The Nation's Health Information Network: History of the Regional Medical Library Program, 1965-1985 BY ALISON BUNTING, Biomedical Librarian, Assistant Deanfor Library Services, School ofMedicine University ofCalifornia, Los Angeles Centerfor the Health Sciences 10833 Le Conte Blvd. Los Angeles, California 90024-1798

INTRODUCTION gram, 1965-1985 is a historical review of the THE MOTIVATION to write this history of the evolution of the network including the National Regional Medical Library Program (RMLP) arose Library of Medicine's administration of the pro- when participating in the development of a chapter gram, the organizational structure of the network on library cooperation for the Handbook of Medi- and its regions, the programs and services provided cal Library Practice [1]. Very few published by each region, and an evaluation of the Regional accounts of this premiere library network existed; it Medical Library Program's accomplishments and was therefore necessary to rely on my memory of impact. Information for this history came primarily events and to seek out unpublished reports and from the published literature including individual news releases. The Regional Medical Library RML newsletters, official reports and minutes, and (RML) network has been in operation for twenty interviews with key participants in the development years, and many health sciences librarians today and operation of the network. It was not possible to perhaps take for granted the structure which has chronicle each region's operation and accomplish- improved the delivery of information to health ments in detail, nor credit the contributions of professionals and introduced technological devel- individual RML staff. Such descriptions are best opments in the practice of health sciences librarian- presented in individual histories, an activity I ship. New participants in the operation and man- encourage my colleagues to undertake. agement of the RML network are also sometimes It is also difficult to adequately describe the unaware of services and programs which were tried significant contributions made by many individuals before. Documentation of the evolution of the net- and institutions to the RML network. Most notable work will serve to assist those involved in its man- are the efforts of the staff in medical school and agement, as well as those interested in what has hospital libraries in each region. They have given of made this network so successful. their time, providing valuable advice and assistance The organization of twenty years of historical to the operation of the network; shared their insti- information presented a considerable challenge. tution's resources; and adapted to change in a way One approach could have been to discuss each that assured the continued viability of the network. program or service (e.g., interlibrary loans) in its For every federal dollar spent on the provision of entirety. The evolution of programs and services RML services, several local dollars were expended was, however, frequently affected by budgetary through in-kind contributions. Health sciences and/or policy considerations which were best pre- libraries have enthusiastically accepted the impor- sented in a chronological format. The final tant responsibility ascribed to them in the Presi- arrangement is a compromise between the strictly dent's Commission Report in 1965: "The medical chronological and the programmatic approach. library thus serves medicine as a guarantor of the The history is divided into four major periods: the organization of its scientific and professional events leading to the creation of the network (prior knowledge, and of accessibility to what is already to 1965), the design and establishment of the known" [2:38]. original network (1965-1970), the operation of the original network (1971-1981), and the reconfi- BACKGROUND AND NEED FOR A REGIONAL gured network (1982-1985). MEDICAL LIBRARY (RML) NETWORK The Nation's Health Information Network: In the period following World War II, the provi- History of the Regional Medical Library Pro- sion of biomedical information to the United States Bull. Med. Libr. Assoc. 75(3) Supplment July 1987 I ALISON BUNTING health care community was significantly and librarians; include library support in ongoing adversely affected by the lamentable condition of research program funding; support bibliographic the nation's health sciences libraries. The inade- control of the scientific literature; and establish "A quacy resulted primarily from the fact that, while system of regional reservoir libraries...encouraged funding for medical research and education had and supported by the National Library of Medicine increased dramatically during this period, funding through the granting of funds..."[4:162]. The for libraries had failed to keep pace. The National results of the Bloomquist study were widely dis- Library of Medicine (NLM) and the health cussed, and NLM advised the health sciences com- sciences library community were keenly aware of munity and appropriate federal officials of their these deficiencies, and undertook a concerted effort desire to implement an extramural program to to improve both health sciences libraries and access assist medical libraries [5:26-7]. to health information. The concept of regional medical libraries gener- The NLM, which became administratively part ated a great deal of interest among librarians, of the Public Health Service in 1956, was most physicians, and federal officials. In early 1963 an interested in receiving authority to award grants informal meeting was convened at the Harvard for the improvement of biomedical information Medical School to explore the possible elements of delivery. Such a plan was discussed by the NLM such a network. Eleven medical school librarians Board of Regents in 1960, and in the summer of met with representatives from NLM and the that year Frank B. Rogers, M.D., director, investi- National Institutes of Health to present six model gated whether the Public Health Service Act per- regional plans. The plans varied considerably; some mitted NLM to make grant awards. Although proposed regional services for large geographic authority was not to be forthcoming until 1964, Dr. areas encompassing several states, while others Rogers immediately began preparing for the even- limited services to a few counties or one state. All of tuality. In 1960 he appointed Scott Adams as his the plans described extensions of existing coopera- deputy for "extramural" activities, and assigned tive services provided by medical libraries, and Estelle Brodman, Ph.D., as Adams' associate. noted that expanded and improved service would be Together, Mr. Adams and Dr. Brodman gathered feasible only if outside financial support were avail- information on the need for extramural support able [6]. programs, and drafted plans for such programs. In early 1964 President Lyndon B. Johnson One of their more significant actions was to con- appointed the President's Commission on Heart tract with Harold Bloomquist, assistant librarian of Disease, Cancer and Stroke, chaired by Michael E. the Harvard University Schools of Medicine and DeBakey, M.D. The commission was appointed to Public Health, to conduct a study on the condition develop a "battle plan" for the defeat of these three of medical school libraries in the United States diseases. In noting the importance of communicat- [3:395-6]. ing to practicing health professionals the results of Bloomquist's study resulted in a landmark paper scientific research in the conquest of disease, the which clearly documented the poor condition of commission cited the poor condition of the nation's medical school libraries and their inability to pro- medical libraries and stated that "...unless major vide even the most basic of services. He warned that attention is directed to improvement ofour national since medical school libraries were not able to medical library base, the continued and accelerated provide information effectively to their users, scien- generation of scientific knowledge will become tists were forced "...to seek other ways by which to increasingly an exercise in futility" [2:25]. satisfy their information needs" [4:158]. Bloom- The commission recommended "...that the quist also suggested that one way to control National Library of Medicine be authorized and adequately supported to serve its logical and neces- ... the great need for physical expansion of libraries is the sary function as the primary source for strengthen- development of the regional reservoir library. In this ing the nation's medical library system" [2:64]. scheme there is ... a large central resource library which this recom- bears the responsibility for collecting materials in depth The background material supporting and which makes its resources and services available to a mendation requested funds for NLM to conduct broad geographic area...[4:1521. research on and develop new methods for the efficient management and dissemination of bio- Bloomquist recommended that federal funds be medical information and to provide grants to sup- made available to: improve medical school library port improved medical libraries; and recommended collections, facilities, and services; train medical legislation to allow NLM to assist medical 2 Bull. Med. Libr. Assoc. 75(3) Supplement July 1987 NATION'S HEALTH INFORMATION NETWORK libraries. A national medical library network was lists of citations on specific topics for individuals. proposed to capitalize on existing cooperative Adams clarified the relationship by stating: arrangements, and to provide equal access to health information to health professionals across the The selection of a library as a MEDLARS search center is not predicated on a willingness to provide regional nation. library service as a unit of a national network. There are Martin M. Cummings, M.D., appointed director many unknown factors in the design of a national medical of NLM in January 1964, was keenly interested in library network...and NLM hopes to support studies in a grants program for NLM, and discussed such a this area....It is difficult to conceive of regional libraries...without MEDLARS search capability; on the concept with Senator Lister Hill of Alabama. Sen- other hand, local MEDLARS search centers...can be ator Hill encouraged NLM to draft specifications established without prejudice to the design of a system of for legislation, a task which Dr. Cummings readily regional medical libraries [11:148]. accepted and assigned to Marjorie Wilson, M.D., the newly appointed head of the Extramural Pro- The legislation drafted by NLM, entitled the grams (EMP) section of NLM. In drafting the bill, Medical Library Assistance Act (MLAA), was Dr. Wilson utilized the background and support introduced by Senator Hill on January 19, 1965; an information provided by the Bloomquist and Presi- identical bill was introduced by Representative dent's Commission reports, and the results of John Fogarty in the House. The MLAA was signed NLM-sponsored studies conducted by the Associa- by President Johnson on October 22, 1965. The tion of American Medical Colleges (AAMC) and expeditious passage of this act was due in large part the Medical Library Association (MLA) on the to the strong support it received from the health needs of medical school libraries [7,8]. and library professions [3:397-9]. Througbout 1964 and 1965 there was wide dis- cussion about the programs which comprised the MEDICAL LIBRARY ASSISTANCE ACT proposed legislation. At the October 1964 AAMC The Medical Library Assistance Act of 1965 annual meeting, Drs. Wilson and Cummings pre- (MLAA), Public Law 89-291, authorized NLM to sented a paper on NLM's relationships to medical provide grant funding in seven program areas: (1) education and research. The idea of a network of construction of new, and renovation, expansion, or regional libraries was advanced. Research would rehabilitation of existing medical library facilities; need to be conducted into the design of such a (2) training of medical librarians and other infor- network, but Wilson and Cummings postulated mation specialists in the health sciences; (3) assis- that should a network be "...fully developed, it tance to special scientific projects; (4) research in seems prudent to place such resources wherever the field of medical library science and related possible in existing private, university, or free- fields; (5) improvement and expansion of the basic standing libraries of excellence" [9:231 ]. Dr. Cum- resources of medical libraries and related facilities; mings provided additional insight into the need for (6) development of a national system of regional a medical library network at the dedication of the medical libraries; and (7) preparation of biomedi- Francis A. Countway Library, Harvard University, cal scientific publications. The MLAA specified in 1965: that the NLM Board of Regents would serve as the National Medical Libraries Assistance Advisory Continued dependency of the more than 6,000 medical libraries upon the services of the National Library of Board to advise on regulations and policy for the Medicine would lead ultimately to the evolution of a administration of the Act and to- review and monolithic medical resource in this nation. Our country approve awards. requires the development of a complex of regional medi- Of most concern, for the purposes of this history cal libraries with adequate facilities, resources, and per- is Section 398 of MLAA sonnel to serve those sections of the nation with underdev- th4 which authorized the eloped library facilities [ 10:161]. establishment of the Regional Medical Library (RML) network. It should be recognized, however, The medical library community was interested that much of the work of the RMLs was greatly in the relationship between the proposed RML facilitated by other provisions of the act, especially network ank NLM's plans to decentralize MED- those programs which provided support directly to LARS (Medical Literature Analysis and Retrieval medical libraries. System) search centers. MEDLARS, developed by Section 398 of the MLAA provided that grants NLM to produce its major listing of the medical could be made to existing public or priv4ate nonpro- periodical literature, Index Medicus, via computer, fit medical libraries to enable them to serve as could also be used to provide computer produced RMLs for a geographic area. Grant funds could be Bull. Med. Libr. Assoc. 75(3) Suppiment July 1987 3 ALISON BUNTING used for (1) acquisition of books, journals, and In 1970, Public Law 91-212, a three-year exten- other similar materials; (2) cataloging, binding, sion of the MLAA of 1965, was passed by Con- and other processing procedures; (3) acquisition of gress. Two modifications were made to the section duplicating devices and other equipment to facili- of the law dealing the RMLP. NLM was autho- tate the use of the library's resources; (4) acquisi- rized to use a contract mechanism, in addition to tion of mechanisms and employment of personnel grants, to fund the RMLs, and the RMLs could use for the speedy transmission of m-aterials from the either grant or contract funds for planning. The RML; and (5) construction or renovation of physi- authorization levels remained the same [13]. cal facilities necessary in order to function as an Public Law 93-45, the Health Programs Exten- RML. Section 398 also provided NLM with autho- sion Act of 1973, extended for one year six of the rization to establish regional branches of NLM in seven program authorities in the MLAA, deleting any geographic area of the United States which construction authority with a corresponding modi- needed an RML, but in which there was no library fication in appropriation authorizations. The which could serve as or be developed into an RML. authorization for regional medical libraries was The appropriation authorization for the RMLP raised to $2,902,000 [14]. was not to exceed $2,500,000 for each of the five The Health Services Research, Health Statis- years beginning with the fiscal year ending June tics, and Medical Libraries Act of 1974, Public 30, 1966, through the fiscal year ending June 30, Law 93-353, extended the MLAA through June 1970 [12]. As can be seen in Table 1, the largest 30, 1977. The new version of the MLAA included amount of funds obligated by NLM to the RML all changes recorded in the 1970 and 1973 exten- network during this period was $2,088,000 in sions, and consolidated the authorization appropri- 1969. ations for the six programs into one sum [151]. Between 1977 and 1982 the MLAA was TABLE 1 extended three times, without any changes in pro- MEDICAL LIBRARY ASSISTANCE ACT BUDGET HISTORY gram authorizations. Public Law 95-83, the Bio- 1966-1986 medical Research Extension Act of 1977, extended Fiscal the authorization through September 30, 1978; Autho... .propi Obligation Year rization Appropriation to RMLP Public Law 95-622, the Biomedical Research Extension Amendments of 1978, provided author- 1966 $11,000,000 $ 5,010,000 ity through September 30, 1981; and Public Law 1967 21,000,000 13,800,000 $ 105,000 97-35, Omnibus Budget, extended funding through 1968 21,000,000 11,250,000 680,000 September 30, 1982. 1969 21,000,000 5,789,000 2,088,000 From 1982 to 1985 several unsuccessful 1970 21,000,000 5,452,000 1,807,000 attempts were made to extend the MLAA for three 1971 23,500,000 5,992,000 2,128,192 years and increase the funding level for the pro- 1972 25,500,000 6,892,000 2,093,000 1973 27,500,000 8,492,000 2,179,808 grams. However, all MLAA programs were funded 1974 8,442,000 7,029,000 2,658,000 during this period under various budget continuing 1975 17,500,000 6,682,000 2,194,000 resolutions. 1976 20,000,000 6,433,000 3,351,000 In 1985, Public Law 99-158, the Health 1977 20,000,000 8,000,000 3,086,000 Research Extension Act, was passed, extending the 1978 14,600,000 7,987,000' 3,020,000 MLAA through September 30, 1988, at increased 1979 15,000,000 7,987,0001 2,848,000 authorization levels. In addition to the changes 1980 16,500,000 9,925,000 2,967,000 described earlier, several differences between the 1981 18,500,000 9,831,000 2,999,000 description of the Regional Medical Library Pro- 1982 7,500,000 7,500,0002 2,399,000 gram in Section 398 of the 1965 law and Section 1983 7,500,0002 2,300,000 475 1984 7,500,0002 2,000,000 of the 1985 law can be noted. In keeping with 1985 7,790,0003 2,000,000 the deletion of construction authorities in the 1986 11,000,000 - 2,300,000 MLAA, RMLs are no longer permitted to use grant or contract funding for construction and 'Excludes one million dollars reprogrammed from NLM renovation of their physical facilities. In addition to intramural activities. agreeing to modify and increase their own library 2Continuing Resolutions. 3Authorizing legislation expired Sept. 30, 1982. Authori- resources, RMLs are asked to "..supplement the zation for FY 1985 is contained in the Appropriation and resources of cooperating libraries in the region..." Continuing Resolution. [16].

4 Bull. Med. Libr. Assoc. 75(3) Supplement July 1987 NATION'S HEALTH INFORMATION NETWORK

The 1965 authorization language for the RMLP staff; and (6) support for specialized information has proven to be extremely flexible and enduring, centers. In order to serve mission-oriented special requiring only minor modifications. Unfortunately, interest groups in the health sciences, bibliographic as illustrated in Table 1, the actual appropriations information would be repackaged for their use. for the MLAA programs, including the RMLP, Figure 1 illustrates NLM's preliminary plan for have never equaled the authorizations. The impact the RML network [17]. of the funding available for the RMLP is noted in the description of the development and evolution of Herner Design Proposal the RMLP which follows. Although passage of the MLAA was a relatively smooth and uncomplicated process, implementa- DESIGN OF THE REGIONAL MEDICAL LIBRARY tion was not. Upon review of the programs autho- NETWORK rized by the MLAA, the Bureau of the Budget felt that a clearer picture of the future course of Once funding for the RMLP was assured, NLM biomedical libraries in light of technological undertook to define in more detail the structure and advances needed to be developed. The bureau function of the network. Several important ques- requested that funding for the construction of tions were raised. Would the RMLs be newly medical libraries be delayed until 1967, and asked established libraries? How many regions, com- the Office of Science and Technology to implement posed of which states, would be established? What a study of future biomedical library needs. A would be NLM's role in the design and operation of contract to conduct the study was let to Herner and the network? Company via the National Science Foundation [18:7]. NLM's Preliminary Design The introduction to the Herner preliminary One of the earliest public descriptions of a report, issued in February 1966, stated that the preliminary concept of the RML network was in study was performed "for the purpose of deter- November 1965, when Dr. Cummings presented a mining an optimal configuration for a national paper at an institute on information retrieval at the network of medical libraries in the United States, University of Minnesota. He stated that "...the and effective means of implementing it" [19:1]. National Library of Medicine believes that any The network as described by Herner called for four national system should build upon existing types of library units. The "central unit" would resources, utilizing new techniques and equipment collect and disseminate the world's biomedical lit- wherever possible to improve the flow of informa- erature; NLM would serve in this capacity. "Local tion throughout the network" [17:175]. The system units" would participate in the network and provide would serve both libraries and subject-oriented for the information needs of their primary clientele, groups. about 2,000 users each. "Special units" were Cummings described three major components of described as libraries containing extensive collec- the system: centralized coordination of the net- tions in narrow subject fields. "Interlibrary units" work, geographic dissemination of information, would serve as depositories for older or little-used and mission-oriented dissemination of information materials from the local units. This proposed net- (e.g., information packaged for a group, generally work was very expensive, since it called for the working in a specific subject area such as vision construction of a fair number of library facilities. research). NLM would be responsible for the cen- The projected costs over a six-year period were tralized coordination including planning, selection $313,641,000. Another key recommendation was of RMLs, and network coordination, and would that planning and administration of the network be continue to collect, process, and make available the handled by the Committee on Scientific and Tech- world's biomedical literature. The RMLs would nical Information or the Office of the Surgeon receive federal support to assume the responsibility General and that it not involve NLM [19]. for the geographic dissemination of published The Herner report was not well received by information. Dissemination included: (1) the con- NLM or the medical library community. In a duct of literature searches by computer; (2) gener- presentation at an invitational conference on RML ation of computer current-awareness listings; (3) service in the Pacific Northwest, Dr. Cummings the provision of copies of documents; (4) the provi- stated: "I want to say that I think it's a poor study. sion of reference services; (5) the conduct of train- It makes projections which I believe would be ing and orientation programs for medical library wasteful of federal funds and critical manpower. I

Bull. Med. Libr. Assoc. 75(3) Suppiment July 1987 5 ALISON BUNTING

SYSTEM INPUT

'A - m - m ¶mi m m m m - m to/ I-J LITERATURE I AND OTHER | V tm LEARNING RESOURCES

