Show Notes
Important databases like PubMed are provided free so that clinicians around the world can locate the biomedical literature of the world. But what if the full text of that literature is tied to multiple subscriptions and you work in a rural area that can’t afford the fees?
On this episode of the NNLM Discovery podcast, Region 4’s communication specialist, Lauren Wittek, shares how NNLM is funding a pilot program to help the ecosystem of health care professionals who operate outside of large institutions. Lauren interviews Christy Jarvis, medical librarian at the Eccles Health Sciences Library at the University of Utah, about the issues faced by rural physicians and how her project enables access for all.
The NNLM is the outreach arm of the National Library of Medicine with the mission to advance the progress of medicine and improve the public health by providing all U.S. health professionals with equal access to biomedical information and improving the public's access to information to enable them to make informed decisions about their health. The seven Health Sciences Libraries function as the Regional Medical Library (RML) for their respective region, with Region Four consisting of: Arizona, Idaho, Colorado, Montana, New Mexico, North Dakota, South Dakota, Utah, and Wyoming.
To learn more about Region 4 visit :www.nnlm.gov/about/regions/region4
All of the artwork for this podcast series has been created with a generative AI text-to-image tool! The text prompt for the episode's artwork was "Doctors receiving equal healthcare access to biomedical literature as abstract painting.”
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Transcript
00;00;03;18 - 00;00;28;03
Yamila El-Khayat
I’m librarian Yamila El-Khayat and this is NNLM Discovery a podcast from the Network of the National Library of Medicine. This podcast series explores how NNLM is conducting research, development, and training for the purpose of improving the public’s health. Today’s episode is, “Equal Healthcare Access in Utah” a story from Region 4. Lauren Wittek, from Region 4, will be telling our story today.
00;00;28;06 - 00;00;29;06
Yamila El-Khayat
Hi, Lauren.
00;00;29;08 - 00;00;30;08
Lauren Wittek
Hey, Yamila.
00;00;30;10 - 00;00;47;09
Yamila El-Khayat
So, full disclosure Lauren. My previous role at NNLM, when we first started this podcast a year ago, was working in your current role as a Communication Specialist for Region 4. So Lauren, you took over my position in July of this year, tell us how it's going so far.
00;00;47;11 - 00;00;59;10
Lauren Wittek
I love it. I'm excited to join the Region 4 team. I have seven years of experience working in academic libraries and I've loved working with my new team and region members. But Yamila, you've got some really big shoes to fill.
00;00;59;12 - 00;01;10;22
Yamila El-Khayat
I did love my time there, and I miss all of my old friends. It's nice to finally meet you, Lauren, even with the microphones turned on. So what's the story you'll be sharing today.
00;01;10;24 - 00;01;31;14
Lauren Wittek
As the title of the show mentions, our story today takes place in Utah, but this story is about an issue that impacts all of America. How do we enhance the quality of our health care system? According to the NNLM mission statement, our organization's goal is to improve the public health by providing all U.S. health professionals with equal access to biomedical information.
00;01;31;16 - 00;01;35;22
Lauren Wittek
And I don't think any story exemplifies that more than this funded grant.
00;01;35;24 - 00;01;38;18
Yamila El-Khayat
Let's kick off our story. Where do we start?
00;01;38;20 - 00;01;44;17
Lauren Wittek
Let's start with some basics for those who aren't in the medical field. What do you know about evidence-based healthcare?
00;01;44;19 - 00;02;00;22
Yamila El-Khayat
I know a lot. But then again, I'm a medical librarian. Evidence-based practice is really important. It's the idea that physicians will make the best informed decisions if they're relying on evidence, as opposed to their own personal experience or advice from colleagues.
00;02;00;24 - 00;02;07;19
Lauren Wittek
So a physician obviously needs to have access to current biomedical literature to actually implement evidence based practice. Right?
00;02;07;21 - 00;02;13;03
Yamila El-Khayat
Absolutely. That's where the traditional medical librarians like a swoop right in.
00;02;13;06 - 00;02;20;07
Lauren Wittek
You're right. But not all physicians work for an institution that has medical librarians. Especially in rural America.
