mem Bia ci Leena Dean Sain po wot , NATIONAL LIBRARY OF MEDICINE CATALOGING IN PUBLICATION Zz . Bunting, Alison 675.M4 The nation’s health information network: history B942n of the Regional Medical! Library Program, 1965-1985 / by Alison Bunting. — Chicago, ML: Medical Library Association, c1987. “Published as a supplement to the Bulletin of the Medical Library Association, July 1987, volume 75, number 3.” 1. National Library of Medicine (U.S.). Regional Medical Library Program 2. Information Services - history - United States 3. Libraries, Medical - history - United States I. Bulletin of the Medical Library Association. V. 75, no. 3 (Supplement) II. Title The Nation’s Health Information Network: History of the Regional Medical Library Program, 1965-1985* By ALISON BUNTING Published as.a Supplement to the Bulletin of the Medical Library Association July 1987, Volume 75, Number 3. *This publication was supported in part by a University of California Research Grant for Librarians, and by NIH Contract No. 1-LM-6-3510 from the National Library of Medicine. of the Medical Library Association Volume 75 Number 3 Supplement July 1987 BMLAAG 75(3) 1-62 (1987) ISSN. 0025-7338 Bull. Med. Libr. Assoc. Contents [Introductions ....s.scsersceccssescssesctsesssccesscenscssneenescetaccessssssessesessseseeessseeHesnaassesaseneeMAeesMeetesssenesGOeesseneeEeressSee4eet4e tts Background and Need for a Regional Medical Library (RML) Network Medical Library Assistance ACt..........:sscsseessesersecsereens Design-of the Regional Medical Library Network NLM'’s Preliminary Design .........:ssssccscsesessseseseeseneenesssncesenteacenens Herner Design Proposal ...........:scccscserececrrresrsreeesensensesearensenensearerees Official Design Guidelines for Applicants .........cecccscssssesesecrsnerssrensessacsseneneenenaaoanes eee NLM’s Management Role .........e+ssssssesscensesesssesesescesereecarsnsarensesnecneenecenenscsaconiesusseanaaress Establishment ‘of the Network (1967-1970)... Network Policies and Architecture Regional Planning Meetings...........--.--sssscssssssesesceerseneeneeneearesesaeeticeresetens Organizational Structure The Original Eleven Regions Organization and Management of the RML Program Regional Organization and Management Management of the Program at NLM.......--scsssccsecssessesssssssneerssecstensatensnecsseersncsnnsraniecassunnecsaneesenteas RIML Directors’ Meetings .........:s-sccccscsssrsrscesssesssscsessescesanenenesacossessneansassrscnsanenasinansosnensenecnasnannersess Programs and Services = Interlibrary Loan ... Union Lists .........ccccsscsersncesseeeee MEDLARS Search Services...... Reference Services... Consulting and Training Services........c.:scssssssssssesesseseressssssesseessnenseseeesesneerneasneensereteentensneserssaseees Publicity and Publications Network Evaluation RML Status Report, 1970... Operation of the Network (1971~1981).... Network Policies and Architecture ...............0. desucccescsceesssuacsasavssseacosseuteneqenensnonsedsssceesensessesssssbeseaenes Contract Funding..........cerceee eseveseusosesesesesrssveusnesensissseacssusssuisssdevsacusventasssveeseesueereete™ RML Policy Statemenit............::-scsssecscsessssssseesssnsecrssseneaneneatsassececsssnonsvenerneasensanesesensansersnenenseneaauasenes Continued on next page Opinions expressed here are those of the authors and do not necessarily represent those of the association. Copyright, © Medical Library Association, 1987 All material subject to this (the Bulletin’s) copyright may be photocopied for the noncommercial purpose of scientific or educational advancement. Contents continued Organization and Management of the RML Program Regional Organization and Management ........:.:-+ee+0+ Management of the Program at NLM............sssssseerrenes Hospital Librarians’ Meetings..........--cccsssesceccsesscsseesseersnssssansensenrennanecsse sense ennnn sete sete0" RML. Directors’ Meetings ..........:.ecccseseresrseeerens Programs and Services.........secceccsscsssessetsseesesssssneerassnsansesnnernnsccarecens Interlibrary Loan ........:cccccceceeeeccertstseeeeseeeees Union Lists and Catalogs MEDLARS/MEDLINE .......-..-.-scersssseesses Reference Services......:...-.00 Ssestsseeceenecesensess Resource Sharing Consulting and Training Services .........se+ GAMUS...ccccseeocsecsssesecccessscescecscsrrseseeeseenescesscesnecseereees Audiovisual Services .........:::cscseereeecscssreresenseres Regional Planning, Evaluation, and Research .........:cs00 Relations with Other Networks and Programs ...............- Technological Development .......--..ccesserseestecererereres Publicity and Publications ...........-sscssssscsserseerecteeseesenneens Network Evaluiation.........c..::csscscsserssscsessnsnecaseessersrenenssenecets RML Evaluation—-1972-1974 1977.and 1980 Evaluation Project .........ssccessseeseereerenss Characteristics of the Original Eleven Regions ...........::00 The Reconfigured Network (1982-1985) ......s-sssersssecseeesseeeee Network Management and Architecture .......scscscsssssrecrsssrersssenersaeeascetennnens Requests for Proposals .......essscccssssersssseessessansecrenserecsanassesescnanesecgsesssesteents Contract Awards Organization and Management of the RML Program .....ccccseesescerererseeerees Management of the Program at NLM RML Directors’ Meetings Prograins and Services..........-0+ Interlibrary Loan .........-.00++ Union Lists-and Catalogs..............- MEDLINE ....c.sscsscseecsecssseeeereeentes Reference Services... Resource Sharing ..........:-ccseeeesseeeees Consulting and Training Services Grant... Audiovisual Services Regional Planning and Evaluation Relations with Other Networks and Programs .........:-sessesssesseseessressereseneenseneneenees Technological Developments Publicity and Publications ......sccsccsssecsescssseesscsssssessnnsisecccsnnesennesnnns see en eet eee eens Impact of the Regional Medical Library Program .... Delivery of Documents to Health Professionals... Delivery of Information to Health Professionals........... Creation of a Viable, Effective National Library Network ........---+ccsssssssscsseesesesenneeennntennensenenersenntets Use of Technology to Improve or Enhance the Delivery of Information Future of the Regional Medical Library Program.......ssssscscssssseccsssssesesennerensnssnesentene ene oe Contents continued 2: NLM Key Stalf........ccessscccsecssscssssssessssossssessssnssscssssessncssatsaneecsesenscatasseneneneassessneserenennensagasecanesssonerens 3: RML Newsletters 4: Experts Consulted and Expert Reviewers ..........::cssessssssssscssssseesscerertensncensneseereenseassseseesnanesaesesneenens 62 Tables and Figures Table 1: Medical Library Assistance Act Budget History Table 2: Original Regional Medical Libraries...................0... Table 3: Regional MEDLARS Service Centers, 1970 ...........0 Table 4: RML/NLM Funded Interlibrary Loans, 1969-1982 ........ssssseren Table 5: Domestic Searches of MEDLARS Databases, 1965-1985 Table 6: MEDLARS/MEDLINE Search Centers/Searchers Trained, 1965-1985 ........scsesessecseseeeeee 27 Table 7; Demographics of the Original Eleven Regions, 1980 Data Table 8: Reconfigured Regional Medical Library Regions .................. Table 9: Demographics of the Reconfigured Regions, 1980 Data.... Table 10: Interlibrary Loan Statistics, 1983-1985 ..........csccssssssscesssssesesserensesssesssserersessesnenneeseeseneneneesnees Table 11: Interlibrary Loan Statistics, 1969-1985 oc. .ccsssssesssseseeeserssessescesessenesentessseenenereneseearensecees Table 12: Region 7 Interlibrary Loan Requests Processed by Resource Libraries and Basic Health Sciences Libraries Table 13: Region V Interlibrary Loans, 1975-1980 ........c:cccssseccsssreressstecsssesenssnetensensseenregeesseeeenees Table 14: Region XI Interlibrary Loans, 1975-1980 Figure 1; Biomedical Library Network Concept..........csceeerer Figure 2: Medical Library Network Plan ...........ccscccsssssessssssecesserssessssceesssceevenssseneesssstensecorsneacaens EDITORIAL SUSAN CRAWFORD Washington University St. Louis, Missouri.63110 Editor PAT L. WALTER UCLA Center for the Health Sciences Los Angeles, California 90024 Associate Editor CAROLYN. G. WEAVER University of Washington Seattle, Washington 98195 Proceedings Editor WILLIAM K. BEATTY Northwestern University Medical School Chicago, Hlinois 60201 Editor of Journal Notes Kate Williams Copy Editor BOARD DORIS BOLEF Rush University Chicago, Illinois 60612 Book Review Editor LUCRETIA McCLURE University of Rochester Rochester, New York 14642 Cover Editor RAYMOND A. PALMER Medical Library Association, Inc. Chicago, Illinois 6061! Business Editor RITA SHAFER Medical Library Association, Inc. Chicago, Illinois 60611 Director of Communications Susan Roberts Indexer CONSULTING EDITORS PANEL DOTTIE EAKIN University of Michigan Ann Arbor, Michigan CAROL FENICHEL Hahnemann University Philadelphia, Pennsylvania LELDE B. GILMAN UCLA Center for the Health Sciences Los Angeles, California BYRD HELGUERA Vanderbilt University Nashville, Tennessee RUTH HOLST Columbia Hospital Milwaukee, Wisconsin CAROLYN LIPSCOMB University of North Carolina Chapel Hill, North Carolina DANA McDONALD Indiana University Indianapolis, Indiana WAYNE J. PEAY University of Utah Salt Lake City, Utah ALAN REES State University of New York Albany, New York JUSTINE ROBERTS University of California San Francisco, California JACQUE-LYNNE SCHULMAN McLean, Virginia LINDA SMITH University of Illinois Urbana, Illinois D. A. THOMAS University of Kansas Kansas City, Kansas LINDA WATSON Houston Academy of Medicine Texas Medical Center Houston, Texas NANCY WOELFL National Aeronautics and Space Administration Lewis Research Center Cleveland, Ohio ANN CAROL WELLER American Medical Association Chicago, Illinois The Nation’s Health Information Network: History of the Regional Medical Library Program, 1965-1985 By ALISON BUNTING, Biomedical Librarian, Assistant Dean for Library Services, School of Medicine INTRODUCTION THE MOTIVATION to write this history of the Regional Medical Library Program (RMLP) arose when participating in the development of a chapter on library cooperation for the Handbook of Medi- cal Library Practice {1}. Very few published accounts of this premiere library network existed; it was therefore necessary to rely on my memory of events and to seek out unpublished reports and news releases. The Regional Medical Library (RML) network has been in operation for twenty years, and many health sciences librarians today perhaps take for granted the structure which has improved the delivery of information to health professionals and introduced technological devel- opments in the practice of health sciences librarian- ship. New participants in the operation and man- agement of the RML network are also sometimes unaware of services and programs which were tried before. Documentation of the evolution of the net- work will serve to assist those involved in its man- agement, as well as those interested in what has made this network so successful. The organization of twenty years. of historical information presented a considerable challenge. One approach could have been to discuss each program or service (e.g., interlibrary loans) in its entirety. The evolution of programs and services was, however, frequently affected by budgetary and/or policy considerations which were best pre- sented in a chronological format. The final arrangement is a compromise between the strictly chronological and the programmatic approach. The history is divided into four major periods: the events leading to the creation of the network (prior to 1965), the design and establishment of the original network (1965-1970), the operation of the original network (1971-1981), and the reconfi- gured network (1982-1985). The. Nation's Health Information Network: History of the Regional Medical Library Pro- Bull. Med. Libr. Assoc. 75(3) Supplment July 1987 University of California, Los Angeles Center for the Health Sciences 10833 Le Conte Bivd. Los Angeles, California 90024-1798 gram, 1965-1985 is a historical review of the evolution of the network including the National Library of Medicine’s administration of the pro- gram. the organizational structure of the network and its regions, the programs and services provided by each region, and an evaluation of the Regional Medical Library Program’s accomplishments and impact. Information for this history came primarily from the published literature including individual RML newsletters, official reports and minutes, and interviews with key participants in the development and operation of the network. It was not possible to chronicle each region’s operation and accomplish- ments in detail, nor credit the contributions of individual RML staff. Such descriptions are best presented in individual histories; an activity I encourage my colleagues to undertake. It is also difficult to adequately describe the significant contributions made by many individuals and institutions to the RML network. Most notable are the efforts of the staff in medical school and hospital !ibraries in each region. They have given of their time. providing valuable advice and assistance to the operation of the network; shared their insti- tution’s resources; and adapted to change in a way that assured the continued viability of the network. For every federal dollar spent on the provision of RML services, several local dollars were expended through in-kind contributions. Health sciences libraries have enthusiastically accepted the impor- tant responsibility ascribed to them in the Presi- dent's Commission Report in 1965: “The medical library thus serves medicine as a guarantor of the organizztion of its scientific and professional knowledge. and of accessibility to what is already known” [2:38]. BACKGROUND AND NEED FoR A REGIONAL MEDICAL LIBRARY (RML) NETWORK In the period following World War II, the provi- sion of biomedical information to the United States I ALISON BUNTING health care community was significantly and adversely affected by the lamentable condition of the nation’s health sciences libraries. The inade- quacy resulted primarily from the fact that, while funding for medical research and education had increased dramatically during this period, funding for libraries had failed to keep pace. The National Library of Medicine (NLM) and the health sciences library community were keenly aware of these deficiencies, and undertook a concerted effort to improve both health sciences libraries and access to health information. The NLM, which became administratively part of the Public Health Service in 1956, was most interested in. receiving authority to award grants for the improvement of biomedical information delivery. Such a plan was discussed by the NLM Board of Regents in 1960, and in the summer of that year Frank B. Rogers, M.D., director, investi- gated whether the Public Health Service Act per- mitted NLM to make grant awards. Although authority was not to be forthcoming until 1964, Dr. Rogers immediately began preparing for the even- tuality. In 1960 he appointed Scott Adams as his deputy for “extramural” activities, and assigned Estelle Brodman, Ph.D., as Adams’ associate. Together, Mr. Adams and Dr. Brodman gathered information on the need for extramural support programs, and drafted plans for such programs. One of their more significant actions was to con- tract with Harold Bloomquist, assistant librarian of the Harvard University Schools of Medicine and Public Health, to conduct a study on the condition of medical school libraries in the United States [3:395-6]. Bloomquist’s study resulted in a landmark paper which clearly documented the poor condition of medical school libraries and their inability to pro- vide even the most basic of services. He warned that since medical school libraries were not able to provide information effectively to their users, scien- lists were forced “...to seek other ways by which to satisfy their information needs” [4:158]. Bloom- quist also suggested that one way to control .. the great need for physical expansion of libraries is the development of the regional reservoir library. In this scheme there is ....a large central resource library which bears the responsibility for collecting materials in depth and which makes its resources and services available to a broad geographic area...[4:152]. Bloomquist recommended that federal funds be made available to: improve medical school library collections, facilities, and services; train medical 2 librarians; include library support in ongoing research program funding; support bibliographic control of the scientific literature; and establish “A system of regional reservoir libraries...encouraged and supported by the National Library of Medicine through the granting of funds...” [4:162]. The results of the Bloomquist study were widely dis- cussed, and NLM advised the health sciences com- munity and appropriate federal officials of their desire to implement an extramural program to assist medical libraries [5:26-7]. The concept of regiona! medical libraries gener- ated a great deal of interest among librarians, physicians, and federal officials. In early 1963 an informal meeting was convened at the Harvard Medical School to explore the possible elements of such a network. Eleven medical school librarians met with representatives from NLM = and the National Institutes of Health to present six model regional plans. The plans varied considerably; some proposed regional services for large geographic areas encompassing several states, while others limited services toa few counties or one state. All of the plans described extensions of existing coopera- tive services provided by medical libraries, and noted that expanded and improved service would be feasible only if outside financial Support were avail- able [6]. . In early 1964 President Lyndon B. Johnson appointed the President’s Commission on Heart Disease, Cancer and Stroke, chaired by Michael E. DeBakey, M.D. The commission was appointed to develop a “battle plan” for the defeat of these three diseases. In noting the importance of communicat- ing to practicing health professionals the results of scientific research in the conquest of disease, the commission cited the poor condition of the nation’s medical libraries and stated that “...unless major attention is directed to improvement of our national medical library base, the continued and accelerated generation of scientific knowledge will become increasingly an exercise in futility” [2:25]. The commission recommended “...that the National Library of Medicine be authorized and adequately supported to serve its logical and neces- sary function as the primary source for strengthen- ing the nation’s medical library system” [2:64]. The background material supporting this recom- mendation requested funds for NLM to conduct research on and develop new methods for the efficient management and dissemination of bio- medical information and to provide grants to sup- port improved medical libraries; and recommended legislation to allow NLM to assist medical Bull. Med. Libr. Assoc. 75(3) Supplement July 1987 NATION’S HEALTH INFORMATION NETWORK libraries. A national medical library network was proposed to capitalize on existing cooperative arrangements, and to provide equal access to health information to health professionals across the nation. Martin M. Cummings, M.D., appointed director of NLM in January 1964, was keenly interested in a grants program for NLM, and discussed such a concept with Senator Lister Hill of Alabama. Sen- ator Hill encouraged NLM to draft specifications for legislation, a task which Dr. Cummings readily accepted and assigned to Marjorie Wilson, M.D., the newly appointed head of the Extramural Pro- grams (EMP) section of NLM. In drafting the bill, Dr. Wilson utilized the background and support information provided by the Bloomquist and Presi- dent’s Commission reports, and the results of NLM-sponsored studies conducted by the Associa- tion of American Medical Colleges (AAMC) and the Medical Library Association (MLA) on the needs of medical school libraries [7,8]. Throughout 1964 and 1965 there was wide dis- cussion about the programs which comprised the proposed legislation. At the October 1964 AAMC annual meeting, Drs. Wilson and Cummings pre- sented a-paper on NLM’s relationships to medical education and research. The idea of a network of regional libraries was advanced. Research would need to be conducted into the design of such a network. but Wilson and Cummings postulated that should a network be “...fully developed, it seems prudent to place such resources wherever possible in existing private. university, or free- standing libraries of excellence” [9:231]. Dr. Cum- mings provided additional insight into the need for a medical library network at the dedication of the Francis A. Countway Library, Harvard University, in 1965: Continued dependency of the more than 6,000 medical libraries upon the services of the National Library of Medicine would lead ultimately to the evolution of a monolithic medical resource in this nation. Our country requires the development of a complex of regional medi- cal libraries with adequate facilities, resources, and per- sonnel to serve those sections of the nation with underdev- eloped library facilities [10.161]. The ‘medical library community was interested in the relationship between the proposed RML network and NLM’s plans to decentralize MED- LARS (Medical Literature Analysis and Retrieval System) search centers. MEDLARS, developed by NLM to produce its major listing of the medical periodical literature, Index Medicus, via computer, could.also be used to provide computer produced Bull. Med. Libr. Assoc. 75(3} Supplment July 1987 lists of citations on specific topics for individuals. Adams clarified the relationship by stating: The selection of a library as a MEDLARS search center is not predicated on a willingness to provide regional library service as a unit of a national network. There are many unknown factors in the design of a national medical library network...and NLM hopes to support studies in this area....It is difficult to conceive of regional libraries...without MEDLARS search capability; on the other hand, local MEDLARS search centers...can be established without prejudice to the design of a system of regional medical libraries [11:148]. The legislation drafted by NLM, entitled the Medical Library Assistance Act. (MLAA), was introduced by Senator Hill on January 19, 1965; an identical bill was introduced by Representative John Fogarty in the House. The MLAA was signed by President Johnson on October 22, 1965. The expeditious passage of this act was due in large part to the strong support it received from the health and library professions [3:397-9]. MEDICAL LIBRARY ASSISTANCE ACT The Medical Library Assistance Act of 1965 (MLAA), Public Law 89-291, authorized NLM to provide grant funding in seven program areas: (1) construction of new, and renovation, expansion, or rehabilitation of existing medical library facilities: (2) training of medical librarians and other infor- mation specialists in the health sciences; (3) assis- tance to special scientific projects; (4) research in the field of medical library science and related fields; (5) improvement and expansion of the basic resources of medical libraries and related facilities: (6) development of a national system of regional medical libraries; and (7) preparation of biomedi- cal scientific publications. The MLAA specified that the NLM Board of Regents would serve as the National Medical Libraries Assistance Advisory Board to advise on regulations and policy for the administration of the Act and to-review and approve awards. Of most concern, for the purposes of this history is Section 398 of the MLAA which authorized the establishment of the Regional Medical Library (RML) network. It should be recognized, however, that much of the work of the RMLs was greatly facilitated by other provisions of the act, especially those programs which provided support directly to medical libraries. Section 398 of the MLAA provided that grants could be made to existing public or private nonpro- fit medical libraries to enable them to serve as RMLs for a geographic area. Grant funds could be z ALISON BUNTING used for (1) acquisition of books, journals. and other similar materials; (2) cataloging, binding, and other processing procedures; (3) acquisition of duplicating devices and other equipment to facili- tate the use of the-library’s resources; (4) acquisi- tion of mechanisms and employment of personnel for the speedy transmission of materials from the RML; and (5) construction or renovation of physi- cal facilities necessary in order to function as an RML. Section 398 also provided NLM with autho- rization to establish regional branches of NLM in any geographic area of the United States which needed an RML, but in which there was no library which could serve as or be developed into an RML. The appropriation authorization for the RMLP was not to exceed $2,500,000 for each of the five years beginning with the fiscal year ending June 30, 1966, through the fiscal year ending June 30, 1970 [12]. As can be seen in Table 1, the largest amount of funds obligated by NLM to the RML network during this period was $2,088,000 in 1969. TABLE 1 MEDICAL LIBRARY ASSISTANCE ACT BUDGET HISTORY 1966-1986 ical Authorization Appropriation oon eation 1966 $11,000,000 $ 5,010,000 — 1967 21,000,000 13,800,000 $ 105,000 1968 21,000,000 11,250,000 680,000 1969 21,000,000 5,789,000 2,088,000 1970 21,000,000 5,452,000 1,807,000 1971 23,500,000 5,992,000 2,128,192 1972 25,500,000 6,892,000 2,093,000 1973 27,500,000 8,492,000 2,179,808 1974 8,442,000 7,029,000 2,658,000 1975 17,500,000 6,682,000 2,194,000 1976 20,000,000 6,433,000 3,351,000 1977 20,000,000 8,000,000 3,086,000 1978 14,600,000 7,987,000! 3,020,000 1979 15,000,000 7,987,000! 2,848,000 1980 16,500,000 9,925,000 2,967,000 1981 18,560,000 9,831,000 2,999,000 1982 7,500,000 7,500,000? 2,399,000 1983 _ 7,500,000? 2,300,000 1984 _ 7,500,000? 2,000,000 1985 — 7,790,000° 2,000,000 1986 11,000,000 — 2,300,000 ‘Excludes one million dollars reprogrammed from NLM intramural activities. 2Continuing Resolutions. ?Authorizing legislation expired Sept. 30, 1982. Authori- zation for FY 1985 is contained in the Appropriation and Continuing Resolution. 4 In 1970, Public Law 91-212, a three-year exten- sion of the MLAA of 1965, was passed by Con- gress. Two modifications were made to the section of the law dealing the RMLP. NLM was autho- tized to use a contract mechanism, in addition to grants, to fund the RMLs, and the RMLs could use either grant or contract funds for planning. The authorization levels remained the same [13]. Public Law 93-45, the Health Programs Exten- sion Act of 1973, extended for one year six of the seven program authorities in the MLAA, deleting construction authority with a corresponding modi- fication in appropriation authorizations. The authorization for regional medical libraries was raised to $2,902,000 [14]. The Health Services Research, Health Statis- tics, and Medical Libraries Act of 1974, Public Law 93-353, extended the MLAA through June 30, 1977. The new version of the MLAA included all changes recorded in the 1970 and 1973 exten- sions, and consolidated the authorization appropri- ations for the six programs into one sum [15]. Between 1977 and 1982 the MLAA was extended three times, without any changes in pro- gram authorizations. Public Law 95-83, the Bio- medical Research Extension Act of 1977, extended the authorization through September 30, 1978; Public Law 95-622, the Biomedical Research Extension Amendments of 1978, provided author- ity through September 30, 1981; and Public Law 97-35, Omnibus Budget, extended funding through September 30, 1982. From 1982 to 1985 several unsuccessful attempts were made to extend the MLAA for three years and increase the funding level for the pro- grams. However, all MLAA programs were funded during this period under various budget continuing resolutions. In 1985, Public Law 99-158, the Health Research Extension Act, was passed, extending the MLAA through September 30, 1988, at increased authorization levels. In addition to the changes described earlier, several differences between the description of the Regional Medical Library Pro- gram in Section 398 of the 1965 law and Section 475 of the 1985 law can be noted. In keeping with the deletion of construction authorities in the MLAA, RMLs are no longer permitted to use grant or contract funding for construction and renovation of their physical facilities. In addition to agreeing to modify and increase their own library resources, RMLs are asked to “..supplement the resources of cooperating libraries in the region...” [16]. Bull. Med. Libr. Assoc. 75(3) Supplement July 1987 NATION’S HEALTH INFORMATION NETWORK The 1965 authorization language for the RMLP has proven to be extremely flexible and enduring, requiring only minor modifications. Unfortunately, as illustrated in Table 1, the actual appropriations for the MLAA programs, including the RMLP, have never equaled the authorizations. The impact of the funding available for the RMLP is noted in the description of the development and evolution of the RMLP which follows. DESIGN. OF THE REGIONAL MEDICAL LIBRARY NETWORK Once funding for the RMLP was assured, NLM undertook to define-in more detail the structure and function of the network. Several important ques- tions were raised. Would the RMLs be newly established libraries? How many regions, com- posed of which states, would be established? What would be NLM’s role in the design and operation of the network? NLM's Preliminary Design One of the earliest public descriptions of a preliminary concept of the RML network was in November 1965, when Dr. Cummings presented a paper at an institute on information retrieval at the University of Minnesota. He stated that “...the National Library of Medicine believes that any national system should build upon existing resources, utilizing new techniques and equipment wherever possible to improve the flow of informa- tion throughout the network” [17:175]. The system would serve both libraries and subject-oriented groups. Cummings described three major components of the system: centralized coordination of the net- work, geographic dissemination of information, and mission-oriented dissemination of information (e.g., information packaged for a group, generally working in a specific subject area such as vision research); NLM would be responsible for the cen- tralized coordination including planning, selection of RMLs, and network coordination, and would continue to collect, process, and make available the world’s biomedical literature. The RMLs would receive federal support to assume the responsibility for the geographic dissemination of published information. Dissemination included: (1) the con- duct of literature searches by computer; (2) gener- ation of computer current-awareness listings; (3) the provision of copies of documents; (4) the provi- sion of reference services; (5) the conduct of train- ing and_orientation programs for medical library Bull. Med. Libr. Assoc. 