National Network of Libraries of Medicine

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From Bench to Bedside:

Research and Testing of Internet Resources and Connections in Community Hospital Libraries

Quarterly Report
July - September 1995

Highlight

The RML sponsored a special session highlighting the extension of the Pilot Connections Project extension at the annual meeting of the Pacific Northwest Chapter/Medical Library Association (PNC/MLA).

Progress to Date

Twenty three librarians attended a special discussion session at the MLA chapter meeting on September 15. At the session, the participants in the Pilot Connections Project extension, testing SLIP/PPP connections, shared their experiences. Eleven librarians are participating in this project; of the eleven, eight were able to attend. Neil Rambo moderated the session and asked project librarians to report on successes and problems of their participation. A brief overview of the session follows.

Michele Spatz (Mid-Columiba Medical Center, The Dalles, OR) is using Internet Express and has Netscape loaded. She gave two examples of successful use of the Web: a physician found CDC slide shows on emerging viruses that he used and nursing students in her facility found information on ebola virus for a term paper. Michele has mentored hospital staff in use of the Internet and has found it valuable to be the "Internet expert." She had one complaint about Web interactions: there are so many false leads.

Valerie Schultheiss (Highline Community Hospital, Seattle, WA) already had a dial-up Northwest Nexus account when the project began, so she followed the Northwest Nexus representative's recommendation of acquiring the Internet in a Box product. After installing the software she sent a message to Northwest Nexus asking to have the account changed to a SLIP connection; the transition was simple and smooth. Northwest Nexus keeps getting better, but does limit the number of connect hours. She uses Mosaic with a 28.8 modem and was amazed at the difference between 14.4 and 28.8. She said that she "knocked some people's socks off" with what she could show. For example, she encouraged a quality improvement consultant to come to the library to see the Internet. Within half an hour he said that it had to be on every desktop. The wonderful part is that she can do everything at once with the icons up on her screen; information moves quickly because she can run a search and immediately e-mail it to her user. Valerie says that her expertise makes her look good, especially with the Information Systems people in her hospital. Michael Boer has been a good resource for her.

Gail Wilkerson (VA Medical Center, Miles City, MT) described some problems that she has had. The computer store in her community did not know about software for Internet connectivity. She had difficulty in connecting and did not know where her connection problems lay. She used WLN as her Internet service provider and Internet in a Box as her software. She did not have enough RAM for Chameleon, which was recommended by WLN and she needed a new serial port chip. She currently has Mosaic up and running. The connection has helped the library become more visible within the institution. She has used the NLM Clinical Practice Guidelines.

Janice Bacino (St. Peter's Community Hospital, Helena, MT) has had good support from the Montana State Library, which sent a representative in the same town out to install Chameleon and Netscape. She uses WLN and simply makes a local call to the state library, getting in through the state's direct connection. There is no extra charge for a SLIP connection from WLN. She uses the Internet daily, not always successfully. She has a one-page instruction sheet up next to her terminal to help her users and feels that just 15 minutes of training can get people started on the World Wide Web. Janice felt that she is encouraging other people to get connections: she printed out some information for a medical records staff person and that person had her own account within two weeks.

Barbara Sherry (St. John's Medical Center, Longview, WA) said that, while there were no Internet service providers in Longview last March, there are now four. Barbara and the local newspaper found that WLN would put in a node if enough people in the community signed up. In two weeks they had 150 people sign up. However, by then Teleport had installed a local node and offered 720 hours over six months for only $62; the negative aspects of Teleport are that one frequently gets a busy signal and 14.4 is the fastest connection possible. Barbara has both WLN and Teleport. Barbara offers a public access station in her library. The city of Longview has asked her to develop a home page and to link it to the city's home page. After Barbara presented the Internet to the medical staff, the hospital administrator got access at home. Barbara gives "Internet Breakfasts" once a week. Her involvement has given stature to her "teeny" library and has given her the title of expert.

Robin Braun (Empire Health Services, Spokane, WA) is using the Internet primarily for listservs. Arleen Libertini, in the same hospital library, is using it for both reference and listservs. Their technician is using the Internet for ILL, listservs, and the online Copyright Clearance Center capability. Arleen said that their Internet services provider loaded the software for them; they do have a problem with busy signals, though that has gotten better. When Arleen has sent database searches to patrons by e-mail they have been thrilled.

Margery Keppel (Harrison Memorial Hospital, Bremerton, WA) moved (and moved her project with her) from Auburn to Bremerton, where she is being encouraged to be the Internet "guru." She is not yet using Netscape.

Neil Rambo asked what the RML can do to help people. Gail Wilkerson said that she had appreciated the latitude given to her by the RML, but that latitude also led to some problems, given the heterogeneity of locations, hardware, software, and providers. Bob Pringle (from the Intercollegiate Center for Nursing Education, Spokane, Washington) asked that the RML help all PNC/MLA members to connect with at least SLIP/PPP connections.

Part of the rationale for this project is for librarian participants to teach each other, lead future participants, and to become community resources at a time when many are grappling with the same problems. The RML is less a leader here than a facilitator and "encourager."

Library-Specific Progress, Problems Encountered, and Corrective Action Taken

Progress, problems encountered, and corrective actions tend to be intertwined and are best described through the e-mail conversations with the SLIP/PPP Project participants, some of which are copied below. Librarians who participated in the special session at PNC/MLA provided their updates through that forum.

