The Next Group of AZHIN Members:  An Issue Paper by Alice Haddix and Michael Kronenfeld

Many, if not most, of the larger hospitals in Arizona are now or may soon be members of AZHIN. Two of the three state universities and the state's academic health science library are members and a state agency will join before the year is out. AZHIN is capable of expanding to include the remaining institutions and entities in the state that have trained librarians and sophisticated internal IS staff and systems with no dramatic change in its present organization and procedures. When, however, we turn to the next tier of possible members, health care delivery or education institutions that may not have trained medical librarians or professionals with searching and reference skills, and/or may not have adequate IS staff, existing internal information networks, or resources for training and equipment--then the picture changes.

At the present time, AZHIN assumes that the prospective member possesses not only the connection to the Internet specified in the Bylaws but the organizational and conceptual foundation to make good use of the network's resources: IS staff who can accommodate the resources and provide wide access; equipment and staff to maintain access technically; library and/or information professionals who can train users and promote the many advantages of the resources; end users who can be trained to any level thought desirable and who understand some of the potential benefits and possibilities of the resources.

When an institution joins AZHIN, basic assistance is provided by the AHSL technical staff to achieve access, to train users in basic searching techniques, to set up user account management and to respond to any individual concerns. Training in using AZHIN resources is provided periodically through formal classes taught by AHSL staff, or informally by librarians in member institutions. As new databases or other resources are added, user training is offered. Some written materials for users and trainers exist and more will be forthcoming shortly, but local searching expertise comes very quickly to reside in the member institution rather than in AHSL staff or AZHIN member volunteers.

AZHIN is now a volunteer organization. Directors and alternates participate as officers and on committees, performing the work of the organization in addition to their institutional responsibilities. Volunteers from the initial members of AZHIN have constituted the organization until recently; they cannot contribute to the organization a great deal more effort than they do now. AZHIN's paid staff and consultants are few and none is full time. Technical assistance and system maintenance now provided by AHSL are part of an agreement that extends through December, 1998, and may be renegotiated thereafter. If new members are not able to be as self-sufficient as the present members are, should AZHIN provide more and/or ongoing assistance? If so, where will the necessary assistance come from?

The formation and implementation of AZHIN to date is in part the response to this question: how can health care delivery and education institutions obtain access to information resources at an advantageous cost and participate in building a statewide information network for their members, learning to use new electronic tools, and sharing their experience? All the current member institutions possess the technical sophistication and information resources necessary to make good use of AZHIN, bringing specific information into the hands of those who need it.

The question AZHIN now faces is how health care institutions and individuals who do not have available significant reference or information expertise can obtain it for end users. Simply joining AZHIN does not solve that problem, since AZHIN offers database and other information resource access but does not provide specific information products (e.g., searches). The institution or person joining AZHIN still needs training and experience to use the resources AZHIN provides, and to acquire and distribute the materials identified through using AZHIN.

People and institutions without library resources may assume that AZHIN will meet all their needs, but this is not the case. Just as AZHIN does not provide connections to the Internet, the step before using AZHIN, so it does not now provide answers to end user information requests, the step after access to knowledge-based information.

If AZHIN is to assist the next group of potential members in obtaining access to knowledge-based resources, then it must develop a plan for how they might obtain full library service. Here are some options:

1. Enforce the requirement that representatives (Directors, Alternates and others) from each member institution be active in the work of AZHIN.
2. Hire AZHIN staff to provide technical assistance.
3. Hire AZHIN staff to provide training and assistance to users and trainers.
4. Hire AZHIN staff to promote AZHIN and educate potential users and members about its advantages, in publications, newsletters, visits, demonstrations, etc.
5. Offer searches and other operations using AZHIN resources, performed by paid AZHIN staff, to members for an additional fee.
6. Identify AZHIN members (such as AHSL or Mayo) or external information providers who can provide or sell the additional information services needed.
7. Restrict AZHIN membership to institutions that can be self-sufficient, as defined by AZHIN.

These options, and others, imply various changes to AZHIN as it is at present or would be if it merely became larger. Here are some of those implications:

1. Requiring participation often leads to descriptions of participation minima. AZHIN would have to develop such descriptions.
2. Hiring significantly more staff means a larger operations budget; should that increase come from members' dues? from adding more members but using additional income to pay staff salaries rather than adding new resources? from fees for certain services in addition to the privileges of membership?
3. Offering a service seems to put AZHIN in business, that of supplying a product (searches and the resulting information), rather than supplying a communications platform, access and certain resources that permit the member to obtain the product. Is this a business we want to be in? is it a business that jeopardizes our tax status? does it affect our licensing agreements with service providers?
4. Offering service for a fee raises the possibility (which need not, of course, become fact) of "the meter running," a condition that hampers use of resources and is contrary to the principle AZHIN has heretofore followed.
5. Restricting membership only to the "able" directly contradicts AZHIN's present statement of purpose, that it be "available to all...[health-related institutions] in Arizona." A change to the Bylaws would be necessary to reflect such a restriction.
6. Restricting membership also appears to have the effect of keeping certain powers and tools in the hands of the few, rather than making them available to all. AZHIN's mission speaks of "widespread use of electronic information management tools," which restriction contradicts.

A corollary issue to providing information for the end user is this: if AZHIN does arrive at a means for providing end user services, should it achieve a level of information access in institutions without library resources equal to the level provided by member institutions with libraries and/or information professionals on staff? This is not easily possible, and it may undermine member libraries by implying that health care institutions can obtain adequate information access without putting the resources into building and maintaining their own library resources (including professional staff).

Behind the options and their various implications lie philosophical principles, some explicitly stated and others taken for granted, that AZHIN has rested upon. The issue of how to serve potential member institutions that do not approach membership with the same institutional characteristics as present members possess, calls for discussion of these principles.

• AZHIN's stated mission is to make knowledge-based information available to all people engaged in health care practice, training and research in the state.
• AZHIN's mission is also to educate such institutions and their members/employees about the advantages of knowledge-based information, and electronic information management and tools.
• AZHIN membership shall be open to any institution or organization that meets the criteria described in the Bylaws.
• AZHIN shall be a volunteer organization, with only small allocations of the operations budget to staff salaries.
• All members shall contribute time and effort to the activities of the organization.

It may be that after discussion, no change in these principles is required but some adjustment in practice is necessary. For example, the "small allocation" for staff salaries that was appropriate when all members were able to use AZHIN well after receiving basic instruction may become larger in order to serve a different member population.

A caution may be necessary with regard to AZHIN's mission to make knowledge-based information available to all those engaged in health care and health science education in the state. While this is AZHIN's stated mission, it is not necessarily a part of the mission or needs of member libraries and institutions. We must be sure that a disproportionate amount of AZHIN resources (as represented by member dues supporting the operating budget) does not support information access for other health care providers unwilling to pay for those services themselves. This is a fine line to walk, of course, as many rural and small providers do not have the resources to access a full range of information services themselves and truly need help.

It will certainly be appropriate, as a result of these discussions, to begin drafting a strategic or long range plan for the organization. Such a document will be the repository for the plans and actions that bring AZHIN to its articulated goals.

10/10/96
A. Haddix
M. Kronenfeld

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Contact AZHIN coordinator for more information
Arizona Health Information Network, Inc., 1501 N Campbell Ave, PO Box 245080,
Tucson AZ 85724-5080
Phone: 520/626-8087; Fax: 520/626-2922