The National Library of Medicine's Commitment to Excellence in Academic Information Management, 1982
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the national library of medicine's commitment to excellence in academic information management the national library of medicine and the association of american medical colleges have a long and honorable history of collaboration from the mid-1860's with individual medical colleges and from the mid-1960's with your association because a number of the library's most important and successful programs have been influenced by the aamc i would like to take a minute to sketch briefly the cooperation between our institutions a report published by the aamc in 1965 was instrumental in bringing about the passage of the medical library assistance act in that same year the guidelines for medical libraries as the report was called laid out the principles that guided the evolution of our grant programs under the medical library assistance act nlm has awarded some 136 million dollars since 1965 two years after the passage of the act in 1967 the association published a second report that articulated principles to guide the library in making grant awards to design and presented by martin m cummings m-d director national library of medicine at the association of american medical colleges annual meeting november 10 1982 washington d.c

Page  2 2 construct new health-science library facilities in the succeeding years eleven american academic health-science libraries received funds for construction from nlm and others from the health resources administration many more were assisted in renovation or expansion projects the 1971 aamc report entitled educational technology for medicine and its supplement the following year called on nlm to assume significant responsibilities for research and development in educational technologies and biomedical communications these recommendations are today being realized through nlm's lister hill national center for biomedical communications more recently nlm's successful computers-in-medicine program owes a great deal to the work of an nlm task force chaired by dr john sherman in 1978 the latest aamc report is marjorie wilson's the management of information in academic medicine this two-volume study distills her accumulated wisdom gained working directly with senior medical school executives over the past ten years filtered through earlier experiences at the veterans administration the national institutes of health and her pioneering role as nlm associate director for extramural programs

Page  3 3 in its turn the nlm has left its mark on the aamc's services products and programs in an innovation for its time the journal of medical education in 1966 began and continues to publish monthly references selected from the medlars files of bibliographic citations relevant to medical education the aamc management advancement program itself was supported by the nlm i hope i have established to your satisfaction that the aamc and the nlm historically have been congenial collaborators and that we share certain common interests in improving biomedical information services within the academic health science community i would like to say a few words now about a unique opportunity we face namely the conjunction of technological capability and the thoughtful blueprint for information management laid out in the report academic information in the academic health sciences center the growth of sophisticated information processing systems and the concurrent advances in telecommunications which have led to the present information revolution have been recently described by donald hillman he provided a number of illustrations of the rapid development of information technology in recent years: 1 the cost of computer main memory has been declining 26 percent per year since 1965 and is expected to continue to do so through the 1980s

Page  4 4 2 there is now a full range of commercially available storage technologies that permit access times as low as a billionth of a second for the small high-speed storage used to process information 3 the new videodisks can store as many as 10 billion bits of information on a disk the size of an ordinary phonograph record 4 slide 1 as you can see from this graph the performance of central processors has increased at a rate of 35 percent per year since they were first introduced slide 2 costs on the other hand have declined by about 20 percent per year 5 word processing devices are acquiring communications features that provide electronic mail functions as well as access to outside databases 6 the use of microprocessors in a number of office devices from dictation equipment to photocopiers has reduced equipment size and enhanced operations significantly together these developments offer institutional administrators exciting new opportunities and capabilities to substantially improve the efficiency of many routine and complex operations

Page  5 5 educational institutions particularly are now faced with acquiring means to access a rapidly enlarging number of databases for example according to martha wllliams,2 there were more than 700 computer readable publicly available databases in 1981 containing some 250 million records h illman points out that the variety of vendors offer i ng information services expands and the methods of transferring information proliferates th i s situation calls for more effective coordination and management of all aspects of information gathering processing and dissemination within an organization recent advances in information handling offer new methods of assisting student learning in a wide diversity of environments educational resources may be geographically dispersed while at the same time providing a flexible and unified opportunity to pursue prescribed course work this brings me to the recommendations contained in the report under discussion today technology has provided the tools to construct an effective and efficient academic health sciences information system and now we have the plans the blueprint provided by this report the power of this report it should be emphasized lies not in the description of better libraries it would be a mistake to concentrate too much on this aspect of the plan the report seems to ignite the imagination of different groups working with information it is possible to start

