BRIEF COMMUNICATIONS Creating and implementing an online patient education catalog* By Jacqueline Snider, M.L.S. Director, Information Resource Centert
Institute of Agricultural Medicine and Occupational Health University of Iowa AMRF, Oakdale Campus Oakdale, Iowa 52319 One of the major challenges of librarianship is to make material accessible by listing its availability and location. It is not unusual to have collections hidden and inaccessibly scattered throughout a single institution. Getting collections to end users (and vice versa) is not only the librarian's task; it also involves other departments and resources. Ideally, information services must work in both directions. Incorporating an informatic function into the basic operations of a hospital begins with connecting users to the library. It ends, however, with making the organization and retrieval of information an integral part of a hospital's institutional structure. A DECENTRALIZED COLLECTION
Mercy Hospital in Iowa City is a 222 acute-care and twelve skilled-care bed community hospital serving seven counties. Patient education, always a high priority, was decentralized, with each nursing unit responsible for ordering and distributing its own material. To locate pamphlets and booklets not available on their own units, nurses committed considerable time to phoning other departments. Mercy staff faced the formidable task of creating an information system to link nurses, and ultimately patients, with materials without exceeding budget limits. In 1985, the Nursing Quality Assurance Committee noted a need for coordinating the location of patient education material. The education office had compiled a list of in-house patient education literature in 1981, which had become out of date.
* Based on a paper presented May 21, 1990, at the Ninetieth Annual Meeting of the Medical Library Association, Detroit, Michigan. t Formerly Health Sciences Librarian, Mercy Hospital, 500 East Market Street, Iowa City, Iowa 52245. t MeSH is a registered trademark of the National Library of Med-
icine. Bull Med Libr Assoc 79(3) July 1991
PARTICIPATIVE MANAGEMENT TEAMS In response to the Nursing Quality Assurance Committee's recommendations, a group was formed in 1987 to examine and coordinate patient teaching. Mercy sponsors a participative management program called Striving Toward Excellence Program (STEP). The patient education STEP team called itself the "Informers" and, unlike other hospital STEP teams, was interdepartmental. Its members included the health sciences librarian, unit nurses, representatives from community relations and the education office, and a systems analyst. Teams followed the problem-solving structure described in Making Things Better: A System for Healthcare Excellence [1]. The process can be painstakingly slow, but it allows groups to work through problems and ultimately reach viable solutions. Team members must first brainstorm to identify problems. The patient education team identified poor organization of material and the lack of a patient education library most often while brainstorming. The group decided to tackle the task of making material accessible to all staff; however, economic constraints and shortage of space prevented the establishment of a separate patient education library.
ONLINE CATALOGS Team members considered the possibility of creating an online database on the hospital's systemwide minicomputers. Terminals on each unit allow staff to access information interactively. The director of the systems department, a program analyst, and the team examined the feasibility of purchasing software or writing a program. In 1982 Mercy had purchased seven NCR minicomputers. Only the operating language, SDL, could be used on the system, restricting the use of commercial software. The program analyst volunteered to write a program within approximately three weeks. Team members decided that each record should include the title, an access number, publisher, date, an annotation, subject, MeSH® t term, location, cost, and type of material. Additional fields, such as an author field, could be added in the future. Material included pamphlets, booklets, instruction sheets, and videos used in-house for patient education. Only two additional terminals, one in the health sciences library and the other in the education office, were needed. The cost of labor and new terminals was estimated at $2,500, far less than the cost of purchasing local area network (LAN) software and a personal computer for each unit. A literature search netted general articles dealing with online catalogs. Only a few studies had appeared on automated patient education catalogs. Crawford's Patron Access: Issues for Online Catalogs [2] provided 321
Brief communications
