History of CHIRS

CHIRS: Consumer Health Information Resource Service: a resource for Nebraska

In January 1985, a cooperative of three independent groups and agencies initiated the Consumer Health Information Resource Service (CHIRS) for Nebraska residents. The cooperative members included the McGoogan Library of Medicine at the University of Nebraska Medical Center, the Nebraska Library Commission, and more than 70 public libraries in the State1. Sixty percent of Nebraska’s population lives in the eastern part of the state in the metro areas of Omaha and Lincoln, while the rest of Nebraska’s residents live in rural areas. In the early 1980's, the state’s public libraries were receiving an increasing number of requests for medical information. However, the public libraries did not have the resources or the professional training to handle these requests. The public libraries referred the requests to the McGoogan Library of Medicine. McGoogan Library is the largest public health sciences library in the state; therefore Nebraskans recognize McGoogan as the logical source for their health information. Unfortunately, McGoogan’s collection at that time concentrated only on professional literature and contained little to no health information written at the lay level. McGoogan Library perceived the need for a consumer health information service based on the large number of requests and referrals for health information from Nebraska’s public libraries. The Nebraska Library Commission (NLC) divides the state in to six library regions, designating six regional resource libraries to support each regions’ smaller libraries. Because of this organized network of libraries, McGoogan recognized the NLC as an obvious partner in providing consumer health information.

In 1984 the McGoogan Library sought an LSCA Title III funding from the Library Commission to develop a consumer health information program for the state. As stated in the grant application, the original objectives of CHIRS were:

1. To work within the structure of Nebraska Library System to improve the delivery of consumer health information to Nebraskans.
2. To provide educational and consultation services to non-health science librarians, which would enable them to deliver enhanced first-line services.
3. To serve as a health information resource library for the state of Nebraska by providing information services beyond the capacity of the local library.

CHIRS aims to provide quality health information to Nebraska residents anywhere in the state at no charge. The public libraries and NLC readily accepted this model because CHIRS intends to enhance public library service. McGoogan resides in the background, while the public library remains the service point for residents.

The grant proposed to provide training and materials to the public libraries. In order for the public librarians to remain comfortable as the first line in the information process, McGoogan provided training throughout the state to increase their knowledge of health resources. Through this training, McGoogan introduced public librarians to specialized health materials. McGoogan also provided written guidelines to improve local public libraries’ abilities to deal with medical questions. Additionally, the grant allowed McGoogan to develop a lay collection of books and journals located at McGoogan Library. McGoogan purchased two copies of each title to allow for a circulating copy and a non-circulating copy. The non-circulating copy allowed McGoogan reference staff access to materials for reference questions while McGoogan loaned the circulating copy to the public libraries to share with their requestors. During the early years McGoogan and the NLC publicized CHIRS to public libraries, healthcare professionals, and consumers by preparing brochures and posters for each audience. Additionally, McGoogan developed a display and slide show that traveled to public libraries that described and promoted this new service. With each CHIRS response, McGoogan Library sent to the requestor a two page questionnaire with a self-addressed return envelope. McGoogan used these evaluations to adjust the level and amount of information that we sent to each requestor. McGoogan Library and the NLC established a CHIRS governing board consisting of members from NLC, representatives from the six library systems, and the Nebraska Department of Health. The board advised and acted as advocates for the program throughout the state. From McGoogan Library, the associate director for public services and the head of reference served as ex officio members.

20 Years of Evolution

The CHIRS program is now 20 years old and has evolved in a number of ways. First, we have changed the collection policy. Over time, we discovered that our customers prefer individualized packets of information that they can keep rather than materials that they must return to the library. We no longer purchase duplicate copies of titles and have expanded our collection with the money we have saved. The second change allows customers to contact us directly. According to our original policy, when a client contacted McGoogan, we referred them back to their local public library in order for the public library to submit the request to McGoogan. We recognized that a direct response to the requestor saved time for both the consumer and library.
After eight years, the CHIRS program had limited funding. The only income to the program came from the NLC for a portion of the document delivery cost. McGoogan Library assumed the cost for most of the program. In order to determine the cost of the program to the library, we implemented a time and motion study in 1994. We learned that an average request took two hours to complete, cost $25.00, and that each of the 5 reference librarians spent 21% of her time on consumer health. Out of these results, the NLC increased our funding for document delivery and McGoogan Library’s Director funded a subscription to a consumer health database with full-text. This report also prompted the NLC to negotiate a state-wide license to the consumer health database for all financially capable public and academic libraries.

In 1995 the NLC donated a staff member and travel costs to conduct four focus groups throughout the state. We wanted to assess the public librarians’ satisfaction level and discuss future directions of CHIRS. From the executive summary of the focus groups we found:

• Participants expressed overwhelming support for the CHIRS program.
• Public librarians want to be the initial point of contact for all CHIRS requests.
• Librarians believed that patrons would pay for health information.
• Librarians asked for annual collection development recommendations from McGoogan for health sources.
• Libraries requested annual promotional materials for CHIRS.
• NLC and McGoogan should explore opportunities to network electronic health information.

As a result of these recommendations, McGoogan’s librarians referred the more common requests back to public libraries; McGoogan developed a new brochure and poster for state-wide distribution; reference librarians from McGoogan Library provided additional classes on consumer health at the regional and state library association meetings; and the NLC supplied additional money to update the CHIRS collection.

The Medical Library Association's Consumer and Patient Health Information Section (CAPHIS) maintains a list of updated links to help with developing a consumer health collection.

Consumer Health Disclaimer:

This information is intended to provide general information for you. Some material may contain information that is the opinion of the author and not necessarily that of your physician. Only a health professional (physician, nurse, etc.) can interpret and individualize the information for a specific person's condition and situation. Please consult your health professional on specific medical questions.