Planning for a Medical Library Network, 1966
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planning for a medical library network by martin m cummings m d if a revolution in the information requirements of a society dependent on scientific advance accompanied by a rapid evolution in communications technology has focussed attention on national needs to develop or modify institutions to provide information services in new forms and at new levels federal agencies industry and universities concerned with science and its applications are engaged in redefining their information responsibilities in relation to the scientific and technical communities to which they correspond in the field of the health sciences and their application to health programs the public health service has a central responsibility for such development within the public health service the national library of medicine has a statutory mandate to devote its information resources broadly to the advance of the health sciences president johnson on the occasion of signing the medical library assistance act of 1965 said this creative process of knowledge expansion cannot go on unless the results of scientific work are available to practicing physicians and to health workers across the country the nation's medical libraries are a vital link between medical education practice and research . this measure provides long needed support for our medical libraries presented at the fourth annual symposium on biomathematics and computer science in the life sciences shamrock hilton hotel houston texas march 24 1966

Page  2 2 this act came at a propitious time for the national library of medicine permitting us to move ahead with planning a national biomedical information network to provide the vital link between medical education practice and research the national library of medicine at the time it was brought into the public health service ten years ago served as a national repository for books mongraphs and journals and provided extensive indexing bibliographic reference and interlibrary loan services today it serves the medical community as an active information center technological developments in information handling during the past decade have provided opportunities for the library to develop automated bibliographic searches computerized cataloging and rapid photocopy services the rising tempo of medical research increases the need for rapid and organized dissemination of information between scientists and practitioners there is increasing awareness that the latest medical developments should be made readily available to practitioners through improved information techniques geared to effective learning processes the biomedical library network for many years the national library of medicine and the nation's medical libraries have comprised an informal biomedical library system the impact of new knowledge generated by accelerated health research has imposed new responsibilities upon the existing system in fact the system is overloaded and is breaking down it has become obvious that if these responsibilities are to be carried out the existing informal system must evolve into a smoothly operating formal service network with modern

Page  3 3 facilities utilizing new technologies such a network must have the capability of acquiring all biomedical information organizing it and making it rapidly accessible to users anywhere at any time to achieve this objective nlm has drawn upon the advice of industry and universities to construct the concepts presented here the nlm program plan calls for a network fig 1 network which will efficiently acquire and provide rapid dissemination of published literature unpublished materials bibliographies and indexes and other learning resources the network should consist of four basic interconnected elements 1 the national library of medicine including its center for biomedical communications and national health information referral program - serving as a central resource for acquisition preservation and distribution of all textual and informational materials related to health 2 regional medical libraries - providing backup services to local libraries on a wide geographic basis these resources should have the capability of responding to 90 of the user requests 3 local libraries - including university medical school libraries teaching and community hospital libraries medical society and free-standing libraries these facilities should have the capability to serve as major learning resources within the community served

Page  4 4 4 specialized information centers - providing comprehensive information services in a particular subject area on a national rather than a local basis a network concept basic input to the system should include the world's published as well as unpublished medical information in addition to other learning resources the national library of medicine will continue its traditional function as a central collecting and switching mechanism by comprehensively acquiring materials and processing them for the widest possible dissemination distribution at the local level will be accomplished in two ways 1 information and other learning resources will be distributed geographically through a network of regional libraries serving local institutions and individual users when practical data communications equipment will be used to speed the flow of information throughout the network 2 materials will be repackaged for specialty groups to meet the particular needs of a subject field or institutional mission b nlm services to the network fig 2 - centralized activities the national library of medicine while continuing to serve as a central resource will assume additional responsibilities in the development and operation of the network with advice and direction from the board of regents and working with the institutions and organizations concerned the nlm will act as principal architect in planning network development and identifying existing centers competent to serve as regional medical libraries the nlm will coordinate activities appraise services and provide guidance for participating

Page  5 5 institutions importantly it will provide funds for the support of the local and regional components in a federal-private sector partnership the nlm will engage in a comprehensive international acquisitions program to procure published medical literature and other learning resources this will necessitate a constant search for all informational materials in the medical field this will require revision of policy on scope and coverage to encompass new interdisciplinary fields eg bio physics and environmental health sciences all materials entering the network through the nlm will be cataloged substantive journal articles will be indexed to ensure standardization of format consistency and economy bibliographic processing will continue to be handled centrally by the nlm which has been indexing and cataloging the world's medical literature for almost a century the nlm's indexing program should be accelerated to include every new journal article of significance the indexes and catalogs will be available to all users in machine readable form as well as in hard copy the bibliographic data generated will be entered into the nlm computer store this data will then be retrieved on demand and transmitted to all regional and local libraries and primary user groups in the past it has not been economically feasible for most libraries to acquire complete issues of all journal titles some of this important material is still available in original form some can be obtained only in microfilm form to ensure the availability of this information the national library will initiate a program of microfilming and the purchase of microfilms from commercial sources information in microform will thus

