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OBJECTIVE: The article offers a current perspective on medical informatics and health sciences librarianship. NARRATIVE: The authors: (1) discuss how definitions of medical informatics have changed in relation to health sciences librarianship and the broader domain of information science; (2) compare the missions of health sciences librarianship and health sciences informatics, reviewing the characteristics of both disciplines; (3) propose a new definition of health sciences informatics; (4) consider the research agendas of both disciplines and the possibility that they have merged; and (5) conclude with some comments about actions and roles for health sciences librarians to flourish in the biomedical information environment of today and tomorrow. SUMMARY: Boundaries are disappearing between the sources and types of and uses for health information managed by informaticians and librarians. Definitions of the professional domains of each have been impacted by these changes in information. Evolving definitions reflect the increasingly overlapping research agendas of both disciplines. Professionals in these disciplines are increasingly functioning collaboratively as 'boundary spanners,' incorporating human factors that unite technology with health care delivery. [ABSTRACT FROM AUTHOR]

The Cushing/Whitney Medical Library began providing end-user access to MEDLINE in 1986 and switched to the OVID system in 1993. MEDLINE is a core service of the library, and the choice of delivery systems has had a significant impact throughout the Yale-New Haven Medical Center. This paper describes the user response to MEDLINE, discusses the effects of MEDLINE on other library services, and suggests ways in which technology, policy, and funding have all influenced use. Yale's experience suggest that removing barriers in all three areas can dramatically expand the points of access, the number of users, and the amount of use with manageable effects on other library services. [ABSTRACT FROM AUTHOR]

Donald A.B. Lindberg M.D., Director of the U.S. National Library of Medicine (NLM) from August 1984 to March 2015, had a remarkable vision for NLM's scope, goals, and function. This vision resulted in many external partnerships and initiatives with the publishing industry, commercial and non-profit, journal editors, and professional organizations. These partnerships ranged from ongoing collaboration and dialogue, such as the NLM Publisher's Committee and the International Committee of Medical Journal Editors (ICMJE). to the more practical, such as the creation of HINARI and the Emergency Access Initiative (EAI). Dr. Lindberg fostered partnerships outside the NLM to expand the use and reach of Library resources, including MEDLINE and ClinicalTrials.gov to support innovations in the processes that build them, and to improve the quality of biomedical journals. Dr. Lindberg also encouraged the use of technology to enhance medical information and supported the early development of fully interactive publications. Attitudes that contained a measure of skepticism and distrust faded as collaborators came to have a better understanding of both NLM and their partners. This chapter discusses these relationships and accomplishments that NLM achieved working with publishers and other creators and disseminators of medical information under Dr. Lindberg's leadership., (© 2022 – The authors. Published by IOS Press.)

This White Paper presents the foundational domains with examples of key aspects of competencies (knowledge, skills, and attitudes) that are intended for curriculum development and accreditation quality assessment for graduate (master's level) education in applied health informatics. Through a deliberative process, the AMIA Accreditation Committee refined the work of a task force of the Health Informatics Accreditation Council, establishing 10 foundational domains with accompanying example statements of knowledge, skills, and attitudes that are components of competencies by which graduates from applied health informatics programs can be assessed for competence at the time of graduation. The AMIA Accreditation Committee developed the domains for application across all the subdisciplines represented by AMIA, ranging from translational bioinformatics to clinical and public health informatics, spanning the spectrum from molecular to population levels of health and biomedicine. This document will be periodically updated, as part of the responsibility of the AMIA Accreditation Committee, through continued study, education, and surveys of market trends.

How do clinical questions emerge and move toward resolution in the intensive care setting over the course of 24 hours? In a 20-bed surgical intensive care unit in a large, tertiary-care teaching hospital, informationists shadowed clinicians for 2 48-hour periods to record questions, noting when they were asked and whether they were answered. Thirty-eight percent of 112 recorded questions remained unanswered. Some unanswered questions persisted across shifts, and clinicians' information-seeking behaviors changed over time. Clinical information services can be improved and integrated more fully into clinical workflows based on a fuller understanding of the life cycle of clinical inquiry.

Study Objective: We determine whether prescription information or services improve the medication adherence of emergency department (ED) patients., Methods: Adult patients treated at one of 3 EDs between November 2010 and September 2011 and prescribed an antibiotic, central nervous system, gastrointestinal, cardiac, or respiratory drug at discharge were eligible. Subjects were randomly assigned to usual care or one of 3 prescription information or services intervention groups: (1) practical services to reduce barriers to prescription filling (practical prescription information or services); (2) consumer drug information from MedlinePlus (MedlinePlus prescription information or services); or (3) both services and information (combination prescription information or services). Self-reported medication adherence, measured by primary adherence (prescription filling) and persistence (receiving medicine as prescribed) rates, was determined during a telephone interview 1 week postdischarge., Results: Of the 3,940 subjects enrolled and randomly allocated to treatment, 86% (N=3,386) completed the follow-up interview. Overall, primary adherence was 88% and persistence was 48%. Across the sites, primary adherence and persistence did not differ significantly between usual care and the prescription information or services groups. However, at site C, subjects who received the practical prescription information or services (odds ratio [OR]=2.4; 95% confidence interval [CI] 1.4 to 4.3) or combination prescription information or services (OR=1.8; 95% CI 1.1 to 3.1) were more likely to fill their prescription compared with usual care. Among subjects prescribed a drug that treats an underlying condition, subjects who received the practical prescription information or services were more likely to fill their prescription (OR=1.8; 95% CI 1.0 to 3.1) compared with subjects who received usual care., Conclusion: Prescription filling and receiving medications as prescribed was not meaningfully improved by offering patients patient-centered prescription information and services., (Copyright © 2013 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.)

