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1.  The SUNY biomedical communication network: six years of progress in on-line bibiographic retrieval. 
The SUNY Biomedical Communication Network became operational in 1968 as the first on-line bibliograhpic retrieval service for biomedical literature. Since 1968, the SUNY/BCN has grown in size from nine to thirty-two medical and university libraries and has expanded its data base coverage to include the ERIC and Psychological Abstracts data bases in addition to the full ten-year retrospective MEDLARS data base. Aside from the continuous provision of an on-line searching system, the SUNY experience over the last six years has yielded valuable information in the following areas of: (1) monograph indexing and retrieval, (2) shared cataloging, (3) user interaction and education in on-line systems, and (4) member participation in Network policy-making processes. The continued success of the SUNY/BCN is evidence that it is possible to provide a high quality on-line bibliographic retrieval system at cost to academic institutions. SUNY's success in this effort is the result of centralized resource sharing and effective regional networking, combined with thoughtful planning by user advisory committees.
PMCID: PMC198883  PMID: 1173557
2.  Public library consumer health information pilot project: results of a National Library of Medicine evaluation 
In October 1998, the National Library of Medicine (NLM) launched a pilot project to learn about the role of public libraries in providing health information to the public and to generate information that would assist NLM and the National Network of Libraries of Medicine (NN/LM) in learning how best to work with public libraries in the future. Three regional medical libraries (RMLs), eight resource libraries, and forty-one public libraries or library systems from nine states and the District of Columbia were selected for participation. The pilot project included an evaluation component that was carried out in parallel with project implementation. The evaluation ran through September 1999. The results of the evaluation indicated that participating public librarians were enthusiastic about the training and information materials provided as part of the project and that many public libraries used the materials and conducted their own outreach to local communities and groups. Most libraries applied the modest funds to purchase additional Internet-accessible computers and/or upgrade their health-reference materials. However, few of the participating public libraries had health information centers (although health information was perceived as a top-ten or top-five topic of interest to patrons). Also, the project generated only minimal usage of NLM's consumer health database, known as MEDLINEplus, from the premises of the monitored libraries (patron usage from home or office locations was not tracked). The evaluation results suggested a balanced follow-up by NLM and the NN/LM, with a few carefully selected national activities, complemented by a package of targeted activities that, as of January 2000, are being planned, developed, or implemented. The results also highlighted the importance of building an evaluation component into projects like this one from the outset, to assure that objectives were met and that evaluative information was available on a timely basis, as was the case here.
PMCID: PMC35252  PMID: 11055298
3.  The National Library of Medicine: from MEDLARS to the sesquicentennial and beyond. 
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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PMCID: PMC406284  PMID: 3535951
4.  Introduction* 
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.
PMCID: PMC1255748  PMID: 16437797
5.  Service providers and users discover the Internet. 
Although the Internet has evolved over more than twenty years, resources useful to health information professionals have become available on the Internet only recently. A survey conducted by the Regional Medical Libraries of the National Network of Libraries of Medicine in the fall of 1993 indicates that libraries at academic institutions are much more likely to have access to the Internet (72%) than are libraries in hospital environments (24%). Health information professionals who take on the challenge and exploit the Internet's resources find rewards for themselves and their clients. The basic electronic mail capability of the Internet allows colleagues to collaborate, communicate, and participate in daily continuing education. Internet terminal and file-transfer capabilities provide improved access to traditional resources and first-time access to new electronic resources. Through the Internet, online catalogs are available worldwide, and document delivery is faster, cheaper, and more reliable than ever before. Institutions can make organizational, full-text, online, and publication information available through Internet tools such as direct file-transfer protocol (FTP), menu-based Gopher, and hypertext-based Mosaic. The National Library of Medicine (NLM) is among organizations finding new ways to provide service through the Internet. NLM now uses electronic mail to communicate with users, FTP service to distribute publications, and tools such as Gopher and Mosaic to distribute publications and graphics and connect users to online services. The Internet allows service providers and health sciences information professionals to work in a rich, new medium whose potential is just beginning to be explored. At the same time, its characteristics--including lack of formal organization, standards, quality control, and permanence--pose a challenge.