00;02;20;09 - 00;02;32;12
Yamila El-Khayat
I can totally see where you're going with this story. This is a huge problem. If you're not affiliated with a bigger institution, then a lot of the biomedical literature out there is only available via subscriptions.
00;02;32;15 - 00;02;52;14
Lauren Wittek
Yes, exactly. There are paywalls that block access. It's kind of like cable TV or I guess more like streaming options now. If you don't pay for the right streaming channel, then you won't get to see the show or movie that you're searching for. These rural physicians could never afford access to all the possible medical journals or paid databases out there.
00;02;52;16 - 00;03;07;13
Lauren Wittek
So our story today is about fixing this problem. We talked with Christy Jarvis, who works at the Eccles Health Sciences Library at the University of Utah. She's the one making sure everyone at the University has access to all this paid content. Here's Christy.
00;03;07;16 - 00;03;43;28
Christy Jarvis
My career has focused on ensuring that the faculty, staff and students at the University of Utah have the information they need to be successful, and I'm proud of that. But it has always disturbed me that there's this whole other ecosystem of healthcare professionals outside of the University of Utah that are, from my perspective, forgotten and neglected and don't have anyone championing their information needs.
00;03;44;01 - 00;04;10;06
Christy Jarvis
I think about the situation where JAMA Psychiatry publishes an article on “effective suicide prevention strategies for adolescents,” and there's no reason in my mind why Dr. Smith, who works at the University of Utah, has access to that to benefit his patients. But Dr. Williams, who works out in Vernal, which is a rural community, doesn't. Right? That has always bothered me.
00;04;10;09 - 00;04;16;06
Lauren Wittek
How much of the published biomedical literature out there is blocked because of publisher paywall?
00;04;16;09 - 00;04;43;03
Christy Jarvis
A lot. There's not a single hard and fast number because there's not a single definition of what the quote unquote biomedical literature is. But it's somewhere between 50% and 75% of biomedical literature is behind publisher paywalls. There's pretty significant variation across disciplines. For example, tropical medicine is largely open access. You can get to most of that.
00;04;43;05 - 00;04;59;13
Christy Jarvis
Pharmacy, on the other hand, is, you know, only like 10% open access because so much of the research in pharmacy is funded by industry as opposed to by federal agencies. And so it tends to remain locked behind publisher paywalls.
00;04;59;15 - 00;05;04;03
Lauren Wittek
Who are the physicians that lack subscriptions to this information?
00;05;04;05 - 00;05;29;24
Christy Jarvis
Well, pretty much anyone who is outside of an academic medical center setting is unlikely to have access to the majority. They may have, you know, the New England Journal of Medicine, JAMA Pediatrics. They may have a couple of the large journal titles, but they are unlikely to have access to the thousands, tens of thousands of journal titles that are out there or the hundreds of databases.
00;05;29;26 - 00;05;40;07
Christy Jarvis
So there are about 1200 physicians in Utah who work specifically in rural frontier, rural and or frontier areas, that don't have access to really any of this.
00;05;40;10 - 00;05;44;29
Lauren Wittek
What sort of health disparities are caused by this lack of information?
00;05;45;01 - 00;06;17;12
Christy Jarvis
Oh, so patient outcomes are definitely affected negatively when their physicians do not practice evidence-based medicine, and that can lead to things like longer hospital stays, misdiagnosis, readmissions to the hospital, unnecessary tests because the physician is not quite sure what he's doing. And so they order additional tests so it can cost more in terms of time and then just patient experience if the physician doesn't have access to evidence, so.
00;06;17;14 - 00;06;22;08
Lauren Wittek
Could you please give us an elevator pitch? What was your grant submission to the NNLM?
00;06;22;11 - 00;06;58;09
Christy Jarvis
So I have launched a pilot program that would allow physicians across the state of Utah to access the published biomedical literature through PubMed without encountering a publisher paywall. This pilot program that NLM has funded feels like a giant step in the direction of leveling that playing field and making it so that information isn't a benefit or a privilege that only certain people get to capitalize on and others, just based on their zip code, don't.