75(3} Supplment July 1987 staff; and (6) support for specialized information centers. In order to serve mission-oriented special interest groups in the health sciences, bibliographic information would be repackaged for their use. Figure 1 illustrates NLM’s preliminary plan for the RML network [17]. Herner Design Proposal Although passage of the MLAA was a relatively smooth and uncomplicated process, implementa- tion was not. Upon review of the programs autho- rized by the MLAA, the Bureau of the Budget felt that a clearer picture of the future course of biomedical libraries in light of technological advances needed to be developed. The bureau requested that funding for the construction of medical libraries be delayed until 1967, and asked the Office of Science and Technology to implement a study of future biomedical library needs. A contract to conduct the study was let to Herner and Company via the National Science Foundation [18:7]. The introduction to the Herner preliminary report, issued in February 1966, stated that the study was performed “for the purpose of deter- mining an optimal configuration for a national network of medical libraries in the United States, and effective means of implementing it” [19:1]. The network as described by Herner called for four types of library units. The “central unit” would collect and disseminate the world’s biomedical lit- erature; NLM would serve in this capacity. “Local units” would participate in the network and provide for the information needs of their primary clientele, about 2,000 users each. ‘Special units” were described as libraries containing extensive collec- tions in narrow subject fields. “Interlibrary units” would serve as depositories for older or little-used materials from the local units. This proposed net- work was very expensive, since it called for the construction of a fair number of library facilities. The projected costs over a six-year period were $313,641,000. Another key recommendation was that planning and administration of the network be handled by the Committee on Scientific and Tech- nical Information or the Office of the Surgeon General and that it not involve NLM [19]. The Herner report was not well received by NLM or the medical library community. In a presentation at an invitational conference on RML service in the Pacific Northwest, Dr. Cummings stated: “I want to say that I think it’s a poor study. It makes projections which | believe would be wasteful of federal funds and critical manpower. I 5 ALISON BUNTING SYSTEM INPUT LITERATURE AND OTHER J i i i i CENTRALIZED FUNCTION OF NATIONAL LIBRARY OF MEDICINE f [ Acoutsrtion, PRESERVATION & PROCESSING I I j I I GEOGRAPHIC DISSEMINATION Ts oo REGIONAL LIBRARIES Le Mies LOCAL & INSTITUTIONAL USERS LEARNING RESOURCES Ty -<———> ISSEMINATION MISSION - ORIENTED I » ‘ EB —a SPECIAL INTEREST meMe GROUPS BIOMEDICAL LIBRARY NETWORK CONCEPT A Fic. 1.—Biomedical Library Network Concept. Source: Oppenheimer GJ. Regional medical library service in the Pacific Northwest. Proceedings of an invitational conference, May 12-13, 1966. Seattle: University of Washington, 1967:144. Reprinted with permission. think the library community is betrayed by the projection of funds that would be made available to you, but more importantly, I think the health community is betrayed by some of the concepts which were introduced” [20:149]. During the dis- cussion which followed Dr. Cummings’ presenta- tion, several participants voiced similar concerns over the survey methods and the quality of the report.. NSF requested further work on the report, but a final version was never published. Some of the details of the Herner plan were, however, eventu- ally included in NLM’s final design of the RML network [21:4]. The Bureau of the Budget did subsequently permit NLM to award MLAA autho- rized construction funds. Official Design NLM Extramural Programs (EMP) staff, Mar- jorie Wilson, M.D., Carl Douglass, Ph.D, and David Kefauver, were charged with preparing draft regulations to implement all the programs autho- 6 rized by. the MLAA, including the RMLP. The draft regulations were approved by the NLM Board of Regents at their March 1966 meeting, and were published in the Federal Register on July 13, 1966. Section C of the Rules and Regulations covered the grants for establishing RMLs. The geographic composition of the regions was not specified; rather, a geographic area was defined as “.,.an area composed of any part or parts of any one or more states that forms an academically and professionally integrated region, taking into consid- eration such factors as location and extent of communication facilities and systems, presence and distribution of educational and medical and heaith facilities and programs...” {22:9502]. In the MLAA, libraries wishing to serve as RMLs were required to “modify and increase their library resources so.as to be able to provide supportive services ...” [12:7]. Modify and increase was defined as “...the use of Federal funds or materials to supplement rather than supplant non-Federal Bull. Med. Libr. Assoc. 75(3) Supplement July 1987 NATION’S HEALTH INFORMATION NETWORK funds available for library resources and services” [22:9502]. Guidelines for Applicants Wilson, Douglass, and Kefauver traveled exten- sively throughout the country in an effort to pro- vide information on the proposed RML grant pro- gram prior to the publication of the official guide- lines. Rather than specify the geographic composi- tion of a region, NLM encouraged interested indi- viduals and groups to schedule formal meetings to “determine the natural and feasible configura- tion of their ‘region’ or area” [23:23]. It was recommended that the meetings include adminis- trators, librarians, health professional users, repre- sentatives from state and local governmental and other health agencies, and other interested parties. After determining the geographic composition of a region, each applicant was required to undertake an extensive analysis of the information needs and resources of the area, and propose cooperative arrangements which built on existing relationships (23]. A preliminary fact sheet [24] followed by a series of Information and Policy Statements [25- 27] issued by NLM formally announced the pur- pose and responsibilities of the RMLs, provided guidelines for applicants, and delineated NLM’s role in the operation of the network. The statement of purpose remained essentially unchanged during the formative years of the network: “The funda- mental purpose of regional medical library services is to optimize and equalize access to, and to provide for the most effective dissemination of health science information in all its forms, in order to respond effectively to the needs of health science investigators, practitioners, educators, and stu- dents” [27:1]. The 1967 Statement suggested that no less than 5% of the nation’s health professionals should reside in a region; subsequent versions deleted this numerical guideline. RMLs needed to consider existing institutional relationships, patterns of communication, and health professional continuing education. and to have adequate resources and facilities to meet regional needs. The 1967 State- ment defined adequate resources as the ability to fill 90% of requests for materials; this numeric standard was dropped in subsequent revisions. A comprehensive regional plan, assessing the infor- mation needs of the region’s health professionals, was an ‘essential part of the proposal, as was the establishment of an RML Advisory Committee including both librarians and health professionals. Bull. Med. Libr. Assoc. 75(3) Supplment July 1987 Each of the three Information and Policy State- ments defined the programs and services of an RML. As summarized below, each RML was required to: 1. Define the level and quality of present (pre- grant) and projected services. 2. Clearly state its goals for grant-supported library services and indicate how it would evaluate and estimate the need for new or revised services. 3. Provide the following services: a. Free loans! of library materials to qualified users within the region, including the pro- vision of free photocopy services in lieu of the loan of the original. Beginning in 1968 a statement was added to allow for the provision of free loans across regional boundaries. b. MEDLARS search services. Initially RMLs were required to operate a MED- LARS search center; by 1968 the wording had been changed to require only the provi- sion of formulation services for qualified users in a region. Beginning in 1968 RMLs were also required to provide search formu- lation services to users in other regions at the request of NLM or another RML. c. Back-up reference support to other libraries in the region, and on occasion, directly to individuals. d. Orientation and training of personnel from user institutions to ensure effective utiliza- tion of the network. In the 1967 Statement the training was to focus on regional library services; the 1968 Statement revised the wording to medical library ser- vices. e. Continual assessment of the region’s infor- mation needs. f. Announcements of new acquisitions. g. Support for health professional continuing education programs. 4, Submit progress reports. 5. Administer the RML grant in accordance with specified legislative and governmental rules and regulations. NLM'’s Management Role NLM’s role in the management of the network became more clearly defined in the successive ‘Loan of library materials is defined as the loan of a physical volume or the provision of a photocopy in lieu of the loan of a volume. ALISON BUNTING versions of the Statements. In 1967 a general statement indicated that NLM would provide lead- ership and essential services, advice to regional planning groups on “...the establishment and oper- ation of MEDLARS search services...” {252], and process the RML grant applications. The 1969 Statement delineated a number of responsibilities including provision of “...guidance for the develop- ment of service interrelationships tequired to coor- dinate the network” [27:1]. NLM would participate actively in the RML network, and was responsible for: (1) supporting the further development of the RMLs, (2) provid- ing “back-up” library services to the RMLs, and (3) supplying ‘*.. guidance and direction necessary to coordinate the services provided by the regional medical libraries so that they may function as a ‘national system’ and thereby optimize and equal- ize access to health science information throughout the country” [27:2]. In this coordinating function NLM could specify standards for communication and practice among RMLs and adjust service workloads among the RMLs and NLM. The addi- tion of such specific language concerning NLM’s role was a result of the growing conviction among key NLM staff that an effective national network would not result without a certain amount of uniformity of policies and services. A further indi- cation of NLM’s intention to ensure uniformity was NLM’s recommendation to the Board of Regents to add to the proposed MLAA extension authority to fund RMLs via contracts as well as grants. The design of the RML network was evolution- ary in nature, spanning the initial five-year period authorized by the MLAA. The final result was a hierarchical. library network (Figure 2) in which NLM served as a comprehensive national back-up resource for all U.S. libraries, the RMLs shared their resources with libraries in a specified geo- graphic area, and local health sciences libraries provided local health professionals with access to their collections and services and to the RML network [28:384]. The responsibility for dissemi- nating mission-oriented information was not for- mally included in the final design of the RML network, since other federally funded projects already provided such services. ESTABLISHMENT OF THE NETWORK (1967-1970) Network Policies and Architecture Regional Planning Meetings The regional planning meetings recommended by NLM were held throughout the country to 8 determine the appropriate geographic boundaries for each region, and to select the library which would apply for the RML grant. The boundaries were not easily drawn, since political affiliations and geographic considerations complicated the decisions. Meeting organizers were free to select the participants, the only NLM requirement was that broad representation from various user and institutional categories be present. In most cases the individuals and institutions invited to partici- pate reflected pre-existing regional afiliations. The selection of an institution to serve as the RML was no less difficult; in several regions no single exceptionally strong library clearly emerged as the natural choice. Uncertainty over the number of RMLs which would eventually be funded also affected the planning process, although by June 1967, Carl Douglass, Ph.D, publicly stated ‘...that about ten such libraries (RMLs) should be sup- ported under the current authorization” [29:50]. NLM’s role throughout this planning process, as defined by Marjorie Wilson, M.D., was ‘...to main- tain, insofar as possible, flexibility in working out -.Supportive arrangements...in developing service patterns and resource configurations within each region...” [30:48]. Participants in the planning meetings included librarians, health professionals, administrators, and representatives from governmental and other health agencies. Of particular concern was the interrelationship between the RMLP and the Regional. Medical Programs (RMP), a separate federal program which had also resulted from the President’s Commission Report [2]. The purpose of the RMP was “...to make the latest advances in medical knowledge of the diagnosis and treatment of heart disease, cancer, and stroke available to physicians for the treatment of their patients all over the nation” [31:56]. To accomplish their mis- sion, the RMPs planned extensive continuing edu- cation programs for health professionals and the lay public. A logical aspect of such continuing education programs was the provision of health information; it was evident that coordination between the two programs was essential. Organizational Structure Between 1966 and 1970 the boundaries for the original eleven regions (Table 2) were determined, and the applicant institution(s) designated. Two Organizational patterns emerged. In centralized regions, regional services and management were primarily provided by staff located at the RML with cooperation and assistance from other Bull. Med. Libr. Assoc. 75(3) Supplement July 1987 NATION’S HEALTH INFORMATION NETWORK MEDICAL LIBRARY NETWORK PLAN AND CENTER FOR BIOMEDICAL COMMUNICATIONS 11 REGIONAL LIBRARIES —_— eee ee 100 ACADEMIC LIBRARIES 500-600 LOCAL LIBRARIES Hospitals, Medical Societies, etc. RELATIONSHIPS COMPATIBLE WITH NATIONAL INFORMATION SYSTEMS. COMPATIBLE WITH OTHER NATIONAL LIBRARIES. ASSIST SPECIALIZED INFORMATION CENTERS. ASSIST MISSION ORIENTED GROUPS, FEDERAL AND PRIVATE. Fic. 2—Medical Library Network plan. libraries in the region. Decentralized regions relied on more direct involvement of larger, mainly medi- cal school libraries, eventually labelled resource libraries (RL). The RLs provided many regional services; the RML administered and managed the service program. The remaining library partici- pants in each region were called basic units or basic health sciences libraries (BHSLs). BHSLs con- sisted mainly of hospital} libraries but also included other libraries serving health professionals or stu- dents, such as community college or pharmaceuti- cal company libraries. The Original Eleven Regions Region I: New England Regional Medical Library Service (NERMLS). The New England Regional Medical Library Service, the first RML to be designated, began operations at Harvard University’s Francis A. Countway Library of Med- icine in October 1967. The geographic composition of the region was easily determined, since the New England states of Connecticut, Maine, Massachu- setts, New Hampshire, Rhode Island, and Vermont had long-standing affiliations. Two regional meet- ings were held in Boston in May 1966 and March Bull. Med. Libr. Assoc. 75(3) Supplment July 1987 1967; the participants agreed that the Countway Library, which had recently been created by the merger of the Boston Medical Library and the Harvard Medical School Library, should apply for an RML grant. “The selection of the Countway Library as the home of...NERMLS...was based on the recognition that the library possessed outstand- ing collections... a new and functional physical plant, and a tradition of regional service long recognized by the community” [32:329]. NERMLS was a centralized operation. There was, however, reliance on other regional resources. Because the Countway Library did not have a strong nursing collection, an arrangement was made with the Boston College School of Nursing Library to share their resources regionally. NERMLS also worked closely with the Postgrad- uate Medical Institute (PM1), an educational arm of the Massachusetts Medical Society. PMI had conducted a survey of hospital educational needs in New England and determined that library service needed improvement. NERMLS and PMI agreed to address this problem in concert. NERMLS collaborated with PMI to identify a “core collec- tion” of books and journals designed to serve as a 9 Region ALISON BUNTING TABLE 2 ORIGINAL REGIONAL MEDICAL LIBRARIES Regional Medical Library Area Served Date Operational Wl VI Vil Vill IX xX! New England Region2! Medical Library Service (NERMLS} The Francis A. Countsay Library of Medicine Harvard University. Boston New York and Northern New Jersey Re- gional Medical Library {NY/NJ RML) New York Academy o/ Medicine Library, New York Mid-Eastern Regionai Medical Library Service (MERMLS) College of Physicians of Philadelphia Library, Philadelphia Mid-Atlantic Region2: Medical Library (MARML) National Library of Medicine. Bethesda Kentucky, Ohio, Michigan Regional Medical Library (KOMRML)* Shiffman Medical Library Wayne State University. Detroit Southeastern Regionai Medical Library Program (SERMLP) A. W. Calhoun Medical Library Emory University, Atlanta Midwest Regional Medical Library (MRML) The John Crerar Library. Chicago Midcontinental Regional Medical Library Program (MCRMLP) Library of Medicine University of Nebrask2. Omaha South Central Regional Medical Library (TALON) Health Science Center Library University of Texas, Dallas Pacific Northwest Regional Health Sciences Library (PNRHSL) Health Sciences Library University of Washington. Seattle Pacific Southwest Regional Medical Library Service (PSRMLS) Biomedical Library University of California, Los Angeles Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont New York and Northern New Jersey Delaware, Pennsylvania, Southern New Jersey Maryland, North Carolina, Virgin- ia, Washington, D.C., West Virginia Kentucky, Michigan, Ohio Alabama, Florida, Georgia, Missis- sippi, South Carolina, Tennessee, Commonwealth of Puerto Rico Illinois, Indiana, Iowa, Minnesota, North Dakota, Wisconsin Colorado, Kansas, Missouri, Ne- braska, South Dakota, Utah, Wyoming Arkansas, Louisiana, New Mexico, Oklahoma, Texas Alaska, Idaho, Montana, Oregon, Washington Arizona, California, Hawaii, Nevada *Initially called the East-Central Regional Medical Library. 10 October 1967 February 1970 July 1968 October 1968 April 1969 January 1970 November 1968 July 1970 February 1970 October 1968 September 1969 Bull. Med. Libr. Assoc. 75(3) Supplement July 1987 NATION’S HEALTH INFORMATION NETWORK minimum hospital library collection [33] and develop guidelines for the establishment of hospital libraries [34,35]. Region II: New York and Northern New Jersey Regional Medical Library (NY/NJ). The metro- politan New York City and northern New Jersey medical libraries enjoyed a long history of coopera- tion. As early as 1959, New York City area libraries had established the Medical Library Cen- ter of New York (MLCNY), created to provide centralized storage and acquisition of less-used materials, develop a Union Catalog of Medical Periodicals (UCMP), establish a delivery system between the Center and New York area libraries, and participate in cooperative acquisitions projects (36]. Then in 1963, Ralph Esterquest, librarian of the Harvard Medical Library, conducted a study on ways of strengthening medical library resources in the state, at the request of the Commissioner of Education of the State of New York. Esterquest recommended a statewide plan which included provisions for the New York Academy of Medicine (NYAM) to serve as a “reservoir” library for the state [37:2]. Thus, as Gertrude Annan described in her presentation at the 1963 Harvard meeting on regional medical library service, the cooperative programs already in place at the MLCNY “...could well be coordinated or integrated with other plans, either state or national” [36:508]. It was on this base of regional planning and cooperative experience that the NY/NJ region was developed. In 1967 the NYAM and the MLCNY submitted a joint application to serve as the RML for New York and Northern New Jersey (Bergen, Essex, Hudson, Hunterdon, Middlesex, Morris, Passaic, Somerset, Sussex, Union, and Warren counties). The NY/NJ application was problemat- ic, since the funds requested to provide interlibrary loan service for the region amounted to “...twice the amount of money now available for the whole [RML] program” [3:2]. The grant proposal included plans to decentralize interlibrary loan services; the projected number of subsidized interli- brary loans which would be provided by the resource libraries in this very populous area of the country was considerable. In the spring of 1968 NLM approved the grant for a two-year period only, at a significantly reduced level of funding (39]. NLM specified that only the NYAM would be designated the RML for Region If and, due to limited funds, the NY/NJ RML began operations, in February 1970, as a centralized region. By the Buil. Med. Libr. Assoc. 75(3) Supplment July 1987 second year of its grant the NY/NJ RML was able to decentralize the interlibrary loan service, and entered into subcontracts with three libraries in the region. Region Ill: Mid-Eastern Regional Medical Library Service (MERMLS). By 1963, Philadel- phia area medical librarians and physicians had begun to develop plans for cooperative library services. They met formally as members of the Philadelphia Regional Medical Library Commit- tee [40], and endorsed the “Philadelphia Plan” for regional library service presented by Elliot Morse at the 1963 Harvard meeting on regional medical library service [41]. This plan included providing services 10 the Philadelphia area, and adjacent counties in New Jersey. The Library of the College of Physicians of Philadelphia had been serving as a regional resource for many years; an RML grant would provide a stable base of funding for such services. Initially there was some concern that only universi- ty-based libraries would be eligible to apply for RML grants [42]. In the final guidelines the only restriction imposed was that applicant institutions be non-profit [24]. By 1965 a “Proposed Cooperative Agreement between the College of Physicians of Philadelphia Library and Philadelphia Area Medical Libraries” was developed and endorsed by forty-five institu- tions. In order to fund some of the proposed services, such as subsidized interlibrary loans, the College library applied for and received a Resource Grant (funded via a separate authority of the MLAA). 2nd applied to be a MEDLARS search center. Concurrently, with the endorsement of the Philadelphia Regional Medical Library Commit- tee, the College submitted a letter of intent to NLM to serve as an RML for Pennsylvania, south- ern New Jersey, and Delaware. Delaware was added after a feasibility study indicated that it was appropriate to provide services to the area. The committee also planned a Regional Medical Library Conference to be held at the College in February 1967 [43]. Over 200 individuals attended the conference and endorsed the regional plan proposed by the College. MERMLS began opera- tions a centralized RML in July 1968 {44,45]. Region IV: Mid-Atlantic Regional Medical Library ‘MARML). The Mid-Atlantic Region, composed of Maryland, North Carolina, Virginia, the District of Columbia, and West Virginia, was designated in 1968. North Carolina was originally included in the planning for the Southeastern Region, but librarians in the state requested assign- 1] ALISON BUNTING ment to the Mid-Atlantic Region since they relied on library resources in Region IV more than those in the Southeast. The NLM made the decision to act as the RML for the Mid-Atlantic region “...because of the Strength of its resources and its central location for the users” {46:6]. There was also little interest among the region's larger libraries in serving as an RML. NLM planned to provide “... new and improved services to the region, including con- tinuing education of medical librarians and train- ing of health professionals in effective use of biblio- graphic resources, as well as providing liaison between NLM, other Federal medical operations, and the biomedical libraries in the region” [46:6]. The Reference Service Division of NLM was assigned the responsibility of coordinating regional services [47]. Two other factors influenced NLM's decision to Serve as an RML. First, as a federal institution NLM was not eligible to receive RML grant funds; it was therefore able to stretch the limited funding available for the RML program. Secondly, NLM staff would be able to gain valuable operational experience if they were responsible for RML ser- vices in Region IV. Region V: Kentucky, Ohio, Michigan Regional Medical Library (KOMRML). Considerable re- gional planning and activity led to the formation of the KOMRML. In the fall of 1964 the library directors of Wayne State University and the Uni- versity of Michigan met to discuss ways of improv- ing biomedical library service, and agreed to sev- eral cooperative ventures including interlibrary loan, shared bibliographic records, cooperative acquisitions, and the establishment of a MED- LARS search center. The University of Michigan became a MEDLARS search center in April 1966, followed in July 1967 by Ohio State University. In late 1965 the medical library directors of Wayne State University and the University of Michigan proposed the establishment of a Biomed- ical Information Services Institute (BISI) to coor- dinate interinstitutional cooperation, and asked various organizations to participate in BISI’s devel- opment. The Greater Detroit Area Hospital Coun- cil, Wayne County Medical Society, and Metropol- itan Detroit Medical Library Group all agreed to participate. The University of Michigan subse- quently withdrew, but the organization continued. Wayne State University and eight hospital libraries in the Detroit area Joined in 1966 to form the Central Medical Library Service (CMLS). 12 With funding from an NLM Resource Grant CMLS expanded its union list of serials and book catalog, provided subsidized interlibrary loan ser- vice, employed staff to bring the CMLS collections under uniform bibliographic control, and supported cooperative acquisitions. Concurrently, the Michi- gan Interinstitutional Committee for Information Systems (MICIS), with membership from Wayne State University, Michigan State University, and the University of Michigan, was formed and began to consider the development of an RML. An initial planning meeting held in April 1967 yielded the recommendation that MICIS contact the academic institutions of Indiana. Kentucky. Ohio, and Michigan to inform them of the preliminary plans for RML services, and invite their comment. While awaiting responses, MICIS prepared a draft RML proposal without designating a head- quarters library. This draft was forwarded to NLM for comment, and was subsequently presented to representatives from ten institutions in Kentucky, Ohio, and Michigan ata regional planning meeting in November 1967. Indiana did not send a repre- sentative, and subsequently became part of the Midwest Region. At the meeting the participants agreed to form a “... cooperative enterprise of a regional library” [48:10], with Wayne State Uni- versity selected to submit the grant application to NLM. KOMRML began operations as the first decentralized region on April 1, 1969 [49]. Region VI: Southeastern Regional Medical Library Program (SERMLP).. Several medical school libraries in the southeastern section of the nation were very interested in receiving grant funds to provide RML services for Region VI. A series of regional meetings were held throughout the area, but consensus on a Single applicant institution was not reached. Subsequently, NLM reviewed appli- cations from the University of Alabama Medical Center, Birmingham; Vanderbilt University Medi- cal Center, Nashville: Duke University Medical Center, Durham; and Emory University, Atlanta. Each proposed that the region be decentralized, with a consortium of twelve medical school (re- source) libraries providing regional services, The A. W. Calhoun Medical Library at Emory University was selected by NLM to serve as admin- istrative headquarters for SERMLP, comprising the states of Alabama, Florida, Georgia, Mississip- pi, South Carolina, and Tennessee, and the Com- monweaith of Puerto Rico. North Carolina tequested and was granted assignment to the Mid- Atlantic Region. Although not officially considered Bull. Med. Libr. Assoc. 75(3) Supplement July 1987 NATION’S HEALTH INFORMATION NETWORK part of the region initially, over time regional services were provided to the Virgin Islands. SERMLP began to offer services in January 1970. Region VII: Midwest Regional Medical Library (MRML)}. Regional planning for the Midwest region began in December 1966. Librarians and health professionals from a number of Chicago’s health sciences institutions met at the American Medical Association (AMA) headquarters with a representative from NLM. Asa result of this initial meeting, a local planning committee was estab- lished to select and sponsor an institution as the RML. In February 1967 librarians from sixteen Chicago institutions met and appointed subcom- mittees to survey the information resources and needs of the area. Contact was made with many health-related organizations and libraries in neigh- boring states to assess interest. Initially the University of Illinois Medical Library, the John Crerar Library, the University of Minnesota Biomedical Library, and the University of Wisconsin Medical Library were all interested in becoming the RML. The University of Wisconsin had in fact, been operating a Medical Library Extension Service since 1926, providing both loan and reference service to health professionals in the state [50]. In July 1967 the first meeting of a regional council, attended by representatives from Illinois, lowa, Wisconsin, and Minnesota, was held and began discussions on regional policies. In the fall of 1967 Crerar submitted an RML grant proposal to NLM. The Crerar proposal was subsequently reviewed and accepted by the regional council, with some revisions. including the addition of Indiana to the original group of states to be served by MRML. In November 1968 the John Crerar Library began to provide centralized service to the states of Ifhi- nois, Indiana. Iowa, Minnesota, and Wisconsin. The geographic composition of the Midwest Region was adjusted in 1970 when North Dakota was added [51]. Region VIII: Midcontinental Regional Medical Library Program (MCRMLP). To quote Bernice Hetzner. the first MCRMLP director, “The Mid- continental Regional Medical Library area came into being by a process of elimination” [52:247]. As the last RML to be formed, it became responsible for those states which had not joined another region. Considerable planning of RML services took place in Region VIII. As early as 1966 a group of librarians from Nebraska, Colorado, lowa, Kan- sas, and North and South Dakota met to discuss Bull. Med: Libr. Assoc. 