Modern Communications Technology and the Dissemination of Biomedical Information, 1980
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modern communications technology and the dissemination of biomedical information frequently surprised by our involvement with computers mr zimmerman ladies and gentlemen it is a pleasure for me to be here this morning to discuss with you how we at the national library of medicine are applying modern communica tions technology to the dissemination of biomedical information we have used computers extensively at the nlm since 1963 - my training is in medicine however and i must admit that my knowledge of computer hardware and soft ware is that of a layman therefore i thought it prudent to ask mr harry bennett to accompany me mr bennett is director of the library's office of computer and communications systems visitors to the national library of medicine are tly surprised communications satellites microprocessors videodisc technology and so forth th is was especially apparent last may when we dedicated a new ten^tory facility known as the lister hill national center for biomedical communications at the ceremony a series of prominent scientists and librarians extolled the virtues of the modern communica tions technology available in the new building at the reception following the ceremony a long'time member of our staff came up to me and said i noticed that a certain four-letter word was avoided in all the presentations today not knowing what to expect i asked him what it was presented by martin m cummings m-d -, director national library of medicine at the december 9 1980 meeting of the interagency committee on automatic data processing washington d-c

Page  2 he leaned over to me and whispered conspiratorially b-o-o-k we at the national library of medicine keep uppermost in our mind that the information systems we develop are based largely on the published literature it is the act of writing that gives order and structure to the thoughts and observations of a scientist it is the published book or journal that gives permanence to this knowledge and it is the library that collects organizes and makes this literature available to all before i tell you about nlf'i's computer-based operations let me briefly describe the library as an organization begin slides 1 nlm & lhc exterior describe location facilities 2 organization chart describe nlm's place in dhhs hierarchy 6 major components of nlm it is of minor historical interest to note that in the late 19th century the first full time director of the national library of medicine dr john shaw billings was involved in the development of what we today call adp equipment in addition to his duties at the library dr billings was in charge of vital statistics for the tenth census 1880 he discussed with herman hollerith a young engineer in the census office the need for a machine to do the purely mechanical work of tabulating the census and population statistics billings suggested that

Page  3 data might be recorded on a card by punching small holes in it and that these cards might be counted and sorted mechanically abased on these principles hollerith developed an electric tabulator that was used with great success in the 1890 census with his equipment the classification and counting were done in a third the time of the 1880 census now you may have heard it said that physicians have little business sense if you haven't you might talk to the descendants of dr blllings he declined hollerith's invitation to join in developing and patenting the tabulator hollerith subsequently improved and refined his machine and eventually sold his patents to what is now ibm the computer system we use at the library today is called medlars an acronym for medical literature analysis and retrieval system medlars became operational in 1964 medlars is based on the skilled indexing and catalog ing of published materials received by the national library of medicine this aspect of the system—extracting pertinent data from the printed page—would be quite familiar to dr billings and in fact is essentially similar to the indexing he did for the index medicus the bibliography he began in 1879 that the library continues to publish to this day since 1966 over three million articles have been indexed and entered into the medlars computers at the national library of medicine we have also computerized many of the functions involved in building the

Page  4 collection ordering invoicing and keeping track of mate rials in process another important aspect of these collec tion activities is the special processing required for serials—ordering renewing claiming check"in binding and gapfilling some of these functions are already automated at nlmj we have plans to computerize the others the cataloging function—under which i also include indexing — remains 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 a vital role in produc ing published indexes and catalogs the index medicus for example is now over 1000 pages a month its annual cumula tion runs to 14 volumes in addition there is an array of other specialized catalogs and b i bl i ograph i es some 30 in all this published output would be virtually impossible without today's high-speed computers perhaps the most remarkable demonstration of nlm's computer capability is in allowing individuals to search the machine's memory to retrieve references on a particular subject.^this system is called medline an acronym for medlars online nlm began providing medline service in october 1971 using medline it is now possible for health pro fessionals throughout the united states and in eleven

Page  5 foreign countries to have rapid access to a data base of about half a million references from the most recent biomedical journals and selected monog raphs • mo re than 1200 institutions in the united states have medline terminals and over 1*8 million computer searches are now being perform ed annually in addition there are more than 200 institu tions in the countries you see listed here that also have access to medline jo1 medline search service has received enthusiastic acceptance by the medical p rof e ss i on b y practitioners researchers and educators throughout the world this is reflected hot only in the usage statistics but also in the number of data bases both bibliographic and nonb i bl i ograph i c that nlm has mounted on its computers these data bases range from medline which contains primarily recent index medicus references and abstracts to catalog information toxicology abstracts and data audiovisual materials and information related to cancer and other specialized areas of health and disease in all over four million references and abstracts are now available for searching through nlm's computerized system the charge for online access to nlm's data bases ranges from 8 to 15 per connect hour depending on the time of day searching is done our computer center at the library uses two ibm 370/168 machines both for publications production and for online searching in addition members of nlm's online network can access our data bases via the backup facility

Page  6 at the state university of new york in albany providing documents to users of health-science libraries is facilitated through a nationwide regional medical library network the network has responsibilities for interlibrary loans coordinating online services consultation reference services and developing and conducting training programs the network is hierarchical at its base are more than 3,000 local institutions usually hospitals with modest collections 100~200 current journal titles and a well-defined group of health professionals for whom biblio graphic and reference services are provided they represent the largest user group in the system ^ 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 network most connected with medical schools that have substantial collections with some 2000 to 3000 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 6000 journal titles and provide document delivery service for materials otherwise unavailable in their geographic regions more than 2 million loans are processed annually nlm assists in funding the regional medical libraries through contracts but users pay a fee for borrowing