I MMISSION-t p I I '|"'~-"7it t~~L1L' ORIENTED X I CENTRALIZED FUNCTION OF DISSE1NATION NATIONAL LIBRARY OF MEDICINE SPECIAL INDIVIDUAL I ACQUISITION, PRESERVATION & PROCESSING INTEJ:REST MEMBERS GEOGRAPHIC DISSEMINATION GROIUPS

lI | < REGIONAL LIBRRIES B 10MEDIICAL LIBRARY I NETWO)RK CONCEPT

LOCAL & INSTITUTIONAL USERS FIG. 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 rized by the MLAA, including the RMLP. The projection of funds that would be made available to draft regulations were approved by the NLM you, but more importantly, I think the health Board of Regents at their March 1966 meeting, community is betrayed by some of the concepts and were published in the Federal Register on July which were introduced" [20:149]. During the dis- 13, 1966. Section C of the Rules and Regulations cussion which followed Dr. Cummings' presenta- covered the grants for establishing RMLs. tion, several participants voiced similar concerns The geographic composition of the regions was over the survey methods and the quality of the not specified; rather, a geographic area was defined report. NSF requested further work on the report, as "...an area composed of any part or parts of any but a final version was never published. Some of the one or more states that forms an academically and details of the Herner plan were, however, eventu- professionally integrated region, taking into consid- ally included in NLM's final design of the RML eration such factors as location and extent of network [21:4]. The Bureau of the Budget did communication facilities and systems, presence subsequently permit NLM to award MLAA autho- and distribution of educational and medical and rized construction funds. health facilities and programs..." [22:9502]. In the MLAA, libraries wishing to serve as RMLs were Official Design required to "modify and increase their library NLM Extramural Programs (EMP) staff, Mar- resources so as to be able to provide supportive jorie Wilson, M.D., Carl Douglass, Ph.D, and services ..." [12:7]. Modify and increase was David Kefauver, were charged with preparing draft defined as "...the use of Federal funds or materials regulations to implement all the programs autho- to supplement rather than supplant non-Federal

6 Bull. Med. Libr. Assoc. 75(3) Supplement July 1987 NATION'S HEALTH INFORMATION NETWORK funds available for library resources and services" Each of the three Information and Policy State- [22:9502]. ments defined the programs and services of an RML. As summarized below, each RML was Guidelinesfor Applicants required to: Wilson, Douglass, and Kefauver traveled exten- 1. Define the level and quality of present (pre- sively throughout the country in an effort to pro- grant) and projected services. vide information on the proposed RML grant pro- 2. Clearly state its goals for grant-supported gram prior to the publication of the official guide- library services and indicate how it would lines. Rather than specify the geographic composi- evaluate and estimate the need for new or tion of a region, NLM encouraged interested indi- revised services. viduals and groups to schedule formal meetings to 3. Provide the following services: "...determine the natural and feasible configura- a. Free loans' of library materials to qualified tion of their 'region' or area" [23:23]. It was users within the region, including the pro- recommended that the meetings include adminis- vision of free photocopy services in lieu of trators, librarians, health professional users, repre- the loan of the original. Beginning in 1968 sentatives from state and local governmental and a statement was added to allow for the other health agencies, and other interested parties. provision of free loans across regional After determining the geographic composition of a boundaries. region, each applicant was required to undertake b. MEDLARS search services. Initially an extensive analysis of the information needs and RMLs were required to operate a MED- resources of the area, and propose cooperative LARS search center; by 1968 the wording arrangements which built on existing relationships had been changed to require only the provi- [23]. sion of formulation services for qualified A preliminary fact sheet [24] followed by a users in a region. Beginning in 1968 RMLs series of Information and Policy Statements [25- were also required to provide search formu- 27] issued by NLM formally announced the pur- lation services to users in other regions at pose and responsibilities of the RMLs, provided the request of NLM or another RML. guidelines for applicants, and delineated NLM's c. Back-up reference support to other role in the operation of the network. The statement libraries in the region, and on occasion, of purpose remained essentially unchanged during directly to individuals. the formative years of the network: "The funda- d. Orientation and training of personnel from mental purpose of regional medical library services user institutions to ensure effective utiliza- is to optimize and equalize access to, and to provide tion of the network. In the 1967 Statement for the most effective dissemination of health the training was to focus on regional science information in all its forms, in order to library services; the 1968 Statement respond effectively to the needs of health science revised the wording to medical library ser- investigators, practitioners, educators, and stu- vices. dents" [27:1]. e. Continual assessment of the region's infor- The 1967 Statement suggested that no less than mation needs. 5% of the nation's health professionals should f. Announcements of new acquisitions. reside in a region; subsequent versions deleted this g. Support for health professional continuing numerical guideline. RMLs needed to consider education programs. existing institutional relationships, patterns of 4. Submit progress reports. communication, and health professional continuing 5. Administer the RML grant in accordance education, and to have adequate resources and with specified legislative and governmental facilities to meet regional needs. The 1967 State- rules and regulations. ment defined adequate resources as the ability to fill 90% of requests for materials; this numeric NLM's Management Role standard was dropped in subsequent revisions. A NLM's role in the management of the network comprehensive regional plan, assessing the infor- became more clearly defined in the successive mation oeeds of the region's health professionals, was an essential part of the proposal, as was the 'Loan of library materials is defined as the loan of a establishment of an RML Advisory Committee physical volume or the provision of a photocopy in lieu of including both librarians and health professionals. the loan of a volume. Bull. Med. Libr. Assoc. 75(3) Supplment July 1987 7 ALISON BUNTING versions of the Statements. In 1967 a general determine the appropriate geographic boundaries statement indicated that NLM would provide lead- for each region, and to select the library which ership and essential services, advice to regional would apply for the RML grant. The boundaries planning groups on "...the establishment and oper- were not easily drawn, since political affiliations ation of MEDLARS search services..." [252], and and geographic considerations complicated the process the RML grant applications. The 1969 decisions. Meeting organizers were free to select Statement delineated a number of responsibilities the participants, the only NLM requirement was including provision of "...guidance for the develop- that broad representation from various user and ment of service interrelationships required to coor- institutional categories be present. In most cases dinate the network" [27:1]. the individuals and institutions invited to partici- NLM would participate actively in the RML pate reflected pre-existing regional affiliations. network, and was responsible for: (1) supporting The selection of an institution to serve as the the further development of the RMLs, (2) provid- RML was no less difficult; in several regions no ing "back-up" library services to the RMLs, and single exceptionally strong library clearly emerged (3) supplying "...guidance and direction necessary as the natural choice. Uncertainty over the number to coordinate the services provided by the regional of RMLs which would eventually be funded also medical libraries so that they may function as a affected the planning process, although by June 'national system' and thereby optimize and equal- 1967, Carl Douglass, Ph.D, publicly stated "...that ize access to health science information throughout about ten such libraries (RMLs) should be sup- the country" [27:2]. In this coordinating function ported under the current authorization" [29:50]. NLM could specify standards for communication NLM's role throughout this planning process, as and practice among RMLs and adjust service defined by Marjorie Wilson, M.D., was "...to main- workloads among the RMLs and NLM. The addi- tain, insofar as possible, flexibility in working out tion of such specific language concerning NLM's ...supportive arrangements...in developing service role was a result of the growing conviction among patterns and resource configurations within each key NLM staff that an effective national network region..." [30:48]. would not result without a certain amount of Participants in the planning meetings included uniformity of policies and services. A further indi- librarians, health professionals, administrators, cation of NLM's intention to ensure uniformity and representatives from governmental and other was NLM's recommendation to the Board of health agencies. Of particular concern was the Regents to add to the proposed MLAA extension interrelationship between the RMLP and the authority to fund RMLs via contracts as well as Regional Medical Programs (RMP), a separate grants. federal program which had also resulted from the The design of the RML network was evolution- President's Commission Report [2]. The purpose of ary in nature, spanning the initial five-year period the RMP was "...to make the latest advances in authorized by the MLAA. The final result was a medical knowledge of the diagnosis and treatment hierarchical library network (Figure 2) in which of heart disease, cancer, and stroke available to NLM served as a comprehensive national back-up physicians for the treatment of their patients all resource for all U.S. libraries, the RMLs shared over the nation" [31:56]. To accomplish their mis- their resources with libraries in a specified geo- sion, the RMPs planned extensive continuing edu- graphic area, and local health sciences libraries cation programs for health professionals and the provided local health professionals with access to lay public. A logical aspect of such continuing their collections and services and to the RML education programs was the provision of health network [28:384]. The responsibility for dissemi- information; it was evident that coordination nating mission-oriented information was not for- between the two programs was essential. mally included in the final design of the RML network, since other federally funded projects Organizational Structure already provided such services. Between 1966 and 1970 the boundaries for the ESTABLISHMENT OF THE NETWORK (1967-1970) original eleven regions (Table 2) were determined, Network Policies and Architecture and the applicant institution(s) designated. Two organizational patterns emerged. In centralized Regional Planning Meetings regions, regional services and management were The regional planning meetings recommended primarily provided by staff located at the RML by NLM were held throughout the country to with cooperation and assistance from other 8 Bull. Med. Libr. Assoc. 75(3) Supplement July 1987 NATION'S HEALTH INFORMATION NETWORK

MEDICAL LIBRARY NETWORK PLAN

NLM AND CENTER FOR BIOMEDICAL COMMUNICATIONS 11 REGIONAL LIBRARIES 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.

FIG. 2-Medical Library Network plan. libraries in the region. Decentralized regions relied 1967; the participants agreed that the Countway on more direct involvement of larger, mainly medi- Library, which had recently been created by the cal school libraries, eventually labelled resource merger of the Boston Medical Library and the libraries (RL). The RLs provided many regional Harvard Medical School Library, should apply for services; the RML administered and managed the an RML grant. "The selection of the Countway service program. The remaining library partici- Library as the home of...NERMLS...was based on pants in each region were called basic units or basic the recognition that the library possessed outstand- health sciences libraries (BHSLs). BHSLs con- ing collections..., a new and functional physical sisted mainly of hospital libraries but also included plant, and a tradition of regional service long other libraries serving health professionals or stu- recognized by the community" [32:329]. dents, such as community college or pharmaceuti- NERMLS was a centralized operation. There cal company libraries. was, however, reliance on other regional resources. Because the Countway Library did not have a The Eleven Original Regions strong nursing collection, an arrangement was Region I: New England Regional Medical made with the Boston College School of Nursing Library Service (NERMLS). The New England Library to share their resources regionally. Regional Medical Library Service, the first RML NERMLS also worked closely with the Postgrad- to be designated, began operations at Harvard uate Medical Institute (PMI), an educational arm University's Francis A. Countway Library of Med- of the Massachusetts Medical Society. PMI had icine in October 1967. The geographic composition conducted a survey of hospital educational needs in of the region was easily determined, since the New New England and determined that library service England states of Connecticut, Maine, Massachu- needed improvement. NERMLS and PMI agreed setts, New Hampshire, Rhode Island, and Vermont to address this problem in concert. NERMLS had long-standing affiliations. Two regional meet- collaborated with PMI to identify a "core collec- ings were held in Boston in May 1966 and March tion" of books and journals designed to serve as a Bull. Med. Libr. Assoc. 75(3) Suppiment July 1987 9 ALISON BUNTING

TABLE 2 ORIGINAL REGIONAL MEDICAL LIBRARIES

Region Regional Medical Library Area Served Operational

I New England Regional Medical Library Connecticut, Maine, Massachusetts, October 1967 Service (NERMLS) New Hampshire, Rhode Island, The Francis A. Countway Library Vermont of Medicine Harvard University, Boston II New York and Northern New Jersey Re- New York and Northern New February 1970 gional Medical Library (NY/NJ RML) Jersey New York Academy of Medicine Library, New York III Mid-Eastern Regional Medical Library Delaware, Pennsylvania, Southern July 1968 Service (MERMLS) New Jersey College of Physicians of Philadelphia Library, Philadelphia IV Mid-Atlantic Regional Medical Library Maryland, North Carolina, Virgin- October 1968 (MARML) ia, Washington, D.C., West Virginia National Library of Medicine, Bethesda V Kentucky, Ohio, Michigan Regional Kentucky, Michigan, Ohio April 1969 Medical Library (KOMRML)* Shiffman Medical Library Wayne State University, Detroit VI Southeastern Regional Medical Library Alabama, Florida, Georgia, Missis- January 1970 Program (SERMLP) sippi, South Carolina, Tennessee, A. W. Calhoun Medical Library Commonwealth of Puerto Rico Emory University, Atlanta VII Midwest Regional Medical Library Illinois, Indiana, Iowa, Minnesota, November 1968 (MRML) North Dakota, Wisconsin The John Crerar Library, Chicago VIII Midcontinental Regional Medical Library Colorado, Kansas, Missouri, Ne- July 1970 Program (MCRMLP) braska, South Dakota, Utah, Library of Medicine Wyoming University of Nebraska, Omaha IX South Central Regional Medical Library Arkansas, Louisiana, New Mexico, February 1970 (TALON) Oklahoma, Texas Health Science Center Library University of Texas, Dallas X Pacific Northwest Regional Health Sciences Alaska, Idaho, Montana, Oregon, October 1968 Library (PNRHSL) Washington Health Sciences Library University of Washington, Seattle XI Pacific Southwest Regional Medical Arizona, California, Hawaii, September Library Service (PSRMLS) Nevada 1969 Biomedical Library University of California, Los Angeles *Initially called the East-Central Regional Medical Library.

10 Bull. Med. Libr. Assoc. 75(3) Supplement July 1987 NATION'S HEALTH INFORMATION NETWORK minimum hospital library collection [33] and second year of its grant the NY/NJ RML was able develop guidelines for the establishment of hospital to decentralize the interlibrary loan service, and libraries [34,35]. entered into subcontracts with three libraries in the Region II: New York and Northern New Jersey region. Regional Medical Library (NY/NJ). The metro- Region III: Mid-Eastern Regional Medical politan New York City and northern New Jersey Library Service (MERMLS). By 1963, Philadel- medical libraries enjoyed a long history of coopera- phia area medical librarians and physicians had tion. As early as 1959, New York City area begun to develop plans for cooperative library libraries had established the Medical Library Cen- services. They met formally as members of the ter of New York (MLCNY), created to provide Philadelphia Regional Medical Library Commit- centralized storage and acquisition of less-used tee [40], and endorsed the "Philadelphia Plan" for materials, develop a Union Catalog of Medical regional library service presented by Elliot Morse Periodicals (UCMP), establish a delivery system at the 1963 Harvard meeting on regional medical between the Center and New York area libraries, library service [41]. This plan included providing and participate in cooperative acquisitions projects services to the Philadelphia area, and adjacent [36]. counties in New Jersey. Then in 1963, Ralph Esterquest, librarian of the The Library of the College of Physicians of Harvard Medical Library, conducted a study on Philadelphia had been serving as a regional ways of strengthening medical library resources in resource for many years; an RML grant would the state, at the request of the Commissioner of provide a stable base of funding for such services. Education of the State of New York. Esterquest Initially there was some concern that only universi- recommended a statewide plan which included ty-based libraries would be eligible to apply for provisions for the New York Academy of Medicine RML grants [42]. In the final guidelines the only (NYAM) to serve as a "reservoir"' library for the restriction imposed was that applicant institutions state [37:2]. Thus, as Gertrude Annan described in be non-profit [24]. her presentation at the 1963 Harvard meeting on By 1965 a "Proposed Cooperative Agreement regional medical library service, the cooperative between the College of Physicians of Philadelphia programs already in place at the MLCNY "...could Library and Philadelphia Area Medical Libraries" well be coordinated or integrated with other plans, was developed and endorsed by forty-five institu- either state or national" [36:508]. tions. In order to fund some of the proposed It was on this base of regional planning and services, such as subsidized interlibrary loans, the cooperative experience that the NY/NJ region was College library applied for and received a Resource developed. In 1967 the NYAM and the MLCNY Grant (funded via a separate authority of the submitted a joint application to serve as the RML MLAA), and applied to be a MEDLARS search for New York and Northern New Jersey (Bergen, center. Concurrently, with the endorsement of the Essex, Hudson, Hunterdon, Middlesex, Morris, Philadelphia Regional Medical Library Commit- Passaic, Somerset, Sussex, Union, and Warren tee, the College submitted a letter of intent to counties). The NY/NJ application was problemat- NLM to serve as an RML for Pennsylvania, south- ic, since the funds requested to provide interlibrary ern New Jersey, and Delaware. Delaware was loan service for the region amounted to "...twice the added after a feasibility study indicated that it was amount of money now available for the whole appropriate to provide services to the area. The [RML] program" [3:2]. The grant proposal committee also planned a Regional Medical included plans to decentralize interlibrary loan Library Conference to be held at the College in services; the projected number of subsidized interli- February 1967 [43]. Over 200 individuals attended brary loans which would be provided by the the conference and endorsed the regional plan resource libraries in this very populous area of the proposed by the College. MERMLS began opera- country was considerable. In the spring of 1968 tions a centralized RML in July 1968 [44,45]. NLM approved the grant for a two-year period Region IV: Mid-Atlantic Regional Medical only, at a significantly reduced level of funding Library (MARML). The Mid-Atlantic Region, [39]. composed of Maryland, North Carolina, Virginia, NLM specified that only the NYAM would be the District of Columbia, and West Virginia, was designated the RML for Region II and, due to designated in 1968. North Carolina was originally limited funds, the NY/NJ RML began operations, included in the planning for the Southeastern in February 1970, as a centralized region. By the Region, but librarians in the state requested assign-

Bull. Med. Libr. Assoc. 75(3) Supplment July 1987 I1I ALISON BUNTING ment to the Mid-Atlantic Region since they relied With funding from an NLM Resource Grant on library resources in Region IV more than those CMLS expanded its union list of serials and book in the Southeast. catalog, provided subsidized interlibrary loan ser- The NLM made the decision to act as the RML vice, employed staff to bring the CMLS collections for the Mid-Atlantic region "...because of the under uniform bibliographic control, and supported strength of its resources and its central location for cooperative acquisitions. Concurrently, the Michi- the users" [46:6]. There was also little interest gan Interinstitutional Committee for Information among the region's larger libraries in serving as an Systems (MICIS), with membership from Wayne RML. NLM planned to provide "... new and State University, Michigan State University, and improved services to the region, including con- the University of Michigan, was formed and began tinuing education of medical librarians and train- to consider the development of an RML. An initial ing of health professionals in effective use of biblio- planning meeting held in April 1967 yielded the graphic resources, as well as providing liaison recommendation that MICIS contact the academic between NLM, other Federal medical operations, institutions of Indiana, Kentucky, Ohio, and and the biomedical libraries in the region" [46:6]. Michigan to inform them of the preliminary plans The Reference Service Division of NLM was for RML services, and invite their comment. assigned the responsibility of coordinating regional While awaiting responses, MICIS prepared a services [47]. draft RML proposal without designating a head- Two other factors influenced NLM's decision to quarters library. This draft was forwarded to NLM serve as an RML. First, as a federal institution for comment, and was subsequently presented to NLM was not eligible to receive RML grant funds; representatives from ten institutions in Kentucky, it was therefore able to stretch the limited funding Ohio, and Michigan at a regional planning meeting available for the RML program. Secondly, NLM in November 1967. Indiana did not send a repre- staff would be able to gain valuable operational sentative, and subsequently became part of the experience if they were responsible for RML ser- Midwest Region. At the meeting the participants vices in Region IV. agreed to form a "... cooperative enterprise of a Region V: Kentucky, Ohio, Michigan Regional regional library" [48:10], with Wayne State Uni- Medical Library (KOMRML). Considerable re- versity selected to submit the grant application to gional planning and activity led to the formation of NLM. KOMRML began operations as the first the KOMRML. In the fall of 1964 the library decentralized region on April 1, 1969 [49]. directors of Wayne State University and the Uni- Region VI: Southeastern Regional Medical versity of Michigan met to discuss ways of improv- Library Program (SERMLP). Several medical ing biomedical library service, and agreed to sev- school libraries in the southeastern section of the eral cooperative ventures including interlibrary nation were very interested in receiving grant funds loan, shared bibliographic records, cooperative to provide RML services for Region VI. A series of acquisitions, and the establishment of a MED- regional meetings were held throughout the area, LARS search center. The University of Michigan but consensus on a single applicant institution was became a MEDLARS search center in April 1966, not reached. Subsequently, NLM reviewed appli- followed in July 1967 by Ohio State University. cations from the University of Alabama Medical In late 1965 the medical library directors of Center, Birmingham; Vanderbilt University Medi- Wayne State University and the University of cal Center, Nashville; Duke University Medical Michigan proposed the establishment of a Biomed- Center, Durham; and Emory University, Atlanta. ical Information Services Institute (BISI) to coor- Each proposed that the region be decentralized, dinate interinstitutional cooperation, and asked with a consortium of twelve medical school (re- various organizations to participate in BISI's devel- source) libraries providing regional services. opment. The Greater Detroit Area Hospital Coun- The A. W. Calhoun Medical Library at Emory cil, Wayne County Medical Society, and Metropol- University was selected by NLM to serve as admin- itan Detroit Medical Library Group all agreed to istrative headquarters for SERMLP, comprising participate. The University of Michigan subse- the states of Alabama, Florida, Georgia, Mississip- quently withdrew, but the organization continued. pi, South Carolina, and Tennessee, and the Com- Wayne State University and eight hospital monwealth of Puerto Rico. North Carolina libraries in the Detroit area joined in 1966 to form requested and was granted assignment to the Mid- the Central Medical Library Service (CMLS). Atlantic Region. Although not officially considered

