Update on The National Network of Libraries for Health

&A Virtual Health Library for

Canada

Jim Henderson

for the

National Network of Libraries for Health Task Force

Canadian Health Libraries Association / Association des bibliothèques de la santé du Canada

Life Sciences Library & Osler Library of the History of Medicine

McGill University

jim.henderson@mcgill.ca

With thanks to Patrick Ellis

Task Force Co-Chair

For use of his presentation to the e-Health Conference, Toronto, November 2007

• Canadian health libraries and nation-wide access to e-resources

• International models• Canadian initiatives• Review of 2007 events and activities• Opportunities and challenges

Overview

• Access to knowledge-based resources is critical to effective health care practice.

• Many Canadian health professionals face significant barriers to access.

Key Issues

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CHLA/ABSC

• Voluntary organization• Membership: 400 librarians, library

technicians and other library staff from all sectors of health care including hospitals, universities, drug companies, government agencies, patient organizations, public libraries

• Chapters: 18 chapters with an additional 400 members

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• One of the driving forces of the organization since its inception in 1975 has been improvement in access to health information in Canada.

CHLA/ABSC

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Our Clientele•Practitioners, patients, researchers,

students, policy makers, facility and program administrators

•Major consumers of journal literature•Growing population of clinicians entering

the field from evidence-based curricula

CHLA/ABSC

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• Canada is the first country outside the US to implement DOCLINE ILL system

• 1997: CHLA/ABSC took the leadership role in bringing DOCLINE to Canada

• 2008: Over 400 libraries utilizing DOCLINE in Canada

CHLA/ABSC

• Health libraries and their users have struggled for decades with the conundrum of how to support the information needs of a highly literate clinical population in need of the best available information.

Access: Not a New Issue

High quality information services now provided by libraries to health professionals

BUTNo coordination to ensure:

−Universal, pan-Canadian access−Cost effectiveness−Best health research information is

available to support patient care

Access: A Growing Issue

• 2008: Library collections are increasingly electronic

• The access model has changed• The days of bound journal collections

and long hours slaving over a hot photocopier are gone the way of the buffalo. But who can use these brave new collections?

Old Wine, New Bottles

Existing Canadian Model

• Canadian Research Knowledge Network (CRKN)

http://researchknowledge.ca/en/index.jsp

Canadian Foundation for Innovation funding.

CRKN: An Existing Canadian Model

• Through its innovative licensing agreements, CRKN provides desktop access to electronic versions of scholarly journals and research databases for 72 participating universities across Canada. Currently, more than 2,200 scholarly journals are available online to over 650,000 university researchers and students.

• CRKN has built a virtual library for the academic community.

• Access is based upon institutional affiliation.

• Can a similar model be built that spans the health community?

CRKN: An Existing Canadian Model

Models in Other Countries

• National networks of health librariesNational Network of Libraries of Medicine,

US National Library of Medicine, National Institutes of Health

National Library for Health, UK National Health Service

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United Kingdom

The mission of the National Library for Health (NLH) is to help patients and professionals use best current knowledge in decision-making. The library consists of three main resources:

1. Firstly, there is the commitment of 1,275 librarians who know the local communities, and their needs and priorities. The plan is for all healthcare organisations to identify a board member to be Chief Knowledge Officer, supported by a librarian acting as Knowledge Manager.

2. The second resource is the national digital knowledge base, a single source of knowledge catalogued, classified and organised so that it is not only easy to find but can be delivered through the media that are now available, for example digital laboratory reports, and e-prescriptions.

3. The third resource is the users, organised in communities of practice, which manage the National Specialist Libraries such as the National Library for Cancer or the National Library for Knowledge Management.

Models in Other Countries (cont’d)

• International coordinationPan-American Health Organization’s

BIREME (Sao Paulo, Brazil)−Infrastructure−Open access−National licensing support (HINARI

and other WHO programs)

Models in Other Countries (cont’d)

• National licenses for specific resources−Australia−Denmark, Finland, Norway, Sweden−Scotland, Ireland, Wales−Spain−South Africa−Iceland

Canada

•National, regional and provincial organizations are broadening the delivery of health knowledge to the clinician’s desktop.

•CMA, CDA, CNA, CAOT, DrsNS, BC Coll Physcns & Surgns Library, OntarioMD, Univ de Montréal RUIS Consortium . . . .