Date: Thu, 29 Jun 1995 05:27:51 -0700 From: Kathy Martin To: RML staff Subject: Quarterly report Having now had a PPP connection for about half (?) a year, I have several opinions/concerns about the Internet which I would like to mention: Getting onto the Internet is not for the faint-of-heart. The software required for obtaining images and sound, for the "unzipping of files, and for decoding files is confusing to use, in addition to which it has to be downloaded in order to be able to get this stuff. I am wading my way through a class on the World Wide Web offered by Thomas Copley, and I was lost (in the first lesson!) until Michael Boer explained to me how Netscape's function as a browser allows me to look at http files. I am still in a bit of a muddle over this, but not like I was. (Thank you, Michael.) I can tell, after watching people who do a lot of reading about the Internet, that I should be doing the same. But, I am reluctant to do so, because I find I am doubting the importance of the files I am finding on the Net. Which brings me to my next point: I find the amount of junk I find on the Internet disconcerting. Files that I search for and find are often useless or just plain terrible. I am suspicious of the advice I receive from files over the Internet. I think as medical librarians we have to be certain that the sources we use have a certain veracity. The textbooks I use and the articles I find are peer-reviewed or edited by those respected in the field. However, when I find a file on the Internet, I am never sure that it is put there as a whim or by someone who knows of what they speak. As an example, I was initially thrilled to find Oncolink on the Internet, since a pediatric radiation oncologist at the University of Pennsylvania was responsible for its contents. However, I recently read an article which said that the physician/scientist no longer has the support of the University, since his superiors felt that much of what he was putting on Oncolink was not peer-reviewed and was often his own opinion. But, the file still remains on the Internet for all of us to use. How do we trust what we find on the Internet? This is a nagging question I ask increasingly. I also find the interface clumsy. I surprise myself when I say that the book/journal paper format is much easier and faster to browse. When I first learned about the Internet, I couldn't wait to get on it. It seemed to me as though it would open up the world to me, and that I would be able to find answers to all those previously left unanswered, because I hadn't had enough resources. And, in fact, it has helped in this respect--by virtue of e-mail. The knowledge shared by my colleagues is fantastic; they have come to my rescue enough times now that I am profoundly amazed and admiring of the breadth of their knowledge. However, if someone said to me that I could not have access to anything on the Internet other than e-mail, I would say, "okay" at this point. I use the web files and gopher files only when I am desperate for information, since the time consumed in looking for information on the Net is sometimes prohibitive. Am I an "Internet doubter?" I am surprised to hear myself say, "yes." What would I like to see the Internet become in the future, particularly in relation to the medical world? I would like to see resources appear which are valid and reliable. I don't need duplication of sources already in print, since I actually prefer the print source. One very helpful source I just found out about is an http file (I think) that gives the original scientific source from which popular media stories originate about health care issues. That's an excellent way for the Internet to fill in a much needed gap. I would like to see files on the Internet which fill in other holes in our information base. I would also like to see librarians more involved with the Information Superhighway super structure. They are absolutely the best people to give some sense and organization to the mess we now have. I am now more of a realist than I was when I was first introduced to the Internet. I remember thinking to myself that the Internet could replace me in my job as a librarian, since it could find anything that anybody wanted without a visit to the library: I wanted to meet the interloper. Now that I see the product, I can see that *nothing* can replace librarians. In fact, librarians will *really* be needed who know the Internet well enough to sort through its garbage to find the few gold nuggets. As a librarian, I see it only as another tool to use in my continual treasure hunt.

Kathy Martin, Willamette Falls Hospital, Oregon City, OR

Date: Wed, 4 Oct 1995 14:58:30 -0700 (PDT) From: Frech Health Sciences Lib To: pressno@u.washington.edu Subject: SLIP IN!

Dear Nancy:

Working with Jon Ponsford (sp?) at WLN, I finally am up and running. It's wonderful and I have showed it to a few of the staff already. We've decided to go ahead with a library workstation for physicians and staff for next year, so this is just the beginning.

Margery Keppel, harrison@wln.com, Harrison Memorial Hospital, Bremerton, WA 98310

Date: Mon, 16 Oct 1995 12:54:48 -0700 (PDT) From: Kay Irvine To: Neil Rambo Cc: npress.washington.edu@ohsu.EDU Subject: Re: yup, project reports

Neil,

I can happily report that after demonstrating the Internet to the faculty one afternoon all my campaigning efforts paid off with a signed purchase order for our own Internet node. We are starting small by only connecting the library building with the intention of placing fiber optic cable to the other campus buildings later this fiscal year. The library facility will have 8 computers connected. I believe this never would have happened if I hadn't had the opportunity to be a part of this project.

I have just downloaded Netscape 2.0 but haven't had a chance to log on.

I my have mentioned this earlier but I attended a Web page Construction class and am chairing a committee for OHSLA to build our own page. It will reside at OHSU.

Western States has a document called Western States at a Glance that outlines our admission requirements and program in general. I sent it via e-mail in ASCII format (I feel so computer savvy) so the webmaster of the Chiropractic Page and he put it on his page. Since then I have contacted other webmasters have done the same (Chiro-Web, Oregon Web page, etc.) We will be working on our own web page once we get our own node.

Kay Irvine, Western States Chiropractic College

PNR Contract Summary and Special Projects

nop | Revised: December 1, 1995