Volume VI, 2008
Article received June 20th, 2007. Revisions requested on September 9, 2007. Article accepted September 12, 2007.
Michigan Go Local: Connecting Michigan Residents with Health Services
Annette M. Healy1, Linda A. Draper2, Jill A. Turner2, Suzanne M. Van Pelt2 and Ellen B. Marks2
1Science & Engineering Library and 2Shiffman Medical Library, Wayne State University, Detroit, MI 48201
Abstract: Comprehensive information about local health services can be difficult for patients and consumers to locate. Michigan Go Local <http://medlineplus.gov/michigan> is an online directory of health services developed in partnership with the National Library of Medicine that enables state residents to locate health services in their community. Each health service in the directory meets specific selection guidelines and is indexed by geographic service area, types of health services provided, and health issues addressed. This article describes the development of Michigan Go Local and how it can be used by librarians and consumers to locate health services in communities throughout Michigan.
Insufficient knowledge about available healthcare services or difficulty navigating complex healthcare systems may prevent patients from accessing needed healthcare services. In many states, including Michigan, information about local health services is difficult to find because it is located in myriad print directories or pamphlets, scattered throughout the Internet, or buried in the websites of healthcare organizations. Likewise, healthcare professionals and health referral providers may lack access to comprehensive information about the healthcare services their clients or patients need. Michigan Go Local, developed in partnership with the National Library of Medicine (NLM), seeks to bridge the gap between Michigan’s residents and available health services by providing a searchable, online directory of health services throughout the state. Michigan Go Local is freely accessible and will greatly assist state residents, librarians and health referral providers in locating a wide range of health services. This article describes the development of Michigan Go Local and how it can be used to locate health services.
What is MedlinePlus Go Local?
MedlinePlus Go Local <http://www.nlm.nih.gov/medlineplus/golocal> is an initiative by the National Library of Medicine to develop online directories of health services. All Go Local projects are linked to MedlinePlus <http://medlineplus.gov>, the gateway to high quality consumer health information developed and maintained by NLM. MedlinePlus is the highest volume government-sponsored resource for consumer health information seekers (Miller, 2006) and provides increased visibility and credibility to the Go Local projects it sponsors. As of June 2007, there were 21 Go Local projects online and several others under development. Go Local projects are developed by state and local organizations in partnership with NLM.
The objective of Go Local projects is to develop databases of health services, programs and providers that are indexed by geographic service area, types of services provided and associated health issues. Libraries and other organizations interested in developing a Go Local project in their state or region can submit a written proposal to NLM as described in the MedlinePlus Go Local Participation Guidelines (U.S. National Library of Medicine, 2006).
Project teams can choose to use the NLM-based Go Local system or to use a locally-supported system such as an existing health-related website. The NLM Go Local system provides the hardware, software, and vocabulary required for the project, thereby greatly reducing the resources and expertise needed for the project. Hilligoss and Silbajoris (2004) of North Carolina have described the development of the first Go Local project, NC Health Info, which uses a locally-supported database system. Based on the NC Health Info experience, NLM developed a database system that could be used by projects that do not have the wherewithal to develop and support their own system. The development of NLM-hosted Go Local projects in Indiana and Massachusetts has recently been described (Gore, 2006; Richwine, Skopelja, & Rider, 2006).
How was Michigan Go Local developed?
The Vera P. Shiffman Medical Library at Wayne State University, the only academic health sciences library in Detroit open to the public, provides a number of outreach information services to various constituents in the state of Michigan. Community Health Information Services <http://www.lib.wayne.edu/shiffman/chis/> provides consumer health information to community members throughout Michigan. The Detroit Community AIDS Library <http://www.lib.wayne.edu/dcal/> provides resources and information for persons living with HIV/AIDS and their friends and family, including the publication of the User Friendly Manual for Persons Living with HIV/AIDS, a handbook of health services for those living with HIV/AIDS in southeastern Michigan. The Urban Health Partners program <http://www.lib.wayne.edu/shiffman/urbanhealth/> provides resources and services to public health providers in southeastern Michigan, including a collection of consumer health materials in Arabic (Charbonneau, Marks, Healy, & Croatt-Moore, 2007; Charbonneau & Healy, 2006). These programs gave the Shiffman Medical Library staff experience in providing health information services to different community groups, established a network of relationships with members of the healthcare community and community-based service organizations and honed expertise in developing and maintaining directories and websites, thus, providing a foundation for leading a Go Local project.