12 Bull. Med. Libr. Assoc. 75(3) Supplement July 1987 NATION'S HEALTH INFORMATION NETWORK part of the region initially, over time regional plans for a union catalog. In 1967 St. Louis, services were provided to the Virgin Islands. Missouri, area medical librarians met with David SERMLP began to offer services in January 1970. Kefauver from NLM to discuss regional medical Region VII: Midwest Regional Medical Library library planning. This group then sponsored a (MRML). Regional planning for the Midwest meeting of representatives from medical libraries region began in December 1966. Librarians and in Colorado, Kansas, Missouri, Nebraska, North health professionals from a number of Chicago's and South Dakota, and Utah held on April 22, health sciences institutions met at the American 1968. This meeting resulted in the formation of a Medical Association (AMA) headquarters with a temporary organization, the Central States Re- representative from NLM. As a result of this initial gional Medical Library Group, which was to desig- meeting, a local planning committee was estab- nate responsibilities for regional service and pre- lished to select and sponsor an institution as the pare the grant application. RML. In February 1967 librarians from sixteen Some regional programs were instituted during Chicago institutions met and appointed subcom- this planning period. For example, the medical mittees to survey the information resources and libraries of Washington University in St. Louis, needs of the area. Contact was made with many and the Universities of Colorado, Kansas, and health-related organizations and libraries in neigh- Nebraska each agreed to contribute funding for the boring states to assess interest. preparation of a union list of serials by the Medical Initially the University of Illinois Medical Library Center of New York. Dr. Estelle Brodman, Library, the John Crerar Library, the University of by that time director of the Washington University Minnesota Biomedical Library, and the University Medical Library, coordinated the technical aspects of Wisconsin Medical Library were all interested in of the union list contract. MEDLARS search ser- becoming the RML. The University of Wisconsin vices had been provided to the area since 1965 by had in fact, been operating a Medical Library the University of Colorado Medical Library. In the Extension Service since 1926, providing both loan end the University of Nebraska submitted the and reference service to health professionals in the RML grant application and became responsible for state [50]. the administration of this decentralized region. The In July 1967 the first meeting of a regional Midcontinental RML became operational in July council, attended by representatives from Illinois, 1970, serving the states of Colorado, Kansas, Mis- Iowa, Wisconsin, and Minnesota, was held and souri, Nebraska, South Dakota, Utah, and Wyom- began discussions on regional policies. In the fall of ing [53]. North Dakota, which had been involved in 1967 Crerar submitted an RML grant proposal to the planning discussions, requested assignment to NLM. The Crerar proposal was subsequently the Midwest Region. reviewed and accepted by the regional council, with Region IX: South Central Regional Medical some revisions, including the addition of Indiana to Library (TALON). "The South Central RML grew the original group of states to be served by MRML. out of an organization known as the Texas Council In November 1968 the John Crerar Library began of Health Sciences Libraries formed in 1966" to provide centralized service to the states of Illi- [54:203]. Council membership was composed of nois, Indiana, Iowa, Minnesota, and Wisconsin. both librarians and health professionals. In Decem- The geographic composition of the Midwest ber 1966 an NLM representative attended a meet- Region was adjusted in 1970 when North Dakota ing of the Council to discuss regional medical was added [51]. library services. In September 1967 the directors of Region VIII: Midcontinental Regional Medical the major medical libraries in the states of Arkan- Library Program (MCRMLP). To quote Bernice sas, Louisiana, New Mexico, and Oklahoma were Hetzner, the first MCRMLP director, "The Mid- invited by the council to a meeting to discuss the continental Regional Medical Library area came formation of an RML. Upon examination of the into being by a process ofelimination" [52:247]. As resources and needs of the region it was "...con- the last RML to be formed, it became responsible cluded that the area did not have an establishment for those states which had not joined another which was of outstanding stature adequate to per- region. Considerable planning of RML services form, by itself, the functions of a regional medical took place in Region VIII. As early as 1966 a group library. This factor ...led to the development of a of librarians from Nebraska, Colorado, Iowa, Kan- consortium of libraries acting as a decentralized sas, and North and South Dakota met to discuss regional library" [54:204].

Bull. Med. Libr. Assoc. 75(3) Suppiment July 1987 13 ALISON BUNTING

The original grant proposed that TALON (Tex- should prepare an RML grant proposal for the as, Arkansas, Louisiana, Oklahoma, and New four-state region. PSRMLS began service in Sep- Mexico) be organized as a separate institution. tember 1969. This idea was not approved by NLM, so TALON PSRMLS operated in a centralized mode with became administratively part of the University of one exception. Interlibrary loan service responsibil- Texas Southwestern Medical School, later re- ities were shared between the UCLA Biomedical named University of Texas Health Science Center, Library (serving Arizona, Hawaii, and Southern Dallas [55:2]. TALON became operational in Feb- California) and the Library of the University of ruary 1970. California, San Francisco (serving Nevada and Region X: Pacific Northwest Regional Health Northern California). This arrangement was Sciences Library (PNRHSL). Formal regional devised to divide the interlibrary loan traffic medical library planning began in the Pacific between the two strongest collections in the region, Northwest at an invitational conference held at the and leave open the possibility of subdividing the University of Washington, May 12-13, 1966. region should additional RML funds become avail- Librarians and health professionals from Washing- able [56]. ton, Oregon, Alaska, Idaho, and Montana were in attendance, as were invited participants from other Organization and Management ofthe RML areas of the United States and British Columbia Program with experience in the provision of regional library services. The conclusion of conference participants was that the Pacific Northwest states should inves- Regional Organization and Management tigate the possibility of forming an RML region for The RML directors were in most cases the the provision of RML services [20]. directors of the library selected as the RML. They An application to serve as the RML for the had overall management and fiscal responsibility Pacific Northwest region was subsequently submit- for the program, and were actively involved in the ted by the University of Washington Health discussion of policy issues, both at national and Sciences Library. PNRHSL began to direct the regional levels. Generally, the day-to-day opera- efforts of this centralized region, which comprised tions of each RML program were the responsibility the states of Alaska, Idaho, Montana, Oregon, and of an associate director. The names of all RML Washington, in October 1968. directors and associate directors are included in Region XI: Pacific Southwest Regional Medical Appendix 1. Library Service (PSRMLS). The Medical Library Each region was required by NLM to have an Group of Southern California (MLGSC) formed a advisory committee which included "...representa- committee in January 1967 to begin planning tives from the fields of professional practice, health RML services for a region which would comprise science librarianship, health communications and Southern California and Arizona. With concur- other fields related to health" [25:7]. In most rence from the Medical Library Group of Arizona, centralized regions one advisory committee, com- MLGSC recommended that the University of Cali- posed of librarians and representatives from the fornia, Los Angeles (UCLA) Biomedical Library various user groups, advised the RML on policy be designated as the RML. The committee was also and procedural issues. in communication with the Northern California Decentralized regions often had more than one Medical Library Group in hopes that planning advisory committee. A committee of librarians and would begin for a region composed of Northern user representatives, or occasionally only user rep- California and Nevada. resentatives, advised on policy issues. A separate By June 1967, it became evident, upon consulta- committee, frequently called the executive commit- tion with NLM, that the size of the proposed region tee, usually composed of RL directors, provided would have to be enlarged, so the MLGSC commit- substantial input into the operation of the RML. tee obtained support from the California Commit- The composition and role of regional advisory tee on Regional Medical Programs to sponsor a committees was an issue of frequent debate regional planning meeting. On March 21, 1968, between the RML directors and NLM. From over fifty health professionals and librarians from NLM's point-of-view, the representation on many Arizona, California, Hawaii, and Nevada attended of the RML advisory committees was too narrowly a meeting at UCLA. The consensus of the partici- defined, with only physicians and medical school pants was that the UCLA Biomedical Library librarians serving. NLM urged RMLs to include

14 Bull. Med. Libr. Assoc. 75(3) Supplement July 1987 NATION'S HEALTH INFORMATION NETWORK representation from all the health professions and RML Directors' Meetings other types of network libraries, believing that it As the RML regions were being formed, most was critical to the program to have input from all policy and procedural discussions concerning the user groups [57]. Another issue was the role of the operation of the RML network ensued indepen- advisory committee in the governance of the RML. dently between NLM staff and individual regions. In some regions, especially decentralized ones, it The RML directors found this situation less than was felt that control of the RML was vested in the satisfactory, since policies previously agreed upon advisory or executive committee. NLM clarified were occasionally revised in light of differing prac- this matter by insisting on only an advisory role for tices or circumstances elsewhere in the country. these committees. In an effort to improve communications between regions, Vern Pings, Ph.D., KOMRML director, invited all RML directors to participate in a meet- Management of the Program at NLM ing to be held in conjunction with the Medical During the formative period of the RML net- Library Association annual meeting in Louisville, work, 1966-70, much of the management of the in October 1969. Joseph Leiter, Ph.D., associate program was the responsibility of the Extramural director of NLM, suggested that the meeting be Programs (EMP) staff. In 1966 a separate division officially sponsored by NLM, thus setting the stage of EMP, the Facilities and Resources Division, was for the first RML Directors' Meeting. These meet- created to oversee the award and management of ings would eventually become a regular semi- the RML grants [ 18]. annual event, designed for the communication and Also in 1966 a Facilities and Resources Commit- discussion of RMLP policies and services, and the tee was appointed to review all Regional Medical sharing of information among regions and NLM. Library, construction, and resource grant propos- A review of the minutes of the RML Directors' als. The NLM Board of Regents, acting in its Meetings in 1969 and 1970 delineates some of the capacity as the National Medical Libraries Assis- policy and procedural questions which arose during tance Advisory Board, gave final approval to all the initial development of the RML network. The RML grant awards. decisions reached had significant impact on the Even though EMP had clear responsibility for operation of the network over time, and serve to the management of the RML program, RML illustrate the evolution of the RMLP. operations were of tremendous concern to NLM's There was considerable discussion about the Library Operations (LO) staff. Not only did merits of centralized versus decentralized mode of regional interlibrary loan policies and procedures operation. NLM was concerned about the varia- need to interrelate smoothly with LO's interlibrary tions in management brought about by the dif- loan operations at NLM, but the management of ferent organizational patterns, and the possibility the decentralized MEDLARS network was the that decentralized regions were more expensive to direct responsibility of LO. Some of the earliest operate. These issues were to be examined after training programs offered in the regions were NLM and the RMLs gained more operational MEDLARS orientations developed initially by experience. NLM staff. The MLAA clearly stated that RML services The grant funding mechanism for the RMLs were to supplement, not supplant, existing services was not conducive to the management control [12]. In order to insure that this guideline was which LO felt was needed in some areas such as being followed, NLM needed to determine a way to MEDLARS. It was difficult, for example, to measure pre- and post-award activity. Initially impose productivity standards on grant recipients. NLM thought that interlibrary loan statistics The idea of funding the basic RML services via a would provide the needed information, but the lack contract mechanism was therefore proposed "...the of standardization in statistical records and the expansion of the decentralized MEDLARS pro- tremendous amount of variation in regional interli- gram, both domestically and internationally, and brary loan practices made this task impossible. the establishment of the RMLP did much to neces- With the agreement of the RML directors, NLM sitate further centralized control to obtain a higher proposed the use of operating budgets as the mea- level of performance" [58:24]. A list of NLM key sure. As long as institutional budgets did not staff who were involved in the management and decrease after receipt of RML funds, then the operations of the RML program is included in requirement of supplementation was met. Appendix 2. Interactions between the RML network and

Bull. Med. Libr. Assoc. 75(3) Suppiment July 1987 15 ALISON BUNTING

other health-related programs were of considerable If an RML could not fill an interlibrary loan concern to NLM. Most particularly, there was request, the request would be referred to NLM or interest in establishing close working relationships another RML; in decentralized regions, RLs also with Regional Medical Program (RMP) offices, so referred requests to other RLs, RMLs or NLM. that programs and services of the RMLs and Health professionals who lacked access to a library RMPs would be complementary. NLM worked at could request materials directly from the RML. the national level to coordinate services [59] and The Midwest Region undertook an analysis of each RML attempted to do the same in its interlibrary loan activity during 1968/1969 to respective region. determine what types of materials were requested Programs and Services and who was using the service. This study revealed that 86.8% of the requests were for periodical Interlibrary Loan articles, 76.3% of the requests were for materials Subsidized (free) interlibrary loans were the published within the last ten years, and 42.9% of most visible and popular service provided by the the interlibrary loans processed were for materials RML network in its first years of operation. requested by physicians [61]. Regional resources were to be used first; NLM In the earliest years of the RML program there would provide interlibrary loan service only after were no restrictions on the number of subsidized regional resources were exhausted. To insure that loans an institution could request. However, in the interlibrary loan requests were submitted first to face of declining funding, some limits on the provi- local libraries, NLM restricted direct access to its sion of subsidized photocopies of journal articles interlibrary loan service to all but a few specified began to be imposed to control costs. In some libraries. Libraries which could submit requests to regions quotas were placed on the number of subsi- NLM included the RMLs, the resource libraries dized loans available, restricting either the number (RLs), and a few "designated" libraries, primarily of photocopy requests which would be filled per libraries which had major collections but were not year, or the number of photocopy exposures which participating in the RML network as RLs. It was would be provided. recognized that the staff of the designated library PSRMLS also developed two "restricted title would have the bibliographic tools to determine lists" to insure compliance with the requirement where interlibrary loans should be sent. Examples that local resources be tried prior to requesting of designated libraries included the Center for material from the RML. One list included 30 Disease Control Library, Atlanta, and the Library commonly available periodical titles, the second of the University of California, Berkeley. listed 100 titles. Subsidized interlibrary loans In centralized regions the subsidized loans were would not be provided for articles published in the provided primarily by the RML, although as noted most recent five years from any of the thirty titles previously, some centralized regions had special on the first list. The 100-title list was used in the interlibrary loan agreements with one or two other metropolitan Los Angeles and San Francisco areas, libraries. Requests for subsidized loans were not where library resources were stronger. supposed to go to the RML unless the requested Several interlibrary loan policy questions arose material was not available locally. Basic health in the first five years of RML network operations. sciences libraries (BHSLs) were expected to use Early versions of the RML Fact Sheet [24] and the the resources of other BHSLs and their local RL Information and Policy Statements [25-27] speci- prior to coming to the RML. In decentralized fied that only non-profit institutions were eligible to regions the RLs received funding from the RML receive RML services, including interlibrary loans. grant to provide subsidized interlibrary loan ser- In response to the considerable pressure exerted on vice. Generally, this was done on a per transaction NLM by members of the for-profit health care contract basis. There was some initial confusion as industry the restriction on the provision of RML to whether this latter practice "supplanted" previ- services to non-profit institutions was removed in ously existing service. In fact, KOMRML initially August 1969. This policy change had an immediate decided that its "participating [resource] libraries" financial effect on the budgets of the RMLs would charge local borrowers for interlibrary loans, already in operation, since they had not planned to according to established practice. NLM, however, provide subsidized loans to this additional category required that loans provided by KOMRML RLs be of user. On September 25, 1969, a small group of subsidized by grant funds, as they were in all other librarians, including some RML directors, and regions [60:2]. NLM staff met at NLM to discuss implementation 16 Bull. Med. Libr. Assoc. 75(3) Supplement July 1987 NATION'S HEALTH INFORMATION NETWORK of this new policy. In his opening remarks at this requests submitted directly by health professionals meeting, Martin M. Cummings, M.D., expressed without access to a library. There was also agree- an NLM management viewpoint which was to ment that some form of an interlibrary loan quota remain consistent over the years: policies estab- system was necessary to insure equal access to lished by the RMLs should be as uniform as health information and to assure that RML interli- possible, and compatible with NLM policies. brary loan funds would not be consumed by heavy Minor regional variations were acceptable when users at the expense of occasional users [62]. necessary, but uniformity was the desired goal. Dr. Cummings also questioned the appropriateness of Union Lists quotas to limit interlibrary loan expenditures, and In most decentralized regions, the creation of a hoped participants would find alternatives [62]. union list of serials, identifying the extent of hold- One result of the meeting was a definition of ings of each owning library, was an essential first interlibrary loan requests which were eligible for step, since it facilitated the referral of interlibrary RML service: all requests for health-related infor- loan requests between the RLs and the RML. mation submitted by libraries for anyone other Some regions, such as NY/NJ and MCRMLP, than lay personnel and high school students, and all already had a list which included the holdings of

