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Ana D Cleveland, Donald B Cleveland
Health Informatics for Medical Librarians.
New York, NY: Neal-Schuman Publishers. 2009. 288 p. Paperback ed. $95.00 (Medical Library Association nonmembers; discount for Medical Library Association members). ISBN: 978-1-55570- 627-2. Alk. paper.
Finally, medical librarianship has a substantive, in-depth approach to the intersection of health sciences librarianship and informatics. Commissioned by the Medical Library Association and coauthored by two highly respected educators in the field, this book will benefit both library and information science (LIS) students and practicing health sciences librarians. Ana D. Cleveland, a Lucretia W. McClure Excellence in Education Award recipient, heads the highly ranked University of North Texas Health Informatics Program and has taught medical librarianship and health informatics for more than thirty years. Donald B. Cleveland, now professor emeritus at the same institution, has served as consultant to governmental agencies and private organizations, including the National Institutes of Health (NIH), National Library of Medicine (NLM), World Health Organization (WHO), the Cleveland Foundation, and the American Heart Association. They have collaborated on several previous publications, including three editions of Introduction to Indexing and Abstracting .
As stated in the preface, the goal in this new text is to provide “medical librarians with background knowledge of healthcare technology that will help clarify their role as it relates to health informatics.” Further, they posit that medical librarians are positioned by both training and professional mission to be an integral part of the health informatics environment; so to fulfill this mission, they should be well versed in the theoretical foundations and practical applications of health informatics (preface, p. xiv). Toward that end, the book has been divided into two parts. Part 1, “Understanding Health Informatics,” defines the discipline and its role in health care, describes the infrastructure, and provides a brief overview of the spectrum of health care professionals and their activities, from paramedics and chiropractors to nurses, physicians, hospitalists, and others. Here, readers may note a rather marked disparity in the level of coverage, as physicians are granted two full pages, including a list of supporting websites, while the other health care occupations receive relatively short shrift. This perhaps unwitting bias toward physicians, large academic or research centers and hospitals, and “medical librarians” (as opposed to “health sciences” librarians) continues throughout the book, even extending to the majority of illustrative vignettes and may imply that there is no role for other health sciences librarians.
Chapter 4, “Major Application Areas,” briefly describes the state of the art of informatics in each of the health-related fields covered previously. As elsewhere in the book, selected contemporary references would provide a more balanced picture, although, admittedly, currency is always problematic for books. In addition to the three older references, why not provide the uniform resource locator (URL) for the American Dental Association (ADA) Standards Committee on Dental Informatics (SCDI) , thereby demonstrating some of the progress that dentistry has made since those older articles were written? Just pages earlier, URLs are given for a few random clinical practice guidelines. Moreover, students and practicing health sciences librarians might well appreciate a separate appendix with a list and descriptions of informatics associations in each field along with their websites, health informatics educational programs with links, and perhaps a short list of major journals and current texts, and so on, replacing the easily overlooked text description of a few associations buried in chapter 13. That way, readers could discover on their own that the International Medical Informatics Association will be releasing its new competences at the end of 2009. (The 2000 competencies are described on p. 250.)
Chapter 5, “Health Science Librarians and Health Informatics,” brings part 1 to a close by examining how the two disciplines interact and work together in a symbiotic relationship, and, in this chapter, the more general phrase “health sciences” has replaced “medical.” The authors emphasize that each profession has its own mission and skill set. A short but well-written history outlining the impacts of changes in health sciences libraries is given, highlighting the profound effects of the integration of computers. The authors give voice to frustrations that librarians have felt that their value has long been undervalued by health care providers who do not recognize the services and resources they provide. Sadly, in the description of what librarians now do best (p. 94), traditional activities, such as “organizing, preserving, and providing access to professional knowledge”; retrieval; evaluation (evidence-based medicine [EBM], evidence-based nursing, evidence-based dentistry, evidence-based practice, and other evidence-based practice are not mentioned); and synthesis (systematic reviews) seem conspicuous in their absence, although a role in EBM is mentioned later. Nonetheless, many will agree with the idea on page 95 that librarians who want to have a meaningful role in informatics must acquire a “medical” knowledgebase.
Part II, “Mastering Health Informatics,” begins with the organization of medical knowledge and knowledge management as a “subjective concept, representing an interpretation of information, and [it] usually implies a dynamic change in the structure of understanding” (p. 112). While librarians have led in the development and implementation of traditional information retrieval systems, knowledge management is more about the design of the systems that cover both the knowledgebase and the information sources, including the system architecture, taxonomy, and the organization and structure. The authors then address topics that seem comfortably familiar to us: terminology (International Classification of Diseases and Related Health Problems, 10th edition [ICD-10], International Classification of Nursing Practice [ICNP]; Diagnostic and Statistical Manual of Mental Disorders, 4th edition [DSM-IV]; Current Dental Terminology [CDT]; Current Procedural Terminology [CPT]; and others) and registries (Breast and Colon Cancer Family Registries; National Exposure Registry; Surveillance, Epidemiology, and End Results [SEER], etc.). There is an overview of medical literature; textbooks are described as being outdated, biased, and error prone, so the emphasis, per usual, is on “medical” (health sciences?) journal literature. Once again, the authors revert to the global “medical,” although it is not clear if they are limiting to medicine specifically or using it as an all-inclusive term.