The creation of Michigan Go Local began with the preparation of documentation and training of staff. According to the Go Local guidelines established by NLM, each project must provide a project director contributing 0.5 FTE to the project. To meet this requirement, two librarians at Shiffman Medical Library served as project co-directors. The co-directors familiarized themselves with the NLM-based database system using documentation provided by NLM, established a style guide to ensure that all data was formatted in the same manner, developed selection guidelines to assist with selection of organizations to be included in the database, and developed training materials.
Once this documentation was in place, two part-time staff members were hired for data evaluation, indexing and entry. Because of the level of expertise needed to evaluate and index health organizations, students or graduates of library and information science programs that possessed a healthcare background were found to be most suitable for these positions. Experience in cataloging or indexing was found to be a desirable characteristic as well. Once these staff members were trained in the use of the NLM-based data input system, database development began.
The first health services entered into the database were from the aforementioned User Friendly Manual for Persons Living with HIV/AIDS because its information was readily available and up-to-date. Next, priorities were established to focus and organize the subsequent development of the database. Public health departments, nursing homes, hospitals, and community mental health agencies were identified as priority organizations that should be added to Michigan Go Local early in its development. Lists of public health departments and community mental health agencies were obtained from the Michigan Department of Community Health. Services provided by those agencies were determined by reviewing their websites or contacting the agency directly. Hospitals in the state were identified using the MedlinePlus Find a Hospital resource <http://apps.nlm.nih.gov/medlineplus/directories/index.cfm>, derived from the American Hospital Association annual survey of hospitals. Services provided by a hospital were determined by reviewing its website. During this review, all outpatient services and facilities listed on a hospital’s site were also entered into the database. Medicare and Medicaid certified nursing homes were identified using the Medicare Nursing Home Compare website <http://www.medicare.gov/NHCompare/Home.asp>. Services provided by a nursing home were identified using data from Medicare and the nursing home’s website if available.
The development of Michigan Go Local was exceptionally challenging because it covered such a large population and geographic area. Michigan Go Local staff, with guidance from NLM staff, ascertained that hospitals, nursing homes, public health departments and community mental health agencies were key organizations that should be included in the database before its official launch. However, staff also recognized that database development would need to continue after Michigan Go Local was made available to the public because of the large numbers of health providers and services located throughout the state that remained to be identified, evaluated and incorporated. In the first eight months after launch, Michigan Go Local has added more than 2200 new records. Michigan Go Local staff is committed to the continued growth of the database so that this resource remains current, comprehensive and relevant. Further development of the database can be monitored at the Michigan Go Local blog (http://www.migolocal.blogspot.com/). The continuation of database development after launch of a Go Local project is not unusual. INHealthConnect, the Go Local project for Indiana, included approximately 3000 records when launched in May 2005, but contained more than 9000 records nearly one year later (Richwine et al., 2006).
Information about a health organization incorporated into the Michigan Go Local database includes the name of organization, parent organization if applicable, address, telephone number, URL if available, and a brief description. Each record is indexed by geographic service area using the zip code, counties served, or the entire state as the service area. If an organization’s service area is not specifically indicated in material reviewed by staff, then the zip code is used to identify the service area. In the geographic mapping system provided by NLM, the zip code automatically maps to the municipality and county where it is located. Thus, as described below, each service can be located by identifying the desired zip code, municipality or county.
