The Woman Behind the NLM's Integrated Advanced Information Management Systems (IAIMS) Initiative 2005 Interview of Nina Matheson Interviewers: Joan S. Ash & Dean F. Sittig Editors: Rebecca M. Goodwin, Joan S. Ash & Dean F. Sittig The Woman Behind the NLM's Integrated Advanced Information Management Systems (IAIMS) Initiative Conversations with Medical Informatics Pioneers: An Oral History Collection Interviewers: Joan S. Ash & Dean F. Sittig Editors: Rebecca M. Goodwin, Joan S. Ash & Dean F. Sittig Published by the U.S. National Library of Medicine, May 15, 2015; updated , 2015. Copyright Information Government information at NLM Web sites is in the public domain. Public domain information may be freely distributed and copied, but it is requested that in any subsequent use the National Library of Medicine (NLM) be given appropriate acknowledgement. Suggested citation: Matheson, NW. "The Woman behind the NLM's Integrated Advanced Information Management Systems (IAIMS) initiative," Conversations with Medical Informatics Pioneers: An oral history collection. Ash JS, Sittig DF, interviewers. Goodwin RM, Ash JS, Sittig DF, editors. Bethesda: U.S. National Library of Medicine (NLM); 2015. Available from: http://lhncbc.nlm.nih.gov/project/medical-informatics-pioneers Photographs: When using NLM Web sites, you may encounter documents, illustrations, photographs, or other information resources contributed or licensed by private individuals, companies, or organizations that may be protected by U.S. and foreign copyright laws. Transmission or reproduction of protected items beyond that allowed by fair use Content distributed via the NLM Conversations with Medical Informatics Pioneers Oral History Project may be subject to additional license and use restrictions applied by the depositor. Oral History Interview with Nina Matheson Editors: Rebecca M. Goodwin, Joan S. Ash, and Dean F. Sittig Interviewers: Joan S. Ash and Dean F. Sittig Managing Editor: Rebecca M. Goodwin Copy Editing: Cindy Allen Design & Layout: Troy HIll, Bona Kim, John Harrington and Anne Altemus Photo Editing: Troy Hill Photo Captions: Nina Matheson, Ed Hammond, Dean Sittig, Patti Brennan Deeds of Gift: Rebecca Warlow, John Rees and Jeff Reznick Contact: wwwnlm@nlm.nih.gov iv Conversations with Medical Informatics Pioneers: An Oral History Collection Nina Matheson (left) receives a Fellowship award from the Medical Library Association (MLA), 1994. The Woman Nina Woo Matheson, ML, DSc, is perhaps best remembered in the Medical Informatics community Behind the NLM's as the lead author of the Association of American Medical Colleges' 1982 Matheson-Cooper report,1 Integrated Advanced which described the future role of medical libraries and led to the creation of the National Library of Information Medicine's Integrated Academic (later changed to Advanced) Information Management Systems (IAIMS) Management initiative.2–6 In this conversation, Dr. Matheson describes Systems (IAIMS) how she became involved in that project, and other Initiative aspects of her long and distinguished career working in various academic libraries and medical library professional organizations.1,7–16 She was Director Dr. Nina Woo Matheson is a medical librarian of the George Washington University Himmelfarb and vocal supporter for the importance of Health Sciences Library from 1974 to 1980 and of the librarians in medical informatics. Welch Medical Library at Johns Hopkins University INTERVIEWED BY beginning in 1984. She was President of the Medical JOAN ASH AND DEAN SITTIG Library Association in 1983 and was elected a Fellow JULY 14, 2005 of the American College of Medical Informatics in CHEVY CHASE, MARYLAND 1986. July 14, 2005 1 An English major in college, she says, "If I've been I went to grade school there, and Queen Anne High successful as a medical librarian, it's not been because School, and then the University of Washington. of any subject matter JA How did you decide to [expertise]....[What is] really important [is]...native Maxine helped me go into library science? intellectual curiosity and a get a job at NLM, NM Well, I was an English critical and analytic cast of mind that is keyed toward when it was down major, and I had a teaching fellowship. I taught for 17,18 on Seventh and one quarter, and realized Independence-an In 1990, she and her that I was not going to husband formally established be a teacher...actually I William & Nina Matheson old red brick building, was not going to do my Books, a member of the which is now where PhD. So I got a job at Washington Antiquarian the University Bookstore Booksellers Association. Matheson Books specializes the Hirshhorn and Bill [Matheson] was working in the stockroom in scholarly bibliography, Museum is. during the summer. He had modern literature and poetry, left University of Chicago and 20th century literary with a master's, and he private presses. had already enrolled in library school. Well, I was at loose ends, and I had no idea what to do. I'd never JA It's July 14, 2005, and Joan Ash and Dean heard of a school of library science, but it seemed like Sittig are in Chevy Chase, Maryland, interviewing a reasonable thing to do, since I had nothing else in Nina Matheson. Would you please tell us where you mind. So, let's see, that was in June, and I managed to were born and raised, just so that we can get some get enrolled, and started in September. background? JA You were both in school together then? NM I was born in Seattle, Washington, and lived there until I left library school, which was about 1958. My NM Yes. Along with Maxine Hanke. The three of mother had a Chinese laundry, and that was how she us graduated together. Maxine had a fellowship or supported the family, and we lived in the back of the internship with the National Library of Medicine. Bill store. We lived on Queen Anne Hill. We were the only had an internship with the Library of Congress, and I non-white family on Queen Anne Hill at that time. had an internship with the New York Public Library. JA Were you married at that time? With her younger sister, Barbara Woo Radke (left), 1939. High school graduate, with her mother, Gee Shee Woo, in Queen Anne Hill, Seattle, 1951. 2 NM No. On weekends Bill commuted up to New back to her desk to work. And it was her version of air York, and I commuted down to Washington. After conditioning. several months, that got really tired, so I moved DS That's good! down to Washington, and Maxine helped me get a job at NLM, when it was down on Seventh and NM Independence-an old red brick building, which is now where the Hirshhorn Museum is. DS Really?! JA I didn't realize that. And And then I got NM Yeah. I think that was partly when he was incubating library school was at NLM? a job on the his idea for Science Citation NM Yes. Well, they paid basis of really Index. JA Who was the director of me at the New York Public Library [laughter], so it was sketchy Chinese, the library then? a real job. Felt like a real job. cataloging Chinese NM Brad Rogers. Seymour materials. I worked at the New York Taine was in charge of the Public Library at the downtown beginning of the automation. 