MLA News Selected Articles

March 2000

The AAMC Medical Informatics Objectives and Librarian Roles

Edited by Virginia A. Lingle, AHIP

Series coordinated by Trudy A. Gardner, Ph.D., Medical Informatics Section; Rush-Presbyterian St. Luke’s, Chicago

Submitted by Bette Anton, Medical Informatics Section; Optometry Library/Health Sciences Information Service, University of California–Berkeley

Editor’s Note: This article is part of a series written by members of the Medical Informatics Section.

Medical Informatics Objectives, available at www.aamc.org/meded/msop/informat.htm, have been developed for the American Association of Medical Colleges (AAMC) by their Medical Informatics Advisory Panel. The objectives are guidelines meant to help guarantee that medical school graduates will be able to utilize information for problem solving and decision making. The document also offers an opportunity for librarians, as information professionals who have worked on informatics initiatives for many years, to collaborate as integral team members in implementing the recommended competencies for students and practitioners in all of the health sciences.

The educational premise of the objectives is that informatics "should be a central feature of the medical curriculum" and that medical school graduates should be able to use biomedical information to formulate problems; arrive at strategies for solutions; collect, critique, and analyze information; take action based on findings; and communicate and document these processes and the results. Five major roles of a physician—life-long learner, clinician, educator/communicator, researcher, and manager—with overlapping attributes, are described by the objectives as they relate to student needs.

Information and its transfer are at the heart of health care, health care education, and continuing education, but burgeoning information means that memorization is neither feasible nor the most optimal means of learning. The trends toward using problem-based learning (PBL) techniques in education, and evidence-based health care (EBHC) principles in clinical practice, encourage critical thinking and the development of "just-in-time" information skills. PBL and EBHC easily incorporate instruction about the structure of biomedical literature, methods of information retrieval and management, and critical evaluation. By integrating library-related informatics training into PBL and EBHC, librarians promote life-long learning skills and may become directly involved in the curriculum and practice of health care.

While the most obvious role for librarians in the Medical Informatics Objectives can be seen in the life-long learner category, a number of additional roles are implied. The remaining physician roles offer multiple spheres in which librarians may comfortably intersect with the curriculum. Librarians are moving toward managing information in a broad environment—in education, research, electronic publishing, and institutional planning. The intersection of librarian and physician roles will continue to promote collaboration with faculty, clinicians, researchers, and other information professionals to help solve the problems of organizing information; further clarify the classification, access, and archiving of resources; and investigate, develop, and promote new forms of communication and publication.

Librarians are developing and providing new forms of value-added content and user services in the context of informatics education and changing information formats. They are working to develop just-in-time retrieval methods to provide information at the point-of-care and to become involved in distance learning and continuing education.

The most significant challenges will be to maintain enough flexibility to adapt to the ever-present changes in curriculum and technology, and continually redefine what constitutes information and librarians’ roles in relation to it.

Computer Ergonomics

Edited by Melissa L. Just

Submitted by Candice Benjes, M.L.I.S., Norris Medical Library, University of Southern California–Los Angeles

Internet Resources

International News

Edited by Zana Etter

Latvian Library Selected to Receive Support

Reported by Donna Flake, AHIP, MLA Representative to EAHIL

MLA is devoted to promoting medical libraries, both in the United States and abroad, and ultimately health and wellness. To support its mission, MLA believes in maintaining strong coalitions with agencies and individuals, at both the national and international level. To this end, the International Cooperation Section of MLA has begun a new international endeavor called the Sister Library Initiative. The goal of this program is to select two libraries from outside the United States to help, to support, and to cooperate with for the next five to seven years.

The Medical Research Library of Latvia, located in Riga, Latvia’s capital city, has been selected as one of the sister libraries. The library serves as the National Medical Library of Latvia and coordinates nine branch libraries throughout the country. Although the librarians collect Latvian and Russian medical materials, they also attempt to collect materials in English, but currently have only twenty-two English-language medical journals. Deputy Director Velta Poznaka will serve as the primary contact for this project; Raisa Kazanina, director of the library, can also be contacted. The library’s Website includes an English version.

