salus: online co-operation between south australian health libraries

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  • 78 Blackwell Science Ltd 2002 Health Information and Libraries Journal, 19, pp.7883

    Blackwell Science, Ltd

    SALUS: online co-operation between South Australian health librariesMary Peterson* & Lindsay Harris, *Deputy, Library and Educational Information Services, Royal Adelaide Hospital/Institute of Medical and Veterinary Science, Libraries Manager, North Western Adelaide Health Services, Adelaide, South Australia


    The establishment of the South Australian Health Libraries Consortium led tothe development of the SALUS project which enabled the online delivery ofcore health, clinical information and bibliographic databases with full-textresources across South Australian government health services. This was thefirst venture of Australian health librarians to create an online consortium.This article discusses the policy and management issues surrounding theimplementation of the SALUS project and its influence on the evolution of thehealth Libraries Consortium over several years. Lessons learned during thisprocess included: the necessity to plan well ahead yet to remain flexible inimplementing those plans, to avoid procedure becoming more important thanimprovization during planning, to be willing to take well judged risks onoccasions, and to be fully aware of changing circumstances in the projectsfunding and political environment. The importance of securing influentialadvocates outside of the participating libraries to support continued projectfunding is also considered.


    The background to the SALUS project

    To understand the evolution of the SALUS onlineproject in South Australian health libraries itis important to describe briefly the social anddemographic conditions under which the projecthas developed since the mid 1990s. The state ofSouth Australia covers a vast area, some 984 000square kilometres, and receives the lowest rainfallof all the Australian states and territories. Overhalf of it is either desert or marginal pastoral land.

    The distribution of population is characterizedby very low densities in the rural regions, withlarge areas in the far north and west almostuninhabited, and elsewhere very small townsscattered across great distances. In contrast, over70% of the states 1.5 million people are con-centrated in the state capital, Adelaide. Thisdemographic imbalance is underlined by the factthat all other urban centres in South Australiaeach have less than 35 000 residents. Con-sequently, nearly all the major hospitals, principalhealth facilities and tertiary educationalinstitutions are located in the Adelaidemetropolitan area.

    In South Australia, there are two Universitymedical schools and seven major public teachinghospitals together with a range of other private

    Correspondence: Mary Peterson, PO Box 14, Rundle Mall, AdelaideSA 5000, Australia. E-mail:

  • SALUS: online co-operation, Mary Peterson and Lindsay Harris

    Blackwell Science Ltd 2002 Health Information and Libraries Journal, 19, pp.7883


    and public hospitals, community health centres,clinics and biomedical research institutions. Allthe public health services, including hospitals,report to the state governments Department ofHuman Services (DHS), and funding is in mostcases derived from both federal and state govern-ment sources.

    A key feature of South Australian health serviceprovision is the overwhelming concentration offacilities, professional staff, biomedical technolo-gies, educational programmes and administrationin Adelaide. In contrast, the sparsely settled andoften distant rural regions have suffered from alack of medical specialists or resident medicalofficers, inadequate advanced diagnostic andintensive care services and poor infrastructure forclinical training. Efforts are now under way toovercome some of these disparities, but this wasvery much the prevailing situation in 1995 whenSouth Australian health libraries first consideredthe feasibility of establishing a state-wide onlinehealth information service.

    The vision for health information and the origins of SALUS

    The germ of the idea that eventually led to SALUScame from a paper presented at the 1995 Special,Health and Law Librarians Conference in Sydneyby Grace Cheng, the Libraries Director for theHong Kong Hospital Authority. In her paper,Cheng outlined the establishment of servicenetworks supported by Health Centre librariesand the setting up of the infrastructure of theHospital Authority Library Information System(HALIS) of the Hong Kong Health CareAuthority.1 This concept inspired Anne Fricker,then librarian at the South Australian Instituteof Medical and Veterinary Sciences (IMVS), toconsider establishing a similar Wide AreaNetwork (WAN) offering access to electronicinformation to health professionals throughoutthe state. This would be achieved with thecollaboration of Adelaide health libraries in thecreation of a commonly supported operatingplatform and associated online products.

