The Johns Hopkins Welch Medical Library as Base: Information Professionals Working in Library User Environments

Kathleen Burr Oliver

The author wishes to acknowledge the significant contribution of colleagues who participated in and shaped the projects described here, some of whom also acted as reviewers and editors of this essay. They are Nancy K. Roderer, director of the Welch Library; Harold Lehmann, director of research for the Johns Hopkins Division of Health Sciences Informatics; and Deborah McClellan, G. Stephen Bova, Jayne Campbell, Doug Varner, Willard F. Bryant, Gwen Rosen, Susan Rohner, Claire Twose, Brian Brown, Holly Harden, Robert Swain, Jocelyn Rankin, Tina Stiller, Ashley Varner, Stuart Grossman, Mehmet Acuner, Kenneth Hill, Jeri Mancini, and Antonio Wolff.

Nearing her deadline, a scientist in the Broadway Research Building at Hopkins is busy preparing a paper on a particular protein sequence. To ensure her findings are new, she needs advice on the best database to validate her work. Instead of walking two blocks to the Welch Medical Library, she simply crosses the corridor to consult with the Welch’s liaison librarian to the basic sciences in the new “touchdown suite.”

At the same time, a breast cancer patient arrives in the Hopkins outpatient clinic. While she sees her doctor, a librarian trained in consumer health information services confers with the clinic’s nurse practitioner on the details of the patient’s diagnosis. Following her appointment, the patient wants to know more about her diagnosis. She steps across the room to meet with the librarian, who is knowledgeable about the specifics of her diagnosis and who guides her to the information she seeks.

These two scenes illustrate an emerging model for information services at The Johns Hopkins medical campus. The idea is to bring the library and librarians to people where they work and when they need the information. The Welch Medical Library is using its resources to meet the changing needs of both researchers and patients. Individuals in the medical disciplines and their patients make extensive use of electronic information and are therefore prime audiences for the delivery of virtual information and services at the place where that information is actually used. But even if these audiences make little use of the central library as place, they rely greatly on the library as a resource or base.

Moving aggressively in recent years to meet the demand for electronic resources and the related need for more-specialized library services, the Hopkins library has employed two primary strategies: first, to acquire all the materials it can in electronic form while working to convert older materials into electronic form; and second, to establish a liaison staff that actively seeks out and assists faculty, staff, and students in their work. In 2005, to further improve the application of new and relevant knowledge to our institution’s primary functions, Welch will begin to train a new cadre of information professionals known as informationists. This new information profession will combine information expertise and subject-domain knowledge. Informationists will participate as members of clinical, research, and teaching teams.

This essay offers examples to illustrate the Welch Library’s approach to information services. The approach is based on the belief that, in an evolving information environment, the library’s users will be well served by a combination of information-service roles. In this environment, traditional library-based reference services will be supplemented by the proactive services provided by liaison librarians and, in the future, informationists. While the format and nature of the new services described vary, all are shaped by an active dialogue between information professionals and information users.

Liaison Services: The Touchdown as a Venue for Training and Consultation

In 2000, the Welch Library began a liaison program designed to seek out users where they accessed information and to engage them as partners in developing library resources and services. The program was sparked by the fact that with the advent of broad access to electronic information, users no longer needed (and, in many cases, no longer preferred) to come to the library itself. This essay describes two kinds of outreach services that Welch has developed: (1) touchdown suites-small library facilities distributed around the campus, where librarians and library users can interact in the users’ own environments; and (2) multidisciplinary teams.

The word touchdown, chosen by an architectural team in designing a plan for Welch’s future, is meant to convey a sense of mobility. Librarians “touch down” in appointed spaces, called touchdown suites, to meet briefly with users; the librarians then continue to circulate through the adjacent halls, laboratories, classrooms, and clinics. The touchdown suite offers a base close to users that encourages encounters, both planned and casual, with librarians.

The first touchdown suites at Hopkins focused on population sciences, basic research, and oncology. They are described in the following sections. At this writing, three more suites are in the exploratory stage of development.

Hopkins Population Center Touchdown

The Population Center Touchdown evolved from a request from the Johns Hopkins Population Center (HPC), one of several federally funded population centers across the United States. HPC supports research conducted at the university in population sciences, including reproductive health and demography. In 2003, the director of the HPC asked the Welch Library to provide information services to its faculty associates. The HPC collection at that time consisted of 106 current journal titles, about 6,300 books, and other materials, including maps, census data, and the working papers of the HPC. One of the center’s most popular services was the circulation of monthly printed tables of contents to the faculty associates.