42nd Street research library. And I just saw Seymour. He But I had no knowledge, no background, really, that used to live in this building and he's moved out to- oh, what is it called? Leisure World? He's married to several months in the Bronx, working in the branch Beryl Ruff, who used to be at WHO as the head of the libraries. But I discovered that I didn't really enjoy library there. The two of them live part of the year in being a policeman, so I was very pleased to come to Geneva and part of the year in Washington. His sons Washington and get a real job in a real library. live in California, and so they keep going back and JA And so what was NLM like then, besides being forth like this. in an old brick building? At that time, they were looking for people within the library who had the NM I went to work for potential to become Sam Lazaro. It seemed involved in automating. to me, as a callow young I remember they gave us thing, that the place was all tests. Yeah! And John full of eccentrics-and I McCarthy and I were actually think it was full selected out of the group of eccentrics. to start training. I don't The building was remember what the nature not air conditioned, and of the training would have summers in Washington, been-programming, at that time, were a COBOL, I suppose, or lot worse than they something like that. But are now, even though then before I really got there's global warming. involved with that, Bill It seemed it was very and I left because he'd hot then. There was a gotten a fellowship at the cataloger that I remember Indiana University Lilly who wore a light kind of Library. shirtwaist that was short- sleeved, and she would JA So how long were go into the women's you at NLM that time? room and soak the shirt and put it on, and then go "Library Internships Go To 3 UW Graduates," June 22, 1958, newspaper clipping. July 14, 2005 3 NM Close to two years. I left in '61. was always licking her thumb. It was a very charming, home-grown kind of operation. JA And what did you do in Indiana? JA How was your budget? NM Well, Bill was learning rare book librarianship; I had a brief job with the School of Music as a secretary. NM It wasn't bad. It was an interesting time, and it's And then I got a job on the basis of really sketchy probably why I got involved with informatics, because Chinese, cataloging Chinese materials. [Chuckles.] George Hulett, who was Director of Mental Health Really sketchy. I could use a dictionary-that was the in the entire state hospital system, had the idea that extent of my Chinese. But they if he could computerize all of needed people at that time. the patient records, they could JA How long did you do that? determiners. And so I think NM That fellowship lasted IBMs. What were they?-17- a year. From there, we went somethings-I can't remember. to St. Louis, where Bill Anyway, they had a lot of was hired to create the rare time, the programmers, and so books and special collections what I got them to do was to department at the Olin Library set up a program so that I could at Washington University. The computerize the card catalog university had just acquired and produce a paper catalog, the collection of a St. Louis which then I could send out to collector, whose collection was the other state hospitals so that inherited by this gentleman's they could at least have some two sisters. And they had just access to the mother library, the turned over materials. They bigger library. So that's how it knew nothing about what their all started. brother had collected. So Bill was able to extract a great deal JA When was that? of stuff that they didn't know NM Oh, about '63 or '4. with autograph materials. DS So you had to type all Nina Woo and John William (Bill) Matheson, He collected signatures, just engaged, Washington, D.C., April, 1961. those in yourself? I mean, presidential signatures, and they didn't have places to presidential documents, things download the book records, like that. So we were there for like they do now? about 10 years. NM That's right. We created IBM cards. Estelle Brodman had taken the job as the Medical Library Director then, but she didn't have a place JA How many volumes are we talking about? for me when I arrived, so I got a job as the Initiating NM It was a small library, about 3,000 volumes. Librarian at the St. Louis State Hospital in St. Louis, which was then the biggest state hospital in the state. DS Fewer than you have in your house, in other It was where the state commissioner of mental health words. had his operation. So I started that professional library, NM That's right! [laughter] I think Science Citation with help from patients. There was one patient who Index was going on at the time, but it didn't include a lot of the psychiatric and psychological material. So then I had the idea, since we had a reasonable cards had evidence of Jessie's lipstick, because she journal collection, of making tables of contents. So I had this little manual SDI [selective dissemination 4 of information] system going, where we photocopied NM Yes. But for some reason, I was aware of her much earlier than that. I really don't know where or the physicians in the state hospital system who were how. interested. And then we sort of matched them up JA She was a physician? with the tables of contents and sent them out twice a month, or something like NM Yes. And she worked that. And then if they were If he could computerize with Marty Cummings to interested, they just marked off the table of contents, all of the patient get the legislation through. She wrote the legislation- sent it back to us, and we records, they could is my recollection-and photocopied the article. It she worked with Marty was all terribly manual. Cummings to grease all DS Terribly! biological determiners. the wheels. NM We had some poor And so I think he bought JA The medical library system legislation? workers who did nothing but stand at the Xerox NM Right. She got that machine all day long, but it through. You know, it's all was effective. very vague. I've written about it someplace. It's in the literature somewhere. JA And then what? What was your next effort? JA Well, Don Lindberg talked about Marjorie NM Actually, I got a grant to do that SDI program. Wilson and said that we should ask you about There was another grant program. I think it was for- oh, yeah! It was for getting-was it a teletype machine were a young grantee. I know you continued to be associated with her. JA AIM Twx we did at the time. NM Yes, but I don't remember how or why, NM Right. So I guess I kind of got to get one of those because when she contacted me about becoming machines, which was very helpful, because then I the investigator for creating the AAMC report, I could produce the card think probably Marty catalogs off of them, too. The programmers set Cummings had something to do with that. He must DS Use the printer, huh? up a program so that I have suggested that she NM Yeah, use the printer. could computerize the contact me. And I really don't remember how we And that was when, at that time, I got to know card catalog. interacted, but I seemed Marjorie Wilson for the to know her and know her career reasonably well at that time. There must have been some committee work or something going on. director, if I'm not mistaken. Or she was second in JA Were you involved with MLA [the Medical command-I can't remember. But she was the one Library Association] as early as when you were in who pushed through the idea that there could be