75(3) Supplment July 1987 plans for a union catalog. In 1967 St. Louis, Missouri, area medical librarians met with David Kefauver from NLM to discuss regional medical library planning. This group then sponsored a meeting of representatives from medical libraries in Colorado, Kansas, Missouri, Nebraska, North and South Dakota, and Utah held on April 22, 1968. This meeting resulted in the formation of a temporary organization, the Central States Re- gional Medical Library Group, which was to desig- nate responsibilities for regional service and pre- pare the grant application. Some regional programs were instituted during this planning period. For example, the medical libraries of Washington University in St. Louis, and the Universities of Colorado, Kansas, and Nebraska each agreed to contribute funding for the preparation of a union list of serials by the Medical Library Center of New York. Dr. Estelle Brodman, by that time director of the Washington University Medical Library, coordinated the technical aspects of the union list contract. MEDLARS search ser- vices had been provided to the area since 1965 by the University of Colorado Medical Library. In the end the University of Nebraska submitted the RML grant application and became responsible for the administration of this decentralized region. The Midcontinental RML became operational in July 1970, serving the states of Colorado, Kansas, Mis- souri, Nebraska, South Dakota, Utah, and Wyom- ing [53]. North Dakota, which had been involved in the planning discussions, requested assignment to the Midwest Region. ‘ Region IX: South Central Regional Medical Library (TALON). “The South Central RML grew out of an organization known as the Texas Council of Health Sciences Libraries formed in 1966” [54:203]. Council membership was composed of both librarians and health professionals. In Decem- ber 1966 an NLM representative attended a meet- ing of the Council to discuss regional medical library services. In September 1967 the directors of the major medical libraries in the states of Arkan- sas, Louisiana, New Mexico, and Oklahoma were invited by the council to a meeting to discuss the formation of an RML..Upon examination of the resources and needs of the region it was “...con- cluded that the area did not have an establishment which was of outstanding stature adequate to per- form, by itself, the functions of a regional medical library. This factor ...led to the development of a consortium of libraries acting as a decentralized regional library” [54:204]. 13 Heiiaecdinaleaits Sete roy ALISON BUNTING The original grant proposed that TALON (Tex- as, Arkansas, Louisiana, Oklahoma, and New Mexico) be organized as a separate institution. This idea was not approved by NLM, so TALON became administratively part of the University of Texas Southwestern Medical School, later re- named University of Texas Health Science Center, Dallas [55:2]. TALON became operational in Feb- ruary 1970. Region X: Pacific Northwest Regional Health Sciences Library {PNRHSL}. Formal regional medical library planning began in the Pacific Northwest at an invitational conference held at the University of Washington, May 12-13, 1966. Librarians and health professionals from Washing- ton, Oregon, Alaska, Idaho, and Montana were in attendance, as were invited participants from other areas of the United States and British Columbia with experience in the provision of regional library services. The conclusion of conference participants was that the Pacific Northwest states should inves- tigate the possibility of forming an RML region for the provision of RML services [20]. An application to serve as the RML for the Pacific Northwest region was subsequently submit- ted by the University of Washington Health Sciences Library. PNRHSL began to direct the efforts of this centralized region, which comprised the states of Alaska, Idaho, Montana, Oregon, and Washington, in October 1968. Region XI: Pacific Southwest Regional Medical Library Service (PSRMLS). The Medical Library Group of Southern California (MLGSC) formed a committee in January 1967 to begin planning RML services for a region which would comprise Southern California and Arizona. With concur- rence from the Medical Library Group of Arizona, MLGSC recommended that the University of Cali- fornia, Los Angeles (UCLA) Biomedical Library be designated as the RML. The committee was also in communication with the Northern California Medical Library Group in hopes that planning would begin for a region composed of Northern California and Nevada. By June 1967, it became evident, upon consulta- tion with NLM, that the size of the proposed region would have to be enlarged, so the MLGSC commit- tee obtained support from the California Commit- tee on Regional Medical Programs to sponsor a regional planning meeting. On March 21, 1968; over fifty health professionals and librarians from Arizona, California, Hawaii, and Nevada attended a meeting at UCLA. The consensus of the partici- pants was that the UCLA Biomedical Library 14 should prepare an RML grant proposal for the four-state region. PSRMLS began service in Sep- tember 1969. PSRMLS operated in a centralized mode with one exception. Interlibrary loan service responsibil- ities were shared between the UCLA Biomedical Library (serving Arizona, Hawaii, and Southern California) and the Library of the University of California, San Francisco (serving Nevada and Northern California). This arrangement was devised to divide the interlibrary loan traffic between the two strongest collections in the region, and leave open the possibility of subdividing the region should additional RML funds become avail- able [56]. Organization and Management of the RML Program Regional Organization and Management The RML directors were in most cases the directors of the library selected as the RML. They had overall management and fiscal responsibility for the program, and were actively involved in the discussion of policy issues, both at national and regional levels. Generally, the day-to-day opera- tions of each RML program were the responsibility of an associate director. The names of all RML directors and associate directors are included in Appendix I. Each region was required by NLM to have an advisory committee which included “...representa- tives from the fields of professional practice, health science librarianship, health communications and other fields related to health” [25:7]. In most centralized regions one advisory committee, com- posed of librarians and representatives from the various user groups, advised the RML on policy and procedural issues. Decentralized regions often had more than one advisory committee. A committee of librarians and user representatives, or occasionally only user rep- resentatives, advised on policy issues. A separate committee, frequently called the executive commit- tee, usually composed of RL directors, provided substantial input into the operation of the RML. The composition and role of regional advisory committees was an issue of frequent debate between the RML directors and NLM. From NLM’s point-of-view, the representation on many of the RML advisory committees was too narrowly’ defined, with only physicians and medical school librarians serving. NLM urged RMLs to include Bull. Med. Libr. Assoc. 75(3) Supplement July 1987 NATION'S HEALTH INFORMATION NETWORK representation from all the health professions and other types of network libraries, believing that it was critical to the program to have input from all user groups [57]. Another issue was the role of the advisory committee in the governance of the RML. In some regions, especially decentralized ones, it was felt that control of the RML was vested in the advisory or executive committee. NLM clarified this matter by insisting on only an advisory role for these committees. Management of the Program at NLM During the formative period of the RML net- work, 1966-70, much of the management of the program was the responsibility of the Extramural Programs (EMP) staff. In 1966 a separate division of EMP, the Facilities and Resources Division, was created to oversee the award and management of the RML grants [18]. Also in 1966 a Facilities and Resources Commit- tee was appointed to review all Regional Medical Library, construction, and resource grant propos- als. The NLM Board of Regents, acting in its capacity as the National Medical Libraries Assis- tance Advisory Board, gave final approval to all RML grant awards. Even though EMP had clear responsibility for the management of the RML program, RML operations were of tremendous concern to NLM’s Library Operations (LO) staff. Not only did regional interlibrary loan policies and procedures need to interrelate smoothly with LO’s interlibrary loan operations at NLM, but the management of the decentralized MEDLARS network was the direct responsibility of LO. Some of the earliest training programs offered in the regions were MEDLARS orientations developed initially by NLM staff. The grant funding mechanism for the RMLs was not conducive to the management control which LO felt was needed in some areas such as MEDLARS. It was difficult, for example, to impose productivity standards on grant recipients. The idea of funding the basic RML services via a contract mechanism was therefore proposed “...the expansion of the decentralized MEDLARS pro- gram, both domestically and internationally, and the establishment of the RMLP did much to neces- sitate further centralized control to obtain a higher level of performance” [58:24]. A list of NLM key staff who were involved in the management and operations of the RML program is included in Appendix 2. Bull, Med.-Libr. Assoc. 75(3) Supplment July 1987 RML Directors’ Meetings As the RML regions were being formed, most policy and procedural discussions concerning the operation of the RML network ensued indepen- dently between NLM staff and individual regions. The RML directors found this situation less than satisfactory, since policies previously agreed upon were occasionally revised in light of differing prac- tices or circumstances elsewhere in the country. In an effort to improve communications between regions, Vern Pings, Ph.D., KOMRML director, invited all RML directors to participate in a meet- ing to be held in conjunction with the Medical Library Association annual meeting in Louisville, in October 1969. Joseph Leiter, Ph.D., associate director of NLM, suggested that the meeting be officially sponsored by NLM, thus setting the stage for the first RML Directors’ Meeting. These meet- ings would eventually become a regular semi- annual event, designed for the communication and discussion of RMLP policies and services, and the sharing of information among regions and NLM. A review of the minutes of the RML Directors’ Meetings in 1969 and 1970 delineates some of the policy and procedural questions which arose during the initial development of the RML network. The decisions reached had significant impact on the operation of the network over time, and serve to illustrate the evolution of the RMLP. There was considerable discussion about the merits of centralized versus decentralized mode of operation. NLM was concerned about the varia- tions in management brought about by the dif- ferent organizational patterns, and the possibility that decentralized regions were more expensive to operate. These issues were to be examined after NLM and the RMLs gained more operational experience. The MLAA clearly stated that RML services were to supplement, not supplant, existing services [12]. In order to insure that this guideline was being followed, NLM needed to determine a way to measure pre- and post-award activity. Initially NLM thought that interlibrary loan statistics would provide the needed information, but the lack of standardization in statistical records and the tremendous amount of variation in regional interli- brary loan practices made this task impossible. With the agreement of the RML directors, NLM proposed the use of operating budgets as the mea- sure. As long as institutional budgets did not decrease after receipt of RML funds, then the requirement of supplementation was met. Interactions between the RML network and 15 ALISON BUNTING other health-related programs were of considerable concern to NLM. Most particularly, there was interest in establishing close working relationships with Regional Medical Program (RMP) offices, so that programs and services of the RMLs and RMPs would be complementary. NLM worked at the national level to coordinate services [59] and each RML attempted to do the same in its respective region. Programs and Services Interlibrary Loan Subsidized (free) interlibrary loans were the most visible and popular service provided by the RML network in its first years of operation, Regional resources were to be used first; NLM would provide interlibrary loan service only after regional resources were exhausted. To insure that interlibrary loan requests were submitted first to local libraries, NLM restricted direct access to its interlibrary loan service to all but a few specified libraries. Libraries which could submit requests to NLM included the RMLs, the resource libraries (RLs), and a few “designated” libraries, primarily libraries which had major collections but were not participating in the RML network as RLs. It was recognized that the staff of the designated library would have the bibliographic tools to determine where interlibrary loans should be sent. Examples of designated libraries included the Center for Disease Control Library, Atlanta, and the Library of the University of California, Berkeley. In centralized regions the subsidized loans were provided primarily by the RML, although as noted previously, some centralized regions had special interlibrary loan agreements with one or two other libraries. Requests for subsidized loans were not supposed to go to the RML unless the requested material was not available locally. Basic health sciences ‘libraries (BHSLs) were expected to use the resources of other BHSLs and their local RL prior to coming to the RML. In decentralized regions the RLs received funding from the RML grant to provide subsidized interlibrary loan ser- vice. Generally, this was done on a per transaction contract basis. There was some initial confusion as to whether this latter practice “supplanted” previ- ously existing service. In fact, KOMRML initially decided that its “participating [resource] libraries” would charge local borrowers for interlibrary loans, according to established practice. NLM, however, required that loans provided by KOMRML RLs be subsidized by grant funds, as they were in all other regions [60:2]. 16 If an RML could not fill an interlibrary loan request, the request would be referred to NLM or another RML; in decentralized regions, RLs also referred requests to other RLs, RMLs or NLM. Health professionals who lacked access to a library could request materials directly from the RML. The Midwest Region undertook an analysis of interlibrary loan activity during 1968/1969 to determine what types of materials were requested and who was using the service. This study revealed that 86.8% of the requests were for periodical articles, 76.3% of the requests were for materials published within the last ten years, and 42.9% of the interlibrary loans processed were for materials requested by physicians [61]. In the earliest years of the RML program there were no restrictions on the number of subsidized loans an institution could request. However, in the face of declining funding, some limits on the provi- sion of subsidized photocopies of journal articles began to be imposed to control costs. In some regions quotas were placed on the number of subsi- dized loans available, restricting either the number of photocopy requests which would be filled per year, or the number of photocopy exposures which would be provided. PSRMLS also developed two “restricted title lists” to insure compliance with the requirement that local resources be tried prior to requesting material from the RML. One list included 30 commonly available periodical titles, the second listed 100 titles. Subsidized interlibrary loans would not be provided for articles published in the most recent five years from any of the thirty titles on the first list. The 100-title list was used in the metropolitan Los Angeles and San Francisco areas, where library resources were stronger. Several interlibrary loan policy questions arose in the first five years of RML network operations. Early versions of the RML Fact Sheet [24] and the Information and Policy Statements [25-27] speci- fied that only non-profit institutions were eligible to receive RML services, including interlibrary loans. In response to the considerable pressure exerted on NLM by members of the for-profit health care industry the restriction on the provision of RML Services to non-profit institutions was removed in August 1969. This policy change had an immediate financial effect on the budgets of the RMLs already in operation, since they had not planned to provide subsidized loans to this additional category. of user. On September 25, 1969, a small group of librarians, including some RML directors, and NLM staff met at NLM to discuss implementation Bull. Med. Libr. Assoc. 75(3) Supplement July 1987 NATION’S HEALTH INFORMATION NETWORK of this new policy. In his opening remarks at this meeting, Martin M. Cummings, M.D., expressed an NLM management viewpoint which was to remain consistent over the years: policies estab- lished by the RMLs should be as uniform as possible, and compatible with NLM policies. Minor regional variations were acceptable when necessary, but uniformity was the desired goal. Dr. Cummings also questioned the appropriateness of quotas to limit interlibrary loan expenditures, and hoped participants would find alternatives [62]. One result of the meeting was a definition of interlibrary loan requests which were eligible for RML service: all requests for health-related infor- mation submitted by libraries for anyone other than lay personnel and high school students, and all TABLE 3 REGIONAL MEDLARS SERVICE CENTERS, JULY 1970 Region I New England Regional Medical Library The Francis A. Countway Library of Medicine Harvard University Boston, MA Region IT New York and Northern New Jersey Regional Medical Library New York Academy of Medicine Library New York, NY Region II Mid-Eastern Regional Medical Library College of Physicians of Philadelphia Library Philadelphia, PA Region IV: Mid-Atlantic Regional Medical Library* National Library of Medicine Bethesda, MD Region V MEDLARS Center* University of Michigan Ann Arbor, MI MEDLARS Center* Health Center Library Ohio State University College of Medicine Columbus, OH Region VI MEDLARS Center* Medical Center Library University of Alabama Birmingham, AL requests submitted directly by health professionals without access to a library. There was also agree- ment that some form of an interlibrary loan quota system was necessary to insure equal access to health information and to assure that RML interli- brary loan funds would not be consumed by heavy users at the expense of occasional users [62]. Union Lists In most decentralized regions, the creation of a union list of serials, identifying the extent of hold- ings of each owning library, was an essential first step, since it facilitated the referral of interlibrary joan requests between the RLs and the RML. Some regions, such as NY/NJ and MCRMLP, already had a list which included the holdings of Southeastern Regional Medical Library A. W. Calhoun Medical Library Emory University Atlanta, GA Region VII Midwest Regional Medical Library The John Crerar Library Chicago, IL Region VII MEDLARS Center* Denison Memorial Library University of Colorado Medical Center Denver, CO Region IX MEDLARS Center*t Texas Medical Center Library Houston, TX Region X Pacific Northwest Regional Health Sciences Library Health Sciences Library University of Washington Seattle, WA Region XI Pacific Southwest Regional Medical Library Biomedical Library University of California, Los Angeles Los Angeles, CA *MEDLARS Center with machine-processing capabilities. 1 tEffective April 1, 1971 the South Central Regional Medical Library, Health Science Center Library, University of Texas, Dallas became the MEDLARS Search Center for Region IX. Bull. Med. Libr. Assoc. 75(3) Supplment July 1987 17 ALISON BUNTING many of the RLs. Others, such as TALON, SERMLP, and KOMRML, had to compile one. In the centralized regions the serials holdings list of the RML served as the initial serials locator publi- cation. Once union list efforts were underway, NLM and the RMLs quickly recognized that a single, national union list of serials would be extremely beneficial. The issue of standards for union lists was discussed, and since several of the RMLs planned to use the services of the Medical Library Center of New York, creators of the Union Catalog of Medical Periodicals and of the NY/NJ RML and the MCRMLP union lists, tentative agreement was reached to use these standards in the creation of all regional lists. MEDLARS Search Services Each RML also coordinated the provision of MEDLARS search services. Searches were formu- lated at regional MEDLARS service centers (Ta- ble 3) and were forwarded to NLM for batch Processing, with an average turnaround time for searches of four to six weeks. In seven regions the RML itself was the MEDLARS service center. In three of the other regions service was provided by the MEDLARS centers which had been estab- lished during the decentralization of MEDLARS, and in Region VI service was shared between the RML and a MEDLARS center. Reference Services Backup reference service was provided in all regions. The amount and nature of this service varied greatly among the regions, and initially RML reference staff spent much of their time deciphering incomplete or incorrect interlibrary loan requests. Other reference services included answering queries referred by BHSLs, locating translations of foreign language journal articles, and compiling bibliographies on topics not suitable for searching on MEDLARS. Consulting and Training Services All RMLs recognized that to insure effective use of the network under development, some form of consulting and training services should be provided. Hospital administrators and library committees would need advice on the type and size of library required by their institution to meet immediate information needs, and many of the individuals staffing these libraries would require basic train- ing. In centralized regions the consulting and train- ing services were provided by RML staff; decen- 18 tralized regions made plans for the provision of this service by staff located at the RLs. Publicity and Publications Other initial services included the publication of brochures, recent acquisitions lists, and newslet- ters; exhibiting at health professional meetings; and planning cooperative efforts with other net- works and programs. Articles describing the RML network and its services were published in a variety of health professional publications [63-85]. A list- ing of RML newsletters is included in Appendix 3. Network Evaluation RML Status Report—1970 Robert Walkington and E. Wayne Herron, EMP staff, prepared a report in 1970 on the RML program. They reviewed the status and develop- ment of the program, and conducted an analysis of the four RMLs with at least one year’s operating experience—NERMLS, MERMLS, MRML, and PNRHSL. Much of the information regarding the Status and development of the RMLP presented in this report has been discussed earlier. What is most interesting was this initial attempt to “evaluate” RML operations. After considering various evaluation methods, the authors felt that “...in a new and complex program a fairly subjective methodology and a case-history approach would be most appropriate” [86:18]. They were interested in the effectiveness of each RML, type and quality of services being provided, advisory committee structure, regional cooperative relationships, and planning efforts. Five major program areas were evaluated: inter- library loan; reference: MEDLARS formulations: consultation and education; and planning, program analysis, and administration. There was regional variation in interlibrary loan performance, based in part on the number of interlibrary loans processed and the strength of the collection at the RML. All four libraries were processing a large number of requests and were doing so expeditiously. With the exception of the Crerar Library, over 80% of the requests received were filled. Considerable varia- tion was found in the type and amount of both reference and consultation and educational pro- grams provided. Both these services were still under development at all the RMLs, and it was clear that policies would need to be discussed in the future. MEDLARS was deemed to be an important activity, and one which consumed a significant portion of RML funds. The four- to six-month training program at NLM for search analysts was expensive. To provide needed coverage, it was Bull. Med. Libr. Assoc. 75 (3) Supplement July 1987 NATION’S HEALTH INFORMATION NETWORK desirable to have a minimum of two search analysts per MEDLARS center, yet the number of regional search requests did not always require this level of staffing. All RMLs evaluated seemed actively involved in the evaluation of existing services. and were han- dling these responsibilities well. Increased empha- sis needed to be placed on the more difficult task of analyzing and projecting overall regional needs. The report identified problems relating to major policy issues, many of which were similar to those already being considered by the RML directors. Some additional policy issues not discussed earlier included: (1) concern that in some regions RML grant funds were being used to support basic library operations in the RML headquarters library; (2) more program publicity and outreach efforts were needed, particularly outside the imme- diate metropolitan area where the RML was located; and (3) the level of grant support in each region varied, due to the way the network was established. That is, programs funded with RML grant funds in one region were not funded in another due to budgetary limitations. In their conclusion, the authors pointed out that the changes authorized by the 1970 extension of the MLAA would be of assistance in solving some of the problems encountered. The increased autho- rization level would benefit the RML budgets, the new section on planning and evaluation would allow funding for these activities. and the use of contracts rather than grants would promote uni- formity among the regions [86]. In their review of the RML program through 1970, Dr. Cummings and Mary E. Corning, Ph.D., addressed the issue of the impact of the RML network on the user. “Conceptually, we believe that the value of the network is clearly demonstrated by the rising number of service requests made to local and regional libraries and by the increasing num- ber of responses made by these libraries. We do not have, however, a quantitative measure of user reaction” [28:390]. The RML network had com- pleted its formative years with decided success, and began to concentrate on program development and evajuation. OPERATION OF THE NETWORK (1971-1981) Network Policies and Architecture Contract Funding The extension of the MLAA in 1970 for a three-year period provided the necessary funding to continue the development of the RML network. Bull. Med. Libr. Assoc. 75(3} Supplment July 1987 Two new authorizations added to the MLAA had a significant effect on the operation of the network: funding of RMLs was now permitted by both the contract and grant mechanisms, and RMLs were authorized to engage in regional planning efforts. In November 1970, the Board of Regents approved policy guidelines for RML contracts. As stated in the policy, “The intent of the conversion to contracts is to use this as a mechanism for a more controlled and coordinated allocation of resources to insure maximum service” [87:Attachment]. Contracts would cover the provision of essential services, defined at that time as interlibrary loan, MEDLARS search formulation, and reference ser- vices. NLM could contract separately for research and development projects for program develop- ment. Regional union book catalogs were expressly excluded from contract negotiations. RMLs could also apply for grant funding to support other “...in- novative and experimental activities” [87:Attach- ment]. As the original RML grants expired, they were converted to contracts, although a number of RMLs continued to receive grant funds for specific projects and services. By June 1971, seven of the ten grant-funded RMLs had completed contract negotiations with NLM. NLM also notified the Board of Regents that it intended to develop a formal RML policy statement to “...eliminate ambiguity and provide uniform understanding of the nature of the pro- gram...” [88:11]. Dr. Cummings also informed the Board that a subcommittee of the Biomedical Library Review Committee (BLRC), called the RML Committee, had been appointed to assist in “reviewing current and potential RML prob- lems” [88:12]. The BLRC had assumed the respon- sibilities of the former Resources and Facilities Committee in 1970. The RML Committee’s review was conducted in the last six months of 1971; its report was issued in May 1972. The RML Committee made eleven recommen- dations or observations which they felt would improve the effectiveness of the RML network [89]. 1. Broader participation in the development of RML policy and procedures in each region should be required. Librarians from all types of libraries and a broad spectrum of health professionals should be represented on advisory committees. 2. A study of the “net lender” concept for interlibrary loan, as it pertained to the financing of interlibrary loan requests, should be undertaken. A net lender was 19 ALISON BUNTING defined as a library that loaned more items than it borrowed. 3. The impact of fees for services and other methods of financing RML services should be measured. 4. The RML program should be evaluated periodically on a national level. . More effective liaison with the RMP should be established. 6. RML directors should review and comment on all resource grant proposals originating from their region. 7. If feasible, RMLs should engage in the distribution of non-print media. 8. NLM should consider designating a specific budgetary amount for the provision of regional services in the Mid-Atlantic Region. 9. RML directors should give more emphasis to overall regional planning and evaluation. 10. NLM should reconsider its present restric- tive policy on the development of union lists. Il. The. designation of existing libraries as RMLs created a potential for conflict between institutional and RML policies. Through proper leadership and manage- ment, such conflicts could be minimized. LA RML Policy Statement The NLM Regional Medical Library Program (RMLP) Policy Statement, published in April 1972, delineated the program objectives and speci- fied the organization and responsibilities of net- work participants. The primary. objective of the RMLP was to provide access to health information through the delivery of documents in a rapid, cost effective, and efficient manner. The hierarchical organization of the network which had evolved since 1967 was formally explained, and specific responsibilities of each of the four categories of participants delineated: (1) basic units, primarily hospital and other health related libraries, were responsible for the develop- ment and management of their own information resources, and for interacting with their nearest resource library; (2) resource libraries, primarily medical school libraries, were requested to support the information needs of local basic units, and work with other RLs, the RML, and NLM towards the development of the network; (3) the RMLs were to provide backup support to the RLs, plan and coor- dinate the region’s network activities, comment on the regional implications of resource improvement 20 and project grants submitted to NLM from their region, and provide backup educational support; (4) NEM was responsible for the coordination and management of both the network and network planning, and served as a backup to the RMLs and as the RML for the Mid-Atlantic Region [90]. The issuance of the policy statement clearly delineated NLM’s expectations for the network and its participants. It was a critical step, since it provided conceptual guidelines and priorities for network activities. In his analysis of the policy statement, Pings outlined the changes necessary in order to accomplish the stated objectives. RMLs and RLs, as departments within universities, would need “‘...to0 expand their ‘sphere of influence,’ and . adjust to new internal routines and procedures in order to have a stabilized network” (91:276]. The base of the network, composed of basic units, would have to be dependable and well developed. “...the RMLP will have to change not only the operations but even some of the objectives of some of the basic units” (91:278]. Effective communications be- tween all levels of the network, and continual evaluation of network activities would be extremely important. The RMEP Policy Statement also specified the RMLPs relation to the Biomedical. Communica- tions Network (BCN), which NLM was in the process of developing [92]. “The network being created in support of the RMLP will form the matrix for the evolution of a more comprehensive BCN in which the nation’s medical libraries will always be important nodes, and the resource and regional medical libraries will be critical switching stations” [90:271]. Harold Schoolman, M.D., who in his role as special assistant to the (NLM) director for Medi- cal Program Development and Evaluation promul- gated the policy statement, recognized the poten- tial conflicts which could arise when libraries assumed these expanded roles. “No matter how organized, the program makes immediate demands for resources and facilities, for the establishment of priorities and, therefore, for specific commitments. These commitments are neither insignificant nor transient.... It is our belief that in the long run the institutional objectives will also be better served; they will gain more than they give up” [93:284]. Organization and Management Regional Organization and Management Several organizational changes in the RML net- work occurred between 1971 and 1981. In May Bull. Med. Libr. Assoc. 