Canadian health care 2.0

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  • "...Print is about logic, context. "E" is about convenience, hyper-connectivity"...TV is about emotion..."
  • "...The Internet tends to push everything toward a self-service model. It happened in retail, banking, government services, and of course libraries. If you've worked in or used libraries for more than twenty years, try to think of all the things patrons once needed personal assistance with but which is now self-service. For example, librarians once mediated the searching of bibliographic databases on behalf of patrons, but since the advent of institutional licensing and IP-based authentication, today's users jump right in and (for better or worse) do all their own searching." — Hutchison, 2013
  • Guardian library series http://www.theguardian.com/higher-education-network/series/library-futures
  • “I skate to where the puck is going to be, not where it has been.” What is the information equivalent?
  • This famous quotation from hockey great Wayne Gretzky explained how he scored so many goals in NHL games. It came to mind recently when I started reflecting on my own career, as well as the path I would advise librarians to take.
  • A panel of experts convened by the publishing giant Thomson Reuters recommends that researchers, universities, and publishers come up with ways to make a researcher’s data available to other scholars even if the researcher doesn’t have a journal article ready for publication.

The panel was assembled to look at “the obstacles to unlocking the value” of the vast quantities of data that cascade out of faculty labs and offices every year, a trove that is projected to grow to the “unfathomable” amount of more than 35 trillion gigabytes of information by 2020, according to a report on the panel’s discussion.

Members of the panel worried that higher education “does not yet recognize or reward researchers for sharing their data,” according to one participant, Alex Wade, director of scholarly communication for Microsoft.

The panel recommends the creation and widespread acceptance of “community standards around the sharing and reuse of research data.” It also says that copyright issues need to be resolved, and that journal publishers need to prepare themselves to play roles different from the one they play now.

  • http://www.healthpromotion.cywhs.sa.gov.au/library/Social_media_use_in_health_promotion_FINAL_REPORT.pdf
  • Canada needs a comprehensive health information (and data) strategy: a medical librarian's perspective
  • Why Canadian health care needs a comprehensive information (and data) strategy
  • Medicine in a time of social media: the pros & cons
  • Canada's chronic health information problems: resolution not anytime soon
  • How web 2.0 is changing medicine: a Canadian perspective
  • To improve Canadian health care, we need our own MEDLINE
  • On being efficient: Canada needs to create its own MEDLINE
  • The DNA of web 2.0
  • Why Canada needs a more coherent health information strategy
  • Canada needs its own MEDLINE database: a medical librarian explains
  • Why Canada needs its own MEDLINE database: a medical librarian explains
  • Why Canada needs its own MEDLINE database: a hospital librarian explains
  • Finding Canadian medical evidence: why we need better strategies
  • In an age with so much uncertainty, nothing could be more secure than the ability to find information
  • On being a medical librarian: Facebook, Twitter and ...what next?
  • Enhancing access to health information in Canada: a medical librarian's perspective
  • Searching for evidence is a search for understanding
  • Health librarians are the sine qua non in information retrieval
  • The quest for nationhood; autonomy for Canadian medicine: creating a Canadian digital library of medicine/MEDLINE
  • Goal is to connect the unconnected but to point to authoritative content
  • Both consumer health and biomedical research is important, though research capacity building (RCB) initiatives are needed
  • What medical librarians deliver is valuable; Our knowledge is finite, Karl Popper emphasized, but our ignorance is infinite
  • Medical information that is easily understood and with a direct practical application to patient care has cachet
  • Communicating research that is of value can be complicated, multifaceted and subjective
  • Relevant, reliable, objective information is highly valued in medicine
  • A future goal should be to create better Canadian health websites, finding tools, databases
  • The creation of CANMEDLINE is as important as the creation of the CMAJ, Confederation and repatriation of the constitution; all three are spurred by a sense of maturity in our own perspectives, and in ourselves
  • "The empowerment one has, when one has information, is astounding"
  • The citation to published studies acknowledges that intellectual work's debt to clinical practice and is evidence of its influence
  • Forget about the web for a moment; consider what we, as a community of health care professionals, will need to renew health care
  • Do emerging social media hold some of the answers to renewing health care in Canada?
  • Serendipitous discovery is fine for browsing but it's not a search strategy

Contents

Other

  • Behind the scene of every successful healthcare team is information; bring awareness to the contributions made by librarians to all healthcare organizations. In today's healthcare world healthcare professionals are more than ever under pressure to keep their knowledge base current. Medical librarians, specialists in the field of health information, sit at the crossroads between information and practice providing the essential services needed by all healthcare professionals to navigate through the ever expanding health science knowledge base. Medical librarians support the healthcare team by working tirelessly to select essential online and print resources to meet their institutions medical and nursing point-of-care, research, and education needs. To support practice at the point-of-care, medical librarians provide education and instruction to the healthcare team on how to effectively and efficiently take advantage of online point-of-care and research tools to provide the best care possible to all patients seeking treatment and care. Medical librarians also provide research support services to the healthcare team by conducting literature searches using their subject knowledge and experience to sift through the mountains of information available on any particular condition or disease facilitating the healthcare professional to provide the most advanced treatment and care available.
  • Although not a visible member of the healthcare team, medical librarians provide the access and support to the information needed to develop the policies, procedures, and practices that reduce unnecessary tests and procedures, hospital stays and admissions, and hospital acquired infections thereby improving the bottom line of any healthcare organization. These are just a few of the benefits professional library services provide to a health care system; librarians play a key role in any medical center and in the delivery of high quality healthcare.