All health services, programs and providers in Michigan Go Local are also indexed by the type of health services they provide. There are more than 160 different health service terms in the Go Local vocabulary provided by NLM, and as many terms as necessary can be used to describe the services provided by a given organization or program. Health service terms include providers such as Cardiologists and Midwives, facilities such as Nursing Homes and Pharmacies, and services such as Support Groups and Hospice Care Services.
To more precisely define the scope of a health service, each health service term is then mapped to one or more health topics. For example, an asthma support group would be indexed as Support Groups, Asthma and a pain clinic for cancer patients would be indexed as Pain Clinic, Cancer. There are approximately 300 health topics to choose from, and these topics are a subset of the more than 700 MedlinePlus health topics. MedlinePlus health topics not included in the Go Local vocabulary are assigned to a broader MedlinePlus health topic. For example, the term Eczema is assigned to the broader topic Skin Conditions. The inclusion of MedlinePlus health topics in the Go Local vocabulary enables the user to move between Go Local to locate services for a particular health topic and MedlinePlus to locate medical information on that health topic.
To build the Michigan Go Local database, project directors assigned specific tasks to each staff member. Assigning a single type of health organization to a staff member was found to be the most efficient method for building the database. For example, one staff member entered all the nursing homes in the state and another staff member entered all the public health departments in the state. In working on a single type of health organization, a staff member became familiar with the services provided, the associated health issues, and other common characteristics of that type of health organization, and this growing familiarity increased the efficiency and accuracy of data entry. In addition, every record entered into the database is reviewed by an experienced staff member for accuracy, completeness and suitability. Between June 2005 and January 2007 Michigan Go Local staff created and approved the more than 6800 records that comprised the database at launch.
To be a reliable and valuable resource for Michigan residents, the records in the Michigan Go Local database must be current and accurate. A continuing responsibility of the Michigan Go Local project is to ensure that the records in the database are regularly audited for accuracy and currency. Project staff has implemented a plan for auditing all the records in the database annually. Post-launch Michigan Go Local experience revealed the need to balance the continued growth of the database with the review of older records for currency and accuracy. Michigan Go Local staff members will accomplish this by dividing their time between adding new records and auditing old records. This strategy will advance growth of the database while maintaining accuracy in existing records. In addition, NLM assists Go Local projects in keeping their databases current by providing automated weekly broken link reports. Each project is notified of the existence of broken links and is responsible for repairing or removing the broken link.
Promotion of Michigan Go Local
Promotional activities undertaken by Go Local projects have been varied and designed to best reach the constituents of a given project. Successful promotional activities used by Go Local projects include public service announcements, radio advertisements, exhibits at health fairs and conferences, and press releases (Gore, 2006; Richwine et al., 2006). As noted above, librarians from Shiffman Medical Library are active in various outreach programs and have developed numerous contacts in the healthcare and public health communities. Thus, Michigan Go Local has been promoted at a variety of events including conferences, workshops and health fairs. Participation in these events increased awareness of and interest in Michigan Go Local and allowed staff to expand their circle of contacts and learn about additional health services that could be included in the database.
Staff took advantage of opportunities to introduce Michigan Go Local to librarians at the Michigan Health Sciences Libraries Association conferences (2005 and 2006), and the Michigan Library Association conference (2006). Contacts in the mental health community led to an invited presentation at the Association of Community Mental Health Boards winter conference (2006), and Michigan Go Local was introduced to public health providers at the Annual Michigan STD & HIV Conference (2005 and 2006). Workshops by library staff at local public health departments also provided opportunities to promote Michigan Go Local.
Promotion and awareness were heightened once Michigan Go Local was made available to the public. NLM promoted Michigan Go Local through a variety of discussion lists for health science and consumer health librarians, as well as featuring the project on the MedlinePlus homepage. In Michigan, Michigan Go Local was promoted to librarians through various discussion lists. The Michigan Electronic Library features Michigan Go Local among its recommended websites for health, medicine and wellness. In addition, a number of public libraries in Michigan have added a link to Michigan Go Local on their websites.
