MLA letter to the Joint Commission 

MLA letter to the Joint Commission re proposed elimination/changes in hospital accreditation standards.

June 28, 2007

Paul Schyve, M.D.
Senior Vice President
The Joint Commission
One Renaissance Blvd.
Oakbrook Terrace, IL 60181

Dear Dr. Schyve:

On behalf of the Medical Library Association, we want to express our deep concern about the proposed elimination of standard I.M.5.10 and the changes to standard I.M.4.10 in the hospital accreditation manual. We understand that concepts in I.M.5.10 will be integrated into the other accreditation chapters and would like to know how this will be accomplished. Also, we are concerned that the time lag between the elimination of I.M. 5.10 and its integration into the other chapters will create a period when evidence-based information and practice is not formally acknowledged as being important to patient care. We believe that both access to evidence-based information and the librarians who provide it are important for positive patient outcomes based upon the results of several research studies listed below.

Impact on Patient Outcomes

Today, patients expect their physicians to have easy access to quality medical information. Research studies suggest professionally led library services have a positive impact on health outcomes for patients and may lead to time-savings for health care professionals. (Health Info and Libraries J, 2005) When MEDLINE searches are conducted early in hospitalization, hospital costs, charges and lengths of stay are significantly lower than those whose searches are conducted later (Acad Med, 1994). Information provided by librarians decreases unnecessary diagnostic tests, affect treatment decisions, and improve patient care. (JMLA, 2005; BMLA, 1992).

Access to Quality Medical Information

By eliminating the need for hospital evidence-based resources, practitioners will be forced to search for these resources elsewhere, thereby taking precious time away from hands-on patient care. Evidence-based medicine cannot be practiced without library resources and librarians (Nurs Econ, 2003). Only 30% of the medical literature and less than one-quarter of the medical and biomedical journals are freely available on the Internet. (Serials, 2005). The majority of medical/nursing publications are only available in electronic format starting in 1994/1995. Google and other Internet search engines access only 7% of available health-related information and cannot perform searches using a controlled vocabulary and extensive limits or search databases that reside behind firewalls. (CMAJ, 2005). Google will provide information, but the perplexity lies in separating “the wheat from the chaff”. Not all electronic formats are the same. Some databases and/or electronic journals are of high quality and are readable. Others are just the opposite, requiring the acquisition of a print copy. Also, in some cases print resources might still be the best option. If there is no physical collection, the hospital may no longer be eligible for interlibrary loan services and may have to purchase materials or use commercial document delivery services, increasing costs to the institution.

Time and Skills Needed to Find Quality Information

It takes an expert searcher with the word terminology skills, command language skills, understanding of what database is best for what topic, etc. to search and find the most pertinent information for the health care provider. Many recent studies show that a majority of health care professionals do not have the time to seek information, training to do expert searches, and knowledge of multiple information sources. (Portals Mag, 2003; Med Net, 2004) Librarians are more proficient searchers than other health care professionals, reducing the time spent on information retrieval and evaluating results. (Nurs Econ, 2003). Also, administration of electronic journals is one of the most work-intensive aspects of providing library services and includes negotiating licensing agreements and continual training in use as well as other responsibilities. (Online Inf Rev, 2001). Difficult MEDLINE searches require the skills of librarians trained in evidence-based methods (Ann Emerg Med, 2002).

Costs of Medical Information

Quality health care/patient care information is not free on the Internet. The companies who produce products such as UpToDate, MDConsult, and OVID databases all charge subscription fees. Additionally, the majority of journal publishers also require an additional fee, above and beyond the print subscription charge, for electronic access to their materials. No one database offers access to all available electronic journals- in fact, there is little overlap between databases and few contain freely available information. (D-Lib Magazine, 2002)

The bottom line is that hospital practitioners and staff rely heavily on having access to high-quality evidence-based information resources in all forms in order to make sound and current decisions in providing quality patient care. In turn, it takes a highly qualified medical librarian to select the best of these resources for the users. We strongly believe, as does the Joint Commission, that there should be no short cuts when it comes to patient care. Therefore, we urge you to reconsider the elimination of IM.5.10 or integrating the standard into the other chapters prior to its elimination. Enclosed for your reference are the Medical Library Association/Hospital Library standards and a list of references appearing in this letter.

While we’re at the Joint Commission for the Liaison Forum on July 10-11, we would like to take the opportunity to meet with you and/or other appropriate people to discuss these standards and efforts to integrate them into other chapters. We look forward to working with you in creating standards that encourage the best possible health care.

Sincerely,

Katherine Stemmer Frumento, MBA, MLS, AHIP

Carla J. Funk, MBA, MLS, CAE
Joint Commission Liaison Executive Director
Medical Library Association Medical Library Association

Cc: Robert A. Wise, M.D., Vice President, Standards Division of Standards and Survey Methods

Carol Gilhooley, Director, Standards and Survey Methods

REFERENCES

1. Weightman, AL and Williamson, J. The value and impact of information provided through library services for patient care: a systematic review. Health Information and Libraries Journal, 2005;22(1):4-25.
2. Klein, MS, et. al. Effect of online literature searching on length of stay and patient-care costs. Academic Medicine, 1994;69(6):489-495.
3. Cuddy, TM. Value of hospital libraries: the Fuld Campus study. Journal of the Medical Library Association, 2005;93(4):446-449.
4. Marshall, JG. The impact of the hospital library on clinical decision-making- The Rochester Study. Bulletin of the Medical Library Association 1992;80(2):169-178.
5. Williams, L and Zipperer, L. Improving access to information: librarians and nurses team up for patient safety. Nursing Economics, 2003;21(4):199-201.
6. McVeigh, ME and Pringle, JK. Open access to the medical literature: how much content is available in published journals? Serials, 2005; Mar:18(1):45-49.
7. Henderson, J. Google scholar: a source for clinicians? Canadian Medical Association Journal, 2005;172(12):1549-1550.
8. Feldman, S. Enterprise search technology: information disasters and the high cost of not finding information. Portals Magazine, 2004;27-28.
9. Darves, B. Strategic searching. Medicine on the Net, 2004;10(5):1-4.
10. Ashcroft, L and McIvor, S. Electronic journals: managing and educating for a changing culture in academic libraries. Online Information Review, 2001;25(6):378-387.
11. Gallagher, PE, et. al. How to find evidence when you need it, part 3: A clinician’s guide to MEDLINE: Tricks and special skills. Annals of Emergency Medicine, 2002;39(5):547-551.
12. King, D. After migration to an electronic journal collection: Impact on faculty and doctoral students. D-Lib Magazine, 2002;8:212.