tips for making catalogs user-friendly. An article by Strozier addressed the pitfalls and benefits of developing an online catalog [3]. Sorrentino et al. provided comprehensive guidelines for cataloging such materials and assigning MeSH terms to pamphlets [4]. The team designed and distributed a survey to managers, staff nurses, and unit clerks asking if they would use an online catalog. The response was overwhelmingly positive. A cost-benefit analysis illustrated that the time saved locating materials outweighed the cost of the entire project. Plans for the project, including the results from the survey and the cost-benefit analysis, were presented to administration and management. Administration concluded that the catalog was an economical solution to the problem. To collect material, the newly appointed patient education coordinator and the health sciences librarian visited all nursing units, the radiology department, and cardiac rehabilitation. These visits helped to target the subject areas that required additional coverage. Because the catalog listed location, it was important that units shared with one another. For updating, staff informed the health sciences librarian of additions and deletions, and deposited one copy of every item in the library. This library collection does not circulate but is available for reference. The material was cataloged using MeSH terms and the National Library of Medicine (NLM) classification scheme. STEP team members helped to assign keyword subject headings. The health sciences librarian and the library clerk, both half-time employees, cataloged and entered data for 500 titles over a six-month period. THE DATABASE
When the system is accessed, a logo appears on the screen with an ID prompt at the bottom left-hand corner. The systems code is "UP," and the function code "MM" calls up the menu. Unit staff can select one of four search strategies. Option twelve, display by subject, allows keyword searching. Option thirteen, display by MeSH heading, offers MeSH searching capabilities. In the future, the health sciences library plans to upload its catalog now available on a PC. Since MeSH terms are assigned to both, the catalogs could easily be integrated. Option fourteen allows access by title. Option twenty, list catalog, is a global search mechanism and acts as a shelflist. The health sciences librarian's ID activates four additional commands not available to other users: option one for adding new material, option two for changing entries, option three for deleting items, and option ten for display by access number, which acts as a shelflist. To initiate a search, the user types option 12, 13, or 14, and the subject, MeSH term, or title. Each record 322
contains the following: title, subject, MeSH term, access number that follows NLM classification and is unique, format (booklet, pamphlet, one-half-inch or three-quarter-inch video), use ("PD" indicates patient distribution, "PR" for patient reference, and "TR" for teacher reference), date of publication, publisher, stock number, cost, resource person, and support group (for example, HOPE, a cancer support group). The comment field provides a brief description of the item, entry date, review date, and location of the material. Records are sorted by entry date; an alphabetical arrangement would be preferable but is not yet possible. Only part of a word is required to search by subject, MeSH term, or title. The same procedures are used to search by keyword, MeSH term, and title. List catalog, option twenty, provides an abbreviated list of titles. An additional menu itemizes the searchable fields: access number, subject, MeSH term, title, and exit. Option one allows searching by NLM classification number. "VTC" produces a list of all the videos in the database. Each screen displays eighteen titles; the user must type "y" at the "continue" prompt for more records.
PROMOTION Data input was completed in November 1988. The database, called the Informer Function, was available to staff in January 1989. Team members held hospitalwide training sessions, visiting each nursing unit. Presentations included the distribution of booklets, quick reference cards (kept on the units beside the terminals), and certificates. Ongoing promotion involves bulletin board displays, advertisements in newsletters, contests, and bookmarks. Unit nurses often suggest additional titles and increasingly rely on the catalog to locate material. Until the systems department is able to extract frequencyof-use data, it is difficult to determine how often the catalog is used. Nursing staff has conscientiously informed the health sciences librarian of additions and deletions to unit collections.
CONCLUSION Providing information services, even with a generous budget, is a complicated process. It is not enough just to attract a core group of users to the library. The library, particularly in hospitals, must go to the end user. And the librarian must uncover and exploit resources already existing within the building. For this to work, librarians must launch a cooperative effort involving hospital personnel and resources. As personnel become involved in the process of improving patron access, they contribute their valuable skills to the operation of the library and educate themselves about its potential uses. By integrating library funcBull Med Libr Assoc 79(3) July 1991
Brief communications
tions, such as online catalogs, into the hospital as a whole, personnel can both gain and provide informational access points. Thus, all become information brokers.
ACKNOWLEDGMENTS The author would like to thank team members Joan Kleopfer, Ginne McLeran, Sandy Reed, Lynn Whisler, and David Alatalo. Special acknowledgment must be given to the team leader, Mary McCarthy.
REFERENCES 1. LABOVITZ G. Making things better: a system for healthcare excellence. Burlington, MA: Organizational Dynamics, 1983. 2. CRAWFORD W. Patron access: issues for online catalogs. Boston: G. K. Hall, 1987. 3. STROZIER SL. Microsearching online catalogs. Small Comput Libr 1987 Sep;7(8):40-2. 4. SORRENTINO S, GOODCHILD EY, FIERBERG J. Cataloging procedures and catalog organization for patient education materials. Bull Med Libr Assoc 1979 Apr;67(2):257-60.
