The Road to Health
The health care reform debate has focused on offering better care and lower costs. Health sciences librarians play
a key role in achieving those goals.
It's a cool, sleepy morning in August, but inside a conference room at University of Minnesota Medical Center-Fairview, things are heating up. Meghan Sebasky and Greg Weber, chief residents in the department of internal medicine at the University of Minnesota Medical School, have presented a case study of a 65-year-old man with skin blemishes and fatigue. Two dozen medical students and residents sit around a table and pepper Sebasky with queries about the man's condition. How long has this been going on? What medications is he taking? How's his appetite?
This high-stakes version of 20 Questions, a daily exercise known as the morning report, helps students and residents make a diagnosis. Today, students have little trouble determining the patient is suffering from dermatomyositis, a muscle disease characterized by a skin rash. Still, at the end of the 45-minute session, Jim Beattie, associate director for the University's Health Sciences Libraries, pops up from the side of the room to showcase several Web sites, including MDConsult, Ovid, and PubMed, all of which can help doctors shorten the list of possible causes of their patients' symptoms. These online tools play a critical role not only in helping health care providers give patients better care, but also in lowering overall health care costs—one of the critical components in the health care reform debate that's happening in Washington and around the country. Beattie says that health sciences librarians can teach practitioners how to use these online tools and databases, helping them become more informed, which can mean fewer expensive and unnecessary tests for their patients. More information means "you don't do things that don't give you much bang for your buck," he says.
As politicians wrangle over the best ways to improve and reduce costs of medical care, health sciences libraries and librarians are quietly working on these issues as well, says Linda Watson, director of the University's Health Sciences Libraries and past president of the Association of Academic Health Sciences Libraries. "We are under the radar," she acknowledges. "But we feel we have a role in helping citizens stay on top of information that can help them make informed decisions."
A 1999 study conducted by Georgetown University's Center on an Aging Society found that low health literacy cost Americans $73 billion in additional health care costs each year.
By helping health care providers find the best research and resources, guiding today's medical students to the tools that will help them throughout their career, and directing patients to clear, accurate health information, health sciences librarians are making a real difference in the way patients receive care. They're working to make care smarter, more effective, and less expensive.
Building a Smarter Health Care Consumer
This year isn't the first time that health care reform has been a top political priority, but for consumers, the world is a vastly different place than it was in the early 1990s, when the Clinton administration was pushing for change. People relied heavily on their doctors to get their medical information; Google hadn't been invented yet. These days, more than half of all American adults get health information online. A Pew Research Center survey notes that nearly three quarters of people between the ages of 18 and 49 head to the Internet to get information about medical issues. Those statistics are one reason that health sciences librarians want consumers to know how to find reputable sources of information before they head to the clinic. "We want people to talk to their health care provider and be educated about their condition and have good questions to ask," says Anne Beschnett, liaison and outreach librarian for the University's Bio-Medical Library. "It's not about doing a Google search and finding a miracle cure for cancer."
At the University, health sciences librarians have tackled a range of initiatives to help consumers get access to smart, unbiased information. In 2007, they launched My Health Minnesota → Go Local. A service of the University's Health Sciences Libraries, the Mayo Clinic Libraries, and Minitex (a joint program of the Office of Higher Education and the University of Minnesota), the Web site harnesses the resources of the National Library of Medicine and provides accurate information on more than 800 health conditions as well as an online directory of nearby clinics, support groups, and health programs. For Minnesotans seeking health care options and information, My Health Minnesota → Go Local is reliable one-stop shopping. The Health Sciences Libraries have also partnered with public libraries statewide. Because public libraries are often the first place people go for information after they've been diagnosed with a disease, health sciences librarians have offered presentations and resources to public librarians so they can help patrons get reliable, up-to-date health information.
Some outreach efforts are even more direct. In September 2009, Beschnett and several University researchers started work on a health literacy program called HeLP Minnesota Seniors. Teaming up with Boutwells Landing, an assisted living facility in Stillwater, Beschnett and others on the research team developed a series of health literacy classes, including courses on communicating effectively with doctors and finding reliable information online. The classes are sorely needed: Not only do people older than 65 account for a disproportionate number of hospital stays, but they are also the least likely of all adults to have the ability to comprehend key health information. Beschnett hopes the project is the start of something bigger: "We hope to develop basic course materials so that other people in senior living facilities can use it as a tool kit," she says. While the approaches that librarians use to improve consumer health are varied, they share a common theme, says Beattie. "We know how to find health information quickly and well," he says. "We're the translators and connectors. We help people make connections to health information, whether they're a patient, doctor, or researcher."
