Karen Gutzman, MSLS, MA 
Head of the Research Assessment and Communications Department  
Galter Health Sciences Library & Learning Center  
Northwestern University 

Elizabeth Laera, MLIS, AHIP 
Medical Librarian 
McMahon-Sibley Medical Library 
Brookwood Baptist Health 

Editor’s Note: This article represents a significant truncation of a “Commentary” written by multiple authors and published in the January 2021 issue of the Journal of the Medical Library Association. It is presented here with the permission of all the authors and the publisher. To read the full article, click here.  

As part of the MLA InSight Initiative Summits in 2019 and early 2020, a group of librarians and representatives from companies who sponsored the InSight Initiatives met multiple times with the goal of understanding and defining the barriers, or “pain points,” that users face when trying to access information. Once they defined the barriers, they then brainstormed potential solutions for each point. The group interacted with a six-member End User Advisory Board (EUAB) composed of physicians, clinical researchers, and clinical faculty in biomedicine and consulted the literature.  

The working group identified the following eight pain points that users experience when they try to access information in a clinical environment. 

1. Time. This barrier includes time to get access, search, find, and receive help. Research has shown that clinicians lack the time needed to answer clinical questions and read up on useful topics. Potential solutions include integrating information resources into the clinician workflow or electronic health record (EHR), implementing library consult services, and providing continued yet improved, easy, and timely access to librarians and informationists. “Everything would be impacted if the time pain point was alleviated,” according to one EUAB member.  

2. Awareness. Despite information providers’ and librarians’ marketing and outreach efforts, users generally lack awareness of the information resources that their institutions license and how to access them efficiently. The EUAB members agreed that librarian participation in orientations and committees is an excellent way to remind clinicians of information resources. Publishers and librarians should collaborate on marketing and outreach for better effect.  

3. Access — including repeated login requests, too many passwords, and complex firewalls that block sites – is another major pain point. Identified obstacles include multiple layers of authentication and personalization requiring an individualized login and password; some hospitals imposing stricter Internet access that results in limiting users’ ability to access information resources they are entitled to; others block certain sites that can provide needed and desired information sources.  

4. Paywalls: “Paywalls [limiting access to full-text] stop all investigations,” said one EUAB member. Another shared that nurses in their organization often resorted to finding illegal copies of paywalled literature. Paywalls also hinder the ability to share content on a larger scale especially with colleagues at other institutions. Potential remedies include using a tool such as Unpaywall, improving verification of library resources via Internet protocol (IP) authentication, and expanding efforts to educate end users on the many ways to obtain full text. Publishers could add an “Easy Button” or “Get It” button to get full text via interlibrary loan.  

5. Resource platforms refers to the situation where needed content is spread across too many platforms that lack standardization and interoperability. Publishers’ platforms have different access rules, interfaces, features, and functionality. The labor involved in searching multiple platforms inhibits users from viewing the full breadth of content that they have access to. Potential solutions include publishers optimizing the discoverability of their content. Institutions and librarians can create data and text mining initiatives that allow users to search for information efficiently across multiple platforms.  

6. Resource scope. While the EUAB agreed that multiple platforms are a pain point, understanding which tool to use and when is even more critical. Users are overwhelmed with the number of resources that are provided and can’t easily discern differences. Google’s simple interface and search speed make it almost irresistible. The literature shows that clinicians often bypass traditional information sources in favor of Google. Potential solutions involve better education and better promotion. Librarians should tailor their instruction to each user group and limit the number of resources demonstrated. Publishers need to understand their products must meet the user friendliness standards of Google and Amazon. Publishers can also create videos with product tours.  

7. Integration of information resources into clinicians’ workflow is a critical need. Information resources need to be easily accessible in and around the patient encounter. Mitigating this pain point requires understanding where users begin their searches. If searches begin in the EHR, then accessing information from resources integrated into the EHR becomes more efficient. The EUAB advocated improved and easier access via mobile devices and “easy” buttons. Making clinical practice guidelines accessible at the point of care would be welcome.  

8. Financial limitations, meaning how financial issues can limit user access to resources, is a foundational barrier. The cost of resources influences access, and difficult decisions regarding resource purchasing and subscription renewals determine the availability of specific resources for end users. The financial burden of acquiring information products or tools causes unequal access for clinical providers. Librarians in limited financial settings should search out and promote free resources that are accurate. Institutions and publishers need to come together for a more nuanced discussion of pricing for information tools and resources and develop creative solutions that benefit everyone. In response to the COVID-19 pandemic, industry partners have demonstrated that opening access to resources has made a significant impact on patient care and illustrates the importance of financial flexibility.