PMCID: PMC225967  PMID: 7841912
6.  Exporting the American (information) revolution: the international impact of the National Library of Medicine. 
The National Library of Medicine has had an enormous impact on health information services all over the world. Although NLM is primarily a national institution, it has become an important international resource by responding to requests from the international community. NLM has been influential in three major ways. First, NLM has provided a model for other national and regional health information services. Second, it has been a catalyst, in that MEDLARS and other services it provides formed the nucleus of many regional networks. NLM helped such networks get started by giving advice on how to set up services and build collections and by "training the trainers" on the MEDLARS system. Third, NLM has supported national and regional operations by providing the additional training and materials needed for day-to-day service.
PMCID: PMC406286  PMID: 3535952
7.  The MEDLARS Project at the UCLA Biomedical Library *† 
The National Library of Medicine has established at the Biomedical Library, UCLA, a remote MEDLARS search station. The agreement between the libraries provided that the Biomedical Library in cooperation with the UCLA Health Sciences Computing Facility would reprogram MEDLARS for the IBM 7094 computer, provide personnel to be trained in machine searching at NLM, and engage in a pilot demonstration of search service to the medical staff of UCLA. This paper describes the place of the search section in the organization of the Biomedical Library and the training of personnel at NLM (the article by Garvis in this issue of the Bulletin relates the problems encountered in making two different computer systems compatible). Search service had not begun when this paper was written; it was scheduled to begin late in 1965. Plans for the future include the enlargement of the UCLA MEDLARS staff and extension of search service to a larger geographical area.
PMCID: PMC198363  PMID: 5901354
8.  HPCC and the National Information Infrastructure: an overview. 
The National Information Infrastructure (NII) or "information superhighway" is a high-priority federal initiative to combine communications networks, computers, databases, and consumer electronics to deliver information services to all U.S. citizens. The NII will be used to improve government and social services while cutting administrative costs. Operated by the private sector, the NII will rely on advanced technologies developed under the direction of the federal High Performance Computing and Communications (HPCC) Program. These include computing systems capable of performing trillions of operations (teraops) per second and networks capable of transmitting billions of bits (gigabits) per second. Among other activities, the HPCC Program supports the national supercomputer research centers, the federal portion of the Internet, and the development of interface software, such as Mosaic, that facilitates access to network information services. Health care has been identified as a critical demonstration area for HPCC technology and an important application area for the NII. As an HPCC participant, the National Library of Medicine (NLM) assists hospitals and medical centers to connect to the Internet through projects directed by the Regional Medical Libraries and through an Internet Connections Program cosponsored by the National Science Foundation. In addition to using the Internet to provide enhanced access to its own information services, NLM sponsors health-related applications of HPCC technology. Examples include the "Visible Human" project and recently awarded contracts for test-bed networks to share patient data and medical images, telemedicine projects to provide consultation and medical care to patients in rural areas, and advanced computer simulations of human anatomy for training in "virtual surgery."
PMCID: PMC225993  PMID: 7703935
9.  Building better connections: the National Library of Medicine and public health 
Purpose: The paper describes the expansion of the public health programs and services of the National Library of Medicine (NLM) in the 1990s and provides the context in which NLM's public health outreach programs arose and exist today.
Brief Description: Although NLM has always had collections and services relevant to public health, the US public health workforce made relatively little use of the library's information services and programs in the twentieth century. In the 1990s, intensified emphases on outreach to health professionals, building national information infrastructure, and promoting health data standards provided NLM with new opportunities to reach the public health community. A seminal conference cosponsored by NLM in 1995 produced an agenda for improving public health access to and use of advanced information technology and electronic information services. NLM actively pursued this agenda by developing new services and outreach programs and promoting public health informatics initiatives.
Method: Historical analysis is presented.