Received August 1990; accepted December 1990
Twenty-four-hour access to a library collection By Donatella Ugolini, Ph.D. Information and Documentation Service University Clinical Experimental Oncology Institute Cristina Fare, Ph.D. Information and Documentation Service National Institute for Cancer Research Viale Benedetto XV, 10 16132 Genoa, Italy Founded in 1978, the National Institute for Cancer Research in Genoa is now one of the leading centers in Italy for experimental and clinical oncology. The aims of the institute are to contribute to scientific knowledge in the field of oncological research; to prevent, diagnose, treat, and rehabilitate tumors; to develop pre- and postgraduate educational programs; and to offer updating and training courses for the medical staff. The library operates in this context and is supported by an information and scientific documentation service. Its stock consists of 310 subscriptions (252 current) to scientific journals and about 3,000 books. The work of the library is to provide a service for users, whose requests are increasingly specific and demanding. An understanding of the real needs of users and latent needs of new users was the Bull Med Libr Assoc 79(3) July 1991
turning point that enabled innovative technology to be placed at the service of the users [1-2]. Today, a library must know the kind and quality of service needed to satisfy its users; this enables the venture to survive and flourish. It is thus necessary to identify the users' expectations and to formulate service strategies to meet these expectations. The library has, therefore, introduced, along with technological innovations (end-user online access to the library's catalogs, Current Contents ® * on disk, and MEDLINEst on CD-ROM have been available since 1990), a policy of twenty-four-hour access to the library 365 days a year. The venture began experimentally on January 1, 1986, and a year later became standard. Since then, data have been collected for studying the behavior of the users, their needs, and any suggestions for improvements. METHODOLOGY The library is open to the public from Monday to Friday between 8:30 A.M. and 5:00 P.M. At the end of the working day, a closed circuit television system is switched on, and the procedure is as follows: * Authorized users hand over their identification badges and are given a magnetic card by the doorkeeper at the porter's lodge; the card allows entry to the reading room. The doorkeeper records the time of entry and exit on a specially prepared form. This form is handed to the library staff the following morning. * The user enters the reading room by inserting the card in the scanning device situated next to the entrance. * The user's movements are sensed by radar, setting in motion a video recorder, which films the user entering and leaving. * A monitor situated in the porter's lodge and linked to video cameras in the reading room enable the user's movements inside the reference room to be monitored at regular intervals. 'U The user, upon leaving the reading room, returns the magnetic card to the doorkeeper. * The following morning a clerk views the recordings and compares the number of entries with those indicated in the forms handed over by the doorkeeper to ensure nothing unusual has occurred. To enable the user to consult documents without assistance, the material in the library has been arranged in a simple and rational way. The books are arranged according to the National Library of Med* Current Contents is a registered trademark of the Institute for Scientific Information. t MEDLINE is a registered trademark of the National Library of Medicine.
323
Institute of Agricultural Medicine and Occupational Health University of Iowa AMRF, Oakdale Campus Oakdale, Iowa 52319 One of the major challenges of librarianship is to make material accessible by listing its availability and location. It is not unusual to have collections hidden and inaccessibly scattered throughout a single institution. Getting collections to end users (and vice versa) is not only the librarian's task; it also involves other departments and resources. Ideally, information services must work in both directions. Incorporating an informatic function into the basic operations of a hospital begins with connecting users to the library. It ends, however, with making the organization and retrieval of information an integral part of a hospital's institutional structure. A DECENTRALIZED COLLECTION
Mercy Hospital in Iowa City is a 222 acute-care and twelve skilled-care bed community hospital serving seven counties. Patient education, always a high priority, was decentralized, with each nursing unit responsible for ordering and distributing its own material. To locate pamphlets and booklets not available on their own units, nurses committed considerable time to phoning other departments. Mercy staff faced the formidable task of creating an information system to link nurses, and ultimately patients, with materials without exceeding budget limits. In 1985, the Nursing Quality Assurance Committee noted a need for coordinating the location of patient education material. The education office had compiled a list of in-house patient education literature in 1981, which had become out of date.
* Based on a paper presented May 21, 1990, at the Ninetieth Annual Meeting of the Medical Library Association, Detroit, Michigan. t Formerly Health Sciences Librarian, Mercy Hospital, 500 East Market Street, Iowa City, Iowa 52245. t MeSH is a registered trademark of the National Library of Med-
icine. Bull Med Libr Assoc 79(3) July 1991
PARTICIPATIVE MANAGEMENT TEAMS In response to the Nursing Quality Assurance Committee's recommendations, a group was formed in 1987 to examine and coordinate patient teaching. Mercy sponsors a participative management program called Striving Toward Excellence Program (STEP). The patient education STEP team called itself the "Informers" and, unlike other hospital STEP teams, was interdepartmental. Its members included the health sciences librarian, unit nurses, representatives from community relations and the education office, and a systems analyst. Teams followed the problem-solving structure described in Making Things Better: A System for Healthcare Excellence [1]. The process can be painstakingly slow, but it allows groups to work through problems and ultimately reach viable solutions. Team members must first brainstorm to identify problems. The patient education team identified poor organization of material and the lack of a patient education library most often while brainstorming. The group decided to tackle the task of making material accessible to all staff; however, economic constraints and shortage of space prevented the establishment of a separate patient education library.
