“Modules of Workforce Development: Pragmatic Approaches to Knowledge Acquisition, Application, and Information Dissemina

1. “Modules of Workforce Development: Pragmatic Approaches to Knowledge Acquisition, Application, and Information Dissemination” Enterprise Access to Evidence-Based Literature: A Dynamic Digital Library for Public Health

2. Enterprise Access to Evidence-Based Literature: A Dynamic Digital Library for Public Health Karen Dahlen, Project Consultant Elaine Martin, Director New England Region NN/LM Lamar Soutter LibraryUniversity of Massachusetts Medical School This project is currently funded by the NLM via contract through the NN/LM, New England Region

3. Enterprise Library Approach to Knowledge Acquisition, Application & Information Dissemination Measure Importance of Trusted Information Access Ensure Direct Access from Intranet-Based Site Access (Without Name/Password Required) Support Core Competencies/Training Use Survey Instruments Adapted to the Location Relate Cost Efficiencies to Enterprise Licensing/Creative Partnerships Document Institutional Change in a Dynamic Environment Evaluate Over Time (Illustrate Efficiencies)

4. Culture of evidence-based practice was affected when funding for public health libraries was eliminated. State Libraries (in many states) were mandated to support state agencies, but had no collections to support public health. Streamlined access to resources through the Digital Library Platform-- along with trust in new relationships--prompted resurgence in use of resources and has facilitated this cultural shift. Training stimulated access to resources reviving evidence-based interest and relationship to practice. Project has the ability to leverage government resources (NLM, CDC, NAL) to improve evidence-based practice. Shifting the Culture to Evidence-Based Practice

5. Background (Why this Project) Project Rationale Partnerships ENTERPRISE ACCESS TO EVIDENCE-BASED LITERATURE: A DYNAMIC DIGITAL LIBRARY FOR PUBLIC HEALTH

6. Competencies: Council on Linkages Project Tied to Competencies Council on Linkages: Academia & Public Health Practice Public Health Competencies • Analytic/Assessment Skills • References sources of public health data and information. • Information technology to collect, store, retrieve data. • Utilizes data to address scientific, political, ethical, and social public health issues. • Policy Development/Program Planning Skills • Analyzes information relevant to specific public health policy issues • Public Health Sciences Skills • Conducts a comprehensive review of the scientific evidence related to : a public health issue, concern, or intervention. • Retrieves scientific evidence from a variety of text and electronic sources. • Knowledge Informatics • Access trusted resources directly from the desktop. • Describe relationships and functionality of e-resources to core public health interests. • Introduce specific types of resources: coding and classification tools. • Informatics Skills • Train on interoperable features that support public health work, including connectivity to trusted sites; advanced search filters, use of topical alerts and information mgt software.

7. Obstacles to Getting Information

9. Gathering and Analyzing EB Information Rapid Detection of Epidemics Detecting an anthrax epidemic one day earlier would save $1-7 billion CDC Presentation by C. Safran citing: http://www.cdc.gov/ncidod/eid/vol3no2/kaufman.htmKaufmann AF, EID, V3, N2

10. Library Without Signature Building Goal of the Project Who ParticipatesObjectives & Data Sets Development of Digital Library ENTERPRISE ACCESS TO EVIDENCE-BASED LITERATURE: A DYNAMIC DIGITAL LIBRARY FOR PUBLIC HEALTH

11. PHIA: Innovative Business ModelNot Tied to Traditional Building Madison, WI Atlanta, GA

12. Full text directly available through DL Full text available through LP Core to public health Goal of PHIAPublic Health Information Access To determine what resources are core, useful, evidence-based to advance public health practice.

13. Unique Aspects of Digital Library • Resides on PHD Intranet (outside a signature building) without need for id and password. • Relies on collaboration, interoperability & funding. • Move toward analysis; less time on access • Skills & training support personalized, interactive styles tied to continuum of learning and institutional-specific priorities and projects. • Collection of evidence occurs in many aspects of Brownson wheel not just at the literature review stage. • Fundamental change in the way resources are distributed and utilized.

14. Public Health Departments& Library Partners

15. PHIA Evaluation ProcessTied to Data Model To advance access to evidence-based resources in support of improved public health practice. What resources are high use? What technical issues arise? What resources are missing? How can training be improved? What project components lead to improved efficiencies? What cost efficiencies are involved with an enterprise approach to digital library implementation, and training. • Logic Model • Resources, activities, outputs, outcomes (minutes, visits, trainings, people lists, IP management, levels of troubleshooting, RML reports. • Data Tools • Overarching questions • Journal SurveyMonkey • Pre-Post Training Surveys • Just-in-time Information Checks • Formal Evaluation (interviews & focus group sessions

16. Data Sets & Sources • Resource Metrics Collected • Journal Survey Monkey Identifies Perceived Need & Library Use. • Document IT technical issues. • Licensing Issues Related to Journals and Databases. • Training Surveys Collected • Preliminary Meetings/Updates Held. • Trainings Held • Year End Evaluation --Interviews & Focus Groups