Problem

  • The problem seems to be that we want medical students to guide students to quality information resources, but for some research questions that can be onerous. If a medical student wants to do some research in Aboriginal health, they will have to search across multiple databases
  • What is the root of the problem? lack of money? rigorous research?
  • Try searching on the web for medical evidence; all the chaos, noise, social media, interruptions. Then think about what might focus your brain without distraction on an important topic in medicine;
  • We talk about the importance of publishing but less about dissemination strategies, preservation, durability
  • One of the sobriquets we hear often is that we live in the "information age" ~ is information a(the) problem?
  • Access to it, control of it, synthesis of it, application of it to health care? Or is this about findability and "Canadian-ness"?
  • Integrated information channels are needed
  • However, Canadian information channels that allow citizens from Long Beach Vancouver Island to Pouch Cove Newfoundland to communicate are needed
  • Why is Canadian important? We have unique geographical, economic, social and cultural reasons to want our own channels
  • In medicine, we have PubMed Central Canada (PMCC) but this is not well-organized or utilized; fragmented
  • To gain some control over our medical stories and research, we need a Canadian Medline

Semantic

  • the Semantic Web as an enabling technology for making data interoperable and thereby expediting biological insight

Canadian MEDLINE

  • McGowan J. Canada urgently needs a national network of libraries to access evidence. Healthcare Quarterly. 2006. 9(1): 72-74.
  • Mother Medline is unmatched as a data source for Canadian physicians, but is increasingly only a part of the story
  • The other issue is that Canadian medical librarians, like Canadian physicians, are context experts of the Canadian content in the medical bibliography; however, the literature is scattered across the web, databases and within the deep web
  • Broad range of Canadian content; Canadian points of view; a significant amount of Canadian content....where?
  • Two sentinel markers help to characterize the trends in growth of biomedical knowledge. The first of these is the National Library of Medicine’s Medline database, which contains citations to the world’s published literature in health-related sciences. Medline includes bibliographic records for articles published in 4,500 journals in thirty languages, dating from 1966 to the present. As of this writing Medline contains about 11.7 million citations and is growing at the rate of more than 400,000 new entries per year. ~ Health Affairs, 2012
  • At the Library and Archives Canada (LAC), we see the disregard politicians have for documentary heritage; even at my own UBC, there is an unnecessary and altogether concerted effort to close physical libraries
  • Paper is not dead, long live paper: while digital access becomes almost ubiquitous, paper is still the pervasive medium of choice. paper’s “unlimited battery life.”
  • Canada is the birthplace of evidence-based medicine; we have iconoclasts like Osler, Bethune, Best, but the lack of control of our own medical bibliography is the final remnant of colonization
  • Canadian legal issues; bioethics; regulatory frameworks; protocols; treatments; drugs/medical devices
  • deep infiltration of digital information into our lives has created a conflict around the supposed corresponding loss of logged-off real life. Each moment is oversaturated with information, text, photos, tweets and emails; everything is a few taps away or pushed directly to your buzzing and chirping pocket computer
  • thoughts, ideas, locations, photos, identities, friendships, memories, politics, and almost everything else have gone viral
  • social media has become part of our lives, burrowed into our awareness; close the Facebook tab, detether, so we can focus on one task undistracted; go out into the “real” world, lift our chins, and our souls, and breathe in the wonders of the offline life
  • "...Canadian content. There was a strong desire to see CJEM maintain a focus on Canadian emergency medicine. Many of you were concerned that, with indexing, we would become "just another venue for publications." Some of you suggested that if articles from other countries were to be published, they should have direct pertinence to Canadian physicians. A common theme in the comments section was a request for news and discussion about people and events within emergency medicine in Canada. This would seem to be best served with a CAEP newsletter, perhaps distributed at the same time as CJEM. ..."
  • "...Characteristics of information needs included topic, depth/breadth of questions and time sensitivity. Approaches to information seeking were variously scattershot, systematic and delegated, depending on the characteristics as well as respondent resources. Major source types were human experts, electronic sources and trusted organisations. Affective (emotion-related) outcomes were common, including frustration and desire for better information systems and sources..." Greyson, HILJ
  • When you need to do research on a Canadian medical topic, what resource immediately comes to mind? What is obvious? Is it any wonder that knowledge translation is not happening in any timely way? For systematic reviews, that 25 to 30 databases have to be searched?
  • Knowledge translation is defined as the use of knowledge in practice and decision making by the public, patients, health care professionals, managers, and policy makers. Failures to use research evidence to inform decision making are apparent across all these key decision maker groups. How can we use evidence, when we can't find it in any timely way?
