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Virginia Libraries

Current editors:
Beth DeFrancis defrancb@georgetown.edu, Editor
John Connolly jpconnolly@crimson.ua.edu, Assistant Editor

April/May/June, 2004
Volume 50, Number 2

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Health Information Referral Project

Librarians and Physicians Collaborate to Empower Patients with Quality Health Information

by Shannon Jones and Jean P. Shipman


Introduction

Physicians often prescribe medications for health conditions. But what if they also want to prescribe quality health information? The American College of Physicians Foundation (ACPF) and the National Library of Medicine (NLM) have partnered to develop a project to allow physicians to do just that. The "Health Information Referral Project" (HIRP) provides physicians with the tools and resources needed to provide their patients with prescriptions for health information from Medline- Plus. Physicians use a prescription pad to write down a diagnosis. The prescription directs the patient to MedlinePlus, which is accessible via the patient's home computer or at a local public or consumer library.

There are several advantages for physicians who use MedlinePlus as a patient education tool. Physicians who direct their patients to MedlinePlus have several assurances. First, the information contained on MedlinePlus is reliable, up-to-date, accurate, and freely available. Second, the patient will not be bombarded with advertisements from vendors selling a product. Third, MedlinePlus does not advocate a product other than quality health information. Fourth, registration is not required to use MedlinePlus.

Background Information

In 2003, ACPF and NLM launched pilot projects in Iowa and Georgia to enable physicians to provide their patients with health information from MedlinePlus. Five hundred and seventeen ACP members chose to participate. Different levels of evaluation were undertaken, which included physician and patient surveys, web hits, and focus groups.

…librarians brainstormed
about what they could
do to help physicians
learn about the project
and to encourage
participation in it.

In preparation for a national launch of the project in April 2004, more information was needed for some areas of the project, such as more feedback on how physicians use project materials; what patients do with the information prescription; and how public, consumer, and health sciences librarians can be involved. In addition, it was important to test changes made to promotional materials based on feedback from the 2003 project.

Virginia Pilot Project

One goal of the Virginia pilot was to explore roles librarians and libraries can offer to the project. To start the discussion of what these roles could be, NLM approached the Virginia academic health science library directors who helped to coordinate a December 2003 planning meeting in Charlottesville. At this meeting, librarians brainstormed about what they could do to help physicians learn about the project and to encourage participation in it. Many suggestions were presented, including:

  1. Assist in promoting the project to local physicians;
  2. Orient physicians and public librarians to MedlinePlus;
  3. Provide Internet-accessible public workstations for patients without such access at home; and
  4. Assist in the development, testing, and implementation of materials to support libraries with their participation when the HIRP is launched nationally.

Librarians also realized the importance of promoting the project to fellow librarians in the state and keeping these librarians informed as the project progressed. In January 2004, NLM sent a letter to state public librarians announcing the project and requesting that they provide feedback as they work with participating physicians. A communications vehicle was developed to facilitate communication between ACPF, NLM, and the participating Virginia librarians. Staff at the Claude Moore Health Sciences Library, University of Virginia, established a listserv to facilitate communication amongst interested librarians in Virginia. In addition, Karen Dillon, president of the Virginia Council of Health Sciences Librarians (VaCoHSL), wrote an article that appeared in the February 2004 issue of the VLA Newsletter and created a webpage about the project on the VaCoHSL website (http://www.cbil.vcu.edu/mac/vacohsl/informationprescription.htm).

Virginia was divided into several regional areas. Resource librarians and other key librarians were asked to develop proposals specifying how they would further support the pilot project in their area. Although the proposals differ in detail, each partner was expected to complete several standard tasks. These libraries included:

  • The Tompkins-McCaw Library for the Health Sciences (TML), a component of the VCU Libraries, Virginia Commonwealth University, Richmond
  • The Claude Moore Health Sciences Library (CMHSL) at the University of Virginia, Charlottesville
  • The Edward E. Brickell Medical Sciences Library (EEBMSL) at Eastern Virginia Medical School, Norfolk
  • The Jacob D. Zylman Health Sciences Library, Inova Health System, Fairfax
  • The Carilion Roanoke Memorial Hospital Library, Carilion Health System, Roanoke

The VCU Experience

This article details the experiences of health sciences librarians at the Tompkins-McCaw Library for the Health Sciences (TML) in particular. TML supports the research, education, and patient care efforts of the VCU Medical Center, which includes the Schools of Allied Health Professions, Dentistry, Medicine, Nursing, and Pharmacy as well as the office of the Vice President of Health Sciences and the VCU Health System (VCUHS). In addition, TML participates in a variety of activities with the Richmond community. TML was asked to develop a plan detailing what tasks it would contribute to the project in the greater Richmond metro area. Librarians at TML identified several activities to promote and recruit participation in the project.