Results/Outcome: NLM took advantage of a propitious environment to increase visibility and understanding of public health information challenges and opportunities. The library helped create partnerships that produced new information services, outreach initiatives, informatics innovations, and health data policies that benefit the public health workforce and the diverse populations it serves.
doi:10.3163/1536-5050.95.3.293
PMCID: PMC1924934  PMID: 17641764
10.  International programs of the National Library of Medicine. 
The National Library of Medicine (NLM) has a broad mission in biomedical information service. There are three major reasons for NLM, as a national institution, having an international program: first, the global nature of disease; second, the international scope of medical literature; and third, the universal goal of better communication. This paper reviews NLM's programs in relation to international medical information exchange: International MEDLARS Centers, collaboration with WHO and PAHO, NLM Special Foreign Currency Program, and development of the NLM collection.
PMCID: PMC227234  PMID: 3285929
11.  The medical libraries of Vietnam--a service in transition. 
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.
PMCID: PMC225670  PMID: 1525617
12.  The Medical Library Assistance Act: An Analysis of the NLM Extramural Programs, 1965-1970 * 
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.
PMCID: PMC197606  PMID: 5146762
13.  Empowering health personnel for decentralized health planning in India: The Public Health Resource Network 
The Public Health Resource Network is an innovative distance-learning course in training, motivating, empowering and building a network of health personnel from government and civil society groups. Its aim is to build human resource capacity for strengthening decentralized health planning, especially at the district level, to improve accountability of health systems, elicit community participation for health, ensure equitable and accessible health facilities and to bring about convergence in programmes and services.
The question confronting health systems in India is how best to reform, revitalize and resource primary health systems to deliver different levels of service aligned to local realities, ensuring universal coverage, equitable access, efficiency and effectiveness, through an empowered cadre of health personnel. To achieve these outcomes it is essential that health planning be decentralized. Districts vary widely according to the specific needs of their population, and even more so in terms of existing interventions and available resources. Strategies, therefore, have to be district-specific, not only because health needs vary, but also because people's perceptions and capacities to intervene and implement programmes vary. In centrally designed plans there is little scope for such adaptation and contextualization, and hence decentralized planning becomes crucial.
To undertake these initiatives, there is a strong need for trained, motivated, empowered and networked health personnel. It is precisely at this level that a lack of technical knowledge and skills and the absence of a supportive network or adequate educational opportunities impede personnel from making improvements. The absence of in-service training and of training curricula that reflect field realities also adds to this, discouraging health workers from pursuing effective strategies.
The Public Health Resource Network is thus an attempt to reach out to motivated though often isolated health workers. It interacts with, and works to empower, health personnel within the government health system as well as civil society, to meaningfully participate in and strengthen decentralized planning processes and outcomes. Structured as an innovative distance-learning course spread over 12 to 18 months of coursework and contact programmes, the Public Health Resource Network comprises 14 core modules and five optional courses. The technical content and contact programmes have been specifically developed to build perspectives and technical knowledge of participants and provide them with a variety of options that can be immediately put into practice within their work environments and everyday roles. The thematic areas of the course modules range from technical knowledge related to maternal and child health and communicable and noncommunicable diseases; programmatic and systemic knowledge related to health planning, convergence, health management and public-private partnerships; to perspective-building knowledge related to mainstreaming gender issues and community participation. Currently the Public Health Resource Network has been launched in four states of India – Chhattisgarh, Jharkhand, Bihar and Orissa – in its first phase, and reaches out to more than 500 participants with diverse backgrounds. The initiative has received valuable support from central and state government departments of health, state training institutes, the National Rural Health Mission – the current comprehensive health policy in the country – and leading civil society organizations.