75(3} Supplement July 1987 NATION’S HEALTH INFORMATION NETWORK 1973 the MRML changed its mode of operation from centralized to decentralized. The name of the region was also changed, first in October 1973, to the Midwest Medical Library Network, and shortly thereafter, in January 1974, to Midwest Health Sciences Library Network (MHSLN) [S1]. In 1975 NLM gave terminal contracts to the New York Academy of Medicine (NY/NJ RML) and the College of Physicians (MERMLS) and issued a Request for Proposal (RFP) for provision of RML services in the two regions. In Region H the Medical Library Center of New York com- peted with the Academy for the RML contract; there was no competition in Region III. At the conclusion of this contract bidding process both the Academy and the College retained their RML contracts, but the geographic composition of the two regions changed. Effective May 1976, Region Il comprised the state of New York and now the entire state of New Jersey; Region III encompassed Delaware and Pennsylvania. By 1979, in response to internal Department of Health, Education, and Welfare regulations con- cerning contract administration, it became neces- sary to compete for all RML contracts. RFPs for three-year RML contracts were issued between 1979 and 1981 as the existing contracts expired. All RML host institutions remained the same except in Region VII. In January 1980, the Univer- sity of Illinois, Library of the Health Sciences, Chicago, replaced the John Crerar Library as the RML for the MHSLN. The only other competition encountered during this round of contract negotia- tions was in Region VI where both the Medical University of South Carolina and Emory Univer- sity submitted proposals. Emory retained the RML contract for Region VI. Management of the Program at NLM The conversion of RML support from grants to contracts precipitated a reconfiguration of the management responsibilities for the RML program at NLM. At the June 1971 Board of Regents meeting, Dr. Harold Schoolman announced that network management and control would be the responsibility of a senior management group. Schoolman would chair this group which also included the associate directors of Library Opera- tions (LO) ‘and Extramural Programs (EMP). LO would be responsible for the negotiation and perfor- mance of the RML contracts. EMP would super- vise and direct the RML grants, and maintain fiscal control over both the contracts and grants. Bull, Med. Libr. Assoc. 75{3) Suppiment July 1987 Schoolman would be responsible for coordinating both the intramural and extramural activities of NLM as they related to the RML program (88]. Until late 1978, management of the RML pro- gram at NLM continued to be the shared responsi- bility of the associate directors of EMP and LO. The RML directors became increasingly frustrated with this arrangement, which occasionally resulted in contradictory policy or procedural interpreta- tions at NLM. The directors regularly reiterated the suggestion, first stated in 1971, that a single RML program coordinator at NLM be appointed. In August 1978, Sheldon Kotzin was appointed the first RML coordinator, initially reporting to the associate director for EMP [94]. By late 1979 all RML functions, including the management of Region IV, were consolidated in the office of the RML coordinator who reported first to the deputy director of NLM and subsequently to the associate director for LO [95]. Hospital Librarians’ Meeting In January 1978, NLM hosted an invitational meeting of one hospital librarian from each of the eleven regions to discuss the relationships between NLM activities and hospital libraries [96]. Their comments resulted in several new program direc- tions, including a decision by NLM to actively encourage hospital libraries to become MEDLINE (MEDLARS Online) search centers.” A statement prepared by the hospital librarians summarized their comments relating to the RMLP: We also want to go on record as strongly supporting the Regional Medical Library concept, although we recog- nize that the RMLs at present function with varying degrees of effectiveness. We hope and expect that the input of hospital librarians into RML plans and programs will help them to effectively serve the needs of their regions {97:5}. RML Directors’ Meetings The changes resulting from conversion to con- tract funding mechanisms and divided manage- ment responsibilities for the RML program at NLM resulted in some temporarily strained rela- tionships between the RML directors and NLM. In May 1971 the RML directors had their first inde- pendent meeting in New York, prior to the official RML Directors’ Meeting sponsored by NLM. Joseph Leiter, Ph.D., associate director of Library 2MEDLINE, the online version of MEDLARS, is described in the MEDLARS/ MEDLINE section which follows. 21 ALISON BUNTING Operations, attended this meeting as the RML director for Region IV. Many of the agenda items dealt with ways to improve communications and management of the RML program. One suggestion was the establishment of a National Council of Medical Librarians to advise NLM on the RML program. The directors also requested that an RML project officer, with pertinent library experi- ence, be appointed at NLM, and that the RML associate directors, who had day-to-day manage- ment responsibilities for the RML. programs in each region, be permitted to attend the RML Directors’ Meetings [98]. These informal meetings continued for several years, providing the RML directors with an opportunity to exchange informa- tion and let off steam. The 1972 RML Program Policy Statement [90], developed in consultation with the RML directors, delineated NLM’s expectations, and assisted in unifying RML program efforts. By 1974 the RMLs and NLM were working in a more coordinated fashion, as evidenced by the RML-NLM Working Committees established to examine various policy issues and services. The work of these committees is further described under Programs and Services. At the November 1978 RML Directors’ Meet- ing, James F. Williams, KOMRML director, sug- gested that NLM and the RML directors conduct an intensive planning meeting to develop a common understanding of the goals of the RMLP; identify future directions and performance measures for the network; establish priorities for funding; strengthen the relations between the eleven RMLs: and design a methodology for continuing the plan- ning process [99]. NLM responded positively and funded a meet- ing for RML directors, associate directors, and NLM staff in April 1979. At this meeting a revised mission statement was developed [100], and seven task forces were established to deal with the various issues raised during the planning session. The task forces were asked to consider: (1) performance indicators for RMLs, (2) RML network configura- tion, (3) content and format for future RML Directors’ Meetings, (4) basic services and priori- ties, (5) communications between NLM and RMLs and. among RMLs, (6) RML funding sources and competitive contracting, and (7) RML/NLM roles and responsibilities [101]. The task forces continued their planning efforts after the April 1979 meeting, reporting and dis- cussing their activities at subsequent RML Direc- tors’ Meetings. Some of the developments resulting from these deliberations included the acceptance of 22 a standardized document delivery statistical reporting form; rotating RML Directors’ Meetings to various RML headquarters locations rather than Just holding them at NLM: and a productive dialogue on the content and structure of the meet- ings. The most far-reaching impact, however, arose from the discussion on the RML network configu- ration. By 1981, after much consideration and largely in response to the fiscal pressures created by reduced MLAA funding, NLM announced its intention to reconfigure the network and reduce the number of regions from eleven to seven. RFPs for three-year RML contracts for the new regions were issued in early 1982, and new contracts were to be awarded on a phased schedule later that year [102]. Programs and Services Interlibrary Loan Health professionals and librarians throughout the country responded enthusiastically to the “free” interlibrary loans proposed ‘in the 1965 MLAA. Table 4 clearly indicates the significant growth in interlibrary loan traffic funded by RML contract/grant funds and by NLM from the begin- ning of the RML network through 1982. The net result was that provision of subsidized interlibrary loans threatened to consume all available RML funds, leaving little for other essential programs and services. It therefore became necessary to consider ways to control interlibrary loan costs without sacrificing what was clearly an important function. As described previously, initial controls came in the form of quotas on the amount of subsidized service, and restricted title lists. These controls were not readily accepted in all regions, so the institution of quotas and implementation of restricted title lists varied. However, in an effort to control costs, NLM announced that renewed RML contracts would require such measures by the end of 1974, At the June 1972 Board of Regents meeting, NLM proposed another approach, in use in some regions, which NLM called the “net lender” con- cept. “Each level of the hierarchy will have to assume fiscal responsibility for the major support of its own constituency. NLM will provide support for the network operation and management and will underwrite the difference (net lender) between levels of service given to a lower level and received from a higher fevel in the hierarchy” [103:7]. Although the net lender concept was discussed in Bull. Med. Libr. Assoc. 75(3) Supplement July 1987 NATION’S HEALTH INFORMATION NETWORK TABLE 4 RML/NLM FUNDED INTERLIBRARY LOANS 1969-1982 1 0.9 ~ 0.8 ~ P v s & 0.7 - § ; 2 0.6 - 6a me ee 0.5 - o= $2 Qe 0.4 - pg a = 0.3 + £ . £ 0.2 ~ 4q 5 0.1 4 0 T T 1 T 1 T T T T T T T 69 70 71 72 73 74 75 76 77 78 79 80 81 82 Year oO RML Total + NLM Total ° Combined Total many forums, it was never officially adopted as policy. Some of the principles inherent in the concept were, however, included in future regional interlibrary loan plans. That is, libraries which lent more than they borrowed were repaid in some fashion: One example occurred in MRML where consortia of libraries were provided with incentives and bonuses, such as an increase in the number of subsidized interlibrary loans they could request from the RML, as a reward for sharing resources locally. Despite efforts to contro! the number of interli- brary loan requests processed through quotas and restricted title lists, the number of institutions requesting. materials continued to increase. Thus, the number of loans handled by the RMLP grew disproportionately to available funding. It there- fore became necessary to consider other cost- sharing measures. At the May 1975 RML Directors’ Meeting, James F. Williams, KOMRML director, proposed that contract funds be used to support the referral service provided by the RLs, and that the cost of interlibrary loans filled locally or by the RLs be Bull. Med. Libr. Assoc. 75(3) Supplment July 1987 borne by the borrowing library [104]. In June 1976 NLM proposed to the RML directors that libraries be responsible for the cost of loans from a core of journal titles (defined as the last ten years of all English language periodicals indexed for Index Medicus), and the RML contract funds would cover the cost of loans from other journals, as well as book and audiovisual loans. NLM’s proposal met vigorous resistance from RML directors and regional advisory committees which felt that the plan would penalize the smaller libraries, which had the greatest need to borrow core titles [105]. NLM also proposed, at the June 1976 RML Directors’ Meeting, that a national cost-sharing plan be adopted. The RML directors expressed concern that a national uniform plan was not feasible given regional variations [105]. It was nevertheless apparent that some sort of cost- sharing measures had to be implemented. After extensive and frequently heated discussion over several years each region had the option of selecting a cost-sharing document delivery plan from one of two models developed by NLM and the RML directors. The models had two elements in 23 ALISON BUNTING common—a national maximum user fee based on an interlibrary loan cost study, and an understand- ing that contract funds would cover interlibrary loan network management costs. The two models were [106]: 1. The cost of loans filled within a defined geographic boundary (state or Health Service Area) would be the responsibility of the bor- rowing library; loans filled by out-of-state libraries would qualify for contract funding. 2. The cost of loans filled within the region would be the responsibility of the borrowing library; contract funds would cover the cost of processing referrals. The national maximum charge for interlibrary loan requests filled was set at $5.00 in February 1978, and each region began to implement its individual plans. Most regions phased in the cost- sharing aspects of their plans over several years; by 1980 all plans were in effect. Throughout this ten-year period, some attention was paid to the cost [107] of providing interlibrary loan service, and the characteristics of the service. PNRHSL instituted an automated interlibrary loan reporting system which yielded valuable data on all transactions. The reports generated provided information on PNRHSL’s performance in han- dling interlibrary loan requests, and on which titles were requested, how frequently, and by whom [108]. KOMRML noted that the number of insti- tutions using RML. interlibrary loan services increased by over 200% between 1968 and. 1972, despite the imposition of curbs on subsidized ser- vice [109]. Union Lists and Catalogs Union lists of serials were an integral part of several regions’ programs since they facilitated the location of serials for interlibrary loan purposes. Regions II, VI, VIII, and IX all had lists, and Region V had one under development. Regions I, Ill, VII, X, and XI all relied on the serials lists of the RML headquarters libraries, although in sev- eral of these regions union lists of hospital library holdings were in existence or under development. As interest in the development of union lists grew, so did concern for the lack of a standardized approach and the amount of funds consumed. Agreement was reached among. NLM and the RML directors that. newly created union lists should utilize the Union Catalog of Medical Peri- odicals format, thus laying the groundwork for an eventual national union list. There was little agree- 24 ment, however, between NLM and some RMLs about whether MLAA funds should be used to develop regional union lists. At its June 1971 meeting the NLM Board of Regents stated that it did “...not favor...the funding of multiple incom- patible union lists containing detailed information on the serial holdings for limited geographic areas” [88]. Several RMLs which had been planning union lists were thus unable to proceed. At the October 1971 RML Directors’ Meeting NLM presented plans for a “National Index of Substantive Biomedical Serials,” which would include approximately 5,000 live biomedical titles, and would be built on the Union Catalog of Medi- cal Periodicals database [110]. The creation of this list would provide access to information on the holdings of all RMLs and RLs for the nation's health sciences libraries. In 1973, NLM developed the SERLINE (Se- rials Online) database, which initially included information on serials owned by NLM, but was eventually expanded to include holdings informa- tion for all RMLs and most RLs. A SERLINE Task Force, with representatives from each region, was appointed by NLM in 1979 to assist in the development of a national serials holdings data- base. Region XI RLs, as part of the PSRMLS Cooperative Serials Acquisitions Program (CO- SAP), experimented with the online addition of information to the SERLINE database [111]. NLM announced, in 1981, plans to develop a National Biomedical Holdings Data Base (NBHDB) which was to include location and hold- ings information for monographs, audiovisuals, and serials. The first step would be the creation of the National Biomedical Serials Holdings. Data Base (NBSHDB). The RMLs were responsible for coor- dinating data collection and input from all inter- ested libraries in their regions. The data were then submitted by the RMLs in machine-readable for- mat according to specifications designed by NLM {112}. Despite the prohibition on the use of contract funds for union catalogs of books, there was signifi- cant interest in their creation. Several regions maintained, at their own expense or with grant funding, card catalogs into which were filed main entry cards submitted by resource libraries. In the TALON region the card file was microfilmed and made available to the contributing libraries, thus increasing accessibility to the information [54]. Such efforts were extremely time consuming and expensive, especially when compared to number of requests for books on interlibrary loan. On average, Bull. Med. Libr. Assoc. 75(3) Supplement July 1987 NATION’S HEALTH INFORMATION NETWORK only 10% to 15% of the total interlibrary loan traffic consisted of book requests. The Midwest Region was awarded an NLM grant to conduct a cost-benefit analysis of the Midwest Union Catalog of Books, which included over 260,000 titles from forty-three contributing libraries: The authors concluded that the cost of maintaining the catalog was high when compared to the low volume of requests, and recommended that long-term plans be made to utilize existing or developing computerized union catalogs of books (e.g., OCLC). The present catalog would be main- tained at minimal levels until suitable computer- ized databases became available [113]. The Mid- west Medical Union Catalog was in fact discontin- ued in 1979 in favor of an online union catalog of monographs and audiovisuals, mounted as a private database by Bibliographic Retrieval Services, Inc. (BRS). The MHSLN contract supported the development and testing of this catalog [114]. MEDLARS/MEDLINE In 1970 the first online version of MEDLARS, AIM-TWxX was tested, marking the beginning of a new era in bibliographic retrieval. By 1971 it was evident that the MEDLARS search formulation stations would eventually be phased out, as MED- LINE became operational. Clearly, there was.a need to speed and improve access to the MED- LARS database, as this service was becoming increasingly popular among health professionals. MEDLINE officially became available in Octo- ber 1971. Initially, only a few search centers were given access to the system, since it was unclear how many simultaneous users could be supported on the NLM computer. The RMLs and certain RLs were among the first to be granted access and send staff for training, eventually BHSLs were added to the system [115]. In some cases these BHSLs formed consortia to share one MEDLINE search code, thus increasing the number of institutions with access to the system [116]. Training classes were held at NLM and at PSRMLS, which contracted to provide training to searchers primarily from the western part of the country. In February 1973 NLM called a special meeting of the RML directors to announce the imposition of MEDLINE user charges. It was proposed that the search center pay for the access and search costs: NLM would continue to fund the creation, mainte- nance, and operation of the system. The proposed rate was $6.00 per hour, to take effect July 1, 1973. The institution of charges was delayed somewhat by the federally imposed price freeze of 1973, but Bull. Med. Libr. Assoc. 75(3) Supplment July 1987 did become effective August 20, 1973. Many MEDLINE search centers found it necessary to pass on these costs to the user, prompting NLM to propose a maximum charge of $5.00 per search. After considerable negotiation with RML direc- tors, the maximum charge was set at $7.50 per request, effective March 1, 1974 [117]. The implementation of MEDLINE search ser- vices in local libraries did create some network management problems because NLM was entering into independent agreements with libraries to pro- vide a service which was to be coordinated by the RMLs. At the June 1974 RML Directors’ Meeting a report prepared by a subcommittee of RML directors on the “Role of the Regional Medical Library in On-Line Search Operation” was dis- cussed. The issues identified were: (1) responsibil- ity for location and designation of MEDLINE centers; (2) definition of the user of the MEDLINE system; (3) quality control of MEDLINE search- ers; (4) continuing education of the MEDLINE searcher; (5) publicity; and (6) management data. The subcommittee cautioned. that a MEDLINE search network operating independently of the RML network could significantly weaken the latter [118]. A subsequent report of the RML-NLM Work- ing Committee on On-Line Network Management outlined the responsibilities of both NLM and the RMLs in management of the online network. RMLs were primarily responsible for coordinating and monitoring the online network within their regions, including publicity, continuing education, and provision of backup MEDLINE service. NLM was responsible for maintenance and development of the databases, providing technical information and initial training, and national coordination of publicity and continuing education. It was agreed that it was not possible to establish and enforce criteria for the selection of online searchers. Instead efforts would be directed to providing continuing education opportunities to update the knowledge and skills of all searchers [119]. The continued development of the MEDLINE network greatly facilitated and improved the delivery of bibliographic citations to health profes- sionals. Tables 5 and 6 illustrate the tremendous growth in the number of MEDLINE searches conducted, search stations, and searchers trained. The management of this evolving network added considerably to NLM’s and the RMLs’ scope of responsibility. The RMLs encouraged and identi- fied BHSLs which would benefit from on-site MEDLINE capabilities and distributed MED- 25 ALISON BUNTING TABLE 5 Domestic SEARCHES OF MEDLARS DATABASES 1965-1985 2.6 2.4 7 2.2 ~ 3 4 5 3 1.8 - 5 . 0 1.6 7 on fe 1.4- £2 g= = 1.2 - oz % 1~ ’ a 0.8 = gf z 0.6 - 0.4 0.2 ~ 0 -}—#} #4 + TT to ot 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 8&5 LINE application packets for submission to NLM. Significant changes were made in the training program for MEDLINE searchers. By 1976 the three-week training program was revised to be one week of initial training, followed several months later by one week of advanced training. Pressure also mounted to hold training courses at sites other than just NLM and UCLA (PSRMLS), so instruc- tors traveled to various regional sites. In 1981 the Midcontinental RML became the third online training center, primarily serving the midwestern states. As the number of trained searchers grew, and as it became imperative to organize a formal means of alerting them to system changes and capabilities, NLM began to issue its Library Network/MED- LARS Technical Bulletin in 1969. The RMLs also issued occasional publications designed to update searchers, or included online search information in their newsletters. In 1977 a Standing Committee for On-Line Retrieval Education (SCORE) was established by NLM to select topics for continuing education courses for online searchers, to identify 26 Year possible instructors, and coordinate online con- tinuing education. SCORE recommended that trained searchers be provided with annual updates on system and databases changes and search tech- niques. Each region subsequently designated a Technical Resource Person (TRP) who was respon- sible for providing these annual updates using course content designed by NLM staff. Reference Services Each RML, in cooperation with its RLs, con- tinued to provide backup reference services, with every effort made to answer questions locally prior to requesting information from regional resources. The amount and type of service varied between regions, and there was no effort to set up a national referral system between the RMLs and NLM for difficult reference questions. In 1974 an RML-NLM Working Committee on Reference Services reviewed the status of regional reference services and recommended continuation of this backup reference support. The committee also suggested that instruction in the provision of Bull. Med. Libr. Assoc. 75(3) Supplement July 1987 NATION’S HEALTH INFORMATION NETWORK TABLE 6 MEDLARS/MEDLINE SEARCH CENTERS/SEARCHERS TRAINED 1965-1985 45 (Thousands) 67 68 69 70 71 72 o Search Centers reference services be given by the RMLs as part of their regional training programs [120]. Resource Sharing Several innovative programs designed to share information resources and coordinate the develop- ment of regional collections were instituted by the RMLs. Of direct benefit to basic unit libraries were serials duplicate exchange programs, which pro- vided free or inexpensive individual] issues or entire runs of serials. Most RMLs promoted the exchange of duplicate serial issues on an informal basis, but two regions, TALON and PNRHSL. operated formal, coordinated programs [121,122]. TALON also developed a serials rationalization program. The libraries which contributed holdings to the TALON Union List of Serials agreed to maintain subscriptions to certain serials thus insur- ing that a core set of serial titles was available within the region [54]. An RML-NLM Working Committee on Coop- erative Acquisitions. and Cataloging. Serials Bull. Med. Libr. Assoc. 75(3) Supplment July 1987 73 74 75 76 77 TTT TT TT Tt 78 79 80 81 82 83 84 85 Year + Searchers Rationalization, Resource Sharing and Coopera- tive Storage. formed in 1974, discussed the net- work’s role in these activities. It recommended that each region develop and maintain book, journal, and audiovisual resources adequate to meet most of its immediate needs, and that it was cost-effective to do so in a cooperative fashion. Cooperative serials acquisitions programs should receive highest priority, and should be coordinated into a national resource. Consideration should be given to develop- ing CATLINE (Cataloging On/ine) into a national locator system [123]. A number of interesting cooperative acquisitions programs were developed by the RMLs. PSRMLS coordinated a Cooperative Serials Acquisitions Program (COSAP) [111] in which each of the RLs committed itself to maintain subscriptions to speci- fied journals which were held by fewer than three libraries in the region. In 1979 TALON instituted a cooperative acquisitions program for monographs to complement its serials rationalization program. Each of the eleven RLs in TALON accepted 27 ALISON BUNTING responsibility for purchasing all books published in appropriate subject fields by an assigned publish- er(s) [124,125]. The development of formalized hospital library consortia to promote the sharing of resources, first proposed by Fink, Bloomquist, and Allen in 1974 [126], was encouraged by the RMLs and NLM. Such cooperative arrangements frequently resulted in increased self-sufficiency without extensive financial drain on individual institutions. In many areas formal consortia primarily involved hospital libraries, but also included corporate, community college, nursing, and medical school libraries. Activities common to these consortia included doc- ument delivery, MEDLINE search services, coop- etative acquisitions projects, education and train- ing of consortia members, and union list develop- ment [127-132]. In some communities health sciences libraries also cooperated with public libraries for the provision of consumer health infor- mation materials [133,134]. In some regions the RLs or state university libraries: received funding to improve health sciences library services in their geographic area. With funding from an NLM Resource Project grant, the MCRMLP worked with the Wyoming College of Human Medicine and the University of Wyoming Libraries to develop a medical informa- tion network in Wyoming. Twenty-nine. hospitals were organized into six consortia, and provided with core health sciences library collections. Con- sulting and training services were provided. from within this subregional network [135]. Resource Project grant funding also assisted the development of a project at the University of Maine to provide information services to rural hospitals [136]. Consulting and Training Services Considerable progress was made in the develop- ment and implementation of regional consulting and training services. The methodology for provid- ing such services varied considerably, influenced in part by the organization of the region. In general, centralized regions were able to institute these services most readily, since they relied primarily on RML staff funded by the RMI contract. NERMLS led the way; in 1968 its staff worked closely with Dr. Norman Stearns, director of the Postgraduate Medical Institute (PMI), to identify a core list of books and journals which should be available in any hospital library [33]. NERMLS then contracted with PMI to contact hospitals and introduce the concept of developing and maintain- ing such acore library, under the supervision of a 28 library manager. In order to acquaint the generally untrained library managers with network opera- tions and library management techniques, NERMLS developed a week-long Library Train- ing Institute (LTI). The LTIs were held at the Countway. Library in Boston and each lasted a full week [137]. The experiences gained in training hospital library managers also prompted Harold Bloomquist, NERMLS director. ta collaborate in the editing of Library Practice in Hospitals, a text for“... untrained, probably newly employed, indi- viduals who find themselves supervising the hospi- tal’s library and do not know where to begin” {138:xiii]. In its first years of operation PNRHSL field librarians visited hospital libraries in the region on a rotating basis. Such visits provided the RML with valuable information on regional needs, and served to publicize its services. A one-day workshop on hospital library management was held at various locations throughout the region [108]. PNRHSL also secured grant funding to establish director of biomedical communications positions in Idaho and Montana, each of which lacked 2 medical school library. The directors assisted with health sciences library development in each state. Several other RMLs, including ,ERMLS and PSRMLS, also conducted one- or two-day work- shops throughout their regions. end provided indi- vidual consulting services on demand. To facilitate its consulting and training activities, PSRMLS published Manual for Librarians in Small Hospi- tals [139] which was subsequently used in several other regions including TALON and MARMLS. Decentralized regions designed consulting and training programs which were offered by RL staff. Initially such programs were grant funded. In the Midwest Region, library coordinator positions were funded in each of the six states. The coordinators began by providing both consulting and training services, and became particularly involved in the development of health sciences library consortia. They produced a loose-leaf training manual entitled Basic Library Management for Health Science Librarians [140] which could be used in different educational settings. In Wisconsin an alternate mode of delivery was employed, and courses were taught via the state's Educational Telephone Network [141]. KOMRML received assistance from staff in each of its participating libraries to provide exten- sion services [142]. The RLs in the TALON region were awarded grants to provide extension services; at the conclusion of these grants, services were Bull. Med. Libr. Assoc. 