Page  6 6 at many different points in this plan the health sciences library is one clinical care systems may be another the educational systems could be a third to bring to a three dimensional reality the academic information management systems described in this report will require the participation of many different groups in the academic community and will depend on realistic funding to assemble the component parts into a working whole the recommendations reflect this reality the recommendations of the report are interlocking the first four are directed to the medical centers the next four to professional bodies the last six are aimed at public and private agencies of which three are directed to the national library of medicine recommendations for one group however are restated as collaborative responsibilities of another group thus there are in all five recommendations that involve the nlm the first of these recommendations is that the aamc the nlm public and private information and health related organizations and professional societies join in a health information coalition the goal is to assist the academic health sciences centers in adapting and utilizing state-of-the art information technologies to strengthen the flow of information between academic centers and medical practice the nlm is prepared to assist the aamc to find available resources both public and private to carry out the

Page  7 7 plans described in this report i believe that federal dollars should be a catalyst a challenge to industry and to the resourcefulness of individual institutions the second recommendation is that nlm and other agencies seek to expand the talent pool in the information sciences the nlm since 1966 has supported a variety of training programs for health professionals from librarians to post-doctoral fellowships in computers-in-medicine more than 350 librarians received training support from 1966 to 1973 the unique computers-in-medicine program begun in 1973 and continuing today has made possible high-level training in medical computing for more than 250 individuals we would expect this program to be the basis for leadership and new initiatives in training flowing from the recommendations in the aamc report the next recommendation to the nlm is that it collaborate with industry and professional organizations to foster and develop state-of-the-art medical information management and transfer technologies and techniques through its extramural and intramural research support branches it should be the lead agency we welcome this leadership role one which we have modestly exercised for many years

Page  8 8 we believe that the development of academic information management systems will require careful planning and many significant potentially transforming strategic decisions within medical centers with that in mind the nlm is prepared to earmark a portion of its fy 1983 extramural program funds to begin the planning for prototype development in several selected medical centers we hope we can make grants collaborating with the aamc in the selection of special academic environments the industrial model has much to teach us in this area i refer to an issue that is rather muted in the aamc report leadership in the medical center for information systems management in my opinion a person at the highest organization levels should be designated by title indicative of the fundamental institutional importance of his or her responsibilities i would suggest that something like a vice president for information resources is indicated that person might be any professional associated with the medical center — a health professional a librarian a computer expert even a dean but to carry off the development of the prototype envisioned in this report will require power at the top

Page  9 9 it is recommended that the nlm develop state-of-the-art network communications throughout the regional medical library network for the purpose of transferring documents in digital as well as analog forms this will require however that public and private sector institutions come together to work out rational solutions to the legal and proprietary problems the new technologies give rise to finally it is recommended that the nlm in collaboration with professional associations and other public and private agencies assist in the development of prototype integrated information management networks in at least seven academic health science centers while we are fully committed to the building of such prototype systems we believe that seven is not an attainable goal we suggest that three demonstration sites representative of several types of organizational structures may be sufficient even for this modest number the resources needed to develop the prototypes are likely to be beyond our resources unless steps are taken to increase the authorization and appropriation levels of the medical library assistance act in closing let me congratulate john cooper the project directors dr marjorie wilson and nina matheson and the advisory committee who produced this report it reaches beyond the health sciences community to the heart of the academic enterprise where excellence in governance and management should reside

Page  10 references 1 hillman d.j decision making with modern information and communications technology opportunities and constraints in science technology and the issues of the eighties policy outlook teich a.h thornton r editors westview press boulder col 1981 2 williams m database of databases information retrieval research laboratory university of illinois at urbana 1981