doi:10.1186/1478-4491-7-57
PMCID: PMC2717913  PMID: 19615106
14.  Transitioning to the Internet: results of a National Library of Medicine user survey. 
In late 1995, several months prior to the introduction of Internet Grateful Med, the National Library of Medicine (NLM) conducted a customer survey as part of its efforts to make a transition from Grateful Med to new forms of electronic information access and retrieval. A questionnaire survey was mailed to a sample of 2,500 online users randomly selected from domestic users (excluding fixed-fee users) who searched NLM databases during the second quarter of 1995. The final response rate was nearly 83% of eligible respondents. About 70% of NLM customers responding already had access to the Internet, and of those, more than 90% had access to the World Wide Web. However, only 26% of customers with Internet access were using the Internet to access NLM databases. Health care providers account for about 46% of NLM customers but, as a group, search NLM databases relatively infrequently even though they have higher-end equipment. Librarians and information professionals represent about one-fifth of NLM customers and are by far the most intensive users, but tend to have lower-end equipment. Overall, the survey results provide a strong basis for the transition to Internet-based delivery of NLM online database services, including Internet Grateful Med and the NLM family of World Wide Web sites. However, Internet access is uneven, especially in rural areas and at hospitals. This reinforces the need for continuing special outreach efforts directed at improving access for rural and hospital-based users and rural libraries, upgrading computer equipment for medical librarians, and training health care providers in more effective use of Internet-based biomedical information resources.
PMCID: PMC226289  PMID: 9431421
15.  The National Library of Medicine's Services: Initial Observations on Indexing, Interlibrary Loan, and Reference * 
How have the three services—indexing, reference (including history of medicine), and interlibrary loan—been provided throughout the years by NLM, and how have they been used? At the present time of great growth and development, the use of the computer has influenced these services and will continue to figure prominently in plans for the future. NLM's services often have not been well or correctly used by its public, even by librarians. Some of its services, however, need to be provided in more depth and on a higher scale, and they should be publicized more widely. History shows that NLM has been faithful to its basic charge and has gone far beyond it in its service to the medical, educational, and library communities. Medical librarians are most fortunate that such a great national resource exists to provide materials and services to fulfill the needs of their libraries.
PMCID: PMC198494  PMID: 6016365
16.  Laws, leaders, and legends of the modern National Library of Medicine 
Purpose: The paper is an expanded version of the 2007 Joseph Leiter National Library of Medicine (NLM)/Medical Library Association Lecture presented at MLA ‘07, the Medical Library Association annual meeting in Philadelphia in May 2007. It presents an historical accounting of four major pieces of legislation, beginning with the NLM Act of 1956 up through the creation of the National Center for Biotechnology Information.
Brief Description: The transition from the United States Armed Forces Medical Library to the United States National Library of Medicine in 1956 was a major turning point in NLM's history, scope, and direction. The succeeding landmark legislative achievements—namely, the 1965 Medical Library Assistance Act, the 1968 Joint Resolution forming the Lister Hill National Center for Biomedical Communications, and the 1988 authorization for the National Center for Biotechnology Information— transformed the library into a major biomedical communications institution and a leader and supporter of an effective national network of libraries of medicine. The leaders of the library and its major advocates—including Dr. Michael DeBakey, Senator Lister Hill, and Senator Claude Pepper—together contributed to the creation of the modern NLM.
doi:10.3163/1536-5050.96.2.121
PMCID: PMC2268223  PMID: 18379667
17.  Assessment of the National Library of Medicine's health disparities plan: a focus on Native American outreach* 
Journal of the Medical Library Association  2005;93(4 Suppl):S10-S20.
Objectives: Overcoming health disparities between majority and minority populations is a significant national challenge. This paper assesses outreach to Native Americans (American Indians, Alaska Natives, and Native Hawaiians) by the National Library of Medicine (NLM). A companion paper details NLM's portfolio of Native American outreach projects.
Method: NLM's Native American outreach is assessed in light of the presentations at a community-based health information outreach symposium and the goals set by NLM's plan to reduce health disparities.
