Medical Library Association | Research : Informationist Web Discussion Transcript

Research

Informationist Web Discussion Transcript - May 9, 2002

The following is a slightly-edited transcript of the real-time Web-based discussion about the Informationist concept, held Thursday, May 9, 2002, from 3:00 p.m. to 4:00 p.m. Central Time. Thanks to all the participants who contributed!

Jean Shipman :

Hi - I'm Jean Shipman, your Web discussion moderator and chair of the MLA Informationist Task Force.
Today, we have with us the two Informationist concept originators - Dr. Frank Davidoff and Dr. Valerie Florance. They have encouraged us to think about what this professional would do, how he/she would differ from the current roster of health professionals and how this person would be trained and employed. The two also were keynote speakers at an Informationist conference held in early April at the National Library of Medicine and have agreed to address questions for the next hour about their concept. Thank you both!!!

All participants - Please feel free to post answers to the questions posed by the two authors or ask questions of Drs. Davidoff and Florance following the instructions provided.

Polly Porter :

D4) What have been (or do you think would be) the greatest barriers to the development of informationist careers and services? What have been (or are likely to be) the factors most likely to contribute to successful development of an informationist profession? Cost and rethinking the library and library profession. It is cost that has precluded clinical librarianship from being implemented in most health care settings. It does not seem reasonable to add to health care costs. However, there are funds for libraries that continue to be invested in distributed collections of print resources while medical libraries go unused and physicians access information electronically. Why not collect print in fewer locations, retain effective document delivery, and use local resources to develop informationist services, i.e., change the role of many medical librarians? Informationist services may include attending in-hospital rounds but should also be explored in light of PDAs, as being an electronic rather than a physical presence. It may be necessary to think further ahead to a central electronic service located in regional or national locations in light of Lois Ann Colaianni's vision of future libraries as data warehouses. Factors for successful development include the ability of medical librarians to accept the changing nature of information collection and access; the acceptance by physicians and other health professions of the necessity and benefit of information to patient care and research; and the development of partnerships with other information management professionals and possibly third-party payers.

Julie Kwan :

D2 - The most important contribution of the informationist to clinical services is to provide information to help the team decide between alternative or opposing points of view. (This was a key result of UCLA's CIS clinical librarian program.)

Michelynn McKnight :

D2) The Informationist, like the Librarian, should be what Nardi and O'Day called a human "intelligent agent"... someone who can interpret a question, retrieve and translate information faster and better than someone else can do for themselves.

Valerie Florance :

Responding to a part of Polly Porter's comment on D4 - I think that reallocation of resources at local libraries is an important but difficult thing. In my own experience, everyone wants to find new money, rather than making hard decisions to give up some traditional activities or reduce the money spent on them. To do that requires a budgeting approach that helps you see where (programmatically) your money goes and also a way of knowing the value users place on a particular activity

Diana Cunningham :

D1) given all that Dr. Davidoff has written, reviewed and edited, why, in your view, has the concept of clinical medical librarian failed to capture the support of more academic and/or clinical institutions. Presumably if they value the service, they will be willing to pay for it.

Julie Kwan :

D4 - Regarding training of medical librarians -- There are not enough courses in health sciences librarianship. Courses are cancelled due to low enrollments or perceived lack of interest. Library schools do not see them as moneymakers as they do business or law courses. I think we should develop a distance education course in health sciences librarianship so that we could provide training to students through- out the country.

Brad Long :

F3- I think that Informationists would flourish in the medical school setting, where education money could be utilized. However, rural and underserved areas would not readily accept this. This profession would be an additional cost that they could not justify. This could end up being another luxury of academia if uniform funding is not found. Thus we could be stuck at the same point we are now with clinical librarian.

Jerry Perry :

D2 - Having attended morning reports in Family and Community Medicine, I found that the instruction I provided (in framing a clinical, answerable question, and in using a range of EBHC tools such as Cochrane, TRIP, etc.) was the most appreciated aspect of the experience...