TABLE 3 REGIONAL MEDLARS SERVICE CENTERS, JULY 1970 Region I Southeastern Regional Medical Library New England Regional Medical Library A. W. Calhoun Medical Library The Francis A. Countway Library of Medicine Emory University Harvard University Atlanta, GA Boston, MA Region VII Region II Midwest Regional Medical Library New York and Northern New Jersey Regional The John Crerar Library Medical Library Chicago, IL New York Academy of Medicine Library Region VIII New York, NY MEDLARS Center* Region III Denison Memorial Library Mid-Eastern Regional Medical Library University of Colorado Medical Center College of Physicians of Philadelphia Library Denver, CO Philadelphia, PA Region IX Region IV MEDLARS Center*t Mid-Atlantic Regional Medical Library* Texas Medical Center Library National Library of Medicine Houston, TX Bethesda, MD Region X Region V Pacific Northwest Regional Health Sciences MEDLARS Center* Library University of Michigan Health Sciences Library Ann Arbor, MI University of Washington MEDLARS Center* Seattle, WA Health Center Library Region XI Ohio State University College of Medicine Pacific Southwest Regional Medical Library Columbus, OH Biomedical Library Region VI University of California, Los Angeles MEDLARS Center* Los Angeles, CA Medical Center Library University of Alabama Birmingham, AL *MEDLARS Center with machine-processing capabilities. 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, tralized regions made plans for the provision of this SERMLP, and KOMRML, had to compile one. In service by staff located at the RLs. the centralized regions the serials holdings list of Publicity and Publications the RML served as the initial serials locator publi- Other initial services included the publication of cation. brochures, recent acquisitions lists, and newslet- Once union list efforts were underway, NLM ters; exhibiting at health professional meetings; and the RMLs quickly recognized that a single, and planning cooperative efforts with other net- national union list of serials would be extremely works and programs. Articles describing the RML beneficial. The issue of standards for union lists network and its services were published in a variety was discussed, and since several of the RMLs of health professional publications [63-85]. A list- planned to use the services of the Medical Library ing of RML newsletters is included in Appendix 3. Center of New York, creators of the Union Catalog of Medical Periodicals and of the NY/NJ RML Network Evaluation and the MCRMLP union lists, tentative agreement RML Status Report-1970 was reached to use these standards in the creation Robert Walkington and E. Wayne Herron, EMP of all regional lists. staff, prepared a report in 1970 on the RML program. They reviewed the status and develop- MEDLARS Search Services ment of the program, and conducted an analysis of Each RML also coordinated the provision of the four RMLs with at least one year's operating MEDLARS search services. Searches were formu- experience-NERMLS, MERMLS, MRML, and lated at regional MEDLARS service centers (Ta- PNRHSL. Much of the information regarding the ble 3) and were forwarded to NLM for batch status and development of the RMLP presented in processing, with an average turnaround time for this report has been discussed earlier. What is most searches of four to six weeks. In seven regions the interesting was this initial attempt to "evaluate" RML itself was the MEDLARS service center. In RML operations. three of the other regions service was provided by After considering various evaluation methods, the MEDLARS centers which had been estab- the authors felt that "...in a new and complex lished during the decentralization of MEDLARS, program a fairly subjective methodology and a and in Region VI service was shared between the case-history approach would be most appropriate" RML and a MEDLARS center. [86:18]. They were interested in the effectiveness of each RML, type and quality of services being Reference Services provided, advisory committee structure, regional Backup reference service was provided in all cooperative relationships, and planning efforts. regions. The amount and nature of this service Five major program areas were evaluated: inter- varied greatly among the regions, and initially library loan; reference; MEDLARS formulations; RML reference staff spent much of their time consultation and education; and planning, program deciphering incomplete or incorrect interlibrary analysis, and administration. There was regional loan requests. Other reference services included variation in interlibrary loan performance, based in answering queries referred by BHSLs, locating part on the number of interlibrary loans processed translations of foreign language journal articles, and the strength of the collection at the RML. All and compiling bibliographies on topics not suitable four libraries were processing a large number of for searching on MEDLARS. requests and were doing so expeditiously. With the exception of the Crerar Library, over 80% of the Consulting and Training Services requests received were filled. Considerable varia- All RMLs recognized that to insure effective use tion was found in the type and amount of both of the network under development, some form of reference and consultation and educational pro- consulting and training services should be provided. grams provided. Both these services were still under Hospital administrators and library committees development at all the RMLs, and it was clear that would need advice on the type and size of library policies would need to be discussed in the future. required by their institution to meet immediate MEDLARS was deemed to be an important information needs, and many of the individuals activity, and one which consumed a significant staffing these libraries would require basic train- portion of RML funds. The four- to six-month ing. In centralized regions the consulting and train- training program at NLM for search analysts was ing services were provided by RML staff; decen- expensive. To provide needed coverage, it was 18 Bull. Med. Libr. Assoc. 75(3) Supplement July 1987 NATION'S HEALTH INFORMATION NETWORK desirable to have a minimum of two search analysts Two new authorizations added to the MLAA had a per MEDLARS center, yet the number of regional significant effect on the operation of the network: search requests did not always require this level of funding of RMLs was now permitted by both the staffing. contract and grant mechanisms, and RMLs were All RMLs evaluated seemed actively involved in authorized to engage in regional planning efforts. the evaluation of existing services, and were han- In November 1970, the Board of Regents dling these responsibilities well. Increased empha- approved policy guidelines for RML contracts. As sis needed to be placed on the more difficult task of stated in the policy, "The intent of the conversion to analyzing and projecting overall regional needs. contracts is to use this as a mechanism for a more The report identified problems relating to major controlled and coordinated allocation of resources policy issues, many of which were similar to those to insure maximum service" [87:Attachment]. already being considered by the RML directors. Contracts would cover the provision of essential Some additional policy issues not discussed earlier services, defined at that time as interlibrary loan, included: (1) concern that in some regions RML MEDLARS search formulation, and reference ser- grant funds were being used to support basic vices. NLM could contract separately for research library operations in the RML headquarters and development projects for program develop- library; (2) more program publicity and outreach ment. Regional union book catalogs were expressly efforts were needed, particularly outside the imme- excluded from contract negotiations. RMLs could diate metropolitan area where the RML was also apply for grant funding to support other "...in- located; and (3) the level of grant support in each novative and experimental activities" [87:Attach- region varied, due to the way the network was ment]. As the original RML grants expired, they established. That is, programs funded with RML were converted to contracts, although a number of grant funds in one region were not funded in RMLs continued to receive grant funds for specific another due to budgetary limitations. projects and services. In their conclusion, the authors pointed out that By June 1971, seven of the ten grant-funded the changes authorized by the 1970 extension of RMLs had completed contract negotiations with the MLAA would be of assistance in solving some NLM. NLM also notified the Board of Regents of the problems encountered. The increased autho- that it intended to develop a formal RML policy rization level would benefit the RML budgets, the statement to "...eliminate ambiguity and provide new section on planning and evaluation would uniform understanding of the nature of the pro- allow funding for these activities, and the use of gram..." [88:1 1]. Dr. Cummings also informed the contracts rather than grants would promote uni- Board that a subcommittee of the Biomedical formity among the regions [86]. Library Review Committee (BLRC), called the In their review of the RML program through RML Committee, had been appointed to assist in 1970, Dr. Cummings and Mary E. Corning, Ph.D., "...reviewing current and potential RML prob- addressed the issue of the impact of the RML lems" [88:12]. The BLRC had assumed the respon- network on the user. "Conceptually, we believe that sibilities of the former Resources and Facilities the value of the network is clearly demonstrated by Committee in 1970. The RML Committee's review the rising number of service requests made to local was conducted in the last six months of 1971; its and regional libraries and by the increasing num- report was issued in May 1972. ber of responses made by these libraries. We do not The RML Committee made eleven recommen- have, however, a quantitative measure of user dations or observations which they felt would reaction" [28:390]. The RML network had com- improve the effectiveness of the RML network pleted its formative years with decided success, and [89]. began to concentrate on program development and 1. Broader participation in the development of evaluation. RML policy and procedures in each region OPERATION OF THE NETWORK (1971-1981) should be required. Librarians from all types of libraries and a broad spectrum of Network Policies and Architecture health professionals should be represented on advisory committees. Contract Funding 2. A study of the "net lender" concept for The extension of the MLAA in 1970 for a interlibrary loan, as it pertained to the three-year period provided the necessary funding to financing of interlibrary loan requests, continue the development of the RML network. should be undertaken. A net lender was Bull. Med. Libr. Assoc. 75(3) Suppiment July 1987 19 ALISON BUNTING

defined as a library that loaned more items and project grants submitted to NLM from their than it borrowed. region, and provide backup educational support; 3. The impact of fees for services and other (4) NLM was responsible for the coordination and methods of financing RML services should management of both the network and network be measured. planning, and served as a backup to the RMLs and 4. The RML program should be evaluated as the RML for the Mid-Atlantic Region [90]. periodically on a national level. The issuance of the policy statement clearly 5. More effective liaison with the RMP should delineated NLM's expectations for the network be established. and its participants. It was a critical step, since it 6. RML directors should review and comment provided conceptual guidelines and priorities for on all resource grant proposals originating network activities. In his analysis of the policy from their region. statement, Pings outlined the changes necessary in 7. If feasible, RMLs should engage in the order to accomplish the stated objectives. RMLs distribution of non-print media. and RLs, as departments within universities, would 8. NLM should consider designating a specific need "...to expand their 'sphere of influence,' and budgetary amount for the provision of ...adjust to new internal routines and procedures in regional services in the Mid-Atlantic order to have a stabilized network" [91:276]. The Region. base of the network, composed of basic units, would 9. RML directors should give more emphasis have to be dependable and well developed. "...the to overall regional planning and evaluation. RMLP will have to change not only the operations 10. NLM should reconsider its present restric- but even some of the objectives of some of the basic tive policy on the development of union units" [91:278]. Effective communications be- lists. tween all levels of the network, and continual 11. The designation of existing libraries as evaluation of network activities would be extremely RMLs created a potential for conflict important. between institutional and RML policies. The RMLP Policy Statement also specified the Through proper leadership and manage- RMLPs relation to the Biomedical Communica- ment, such conflicts could be minimized. tions Network (BCN), which NLM was in the process of developing [92]. "The network being RML Policy Statement created in support of the RMLP will form the The NLM Regional Medical Library Program matrix for the evolution of a more comprehensive (RMLP) Policy Statement, published in April BCN in which the nation's medical libraries will 1972, delineated the program objectives and speci- always be important nodes, and the resource and fied the organization and responsibilities of net- regional medical libraries will be critical switching work participants. The primary objective of the stations" [90:271]. RMLP was to provide access to health information Harold Schoolman, M.D., who in his role as through the delivery of documents in a rapid, cost special assistant to the (NLM) director for Medi- effective, and efficient manner. cal Program Development and Evaluation promul- The hierarchical organization of the network gated the policy statement, recognized the poten- which had evolved since 1967 was formally tial conflicts which could arise when libraries explained, and specific responsibilities of each of assumed these expanded roles. "No matter how the four categories of participants delineated: (1) organized, the program makes immediate demands basic units, primarily hospital and other health for resources and facilities, for the establishment of related libraries, were responsible for the develop- priorities and, therefore, for specific commitments. ment and management of their own information These commitments are neither insignificant nor resources, and for interacting with their nearest transient.... It is our belief that in the long run the resource library; (2) resource libraries, primarily institutional objectives will also be better served; medical school libraries, were requested to support they will gain more than they give up" [93:284]. the information needs of local basic units, and work with other RLs, the RML, and NLM towards the Organization and Management development of the network; (3) the RMLs were to provide backup support to the RLs, plan and coor- Regional Organization and Management dinate the region's network activities, comment on Several organizational changes in the RML net- the regional implications of resource improvement work occurred between 1971 and 1981. In May 20 Bull. Med. Libr. Assoc. 75(3) Supplement July 1987 NATION'S HEALTH INFORMATION NETWORK

1973 the MRML changed its mode of operation Schoolman would be responsible for coordinating from centralized to decentralized. The name of the both the intramural and extramural activities of region was also changed, first in October 1973, to NLM as they related to the RML program [88]. the Midwest Medical Library Network, and Until late 1978, management of the RML pro- shortly thereafter, in January 1974, to Midwest gram at NLM continued to be the shared responsi- Health Sciences Library Network (MHSLN) bility of the associate directors of EMP and LO. [51]. The RML directors became increasingly frustrated In 1975 NLM gave terminal contracts to the with this arrangement, which occasionally resulted New York Academy of Medicine (NY/NJ RML) in contradictory policy or procedural interpreta- and the College of Physicians (MERMLS) and tions at NLM. The directors regularly reiterated issued a Request for Proposal (RFP) for provision the suggestion, first stated in 1971, that a single of RML services in the two regions. In Region II RML program coordinator at NLM be appointed. the Medical Library Center of New York com- In August 1978, Sheldon Kotzin was appointed the peted with the Academy for the RML contract; first RML coordinator, initially reporting to the there was no competition in Region III. At the associate director for EMP [94]. By late 1979 all conclusion of this contract bidding process both the RML functions, including the management of Academy and the College retained their RML Region IV, were consolidated in the office of the contracts, but the geographic composition of the RML coordinator who reported first to the deputy two regions changed. Effective May 1976, Region director of NLM and subsequently to the associate II comprised the state of New York and now the director for LO [95]. entire state of New Jersey; Region III encompassed Delaware and Pennsylvania. Hospital Librarians' Meeting By 1979, in response to internal Department of In January 1978, NLM hosted an invitational Health, Education, and Welfare regulations con- meeting of one hospital librarian from each of the cerning contract administration, it became neces- eleven regions to discuss the relationships between sary to compete for all RML contracts. RFPs for NLM activities and hospital libraries [96]. Their three-year RML contracts were issued between comments resulted in several new program direc- 1979 and 1981 as the existing contracts expired. tions, including a decision by NLM to actively All RML host institutions remained the same encourage hospital libraries to become MEDLINE except in Region VII. In January 1980, the Univer- (MEDLARS Online) search centers.2 A statement sity of Illinois, Library of the Health Sciences, prepared by the hospital librarians summarized Chicago, replaced the John Crerar Library as the their comments relating to the RMLP: RML for the MHSLN. The only other competition encountered during this round of contract negotia- We also want to go on record as strongly supporting the tionis was in Region VI where both the Medical Regional Medical Library concept, although we recog- nize that the RMLs at present function with varying University of South Carolina and Emory Univer- degrees of effectiveness. We hope and expect that the sity submitted proposals. Emory retained the RML input of hospital librarians into RML plans and programs contract for Region VI. will help them to effectively serve the needs of their regions [97:5]. Management of the Program at NLM RML Directors' Meetings The conversion of RML support from grants to contracts precipitated a reconfiguration of the The changes resulting from conversion to con- management responsibilities for the RML program tract funding mechanisms and divided manage- at NLM. At the June 1971 Board of Regents ment responsibilities for the RML program at meeting, Dr. Harold Schoolman announced that NLM resulted in some temporarily strained rela- network management and control would be the tionships between the RML directors and NLM. In responsibility of a senior management group. May 1971 the RML directors had their first inde- Schoolman would chair this group which also pendent meeting in New York, prior to the official included the associate directors of Library Opera- RML Directors' Meeting sponsored by NLM. tions (LO) and Extramural Programs (EMP). LO Joseph Leiter, Ph.D., associate director of Library would be responsible for the negotiation and perfor- mance of the RML contracts. EMP would super- 2MEDLINE, the online version of MEDLARS, is vise and direct the RML grants, and maintain described in the MEDLARS/MEDLINE section which fiscal control over both the contracts and grants. follows. Bull. Med. Libr. Assoc. 75(3) Suppiment July 1987 21 ALISON BUNTING

Operations, attended this meeting as the RML a standardized document delivery statistical director for Region IV. Many of the agenda items reporting form; rotating RML Directors' Meetings dealt with ways to improve communications and to various RML headquarters locations rather than management of the RML program. One suggestion just holding them at NLM; and a productive was the establishment of a National Council of dialogue on the content and structure of the meet- Medical Librarians to advise NLM on the RML ings. The most far-reaching impact, however, arose program. The directors also requested that an from the discussion on the RML network configu- RML project officer, with pertinent library experi- ration. By 1981, after much consideration and ence, be appointed at NLM, and that the RML largely in response to the fiscal pressures created by associate directors, who had day-to-day manage- reduced MLAA funding, NLM announced its ment responsibilities for the RML programs in intention to reconfigure the network and reduce the each region, be permitted to attend the RML number of regions from eleven to seven. RFPs for Directors' Meetings [98]. These informal meetings three-year RML contracts for the new regions were continued for several years, providing the RML issued in early 1982, and new contracts were to be directors with an opportunity to exchange informa- awarded on a phased schedule later that year tion and let off steam. [102]. The 1972 RML Program Policy Statement /901, developed in consultation with the RML directors, Programs and Services delineated NLM's expectations, and assisted in unifying RML program efforts. By 1974 the RMLs Interlibrary Loan and NLM were working in a more coordinated Health professionals and librarians throughout fashion, as evidenced by the RML-NLM Working the country responded enthusiastically to the Committees established to examine various policy "free" interlibrary loans proposed in the 1965 issues and services. The work of these committees is MLAA. Table 4 clearly indicates the significant further described under Programs and Services. growth in interlibrary loan traffic funded by RML At the November 1978 RML Directors' Meet- contract/grant funds and by NLM from the begin- ing, James F. Williams, KOMRML director, sug- ning of the RML network through 1982. The net gested that NLM and the RML directors conduct result was that provision of subsidized interlibrary an intensive planning meeting to develop a common loans threatened to consume all available RML understanding of the goals of the RMLP; identify funds, leaving little for other essential programs future directions and performance measures for the and services. It therefore became necessary to network; establish priorities for funding; consider ways to control interlibrary loan costs strengthen the relations between the eleven RMLs; without sacrificing what was clearly an important and design a methodology for continuing the plan- function. ning process [99]. As described previously, initial controls came in NLM responded positively and funded a meet- the form of quotas on the amount of subsidized ing for RML directors, associate directors, and service, and restricted title lists. These controls NLM staff in April 1979. At this meeting a revised were not readily accepted in all regions, so the mission statement was developed [1001, and seven institution of quotas and implementation of task forces were established to deal with the various restricted title lists varied. However, in an effort to issues raised during the planning session. The task control costs, NLM announced that renewed RML forces were asked to consider: (1) performance contracts would require such measures by the end indicators for RMLs, (2) RML network configura- of 1974. tion, (3) content and format for future RML At the June 1972 Board of Regents meeting, Directors' Meetings, (4) basic services and priori- NLM proposed another approach, in use in some ties, (5) communications between NLM and regions, which NLM called the "net lender" con- RMLs and among RMLs, (6) RML funding cept. "Each level of the hierarchy will have to sources and competitive contracting, and (7) assume fiscal responsibility for the major support RML/NLM roles and responsibilities [101]. of its own constituency. NLM will provide support The task forces continued their planning efforts for the network operation and management and after the April 1979 meeting, reporting and dis- will underwrite the difference (net lender) between cussing their activities at subsequent RML Direc- levels of service given to a lower level and received tors' Meetings. Some of the developments resulting from a higher level in the hierarchy" [103:7]. from these deliberations included the acceptance of Although the net lender concept was discussed in

22 Bull. Med. Libr. Assoc. 75(3) Supplement July 1987 NATION'S HEALTH INFORMATION NETWORK

TABLE 4 RML/NLM FUNDED INTERLIBRARY LOANS 1969-1982

0.9 -_

0.8 - 1 0.7 - Y, 0.6 - c c 0.5 a.;5:I 0.4- 2 f. 0.3 - 4. C 0.2 -

0.1 -

0- 69 70 71 72 73 74 75 76 77 78 79 80 81 82 Year 13 RML Total + NLM Total Combined Total many forums, it was never officially adopted as borne by the borrowing library [104]. In June 1976 policy. Some of the principles inherent in the NLM proposed to the RML directors that libraries concept were, however, included in future regional be responsible for the cost of loans from a core of interlibrary loan plans. That is, libraries which lent journal titles (defined as the last ten years of all more than they borrowed were repaid in some English language periodicals indexed for Index fashion. One example occurred in MRML where Medicus), and the RML contract funds would consortia of libraries were provided with incentives cover the cost of loans from other journals, as well and bonuses, such as an increase in the number of as book and audiovisual loans. NLM's proposal subsidized interlibrary loans they could request met vigorous resistance from RML directors and from the RML, as a reward for sharing resources regional advisory committees which felt that the locally. plan would penalize the smaller libraries, which Despite efforts to control the number of interli- had the greatest need to borrow core titles [105]. brary loan requests processed through quotas and NLM also proposed, at the June 1976 RML restricted title lists, the number of institutions Directors' Meeting, that a national cost-sharing requesting materials continued to increase. Thus, plan be adopted. The RML directors expressed the number of loans handled by the RMLP grew concern that a national uniform plan was not disproportionately to available funding. It there- feasible given regional variations [105]. It was fore became necessary to consider other cost- nevertheless apparent that some sort of cost- sharing measures. sharing measures had to be implemented. At the May 1975 RML Directors' Meeting, After extensive and frequently heated discussion James F. Williams, KOMRML director, proposed over several years each region had the option of that contract funds be used to support the referral selecting a cost-sharing document delivery plan service provided by the RLs, and that the cost of from one of two models developed by NLM and the interlibrary loans filled locally or by the RLs be RML directors. The models had two elements in