Results: NLM's current portfolio of Native American outreach projects appears most advanced in meeting the goal set in area 1 of the health disparities plan, “Promote use of health information by health professionals and the public.” NLM's portfolio also shows significant strength and good progress regarding area 2 of the plan, “Expand partnerships among various types of libraries and community-based organizations.” The portfolio is weaker in area 3, “Conduct and support informatics research.” More knowledge-building efforts would benefit NLM, the National Network of Libraries of Medicine, and Native American and community-based organizations.
Implications: The current Native American outreach portfolio should be continued, but new approaches are needed for evaluating Native American outreach and for forging collaborations with Native American groups, approaches grounded in consultation and mutual understanding of needs and perspectives.
PMCID: PMC1255749  PMID: 16239954
18.  Meeting information needs in health policy and public health: Priorities for the national library of medicine and the national network of libraries of medicine 
Those seeking information in health policy and public health are not as well served as those seeking clinical information. Problems inhibiting access to health policy and public health information include the heterogeneity of professionals seeking the information, the distribution of relevant information across disciplines and information sources, scarcity of synthesized information useful to practitioners, lack of awareness of available services or training in their use, and lack of access to information technology or to knowledgeable librarians and information specialists. Since 1990, the National Library of Medicine and the National Network of Libraries of Medicine have been working to enhance information services in health policy and public health through expanding the coverage of the NLM collection, building new databases, and engaging in targeted outreach and training initiatives directed toward segments of the health policy and public health communities. Progress has been made, but more remains to be done. Recommendations arising from the meeting,Accessing Useful Information: Challenges in Health Policy and Public Health, will help NLM and the National Network of Libraries of Medicine to establish priorities and action plans for the next several years.
doi:10.1007/BF02344515
PMCID: PMC3456023  PMID: 9854247
19.  National Library of Medicine Disaster Information Management Research Center: Establishment and growth, 2008–2010 1 
Information services & use  2013;33(3-4):273-298.
In 2008, the National Library of Medicine (NLM) established the Disaster Information Management Research Center (DIMRC). Prior to 2008, NLM had a long history of involvement in providing health information for disaster management. Aware of this legacy and moved by the catastrophic aftermath of Hurricane Katrina, the NLM long range plan (Charting a Course for the 21st Century: NLM’s Long Range Plan 2006–2016) called for creation of a center to show “a strong commitment to disaster remediation and to provide a platform for demonstrating how libraries and librarians can be part of the solution to this national problem”. NLM was urged to “ensure continuous access to health information and effective use of libraries and librarians when disasters occur”. In response to this charge, NLM has undertaken substantial efforts to ensure that medical libraries have plans for the continuity of their operations, librarians are trained to understand their roles in preparedness and response, online disaster health information resources are available for many audiences and in multiple formats, and research is conducted on tools to enhance the exchange of critical information during and following disasters. This paper documents the history, goals, initiatives, accomplishments and future plans of the Center.
doi:10.3233/ISU-130709
PMCID: PMC4196694  PMID: 25324584
National Library of Medicine; Disaster Information Management Research Center; history; preparedness; response; recovery; public health emergencies; emergency management; libraries; librarians; informationists; Bethesda Hospitals’ Emergency Preparedness Partnership; hazards databases; internet; web; research and development; WISER; REMM; CHEMM; Resource Guide for Public Health Preparedness; National Network of Libraries of Medicine
20.  Adjusting to progress: interactions between the National Library of Medicine and health sciences librarians, 1961–2001* 
Most health sciences librarians would agree that the National Library of Medicine's (NLM's) leadership and its services have been highly beneficial to the field, but this does not prevent specific NLM actions—or lack of action—from being perceived as annoying or infuriating. Over the past forty years, NLM's interactions with health sciences librarians have been affected by significant additions to NLM's mission and services, the expansion of NLM's direct user groups, and the growing range of possible relationships between health sciences librarians and NLM. The greatest friction between NLM and health services librarians occurs when there is a fundamental change in the way NLM carries out its mission—a change that adds to the web of relationships that link librarians and NLM and prompts corresponding changes in the way other libraries do business. Between 1961 and 2001, there were two such fundamental changes: the implementation of the National Network of Libraries of Medicine and the development and promotion of services targeted toward individual health professionals. On a lesser scale, each new service that connects NLM and health sciences librarians is another potential source of irritation, ready to flare up when the service is interrupted, changed, or eliminated. Other factors—including strong personalities, mistakes, and poor communication—add to, but do not cause, the intermittent problems between NLM and its most longstanding and engaged user group. These problems are in essence the price we pay for the leadership and vision of NLM's directors and for NLM's success in developing excellent services and in enhancing them based on advice from librarians and other users.
