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Reimagining the Hospital Medical Library

Maintaining an under appreciated asset

By Hilton M. Hudson, MD, FACS

Medical knowledge is always evolving.

The message hasn’t resonated, if the trend of medical library closures and consolidations across the U.S. is any indication. Docline, the National Library of Medicine’s interlibrary loan-request routing system, showed a decrease from 3,166 medical libraries in 2007 to 2,140 in 2017. Currently the network of the National Library of Medicine shows 1,701 members in its online directory, a number that includes some college and university hospitals. Against this backdrop, it’s worth revisiting the many benefits a medical library can offer hospitals and health systems moving forward in the information age.

Knowledge-based information

Among health care professionals, the hunger for the most current knowledge requires constant feeding. Medical knowledge is always evolving. The latest research will always inform a hospital’s best practices, regardless of the type of medicine being practiced. Research bears this out.

If these reasons weren’t compelling enough to maintain a current medical library, the Joint Commission on the Accreditation of Hospitals requires that hospitals meet its standard for providing knowledge-based information (KBI) in order to maintain accreditation. The Medical Library Association maintains an evolving set of recommendations for its member libraries as well.

In 2022, the MLA updated its standards of practice for hospital libraries and librarians to reflect recent changes to the health care ecosystem, including:



• bringing to light the increasing involvement of librarians with IT applications and teams, including KBI source links in electronic health records, mobile application support and interactions with electronic resource products and vendors
• broadening the concept of library space to include physical and virtual libraries
• highlighting new research available for calculating staffing ratios and coordinating staffing with library service levels
• expanding roles in teaching, researching and appraising evidence-based literature across clinical specialties and to hospital staff at every level
• expanding suggested duties of the librarian to include support for publishing and adhering to copyright laws, developing a needs assessment and strategic plan for the library, planning physical and virtual library spaces, including an intra- or internet presence.
  

Evolving with the information age

The last of these bullet points underscores a shift among medical librarians into a role of “informationists.” One article distinguished informationists from traditional clinical librarians “by their training in biomedical as well as information science, and their position as specialists embedded within their teams.” The academic term was introduced in 2000. Since then, informationists have come to pervade the clinical, biomedical research and public health settings as electronic access to knowledge-based information sources grew in size and scope.

Doctors aren’t the only beneficiaries of this information. The revised MLA standards explicitly describe how the role of librarians has expanded in healthcare settings over the past two decades: “The term health sciences librarians easily expanded from serving physicians to (include) nurses, pharmacists, physical and allied health therapists, technicians and ultimately administrators.”

The MLA also details how the library itself has changed: “The term library has evolved and should reflect the dynamics of the health information world. Given the ever-changing needs of a health care organization, a library must be nimble and flexible to meet the needs of users. Traditionally, the library was a physical space located onsite with a print collection. Today a library can be a single physical location that provides resources, staff and services to one or more facilities, or it could be a completely virtual presence or any combination of the two. A library that meets the needs of the organization it serves, whether physical, virtual or a combination of the two is a library that is likely to be well utilized.”

The Johns Hopkins case illustrates the critical need for doctors and nurses to have unfettered access to e-books, articles and other relevant literature at a moment’s notice. Indeed, the MLA recommends 24/7 library availability among the most important services a hospital can offer, akin to an emergency room. Unlike the physical libraries of yesteryear, the virtual library offers immediate access to medical literature through nothing more than a smartphone or tablet.

Reimagining the Hospital Medical Library

Maintaining an under appreciated asset.

Along with this ease of use comes the potential for reduced costs. For hospitals in general, cutting costs has been a clear mandate in the wake of the COVID-19 pandemic. Some of these cost-cutting measures can be seen as practical. Consider the impact of consolidation and digitization on a health system that allows clinicians from multiple hospitals to share access to a centralized digital library. Historically, every physical building in that system would need to subscribe to physical copies of multiple academic journals to ensure access to the knowledge-based information its personnel needed. Now, every employee in the system has access to its own digital library on-the-go while sharing the cost of subscriptions. These “virtual libraries” enable a health system to maintain access to the KBI it needs for accreditation and to promote best practices on-site.