Michelynn McKnight :

D4 - As an Interdisciplinary professional, a Clinical Informationist would need to study in clinical disciplines and not just in librarianship, even if those librarianship courses are in a special practice area.

Frank Davidoff :

D2) I like the notion of the "intelligent agent" very much, primarily because it recognizes more fully the extensive intellectual resources available among clinical librarians and other (potential) informationists. Intelligence alone isn't enough, of course - it needs to be coupled with appropriate training and field experience.

Valerie Florance :

Responding to Diana on D1: I think there have been many flavors of clinical librarian - everything from an informationist to someone who just captures user search requests on site and then goes away to do the searches. This is once reason it's so difficult to explain why it hasn't flourished - the 'it' is ill-defined and somewhat personality dependent.

Lorri Zipperer :

in response to Polly's comments, I think one key to making this change is to find a physician champion and gather hospital leadership--including board member--support for the project. From what we have seen in trying to implement culture change for patient safety, those elements are key in the success of the effort. This approach also rings true in the corporate library environment as well. Has anyone had any successes with involving their hospital leadership in this issue.

Julie Kwan :

F3 - I think an informationist is more likely to flourish in an environment that places value on relationships. Some institutions have a corporate culture that support this while others do not.

Valerie Florance :

The notion of the intelligent agent is also familiar in qualitative research, which really depends on the researcher is using human intelligence as well as methodological technique to discover things

Jerry Perry :

F1 and F2 - I am also personally interested in the disintermediation of the role of an Informationist. By this I mean the development of expert systems that can be accessed at point of need by a practitioner and that do not require a human to interpret. So much of the clinical experience is idiosyncratic; expert systems, probably linked to order entry/patient record data could potentially provide access to very specific bits of information relevant to the very specific patient on hand (or in the bed, as it were)...

Diana Cunningham :

Valerie/Dr. Davidoff: In your view can the "informationist" concept be more clearly defined? It seems to depend on the setting and, I believe, specific personal attributes have always defined success in professions. However, successful librarians may not equate with successful informationists.... So, in your view, how can we better succeed...

Linda Watson :

DI) Regarding refinements of the informationist concept. We heard at least three roles for a clinical informationist at the conference: 1) being physically present as a member of the clinical team at the time and place where a question has been asked and a decision is needed 2) teaching clinicians how to find and evaluate information themselves, and 3) lending our expertise to the development of point of care clinical information systems and tools that can approximate some of our knowledge.

Valerie Florance :

Responding to Jerry's comment on disintermediation: many people have asked 'why bother having a human informationist, why not go straight to machine intelligence?' It is possible that an informationist is only an interim step toward truly intelligent systems, but it is a crucial one.

Polly Porter :

In response to Valerie on D4, yes it is difficult. I was assuming this radical change in terms of D1 or moving from invention to innovation. I think the value of the concept represented by the informationist has been understood my medical librarians for a long time. But, it has been seen as an accessory rather than central function. To get to innovation that has to change, and, as indicated, it does require changing its value to users.

Julie Kwan :

D4 - One barrier to informationists in the research setting is that the number one issue voiced by research faculty is for research -- i.e., laboratory -- space. This happens at institutions throughout the country. Faculty members complain to their administrators about funding for space, not information services. Can we somehow tie them together?

Valerie Florance :

Several people at the conference talked about the concept being fuzzy. I think Linda's list of roles is one way to help pin it down, but I also wonder how much is needed? Frankly, isn't librarian a fuzzy concept too? I think it is useful to define some functions that are common to an informationist in any setting. What Linda describes can be applied in educational setting or research setting, too.

Danny O'Neal :

I am in an academic health sciences library. We do not have clinical librarians due to staff limitations.

Tom Williams :

I recall years ago trying to implement a LATCH program at a V.A. hospital where I worked. It was very popular. I even tagged along at times to serve as a "clinical" librarian. This, too, was popular and well received. However, time did not permit me to spend a great deal of time on the LATCH/Clinical Librarian program. And, naturally enough, there was not money to add staff to do this more regularly. This seems to be still going on to a large degree. Perhaps the solution is to develop a comprehensive marketing plan.

