In their 2000 Annals of Internal Medicine
editorial, Davidoff and Florance called for a new role on the clinical care team: the informationist [1
]. This role was needed, they believed, to bring evidence to clinical practices facing continued growth of published literature, patient safety concerns, and general lack of time available to health care professionals. The Institute of Medicine (IOM) also noted that training and encouraging clinicians to identify and apply evidence was not the complete solution to improving practice [2
]. They too suggested that an informationist be part of the clinical team. Davidoff and Florance and the IOM thought clinical knowledge and experience, as well as strong information science and related technology skills, were required to perform this function.
The National Institutes of Health (NIH) Library hired its first two informationists—librarians with extensive expertise in a clinical or research specialty—in 2001 and assigned them to research teams in their fields of expertise. Over the intervening years, the informationist program grew, and currently the library has fifteen informationists who are members of more than forty NIH clinical and/or basic science research teams. In addition to being expert information scientists, some of the NIH informationists have doctoral degrees in basic biomedical sciences such as molecular biology, biochemistry, and neuroscience. All of them are expected to continue their education by taking graduate-level courses in the specialties they support and participating in the specialties' professional meetings, in addition to maintaining their skills as information scientists. (A more detailed description of the NIH informationist program was published in 2008 [3
].) From the start, informal feedback from the research teams was positive; however, as the commitment to the program increased, a formal evaluation was suggested. The study reported here looks at the effects the NIH informationists have had on participating clinical research teams.
Because every patient at NIH is enrolled in a clinical trial that takes place over an extended period with several return visits and the costs of participation—including transportation, lodging, and meals—are covered by NIH, traditional measures of information effects in a hospital—such as differences in patient length of stay, money saved, or patient outcome—would not provide the data needed to evaluate the NIH Library's informationist program. As a result, the evaluation looked instead at changes over time in the information behaviors of the participating clinical research teams, not specific individuals. The training and experience needed to perform the informationist role effectively were also explored.
Numerous studies exploring the information behaviors of health professionals have underscored the need for better support for their information needs. Covell found that many information needs were not recognized by practicing physicians and others went unanswered [4
]. In 1991, analyzing information requests during clinical teaching, Osheroff reported frequent requests, but many required the synthesis of patient information and medical knowledge and thus were difficult to answer [5
]. A more recent taxonomy of fifty-nine barriers to information use illustrated the complexity of developing successful interventions [6
]. However, Gorman showed how the biomedical literature of 1994 could answer primary care information needs, and, more recently, Westbrook found that use of online information resources enhanced the accuracy of answers provided to typical clinical problems by experienced clinicians [7
]. Nonetheless, online databases and libraries, even when available, continue to be infrequently consulted due to lack of time and search skills [9
The 2000 Annals of Internal Medicine
editorial proved a stimulus to librarians already exploring ways to better integrate information into the clinical context. In the United States and internationally, academic medical centers and other health organizations established model informationist programs [3
]. A recent literature review found what appears to be two informationist maturation models: First is an embedded model, usually in a clinical setting, that initially focuses on traditional information services but later progresses to support the team's technical and informatics information needs as well. Second is the consultant or bioinformatics model, which begins with a strong technical focus and, over time, provides more personalized service [17
]. While a few institutions were true innovators, the literature review also confirmed that informationist programs, when considered as innovations, remained in the early adopter stage, with libraries trying out the idea “in a careful way” [18
Findings from studies in clinical settings suggest that embedding informationists encourages questioning and that trained informationist librarians can perform critical appraisal of the literature comparable to clinicians [14
]. These studies also show that program success requires technical expertise, service excellence, and commitment by management [3
]. In addition, success requires informationists to demonstrate domain knowledge, engage in continuous learning, and be completely embedded in the team [3
]. Studies of the bioinformatics informationist model, on the other hand, have been descriptive but suggest that subject knowledge (molecular biology in particular) in support of project-specific consultation, generalized training, and development of web portals for easy access to sequence analysis tools and other resources are key elements for success [11
Evaluation of programs employing both informationist models is needed but is challenged by the fact that these programs are inherently customized and targeted to small groups [17
]. However, it is still the case, as Schacher observed, that while the benefits of having the literature available at the point of care are clear, more and better data on the impact of informationists are needed to secure routine positioning of these professionals on health care teams [21
]. This study attempts to provide evidence of the impact that NIH's informationists have had on the clinical research teams with whom they work.