The selection of this library was indirectly the result of the 1999 European Association for Health Information and Libraries (EAHIL) meeting held in Tartu, Estonia. After the meeting, Donna Flake, AHIP, MLA representative to EAHIL, visited Latvia and the Medical Research Library of Latvia and learned of its needs. MLA is proud to welcome the library as the choice for this project.

As part of the Sister Library Initiative, a second medical or hospital sister library from the Caribbean or adjacent area will be selected. The members of the Sister Library Committee are Chair Vicki Croft, AHIP, Veterinary Medical/Pharmacy Library, Washington State University–Pullman; Donna Flake, AHIP, Medical Library, Coastal Area Health Education Center, Wilmington, NC; Janet Fisher, AHIP, James H. Quillen Medical Library, East Tennessee State University–Johnson City; Livija Carlson, Veterinary Medical Library, University of Minnesota–St. Paul; Diane C. P. Ebro, AHIP, Stillwater, OK; Barbara Ruelle, AHIP, Health Sciences Center Library, Emory University, Atlanta; Avril Reid, Library, Caribbean Epidemiology Centre, Port of Spain, Trinidad & Tobago, West Indies; and Lenny Rhine, Ph.D., AHIP, Health Science Center Library, University of Florida–Gainesville.

Genomics Symposium Offered at ICML
As part of the International Congress on Medical Librarianship (ICML) continuing education program, a one-day symposium on genomics will be held on June 30, 2000, in London. The current explosion of genetic information is profoundly affecting all health care disciplines. Medical librarians must learn to understand this new area of information, as well as the needs of researchers, health care workers, and patients.

Genome projects are rapidly generating an array of new resources including sequence, structure, mapping, and functional databases. Increased knowledge about genetic disorders and genetic aspects of common diseases is beginning to impact medical practice. Magazines and newspapers regularly publish information about these issues, but there is still ignorance and misunderstanding of what effect genome research will have on health care. All of these issues pose challenges for librarians in health care and medical research libraries.

This symposium is designed to improve librarians’ awareness of the influence of new genomic knowledge on medicine. It also aims to encourage librarians to learn about genomic information resources and to promote their exploitation. Attendees will gain an appreciation of the impact of the Human Genome Project on medical practice and research, current ethical debate, and the information needs of the public in this area.

The preliminary program will be available soon, but confirmed speakers include Graham Cameron, joint head, European Bioinformatics Institute; Sir David Weatherall, director, Institute of Molecular Medicine; Tom Wilkie, head, Biomedical Ethics, Wellcome Trust; Jo McEntyre, U.S. National Center for Biotechnology Information; Alastair Kent, director, Genetic Interest Group; and Bernard Keavney, Oxford University Medical School. There will also be a speaker from Iceland to talk about the Icelandic Healthcare Database and a speaker from the pharmaceutical industry to talk about the use of bioinformatics in drug discovery. More details are available at the 8ICML Website.

IFLA’S Secretary General Honored
Ross Shimmon, secretary general of the International Federation of Library Associations and Institutions (IFLA) has been honored in the British Prime Minister’s New Year’s honors list. He becomes an Officer of the British Empire (OBE) for services to librarianship and information provision. Shimmon says he is astonished and delighted to receive the award and is particularly pleased by the recognition it gives to librarians and libraries in the United Kingdom. He expects to receive the medal at Buckingham Palace later in the year. Other recipients of awards in the New Year’s honors list include actress Elizabeth Taylor and entertainer Julie Andrews, who both become Dames of the British Empire (DBE); author Doris Lessing, who receives a Companion of Honour (CH); and Richard Branson, who becomes a knight.

Web Magazine Highlights Telematics Projects
Reported by Brian Kelly, United Kingdom Web Focus

Exploit Interactive, a Web magazine funded by the European Commission’s Telematics for Libraries program, has just released the fourth issue. The issue contains articles on the theme "New Services for the New Millennium," including special feature articles on building Europe’s largest library from Bernard Smith, head of the Cultural Heritage Applications Unit in the European Commission; and Steve Coffman, director of FYI, County of Los Angeles Public Library. There are also articles on several telematics for libraries projects, news on CULTIVATE-EU (a Fifth Framework project), and conference reports.