Frank Davidoff :

D4) The idea of redirecting some existing library resources is pretty interesting; it's a good example of thinking "outside the box," or refining the informationist concept, which seems entirely appropriate at this early stage of development of the concept. (It's the kind of thing needed to move from an invention to a true innovation.)

At the same time, like Valerie, I'm a bit surprised that dollars could really be found in library budgets - great, if that's true. In the long run, however, I think the financing of informationist services needs deep rethinking. I truly believe that informationist services are a valuable part of clinical care (and clinical/laboratory research activity) and as such can and must ultimately be paid for, in just the same way that clinical laboratory, x-ray, medical or surgical consultations, etc. are paid for - that's for the long haul, obviously.

There may be a place for the centralizing of informationist services, but my vision of includes a much more distributed service. I'd like to see at least one person with basic informationist training actually working in any clinical (or research) group of any respectable size.

Valerie Florance :

Lorri [Zipperer's] comment about finding a champion seems very important. For every successful example of an informationist we have heard about, we have also heard about someone on the 'team' who supported and enabled the informationist's participation at the beginning.

Peg Spinner :

I agree with Julie that building relationships is important. Earning the trust and confidence of clinicians can involve not only searching skill but also making sure to attend and participate at every opportunity.

Danny O'Neal :

Regarding Diana's question about defining the 'informationist' concept, are there significant distinctions in the role of informationists vs. clinical librarians?

Peg Spinner :

F3-I agree with Julie Kwan that building relationships is important. Earning the trust and confidence of clinicians can involve not only searching skill but also making sure to attend and participate at every opportunity.

Ann Farrell :

Why not create another CIA (clinical informationist agency)? Seriously, can the informationist concept be incorporated into the burgeoning field of medical informatics?

Diana Cunningham :

Building the trust and confidence of physicians/researchers, to me, is part of the suite of personal attributes that are essential.

Valerie Florance :

Re Frank's comments on financing informationists. Many libraries are already functioning under the kind of financing model you allude to - i.e., tuition money helps support the library and so do indirect costs that flow into the institution's central pool. The 'charge-back' model, however, has not been as successful in these settings as it is in clinical care. An exception might be research groups that buy central services from a 'core', like biostatistics services.

Brad Long :

D4 - As for a major barrier I see to developing the Informationist as a profession is at the academic training level. Do the health sciences programs, library schools, medical informatics programs, medical schools, or hybrids of these take the lead in developing this training? Or do we look at this as professional training program for those who are already doctors, nurses, pharmacists, allied health professionals, librarians, etc.?

Janie Kaplan :

In response to the issue of artificial intelligence versus human relationship-so much of what was successful about Gertrude Lamb's concept of the clinical librarian was the "intuitive" ability of the CML to attend, observe, and hear patient care discussion and then intuitively respond with information- I somehow see this missing in A.I.-no matter how efficient it may seem.

As to response to funding, the original formations of CLPs were based on partnerships. Collaborative , vested partnerships between a clinical department and a library dedicating full-time information support to the clinical staff of that department.

Jerry Perry :

F1 - At the Informationist conference we heard from Ed Bednarczyk (sp?!), a Pharm.D. in Buffalo who talked a bit about the transformation of the role of the pharmacologist in the clinical setting. After returning, I spoke to a Pharm.D. educator at my site who did a residency in drug information. I was personally clueless that there were such residencies! What she does seems a lot like the proposed Informationist - a strong focus on EBHC, transformative learning/instruction, teaching how to frame questions, retrieve answers and evaluate them, etc. I think we need to learn more about such Pharm. D. programs, residencies, and worklife experiences...

