Ada Ducas, Head Neil John Maclean Health Sciences Library University of Manitoba Libraries

1. The Manitoba Health Information & Knowledge Network (MHI-KNET) A Proposal for Expanded Access to Knowledge-Based Health Information in Manitoba Ada Ducas, Head Neil John Maclean Health Sciences Library University of Manitoba Libraries Phone: (204) 789-3821 Email: ada_ducas@umanitoba.ca Fax: (204) 789-3923

2. Goals of presentation • Outline the importance of access to current health sciences information. • Review the present situation with regard to the provision of health information within Manitoba. • Make recommendations for ways in which service could be improved and expanded through a cooperatively funded program, MHI-KNET.

3. Critical role of knowledge-based health information Quality information = quality careImproved quality and reduced costs result when current health sciences literature is applied to patient care. Avoiding malpractice litigationIn addition to enhancing the quality of care, searching the literature before treatment is a useful, strategic move in avoiding malpractice litigation.

4. Critical role of knowledge-based health information Meeting accreditation standards Canadian accreditation standards for health services require the provision of up-to-date information resources to facilitate clinical and managerial decision making. Continuing education/lifelong learningEssential to the maintenance of continuing professional expertise as well as to licensing and certification requirements.

5. Critical role of knowledge-based health information Recruitment and retentionHealth professionals need to know that they are supported in their efforts to provide quality care and maintain professional expertise. Consumers are demanding access to more informationPatients and their families need to have access to clear and accurate information about interventions and treatments.

6. Existing knowledge-based resources The NJMHSL opened in June 1996 incorporating: • Medical Library • Neilson Dental Library • Health Sciences Centre Library Services. In 1999 these resources were augmented with: • Manitoba Health Library (journals and books).

7. Core components of resources & services • Print and Electronic JournalsCurrent subscriptions to over 1400 journal titles in medicine, nursing, and allied health. Approximately 2000 titles available electronically. • Monographs and audiovisual resourcesA collection of over 180,000 volumes comprised of print, audiovisual and computer based media

8. Core components of resources & services • Online ResourcesAccess to over 100 online databases including 20 specifically relevant to the health sciences:MEDLINE, CINAHL, PsycLit, Harrison’s Principles of Internal Medicine Online, Cochrane Library (an evidence-based medicine database),and MD-Consult • Document DeliveryCapability of obtaining books, journal articles and videos through cooperative arrangements with other libraries using the U.S. National Library of Medicine’s DOCLINE system

9. Core components of resources & services Other unique resources include: • Aboriginal Health CollectionA special collection of resources focusing on the health of North American Aboriginal peoples. • Consumer Health Collection A collection of resources designed to meet consumer health information needs.

10. Extending access... • Since 1996 the NJMHSL has become the primary resource for health professionals at the Health Sciences Centre. • In August of 1998 after a two-year negotiation period, the St. Boniface General Hospital Library became a unit of the NJMHSL. • In April 1999, the Victoria General Hospital Library also became a unit of the NJMHSL.

11. Extending access... • In November 2000 the Subsidiary Affiliation Agreement between the University of Manitoba and the Winnipeg Regional Health Authority was signed. This Agreement stipulates that a Service Assessment be conduct of all hospital libraries in the city of Winnipeg with a view to transfer their management to the Neil John Maclean Health Sciences Library. • Since November 2000, the NJMHSL has been providing library service to WRHA Corporate Office

12. Extending access... • Since October 1997, the Burntwood Regional Health Authority has contracted services from the NJMHSL. • Since April 1999, the Kivalliq Region of Nunavut has also contracted service from the NJMHSL. • In May 2001, the FNIHB (First Nations and Inuit Health Branch – Manitoba Region) has contracted services from the NJMHSL.

13. Extending access... • Manitoba Health Information Network (MHINET) Library services for northern, rural, and urban MARN members who do not have access to onsite library services. Service is paid for by CRNM • INFO-Rx Fee-for-service to any health professional (e.g. $40 a half hour for a literature and $5 for a photocopy of an article or to borrow a book from a Manitoba Library).

