Will duct tape cure PubMed? Simplicity vs. the Curse of Knowledge

A designer knows he has achieved perfection not when there is nothing left to add, but when there is nothing left to take away.

~Antoine de Sainte-Exupery, quoted in
Made to Stick: Why Some Ideas Survive and Others Die by Chip Heath & Dan Heath (pg. 28)

Made To Stick has a large piece of fake duct tape as part of the dust jacket. Its case for simplicity as part of the measure of SUCCESs (Simple, Unexpected, Concrete, Credible, Emotional & Stories) for both creating and communicating good, lasting ideas has really struck a harmonic chord with me. Unfortunately, another good C (concise!) tends to elude my writing but I keep striving towards it.

I believe the recent changes in the PubMed's Automatic Term Mapping (ATM) came along as Unexpected for most of us in the medical library field. The source institution for PubMed (National Library of Medicine, or NLM) is certainly Credible, and the changes have inspired plenty of Emotional Stories that I will not rehash here.

Concreteness has been left in the dust. More than a month after the changes were unveiled, we have little from the source of Credibility except the midsection of a 25 minute conference video to answer the traditional journalism Who/What/Where/When/Why/How? (5 Ws/H) and a blurb in the Help page about these changes.

The intent may be to make PubMed queries easier for users to retrieve relevant results, but in reality they are anything but Simple. I want to clarify: Simple here does not merely mean the lowest common denominator, but one of "elegance and prioritization, not dumbing down." (Heath and Heath, p. 30) From the breakdown of the ATM to include so many different attributes to increasing consumer health education needs, there have been many protests of 'dumbing down' things when in reality those protesting often have the Curse of Knowledge.

The Curse of Knowledge... [is] the difficulty of remembering what it was like not to know something. Accuracy to the point of uselessness is a symptom of the Curse of Knowledge... People are tempted to tell you everything, with perfect accuracy, right up front, when they should be giving you just enough info to be useful, then a little more, then a little more. (Heath and Heath, p.57)

Sound familiar? How many of us have had users' eyes glaze over while providing them with information that we believe to be both concise and accurate? If there are any librarians out there who have never had this happen, please share with me how because I'm still learning the fine art of balance in this department.

Please, keep sending in feedback directly to NLM (at the bottom of each PubMed page) that is Simple and Concrete along the 5Ws/H! While there is always room for improvement, I have to believe that the decisions to implement PubMed changes were based on valid website usage/statistical analysis and (hopefully) usability studies before these changes left development and not because they wanted to torture medical librarians. NLM is apparently not receiving all that much feedback from anyone about the changes, and then only from librarians. Generally that means other users aren't finding much to gripe about since it's a rare day when someone submits feedback of 'Woohoo, awesome!' about anything.

Medical librarians are not the sole users of PubMed, and we have a whole arsenal of Cursed Knowledge to refine queries for us as we both assist and teach users ([MHDA], anyone? (seriously)) and that's ok. We don't want eyes to glaze over explaining everything about PubMed to our users at once. Conducting a good health reference interview, determining what filters and tabs are appropriate for the information needed, assessing our users' comfort level with query construction (I think far too many assumptions are made in this area but that's a post for another time), then suggesting and teaching appropriate modifications is the way to go. We want to provide just enough info, then a little more, and keep them coming back to us to keep learning and refine things as needed. 'Just in time, not just in case' is far more than a collection development policy.

As an FYI my duct tape and I are heading out until mid-July so things will be temporarily quiet around here, but don't be surprised if you see us pop up somewhere else in the biblioblogosphere as a guest over the next few weeks!

EMR, PHR, HIE, Aieee!

If I go overboard in explaining acronyms here it is because I can hardly stand the things. I understand their necessity, especially in writing, but when assumptions are made regarding their usage that's when barriers to information access start going up in the name of jargon. Perhaps I'm overly aware of them due to my journalism background, my human resources experience where some days all I did was demystify the acronyms involved in the Family & Medical Leave Act (FMLA, which will never mean Fellow of the Medical Library Association to me), or because I'm new to the field and trying to find covert ways to get my colleagues to explain and pronounce acronyms and listserv names so I don't sound like a dork.

