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The Bowker Annual Chapter on NLM, 1999
National Library of Medicine
Robert Mehnert
Public Information Officer
Published in:
The Bowker Annual, 1999
44th Edition
Providence, NJ
R.R. Bowker
Pages 112-117
The National Library of Medicine (NLM), a part of the Department of Department of Health and Human Service's National Institutes of Health in Bethesda, Maryland, is the world's largest library of the health sciences. NLM has two buildings with 420,000 total square feet. The older building (1962) houses the collection, public reading rooms, exhibition hall, and library staff and administrative offices. The adjacent 10- story Lister Hill Center Building (1980) contains the main computer room, auditorium, audiovisual facility, offices, and research/demonstration laboratories. At the end of 1998 the main reading room and exhibition hall were temporarily shut down for a series of facility upgrades, including the installation of additional computer terminals for online searching, a new raised floor system to accommodate telecommunications connections, and new carpeting and other enhancements to the appearance of these public areas.
Public Access
In 1998 NLM began a formal program to encourage consumer access to health information via the NLM Web site. The library was encouraged to take this step by the enthusiastic response of the public to free MEDLINE searching for users of the World Wide Web, which NLM began providing in 1997. Usage has climbed from an annual rate of 7 million searches a year to more than 120 million. It became obvious that the audience for MEDLINE was much broader than had been previously suspected.
NLM's decision to include the public among its primary audiences is a notable one. In its early days, the library was seen as a resource for the military medical establishment; it later assumed a de facto larger role in the health sciences and, in 1956, NLM was formally designated by the Congress as a national resource for all health professionals. Thus, to seek to become a source of medical information for everyone is to expand significantly the library's responsibility. The decision to do so was affirmed at an extended meeting of the Library's senior managers in December 1998.
The popularity of MEDLINE on the web was not the only contributing factor to this decision. NLM has considerable experience over the past three decades in applying computers to medical information storage and retrieval. The resulting computer- based information sources are now used daily by scientists and high school students, physicians and ordinary patients, librarians and senior citizens. In addition to MEDLINE, with its 10 million references and abstracts, these databases encompass human genome information, reports and data about hazardous substances and chemical spills in localities across the country, and a wide variety of information gathered specifically to help citizens make decisions about their health care.
Public Library Initiative
On October 22, 1998, NLM launched a pilot project to help local librarians use the Internet to find health information pertinent to their patrons' needs. This project will provide health information to citizens without Web access and at the same time create an experienced cadre of public librarians who can guide consumers to sources of reliable health information. The project is a cooperative one: NLM is working with members of the National Network of Libraries of Medicine (NN/LM), the American Library Association, the Medical Library Association, and the W.K. Kellogg Foundation. The participating 39 public library systems (representing several hundred individual libraries) were chosen from three NN/LM regions to represent a range of community sizes and diverse populations.
NLM, which is supplying descriptive materials and training, has created a new "MEDLINEplus" information resource specifically for use by public librarians and the general public. Accessible through the NLM home page, MEDLINEplus provides web users with access to reviewed sources of health information- from NLM, the National Institutes of Health, other government agencies, and from selected nongovernment organizations. The new service provides access to extensive information about 50 specific diseases and conditions (cancer, diabetes, alcoholism, etc.) and also has links to self-help groups, NIH consumer health information, clearinghouses, dictionaries, lists of hospitals and physicians, health information in Spanish, and clinical trials. One unique feature of MEDLINEplus is a series of preformulated MEDLINE searches on various aspects of diseases (for example, in the extensive section on diabetes, a search on "nutrition and diet"). The user need not know any searching strategy; the preformulated query does a real-time search and returns up-to-date references and abstracts that will be useful to the general public. MEDLINEplus is being expanded as rapidly as possible; we expect the 45 topics to be increased to several hundred within a year.
Other sources of useful information that will be made available through the public library project are the Human Gene Map (described later in this article), the text of NIH consensus development statements, up-to-date syntheses of cancer treatment information, and federally sponsored clinical practice guidelines. The public library project began in October 1998, and already there are reports about how useful the new site is in providing information for the public. If the pilot project is successful, NLM may seek the resources to mount a national program.