Page  6 6 be available for strengthening the resources of regional and local medical libraries either on a duplicate film purchase plan or on an interlibrary loan basis a graphic image storage and retrieval system will be linked to the computer system as a major transfer mechanism in an effort to provide regional and local libraries with abstracts of significant articles in addition to regular bibliographic services the nlm plans to develop a central computer file of abstracts the abstracts will be produced through contracts with outside groups and through other cooperating phs programs the abstracts will be stored in microform in a mechanized file and will be retrieved automatically as an adjunct to medlars bibliographic services through a newly created nlm center for biomedical communication fig 3 - cbc the nlm will procure and develop other learning resources for dissemination throughout the network these resources may include motion pictures videotapes and other audio-visual materials as well as un published reports this center will be located in a university based medical complex and will serve as the major research and development arm of nlm as the use of automated printing increases magnetic tapes or paper tapes carrying complete texts of documents might be made available to the nlm for experimental use in automatic indexing to keep current with new publishing technology and to assist in developing new publishing procedures which may lead to improved bibliographic processing the nlm will maintain a continual liaison with publishers the nlm will provide service to components of the network and will continue to provide local or direct services to other federal agencies

Page  7 7 professional societies and will serve as the regional library of the middle atlantic states through grant programs authorized by the medical library assistance act the nlm will provide supporting services to the network for the development of facilities resources and secondary publications and the support of local research and training activities c geographic dissemination access to the network's information holdings by users in the biomedical community is graphically presented in figure 4 the user community consists of 1 research workers at universities research institutes and industrial establishments 2 teachers and students at medical and other health profession schools and related institutions 3 health practitioners primary access to the system would be through the local library medical school hospital professional society state extension service however entry to the system by local terminals and dataphone linkages should be possible in the near future the library should be adapted to meet user needs rather than compelling users to conform to existing service patterns the nlm will periodically update the information stores of the regional medical libraries with bibliographic data in electronic form printed bibliographies microforms of selected publications which are not commercially available and other learning resources the regional medical libraries will be responsible for furnishing local institutions

Page  8 8 with 1 literature searches by computer 2 computer generated current-awareness listings 3 complete documents or when available abstracts of the original documents in either hard copy or microform 4 other learning resources audio-visual materials 5 reference services 6 training and orientation of medical librarians 7 research and development in information handling and 8 support to specialized information centers eventually as demand dictates and technology and funds permit the regional libraries will have direct electronic linkages to key institutions in their regions local connecting equipment on consoles or terminals will enable direct interrogation of the bibliographic data base in the regional computers the local institutions should be able to provide both current awareness and demand search services to their own users the medical library assistance act authorizes a program of grants to institutions to enable them to broaden their information capabiliy computer 2 computer generated current-awareness listings 3 complete documents or when available abstracts of the original documents in either hard copy or microform 4 other learning resources audio-visual materials 5 reference services 6 training and orientation of medical librarians 7 research and development in information handling and 8 support to specialized information centers eventually as demand dictates and technology and funds permit the regional libraries will have direct electronic linkages to key institutions in their regions local connecting equipment on consoles or terminals will enable direct interrogation of the bibliographic data base in the regional computers the local institutions should be able to provide both current awareness and demand search services to their own users the medical library assistance act authorizes a program of grants to institutions to enable them to broaden their information capabilities grants will be available for acquisition of library resources cataloging binding and other processing procedures acquisition of ey computer 2 computer generated current-awareness listings 3 complete documents or when available abstracts of the original documents in either hard copy or microform 4 other learning resources audio-visual materials 5 reference services 6 training and orientation of medical librarians 7 research and development in information handling and 8 support to specialized information centers eventually as demand dictates and technology and funds permit the regional libraries will have direct electronic linkages to key institutions in their regions local connecting equipment on consoles or terminals will enable direct interrogation of the bibliographic data base in the regional computers the local institutions should be able to provide both current awareness and demand search services to their own users the medical library assistance act authorizes a program of grants to institutions to enable them to broaden their information capabilities grants will be available for acquisition of library resources cataloging binding and other processing procedures acquisition of equipment to facilitate the use of the resources the acquisition of mechanisms and the employment of personnel for the speedy transmission of materials and information between the regional and the local libraries served by it and necessary construction renovation rehabilitation or expansion of their facilities grantee institutions serving as regional medical libraries

