Rowland Institute Library Blog

An interesting post shown to me yesterday is Kibbe and Klepper’s “EHRs for a Small Planet.” They borrow Rene Dubos’s “small planet” concept (Evidently, Dubos also first said “think globally, act locally) and underline five suggestions for the implementation of electronic health records on a small, manageble, measurable scale. Among their suggestions are: “Define success with local health and health care problems in mind;” use existing technology; concentrate on “the smallest unit of care delivery, with a focus on connectivity and communications; ” consider people’s desire for personal connections in using technology; and that “data – the message – is deliverable regardless of the sending or receiving applications, and independent of the network or transport layer that carries it.”

I’d like to consider these in light of my experience working in libraries.

1. Defining success locally connotates direct interaction with patrons and getting to know their needs, from the individual to the community (may include demographics, education-level, facility with technology, cultural competence, sensitivity to persons w/disabilities.) I’m able to do this in my current environment, working with the scientists at the Rowland Institute at Harvard. For example, one group I know studies bacterial motion. By getting to know their projects, I learn their interests may extend to forces on cells, communities of cells, statistical physics and mechanics, and microscopy and related instrumentation. What a patron requested once, they may like something similar or analogous to it in the future. Amazon, among others, really exploits this well with suggested purchases based on what similar buyers read and like, customer reviews and lists, and we have seen similar execution with communities such as LibraryThing and GoodReads. So I meet my patrons, share anything that may contribute (alerting the user to new books, papers, news stories, blog posts, etc.) and accept feedback and see what works. I apply this method to all the labs I serve and I maintain that this can be applied elsewhere. I have to engage with my patrons and demonstrate my commitment and my usefulness. What if there is no answer? It may be, as some say, “contented silence.” Or, maybe I can take the lesson from my college days. A professor was on the street and a student passed him and they greeted each other. “I came by your office the other day and you weren’t there, ” the kid said. “So what?” replied the professor. “You stopped trying?”

2. By “using existing technology, ” Kibbe and Klepper urge consideration of what’s available to us now, as opposed to investing in expensive EHR technology, software and hardware. Yes, we librarians need to keep current with new applications (such as databases and social networking) and see that our libraries are up-to-date with computer hardware and software. At the same, the barrier for adopting technology and getting a lot of computing power is lower than it ever has been. But using existing technology reminds me of Edwin Land‘s thinking, that the problem can be solved with the materials in the room at the time. And, with a certain amount of time and patience, alternatives appear. The expensive textbook the patron wants is not available; but maybe there are similar books which would fill the need, or maybe even an article, with all the databases at our reach in many academic and public libraries. One of my LIS professors emphasized to me that sometimes the article or the paper contains the essentials, the kernel, which would take longer to find in a book. This gentleman also drilled into me the concept “there’s a literature there to help you,” and that it’s unlikely that a problem hasn’t been experienced, written about and even solved by someone before me.

3. “The smallest unit of care delivery with a focus on connectivity and communications.” To care seems to me the essence of service provision. I am reminded of when my ex and I were flying to Minneapolis for the holidays and our flight was cancelled. Travellers were scrambling for alternatives. An irate older woman, listening to a flight attendant list her options, sputtered “I don’t care, ” to which the other replied “Well, I don’t care, either, Ma’am.” And sometimes, the problem may not be solved and it may appear that for some individuals the systems we have just don’t work. However, I have to be equal to every encounter with a patron, and if I don’t know the answer, ask for help, take the time to consider alternatives while considering the other person’s time. Sometimes, people have said to me “Sorry for disturbing you.” Sadly, many among us may think they’re coming to a busy office, rather than a library, and that the employees are very busy and not to be interrupted. (My mother, a reference librarian for more than thirty years, always kept a sign which read “please interrupt me.” For me, this means engaging with the individual now and thinking what might this person need and what can be done. And I am engaging with library users more (if not almost entirely) through email, and maybe I will through social networks. Many librarians consider Twitter and Facebook a waste of time. I need to be there because my current and potential patrons may be there, and while I’m there I am exposed to information about libraries and technology that I might not have learned about otherwise. And I have helped and been helped by people I would never have known otherwise. My world has expanded through social networks where as before it was so small. Nevertheless, there is nothing like the face-to-face, listening and responding encounter now, which makes the library a place worth seeking.

4. “Recognize that what sustains most information technologies is people’s desire to connect with one another.” Kippe and Klopper state that current EHR technology does nothing to alleviate barriers of communication among providers and nurses and between providers and patients. So what are the barriers of communication between my patrons and me? Kippe and Klepper add:

EHRs that can share data, information, and connect the experience of patients, caregivers and doctors more directly are much more likely to be utilized at the community level than EHRs that in essence capture and remove data, isolating them and their potential social uses in faraway databases that no one can get into.

What might that mean for libraries, service and interaction with patrons? Could it mean getting rid of arcane systems like LC, Dewey and MARC and adopting a more social experience for the user who could rank and recommend materials through the online catalog? Could it extend to Facebook pages, groups, Google waves, games, sharing among patron communities local and remote and sharing and collaboration between libraries to “save the time of the user” and supply the information to whomever needs it at that moment in time? (Kippe and Klopper mention the success of health social websites, that they are closing the “”collaboration gap” between patient and provider, or even patient and patient. Stephen Abram and others surely have thought more deeply about this than I am at the moment. And while we want a system that will serve the greatest number of people, it is the individual encounters between patron and librarian that make up my life – now. That’s my work. William James, in the Varieties of Religious Experience, spoke of the scholars who were not interested in individual religious experience but who rather demanded a God “who does a wholesale and not a retail business.” However, James went on to show, taking theology rather than one’s own individual experience, was like looking at the menu rather than having the meal. So it is with serving the patron in the moment, and we may never meet again or there may no acknowledgement. I keep on, this is what I do. It’s now.

5. Finally, Kippe and Klopper stress that the information can get where it’s going, that the sender and the recipient can both be served and accomplish what’s needed, regardless of the specific software/hardware or particular system. “[D]ata – the message – is deliverable regardless of the sending or receiving applications, and independent of the network or transport layer that carries it.” They go on to talk about the barriers to information sharing that would result if EHRs, for example, are kept behind “”walled gardens,” such that hospitals using different platforms can’t communicate with each other. Interoperability is key. Likewise, maybe a patron shouldn’t have to learn a new system just to use a library or access information. This could be the promise of open access, open data, social sharing, and a levelling of such barriers and an enhancement of communication and our lives.

I don’t remember where I heard the phrase “think in other categories, ” but Kippe and Klopper’s lucid proposals can be applied in other settings, with similar goals and potentially similar outcomes.