docMD:docMD:

Eric H. Schnell (schnell.9@osu.edu)Eric H. Schnell (schnell.9@osu.edu)

Associate ProfessorAssociate Professor

Head, Information Technology Head, Information Technology

Prior Health Sciences LibraryPrior Health Sciences Library

The Ohio State UniversityThe Ohio State University

(DOCument Mediated Delivery)

docMD is funded through support by the National Network of Libraries of Medicine, Greater Midwest Region. Ohio State University project number 743202

docMD GoaldocMD Goal

“ “ To establish an electronic To establish an electronic document delivery service for document delivery service for hospital libraries that are unable to hospital libraries that are unable to support such a service themselves support such a service themselves due to limited human, financial, or due to limited human, financial, or technical resources “ technical resources “

docMD ObjectivesdocMD Objectives

Establish a mediated direct-to-Establish a mediated direct-to-customer document delivery service customer document delivery service for hospital libraries for hospital libraries

Identify the costs involved in Identify the costs involved in providing such a service providing such a service

Develop a model for use by other Develop a model for use by other resource libraries in other regions of resource libraries in other regions of the country the country

What is IDD/EDD?What is IDD/EDD?

Internet Document Delivery / Internet Document Delivery / Electronic Document DeliveryElectronic Document Delivery

Reduces telecom costs (Landes ’97)Reduces telecom costs (Landes ’97)

Reduces turnaround timeReduces turnaround time1986: 13.76 days (Budd)1986: 13.76 days (Budd)

1999: reduced to 2.52 (Sellen)1999: reduced to 2.52 (Sellen)

Reduces supply costs (Weible ’02)Reduces supply costs (Weible ’02)

Barriers to Hospital Barriers to Hospital Library IDD Library IDD ImplementationImplementation

Firewalls (McKnight 2001)Firewalls (McKnight 2001) communication portscommunication ports

network authoritynetwork authority

Workflow / staffing (Jackson 1993) Workflow / staffing (Jackson 1993)

Access to technical staffAccess to technical staff

Fiscal resourcesFiscal resources

How docMD Jumps How docMD Jumps these Barriersthese Barriers

Firewalls Firewalls a common communication port is used (80)a common communication port is used (80)

Workflow / staffingWorkflow / staffingDOCLINE processing remains the sameDOCLINE processing remains the sameless physical processing of documentsless physical processing of documents

Access to technical staffAccess to technical staffessential technical staff at mediation centeressential technical staff at mediation centerlittle technical site support neededlittle technical site support needed

Fiscal resourcesFiscal resourcesGMR supportedGMR supported

TimelineTimeline

Approval July ‘02 Approval July ‘02

Planning Fall ‘02Planning Fall ‘02

11stst test document December ‘02 test document December ‘02

6 phase one sites online February 6 phase one sites online February ’03’03

12 phase two sites June ’0312 phase two sites June ’03

Through December ’04Through December ’04

Participating Libraries Participating Libraries Must:Must:

Be a DOCLINEBe a DOCLINE®® library libraryIdentify the populations this project could Identify the populations this project could

potentially reach potentially reach Provide a letter of interest Provide a letter of interest Be willing to assist their users with local Be willing to assist their users with local

issues issues Implement and market the service locally Implement and market the service locally Be willing to "go with the flow" Be willing to "go with the flow" Provide the project with feedback and Provide the project with feedback and

participate in the evaluation process    participate in the evaluation process    

Current Direct to Customer Current Direct to Customer Processing ModelProcessing Model

Local Library

Customer

OCLC / DOCLINE

Ohio Lending “A” Ohio Lending “B”

Scans/Sends though IDD Scans/Sends though IDD

EDD

Web Server

docMD Delivery ModeldocMD Delivery Model

Local Library

Customer

DOCLINE

Lending “A” Lending “B”

Scans/Sends though IDD Scans/Sends though IDD

docMD

Web Server

Email with docID#

Email Alert

docMD Client DemodocMD Client Demo

Survey ToolsSurvey Tools

Project Librarian SurveyProject Librarian Survey

Attitudes SurveyAttitudes Survey

Technical SurveyTechnical Survey

Turnaround Time StudyTurnaround Time Study

Customer Attitudes Customer Attitudes SurveySurvey

How confident in ability to get articles How confident in ability to get articles from your library:from your library: Reasonably-totally: 91%Reasonably-totally: 91%

How confident in ability to get articles How confident in ability to get articles not in library collection:not in library collection:Reasonably-totally: 97%Reasonably-totally: 97%