PMCID: PMC64753  PMID: 11838459
21.  Providing consumer health information through institutional collaboration. 
In the past several years, The Claude Moore Health Sciences Library of the University of Virginia Health Sciences Center (HSC) has noted a growing demand for consumer health information. However, because the primary role of the library is to provide information services to health professionals at the HSC, questions have been raised as to the amount of time, energy, and money that should be expended to provide health care information to consumers. The library staff, because it can provide special expertise regarding the availability and utilization of consumer health materials, has felt the responsibility to participate in HSC initiatives that reach a broad audience. Library efforts in that regard include assisting with inventory and management of patient education materials, participating in a community health promotion task force, collaborating with hospital departments in planning a consumer health information center, establishing a consumer health information reference section in the library, and obtaining a grant to offer a networked health information system to local public and community college libraries. Consumers of health information benefit from the enhanced services that result from combining the expertise of health professionals and patient educators with the information management skills of library staff.
PMCID: PMC225860  PMID: 8136761
22.  A Health Department’s Collaborative Model for Disease Surveillance Capacity Building 
Objective
Highlight one academic health department’s unique approach to optimizing collaborative opportunities for capacity development and document the implications for chronic disease surveillance and population health.
Introduction
Public Health departments are increasingly called upon to be innovative in quality service delivery under a dwindling resource climate as highlighted in several publications of the Institute of Medicine. Collaboration with other entities in the delivery of core public health services has emerged as a recurring theme. One model of this collaboration is an academic health department: a formal affiliation between a health professions school and a local health department. Initially targeted at workforce development, this model of collaboration has since yielded dividends in other core public health service areas including community assessment, program evaluation, community-based participatory research and data analysis.
The Duval County Health Department (DCHD), Florida, presents a unique community-centered model of the academic health department. Prominence in local informatics infrastructure capacity building and hosting a CDC-CSTE applied public health informatics fellowship (APHIF) in the Institute for Public Health Informatics and Research (IPHIR) in partnership with the Center for Health Equity Research, University of Florida & Shands medical center are direct dividends of this collaborative model.
Methods
We examined the collaborative efforts of the DCHD and present the unique advantages these have brought in the areas of entrenched data-driven public health service culture, community assessments, program evaluation, community-based participatory research and health informatics projects.
Results
Advantages of the model include a data-driven culture with the balanced scorecard model in leadership and sub-departmental emphases on quality assurance in public health services. Activities in IPHIR include data-driven approaches to program planning and grant developments, program evaluations, data analyses and impact assessments for the DCHD and other community health stakeholders.
Reports developed by IPHIR have impacted policy formulation by highlighting the need for sub county level data differentiation to address health disparities. Unique community-based mapping of Duval County into health zones based on health risk factors correlating with health outcome measures have been published. Other reports highlight chronic disease surveillance data and health scorecards in special populations.
Partnerships with regional higher institutions (University of Florida, University of North Florida and Florida A&M University) increased public health service delivery and yielded rich community-based participatory research opportunities.
Cutting edge participation in health IT policy implementation led to the hosting of the fledgling community HIE, the Jacksonville Health Information Network, as well as leadership in shaping the landscape of the state HIE. This has immense implications for public health surveillance activities as chronic disease surveillance and public health service research take center stage under new healthcare payment models amidst increasing calls for quality assurance in public health services.