Valerie Florance :

Not to create horror everywhere, but how about a radical example of how library funds might be reallocated: what if the circulation system was made 'self-service' and the FTE's were re-allocated to other work? I don't think it's the same as cost shifting - they (the users) get benefit somewhere else. This is not a solution, it's an example of trying to think through ways to do this. If the library's job is to provide services tailored to the needs of its clientele, and its clients need in-context services, then the task at hand is to figure out how to provide them well.

Frank Davidoff :

Diana Cunningham asks why hasn't the clinical librarian/informationist concept spread? A complicated question, but even the best of innovative ideas don't spread by themselves (as someone has said recently: people don't, in fact, automatically beat a path to your door for a better mousetrap - you have to market the hell out of it!). I suggested some ideas for how to get the concept adopted in my comments at the recent MLA/NLM meeting.

Linda Watson :

Regarding training - I wonder if we need to think about developing or facilitating more joint degree programs at our universities. For example there are joint MSN/MBA Degrees. Why not a joint MSN/Information Science degree? Or a joint MS with another of the allied health professionals? Maybe there are some of these in existence and we need to take more advantage of them?

Tom Williams :

Since NLM is currently experiencing a "healthy" budget, perhaps there might be some possibilities of their providing grants for clinical librarian/informationist programs.

Valerie Florance :

Re Brad [Long's] questions about training, I admit that I have tended to think of the informationist in the latter group, professionals in one area who expand their horizons (so to speak). I can't see why existing library school programs and/or informatics programs couldn't support this type of training now. The pieces are there in terms of the scholarly areas that need to be covered. The earlier suggestion about distance learning will be very important, I think, if we are to think of people 'adding to' skills they have.

Michelynn McKnight :

Development of better-automated systems pushes professionals to develop better service skills. Once upon a time, Library Science training included learning a kind of calligraphy called "library hand". When librarians were freed from that activity they developed better professional services than they had practiced before. Amateur information seekers are no more of a threat to real information professionals than are consumers practicing intelligent self care to the medical profession.

Diana Cunningham :

Do you think that the current library school curriculum is the best place to education and create informationists? Would other professional schools also work? Not sure in my own mind whether graduate schools of public health, informatics programs, would more effectively foster the informationist

Frank Davidoff :

Jerry Perry's comments about the PharmD programs is very much to the point. Much of the correspondence Valerie and I got about our informationist editorial in Annals of Internal Medicine was from pharmacists, who said "We've been doing exactly this (in the area of therapeutics) for years now). There's obviously a lot the "informationist movement" can learn from working with the pharmacy community, although "the movement" is much broader than therapeutics.

Carol Jenkins :

D4 - Following on the discussion of funding a central or distributed informationist service in a research setting, since research funding is typically external to the institution, it seems like an easier task to "convince" an investigator or unit of the value of the Inf. services to their research, and pay for them directly through their grants. If it were a distributed model it could be paid for by indirect costs but those are much more problematic.

Julie Kwan :

I think the library needs to rethink how and where it offers service. We used to assume that complex interactions would be handled inside the library (that's where the reference desk was located). But as more things are available electronically, the numbers of people coming into the library is going down. I think we need to change our thinking and our mind-set. We should expect that complex interactions should occur outside of the library's physical space. We need to get to where people are working and making decisions.

Valerie Florance :

Regarding Tom's suggestion about NLM grants: we have grants now that would support the implementation and evaluation of an informationist activity (meaning system grant) and 'pre-doctoral' fellowships and also IAIMS fellowships that could support the cross training. It would be very helpful to those interested in all of this if we/someone could help specify some general outline of the topics that should be covered in training. Then people who apply could say 'we will follow the xx suggestions for curriculum'

Janie Kaplan :

I think the role could be applied to almost any school or disciple-and certainly should be considered with other professional schools. The concept has always be well received-it is the actual dollars to make it happen in the real world that have always been a problem.

Jerry Perry :

Re: Diana's comment on library schools. Domain knowledge coupled with clinical culture knowledge (relationships and how they work) is crucial. I think the Vanderbilt model makes a lot of sense in this area - strong mentoring/leadership, a lot of prior training (nursing/public health classes) and then on the job enculturation.