The library proposed to develop a touchdown suite with both virtual and physical components. To achieve this goal, liaison librarians first interviewed the faculty associates to assess their information needs. Any item that the associates identified as important and was available electronically was selected for inclusion in the collection in the Population Digital Library (PDL), a virtual touchdown suite that would be accessible from any location.

Most items in the library’s print collection were found to be little used and of little value to the associates. These items were either discarded or distributed to other collections on the basis of criteria that included usage, historical value, or availability elsewhere. Publications in the print collection identified by associates as important were retained and will be considered for future digitization. When digitized, they will be added to the PDL. Current awareness “table of contents” services were converted from print to electronic format, with links to these through PDL.

Meanwhile, the liaison librarians sought out and assisted researchers, other faculty, and students in their work. They also planned the fall 2004 opening of a new, 400-square-foot space near the offices of the associates. The new space is a physical touchdown suite designed to complement the virtual touchdown suite, where liaison librarians can meet with faculty from the HPC and other departments. The PDL suite will also offer computers and space for small-group instruction.

The library will evaluate the results and share its experience with the HPC, the Welch Library advisory committee, other federally funded population centers, and members of the public health and information services professions.

The Basic Research Touchdown

When a new basic science research building was being planned at Hopkins, the library learned that one floor would contain laboratories, meeting rooms, and a number of shared resources and services for the basic science departments. Recognizing this as an opportunity to offer on-site support and resources, the library’s leaders contacted the department chair responsible for the shared support space with a proposal to provide information services. The plan was developed by the basic science liaison librarian at Welch, who had experience in serving the information needs of the basic science departments. An agreement was reached, and a touchdown suite opened in spring 2004.

The basic science touchdown suite is a space where the liaison librarian, in collaboration with faculty, students, and staff, is defining and offering information services. Basic science researchers, regardless of specific discipline, need many of the same resources and services. For example, yeast research is being conducted in the departments of molecular biology and genetics, biology, cell biology and anatomy, and physiology. The services plan proposed by Welch is designed to meet those cross-disciplinary information needs. It includes

a customized basic sciences research toolkit Web site
customized training courses
a partnership between the library’s advanced technologies and information systems department and the basic science network office for software hosting
office hours for reference and training of faculty in the sciences, students, and staff
grant-writing services, including grant application editing, writing skills, and help in identifying funding sources
physical space for researchers to use computers
ongoing assessment of users’ needs

Oncology Patient Information Touchdown

In 2003, the Welch Library began discussions with the Johns Hopkins Kimmel Comprehensive Cancer Center on the creation of a touchdown suite. The demand for better methods of meeting patient information needs emerged early in these discussions. Patients’ level of satisfaction with health care is closely associated with the receipt of information related to their diagnoses and treatment. Oncology health care providers expressed a need for professional help in identifying relevant information and for the structures to provide that information to clinicians and patients.

A multidisciplinary team was formed to discuss the types of information that oncology patients needed. The team includes a senior oncologist, an oncology resident, several oncology nurses whose responsibilities include providing patients with information related to their diagnosis and treatment, and three librarians. The librarians are the associate director for communication and liaison services and two other liaison librarians. One liaison librarian serves as liaison to the oncology department, and the other liaison librarian has extensive experience in working with patients to meet their information needs. Their discussions were characterized by a wide-ranging exploration of current clinical efforts to meet patient information needs and of the topics covered by these efforts.

The group decided to develop two prototypes-for brain tumor and for colon cancer information-to demonstrate the concept of a patient information touchdown. The prototypes are designed to be virtual and adaptable to any physical location where information is needed. The team has identified content areas and types of information for both prototypes. A beta information structure for the brain tumor prototype is available on 2,200 hospital workstations used by Hopkins clinicians and is being populated with content.

Oncology Training Touchdown

The oncology training touchdown suite differs from the other two touchdowns in that it did not evolve from a particular location within a department. During preliminary touchdown discussions with the education committee at the Kimmel Comprehensive Cancer Center, members of the oncology faculty expressed a greater need for training than for a place where they could go to meet with a librarian for assistance. They described a need for training faculty and administrative staff in software use, information resources, and writing skills needed for submitting research papers, preparing poster sessions, and managing reprint files as a high priority.

