© 2008 The authorsJournal compilation © 2008 Health Libraries Group.

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DOI: 10.1111/j.1471-1842.2008.00809.x

Blackwell Publishing Ltd

Practitioner commentary on Garfield E. The impact of health information delivery on the quality of patient care: whither medical information science?

Health libraries review

1985, 2 (4), 159–169*

Linda Ward*, Sarah Sutton†, Pip Divall* & Louise Hull*, *

UHL NHS Libraries, University Hospitals of Leicester NHS Trust, Leicester, UK

, †

Clinical Sciences Library, University of Leicester, Leicester, UK

Introduction

This wide-ranging essay touches on some aspectsof health library and information service practicethat today’s librarians will recognize and some thatwill provide a jarring note, considering changes inpractice since 1985.

Despite the US setting of Garfield’s perspective,many in the UK can relate to the topic of libraryservices under threat. It may not be the directthreat as described in the article, with the removalof a legal obligation to provide library and infor-mation services (LIS); in the UK the familiarHealth Services Guideline HSG (97)47

1

stillrequires that NHS staff have access to effectivelibrary services. However, LIS in this country aresusceptible to the same financial pressures thataffect all health-care organizations.

Meeting information needs

Garfield begins with the ‘key question’ of whetherhospital libraries are necessary for health-careprofessionals to keep up with current medicaltrends. He suggests that the exponential growth ofinformation, of itself, does not justify hospitallibraries. It is the ‘need for more specific infor-mation that makes libraries, indexes and especiallylibrarians more relevant’ (p. 160).

This rings true in 2008 where access to informa-tion is no longer the specialist province of libraryprofessionals. Routes to the knowledge base are

made easier with summary resources such assystematic reviews and guidelines. The NationalLibrary for Health (NLH)

2

is just one provider ofcustomized and personalized portals to information.

Garfield describes a range of service deliverymethods to meet the need for specific, patient-related research information, including modelssuch as Clinical Medical Librarianship (CML)and similar outreach services, well established inthe US in 1985 and gaining acceptance in the UKin more recent years.

His essay illustrates how such outreach servicesare adapted to best fit clinical requirements.Variation in practice occurs based on the urgencyof the information need or the profession of theinformation-seeker. This reflects the multidis-ciplinary approach and the widening user base inUK outreach services.

Garfield’s description of CML services extend-ing their practice to meet the information needs ofpatients and families illustrates ‘recognition by themedical community of the consumer’s growingparticipation in health care and the individual’sright to make informed decisions about care andtreatment’ (p. 165). In an information literatesociety, providing information on treatments topatients often feels like a new phenomenon butclearly it is not.

Divergence from the US prototype to matchUK needs is explored by Garfield, referring toearly NHS projects. More recently a UK 2005survey

3

of such services identified 25 such practi-tioners, probably an underestimate of the currentposition in 2008. The recent Review of NHSLibrary Services

4

links the Clinical Librarian roleto that of ‘Team Knowledge Officer’ which itrecommends to ensure that the research evidence

*Paper given at the Medical, Health and Welfare Libraries GroupConference, Coventry, 5 July 1985. Reprinted in this supplement,pp. 52–62.Correspondence: linda.ward@uhl-tr.nhs.uk

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base is embedded in everyday practice; anopportunity for libraries to be central to the ‘flowof information from the research front’ (p. 160).

An interesting commentary on our role aslibrarians is that we provide a balanced per-spective on medical issues. As clinical librarianswe are aware of differences in clinical opinion andcan act as ‘honest brokers’ of information to guidefinal decisions.

Technology

Inevitably, it is in the area of informationtechnology (IT) where Garfield’s essay seems themost dated. The use of personal collections ofreferences as an ‘auxiliary memory’ feels likean anachronism. A personal file might containresearch that has been superseded and onlineaccess provided for NHS staff should make such aresource redundant.

Garfield expected a slowly increasing use ofcomputers for organizing information. He refersto librarian ‘fears of automation’, reassuring theprofession that physicians training in literaturesearching are better clients for literature searchservices. We would agree and our experience is thattraining end-users and also offering literaturesearch services can work successfully in tandem.

We now know that the use of personal computers(PCs) and other technologies has dramaticallyexpanded. Further, librarians have taken a lead inusing IT and exploring, for example, mobile techno-logies such as Personal Digital Assistants (PDAs)

5

to take research evidence to where it is needed.What Garfield does not identify is the expansion

of computers to include multimedia and theinfluence of e-learning on continuing education.Librarians are combining their knowledge of ITsystems and software with their educationalrole in developing online learning (e-learning) forteaching and learning.

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Online social networking, blogs and RSS feedsmake current awareness alerts (referred to as‘SDIs’ in the article) not only easier for the end-user to set-up but, with tightly focused contentoutput, they can fulfil the need for specificinformation identified in 1985.

Garfield does however, foresee the advent ofnative language searching, the interaction between

clinical and information specialists, and thecapturing of organizational data (i.e. knowledgemanagement). He also describes the creationof ‘expert systems’ predicting decision supportsystems such as Map of Medicine.

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Value and impact

Garfield makes no reference to the term ‘evidence-based’, which was not used in a published articleuntil 1992.

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But he was clearly aware of the conceptand the thrust of his essay is about the importanceof getting research evidence to the frontline andproving the value of LIS in bridging the research–practice gap.

He identified the need in 1985 for LIS to provideregular quantitative evaluations of their servicesand supplies us with useful references that couldsupport current funding bids. He specificallydescribes the need for evidence of effectiveness,cost-effectiveness and cost–benefit. This is a targetthat is equally relevant

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(and equally difficult toachieve) today.

Evidence-Based Library and InformationPractice (EBLIP) encourages librarians to extendevaluation, using methodologies which providestronger evidence. Such evaluations have proved aformidable task considering the role of confound-ing factors in influencing outcomes

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and theproblems with recruitment to LIS studies.

11,12

Recent reviews repeat Garfield’s messagesand encourage us to include the direct effect forpatients among the outcome measures

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whilere-emphasizing the need for value and impactstudies.

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We hope that the NHS Libraries Review recom-mendation that ‘Library’ should figure within thenaming of NHS LIS will mark the end of whatGarfield calls the ‘semantic problem of calling aninformation-switching centre a library’ (p. 160).This is still a problem today with librarians awarethat funding decisions may be made based upon out-dated models of LIS.

Marketing our services and justifying LIS hasrisen up our agenda. Comparing research questionssuggested by librarians in 2001 and in 2006,

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thedomain of marketing/promotion ranked higher in2006 (18.5%, equal second with education) than in2001 (1%) when it ranked lowest.

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The messages in Garfield’s essay still resonatestrongly today. We have made some progress butmost of the issues remain.

Conflicts of interest

LW, SS, PD and LH have declared no conflicts.

References

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2 National Library for Health. Available at: http://www.library.nhs.uk. Accessed on 18 May 2008.

3 Ward, L. Final report and contribution to the audit of rapid response clinical question answering services in England and Wales 2005. September 2005. Available at: http://www.uhl-library.nhs.uk/clinical_librarian/uk_clinical_librarian_survey_2005.doc Accessed on 18 May 2008.

4 Hill, P. Report of a national review of NHS health library services in England: from knowledge to health in the 21st Century. 2008. Available at: http://www.library.nhs.uk/aboutnlh/review Accessed on 18 May 2008.

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