Experiences with the U.S. Medical Library Network, 1971
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experiences with the us medical library network introduction a realistic appraisal of medical libraries in the united states has demonstrated that there is a great disparity between the present and potential roles of a medical library problems exist in meeting the needs of the professional user whether he be in health research education or practice these problems can be traced to the fundamental issues of the nature availability and utilization of resources both human and material we have some excellent libraries in the united states but we also have many which are ill equipped and with inadequately trained staff thus we have physicians and scientists who are geographically distant from modern library facilities and hence they may be isolated from current information sources to remedy these difficulties the national library of medicine re-examined its mandate from the us congress martin m curcmings md director national library of medicine

Page  2 2 to serve as a national resource and to assist the advancement of medical and related sciences and to aid the dissemination and exchange of scientific and other information important to the progress of medicine and to the public health as a result of this examination we have developed new programs which are directed at both the individual and the institution and at local regional and national levels under our programs initiated in 1966 us medical libraries receive financial assistance to improve library resources and the provision of services to increase the number of specialized staff to apply electronic technology to library processes and information services and to develop interlibrary network relationships the national library of medicine now also has a national medical audiovisual center for the acquisition cataloging and distribution of audiovisual resources and specialized information services in 1968 we established a new component of the library the lister hill national

Page  3 3 center for biomedical communications this is a result of our belief that scientific communications must have the benefit of the latest technological advances and the continuing attention of research and development medical library network my discussion of our programs and efforts represents a sharing of our experiences and should not be interpreted as a total resolution of our problems nor as a recommended means of resolution we are changing some aspects of our programs as a result of our experience but our primary objective remains unchanged ie to respond more effectively to the needs of the health professional by improving medical library resources and services we believe that we can best achieve this goal through a network of medical libraries a network does not connote a rigid unchanging snare of inter connections it does signify a planned sharing of resources systematically so that improved services can

Page  4 4 be provided with maximum efficient utilization of available resources manpower fiscal and technological thus the underlying principle is cooperative service in the us there are approximately 6000 medical libraries of differing size and scope they may be located within a university a medical center or a local hospital these libraries may differ in organizational setting but not in the service they should perform for the medical profession many are too ill equipped and poorly staffed to provide adequate service in order to assist these institutions in a systematic and constructive manner we established a regional link to interrelate the national and local institutional levels this link is the regional medical library regional medical libraries are principally university based are selected on a competitive basis from libraries with a strong collection a well trained staff and a record of providing medical library services the first regional medical library was established in 1967 and today there are eleven such regional medical libraries with the national library of medicine itself

Page  5 5 designated as a regional library for a geographic area in the mid-atlantic united states this latter action was deemed necessary to obtain operating experience to enable our library to be sensitive to the day-by-day operational problems encountered by the regional libraries throughout the country the hierarchical system for the medical library network therefore consists of 1 the nlm as the comprehensive national resource which can assist other medical libraries in terms of material not in their collection as well as serving as the indexing and cataloging center for the nation 2 the regional libraries which will improve and expand their reference and interlibrary loan services to medical and hospital libraries in a broad geographic area and 3 the local libraries which must serve many individual health professionals on site

Page  6 6 the national library of medicine has unique national responsibilities not only to serve as a resource but to encourage the establishment of library standards union serial lists and cooperative cataloging some of these tools and procedures are best developed cooperatively on an overall national basis with subsequent availability to all otherwise uncorrelated independent efforts will consume the limited available resources and produce few overall advances on a national basis the library has been working cooperatively with the library of congress and the national agricultural library in an experimental project on developing a computer-based national union serials list the national library of medicine has supplied some 4400 titles and holdings to this national serials data project to assist other libraries in their acquisition and cataloging our library has been producing a bi-weekly current catalog of all our new acquisitions in addition the library has plans to develop a catalog

Page  7 7 card service it is anticipated that by mid-1971 there will be commercial production and distribution of national library of medicine catalog cards which will carry full descriptive and subject cataloging and national library of medicine classification this will enable other libraries hopefully to achieve an efficient acquisition and cataloging program with minimum expenditure of time and funds designation as a regional medical library requires the recipient institution to increase its scope and nature of services to health professional users in a broader geographic area since the operation of the first regional medical library in 1967 4-i/2 million dollars have been expended and all eleven of the regional medical libraries are in various stages of operational activity if one examines the last year of operations for 7 regional medical libraries with 4 of them operational for less than one year the distribution of 1.65 million dollars in grant funds in terms of service is

Page  8 8 42 for interlibrary loan services 17 medlars demand search services 9 education and consultation primarily for local hospital libraries 7 preparation of union lists 6 orientation and information programs 4 reference services 15 other management and overhead this slide shows the inter library loan circulation for our library from 1965-1970 in terms of requests received filled and unfilled it also illustrates the increased use of twx for submission of these requests to us prior to the 1967 establishment of the regional medical libraries the national library of medicine was receiving on a national basis approximately 175000 interlibrary loan requests annually in three years 1 time and with the regional medical libraries in various stages of operational capability the total national interlibrary loan activity for both the national library