Because the library had offered such training for many years, preliminary content was readily available for instruction on topics such as the use of reference-management software, resources for funding research, and creation of PowerPoint presentations. The challenge was to ensure that the examples used in the training were relevant to the immediate and longer-term needs of faculty and staff. Examples might include a demonstration of how to incorporate scientific data into a PowerPoint slide or, during a PubMed training session, the demonstration of a search topic relevant to the audience. This goal was accomplished by partnering an education librarian with a faculty liaison from the cancer center’s education committee. These two individuals discussed content, prepared relevant examples, and jointly reviewed the materials to be presented at each training session. During the recently completed first year of the training touchdown, attendance reached 350, which compares favorably to that at educational sessions that the library offered previously. The success of the program is attributed to the collaboration between liaison librarians and instructors and oncology faculty and staff.

Liaison Services: New Service and Project Teams

The library as “base” takes on a new dimension when librarians serve as information resources on clinical, research, and teaching teams. At Johns Hopkins, we have sought funding to test new team roles for librarians. These roles aim to make an effective connection between users and the information they need. A few of these roles are described here.

AIDS Information Outreach at Maternity Center East

In 2002, with support from the National Library of Medicine, Welch Library began working with the Maternity Center East to offer librarian-mediated patient information services. The Maternity Center East, located in east Baltimore, is a community-based primary care clinic that provides medical, nursing, nurse-midwifery, social work, and laboratory services to poor, uninsured, marginally literate women of east Baltimore. Clinical sessions incorporate counseling and education tailored to each patient’s needs.

The purpose of the patient information service, entitled Maternity Center East AIDS Information Outreach, is to supplement and enhance the center’s HIV/AIDS screening and counseling services. The outreach service provides local and relevant national AIDS/HIV resources in a Web-based format enhanced by audio recordings made by the women’s health care providers. Librarians guide the patients in the use of the information resources and answer any questions that might arise during the sessions. The goals of the project are to provide information access, and, through audio recordings and librarian assistance, to enhance patients’ confidence in the resources and to overcome any barriers to understanding the textual presentation of the information.

The design of the information service was preceded by two years of meetings and discussions about the clinic and the information needs of clinicians and patients. Information resources were designed to address a primary barrier to learning-low literacy-identified in the needs-assessment period. Project librarians selected Web-based information resources and offered them from a specially designed Web site. A nurse-midwife reviewed the selected materials and prepared audio essays on the disorders most frequently seen at the clinic. Patients can listen to these essays while reviewing the resources on the Web site.

To assess the Web site’s usefulness, project staff compared feedback from patients who were given Web-based information with that from patients given print-based information. They found that patients responded more favorably to the information offered in Web format. The project team also evaluated the impact of this service on the providers and the clinic. Both nurse-midwives were asked how the service affected them and whether they perceived any effect on their patients’ level of satisfaction, the questions patients asked, and the care patients sought. The clinical and support staff reported that the service was very well received. Respondents stated on more than one occasion that it is the “best thing happening at the clinic.” They noted that some patients, after reviewing the information, returned for preventive care previously refused.

An Information Prescription Service

In December 2002, Welch Library launched a second project-a pilot-to provide patient information services. The service, called the Information Prescription Service (IRx), drew on the example of Patient Informatics Consult Services, offered by Vanderbilt University’s Eskind Biomedical Library (Williams et al. 2001). Welch Library staff worked with the hospital’s family resource librarian and nurses, physicians, social workers, and child life specialists in the pediatric units to develop an online form through which patients could request information about their diagnoses. The pilot had three purposes: to develop and test a process for offering information services to patients through their providers, to gain an idea of the benefits of such services to the clinical process, and to informally measure patient and provider satisfaction with the service.

The information selected by the librarian in response to the request, or “prescription,” is delivered to the patient or family member as requested by the provider. The patient may keep most of the print materials provided; whole books or audiovisual materials are available from the Family Resource Center for the duration of the patient’s hospital stay. A summary of information provided is added to the patient’s chart and electronic patient record.

Thirty-five prescriptions were completed during the eight-month pilot project. Patients, providers, and librarians all expressed satisfaction with the service. Librarians valued consulting with the project team to resolve problems. They found that the IRx enabled them to reach and serve more patients and form partnerships with clinical staff to meet patient information needs.

Building on this experience, the Welch Library asked for and received funding from the National Library of Medicine for a randomized controlled trial on information services in the hospital’s breast cancer and pediatric leukemia clinics. The information service will not depend on access to an online prescription form or on the clinicians’ awareness of the availability of the service. It is being tested as one part of the standard care offered to all patients. Although the Welch Library is not currently funded to provide patient-level services such as the IRx, the proposed project aims to establish the effectiveness of the IRx service as a prelude to enlarging the scope of funded Welch services. As in the pilot, librarians will partner with pediatric and oncology nurse educators in providing information services, referring patients to them when questions extend beyond the identification of relevant information.

