The National Library of Medicine's Role in the National Biomedical Library Network, 1966
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THE NATIONAL LIBRARY OF MEDICINE'S ROLE IN THE NATIONAL BIOMEDICAL LIBRARY NETWORK by Martin M. Cummings, M. D.* [* Presented before the.Conference on Biomedical Communication: Problems and Resources, sponsored by the New York Academy of Sciences and the Public Health Service Audiovisual Facility, the Waldorf-Astoria, Park Avenue, New York City, April 6, 1966.] A revolution in the information requirements of a society dependent on scientific advance accompanied by a rapid evolution in communications technology has focused 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 improvement of our nation's health and to the advance of the health sciences[1]. The Public Health Service recently published a Report to the People on Health which was dramatically entitled "...foundation for all our aspirations.[2/]" The report emphasizes that "This year the government will support more than 16,000 separate medical research projects and the advanced training of about 25,000 scientists." These research projects will create new data and findings adding to the already existing information

Page  2 overload. This report is concerned also with the distribution of knowledge. It clearly identifies the role of the National Library of Medicine in collecting, organizing, and disseminating this information. President Johnson, on the occasion of signing the Medical Library Assistance Act of 1965 [3/] 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." The National Library of Medicine's responsibility, in the national effort to improve the total health of the people, is a large one and it should be emphasized that all medical libraries share this responsibility. As the nation's primary resource for accumulating, preserving and distributing information relevant to health, the National Library of Medicine is the custodian of nearly 1,250,000 books, journals, theses, photographs and other graphic materials relating to the health sciences and professions. For many years the Library has been the center of an informal medical libraries system with well established mechanisms for exchange and sharing of collections. With advanced systems of information handling, the Library's ability to disseminate published knowledge related to human health is unequalled. The National Library of Medicine, at the time it was brought into the Public Health Service ten years ago, served as a national repository

Page  3 for books, monographs, 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. It now recognizes that other learning resources such as audio-visual materials must be added to its collections so that access to them is democratized in the same way as printed texts. The rising tempo of medical research increases the need for rapid and organized dissemination of information between scientists and practitioners[4/]. There is increasing awareness that the latest medical developments should be made readily available to practitioners through improved information techniques. The Library also serves as a base for effective continued learning and education. The National Library of Medicine is responding to the increasing expectations of the American people for greater access to comprehensive health services by applying new technologies to augment traditional medical library services. The emphasis for redirecting and reshaping of the Library's programs has been on achieving more effective and more rapid response to the demands of the nation's physicians, scientists and educators. In January 1964, the National Library of Medicine began operation of MEDLARS, a new computer-based Medical Literature Analysis and Retrieval System (Figure 1)[5/]. MEDLARS is now providing more than 3,000

Page  4 demand search bibliographies each year. Each month medical libraries throughout the world receive Index Medicus, a comprehensive subject and author oriented bibliography produced by MEDLARS. Annually, Index Medicus cites references to more than 170,000 articles in the biomedical journal literature. Another product of the Library's computer program is the recurring bibliographies produced in cooperation with leading national public and private health agencies. As one example, Index to Dental Literature is produced in cooperation with the American Dental Association[6/] . The newest product of the system is the Library's computer produced Current Catalog. All libraries may now receive the descriptive catalog of all NLM acquisitions in express book form, biweekly. This service, available for $15. per year, will save the nation several million dollars now spent in duplicative cataloging of the same materials. Although the system is only two years old, MEDLARS is rapidly reaching its maximum capacity. With an expanding demand for its products, and with rapidly increasing information to be analyzed, organized and distributed, decentralization of the system is clearly indicated. It is a tribute to the foresight of those who planned MEDLARS that when we reached the point in time when decentralization became a matter of urgency, the system was able to accommodate the need. Today, decentralized MEDLARS search centers are in operation at the University of California Medical Center in Los Angeles and at the University of Colorado Medical Center in Denver, while other centers are being established at the

Page  5 University of Alabama, University of Michigan, and Harvard. More decentralized MEDLARS centers are being developed as part of the proposed national network of regional MEDLARS facilities[7/]. Medical libraries throughout the country, historically structured in the "free public library" pattern, because of increased demands and under-support in recent years, have been compelled to make charges for library loan and reference services. To assure the nation of a free flow and transfer of medical information the Presidentially appointed Board of Regents of the National Library of Medicine [1/] has made the following policy determination: l. Access to the information in the National Library of Medicine should be available to all qualified users without charge, as a public service. 2. The National Library of Medicine's services should be viewed as part of the total responsibility of the Federal Government for the health of the people. 3. All cooperative service programs between the National Library of Medicine and other agencies, institutions or organizations should reflect these service policies. As such a national resource, it can and should play a major role in supporting and improving both basic and continuing education of the health professions by providing information and communication resources essential to the educational process. The Library's plans call for bold and vigorous programs which will respond with quality and speed to the increasing demands for information by the biomedical community.