14. Barriers to access • Inequalities in access provisionThose within Winnipeg have better access and services than those outside Winnipeg. • Fee-based services serves as a barrier to access Those that must pay for service may not be able to afford the cost.

15. Barriers to access • No coordinated approach to provincial deliveryNot clear to health professionals where they should go for information and how they can obtain needed information. • No training in information retrieval skillsPractitioners seeking information do not necessarily retrieve the most recent and most accurate information, and worse, may not even be aware of the problem.

16. Solution =MHI-KNET • A province –wide system of electronic databases and Library Services

17. Solution = MHI-KNET • Electronic ResourcesProviding desk-top “point and Click” access via a World Wide Web site for all hospitals and health care professionals in Manitoba to key electronic knowledge-based health information resources including: • MHI-KNET Website • Electronic Tables of Contents - e.g. CISTI Source • Online Databases - e.g.CINAHL, MD-Consult • Full-Text Resources - e.g. Health Reference Centre, Cochrane Library, Stat-Ref, Harrison’s Principles of Internal Medicine

18. Solution = MHI-KNET • On-Demand Mediated ServicesFacilitating access to the considerable resources of the NJMHSL for RHA health professionals and patients by providing: • Reference and Literature Search Services • Document delivery services

19. Solution = MHI-KNET • Distance EducationTraining RHA health professionals to effectively and efficiently utilize and search knowledge-based health information resources by: • Utilizing Telehealth system for instruction • Developing web-based instructional resource • Providing on demand access to expertise of professional health librarians.

20. Health Professional Mediated Services • Literature Searches • Document Delivery • Training on use of Resources Patient • 1-800 MHIKNET • Email or Mail • Fax • Telehealth System • 1-800 MHIKNET • Email or Mail • Fax Librarians & Library Technicians MHI-KNET Website Videos Videos Books and E-Books Online Databases & Resources Journal and E-Journal Articles Rural Area Neil John Maclean Health Sciences Library

21. Potential impacts on health in Manitoba • Improved patient care because health professionals will access to the knowledge-based information required to practice evidence-based medicine. • Morecost-effective delivery of health care services because health professionals will be accessing knowledge-based information and making practice decisions based on current information. • Enhancedsupport of continuing education and lifelong learning for health professionals.

22. Potential impacts on health in Manitoba • Additionalrecruitment incentive for rural and northern Regional Health Authorities. With provinces competing with each other for health professionals, MHIKNET serves as an added bonus to attract qualified personnel. • Betterretention of rural health professionals because they have access to the information they need to provide quality care and to continue their education. • Strongerinformation retrieval skills for health professionals through training and support from professional health science librarians.

23. Project innovations The MHI-KNET project will build on the success of projects undertaken in other jurisdictions (e.g. the Health Knowledge Network in Alberta). However, the project is unique in that it will: • Demonstrate how a combination of information technology and on demand library services can eliminate barriers to accessing knowledge-based health information for a significant portion of Manitoba's health professionals. • Explore the strengths and weaknesses of Internet information technologies in meeting the knowledge-based information needs of health professionals

24. Project innovations • Measure the impact of eliminating barriers to accessing knowledge-based health information on patient care, cost-effectiveness, continuing education, and recruitment and retention. • Analyze the effectiveness of a telehealth system for providing training and instruction in the effective and efficient use of knowledge-based health information.

25. Equity in Access • Alberta has the Health Knowledge Network • Newfoundland and Labrador have the Newfoundland and Labrador Health Information Network • Saskatchewan was recently funded for SHIRP • Ontario has excellent urban and rural libraries is in the process of funding the eHealth Library that would provided electronic access to health databases for all health professionals in Ontario.

26. MHI-KNET Proposal • Presented to the Health Services Programs Executive Network (HPSEN) • Have sent a copy to Milton Sussman, Deputy Minister of Health and Dwight Barma, Assistant Deputy Minister of Health

27. Suggestions