Page  9 9 of medicine and the regional medical libraries has more than doubled if one excludes interlibrary loan requests nlm receives in its role as a regional medical library and from foreign sources then the level of interlibrary loan requests nlm receives in its capacity as a domestic national resource has dropped to approximately 48000 it is anticipated that with the full operation of all the regional medical libraries this figure of 48000 may well be the maximum for the nlm and we are hoping that there may even be a further downward trend although fewer in number these requests are for the most inaccessible and rare items in the medical literature the establishment in 1964 of the nlm's computer based bibliographic storage and retrieval system medlars generated considerable demand for medlars demand searches throughout the us and abroad accordingly decentralized medlars centers were established in the united states some of these centers are part of the regional medical libraries others are institutions in

Page  10 10 the same region and they work cooperatively with the regional medical library in the last year there were 22000 medlars demand searches released of these approximately 36 were by foreign centers 48 were by us centers 16 were by nlm the interlibrary loan and the demand search services are thus two service functions of the national library of medicine which have been decentralized in an effort to make these services available more efficiently to the professional health user i would like to cite a very interesting development by the new england regional medical library this was a project to provide guidance to hospitals on medical library development and on the selection of a core medical library appropriate to a community hospital this has been extremely useful and the national library of medicine has used this as a basis for a slightly expanded collection described as a basic hospital library

Page  11 11 resource grants it is clear that decentralization of services through our regional medical libraries cannot occur without some corresponding improvement in the resources of medical libraries in this country because it is upon resources that information services depend nlm accordingly developed a resource grant program and 401 grants have been made in a five-year period totaling almost 12 million dollars the distribution and utilization of these grants provides us with an interesting commentary on medical library operations approximately 50 of the number of resource grants went to hospital libraries but approximately 63 of the monies went to medical libraries within academic institutions over 50 of the monies expended under the resource grants were to acquire journals books and informational materials approximately 24 of the monies enabled the medical libraries to increase the number of their staff and 16 was for the purchase of equipment

Page  12 12 this experience illustrates the need to change the emphasis of this program from acquisitions to services utilizing the materials in the collection this is consistent with our basic philosophy that a modern medical library dynamically utilizes the resources available to it graphic image system because interlibrary loan photocopy service is a major component of a medical librarys service activities the national library of medicine began to explore alternative approaches in handling the heavy load of interlibrary loan requests received annually by our library an analysis done of the interlibrary loan services of our library showed that 30 percent of the interlibrary loan requests are for articles published within the last five years in 300 journals indexed in index medicus therefore the library has been developing a prototype automated graphic image storage and retrieval

Page  13 13 device to be applied to our interiibrary loan production this system is in the final stages of completion it is a fully automated system which can store on microfilm about 200000 articles from five years of publica interiibrary loan production this system is in the final stages of completion it is a fully automated interiibrary loan production this system is in the final stages of completion it is a fully automated system which can store on microfilm about 200000 articles from five years of publica interiibrary loan production this system is in the final stages of completion it is a fully automated system which can store on microfilm about 200000 articles from five years of publication of the 300 high-use journals the output is an enlarged paper print of the article with a total transaction time of about two minutes the physical appearance of the equipment will be similar to that indicated in this artists drawing the system consists of a varian mini-computer process controller a teletypewriter for inputting and a television for monitoring the main power file is shown in this slide which will contain the printout mechanism and 140 modules each module consists of 350 retainers and each retainer contains 33 images or pages on microfilm stripped onto the retainer this is the equivalent of about 3 articles to a retainer 1050 articles to a module and between 150000-200000 articles for total capacity the process will consist of one human action the initial input on the teletypewriter of an identification

Page  14 14 code for the article requested on the interlibrary loan forms we receive it is also anticipated that we can input directly from formatted punched paper tape from the twx interlibrary requests sent to us we intend to use this system in our own inter library loan operations we anticipate an improvement in our ability to respond to interlibrary loan requests with a decrease in staff time and the wear and tear of our periodical holdings we are examining the potential of remote inquiry and also whether installation of this system in our regional medical libraries would be functionally and economically desirable experimentation will also be done on storing and retrieving abstracts and relating this material to our medlars demand searches it is certain that applications not now envisaged will emerge in the same way that the current catalog was a new and unanticipated development from the medlars i system this was due primarily to the

Page  15 15 alertness of both our library and computer staff to existing needs and their ability to explore applications of computerized data bases aim-twx the medlars system of the nlm which became operational in 1964 began with the literature of 1963 the worlds biomedical literature is analyzed and indexed according to subject by staff expert in both subject and language some of this important intellectual effort is performed in israel the united kingdom sweden france germany australia and japan under special arrangements with the nlm medlars i has two primary purposes preparation of bibliographic publications and provision of subject-oriented demand searches the principal nlm publication is index med1cus a monthly bibliography of 2400 journals selected from the worlds biomedical literature in addition the library cooperates with scientific and professional societies who

