Health Sciences Libraries: Infrastructure for Information Services, 1980
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health science libraries infrastructure for information services martin m cummings md director national library of medicine as delegates to this international congress you may be interested to know that the word international entered the english language exactly 200 years ago in 1780 today international is an indispensable word in the health sciences this is especially evident in the biomedical literature where more than 1500 of the almost 14000 english-language journals use the word in their title health-science librarians through whom the mass of bioniedical literature is made accessible and available are members of a truly international profession as health-science librarians you are all aware that todays extraordinary pace of scientific advances has resulted in an unprecedented accumulation of published information this information whether in the form of empirical data or in the highly processed form we call knowledge is a resource critical to human well-being and public health the wealth of scholarly and research information in libraries is one of the great strengths of modern society but like many other resources knowledge and information are of little use unless they are easily accessible the culture of civilized societies is handed down to successive generations in recorded form today this consists of books journals audio and visual materials and other representations of data and information which can be stored and manipulated by computers as the store of knowl delivered at the fourth international congress on medical librarianship september 1980 belgrade yugoslavia volume v of the oxford english dictionary 1901 notes its first recorded usage in that year by the english philosopher jeremy bontham in his introduction to the principles of morals and legislation

Page  2 edge grows and the number of records increases our dependence upon information systems for access becomes crucial to society can advance continuously without effective access to the body of knowledge represented in its collective records conversely a society that loses control of its records will regress i would like to move now from these philosophical ruminations about knowledge and its transmission to the practice of medical librarianship a few simple definitions are in order a library is an entity that collects organizes and distributes information in printed and other formats it occupies valuable space allocates and expends capital and employs some number of professional technical and administrative staff in addition a good library provides an array of useful information services to its clients a modern library utilizes new computer and communications technologies to perform these services efficiently and effectively a resource library uses modern technologies to provide rapid and reliable services not only to its own patrons but also to other institutions within a formalized network or a consortium of resource-sharing organizations i will comment first on the infrastructure within a library and then on the library as the basic infrastructure for information services the infrastructure of a contemporary medical library includes a collection of print and nonprint materials access to other information resources a qualified professional staff and a facility adequate to properly house the collection as well as the librarys users

Page  3 the modern medical library itself serves as the basic element within the infrastructure of local regional and national medical information systems for it is the library to which society usually turns first in seeking information libraries that build appropriate collections that forge links to other information sources and that organize themselves for the efficient delivery of services-these libraries are recognized for their contributions and receive support those libraries which do not keep pace with rising user expectations soon find that their financial support erodes and as their resources dwindle they are even less able to meet the needs of their users i suggest that the three c's of librarianship are collect catalog and communicate a fourth c the computer may be the most important library instrument since the invention of classified cataloging-for the computer can greatly assist in performing the various functions associated with the 3 c's the following library functions are computer assisted in various libraries collecting paper work is the bane of the health-science librarian who is involved in selecting ordering invoicing and receiving the literature the complex record-keeping of these tasks however lends itself well to computerization at the national library of medicine two automated files-inproc which stands for inprocess and invoice-have considerably eased the

Page  4 burden of record-keeping and allow our librarians to determine rapidly the status of any on-order item another important aspect of these collection activities is the special processing required for serials — ordering renewing claiming check-in binding and gap-filling some of these are already automated at nlm we have plans to computerize the others cataloging the cataloging function — under which i also include indexing — re mains primarily an exercise of the human intellect it is necessary for highly trained literature analysts to examine each piece of literature individually and to determine how it should be cataloged or in the case of an article indexed computers however do have an important role in producing book catalogs and in allowing online access to organized cataloging information at the national library of medicine records for all books and serials cataloged since 1965 are available for online searching in our catline data base we are now working to include all pre-1965 records in this file when this is accomplished we will be able to remove our voluminous public card catalog and replace it with an array of computer terminals this will no doubt be traumatic for some of our users but we believe it is a necessary step in providing better information services we are attempting to ease this transition by developing what is called a user cordial interface a method that will allow our patrons to have direct rapid and convenient access to the computerized catalog in a sense everything i have said about collecting and cataloging is prologue to the