Communications-Related Collaborations
Under a new "Partners in Information" program, NLM has awarded 13 contracts in September 1998 to public health agencies to help them hook up to the Internet and make it easier to access health information. The program is a joint activity of NLM and several federal and nonfederal groups, including the Centers for Disease Control and Prevention. The awards are scattered around the U.S. in rural and underserved areas, from Alaska to Vermont, and involve information services for public health officials of all kinds who are addressing a variety of community health problems and special populations.
Another set of 14 awards, also made by NLM in the fall of 1998, is aimed at speeding life-saving treatment to those who suffer heart attacks. Working with the National Heart, Lung, and Blood Institute, the library is trying to find out if the techniques of medical informatics can help ensure that known clot-dissolving agents are applied immediately after a heart attack. Although the efficacy of these agents has been known for years, only a fraction of the 1.1 million people who suffer a heart attack each year receive this treatment. If it is successful, NLM's program would be a dramatic example of how timely information can potentially save many thousands of lives.
In the international arena, the library has always emphasized collecting and organizing the medical publications of other countries; this is reflected in the international character of MEDLINE and the other databases. It is estimated that 45 percent of all MEDLINE searches are done by and for non-U.S. health professionals. A Long Range Planning Panel on International Programs was set up by the Board of Regents and, in its final report, issued in 1998, the Panel recommended that the library maintain and expand its involvement with other governments and with non-U.S. health science institutions. One special international program is to participate in the Multilateral Initiative on Malaria by enhancing the communications and networking capabilities of African malarial researchers. NLM's work in improving their telecommunications and information infrastructure has the potential to lessen he toll in Africa from this dread disease.
Another collaborative undertaking is Phase II of the Digital Libraries Initiative. The term "digital libraries" is used to denote the vast distributed collections of text and images available through the Internet. The goals of the first phase were to advance fundamental research and to build testbed networks for developing and demonstrating new technologies. Supported projects in Phase II are looking beyond the technology and testbeds and are actually seeking to apply what has been learned. NLM is contributing funds to the National Science Foundation, which is managing the program, to support projects that relate to health domains.
Support of Research
NLM is supporting cutting-edge research that seeks to learn how the capabilities of the Next Generation Internet (NGI) can be used to improve health care, health education, and medical research. NLM itself depends to a great extent on the Internet to deliver health information services, and it thus has a vested interest in preserving and promoting the health of the network. The Next Generation Internet initiative is a partnership among industry, academia, and government agencies that seeks to provide affordable, secure information delivery at rates thousands of times faster than today. If we can transmit massive amounts of data quickly, and with accuracy and security, will this lower health costs, increase the quality of care, and safeguard patient privacy? In 1998 NLM supported 24 projects aimed at finding answers to these questions. These investigations, located at universities, medical schools, and private companies, encompass a number of projects: telemedicine, telepresence, teleconferencing, tele-immersion, telemammography, teleradiology, and teletrauma. Several use the capabilities afforded by the Visible Human Project.
The Visible Human Project continues to command great interest in the scientific community and public media. The two datasets, which contain detailed, submillimeter, anatomical images of a male and female, are being used (without charge) by more than 1,000 licensees in 30 countries. Current uses of these datasets include the following: "Surgical simulators" that let doctors rehearse delicate medical procedures on computer; "Recyclable cadavers" to help medical students learn about anatomy via computer; "Virtual prototyping," to create perfectly fitted hip and knee replacements on computer; and "Virtual colonoscopy," a procedure that reduces the time, cost, and discomfort associated with a "real" colonoscopy and is expected to become an important tool in screening for colon cancer. NLM is cooperating with three other NIH Institutes to fund jointly the development of an interactive, Internet-accessible atlas of head and neck anatomy based on the Visible Human Project data sets.
A new service introduced by NLM in 1998 is "Profiles in Science," a web site that will allow a look behind the scenes of scientific findings and read the unpublished writings, letters, photographs, and lab notes of great scientists and great scientific discoveries. The first collection to be put up is for Oswald Theodore Avery, whose research in the first half of the twentieth century laid the groundwork for modern genetics and molecular biology. The new web site, which brings together the best in archival practices with state-of-the-art technology, will be continually enriched with the papers of other great scientists of this century. The library hopes that "Profiles in Science" will kindle users' interest in and appreciation of scientific discoveries in biology and medicine.
