Improving health care through information: research challenges for health sciences librarians

ABSTRACT

RESEARCH QUESTIONS IN HEALTH SCIENCES LIBRARIES are influenced by the health care environment. Three fundamental problems underlie most research in health sciences librarianship: determining what therapies are effective and of good quality, delivering information when and where it is needed, and in forms that will increase its use. Adapting to sweeping changes in all kinds of libraries is made more complex because of equally challenging shifts in medical practice and consumer health. Developments in health information research will be advanced through collaboration across disciplines and between organizations.

INTRODUCTION

While many of the problems and issues facing health sciences libraries are held in common with other libraries, problems and issues specific to health sciences libraries are driven by the agenda of the health sciences in general. In health sciences, as perhaps in no other major library sector, the strength and importance of the national library, of grant funding, and of the community of users themselves, drive the direction of research. While health sciences libraries certainly face issues of collection preservation and management, digital library system design, effective organization and staffing, and public relations, health sciences libraries have unique challenges and opportunities. Health sciences libraries operate within the environment of health care delivery and are therefore affected by the trends and factors that characterize this environment. Quality health care--accessible to all who need it, at a fair price--is the primary driver in the health care environment. Fundamental to virtually every issue in health sciences librarianship is one or more of the following problems:

* Determining what therapies are effective and of good quality;

* Delivering information when and where it is needed in forms that will increase use;

* Developing an effective economic model.

This situation is not new. The Medical Library Association (MLA) founded the Library Research Section in June 1982; one of its stated purposes was to serve as an action group for the advancement of library-related research. This purpose was later expanded in 1996 when the name was changed to the "Research Section" to reflect interest in general research, not just that of libraries. (1) In the 1990s, MLA undertook the development of a policy statement on research. The opening paragraph of the research policy reflects these central concerns:

   Society is concerned about access to high-quality health care at
   reasonable cost. Increasing numbers of health care leaders
   recognize the importance of information to excellent, affordable
   health care. Clinical decisions should be based on the scientific
   evidence traditionally recorded in the health sciences literature.
   The development and use of evidence-based practice guidelines
   demand a sophisticated analysis of the literature, creative ways
   of delivering information to practitioners at the point of care,
   and an understanding of the effect of information on practice
   patterns and costs. There is a growing need for computer-based
   patient record systems that can generate new scientific knowledge
   as a by-product of current care. (Medical Library Association,
   1995, p. 4)

This statement reflects the influence of three external events that have resulted in sweeping changes affecting the role of health sciences libraries. As with all libraries, the advent of the Internet irreversibly altered practice, but in health libraries especially, the availability of free, public access to MEDLINE signaled a major shift in emphasis by the National Library of Medicine (NLM) toward providing health information to the public. Second, the report issued by the American Association of Medical Colleges (AAMC), which introduced the concept of the Integrated Academic Information Management System (IAIMS) in 1982, has continued to alter the landscape of academic health information centers, just as the release of the 1994 Joint Commission's Standards for Accreditation of Health Care Organizations affected hospital libraries. (2) Third, the rise of the evidence-based medicine movement has affected the role of information (data and knowledge) in the practice of medicine.

Within the practice of librarianship, the changes have been no less dramatic. Libraries as organizations have traditionally been concerned with the acquisition, organization, and dissemination aspects of the information transfer cycle. With the advent of digital information where "everyone is a publisher," librarians have increasingly become concerned with the creation of information. And, as they become collaborators in the design of information systems, they increasingly become involved with the use of information. These changes are especially apparent in the health sector, where health sciences librarians are beginning to recognize that "collections of data aggregated from individual health records, like the clinical data warehouse or the population health data set, can be viewed as part of the larger digital library needed to support biomedical research, education, and informed health care decisions" (Humphreys, 2000, p. 446).