Integrated Academic Information Management System: The NLM Response, 1983
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integrated academic information management system the nlm response thank you nina i'm pleased to have been invited to be with you again especially at the meeting where my predessor brad rogers was honored so appropriately the suggestion for a study of how to improve the management of information in academic health sciences centers originated with your next speaker dr marjorie wilson if i were a medical librarian and could choose the dean i might work for my choice would be marjorie wilson dr wilson's talents were well known to us thirty years ago she was my colleague at the research service of the veterans administration twenty years ago i recruited her as associate director of the national library of medicine because of her demonstrated knowledge of medical libraries and medical schools we enthusiastically accepted her proposal and provided financial support it is obvious that she has succeeded her first brilliant move was to engage nina matheson as principal investigator the result of their study provides a realistic blueprint for the future i can't remember when a report has generated so much discussion and excitement in the health sciences academic community in fact the concepts within this report are now being accepted by universities and industry as well most of you are aware i am sure of that special library shelf in limbo reserved for well intentioned but ineffectual studies commissioned by the government i can assure you that this report will not sit on that shelf the national library of medicine is committed to funding several planning grants which should lead to the development of prototype information presented at the medical school libraries section of the medical library association june 1 1983 by martin m cummings m.d director national library of medicine

Page  2 2 systems in a variety of academic health settings we believe that these models will have a profound beneficial effect on biomedical communications by demonstrating how information required for research education patient care and management can be integrated in an efficient systematized way one reason for my optimism is the amazing growth of sophisticated information processing systems and the concurrent advances in telecommunications matheson points out the need for applying computer technology for developing institutional networks donald hillman 1 recently reviewed the cost effectiveness of new technologies generally he reported that 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 1980's 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 videodiscs can store as many as 10 billion bits of information on a disk the size of an ordinary phonograph record 4 the performance of central processors has increased at a rate of 35 percent per year since they were first introduced 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

Page  3 3 together these developments offer institutional administrators exciting new opportunities and capabilities to substantially improve the efficiency of many routine and complex operations aside from massive clinical records health related institutions are faced with large numbers of documents which are not organized or managed by their libraries it is in this area that the professional librarian needs to become involved as a planner designer and manager of institutional records in addition educational institutions are now faced with the difficult task of acquiring means to access a rapidly enlarging number of databases according to martha williams 2 there were more than 700 computer readable databases publicly available in 1981 they contain more than 250 million records the number of vendors offering various information services expands and the methods of transferring this information proliferate this 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 here the librarian can assist the teaching faculty in providing materials in a well organized and efficient way as technology makes such capabilities increasingly feasible the rising cost of the traditional published literature books and journals makes new formats increasingly more competitive at the turn of the last century one observer noted that this will never be a civilized country

Page  4 4 until we expend more money for books than we do for chewing gum 3 the good news is that we now spend more in the u s on books than we do on chewing gum the bad news is that this results less from intellectual advancement than from advancing inflation in the publishing industry in a recent ten year period the price of scientific and scholarly books rose fourfold that of journals by a factor of five during this time the price of a ten cent pack of gum on the other hand had risen only to a quarter in however roundabout a way this brings me now to some of 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 real advance will come from involving librarians who are broadly based in computer and information science in this development it is possible to start 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 association

Page  5 5 tions 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 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 nlm cannot assume the responsibility for funding operating systems 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 and librarians more than 350 librarians received training support from 1966 to 1973 the unique computers-in-medicine program begun in 1973 has made possible high level training of health professionals in medical computing for about 350 individuals from these talent pools should emerge the leaders of these new systems the next recommendation to the nlm is that it collaborate with industry and professional organizations to foster and develop state of

Page  6 6 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 another recommendation is 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 i applaud this recommendation but it will require public and private sector institutions to come together to work out rational solutions to the legal and proprietary problems the new technologies give rise to i am sure this audience will appreciate why nlm does not wish to ignore or ignite copyright issues particularly finally it is recommended that the nlm in collaboration with profes sional 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 planning support of such prototype systems we believe that because of budgetary constraints seven is not an easily attainable goal we suggest that three or four demonstration sites representative of several types of organizational structures may be sufficient to make this recommendation a reality nlm has earmarked some of its fy 1983 extramural funds to begin the planning for prototype development in several selected academic medical centers we hope to supplement this with additional funds next year on march 2 the library announced that it was seeking proposals to plan such prototype systems as of last week we had received almost 200 inquiries from institutions seeking the formal request for proposal the

Page  7 7 actual proposals and requests for funding are due by june 10 and we hope to make several awards for prototype development by the end of august more than half of the inquiries were from universities and medical centers but there were also requests from library schools professional associations hospitals r & d companies and even several requests from institutions in foreign countries i believe this response to be a signal that the report's recommendations are timely and potentially useful and that the academic community is ready to receive and act on them it also indicates that the recommendations are applicable not just to academic health science centers but to university wide systems and perhaps to other settings as well i must introduce a somber note here about the realities of federal funding the money we have earmarked is for planning to develop the prototypes will likely require resources beyond our present authorization and appropriation levels under the medical library assistance act even if our authorization levels are increased when the legislation is renewed this may not be matched by an increased dollar appropriation although we will do what we can to bring about such increases two other courses of action suggest themselves first we at nlm must encourage applications for grants in our established categories resource improvement resource project research and training that are coordinated with the prototype development projects we will give special attention to applications that propose to work closely with and further the goals of the prototypes secondly it will be necessary to involve as many departments as

Page  8 possible within the academic health science centers in the development of prototypes each department has some extra institutional sources of funding federal and private if the policy makers in these departments can be convinced of the benefits of an integrated information system they might be willing to tap these sources for funds in this respect there is one issue crucial to prototype development 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 computerealth science centers in the development of prototypes each department has some extra institutional sources of funding federal and private if the policy makers in these departments can be convinced of the benefits of an integrated information system they might be willing to tap these sources for funds in this respect there is one issue crucial to prototype development 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 potentially powerfuealth science centers in the development of prototypes each department has some extra institutional sources of funding federal and private if the policy makers in these departments can be convinced of the benefits of an integrated information system they might be willing to tap these sources for funds in this respect there is one issue crucial to prototype development 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 potentially powerful prototypes envisioned in this report will require the power which resides at the top of organiza tions in closing let me once again congratulate marjorie wilson and nina matheson for their creative study and well articulated far reaching report they have opened our eyes to the future it is up to us to make it work thank you

Page  9 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 3 hubbard e from the philistine