DCHD is currently hosting a CDC-funded fellowship in applied public health informatics. Some of the projects materializing from the fellowship are the mapping of the current public health informatics profile of the DCHD, a community based diabetes disease registry to aid population-based management and surveillance of diabetes, development of a proposal for a combined primary care/general preventive medicine residency in UF-Shands Medical Center, Jacksonville and mobilization of DCHD healthcare providers for the roll-out of the state-built electronic medical records system (Florida HMS-EHR).
Conclusions
Academic health centers provide a model of collaboration that directly impacts on their success in delivering core public health services. Disease surveillance is positively affected by the diverse community affiliations of an academic health department. The academic health department, as epitomized by DCHD, is also better positioned to seize up-coming opportunities for local public health capacity building.
PMCID: PMC3692891
Academic Health Departments; collaborative model; health informatics projects
23.  Evaluating Internet End-to-end Performance 
Abstract Objective: An evaluation of Internet end-to-end performance was conducted for the purpose of better understanding the overall performance of Internet pathways typical of those used to access information in National Library of Medicine (NLM) databases and, by extension, other Internet-based biomedical information resources.
Design: The evaluation used a three-level test strategy: 1) user testing to collect empirical data on Internet performance as perceived by users when accessing NLM Web-based databases, 2) technical testing to analyze the Internet paths between the NLM and the user's desktop computer terminal, and 3) technical testing between the NLM and the World Wide Web (“Web”) server computer at the user's institution to help characterize the relative performance of Internet pathways.
Measurements: Time to download the front pages of NLM Web sites and conduct standardized searches of NLM databases, data transmission capacity between NLM and remote locations (known as the bulk transfer capacity [BTC], “ping” round-trip time as an indication of the latency of the network pathways, and the network routing of the data transmissions (number and sequencing of hops).
Results: Based on 347 user tests spread over 16 locations, the median time per location to download the main NLM home page ranged from 2 to 59 seconds, and 1 to 24 seconds for the other NLM Web sites tested. The median time to conduct standardized searches and get search results ranged from 2 to 14 seconds for PubMed and 4 to 18 seconds for Internet Grateful Med. The overall problem rate was about 1 percent; that is, on the average, users experienced a problem once every 100 test measurements. The user terminal tests at five locations and Web host tests at 13 locations provided profiles of BTC, RTT, and network routing for both dial-up and fixed Internet connections.
Conclusion: The evaluation framework provided a profile of typical Internet performance and insights into network performance and time-of-day/day-of-week variability. This profile should serve as a frame of reference to help identify and diagnose connectivity problems and should contribute to the evolving concept of Internet quality of service.
PMCID: PMC61333  PMID: 9824800
24.  E-Learning as New Method of Medical Education 
Acta Informatica Medica  2008;16(2):102-117.