Launa Kliever :

D4-I have to echo Brad Long and his bringing the question to the level of training of the informationists; it seems like what I've read about who would take the lead focuses on the library/information sciences end...i.e.: professionals in the field presently who would do what was necessary to increase their knowledge of the medical terminology. I am wondering about those trained in the medical professions who might be interested in branching into the information side of things. It seems to me that one way to move from invention to innovation is to implement "hybrid" programs in which professionals are trained more equally in both disciplines. This would also address the issue of trust that has been mentioned several times here as well as in the literature. In my experience, there is no substitute for building trust by engaging with those with whom you want and need to work at a PEER level. In other words, if informationists were studying WITH medical students, those students (as well as others in the field) may be more likely to trust the informationists' ability to interpret the literature.

Tom Williams :

In response to Diana's question about other professional schools creating the informationist. We could then up with non-librarian informationists and is that really what we want? Most library school programs (haven't looked in a few years) have been fairly week in medical library-specific topics. Offering more courses such as an informationist course would sure help. Even then, we wouldn't want to send a librarian on rounds without sufficient experience on the job. We learn concepts in library school but we learn functionality on the job.

Frank Davidoff :

Thinking of informationists as an intermediate step while we're waiting for the right automated system(s) seems to me an artificial dichotomy. I think it's highly unlikely that automated systems will ever solve the time problem, i.e., that clinicians (and many researchers) don't have the time to get the information they need. Also, the skills of searching, filtering, and selecting are likely to get more complex over time, rather than less, and it seems to me unrealistic to expect clinicians and researchers to get, and maintain, those skills, any more than they should be expected to be experts in statistics, or administration, etc., etc.

Carol Jenkins :

At UNC there are currently joint degree programs underway with the School of Information and Library Science and the Schools of Public Health, Nursing and Pharmacy. We are already thinking about how great it would be to hire these new graduates in the library! This seems like it could be a useful core of experts to be informationists in various settings.

Julie Kwan :

Regarding Valerie's comments on training, I don't think the library schools at present see the numbers of potential students to make this viable nor do their existing faculty have the skills needed to do this. I think that the educational effort must extend beyond our individual library schools.

Lorri Zipperer :

I agree with Julie. There is movement afoot where executives "walk around" hospitals to get the lay of the land to learn "in situ" about problems and successes with their staff and how care is delivered in hospitals. Perhaps a similar program involving the librarians, director of pharmacy and supportive leadership, whomever, could help to raise the visibility of the possibility of the informationist role there and position a changing role for the librarian within the hospital.

Valerie Florance :

When I was doing background reading for the JMLA article, I looked around at what library schools require in terms of practicum or disciplinary experience. I was disappointed at what I found. At most, the practicum was 'in a library', or maybe 'learning about another field.' I think the immersion in the culture you will be working in is fundamental to the informationist idea. It is possible that library schools would support this definition of 'practicum'.

Janie Kaplan :

With regards to Launa [Kliever] and her conversation on D4-one of the reasons the CL are successful is because they build relationships with individuals that they work with, i.e., the house staff, attendings, and multi-disciplinary teams. We have house staff that leave and continue to use the services of our CLP because they always have expressed respect for the training on access of information they received. With re: to training-could not workplace orientations for CL be of some "meat" - CL spend many months acclimating themselves to a particular discipline- I know we use an extensive orientation program that relies on mentoring a lot.

Brad Long :

D4 - I had the opportunity to talk to Carol Jenkins personally about recruiting health science and allied health undergrads to the library profession. I think that if library schools want to take the lead in this area, they have to do a much better job of recruiting form this group of students. I happen to be a Health Sciences undergrad that went on to library school, which is a minority among medical librarians.