Page  16 16 have specialized information needs by providing recurring bibliographies in such fields as medical education nursing dentistry rheumatology epidemiology nutrition endocrinology cerebrovascular diseases and toxicity of drugs in an effort to provide a more compact information tool for the individual practititoner we developed abridged index medicus this publication is derived from 100 english-language journals in the medlars data base these journals were selected to provide information pertinent to the needs of the individual practitioner and libraries of small hospitals and clinics the response to the first year of this publication has been enthusiastic to increase rapid access to this information the library has now developed a time-shared on-line retrieval system for a data base consisting of the bibliographic information in the last five years of journals covered in abridged index medicus this system is called aim-twx the bibliographic

Page  17 17 information is stored in a large time-sharing computer ibm 360/67 across the continent in california it can be accessed by twx terminals or computer terminals connected to the telephone network the direct interaction between the user and the computer consists of the following the user places a call to the computer and signs in with his number the terminal user then receives instructions from the computer explaining how to search the stored bibliographic information in an ordinary conversational way he can search the vocabulary to find appropriate search terms or enter directly subjects subheadings dates authors names languages or other search terms the computer responds by informing him of the number of documents for each term he can combine terms using or and and not to pinpoint his interest and finally he can print out his bibliography at his terminal or have it mailed to him

Page  18 18 the objectives of the aim-twx project are to give us operating experience in direct access systems to develop program and management data and to provide a rapid information service for our users these objectives are being realized future our experience with the medical library network has convinced not only us but the participating regional and local libraries and the professional user community that a medical library network is no longer a concept but a reality and a necessity the value of the network is demonstrated in two ways first in the linkage which the regional medical library provides between the nlm as the national resource and the local institutional libraries and second in the increased awareness and utilization on the part of the individual health professional of the availability and usefulness of current biomedical information

Page  19 19 the linkage aspect of the network permits not only a more effective redistribution of functions and workloads at all levels but also an overall increase in both the number and kinds of services and users thus there has been some shift from the national level to the regional level in the provision of interlibrary loans and medlars demand services to the individual this yields quicker service the nlms role specifically with regard to interlibrary loan service is now solely to respond to those interlibrary requests which the regional medical libraries cannot fill we believe that our experience with the medical library network is of sufficient duration to detect some definitive trends we are now prepared to begin some innovations in the role functions and services of the regional medical libraries this is particularly important now when the workloads will continue to increase at national regional and local levels without a corresponding increase in fiscal and personnel resources

Page  20 20 of the services now being provided by the regional medical libraries we would anticipate an increase in the interlibrary loan activity a change in the medlars demand search function an increase in the reference services a new emphasis on consultation and education programs and the possible inclusion of multi-media functions for the regional medical libraries with regard to the interlibrary loan services a study by orr projected an overall national activity level of 900000 requests annually upon full operational activity of our new graphic image storage and retrieval system for interlibrary loan production we shall explore how this system or its modification can directly or indirectly be useful to the medical library network we will take a new approach in terms of the regional medical libraries providing individual medlars demand searches whereas today these searches are done on the total medlars data base we believe that the aim-twx would be a most effective modality within

Page  21 21 the regional medical library to provide quick direct and easy access to current information for the practitioner this is consistent with the regional medical libraries unique relationship to local hospital libraries the consultation and educational role of the regional medical libraries will be developed so that they may become demonstration and training centers this does not mean that regional medical libraries will vie with academic institutions for formal training programs but would be a unique resource for intern ships and specialized work experiences because we are convinced that audiovisual materials as well as the printed word are media to convey information we shall examine how best the regional medical library can serve in this area it will be a question of determining whether the regional medical library should itself become a multi-media information center and/or a depository for the collection and dissemination of audiovisual materials

Page  22 22 the future modifications which would thus be made in the regional medical libraries would relate to improving and modifying current services adding new services and increasing the interaction and the sophistication of both the information specialist and the professional user through this improved interaction we believe libraries will be converted from passive repositories of knowledge to active information centers january 8 1971

Page  23 list of slides for talk on experiences with the us medical library network silde no 1 map of regional medical libraries and medlars center 2 medical library network plan hierarchical structure 3 medical library network plan nlm national resource 4 medical library network plan regional medical libraries 5 medical library network plan local libraries 6 nlm interlibrary loan circulation for 1965-70 7 nlm & rmls interlibrary loan activity 1966-71 8 medlars demand searches released for 1964-70 9 nlm basic hospital library 10 nlm resource grants of grants by type of grants institution 1966-70 11 nlm resource grants monies distributed by type of institution 1966-70 12 characteristics of nlm graphic image system 13 artists drawing of gris showing mini-computer teletypewriter and tv for monitoring 14 artists drawing of gris power file 15 gris module showing retainer 16 gris benefits 17 number of journals & articles indexed into medlars 1961-69 18 medlars publications 19 demand search printout card 20 list of recurring bibliographies 21 list of recurring bibliographies 22 abridged index medicus 23 aim-twx exhibit