CONFLICT OF INTEREST: NONE DECLARED
Distance learning refers to use of technologies based on health care delivered on distance and covers areas such as electronic health, tele-health (e-health), telematics, telemedicine, tele-education, etc. For the need of e-health, telemedicine, tele-education and distance learning there are various technologies and communication systems from standard telephone lines to the system of transmission digitalized signals with modem, optical fiber, satellite links, wireless technologies, etc. Tele-education represents health education on distance, using Information Communication Technologies (ICT), as well as continuous education of a health system beneficiaries and use of electronic libraries, data bases or electronic data with data bases of knowledge. Distance learning (E-learning) as a part of tele-education has gained popularity in the past decade; however, its use is highly variable among medical schools and appears to be more common in basic medical science courses than in clinical education. Distance learning does not preclude traditional learning processes; frequently it is used in conjunction with in-person classroom or professional training procedures and practices. Tele-education has mostly been used in biomedical education as a blended learning method, which combines tele-education technology with traditional instructor-led training, where, for example, a lecture or demonstration is supplemented by an online tutorial. Distance learning is used for self-education, tests, services and for examinations in medicine i.e. in terms of self-education and individual examination services. The possibility of working in the exercise mode with image files and questions is an attractive way of self education. Automated tracking and reporting of learners’ activities lessen faculty administrative burden. Moreover, e-learning can be designed to include outcomes assessment to determine whether learning has occurred. This review article evaluates the current status and level of tele-education development in Bosnia and Herzegovina outlining its components, faculty development needs for implementation and the possibility of its integration as official learning standard in biomedical curricula in Bosnia and Herzegovina. Tele-education refers to the use of information and communication technologies (ICT) to enhance knowledge and performance. Tele-education in biomedical education is widely accepted in the medical education community where it is mostly integrated into biomedical curricula forming part of a blended learning strategy. There are many biomedical digital repositories of e-learning materials worldwide, some peer reviewed, where instructors or developers can submit materials for widespread use. First pilot project with the aim to introduce tele-education in biomedical curricula in Bosnia and Herzegovina was initiated by Department for Medical Informatics at Medical Faculty in Sarajevo in 2002 and has been developing since. Faculty member’s skills in creating tele-education differ from those needed for traditional teaching and faculty rewards must recognize this difference and reward the effort. Tele-education and use of computers will have an impact of future medical practice in a life long learning. Bologna process, which started last years in European countries, provide us to promote and introduce modern educational methods of education at biomedical faculties in Bosnia and Herzegovina. Cathedra of Medical informatics and Cathedra of Family medicine at Medical Faculty of University of Sarajevo started to use Web based education as common way of teaching of medical students. Satisfaction with this method of education within the students is good, but not yet suitable for most of medical disciplines at biomedical faculties in Bosnia and Herzegovina.
doi:10.5455/aim.2008.16.102-117
PMCID: PMC3789161  PMID: 24109154
Medical education; Distance learning; Bosnia and Herzegovina
25.  Comparison of Iranian National Medical Library with digital libraries of selected countries 
Introduction:
The important role of information and communication technologies and their influence on methods of storing, retrieving information in digital libraries, has not only changed the meanings behind classic library activates but has also created great changes in their services. However, it seems that not all digital libraries provide their users with similar services and only some of them are successful in fulfilling their role in digital environment. The Iranian National Medical library is among those that appear to come short compared to other digital libraries around the world. By knowing the different services provided by digital libraries worldwide, one can evaluate the services provided by Iranian National Medical library. The goal of this study is a comparison between Iranian National Medical library and digital libraries of selected countries.
Materials and Methods:
This is an applied study and uses descriptive – survey method. The statistical population is the digital libraries around the world which were actively providing library services between October and December 2011 and were selected by using the key word “Digital Library” in Google search engine. The data-gathering tool was direct access to the websites of these digital libraries. The statistical study is descriptive and Excel software was used for data analysis and plotting of the charts.
Results:
The findings showed that among the 33 digital libraries investigated worldwide, most of them provided Browse (87.87%), Search (84.84%), and Electronic information retrieval (57.57%) services. The “Help” in public services (48/48%) and “Interlibrary Loan” in traditional services (27/27%) had the highest frequency. The Iranian National Medical library provides more digital services compared to other libraries but has less classic and public services and has less than half of possible public services. Other than Iranian National Medical library, among the 33 libraries investigated, the leaders in providing different services are Library of University of California in classic services, Count Way Library of Medicine in digital services, and Library of Finland in public services.
Results and Discussion:
The results of this study show that among the digital libraries investigated, most provided similar public, digital, and classic services and The Iranian National Medical library has been somewhat successful in providing these services compared to other digital libraries. One can also conclude that the difference in services is at least in part due to difference in environments, information needs, and users.
Conclusion:
Iranian National Medical Library has been somewhat successful in providing library services in digital environment and needs to identify the services which are valuable to its users by identifying the users’ needs and special characteristics of its environment
doi:10.4103/2277-9531.145897
PMCID: PMC4275611  PMID: 25540782
Digital library; Iranian National Medical Library; services

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