Page  5 third c communicating there was a time not too long ago when it was considered sufficient for a library simply to acquire printed material classify and catalog it and put it on shelves the biomedical library of today however if it is to be fully responsive to the needs of its users must provide an array of information services increasingly these services rely on computers and other modern communications technology national library of medicine - infrastructure of a medical infomation system the national library of medicine has employed computers since 1964 when medlars was first used to produce index medic us today as you know nlm utilizes 15 data bases both bibliographic and nonbibliographic that provide rapid online access to biomedical information these data bases range from medline which contains primarily recent index medicus references to catalog information toxicology literature and data audiovisual materials and information related to cancer and other specialized areas of health and disease in all over four million references are now available for computerized searching through nlms system there is widespread access to this information more than 1000 institutions in the united states provide online search services to their patrons and centers in eleven other countries make nlms data bases available world wide today there are medlars centers in australia canada france great britain italy japan mexico south africa sweden west germany and at the pan american health organizations regional medical library in brazil because health professionals in many developing countries also have need of computerized access to the literature nlm and the world health organization are cooperating to provide medlars computer searches and

Page  6 photocopies of journal articles to the developing countries in who's regions of africa southeast asia the eastern mediterranian and the western pacific one trend of increasing importance in the infrastructure of communi cation is that of consortium development health-science libraries faced with a rapidly growing corpus of biomedical literature that is increasingly expensive are finding it advantageous to join together with others in their area to form a consortium in contrast to largely informal arrangements for inte'rl ibrary loan a consortium requires that its members share in planning developing and operating cooperative pro grams of resource development and sharing beginning in 1977 nlm has emphasized the awarding of grants to fund consortia of health-science libraries in the united states since that time we have provided almost three million dollars to about 100 consortia each consortium has an average of six members so about 600 institutions have received grant assistance in just four years we believe that these formal cooperative arrangements at the local level constitute a vital component of the national biomedical communications network in the united states we also believe that they have resulted in improved library service to the user community the network's role in biomedical communications libraries have a long-standing tradition of cooperation most frequently in inter ibrary lending beginning in the late 1960's these arrangements were formalized for biomedical libraries in the united states with the in stitution of the regional medical library network the network has important

Page  7 responsibilities for interlibrary loans coordinating online services and developing and conducting traning programs the network is hierarchical at its base are more than 3000 local institutions usually hospitals with modest collections 100-200 current journal titles and a well-defined group of health professionals for whom reader and reference services are provided the next level in the hierarchy and the level that local libraries first turn to for help is the resource library there are about 120 resource libraries in the us most connected with medical schools that have substantial collections with some two to three thousand journal titles available the regional medical library is the next level in the network there are eleven rmls at major health-science libraries associated with leading medical schools and medical societies they have large collections 3000 5000 journal titles and provide document delivery services for materials otherwise unavailable in their geographic regions the regional medical library also assist in coordinating online services within their regions provide consultation and training opportunities for local health-science librarians and serve as a regional resource for reference services nlm assists in funding the regional medical libraries through contracts the backup for the entire network is the national library of medicine nlm provides document delivery service from its collection of some 2.5 million items including 20000 serial titles we provide about one quarter million interlibrary loans each year and support another three quarter million loans through the rml network together these represent about one

Page  8 half of all inter ibrary loa-n activity in the health sciences in the u.s another major nlm function within the regional medical library net work is to provide accgss to the online data bases i mentioned earlier the amount of searching over the online network has grown astonishingly since the introduction of medline in 1971 the more than 1,000 user in stitutions in the u.s conducted over 1.4 million searches last year and preliminary estimates suggest that this will rise to about 1.8 million for 1980 in addition to automated reference retrieval nlm's reference librarians last year answered some 46,000 reference queries for patrons and by mail and telephone one of the most valuable and time-honored functions of the nlm is the publishing of catalogs and indexes to the biomedical literature this was begun by dr john shaw billings who in 1879 compiled the first volume of index medicus and a year later the first in the series of index-catalogues of the library erf the surgeon general s office index medicus continues today under the same title while the index-catalog has been replaced by the nlm current catalog the index medicus grew to such proportions that about ten years ago a smaller version—abridged index medicus--began pub lication the quarterly nlm audiovisuals catalog is another new publication covering nonprint materials received by the library these catalogs and indexes represent only a part of nlm's publication activity there are also some two dozen recurring bibliographies on specialized subjects produced by the library from its computerized data bases and printed and distributed by cooperating professional organizations

Page  9 one example at the international level is the quarterly bibliography ojf maj^r tropical diseases published by the national library of medicine in cooperation with the world health organization another nlm service widely used by heaal diseases published by the national library of medicine in cooperation with the world health organization another nlm service widely used by health professionals thral diseases published by the national library of medicine in cooperation with the world health organization another nlm service widely used by health professionals throughout the network is nlm's literature search service literature searches are computer-produced bibliographies on topics of current interest that the library publishes and distributes without charge last year we sent out about 40,000 literature searches to requestors their topicality is suggested by some recent titles terrorism or civil disorders in vitro fertilization or embryo transfer and population control in developing countries these particular literature searches ranged from 98 to 213 citations we believe that the regional medical library network has served well the information needs of america's health professionals rapid on line retrieval of references combined with a nationwide system of document delivery has had the intended effect of making access to the biomedical literature independent of geographic location the remote health profes sional now has the same information services available to him as his colleague in a major urban area i believe that unimaginative librarians who limit themselves to providing traditional on-site services are doomed eventually to disappear the active library however which provides innovative and useful services even to remote or distant users will become an indispensable part of emerg ing large-scale information systems

