This chapter will provide a strategic approach and firsthand insight into the best practices for Nyack Hospital’s User Community “Gateway to NH Medical Library Resources” Virtual Library 24/7 service. In an effort to maximize Library and Information Services (LIS) while minimizing the department’s planned budget and licensing fees, the author will share current practices of the knowledge-based information needs of the Hospital: Nyack Hospital and LIS Mission/Goals/Objectives, US Federal Government Mandates for Electronic Medical Records (EMR), Nyack’s McKesson Paragon Hospital Information System, Coordination of Knowledge Management – eResources (Web-version) and the function of hard copy, Acquisition, Annual Licensing Agreement (Institutional), Dissemination, and Preservation of Information Resources, Coordination with Southeastern New York Library Research Council (SENYLRC) and Hospital Library Program Services (HLSP), Extensive Literature Search and Document Delivery Services thru NLM/DOCLINE and ILL, End-User Orientation and Training, Continuing Medical Education (CME) Services. The author will present the current status of the state-of-the-art Med Lib Research Info Center and conclude with the future direction of the Research Learning Center.
TopIntroduction
The advent of the Internet in the 1970s and the birth of the Intranet have revolutionized the information world of the 21st century. As members of the Medical Library Association and Special Library Association, we understand that our role is to develop, deploy, and manage information resources and services to advance the mission of the organizations that employs us (Thibodeau & Funk, 2009; Tooey, 2009).
At Nyack Hospital, we staff 600+ physicians (MDs), 555+ Registered Nurses (RNs), and 375 ‘Staffed Beds.’ We are a community hospital of Rockland County located along the Hudson River, 25 miles north of New York City. Nyack Hospital’s Mission is “to provide competent, innovative, and accessible emergency and acute care services for the residents of Rockland County. We are caring people operating an extraordinary hospital” (Nyack Hospital, 2009a, 2009b).
Vision
In its second century of service, Nyack Hospital and the New York Presbyterian Healthcare System will set the pace for sophisticated care in Rockland County. Getting better means all of us will be responsible for taking great care of our patients, each other, and our hospital.
Value Statement
Nyack Hospital’s values closely support its mission. They represent guiding principles that are not independent criteria, but rather, are an integral part of every task of interaction—Safety, Competence, Courtesy, Efficiency, and Integrity.
Along with Nyack’s Mission and Goals, over the past decades, four significant Federal Mandates have been issued regarding adoption of Electronic Medical Records (EMR).
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1996: Health Insurance Portability and Accountability Act (HIPPA).
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2003: Medicare Prescription Drug Improvement and Modernization Act (MMA).
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2004: Executive order 13,335 calls for the complete computerization of health care.
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2009: American Recovery and Reinvestment Act (ARRA) of 2009 (Smatz & Benner, 2007; Neusoft, 2011; National Center for Health, 2009; Dell, 2012; NARA, 2006; Medical Board of California, 2006; Foreman, 2006; US Department of Health and Human Services, 2012).
With more than $17 billion in stimulus funding, the Obama Administration is encouraging the adoption of e-health records by 2014 to medical providers to adopt electronic medical records from old paper files to sophisticated computer databases. The American Recovery and Reinvestment Act (ARRA) of 2009 provides incentive payments for professionals and hospitals participating in Medicare and Medicaid programs that adopt and meaningfully use certified electronic health records.
Emrs In The United States
Usage
Even though EMR systems with a Computerized Provider Order Entry (CPOE) have existed for more than 30 years, fewer than 10 percent of hospitals as of 2006 had a fully integrated system (US Health Policy Gateway, 2012).
In the United States, the CDC reported that the EMR adoption rate had steadily risen to 48.3 percent at the end of 2009 (Medical News Today, 2012). This is an increase over 2008, when only 38.4% of office-based physicians reported using fully or partially Electronic Medical Record systems (EMR) in 2008 (Winterkamp, 2005). However, the same study found that only 20.4% of all physicians reported using a system described as minimally functional and including the following features: orders for prescriptions, orders for tests, viewing laboratory or imaging results, and clinical notes.
The cost of implementing an EMR system for smaller practices has also been criticized. Despite this, tighter regulations regarding meaningful use criteria have resulted in more physicians adopting EMR systems. Software, hardware, and other services for EMR system implementation are provided for cost by various companies, including Dell (Finding Dulcinea, 2009). Additionally, there is a wide range of open-source EMR system software.