75(3) Supplement July 1987 NATION’S HEALTH INFORMATION NETWORK continued by some of the RLs, albeit on a reduced level [54]. It should be noted that in several regions the RMLs cooperated with RMP library projects to develop materials of use in consulting and training services. This was particularly true in the New England, Mid-Atlantic, and Pacific Southwest regions. The extent of consulting and training services varied considerably among regions, due in part to the fact that in some regions such services were not funded by the RML contract. At the December 1974 RML Directors’ Meeting the RML Working Committee on Training, Continuing Education, and Extension Services recommended that all funding for such services be via the contracts mechanism. and that training opportunities be available in all regions. They further recommended that NLM assume responsibility for a clearing- house of educational materials developed by the various RMLs [143]. In addition to offering basic courses designed to teach untrained library managers the principles of organizing a small library and providing basic services. most regions developed specialized courses on topics such as the formation of consor- tia, the management of audiovisuals, and adminis- trative techniques. PSRMLS developed a series of manuals for use in these courses [144-146]. MERMLS invited selected hospital librarians from throughout Region III to a leadership institute designed to prepare them to provide regional exten- sion services in their geographic area [147]. As the educational services offered by the RMLs increased in scope and magnitude, and library staff in each region welcomed educational opportunities provided locally, it became obvious that the RML’s role in this area required clearer definition. Most critical was the division of responsibility among the RMLs. NLM, and the Medical Library Associa- tion (MLA), which had a well-established con- tinuing education program. In July 1978 a position paper delineating the responsibilities was issued by MLA. MLA would serve as primary provider for educational activities at the “professional” level, the RMLs would concentrate on the “untrained” library managers, and NLM would be responsible for training MEDLINE searchers and regional audiovisual consultants [148]. It was agreed that the RMLs might on occasion provide professional training if MLA did not have a current or planned educational program. An exam- ple of professional training coordinated by the RMLs and NLM occurred in 1980 when the Bull. Med. Libr. Assoc. 75{3) Supplment July 1987 RMLs selected catalogers from each region to attend a training session at NLM on the changes in cataloging rules described in the second edition of the Anglo-American Cataloguing Rules (AACR2) (149]. These catalogers subsequently taught regional workshops attended primarily by profes- sional librarians. Another issue discussed during this period was the relationship of RML consulting services to the medical library consultant first mentioned in the 1978 Joint Commission on the Accreditation of Hospitals (JCAH), “Standards for Professional Library Services” [150]. It was agreed that RML consulting services were designed to provide initial evaluation and advice on hospital library services, but would not substitute for the formal, on-going consultant services required by the JCAH in a hospital where a professional medical librarian was not on the staff. Several RMLs gathered data on the hospital libraries in their regions in an attempt to measure development and impact of RML services. An evaluation of the training program in the Midconti- nental Region reported that attendance at work- shops encouraged library managers to provide new services to health professionals, and assisted in the improvement of existing services [151]. KOMRML developed a formalized documenta- tion process to gather baseline data [152]. The data showed that the libraries which had regular contact with KOMRML extension librarians provided more sophisticated administrative, public, and technical services and became more active network participants than did libraries without such con- tact. It was not possible to correlate this. positive development with the extension services provided, but valuable baseline data were gathered which might prove useful in future evaluations (153]. PSRMLS analyzed the development of hospital libraries in Region XI over an eight-year period, 1971-1978. The data demonstrated that there was definite improvement in hospital library activity in three critical areas: appropriate staffing, collec- tions, and the availability of services. As with the KOMRML study, it was not possible to demon- strate that the library improvement was a direct result of PSRMLS involvement. However, the hos- pitals which showed some of the strongest develop- ment were those that had used PSRMLS services most heavily [154]. Grants In December 1972 the Biomedical Library Review Committee (BLRC) issued guidelines deal- 29 ALISON BUNTING ing with interactions between the RMLs and the BLRC regarding both Resource and Regional Medical Library grant applications. For RML grants, the applications would be required to include a statement by the RML director on how the grant-funded project related to the region’s plan. RML directors were also requested to work closely with applicants for resource grants, and to comment, once the grant application was submit- ted, on the relationship of the project to regional plans [155]. RML directors agreed to provide such commentary, although there was some concern that they were being asked to judge applications without benefit of a thorough analysis of the pro- posed project. By late 1974 procedures for RML interaction in the grant process were formalized. In addition to commenting on proposed projects, the RMLs were responsible for distributing grant application pack- ets, thus establishing a definite RML role in the application process. The NLM Resource Improvement and. Project grants were extremely useful in promoting library development on a regional level. RML staff encouraged institutions interested in developing their library service to apply for appropriate grants, and often reviewed drafts of the applications. The Resource Improvement grants, which from 1971 to 1975 provided one-year awards of a maxi- mum of $3,000 to establish a basic library collec- tion, provided a much needed incentive to many institutions. An evaluation of this program by Matheson and West [156] revealed that the grants did stimulate library development. The study also included a recommendation to modify the grant program to support applications by consortia of libraries. In 1975 the Resource Improvement Grant guidelines were revised: up to $4,000 could be requested. in the first year to plan consortium activities; in. the second year each institution in the consortium could receive up to $3,000 for collection development, provided it matched the amount awarded on a three to one ratio. Audiovisual Services In October 1973 an Ad Hoc RML Committee on Requirements for a Training Program for RML Media Consultants met to discuss the need for media consulting services in each region. It recom- mended that two individuals from each region be trained to serve as media consultants to promote increased use of non-print materials. The commit- tee designed a four-week training program which could be taught in one-week segments. The first of 30 these training sessions was held at the National Medical Audiovisual Center (NMAC) in Atlanta in July 1974 [157]. An RML-NLM Working Committee on AV and CAI Networks discussed the interrelationships between NMAC and the RMLs. Of particular concern was the development of the AVLINE (Audiovisuals Online) database. It was agreed that the RMLs and NMAC would cooperate in the development of AVLINE, the provision of AVLINE access and audiovisual software, and the development and provision of audiovisual consult- ing and training services [158]. , The initial cadre of audiovisual consultants trained at NMAC was supplemented in 1976 by a second trained consultant for each region. Updates for the experienced consultants were also scheduled in 1976, and by late that year each region was charged with formulating an audiovisual plan. Although there was some initial confusion over the exact role of the audiovisual consultants, a common understanding emerged. The audiovisual consul- tants developed and taught workshops on estab- lishing audiovisual collections, services and facili- ties, and were available for individual consulta- tions. In some regions they actively promoted shar- ing of audiovisual programs via interlibrary loan mechanisms, and the creation of audiovisual union lists. In January 1981, NLM provided each region with a satellite collection of 300 videocassettes from NMAC’s collection. The titles were available for interlibrary loan within each region, so that libraries could preview titles before purchase. NLM’s total collection of over 1,000 videocassette titles was also available for loan. Regional Planning, Evaluation, and Research The RMLs conducted a great deal of their planning via their advisory committees. In some cases, subcommittees were appointed to discuss specific problems or plan programs and services. In addition, various working committees composed of RML directors, associate directors, and other NLM and RML staff considered national issues. These working committees, as mentioned previous- ly, were formed to establish national network goals in specific program areas. NLM intended that each region would then develop regional plans to meet these goals. TALON planned several research programs during its first years of operation to investigate user needs and improved means of information delivery. An automated statistical interlibrary loan package Bull. Med. Libr. Assoc. 75(3) Supplement July 1987 NATION’S HEALTH INFORMATION NETWORK called NEMIS (Network Management Informa- tion System) was developed, but was never imple- mented because preparation of data for input at each RL was not cost-effective. Another study determined that it was not feasible to centralized purchasing, processing, and cataloging of library materials for the RLs. The Houston Academy of Medicine-Texas Medical Center Library con- ducted a study to determine the cost of various library services, which yielded valuable informa- tion of potential use to the network [54]. In an effort to assist the RMLs in the develop- ment of regional plans, as recommended by the evaluation consultants in 1974, NLM requested expressions of interest from RMLs wishing to develop a model planning process. The Midwest Region designed a program planning model (PPM) with the assistance of two professional planners from. the University of Wisconsin. The PPM involved key reference groups, including consumers and participants in the MHSLN, in the develop- ment and evaluation of network services. Both Delphi and nominal group techniques were used to elicit information [159,160]. MERMLS developed a “plan to plan” (104]; a significant recommenda- tion from this process was that the “...RML role shift to being managers of information flow and distribution rather than serving as sources of infor- mation...” [161:14]. MCRMLP surveyed its Advisory Committee to establish priorities for the Midcontinental RML activities and services. Docu- ment delivery was ranked in first place, followed by information services, a category which included computerized bibliographic services such as MED- LINE and reference services. Also important were technical, educational, and consultation services [162]. In KOMRML an examination of the gover- nance structure resulted in the addition of BHSL representatives, with full voting rights, to Region V’s Executive Committee [163]. The development of formal, published regional plans varied among regions, since some RML directors were reluctant to write a plan without specific information from NLM on the essential elements of a plan. NLM did not provide written guidelines until 1982 when it issued the Request for Proposal (RFP) at the time of network reconfigu- ration. Relations with Other Networks and Programs NLM and the RMLs maintained close working relationships with RMPs through 1973, when all funding for RMP projects ceased. To gain support for RML programs and plans from academic Bull. Med. Libr. Assoc. 75(3) Supplment July 1987 health sciences center deans, NLM prepared a “white paper” on RML network development for discussion at the Association of Academic Medical Colleges (AAMC) Council of Deans meeting in 1973 [164]. Meetings were also held with officials of the Veterans Administration to discuss VA participation in the RML and Biomedical Commu- nications Network. The RMLs recognized the importance of work- ing closely with existing networks and organiza- tions in their regions to coordinate services [165].A notable example was the interrelationship between the NY/NJ RML and the New York State Interli- brary Loan (NYSILL) program, a state funded interlibrary loan program providing interlibrary loan access to research library materials through- out the state. By agreement, health professionals without access to health sciences libraries could obtain needed material via their public library. The RML agreed to honor requests submitted by the New York State Library, and RML network libraries also benefited by being able to request needed non-medical research materials through NYSILL [166]. The RML-NLM Working Committee on Net- work Interface/Document Delivery addressed the need for coordination of document delivery activi- ties in areas where state funding for document delivery services was available. The committee recommended that formal planning to develop a model coordinated system be undertaken, and sug- gested that the MHSLN submit a proposal to NLM for such a study [167]. MHSLN made arrangements with two state interlibrary loan net- works, the Wisconsin Interlibrary Loan Service (WILS), and the Illinois Library and Information Network (ILLINET), to refer requests between the MHSLN and the WILS and ILLINET net- works [168]. The newly emerging Area Health Education Centers (AHECs), which were charged with the provision of training and continuing education of health professionals in underserved areas of the United States, provided a new arena for coopera- tion. NLM and the Bureau of Health Manpower, which administered the AHEC program, under- took a project to inventory AHEC library projects throughout the country and identify AHEC infor- mation resource needs. The study revealed that AHEC activities resulted in significant informa- tion needs, but that library and information ser- vices were usually not considered in AHEC pro- grams. NLM EMP staff therefore initiated discus- sions with appropriate AHEC funding agencies to 31 ALISON BUNTING delineate responsibilities for program funding, and to coordinate information services activities [169]. In some AHECs extensive library programs were undertaken, supplementing the RML network’s efforts to develop and facilitate access to health information sources for health. professionals [170- 176}. Formal relations with state library agencies were established in 1976 when the Ad Hoc Committee to Study the Relationship Between State Library Agencies and Health Information Libraries was established by the Association of Specialized and Cooperative Library Agencies (ASCLA), a section of the American Library Association. The commit- tee determined that state libraries and the RMLs did not have good channels of communication, and were generally unfamiliar with one another’s ser- vices and programs. Representatives from. state libraries, NLM, and the RMLs proposed that informational meetings be organized in each of the eleven regions. Meetings were subsequently held in the TALON, Pacific Northwest, and Midwest regions [177], while other RMLs appointed state library directors to their advisory committees, thereby establishing a continuing communications link. MERMLS participated as a member of the Council of Pennsylvania Library Networks, estab- lished by the Pennsylvania State Library to pro- mote cooperation among networks, cooperatives, and consortia [178]. Technological Developments NLM and the RMLs readily adopted technolog- ical developments in order to improve or speed access to information. In 1976 NLM began to develop DOCLINE (Documents Online), an auto- mated interlibrary loan request routing system which would also provide accounting and statistical data on the national interlibrary loan traffic. DOCLINE would interface with a single, national serials holdings file (eventually named SER- HOLD),-which would provide the necessary infor- mation for routing requests to a library owning the needed title, and with the MEDLARS biblio- graphic files, eliminating the need to key in journal article citations [161]. Full implementation of DOCLINE on a national level was delayed until 1985, but the RMLs provided design input during the developmental phase, and assisted in gathering information for the serials locator file. MCRMLP, which had access to PHILSOM (Periodical Holdings in Libraries of Schools of Medicine), an online serials holdings file created and maintained by Washington University in St. 32 Louis, developed Octanet in 1980-1981. By early 1982, Octanet was providing automated routing of interlibrary loan requests between libraries in the Six states of the MCRMLP. Eventually, an auto- mated link was developed between Octanet and the DOCLINE system in use internally at NLM. Octanet also facilitated union list production for library consortia, and provided an electronic mes- saging capability. Octanet development and use costs were supported by the MCRMLLP contract until January 1983, when user charges were insti- tuted [179-181]. Octanet proved to be more cost- effective than other forms of interlibrary loan request transmission such as mail, the OCLC inter- library loan subsystem, and TWX, and signifi- cantly reduced the transmission time for requests which had to be sent to more than one library. It also provided useful management reports and sta- tistics [181]. In an effort to speed delivery of the document itself, some regions experimented with telefacsim- ile transmission between health sciences libraries [182]. Although such transmission had the poten- tial of greatly reducing the elapsed time between requesting and receiving a document, the cost and various operational deficiencies prevented wide- spread adoption of this technology. Publicity and Publications Regional publicity was accomplished primarily through the publication of RML newsletters (Ap- pendix 3) on a monthly, or, as funding decreased, quarterly basis. The recent acquisitions lists issued in the early days of the program were discontinued as a cost-saving measure. In addition, most RMLs developed brochures and posters describing and advertising regional services. The National Library of Medicine News included a series of articles on the RMLs, describing the unique features of each region to a national readership [168,178,183-202]. Full-length articles in health professional and library publications aiso served to provide informa- tion on the accomplishments of the RML program [203-208]. In addition, RML exhibits were mounted at health professional meetings, in an increasing effort to reach health professionals directly. A very popular feature at RML exhibits was the online demonstration of MEDLINE. Network Evaluation RML Evaluation—1972-1974 The 1972 report of the BLRC’s RML Commit- tee recommended that the RML program be evalu- ated periodically. Later that same year, NLM appointed a committee of RML Evaluation Con- Bull. Med. Libr. Assoc. 75(3) Supplement July 1987 NATION’S HEALTH INFORMATION NETWORK sultants. This committee organized site visits to each of the eleven RMLs by consultation teams composed of representatives of the BLRC, the Board of Regents, health and library professionals, key NLM staff, and an RML director. The visits took place between November 1972 and February 1974. During the site visits, the consultation teams met with RML staff, administrators from the RML institution, and representatives from RML user groups, including both librarians and health profes- sionals. Individual reports for each RML were issued by the site review team, including recom- mendations for improvements and changes in the various programs and services. Most pertinent were the recommendations and comments which applied uniformly to each of the eleven RMLs. The site visitors concluded that in each region the document delivery system was operating “...toa most satisfying degree of efficiency and effective- ness” {209:4]. It was noted that the services most in need of expansion in the coming years were out- reach programs, including consultation and train- ing; communications in the form of publications; and resource sharing efforts, such as cooperative serials acquisitions and retention programs. The regional boundaries as constituted presented no rea! difficulties, but flexibility was encouraged whenever traditional boundaries differed from RML lines. Teams found considerable talent and leadership among RML staff, and the institutional support for the RML headquarters library was firmly based. It was felt, however, that nearly all the RML advisory committees needed to be res- tructured or revitalized. This was particularly important in light of regional planning efforts, where advice from a broad range of network partic- ipants was essential. Communication between RMLs should also be strengthened and improved. Each RML was advised to develop a regional plan. Much of the planning to date had taken place on an.ad_hoc or informal basis, and had not involved the RML user population. NLM was encouraged to provide planning guidance by stat- ing the goals for regional plans. The consultants recommended that RML program evaluation efforts continue, but that in the future the RML directors, accompanied by several representatives from their region, brief the evaluation consultants on regional activities and progress [209]. 1977 and 1980 Evaluation Projects In 1977 the National Institutes of Health’s Office of Program Planning and Evaluation Bull. Med. Libr. Assoc. 75(3) Supplment July 1987 approved an NLM proposal to fund various evalua- tion projects proposed by interested RMLs, in addition to an NLM-conducted study on the total interlibrary loan activity provided by the RMLP. The interlibrary loan analysis indicated that only about 25% of regional interlibrary loan traffic was funded by RML contracts, and that hospital libraries received about 50% of network loans. Statistical information on the interlibrary loan traffic emanating from hospital libraries was gen- erally not available, and it was recognized that this would be important information to gather in the future. In four regions where such data were avail- able, analysis revealed that interhospital interli- brary loan traffic exceeded or almost equaled RML/RL interlibrary loan traffic [210]. Regional studies included further analyses of interlibrary loan data, evaluation of extension services and local library development, and the effectiveness of regional newsletters [154]. In 1980, as a direct result of the decision reached at the 1979 planning meeting to examine the RML network configuration, NLM contracted with Abt Associates, Inc. to conduct an evaluation of the RMLP. The contractor would “‘...review the impact of national performance standards, the effect of user charges, the implication of developing technol- ogies and MEDLARS III, the ideal relationship between the RML network and other networks, and the soundness of a decentralized hierarchical network” [95:7]. An exploratory evaluation report, submitted in 1981, included preliminary data and the results of interviews with network administra- tors and library participants [211]. The evaluation contract with Abt was terminated by NLM after submission of the exploratory report. NLM had decided that changes in the RML network struc- ture would be required in the very near future for budgetary reasons, and could not be delayed until the evaluation was completed. Characteristics of the Original Eleven Regions A summary of the original eleven regions, emphasizing their distinctive characteristics and major accomplishments, serves to illustrate one of the strongest features of the RML network—the development of programs and services responsive to local needs to accomplish national objectives. Table 7 illustrates the demographic diversity of each region, featuring those programs and services. for which each RML is best remembered. Region I: New England Regional Medical Library Service (NERMLS). NERMLS served a region which was geographically cohesive, contain- 33 ALISON BUNTING “ | “es 1980 Data We 0.9 + Us os - ZY OZ a ZAUISINGZ Y Lia V7 N AO) “i JY» GINS MAP “yZ Qa AZGGGZ “KNENSNZZZIZ RAS AVIA AZ, ing both major metropolitan cez:ers with strong library resources and rural states «ith perhaps only one. strong health sciences librz:¥ collection. A major focus of the NERMLS prez-am was educa- tion, particularly for untrained Zospital library managers. Both the core library collection [33], and hospital library consortium ccexcepts [126,127] were developed and widely used in the New England Region. As the first RML. NERMLS was called upon to provide extensive advice to other regions on their organization anc development of RML programs. Region II: New York/New Jersey Regional Medical Library (NY/NJ). The NY/NJ Region contained very rich health sciences library resources in the greater New Yorx City metropoli- tan area. Over 90% of the populazion of the region was located in urban areas. Libra-‘es in both New York City/Northern New Jersey and throughout the state of New York had long-s:zading history of cooperation both at the local and state level. Not surprisingly, therefore, the NY/NJ RML is noted for strong union list programs, and for the integra- 34 tion or alliance of health sciences libraries with existing or developing local or statewide library networks. Region IH: Mid-Eastern Regional Medical Library Service (MERMLS). Region III encom- passed the smallest geographic area of the original RMLs. The strongest health sciences library resources in the Mid-Eastern Region were located in the Philadelphia area, and approximately 70% of its population was concentrated in urban areas, MERMLS was noted for rapid and cost-effective interlibrary loan service, a strong and active refer- ence service, a substantive newsletter from which other regions often reprinted articles, leadership institutes [147] which trained librarians in the region to provide consulting and training services in rural areas, and a high degree of user satisfaction. Region IV: Mid-Atlantic Regional Medical Library (MARML). The Mid-Atlantic Region con- tained a concentration of health sciences libraries in the greater Washington, D.C. metropolitan area which had traditionally relied heavily on the resources of a great, local library—the National Bull. Med. Libr. Assoc. 75(3) Supplement July 1987 NATION’S HEALTH INFORMATION NETWORK Library of Medicine. Other areas of the region were predominantly rural; the strongest library resources here were the academic health sciences libraries. RML programs and services in the Mid- Atlantic region were not as identifiable as in other regions, because NLM staff who were assigned Region IV responsibilities were frequently identi- fied with NLM rather than the regional office. Region IV relied heavily on committees of librar- ians to set policies, develop, and, in some cases, provide regional services. Region V: Kentucky, Ohio, Michigan Regional Medical Library (KOMRML). As the first decen- tralized region, KOMRML built upon the services and expertise provided by its participating (re- source) librarigs. KOMRML developed a strong regional communications program, generating extensive documentation for the establishment of policies and the recording of accomplishments and future goals. The RML office served to coordinate all regional activities, thus insuring consistency of service in a decentralized program. Region. VI: Southeastern Regional Medical Library Program (SERMLP). SERMLP provided regional services via resource libraries located in primarily rural states. SERMLP staff and instruc- tors from the resource libraries taught a variety of basic courses for library managers throughout the region, with particular emphasis on consortia development. Resource libraries assumed responsi- bility for several major program efforts, including MEDLARS search services and the compilation and production of a regional union list. Region VH: Midwest Regional Medical Library (MRML). The Midwest Region included both major metropolitan areas, with strong health sciences library resources, and predominantly rural states. The state coordinators program was a model for the provision of consulting and training pro- grams in a decentralized region, and the manual [140] developed for this purpose was widely used, including a Japanese translation prepared by the Japan Medical Library Association [212]. The Midwest Region conducted the most formal and extensive regional planning program, involving all types of health professionals and librarians. Con- sortia development was especially strong in this region; thirty-nine consortia with over 500 member institutions were in operation by 1978 [168]. Region VIII: Midcontinental Regional Medical Library. Program (MCRMLP). The Midcontinen- tal Region included the largest number of states (seven) in any region, covering a vast geographic area with library resources concentrated in a few Bull. Med. Libr. Assoc. 