Bull. Med. Libr. Assoc. 75(3) Supplment July 1987 23 ALISON BUNTING

common-a national maximum user fee based on ment, however, between NLM and some RMLs an interlibrary loan cost study, and an understand- about whether MLAA funds should be used to ing that contract funds would cover interlibrary develop regional union lists. At its June 1971 loan network management costs. The two models meeting the NLM Board of Regents stated that it were [106]: did "...not favor...the funding of multiple incom- 1. The cost of loans filled within a defined patible union lists containing detailed information geographic boundary (state or Health Service on the serial holdings for limited geographic areas" Area) would be the responsibility of the bor- [88]. Several RMLs which had been planning rowing library; loans filled by out-of-state union lists were thus unable to proceed. libraries would qualify for contract funding. At the October 1971 RML Directors' Meeting 2. The cost of loans filled within the region NLM presented plans for a "National Index of would be the responsibility of the borrowing Substantive Biomedical Serials," which would library; contract funds would cover the cost of include approximately 5,000 live biomedical titles, processing referrals. and would be built on the Union Catalog of Medi- The national maximum charge for interlibrary cal Periodicals database [110]. The creation of this loan requests filled was set at $5.00 in February list would provide access to information on the 1978, and each region began to implement its holdings of all RMLs and RLs for the nation's individual plans. Most regions phased in the cost- health sciences libraries. sharing aspects of their plans over several years; by In 1973, NLM developed the SERLINE (Se- 1980 all plans were in effect. rials Online) database, which initially included Throughout this ten-year period, some attention information on serials owned by NLM, but was was paid to the cost [107] of providing interlibrary eventually expanded to include holdings informa- loan service, and the characteristics of the service. tion for all RMLs and most RLs. A SERLINE PNRHSL instituted an automated interlibrary Task Force, with representatives from each region, loan reporting system which yielded valuable data was appointed by NLM in 1979 to assist in the on all transactions. The reports generated provided development of a national serials holdings data- information on PNRHSL's performance in han- base. Region XI RLs, as part of the PSRMLS dling interlibrary loan requests, and on which titles Cooperative Serials Acquisitions Program (CO- were requested, how frequently, and by whom SAP), experimented with the online addition of [108]. KOMRML noted that the number of insti- information to the SERLINE database [ I I I ]. tutions using RML interlibrary loan services NLM announced, in 1981, plans to develop a increased by over 200% between 1968 and 1972, National Biomedical Holdings Data Base despite the imposition of curbs on subsidized ser- (NBHDB) which was to include location and hold- vice [109]. ings information for monographs, audiovisuals, and serials. The first step would be the creation of the National Biomedical Serials Holdings Data Base Union Lists and Catalogs (NBSHDB). The RMLs were responsible for coor- Union lists of serials were an integral part of dinating data collection and input from all inter- several regions' programs since they facilitated the ested libraries in their regions. The data were then location of serials for interlibrary loan purposes. submitted by the RMLs in machine-readable for- Regions II, VI, VIII, and IX all had lists, and mat according to specifications designed by NLM Region V had one under development. Regions I, [112]. III, VII, X, and XI all relied on the serials lists of Despite the prohibition on the use of contract the RML headquarters libraries, although in sev- funds for union catalogs of books, there was signifi- eral of these regions union lists of hospital library cant interest in their creation. Several regions holdings were in existence or under development. maintained, at their own expense or with grant As interest in the development of union lists funding, card catalogs into which were filed main grew, so did concern for the lack of a standardized entry cards submitted by resource libraries. In the approach and the amount of funds consumed. TALON region the card file was microfilmed and Agreement was reached among NLM and the made available to the contributing libraries, thus RML directors that newly created union lists increasing accessibility to the information [54]. should utilize the Union Catalog of Medical Peri- Such efforts were extremely time consuming and odicals format, thus laying the groundwork for an expensive, especially when compared to number of eventual national union list. There was little agree- requests for books on interlibrary loan. On average,

24 Bull. Med. Libr. Assoc. 75(3) Supplement July 1987 NATION'S HEALTH INFORMATION NETWORK only 10% to 15% of the total interlibrary loan did become effective August 20, 1973. Many traffic consisted of book requests. MEDLINE search centers found it necessary to The Midwest Region was awarded an NLM pass on these costs to the user, prompting NLM to grant to conduct a cost-benefit analysis of the propose a maximum charge of $5.00 per search. Midwest Union Catalog of Books, which included After considerable negotiation with RML direc- over 260,000 titles from forty-three contributing tors, the maximum charge was set at $7.50 per libraries. The authors concluded that the cost of request, effective March 1, 1974 [117]. maintaining the catalog was high when compared The implementation of MEDLINE search ser- to the low volume of requests, and recommended vices in local libraries did create some network that long-term plans be made to utilize existing or management problems because NLM was entering developing computerized union catalogs of books into independent agreements with libraries to pro- (e.g., OCLC). The present catalog would be main- vide a service which was to be coordinated by the tained at minimal levels until suitable computer- RMLs. At the June 1974 RML Directors' Meeting ized databases became available [113]. The Mid- a report prepared by a subcommittee of RML west Medical Union Catalog was in fact discontin- directors on the "Role of the Regional Medical ued in 1979 in favor of an online union catalog of Library in On-Line Search Operation" was dis- monographs and audiovisuals, mounted as a private cussed. The issues identified were: (1) responsibil- database by Bibliographic Retrieval Services, Inc. ity for location and designation of MEDLINE (BRS). The MHSLN contract supported the centers; (2) definition of the user of the MEDLINE development and testing of this catalog [ 1 14]. system; (3) quality control of MEDLINE search- ers; (4) continuing education of the MEDLINE MEDLARS/MEDLINE searcher; (5) publicity; and (6) management data. In 1970 the first online version of MEDLARS, The subcommittee cautioned that a MEDLINE AIM-TWX was tested, marking the beginning of a search network operating independently of the new era in bibliographic retrieval. By 1971 it was RML network could significantly weaken the latter evident that the MEDLARS search formulation [118]. stations would eventually be phased out, as MED- A subsequent report of the RML-NLM Work- LINE became operational. Clearly, there was a ing Committee on On-Line Network Management need to speed and improve access to the MED- outlined the responsibilities of both NLM and the LARS database, as this service was becoming RMLs in management of the online network. increasingly popular among health professionals. RMLs were primarily responsible for coordinating MEDLINE officially became available in Octo- and monitoring the online network within their ber 1971. Initially, only a few search centers were regions, including publicity, continuing education, given access to the system, since it was unclear how and provision of backup MEDLINE service. NLM many simultaneous users could be supported on the was responsible for maintenance and development NLM computer. The RMLs and certain RLs were of the databases, providing technical information among the first to be granted access and send staff and initial training, and national coordination of for training, eventually BHSLs were added to the publicity and continuing education. It was agreed system [115]. In some cases these BHSLs formed that it was not possible to establish and enforce consortia to share one MEDLINE search code, criteria for the selection of online searchers. thus increasing the number of institutions with Instead efforts would be directed to providing access to the system [1 16]. Training classes were continuing education opportunities to update the held at NLM and at PSRMLS, which contracted knowledge and skills of all searchers [1 19]. to provide training to searchers primarily from the The continued development of the MEDLINE western part of the country. network greatly facilitated and improved the In February 1973 NLM called a special meeting delivery of bibliographic citations to health profes- of the RML directors to announce the imposition of sionals. Tables 5 and 6 illustrate the tremendous MEDLINE user charges. It was proposed that the growth in the number of MEDLINE searches search center pay for the access and search costs; conducted, search stations, and searchers trained. NLM would continue to fund the creation, mainte- The management of this evolving network added nance, and operation of the system. The proposed considerably to NLM's and the RMLs' scope of rate was $6.00 per hour, to take effect July 1, 1973. responsibility. The RMLs encouraged and identi- The institution of charges was delayed somewhat fied BHSLs which would benefit from on-site by the federally imposed price freeze of 1973, but MEDLINE capabilities and distributed MED-

Bull. Med. Libr. Assoc. 75(3) Suppiment July 1987 25 ALISON BUNTING

TABLE 5 DOMESTIC SEARCHES OF MEDLARS DATABASES 1965-1985 2.6 2.4 2.2 2 U C 1.8 8 1.6 1.4 oc *a=i 1.2 0 0 I L. .0 0.8 E z 0.6 0.4 0.2 0 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 Year

LINE application packets for submission to possible instructors, and coordinate online con- NLM. tinuing education. SCORE recommended that Significant changes were made in the training trained searchers be provided with annual updates program for MEDLINE searchers. By 1976 the on system and databases changes and search tech- three-week training program was revised to be one niques. Each region subsequently designated a week of initial training, followed several months Technical Resource Person (TRP) who was respon- later by one week of advanced training. Pressure sible for providing these annual updates using also mounted to hold training courses at sites other course content designed by NLM staff. than just NLM and UCLA (PSRMLS), so instruc- tors traveled to various regional sites. In 1981 the Midcontinental RML became the third online Reference Services training center, primarily serving the midwestern Each RML, in cooperation with its RLs, con- states. tinued to provide backup reference services, with As the number of trained searchers grew, and as every effort made to answer questions locally prior it became imperative to organize a formal means of to requesting information from regional resources. alerting them to system changes and capabilities, The amount and type of service varied between NLM began to issue its Library Network/MED- regions, and there was no effort to set up a national LARS Technical Bulletin in 1969. The RMLs also referral system between the RMLs and NLM for issued occasional publications designed to update difficult reference questions. searchers, or included online search information in In 1974 an RML-NLM Working Committee on their newsletters. In 1977 a Standing Committee Reference Services reviewed the status of regional for On-Line Retrieval Education (SCORE) was reference services and recommended continuation established by NLM to select topics for continuing of this backup reference support. The committee education courses for online searchers, to identify also suggested that instruction in the provision of

26 Bull. Med. Libr. Assoc. 75(3) Supplement July 1987 NATION'S HEALTH INFORMATION NETWORK

TABLE 6 MEDLARS/MEDLINE SEARCH CENTERS/SEARCHERS TRAINED 1965-1985 4.5

4

3.5

3

01 2.5 0 I- 2

1.5

I

0.5

0 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 60 81 82 83 64 65 Year n Sarch Center + SWrchm reference services be given by the RMLs as part of Rationalization, Resource Sharing and Coopera- their regional training programs [ 120]. tive Storage, formed in 1974, discussed the net- work's role in these activities. It recommended that Resource Sharing each region develop and maintain book, journal, Several innovative programs designed to share and audiovisual resources adequate to meet most of information resources and coordinate the develop- its immediate needs, and that it was cost-effective ment of regional collections were instituted by the to do so in a cooperative fashion. Cooperative RMLs. Of direct benefit to basic unit libraries were serials acquisitions programs should receive highest serials duplicate exchange programs, which pro- priority, and should be coordinated into a national vided free or inexpensive individual issues or entire resource. Consideration should be given to develop- runs of serials. Most RMLs promoted the exchange ing CATLINE (Cataloging Online) into a national of duplicate serial issues on an informal basis, but locator system [123]. two regions, TALON and PNRHSL, operated A number of interesting cooperative acquisitions formal, coordinated programs [ 121,122]. programs were developed by the RMLs. PSRMLS TALON also developed a serials rationalization coordinated a Cooperative Serials Acquisitions program. The libraries which contributed holdings Program (COSAP) [ I ] in which each of the RLs to the TALON Union List of Serials agreed to committed itself to maintain subscriptions to speci- maintain subscriptions to certain serials thus insur- fied journals which were held by fewer than three ing that a core set of serial titles was available libraries in the region. In 1979 TALON instituted within the region [54]. a cooperative acquisitions program for monographs An RML-NLM Working Committee on Coop- to complement its serials rationalization program. erative Acquisitions and Cataloging, Serials Each of the eleven RLs in TALON accepted

Bull. Med. Libr. Assoc. 75(3) Suppiment July 1987 27 ALISON BUNTING responsibility for purchasing all books published in library manager. In order to acquaint the generally appropriate subject fields by an assigned publish- untrained library managers with network opera- er(s) [124,125]. tions and library management techniques, The development of formalized hospital library NERMLS developed a week-long Library Train- consortia to promote the sharing of resources, first ing Institute (LTI). The LTIs were held at the proposed by Fink, Bloomquist, and Allen in 1974 Countway Library in Boston and each lasted a full [126], was encouraged by the RMLs and NLM. week [137]. The experiences gained in training Such cooperative arrangements frequently resulted hospital library managers also prompted Harold in increased self-sufficiency without extensive Bloomquist, NERMLS director, to collaborate in financial drain on individual institutions. In many the editing of Library Practice in Hospitals, a text areas formal consortia primarily involved hospital for "... untrained, probably newly employed, indi- libraries, but also included corporate, community viduals who find themselves supervising the hospi- college, nursing, and medical school libraries. tal's library and do not know where to begin" Activities common to these consortia included doc- [1 38:xiii]. ument delivery, MEDLINE search services, coop- In its first years of operation PNRHSL field erative acquisitions projects, education and train- librarians visited hospital libraries in the region on ing of consortia members, and union list develop- a rotating basis. Such visits provided the RML with ment [ 127-132]. In some communities health valuable information on regional needs, and served sciences libraries also cooperated with public to publicize its services. A one-day workshop on libraries for the provision of consumer health infor- hospital library management was held at various mation materials [133,134]. locations throughout the region [108]. PNRHSL In some regions the RLs or state university also secured grant funding to establish director of libraries received funding to improve health biomedical communications positions in Idaho and sciences library services in their geographic area. Montana, each of which lacked a medical school With funding from an NLM Resource Project library. The directors assisted with health sciences grant, the MCRMLP worked with the Wyoming library development in each state. College of Human Medicine and the University of Several other RMLs, including MERMLS and Wyoming Libraries to develop a medical informa- PSRMLS, also conducted one- or two-day work- tion network in Wyoming. Twenty-nine hospitals shops throughout their regions, and provided indi- were organized into six consortia, and provided vidual consulting services on demand. To facilitate with core health sciences library collections. Con- its consulting and training activities, PSRMLS sulting and training services were provided from published Manualfor Librarians in Small Hospi- within this subregional network [135]. Resource tals [139] which was subsequently used in several Project grant funding also assisted the development other regions including TALON and MARMLS. of a project at the University of Maine to provide Decentralized regions designed consulting and information services to rural hospitals [136]. training programs which were offered by RL staff. Initially such programs were grant funded. In the Consulting and Training Services Midwest Region, library coordinator positions were Considerable progress was made in the develop- funded in each of the six states. The coordinators ment and implementation of regional consulting began by providing both consulting and training and training services. The methodology for provid- services, and became particularly involved in the ing such services varied considerably, influenced in development of health sciences library consortia. part by the organization of the region. In general, They produced a loose-leaf training manual centralized regions were able to institute these entitled Basic Library Management for Health services most readily, since they relied primarily on Science Librarians [140] which could be used in RML staff funded by the RML contract. different educational settings. In Wisconsin an NERMLS led the way; in 1968 its staff worked alternate mode of delivery was employed, and closely with Dr. Norman Stearns, director of the courses were taught via the state's Educational Postgraduate Medical Institute (PMI), to identify Telephone Network [141]. a core list of books and journals which should be KOMRML received assistance from staff in available in any hospital library [33]. NERMLS each of its participating libraries to provide exten- then contracted with PMI to contact hospitals and sion services [ 142]. The RLs in the TALON region introduce the concept of developing and maintain- were awarded grants to provide extension services; ing such a core library, under the supervision of a at the conclusion of these grants, services were 28 Bull. Med. Libr. Assoc. 75(3) Supplement July 1987 NATION'S HEALTH INFORMATION NETWORK continued by some of the RLs, albeit on a reduced RMLs selected catalogers from each region to level [54]. attend a training session at NLM on the changes in It should be noted that in several regions the cataloging rules described in the second edition of RMLs cooperated with RMP library projects to the Anglo-American Cataloguing Rules (AACR2) develop materials of use in consulting and training [ 149]. These catalogers subsequently taught services. This was particularly true in the New regional workshops attended primarily by profes- England, Mid-Atlantic, and Pacific Southwest sional librarians. regions. Another issue discussed during this period was The extent of consulting and training services the relationship of RML consulting services to the varied considerably among regions, due in part to medical library consultant first mentioned in the the fact that in some regions such services were not 1978 Joint Commission on the Accreditation of funded by the RML contract. At the December Hospitals (JCAH), "Standards for Professional 1974 RML Directors' Meeting the RML Working Library Services" [150]. It was agreed that RML Committee on Training, Continuing Education, consulting services were designed to provide initial and Extension Services recommended that all evaluation and advice on hospital library services, funding for such services be via the contracts but would not substitute for the formal, on-going mechanism, and that training opportunities be consultant services required by the JCAH in a available in all regions. They further recommended hospital where a professional medical librarian was that NLM assume responsibility for a clearing- not on the staff. house of educational materials developed by the Several RMLs gathered data on the hospital various RMLs [143]. libraries in their regions in an attempt to measure In addition to offering basic courses designed to development and impact of RML services. An teach untrained library managers the principles of evaluation of the training program in the Midconti- organizing a small library and providing basic nental Region reported that attendance at work- services, most regions developed specialized shops encouraged library managers to provide new courses on topics such as the formation of consor- services to health professionals, and assisted in the tia, the management of audiovisuals, and adminis- improvement of existing services [151]. trative techniques. PSRMLS developed a series of KOMRML developed a formalized documenta- manuals for use in these courses [144-146]. tion process to gather baseline data [152]. The data MERMLS invited selected hospital librarians from showed that the libraries which had regular contact throughout Region III to a leadership institute with KOMRML extension librarians provided designed to prepare them to provide regional exten- more sophisticated administrative, public, and sion services in their geographic area [147]. technical services and became more active network As the educational services offered by the RMLs participants than did libraries without such con- increased in scope and magnitude, and library staff tact. It was not possible to correlate this positive in each region welcomed educational opportunities development with the extension services provided, provided locally, it became obvious that the RML's but valuable baseline data were gathered which role in this area required clearer definition. Most might prove useful in future evaluations [153]. critical was the division of responsibility among the PSRMLS analyzed the development of hospital RMLs, NLM, and the Medical Library Associa- libraries in Region XI over an eight-year period, tion (MLA), which had a well-established con- 1971-1978. The data demonstrated that there was tinuing education program. In July 1978 a position definite improvement in hospital library activity in paper delineating the responsibilities was issued by three critical areas: appropriate staffing, collec- MLA. MLA would serve as primary provider for tions, and the availability of services. As with the educational activities at the "professional" level, KOMRML study, it was not possible to demon- the RMLs would concentrate on the "untrained" strate that the library improvement was a direct library managers, and NLM would be responsible result of PSRMLS involvement. However, the hos- for training MEDLINE searchers and regional pitals which showed some of the strongest develop- audiovisual consultants [ 148]. ment were those that had used PSRMLS services It was agreed that the RMLs might on occasion most heavily [154]. provide professional training if MLA did not have a current or planned educational program. An exam- Grants ple of professional training coordinated by the In December 1972 the Biomedical Library RMLs and NLM occurred in 1980 when the Review Committee (BLRC) issued guidelines deal-