The launch of Michigan Go Local was publicized to public health providers at the Michigan HIV/AIDS Council meeting in March 2007. In May 2007, Michigan Go Local staff conducted a training session sponsored by the Michigan Health Sciences Libraries Association for librarians and library support staff. Michigan Go Local staff continues to seek out promotional opportunities and use community and collegial contacts to disseminate information about this important resource. Project staff also continues to seek partners to participate in Michigan Go Local’s continued development and enhancement.
NLM provides each NLM-hosted Go Local project with a monthly report containing comprehensive usage data. These reports contain a variety of data including visitors per month, page views per month, location of visitors by city and referring domains. Michigan Go Local staff are currently reviewing and evaluating these data and developing strategies to guide future database development and promotional efforts
Locating Health Services using Michigan Go Local
Michigan Go Local is easy to use and offers flexible options for accessing its resources. From each MedlinePlus topic page, users can select a Go Local project from the drop down menu in the Go Local box to locate health services for that topic. Figure 1 shows the Go Local link from the MedlinePlus Asthma page.
Users would choose Michigan from the available Go Local projects and then narrow their search to a geographic area within Michigan by choosing a zip code, county, city or the entire state. The user will then see asthma services for the geographic area they chose arranged by service type. Figure 2 shows services for asthma in Macomb County, which include allergists, pulmonologists, health education programs and physical rehabilitation programs.
On each page of services within Michigan Go Local, users will also find links to MedlinePlus to access consumer health information on their health topic(s) of interest (not shown). For example, a Michigan Go Local page containing services for diabetes will have a link to the MedlinePlus Diabetes topic page. This arrangement offers easy navigation between quality consumer health information and pertinent local services.
A user can also access Michigan Go Local directly by entering the URL <http://medlineplus.gov/michigan> into their web browser or by clicking on a link that directs them to the Michigan Go Local homepage. There are a number of options for navigation from the Michigan Go Local homepage. A search box is available for key word searches (not shown). As shown in Figure 3, users can also choose to browse by location, type of service provider or health issue.
Users that choose to browse by location are asked to narrow their search to a city or county. A list of all health services in the database in that geographic area is then presented. Clicking on a specific service will bring the user to detailed information about specific service providers in that area such as the information on allergists in Macomb County shown in Figure 4.
Users that choose to browse healthcare providers, facilities and services will choose the type of service they are interested in from an alphabetical list and then narrow their search geographically by choosing a city, county, the entire state, or searching within 10-200 miles of a given zip code. They will then see a list of organizations providing that service in the location they chose.
Users that choose to browse by health topic can choose a health topic from an alphabetical list and then narrow their search geographically as described above. They will then see all health services associated with that health topic in the chosen geographic region. As shown in Figure 4, information available to the user about a given healthcare provider, facility or service includes name, address, contact information, a brief description and a link to the provider’s website if available. In addition, NLM has partnered with MapQuest so that each Go Local record includes a link to a map and driving directions to the provider’s location.
Michigan Go Local is an easy-to-use resource developed in partnership with NLM that connects Michigan residents with available health services in their community. It provides a comprehensive and reliable resource for locating health facilities, providers and services that is continuously reviewed and updated. Michigan Go Local is unique in that there are no other comprehensive directories of health services in Michigan that are freely available online. Michigan Go Local consolidates information previously scattered throughout numerous websites or print directories and greatly facilitates locating health services in the state.
In addition, the numerous indexing terms available in the Go Local vocabulary enables consumers, librarians and health referral providers to precisely locate health services that meet their needs. The links between Michigan Go Local and MedlinePlus allows users to easily locate both consumer health and health service information. Librarians across the state can play a pivotal role in the success of Michigan Go Local by utilizing this valuable resource to assist patrons, promoting its use in their communities, and keeping Michigan Go Local staff up-to-date on health service information in their communities.
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