In healthcare outcomes improvement work, where best-practice insight and evidence-based knowledge are critical, medical libraries are an essential resource. Medical libraries are more valuable than ever in today’s digital world, in which information is readily available, but accessing accurate, focused evidence requires specialized skill and means. Organizations aiming to improve quality and move successfully toward value-based care need both data from the enterprise data warehouse (EDW) and evidence from the medical library. While data identifies opportunities for improvement, evidence furnished by the medical library shows whether proposed solutions are viable. Together, both knowledge bases drive pragmatic, sustainable improvement.

1. Medical Libraries:
An Essential Resource in Outcomes Improvement
James Bulger

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Medical Libraries: An Essential Resource
By systematically researching and accessing
best practice and evidence, medical libraries
connect organizations with knowledge to
drive outcomes improvement.
Medical libraries are particularly valuable in
today’s information-rich digital world.
Google quickly answers any query, but
accessing accurate, focused information
requires diligence, skill, and the highest
quality resources.

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Medical Libraries: An Essential Resource
Medical librarians, who hold master’s
degrees in their specialty, are uniquely
qualified to connect outcomes
improvement teams with reliable,
current, and relevant evidence.
Many medical librarians receive
credentialing through the Medical
Library Association Academy of Health
Information Professionals in recognition
of their exemplary qualifications, health
information knowledge, and
commitment to the profession.

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Medical Libraries: An Essential Resource
In recent years, tightening health system finances
have put medical libraries under pressure.
Some organizations have closed their libraries, and
others have reduced staff—often in conjunction with
hospital mergers.
Some hospital administrators aren’t aware of the
value of medical libraries, or don’t understand that
paid subscriptions deliver high-quality, evidence-
based information they can’t access online for free.
This presentation describes how getting the most out
of published knowledge requires the resources of
medical libraries and expertise of medical librarians.

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Medical Libraries Are Growing and Diversifying
As technology advances, the medical
librarian’s role is diversifying.
Medical librarians support research through
advanced search skills, instruction on
effective use of information resources, and
support of institution-level performance
improvement or quality initiatives.
Some participate in hospital rounds as
clinical medical librarians, providing direct
support as caregiver team members.
Others fill the role of informationists,
contributing both information science and
clinical/biomedical science.

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Medical Libraries Are Growing and Diversifying
To keep up with the increasing availability
of online resources, today’s librarians are
adept at gaining access to electronic resources
through contract and licensing negotiations.
They make information resources accessible
from multiple locations; whether through
enhanced retrieval from search engines or
automated linking, medical librarians provide
seamless access to full-text articles from
PubMed citations.
They can also establish proxy-server systems,
which allow access to information from
outside the institution.

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Medical Libraries Are Growing and Diversifying
Librarians may also lead their institutions on
maintaining compliance with copyright guidelines.
Through their management of print and online
journals, books, and information resources,
medical libraries provide a deep knowledge base
for the institution.
This includes access to national guidelines,
systematic reviews (e.g., the Cochrane
Collaboration), or point-of-care tools (e.g.,
UpToDate), whether resources are focused by
subject (e.g., drug information) or provider type
(e.g., nursing-related collections).

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Medical Libraries Connect Organizations with
Knowledge to Drive Outcomes Improvement
Research demonstrates that medical
libraries improve healthcare quality, and
save time and money for clinicians and
healthcare organizations.
Hospital and health system libraries
support outcomes improvement by
providing evidence-based research.
Medical librarians often sit on committees
to help guide quality initiatives or develop
evidence-based clinical guidelines.

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Medical Libraries on the Front Line of
Outcomes Improvement
Allina Health sought to improve spine surgery
performance at some of its facilities, which
prompted a major improvement initiative in
the form of a multidisciplinary spine program.
With support from the medical library,
including a series of literature searches
focused on spine surgery outcomes as well
as the delivery of pertinent journal articles, the
organization developed an evidence-based
care model.
The model aims to deliver care to every spine
patient right care at the optimal time for the
best possible outcome.