Bull. Med. Libr. Assoc. 75(3) Suppiment July 1987 29 ALISON BUNTING ing with interactions between the RMLs and the these training sessions was held at the National BLRC regarding both Resource and Regional Medical Audiovisual Center (NMAC) in Atlanta Medical Library grant applications. For RML in July 1974 [157]. grants, the applications would be required to An RML-NLM Working Committee on AV and include a statement by the RML director on how CAI Networks discussed the interrelationships the grant-funded project related to the region's between NMAC and the RMLs. Of particular plan. RML directors were also requested to work concern was the development of the AVLINE closely with applicants for resource grants, and to (Audiovisuals Online) database. It was agreed that comment, once the grant application was submit- the RMLs and NMAC would cooperate in the ted, on the relationship of the project to regional development of AVLINE, the provision of plans [155]. RML directors agreed to provide such AVLINE access and audiovisual software, and the commentary, although there was some concern development and provision of audiovisual consult- that they were being asked to judge applications ing and training services [158]. without benefit of a thorough analysis of the pro- The initial cadre of audiovisual consultants posed project. trained at NMAC was supplemented in 1976 by a By late 1974 procedures for RML interaction in second trained consultant for each region. Updates the grant process were formalized. In addition to for the experienced consultants were also scheduled commenting on proposed projects, the RMLs were in 1976, and by late that year each region was responsible for distributing grant application pack- charged with formulating an audiovisual plan. ets, thus establishing a definite RML role in the Although there was some initial confusion over the application process. exact role of the audiovisual consultants, a common The NLM Resource Improvement and Project understanding emerged. The audiovisual consul- grants were extremely useful in promoting library tants developed and taught workshops on estab- development on a regional level. RML staff lishing audiovisual collections, services and facili- encouraged institutions interested in developing ties, and were available for individual consulta- their library service to apply for appropriate grants, tions. In some regions they actively promoted shar- and often reviewed drafts of the applications. ing of audiovisual programs via interlibrary loan The Resource Improvement grants, which from mechanisms, and the creation of audiovisual union 1971 to 1975 provided one-year awards of a maxi- lists. mum of $3,000 to establish a basic library collec- In January 1981, NLM provided each region tion, provided a much needed incentive to many with a satellite collection of 300 videocassettes institutions. An evaluation of this program by from NMAC's collection. The titles were available Matheson and West [156] revealed that the grants for interlibrary loan within each region, so that did stimulate library development. The study also libraries could preview titles before purchase. included a recommendation to modify the grant NLM's total collection of over 1,000 videocassette program to support applications by consortia of titles was also available for loan. libraries. In 1975 the Resource Improvement Grant guidelines were revised: up to $4,000 could Regional Planning, Evaluation, and Research be requested in the first year to plan consortium The RMLs conducted a great deal of their activities; in the second year each institution in the planning via their advisory committees. In some consortium could receive up to $3,000 for collection cases, subcommittees were appointed to discuss development, provided it matched the amount specific problems or plan programs and services. In awarded on a three to one ratio. addition, various working committees composed of RML directors, associate directors, and other Audiovisual Services NLM and RML staff considered national issues. In October 1973 an Ad Hoc RML Committee on These working committees, as mentioned previous- Requirements for a Training Program for RML ly, were formed to establish national network goals Media Consultants met to discuss the need for in specific program areas. NLM intended that each media consulting services in each region. It recom- region would then develop regional plans to meet mended that two individuals from each region be these goals. trained to serve as media consultants to promote TALON planned several research programs increased use of non-print materials. The commit- during its first years of operation to investigate user tee designed a four-week training program which needs and improved means of information delivery. could be taught in one-week segments. The first of An automated statistical interlibrary loan package 30 Bull. Med. Libr. Assoc. 75(3) Supplement July 1987 NATION'S HEALTH INFORMATION NETWORK called NEMIS (Network Management Informa- health sciences center deans, NLM prepared a tion System) was developed, but was never imple- "4white paper" on RML network development for mented because preparation of data for input at discussion at the Association of Academic Medical each RL was not cost-effective. Another study Colleges (AAMC) Council of Deans meeting in determined that it was not feasible to centralized 1973 [164]. Meetings were also held with officials purchasing, processing, and cataloging of library of the Veterans Administration to discuss VA materials for the RLs. The Houston Academy of participation in the RML and Biomedical Commu- Medicine-Texas Medical Center Library con- nications Network. ducted a study to determine the cost of various The RMLs recognized the importance of work- library services, which yielded valuable informa- ing closely with existing networks and organiza- tion of potential use to the network [54]. tions in their regions to coordinate services [165]. A In an effort to assist the RMLs in the develop- notable example was the interrelationship between ment of regional plans, as recommended by the the NY/NJ RML and the New York State Interli- evaluation consultants in 1974, NLM requested brary Loan (NYSILL) program, a state funded expressions of interest from RMLs wishing to interlibrary loan program providing interlibrary develop a model planning process. The Midwest loan access to research library materials through- Region designed a program planning model (PPM) out the state. By agreement, health professionals with the assistance of two professional planners without access to health sciences libraries could from the University of Wisconsin. The PPM obtain needed material via their public library. The involved key reference groups, including consumers RML agreed to honor requests submitted by the and participants in the MHSLN, in the develop- New York State Library, and RML network ment and evaluation of network services. Both libraries also benefited by being able to request Delphi and nominal group techniques were used to needed non-medical research materials through elicit information [159,160]. MERMLS developed NYSILL [166]. a "4plan to plan" [104]; a significant recommenda- The RML-NLM Working Committee on Net- tion from this process was that the "...RML role work Interface/Document Delivery addressed the shift to being managers of information flow and need for coordination of document delivery activi- distribution rather than serving as sources of infor- ties in areas where state funding for document mation..." [161:14]. MCRMLP surveyed its delivery services was available. The committee Advisory Committee to establish priorities for the recommended that formal planning to develop a Midcontinental RML activities and services. Docu- model coordinated system be undertaken, and sug- ment delivery was ranked in first place, followed by gested that the MHSLN submit a proposal to information services, a category which included NLM for such a study [167]. MHSLN made computerized bibliographic services such as MED- arrangements with two state interlibrary loan net- LINE and reference services. Also important were works, the Wisconsin Interlibrary Loan Service technical, educational, and consultation services (WILS), and the Illinois Library and Information [ 162]. In KOMRML an examination of the gover- Network (ILLINET), to refer requests between nance structure resulted in the addition of BHSL the MHSLN and the WILS and ILLINET net- representatives, with full voting rights, to Region works [168]. V's Executive Committee [ 163]. The newly emerging Area Health Education The development of formal, published regional Centers (AHECs), which were charged with the plans varied among regions, since some RML provision of training and continuing education of directors were reluctant to write a plan without health professionals in underserved areas of the specific information from NLM on the essential United States, provided a new arena for coopera- elements of a plan. NLM did not provide written tion. NLM and the Bureau of Health Manpower, guidelines until 1982 when it issued the Request for which administered the AHEC program, under- Proposal (RFP) at the time of network reconfigu- took a project to inventory AHEC library projects ration. throughout the country and identify AHEC infor- mation resource needs. The study revealed that Relations with Other Networks and Programs AHEC activities resulted in significant informa- NLM and the RMLs maintained close working tion needs, but that library and information ser- relationships with RMPs through 1973, when all vices were usually not considered in AHEC pro- funding for RMP projects ceased. To gain support grams. NLM EMP staff therefore initiated discus- for RML programs and plans from academic sions with appropriate AHEC funding agencies to

Bull. Med. Libr. Assoc. 75(3) Supplment July 1987 31 ALISON BUNTING delineate responsibilities for program funding, and Louis, developed Octanet in 1980-1981. By early to coordinate information services activities [169]. 1982, Octanet was providing automated routing of In some AHECs extensive library programs were interlibrary loan requests between libraries in the undertaken, supplementing the RML network's six states of the MCRMLP. Eventually, an auto- efforts to develop and facilitate access to health mated link was developed between Octanet and the information sources for health professionals [170- DOCLINE system in use internally at NLM. 176]. Octanet also facilitated union list production for Formal relations with state library agencies were library consortia, and provided an electronic mes- established in 1976 when the Ad Hoc Committee to saging capability. Octanet development and use Study the Relationship Between State Library costs were supported by the MCRMLP contract Agencies and Health Information Libraries was until January 1983, when user charges were insti- established by the Association of Specialized and tuted [179-181]. Octanet proved to be more cost- Cooperative Library Agencies (ASCLA), a section effective than other forms of interlibrary loan of the American Library Association. The commit- request transmission such as mail, the OCLC inter- tee determined that state libraries and the RMLs library loan subsystem, and TWX, and signifi- did not have good channels of communication, and cantly reduced the transmission time for requests were generally unfamiliar with one another's ser- which had to be sent to more than one library. It vices and programs. Representatives from state also provided useful management reports and sta- libraries, NLM, and the RMLs proposed that tistics [ 1 81 ]. informational meetings be organized in each of the In an effort to speed delivery of the document eleven regions. Meetings were subsequently held in itself, some regions experimented with telefacsim- the TALON, Pacific Northwest, and Midwest ile transmission between health sciences libraries regions [177], while other RMLs appointed state [182]. Although such transmission had the poten- library directors to their advisory committees, tial of greatly reducing the elapsed time between thereby establishing a continuing communications requesting and receiving a document, the cost and link. MERMLS participated as a member of the various operational deficiencies prevented wide- Council of Pennsylvania Library Networks, estab- spread adoption of this technology. lished by the Pennsylvania State Library to pro- Publicity and Publications mote cooperation among networks, cooperatives, and consortia [178]. Regional publicity was accomplished primarily through the publication of RML newsletters (Ap- Technological Developments pendix 3) on a monthly, or, as funding decreased, quarterly basis. The recent acquisitions lists issued NLM and the RMLs readily adopted technolog- in the early days of the program were discontinued ical developments in order to improve or speed as a cost-saving measure. In addition, most RMLs access to information. In 1976 NLM began to developed brochures and posters describing and develop DOCLINE (Documents Online), an auto- advertising regional services. The National Library mated interlibrary loan request routing system of Medicine News included a series of articles on which would also provide accounting and statistical the RMLs, describing the unique features of each data on the national interlibrary loan traffic. region to a national readership [168,178,183-202]. DOCLINE would interface with a single, national Full-length articles in health professional and serials holdings file (eventually named SER- library publications also served to provide informa- HOLD), which would provide the necessary infor- tion on the accomplishments of the RML program mation for routing requests to a library owning the [203-208]. In addition, RML exhibits were needed title, and with the MEDLARS biblio- mounted at health professional meetings, in an graphic files, eliminating the need to key in journal increasing effort to reach health professionals article citations [ 161 ]. Full implementation of directly. A very popular feature at RML exhibits DOCLINE on a national level was delayed until was the online demonstration of MEDLINE. 1985, but the RMLs provided design input during the developmental phase, and assisted in gathering Network Evaluation information for the serials locator file. RML Evaluation-1972-1974 MCRMLP, which had access to PHILSOM The 1972 report of the BLRC's RML Commit- (Periodical Holdings in Libraries of Schools of tee recommended that the RML program be evalu- Medicine), an online serials holdings file created ated periodically. Later that same year, NLM and maintained by Washington University in St. appointed a committee of RML Evaluation Con- 32 Bull. Med. Libr. Assoc. 75(3) Supplement July 1987 NATION'S HEALTH INFORMATION NETWORK sultants. This committee organized site visits to approved an NLM proposal to fund various evalua- each of the eleven RMLs by consultation teams tion projects proposed by interested RMLs, in composed of representatives of the BLRC, the addition to an NLM-conducted study on the total Board of Regents, health and library professionals, interlibrary loan activity provided by the RMLP. key NLM staff, and an RML director. The visits The interlibrary loan analysis indicated that only took place between November 1972 and February about 25% of regional interlibrary loan traffic was 1974. funded by RML contracts, and that hospital During the site visits, the consultation teams met libraries received about 50% of network loans. with RML staff, administrators from the RML Statistical information on the interlibrary loan institution, and representatives from RML user traffic emanating from hospital libraries was gen- groups, including both librarians and health profes- erally not available, and it was recognized that this sionals. Individual reports for each RML were would be important information to gather in the issued by the site review team, including recom- future. In four regions where such data were avail- mendations for improvements and changes in the able, analysis revealed that interhospital interli- various programs and services. Most pertinent were brary loan traffic exceeded or almost equaled the recommendations and comments which applied RML/RL interlibrary loan traffic [210]. Regional uniformly to each of the eleven RMLs. studies included further analyses of interlibrary The site visitors concluded that in each region loan data, evaluation of extension services and local the document delivery system was operating "...to a library development, and the effectiveness of most satisfying degree of efficiency and effective- regional newsletters [154]. ness" [209:4]. It was noted that the services most in In 1980, as a direct result of the decision reached need of expansion in the coming years were out- at the 1979 planning meeting to examine the RML reach programs, including consultation and train- network configuration, NLM contracted with Abt ing; communications in the form of publications; Associates, Inc. to conduct an evaluation of the and resource sharing efforts, such as cooperative RMLP. The contractor would "...review the impact serials acquisitions and retention programs. of national performance standards, the effect of The regional boundaries as constituted presented user charges, the implication of developing technol- no real difficulties, but flexibility was encouraged ogies and MEDLARS III, the ideal relationship whenever traditional boundaries differed from between the RML network and other networks, RML lines. Teams found considerable talent and and the soundness of a decentralized hierarchical leadership among RML staff, and the institutional network" [95:7]. An exploratory evaluation report, support for the RML headquarters library was submitted in 1981, included preliminary data and firmly based. It was felt, however, that nearly all the results of interviews with network administra- the RML advisory committees needed to be res- tors and library participants [21 1 ]. The evaluation tructured or revitalized. This was particularly contract with Abt was terminated by NLM after important in light of regional planning efforts, submission of the exploratory report. NLM had where advice from a broad range of network partic- decided that changes in the RML network struc- ipants was essential. Communication between ture would be required in the very near future for RMLs should also be strengthened and improved. budgetary reasons, and could not be delayed until Each RML was advised to develop a regional the evaluation was completed. plan. Much of the planning to date had taken place on an ad hoc or informal basis, and had not Characteristics ofthe Original Eleven Regions involved the RML user population. NLM was A summary of the original eleven regions, encouraged to provide planning guidance by stat- emphasizing their distinctive characteristics and ing the goals for regional plans. The consultants major accomplishments, serves to illustrate one of recommended that RML program evaluation the strongest features of the RML network-the efforts continue, but that in the future the RML development of programs and services responsive to directors, accompanied by several representatives local needs to accomplish national objectives. Table from their region, brief the evaluation consultants 7 illustrates the demographic diversity of each on regional activities and progress [209]. region, featuring those programs and services for which each RML is best remembered. 1977 and 1980 Evaluation Projects Region 1: New England Regional Medical In 1977 the National Institutes of Health's Library Service (NERMLS). NERMLS served a Office of Program Planning and Evaluation region which was geographically cohesive, contain- Bull. Med. Libr. Assoc. 75(3) Supplment July 1987 33 ALISON BUNTING

TABLE 7 DEMOGRAPHICS OF THE ORIGINAL ELEVEN REGIONS 1980 DATA 1.1

1 -

0.9 - 00, 0.8 -

0.7 -

a c 0.6 - .2 P., 0.5 - N

0.4 - I/ .r I/' 0.3 - \.N 0.2 - el

1.11\N elIr oor oor 0.1 -

X 0 - I I I I I I I I I XI I 11 III IV V VI VIl Vill IX X Xl- Regions VZJ Sq. Mlies i\u Hoop. Be 00 Hlth. Profe.

ing both major metropolitan centers with strong tion or alliance of health sciences libraries with library resources and rural states with perhaps only existing or developing local or statewide library one strong health sciences library collection. A networks. major focus of the NERMLS program was educa- Region III: Mid-Eastern Regional Medical tion, particularly for untrained hospital library Library Service (MERMLS). Region III encom- managers. Both the core library collection [33], passed the smallest geographic area of the original and hospital library consortium concepts [126,127] RMLs. The strongest health sciences library were developed and widely used in the New resources in the Mid-Eastern Region were located England Region. As the first RML, NERMLS was in the Philadelphia area, and approximately 70% of called upon to provide extensive advice to other its population was concentrated in urban areas. regions on their organization and development of MERMLS was noted for rapid and cost-effective RML programs. interlibrary loan service, a strong and active refer- Region II: New York/New Jersey Regional ence service, a substantive newsletter from which Medical Library (NY/NJ). The NY/NJ Region other regions often reprinted articles, leadership contained very rich health sciences library institutes [ 147] which trained librarians in the resources in the greater New York City metropoli- region to provide consulting and training services in tan area. Over 90% of the population of the region rural areas, and a high degree of user satisfaction. was located in urban areas. Libraries in both New Region IV: Mid-Atlantic Regional Medical York City/Northern New Jersey and throughout Library (MARML). The Mid-Atlantic Region con- the state of New York had long-standing history of tained a concentration of health sciences libraries cooperation both at the local and state level. Not in the greater Washington, D.C. metropolitan area surprisingly, therefore, the NY/NJ RML is noted which had traditionally relied heavily on the for strong union list programs, and for the integra- resources of a great, local library-the National

34 Bull. Med. Libr. Assoc. 75(3) Supplement July 1987 NATION'S HEALTH INFORMATION NETWORK

Library of Medicine. Other areas of the region metropolitan areas. MCRMLP is best noted for its were predominantly rural; the strongest library sophisticated use of technology to facilitate or resources here were the academic health sciences enhance regional services including the develop- libraries. RML programs and services in the Mid- ment of Octanet in cooperation with the PHIL- Atlantic region were not as identifiable as in other SOM network. MCRMLP staff were also active in regions, because NLM staff who were assigned the conduct of formal evaluations of regional ser- Region IV responsibilities were frequently identi- vices, such as training and Octanet, and publishing fied with NLM rather than the regional office. the results, and, in 1981, began to provide online Region IV relied heavily on committees of librar- training for the center of the country. ians to set policies, develop, and, in some cases, Region IX: South Central Regional Medical provide regional services. Library (TALON). TALON also covered a vast, Region V: Kentucky, Ohio, Michigan Regional primarily rural, geographic area, and operated its Medical Library (KOMRML). As the first decen- region with the cooperation of resource libraries. tralized region, KOMRML built upon the services Particular emphasis was placed on the development and expertise provided by its participating (re- of union lists of monographs, serials, and audiovi- source) libraries. KOMRML developed a strong suals; the operation of a serials duplicate exchange regional communications program, generating program; and cooperative acquisitions programs. extensive documentation for the establishment of Emphasis was placed on continuing education for policies and the recording of accomplishments and hospital library managers and a training manual, future goals. The RML office served to coordinate produced in 1979 [213], was used by other all regional activities, thus insuring consistency of regions. service in a decentralized program. Region X: Pacific Northwest Regional Health Region VI: Southeastern Regional Medical Sciences Library (PNRHSL). Region X comprised Library Program (SERMLP). SERMLP provided the largest geographic area of any of the regions, regional services via resource libraries located in and contained only two academic health sciences primarily rural states. SERMLP staff and instruc- libraries. Thus, emphasis was placed on developing tors from the resource libraries taught a variety of partnerships with state or university libraries to basic courses for library managers throughout the assist in providing health sciences library services region, with particular emphasis on consortia to the region's health professionals. PNRHSL was development. Resource libraries assumed responsi- also noted for the development of an automated bility for several major program efforts, including interlibrary loan statistical program, and for pro- MEDLARS search services and the compilation moting and developing standards for the collection and production of a regional union list. of such statistics. Region VII: Midwest Regional Medical Library Region XI: Pacific Southwest Regional Medical (MRML). The Midwest Region included both Library Service (PSRMLS). Region XI included major metropolitan areas, with strong health one highly populous state (California) with eight sciences library resources, and predominantly rural academic health sciences libraries, and three pri- states. The state coordinators program was a model marily rural states. Particular emphasis was placed for the provision of consulting and training pro- on the development of strong hospital libraries grams in a decentralized region, and the manual through an extensive consulting and training pro- [140] developed for this purpose was widely used, gram. Training manuals developed by PSRMLS including a Japanese translation prepared by the were used throughout the RML network [ 139,144- Japan Medical Library Association [212]. The 146]. Several analyses of hospital library develop- Midwest Region conducted the most formal and ment in the region were conducted [154,171 ]. extensive regional planning program, involving all PSRMLS also served as the West Coast online types of health professionals and librarians. Con- training center, facilitating the development of sortia development was especially strong in this online centers in the western part of the country. region; thirty-nine consortia with over 500 member THE RECONFIGURED NETWORK institutions were in operation by 1978 [168]. (1982-1985) Region VIII: Midcontinental Regional Medical Network Management and Architecture Library Program (MCRMLP). The Midcontinen- Reconfiguration of the network from eleven to tal Region included the largest number of states seven regions was necessary primarily because the (seven) in any region, covering a vast geographic amount of funding available for the RMLP had not area with library resources concentrated in a few kept pace with costs. In contrast to the original

