Archive for the ‘HIT’ Category

Education in Medicine lecture

Thursday, May 3rd, 2012

A long time ago (February) in a place not so far away (upstairs a few floors at work) I attended a lecture entitled Medical Education in the Era of Ubiquitous Information by Charles P Friedman, which focused on the knowledge cloud concept increasingly supporting both medical education and then practice with it factoring into clinical decision making well beyond the current concept of clinical decision support (CDS) in electronic health records (EHRs).  Here is my Google docs notes coverage.

That was the first time I gave a Google-docs-via-iPad-with-Kensington-keyboard note-taking strategy a try and I wasn’t all that impressed. I’m a relatively fast typist and there was a strange lag resulting in missing letters numerous times. Google Docs then crashed outright several times, wiping out a line or so of notes with each fall. Other experiments since February haven’t been all that much better, so while I’ll probably iPad most of the MLA meeting here in Seattle I’ll go old school and haul in my heavy old laptop from home when I’m Twitter Jockey for the Top Tech Trends session because I’ll stand a fighting chance at being able to keep up. Let us keep our fingers crossed for steady wireless connectivity!

Of Informatics and Twitter Evolution: Woods Hole

Thursday, June 2nd, 2011

Long time readers may remember that I was in the Spring 2009 MBL/NLM BioMedical Informatics cohort and I blogged my brains out about it. Back then I intermittently used Twitter to connect with a few people during it mostly as an additional information seeking tool to clarify or expand on the subjects we were learning about.

My stated purpose in attending there was to create the online class Making Connections: Librarians & EHRs. The problem new development that happened in the meantime and caused an enormous delay in launching the class until this year was that a whole new political angle emerged (see the week 2 module) that medical librarians need to understand as part of their involvement with electronic health records.

From what I’ve seen from our medical librarian colleagues on twitter (#BMISpring2011) attending the Spring 2011 MBL/NLM BioMedical Informatics cohort, the curriculum there has been substantially overhauled since Fall 2010 to include a wealth of information about the current political background and specific EHR components. Their group project involves hands-on work with an EHR system. This is so exciting!

Also exciting is the evolution of how the medical librarians there, recently fueled by connecting with the greatly expanded use of the #mlanet11 Twitter at the recent Medical Library Association annual meeting in Minneapolis, have taken it a step further with sharing information from Woods Hole. I caution them to not burn out in the process as information overload hits heavily right about now, and am resurrecting one of my concluding statements from when I was there in 2009:

Why isn’t MLA collectively tapping Woods Hole alumni for the Vital Pathways project?

A commenter kindly pointed out that was an over & done project but my question remains: Why is the collective energy of medical librarian Woods Hole alumni not being tapped to help share our knowledge with the field? What kind of change agents are we if we’re not, you know, out there changing things together?

Do I need to spell it out in MLA meeting themes that the ReThink has already happened and we’re supposed to be Growing Opportunities and Changing Our Game now?

Picture by Clare Leibfarth

You may never know what results come of your action, but if you do nothing there will be no result. ~Mahatma Gandhi

I’m trying. Who’s with me?

NLM APIs: Why medical librarians should care

Monday, September 20th, 2010

On Friday, the National Library of Medicine (NLM) announced the release of their application programming interface (API) web page via the Technical Bulletin.

It’s Monday and I know we’re all gearing up for a crazy busy fall so I’ll keep this short and sweet

What’s an API?

NLM’s definition from the API webpage: a set of routines that an application uses to request and carry out lower-level services performed by a computer’s operating system.

Huh? What’s so exciting about that?

Agreed. We need to stop talking about technology to explain technology.

Let’s paraphrase Webpopedia: An API is part of a set of tools for building software applications. A good API makes it easier to develop a program. This is good for users because all programs using a common API will have similar interfaces. This makes it easier for users to learn new programs.

Oh, does that include mobile applications and such?

Yes, releasing APIs does make it easier to develop mobile apps.

Does that API page include PubMed too?

Yes, as part of Entrez Programming Utilities (currently third down).

Why should I care/know when I don’t write software?

As I learned in Woods Hole last year, the future in direct data access is now and we need to stay on top of the latest.

NLM has invited the public to develop computer and mobile interfaces and are seeking comments and recommendation for future APIs. I am hopeful NLM will also create resources including these third-party interfaces once they are developed so we don’t have to search high & low for them.

Now’s your chance to let people know this is in the works and submit your own recommendations to NLM for what you’d like to see developed.

Electronic Health Records: A snapshot of ephemeral chaos

Thursday, July 1st, 2010

Last month I wrote about how electronic health records (EHRs) are not all about the machine with perspectives from others combined with my own and the launch of the OpenNotes study.