ONLINE CATALOGS Team members considered the possibility of creating an online database on the hospital's systemwide minicomputers. Terminals on each unit allow staff to access information interactively. The director of the systems department, a program analyst, and the team examined the feasibility of purchasing software or writing a program. In 1982 Mercy had purchased seven NCR minicomputers. Only the operating language, SDL, could be used on the system, restricting the use of commercial software. The program analyst volunteered to write a program within approximately three weeks. Team members decided that each record should include the title, an access number, publisher, date, an annotation, subject, MeSH® t term, location, cost, and type of material. Additional fields, such as an author field, could be added in the future. Material included pamphlets, booklets, instruction sheets, and videos used in-house for patient education. Only two additional terminals, one in the health sciences library and the other in the education office, were needed. The cost of labor and new terminals was estimated at $2,500, far less than the cost of purchasing local area network (LAN) software and a personal computer for each unit. A literature search netted general articles dealing with online catalogs. Only a few studies had appeared on automated patient education catalogs. Crawford's Patron Access: Issues for Online Catalogs [2] provided 321
Brief communications
tips for making catalogs user-friendly. An article by Strozier addressed the pitfalls and benefits of developing an online catalog [3]. Sorrentino et al. provided comprehensive guidelines for cataloging such materials and assigning MeSH terms to pamphlets [4]. The team designed and distributed a survey to managers, staff nurses, and unit clerks asking if they would use an online catalog. The response was overwhelmingly positive. A cost-benefit analysis illustrated that the time saved locating materials outweighed the cost of the entire project. Plans for the project, including the results from the survey and the cost-benefit analysis, were presented to administration and management. Administration concluded that the catalog was an economical solution to the problem. To collect material, the newly appointed patient education coordinator and the health sciences librarian visited all nursing units, the radiology department, and cardiac rehabilitation. These visits helped to target the subject areas that required additional coverage. Because the catalog listed location, it was important that units shared with one another. For updating, staff informed the health sciences librarian of additions and deletions, and deposited one copy of every item in the library. This library collection does not circulate but is available for reference. The material was cataloged using MeSH terms and the National Library of Medicine (NLM) classification scheme. STEP team members helped to assign keyword subject headings. The health sciences librarian and the library clerk, both half-time employees, cataloged and entered data for 500 titles over a six-month period. THE DATABASE
When the system is accessed, a logo appears on the screen with an ID prompt at the bottom left-hand corner. The systems code is "UP," and the function code "MM" calls up the menu. Unit staff can select one of four search strategies. Option twelve, display by subject, allows keyword searching. Option thirteen, display by MeSH heading, offers MeSH searching capabilities. In the future, the health sciences library plans to upload its catalog now available on a PC. Since MeSH terms are assigned to both, the catalogs could easily be integrated. Option fourteen allows access by title. Option twenty, list catalog, is a global search mechanism and acts as a shelflist. The health sciences librarian's ID activates four additional commands not available to other users: option one for adding new material, option two for changing entries, option three for deleting items, and option ten for display by access number, which acts as a shelflist. To initiate a search, the user types option 12, 13, or 14, and the subject, MeSH term, or title. Each record 322
contains the following: title, subject, MeSH term, access number that follows NLM classification and is unique, format (booklet, pamphlet, one-half-inch or three-quarter-inch video), use ("PD" indicates patient distribution, "PR" for patient reference, and "TR" for teacher reference), date of publication, publisher, stock number, cost, resource person, and support group (for example, HOPE, a cancer support group). The comment field provides a brief description of the item, entry date, review date, and location of the material. Records are sorted by entry date; an alphabetical arrangement would be preferable but is not yet possible. Only part of a word is required to search by subject, MeSH term, or title. The same procedures are used to search by keyword, MeSH term, and title. List catalog, option twenty, provides an abbreviated list of titles. An additional menu itemizes the searchable fields: access number, subject, MeSH term, title, and exit. Option one allows searching by NLM classification number. "VTC" produces a list of all the videos in the database. Each screen displays eighteen titles; the user must type "y" at the "continue" prompt for more records.