75(3) Supplment July 1987 metropolitan areas. MCRMLP is best noted for its sophisticated use of technology to facilitate or enhance regional services including the develop- ment of Octanet in cooperation with the PHIL- SOM network. MCRMLP staff were also active in the conduct of formal evaluations of regional ser- vices, such as training and Octanet, and publishing the results, and, in 1981, began to provide online training for the center of the country. Region 1X: South Central Regional Medical Library (TALON). TALON also covered a vast, primarily rural, geographic area, and operated its region with the cooperation of resource libraries. Particular emphasis was placed on the development of union lists of monographs, serials, and audiovi- suals; the operation of a serials duplicate exchange program; and cooperative acquisitions programs. Emphasis was placed on continuing education for hospital library managers and a training manual, produced in 1979 [213], was used by other regions. Region X: Pacific Northwest Regional Health Sciences Library (PNRHSL). Region X comprised the largest geographic area of any of the regions, and contained only two academic health sciences libraries. Thus, emphasis was placed on developing partnerships with state or university libraries to assist in providing health sciences library services to the region’s health professionals. PNRHSL was also noted for the development of an automated interlibrary loan statistical program, and for pro- moting and developing standards for the collection of such statistics. Region XI: Pacific Southwest Regional Medical Library Service (PSRMLS). Region XI included one highly populous state (California) with eight academic health sciences libraries, and three pri- marily rural states. Particular emphasis was placed on the development of strong hospital libraries through an extensive consulting and training pro- gram. Training manuals developed by PSRMLS were used throughout the RML network [139,144— 146]. Several analyses of hospital library develop- ment in the region were conducted [154,171]. PSRMLS also served as the West Coast online training center, facilitating the development of online centers in the western part of the country. THE RECONFIGURED NETWORK (1982-1985) Network Management and Architecture Reconfiguration of the network from eleven to seven regions was necessary primarily because the amount of funding available for the RMLP had not kept pace with costs. In contrast to the original 35 ALISON BUNTING formation of the RML network, where the geo- graphic composition of each region was for the most part self-determined by librarians and health professionals in the regions, the boundaries of the reconfigured regions were determined by NLM with the assistance of outside consultants [214:5]. Comments on the RML program were solicited from network participants and factored into the program review at NLM (215]. Request for Proposals A revised RMLP mission statement delineated in NLM’s Request for Proposal stated that the RMLP shall: Provide health sciences practitioners, investigators, edu- cators, and administrators in the United States with timely, convenient access to health care and biomedical information resources. The Program is coordinated by the National Library of Medicine and carried out through a nationwide network of health-sciences libraries and infor- mation centers [102:3]. In early 1982 RFPs for three-year RML con- tracts for the new regions were issued; new con- tracts were awarded on a phased schedule between September 1982 and January 1983 [216]. Table 8 lists the new regions and RML headquarters, the number designations for the regions changed from roman to arabic with the reconfiguration. Table 9 illustrates each region's demographic characteris- tics. Contract Awards Four of the regions—Region 4 (MCRMLP), Region 5 (TALON), Region 6 (PNRHSL), and Region 7 (PSRMLS)—remained essentially un- changed in geographic composition, although TABLE 8 RECONFIGURED REGIONAL MEDICAL LIBRARY REGIONS Region Regional Medical Librar Area Served Date Bh e , J Operational 1 Greater Northeastern Regional Medical Connecticut, Delaware, Maine, December 1982 Library Program (GNRMLP) New York Academy of Medicine Library, New York 2 Southeastern/ Atlantic Regional Medical Library (SEARML) Health Sciences Library, University of Maryland, Baltimore 3 Greater Midwest Regional Medical Library Network (GMRMLN) Library of the Health Sciences University of Iinois at Chicago 4 Midcontinental Regional Medical Library Program (MCRMLP) Library of Medicine University of Nebraska, Omaha 5 South Central Regional Medical Library (TALON) University of Texas Health Science Center at Dallas 6 Pacific Northwest Regional Heatlh Sciences Library Service (PNRHSLS) Health Sciences Information Center University of Washington, Seattle 7 Pacific Southwest Regional Medical Library Service (PSRMLS) Biomedical Library University of California, Los Angeles 36 Massachusetts, New Hampshire, New Jersey, New York, Pennsylva- nia, Rhode Island, Vermont and Puerto Rico Alabama, Florida, Georgia, Mary- January 1983 land, Mississippi, North Carolina, South Carolina, Tennessee, Virgin- ia, West Virginia, District of Co- lumbia, and the Virgin Islands Illinois, lowa, Indiana, Kentucky, January 1983 Michigan, Minnesota, North Dako- ta, Ohio, South Dakota, Wisconsin Colorado, Kansas, Missouri, Ne- January 1983 braska, Utah, Wyoming Arkansas, Louisiana, New Mexico, November 1982 Oklahoma, Texas Alaska, Idaho, Montana, Oregon, September 1982 Washington Arizona, California, Hawaii, Ne- September 1982 vada, and U.S. territories in the Pa- cific basin Bull. Med. Libr. Assoc. 75(3) Supplement July 1987 NATION’S HEALTH INFORMATION NETWORK 7" ] WIV WAAC South Dakota, formerly part of the Midcontinental region. requested and received reassignment to the newly configured Region 3—-Greater Midwest Regional Medical Library Network (GMRMLN). In each case the existing RML headquarters library submitted a successful RML contract pro- posal without competition from other libraries. Significant change and considerable competition occurred in the three newly configured eastern and midwestern regions. The old Regions I, II, 1H, and Puerto Rico, formerly part of Region IV, were combined into Region |, the Greater Northeastern Regional Medical Library Program (GNRMLP). Three proposals to provide RML services for Region | were submitted by the New York Acad- emy of Medicine, New York; the College of Physi- cians, Philadelphia; and the University of Connect- icut. Health Sciences Library, Farmington, which submitted a joint proposal with the Countway Library. Harvard University, Boston. The New York Academy of Medicine was selected as the RML. effective December 1, 1982. Old Regions IV and VI were combined to form the Southeastern/Atlantic Regional Medical Li- Bull. Med. Libr. Assoc. 75(3) Supplment July 1987 brary Service (SEARML). NLM had decided to concentrate on network administration and man- agement, and withdrew from its role as an RML. One proposal, which included a subcontract to provide MEDLINE training with the University of North Carolina, Chapel Hill, Health. Sciences Library, was received from the University of Mary- land Health Sciences Library, Baltimore. The Uni- versity of Maryland Health Sciences Library was awarded the contract for RML services in Region 2. The online training subcontract was not awarded, and NLM continued to provide online training for this area. The Region 2 contract did, however, include a subcontract with the University of Alabama, Lister Hill Library of the Health Sciences, to provide extension services for the southern states. In the Midwest, old Regions V and VII and South Dakota were combined to form the Greater Midwest Regional Medical Library Network (GMRMLN), Region 3. The University of Illinois at Chicago, Library of the Health Sciences was the sole bidder for this contract which was awarded in January 1983. 37 ALISON BUNTING Organization and Management of the RML Program Management of the Program at NLM After Sheldon Kotzin accepted another position at NLM, Duane Arenales served as the acting RML coordinator from 1982-1983: Becky Lyon- Hartmann was appointed to this position in 1984. The RML coordinator continued to report to the associate director for Library Operations, Lois Ann Colaianni replaced Joseph Leiter. Ph.D., in this position first on an acting basis in 1982, and permanently in 1984. Martin M. Cummings, M.D., director of NLM since the inception of the RML program, retired early in 1984; Harald Schoolman, M.D., served as acting director until Donald A.B. Lindberg, M.D. was appointed in October 1984. An RML Policy Group was estab- lished at NLM, composed of the deputy director for NLM and the associate directors for Extramu- ral Programs and for Library Operations. The Policy Group served as the oversight body, coordi- nating major policy discussions and changes in the RML program. The MLAA funding levels remained static throughout this entire period, as almost all federal government agencies and programs operated under a continuing resolution. The amount of funding obligated to the RMLP decreased from $2,399,000 in 1982 to $2,000,000 in 1985. Despite the saving generated by decreasing the number of regional libraries from eleven to seven, and the institution of cost-recovery measures for certain RML programs and services, it still became necessary to make additional cuts by the third year of the contracts. These budgetary limitations, coupled with concern over whether the MLAA would receive renewed authorization, made it difficult to respond to new regional needs and to recruit staff. The require- ment to make budget cuts quickly also precluded appropriate preparation and consultation with net- work participants concerning the instituted changes. Steadily increasing indirect cost rates, charged to the RML contract by the host institu- tion, reduced the amount of contract funds avail- able for RML services. RML directors attempted to arrange reduced indirect cost rates, but had limited success since the rates were generally nego- tiated by their parent institution with the Depart- ment of Health and Human Services to cover a wide range of federally funded projects. RML Directors’ Meetings Reconfiguration and the attendant pressures caused by the competitive contract bidding process 38 caused occasional communications breakdowns and strained relations between NLM and the RML directors. At the May 1983 RML Directors’ Meet- ing only the RML directors were permitted to attend. The directors objected to this practice, as they had in 1971, since the associate directors were responsible for the daily operation of regional pro- grams and could not function effectively if they were excluded from policy and program discussions at this important forum. After considerable debate and negotiation, the associate directors were included in subsequent meetings. Another change took place when NLM began treating RML Direc- tors’ Meeting as a meeting of contractors, thus excluding outside observers. At the RML Directors’ Meeting in 1983 and 1984, several discussions ensued concerning the future of the RML program. Topics included the implications of the existence of, or lack of, an RML network, and identification of core RML program elements. These discussions provided background information for a working group of NLM staff charged with re-examining the existing RML pro- gram. The NLM Working Group recommended that the RML program should continue as pres- ently configured. It further recommended that Requests for Proposal (RFPs) for five-year, incre- mentally funded contracts be issued. as existing contracts expired [217]. Three basic goals for the program were defined (218:24]: 1. To improve access to and delivery of informa- tion to health professionals. 2. To develop and maintain an effective and efficient network of health science libraries. 3. To develop and maintain linkages between the network and other library/information networks or health professional organizations to share resources. The passage of the Health Services Extension Act in 1985, extending the MLAA through Sep- tember 1988 at increased authorization levels, made implementation of the programs proposed in the new contracts possible. NLM issued an RFP for the RML contracts in February 1985. By early 1986 awards had been made to the existing RMLs, which were the sole bidders in each of the seven regions [219]. Programs and Services The contracts issued in 1982 and 1983 gave priority to the provision of information services to health professionals regardless of geographic loca- tion. Each RML identified underserved areas in its Bull. Med. Libr. Assoc. 75(3) Supplement July 1 987 NATION’S HEALTH INFORMATION NETWORK region, and developed plans to improve access to information in these areas. Basic RML services remained essentially unchanged, although the cost of providing several of the services was now shared with the recipients. Evaluation to determine achievement of network goals, demonstrate the benefits of network services, and examine new or emerging information needs continued to be an important activity. The RML RFP also included provisions for the award of three “options,” or supplementary activi- ties, in addition to the basic contract. They were: (1) the provision of initial and advanced online MEDLINE training, (2) the creation of instruc- tional packages primarily for BHSL personnel, and (3) the development of model projects in informa- tion transfer. Despite the submission of proposals for all three options, the only option awarded was for online training; PSRMLS and MCRMLP con- tinued to provide these services. Interlibrary Loan All the new contracts required RMLs to provide interlibrary loan services, specifying that the charge per filled request not exceed the then national maximum of $6.00. The intent was to complete the phasing out of contract funding for the delivery of documents, restricting their use to support management of the system. Table 10 illus- trates the regional interlibrary loan traffic handled by the RLs during this period. Significant changes were also instituted in the hierarchical referral network which had been in place since the inception of the RML network. Effective October 1983, NLM began to accept requests directly from any library for periodical articles unavailable within a region, [220] and established, for the first time, a charge of $5.00 for all interlibrary loan requests filled for domestic libraries [221]. Interlibrary loan network management responsi- bilities included the implementation of DOCLINE as it became operational in the regions. Throughout 1984 DOCLINE was tested by the RMLs, and on March 15, 1985, the UCLA Biomedical Library, which had served as a test site for DOCLINE development since 1976, transmitted the first offi- cial DOCLINE request to NLM [222]. In order to TABLE 10 INTERLIBRARY LOAN STATISTICS 1983-1985 1.1 = 1 “ nm —{] q 0.9 - a] s i 0.8 + 2 3 2 0.7 74 airy ec c & 0.6 7 o= Sz e 0.5 ~ £ a x 0.4 77 4 E 0.3 7 0.2 7 0.1 Tt 83 84 / 85 Yeer Oo RML Total + NLM Total > Combined Total 39 Bull. Med. Libr. Assoc. 75(3) Supplment July 1987 ALISON BUNTING evaluate carefully the impact of DOCLINE on the overall performance of the NLM online system, other libraries were added gradually. The RMLs came first, followed in May 1985 by the RLs in Region 1, and in July by libraries in the Medical Library Center of New York consortium. Region 7 libraries in the states of Arizona, Hawaii, and Nevada began to use the system in September 1985; California libraries were added in January 1986. All RLs in the country, except those in Region 4 which utilized Octanet, had been added by December 1985, and plans were in place to add all remaining BHSLs by the end of 1986 [223]. Union Lists and Catalogs Union list efforts concentrated primarily on the submission of serials holdings data from as many network libraries as possible to SERHOLD (Se- rials Holdings), formerly known as the National Biomedical Serials Holdings Database. The pri- mary objective of SERHOLD was to support the automated routing of interlibrary loan requests on DOCLINE. When a request was entered into DOCLINE, the computer would check SER- HOLD and automatically route the request to a library which owned the serial title. SERHOLD data could also be manipulated to produce regional union lists in print or microform format. Each RML appointed a SERHOLD holdings data coor- dinator who assumed responsibility for collecting regional serials holding data for submission. to SERHOLD, disseminating policy information, and reproducing and distributing products within the region (224]. During this same period, NLM investigated the feasibility of developing an online holdings data- base for monographs and audiovisuals, but con- cluded that the small number of such loans pro- cessed by network libraries, generally less than 20% of the total traffic, did not justify the cost of developing such a database. NLM and the RMLs would instead concentrate on developing linkages to existing databases such as OCLC. BHSLs were identified as the libraries most in need of access to monograph and audiovisual location information, and the RMLs were very interested in providing access to such information [225]. GMRMLN con- tinued to provide such access via its online union catalog [114]. MEDLINE The NLM online network continued to grow significantly, as did the number of trained search- 40 ers. The online training centers at NLM, UCLA, and the University of Nebraska expanded the number of off-site initial and advanced training classes offered, with technical resource persons (TRPs) continuing to provide annual updates at various locations. In response to complaints from users about inconsistent charges for MEDLINE searches, NLM proposed a national maximum $25.00 fee for a basic MEDLINE search provided by RMLs or RLs. In presenting the policy at the May 1983 RML Directors’ Meeting, NLM defined a basic or “minimum” search as [218:9}: 1. Search of a single non-royalty database. 2. Formulation, retrieval, and evaluation requir- ing not more than thirty minutes. 3. Searching consuming approximately fifteen minutes or less of online connect time, includ- ing searching and printing online retrieval. 4. In most cases, retrieval will include author, title, and source data elements; or author, title, publisher and year of publication. 5. The search may include requesting an offline print, but the cost of the offline print itself is not included. With a national maximum charge in place, NLM was willing to make referrals for online searches to institutions which agreed to the stated guidelines. Technological advances precipitated two signifi- cant changes in the use of NLM online databases during this period. The increasing availability of microcomputers created greater interest among health professionals in conducting their own online searches. NLM responded by developing a one-day course and workbook, The Basics of Searching MEDLINE: Guide for the Health Professional, [226] to train health professionals how to search MEDLINE. This course was quickly followed by a course for librarians entitled “Teaching MED- LINE to the Health Professional: A Workshop for Search Intermediaries.” By training trainers, the number of individuals who could provide the “Ba- sics of Searching MEDLINE” course throughout the country increased substantially. The RMLs took an active role in encouraging librarians throughout the region to take the “Teaching MED- LINE” course and to provide instruction to health professionals [227]. Such encouragement to teach was welcomed by most libraries, which rapidly developed active training programs for health pro- fessionals. Institutions and individuals also became inter- ested in mounting portions of the various NLM databases on in-house computers, to allow for local Bull. Med. Libr. Assoc. 75{3) Supplement July 1987 NATION’S HEALTH INFORMATION NETWORK searching without incurring online connect charges. In response to this interest, NLM devel- oped a Domestic MEDLARS Subset Policy [228] designed to make it possible to lease subsets of the MEDLARS database on tape, and to mount these subsets of MEDLARS on personal or institutional computers. Reference Services The provision of backup reference services con- tinued. in most regions. In 1983 NLM and the RMLs in Regions 3, 6, and 7 participated in a test project to determine the feasibility and need for a cooperative reference network consisting of the RMLs and NLM. The participants used electronic mail to broadcast difficult reference questions which had not been answered locally. Only a few questions were submitted during the project period and the results were inconclusive. However, RMLs were encouraged to submit difficult questions to NLM, which would try to locate answers or make an appropriate referral [224]. Resource Sharing One new element of the RML contracts was the provision of funding for cooperative acquisitions of most types of library materials. Region 1 developed a Cooperative Acquisitions Program (CAP) which identified, through examination of interlibrary loan requests, subject area and serial title gaps. Resource libraries were. funded to purchase these needed materials, thus making them available to Region 1 libraries via interlibrary loan. Region 1 also developed a serials acquisitions and retention program called Regional Coordination of Biomedi- cal Information Resources (RECBIR). RECBIR was coordinated and operated by the Medical Library Center of New York; the RLs and some of the larger libraries in Region | agreed to maintain subscriptions to journals indexed in Index Medicus and other health indexes and abstracts [229]. In Region 3, the funds were allocated to RLs and BHSLs in each of the ten states in the region, with emphasis placed on purchasing materials for sub- ject areas not widely held in the region [230]. TALON applied its funding to its cooperative acquisitions program for monographs, established in 1979-[215]. Consulting and Training Services The consulting and training services, designed to prepare hospital library managers to provide infor- Bull. Med. Libr, Assoc. 75(3) Supplment July 1987 mation services and make use of network services, were continued in the new contracts, albeit on a cost-recovery basis. In the first year, RMLs were required to recover 25% of the cost of providing consultations and presenting workshops. By the third year, participants were to pay 75% of the costs. This cost recovery approach was “‘...expected to lead to self-sustaining basic training and consul- tation programs” [216:3]. NLM compiled and distributed a list of all RML training manuals to promote sharing of this infor- mation among RMLs and other interested trainers. At the February 1984 RML Directors’ Meeting, ‘NLM announced that the need to continue federal funding of consulting and training programs would be considered in the overall RML program evalua- tion in preparation for the next round of RML contract bids [231]. By the end of that year, it became clear that these consulting and training services. would most likely be phased out as an RML service in future contracts. Several RMLs began to develop rosters of individuals willing to serve as consultants in their regions, in order to provide referrals when such services were requested. PSRMLS also developed a workshop entitled “Consulting Services and Library Skills Training: A Seminar for Librarians,” designed to interest local librarians in serving as consultants and trainers, and to acquaint them with available resources for the provision of these services. Grants The role of the RMLs in the NLM grant review process changed substantially in 1983. Providing comments on grants, as requested initially by the BLRC in 1972, was “‘...regarded by some as preju- dicial to the NIH peer review process” (218:4]. RMLs, therefore, no longer provided such com- ments, but continued, upon request, to work closely with applicants during the proposal preparation phase [232]. Audiovisual Services The RMLs continued to coordinate the provision of audiovisual loans from the NMAC videocassette satellite collections in each region. The role of regional audiovisual consultants, as a formal part of the RML program, was eliminated in the new contracts. However, names of individuals willing to serve as audiovisual consultants were usually part of regional consultant rosters. Some RMLs con- tinued to provide training courses on the acquisi- 41 ALISON BUNTING tion and management of audiovisuals in a health sciences library. Regional Pianning and Evaluation Each RML was charged with selecting some aspect of its programs and services to evaluate during the contract period. Projects undertaken included: (1) evaluation of an online catalog of monographs and audiovisuals (Region 3); (2) the effect of Octanet on interlibrary loan turnaround time (Region 4); (3) the development of baseline data on consultation programs and locator tools (Region 2); (4) the effect of a cooperative acquisi- tions program (Regions | and 5); (5) the extent of non-contract RML program support (Regions 4 and 6); (6) the effect of locator tools on interlibrary loan patterns (Region 7); (7) the impact of RML programs on underserved areas (Regions 3 and 6); and (8) the impact of the RML program on the development of hospital libraries (Region 7) [217]. The evaluation of the TALON Cooperative Acquisitions Program demonstrated that an increased availability in that region of monographs issued by the publishers whose publications the RLs had agreed to obtain. This study also provided valuable information on the objectives of the pro- gram which were not being met, thereby instigating an overall reassessment of policies and procedures [125]. Region | gathered baseline data to assist ina future evaluation of the effect of its Cooperative Acquisitions Program on regional interlibrary loan fill rates and to identify additional journal titles or subject areas which needed to be strengthened. The. survey of network library contributions to the RML program in Region 4 indicated that 22.8% of its RML program expenditures were contributed by the RLs, primarily in staff efforts [227]. In Region 7 a preliminary analysis of the effect of union lists on interlibrary loan borrowing patterns revealed that interlibrary loan traffic among BHSLs in a sub-regional area increased after publication of the first union list for that area. It was not possible to show a definite cause and effect relationship, but PSRMLS felt that the publication of the union list did contribute to this change: [217]. Region 2, which published its first regional union list in October 1983 gathered base- line interlibrary loan data to determine if there was any relationship between the availability of the union list and interlibrary loan traffic patterns and fill rates. A complete analysis was scheduled when sufficient data become available [233]. Regions 5, 6, and 7 all conducted surveys of 42 BHSLs in their regions to gather baseline data on library collections, organizations, services, and staffing. In Regions 5 and 6 these data were tabulated [234-236] and plans were made to con- duct future studies once longitudinal data were: collected and analyzed. Because baseline data from surveys conducted both in 1969 and 1971 were available, Region 7 was able to conduct an evaluation of the develop- ment of hospital libraries in its region, and to assess the quality of PSRMLS programs and their effects on the libraries surveyed. The study revealed that hospital libraries in Region 7 had improved signifi- cantly on a number of criteria between 1969 and 1984. In 1969 only 40% of the hospital libraries were staffed by library managers or librarians, as compared to 69% in 1984. The number of hospital librarians with M.L.S. degrees increased from 35 in 1969 to 249.5 in 1984. Collection size also improved significantly. In 1969 70% of hospital libraries subscribed to fifty or fewer journal titles; in 1984 only 40% of the libraries subscribed to fifty or fewer journal titles. The range and amount of services provided also increased. For example in 1969, 30% of BHSLs provided manual or compu- terized bibliographies, as compared to 100% in 1984, Interlibrary lending and borrowing activities increased substantially, and organization and cur- rency of the collections also improved, with more libraries regularly weeding and cataloging their collections. Data analysis also confirmed that PSRMLS had a major impact on library operations and services in the region. Respondents gave highly positive ratings to the quality of PSRMLS pro- grams, and the direct impact of these programs on library operations was demonstrated [237,238]. Relations with Other Networks and Programs Increased emphasis was placed on exploring possible avenues of cooperation with other library networks. Particularly pertinent was the emerging national interest in intertype library networks which promoted cooperation and resource sharing between all types of libraries such as public, aca- demic, and special, including health sciences, libraries. Technological Developments In the interim between DOCLINE experimenta- tion and implementation, basic health sciences libraries, with the encouragement of the RMLs, began to use electronic mail to speed the transmis- sion of interlibrary loan requests [239]. NLM conducted an electronic mail pilot test with Bull. Med. Libr. Assoc. 75(3) Supplement July 1987 NATION’S HEALTH INFORMATION NETWORK Regions 6 and 7, and developed, with RML input, a recommended format for the transmission of inter- library loan requests via electronic mail [227]. Region 4 continued to use Octanet for the elec- tronic transmission of interlibrary loan requests within the region and to NLM. Region 6 experimented with a remote search system designed to allow two geographically sepa- rate users of an online search system to see simulta- neously the results of an online search being con- ducted by one of the users. This search capability allowed a health professional located in an area without a trained online searcher to interact with a searcher at another location while a search was being conducted [240]. Region 3 conducted a pilot serials exchange study, designed to create a machine-readable data- base of duplicate serials available for exchange between libraries. A microcomputer program was developed, which combined into one alphabetical sequence the lists of duplicate journal issues sub- mitted via electronic mail by participating libraries (240]. Publicity and Publications In an effort to reach health professionals directly, increased emphasis was placed on exhibit- ing at health professional meetings. Several RMLs designed special exhibits advertising the availabil- ity of information services. The health professional online training course, “The Basics of Searching Medline,” was taught by NLM and RML online trainers at several national meetings. Publications emphasizing the accomplishments of the network were also prepared [241]. IMPACT OF THE REGIONAL MEDICAL LIBRARY PROGRAM In the twenty years since the passage of the MLAA, the RMLP has significantly improved the means by which health professionals and health sciences librarians obtain and manage information. The network, as developed in the late 1960s, has stood the test of time, undergoing constant modifi- cation in response to fiscal and environmental changes, yet never losing sight of its ultimate goal—rapid and effective delivery of health infor- mation to health professionals. Delivery of Documents to Health Professionals The interlibrary loan network organized and managed by the RMLP, greatly improved delivery of documents to health professionals. As illustrated in Table 11, the NLM, the RMLs, and the RLs Bull. Med. Libr. Assoc. 