grants the psychiatry library? made to the libraries. I had one of those early ones, a couple of the early ones. NM I became a member. I think that was about the extent of my involvement. I didn't really do a lot in JA You got to know her because you were awarded MLA before the late '70s. a grant when you were still in St. Louis at the psychiatry library? JA So psychiatry library, and then what? July 14, 2005 5 NM Let's see, when we came back [to NLM] in '71, JA Was there tension between normal library Lee Langley was head of Extramural Programs, and he operations and the other things that were going on? took me on. I was at Extramural Programs for a couple NM [long pause] Well, I don't know. There's always a of years, and then I went from there to G.W. [George tension between the traditional functions and the other Washington University]. functions. And at that time, there was a transition- JA So what did you do in Extramural Programs? or the beginning of the transition-of the Regional Medical Library Program from a grant program to the NM Well, Langley made room for me as a special contracts. There was a fair amount of tension around assistant to the director. Then I became head of a that issue for a long time. one-person unit for program evaluation, which meant that Well, now that I DS What kind of grants were you giving out? You said you think of it, I think I had to prepare the monthly were in program evaluation. Langley when he would meet the Regional Do you remember who was getting those? It was called Cummings and all the senior staff. Those were [gasps] Medical Library Program was the terrifying preparations because wasn't it? Marty Cummings liked to NM There was a fairly large surprise his staff with questions largest part of international program at that that they hadn't anticipated, for which they had no answers. Extramural at that time, and a fair amount of grants went into supporting So there was always anguish time. publications programs, overseas beforehand wondering what publication programs. he was going to ask, where he was going to come from. Then afterwards, there was DS Catalog publications or Index Medicus? the mopping-up business. Joe Leiter was there. The NM Well, no, actually, they were scholarly, historical entire cast was there: Kent Smith, Harold Schoolman, research-history of medicine kinds of things. The they were all there at that time. Lee Langley was small hospital library program was going on at the head of Extramural Programs for maybe three or four time. I don't think there was a great deal of non-library years. Marty got rid of him, in part, because Langley supported grant activity at the time. I can't imagine was such a womanizer and was caught in the parking what it would have been, if there had been, because- lot with friends. [embarrassed laughter] Those were well, that's not true, because Don Lindberg was active carefree days. in Missouri in the late '70s, wasn't he? JA Amazing. So this was now in the new building? DS Yeah, but he was doing basic science more, NM Yes. The Lister Hill Building had already been using the computer, so building lab systems and built. things like that. I mean, there were people who were doing informatics-type work but they would get JA And so what was it like? If Lister Hill was there, their money from like the Heart Research Institute. they were already doing research. NM Well, naturally, there was a lot of rivalry, because there were limited resources. They were starting a lot NM Well, now that I think of it, I think the Regional of new programs: toxicology, information service, Medical Library Program was the largest part of plus the research programs. That was partly what the Extramural at that time. everybody up to speed. But they tended to be kind of DS Right. And there were some people there doing show-and-tells, with the idea of impressing everyone informatics-type work. So we've interviewed Tony Komaroff, for example, who was at the Lincoln Lab [laughing]. But it was a very exciting time. in Boston. They had a big program to build some algorithms there. 6 JA The Regional Medical Library Programs. JA So the ambivalence about extramural programs, because it wasn't a normal library activity, do you DS Right. think? NM They were trying to be meshed together. That NM I think he probably had trouble integrating it with was a big push to piggyback on the Regional Medical his thinking about where the library was going. Library [RML] Programs. DS Well, that was a big change, I think. I mean, JA And so what I think you're saying is that that was like a new way of thinking about the the RML program was part of the Extramural library and the role of the library. Programs at that time, and NM And I think the Lister Hill then it became a contract program, so that it separated Cummings' great program never had, as far as I out from Extramural contribution to could tell, a very clear focus as Programs. to what its research was aimed the library, his at and where they saw their NM Although it didn't have to. We made contracts out of whole overarching research pushing things along. the Extramural Program. I'm not sure now how or why that aim, was actually JA I think Don Lindberg sort of mentioned that too, and division came about. I'm pretty automating the that was one of the things he sure it was a political decision. entire library. I mentioned about why it was so important to have a long- DS Of course. mean, he picked range plan, like that. JA So what was Marty Cummings like, and thinking up the Index NM Yeah, because in Lister Hill at that time, there were a of this transition more into informatics, what role did he Medicus at a number of people who had very play? time when it was strong individual commitments, and they were taking their NM [long pause] I think really beginning to programs in the directions that Cummings' great contribution to the library, his whole collapse under its they wanted to go, regardless of where the library was going. overarching aim, was actually own weight. JA Well, now, at that point automating the entire library. I then, you spent a couple mean, he picked up the Index of years in Extramural Medicus at a time when it was really beginning to Programs, and then you left. collapse under its own weight. NM Yes. DS Those were the big books they used to have? JA And what was it that motivated you to go NM Yeah, when they were using a computer to elsewhere? generate prints. And so he made that transition, along with-oh, I can't remember his name- you'd NM Well, I didn't see myself going anyplace in know his name. He was sort of short and sandy- Extramural Programs, particularly. And it was really a haired and thin. Anyway, he was in the library part. very frustrating kind of job. The last task that I had in He oversaw the computer system for the library. Extramural Programs was overseeing some evaluation Marty's attitude towards extramural programs was contracts.19 always very ambivalent. At least at the time that I was study. That was very frustrating. This contractor involved. I'm not sure what he thought about medical dumped a huge amount of data into the report, without informatics as informatics. any real analysis-not real-without any analysis. And I was struggling to try to interpret what they had found and wasn't able to. So in part, I was sort