Librarianship and Information Technology (IT) are fields loaded with acronyms, and combining the two in the area of health/medical informatics is especially deadly. The fact that there are over 100 controlled vocabularies in the Unified Medical Language System® (UMLS®) where nearly every language vocabulary itself is also an acronym, and you'll see why I nearly went insane last year trying to tackle comprehension of UMLS® as part of my coursework.

This is why I was relieved to see a focused effort to not only clarify the acronyms involved in electronic medical/health records (EMRs and EHRs) and other health IT issues, but also the meaning behind the words themselves instead of tossing them around to look trendy and in the know. However, the Life as a Healthcare CIO source cited by Kevin, MD began with a sea of acronyms so I knew I needed to dig deeper to the original source. I do have a lot of respect for healthcare Chief Information Officers (CIOs), by the way, and this is exactly how they talk. I was a babysitter for one of them 2 states away as a 15-year-old and that connection is how I got my foot in the door & interested in the health information field.

The National Alliance for Health Information Technology (NAHIT) recently issues a 40 page pdf report on what two workgroups (one for records, one for network) who used a 'comprehensive literature review'*, forums and comments to propose definitions for health IT infrastructure.

Without further ado (click the image to enlarge),


Concise, jargon-free descriptions that clearly define the difference between EMRs, EHRs & PHRs. Brilliant! I don't think most people (except healthcare IT and their stakeholders) need to be as concerned about the network terms, but personally I appreciate the proposed distinctions between these different types of medical records and hope they are adopted so everyone is on the same page with terminology as EMR, EHR & PHR usage becomes more common. They even envision a health informatics future of (click image to enlarge)



Now the big question posed by The Health Blog: Do people even care? Interesting post and comment thread there, and combined with my own suspicion of Google Health's 'no advertising unless our partners include it under our terms' I think medical librarians need to have an increased role in EMRs, EHRs & PHRs because I'm not convinced other entities are looking at things from the perspective of patients as more than sources of data and revenue. We are experienced not only in information organization, but in information-seeking behavior and consumer health literacy and I'm not hearing much about how these are being incorporated in PHRs or patient-accessible EMRs and EHRs.

* I also hope medical librarians were involved in this 'comprehensive literature search', perhaps my colleagues in the Medical Informatics Section. The report states what sources were reviewed by the work groups, but not how they did their search to obtain the sources. The degrees and titles of those on the work groups don't seem to indicate the inclusion of medical librarians, but it doesn't indicate if other sources helped collaborate on the project.

New ATM & PubMed: Straight to the source

I wanted to provide an update to my brief PubMed Review shoutout during MLA 08 with a direct link to the 25-minute PubMed Review slides & audio presentation that was shown at the NLM Theater in Chicago. If you have not previously used Adobe Acrobat Connect (formerly Macromedia Breeze) on your computer, you may be prompted to a free upgrade/install... just a heads up that this isn't Slideshare.

In the interest of time & highlights, here's an approximate breakdown of where in the timeline subjects are featured so you can skip around

• :00 - PubMed Factoids
• :50 - Collections Updates/MyNCBI
• 2:03 - PubMed Central ID (PMCID)
• 3:09 - Collaborators vs. Authors
• 4:18 - Abstract Plus
• 5:46 - Patient Drug Information on Abstract Plus
• 6:22 - Related Reviews on Abstract Plus
• 6:50 - Advanced Search Beta (must see)
• 13:55 - New Automatic Term Mapping (ATM) (critical to see)
• 18:00 - Using Advanced Search to focus subjects due to ATM (must see)
  
• 18:44 - Citation Sensor (ties in to ATM)
• 19:52 - Diacritics
• 20:19 - Summary Display
• 21:05 - Browser Advice
• 21:29 - Future Attractions
• 22:40 - Audience questions (hard to follow)

The Pacific Northwest Region of the National Network of Library of Medicine (NN/LM PNR) also posted a blog entry giving a brief guided tutorial to the changes.