  • We seem to have a real problem in Canada with vision around our documentary heritage, and information organization. We seem to enjoy our reliance on the United States and the US National Library of Medicine
  • Innovation Takes Leadership: Opportunities & Challenges for Canada’s Health Care System
  • importance of EVIDENCE-based medicine (yes, term has been hijacked by some, distorted by others, and parodied)
  • BUT central concept of evaluating what works, then applying it, is still the heart of EBM. As I tell students and residents, I'm less concerned about whether it is "complementary" or "conventional" (or whatever) BUT I want to know what will work to help my patients live better, healthier lives (thus, patient participation in deciding WHAT the outcomes-of-interest are, is vital)
  • The question about the amount of Canadian content in PubMed is an important one. True, PubMed may appear to have an American bias, but this may be because of several factors related to where journals are published and where clinicians work. However, to determine how much Canadian content resides in a database, searchers should consider that there are Medical Subject Headings (MeSH) that permit the application of terms for all provinces and territories. Use Canada or Canadian as keywords, for example. Specific health issues regarding Canada's health care systems are not well-addressed by PubMed and there is an inherent American bias (as mentioned) in the controlled vocabulary. Geographic subdivisions - Canada, and the provinces - are recommended for health issues pertaining to specific regions of the country ie. HIV infection in the downtown Eastside of Vancouver, try "British Columbia" or "Canada"[MeSH] and "downtown eastside" (or its variants). See also Aboriginal health search filter.
  • "...Lack of Canadian content was identified as a major disadvantage of the Clinical Pharmacology database..."
  • "...Nutrient values were examined and modified to reflect the Canadian content of minerals (calcium, iron, zinc) and vitamins (A, C, D, thiamin, riboflavin, niacin, B6, folate and B12)..."
  • "...I am all for Canadian content in the Short Portable Mental Status Questionnaire.' Is there something basically wrong with asking our patients (as I do): Who is the Prime Minister of Canada? Who was the Prime Minister before him? It is bad enoug h that we get Americanized everywhere else-do we haveto get it even in the Canadian Family Physician?"
  • "...the Canadian reality of the use of a drug is apparent in Therapeutic Choices; for example, if a drug is no longer available in the US and possibly dropped from mention in United States Pharma­copeia but re­mains appropriate therapy in Canada, e-Therapeutics will provide therapeutic information...."
  • "...incorporates the Medical Council of Canada (MCC) objectives on Considerations of Legal, Ethical and Organizational aspects of medicine (CLEO) with the cultural and medical communication factors important to practicing medicine in a Canadian context (C2LEO). The program is specifically designed for physicians and will be of particular interest to International Medical Graduates (IMGs) who may not be familiar with this uniquely Canadian content. It is our intention that through web-based self-study, participants have the opportunity to explore specific aspects of the Canadian Health Care system that have been traditionally difficult to access prior to entry into the system. The website is organized around a number of clinical cases, each of which incorporates one or more C2LEO objectives. The roles of the physicians in these cases are based upon the CANMED’s roles and are designed to provide opportunities to reflect upon the knowledge, skills and attitudes required of physicians in successful Canadian practice...."
  • The CMA hosts Asklepios, the only social networking site specifically for Canadian physicians. Why do we need a specific social network for Canadian physicians? Because it helps to maintain and promote national identity, subject expertise and context.
  • ...our medical heroes are important in terms of Canadianization of medicine; physicians, nurses, pharmacists of varying stripes gradually became comfortable with the idea of a Canadian identity and philosphical orientation in medicine.... Canadian health care gives vital expression and embodiment to the distinctive character of Canada as a nation. As Canadian nationalism has become paradigmatic in public discourse and public policy, the default point of reference for coping with seismic social and political changes that confronted the country is Canadian health care: ethnic differentiation, Quebec separatism, US culture hegemony (imperialism), globalization, and the unstoppable spread of mass media; in fact, the link between medicine and Canadianization is organic and sufficiently hardy to withstand even movable definitions of our nationhood. But think about that would be imperilled without sufficient control over our own knowledge base..."
  • By information systems, he means the "methods and techniques by which people organize and manage information" as distinct from the "content of the information itself" (p. 4). Long before the "great push" to mechanize information during the mid-nineteenth century, statesmen, scientists, and learned men and women devised the "efficient information systems" (p. v) that today play such a major role in commerce, politics, and culture." ~ Headrick, 2000
  • Headrick is mindful that widespread public interest in access to information is a relatively recent phenomenon.
  • Canada health system review HiT (2013). World Health Organization 2013 http://bit.ly/UYZOy2
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