of July 14, 2005 7 cowardly, running away to a better job, a better life NM They had just built a new building, and the [laughs], running a small library. librarian who had been there for 30 years, retired. They were looking at a real change in direction. So DS I've done that before. once again, I became involved JA So that evaluation project in library automation- was an early attempt at doing this time, it was creating a a Delphi study to predict computerized circulation what might be happening in system. We did do a home- medical libraries? grown circulation system. And we did do a sort of home-grown NM Yes. catalog, as well. You know, I JA So it was a predecessor of don't remember where I got the your project? money to do that. But that was a very interesting time, because NM Yes, you could say part of the building was given that. It was a Delphi study over to another research that had too many questions project, which I no longer remember the name of. But it trying to look at where would was run by this man who owns interlibrary loans be, for Airlie House. Oh dear. This is example, what form. We were one of those stories that never trying to uncover how medical gets told much. This man had a records might be integrated law degree, a dental degree, an with literature, parallel Nina Matheson served as Director of the Himmelfarb Health Sciences Library at George MD, and a PhD. And he owned delivery of information, that Washington University School of Medicine and Airlie House, which is a big kind of thing. And I think Health Sciences in Washington, DC, from 1975 to 1980. conference center in Virginia. we used the [NLM] Board I think it still functions as a of Regents as experts. And conference house. we had other experts, also. We assembled a whole group of names, I think, including most of the Board DS Yeah, I think I've been to a conference at the of Regents, because I remember Vladimir Slamecka Airlie Center. [from Georgia Tech] was on the Board of Regents NM Yeah. But he was also a man who was open to at that time, and he was also one of the experts. bribery-I mean, not bribery himself, but he bribed Anyway, that report is part of people. G.W. was one of those the general literature, but it never got mashed into some Once again, I private schools, along with useful shape, into some kind of became involved Georgetown, that always had to go to Congress for additional communicable article. in library funding. And Congress was JA So you moved on to G.W. [George Washington automation- prone to say, "Okay, we'll bail you out this time, but University] then? this time it this is the last time." While I was creating a was librarian there, it became NM Yes. really critical to get more JA And you became Library computerized money from Congress. I cannot Director. remember how I got a hold of circulation system. this information, but I think NM Yes, they recruited me- it was told to me by that man they came and recruited me. It himself. He said that he had was a nice feeling. insured G.W.'s claim by handing over an envelope full DS I guess! of green stuff to the right people. In fact, that was it! 8 This came out in a faculty meeting, and some faculty NM Yeah. And of course Naomi got Marty mad had the temerity to stand up and say, "What?! Am I because she did the mini Medline, without permission. hearing this correctly? You essentially bribed members DS My goodness! There's punishment for that! of Congress to give us funding?!" And the answer was, "Yes. How can you be so naïve?" NM Without asking Marty Cummings, she just did DS [laughs] My goodness. it-and he didn't want that. JA You were at G.W. then how long? DS That was a version of Medline that ran on a small computer, didn't it? And DS Till Congress changed? you could do a query. [laughter] She did the mini NM Yeah, it was a subset of NM Till 1980, because that's Medline, without Medline, the most commonly when I went to the AAMC [Association of American permission. referenced journals. DS Medical Colleges], because top journals or something like I was there from '80 to '82, and then after that that. contract ended, I went back to the National Library of Medicine as a special expert consultant for two years. NM Right. At the end of that, I went to Hopkins. DS We had that at Yale when I was there. JA When you were at G.W., then, that was quite a while. Your career, that was when you were active in NM She was a marvel. MLA? DS I'd forgotten about that. NM Yes. And active in the Regional Medical Library NM You'll have to interview Program. That was '75 to '80. her. JA And active in the Marjorie had the DS Regional Medical Library vision and the Program in what way? JA Where is she now? sensitivity to NM Making trouble. NM San Diego. [laughing] At one point, see that medical DS Wow! Whe should do it in Marty Cummings told my libraries were the winter. [laughter] dean, "Tell this woman to stop making trouble." Naomi going to be going JA So now we're up to the Broering and I were trying to get some rationalization into through a real time when something took you away from G.W. to go the interlibrary loan system, transition. to AAMC. How did that because there was some kind transition happen? of hierarchy in the interlibrary NM Actually, [Marjorie] loan. So we tried to manipulate the system to our Wilson had gotten the contract to do another medical advantage. library study that was sort of a second Bloomquist DS Was Naomi working for you then at G.W.? study. Remember, Hal Bloomquist did the study that more or less provided the data for the Medical NM Oh, no, she was at Georgetown-she was always Library Assistance Act. And then there were other at Georgetown. AAMC studies along the way. There was the one on JA The two of you ganged up then, on Marty A.V.s. There was another one I don't remember. But Cummings? Marjorie had the vision and the sensitivity to see that medical libraries were going to be going through a real transition and wasn't sure in what direction or July 14, 2005 9 what shape and form it was going to take. So she had DS I can imagine. the idea, and she went and got the contract money JA Why do you think she recruited you-not that from NLM to do another study of the state of medical we're surprised, but-? libraries and try to articulate what the future might bring. DS Well, she'd known you for a long time-it wasn't like she just picked you out. She'd known DS So how do you leave a you since Washington job where you're the head of a library, to go to what you So she got the University, right? know is a temporary project? contract money NM Yes, that's true. You could see it was going to be important, obviously. Did from NLM to do DS She was following you. you know how important it would be? another study NM Yeah, I think she probably had been following, a little bit. NM No. of the state of And then she was up to date DS But you thought that was medical libraries with what was happening at NLM and talked to a lot of a good risk, to take another and try to people there. I suppose she got job like that? articulate what the some advice. NM I never thought of it as a risk. future might bring. JA Then how did you start? NM I did a literature search. DS You didn't? [laughs] NM DS She's a librarian, after all! turn up. NM DS That's good! It did! And so the report that came broad kind of