Bioscience Information Expert

In addition to exploring new roles for librarians in providing information to patients, the Welch will be exploring new roles for librarians in research laboratories. This role closely aligns itself with that of the informationist described in the next section. The nature of the librarian’s role in providing information for the scientific discovery process is being examined in a Johns Hopkins project funded by the National Cancer Institute in 2004. The project is designed to improve clinically oriented basic life science research productivity by completing the development of Labmatrix, a laboratory software-based platform for the collection, manipulation, and interrelation of molecular, genomic, and clinical laboratory data.

It is assumed that the process and outcome of scientific discovery are shaped by the published literature that forms the core of the scientific record. Some posit, however, that data from the scientific record are often not considered for a variety of reasons: lack of time, barriers to access, inadequate retrieval mechanisms, the size of the published literature and data sources, and the lack of expertise required to master search interfaces and a wide array of information tools.

The librarian’s role will evolve during the project. A senior librarian and an operational librarian will work side-by-side with laboratory scientists, software engineers, and other key personnel; their interactions will define the librarian’s role. Team members will examine each step in the bioscience research cycle to identify literature-based evidentiary needs and documentation. The team’s findings will be used in the development of Labmatrix. After the software is completed, its impact on productivity will be tested in two laboratories. The bioscience information specialist will help in this evaluation by collecting data before, during, and after the software is implemented.

Literature search enhancements for Labmatrix will capture and update the knowledge investment made in identifying relevant studies. System enhancements may include, for example, specific references to the literature or linked search statements constructed as PubMed-search URLs. When searching in PubMed, one can save a search strategy as a Web address or URL, and link to the URL from a database or Web page. When a user clicks on the linked URL, she or he will be taken to PubMed, the search statement will be executed, and an up-to-date list of references will be displayed. In sum, the bioscience information specialist will enhance the scientific discovery process by helping to improve Labmatrix with features that offer access to the literature or to other scientific resources related to the research and by contributing his or her expertise in literature searching.

The Future: Defining and Demonstrating Informationist Roles

In 2000, Davidoff and Florance published an article warning that clinical decision making was not adequately taking into account new knowledge from the literature. They called for the development of a new professional to address this gap and proposed creating a “national program, modeled on the experience of clinical librarianship, to train, credential, and pay for the services of information specialists” (Davidoff and Florance 2000, 997). In 2002, a conference sponsored by the Medical Library Association called for a similar team role for the basic research, public health, and consumer health information domains. These informationists, as described in the literature, would be cross-trained specialists who have specific content knowledge, can provide in-depth information services, and are uniquely qualified to apply their expertise to domain-specific information problem solving.

To test the value of the informationist concept, the National Library of Medicine initiated funding in 2004 for a new fellowship to train information experts to practice in clinical, public health, basic science, and consumer health information settings. The training protocol includes coursework, a practicum, and a project to demonstrate newly acquired skills. The Welch Library will train two fellows in 2005 through 2007, one in clinical practice and the other in public health practice.

Conclusion

Each case study presented in this essay has common elements that are necessary for the development of information services designed to improve the application of scholarly information to scientific research, clinical services, and the public health. The common elements are needs assessment, collaboration between information professionals and information users, and evaluation. We believe that these elements have contributed to the success of our projects by meeting our clients’ immediate information needs. Moreover, each case study described here has provided experience and data to inform future initiatives to identify information services, librarian skill sets, and the use of computer and telecommunications technologies.

Our project and service initiatives have persuaded us that the very presence of information expertise in clinical and research settings has contributed to the discussion and testing of new models for information access and delivery. Moreover, the projects and initiatives described here have led to enduring professional relationships between librarians and the clients they serve. These relationships hold the promise of successful future collaborations to advance the research, patient care, and teaching missions of Johns Hopkins University and to contribute to the development of professionals trained to meet health information needs in the present and the future.

References

Davidoff, F., and V. Florance. 2000. The Informationist: A New Health Profession? Annals of Internal Medicine 132(12): 996-998.

Williams, M. Dawn, Kimbra Wilder Gish, Nunzia B. Giuse, Nila A. Sathe, and Donna L. Carrell. 2001. The Patient Informatics Consult Service (PICS): An Approach for Patient-centered Services. Bulletin of the Medical Library Association 89(2): 185-193.