More information, smaller library staffs

What presents as a convenience has also come at great strain to the medical librarians who must source information using a variety of media for larger groups of medical professionals than ever before. A doctor who needs one book quickly might have no idea his hospital’s librarian is servicing five other hospitals simultaneously when the e-book he needs is fetched minutes later with the relevant passage highlighted. 

An article in the June 2013 issue of the Journal of Health Information summarized the current predicament: “The provision of the right information to the right person at the right time has been a challenge especially in the face of inadequate funding and current resources. The introduction of IT increased users’/consumers’ awareness and their information needs. The avalanche of e-sources was meant to address these shortcomings, but created additional problems for libraries trying to grapple with the acquisition of the resources, improving the skill of the librarians to effectively apply them where available and the challenges of infrastructure to maintain them.”

In the face of staffing shortages, human medical librarians serve a critical function in the current health care environment. They’re good at knowing what clinicians need, whether they’re working on-site or remotely. Their ability to filter through a mountain of physical and electronic sources to find knowledge-based information quickly frees up their peers to focus on other, more important tasks. The MLA now recommends that all medical librarians hold “an advanced degree or AHIP (Academy of Health Information Professionals) certification.” As artificial intelligence and machine learning tools increase our ability to access the most relevant knowledge-based information quickly, tomorrow’s medical librarians can further benefit patients and staff by mastering these tools quickly.

A recent study published in the International Journal on Semantic Web and Information Systems describes how causality research in the machine learning community has improved the accuracy of medical diagnoses. To test these findings, researchers developed a chatbot application for answering health condition questions and providing advice on symptom-based predictions, drawing on the U.K.’s National Health Service website for common diseases. In separate tests, the chatbot achieved an average of 93.63% and 89.60% accuracy. This suggests we aren’t far from a world in which medical librarians with computer science backgrounds can help implement AI tools for the health systems and hospitals they serve. 

Cost/benefit analysis

Positive health outcomes should be enough to justify the expense of a medical library. The leaders of today’s hospitals and health systems view every line-item expense with unprecedented scrutiny, however. Investing in a medical library is not enough; the investment must be wise within the context of the hospital or health system’s overall budget.

Consolidating library services among multiple hospitals and moving to digital subscriptions are popular means for saving money. In the future, the potential for AI tools to predict complicated diagnoses at faster speeds and greater accuracy than humans could also cut some costs. The role informationists can play in overseeing AI implementation goes beyond the scope of a typical hospital IT department’s tasks. Even then, the need to source knowledge-based information and put it into practice at a moment’s notice predicts that medical library services can make a needed impact on care delivery.

Medical librarians can also ask critical money-saving questions such as: Should every hospital in our system subscribe to every title in this publisher’s bundle? Or, can increasing our investment in certain library services actually increase our spending power? Consider the impact of extending library services to patients and their loved ones. A medical librarian might be able to send information about a surgical procedure that a patient is about to undergo to the patient’s entire family—a welcome alternative to recommending a patient or family member “just Google it” in response to earnest questions. In this way, a hospital with a medical library might set itself apart from others in the region among potential future patients.

Almost anyone in a health care ecosystem—doctors, nurses, patients, administrators, therapists, technicians—can benefit from a medical library’s services. Having up-to-date, reliable medical knowledge-based information close at hand is in some cases more a necessity than a luxury. Whereas the size and shape of medical libraries have changed dramatically in recent years, their utility has remained constant, making them a justified expense for hospitals with shrinking budgets now and in the future.

Hilton M Hudson, MD, FACS, is a board-certified cardiothoracic surgeon and the chief of cardiothoracic surgery at Franciscan’s Michigan City and Olympia Fields health systems. He is also the CEO of HPC International (HPC), the leading educational purchased-services supplier for health care, corporations and academic institutions.