Page  6 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 facilities utilizing new technologies. The NLM is now planning for a user-responsive biomedical library network 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 of a medical library network presented here. It takes into account the following factors: 1. Consumer requirements; 2. Operational costs and administrative problems; 3. Throughput time requirements; 4. Transmission quality requirements based on the current state of the art of electronic and computer linkages. The NLM visualizes a network (Figure 2 Network) which will efficiently acquire and provide rapid dissemination of published literature, unpublished materials, bibliographies and indexes, and other learning resources. We view the network as consisting of four basic interconnected elements:

Page  7 1. The National Library of Medicine (including a proposed new Center for Biomedical Communications and National Health Information Clearinghouse and 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. 4. Specialized Information Centers - providing comprehensive information services in a particular subject area on a national rather than a local basis. These should serve as specialized evaluative and synthetic nodes in the network. 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 collection and switching mechanism by comprehensively acquiring materials and processing them for the medical information, in addition to other learning resources. The National Library of Medicine wed, medical information, in addition to other learning resources. The National Library of Medicine will continue its traditional function as a central collection and switching mechanism by comprehensively acquiring materials and processing them for the medical information, in addition to other learning resources. The National Library of Medicine will continue its traditional function as a central collection and switching mechanism by comprehensively acquiring materials and processing them for the

Page  8 widest possible dissemination. Distribution to 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 (Figure 3 - Centralized Activities) It is important to note that the NLM is particularly concerned with the quality and scope of input to the system. We recognize that acquisition of published literature, traditionally the major source of medical information, is only part of the story. Unpublished materials, such as films audio and video tapes, will become a more significant part of the collection enabling us to effectively fulfill our responsibility as a national information resource. 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 indexes and catalogs will be available to all users in machine readable form as well as in hard copy.

Page  9 The bibliographic data generated will be entered into the NLM computer store. These data will then be retrieved on demand and transmitted to all regional and local libraries and specialized user groups. To ensure the availability of information in microform, the National Library is expanding its program of microfilming and purchasing microfilms from commercial sources. Information in microform will 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. Through a planned NLM Center for Biomedical Communication (Figure 4 - Center for Biomedical Communication) the NLM will procure and process other learning resources for dissemination throughout the network. These resources may include motion pictures, videotapes, and other audio-visual materials, as well as unpublished reports. This Center will be located in a university based medical complex and will serve as the major research and development arm of NLM. The proposed Center will also serve as a PHS referral unit where entry into all health information resources may be obtained. In addition it will serve as a regional branch of the NLM serving the area of the nation in which it is located. C. Geographic Dissemination The objective is to provide equal and rapid access to medical information by users in any part of the nation. Primary access to the network would be through the local library (medical school, hospital,

Page  10 professional society, state extension service). However, entry to the system by local terminals and dataphone linkages should be possible in the near future [8]. The local library should be adapted to meet user needs rather than compelling users to conform to existing service patterns. Access to the network's information holdings by users in the biomedical community is graphically presented in Figure 5. 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. We are projecting a series of interrelated, yet independent regional medical libraries. Most of these libraries will be developed by expansion of existing university-based or free-standing institutions of excellence. Each library should be capable of responding to 90% of all requests for service. In regions where no such facilities exist, the NLM is authorized [3/] to provide regional medical library services by establishing NLM branches. Eventually, as demand dictates and technology and funds permit, the regional libraries will have direct electronic linkages to key local institutions in their regions. Connecting equipment (consoles or terminals) will enable direct interrogation of the bibliographic and reference data base in the regional computers.