17. View of PHIA Digital Libraries Connecticut Digital Library Arkansas Digital Library

18. Resources on Digital Library Use of Resources Article Delivery Use & Costs ENTERPRISE ACCESS TO EVIDENCE-BASED LITERATURE: A DYNAMIC DIGITAL LIBRARY FOR PUBLIC HEALTH

19. Databases & Major Publishers of Resources PubMed , Other NLM DatabasesNAL, CDC & Other Gov’t Resources CLSI (Clinical Laboratory Standards) Global Health Cochrane Library • Systematic Reviews Stat!Ref—E Books (35) -- Coding & Classification ASABE –Health Linked to Agriculture

20. Identifying Core, Useful, & Evidence-Based Journals

21. NEJM Use2010-2013

23. Oxford University Press UseJan-Dec 2013 Total Use by Each PHDN=13,827 High Use Journal Titles

24. STAT!Ref E-Books/Tools Provide Basic Understanding of Topic Filters & Tools • Codes[5] • CPT with RVUs Data File, INGENIX® (2011)[1] • ICD-9+CM - Volumes 1, 2 & 3 (2012) • Titles By Discipline[344] Searchable Alerts (by topic) • Functionality with NLM • Chapters link to PubMed • TOXNET linked to Search • Related Concepts/Meta…Functionality with CDC • MMWR, Community Guide;

25. STAT!Ref E- Books for Public Health Titles Containing PH Content Coding & Classification Books

26. CLSI (Clinical & Laboratory Standards)20 Documents Used 790 TimesApril 21, 2014

27. Calculations Related to Enterprise Licensing Enterprise Licensing is based on 10% of the Total FTE level to capture baseline information and measure use/interest of resources.

28. May 2012 --- April 2013; Cost=$12,241 Article Delivery Costs Via Library Partnerships May 2011 – April 2012; Cost=$18,384

29. Training Topics Embrace National and State Interests Maryland DHMH Health Initiatives • Health Disparities(sexual minorities)     • Preventive Services ACA* HIV Screening • Immigrant Health Undocumented individuals under ACA • Drug Resistant Disease which impacts Impact on TB, STI (plus others) • Health Care Reform and Interpersonal Violence/Domestic Violence • Infectious Diseases; Hepatitis C Virus HIV Infections --HIV and HCV Co-Infection

30. Number of Trainings/Diversity of Workforce

31. Enterprise EfficienciesUnique Aspects of the Business ModelEvaluation Processes ENTERPRISE ACCESS TO EVIDENCE-BASED LITERATURE: A DYNAMIC DIGITAL LIBRARY FOR PUBLIC HEALTH

32. Alternative Article Delivery Cost Efficiencies: Article Analysis Direct Access to Articles

33. Enterprise Licensing Efficiencies: Single TitlesContract Year May 2012-April 2013

34. PHIA: Innovative Business Model • Enterprise licensing saves time, money, and effort. • Central management of IP addresses ensures quick turn-around. • Ability to understand change (System, personnel, environment). • Resources are identified via benchmarking,metrics of direct use through Digital Library, and requests from PHDs. • Journals are identified via “Article Delivery” on Library Partner side. • Alternative delivery of resources strengthens state relationships with immediate access (within 4-24 hours).

35. EVALUATION PROCESSES Levels of Data Collection • Journal SurveyMonkey (baseline data for PHIA and PHD) • Enterprise Licensing (cost effectiveness over time) • Vendor statistical reports (validates “use of resources”) • Monthly reports from “library partners” (measures use and identify resources to develop Digital Libraries). • Ongoing capture of suggested e-books, journals, and databases to enhance collection • Pre-Post training links • (data related to knowledge of resources) • Feedback from hands-on training • Interviews with leaders and workforce • Focus group sessions (after one year; subsequently) • Quarterly/Annual Reports (submitted to NLM)

36. Results • Digital libraries will be in place in 17 PHDs by July. • Full-text access to more than 150 e-journals, 5 databases, reports and more. • Introductory sessions have introduced PHD leadership to the project and explained obligations. • More resources have been added to “digital library.” • Structured training has been held in 15 PHDs. • More than 600 people have been trained with backup models currently in test stage.

37. NACCHO Award Brings Recognition to Project • March 2012 and 2013, the PHIA PHD Digital Library Project received a “promising practice award” from NACCHO. • Presentations have been held at national and local meetings, e.g., APHA in Washington, DC in 2011 and Boston in November 2013. • Article was published in AJPH in January 2014. Project was cited in August 2012 EID (CDPHE). • Presentations have been made at national public health meetings, national and regional library meetings.

38. Testimonial “Great recognition for this very valuable initiative. Kudos and thank you.” Jewel Mullen, MD, MPH, MPA, Commissioner, Connecticut Department of Public Health

39. Discussion & OutcomeHow Do We? • Expand PHIA to all 50 states. • Enhance partnerships & relationships. • Continuously train PH Workforce to improve competencies (knowledge and skills) given staff turnover. • Build a sustainable model including cost structure and project management.