Clinical extracts of biomedical literature for patient-centered problem solving.

This paper reports on a four-part qualitative research project aimed at designing an online document surrogate tailored to the needs of physicians seeking biomedical literature for use in clinical problem solving. The clinical extract, designed in collaboration with three practicing physicians, combines traditional elements of the MEDLINE record (e.g., title, author, source, abstract) with new elements (e.g., table captions, text headings, case profiles) suggested by the physicians. Specifications for the prototype clinical extract were developed through a series of relevance-scoring exercises and semi-structured interviews. For six clinical questions, three physicians assessed the applicability of selected articles and their document surrogates, articulating relevance criteria and reasons for their judgments. A prototype clinical extract based on their suggestions was developed, tested, evaluated, and revised. The final version includes content and format aids to make the extract easy to use. The goals, methods, and outcomes of the research study are summarized, and a template of the final design is provided.

Managing information in the academic medical center: building an integrated information environment.

The strategic importance of integrated information systems and resources for academic medical centers should not be underestimated. Ten years ago, the National Library of Medicine in collaboration with the Association of Academic Medical Centers initiated the Integrated Advanced Information Management System (IAIMS) program to assist academic medical centers in defining a process for addressing deficiencies in their information environments. The authors give a brief history of the IAIMS program, and they describe both the characteristics of an integrated information environment and the technical and organizational structures necessary to create such an environment. Strategies some institutions have used to implement integrated information systems are also outlined. Finally, the authors discuss the role of librarians in integrated information system design.

Educating physicians to use the digital library.

Skill in creating, finding, managing, and using biomedical information is a vital component of modern medical practice. Medical schools recognize the revolutionary implications of computing technology and use a number of different strategies to integrate "informatics education" into their curricula. In many institutions, leadership for this effort rests with the health sciences library and/or the department of medical informatics. Examples are presented of how nine medical schools have implemented informatics education; no single informatics-education strategy prevails, and these schools' strategies do not exhaust the possibilities. Informatics education programs will require better planning and integration in the future because of the need to keep pace with curriculum reform, the changing context of medical practice, and the speed of technological innovation.

The organization of the digital library.

As digital information proliferates and the difficulties of managing it threaten to overwhelm traditional publication and information delivery processes, new visions of a digital library are forming. Exactly what a digital library is and how it is to be organized have not yet been determined, and bibliographic organization of digital information has not been sufficiently addressed. Bibliography is the systematic description or classification of writings or publications considered as material objects. In today's digital world, such material objects may no longer be relevant, but the need for systematic description remains. The important issue is not whether digital bibliography is needed but, instead, whether or not existing bibliographic techniques are appropriate for this new media. A second issue is the location of the responsibility for a new digital bibliography. Does it rest with medical informaticians, often the producers of this new digital information, or with librarians, traditionally the classifiers of information? Developments in both medical informatics and medical librarianship indicate a need for greater collaboration between these specialties in order to achieve their common purpose--the creation, classification, and dissemination of scholarly information.

Informatics and medical libraries: changing needs and changing roles.

Medical librarians play a crucial role in the evolution of institutional information policy. As information professionals, they share many similarities with their medical informatics counterparts. Both groups emphasize information delivery to the point of decision making; both groups serve as curators of institutional knowledge bases. If the term "publication" encompasses the delivery of clinical information relevant to individuals or populations, both librarians and medical informaticians have an immediate interest in the nature of biomedical publishing, particularly in areas of intellectual ownership, confidentiality, distribution, and access. Both groups also have been early leaders in applying information technology to solve pressing knowledge-management problems, and both groups have a strong commitment to educating colleagues in the effective use of information. Although the challenges faced by librarians and medical informaticians are sometimes different, the evolution of information technology and new forms of biomedical communication suggest that there is now a greater convergence between the two disciplines.

Evaluating library renovation at the University of Rochester Medical Center.

In 1987, the Edward G. Miner Library of the University of Rochester Medical Center completed the second major renovation in its 62-year history. The goal of the renovation was to provide additional space for the library's 3 main constituencies: its readers, its collections, and its staff. A case study of the renovation is presented, outlining processes and issues that shaped the final outcome. The success of the renovation is assessed in terms of project goals, design, and functionality. Changes made since 1987 to accommodate automation are also summarized. The conclusion suggests that library renovation be viewed as a continuing process, and proposes that principles of interface design are appropriate guidelines for evaluating library design across time.

Medical knowledge for clinical problem solving: a structural analysis of clinical questions.

Despite technological advances that support wide-ranging access to and transfer of knowledge, practicing physicians continue to underutilize current biomedical literature. This paper explores the nature of clinically applicable medical knowledge through a structural analysis of clinical questions. The author analyzed a set of sixty questions, based on actual online search requests of practicing physicians, for stated and unstated needs, certainty levels, implicit and explicit assumptions, decision-making processes, and type of answer required. As a result, four states of information valuable in patient care were identified: prediagnostic assessment, diagnosis, treatment choice, and learning. These states are presented in frame-like structures that integrate declarative and procedural components of medical decision making. It is concluded that clinical problem solving requires a blend of declarative and procedural knowledge. The ratio depends, in part, upon the reasoning process underway at the time of the request. Procedural knowledge required for clinical problem solving may be absent from current biomedical journal literature or difficult to identify.