How satisfied with ability to get articles How satisfied with ability to get articles in timely fashion:in timely fashion:95%95%

Customer Attitudes Customer Attitudes SurveySurveyHow often do you request articles:How often do you request articles:

weekly: 5%weekly: 5% monthly: 29%monthly: 29% every few months: 46%every few months: 46% Rarely: 20%Rarely: 20%

How long does it take to get articles:How long does it take to get articles: 1 week or less: 48%1 week or less: 48% 1-2 weeks: 44%1-2 weeks: 44% 2+ weeks: 8%2+ weeks: 8%

Customer Technology Customer Technology SurveySurvey

Computer in office:Computer in office: 97% (95% with Internet access)97% (95% with Internet access)

Computer at home:Computer at home: 94% (92% with Internet access)94% (92% with Internet access)

How often is web browser used:How often is web browser used: 65% daily65% daily

How often is email checked:How often is email checked: 85% daily or constantly85% daily or constantly 84% sure they can check it84% sure they can check it

Customer Technology Customer Technology SurveySurvey

Adobe Acrobat is a document viewer:Adobe Acrobat is a document viewer: 87%87%

docMD StatisticsdocMD Statistics (as of Sept 2, (as of Sept 2,

‘04)‘04)

406 registered customers406 registered customers

3111 documents processed3111 documents processed

15% have gone unviewed15% have gone unviewed

<1% posting failures<1% posting failures

44% sent to the librarian 44% sent to the librarian

1% required reposting1% required reposting

1% alternative distribution1% alternative distribution

docMD StatisticsdocMD Statistics

Turnaround timeTurnaround time Pre – docMD: 6.53 days (max 19 Pre – docMD: 6.53 days (max 19

days)days) Post – docMD: 3.11 days (max 9) Post – docMD: 3.11 days (max 9)

docMD StatisticsdocMD Statistics

Average document processing time: Average document processing time: 1 minute 1 minute

Average number of documents requiring Average number of documents requiring follow up: 2 per week follow up: 2 per week

Number of customers contacting docMD Number of customers contacting docMD central regarding difficulty in central regarding difficulty in

downloading downloading a document: 10a document: 10Percentage of documents arriving upside Percentage of documents arriving upside

down: 15% down: 15% 1% 1%

docMD StatisticsdocMD Statistics

Documents without transmittal sheet: Documents without transmittal sheet:

2 per week 2 per week

Documents without customer email Documents without customer email address: address:

2 per week 2 per week

Documents ordered but never received:Documents ordered but never received:

1 per week1 per week

FeedbackFeedback

“ “Our docs are always so delighted when Our docs are always so delighted when personalized mail arrives for them.” personalized mail arrives for them.” one has a “raft of administrators tooling one has a “raft of administrators tooling past his office wanting to know how his past his office wanting to know how his articles were retrieved electronically. articles were retrieved electronically. They believe that he magically pulled They believe that he magically pulled them up all by himself. “them up all by himself. “

“ “another test subject… has been running another test subject… has been running around Nursing telling people…” around Nursing telling people…”

FeedbackFeedback

“ “The hardest part of this project has The hardest part of this project has been getting email addresses from been getting email addresses from people. Everything else has been very people. Everything else has been very easy so far.“easy so far.“

“ “I think that it might be an age thing. I think that it might be an age thing. The younger, more computer savvy The younger, more computer savvy docs are ready to try anything new. docs are ready to try anything new. Some physicians just haven't found the Some physicians just haven't found the time to utilize computers. We're time to utilize computers. We're working on it, though. “ working on it, though. “

IssuesIssues

How do we make sure the librarians How do we make sure the librarians “really” understand the “really” understand the project?project?

Lending libraries often do not follow Lending libraries often do not follow delivery instructions delivery instructions

Some sites the feel docMD is at fault Some sites the feel docMD is at fault if a if a document is not posted.document is not posted.

Issues: GeographyIssues: Geography

Geography I: Project leaders / librarian Geography I: Project leaders / librarian face-to-face contact difficult face-to-face contact difficult

Geography II: Difficult if not impossible Geography II: Difficult if not impossible to organize group trainingto organize group training

Geography III: Email helps. The phone Geography III: Email helps. The phone is more effective, however, more is more effective, however, more time consuming time consuming

Issues:Issues:

How docMD is implemented at a site How docMD is implemented at a site is is dependent on the hospital dependent on the hospital librarianlibrarian

Level of participation is dependent Level of participation is dependent on on the marketing performed by the the marketing performed by the

hospital librarianshospital librarians Too much hand-holding or separation Too much hand-holding or separation

anxiety?anxiety?