Page  10 information services for developing countries i have a deep concern that libraries are not receiving adequate support in developing countries in my view the development of medical libraries in me these countries is being hindered by world health organization's current em phasis on unpublished reports the fugitive literature at the expense of the more substantial published literature the development of significant medical libraries is further inhibited by the questionable recommendations of goffman and warren that medical 1 ibraries require only very small collections because they have found that the major literature of a single disease is contained in only a few journals they fail to take into account that there are at least ' 5,000 subjects encompassed within the health sciences and that the important literature dealing with these subjects is contained in at least 2,500 journals containing more th for developing countries i have a deep concern that libraries are not receiving adequate support in developing countries in my view the development of medical libraries in me these countries is being hindered by world health organization's current em phasis on unpublished reports the fugitive literature at the expense of the more substantial published literature the development of significant medical libraries is further inhibited by the questionable recommendations of goffman and warren that medical 1 ibraries require only very small collections because they have found that the major literature of a single disease is contained in only a few journals they fail to take into account that there are at least ' 5,000 subjects encompassed within the health sciences and that the important literature dealing with these subjects is contained in at least 2,500 journals containing more than 250,000 articles per year i believe therefore that each region of the world should have at least one large collection to serve the needs of those countries which cannot afford to develop and maintain their own national medical libraries it is my view that who would be better advised to support the establishment of a global network of regional libraries instead of developing an expensive system of collecting and indexing ephemeral non refereed unpublished reports although countries with different political systems have different mech anisms for planning and coordination it is clear that the desire for a central ized national information policy exists in most nations this is necessary if the information policy is to reflect the social purposes which the information system is expected to serve

Page  11 the u.s probably has the most pluralistic apparatus which in a sense represents both its strength and weakness the diversity of federal and private involvement has led to the development of a wide array of in formation services which utilize all forms of modern communications tech nologies government departments contribute to the development and support of information systems while the private sector operates the communications services that make this information available to institutional or individual users unfortunately this lack of centralized control has led to a certain * • amount of incoherence and incompatibility among various systems the national library of medicine is somewhat of an exception to this heterogeneous arrangement since it collects organizes and disseminates medical information through direct and indirect services these services involve technological subsystems which have been shared with other countries through a series of quid-pro-quo agreements these arrangements are exemplary models of international cooperation partner institutions in the eleven countries i mentioned earlier provide indexed references to their national periodical literature ready for input into the medlars data base these references are simultaneously published by nlm in index medicus and entered into the online data base medline in return the cooperating institution is able to provide medlars services to users in its own and neighboring countries nlm provides either magnetic tapes which are mounted on a computer in the host country or direct online access to the medlars computers in bethesda

Page  12 this relationship between nlm and its partners in other countries is an example of a mode of operation that is taking on increasing importance within the information infrastructure this is the function of health-science libraries acting as a broker of information modern libraries have become switching centers connecting users to information that may reside in a system or an institution across town in the next state or half-way around the world nor is this information necessarily bibliographic more and more of todays information utilities put users in touch with numerical data evaluated scientific knowledge audio visual materials and information in microform infrastructure of the future the successful development of communications satellites has provided new mechanisms for reliable inexpensive and rapid information transfer internationally new glass-based communications cables with wide-band width are becoming available and cheaper than copper they will provide new opportunities for inexpensive telefacsimile and other types of communications these advances coupled with the marked reduction in the cost of computer memories and storage devices offer remarkable opportunities for a new type of library infrastructure for example nlm is now designing a system that would store great quantities of printed information on videodiscs each the size of a phonograph record it is estimated that all the text and graphics in 4000 journal issues can be stored on one videodisc and that any information on the disc could be located and retrieved in seconds the ability to

Page  13 store millions of pages of text and graphics combined with a system to access and display this information at remote terminals would make obsol ete our present methods of sending inter ibrary loan materials by mail capabilities such as these will constitute a true revolution in the way information is transmitted to health professionals they have the potential to lower geographic barriers and bring needed information to all working in the health sciences--in developing and developed counteries alike it is only necessary that we in the medical library community have sufficient ingenuity determination and resources to apply the new tech nologies intelligently