The authors define e-journals as “digital artifact(s) that exist(s) only in cyberspace,” yet they give the Journal of Biological Chemistry, currently still available in print format, as an example in the same sentence as the legitimate e-only Online Journal of Current Clinical Trials, the classic joint venture between OCLC and the American Association for the Advancement of Science. The authors move on to contemporary issues, such as quality control, online peer-review preservation, and open access, and then PubMed, PubMed Central, and BioMed Central. There is an odd observation on page 125 that fees are charged for some items in PubMed, despite an increase in the use of this “open” database, as if open access journals or articles were being confused with a freely available, albeit subsidized, database. The section on cataloging, classification, vocabularies, indexing, and the Unified Medical Language System (UMLS) likewise covers part of librarians' domain, although they share these principles with health informatics.
Chapter 7 delves into technology, networking, database management systems, Web 2.0, (including mobile, wireless, and even mobile or wearable technologies), and artifical intelligence. Robotics, virtual reality, and even the possibility of a national health information infrastructure are described as well, but in this chapter, the librarian's role, if one exists, is not defined; this chapter seems primarily designed to educate librarians. Chapter 8 moves on to the electronic health record (EHR), and it seems a likely place for librarians to be portrayed as part of the health care team as they add significant clinical information to the EHR, but that disappointingly is not mentioned where most readers would expect it. Like the rest of the chapter, this section is more about a tour of technology in action and less about the possible involvement of health sciences librarians. The vignette here revolves around an informationist with a graduate degree in information technology and years of experience managing health record systems, a specialist who bears little resemblance to most librarians, even those with a subject background. Almost as an afterthought, an “opportunity” for librarians to embed links in patient records to online resources is mentioned at the end of the chapter.
Chapter 9 continues the technology tour with a visit to health care management systems (HMSs), highlighting information resources mangement, hospital information systems, patient admissions and billing, and networking. Considerable background, detail, and practical advice are provided, making it an excellent guide at any level of expertise. One small paragraph at the end of the chapters notes that librarians who are well suited to working with an HMS are typically not assigned such duties and that the role of the library is markedly absent in the literature. This observation begs the question that, even if librarians receive recognized informatics training, would they then be accepted as participants in planning and maintaining an HMS?
Chapter 10 on medical imaging describes various types of imaging and follows with the organization, transfer, manipulation, and storage of images. Fascinating in the implications for many librarians are the concepts of text indexing, data extracts, metadata for the images and subsequent searching, data mining, data retrieval, and the ways these are incorporated into a global archiving and communication system. Here, the authors highlight the obvious new roles that librarians can and should assume in implementing these developing technologies.
The last portion of the book focuses on ethical and legal issues, again, an area where health sciences librarians can bring their expertise to the table, particularly regarding the Health Insurance Portability and Accountability Act (HIPAA), copyright and intellectual rights, codes of ethics, patients' rights, the USA Patriot Act, and so forth. Chapter 12 seems as if it should have been included in a different part of the book, or at least before the chapter on ethical and legal issues, but perhaps the authors feel that their overview of genetic testing, stem cell research, and genetic engineering benefits from issues presented in the previous chapter, especially in regard to the “societal concerns” they mention. Here again, librarians are promoted as having the potential to provide a wide range of genomic or biological services, including searching and database design; they are well prepared for careers in bioinformatics. The final chaper ties the threads together into preparation for possible career paths and opportunities for health care information professionals who are willing to take advantage of the many resources now available for continued learning. The added content suggested earlier in this review could appropriately be added to this chapter instead of in a separate appendix.
It is in the nature of books to be outdated upon publication, and this book is no exception. It generally appears to be at least a year behind the forefront in this rapidly evolving area. The few 2008 and 2009 references are to websites. The aforementioned addition to the last chapter or separate appendix would be an extremely useful resource. The book has the usual occasional typos, awkward grammatical constructions, and unexpected changes in voice, going from passive to active, for example, on pages 181 to 182. Nursing librarians and others will wonder if “medical librarians” is a synonym for “health sciences librarians.” Additional vignettes—perhaps including more librarians from dentistry, nursing, public health, and so on—might provide new incentives for professionals. However, the placement of these case studies is awkward, often appearing mid-sentence or mid-paragraph; perhaps they could be moved to the end of a section or chapter. Readers may want to consider the new editions of works by authors frequently cited in the book (Hersh, for one) or other recently published works for more balance from other health-related fields:
Nonetheless, with a little gentle tweaking, this needed new text is destined to become a classic for both LIS students and practicing health sciences librarians in years to come.