Issues: FundingIssues: Funding

Pay-to-Play (1)Pay-to-Play (1)Each hospital pays a fee based on scale determined by the Each hospital pays a fee based on scale determined by the

number of documents they normally process through number of documents they normally process through DOCLINE in relation to other participants in a tiered fee DOCLINE in relation to other participants in a tiered fee schedule. schedule.

Pay-to-Play (2) Pay-to-Play (2) Each hospital pays a per-document fee based on the actual Each hospital pays a per-document fee based on the actual

number of documents they process using docMD and is billed number of documents they process using docMD and is billed on a quarterly or annual or per-document basis. on a quarterly or annual or per-document basis.

Subsidized (1)Subsidized (1)Each NNLM region establishes funding opportunities for resource Each NNLM region establishes funding opportunities for resource

libraries to support a docMD service for their resource area. libraries to support a docMD service for their resource area. Resource libraries apply for the available awards. Resource libraries apply for the available awards.

Subsidized (2)Subsidized (2)Each NNLM region provides a funded mandate to each resource Each NNLM region provides a funded mandate to each resource

library to establish a docMD service in their area. library to establish a docMD service in their area. Benevolent Benevolent

Any library can provide the service but supports it using their Any library can provide the service but supports it using their individual operating funds and can pursue reimbursement individual operating funds and can pursue reimbursement from the participants.from the participants.

Issues: StandardsIssues: Standards

GEDI: Generic Electronic Document GEDI: Generic Electronic Document InterchangeInterchange

Established in early 1990sEstablished in early 1990s

Ariel 1.x - 3.4Ariel 1.x - 3.4

OdysseyOdysseyOpen StandardOpen Standard

Ariel 4.xAriel 4.x

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proprietaryproprietary

Issues: StandardsIssues: Standards

Question: Is Ariel 3.4 compatible with all other versions of Question: Is Ariel 3.4 compatible with all other versions of Ariel?Ariel? Answer:Answer: Yes. Ariel 3.4 is able to send and receive documents with Ariel versions Yes. Ariel 3.4 is able to send and receive documents with Ariel versions 2 and 3. 2 and 3.

However, Infotrieve has in important announcement about Ariel: However, Infotrieve has in important announcement about Ariel: Infotrieve continues to improve and upgrade Ariel, which will greatly Infotrieve continues to improve and upgrade Ariel, which will greatly change Ariel’s technology (especially with an eye to building a change Ariel’s technology (especially with an eye to building a networked version of Ariel 4.0). We foresee that future versions of Ariel networked version of Ariel 4.0). We foresee that future versions of Ariel will no longer be technically compatible with older versions. We will no longer be technically compatible with older versions. We anticipate that Ariel 3.4 will be the “cut off” version for future anticipate that Ariel 3.4 will be the “cut off” version for future compatibility. Hence, we encourage all 3.x users to upgrade to 3.4 for compatibility. Hence, we encourage all 3.x users to upgrade to 3.4 for free, to be prepared for this future change. We also encourage Ariel 2.x free, to be prepared for this future change. We also encourage Ariel 2.x users to take advantage of our upgrade discount and get current to users to take advantage of our upgrade discount and get current to prevent incompatibilty with future releases of Ariel. Infotrieve will prevent incompatibilty with future releases of Ariel. Infotrieve will continue to communicate about this important issue so that our continue to communicate about this important issue so that our customers can plan and budget accordingly. When we release the next customers can plan and budget accordingly. When we release the next version of Ariel, we will provide Ariel 3.4 users with a patch that will version of Ariel, we will provide Ariel 3.4 users with a patch that will ensure compatibility with the next version, Ariel 4.0. It is important to ensure compatibility with the next version, Ariel 4.0. It is important to take advantage of this release now. take advantage of this release now. http://www4.infotrieve.com/ariel/FAQ.htmlhttp://www4.infotrieve.com/ariel/FAQ.html

Issues: StandardsIssues: Standards

Lack of IDD standards will result in Lack of IDD standards will result in the pilot project ending in the pilot project ending in December 2004December 2004

Lack of IDD standards will prevent a Lack of IDD standards will prevent a wide scale implementation of the wide scale implementation of the conceptconcept

Thanks! Thanks!

E-mail:E-mail: schnell.9@osu.eduschnell.9@osu.edu

Project:Project: docmd.med.ohio-docmd.med.ohio-

state.edustate.edu