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Question: What are some of the forces shaping the evolution of medical libraries, and where might they lead?

Data Sources: Published literature in the fields of library and information sciences, technology, health services research, and business was consulted.

Main Results: Medical libraries currently have a modest footprint in most consumers' personal health ecologies, the network of resources and activities they use to improve their health. They also occupy a relatively small space in the health care, information, and business ecologies of which they are a part. Several trends in knowledge discovery, technology, and social organizations point to ways in which the roles of medical libraries might grow and become more complex.

Conclusion: As medical libraries evolve and reach out to previously underserved communities, an ecological approach can serve as a useful organizing framework for the forces shaping this evolution.

In 1990, the Republican Scientific-Medical Library (RSML) of the Ministry of Health of Armenia in collaboration with the Fund for Armenian Relief created a vision of a national library network supported by information technology. This vision incorporated four goals: (1) to develop a national resource collection of biomedical literature accessible to all health professionals, (2) to develop a national network for access to bibliographic information, (3) to develop a systematic mechanism for sharing resources, and (4) to develop a national network of health sciences libraries. During the last decade, the RSML has achieved significant progress toward all four goals and has realized its vision of becoming a fully functional national library. The RSML now provides access to the literature of the health sciences including access to the Armenian medical literature, provides education and training to health professionals and health sciences librarians, and manages a national network of libraries of the major health care institutions in Armenia. The RSML is now able to provide rapid access to the biomedical literature and train health professionals and health sciences librarians in Armenia in information system use. This paper describes the evolution of the RSML and how it was accomplished.

Objective: The article offers a current perspective on medical informatics and health sciences librarianship.

Narrative: The authors: (1) discuss how definitions of medical informatics have changed in relation to health sciences librarianship and the broader domain of information science; (2) compare the missions of health sciences librarianship and health sciences informatics, reviewing the characteristics of both disciplines; (3) propose a new definition of health sciences informatics; (4) consider the research agendas of both disciplines and the possibility that they have merged; and (5) conclude with some comments about actions and roles for health sciences librarians to flourish in the biomedical information environment of today and tomorrow.

Summary: Boundaries are disappearing between the sources and types of and uses for health information managed by informaticians and librarians. Definitions of the professional domains of each have been impacted by these changes in information. Evolving definitions reflect the increasingly overlapping research agendas of both disciplines. Professionals in these disciplines are increasingly functioning collaboratively as “boundary spanners,” incorporating human factors that unite technology with health care delivery.

The founders of the Association of Academic Health Sciences Libraries (AAHSL) envisioned the development of a professional organization that would provide a greater voice for academic health sciences libraries, facilitate cooperation and communication with the Association of American Medical Colleges, and create a forum for identifying problems and solutions that are common to academic health sciences libraries. This article focuses on the fulfillment of the “greater voice” vision by describing action and leadership by AAHSL and its members on issues that directly influenced the role of academic health sciences libraries. These include AAHSL's participation in the work that led to the publication of the landmark report, Academic Information in the Academic Health Sciences Center: Roles for the Library in Information Management; its contributions to the recommendations of the Physicians for the Twenty-first Century: The GPEP Report; and the joint publication with the Medical Library Association of Challenge to Action: Planning and Evaluation Guidelines for Academic Health Sciences Libraries.

The two decades since the introduction of MEDLARS and the passage of the Medical Library Assistance Act have been especially eventful in the history of the National Library of Medicine. The library's collections and services have grown to keep pace with the expanding health sciences literature and the needs of health professionals. Networking has emerged as an invaluable method for disseminating biomedical information. NLM has assumed new responsibilities for information services in toxicology, pharmacology, and environmental health, and for research and development in biomedical communications. Research now being carried out by NLM has the potential for enhancing the library's archival programs and for improving information dissemination in support of health sciences research, education, and practice.

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Question: What are some of the historical societal, medical, and public health trends leading to today's provision of hospital library services to patients?

Data Sources: Literature from the archives of the Bulletin of the Medical Library Association and other library sources, medical journals, primary historical documents, and texts from the history of medicine form the core of this review.

Study Selection: The period of review extends from about 1790 through 1950 and focuses solely on trends in the United States. Of primary concern are explicitly documented examples that appear to illustrate the patient-physician relationship and those between librarians and their patient-patrons during the earliest years of the profession's development.

Data Extraction: An historical timeline was created to allow the identification of major trends that may have affected library services. Multiple literature searches were conducted using library, medical, and health anthropology resources. When possible, primary sources were preferred over reviews.

Main Results: Juxtapositioning historical events allows the reader to obtain an overview of the roots of consumer health services in medical libraries and to consider their potential legacy in today's health care libraries.