Jerry Perry :

Re: Frank Davidoff's comment on automated systems. The knowledge base is locked away in databases that are just too cumbersome/difficult to use. Expert systems can solve the time problem and obviate the need to develop advanced searching skills. What's needed is the ability to identify the most relevant variables in a given clinical situation as they apply to a specific patient. I guess I'm hopeful about disintermediation - looking at such nascent systems as developed by the Center for Information Therapy...

Rena Sheffer :

re: training issue and where the informationist would exist--a problem is that we're asking someone to have a dual focus, be as interested in information as they are about their bench research in a very focused field. How many people want training in both biochemistry (example) and informatics? Though I think library schools should look at this possibility --not a full Masters or PhD in biochem but enough to be proficient. Of course, then you limit your work opportunities to bc!

Valerie Florance :

Frank's comment about 'human vs. A.I' reminded me of something that came up in the conference a few times. Some people define the primary role of an informationist as expert searching. I think it is more (and I know Frank does, too). This is important as we think about the information science/library science concepts that belong in an informationist curriculum. Is expert searching the only thing the MDs and Nurses and PharmDs need to know? If it is, we don't need informationists.

Frank Davidoff :

In response to Brad Long's question about who should take the lead in developing informationist programs, I don't think it's clear yet. The most obvious possibility, however, seems to me to be the medical library community: that's where clinician librarianship - the thinking and experience closest to the informationist concept -already reside. But ideally, it seems to me, it should be a collaborative movement: involving the pharmacists, major clinical disciplines/organizations, research groups, and administrators, if possible. Ultimately, representatives of patient groups should be included, but that might come later.

Michael Homan :

One of the issues that I think will be important to consider in libraryland is attitude or the cultural environment of a library as reactive to questions or issues that are presented to it as an institution with a reference desk, etc. versus the proactive concept of an informationist. In the drug development team liaisons in the pharmaceutical research environment we had information specialists and information scientists with science degrees up to the Ph.D. level that were quite knowledgeable about the drug development process and its information requirements, were expert searchers, but were initially hesitant to serve on drug development teams as "informationists". There needed to be an attitude change -- to build confidence and to develop a toolkit of services. Once that hurdle was overcome, the program became successful.

Janie Kaplan :

In response to Valerie Florance's last statement: I again bring up the concept of intuitiveness-which cannot be replicated by AI- and once we look to that-then we move to sharing knowledge base information....

Valerie Florance :

Regarding who should do the training: I always imagined academic health sciences centers to be the perfect setting for informationist training. There are health professions courses and research courses, a strong library, a commitment to innovation, There are often business schools and computer science schools and sometimes even library schools and medical informatics or health informatics programs as part of the organization. I guess this implies that I believe it will be easier to 'import' the information science curriculum and operate it from the AHSL than to import the health sciences into a library school.

Michael Homan :

MLA's developing National Center for Health Information Education & Research is a natural place for leadership and promotion of the informationist concept to occur.

Frank Davidoff :

Danny O'Neal raises the important question of the difference between a clinical librarian and an informationist. While the concepts are obviously still evolving, I think what Valerie and I had in mind was that a) and informationist would be much more of a "hybrid" of information professional and clinical (or research) team member than a clinical librarian; and b) an informationist would be hired by, and work in and for, a clinical team or service, a research group, a hospital or health system administration, etc. (Some federal health agencies could stand to have a good informationist or two on their staff too!)

Jerry Perry :

Re: Michael Homan's post: I wonder if there have been ethnographic studies of change as it occurs in library settings, in response to role change and evolution of mission (or radical change in mission)...

Valerie Florance :

I'm agreeing with Janie [Kaplan] and Frank [Davidoff] - I actually think there are unique abilities a human will always bring to the decision setting. But I also want those humans, including the informationist, to have ever smarter systems helping them. The flow of information and complexity of decisions is only going to continue to increase as genome & proteome and other data filter into health settings and education settings. The systems must help with the capture and filtering and presentation.