search. And at that time, there was a lot out of that study is what we call the Matheson- of forecasting literature. There was actually a journal Cooper Report, the thing that made the IAIMS of-. program, sort of. JA Technological NM Yes. At that time, they Forecasting. DS And then Marjorie Wilson helped get the money. were talking about NM Yeah, right. And at that NM Marjorie Wilson got the nanobits. Nobody time, they were talking about nanobits. Nobody ever knew money, and her name should ever knew what a what a nanobit was. [laughter] nanobit was. Let's have been on the report, but it Let's see, that was 1980, so PCs didn't get there. She had left had just begun to permeate a the AAMC by that time. By the see, that was 1980, little bit. But Marjorie Wilson kept asking me the question, so PCs had just end of the study, she'd gone to University of Maryland as "What good are these PCs associate dean, I think. begun to permeate for, except to balance your checkbook? I still don't see DS Wow. a little bit. what they can do for me. JA Did she recruit you, or Why would I want one in my how did that match happen? home?" She was the kind of person who would ask those kinds of questions to NM She recruited me. She invited me over to talk stimulate, to have you think about what are all the about her project, and to see what I thought. I was negatives in the things you really have got to account thrilled, really thrilled. for. At the time I went to AAMC, they had none of the 10 data actually under any kind of processing control. JA I was on the board of MLA, so that was one of They were doing, I'm sure, all of the residency the groups, I think, that you did. matching programs basically by hand. They were just NM Yup. beginning to computerize the medical school data. JA How did you come up with the idea of the JA You were there physically, did you have an Delphi? NM Go visit some NM Well, I had to get data somehow, and at that point- there. Once again, I was lucky, because the people in the medical centers and I think it's still true- computer center were very and talk to the there was a federal law that prohibited doing surveys, people about what happy to see me, because I was conventional data-gathering at least willing to push the idea surveys. So the Delphi was the that you could use them for it is that they're way around the survey. handling data. We weren't even doing much word processing doing, and where DS Meaning it's a survey at the time. I'm pretty sure that was true, because I taught are they going. that you get feedback, and then you do another survey? the computer center to run the Seems like two surveys more Delphi data for me, and they also helped me with the than no survey. iterations of the report, the various editions, because I NM I didn't call it a survey. didn't have a secretary, so I did all of that myself. So it was an interesting time. DS Okay, I just wanted to make sure I knew what the Delphi was. That's where you send out a DS I guess! survey and get the answers back, and then send the JA I still want to know where you started, as far answers back? as you did the literature NM Well, it wasn't a survey, search-? NM Marjorie said that, well, Don [Lindberg] because you had an expert group, and you were eliciting one of the things that I should was thinking opinions of an expert group. do is to go visit some medical centers and talk to the people a little more DS Okay. about what it is that they're broadly in terms NM So it wasn't just a shotgun doing and where are they of communication kind of open-ended sort of going. You know, I really didn't thing. know very much about medical networks. DS At least there wasn't a centers, but she knew that. She rule against it. was always impressing on me how complex they were-they are. So I visited, with NM Yeah, there wasn't a rule against it. her opening doors, I visited a number of schools. I can't remember where I went. I did go to Maryland, JA Now, we do qualitative research, so we know and I think I went to Harvard. So I did that kind of very well that you didn't have a computer center crunch all the data and spit out the report. So as the survey. Then I did the Delphi, using library directors surveys came back, there was a lot of text. as the experts. DS These were open-ended questions, right? JA And others. I was one of your subjects. NM [pause] Yeah, they were open-ended questions, NM Oh! but there were very few. Let's see, if I remember, there July 14, 2005 11 was a range. You were actually given a choice, zero to but who are in a position to do something for you, they 10 or something, zero to 5. could do something with the outcome. If they bought into the process, they would need to be in a position JA But then you wrote a lot. to take it the next step. So it was with that principle NM Yeah, then you could write something. But there in mind that the advisory committee was put together, were very few questions. and it was one of the reasons why there was some misunderstanding on the part of the library community JA So anyway, what I'm getting at is, you read all as to why certain people were chosen and certain the responses? people were not chosen. Estelle Brodman wanted to NM Yes. Yes, I did the number crunching. know why she wasn't on the advisory committee, for example, and Louise Darling was-I think she was. JA By yourself? Well, I mean, with the computer Maybe not. It's been a long time since I've thought center, but as far as the synthesis, the results, did about it. But in any case, we had to choose the library you have a committee helping you, or how did that representatives-and we had to choose on the basis of work? their being consensus builders and leaders recognized NM There was an advisory committee, of course, by the community. And so Estelle believes we're because AAMC never does anything without an pretty much on the downward slope, as far as those advisory committee. Marjorie Wilson taught me how criteria were applied. Anyway, there were two or three to choose an advisory committee, the primary rule advisory committee meetings, and they looked over being that you chose people who not only are experts, the Delphi studies and they participated in the Delphi In 1995, the Washington University School of Medicine (WUSM) renamed its library in honor of Bernard Becker, a noted researcher who headed the ophthalmology department at the Washington University School of Medicine for 35 years, discovered W. Matheson, Estelle Brodman (director and associate professor in the history of medicine, WUSM), Bernard and Janet Becker, and Mark Frisse (Vanderbilt University Department of Biomedical Informatics). 