Bull. Med. Libr. Assoc. 75(3) Suppiment July 1987 35 ALISON BUNTING formation of the RML network, where the geo- National Library of Medicine and carried out through a graphic composition of each region was for the nationwide network of health-sciences libraries and infor- most part self-determined by librarians and health mation centers [102:3]. professionals in the regions, the boundaries of the In early 1982 RFPs for three-year RML con- reconfigured regions were determined by NLM tracts for the new regions were issued; new con- with the assistance of outside consultants [214:5]. tracts were awarded on a phased schedule between Comments on the RML program were solicited September 1982 and January 1983 [216]. Table 8 from network participants and factored into the lists the new regions and RML headquarters; the program review at NLM [215]. number designations for the regions changed from roman to arabic with the reconfiguration. Table 9 Request for Proposals illustrates each region's demographic characteris- A revised RMLP mission statement delineated tics. in NLM's Request for Proposal stated that the Contract Awards RMLP shall: Four of the regions-Region 4 (MCRMLP), Provide health sciences practitioners, investigators, edu- cators, and administrators in the United States with Region 5 (TALON), Region 6 (PNRHSL), and timely, convenient access to health care and biomedical Region 7 (PSRMLS)-remained essentially un- information resources. The Program is coordinated by the changed in geographic composition, although

BLE 8 RECONFIGURED REGIONAL MEDICAL LIBRARY REGIONS

Region Regional Medical Library Area Served Operational

I Greater Northeastern Regional Medical Connecticut, Delaware, Maine, December 1982 Library Program (GNRMLP) Massachusetts, New Hampshire, New York Academy of Medicine Library, New Jersey, New York, Pennsylva- New York nia, Rhode Island, Vermont and Puerto Rico 2 Southeastern/Atlantic Regional Medical Alabama, Florida, Georgia, Mary- January 1983 Library (SEARML) land, Mississippi, North Carolina, Health Sciences Library, University of South Carolina, Tennessee, Virgin- Maryland, Baltimore ia, West Virginia, District of Co- lumbia, and the Virgin Islands 3 Greater Midwest Regional Medical Library Illinois, Iowa, Indiana, Kentucky, January 1983 Network (GMRMLN) Michigan, Minnesota, North Dako- Library of the Health Sciences ta, Ohio, South Dakota, Wisconsin University of Illinois at Chicago 4 Midcontinental Regional Medical Library Colorado, Kansas, Missouri, Ne- January 1983 Program (MCRMLP) braska, Utah, Wyoming Library of Medicine University of Nebraska, Omaha 5 South Central Regional Medical Library Arkansas, Louisiana, New Mexico, November 1982 (TALON) Oklahoma, Texas University of Texas Health Science Center at Dallas 6 Pacific Northwest Regional Heatlh Sciences Alaska, Idaho, Montana, Oregon, September 1982 Library Service (PNRHSLS) Washington Health Sciences Information Center University of Washington, Seattle 7 Pacific Southwest Regional Medical Arizona, California, Hawaii, Ne- September 1982 Library Service (PSRMLS) vada, and U.S. territories in the Pa- Biomedical Library cific basin University of California, Los Angeles

36 Bull. Med. Libr. Assoc. 75(3) Supplement July 1987 NATION'S HEALTH INFORMATION NETWORK

TABLE 9 DEMOGRAPHICS OF THE RECONFIGURED REGIONS 1980 DATA 1.4 -

1.3 - 1.2 -

1.1 - I1- oll, N, I.-, 0.9 - ol 0.8- 0 0.7 - 00, i %d 0.6 - 00, 0.5 - r

0.4 - 000' 000'

0.3 -

I 00, 0.2 -

0.1 - 0 X- v I 2 3 4 5 6 7

1Z1 Sq. Mile Hoop. MF/%l Hith. Prof.

South Dakota, formerly part of the Midcontinental brary Service (SEARML). NLM had decided to region, requested and received reassignment to the concentrate on network administration and man- newly configured Region 3-Greater Midwest agement, and withdrew from its role as an RML. Regional Medical Library Network (GMRMLN). One proposal, which included a subcontract to In each case the existing RML headquarters provide MEDLINE training with the University of library submitted a successful RML contract pro- North Carolina, Chapel Hill, Health Sciences posal without competition from other libraries. Library, was received from the University of Mary- Significant change and considerable competition land Health Sciences Library, Baltimore. The Uni- occurred in the three newly configured eastern and versity of Maryland Health Sciences Library was midwestern regions. The old Regions I, II, III, and awarded the contract for RML services in Region Puerto Rico, formerly part of Region IV, were 2. The online training subcontract was not combined into Region 1, the Greater Northeastern awarded, and NLM continued to provide online Regional Medical Library Program (GNRMLP). training for this area. The Region 2 contract did, Three proposals to provide RML services for however, include a subcontract with the University Region 1 were submitted by the New York Acad- of Alabama, Lister Hill Library of the Health emy of Medicine, New York; the College of Physi- Sciences, to provide extension services for the cians, Philadelphia; and the University of Connect- southern states. icut, Health Sciences Library, Farmington, which In the Midwest, old Regions V and VII and submitted a joint proposal with the Countway South Dakota were combined to form the Greater Library, Harvard University, Boston. The New Midwest Regional Medical Library Network York Academy of Medicine was selected as the (GMRMLN), Region 3. The University of Illinois RML, effective December 1, 1982. at Chicago, Library of the Health Sciences was the Old Regions IV and VI were combined to form sole bidder for this contract which was awarded in the Southeastern/Atlantic Regional Medical Li- January 1983. Bull. Med. Libr. Assoc. 75(3) Supplment July 1987 37 ALISON BUNTING

Organization and Management ofthe RML caused occasional communications breakdowns Program and strained relations between NLM and the RML Management of the Program at NLM directors. At the May 1983 RML Directors' Meet- ing only the RML directors were permitted to After Sheldon Kotzin accepted another position attend. The directors objected to this practice, as at NLM, Duane Arenales served as the acting they had in 1971, since the associate directors were RML coordinator from 1982-1983; Becky Lyon- responsible for the daily operation of regional pro- Hartmann was appointed to this position in 1984. grams and could not function effectively if they The RML coordinator continued to report to the were excluded from policy and program discussions associate director for Library Operations; Lois Ann at this important forum. After considerable debate Colaianni replaced Joseph Leiter, Ph.D., in this and negotiation, the associate directors were position first on an acting basis in 1982, and included in subsequent meetings. Another change permanently in 1984. Martin M. Cummings, took place when NLM began treating RML Direc- M.D., director of NLM since the inception of the tors' Meeting as a meeting of contractors, thus RML program, retired early in 1984; Harold excluding outside observers. Schoolman, M.D., served as acting director until At the RML Directors' Meeting in 1983 and Donald A.B. Lindberg, M.D. was appointed in 1984, several discussions ensued concerning the October 1984. An RML Policy Group was estab- future of the RML program. Topics included the lished at NLM, composed of the deputy director implications of the existence of, or lack of, an RML for NLM and the associate directors for Extramu- network, and identification of core RML program ral Programs and for Library Operations. The elements. These discussions provided background Policy Group served as the oversight body, coordi- information for a working group of NLM staff nating major policy discussions and changes in the charged with re-examining the existing RML pro- RML program. gram. The NLM Working Group recommended The MLAA funding levels remained static that the RML program should continue as pres- throughout this entire period, as almost all federal ently configured. It further recommended that government agencies and programs operated under Requests for Proposal (RFPs) for five-year, incre- a continuing resolution. The amount of funding mentally funded contracts be issued as existing obligated to the RMLP decreased from $2,399,000 contracts expired [217]. in 1982 to $2,000,000 in 1985. Despite the saving Three basic goals for the program were defined generated by decreasing the number of regional [218:24]: libraries from eleven to seven, and the institution of 1. To improve access to and delivery of informa- cost-recovery measures for certain RML programs tion to health professionals. and services, it still became necessary to make 2. To develop and maintain an effective and additional cuts by the third year of the contracts. efficient network of health science libraries. These budgetary limitations, coupled with concern 3. To develop and maintain linkages between over whether the MLAA would receive renewed the network and other library/information authorization, made it difficult to respond to new networks or health professional organizations regional needs and to recruit staff. The require- to share resources. ment to make budget cuts quickly also precluded The passage of the Health Services Extension appropriate preparation and consultation with net- Act in 1985, extending the MLAA through Sep- work participants concerning the instituted tember 1988 at increased authorization levels, changes. Steadily increasing indirect cost rates, made implementation of the programs proposed in charged to the RML contract by the host institu- the new contracts possible. NLM issued an RFP tion, reduced the amount of contract funds avail- for the RML contracts in February 1985. By early able for RML services. RML directors attempted 1986 awards had been made to the existing RMLs, to arrange reduced indirect cost rates, but had which were the sole bidders in each of the seven limited success since the rates were generally nego- regions [219]. tiated by their parent institution with the Depart- ment of Health and Human Services to cover a Programs and Services wide range of federally funded projects. The contracts issued in 1982 and 1983 gave RML Directors' Meetings priority to the provision of information services to Reconfiguration and the attendant pressures health professionals regardless of geographic loca- caused by the competitive contract bidding process tion. Each RML identified underserved areas in its 38 Bull. Med. Libr. Assoc. 75(3) Supplement July 1987 NATION'S HEALTH INFORMATION NETWORK region, and developed plans to improve access to charge per filled request not exceed the then information in these areas. Basic RML services national maximum of $6.00. The intent was to remained essentially unchanged, although the cost complete the phasing out of contract funding for of providing several of the services was now shared the delivery of documents, restricting their use to with the recipients. Evaluation to determine support management of the system. Table 10 illus- achievement of network goals, demonstrate the trates the regional interlibrary loan traffic handled benefits of network services, and examine new or by the RLs during this period. emerging information needs continued to be an Significant changes were also instituted in the important activity. hierarchical referral network which had been in The RML RFP also included provisions for the place since the inception of the RML network. award of three "options," or supplementary activi- Effective October 1983, NLM began to accept ties, in addition to the basic contract. They were: requests directly from any library for periodical (1) the provision of initial and advanced online articles unavailable within a region, [220] and MEDLINE training, (2) the creation of instruc- established, for the first time, a charge of $5.00 for tional packages primarily for BHSL personnel, and all interlibrary loan requests filled for domestic (3) the development of model projects in informa- libraries [221]. tion transfer. Despite the submission of proposals Interlibrary loan network management responsi- for all three options, the only option awarded was bilities included the implementation of DOCLINE for online training; PSRMLS and MCRMLP con- as it became operational in the regions. Throughout tinued to provide these services. 1984 DOCLINE was tested by the RMLs, and on March 15, 1985, the UCLA Biomedical Library, Interlibrary Loan which had served as a test site for DOCLINE All the new contracts required RMLs to provide development since 1976, transmitted the first offi- interlibrary loan services, specifying that the cial DOCLINE request to NLM [222]. In order to

TABLE 10 INTERLIBRARY LOAN STATISTICS 1983-1985 1.1

1 i 0.9 - 0 . 0.8 -

0.7 - oa I _ 0 0.6 -

.0 0.5 - C 0.4 -

0.3 -

0.2 .4 0.1 I 83 84 8S Yewr O RML Total + NLM Total Combined Total Bull. Med. Libr. Assoc. 75(3) Suppiment July 1987 39 ALISON BUNTING evaluate carefully the impact of DOCLINE on the ers. The online training centers at NLM, UCLA, overall performance of the NLM online system, and the University of Nebraska expanded the other libraries were added gradually. The RMLs number of off-site initial and advanced training came first, followed in May 1985 by the RLs in classes offered, with technical resource persons Region 1, and in July by libraries in the Medical (TRPs) continuing to provide annual updates at Library Center of New York consortium. Region 7 various locations. libraries in the states of Arizona, Hawaii, and In response to complaints from users about Nevada began to use the system in September inconsistent charges for MEDLINE searches, 1985; California libraries were added in January NLM proposed a national maximum $25.00 fee for 1986. All RLs in the country, except those in a basic MEDLINE search provided by RMLs or Region 4 which utilized Octanet, had been added RLs. In presenting the policy at the May 1983 by December 1985, and plans were in place to add RML Directors' Meeting, NLM defined a basic or all remaining BHSLs by the end of 1986 [223]. "minimum" search as [218:91: 1. Search of a single non-royalty database. Union Lists and Catalogs 2. Formulation, retrieval, and evaluation requir- ing not more than thirty minutes. Union list efforts concentrated primarily on the 3. Searching consuming approximately fifteen submission of serials holdings data from as many minutes or less of online connect time, includ- network libraries as possible to SERHOLD (Se- ing searching and printing online retrieval. rials Holdings), formerly known as the National 4. In most cases, retrieval will include author, Biomedical Serials Holdings Database. The pri- title, and source data elements; or author, mary objective of SERHOLD was to support the title, publisher and year of publication. automated routing of interlibrary loan requests on 5. The search may include requesting an offline DOCLINE. When a request was entered into print, but the cost of the offline print itself is DOCLINE, the computer would check SER- not included. HOLD and automatically route the request to a With a national maximum charge in place, NLM library which owned the serial title. SERHOLD was willing to make referrals for online searches to data could also be manipulated to produce regional institutions which to the format. Each agreed stated guidelines. union lists in print or microform Technological advances precipitated two signifi- data coor- RML appointed a SERHOLD holdings cant changes in the use of NLM online databases dinator who assumed responsibility for collecting during this period. The increasing availability of regional serials holding data for submission to created interest SERHOLD, disseminating policy information, and microcomputers greater among within the health professionals in conducting their own online reproducing and distributing products searches. NLM responded by developing a one-day region [224]. course and workbook, The Basics of Searching During this same period, NLM investigated the data- MEDLINE: Guide for the Health Professional, feasibility of developing an online holdings [226] to train health professionals how to search but con- base for monographs and audiovisuals, MEDLINE. This course was quickly followed by a cluded that the small number of such loans pro- course for librarians entitled "Teaching MED- cessed by network libraries, generally less than 20% LINE to the Health Professional: A Workshop for of the total traffic, did not justify the cost of Search Intermediaries." By training trainers, the developing such a database. NLM and the RMLs number of individuals who could provide the "Ba- would instead concentrate on developing linkages sics of Searching MEDLINE" course throughout to existing databases such as OCLC. BHSLs were the country increased substantially. The RMLs identified as the libraries most in need of access to took an active role in encouraging librarians monograph and audiovisual location information, the to take the MED- in throughout region "Teaching and the RMLs were very interested providing LINE" course and to provide instruction to health access to such information [225]. GMRMLN con- professionals [227]. Such encouragement to teach tinued to provide such access via its online union was welcomed by most libraries, which rapidly catalog [ 1 14]. developed active training programs for health pro- fessionals. MEDLINE Institutions and individuals also became inter- The NLM online network continued to grow ested in mounting portions of the various NLM significantly, as did the number of trained search- databases on in-house computers, to allow for local