00;06;58;11 - 00;07;19;17
Lauren Wittek
I just wanted to quickly jump in for the general audience who may not know and explain that PubMed is the free database site run by the National Library of Medicine that provides search and retrieval of biomedical and life sciences literature. It currently contains about 36 million citations and abstracts of biomedical literature. So this is a vital resource for physicians and researchers.
00;07;19;20 - 00;07;31;22
Lauren Wittek
But PubMed doesn't include full text journal articles. It provides links to the full text from other sources, such as the publisher's website. And many of the publishers require a subscription to access the full article.
00;07;31;25 - 00;07;55;20
Yamila El-Khayat
In Arizona, we tackle this issue slightly differently. The University of Arizona identified this early on and started what we called AzHIN, or the Arizona Health Information Network, where we negotiated group rates and split the cost amongst those who participated. This allowed those in rural areas with less staff to pay less in comparison to those in urban areas affiliated to larger medical institutions.
00;07;55;22 - 00;08;03;18
Yamila El-Khayat
But being free, Lauren, that's way better because there's hundreds of possible subscriptions to access the articles you need.
00;08;03;20 - 00;08;28;21
Lauren Wittek
It gets expensive. So Christy’s pilot project provides licensed physicians in Utah access to a third party site called Reprints Desk. After setting up an account, PubMed adds a feature where a link is available to access the full text PDF for free. Since physicians already use PubMed regularly, Christy was really trying to minimize their learning curve while also minimizing the costs of not building a new platform.
00;08;28;23 - 00;08;53;24
Christy Jarvis
And it's simple for them to use because it's not new tools and it's simple for the library to implement because it doesn't require, you know, building a whole portal of resources or anything like that. It's really just like PubMed on steroids. It's an enhanced version, enhanced way for those physicians to get full text from the platform where they're already searching for information.
00;08;53;27 - 00;09;17;10
Lauren Wittek
So Christy actually won two NNLM grants for this effort, which is divided into a phase one and phase two for the project. The first phase was building a platform and testing the service with two community health partner sites in rural Utah. They wanted to make sure that everything was easy to understand and that the instructions for ordering articles could be achieved with no technical issues by non-librarians in PubMed.
00;09;17;13 - 00;09;37;14
Lauren Wittek
The second phase was expanding the pilot project to three additional partner sites. During this phase, they tracked the service and cost of how many physician requests came in. This initial information is vital for the possibility of scaling the program into something bigger and to ensure long term success. Let's jump back into my conversation with Christy.
00;09;37;16 - 00;09;41;07
Lauren Wittek
What has been the feedback from physicians who have used it so far?
00;09;41;09 - 00;10;25;01
Christy Jarvis
So I can tell you that the feedback from the facility administrators, right? So the C-suite people, has been ecstatic. This, from their perspective, has solved their challenge of how do we make sure our physicians have information they need when we can't afford subscriptions to 7500 different journal, you know journal, journal titles? And they felt that this was a very good solution to, “give me what I need when I need it, because I can't plan it in advance for all the things that I might, maybe, kind of, sort of, would need.”
00;10;25;03 - 00;11;05;17
Christy Jarvis
So the administrators have been very thrilled with this. A handful of physicians have reached out to us individually and sent emails and said, “this is the greatest thing since sliced bread.” So they've been pretty positive about it. In the interest of full disclosure, I will tell you that the one complaint or the one kind of sticking point has been that we are offering this service currently only to licensed physicians, and there are hospitals in rural Utah where the highest level clinician in the emergency room is a PA or an NP.
00;11;05;20 - 00;11;44;12
Christy Jarvis
And right now we are not including them. And that is simply because of scale that we don't have the ability to manage registrations or accounts for clinicians at every level. However, there has been enough interest and inquiry from some of our partner sites about this that as we are contemplating rolling this out on a statewide basis, that is kind of on our ultimate roadmap development, for including additional levels of clinicians.
00;11;44;15 - 00;11;49;20
Lauren Wittek
Where do you see this program going in the future and what are your long term goals?
00;11;49;22 - 00;12;39;16
Christy Jarvis
So where I would like to see this project go is statewide. My vision for this is that every licensed physician in the state of Utah has access to the published biomedical literature without being impeded by a publisher paywall, and I have a grant submission under review by NLM to take this statewide. With the goal being that we would run this statewide for three years with the next step being at the end of that three years to have a proposal to take to the state legislature showing that this is the reach, this is how many physicians have registered, this is how many articles that have been ordered, and this is how much it costs.
