Toxicology and Environmental Health Information Resources: The Role of the National Library of Medicine (1997)

Institute of Medicine

National Academy of Sciences

Committee on Toxicology and Environmental Health Information Resources for Health Professionals

Cecil and Ida Green Building

2001 Wisconsin Avenue, N.W.

Washington, DC

Wednesday, May 22, 1996

9:00 a.m.–2:30 p.m.

Workshop on Toxicology and Environmental Health Information Resources May 22, 1996

Allison Ansher

Virginia Department of Health

Manassas, VA

Gershon Bergeisen

U.S. Environmental Protection Agency

Washington, DC

Karen Bolla

Johns Hopkins Bayview Medical Center

Baltimore, MD

Randall Brinkhuis

U.S. Environmental Protection Agency

Washington, DC

Gail Buckler

Robert Wood Johnson Medical School

Piscataway, NJ

Keith Burkhart

Central Pennsylvania Poison Center

Hershey, PA

Maureen Caborette

Johns Hopkins University School of Hygiene and Public Health

Baltimore, MD

Ann Cary

George Mason University

Fairfax, VA

Cathleen Clancy

National Capital Poison Center

Washington, DC

Robert Copeland

Howard University College of Medicine

Washington, DC

Mark Ennen

George Washington University School of Medicine

Washington, DC

Steve Galson

U.S. Department of Energy

Washington, DC

Rosemary Garrett

U.S. Postal Service

Washington, DC

Gary Greenberg

Duke University Medical Center

Durham, NC

Bryan Hardin

National Institute for Occupational Safety and Health

Atlanta, GA

Joseph Kaczmarczyk

Division of Federal Occupational Health

U.S. Public Health Service

Bethesda, MD

Linda Karbonit

Virginia Department of Health

Vienna, VA

Phyllis Lansing

University of Maryland at Baltimore

Baltimore, MD

Melissa McDiarmid

Occupational Health and Safety Administration

Washington, DC

Robert Mueller

Virigina Commonwealth University

Richmond, VA

Thomas Obisesan

Howard University Hospital

Washington, DC

Jerome Paulson

George Washington University School of Medicine

Washington, DC

Dalton Paxman

U.S. Department of Health and Human Services

Washington, DC

Janet Phoenix

National Safety Council

Washington, DC

Karyn Pomerantz

George Washington University School of Medicine

Washington, DC

Liz Ribadenyra

U.S. Department of Health and Human Services

Washington, DC

Diane Rodill

Division of Federal Occupational Health

U.S. Public Health Service

Bethesda, MD

Nadia Shalauta

Johns Hopkins University School of Hygiene and Public Health

Baltimore, MD

Anthony Shephard

Howard University College of Medicine

Washington, DC

Ginny Stone

University of Maryland at Baltimore

Baltimore, MD

Gregory Szlyk

George Washington University School of Medicine

Washington, DC

Terrance Tobias

Dalghren Memorial Library

Georgetown University

Washington, DC

Anne Tschirgi

Maryland Poison Center

Baltimore, MD

Daniel Wartenberg

Environmental and Occupational Health Sciences Institute

Piscataway, NJ

Thirty-four individuals participated in four focus groups sponsored by the IOM Committee on Toxicology and Environmental Health Information Resources for Health Professionals. The focus groups were held at the morning session of the committee's May 22, 1996 workshop. Facilitators from Jupiter Corporation, a scientific consulting firm, worked with input from committee members and IOM staff to develop a structured set of questions and issues that were then discussed in the focus group sessions.

Focus group participants included specialists in toxicology and environmental health (e.g., poison control center staff and occupational and environmental health professionals); government science and health policy advisors; researchers and information specialists; practicing health professionals in general practice or specialties other than toxicology, occupational medicine, or environmental health; health educators; and medical students.

Participants of the focus groups were asked for input on four key topics:

1. toxicology and environmental health information needs;

2. methods and sources used to locate and retrieve toxicology and environmental health information;

3. current use of toxicology and environmental health databases and other information resources in meeting information needs; and

4. future directions for toxicology and environmental health information resources.

The frequency of use of toxicology and environmental health databases and the need for toxicology and environmental health information varied widely among the participants, from several times a day to less than once a month. The groups that used toxicology and environmental health information most frequently (daily to weekly) were the specialists and researchers. Emergency room physicians and government policy advisors had an intermediate level of need and use; emergency room physicians frequently used a commercial CD-ROM database product (POISINDEX®) or call a poison control center. Physicians practicing in other fields, educators, and medical students needed toxicology and environmental health information least often (generally less than once a month).

Toxicology and environmental health information needs were categorized in two ways: (1) time sensitive (i.e., dependent on the critical need or time frame within which an answer or information is needed) and (2) the level of summarization or "distillation" of data desired (i.e., does the requester want original data

or summarized—bottom-line—information). Participants felt that there is a correlation, specifically, an inverse relationship, between these two factors: acute information needs (such as immediate patient treatment) require a short, factual, bottom-line answer (or "distilled" information), whereas for a greater depth and amount of data, a longer amount of time can be taken to locate the comprehensive information needed.