75(3} Supplment July 1987 delivered over ten million documents to health professionals between 1969 and 1983. Statistics on the BHSL document delivery traffic are not avail- able, but it is estimated that over 50% of the interlibrary loan traffic in each region is handled by these libraries. If this assumption is valid, then the total number of documents delivered by all types of health sciences libraries during this period is in excess of twenty million. Table 12 provides a comparison of the BHSL and RML/RL interli- brary loan requests filled in Region 7. In the years just prior to the passage of the MLAA, NLM was processing a significant number of interlibrary loan requests for the nation’s libraries. An analysis of the interlibrary loan requests processed in 1959 [243] tabulated the number of loans to individual libraries, and recorded the most frequently requested journal titles. The top five journals requested at that time were [243:3]: 1. Lancet 2. British Medical Journal 3. American Journal of Physiology 4. Journal of the American Medical Associa- tion 5. Journal of Biological Chemistry A recent analysis of NLM’s 1984 interlibrary loan requests [244] revealed that regional reliance on NLM for interlibrary loan purposes had decreased significantly. For example, in 1959, 55% of the libraries submitting requests to NLM received ten or fewer loans; in 1984 71% were in this occasional use category. In 1959 16% of the libraries received only one photocopied article, by 1984 26% were in that category [244:9]. In 1984 the most heavily requested titles were quite dif- ferent from those requested in 1959 [244:12]: 1. Clinical and Experimental Obstetrics and - Gynecology 2. Italian Journal of Neurological Sciences 3. European Journal of Gynaecological Oncology 4. Medicina Clinica 5. Nursing The comparison of the journal titles most fre- quently requested in 1959 and 1984 suggests that regional resources are now sufficient to meet the need for widely used journal titles, and NLM is needed only as a backup for unusual, mainly for- eign titles. Through the creation of union lists the RMLP has clearly identified what is available locally, cooperative acquisitions programs among both RLs and BHSLs have identified titles which should be available locally based on frequency of 43 ALISON BUNTING TABLE 11 INTERLIBRARY LOAN STATISTICS 1969-1985 1.1 17 0.9 = a] s E 0.8 ; 0.7 3 32 we 0.6 “y ce 8 = 0.5 7 ave 2 5 0.3 — 2 £& 0.2 5 q 0.1 0 T T T T T T T T T T T T T T T 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 Year oO RML Total + NLM Total ° Combined Total use, and network protocols have insured the uuliza- tion of these loca! resources. One measure of the value of the documents delivered to health professionals by the RML net- work is the willingness of the consumer to absorb the costs of obtaining these documents once federal funding was withdrawn. Tables 13 and 14 clearly illustrate that more loans processed by RMLs and RLs were funded by the user than by RML con- tract funds. Delivery of Information to Health Professionals As stated in the 1964-65 President’s Commis- sion report: To achieve “fingertip” control of the literature of all that is known about the causes, pathology, and treatment of heart disease; cancer, and stroke, and to make this knowledge available.to researchers, educators, and practi- tioners, is an objective to which anyone may whole- heartedly subscribe [2:381, vol. 2]. The development of the MEDLARS system, including the provision of online access to its data- bases, proved to be the means by which health professionals could have “fingertip” access to the 44 published literature. The RML program was instrumental in the creation of a network of online search centers, including both libraries and individ- ual health professionals, which greatly facilitated and increased access to this wealth of health sciences information. The change over the past twenty years is remarkable. In 1964 there were only three locations from which health profession- als could request computerized literature searches; in 1985 over 4,000 libraries and individuals could access the system directly. In 1965 it took an average of four weeks to generate a list of refer- ences; in 1985 it took only minutes. A 1982 study indicated that MEDLINE searches were requested predominantly for patient care (34%) and research (34%), with educational purposes coming third (18%). The majority of searches (87%) were con- ducted in hospital and academic health sciences libraries [245]. Such instantaneous and convenient access to the literature has saved lives. To provide just two examples, at Sinai Hospital in Detroit a child with a rare blood disorder could possibly not tolerate the normal antidote for a snake bite she had suffered. Bull. Med. Libr. Assoc. 75(3) Supplement July 1987 fia ae 'O1l WEALTH INFORMATION NETWORK TABLE 12 Wy. . Mitt 7 INTERLIBRARY LOAN REQUESTS HNewessed by Resource Libraries and 180 + | Nasic Health Sciences Libraries 170 + 160 + 150 140 + 130 ~ 120 - 110 - 100 - Wl LL 90 - 80 + 70 - 60 - 50 - Interilbrary Loan Requests Filled (Thousanda) 30 + 20 - 10 - o- \ NS SN XX WN SS WG UL VY Remi, © I tbrartes MEDLINE Provided citutinsy, , which indicated an alleriatyy, I to articles ment [246]. An internist ,,, Ma “aving treat- MEDLINE for assistimne + nn ‘i, turned to difficult case. The refereus, ,, Win a cha to order further diagnostic stu, , ved «atised him a Burkitt’s lymphonva aid jx ny “li h revealed sive treatment [247]. thearly, agpres- Creation of a Viable, F fjv, 44,,. N . Netwoy A Y onal Library To cite the President's, « Te “Communication of MOL he ; fj practitioners is critically Miportan “entists and research and application «y Mia 'y progress in Medical libraries are thy hal knowledge. accomplishing this commun tay vehicle for vol. 1). The RMLP played af, y hohe any” [5:65, of a viable, effective nati) ; Hi the creation library network, and provides nang “lth sciences health science libraries, chabliny von © 10 many to a stage where they cont} Patty "i to develop activities. tote in network Me nert again, Bull. Med. Libr. Assoc. 74,5), ; MED i ig Jul v 1987 >> Year [XN] SHSLs From the outset, the RMLs recognized that in order to accomplish network objectives successful- ly, each region needed a cadre of well-developed health sciences libraries. Without local access to well-organized library resources, there could be intolerable delays in the delivery of information. A study of hospital library development in one region of the RML network documented extensive growth among hospital libraries between 1969 and 1984 in the areas of staffing, collection size, and services. The programs of the RML in this region were credited with stimulating specific improvements in library resources and services [237,238]. As hospi- tal libraries across the nation developed, they orga- nized sub-regional networks, or consortia, to pro- mote cooperation and resource sharing on a local level. Over 267 consortia were in existence by 1985. As Topper stated: One of the great successes of the RMLP...has been to encourage the professional growth of hospital librar- ians....By providing a mechanism for librarians to tap the . vast resources of the medical literature...the RMLP has helped hospital libraries to demonstrate their effective- 45 ~ ALISON BUNTING TABLE 13 REGION V INTERLIBRARY LOANS 1975-1980 80 70 60 - MLL Wu MT ON 47 N INeZ S MMM 2 MLL 75/76 76/77 [77] RML Funded Loans ness and broaden their user population. As...funding has decreased, librarians have been encouraged to rely on one another and develop new avenues to satisfy the needs of their enlarged clientele [248:61]. Health sciences libraries cooperated prior to the development of the RML network, but such coop- eration frequently was limited to circumscribed geographic areas, or among libraries of similar types. The RML network has successfully coordi- nated the activities of over 3,000 libraries, located in 50 states and several U.S. territories, towards the accomplishment of a common goal. The network development has been evolutionary in nature, responding to fiscal and environmental influences and the changing information needs of health pro- fessionals. The national policies promulgated by the program provide a reasonable degree of uni- formity in the delivery of health care information, without jeopardizing necessary regional variations. The RML network is a model which: allows for a distribution of service consistent with the level of need and the characteristics of the individual regions. It allows for innovative solutions that vary with 46 LEE: TINY IN WN 2 [XN] User Funded Loans the level, extent, and priority of the problem. It provides for testing different marketing models for RML network products and services so that if one fails the entire network does not fail and if one succeeds it can be transferred. And this transfer characteristic or diffusion of innovation throughout the network is the stimulus for the biological evolution of network programs and services. And yet the innovation does not override national network uniformity. The common mission, guiding principles, program areas, and goals remain constant. Only the objectives vary and are open to this creative process (242:121-2]. And, as noted by Cheshier, the RML network has coordinated its programs and services with other networks: Make no mistake, our medical library network has become a much envied model. As the program has expanded and improved, medical libraries have become more involved with other types of libraries and with all types of technology. OCLC, for example, by creating access and hence a variety of linkages among 2,500 libraries, has lessened the perceived differences among types of libraries at the same time it has broadened medical libraries’ participation. I believe that this trend will continue and that we will increasingly concentrate Bull. Med. Libr. Assoc. 75(3} Supplement July 1987 NATION’S HEALTH INFORMATION NETWORK oe wen A RIN N N N A i GN N NN \N tN WA Bm INARA ‘AINA UN WWW _S 75/76 76/77 [7/7] RML Funded Loans upon using such systems to serve our users without necessarily relying primarily on libraries like ours (249:377]. Use of Technology to Improve or Enhance the Delivery of Information A key factor in the delivery of information to health professionals is the time elapsed between a request for information and receipt of the docu- ment: In patient care situations, a few hours can make a significant difference. Starting with the use of teletypewriters to transfer requests for informa- tion, the RML network has promoted the use of new technologies as they become available to insure rapid information delivery. The development and implementation of DOCLINE, which virtually eliminates the time-consuming process of locating a source for the needed information will signifi- cantly decrease the time it takes to place a needed document in the user’s hand. Health sciences libraries are actively experimenting with technolo- gies such as telefacsimile to speed the delivery of the documents even more. Health sciences libraries have been leaders in the Bull. Med. Libr. Assoc. 75(3) Supplment July 1987 77/78 78/79 79/80 Year [XN] User Funded Loans application of technology to the management of information. NLM’s MEDLARS system was one of the first, and most successful examples of the use of computers to organize and provide access to the ever-growing scientific periodical literature. To pinpoint locations of source documents, RML net- work participants have made extensive use of com- puters to create union lists of serials, monographs, and audiovisuals. Once these lists were completed the network libraries compared regional holdings to interlibrary loan traffic and utilized this informa- tion to set priorities for cooperative collection development projects. The familiarity with computers and computer applications gained when searching online data- bases, or creating union lists, helped to prepare many health sciences librarians for today’s micro- computer environment, and for the automation of many library operations, thus facilitating the provi- sion of better and more efficient service. Health professionals also benefited from the increased availability of audiovisual educational programs made available through NLM, the RML network, and local libraries. In many instances, librarians 47 ALISON BUNTING introduced the use of audiovisuals for educational purposes in their own institutions. FUTURE OF THE REGIONAL MEDICAL LIBRARY PROGRAM The new five-year RML contracts for the period 1986-1990 indicate some of the future activities of the RMLP. RMLs will continue to coordinate network activities in areas such as interlibrary loan, development and maintenance of union lists, and cooperative acquisitions and resource sharing pro- grams. Consulting and training programs for hospi- tal library managers provided by RML staff will be phased out completely in all regions by 1988, although the RMLs will continue to coordinate educational and training programs to some extent. Individuals or institutions needing training or con- sulting services will be referred by the RMLs to regional consultants. Online training and services are now the responsibility of three RMLs: the New York Academy of Medicine serves the Eastern Online region, comprising Regions 1 and 2; the University of Nebraska is responsible for the Mid- lands Online region, containing Regions 3, 4, and 5; and the UCLA Biomedical Library provides ser- vices to Regions 6 and 7, which make up the Western Online Region. Two new programs, a national reference referral network and a national preservation plan for health sciences libraries, are scheduled to be developed and implemented during the contract period. The RMLs also had an opportunity to submit proposals for special RML program enhancements, designed to improve or expand network services, or to pro- vide essential data for the design of improved information services programs [219]. Three initial enhancements were funded: Region 1 will be exper- imenting with the addition of non-NLM titles to the SERHOLD database; Region 6 will develop a microcomputer-based local information directory; and Region 7 will conduct an evaluation project to assess the actual use by health professionals. of documents delivered through the RML interlibrary loan network [250]. It is clear that technological developments have and will continue to influence the means by which individuals access information. To date, the RMLP has capitalized on such developments, thus creating a responsive network capable of providing access to and delivering information rapidly and effectively. Much, however, still needs to be done. Although it is now possible to retrieve quickly citations for articles on a particular topic, and to transmit requests for copies of these articles rap- 48 idly, the delivery of the actual document can still be delayed by several days. It is now important to concentrate on development of improved mecha- nisms for the delivery of information, including telefacsimile, optical disk technology, and online access to the complete text of documents. It is also critical to provide more detailed information on the contents of lengthy information sources such as books so that requesters can ask for the transmis- sion of needed portions only. The RMLs can play an important role in the introduction of technological developments in health sciences libraries which, as Palmer states, “must be converted into information-manage- ment centers... This requires not only expanding use of technology such as development of expert systems and methods to aid in processing informa- tion, but also providing health sciences librarians with the baseline knowledge to manage.the auto- mated library and data files” [251:46]. The RMLs can also serve as testing grounds for newer infor- mation technologies, and promote their adoption among health sciences libraries. Despite the best efforts of the RMLP, there are still areas of the country where health professionals do not have ready and convenient access to infor- mation. Even in areas with excellent information resources, there is increased interest in the ability to access information from office, laboratory, or home settings. Scientific research is becoming increasingly interdisciplinary; information must therefore be obtained from a variety of sources. The development of an electronic medical informa- tion network, which would allow any health profes- sional or librarian to obtain specific information, conduct a literature search, or obtain a document directly through a personal microcomputer, would address these needs. The medical information net- work should be electronically linked to all types of libraries, databases, health agencies, or any other pertinent source of information. The organization and development of such a network presents a considerable challenge to the RMLs and NLM since it would require the development of complex electronic communications protocol, “user friend- ly” search systems, and the establishment of links with many libraries, publishers, database vendors, institutions, and agencies. Research into the nature and use of health information, its value to the health care delivery system, and its relation to the improvement of health must receive high priority, so that informa- tion delivery mechanisms can effectively address user needs. The RMLs, in collaboration with insti- Bull. Med. Libr. Assoc. 75(3} Supplement July 1987 NATION’S HEALTH INFORMATION NETWORK tutions and libraries in their regions, can be active participants in the conduct of such research. Data- bases of pertinent health sciences library manage- ment information. should be created and main- tained, and trends and developments analyzed and reported in the literature. None of these proposed projects can be accom- plished without a coordinated national effort and effective leadership. The NLM and the RMLs working in concert have created a model national information access and delivery network. They are well qualified and possess the skills to transform the RML network in the future environment, so as to continue to fulfill the national need for health information so eloquently described by President John F. Kennedy: The accumulation of knowledge is of little avail if it is not brought within reach of those who can use it. Faster and more complete communication from scientist to scientist is needed, so that their research efforts reinforce and complement each other; from researcher to practicing physician, so that new knowledge can save lives as swiftly as possible; and from the health professions to the public, so that people may act to protect their own health [252]. ACKNOWLEDGEMENTS Authorship of The Nation's Health Information Net- work: A History of the Regional Medical Library Pro- gram, 1965-1985 would not have been possible without the support of Wade Bunting, who cheerfully tolerated my long absences on research trips and at the computer, and Louise Darling, who brought me into the exciting and challenging world of health sciences librarianship and continues to provide sage advice and counsel. Special thanks are due to Maryann Elbaum, for her expertise in editing this history; the staff of the UCLA Biomedical Library who accomplished our work with professionalism and dedication despite my divided attention; to many staff at the National Library of Medicine who willingly assisted me in verifying information, especially Becky Lyon-Hartmann, Frances Johnson, and Sheldon Kotzin; to Raymond Palmer and Rita Shafer of the Medical Library Association who collaborated in the preparation of this history; and to. Mark Hodges, who carefully read every draft and supplied much valuable information. Many others assisted in the verification of historical details through personal recollection or written documen- tation; their names are listed in Appendix 4. Also included in Appendix 4 are the names of the expert reviewers who read early drafts, and made excellent suggestions on content and format; their efforts were greatly appre- ciated. The most rewarding aspect of this undertaking was the opportunity to talk with some of the distinguished professionals in the field of health sciences librarianship and information science. It is an experience I would highly recommend to my colleagues. REFERENCES 1. Horres MM, Bunting A. Interlibrary cooperation among health science libraries. In: Darling L, ed. Handbook of medical library practice. 4th ed. Bull. Med. Libr. Assoc. 75(3) Supplment July 1987 19. 20. vol. 3. Chicago: Medical Library Association, 1987. _ US. President’s Commission on Heart Disease, Cancer and Stroke. Report to the President. A national program to conquer heart disease, can- cer, and stroke. 2 vols. Washington, D.C.: US. Government Printing Office, 1964-65. . Miles WD. A history of the National Library of Medicine. The nation’s treasury of medical knowledge. Washington, D.C.: U.S. Government Printing Office, 1982. . Bloomquist H. The status and needs of medical school libraries in the United States. J Med Educ 1963 Mar;38(3):145-163. . Adams S. Medical library resources and their devel- opment. J Med Educ 1963 Jan;38(2):20-27. . Esterquest RT. Regional plans for medical library service. Bul] Med Libr Assoc 1964 Jul;52(3):497- 523. . DATAGRAM. Medical library needs. J Med Educ 1965 Apr;40(4):396-397. . Guidelines for medical school libraries. J Med Educ 1965 Apr;40(1):5-64. . Wilson MP. The National Library of Medicine: relationships to medical education and research. J Med Educ 1965 Mar;40(3):225-232. . Cummings MM. The edge of husbandry: the role of the NLM. In: McCord D, ed. Biblioteca medica: physician for tomorrow. Boston: Harvard Medi- cal School, 1966. . Adams S. MEDLARS: performance, problems, possibilities. Bull Med Libr Assoc 1965 Apr:53(2)139-151. . US. Public Law 89-291. Medical Library Assis- tance Act. 89th Congress. October 22, 1965. . US. Public Law 91-212. Medical Library Assis- tance Act Extension. 91st Congress. March 13, 1970. _ US. Public Law 93-45. Health Programs Extension Act. 93rd Congress. June 18, 1973. _ US. Public Law 93-353. Health Services Research, Health Statistics and Medical Libraries Act of 1974. 93rd Congress. July 23, 1974. _ US. Public Law 99-158. Health Research Exten- sion Act. 99th Congress. November 20, 1985. . Cummings MM. Plans for the development of a medical library network. In: Simonton W, Mason C, eds. Information retrieval, with special refer- ence to the biomedical sciences. Second Institute on Information Retrieval, Minneapolis: Univer- sity of Minnesota, 1966. _ National Library of Medicine. Annual report. Fis- cal year 1966. Bethesda: National Library of Medicine, 1967. Herner and Company. A recommended design for the United States medical library and informa- tion system. 2 vols. Washington, D.C.: Herner and Company, 1966. Oppenheimer GJ. Regional medical library service in the Pacific Northwest. Proceedings of an invi- tational conference, May 12-13, 1966, University of Washington. Seattle: University of Washing- ton, 1967. . National Library of Medicine. Board of Regents minutes. November, 1966. 49 ma 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. 4l. 50 ALISON BUNTING Rules and Regulations. National Library of Medi- cine grants. Fed Regist 1966 Jul 13;31(134):9499-9505. Wilson MP, Douglass CD, Kefauver DF. Extramu- ral programs of the National Library of Medi- cine: program objectives and present status. Pho- tocopied paper. Bethesda: National Library of Medicine, 1966. Fact Sheet. The Regional Medical Library grant program. Bethesda: National Library of Medi- cine, March, 1966. Public Health Service grants for regional medical libraries. Information and policy statement. Bethesda, MD: National Library of Medicine, Revised, July 1967. Grants for regional medical libraries. Information and policy statement. Bethesda, MD: National Library of Medicine, revised, August 1968. Grants for regional medical libraries. Information and policy ‘statement. Bethesda, MD: National Library of Medicine, revised, January 1969. Cummings MM, Corning ME. The Medical Library Assistance Act: an analysis of the NLM extramural programs, 1965-1970. Bull Med Libr Assoc 1971 Jul;59(3):375-91. Douglass CD. The regional medical library grant program of the National Library of Medicine. Bull Med Libr Assoc 1968 Jan;56(1):49-51. Wilson MP. Implications of planning for regional libraries: our underlying philosophy. Bull Med Libr Assoc 1968 Jan;56(1):46-48. Sloan MH. The relationships of medical libraries to regional medical program planning. Bull Med Libr Assoc 1968 Jan;56(1):56-8. Hodges TM, Colby CC, Bloomquist H. NERMLS: the first year. Bull Med Libr Assoc 1969 Oct;57(4):329-37. Stearns NS, Ratcliff WW. A core medical library for practitioners in community hospitals. New Eng J Med 1969 Feb 27;280:474-480. Stearns NS, Bloomquist H, Ratcliff WW. The hospital library—part 1. Hospitals 1970 March 1;44(5):55-59. Stearns NS, Bloomquist H, Ratcliff WW. The hospital library—-part 2. Hospitals 1970 March 16;44(6):88-90. Annan GL, Felter JW, Meyerhoff E, Ash L. Regional plans for medical library service: New York State and the New York metropolitan area. Bull Med Libr Assoc 1964 Jul;52(3):503-508. Esterquest RT. Strengthening medical library resources in New York State. Albany, NY: Uni- versity. of the State of New York, 1963. Minutes of the meeting to discuss plans for a regional medical library in New York. New York Academy of Medicine, April 21, 1969. Minutes of the meeting of the advisory council for the regional medical library grant. New York Academy of Medicine, April 22, 1969. Gibbon JH Jr. A note on the Philadelphia regional medical library committee. Bull Med Libr Assoc 1965 Oct;53(4):559-62. Morse EH. Regional plans for medical library ser- vice. Medical library cooperation in the Philadel- hia area. Bull Med Libr Assoc 1964 Jul;52(3):509-513. 42. 43. 44. 45. 46. 47. 48. 49. 50. 51. 52. 53. 54. 35. 56. 57. 58. 59, 60. 61. 62. 63. Annual report on the library. Trans Stud Coll Physicians Phila 1964 Apr;31(4):351-362. Annual report on the library. Trans Stud Coll Physicians Phila 1967 Apr,34(4):177-189. Annual report on the library. Trans Stud Coll Physicians Phila 1968 Apr;35(4):212-228. Annual report of the committee on the library. Trans Stud Coll Physicians Phila 1969 Apr;36(4):263-279. MLA area group meets. Natl Libr Med News 1968 Oct;23(10):6. National Library of Medicine. Annual report. Fis- cal year 1968. Bethesda: National Library of Medicine, 1969. Pings VM. Kentucky, Ohio, Michigan Regional Medical Library Program. A discussion of its formation. Detroit: Kentucky-Ohio-Michigan Regional Medical Library, April, 1969. (Papers and Reports, no. 3). Pings VM. Regional medical libraries: a concept and a necessity. Bull Med Libr Assoc 1971 Apr;59(2):242-6. Crawford H. Regional plans for medical library service. Proposal for an expanded medical library extension service for Wisconsin. Bull Med Libr Assoc 1964 Jul;52(3):514-520. A brief history of the Midwest Health Sciences Library Network. Chicago: John Crerar Library, June, 1974. Mimeographed paper. Hetzner BM. The Midcontinental Regional Medi- cal Library: a decentralized service. Bull Med Libr Assoc 1971 Apr;59(2):247-53. Application for a regional medical library grant. Omaha: University of Nebraska, August 19, 1969. Hendricks DD. TALON—the first five years. Bull Med Libr Assoc 1976 Apr:64(2):203-11. South Central Regional Medical Library Program. Status review. Dallas: TALON, Summer, 1971. Photocopied paper. Application for a regional medical library grant. Los Angeles: University of California, August 30, 1968. Waters ST. The regional medical library and the hospital library. Bull Med Libr Assoc 1971 Apr;59(2):337-9. National Library of Medicine. Annual report. Fis- cal year 1968. Bethesda: National Library of Medicine, 1969. Kefauver DF. Coordination of regional libraries with Regional Medical Program projects. Bull Med Libr Assoc 1970 Jul;58(3):325-9. Pings VM. KOMRML, the first year’s experience. Detroit: Kentucky-Ohio-Michigan Regional Medical Library, March 1970. (Papers and Reports, no. 5). Gomes SS. The nature of the use and users of the Midwest Regional Medical Library. Bull Med Libr Assoc 1970 Oct;58(4):559-77. Summary of a meeting held by NLM on September 25, 1969 to discuss implementation of a new policy on “qualified users.” Bethesda: National Library of Medicine, 1969. Sawyer WA. The Southeastern Regional Medical Library: services for health practitioners. SC Dent J 1969 Sep;27(9):4-5. Bull. Med. Libr. Assoc. 75(3) Supplement July 1987 64. 65. 66. 67. 68. 69. 70. 71. 72, 73. 74, 75. 76. 77. 78. 79. 80. 81. 82. 83. 84. 85. 86. 87. NATION'S HEALTH INFORMATION NETWORK Ekendahi JE. Information action at the Pacific Northwest Regional Health Sciences Library. PNLA Quarterly 1969 Spring;33(3):25-26. Darling L. The Pacific Southwest Regional Medical Library and MEDLARS service. Ariz Med 1970 Jul;27(7):22-4. Gilman NJ. The Pacific Southwest Regional Medi- cal Library Service. Calif Med 1971 Oct;115(4):67-8. Gilman NJ. The Pacific Southwest Regional Medi- cal Library Service. Calif Nurse 1971 Jul/ Aug;67(5):5. Gilman NJ. The Pacific Southwest Regional Medi- cal Library Service. Hawaii Med J 1971 Jul/ Aug;30(4):274-5. Gilman NJ. The Pacific Southwest Regional Medi- cal Library Service. J South Calif State Dent Assoc 1971 Jan;39(1):49-50. Countway Medical Library first to operate region- ally. Libr J 1967 Nov;92(19):3954. Crerar named Midwest Regional Medical Library. ALA Bull 1968 Dec;62(11):1328. Establishment of the East Central Regional Medi- cal Library at the Wayne State University. Libr Congr Inf Bull 1969 Jan;28(5):62-63. John Crerar Library joins medical net. Libr J 1968 Nov;93(19):4084. Nation’s fifth regional medical library, serving the health professions in Michigan, Ohio, and Ken- tucky has been established. Wilson Libr Bull 1969 Mar;43(7):598. Regional medical library established. Ky Libr Assoc Bull 1969 Apr;33(2):26-7. Steinke EG, Tannehill RS. Regional medical library planning in the Southeastern United States. Coll Res Libr 1969 Jul;30 (4):327-34. Two medical libraries get regional grants. Libr J 1968 Aug;93 (14):2786. UCLA Biomedical Library designated Pacific Southwest Regional Medical Library. Hawaii Libr Assoc J 1969 Jun;26(1):25-6. Announcement of services: the Midcontinental Regional Medical Library, Omaha. Kans Libr Bull 1970;39(2):21. Darling L. Regional services for medical libraries. Calif Libn 1970 Jan;31(1):46-52. Ekendahl JE. Serving a million square miles with health information: Pacific Northwest Regional Health Sciences Library. Libr News Bull 1970 Jan;37(1):22-5. Hodges TM. Southeastern and the national medical library network. Tenn Libr 1971 Apr;23(3):133- 7. McCullough FS. Regional medical libraries. Cathol Libr Wkly 1970 Mar;41(7):472-6. Medical reference service: new tie-in with Pacific Northwest Regional Health Sciences Library. Seattle. Idaho Libr 1969 Oct;21:163. Regional medical libraries for Texas and Nebraska. Libr J 1970 May;95(9):1695. Walkington RA, Herron EW. The regional medical library 1970—a status report. Bethesda: Na- tional Library of Medicine, June 1970. National Library of Medicine. Board of Regents. Minutes. November, 1970. Bull. Med. Libr. Assoc. 75(3) Supplment July 1987 88 89. 90. OL. 92. 93. 94. 95. 96. 97. 98. 99. 100. 101. 102. 103. 104. 106. 107. 108. 109. 110. HA. 1 3. . National Library of Medicine. Board of Regents. Minutes. June, 1971. National Library of Medicine. Biomedical Library Review Committee. Summary of recommenda- tions of the RML committee. Bethesda: National Library of Medicine, July-December 1971. Pho- tocopied paper. National Library of Medicine regional medical library program policy statement. Bull Med Libr Assoc 1972 Apr;60(2):271-273. Pings VM. Regional medical library program devel- opment. Bull Med Libr Assoc. 1972 Apr;60(2):274-83. Davis RM. The national biomedical communica- tions network as a developing structure. Bull Med Libr Assoc 1971 Jan;59(1):1-20. Schoolman HM. National Library of Medicine regional medical library program. Bull Med Libr Assoc 1972 Apr;60(2):284-5. Kotzin named to new RML post. Natl Libr Med News 1978 Jul/Aug;33(7-8):3. RML Directors’ Meeting. Minutes. Dallas, TX, Nov. 8-9, 1979; Hospital librarians, NLM _ staff discuss mutual interests. Natl Libr Med News 1978 Feb;33(2):4. Summary statement of hospital librarians. Natl Libr Med News 1978 Feb;33(2):5. RML Directors’ Meeting. Resume. New York Academy of Medicine, May 27, 1971. RML Directors’ Meeting. Minutes. Bethesda, MD, Nov. 30-Dec. I, 1978. Mission for Regional Medical Library Program. Draft mission statement developed at NLM/ RML Planning Session, April 19-21, 1979. RML Planning Session. Summary minutes. Reston, VA. April 19-21, 1979. NLM announces network reconfiguration. Natl Libr Med News 1981 Nov;36(11):1-3. National Library of Medicine. Board of Regents Meeting. Minutes. June, 1972. RML Directors’ Meeting. Minutes. Cleveland, OH; May 29, 1975. . RML Directors’ Meeting. Minutes. Minneapolis, MN, June 12-13, 1976. New plan to subsidize document delivery. Nat] Libr Med News 1977 Jul/Aug;32(7-8):1. Spencer CC. Unit costs of interlibrary loans and photocopies at a regional medical library. Prelim- inary report. Bull Med Libr. Assoc 1970 Apr:58(2):189-90. Oppenheimer G. The Pacific Northwest Regional Health Sciences Library: a centralized operation. Bull Med Libr Assoc 1971 Apr;59(2):237-41. Pings VM. Improved document delivery services. Libr Trends 1974 July;23(1):89-107. RML Directors’ Meeting. Minutes. Bethesda, MD. Oct. 10-11, 1971. Bunting A. Region XI Cooperative Serials Acquisi- tions Program (COSAP). Terminal progress report. Los Angeles: Biomedical Library, PSRMLS, January 1, 1979. 