Our recruitment efforts
have resulted in getting a
total of 47 Richmond-area
physicians to participate.

From the beginning, physicians were encouraged to participate and a core group of these participants was recruited to provide feedback to the NLM and ACPF regarding how they use the prescription pads in practice, their impressions of MedlinePlus, and how the project could be enhanced. Our recruitment efforts have resulted in getting a total of 47 Richmond-area physicians to participate in the project. A variety of methods were used to promote and recruit participants for the project. The following discussion details the methodologies used.

Recruitment

TML's philosophy when interacting with VCU faculty is to promote the library's services at events attended by VCU faculty, staff, and students. The first objective was to identify upcoming local conferences where we could promote the HIRP. We attended the following professional conferences:

  • 5th Annual Clinical Skills Workshop for Preceptors, which was held on February 28, 2004. Each year the School of Medicine's Foundation of Clinical Medicine division hosts a clinical skills workshop for its 300 community preceptors. FCM community preceptors are family physicians, general internists, or general pediatricians who have students in their offices during the students' first two years of medical school to support practice-based learning. This conference is designed for physicians who teach medical students.
  • 12th Annual Women in Science and Medicine conference held at the Richmond Marriott on March 5, 2004. The Women in Science and Medicine conference is hosted by the VCU Office of Continuing Medical Education (OCME). The OCME manages programs for physicians and other health care professionals throughout Virginia. This conference program is designed to promote professional development through enhancement of leadership skills for community practitioners, academic physicians, dentists and scientists, administrators, other health care professionals, and community leaders.

The HIRP was also promoted at the following meetings:

  • Foundation of Clinical Medicine (FCM) staff meeting (to identify potential participants from its cadre of community preceptors. In addition, an announcement was placed on the preceptors' webpage to solicit participants.)
  • VCU Internal Medicine Department meeting
  • Regional Advisory Council (RAC), National Network of Libraries of Medicine Southeastern/Atlantic Region
  • VCUHS Management Group Meeting
  • VCU Libraries Advisory Committees

MedlinePlus Training

Our second objective was to provide MedlinePlus training to public librarians in the greater Richmond metro area and group classes and/ or one-on-one consultations for physicians affiliated with VCU. This project allowed TML librarians to offer MedlinePlus training sessions in a variety of venues on and off campus. The first hurdle we faced as we began to promote the project to Richmond-area physicians was simply making physicians aware of MedlinePlus's existence. The average physician is more familiar with NLM's MEDLINE, which is accessible over the Internet through the PubMed interface (http://www.pubmed.gov). MEDLINE differs from MedlinePlus in that it is the premier database for researchers, physicians, or clinicians searching for bibliographic citations from biomedical journals. MedlinePlus, on the other hand, is NLM's consumer-friendly Internet source of current health information. Both resources are freely available over the Internet.

The advantage of the
HIRP is that patients
receive directions to
the best resource as
opposed to simply using
a search engine …

Time is always critical in a clinical environment and as a result, physicians often do not have enough time to spend with patients. Physicians often rely on office staff to assist with patient education tasks. This includes putting patients in contact with the most appropriate consumer-friendly resources written in lay terminology. The advantage of the HIRP is that patients receive directions to the best resource as opposed to simply using a search engine, which can retrieve thousands of results from potentially questionable sources. Many patients no longer rely on their physicians to provide health information due to the explosion of information on the Internet. The Internet in some ways can impede the examination process because physicians often have to spend appointment time explaining or convincing a patient why information obtained from the Internet may be outdated, inappropriate, or inaccurate. Use of the information prescription pad has the potential to improve this process by allowing the physician to guide the patient's search for health information by referring the patient to the most appropriate resource. Conversations with physicians show that this concept of patient education is well appreciated.

Nurses throughout the health system assist physicians with patient education on a daily basis, so it was vital that we make them aware of the project. The VCU Medical Center is comprised of an 820-bed hospital, outpatient clinics, a 600-physician-faculty group practice, and the VCU health sciences schools of Allied Health Professions, Dentistry, Medicine, Nursing, and Pharmacy. With such an expansive network, we decided that the train-the-trainer method could work best in this environment, as staffing limitations in the clinics and units might prevent some nurses from attending the training.

We worked with the VCUHS staff educator to identify nurse managers who could attend an hour-long training session and then be responsible for sharing the information with their colleagues. Just as with the physicians, we had to explain the difference between MedlinePlus and MEDLINE. Overall, the training sessions with the nurses were well received, as the nurses expressed that they would use MedlinePlus as a tool when educating patients on health conditions. The outcome of our training with the nurses is that we will soon explore implementing an information prescription project with VCUHS nurses.