12 critical suggestion of his, too. John Cooper made a report. They went through each iteration-some more critical suggestion, which I cannot remember now. I than others. it, and made a suggestion that I thought made it into a JA Now, Don Lindberg said he was part of-I can't more cohesive kind of report. And that was one of the remember what role he played. reasons why his name was on the report.1,20,21 NM He was on the advisory committee. JA Otherwise, what role did he play? DS Was he at the NLM by then? NM Nothing much. I mentioned that Marjorie's name NM No. No, he was still in should have been on the report, Missouri. He came to NLM What Bill Cooper because she got the money. made possible just as I left, because I was at JA And it sounds like she the end of this two-year special was part of the discussion all expert-. The decision had was for me to along. been taken that there wasn't probably any place for me at go back to the NM Oh yeah, absolutely. NLM, for me to move into. And that was when Cummings National Library JA So let's see, we're at retired. of Medicine, the point now where you've written the report and passed DS They never considered to write up the it by the advisory committee, and it's ready to be released. I you to be the head of the National Library of Medicine program that then remember it was published in at that point? the Extramural two different venues. Wasn't it part of Academic Medicine NM Oh! heavens no! Programs would and it came out separately? DS Or did you have to be a doctor to do that? support with NM No, it was always a funding. supplement. NM You had to be an MD. JA Oh, it was a separate DS Not a librarian. supplement? NM Not a librarian. For heaven's sake! NM A separate supplement to the Journal of Medical Education. And that had to be funded separately, DS Joan was mentioning that yesterday. so there was another small grant to do that, to get the money to do that. At that time, Bill Cooper had NM Well, I think these days it would be different. joined the advisory committee as the NLM liaison. I DS We'll see! If we get a new director of the can't remember whether he was there from the very National Library of Medicine. beginning or not, but he was certainly there at the end and was a great champion of the report. JA Getting back to the synthesis and the writing, Don Lindberg did mention that he had brought JA Well, he was part of the network that the idea of networking into it. And so was that transitioned it into IAIMS, I know. like me-that you surveyed, didn't come up with, NM Yes. and he, because of his technical expertise, thought JA would be coming in the future? point, and apparently he was part of the effort. NM I think the library community was thinking NM Yes. of networking individual medical libraries. Don was thinking a little more broadly in terms of JA So you wrote this report, and what was the communication networks. And that was a really feedback from the community about it? July 14, 2005 13 NM Well, it was split between the group that said, "We've already done that," and the group that said, came out of extramural funding. There was no extra "I don't think we can do that." [uproarious laughter] Naomi said she could do it. And Nancy Lorenzi, from So he put aside the Extramural Programs money to the very beginning, saw opportunity. So did Rachel. three of them? So my job at DS Rachel Anderson? What was the NLM at that time was to write NM Yeah. She saw an up the specs for the program, opportunity. Some saw the feedback from the the IAIMS program, and get it opportunity, but just couldn't get the kind of support that they community? through the hierarchy at NIH, organize the review, to do all needed. They didn't have the It was split that stuff. So by the end of two connections within the medical schools to bring it about. between the group years, it was pretty well under way. JA So getting the opportunity that said, "We've JA So you had spent two at the individual campus already done that," years at AAMC, and then you depended on library directors spent two years at NLM. who had an idea how to make and the group that DS So when you said you it real within their-. said, "I don't think were wondering why we came NM Right. we can do that." down from Yale to see you, maybe it was because you JA What about the had written the whole grant physicians, for example, program, and so you knew all outside the library community? the inside scoop. NM Hm, I don't remember there was much in the way NM Oh, yeah, that was John-. of a response. DS John Paton had, but Perry Miller was the one DS So when you mentioned someone like Rachel that really drove all that, behind the scenes. Anderson, one of her things was to hire Paul Clayton and bring him to Columbia to help head up NM Oh, was that true? I didn't realize that. a program. The two of them were together, weren't DS He's the one who understands how to get the they, working on that? That must have been, like, in grants. He probably wrote the grant for John. '85. Like in '84-'85, Paul Clayton started going to Columbia, working with her. JA So what happened at the end of the two years? NM NM Hopkins was having-I wouldn't say trouble, And so was that how she brought Paul in? recruiting, but they hadn't found anyone that had struck a chord with the search committee. So when DS He came and did that with her. But he was I was asked if I would like to be considered-and I leaving Utah, I remember, and he was being a consultant to them, on and off, like in '85. He that and suggested to the search committee that they probably went there in '86, and I think that was the should talk to me. grant. DS Even though you'd been sort of bothering him. NM I see. What Bill Cooper made possible was for NM Oh, well, no, he had forgiven me. me to go back to the National Library of Medicine, to write up the program that then the Extramural DS I see. He realized maybe you were right on Programs would support with funding. Art Broering some of those points, huh? [laughter] was very supportive, and he took money out of the NM I don't know about-. 14 DS At least forgiven. in some other kinds of activities. And that was when I realized that-oh, my goodness, I am having a senior NM He had forgotten, maybe. [laughs] I do remember moment! DS Online at McKusick and Mann, that one? afterwards was, "All you've described is process." NM Yeah. Victor McKusick. I had been aware while And I was really rather shocked, because I thought I was at NLM that last time that Lister Hill had had there was more than process that was what I had talked some involvement with Victor. They were trying to about. But he was very acute in his observations. use Mendelian Inheritance in Man as a basis for an Anyway, I went to Hopkins with the idea of picking up online text, I think. But because of where they were, where the former director had left off. both technologically and as far as personalities went, JA It was a physician, wasn't it? nothing had come of it. And the last I had heard was that Lister Hill had given up on McKusick because he NM Yes. was just a "crazy old man." And McKusick had given JA Male physician? up on them because they were just-. NM Yes. A German male physician. [chuckles] DS Just crazy. He was such a charming man, and his wife was so NM They were crazy-they didn't have any idea of charming. I can't remember the occasion, but we were the practical needs. And what was important to him talking about opera and about personalities. Polacek! was the process of editing and compiling his book, not having his stuff outside of his control. So I thought something about how he liked the The Ring Cycle, that one of the things that could happen would be that and his wife had said, "Well, of course! You think of if we could computerize his book, so that it could be yourself as Wotan!" [laughter] Anyway, they'd written computer generated-. an integrated library system at Hopkins, and it was functioning, and it was working. So what I needed to DS That's been sort of a theme for a