Conclusion: This review article highlights early developments in hospital library service to patients. Further research is needed to verify a preliminary conclusion that in some medical library settings, services to the general public are shaped by the broader health care environment as it has evolved.

Background

The SYMBIOmatics Specific Support Action (SSA) is "an information gathering and dissemination activity" that seeks "to identify synergies between the bioinformatics and the medical informatics" domain to improve collaborative progress between both domains (ref. to ). As part of the project experts in both research fields will be identified and approached through a survey. To provide input to the survey, the scientific literature was analysed to extract topics relevant to both medical informatics and bioinformatics.

Results

This paper presents results of a systematic analysis of the scientific literature from medical informatics research and bioinformatics research. In the analysis pairs of words (bigrams) from the leading bioinformatics and medical informatics journals have been used as indication of existing and emerging technologies and topics over the period 2000–2005 ("recent") and 1990–1990 ("past"). We identified emerging topics that were equally important to bioinformatics and medical informatics in recent years such as microarray experiments, ontologies, open source, text mining and support vector machines. Emerging topics that evolved only in bioinformatics were system biology, protein interaction networks and statistical methods for microarray analyses, whereas emerging topics in medical informatics were grid technology and tissue microarrays.

Conclusion

We conclude that although both fields have their own specific domains of interest, they share common technological developments that tend to be initiated by new developments in biotechnology and computer science.

The imbalance between medical library resources and information needs of the health professional led to a reexamination of the mandate for the National Library of Medicine. Legislation known as the Medical Library Assistance Act (MLAA) was passed in 1965 which enabled the NLM to (1) initiate programs to assist the nation's medical libraries and (2) develop a medical library network with the establishment of regional medical libraries to link the NLM with local institutions.

The National Library of Medicine, through the MLAA, has made available $40.8 million to the medical library community under a competitive grant and contract mechanism for the period July 1965—June 1970. A total of 604 projects has been executed in resources, research and development, training, construction, regional medical libraries, publications, and special scientific projects. An assessment is given of each of these programs and their impact on both the National Library of Medicine and individual medical libraries. In the aggregate, these programs have significantly improved library and information services to the professional health user. The principal limitation has been inadequate funding to accomplish the level of originally stated objectives.

Data management and integration are complicated and ongoing problems that will require commitment of resources and expertise from the various biological science communities. Primary components of successful cross-scale integration are smooth information management and migration from one context to another. We call for a broadening of the definition of bioinformatics and bioinformatics training to span biological disciplines and biological scales. Training programs are needed that educate a new kind of informatics professional, Biological Information Specialists, to work in collaboration with various discipline-specific research personnel. Biological Information Specialists are an extension of the informationist movement that began within library and information science (LIS) over 30 years ago as a professional position to fill a gap in clinical medicine. These professionals will help advance science by improving access to scientific information and by freeing scientists who are not interested in data management to concentrate on their science.

Objectives: This paper introduces the special supplement to the Journal of the Medical Library Association (JMLA) that documents the proceedings of the “Symposium on Community-based Health Information Outreach” held on December 2 and 3, 2004, at the National Library of Medicine (NLM). The goal of the symposium was to explore new models of health information outreach that are emerging as technology dramatically changes the abilities of medical and health services libraries to provide resources and services beyond their traditional institutional boundaries, with particular concern for consumer health information outreach through community-based organizations. The symposium's primary objectives were to learn about successful and promising work that had already been done as well as to develop a vision for the future that could inform the NLM's next National Network of Libraries of Medicine (NN/LM) contract. Another objective was to review and assess the NLM's Strategic Plan to Reduce Health Disparities with special emphasis on Native Americans.

Method: The paper describes the background events and rationale that led to the NLM's decision to convene the symposium and summarizes the supplement's ten other papers, some of which were presented at the symposium and some of which were written afterward to capture the symposium's working sessions.

Results: The symposium convened approximately 150 invited participants with a wide variety of perspectives and experience. Sessions were held to present exemplary outreach projects, to review the NLM's Strategic Plan to Reduce Health Disparities, to summarize the research underpinnings for evaluating outreach projects, and to provide a futurist's perspective. A panel of community representatives gave voice to the participants in outreach projects, and sixteen posters describing outreach projects were available, many of them with community representatives on hand to explain the work.

Implications: This JMLA supplement provides a comprehensive summary of the state of the art in community-based outreach and a jumping-off point for future outreach efforts.