    Despite the economic and social differencesbetween the two jurisdictions, there were certainsimilarities in the structure of their health services

    that made the Hong Kong model attractive toSouth Australian health librarians. Both operatedBritish influenced health systems with the princi-pal health care units and services concentrated insmall, heavily-populated urban regions dominatedby government-funded teaching hospitals, whichare in close geographical proximity to each otherand the major educational institutions. Bothsystems are controlled by a single official healthauthority with many clinical practices and trainingprograms that are common in content to each. Inaddition, both groups of health librarians wereaccustomed to working closely together and mostwere ultimately answerable to their respectivegovernmental health authorities.

    Following the Sydney Conference, a meeting ofhealth library managers was convened in Adelaidein late 1995 to establish a South Australian HealthLibraries Consortium with the express pur-pose of wide area networking electronic full textand bibliographic health knowledge products.2

    Chaired by Anne Fricker, an eight-person Work-ing Group was formed representing the 16members of the Health Libraries Consortium toprepare a business case for the funding and imple-mentation of a WAN project in health informa-tion. It was envisaged that this WAN would useCompact Discs (CDs) on networked servers basedat one of the participating hospitals.

    This project was distinguished, not just by thesignificant technical aim to create a WAN accessi-ble to all health professionals employed in the statehealth system, but also by its intended scope. Thegoal was to provide a readily available onlineservice offering core bibliographic databases like along with seamless access to full-textelectronic publications: quite an ambitious plan,technologically speaking, for that period in themid 1990s.

    Weight was given to our aim by the well knownRochester Study3 and supported by several otherstudies including the Canberra Study.4 All of thesedemonstrated conclusively that use of appropriateinformation sources from libraries significantlyinfluenced physicians in their practice of medicineand resulted in better patient outcomes and fewermedical errors.

    In brief the stated objectives of the Consortiumproject were:

  • SALUS: online co-operation, Mary Peterson and Lindsay Harris

    Blackwell Science Ltd 2002 Health Information and Libraries Journal, 19, pp.7883


    1 To provide and improve access at the desktop toa wide range of electronic health products.

    2 To promote equity of access to database servicesfor all health professionals.

    3 To improve service delivery and informationsharing amongst the staff of all participatingConsortium members.

    4 To establish a standard networked system ofinformation sources using existing state govern-ment systems and networks.

    5 To improve the development of appropriatetraining programs for all staff in the Consortiumto ensure the effective usage of databases.

    6 To achieve economies of scale in the purchase ofhardware and software, negotiating licensingagreements and the installation of databases.5

    The promise unfulfilled: the first attempt at networking

    In the following year, the Consortium WorkingGroup prepared terms of reference for the projectand wrote several drafts of a Business Case. Thisinvolved complex cost-benefit analysis todemonstrate the value of the proposal over theretention of the status quo of individual healthlibraries operating in an uncoordinated manner.

    Extensive reviews of the available products werecarried out, including the various searchingplatforms for the major biomedical bibliographicdatabases. Vendors were invited to give productdemonstrations to the Consortium and interestedclinicians. At this stage of the project, a list of coreproducts was identified based on current sub-scriptions already held by individual Consortiummembers and their availability on CD ROM.

    Funding was secured for the employment of aProject Officer, Greg Fowler, who had beenmanager of the states Drug and Alcohol ServicesCouncil Library and an inaugural member of theConsortium Working Group. The appointment ofa Project Officer was crucial in permitting thecompletion of a major Business Case report,which would otherwise have been beyond thecapacity of a volunteer Working Group to draft.As well it indicated departmental support for thenetworking concept behind the Business Case.6

    The Business Case envisaged a CD based WANbecause of the state of information technology in

    the mid 1990s. The roll-out of networked onlineconnections across the South Australian healthsector was incomplete and the Internet at that timewas viewed as too slow and unreliable for thepurposes of t