Julie Kwan :

Regarding training in clinical and information disciplines --I think the question is how one keeps up to date in both areas. I argue that the informationist's primary area is library-science/informatics and that the clinical or research areas are more generalized in nature. I think the informationist will need to be an ethnographer of whatever population he/she serves. The informationist must understand how the ultimate user/decision-maker works, receives information input, recognizes conflicts in what needs to be know vs. what is known, and ultimately makes decisions. The informationist must have the observational prowess of an anthropologist. The informationist must also be accessible (whether in person or mediated through technology).

Carol Jenkins :

Thank you, Michael [Homan]! I think MLA is interested in knowing how we can help promote the movement from invention to innovation for informationists. There are possibilities in the areas of recruiting, training, funding, and more. What specific activities should MLA encourage?

Frank Davidoff :

Including informatics in the faculty and curriculum development of informationist training might contribute importantly to the whole effort. As I see it, however, much of medical informatics has been primarily an academic, research discipline, not really attuned to the kind of working clinical role that informationists would play. An interface with the informatics community should be cultivated, but it remains to be seen just how, and how much, it could contribute to training and practice.

Valerie Florance :

The role of participant/observer is (in my mind) a fundamental value the informationist brings to any setting, clinical or not. Julie [Kwan] and Jerry [Perry] have got the right idea - if the informationist is not reflective, and does not report the findings in some way like an ethnography, then no one will learn and move on to discovering new things, trying new things, building systems that are more adaptive to situations

Danny O'Neal :

It appears that the informationist would have to become a subject specialist within an area of specialization, as Rena [Sheffer] said. By becoming a subject expert would this limit the potential for employment? We currently have several opportunities for this type of collaboration, but many of these are grant funded opportunities that may be short lived. Would the informationist risk job security by being so specialized?

Michelynn McKnight :

What specific activities should MLA encourage? Instruction in clinical subjects for health care librarians ... an extension of courses like the famous "Neoplasia" C'E course of yesteryear.

Ruth Holst :

On the subject of expert searching and automated systems, I think that better systems improve our searching techniques but at that same time allow us to become intellectually lazy at times. It's easier now to do a quick superficial search because of better search engines, etc. On the recent survey done by MLA on expert searching, several librarians confessed that they are lazier searchers now than they were 15 years ago.

Jeanette McCray :

I think this is all very interesting. It sounds as if the potential exists if we're talking about academic environments and perhaps very large hospital systems. But I'm wondering about community hospitals, and places even smaller where no infrastructure or institutional culture exists to provide access to information on any level. Does anyone see a way for an informationist approach to succeed in the most basic units of our health care system?

Jerry Perry :

Re: Michelynn [McKnight's] post. I think rigor in instruction in clinical subject areas is very important as it relates to the credibility of the Informationist. And as a patient, I'd like the Informationist on MY team to be scrupulously credentialed!

Julie Kwan :

Regarding Danny [O'Neal's] comment about overspecialization putting one out of business -- this is partially why I think the specialization should be broad not deep (does that contradict itself?).There is a level of specialization in which one knows how a group of people tends to think and to make decisions that is really important here. Another thing to remember is that the subject domain will always change. So we need to make sure we have a handle on fundamental issues and are very close to them. We need to find the forest not the trees, even if along the way we stop and linger at one of them.

Diana Cunningham :

Jeannette [McCray], I can't help but wonder if community hospitals sponsor CE or CME or residency programs themselves. Would/could this be a way to get it started, have it spread and get it funded?

Lorri Zipperer :

Carol [Jenkins] - is it possible to have non-librarian speakers teach classes at MLA for continuing education credit? Perhaps a track could be created specifically for this purpose? Granted, it wouldn't be like going to school, but it may present an opportunity to gain some instruction that would be helpful.

Frank Davidoff :

Julie Kwan raises a key issue I haven't heard mentioned before: how informationists would maintain, develop, and improve their skills - a core obligation of all professions. That's a challenge that practicing clinicians are still struggling with - and often not very successfully. (It's also part of the reason we need informationists!) Of course, working in and with a clinical or research team every day will teach informationists a huge amount, but the question of how they would continually extend their skills and knowledge remains on the table. In that connection, it would probably help if the informationist movement got connected early with the "quality improvement" community, which is well developed in other industries, but just really emerging in medicine.