A major component of this project was ensuring that public librarians in the greater Richmond metro area were aware of the project and were equipped with the appropriate resources to respond to HIRP health information requests. Richmond-area library systems were identified based on the patient population served by the VCUHS. Current health system data show that the VCUHS primary service area typically includes residents from Richmond City, Henrico County, Chesterfield County, Hanover County, Petersburg City, Hopewell City and Colonial Heights City. The population in this area is about 900,000. In addition to these localities, the hospital also has a secondary service area that includes most of central Virginia - east to Tidewater, south to the North Carolina border, west through Goochland and Powhatan counties, and north to Fredericksburg and over to the Northern Neck.

Based on the VCUHS patient geographic demographics, we offered MedlinePlus training to librarians from the counties of Henrico and Chesterfield; the cities of Richmond, Petersburg, and Williamsburg; and the Pamunkey Regional Library, which serves the counties of Hanover, Goochland, King and Queen, and King William. To date we have trained 53 public librarians and support staff since the Virginia pilot began in January 2004. Staffing issues and timing prevented us from providing training to all library systems in our target area during the three-month pilot.

Each session consisted of a one-hour in-depth session highlighting the key features of MedlinePlus. Public librarians were also encouraged to subscribe to the Healthinforxproject listserv (https://list.mail.virginia.edu/mailman/listinfo/healthinforxproject), which is a discussion list where public and health science librarians throughout the state can exchange information about the project. This listserv is not limited to participating librarians. All librarians interested in learning more about the project are encouraged to subscribe to the listserv. The training sessions were well received and the attendees expressed the potential usefulness of MedlinePlus. Class attendees were given the opportunity to provide feedback to NLM by way of an evaluation form. Survey results indicate the public librarians see the HIRP as very useful. In addition, respondents identified the role they will play in the project as that of facilitator. They also offered feedback on what promotional materials would work best in a customized toolkit to assist libraries participating in the project.

Health sciences librarians often seek opportunities to integrate instruction into the medical curriculum. The HIRP opened a number of teaching opportunities for TML librarians to do just that. As a direct result of the project, faculty from the School of Medicine requested a one-hour MedlinePlus presentation for students enrolled in a fourth-year medical elective course. We will also offer several open workshops for VCU students, faculty, and staff who are interested in learning about MedlinePlus.

Educating patients has become more complex because of the accessibility of health information on the Internet. Finding up-to-date, accurate health information on the Internet can be challenging for the average citizen. At VCU, we have the unique opportunity to assist patients as they endeavor to learn more about their health through our Community Health Education Center or CHEC (http://www.vcuhealth.org/chec/). The CHEC provides resources that are appropriate for educating patients on a variety of health topics in a self-learning environment. This center serves as a focal point for providing information, assistance, and access to health information to patients and consumers.

Physicians who write information prescriptions may refer their patients without Internet access at home to CHEC or direct them to a local public library. CHEC also acts as a distribution center for disseminating promotional material to patients and physicians. The CHEC Librarian encourages patients and family members who enter the facility with an information prescription to provide feedback via the ACPF online survey. In addition to this, the CHEC collects comments from users.

Promotion

TML librarians have also participated in a number of activities to promote the information prescription project within the local community. The VCU Libraries use a "What's New" service to announce upcoming programs and events that may interest VCU students, staff, and faculty. Our first promotional activity was to post a description of the HIRP on the VCU Libraries' homepage as a "What's New" item (http://www.library.vcu.edu/whatsnew/news_result.cfm?ID=510).

Librarians at TML also sit on a number of committees throughout the University. Our participation on these committees allows us to promote the Libraries' programs and services at events targeted towards individuals we would not reach otherwise. One such activity was the Black History Month Health Expo sponsored by the VCUHS in conjunction with the VCU Institute of Women's Health (IWH). The expo highlighted diseases and conditions that are more prevalent among African Americans. The health expo was targeted towards VCUHS employees and patients. The benefits of participating in this event were twofold, as we were able to promote the HIRP to patients and hospital staff.

Not only does the information prescription pad resemble the prescription pad physicians use to prescribe medications, the information prescriptions are also disseminated in the same manner. This similarity introduced the idea that some patients might take their information prescriptions to a pharmacy to fill. With that concept in mind, the CHEC Librarian met with the VCUHS pharmacists to make them aware of the project. In the event that patients take information prescriptions to the VCUHS pharmacy, they will be referred to CHEC.