The ADL Librarian continues with EHRs and Librarians part 2, giving us a snapshot of the rush to figure out how medical librarians can be involved as part of EHR implementation initiatives. He identified 3 core librar* (I like to think both libraries as institutions and librarians as people have places here) roles of Information Retrieval, Information Organization, and Information Access and includes

This is an ideal time to offer to help organize the piles of forms and documentation. We mustn’t assume that the librarians role in EHR implementation is obvious to the professionals handling the implementation.

Indeed, not much regarding EHR implementation is clearly obvious at this point in time when the final 53 page PDF Temporary Certification Rule was just published (and summarized well at Life as a Healthcare CIO) and applications to be an Authorized Testing and Certification Body (ATCB) are open beginning today. Final Temporary Certification Rule. A Final Permanent Certification Rule by this fall, the permanent certification program in place by fall 2012.

My mind boggles thinking about the amount of time and energy involved in that process alone, and when it comes to implementing the ‘meaningful use’ requirements of EHRs 80% of hospital chief information officers (CIOs) don’t think they’ll be ready to meet the 2015 deadline as covered by the Wall Street Journal Health Blog.

Specifically, they’re worried about the requirements that will actually mean changing how care is delivered — such as using computerized evidence-based guidelines when ordering tests or procedures — says Bruce Henderson, leader of the electronic health records practice at PwC. “There’s lots of focus on the technology, but this is really about standardizing care processes at the highest level of quality with an eye towards the reduction of costs,” he tells the Health Blog. That means changing how doctors, nurses and other personnel work — and changing how anyone does his or her job is not easy.

Very true. In my previous entry I wrote about an experience with one doctor who was clearly very familiar with the electronic workflow; I also had an experience with another doctor last month who clearly was not and vocalized frustration in not being able to locate what she was seeking from the order set.

E-Patient Dave came to the realization that we are human (I reject his claim that he’s not as observant as he thought) and do not recall everything from doctor’s appointments a week later, and found out how helpful access to visit notes are. Read about his first experience as a result of participating in OpenNotes to see what he did.

This is how it should be: everything about our healthcare information accessible in one place, without having to wage a war in the process. Despite what sounds like a long stretch of oppressive heat and humidity in the other Washington, I wish I could be there for Regina Holliday’s e-Patient Ephemera: 73 Cents meets the world of data capture art exhibition on July 29th in Georgetown. She writes:

For too many years the medical record has been viewed as only a billing document and a piece of daily medical ephemera. Hundreds of pages of vitals, imaging results, medical reconciliation and surgeries are distilled into the few pages that form a transfer summary. At each facility this process continues; each set of daily records entering the ether of a payment structure. A daily accumulation of data that will remain untouched by many, if a lawyer and a potential lawsuit is not involved.

How did a document originally intended to facilitate communication and the medical history of a patient become a piece of billing ephemera? How dare institutions consign this living document a role as nothing more than a receipt of services rendered? With the advent of health information technology, the electronic medical record has the potential to leave its old role of medical ephemera and enter the virtual eternity of cloud based computing. Ah, the ability to create a lifetime electronic medical record consisting of transferable and actionable data is within our grasp. Or does this really matter?

I pointed to a picture of my then 7, now 8 year old son on my laptop when I met Regina in May.

All of his healthcare information since the day he was born (my prenatal care is in mine) to now are contained within an electronic medical record.

It really matters to me. I appreciate the struggle and chaos of the work being done now so that one day almost everyone can have them as well. Edit: Let’s hope that soon information about EHRs is in a format as easy to understand as the new site is!

iPad + Goodreader = Scary security risk

Saturday, June 26th, 2010

It’s not often I blog at 8am on a Saturday but this alert about Goodreader on the iPad from Jason Griffey’s discovery at the American Library Association conference is too scary to let pass by.

By default, Goodreader doesn’t require authentication or any warning to connect via Bonjour, and it allows you to browse AND DOWNLOAD any files that are so shared. Sitting in the Conference Center lobby, I was able to connect to two different iPads, view and grab files arbitrarilly, and push files TO the iPads as well.

Thinking about the implications of iPads that may contain cached sensitive medical information or documents with login or other data outside a secure hospital system (how many of us catch up on a little bit of work while at Starbucks?) setting  freaks me out even more. What opportunities are there for medical librarians, hospital IT departments and med students/residents/clinicans to easily share what devices they are using and be aware of the latest security risks and how to resolve them?

Of Impact, Information and Ideas

Wednesday, June 16th, 2010

ePatient Dave deBronkart, me, and Susannah Fox (Pew Internet)

I learned from previous experience that the wireless card wouldn’t work in the audience area of the room the E-Patient Symposium was held in at the Medical Library Association meeting, which I covered in two parts as The View From The Trenches and Personal Health Records (PHRs) in the official conference blog.

Via Twitter you often tend to make professional friends online first, then meet face to face as you huddle around outlets at conferences. This was the case for me with ePatient Dave who was the first one back there. He didn’t recognize me initially when I showed up with my 6-outlet surge protector to share (a great way to make instant conference friends).