long time, as do when I got there was to expand it and to try to bring you were using the computer to create paper books. Nina Matheson and Nancy Lorenzi at the 1994 Medical Library Association (MLA) annual meeting in San Antonio, TX. July 14, 2005 15 NM Right. Right. And since he didn't want anything DS Late '80s-before we had what you call the but a paper book, that was perfect, because then the Internet. Was it available online? Could they dial in byproducts would be available for other purposes. to Johns Hopkins to search it? Well, you know, as it turned out, they had to work NM Yeah, I think it was a dial-in. with the Hopkins University Press, and the press was only interested in publishing in the way that they had DS You weren't part of, like, the SUMEX-AIM always done it. [Stanford University Medical Experimental computer research resource for applications DS So when you say the press, you mean like the publishers, or the printing presses? or anything like that, or any of the big sort of NM No, the publisher, Johns Hopkins, yes. They had computer resources that were in-. a perfectly adequate system. NM No, but I think-. Well, I think it was dial-up. DS They didn't want your computer-generated DS And did they pay, or did you support that? output, in other words. NM We supported that. NM That's right. So it worked, and it didn't work, because we did put it up online. We got some DS So I could dial in for free, for example? feedback, which was very gratifying. People from NM Yeah, right. Southeast Asia wrote and said how wonderful it was. DS Search the book? DS How was it available? So this was like in the mid '80s, right? NM Right. NM Late '80s. At the 1994 meeting of the Association of Academic Health Sciences Library Directors (AAHSLD), presenting David L. Atkins 16 DS Seems like I remember trying to do those kinds NM I think they created a sort of center of research or of searches. something like that for him, because he wasn't really a deputy in the sense of what we're seeing in any part of NM Yeah, they were very clumsy-enough to turn the library. people off. DS Yeah, I think so. DS Well, it was hard: the modems weren't very good back then. You were talking about a 300 or JA So at this time, then, you're not at NLM, but baud modem or something. This was before they you're sort of seeing the fruits of your labor come had-I mean, I never had into the mainstream, because a 9600-baud modem for a Well, the role now people are applying for long time. When we were at Yale, trying to build these, we of the Board of IAIMS grants, and, really built an interface that would Regents is really there. I want to know what it allow you to dial out to that felt like when you read about book to sort of show how our as a conscience. it. IAIMS was going to work. We accessed mini Medline The Board makes NM What it felt like? the same way. We had an [NLM] accountable JA What was it like when you interface you could click, and it would dial the modem to the community. read the literature and you saw what was going on? How and call up and give you this did you feel about IAIMS? little search interface to show someone how that would work. That's probably NM Well, I never had any problem letting go of why we went down to learn more about dialing into things. Once it was done, it was done, and it had a that, and sort of try to understand that we could life of its own. I couldn't take any credit for what was do that a little bit better, to make it look a little happening afterwards. I just watched it. I didn't have more integrated, as they said in the IAIMS idea. anything to do with it. [chuckles] DS Did you feel especially proud? JA So how was Hopkins as a place to be? NM No. You know, I don't have maternal instincts. I NM Hopkins was a wonderful place. It was really the don't, I really don't. most exhilarating place I've ever worked. The people were so enabling, and so cooperative. Just an amazing JA Well, maybe you felt some chagrin that environment. I think it still is an amazing environment. sometimes things were not the way-. You know, from a librarian's point of view, that report was all It truly is like no other place I've ever worked. about libraries and the growing or increasing role DS There was a guy there that I remember, that of libraries. And for a while, I have to say I think it had done a lot of the computer work in your group, turned into something different. Maybe even now and we spent a lot of time with him when I went it's turned into something different. And that's what down there that one day. I don't even remember I'm getting at here: what's become of that original his name at all, but it seemed like he was the head idea? programmer or the-. NM Well, I think what I didn't appreciate at the time NM Oh, Gary Moore, I think, was in charge of that was just what libraries are, that really it's not in the overall. Was Dick Lucier there? cards to use a library as a launching pad for anything DS Oh, yeah, Dick Lucier. That was the guy. Now for a long time. I remember that name. What was his role? Was he your deputy or something like that? DS Is that because there's not as much money in the library, or some other reason? NM [long pause] Yeah, I think he was. JA I think he had a research role, too. July 14, 2005 17 NM I think it's cultural as well as political. There establishment is too entrenched. Even NIH has not is ingrained such a view of libraries as passive been able to overcome that. resources-not only from the point of view of the people who use libraries, but from the people who they've just passed that law that says you have to work there. Power is everything in the medical setting. make all the data available, the journal has to be And money is the way to power in medical centers, online after so many months or years-it has to be but I don't think it's the real driving force-at least it isn't in Hopkins. At Hopkins, NM Yeah, they would. you could have lots of money, but unless the contribution is [The study] raised DS Don't worry about that. the consciousness and necessary, it's not going to NM They want their two cents of both parties- for every copy, every page DS I suppose if you think the library copy, or every hit. about it, and you're doing a research project, and you ask community and DS Exactly. a statistician for help, you put the medical JA You wanted to ask about the Board of Regents, because community- the statistician on the paper. When you ask a librarian we saw the picture yesterday. for help, you never put the librarian's name on the paper. as much as DS So it was while you were it penetrated at Hopkins that you got onto You don't consider that they the Board of Regents for the have an active role. the physician National Library of Medicine. And you were elected to NM Well, the librarian's role truly is passive, because there's community. But the Institute of Medicine. no knowledge generated, or true I think it helped You made a huge step up, I suppose, in your career. the informatics knowledge manipulated by a At least I would think, if I librarian. got elected to either of those DS There's something community. things-. to be said for knowledge NM Yeah, those were amazing management. It's getting to honors. be bigger. I'm not sure how that's going to affect libraries. DS What's the role of the Board of Regents, and