tools when they need to go deeper.

Oh yeah—and we’re the ones who make sure a lot of our licensed full-text content is seamlessly available for our users when they do a Google or Scholar search. They may think it’s free because no one at JAMA or NEJM asks for a credit card or login. But that’s a Librarian’s handywork behind the scenes!

So even though we may not be at the point-of-care, we are still present for our Clinicians. Maybe we’re no longer at the top of the EBP, we’re a little further down where the Clinicians can take a breath, and a little more time to search for and absorb the info they need – at the point-of-reference, and the point-of-learning—where they can turn that new info into usable knowledge for better patient care. 

I would love to see a WHSLA Wisdom Chat centered around this topic (the video and/or the articles) to hear what the rest of YOU think. I am looking forward to a lively discussion on this topic!