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Medical Libraries on the Front Line of
Outcomes Improvement
The Allina Library Services process produced
25 systemwide guidelines and contributed to
several clinical outcomes improvement:
A five percent reduction in Stage 1 lung
cancer treatment variation, with a focus on
optimal treatment.
A 20 percent decrease in the number of
heparin protocols, which has resulted in
reduced incidence in bleeding, along with
other safety benefits.
Implementation of a system-wide guideline
for acute pain management with opioids.
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Medical Libraries on the Front Line of
Outcomes Improvement
Library Services also works closely with Allina’s Clinical Service Line
councils and participates in the Clinical Practice Council, providing the
knowledge base for Allina to make peer-reviewed, evidence-based
recommendations for several issues:
Appropriate conditions to prescribe medical cannabis.
Appropriate age for mammography screening.
Evidence in support of preoperative screening protocols.
Appropriate use of postoperative pulse oximetry.
Procedures in robotic surgery achieves the best cost and clinical outcomes.
The effectiveness of decision-making in colorectal screening.
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Medical Libraries on the Front Line of
Outcomes Improvement
On a monthly basis, Library Services helps Allina identify possible improve-
ment opportunities by searching the literature for current articles on clinical
variation and cost reduction.
Recent articles considered cover several important improvement areas:
Variation in the cost of common surgical procedures.
Cost analysis of a national surgical consensus guideline
in breast cancer surgery.
Analysis of safety and potential cost savings with early
discharge after percutaneous coronary intervention.
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High-Quality, Value-Based Care Requires
Data and Evidence
High-quality, value-based care must be both data
driven and evidence based to support the right
kinds of improvement.
Data from an enterprise data warehouse (EDW)
can show areas of clinical variation and are
strengthened when presented with the medical
library to show the value and effectiveness of
potential solutions to address that variation.
Also, hot topics in the literature around variation
can be funneled to an analytics team to dig in
and understand how the topic may be affecting
an organization.

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High-Quality, Value-Based Care Requires
Data and Evidence
Recently, a large-scale, multisite study focused
on the value and impact of medical libraries.
The survey found that information provided by
the library facilitated outcomes improvement:
Contributed to a higher quality of care
(93 percent of respondents).
Saved time (85 percent).
Provided new knowledge or substantiated
prior knowledge or belief (91 percent).
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High-Quality, Value-Based Care Requires
Data and Evidence
The study confirmed that information provided
by the library can drive better informed clinical
decisions by substantiating prior knowledge or
providing new knowledge.
In one key improvement area—avoidance of
adverse effects—the study highlighted a number
of key outcomes related to patient safety, which
the organization avoided as a result of
information furnished by the medical library.
These patient safety events included:
misdiagnoses (13 percent), adverse drug
reactions or interaction (13 percent), and
medication error (12 percent).

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High-Quality, Value-Based Care Requires
Data and Evidence
Given the rate of medical knowledge growth,
it is almost impossible for clinicians to keep
up with current findings, even in highly
specialized fields.
In 2016, nearly 870,000 citations were added
to the MEDLINE database.
Because clinicians make difficult decisions
on a regular basis, the medical library
provides expert direction on this huge
volume of literature with focused,
targeted information and answers.

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Medical Libraries-Key to Better Care, Reduced Cost
Medical libraries help health systems
improve outcomes by providing
focused, reliable access to knowledge
and information that defines best
practice and evidence.
They play key roles in achieving a
higher quality of care that improves
patient experience and population
health, and reduces cost.

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Medical Libraries-Key to Better Care, Reduced Cost
With the expertise to efficiently search
the literature, medical librarians save
valuable clinician time and provide
evidence to support data-driven
improvement and identify improvement
opportunities.
For many health systems with an
outcomes improvement strategy, the
medical library is a critical asset.

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For more information:
“This book is a fantastic piece of work”
– Robert Lindeman MD, FAAP, Chief Physician Quality Officer

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More about this topic
Link to original article for a more in-depth discussion.
Medical Libraries:An Essential Resource in Outcomes Improvement
Improving Outcomes That Matter Most to Patients
Caleb Stowell; Sara Sprinkhuizen – from ICHOM
The Top Six Early Detection and Action Must-Haves for Improving Outcomes
Kirstin Scott, Senior Medical Writer; Tracy Vayo, VP of Knowledge Services
7 Features of Highly Effective Outcomes Improvement Projects
Brant Avondet, VP of Client Operations
A Guide to Successful Outcomes Using Population Health Analytics
Tom Burton, Senior VP and Co-Founder
How Allina Health Deployed Evidence-Based Decision Making and Reduced Variation
Health Catalyst Success Story

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James Bulger joined Health Catalyst January, 2015. Prior to coming to Health Catalyst,
he worked for Allina Health, spending nearly 20 years in Library Services, and as
manager for the past 8 years. James has a Master in Library Science (MLIS) degree
from Dominican University.
Other Clinical Quality Improvement Resources
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James Bulger