Page  7 materials the backup for the entire network is the national library of medicine with its collection of some 2«5 million items i ncluding 20,000 serial titles we provide 250,000 loans annually generally for items not available at the local or regional level now let me turn briefly to the problems of libra ries which result from economic rather than technical weakness particularly i wish to comment on the beneficial effects of adve rs i t y • u ra ke and 0lsen have described how reductions in library budgets and inflation have forced librarians to develop innovative strategies to achieve more cost-effective operations automation low"cost communica tions and resource sharing have all contributed to improved library performance while computer and communications costs decline salaries continue to rise at a high rate this suggests that libraries will continue to seek methods of applying new technologies to replace labor-intensive processes io assist in developing and adapting new technology to health-science information the congress created in 1968 a research and development component for the library known as the lister hill national center for biomedical communica tion much of the early development for medlinl was done by the center in the seventies the lister hill center conducted drake m-a and olsen h-a the lconomics of library innovation lll£a£y xrje n jj j : 28:89 summer 1979

Page  8 8 several experimental projects involving communication satellites these ranged from a voice communication network begun in alaska using nasas ats-1 satellite to a two-way video network in alaska and the pacific northwest using the ats-6 satellite the more sophisticated communications technology satellite was used later for continuing health education and teleconferencing nlm constructed a studio within the library to serve as the network coordinating center for this experiment two of the centers current projects are worthy of special note-one to improve the operation of biomedical libraries the other to provide an entirely new kind of information retrieval service for health practitioners the first is an integrated library system that may be adapted by libraries of all sizes to integrate and automate a wide variety of library functions such as circulation serials check-in and the creation of bibliographic records this photograph is of the integrated library system as it is now used at the army library in the pentagon the system may be run on a wide variety of minicomputers and its software and documentation are available for purchase from the national technical information service the second project is known as the knowledge base program knowledge bases as developed by the center contain information derived from the biomedical literature that is subsequently reviewed condensed synthesized and

Page  9 reorganized by experts in selected medical areas the resulting core of information — or knowledge — is then made available thrqugh computerized online retrieval the first knowledge base to be developed on the subject of hepatitis is now undergoing testing at field sites a major developmental effort now underway at nlm is medlars iii medlars iii will apply computerized tech niques to controlling the internal library processes of indexing cataloging acquisitions serial processing inventory control and document delivery and the integra tion of all these processes through a single authoritative master bibliographic record there are four basic network services that would be of great value to the health'sci ence community and that will be incorporated as major components in medlars 111 these are standardized bibliographic control and support for centralized record creation and maintenance biblio graphic retrieval centralized national locator information with automated linkages to a national document delivery system and the document delivery system itself two of these network services exist at pres ent"b i bl i ograph i c retrieval which is already highly automated and document delivery essentially a manual interlibrary loan service dependent on"or perhaps i should say at the mercy of"the postal service so far efforts to use telefacs imile trans

Page  10 10 mission of documents have failed to attract sufficient users willing to pay 1 per page however a much larger number of users are paying 50 cents for these services which we offer through the regional medical libraries in chicago dallas and philadelphia the problem of improving the document delivery system is the subject of several developmental efforts now going on at the library the first of these employs a digital facsimile network called intelpost international electronic post to send black and white material via satellite between the british lending library and the national library of medicine although the initial demon stration was successful there are still some unanswered questions regarding costs and standards of quality for transmitting photographs ( e • g • , x"rays ) , complex drawings and fine print the second research effort is to develop a system that will store large quantities of information from printed documents on optical discs which allow rapid retrieval and transmission of the information the contents of up to 108,000 pages can be stored on both sides of one optical disc and mlm is now exploring the possibility of a system capable of storing a thousand such discs with online access time of a few seconds such a system if implemented would occupy less than a hundred square feet of floor space and contain a collection equivalent to several million

Page  11 11 journal issues the ability to store tens of millions of pages of text and graphics combined with a system to access and display this information at terminals in medical libraries around the country would be a true revolution in handling printed information some librarians view such developments as a threat to their survival because such a system would allow the user to make direct access to literature without an intermediary the design of a user cordial system is a goal which is being pursued in many places if successful great use of such compacted libraries can be predicted safely i would like to close with a quote from an unlikely eighteenth-century source edward gibbon's decline and fall ojf the roman empire speaking of emperor gordianus glbbon wrote twenty-two acknowledged concubines and a library of sixty-two thousand volume5 attested the variety of his inclinations and from the production which he left behind him it appears that the former as well as the latter were designed for use rather than for ostentation as in so much of gibbon there is a lesson here for us today namely that user-cordial interface is not a twent i eth"century invention

Page  12 slides for 12/9/80 presentation 1 nlm & lhc exterior 2 organization chart of nlm 3 john shaw billings 4 electric tabulator 5 medlars acronym 6 size of medlars data base 7 index medicus 8 medline data base 9 map of u.s centers non-u.s also listed 10 medline growth chart 11 list of online data bases 12 new nlm computer room 13 map of regions 14 pyramid base local libraries 15 pyramid continued resource libraries 16 pyramid continued rmls 17 complete pyramid 18 lhc name spelled out 19 ats-1 sale lite 20 alaska map with ats-1 locations 21 aide's cabin & antenna 22 tanana hospital & antennas 23 cts studio 24 ils at pentagon library