Designing and building new or renovated space is time consuming and requires politically sensitive discussions concerning a number of both long-term and immediate planning issues. The Medical Library Association's fourth annual survey of library building projects identified ten health sciences libraries that are planning, expanding, or constructing new facilities. Two projects are in predesign stages, four represent new construction, and four involve renovations to existing libraries. The Texas Medical Association Library, the King Faisal Specialist Hospital and Research Centre Library, and the Northwestern University Galter Health Sciences Library illustrate how these libraries are being designed for the future and take into account areas of change produced by new information technologies, curricular trends, and new ways to deliver library services.

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Librarians are exploring new approaches to information sharing to cope with a rapidly changing environment dominated by budget cuts, information explosion, and globalization of the economy, science, and culture. In 1990, the University of Illinois at Chicago Library of the Health Sciences (UIC LHS) initiated a pilot project aimed at establishing an effective balance between state-of-the-art information technology and traditional library methods and promoting cooperation among health information professionals by establishing the Health Information Referral Network (HIRN) in the state of Illinois. HIRN's background and development, Internet home page, and networking techniques reviewed in this paper are applicable to multitype libraries and information centers interested in improving information use and the referral process.

Purpose: The study seeks to determine how medical library professionals performing information-technology (IT) roles are compensated and how their positions are designed compared to information technology staff in their institutions.

Methods: 550 medical library directors in hospital and academic medical libraries were surveyed. The data was then compared to survey data from other compensation studies of the IT industry.

Results: There is a gap in compensation between medical library professionals and IT professionals performing similar functions using information technology. Technology-intense library jobs are compensated at higher levels than more traditional jobs.

Conclusions: To compete with IT salaries, managers of medical library professionals will need to be ever more cognizant of the employment practices of IT professionals in nonmedical library disciplines. It is typically in the medical library's best interest to ensure that IT-related jobs, accountabilities, and capabilities of the medical library are known and understood by others, especially in the human resources and information technology staff departments.

The field of informatics has been going through a rapid change over the past decade. New technologies such as grid computing[1–5] and knowledge anchored data, combined with major funding and growing community thrusts aimed at creating a richer multi-institutional research and clinical environment such as caBIG™[6–8] (Cancer Bioinformatics Grid), BIRN[9] (Bioinformatics Research Network), and CTSA(Clinical and Translational Science Awards) have lead to new ways to bring together information across institutional boundaries. This had lead to service oriented architectures based developments in creating semantically interoperable data and analytical services to increase speed, efficiency, and outcome of clinical and research efforts spanning the fields of medicine. The TRIAD (Translational Informatics and Data Management Grid) System, which will be used as the middleware system enabling the OSU CTSA to create a scalable, secure, and knowledge anchored data sharing environment, will adopt and adapt the caGrid infrastructure designed for the caBIG™ program.

Support for molecular biology researchers has been limited to traditional library resources and services in most academic health sciences libraries. The University of Washington Health Sciences Libraries have been providing specialized services to this user community since 1995. The library recruited a Ph.D. biologist to assess the molecular biological information needs of researchers and design strategies to enhance library resources and services. A survey of laboratory research groups identified areas of greatest need and led to the development of a three-pronged program: consultation, education, and resource development. Outcomes of this program include bioinformatics consultation services, library-based and graduate level courses, networking of sequence analysis tools, and a biological research Web site. Bioinformatics clients are drawn from diverse departments and include clinical researchers in need of tools that are not readily available outside of basic sciences laboratories. Evaluation and usage statistics indicate that researchers, regardless of departmental affiliation or position, require support to access molecular biology and genetics resources. Centralizing such services in the library is a natural synergy of interests and enhances the provision of traditional library resources. Successful implementation of a library-based bioinformatics program requires both subject-specific and library and information technology expertise.

This study seeks to increase our understanding of the structure of Medical Informatics. In particular, it focuses on the relationships between information science and information technology on the one hand, and biomedical research, clinical practice, and medical education on the other, that have defined "medical informatics." Using indexing terms and MeSH tree structures assigned to medical informatics literature covered by MEDLINE, co-occurrence analysis provides a "map" of the field. Major research and application focuses arrayed within the map elucidate a finer structure than reported previously. Dimensions "Techniques vs. Systems" and "Signs & Symptoms vs. Processes" form the two axes of the map and relate to the relationships underlying the indexing assignments given to the literature studied. Related studies underway using the INSPEC database will provide a complementary perspective on the structure of medical informatics as a field.