Page  9 9 would be required to expand and modify their resources to provide supportive services and to agree to provide free loan service and materials to qualified requesters in the early period of the establishment of the regional libraries those institutions receiving grant support will serve also as laboratories for the testing of devices and procedures for eventual incorporation into the total network d mission-oriented dissemination fig 5 - mission-oriented dissemination current criticism of the inadequacies of information systems in the sciences is not without foundation but before it is possible to reply to the critics with ready to implement corrective action the factors causing the deficiencies must be isolated and understood critical studies of user requirements represents a major problem area mission-oriented science has created fundamental changes in the requirements for information services traditional information services no longer respond properly to the changing demands of highly specialized information users in the biomedical sciences the new requirement to organize and service information by mission that is by special disease or health program category is being met by uncoordinated efforts to satisfy these needs the biomedical community is creating new specialized information centers based on grantsmanship rather than on carefully planned well identified national goals or objectives a specialized information center often has more financial support than the entire university library system the co-existence of traditional academically-oriented institutions with the new mission-oriented information service centers presents a

Page  10 10 challenge resources should not be unnecessarily duplicated and functions require sharper delineation libraries and specialized mission-oriented services must reinforce each other's functions without duplicating them the following general principles underlie the nlm's approach to this relationship 1 mission-oriented information centers have a primary function of evaluating and synthesizing information bearing on their missions or categorical areas 2 it is the nlm's responsibility to provide the primary materials which the mission-oriented information centers will analyze evaluate and distribute to their clients 3 mission-oriented information centers provide a secondary screening or indexing in depth whenever such service is an essential mission requirement we believe that depth indexing should be derivative from and compatible with the primary vocabulary the nlm's mesh medical subject headings list the vocabulary and nomenclature itself will be developed by these centers 4 mission-oriented information centers are intended to serve a national audience rather than a local one mission-oriented information centers will acquire library services directly from nearby regional medical libraries and/or local library units the centers will be provided photocopy services and bibliographies derived from medlars tapes an operational example is the current relationship between the medlars center at the university of california at los angeles and the brain research information center where the ucla library is

Page  11 11 searching medlars tapes furnished by the nlm and producing magnetic tape files of citations of special interest to the bric selected citations are then reworked by both supplier and user to provide increased depth of indexing and to serve as a base for analysis and critical review of the subject materials considerable effort has been placed on the compatibility of the brain research information center microthesaurus and the nlm medical subject headings list vocabulary and classification input from the specialized center upgrades the national resource itself other mission-oriented users of bibliographic services are directly served by the nlm they are considered broadly as two categories 1 federal agencies tapes from medlars constitute a resource which can be used by different agencies to provide current awareness and demand searches for the specific purposes of the agency the veterans administration is considering the use of medlars to develop services related to the va's mission the nlm is now developing similar relationships with the national institutes of health and other federal agencies such as fda 2 private or public professional groups during the past two years the nlm has developed cooperative arrangements using medlars to prepare master film copies of specialized recurring bibliographies which have been printed and distributed by the cooperating private professional groups these recurring bibliographies include the semimonthly index of rheumatology published by the american rheumatism association the index t dental literature published by the american dental association and the bibliography of medical education published

Page  12 12 by the aamg the nlm has agreed to furnish the pharmaceutical manufacturers association with duplicate medlars tapes for use in pma's proposed search service for its member companies these examples are representative of the many types of organizations and institutions which will provide specialized services to their membership by means of nlm's centrally prepared data tapes thus mission-oriented information centers directly serviced by the nlm will become an important link in the overall network finally the medical library network should be viewed as a major subsystem of a larger national information network here many problems remain to be solved it seems clear however that the ultimate destiny of medical libraries lies in their conversion into active biomedical communications centers summary the concepts of organization of existing library resources augmented and linked by new technologies we believe represent the most economic approach to improvement of biomedical communications we recognize that more sophisticated information systems will emerge and that ultimately the medical library network must fit into the structure of a national information system the on-going cybernetic revolution affects language information and society broadly medical libraries will be governed to a large degree by these developments i believe that libraries now have the proper attitude and interest to utilize and capitalize upon this important contribution of mathematics to medicine the technology is now fairly well developed where we are lacking is in resources and performance 1