Page  11 The NLM will periodically update the information stores of the regional medical libraries with bibliographic data in electronic form, printed bibliographies, microforms of selected high use publications, and other learning resources. The regional medical libraries will be responsible for furnishing local institutions 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. Literature support to specialized information centers; 7. Training of medical librarians. D. Mission-Oriented Dissemination 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[9/]. In the biomedical sciences the new requirement to organize and provide information by mission or categorical health program now is being attempted by uncoordinated efforts. To satisfy these needs, the biomedical community is creating new specialized information centers based on local interest rather than on carefully planned, well identified national goals or objectives. The co-existence of traditional, academically-oriented institutions

Page  12 with the new mission-oriented information service centers presents a challenge. Resources should not be unnecessarily duplicated and functions require sharper delineation. Libraries and specialized mission-oriented services must reinforce each others functions without duplicating them. The proposed relationships of the mission-oriented information centers and the planned medical library network is shown on the next chart (Figure 6). 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 relating to their categorical health interests. 2. NLM plans to provide the primary informational materials which the mission-oriented information centers will analyze, evaluate and distribute to their clients. 3. Mission-oriented information centers will provide abstracts or indexing in depth whenever such service is an essential mission requirement. We believe that depth indexing should be compatible with the NLM Medical Subject Headings[10/]. New vocabulary and nomenclature may be developed by these centers and in turn will be integrated into the central thesaurus. 4. Mission-oriented information centers are intended to serve a national audience rather than a local one.

Page  13 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. Feedback in the form of vocabulary and classification input from the specialized center is expected to upgrade the national resource itself. For the last two years, NLM has been working with professional societies and other specialized organizations in providing missionoriented bibliographies through the MEDLARS computer system. Master film copies of many specialized bibliographies have already been prepared. We foresee a growing list of users who may be considered broadly as falling in 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 needs of the agency. 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. Examples of such recurring bibliographies include the semimonthly Index of Rheumatology, published by the American Rheumatism Association, the Index to Dental Literature published by the American Dental Association, and the Bibliography of Medical

Page  14 Education published by the AAMC. Thus, mission-oriented information centers directly serviced by the NLM will become an important link in the overall network. 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 from passive repositories of information into active biomedical communications centers. Many plans have been proposed for the development of national information systems and networks. Unfortunately, many of these proposals disregard existing institutions, such as universities and their libraries, and the role they can play in the development of a national information network. We at the National Library of Medicine are convinced that any national system should be built on existing improved resources. The network may be built from the apex (NLM downward, or from the base (local libraries) upward. We are convinced that an effective network cannot be built, as some suggest, from an uncoordinated effort outside the triangle or existing local, regional, and national library resources. Summary The scientific revolution of the 20th Century must be accompanied by technological improvement in information science which will make knowledge generated by research readily available to all who need to apply it for the ultimate benefit of mankind.

Page  15 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. As a strong nation requires a healthy scientific base, so does a strong science require excellent communications. As an instrument invented by society, libraries will be governed to a large degree by scientific and technological developments. We believe that libraries now have the proper attitude and interest to utilize and capitalize upon the important contributions of mathematics to medicine. Communications technology is now fairly well developed. Where we are lacking is in resources and performance!

Page  16 ILLUSTRATIONS Fig. 1 MEDLARS Fig. 2 Biomedical Library Network Concept Fig. 2 Centralized Activities at NLM Fig. 4 Center for Biomedical Communications Fig. 5 Geographic Dissemination Fig. 6 Mission-Oriented Dissemination

Page  17 REFERENCES 1. National Library of Medicine Act (P.L. 84-841) 2. U.S. Public Health Service. Foundation for all our aspirations; a report to the people on health (Washington) (1966) 3. Medical Library Assistance Act (P.L. 89-291) 4. U.S. President's Commission on Heart Disease, Cancer and Stroke. A national program to conquer heart disease, cancer and stroke; report to the President, V. II. Washington, D. C., U.S. Government Printing Office, February 1965. 5. U.S. Public Health Service. The MEDLARS Story at the National Library of Medicine, Washington, D.C., U.S. Government Printing Office, 1963 6. Anonymous "Index to Dental Literature' has a new look," Journal of the American Dental Association, October 1965, 71:952 7. U.S. National Library of Medicine. Board of Regents. Advisory report on Policy to the Surgeon General of the U.S. Public Health Service. Nov. 15, 1965 8. Licklider, J.C.R. Libraries of the future. Cambridge, the M.I.T. Press, 1965 9. Simpson, Jr., G.S. Scientific information centers in the United States. American Documentation, January 1962, 13:1 10. U.S. Public Health Service. Medical Subject Headings, Washington, D.C., U.S. Government Printing Office, 1966

Page  18 [MEDLARS workflow diagram]

Page  19 [biomedical library concept diagram]

Page  20 [centralized activities diagram]

Page  21 [center for biomedical communications diagram]

Page  22 [geographic dissemination of biomedical information diagram]

Page  23 [mission oriented dissemination of bibliographic information diagram]