From the vantage point of her personal experience, the author examines milestones since the 1960s which have changed the medical library profession and helped shape the Medical Library Association. The advent of automation, including cataloging with OCLC and online literature searching through the SUNY Biomedical Communication Network, was a dramatic event that transformed the work and priorities of librarians, fulfilling the dreams of earlier visionaries. The application of technology in libraries led to an increased demand for education and training for librarians. The Medical Library Association responded with continuing education programs, and a series of important reports influenced how the association filled its role in professional development. Legislation providing federal funding, such as the Medical Library Assistance Act, resulted in a period of expansion for libraries and their services. The Medical Library Association has developed a legislative agenda to influence action in areas such as copyright. In the future, health sciences librarians must take a leadership role.

A national sample of health sciences and other types of libraries having significant holdings of biomedical literature was studied to determine the status of library preservation programs. Findings pertaining to 134 basic health sciences libraries and to ninety-seven resource libraries in the Regional Medical Library Program network are reported and discussed. Basic health sciences libraries participating in the study were primarily hospital libraries; resource libraries were primarily academic health sciences center libraries. Findings include information on topics perceived to be of greatest need for staff training and for informational or educational materials; on levels of preservation activity, staffing, and funding; and on capabilities for participating in a national cooperative preservation program. Efforts to identify general and special biomedical collections of potential importance to a national preservation program met with limited success.

Objective

To establish the empirical evidence base for the information that participants want to know about medical research and to assess how this relates to current guidance from the National Research Ethics Service (NRES).

Data sources

Medline, Web of Science, Applied Social Sciences Index and Abstracts, Sociological abstracts, Health Management Information Consortium, Cochrane Library, thesis index's, grey literature databases, reference and cited article lists, key journals, Google Scholar and correspondence with expert authors.

Study selection

Original research studies published between 1950 and October 2010 that asked potential participants to indicate how much or what types of information they wanted to be told about a research study or asked them to rate the importance of a specific piece of information were included.

Study appraisal and synthesis methods

Studies were appraised based on the generalisability of results to the UK potential research participant population. A metadata analysis using basic thematic analysis was used to split results from papers into themes based on the sections of information that NRES recommends should be included in a participant information sheet.

Results

14 studies were included. Of the 20 pieces of information that NRES recommend should be included in patient information sheets for research pooled proportions could be calculated for seven themes. Results showed that potential participants wanted to be offered information about result dissemination (91% (95% CI 85% to 95%)), investigator conflicts of interest (48% (95% CI 27% to 69%)), the purpose of the study (76% (95% CI 27% to 100%)), voluntariness (39% (95% CI 2% to 100%)), how long the research would last (61% (95% CI 16% to 97%)), potential benefits (57% (95% CI 7% to 98%)) and confidentiality (44% (95% CI 10% to 82%)). The level of detail participants wanted to know was not explored comprehensively in the studies. There was no empirical evidence to support the level of information provision required by participants on the remaining seven items.

Conclusions

There is limited empirical evidence on what potential participants want to know about research. The existing empirical evidence suggests that individuals may have very different needs and a more tailored evidence-based approach may be necessary.

Article summary

Article focus

What information do potential participants want to know when they are deciding whether to take part in research?

What is the established empirical evidence base?

How does the current empirical evidence base relate to current guidance from the NRES?

Key messages

There is little empirical evidence of what information potential participants want to know about research when they are making the decision to take part.

The limited empirical evidence available suggests that potential participants may have very different information needs.

Further research is required to determine what potential participants really want to know about research and how this can be delivered in a way that takes into account their different informational needs.

Strengths and limitations of this study

An extensive search strategy ensured that the review was systematic in capturing all available empirical evidence.

Papers included in the review differed in their methodologies and presentation of results, making comparisons between papers extremely difficult.

The Florida Health Information Network (FHIN) was established in October 1989 to provide biomedical information services to the University of Florida Health Science Center (HSC) and to health professionals throughout the state--especially the northern thirty-nine counties of the state. FHIN services are available to all affiliates of the HSC and by annual subscription to nonaffiliates. At present, FHIN services include database access, circulation services, document delivery, and information services. Training network users has been an objective since the inception. Training has targeted both the HSC Library staff and HSC users and now is expanding to include remote users. Because many users have had insufficient experience with computers, the library has to teach the mechanics of access and network use and to instruct users regarding applications and database searching. This paper describes the development and implementation of the medical informatics education program. Topics include library staff training; educational offerings for HSC faculty, staff, and students; development and implementation of the remote training program; and organizational and budgetary implications for the construction of such a program.

