Librarians at the Arizona Health Sciences Library (AHSL) have, through observation and focused discussion with users, long-suspected that clinical information-seekers frequently use non-library Internet search engines, even if they have been introduced to the library web site. Navigating the library's web site can be complex for the untrained user, due to the need to select from a myriad of information resources, as well as learning to use multiple product interfaces. Dialogue with Emergency Department (ED) clinicians at our institution suggested they knowingly bypassed excellent resources in favor of simplicity, primarily due to time constraints. The ED, therefore, seemed a sensible clinical setting to assess the knowledge transfer obstacles and seek solutions with impact. We hypothesized that if the library could produce a tool that emulated the simplicity of an Internet search engine, clinicians might be more inclined to use it. As a result, AHSL concentrated its efforts on aggregating and delivering packages of key resource subsets via a search engine.
The project began with meetings between the Emergency Department Residency Program Director and a reference librarian, which focused on the problem of transferring knowledge from the medical literature to physicians in a busy practice environment. Among the possible solutions was the idea of creating a search interface limited to the list of full-text databases and textbooks that would be of immediate use to busy clinicians of that specialty. Needing technical guidance, the Head of the Systems department was consulted. A triangular, collaborative and productive relationship quickly developed between the residency director, the reference librarian and the systems librarian, who brainstormed about the technical feasibility of enhancing access to digital resources for this target group.
The reference librarian coordinated a small number of highly focused meetings during the planning, implementation and troubleshooting stages, which involved all three parties. More frequent meetings took place between the reference librarian and a second party on issues where the third party was not needed. The reference librarian therefore acted as both an advisor and conduit between the systems and clinical parties, in addition to designing the layout of the user interface. The result was a customized federated search tool that was conveniently launched from clinician desktops in their busy emergency department.
The residency director played an important role in two stages of the project – design and promotion. During the design phase, he was instrumental in communicating the clinical decision-making needs of ED clinicians, provided valuable insights into ED workflow, as well as other important contextual information about work within the ED. He also played an important role in promoting the tool to clinicians in the ED, as well as during monthly journal club meetings with residents. The reference librarian promoted use of the search engine during a demonstration at Emergency Grand Rounds, and subsequently visited the ED frequently to both raise awareness of the tool and train users.
The systems librarian role was to translate the input received from the reference librarian and residency director into workable technical specifications. This included a significant amount of dialogue to clarify development priorities and details within the specifications so that rapid prototyping and roll-out could be achieved. He was then involved in working with staff developers to implement the tool. The search engine was locally developed using Cold Fusion and Flash. The tool allows a user to input a keyword search, which is then combined with librarian-constructed search hedges to construct links to pre-executed searches in native interfaces. This allows users a simple interface to powerful search capabilities, including any vocabulary mapping supported within the native interface. Additionally, results are displayed in a hierarchical manner ordered by level of clinical evidence. Currently, the system employs the National Library of Medicine's e-utils service to retrieve the number of hits for PubMed searches, and plans are underway to implement a Z39.50 to Web Services gateway to provide similar functionality for databases that do not support Web Services interfaces. A future article will elaborate further on technical design features, including details about both the user and management interfaces.
The same strategy was used to develop a similar customized search engine for other specialties in the institution. For example, the Pediatrics Residency Director later requested that a customized search tool be developed for that specialty, and a similar process ensued with that group. These web-based federated search engines were launchable from desktops of computers in the respective departments in the immediate vicinity of patient beds. All had customized filters and displayed retrieved references according to an evidence ranking system that addressed the individual needs of these specialties. Site visit statistics, as well as qualitative evidence about the utility and performance of each tool has been favorable. Work is underway to address the needs of new target groups, as well as formally evaluate performance.