We have also used several communications media to announce our participation in the project. For instance, an article updating the Mid-Atlantic Chapter (MAC) of the Medical Library Association membership about Virginia librarians' participation in the pilot project will appear in the March/April 2004 issue of MAC Messages. MAC Messages is the official newsletter of MAC, whose membership spans the District of Columbia, Maryland, North Carolina, Virginia, and West Virginia. In addition, librarians from TML, CMHSL, and EEBMSL will present a poster titled "Health Information Prescriptions - Librarians and Physicians Collaborate to Empower Patients via Quality Health Information" at the upcoming joint meeting of the Group on Business Affairs, Group on Institutional Planning, and Group on Information Resources, American Association of Medical Colleges (AAMC), in Salt Lake City, Utah in May 2004. This poster will highlight the roles each of the participating libraries played in the project.

Each month, VCUHS promotes the artwork, collections, and services of local artists and VCU affiliates. We will use this opportunity to promote a patient education-themed four-panel poster display featuring the Community Health Education Center, MedlinePlus, HIRP, and Tompkins-McCaw Library in July 2004.

The Road Ahead

Throughout the pilot, Virginia librarians and core physicians will be providing periodic feedback to ACPF and NLM via teleconference calls, dinner meetings, surveys, and informal means. This feedback will help to shape the tools developed for physicians and librarians for the national project. A librarian toolkit is being created to assist librarians who may be asked by users to "fill my information prescription, please." It is important that librarians be informed of the project to assist users. Information prescriptions will soon be coming our way! Please prepare by reviewing the MedlinePlus website and by contacting one of the Virginia regional library coordinators to arrange group training for your library.

American College of Physicians, http://www.acponline.org/

The American College of Physicians (ACP) is the nation's largest medical specialty society. Its mission is to enhance the quality and effectiveness of health care by fostering excellence and professionalism in the practice of medicine. ACP membership includes about 115,000 physicians and students in general internal medicine and related subspecialties, including cardiology, gastroenterology, nephrology, endocrinology, hematology, rheumatology, neurology, pulmonary disease, oncology, infectious diseases, allergy and immunology, and geriatrics.


National Library of Medicine (NLM), http://www.nlm.nih.gov/

The National Library of Medicine, on the campus of the National Institutes of Health in Bethesda, Maryland, is the world's largest medical library. The Library collects materials in all areas of biomedicine and health care, as well as works on biomedical aspects of technology, the humanities, and the physical, life, and social sciences. The collections stand at more than seven million items - books, journals, technical reports, manuscripts, microfilms, photographs, and images.


MedlinePlus, http://www.medlineplus.gov/

MedlinePlus is a comprehensive, free, and easy-to-use consumer-level website developed by the National Library of Medicine. With information on over 650 health topics, MedlinePlus is the premier resource for finding reliable health information in English and Spanish. The site also provides links to organizations, directories, drug information, an encyclopedia, a dictionary, clinical trials, current health news, and interactive health tutorials.


National Network of Libraries of Medicine, http://nnlm.gov/

The mission of the National Network of Libraries of Medicine (NN/LM) is to advance the progress of medicine and improve the public health by providing all U.S. health professionals equal access to biomedical information and by improving the public's access to information to enable them to make informed decisions about their health. The program is coordinated by the NLM and carried out through a nationwide network of health science libraries and information centers. NN/LM consists of eight Regional Medical Libraries (major institutions under contract with the National Library of Medicine), more than 140 Resource Libraries (primarily at medical schools), and some 4,700 Primary Access Libraries (primarily at hospitals). Public libraries are eligible for participation in the NN/LM. Interested public library systems should call the Regional Medical Libraries' toll-free number, 1-800-338-7657, for more information.


Resources

American College of Physicians Foundation. "Information Rx Project: A Joint Project of the ACP Foundation and the National Library of Medicine." 2003. http://foundation.acponline.org/healthcom/info_rx.htm (20 April 2004).

National Library of Medicine and American College of Physicians Foundation. "Health Information Rx Pilot." December 17, 2003. http://www.cbil.vcu.edu/mac/vacohsl/acpupdatedec2003.ppt (20 April 2004).

Provides an update on the Georgia/Iowa ACP Pilot Project. American College of Physicians. "MedlinePlus Project: Premium Information for Patients." ACP Observer, December 2003. http://www.acponline.org/journals/news/dec03/MedlinePlus.htm (20 April 2004).

Dillon, Karen. "NLM/ACPF 'Health Information Referral' project launched in Virginia." VLA Newsletter, Vol. 28, No. 1, February 2004. http://www.vla.org/ (20 April 2004). VL



Shannon D. Jones is Special Projects Librarian at Tompkins-McCaw Library for the Health Sciences, Virginia Commonwealth University Libraries. She may be reached at sdjones@vcu.edu.

Jean P. Shipman is Director and Associate University Librarian at the Virginia Commonwealth University Libraries. She may be reached at jpshipma@vcu.edu.


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