Suddenly his entire face lit up with unmistakably genuine joy.

“It’s YOU!” and he quickly whipped out his cell phone camera.

“You have got to be kidding me, Dave. This “YOU!” is so the other way around,” I silently thought to myself.

Throughout the rest of the symposium we listened attentively to the speakers, chatted, and he graciously introduced me to Regina Holliday (the “is my savior in the cloud?’ line from her poem and paintings haunt me still) and Susannah Fox.

What amazing, dynamic people who I continue to connect and share ideas with about healthcare information via Twitter. It’s not about the channel though; whatever method of communication opens up in the future, I’m pretty sure we’ll all be there connecting through it.

Are librarian bloggers not radical enough, as Connie Crosby hypothesizes, due to a lack of blog comments? Is blogging dead? No.

What about Abigail’s point in her Hedgehog Librarian blog?

We may know we’re doing cool things but we’re insular and primarily talk to ourselves and about ourselves. We have our own conferences, our own professional networks, and the navel gazing can become exhausting.


What are you doing that leads to the “YOU!” moments, especially from those outside the library field who are among our most passionate advocates?

I would be remiss in not honoring a “YOU!” colleague who was taken much too soon from us last week: Cynthia Kahn. She was not only an outstanding librarian but her work in diabetes advocacy, especially with youth in Adventures for the Cure, was phenomenal and she will be dearly missed. A quick search of her Twitter account name during the time of the shocking news of her sudden death identifed another Twitter community besides medical librarians who were grieving the same loss:

What are you doing to identify and bridge these connections with others?

The relationships and impact of shared information and ideas is what matters. It’s not about specific communication channels or carefully guarded power structures. We have so many ways available to make it easier than ever to break down information silos. This is a vision for geolocation. What similar vision do we have for healthcare information?

NLM Theater at MLA

Tuesday, May 18th, 2010

Has it really been 2 years since my MLA 2008 post about the NLM Theater presentations I attended about PubMed (when the automatic term mapping change was the only big deal) & the Drug Information Portal that I later broke down into sections to highlight?

The truth of the matter is that in my short career as a medical librarian, I have been to to the MLA meeting once and then only for one day. Seriously. DC will be my first full MLA conference experience and I’ll also be an official conference blogger, session Twitter jockey (really!) and moderator of another session there. I would love to meet everyone! I’ll be the tall (5’10” in flats) somewhat lanky one usually wearing some shade of black and probably looking slightly overwhelmed by the whole scene.

I finally got a chance to look over the schedule for the NLM Theater presentations this year (get the PDF, it has more detail) and two things jumped out at me that I wasn’t expecting. Keep in mind my standard disclaimer: I’m not speaking on behalf of my employer here, I’m speaking as a medical librarian with an eye on the horizon.

Introduction to NCBI Molecular Databases .… In particular, pre-computed associations between data now promoted in the Discovery initiative expose useful and hypothesis generation relationships that further scientific investigation.

Whoa, hello Discovery initiative in the brochure! Given the level of integration we now see of the 29 databases in PubMed search results, getting a better understanding of what they are about straight from NCBI staff is probably a really good idea.

MedlinePlus Update … Come hear about our recent developments including Mobile MedlinePlus, MedlinePlus email updates and connecting MedlinePlus to EHRs/PHRs. Also be one of the first to get a glimpse of the forthcoming MedlinePlus site redesign.

I definitely want to know more about these connections and what’s up with the site redesign.

I will be covering at least two sessions a day as a conference blogger (my strategy is here), and I’ll write some compilation posts here at my home blog linking to my entries on the conference blog in addition to pictures and additional insights. See you there at MLA, or if not please let me know what questions you have that I can try to find answers for! Comments here or @eagledawg on Twitter will be the best way to make sure I see them in the days ahead.

Wrong again: (F)NLM and Social Media Growth

Monday, April 5th, 2010

On Friday I lied, today I joyfully announce that I’m finally wrong about something else. To quote myself from May 2009, I’m still hopeful for the day when we will see an NLM social media presence.

I lamented the lack of a specific NLM social media presence as recently as February: PubMed. The Twitter account I was told was not official (see comments) for months now is. See the complete list of official NLM social media channels at

Even better, there is a Friends of the National Library of Medicine (FNLM) conference being held April 6-7th entitled The ePatient: Digital and Genomic Technologies for Personalized Healthcare that is making use of the Twitter hashtag #eNLM. This may not seem all that remarkable but things have come a long way from a total lack of NLM presence in social media less than a year ago to a dedicated webpage of social media channels, and their news account on Twitter promoting a conference hashtag:

Being the librarian/archivist type that I am, I discovered no one else created the wthashtag wiki page for the conference so I did. Learn what’s being discussed, see who the main participants are, and run transcripts by selecting date ranges at

I wish I wasn’t on the other side of the country and could be there, and hopeful that those who are will share the wealth of information with the rest of us!