Issue 4 has undergone a technical upgrade. In addition to enhancements to the user interface, the search interface has been upgraded to provide a notification service of new issues. Users can print the complete issue, features only, or columns only. Enhanced searching and browsing in current and previous issues is also available.

Issue 5 is due out in April 2000. Please send email to the Exploit Interactive editor if you would like to contribute.

UNESCO Creates New Information Program
The United Nations Educational, Scientific and Cultural Organization (UNESCO) is creating a new program for contributing to a "just and free" information society with universal benefit. Member States of UNESCO hope that the new program, which will replace the General Information Program and the Intergovernmental Informatics Program, will promote free and universal access to information that individuals need to participate equitably in the global information society. The program will also strive to provide an appropriate framework for the preservation and global sharing of information and knowledge, which is of particular relevance to the archives and library community. Information experts are invited to submit suggestions as to the scope and activities of the new program as well as to its name at the UNESCO programme Website.

Computer What Is Linux?

Edited by Melissa L. Just

Submitted by Doug Blansit, Reference Library, Medical University of South Carolina–Charleston

Linux (pronounced LEE-nucks) is both a computer operating system (OS) and a development concept undergoing phenomenal growth since its release in 1991. An estimated 24% of servers sold in 2003 will use Linux. Such estimates are based on purchased packages, not free copies, and therefore underestimate the total number of servers that will use Linux.

Two great assets are its price and capability for decreasing the cost of the upgrade treadmill. Hardware requirements for Linux are nominal, and distributions and software are freely downloadable. However, some individuals find it easier to purchase Linux on CD-ROM. Linux can be obtained free or prices range up to $80 for a deluxe edition, which includes printed manuals and technical support.

The operation system is just part of the equation for building a useful computer system. A functional system also requires software packages that will run on that particular OS. For example, many personal computers run the Microsoft Office suite on the Windows OS. Linux CD-ROMs often include a wealth of free software that is compatible with the OS, and more commercial products are available for purchase. For example, users who want a powerful integrated office package may choose to download StarOffice (a suite of software similar to the functionality of MS Office), which is available from the Sun Website for free. The commercial version of StarOffice costs $30 and includes the printed manual and versions for various operating systems. Thus, Linux and the StarOffice suite is available for just over $100 and may be loaded on multiple computers; upgrades can likewise be obtained by download for a nominal cost. The cost of the equivalent Windows and Microsoft Office would be greater when calculated on a per machine basis with purchased upgrades.

The Linux concept is part of the "open source movement," which seeks to make source code available to allow users to write enhancements, which may then be incorporated into future releases. Thus, Linux provides a worldwide team of collaborators and, consequently, a large number of Websites offering help at all levels of sophistication.

Understandably, this concept is also a deeply held philosophy and allows for various versions of Linux to be developed according to individual preferences. These versions share the Linux kernel (or core code) and additional tools are added by individual distributors. Subsequently, each version varies according to focus. For example, the free software that Red Hat distributes with their version of Linux differs from the software distributed by Slackware, SuSE, and others. One of the greatest difficulties with Linux is settling on the "best" distribution with the tools to fit one’s needs.

Like other operating systems, Linux coordinates the workings of the computer. It offers full UNIX-networking capabilities as both a workstation and a network server. It has advanced security features, including the ability to allow or disallow individual user’s access to programs and files. Linux can be used as a command line OS (similar to DOS) or with a graphical user interface similar to Windows or Macintosh, provided by XWindows.

In short, Linux is an operating system offering the power, stability, and portability of UNIX and the support of a worldwide collaborative community. Both initial experimentation and final deployment may be done inexpensively with commercial distributions and enhanced by software developed by many standard third-party vendors. Help is readily available through the Linux community and its numerous Websites. The following is a list of some Linux help and news sites.