Provincial Initiatives

• e-HLbchttp://www.ehlbc.ca/

• Alberta’s Health Knowledge Networkhttp://www.hkn.ca/

• Saskatchewanhttp://www.shirp.ca/

The Electronic Health Library of BC provides the academic and health care community of British Columbia with easy access to online health library resources. The purpose of the e-HLbc is to support and improve practice, education, and research in the health sciences.

eHLbc– 6 health authorities– 24 publicly-funded post-secondary

institutions– 3 provincial ministries– College of Physicians and Surgeons

• CMA Clnical Resourceshttp://www.cma.ca/index.cfm/ci_id/50587/la_id/1.htm

• NurseOne, the CNA Portalhttp://www.nurseone.ca

• OntarioMDhttp://www.ontariomd.ca

Association Initiatives

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Evidence-Based Health Care : Proof of NNLH

Concept

• Canadian Cochrane Library rollout has been fragmented and distribution very uneven.

• But . . . other countries have made it work:

Australia, Denmark, England, Finland, Ireland, India, New Zealand, Northern Ireland, Norway, Scotland, South Africa, all of South and Central America, Spain, Sweden, Wales and the state of Wyoming all have unrestricted access.

Cochrane : Proof of NNLH Concept

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The Cochrane Library has been licensed for all citizens of:

Cochrane : Proof of NNLH Concept

Saskatchewan

New Brunswick

Northwest Territories

Nunavut

Yukon

Nova Scotia

Cochrane: Proof of NNLH Concept

How Much Would it Cost?• Total cost now:

US $250,000-300,000• National license: US $491,500• $0.015 per Canadian per year• Less than double the current investment

opens access by about 90%! 

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CHLA/ABSC Vision

The NNLH/RNBS will contribute to the maintenance and improvement of the health of Canadians by promoting and facilitating universal access to relevant, peer-reviewed health information for practitioners, consumers, researchers, policy makers and government officials by coordinating virtual library linkages.

History of Task Force Activities

• 2001: Government On Line submission presented • 2002: CHLA submitted proposal to Romanow

Commission advocating the need for a NNLH/RNBS• 2003: NNLH/RNBS Task Force conducted

environmental scan of provincial initiatives• April 2004: NNLH/RNBS website went live• August 2004: Proposal submitted to Health Canada

promoting a national license for the Cochrane Library• 2005: Stakeholders meeting in Ottawa• 2005 to 2006: Project Advisory Team formed, RFP

issued, and RFP contract finalized• September 2006: Concept of Operations released

Concept of Operations

Local / Regional

Health Libraries

Health Care Professionals

NNLH / RNBS National

Coordinating Office

Concept of Operations

Coordination of existing library programs and expertise

Ensure universal access to knowledge for health professionals

Sir J.A. Muir GrayCanadian clinicians and patients need

clean, clear knowledge /Les cliniciens et les patients ont besoin

de connaissances nettes et clairesCMAJ 175 (2): 129, 131 (July 18, 2006)

Recent Events

2007•CMAJ editorial (March) suggesting

free Cochrane Library access could be forthcoming – but not yet

•Announcement of closure of Canadian Health Network

2007– No / Slow Progress:

•Ontario – LHIN initiatives for electronic resource access

•Quebec – interRUIS initiatives for electronic resource access

•Federal e-Science Library

Recent Events

2007•Consolidation of definition of

“knowledge translation” at CIHR•Continuing escalation of demand

for access to clinical electronic resources

Recent Events

Task Force Activities

2007•Continuing strong support from CISTI and the Public Health Agency of Canada and participation / support from Canadian Nurses Association

Task Force Activities

2007•Yet more support for NNLH among

professional organizations and academic groups confirmed

Task Force Activities

2007•Endorsement of library-based model

including −Infrastructure−Training−Expert searching

as well as −Virtual Health Library

Task Force Activities

2007•Building the business case for a

“Virtual Health Library”•Currently in the environmental

scan and consultation process

Task Force Activities

2007• Linking health knowledge to decision

making in a complex system – building a pan-Canadian Virtual Health Library

Opportunities and Challenges

Can we build a Virtual Health Library based upon the exponential growth in Canadian electronic libraries?

Challenges:– Affiliation – Infrastructure support– $– User support

Opportunities and Challenges

Can we link the health library knowledge support initiatives with the electronic health records initiatives?

Challenges: - Until now, nobody has asked

BUT records without knowledge? . .

Sir Muir Grey (paraphrased):

“Electronic health records will allow practitioners to diagnose and treat more people, faster, and in a greater number of communities . . .”

Sir Muir Grey (paraphrased):

“. . . using out-of-date techniques and incorrect choices for medications if these records are not linked to knowledge sources.”

Summary

• Significant growth in demand for and support of a Virtual Health Library

• Endorsement of library-based model• Growing success of local and regional

programs• Continuing lack of access for many,

duplicate access for others

NNLH/RNBS Web Site

http://chla-absc.ca/nnlh/indexe.htm

http://chla-absc.ca/nnlh/indexf.htm

Comments & Questions??