00;12;39;19 - 00;12;59;19
Christy Jarvis
So that we can show the state that this is a modest investment for something that has far reaching significance for providers and patients throughout the state. Utah is still a very rural state and huge chunks of our population live in rural areas.
00;12;59;21 - 00;13;07;19
Lauren Wittek
That's perfect for leading into this next question. Is this a need that will go away or will need long-term funding solutions?
F
Christy Jarvis
It will need a long-term funding solution. However, compared to some other approaches to addressing this unequal access to information that exists in many places across the country, right. This approach comes with the, probably, lowest price tag attached to it. Based again on early, what we have, the data we have thus far. If we expand it and project it into the future, it's looking like it's going to cost around $175,000 a year, which is not cheap.
00;13;49;20 - 00;13;58;24
Christy Jarvis
But for a statewide access service is significantly less than other models that we explored.
00;13;58;27 - 00;14;05;22
Lauren Wittek
How do you see this improving the healthcare in rural, underserved, and under-resourced areas in the state?
00;14;05;25 - 00;14;18;21
Christy Jarvis
Well, ideally, this will follow the trajectory of what is known about evidence-based practice, which is that those patients do see better outcomes when their providers are practicing in an evidence-based manner.
00;14;18;29 - 00;14;30;29
Lauren Wittek
One of NNLM’s goals is to advance the progress of medicine and improve public health by providing U.S. health professionals with equal access to biomedical information. How is this grant achieving that?
00;14;31;02 - 00;14;55;20
Christy Jarvis
Well, one of the main barriers to equal access to that information is the publisher paywall. And the whole goal of this project is to eliminate that barrier completely. So I think we've taken a huge step in that direction of making all of the published biomedical information available to physicians in the state.
00;14;55;23 - 00;15;01;24
Lauren Wittek
Was working with NNLM difficult and is this something you would do again? No pressure.
00;15;01;26 - 00;15;15;11
Christy Jarvis
It was not difficult at all. The NNLM staff were very supportive and encouraging and helpful. They answered every silly question I had along the way and were very supportive.
00;15;15;14 - 00;15;21;26
Lauren Wittek
And what advice would you give someone else who is thinking about applying for an NNLM grant?
00;15;21;29 - 00;15;49;10
Christy Jarvis
Reach out to the regional NNLM staff and tell them that you're interested and you will probably make them perk up. They'll be very excited, and they will let you know what opportunities are available. I mean, I don't know if I should speak on anyone's behalf, but I felt like they really wanted the proposal to be successful and they were happy to share ideas to help make it that way.
00;15;49;12 - 00;15;57;05
Yamila El-Khayat
You're right, Lauren, This story does exemplify NNLM’s mission. I look forward to hearing how it gets expanded throughout Utah.
00;15;57;08 - 00;16;03;13
Lauren Wittek
Thanks Yamila. I'll keep you posted. I hope this is just the beginning of expanding this pilot program nationwide.
00;16;03;15 - 00;16;22;19
Yamila El-Khayat
It's definitely needed. And I'm sure there's more Christy’s out there listening that will be inspired to take this on in their state. And we are here to help. So we're encouraging all listeners to sign up and become members of the NNLM. It's free. Just visit nnlm.gov to learn more. It was nice meeting you, Lauren.
00;16;22;21 - 00;16;27;24
Yamila El-Khayat
Good luck taking over my old role at Region 4. I had a blast there.
00;16;27;27 - 00;16;31;11
Lauren Wittek
You're welcome. Wishing you continued success as well.
00;16;31;13 - 00;16;57;20
Yamila El-Khayat
We’ll be featuring other profiles, grants, and interesting information from all of our Regions during this season of NNLM Discovery. Subscribe to our podcast and follow NNLM Discovery online, as we develop podcast episodes from all of our Regions in the Network. You can learn more about the NLM health information resources, like PubMed or MedlinePlus, by visiting the National Library of Medicine at: NLM.gov. This is NNLM Discovery.