• Linux.com at www.linux.com
• LinuxHelp Online at linuxhelp.org
• LinuxNewbie.org at linuxnewbie.org
• Linux Online at www.linux.org
• Linux Start: Search Engine at linuxstart.com
• SlashDot: News for Nerds at slashdot.org

Research Spotlight

Submitted by Kristin Stoklosa, National Institutes of Health Library, Bethesda, MD

Editor's Note: This series features MLA members’ research projects published outside the library literature in scientific and biomedical publications. The Research Resources Committee of the MLA Research Section shares this series to promote awareness of information research, encourage research in library practice, stimulate interest in a variety of publications, and inspire further MLA research.

"Telemedicine to Iowa’s Correctional Facilities: Initial Clinical Experience and Assessment of Program Costs"

MLA Member
Susan Zollo, Telemedicine Resource Center, College of Medicine, University of Iowa–Iowa City

Source
Zollo S, Kienzle M, Loeffelholz P, Sebille S. Telemedicine to Iowa’s correctional facilities: initial clinical experience and assessment of program costs. Telemed J 1999;5(3):291–301.

Project Description
This cost-benefit analysis of a prison telemedicine program is successful in at least three areas: evaluating the annual implementation costs of a telemedicine program to Iowa’s prisons, presenting a formula for estimating telemedicine service costs, and comparing these costs to onsite visit costs. The University of Iowa Hospitals and Clinics (UIHC) serve the state’s Department of Corrections (DOC) facilities. Telemedicine between UIHC and DOC began in 1997 with connections to two facilities. In total, the survey was taken from four prisons and an academic tertiary-care facility. The telemedicine data consisted of demographic and diagnostic information collected about 274 prison consultations performed during the first year of operation, from March 1997 to February 1998. The annual estimated telemedicine cost factored circuit charges, equipment, per-minute charges, personnel, and space for facilities. These cost data were compared to the 1997 cost data for prisoners transported to the UIHC for onsite care.

The most significant result of this comparison was the break-even point: the point at which the telemedicine cost approaches the onsite-visit cost. The authors calculated 275 teleconsultations per year, per site, as necessary to break even; factoring in the high equipment investment at UIHC would raise this number to 2,000 total per year. In addition, the authors performed a qualitative survey of physician satisfaction with the telemedicine system for patient care, which revealed that referring providers were more satisfied than specialists were. The authors caution against early anticipation of cost-effectiveness, which can be achieved as the volume of telemedicine consults increases. Rather, they recommend taking an initial cost-acceptable view for a telemedicine project.

"Automatic Indexing of Documents from Journal Descriptors: A Preliminary Investigation"

MLA Member and Project Leader
Susanne M. Humphrey, AHIP, Lister Hill National Center for Biomedical Communications, National Library of Medicine, Bethesda, MD

Source
Humphrey SM. Automatic indexing of documents from journal descriptors: a preliminary investigation. J Am Soc Inf Sci 1999;50(8):661–74.

Project Description
This article investigates an automatic indexing approach for using journal descriptors (JDs) from the SERLINE database. Using a portion of the MEDLINE database as a training set, the indexing process associates textwords from the citations’ titles and abstracts with JDs in the journals’ SERLINE records. The method uses the set of citations in a global fashion: textwords from the citations are associated with the JDs of the journals based on occurrence factors within the set. Word JD profiles are computed based on the strength of association between textwords and JDs in the set. For each citation, the indexing procedure calculates a document JD profile that presents a ranked list of JDs for each textword in that citation. The result is that journal descriptors can be applied as general indexing terms at the document level. For example, if certain textwords from a given document appear more often in citations from journals with the JD "cardiology," the JD "cardiology" could be used to index that document.

The advantage of this new, hypothetical approach is its independence from manual indexing of large numbers of documents. The indexing process itself creates a system of associations between words and JDs applicable to documents outside the training set, such as monographs, Web documents, and reports. For information retrieval, journal descriptor indexing could assist in several arenas: for search strategies by providing general search parameters, for current awareness systems by partitioning databases into large topical areas, and for disambiguation in natural language processing by weeding out undesirable results.