Clinical Trials Database
Also in 1998 the library was given the task of establishing a database that will contain information about clinical trials, whether federally or privately funded, for experimental treatments for serious diseases and conditions. The database should allow nonscientific users to understand the purpose of the trial, the eligibility criteria for participating, where the clinical trial is being conducted, and how to get in touch with those conducting it. NLM is already the home of AIDSTRIALS (a database of clinical trials relating to AIDS), and HSTAT (which links to a file of NIH intramural clinical trials). Also, NLM's new MEDLINEplus service links to clinical trials (both federal and nonfederal) in a number of disease areas. The library plans to create a central search engine that will provide a uniform interface to all clinical trials and thus simplify the task of finding information.
Genetic Medicine
Ten years ago, in anticipation of the explosion of genomic information and the growing importance of molecular biology, Congress created the National Center for Biotechnology Information as part of the National Library of Medicine. By creating and maintaining immense databanks as well as sophisticated tools that allow it to be used in making further discoveries, the NCBI is making a major contribution to the Human Genome Project. Scientists in universities, research institutions, government agencies, and commercial organizations submit the results of their work to the Center's highly evolved information resources so that the data will be available for use by others. As a result of the accelerating pace of research, the GenBank database of DNA sequence information is growing to vast proportions. The database now contains some 3 million sequences with a total of 2 billion base pairs, and the NCBI Web site (where GenBank is made freely available) receives some 600,000 queries per day. NCBI scientists have also collaborated with colleagues in laboratories around the world to produce a new "gene map" that pinpoints the chromosomal locations of almost half of all genes. This milestone in the Human Genome Project, available to all on the World Wide Web, will greatly expedite the discovery of human disease genes and, by extension, contribute to advances in detection and treatment of common illnesses.
Basic Library Services
The library's collections constitute an unparalleled treasure for the nation. They are broad (encompassing all the health sciences) and deep (from the 11th century to the present). NLM subscribes to more than 22,000 serial publications and indexes almost 4,000 of them for MEDLINE, resulting in more than 400,000 references and citations being added to the database in an average year. In addition to NLM's online resources, extensive use is made of the library's physical collection: NLM responded to almost 700,000 requests for articles and books in 1998, by e-mail, fax, post, and on-site patrons. The library was able to handle this record workload with the help of a new interlibrary loan system called Relais, installed in 1998. Relais utilizes scanning, touch-screen, and bar code technology to process requests much faster, with less effort and paperwork, and with a higher quality copy being delivered to the requester. Clinical emergencies are given special priority; doctors a thousand miles away have been astounded to receive a copy of an article from the NLM within a half hour.
In fiscal year 1998 NLM received and processed 169,000 modern books, serial issues, audiovisuals, and computer-based materials. Preservation microfilming was done for 5,503 volumes (2,301,600 pages). A net total of 63 journals was added to those indexed for MEDLINE (the number indexed is now 3942).
A crucial element in delivering library services is the role played by the National Network of Libraries of Medicine. The NN/LM, with its 4500 members, is organized through eight regions, each with a Regional Medical Library designated and supported by NLM. Those institutions, together with 140 large academic health science libraries and the many hospital and other libraries in the network, provide crucial information service to scientists, health professionals, and, increasingly, the public. Working with NN/LM, NLM also has outreach programs designed to reach underserved populations, including minority and Native American communities, rural areas, and senior citizens.
The director of the library is Donald A. B. Lindberg, M.D. NLM is guided in matters of policy by a Board of Regents consisting of 10 appointed and 11 ex officio members. Tenley E. Albright, M.D., chairs the Board. In 1998 the Regents welcomed three new members to 4- year terms: Henry Foster, M.D., Ph.D., Senior Advisor to the President on Teen and Youth Issues; Joshua Lederberg, Ph.D., President Emeritus, Rockefeller University; and Herbert Pardes, M.D., Vice President for Health Sciences and Dean, Faculty of Medicine, College of Physicians and Surgeons, Columbia University.
| Library Operations | Volume |
| Collection (book and nonbook) | 5,330,000 |
| Items cataloged | 18,800 |
| Serial titles received | 22,250 |
| Articles indexed for MEDLINE | 412,000 |
| Circulation requests processed | 694,000 |
|
375,000 |
|
319,000 |
| Computerized searches (all databases) | 104,000,000 |
| Budget authority | $170,992,000 |
| Full-time staff | 577 |
*For the year ending September 30, 1998
Last updated: 13 February 2004
First published: 04 August 1999
Metadata| Permanence level: Permanence Not Guaranteed