Objective: The research sought to evaluate whether providing personalized information services by libraries can improve satisfaction with information services for specific types of patients., Methods: Adult breast cancer (BrCa) clinic patients and mothers of inpatient neonatal intensive care unit (NICU) patients were randomized to receive routine information services (control) or an IRx intervention., Results: The BrCa trial randomized 211 patients and the NICU trial, 88 mothers. The BrCa trial showed no statistically significant differences in satisfaction ratings between the treatment and control groups. The IRx group in the NICU trial reported higher satisfaction than the control group regarding information received about diagnosis, treatments, respiratory tradeoffs, and medication tradeoffs. BrCa patients posed questions to librarians more frequently than did NICU mothers, and a higher percentage reported using the website. Questions asked of the librarians by BrCa patients were predominantly clinical and focused on the areas of treatment and side effects., Conclusions: Study results provide some evidence to support further efforts to both implement information prescription projects in selected settings and to conduct additional research on the costs and benefits of services.

Despite speculation that Telemicroscopy and Digital Microscopy will follow the same diffusion curves as their counterparts in the world of Radiology - Teleradiology and Filmless Radiology, no study has offered definitive evidence in support of this hypothesis. To address this gap in the informatics knowledge base, dual survey instruments were created to measure current opinions on both technologies among Pathologists and Radiologists and disseminated to Pathologists and Radiologists at two major academic medical centers.

In the information portal environment, user profiles helps librarians to better understand users' needs and build individualized services. We have used a locally developed UMLS-based MeSH indexer to process and extract MeSH concept terms from the contents of individuals' usage files on our library's portal system (MyWelch). The algorithm was also developed to refine these extracted terms and assign weights to individual terms. This process yielded a weighted MeSH term set for each individual user that can be considered to define the individual user's areas of research interest profile.

Current information is a critical component of good healthcare. In this article we offer a definition of a new health professional, the 'informationist', whose function it is to ensure evidence-based health practice. We describe the literature and discussions that led to the proposal of this new role, and offer a description of the steps being taken to further elaborate this career. In particular, we describe efforts at Johns Hopkins to train informationists and informaticists and to offer services that lead to the integration of these and other information professionals into clinical care, public health and research.

One of the important procedures during the operation of an Institutional Repository System (IRS) is to categorize and index the submitted digital objects. Based on current practice, human catalogers are frequently involved in this process to make accurate categorization. Funded by NLM development grant, we are developing an UMLS-based indexing tool. The tool will be integrated or plug-in into most IRS, and categorize and assign MeSH headings and keywords to text-based digital objects automatically.

Preparing librarians to meet the information challenges faced in the current and future health care environments is critical. At Johns Hopkins University, three NLM-funded fellowship programs provide opportunities for librarians to utilize the rich environments of the Welch Medical Library and the Division of Health Sciences Informatics in support of life-long learning.

The William H. Welch Medical Library was founded in 1929 with the merger of three libraries, namely, the library of the School of Medicine, the library of the School of Hygiene and Public Health, and the library of the Johns Hopkins Hospital. Engendered by the dreams of Johns Hopkins University bibliophiles, such as founding Hopkins physicians William Osler, William Stewart Halsted, Howard Kelly, and William Henry Welch, the library flourished and expanded. At the same time as the founding of the central medical library, the Institute of the History of Medicine collection was established in the Welch Library building, with William H. Welch as its first director. Innovative leadership led to many exciting projects, such as the Welch Indexing Project, which was a prototype for the National Library of Medicine's medical subject headings, and the establishment of a laboratory for research into the application of information technologies to knowledge management. The Welch Library enters the 21st century as a dynamic library committed to the continuing delivery of information services, as well as ongoing research into the development of library services for the coming 100 years.

Systems developed through informatics methods can be evaluated at different levels, depending on the purpose of the evaluation. A key class of measures useful in relating information systems to the quality of patient care is benefit or out-come measures, which reflect differences in the health or welfare of the patient that result from the system being utilized. A framework for describing evaluation measures is presented, definitions are discussed, and the results of a literature review are presented to indicate outcome measures used in medical informatics over several decades. The conclusion suggests that more attention should be given to the standardization of terminology and to outcome measures and methods.