The University of Illinois Library of the Health Sciences at Rockford (LHS-Rockford) long has honored a commitment to serving the health information needs of the greater Rockford community. Utilization data collected over the past five years indicate that approximately 50% of reference transactions involve persons not affiliated with the university. In early 1994, LHS-Rockford submitted a proposal to the Northern Illinois Library System (NILS), a multitype system spanning twelve counties in northwestern Illinois, asking to serve as a resource library for improving medical and health information services provided by the 138 NILS member libraries. The NILS funded this pilot project as part of an effort to implement a new strategic plan, which encouraged member libraries to form networks to provide reference back-up service. LHS-Rockford acquired InfoTrac's Health Reference Center, a consumer health information database, and set up a dedicated workstation near the information and circulation desk. Referral guidelines were established and the project was promoted among NILS member libraries. Activities were documented in order to track project success in terms of referrals and outcomes. The demonstration project was very successful, and it proves public consumers seeking health information can benefit greatly from this type of cooperative arrangement.

Historically, medical information has been provided to patients at the physician's discretion. Although this method never has been wholly satisfactory, the trend toward bureaucratic organization of medical care, characterized by impersonal patient encounters and prompted by increased emphasis on cost controls, has restricted patient information even further. Yet, at the same time, the upsurge in consumer power has created patient demand for more health information. Consumers feel they have a right to expect help in obtaining information so they can make informed decisions with respect to their medical care. This paper focuses on the medical school-based consumer health service in this context. In particular, it calls attention to the medical school library as the foundation for expanded health information resources, pointing to the tools of information retrieval, as well as the substantive information contained in the medical, nursing, and allied health literature. In this setting, the consumer health librarian is called upon to act as a mediator in providing quality-filtered information to the patron, while at the same time remaining within the confines of professional expertise as a librarian. Important sources of health information are highlighted, particularly online databases, drug indexes, therapeutic texts, and physician specialist directories.

A “Digital Divide” in information and technological literacy exists in Utah between small hospitals and clinics in rural areas and the larger health care institutions in the major urban area of the state. The goals of the outreach program of the Spencer S. Eccles Health Sciences Library at the University of Utah address solutions to this disparity in partnership with the National Network of Libraries of Medicine—Midcontinental Region, the Utah Department of Health, and the Utah Area Health Education Centers. In a circuit-rider approach, an outreach librarian offers classes and demonstrations throughout the state that teach information-access skills to health professionals. Provision of traditional library services to unaffiliated health professionals is integrated into the library's daily workload as a component of the outreach program. The paper describes the history, methodology, administration, funding, impact, and results of the program.

The medical libraries of Vietnam maintain high profiles within their institutions and are recognized by health care professionals and administrators as an important part of the health care system. Despite the multitude of problems in providing even a minimal level of medical library services, librarians, clinicians, and researchers nevertheless are determined that enhanced services be made available. Currently, services can be described as basic and unsophisticated, yet viable and surprisingly well organized. The lack of hard western currency required to buy materials and the lack of library technology will be major obstacles to improving information services. Vietnam, like many developing nations, is about to enter a period of technological upheaval, which ultimately will result in a transition from the traditional library limited by walls to a national resource that will rely increasingly on electronic access to international knowledge networks. Technology such as CD-ROM, Integrated Services Digital Network (ISDN), and satellite telecommunication networks such as Internet can provide the technical backbone to provide access to remote and widely distributed electronic databases to support the information needs of the health care community. Over the long term, access to such databases likely will be cost-effective, in contrast to the assuredly astronomical cost of building a comparable domestic print collection. The advent of new, low-cost electronic technologies probably will revolutionize health care information services in developing nations. However, for the immediate future, the medical libraries of Vietnam will require ongoing sustained support from the international community, so that minimal levels of resources will be available to support the information needs of the health care community. It is remarkable, and a credit to the determination of Vietnam's librarians that, in a country with a legacy of war, economic deprivation, and international isolation, they have somehow managed to provide a sound basic level of information services for health care professionals.

Background: The information landscape in biological and medical research has grown far beyond literature to include a wide variety of databases generated by research fields such as molecular biology and genomics. The traditional role of libraries to collect, organize, and provide access to information can expand naturally to encompass these new data domains.

Methods: This paper discusses the current and potential role of libraries in bioinformatics using empirical evidence and experience from eleven years of work in user services at the National Center for Biotechnology Information.

Findings: Medical and science libraries over the last decade have begun to establish educational and support programs to address the challenges users face in the effective and efficient use of a plethora of molecular biology databases and retrieval and analysis tools. As more libraries begin to establish a role in this area, the issues they face include assessment of user needs and skills, identification of existing services, development of plans for new services, recruitment and training of specialized staff, and establishment of collaborations with bioinformatics centers at their institutions.

Conclusions: Increasing library involvement in bioinformatics can help address information needs of a broad range of students, researchers, and clinicians and ultimately help realize the power of bioinformatics resources in making new biological discoveries.