PROMOTION Data input was completed in November 1988. The database, called the Informer Function, was available to staff in January 1989. Team members held hospitalwide training sessions, visiting each nursing unit. Presentations included the distribution of booklets, quick reference cards (kept on the units beside the terminals), and certificates. Ongoing promotion involves bulletin board displays, advertisements in newsletters, contests, and bookmarks. Unit nurses often suggest additional titles and increasingly rely on the catalog to locate material. Until the systems department is able to extract frequencyof-use data, it is difficult to determine how often the catalog is used. Nursing staff has conscientiously informed the health sciences librarian of additions and deletions to unit collections.
CONCLUSION Providing information services, even with a generous budget, is a complicated process. It is not enough just to attract a core group of users to the library. The library, particularly in hospitals, must go to the end user. And the librarian must uncover and exploit resources already existing within the building. For this to work, librarians must launch a cooperative effort involving hospital personnel and resources. As personnel become involved in the process of improving patron access, they contribute their valuable skills to the operation of the library and educate themselves about its potential uses. By integrating library funcBull Med Libr Assoc 79(3) July 1991
Brief communications
tions, such as online catalogs, into the hospital as a whole, personnel can both gain and provide informational access points. Thus, all become information brokers.
ACKNOWLEDGMENTS The author would like to thank team members Joan Kleopfer, Ginne McLeran, Sandy Reed, Lynn Whisler, and David Alatalo. Special acknowledgment must be given to the team leader, Mary McCarthy.
REFERENCES 1. LABOVITZ G. Making things better: a system for healthcare excellence. Burlington, MA: Organizational Dynamics, 1983. 2. CRAWFORD W. Patron access: issues for online catalogs. Boston: G. K. Hall, 1987. 3. STROZIER SL. Microsearching online catalogs. Small Comput Libr 1987 Sep;7(8):40-2. 4. SORRENTINO S, GOODCHILD EY, FIERBERG J. Cataloging procedures and catalog organization for patient education materials. Bull Med Libr Assoc 1979 Apr;67(2):257-60.
Received August 1990; accepted December 1990
Twenty-four-hour access to a library collection By Donatella Ugolini, Ph.D. Information and Documentation Service University Clinical Experimental Oncology Institute Cristina Fare, Ph.D. Information and Documentation Service National Institute for Cancer Research Viale Benedetto XV, 10 16132 Genoa, Italy Founded in 1978, the National Institute for Cancer Research in Genoa is now one of the leading centers in Italy for experimental and clinical oncology. The aims of the institute are to contribute to scientific knowledge in the field of oncological research; to prevent, diagnose, treat, and rehabilitate tumors; to develop pre- and postgraduate educational programs; and to offer updating and training courses for the medical staff. The library operates in this context and is supported by an information and scientific documentation service. Its stock consists of 310 subscriptions (252 current) to scientific journals and about 3,000 books. The work of the library is to provide a service for users, whose requests are increasingly specific and demanding. An understanding of the real needs of users and latent needs of new users was the Bull Med Libr Assoc 79(3) July 1991
turning point that enabled innovative technology to be placed at the service of the users [1-2]. Today, a library must know the kind and quality of service needed to satisfy its users; this enables the venture to survive and flourish. It is thus necessary to identify the users' expectations and to formulate service strategies to meet these expectations. The library has, therefore, introduced, along with technological innovations (end-user online access to the library's catalogs, Current Contents ® * on disk, and MEDLINEst on CD-ROM have been available since 1990), a policy of twenty-four-hour access to the library 365 days a year. The venture began experimentally on January 1, 1986, and a year later became standard. Since then, data have been collected for studying the behavior of the users, their needs, and any suggestions for improvements. METHODOLOGY The library is open to the public from Monday to Friday between 8:30 A.M. and 5:00 P.M. At the end of the working day, a closed circuit television system is switched on, and the procedure is as follows: * Authorized users hand over their identification badges and are given a magnetic card by the doorkeeper at the porter's lodge; the card allows entry to the reading room. The doorkeeper records the time of entry and exit on a specially prepared form. This form is handed to the library staff the following morning. * The user enters the reading room by inserting the card in the scanning device situated next to the entrance. * The user's movements are sensed by radar, setting in motion a video recorder, which films the user entering and leaving. * A monitor situated in the porter's lodge and linked to video cameras in the reading room enable the user's movements inside the reference room to be monitored at regular intervals. 'U The user, upon leaving the reading room, returns the magnetic card to the doorkeeper. * The following morning a clerk views the recordings and compares the number of entries with those indicated in the forms handed over by the doorkeeper to ensure nothing unusual has occurred. To enable the user to consult documents without assistance, the material in the library has been arranged in a simple and rational way. The books are arranged according to the National Library of Med* Current Contents is a registered trademark of the Institute for Scientific Information. t MEDLINE is a registered trademark of the National Library of Medicine.
323