Those connections do more than just improve health literacy—hey may also help reduce ballooning health care costs: a 1999 study conducted by Georgetown University's Center on an Aging Society found that low health literacy cost Americans $73 billion in additional health care costs each year.
All Available Evidence
Evidence-based medicine—the practice of using the best available information to make decisions about the care of patients—has become something of a buzz phrase during the health care debate. And while the idea of using the best possible facts to arrive at a diagnosis is an appealing one, it's also an incredibly labor-intensive one. It's also where health sciences librarians play a central role. Health professionals can spend years in school and residency programs, but learning about new technologies and techniques continues for a career. An editorial in the British Medical Journal estimated that a typical physician would have to read 19 journal articles every day of the year just to keep up with the flood of advances. Such expectations are unreasonable, of course; health sciences librarians help health care providers sift through the acres of new information.
Many doctors, when facing a medical issue for the first time, will ask other doctors for advice. While this method can be effective, sometimes further research is required. Liaison librarian Lisa McGuire believes that a good health sciences librarian can be as helpful as a doctor's smartest colleague. "How do you do something? What's worked somewhere else? What are best practices?" she says. "There are so many sources out there, but we can help focus questions and uncover those pieces of information." Researchers, too, count on health sciences librarians to help them find the proverbial needle in the Bio-Medical Library's haystack of 430,000 print volumes and myriad e-resources. Del Reed, who works in reference services, recently helped dig up statistics for a researcher working on a book about cancer and guided another through the labyrinthine health databases created by the government. "The government puts out all sorts of statistical resources, but for the most part, they're not very intuitive for users," he says. "That's why I'm here: to help people work their way through them to get what they need."
Perhaps the most ambitious project in the works is a proposal under development and sponsored in part by the Health Sciences Libraries that would give all Minnesota health care providers online access to an array of clinical information resources. While the licensing costs could be up to $2 million, Watson believes that providing such access to the state's 200,000 health professionals and students would be well worth the cost. "We're trying to get good information to rural health professionals so they can have up-to-date information," she says. "That broad access is key for us."
Evidence-based medicine may be an exceptional way to deliver health care. Providing the tools and guidance to help practitioners do that is an essential first step in that process.
Educating Future Health Care Providers
Teaching the next generation of doctors, nurses, dentists, pharmacists, allied health professionals, public health professionals, and veterinarians to navigate myriad printed and online journals and databases is a critical task—especially for students who have been raised on Wikipedia and Google. "People think that just because they've done a Google search that they've gotten all the resources that are out there," says Reed. "It gives them a false sense of confidence. But you've got to know the limitations of your information resources."
Health sciences librarians are eager to help students broaden and deepen their searches for information. While teaching students how to use the resources within the Health Sciences Libraries isn't a formal part of the University's Academic Health Center curricula, some instructors have pulled in librarians to do mini-tutorials when students are assigned research projects, and many students sign up for one-on-one reference consultations.
McGuire sees this as an opportunity not just to share specific tools, but to teach them techniques that they can use in the future. "I feel like if I can help students build the skills they need to find information, it's a lifelong skill," she says. "When you understand how a database is put together, how to create an effective search strategy, you can take that information and apply it to whatever you're working on. I think a lot of professional schools assume that people are learning these skills at the undergraduate level or the high school level, but that's not always the case. Our goal is take them from where they are to where they need to be in their professional career."
In recent years, a required primary care clerkship course at the University's medical school included a project in which students researched common medical questions or topics. The students turned that research into reader-friendly brochures that could be given to patients with questions on the topic. The health sciences librarians helped oversee the research process and showed students tools they needed to make sure the brochures were simple and jargon-free. Now, says Beattie, the brochures are all available online (see sidebar). He notes that the collection receives hundreds of downloads each month, with pink eye and lactose intolerance being some of the most popular topics.
For Beattie, such projects illuminate the many ways librarians play a role in helping change health care through small but real improvements over time. "When you're dealing with health care, you need a variety of experts to direct their intellectual firepower at complex problems," he says. "They're trying to solve problems in real time. Our role is helping train health professionals to access quality health information quickly as it relates to solving patient problems."
Providing better health care is not just about reforming the current system, but fundamentally shifting the way the health care providers and patients connect with information and each other. By providing access and guidance to the wealth of health information contained online and in the pages of books and journals, health sciences librarians are playing a vital role in changing—and improving—health care.