how do you interact with the library? How did that NM If libraries were in control of, were the publishers work? It's more than an honor-I'm sure there's a of online information, for example, then they'd be in a lot of work involved. role to do knowledge management, but as a third party, they're too distant. NM Well, no. DS That's true. So do you see these new online DS No work involved?! Dinners? open journals-I don't even know who publishes Biomed Central. They're only electronic journals, NM Dinners. Well, the role of the Board of Regents is and a lot of libraries are starting-I think the really as a conscience. So since the Library Director is libraries are publishing and controlling a lot of not accountable to anyone-I don't think-in a way, them. the Board makes it accountable to the community. It isn't that the Director seeks approval or anything NM Not medical libraries. Stanford, I think, is one from the Board, and the Board certainly has no who's doing online publishing, but not the medical. policymaking or decision-making role, but it exists as And I don't think they ever will. The publishing a body that can help the Director promote certain kinds of things. He did, when I was there, use the Board in 18 long-range planning. But then, once again, that was NM Right. pretty much directed by the staff, as you would expect. DS Did they know that? Was that a conscious JA Now, the Board of Regents has to give its stamp decision? of approval to every grant. I know they tell you that you get a certain score and it looks like you'll be JA Right, on somebody's part? funded, but it has to be approved by the Board of NM Surely it was a conscious decision. I'm not sure Regents. Did they ever say no? NM Well, yes, on occasion. The Board could question. I don't remember how that process goes-do you? The question goes back to the Review Committee DS I don't know either. I guess I'm more and needs to be defended. The Board doesn't really concerned how they found Don Lindberg. They overturn an action. And it really doesn't have the knew him, obviously, because he was on-. power to say, "Look at this one again, and improve the score," or something like that. It does serve as a NM He was on the Board of Regents, and he was on checks and balances of a sort. the IAIMS panel. He was, for a while, pretty much the most visible kind of informatics person around, I JA We talked of Don Lindberg yesterday, and think. I wonder if you can think back to the transition between Marty Cummings and Don Lindberg. I DS This was in the early '80s? guess I'll come right out and ask the question, NM Yeah, the early '80s. Yeah, I suppose so. It's which is, it seems like Don Lindberg, as a quite true that what he did at Missouri never coalesced choice, was really moving NLM more towards an informatics emphasis. friendly word. NM Uh-huh. And less on libraries. DS Well, it never made it outside of Missouri. JA And less on libraries. In 1999, the University of North Carolina (UNC) at Chapel Hill awarded Nina Woo Matheson the degree of Doctor of Science for "her outstanding contributions to the world of knowledge." Pictured with Samuel Hitt (former director of the Health Sciences Library at UNC), Carol G. Jenkins (director of the Health Sciences Library at UNC), and Joanne Gard Marshall (UNC School of Information and Library Science). July 14, 2005 19 NM Yeah, right. very great horse people. He was complaining to his sister about this particular horse that he was very, very DS You could say a lot of informatics projects have had that problem. her trained. And his sister said, "You know, Don, NM There's a great deal sometimes you just have to of anxiety attached to the You really need to change horses." Created all persevere if you transition. kinds of anxiety in people who heard this story, wondering DS I bet. On the part of the library, the people in the have a vision, and whether he was giving a message. [laughter] library, or someone else? stick with it. DS Oh, dear! Oh, boy. That's NM I think on the part of a management strategy for everyone. You know, it was sort ya! So you left before he got there? of the way when a new president is chosen, everyone serves at the pleasure of the president. So there was NM Yeah. a lot of anxiety about, "Is he going to want to bring DS You realized that there wasn't going to be a in all of his friends?" That sort of stuff. I remember place for you? Lois Colaianni22 telling me that at one point, Don was talking to a group of people and he and his sister were Nina and Bill Matheson, August 1999, in their home and headquarters of their antiquarian booksellers company in Chevy Chase, MD. 20 NM Oh, I was told there was not going to be a place NM Well, if you have a vision, if you have an idea for me. of where you think things ought to go, and you can imagine yourself doing-or position yourself to do- DS By Marty Cummings, then? something about it, you need to not worry so much NM It was a person to whom I reported as a special about the inhibitions, the inhibitory criticisms bound expert. Oh, yeah! [pause] I left just before Don came to come down on you from all sides. I especially think in. [phone rings] I remember Bill Cooper telling me if I had paid more attention to the objections of people that he had asked Don why he didn't keep me on. to the negatives, these things wouldn't have happened. Don had told him that he didn't have a choice, it was But being somewhat closed-minded, you just go ahead already done by the time he got there. and do things. I don't think one should [be] close- minded-I was sort of joking-but I think you really JA need to persevere if you have a vision, and stick with is, what would you consider the accomplishment it. that you're most proud of? JA One last question: that sounds like risk-taking NM Oh, well, I suppose the completion of that to me. It sounds like you thought it was a risk to study is the enduring contribution, because it led on publish the report, in some ways. to various consequences. Well, in part, I think its importance was it raised the consciousness of both NM Oh no, I never thought of it as a risk. I just don't parties-the library community and the medical think about risks. community- as much as it penetrated the physician DS Just think of doing what you think is right. community. But I think it helped the informatics community. NM Yeah. DS Absolutely. DS There's no risk in doing what you think is right. NM And that really is the important thing, I think. NM Yeah. If you lose your job, there's always something else. JA advice to offer, let's say, to future informaticians DS That's good advice. [laughter] Thank you. or librarians or people who are a combination, information science in medicine people, what advice [Published May 15, 2015; updated , 2015] would you give? July 14, 2005 21 For additional Conversations with Medical Informatics Pioneers, please visit: http://lhncbc.nlm.nih.gov/project/medical-informatics-pioneers References Ash JS, Sittig DF, interviewers. Conversations with Medical fcgi?artid=226684&tool=pmcentrez&rendertype=abstract. * Informatics Pioneers. Goodwin RM, Ash JS, Sittig DF, Accessed May 7, 2015. editors. Bethesda: U.S. National Library of Medicine; 2015. Available from: http://lhncbc.nlm.nih.gov/project/ 10. Matheson NW. 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