All of the MLA 2008 presentations are on the NLM Distance Education Program Resources page; scroll way, way down to the Medical Library Association 2008 Annual Meeting Theater Presentations for them. My kingdom for an anchor tag! This page also includes a large number of NLM tutorial and handout resources, although due to the ATM changes use caution before passing them on as the information regarding PubMed search strategies has certainly changed since last month.

Please send feedback to NLM regarding your experience with these changes. At the bottom of every PubMed page is a tiny little hyperlink of Write to the Help Desk. If you do not need help but have a comment, this is still the method to do so. Decisions to create and change resources are not done in a vacuum at NLM. We are their users and they respond to our needs and feedback just as we do to our own library users!

Cajun sashimi: Freshly (un?)seasoned & ready to roll

I want to begin by thanking T.Scott for the comment he left on my entry about communication and change to let me know that

... the vision he [immediate past Medical Library Association (MLA) president Mark Funk, referral to last post] has for the association is strongly shared by the board of directors and headquarters staff, but it'll take the involvement of people like you to help make it happen. Associations move & change slowly and we all get frustrated with it at times, but the commitment to make the changes we need to make is definitely there.

This is truly heartening to know because to be perfectly honest I have no clear sense of 'What now?' with MLA since our 2008 conference ended. I'm new here; I don't know how much weight the current/elected/immediate past presidency carries, exactly how directors factor into the leadership equation or how they get to be there, and what they stand for as a collective whole. I know the current/elected decide committee members on a national level, and I know who our current president is. However, I wasn't able to hear her inaugural speech and no one else has said anything about it online that I've read. Why is this?

I also have to smile at Mark's response to Gail's question about what "younger" means with

...“seasoning” comes from life experience as well as years in the profession. But by using Web 2.0 tools – opening up participation in the many units of MLA beyond the appointed members – younger and unseasoned members can not only get a quicker grasp of how MLA “works,” they can begin offering us their opinions and ideas more easily and earlier in their careers than before.

I'm not younger; in fact I jumped up a demographic bar right in the middle of all the Chicago festivities and didn't know until it was in my face on a slide during a plenary session the day after my birthday. Talk about a depressing revelation! Life experience, on the other hand, I have in spades as does Gail when she began her medlib career and so do numerous others... just not in this profession which I have only been able to claim a professional part of for a whopping month. Not under 10 or 5 years or even a year, a month. Get me started on human resources, hospital systems, PHI, HIPAA, EMRs and a variety of other issues that are directly relevant to our field, though, and you'll never get me to shut up.

What am I? When in doubt I turn to fusion cuisine, so an image of Cajun sashimi came to mind: a blend of cultures leading to a strongly seasoned life with the freshest of unseasoned careers. It works, I'm already a fusion of Texan education with a West coast life to be an Eagle Dawg, right?

With this in mind I read comments like Michelle's on The Krafty Librarian's blog of

I didn't have a chance to go to the New Member Breakfast, but did attended the New Member SIG meeting and was surprised to find only a handful of people!

I've confessed this in several venues already but will here as well. I was a student member of MLA since fall 2006 through graduation just 5 months ago, and until the New Member Breakfast on May 18th this year I had no clue what the difference was between a Section and a Special Interest Group (SIG), nor did I think students were welcome to either. This impression is from someone who received a full-ride health informatics fellowship and was always in touch with a number of incredibly helpful people filling me in on all sorts of information about the field.

Why? Do you see any explanation, let alone mention, of what sections or SIGs are on the MLA page for students where we are encouraged to connect, ask questions and learn about the field? They are only mentioned in passing as an opportunity on the page to sign up as a student member. This does not convey sincere openness for genuine involvement but an afterthought, and it's one that has stayed with me as I've made the transition from student to professional this year. Could this help explain why so few people were at the New Member SIG meeting?

First impressions are lasting, and if the website is going to be one of our recruiting tools to point to as an information resource we seriously need to work on MLA's. I want to help and even now... I don't know how. MLANET's Editorial Board information is current to 2006/07.

What now?