Specialists, researchers, and government policy advisors had the broadest range of information needs, citing almost all topics related to toxicology and environmental health, including short-term and long-term effects of exposure, dose-response information, epidemiologic data, regulatory and policy requirements and background information leading to the drafting of regulations, scientific and regulatory information from the international community, personal protective information, workplace release and exposures, treatment protocols, status of research and studies, and analytic chemistry data.

Focus group participants indicated that the methods or sources of information they use depend primarily on whether the information need is acute (time critical) and secondarily on the level of toxicology and environmental health expertise of the person needing the information. Ease of locating and retrieving the desired information and cost were also factors in choosing sources. In general, people want to expend the least amount of time, effort, and money to get the information they need in the format they want.

Those with acute time-critical needs (e.g., emergency room physicians) and those requiring "distilled" information (e.g., general practice physicians responding to a patient's question about possible workplace exposure risks) primarily used textbooks, CD-ROM databases, and calls to experts.

Toxicology and environmental health specialists, government policy advisors, and research and information specialists were more likely to use online databases, as well as a wide range of other sources of information. These sources included printed material, other experts and colleagues, other agency sources of information, CD-ROM databases, and the Internet. The wide variety of sources used reflects the fact that these groups generally need a significant depth and breadth of data and information.

The starting point or "trigger" for a search for toxicology and environmental health information also varied widely. The most common starting point reported by all participants was the name of the chemical, although emergency room physicians stated that they often started with a drug's street name or a product's brand name and needed to "translate" this to the chemical name. Participants involved in patient care indicated that their starting point for an information query is frequently specific symptoms combined with information on the

source of the exposure, such as the workplace or occupation. Exposure-related starting points (such as place of work, type of work or job, and geographic location) were also cited as common starting points by all participants.

Some of the participants in the focus groups conducted searches for information themselves; others stated that they had other staff members, such as assistants or research librarians, run database searches for them. The choice seemed to be based on (1) an ability to conduct a database search (access to the database and knowledge on how to conduct the search), (2) the time available to conduct the search, and (3) whether a high value was placed on seeing the data and information available and then "following leads" and data "trails." Specialists, researchers, and information specialists were most likely to conduct searches themselves. Policy advisors, educators, and medical students sometimes searched themselves and sometimes requested that searches be done by others. Physicians in general practice or nontoxicology-related fields were most likely to have others search for them.

All 34 focus group participants used computers at home and at work. Since all were computer literate, lack of ability or unwillingness to use a computer were not barriers to using online databases. Toxicology and environmental health specialists, researchers, and information specialists used online databases most frequently, followed by government policy advisors.

Focus group participants indicated that the primary advantages to using online databases rather than other sources were the ability to obtain information, particularly a large amount of information rapidly; frequency of updates; and the convenience of being able to access information from any computer with a modem (office or home).

The primary barriers to locating information through the use of online databases cited by participants were (1) cost of use, particularly downloading large files and, for nonfrequent users, the amount of time required to develop a query, and (2) the time and expertise needed to locate and process information (many separate databases, different search protocols, and the large volume of information to sort through in nonstandard or difficult-to-use formats). Although convenience and accessibility from any computer with a modem were cited as advantages to using online databases, participants also noted that if a potential user did not have access to a computer with the appropriate hardware, software, and "subscription," this would be a barrier resulting in the use of other readily available information sources (e.g., textbooks, colleagues). Several participants also cited the inability to get full-text information (e.g., copies of study reports or articles) directly from or through the database as a barrier.

Focus group participants expressed three primary concerns with the content of online toxicology and environmental health databases:

1. Validity and reliability of information. They were concerned that summarized data did not present a true picture, particularly regarding the weight of evidence. In addition, some participants wanted both peer-reviewed and nonpeer-reviewed information and wanted to know which was which.

2. Lack of availability of human data.

3. Inability to determine if a complete picture (all information) had been located or if a lack of information was due to (a) poor search technique, (b) information being "pulled" from the database due to controversy or while under study, or (c) a true lack of information.

All focus group participants expressed a desire for a more user-friendly system. Suggestions included the following:

• standardize protocols and terminology for searching;

• "one-stop shopping" (link databases so that they can be accessed with one query);

• lower costs;

• go to a "point-and-click" environment; and

• add the ability to email or otherwise transfer information directly and efficiently, and include the ability to access and download full texts of articles and studies.

Participants also had suggestions for improving health professionals' awareness of online databases including increasing training courses, particularly hands-on workshops, and online or demonstration disk tutorials; improved technical support resources, such as a toll-free telephone help-line, good help instructions, or user-friendly manuals and documentation; and advertising through articles in journals, newsletters, and other media.