2, NLM's national biomedical holdings data base. Natl Libr Med News 1981 May;36(5):1-3. Olson PE, Pletzke CJ. Analysis of the Midwest Medical Union Catalog. Final report. Chicago: 51 il4. 115. 116. 117. 118. 119. 120. 121. 122. 123. 124. 125. 126, 127. 128. 129. 130. 131. 132. 52 ALISON BUNTING Midwest Health Science Library Network, May, 1975. Hammell KA. Regional online union catalog of the Greater Midwest Regional Medical Library Net- work: development and operation. Bull Med Libr Assoc 1984 Apr;72(2):155-61. MEDLINE network shifts into high gear. Nat! Libr Med News 1972 Mar;27(3):1-3. DeSchryver V, Pings V. Detroit MEDLINE consor- tium: an interim report. Detroit: Kentucky-Ohio- Michigan Regional Medical Library, July 1973. (Papers and Reports, no. 14). Standardized charges for MEDLINE searches. Natt Libr Med News 1974 Jan;29(1):2. Role of the regional medical library in on-line search operation. Report of a subcommittee of Regional Medical Library Directors, May, 1974. RML-NLM Working Committee On-Line Net- work Management. Draft report. October 31, 1974. RML-NLM Working Committee on Reference Services. Report. October 28, 1974. Dobroski CH, Hendricks DD. Mobilization of duplicates in a regional medical library program. Bull Med Libr Assoc 1975 Jul;63(3):309-18. Journal clearinghouse to serve region. Supplement News Pac Northwest Reg Health Sci Libr 1976 Aug:1. RML-NLM Working Committee on Cooperative Acquisitions and Cataloging, Serials Rationaliza- tion, Resource Sharing and Cooperative Storage. Report. November 15, 1974. Kronick DA: A regional cooperative acquisition program for monographs. Bull Med Libr Assoc 1979 Jul;67(3):297-301. Bowden VM, Comeaux EA, Eakin D. Evaluation of the TALON Cooperative Acquisitions Program for monographs. Bull Med Libr Assoc 1984 Jul;72(3):241-50. Fink WR, Bloomquist H, Allen RG. The place of the hospital library consortium in the national biomedical communications network. Bull Med Libr Assoc 1974 Jul;62(3):258-265. Moulton B, Fink WR. Components for consider- ation by emerging consortia. Bull Med Libr Assoc 1975 Jan;63(1):23-28. Bailey AS, Tibbetts P. The Twin Cities Biomedical Consortium. Bull Med Libr Assoc 1975 Jul;63(3):252-258. Koplan SM, Chewning CJ, Bumgarner J. Coopera- tive library services for Atlanta’s hospitals. J Med Assoc Georgia 1976 Feb;65(2):55-57. Gillikin P, Price L, Lee S, Sprinkle MD. A self- supporting library service in a rural region: a new look at hospital consortia. Bull Med Libr Assoc 1982 Apr;70(2):216-223. Jensen MA, ed. Proceedings of a forum sponsored by the Coastal Health Library Information Con- sortium. Exploring opportunities for cooperation in California: a forum exploring cooperation among health science library consortia, Shore Cliff Lodge and Inn, Pismo Beach, California, Nov, 13, 1981. Fresno, CA: California Area Health Education Center System, 1982. Bolef D, Fisher JS. A health sciences libraries 133. 134. 135. 136. 137. 138. 139. 140. 141. 142, 143. 144, 145. 146. 147. 148, 149. 150 consortium in a rural setting. Bull Med Libr Assoc 1978 Apr;66(2):185-189. Goodchild EY, Furman JA, Addison BL, Um- barger HN. The CHIPS project. A health infor- mation network to serve the consumer. Bull Med Libr Assoc 1978 Oct;66(4):432-436. Gartenfeld E. Community Health Information Net- work (CHIN). Atlanta, GA: U.S. Dept. of Health and Human Services. Center for Health Promotion and Education, August, 1981. Pride RB, Keiter L, Bub K. Development of a state-wide health sciences information network: a cooperative effort. Bull Med Libr Assoc 1983 Jul;71(3):287-98. Sekerak RJ. Cooperation strengthens small hospital libraries in a rural area of New England: a five-year experience. Bull Med Libr Assoc 1979 Jul: 67: 322-329. Hodges TM. NERMLS and the community hospi- tal: service, education and advice. Bull Med Libr Assoc 1970 Jul;58(3):320-4. Bloomquist H, Rees AM, Stearns NS, Yast H, eds. Library practice. in hospitals: a basic guide. Cleveland: Press of Case Western Reserve Univ., 1972. Colaianni LA, Mirsky PS. Manual! for librarians in small hospitals. Los Angeles: Biomedical! Library, University of California, 1969. Midwest Health Science Library Network. Basic library management for health science librarians. Chicago: MHSLN, 1975. Holtum EA, McKloskey J, Mahan R. Coordinators for health science librarians in the Midwest Health Science Library Network. Bull Med Libr Assoc 1977 Apr;65(2):224-30. Pings VM. The medical library consultant—a pro- posal for investigation and evaluation. Detroit: Kentucky Ohio Michigan Regional Medical Library, April 1972. (Papers and Reports, no. 12). RML Working Committee on Training, Continuing Education and Extension Services. Preliminary report of recommendations. December, 1974. Bunting A. Interlibrary loan manual for users of the Pacific Southwest Regional Medical Library Ser- vice. Los Angeles: PSRMLS. UCLA Biomedical Library, 1973. Beamish BS. Reference materials for a health sciences core library.. Los Angeles: PSRMLS, UCLA Biomedical Library, 1972. Lamkin CC. Cataloging policies and procedures for the hospital library. Los Angeles: PSRMLS, UCLA Biomedical Library, 1976. Snelbecker GE, Timour JA, Vick K. The MERMLS leadership institute for hospital librarians: a new concept in extension service. Bull Med Libr Assoc 1977 Jan:65(1):31-9. Revised position paper on education responsibilities of NLM, RMLs and MLA. Memo from Robert Berk, MLA Director of Education, July 10, 1978. Photocopied memo. Gorman M, Winkler PW, eds. Anglo-American cataloguing rules. Prepared by the American Library Association. 2nd ed. Chicago: American Library Association, 1978. . Accreditation manual for hospitals. 1978 edition. Bull, Med. Libr. Assoc. 75(3) Supplement July 1987 HSI. 152. 153. 154. 155. 156. 157, 158. 159. 160. 161. 162. 163. 164. 165. 166. 167. 168. 169. 170. NATION’S HEALTH INFORMATION NETWORK Chicago: Joint Commission on Accreditation of Hospitals, 1978. Gadzikowski C. Appraisal and evaluation of the workshop instruction program for untrained health sciences library managers in Region VIII: 1976-1978. Bull Med Libr Assoc 1982 Apr;70(2):207-15. Van Toll F, McNamara ME. Accountability in a regional medical library consultant/extension program: the evolution of documentation proce- dures. Detroit: Kentucky Ohio Michigan Re- gional Medical Library 1980. (Papers and reports, no. 17).” Van Toll F, McNamara ME. Data assessment in a regional medical library consultant/extension program: indicators of institutional change. Detroit: Kentucky Ohio Michigan Regional Med- ical Library, 1980, (Papers and reports, no. 18). Bunting A. Evaluation report: impact of PSRMLS extension service. Los Angeles: PSRMLS, UCLA Biomedical Library, April, 1980. Guidelines for interaction between the National Library of Medicine, Biomedical Library Review Committee, and Regional Medical Library Directors. December, 1972. Metheson NW, West RT. NLM Medical Library Resource Improvement Grant Program: an evalu- ation. Bull Med Libr Assoc 1976 Jul;64(3):309- 19. Ad. Hoc RML Committee on Requirements for a T-aining Program for RML Media Consultants. Recommendations. October, 1973. RML Working Committee on AV and CAI Net- works. Draft report. 1974. Report of the MHSLN Planning Committee. Chi- cago: MHSLN, April 1977. Ovisky MM. Evaluation report. Long range plan- fing program, 1975-1979. Chicago: MHSLN, September 1979, RMUL Directors’ Meeting. Minutes. Bethesda, MD. Feb. 11-12, 1976. Bishop D. Activities for a regional medical library: a view of priorities by users and librarians. Bull Med Libr Assoc 1975 Jul,63(3):247-51. Var Toll F. The role of basic-unit librarians in RML decision making: an evolutionary process. Bzf! Med Libr Assoc 1983 Apr;72(2):210-2. Regional medical library network development. National Library of Medicine, November, 1973. Unpublished report. Gilman NJ. RMLs and local resources. Bull Med Libr Assoc 1972 Jan;60(1):148-9. Roiins JG. The interface of NYSILL and the regional medical library program in New York state, Bookmark 1985 Fall;44(1):50-53. RML-NLM Working Committee on. Network rterface/Document Delivery. Report. Novem- ber, 1974. Jones P, Budington WS. Midwest Health Science Library Network. Nat! Libr Med News 1979 Jan:34(1):5-6. West RT, Howard FH. Area Health Education Centers and health science library services. Bull Med Libr Assoc 1977 Jul;65(3):368-376. Szwyer WA, Mangiaracina J. Area Health Educa- tion Centers as the foundation for a statewide Bull. Med. Libr. Assoc. 75(3) Supplment July 1987 171. 172. 173. 174. 175. 176. 177, 178. 179. 180. 181. 182, 183. 184. 185. 186. 187, 188. biomedical communications network. Bull Med Libr Assoc 1974 Oct;62(4):343-347. Evans A, Mirsky PS, de Victoria MJ. Evaluation of a library program in a Carnegie model Area Health Education Center. Bull Med Libr Assoc 1978 Apr;66(2):190-199. Bandy CR. Area Health Education Center libraries and medical school libraries. Establishing an interface. Bull Med Libr Assoc 1978 Oct;66(4):426-431. Gillikin P, Parker CF, Lee S. Planning and manage- ment of a regional learning resource network: the library can do it. J Biocommunication 1978 Nov;5(3):9-16. Ettl L. The North Dakota AHEC library system. Atlanta, GA: U.S. Dept. of Health and Human Services, Center for Health Promotion and Edu- cation, August 1981. Davidson RW. The library/learning resource center network of the North Carolina AHEC program. Atlanta, GA: U.S. Dept. of Health and Human Services, Center for Health Promotion and Edu- cation, August 1981. Jensen MA, Maddalena B. The AHEC library program and consortia development in Califor- nia. Bull Med Libr Assoc 1986 Jul;74(3):222- 226. Ovitsky MM. Report of cooperation meeting. Region VII regional medical library program and state library agencies. October 4-5, 1979, Chica- go, IL. Chicago: Midwest Health Science Library Network, November 1979. Fulton JH. The Mid-Eastern Regional Medical Library Service. Nat! Libr Med News 1978 Jul/ Aug;33(7/8):4-5. Gadzikowski C. Octanet/PHILSOM: using a serials control system for interlibrary loan. Tech Serv Q 1984 Spring; 1 (3):45-53. Crawford S, Johnson MF, Kelly EA. Technology at Washington University School of Medicine Library: BACS, PHILSOM, and Octanet. Bull Med Libr Assoc 1983 Jul;71(3):324-7. Weaver CG. Electronic document delivery: direct- ing interlibrary loan traffic through multiple elec- tronic networks. Bull Med Libr Assoc 1984 Apr:72(2):187-92. Algermissen V, Billings P, Grace S, Guidry B, Blair J. Subminute telefacsimile for ILL document delivery. Inf Tech Libr 1982 Sept;1(3):274-77. Feeney ME. The Regional Medical Libraries— Region 1. Natl Libr Med News 1974 May:29(5):3-5. Brandon AN, Bruette VR. The Regional Medical Libraries—Region II. Natl Libr Med News 1974 Jul:29(7):3-4. Timour JA, Beautyman KV. The Regional Medical Libraries—Region III. Natl Libr Med News 1974 Oct;29(10):4-5. Rustigian J. The Regional Medical Libraries— Region IV. Natl Libr Med News 1974 Dec:29(12):3-4. . Monroe J. The Regional Medical. Libraries— Region V. Natl Libr Med’ News 1975 Feb:30(2):3. Foster EC. The Regional Medical Libraries— 53 189. 190. 191. 192, 193. 194. 195. 196. 197. 198. 199. 200. 201. 202. 203. 204. 205. 206. 207. 208. 209. 210. 211. 54 ALISON BUNTING Region VI. Natl Libr Med News 1975 May;30(5):4-5. Pletske CJ. The Regional Medical Libraries— Regional VII. Natl Libr Med News 1975 Jul;30(7):6-7. Petgen E. The Regional Medical Libraries— Region VIII. Natl Libr Med News 1975 June;30(6):5-6. Hendricks DD. The Regional Medical Libraries— Region IX. Natl Libr Med News 1975 Sep;30(9):3-4. Oppenheimer GJ. The Regional Medical Li- braries—Region X. Nat] Libr Med News 1975 Deéc;30(12):3-4. Mirsky PS. The Regional Medical Libraries— Region XI. Natl Libr Med News 1976 Jan;31(1):3-5. LeSueur CR. The New England Regional Medical Library Service. Natl Libr Med News 1979 Jul: 34(7):4-6. Kasner L. The New York and New Jersey Regional Medical Library. Natl Libr Med News 1978;33(6):3-4. Mikail. J. The Mid-Atlantic: Regional Medical Library Program. Nat! Libr Med News 1978 Sept;33(9):4-5. Van Toll F. Kentucky-Ohio-Michigan Regional Medical Library Program. Natl Libr Med News 1978 Oct/Nov;33(10-11):7. Torrente MJ. Southeastern Regional Medical Library Program. Natl Libr Med News 1978 Dec;33(12):5-6. Petgen E. The Midcontinental Regional Medical Library Program. Nat! Libr Med News 1979 Feb;34(2):5-6. Miller JK. South Central Regional Medical Library Program. Natl Libr Med News 1979 Mar;34(3):4-5. Oppenheimer GJ. The Pacific Northwest Regional Health Sciences Library. Nat] Libr Med News 1979 Apr/May;34(4-5):6-7. Mirsky PS. Pacific Southwest Regional Medical Library Service. Natl. Libr Med News 1979 Jun;34(6):4-5. Batterton DL, Horvath SM. The regional medical library program. Am J Med Technol 1971 Aug;37(8):332-7. Hendricks DD. The regional medical library pro- gram. Libr Trends 1975 Oct;24(2):331-45. Kasner L. The regional medical library program: a national medical information network. Sci Tech Libr 1980 Winter;1(2):43-51. Robertson WO. Letter: regional medical libraries. JAMA 1976 Mar 1;235(9):908. Gilman NJ: Library services for health profession- als. Calif Libr 1972 Apr;33(4):110-13. Darling L. Changes in information delivery since 1960 in health science libraries. Libr Trends 1974 Jul;23(1):31-62. National Library of Medicine. Regional medical library program evaluation. Bethesda: National Library of Medicine, April 12, 1974. Regional Medical Library Program Evaluation. Preliminary report of results. Bethesda: National Library of Medicine, October 22, 1979. Abt Associates Inc., Exploratory evaluation report. 212. 213. 214. 215. 216. 217. 218. 219. 220. 221. 222. 223. 224, 225. 226. 227. 228. 229. 230. 231. 232. 233. 234. 235. 236. 237. A comprehensive evaluation of the Regional Medical Library (RML) network. Volume I: Technical Report. Cambridge, MA: Abt Asso- ciates, Inc., March 20, 1981. Wender RW, ed. Organizing and administering the small hospital library. Dallas: TALON, 1979. Wakeley PJ, May RS. Herususaiensu toshokan-in no kiso chishiki (Basic library management for health science librarians). Tokyo: Nichigai Aso- chieetsu Kabushiki Kaisha, Jan. 1976. , National Library of Medicine. Programs and ser- vices. Fiscal year 1982. Bethesda: National Library of Medicine, 1983. RML network review. Natl Libr Med News 1981 Aug;36(8):3. New regional medical library configuration an- nounced. Natl Libr Med News 1983 Jan:38(1):1- 3. RML. Directors’ Meeting. Minutes. Baltimore, MD, Nov. 29-30, 1984. RML Directors’ Meeting. Minutes. Houston, TX, May 29, 1983. New regional medical library contracts awarded. Natl Libr Med News 1986 Feb;41(2):12. New NLM interlibrary loan policies. PSRMLS Newsletter 1983 Jul/Aug;142:2. NLM announces ILL changes to begin in October. Natl Libr Med News 1983 Jun;38(6):1. March 15th marks first official DOCLINE trans- mission. Natl Libr Med News 1985 Apr:40(4):3. DOCLINE marks first year of service. Natl Libr Med News 1986 Apr;41(4):11-12. RML Directors’ Meeting. Minutes. Denver, CO, May 27, 1984. Fishel MR. National biomedical serials holdings database (SERHOLD). Nat! Libr Med News 1984 Sep;39(9):1-4. The basics of searching MEDLINE: a guide for the health science professional. Bethesda: National Library of Medicine, 1985. Teaching MEDLINE to health professionals. Natl Libr Med News 1984 Dec;39(12):4. National Library of Medicine domestic MED- LARS subset policy. Natl Libr Med News 1984 Jul/Aug;39(7-8):9-11. Due KM. The role of the regional medical library program in the delivery of health care informa- tion. Bookmark 1985 Fall;44(1):41-44. 1984 collection development. funds available...read on. 3 Sources 1984;2(2):2. RML Directors’ Meeting. Minutes. Chicago, IL. February 9-10, 1984. Change in RML review of library grant applica- tions. Natl Libr Med News 1983 Jul/Aug;38(7- 8):2. RML Directors’ Meeting. Minutes. New York, NY, May 26, 1985. TALON hospital library survey. Synergy 1986;16(3):4. Results of the 1983 survey of hospital libraries. Seattle: Pacific Northwest Regional Health Sciences Library Service, March, 1985. Results of the 1985 survey of hospital libraries. Seattle: Pacific Northwest Regional Health Sciences Library Service, December, 1985. Graham E, Van Vuren DD, Flack V. Impact of the Bull. Med. Libr. Assoc. 75(3) Supplement July 1987 238. 239. 240. 241. 242. 243. 244, NATION’S HEALTH INFORMATION NETWORK Pacific Southwest Regional Medical Library Ser- vice on hospital library development. Bull Med Libr Assoc 1987 Jul;75(3):214-220. Van Vuren DD, Graham E, Flack V. Hospital library development and the impact of PSRMLS services: report of an evaluation project. Los Angeles: PSRMLS, 1985. Van Vuren DD, Johnson DEP. Getting started with electronic mail. Bull Med Libr Assoc 1985 Jul;73(3):267-70. Graham DL. Simultaneous remote search: a tech- nique or providing MEDLARS services at remote locations. Bull Med Libr Assoc 1980 Oct;68(4):371. GMRMLN serials exchange pilot study. 3 Sources 1985 Feb;3(1):1. Braude RM. National networking—the regional medical library model. Res Sharing Infor Net- works 1984 Spring/Summer;] (3/4):107-124. Kurth WH. Survey of the interlibrary loan opera- tion of the National Library of Medicine. Bethes- da, MD:-U.S. Dept. of Health, Education Wel- _fare, Public Health Service, 1962. Lacroix EM, Dutcher GA. A comparison of interli- Bull. Med. Libr. Assoc. 75(3) Supplment July 1987 245. 246. 247. 248. 249. 250. 251. 252. brary loan requests received by the National Library of Medicine: 1959 and 1984. Bull Med Libr Assoc 1987 Jan;75(1):7-13. Fazzone N, DeSimone MG. MEDLARS utilization profile in New England. Bull Med Libr Assoc 1984 Jan;72(1):6-11. Region V librarians featured in a newspaper article. Nat! Libr Med News 1981 Oct;36(10):6. McClatchey WM. The computer as a medical tool. J Med Assoc GA 1985 May;74(5):290-291. Topper JM. The RMLP and hospital librarians [letter]. Bull Med Libr Assoc 1982 Jan;70(1):61. Cheshier RG. The limits of the comprehensible: reflections on medical librarianship. Bull Med Libr Assoc 1981 Oct;69(4):373-381. RML Directors’ Meeting. Minutes. Minneapolis, MN, May 18, 1986. Palmer RA. Effect of federal programs on health sciences libraries. J Am Soc Inf Sci 1987 Jan;38(1):40-47. Kennedy JF. Special message to the Congress on national health needs. In: Public papers of the Presidents: John F. Kennedy, Washington, DC: U.S. Government Printing Office, 1963. 55 AACR2 AAMC AHEC AIM-TWX AMA ASCLA AVLINE BCN BHSL BISI BLRC BRS CAI CAP CATLINE CMLS COSAP DOCLINE EMP GMRMLN GNRMLP ILLINET JCAH KOMRML LO LT! MARML MCRMLP MEDLARS MEDLINE MERMES MHSLN MICIS 56 ALISON BUNTING GLOSSARY OF ACRONYMS AND INITIALISMS Anglo American Cataloguing Rules, 2nd edition Association of American Medical Colleges Area Health Education Center Abridged Index Medicus on Tele- typewriter Exchange American Medical Association Association of Specialized and Co- operative Library Agencies Audiovisuals Online Biomedical! Communications Net- work Basic health sciences libraries Biomedical Information Services Institute Biomedical Library Review Com- mittee Bibliographic Retrieval Services Computer assisted instruction Cooperative Acquisitions Program Cataloging Online Central Medical Library Service Cooperative Serials Acquisitions Program Documents Online Extramural Programs (NLM) Greater Midwest Regional Medi- cal Library Network Greater Northeastern Regional Medical Library Program Illinois Library and Information Network Joint Commission on Accredita- tion of Hospitals Kentucky-Ohio-Michigan Re- gional Medical Library Library Operations (NLM) Library Training Institute Mid-Atlantic Regional Medical Library Midcontinental Regional Medical Library Program Medical Literature Analysis and Retrieval System MEDLARS Online Mid-Eastern Regiona! Medical Library Service Midwest Health Sciences Library Network Michigan Interinstitutional Com- mittee for Information Science . MLA MLAA MLCNY MLGSC MRML NBHDB NBSHDB NEMIS NERMLS NLM NMAC NY/NJ RML NYAM NYSILL OCLC Octanet PHILSOM PMI PNRHSL PNRHSLS PPM PSRMLS RECBIR RFP RL RML RMLP RMP SEARML SERHOLD Medical Library Association Medical Library Assistance Act Medical Library Center of New York Medical Library Group of South- ern California Midwest Regional Medical Li- brary National Biomedical Holdings Data Base National Biomedical Serials Hold- ings Data Base Network Management Informa- tion System New England Regional Medical Library Service National Library of Medicine National Medical Audiovisuals Center New York/New Jersey Regional Medical Library New York Academy of Medicine New York State Interlibrary Loan Program Online Computer Library Center Automated interlibrary loan net- work Periodical Holdings in Libraries of Schools of Medicine Postgraduate Medical Institute Pacific Northwest Regional Health Sciences Library Pacific Northwest Regional! Health Sciences Library Ser- vices Program Planning Model Pacific Southwest Regional Medi- cal Library Service Regional Coordination of Biomed- ical Information Resources Request for Proposal Resource Library Regional Medical Library Regional Medical Library Pro- gram Regional Medical Programs Southeast Atlantic Regional Med- ical Library Serials Holdings Database Bull. Med. Libr. Assoc. 75(3) Supplement July 1987 NATION’S HEALTH INFORMATION NETWORK SERLINE Serials Online SERMLP Southeastern Regional Medical Library Program SCORE Standing Committee for On-Line Retrieval Education TALON Texas, Arkansas, Louisiana, Okla- homa, New Mexico Bull. Med. Libr. Assoc. 75(3) Suppiment July 1987 TRP UCLA UCMP WILS Technical Resource Persons University of California, Los An- geles Union Catalog of Medical Periodi- cals Wisconsin Interlibrary Loan Net- work 57 ALISON BUNTING APPENDIX 1: DIRECTORS AND ASSOCIATE DIRECTORS OF REGIONAL MEDICAL LIBRARIES The terminology used for the administrative heads of each RML varied among regions. For the gake of consistency in this listing, the term director is used for the director of the library responsible for providing RML services, the term associate director is used for the individual(s) responsible for the day-to-day operations of the RML. ORIGINAL ELEVEN REGIONS Region I: New England Regional Medical Library Service Ralph T. Esterquest, 1967-1968 Harold Bloomquist, 1968-1975 Foster M. Palmer (Acting), 1975-1977 C. Robin LeSueur, 1977-1982 Associate Mark Hodges, 1967-1970 Director: Mary E. Feeney, 1970-1976 Arlee Mav, 1977-1982 Director: Region I: New York/New Jersey Regional Medical Library Gertrude L. Annan, 1969-1970 Thomas G. Basler, 1970-1972 Alfred \. Brandon, 1973-1978 Brett A. Kirkpatrick, 1979-1982 Associate Ann Hutchinson, 1969-1971 Director. Vernon R. Bruette, 1973-1978 Lynn Kasner Morgan, 1978-1980 Kay Mills Due, 1981-1982 Director: Region III: Mid-Eastern Regional Medical Library Service Elliott H. Morse, 1968-1981 Anthony Aguirre, 1981-1982 Associate Carol C. Spencer, 1970-1972 Director: John A. Timour, 1973-1975 June H. Fulton, 1975-1982 Director: Region IV: Mid-Atlantic Regional Medical Library Erika Love, 1977-1977 Carol C. Spencer, 1977-1978 Maxine Hanke, 1978-1982 Associate Jackie Rustigian Mikail, 1974-1981 Director: Peggy J. Beavers, 1981-1982 Director: 58 Region V: Kentucky, Ohio, Michigan Regional Medical Library Vern M. Pings, 1969-1975 James F. Williams, II, 1975-1982 Associate Jean Monroe, 1969-1977 Director: Faith Van Toll, 1977-1982 Director: Region VI: Southeastern Regional Medical Library Program Director: Miriam H. Libbey, 1970-1982 Associate Mark Hodges, 1970-1972 Director. Eloise C. Foster, 1973-1975 Michael Torrente, 1976-1982 Region VII: Midwest Regional Medical Library Director: William S. Budington, 1968-1979 Irwin H. Pizer, 1980-1982 Associate Richard Davis, 1968-1972 Director: Chester Pletzke, 1972-1978 Ruby S. May, 1978-1982 Region VIH: Midcontinental Regional Medical Library Program Director: Bernice M. Hetzner, 1970-1973 David Bishop, 1973-1977 Robert M. Braude, 1978-1982 Associate Elizabeth Petgen, 1971-1979 Director: Richard B. Pride, 1980-1982 Region IX: South Central Regional Medical Library Director: Donald D. Hendricks, 1970-1977 S. Joe McCord (Interim), 1977-1978 Jean Miller, 1979-1982 Associate John A. Murphey, 1973-1981 Director: James Pat Craig, 1982 Region X: Pacific Northwest Regional Health Sciences Library Director. Gerald J. Oppenheimer, 1968-1982 Associate Dale R. Middleton, 1980-1982 Director: Region XI: Pacific Southwest Regional Medical Library Service Louise Darling, 1969-1979 Gloria Werner, 1980-1982 Director: Bull. Med. Libr. Assoc. 75(3) Supplement July 1987 NATION’S HEALTH INFORMATION NETWORK Nelson J. Gilman, 1969-1971 Phyllis S. Mirsky, 1971-1979 Alison Bunting (Acting), 1979 Robert Bellanti, 1979-1982 Associate Director: SEVEN RECONFIGURED REGIONS Region 1: Greater Northeastern Regional Medical Library Program Director: Brett A. Kirkpatrick, 1983~ Associate Kay Mills Due, 1983-1986 Director: Mary Mylenki, 1986— Region 2: Southeastern/Atlantic Regional Medical Library Director: Cyril C. Feng, 1983- Associate Carol G. Jenkins, 1983-1986 Director: Suzanne Grefsheim, 1986- Region 3: Greater Midwest Regional M edical Library Network Director: Irwin H. Pizer, 1983- Associate Ruby S. May, 1983- Director: Bull, Med. Libr. Assoc. 75(3) Supplment July 1987 Region 4: Midcontinental Regional Medical Library Program Robert M. Braude, 1983-1986 Nancy N. Woelfl, 1987- Associate Richard B. Pride, 1982-1983 Director: Carolyn Reid, 1983— Director: Region 5: South Central Regional Medical Library Jean Miller, 1982— Associate James Pat Craig, 1982-1985 Director: Regina Harris Lee, 1985- Director: Region 6: Pacific Northwest Regional Health Sciences Library Service Director: Gerald J. Oppenheimer, 1982- Associate Dale R. Middleton, 1982— Director: Region 7: Pacific Southwest Regional Medical Library Service Director. Gloria Werner, 1982-1984 Alison Bunting, 1984- Associate Darcy D. Van Vuren, 1982-1985 Director: Elaine Graham, 1985-— 59 ALISON BUNTING APPENDIX 2: KEY NATIONAL LIBRARY OF MEDICINE STAFF INVOLVED WITH THE RML PROGRAM Office of the Director Director: Frank Bradway Rogers, M:D., 1949-1963 Martin M. Cummings, M.D., 1964-1983 Donald A. B. Lindberg, M.D., 1984- Deputy Director: Scott Adams, 1960-1969 G. Burroughs Mider, M.D., 1969-1972 Melvin S. Day, 1972-1978 Kent A. Smith, 1978- Deputy Director for Research and Education (for- merly Special Assistant to the Director for Medical Program Development and Evaluation): , G. Burroughs Mider, M.D., 1968-1969 Harold M. Schoolman, M.D., 1970- Associate for Extramural Planning Estelle Brodman, Ph.D., 1960-1961 Library Operations Associate Director: Joseph Leiter, Ph.D., 1965-1983 Lois Ann Colaianni, 1984- Deputy Associate Director: James P. Riley, 1967-1968 Samuel T. Waters, 1969-1970 60 Erika Love, 1971-1977 James W. Barry, 1977-1980 Lois Ann Colaianni, 1980-1984 Betsy L. Humphreys, 1984— RML Coordinator: Sheldon Kotzin, 1978-81 Duane Arenales (Acting), 1982-1983 Becky Lyon-Hartmann, 1984— Extramural Programs Associate Director: Marjorie P. Wilson, M.D., 1964-1967 David F. Kefauver, 1967-1970 Leroy Langley, M.D., 1970-1973 Ernest M. Allen, M.D., 1973-1982 William Cooper, Ph.D., 1982-1985 Arthur Broering (Acting), 1985— Deputy Associate Director: Robert A. Walkington, 1970-1973 Arthur Broering, 1974- Facilities and Resources Division (1966-1973): Carl Douglass, 1966-1967 Louis S. Gerber, M.D., 1967-1968 Robert Walkington (Acting), 1968 Arthur Broering, 1968-1973 Bull. Med. Libr. Assoc. 75(3) Supplement July 1987 Original Regions I I WI IV VI Vu Vil NATION’S HEALTH INFORMATION NETWORK APPENDIX 3: REGIONAL MEDICAL LIBRARY NEWSLETTERS Newsletter NERMLS News. Quarterly newsletter of the New England Regional Medical Library Service. Boston, MA, no. I, Jan/Mar 1970-no. 56, Aug 1982. New York and Northern New Jersey Regional Medical Library News..New York, NY, v. 1, Aug 1971-no. 5, May 1974. New York and New Jersey Regional Medical Library News. New York, NY, v. 1, Oct 1976-v. 6, Oct 1982. MERMLS News. Newsletter of the Mid-Eastern Regional Medical Library Service. Philadelphia, PA, v. 1, Jan 1970-v. 13, Nov 1982. RML IV. Mid-Atlantic Regional Medi- cal Library Program. Newsletter. Be- thesda, MD, no. 1, Apr 1974-no. 42, Nov/Dec 1982. KOMRML Commentary. Detroit, MI, v. 1, 1976. KOMRML. Kommentary. Detroit, MI. v. 1, May 1977-v. 2, Mar 1979. KOMmentary on the kentucky ohio michigan regional medical library net- work. Detroit, MI, no. 1, Summer 1979- no. 7, Winter 1982. Program Notes. Southeastern Regional Medical Library Program. Atlanta, GA. no. 1, Jan 1971-no. 40, Dec 1982. News Notes. Midwest Regional Medical Library. Chicago, IL, no. 1, Aug 1969- no. 15, Dec 1972. Resources. Midwest Health Science Library Network. Chicago, IL, v. 1. Autumn 1973-v. 9, Dec 1982. Octasphere. Newsletter of the Midconti- nental Regional Medical Library Net- work. Omaha, NE, v. 1, Feb 1973-. Bull. Med. Libr. Assoc. 75(3) Supplement July 1987 IX XI Synergy. Newsletter of the TALON Regional Medical Library Program. Dallas, TX, v. 1, Feb 1970-. Supplement. Newsletter/Pacific North- west Regional Health Sciences Library. Seattle, WA, Mar 1970-. Pacific Southwest Regional Medical Library Service Newsletter. Los An- geles, CA, no. 1, Oct 1969-. Reconfigured Regions 1 Greater Northeastern Regional Medical Library Program Newsletter. New York, NY, v. 1, Feb 1983-. SEA Currents. Newsletter of the South- eastern Atlantic Regional Medical Li- brary Service. Baltimore, MD, v. 1, Mar 1973. 3 Sources. The Region 3 newsletter. Greater Midwest Regional Medical Library Network. Chicago, IL, v. 1, 1983-. Octasphere. Newsletter of the Midconti- nental Regional Medical Library Net- work. Omaha, NE, v. 1, Feb 1973-. Synergy. Newsletter of the TALON Regional Medical Library Program. Dallas, TX, v. 1, Feb 1970-. (Effective with v. 14, 1984 the subtitle changed to Newsletter of the South Central Re- gional Medical Library Program.) Supplement. Newsletter / Pacific North- west Regional Health Sciences Library. Seattle, WA, Mar 1970-. (Effective 1983 the subtitle changed to Newslet- ter/Pacific Northwest Regional Health Sciences Library Service.) Pacific Southwest Regional Medical Library Service Newsletter. Los An- geles, CA, no. 1, Oct 1969-. 61 ALISON BUNTING APPENDIX 4: ExPERTS CONSULTED AND EXPERT REVIEWERS Experts Consulted Gertrude L. Annan Duane Arenales Thomas G. Basler Alfred N. Brandon Estelle Brodman Arthur J. Broering William S. Budington Lois Ann Colaianni William G. Cooper Mary E. Corning Martin M. Cummings Louise Darling Myr! Ebert Donald D. Hendricks Bernice M. Hetzner Samuel Hitt Mark Hodges Mary M. Horres Ann P. Hutchinson Frances E. Johnson Sheldon Kotzin Joseph Leiter C. Robin LeSueur Erika Love Becky Lyon-Hartmann Lucretia McClure Erich Meyerhoff Jackie Rustigian Mikail 62 Elliott H. Morse Vern M. Pings Harold M. Schoolman Kent A. Smith Richard T. West Marjorie P. Wilson Expert Reviewers Duane Arenales David Bishop Susan Crawford Louise Darling June H. Fulton Suzanne Grefsheim Mark Hodges Brett A. Kirkpatrick Sheldon Kotzin C. Robin LeSueur Becky Lyon-Hartmann Jackie Rustigian Mikail Jean Miller Phyllis S. Mirsky Gerald J. Oppenheimer Raymond A. Palmer Irwin H. Pizer Carolyn Reid Kent A. Smith Faith Van Toll Pat L. Walter Bull. Med. Libr. Assoc. 75(3) Supplement July 1987