Objective: To evaluate use of information resources during the first year of IAIMS implementation at the Yale-New Haven Medical Center. The evaluation asked: (1) Which information resources are being used? (2) Who uses information resources? (3) Where are information resources used? (4) Are multiple sources of information being integrated?, Design: Measures included monthly usage data for resources delivered network-wide, in the Medical Library, and in the Hospital; online surveys of library workstation users; an annual survey of a random, stratified sample of Medical Center faculty, postdoctoral trainees, students, nurses, residents, and managerial and professional staff; and user comments., Results: Eighty-three percent of the Medical Center community use networked information resources, and use of resources is increasing. Both status (faculty, student, nurse, etc.) and mission (teaching, research, patient care) affect use of individual resources. Eighty-eight percent of people use computers in more than one location, and increases in usage of traditional library resources such as MEDLINE are due to increased access from outside the Library. Both survey and usage data suggest that people are using multiple resources during the same information seeking session., Conclusions: Almost all of the Medical Center community is using networked information resources in more settings. It is necessary to support increased demand for information access from remote locations and to specific populations, such as nurses. People are integrating information from multiple sources, but true integration within information systems is just beginning. Other institutions are advised to incorporate pragmatic evaluation into their IAIMS activities and to share evaluation results with decision-makers.

Objective: To explore the software design issues involved in implementing an operational information sources map (ISM) knowledge base (KB) and system of navigational tools that can help medical users access network-based information sources relevant to a biomedical question., Design: A pilot biomedical ISM KB and associated client-server software (ISM/Explorer) have been developed to help students, clinicians, researchers, and staff access network-based information sources, as part of the National Library of Medicine's (NLM) multi-institutional Unified Medical Language System (UMLS) project. The system allows the user to specify and constrain a search for a biomedical question of interest. The system then returns a list of sources matching the search. At this point the user may request 1) further information about a source, 2) that the list of sources be regrouped by different criteria to allow the user to get a better overall appreciation of the set of retrieved sources as a whole, or 3) automatic connection to a source., Results: The pilot system operates in client-server mode and currently contains coded information for 121 sources. It is in routine use from approximately 40 workstations at the Yale School of Medicine. The lessons that have been learned are that: 1) it is important to make access to different versions of a source as seamless as possible, 2) achieving seamless, cross-platform access to heterogeneous sources is difficult, 3) significant differences exist between coding the subject content of an electronic information resource versus that of an article or a book, 4) customizing the ISM to multiple institutions entails significant complexities, and 5) there are many design trade-offs between specifying searches and viewing sets of retrieved sources that must be taken into consideration., Conclusion: An ISM KB and navigational tools have been constructed. In the process, much has been learned about the complexities of development and evaluation in this new environment, which are different from those for Gopher, wide area information servers (WAIS), World-Wide-Web (WWW), and MOSAIC resources.

Navigating any complex set of information resources requires tools for both browsing and searching. A number of tools are available today for using Internet resources, and more are being developed. This article reviews existing navigational tools, including two developed at the Yale University School of Medicine, and points out their strengths and weaknesses. A major shortcoming of the present Internet navigation methods is the lack of controlled descriptions of the available resources. As a result, navigating the Internet is very difficult.

NetMenu is a program, developed at Yale, which enables straightforward access to online information systems. NetMenu has been deployed in several diverse settings within our medical center. In the hospital, NetMenu is functioning as a front-end for our clinical workstation providing access to the hospital information system, the clinical laboratory computer, a drug database and several bibliographic databases. The medical libraries are utilizing NetMenu for both medical education workstations and for scholarly information workstations. This paper describes our initial experience in the implementation, support, and maintenance of NetMenu as an institutional menu of information sources.

The concept of "one-stop information shopping" is becoming a reality at Columbia-Presbyterian Medical Center. Our goal is to provide access from a single workstation to clinical, research, and library resources; university and hospital administrative systems; and utility functions such as word processing and mail. We have created new organizational units and installed a network of workstations that can access a variety of resources and systems on any of seventy-two different host computers/servers. In November 1991, 2,600 different individuals used the clinical information system, 700 different individuals used the library resources, and 900 different individuals used hospital administrative systems via the network. Over the past four years, our efforts have cost the equivalent of $23 million or approximately 0.5% of the total medical center budget. Even small improvements in productivity and in the quality of work of individuals who use the system could justify these expenditures. The challenges we still face include the provision of additional easy-to-use applications and development of equitable methods for financial support.

A key element of IAIMS development at the Columbia Presbyterian Medical Center (CPMC) is the Medical Logic Module (MLM), designed to provide decision support to clinical users. A standard has been established for MLMs, and a number of institutions have agreed in principle to share them. At CPMC, MLMs are under development and MLMs from other institutions are being reviewed. The Columbia Health Sciences Library has developed a management system for MLMs which supports both internal development and sharing of MLMs among institutions. This paper describes the elements of the MLM management system.