Valerie Florance :

In the class of '93 at Woods Hole Informatics Course, we librarians were paired with health professionals for our exercises. This was one of the best learning experiences I've ever had. Perhaps MLA could help create ways for its members to work in tandem with health professionals, perhaps in CE courses. Sometimes that kind of partnership is difficult to get started in your own institution, but having a chance to 'test drive' might help people who want to do this.

Ruth Holst :

Following up on Jeanette [McCray's] comments about smaller institutions, it's ironic that the environments that could most benefit from the services of an informationist will be least likely to afford it, e.g. poor urban neighborhoods, etc.

Frank Davidoff :

Jeannette [McCray]: Smaller groups and systems probably won't, in fact, be able to have their "own" informationist unless and until their services are paid for, e.g., through medical insurance, research grants, administrative overhead, etc. But that's not out of the question, in the long run.

Julie Kwan :

I think the informationist can flourish in a community hospital. Perhaps some of the training needs to occur in an academic medical center, but we should definitely target community hospitals as an arena for providing service. We need to think about where different points of view occur in the clinical setting (I suppose this can happen even in the mind of one individual) and get the informationist talking to those people.

Michelynn McKnight :

As a community hospital librarian, I can envision a librarian with clerical staff support being an informationist in the units on a part-time basis. Occasionally I am paged to perform such a service now.

Valerie Florance :

re Jeanette's question, this is one reason we need more 'experiment's. It's been pointed out that the clinical librarian really only flourishes in a teaching hospital because that's where 'rounds' happen. The question is - how would / could the concept play out in a community based practice or community health center. We would need to characterize the context - how the work flows, etc. This could be done, I just haven't seen it yet. Circuit librarians may have some insight for us here.

Janie Kaplan :

I think many clinical librarians are already acting as "hybrids" and that all these "buzz" words may be creating muddy waters-how much difference is there really between a full-time clinical librarian and an informationist?-for many-they are one in the same-just different words in a different time.

Frank Davidoff :

Danny [O'Neal's] point about generalist vs. specialist informationists is very much to the point: this will have to be dealt with, as informationist training and careers emerge. There are, however, plenty of models from other disciplines. In medicine itself, of course, the usual approach is to give everyone the same basic skills and knowledge at the beginning, then let them differentiate into narrower and more specialized areas as they move on, in specialized fellowships, and in the real world and real jobs. I'd see informationists doing the same thing.

Julie Kwan :

I would just like to reiterate our experience -- that the clinical librarian flourished where there were different points of view -- and how to make an effective decision when choices need to be made. I think that informationists will play a role. It might be similar to Michael [Homan's] description of the team developing new pharmaceuticals or a clinical setting involving decisions for drug treatment versus other therapies. I think one reason the PharmD's have been successful is that there have been so many decision points regarding choice of drug. Information helps people make decisions.

Brad Long :

I have worked in a large inner city teaching hospital library, a rural community hospital, and a medical school library. None of these had clinical librarianship programs or anything related because of one thing - lack of money to provide staffing for these programs. Until this issue is dealt with effectively, I don't see the Informationist movement going too far forward.

Frank Davidoff :

Every good team participant, no matter what kind of team, needs to be something of a good ethnographer, whether they're trained for this or not. This aspect of the informationist role could, and should, be considered as something to be formally included in training and job description.

Jean Shipman :

Our discussion time has come to a close. I'd like to thank our two guests - Drs. Davidoff and Florance, for their participation today and for all of their contributions to date. I'd also like to thank all of you who have conversed. It has been an excellent session. You can continue to post messages (but not questions) until 5:00 central time. A summary of today's discussion will be posted to the conference Website found at http://mlanet.org/research/informationist/index.html. Thank you again!! Jean S.