It’s coming up on my three-year anniversary of no longer working in a library. Funny… I stare at that sentence and I’m forced to deal with an entire spectrum of conflicting feelings. So, forgive me if I go all introspective for a moment, but I never would have guessed three years ago that I’d be sitting here, doing what I do today. Sure I miss the trappings of a traditional library job – that’s what attracted me to the profession in the first place. But then I think of the absolutely cool, ground-breaking stuff that I get to help out with – stuff that is actually making a difference in patient care in a hospital setting – and I can’t help issuing a Keanu Reeves’ style “Whoa” – mentally at least. Why don’t I take a step back and fill you in on just where I am and how I got here? I’m currently employed by the University Health Network (UHN), which is the merged Toronto General, Toronto Western, and Princess Margaret Hospitals. I work in a department called Shared Information Management Services (SIMS) – the I.T. department. SIMS has two primary focuses: supporting the technical applications, databases and infrastructure that help the hospitals run, and implementing an aggressive strategy to move the hospitals to a totally electronic patient chart by the year 2005. My group is called Clinical Decision Support (CDS), and is part of the latter focus. The whole point of CDS is to use “technology for best practice” – I’ve got stationery to prove it. CDS is the “value-add” of having an electronic chart. It’s through CDS systems that we alert clinicians to the fact that perhaps they needn’t really order that test, or remind them that the patient is allergic to that antibiotic, or suggest to them that perhaps, given the patient’s condition, they should consider ordering a test to check for this. I was originally brought on board to implement a web-based virtual library on the hospital intranet. For the first year and a half, I felt like an outsider in the group. The rest of CDS was working on implementing alerts in the patient record and analyzing laboratory utilization patterns, while I was left out of their reindeer games to do my library related projects. Now thanks to staff turnover (sometimes the best opportunities!) I’m heading the CDS programme. You might wonder why I was a part of the CDS group if I wasn’t really involved in their core activities. Well, the head of the group at the time, a doctor with an interest in the application of computer technology, knew the value of libraries in supporting healthcare. He was also a visionary who saw the ultimate integration of knowledge-based resources at the point of care in an electronic patient record. He knew he’d need librarians to help get him there. And, it probably helped that his mother is a member of our profession. A convergence is happening in healthcare – two major movements within the field, each with their own demand for people with our skills, are meeting and in their synergistic amalgamation, requiring even more talent in the areas of bringing humans and computers together, as well as understanding and being able to synthesize and critically appraise the research literature. The first movement is that of healthcare informatics, a phrase that is gaining credibility in the curricula of academic institutions. Simply stated, it is the application of computer technology to the field of healthcare. This may not seem like such a big deal to my colleagues in industry, but healthcare is probably a good decade or two behind the corporate sectors in the whole scale, integrated use of technology. Yes, huge advances are being made in medical technologies, but across the board adoption of computerized systems as tools for all aspects of running a hospital is still a ways off. Ironically, small community hospitals probably have an easier task ahead of them compared to larger academic health centres which may already have a decade or so invested in legacy systems that only do part of the job. This trend on its own is providing opportunities for librarians. Think of it – installing large systems across an organization requires project management skills as well as the ability to speak I.T. and translate that language to those you’re inflicting change upon. Give me a librarian who’s implemented an online catalogue system over a Microsoft Certified Systems Engineer any day! The other big movement in healthcare is known as “Evidence Based Medicine” (EBM). You may be scratching your head at the apparent redundancy in that, as I once did, wondering what else would it be based on. Trust me though, this is big. The concept has been around since the early 1980’s and is based on the simple fact that no clinician can possibly keep up with the flood of research going on in health care on their own. This has lead to a number of organizations who have taken on the task of reviewing the literature, appraising it, and producing systematic reviews which boil it all down to the “best evidence” in various subject areas. Can you see a role there for librarians? (That was a rhetorical question!) Much has been published in the medical library literature on this field of EBM, and one of the best known international organizations, the Cochrane Collaboration, employs numerous librarians in its mission. If you’re interested in finding out more about this field, Greg Fowler has written an excellent review, “Evidence based health care: diverse career opportunities for librarians.” http://www.alia.org.au/conferences/alia2000/proceedings/greg.fowler.html By the time 2005 rolls around, and we’ve got that completely electronic patient record at UHN, I envision a computerized system that knows what’s wrong with the patient, because it includes a controlled medical vocabulary – one that was designed and implemented with the help and leadership of librarians. The system monitors the patient’s lab results, medications, and vital signs, and alerts the physician to potential conflicts and patient care issues – based on the evidence gathered by librarians. And while this is happening, the system is taking that contextual information about the patient, and reaching out to external knowledgebases to retrieve the latest evidence for the clinician to peruse – all based on search algorithms developed by librarians. Opportunities indeed! |
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