40 Bull. Med. Libr. Assoc. 75(3) Supplement July 1987 NATION'S HEALTH INFORMATION NETWORK searching without incurring online connect mation services and make use of network services, charges. In response to this interest, NLM devel- were continued in the new contracts, albeit on a oped a Domestic MEDLARS Subset Policy [228] cost-recovery basis. In the first year, RMLs were designed to make it possible to lease subsets of the required to recover 25% of the cost of providing MEDLARS database on tape, and to mount these consultations and presenting workshops. By the subsets of MEDLARS on personal or institutional third year, participants were to pay 75% of the computers. costs. This cost recovery approach was "...expected to lead to self-sustaining basic training and consul- Reference Services tation programs" [216:3]. NLM compiled and distributed a list of all RML The provision of backup reference services con- training manuals to promote sharing of this infor- tinued in most regions. In 1983 NLM and the mation among RMLs and other interested trainers. RMLs in Regions 3, 6, and 7 participated in a test At the February 1984 RML Directors' Meeting, project to determine the feasibility and need for a .NLM announced that the need to continue federal cooperative reference network consisting of the funding of consulting and training programs would RMLs and NLM. The participants used electronic be considered in the overall RML program evalua- mail to broadcast difficult reference questions tion in preparation for the next round of RML which had not been answered locally. Only a few contract bids [231]. By the end of that year, it questions were submitted during the project period became clear that these consulting and training and the results were inconclusive. However, RMLs services would most likely be phased out as an were encouraged to submit difficult questions to RML service in future contracts. Several RMLs NLM, which would try to locate answers or make began to develop rosters of individuals willing to an appropriate referral [224]. serve as consultants in their regions, in order to provide referrals when such services were Resource Sharing requested. PSRMLS also developed a workshop One new element of the RML contracts was the entitled "Consulting Services and Library Skills provision of funding for cooperative acquisitions of Training: A Seminar for Librarians," designed to most types of library materials. Region 1 developed interest local librarians in serving as consultants a Cooperative Acquisitions Program (CAP) which and trainers, and to acquaint them with available identified, through examination of interlibrary loan resources for the provision of these services. requests, subject area and serial title gaps. Resource libraries were funded to purchase these Grants needed materials, thus making them available to Region 1 libraries via interlibrary loan. Region 1 The role of the RMLs in the NLM grant review also developed a serials acquisitions and retention process changed substantially in 1983. Providing program called Regional Coordination of Biomedi- comments on grants, as requested initially by the cal Information Resources (RECBIR). RECBIR BLRC in 1972, was "...regarded by some as preju- was coordinated and operated by the Medical dicial to the NIH peer review process" [218:4]. Library Center of New York; the RLs and some of RMLs, therefore, no longer provided such com- the larger libraries in Region 1 agreed to maintain ments, but continued, upon request, to work closely subscriptions to journals indexed in Index Medicus with applicants during the proposal preparation and other health indexes and abstracts [229]. phase [232]. In Region 3, the funds were allocated to RLs and BHSLs in each of the ten states in the region, with Audiovisual Services emphasis placed on purchasing materials for sub- ject areas not widely held in the region [230]. The RMLs continued to coordinate the provision TALON applied its funding to its cooperative of audiovisual loans from the NMAC videocassette acquisitions program for monographs, established satellite collections in each region. The role of in 1979 [215]. regional audiovisual consultants, as a formal part of the RML program, was eliminated in the new contracts. However, names of individuals willing to Consulting and Training Services serve as audiovisual consultants were usually part The consulting and training services, designed to of regional consultant rosters. Some RMLs con- prepare hospital library managers to provide infor- tinued to provide training courses on the acquisi- Bull. Med. Libr. Assoc. 75(3) Suppiment July 1987 41 ALISON BUNTING tion and management of audiovisuals in a health BHSLs in their regions to gather baseline data on sciences library. library collections, organizations, services, and staffing. In Regions 5 and 6 these data were Regional Planning and Evaluation tabulated [234-236] and plans were made to con- Each RML was charged with selecting some duct future studies once longitudinal data were* aspect of its programs and services to evaluate collected and analyzed. during the contract period. Projects undertaken Because baseline data from surveys conducted included: (1) evaluation of an online catalog of both in 1969 and 1971 were available, Region 7 monographs and audiovisuals (Region 3); (2) the was able to conduct an evaluation of the develop- effect of Octanet on interlibrary loan turnaround ment of hospital libraries in its region, and to assess time (Region 4); (3) the development of baseline the quality of PSRMLS programs and their effects data on consultation programs and locator tools on the libraries surveyed. The study revealed that (Region 2); (4) the effect of a cooperative acquisi- hospital libraries in Region 7 had improved signifi- tions program (Regions 1 and 5); (5) the extent of cantly on a number of criteria between 1969 and non-contract RML program support (Regions 4 1984. In 1969 only 40% of the hospital libraries and 6); (6) the effect of locator tools on interlibrary were staffed by library managers or librarians, as loan patterns (Region 7); (7) the impact of RML compared to 69% in 1984. The number of hospital programs on underserved areas (Regions 3 and 6); librarians with M.L.S. degrees increased from 35 and (8) the impact of the RML program on the in 1969 to 249.5 in 1984. Collection size also development of hospital libraries (Region 7) improved significantly. In 1969 70% of hospital [217]. libraries subscribed to fifty or fewer journal titles; The evaluation of the TALON Cooperative in 1984 only 40% of the libraries subscribed to fifty Acquisitions Program demonstrated that an or fewer journal titles. The range and amount of increased availability in that region of monographs services provided also increased. For example in issued by the publishers whose publications the 1969, 30% of BHSLs provided manual or compu- RLs had agreed to obtain. This study also provided terized bibliographies, as compared to 100% in valuable information on the objectives of the pro- 1984. Interlibrary lending and borrowing activities gram which were not being met, thereby instigating increased substantially, and organization and cur- an overall reassessment of policies and procedures rency of the collections also improved, with more [125]. Region 1 gathered baseline data to assist in a libraries regularly weeding and cataloging their future evaluation of the effect of its Cooperative collections. Data analysis also confirmed that Acquisitions Program on regional interlibrary loan PSRMLS had a major impact on library operations fill rates and to identify additional journal titles or and services in the region. Respondents gave highly subject areas which needed to be strengthened. positive ratings to the quality of PSRMLS pro- The survey of network library contributions to grams, and the direct impact of these programs on the RML program in Region 4 indicated that library operations was demonstrated [237,238]. 22.8% of its RML program expenditures were contributed by the RLs, primarily in staff efforts Relations with Other Networks and Programs [227]. In Region 7 a preliminary analysis of the Increased emphasis was placed on exploring effect of union lists on interlibrary loan borrowing possible avenues of cooperation with other library patterns revealed that interlibrary loan traffic networks. Particularly pertinent was the emerging among BHSLs in a sub-regional area increased national interest in intertype library networks after publication of the first union list for that area. which promoted cooperation and resource sharing It was not possible to show a definite cause and between all types of libraries such as public, aca- effect relationship, but PSRMLS felt that the demic, and special, including health sciences, publication of the union list did contribute to this libraries. change [217]. Region 2, which published its first regional union list in October 1983 gathered base- Technological Developments line interlibrary loan data to determine if there was In the interim between DOCLINE experimenta- any relationship between the availability of the tion and implementation, basic health sciences union list and interlibrary loan traffic patterns and libraries, with the encouragement of the RMLs, fill rates. A complete analysis was scheduled when began to use electronic mail to speed the transmis- sufficient data become available [233]. sion of interlibrary loan requests [239]. NLM Regions 5, 6, and 7 all conducted surveys of conducted an electronic mail pilot test with

42 Bull. Med. Libr. Assoc. 75(3) Supplement July 1987 NATION'S HEALTH INFORMATION NETWORK

Regions 6 and 7, and developed, with RML input, a delivered over ten million documents to health recommended format for the transmission of inter- professionals between 1969 and 1983. Statistics on library loan requests via electronic mail [227]. the BHSL document delivery traffic are not avail- Region 4 continued to use Octanet for the elec- able, but it is estimated that over 50% of the tronic transmission of interlibrary loan requests interlibrary loan traffic in each region is handled within the region and to NLM. by these libraries. If this assumption is valid, then Region 6 experimented with a remote search the total number of documents delivered by all system designed to allow two geographically sepa- types of health sciences libraries during this period rate users of an online search system to see simulta- is in excess of twenty million. Table 12 provides a neously the results of an online search being con- comparison of the BHSL and RML/RL interli- ducted by one of the users. This search capability brary loan requests filled in Region 7. allowed a health professional located in an area In the years just prior to the passage of the without a trained online searcher to interact with a MLAA, NLM was processing a significant number searcher at another location while a search was of interlibrary loan requests for the nation's being conducted [240]. libraries. An analysis of the interlibrary loan Region 3 conducted a pilot serials exchange requests processed in 1959 [243] tabulated the study, designed to create a machine-readable data- number of loans to individual libraries, and base of duplicate serials available for exchange recorded the most frequently requested journal between libraries. A microcomputer program was titles. The top five journals requested at that time developed, which combined into one alphabetical were [243:3]: sequence the lists of duplicate journal issues sub- 1. Lancet mitted via electronic mail by participating libraries 2. British Medical Journal [240]. 3. American Journal ofPhysiology 4. Journal of the American Medical Associa- Publicity and Publications tion In an effort to reach health professionals 5. Journal ofBiological Chemistry directly, increased emphasis was placed on exhibit- A recent analysis of NLM's 1984 interlibrary ing at health professional meetings. Several RMLs loan requests [244] revealed that regional reliance designed special exhibits advertising the availabil- on NLM for interlibrary loan purposes had ity of information services. The health professional decreased significantly. For example, in 1959, 55% online training course, "The Basics of Searching of the libraries submitting requests to NLM Medline," was taught by NLM and RML online received ten or fewer loans; in 1984 71% were in trainers at several national meetings. Publications this occasional use category. In 1959 16% of the emphasizing the accomplishments of the network libraries received only one photocopied article, by were also prepared [2411. 1984 26% were in that category [244:9]. In 1984 the most heavily requested titles were quite dif- IMPACT OF THE REGIONAL MEDICAL LIBRARY ferent from those requested in 1959 [244:12]: PROGRAM 1. Clinical and Experimental Obstetrics and In the twenty years since the passage of the Gynecology MLAA, the RMLP has significantly improved the 2. Italian Journal ofNeurological Sciences means by which health professionals and health 3. European Journal of Gynaecological sciences librarians obtain and manage information. Oncology The network, as developed in the late 1960s, has 4. Medicina Clinica stood the test of time, undergoing constant modifi- 5. Nursing cation in response to fiscal and environmental The comparison of the journal titles most fre- changes, yet never losing sight of its ultimate quently requested in 1959 and 1984 suggests that goal-rapid and effective delivery of health infor- regional resources are now sufficient to meet the mation to health professionals. need for widely used journal titles, and NLM is needed only as a backup for unusual, mainly for- Delivery ofDocuments to Health Professionals eign titles. Through the creation of union lists the The interlibrary loan network organized and RMLP has clearly identified what is available managed by the RMLP, greatly improved delivery locally, cooperative acquisitions programs among of documents to health professionals. As illustrated both RLs and BHSLs have identified titles which in Table 11, the NLM, the RMLs, and the RLs should be available locally based on frequency of

Bull. Med. Libr. Assoc. 75(3) Supplment July 1987 43 ALISON BUNTING

TABLE 11 INTERLIBRARY LOAN STATISTICS 1969-1985

1.1 - __

0.9- .I 0.8-1

0.7 -

0.6 - c IS : i 0.5 0.4- 4- C 0 0.3-

0.2-

0.1 -

0

69 770 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 Yar O RML Total + NLM Total O CombIned Total use, and network protocols have insured the utiliza- published literature. The RML program was tion of these local resources. instrumental in the creation of a network of online One measure of the value of the documents search centers, including both libraries and individ- delivered to health professionals by the RML net- ual health professionals, which greatly facilitated work is the willingness of the consumer to absorb and increased access to this wealth of health the costs of obtaining these documents once federal sciences information. The change over the past funding was withdrawn. Tables 13 and 14 clearly twenty years is remarkable. In 1964 there were illustrate that more loans processed by RMLs and only three locations from which health profession- RLs were funded by the user than by RML con- als could request computerized literature searches; tract funds. in 1985 over 4,000 libraries and individuals could access the system directly. In 1965 it took an to Health Delivery ofInformation Professionals average of four weeks to generate a list of refer- As stated in the 1964-65 President's Commis- ences; in 1985 it took only minutes. A 1982 study sion report: indicated that MEDLINE searches were requested To achieve "fingertip" control of the literature of all that predominantly for patient care (34%) and research is known about the causes, pathology, and treatment of (34%), with educational purposes coming third heart disease, cancer, and stroke, and to make this (18%). The majority of searches (87%) were con- knowledge available to researchers, educators, and practi- ducted in hospital and academic health sciences tioners, is an objective to which anyone may whole- libraries heartedly subscribe [2:38 1, vol. 2]. [245]. Such instantaneous and convenient access to the The development of the MEDLARS system, literature has saved lives. To provide just two including the provision of online access to its data- examples, at Sinai Hospital in Detroit a child with bases, proved to be the means by which health a rare blood disorder could possibly not tolerate the professionals could have "fingertip" access to the normal antidote for a snake bite she had suffered.

44 Bull. Med. Libr. Assoc. 75(3) Supplement July 1987 NATION'S HEALTH INFORMATION NETWORK

TABLE 12 REGION 7 INTERLIBRARY LOAN REQUESTS Processed by Resource Libraries and Basic Health Sciences Libraries 180 170 N 160 IN 150 'Ns" \'INN 140 E 130 120 V I.. 110 100 C. 'I/ 90 c0 so I., oll mC 70 C 60 I., 50

40 - 1-1 30 I., 20 10

. J 0 -

83 84 85

Year EZi Rmurce Ubrarhin BHUSL

MEDLINE provided citations to two articles From the outset, the RMLs recognized that in which indicated an alternative, life-saving treat- order to accomplish network objectives successful- ment [246]. An internist in Atlanta turned to ly, each region needed a cadre of well-developed MEDLINE for assistance in the diagnosis of a health sciences libraries. Without local access to difficult case. The reference retrieved caused him well-organized library resources, there could be to order further diagnostic studies, which revealed intolerable delays in the delivery of information. A a Burkitt's lymphoma and permitted early, aggres- study of hospital library development in one region sive treatment [247]. of the RML network documented extensive growth among hospital libraries between 1969 and 1984 in a Creation of Viable, Effective National Library the areas of staffing, collection size, and services. Network The programs of the RML in this region were To cite the President's Commission report again, credited with stimulating specific improvements in "Communication of information to scientists and library resources and services [237,238]. As hospi- practitioners is critically important to progress in tal libraries across the nation developed, they orga- research and application of medical knowledge. nized sub-regional networks, or consortia, to pro- Medical libraries are the primary vehicle for mote cooperation and resource sharing on a local accomplishing this communications process" [5:65, level. Over 267 consortia were in existence by 1985. vol. 1]. The RMLP played a key role in the creation As Topper stated: of a viable, effective national health sciences library network, and provided assistance to many One of the great successes of the RMLP...has been to encourage the professional growth of hospital librar- health science them to libraries, enabling develop ians....By providing a mechanism for librarians to tap the to a stage where they could participate in network vast resources of the medical literature...the RMLP has activities. helped hospital libraries to demonstrate their effective-

Bull. Med. Libr. Assoc. 75(3) Suppiment July 1987 45 ALISON BUNTING

TABLE 13 REGION V INTERLIBRARY LOANS 1975-1980 s0 -

70 - I

"'IN * 60 -

* 50 - I

o a 40- I

.0 3=a 30- I

4-1 20- c

10 - 000/

0- v / 75/76 76/77 77/78 78/79 79/80 Year ViZ! RML Funded Loans User Funded Loans ness and broaden their user population. As...funding has the level, extent, and priority of the problem. It provides decreased, librarians have been encouraged to rely on one for testing different marketing models for RML network another and develop new avenues to satisfy the needs of products and services so that if one fails the entire their enlarged clientele [248:611]. network does not fail and if one succeeds it can be transferred. And this transfer characteristic or diffusion Health sciences libraries cooperated prior to the of innovation throughout the network is the stimulus for the biological evolution of network programs and services. development of the RML network, but such coop- And yet the innovation does not override national network eration frequently was limited to circumscribed uniformity. The common mission, guiding principles, geographic areas, or among libraries of similar program areas, and goals remain constant. Only the types. The RML network has successfully coordi- objectives vary and are open to this creative process [242: 121-21. 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 And, as noted by Cheshier, the RML network development has been evolutionary in nature, has coordinated its programs and services with responding to fiscal and environmental influences other networks: and the changing information needs of health pro- fessionals. The national policies promulgated by Make no mistake, our medical library network has the program provide a reasonable degree of uni- become a much envied model. As the program has formity in the delivery of health care information, expanded and improved, medical libraries have become more involved with other types of libraries and with all without jeopardizing necessary regional variations. types of technology. OCLC, for example, by creating The RML network is a model which: access and hence a variety of linkages among 2,500 libraries, has lessened the perceived differences among ...allows for a distribution of service consistent with the types of libraries at the same time it has broadened level of need and the characteristics of the individual medical libraries' participation. I believe that this trend regions. It allows for innovative solutions that vary with will continue and that we will increasingly concentrate

46 Bull. Med. Libr. Assoc. 75(3) Supplement July 1987 NATION'S HEALTH INFORMATION NETWORK

TABLE 14 REGION XI INTERLIBRARY LOANS 1975-1980 100

90

I 60 "IN .2 C: 7070 N, ^% 60 X IV

;C 40

0 30

4-. c 20

10

x r z / 0 I 75/76 76/77 77/78 78/79 79/80 Year 1;ZI1 RML Funded Leans Uer Funded Leans upon using such systems to serve our users without application of technology to the management of necessarily relying primarily on libraries like ours information. NLM's MEDLARS system was one [249:377]. of the first, and most successful examples of the use of computers to organize and provide access to the Use of Technology to Improve or Enhance the ever-growing scientific periodical literature. To Delivery ofInformation pinpoint locations of source documents, RML net- A key factor in the delivery of information to work participants have made extensive use of com- health professionals is the time elapsed between a puters to create union lists of serials, monographs, request for information and receipt of the docu- and audiovisuals. Once these lists were completed ment. In patient care situations, a few hours can the network libraries compared regional holdings to make a significant difference. Starting with the use interlibrary loan traffic and utilized this informa- of teletypewriters to transfer requests for informa- tion to set priorities for cooperative collection tion, the RML network has promoted the use of development projects. new technologies as they become available to insure The familiarity with computers and computer rapid information delivery. The development and applications gained when searching online data- implementation of DOCLINE, which virtually bases, or creating union lists, helped to prepare eliminates the time-consuming process of locating many health sciences librarians for today's micro- a source for the needed information will signifi- computer environment, and for the automation of cantly decrease the time it takes to place a needed many library operations, thus facilitating the provi- document in the user's hand. Health sciences sion of better and more efficient service. Health libraries are actively experimenting with technolo- professionals also benefited from the increased gies such as telefacsimile to speed the delivery of availability of audiovisual educational programs the documents even more. made available through NLM, the RML network, Health sciences libraries have been leaders in the and local libraries. In many instances, librarians

Bull. Med. Libr. Assoc. 75(3) Suppiment July 1987 47 ALISON BUNTING

introduced the use of audiovisuals for educational idly, the delivery of the actual document can still be purposes in their own institutions. delayed by several days. It is now important to concentrate on development of improved mecha- FUTURE OF THE REGIONAL MEDICAL LIBRARY nisms for the delivery of information, including PROGRAM telefacsimile, optical disk technology, and online The new five-year RML contracts for the period access to the complete text of documents. It is also 1986-1990 indicate some of the future activities of critical to provide more detailed information on the the RMLP. RMLs will continue to coordinate contents of lengthy information sources such as network activities in areas such as interlibrary loan, books so that requesters can ask for the transmis- development and maintenance of union lists, and sion of needed portions only. cooperative acquisitions and resource sharing pro- The RMLs can play an important role in the grams. Consulting and training programs for hospi- introduction of technological developments in tal library managers provided by RML staff will be health sciences libraries which, as Palmer states, phased out completely in all regions by 1988, "...must be converted into information-manage- although the RMLs will continue to coordinate ment centers.... This requires not only expanding educational and training programs to some extent. use of technology such as development of expert Individuals or institutions needing training or con- systems and methods to aid in processing informa- sulting services will be referred by the RMLs to tion, but also providing health sciences librarians regional consultants. Online training and services with the baseline knowledge to manage the auto- are now the responsibility of three RMLs: the New mated library and data files" [251:46]. The RMLs York Academy of Medicine serves the Eastern can also serve as testing grounds for newer infor- Online region, comprising Regions 1 and 2; the mation technologies, and promote their adoption University of Nebraska is responsible for the Mid- among health sciences libraries. lands Online region, containing Regions 3, 4, and 5; Despite the best efforts of the RMLP, there are and the UCLA Biomedical Library provides ser- still areas of the country where health professionals vices to Regions 6 and 7, which make up the do not have ready and convenient access to infor- Western Online Region. mation. Even in areas with excellent information Two new programs, a national reference referral resources, there is increased interest in the ability network and a national preservation plan for health to access information from office, laboratory, or sciences libraries, are scheduled to be developed home settings. Scientific research is becoming and implemented during the contract period. The increasingly interdisciplinary; information must RMLs also had an opportunity to submit proposals therefore be obtained from a variety of sources. for special RML program enhancements, designed The development of an electronic medical informa- to improve or expand network services, or to pro- tion network, which would allow any health profes- vide essential data for the design of improved sional or librarian to obtain specific information, information services programs [219]. Three initial conduct a literature search, or obtain a document enhancements were funded: Region 1 will be exper- directly through a personal microcomputer, would imenting with the addition of non-NLM titles to address these needs. The medical information net- the SERHOLD database; Region 6 will develop a work should be electronically linked to all types of microcomputer-based local information directory; libraries, databases, health agencies, or any other and Region 7 will conduct an evaluation project to pertinent source of information. The organization assess the actual use by health professionals of and development of such a network presents a documents delivered through the RML interlibrary considerable challenge to the RMLs and NLM loan network [250]. since it would require the development of complex It is clear that technological developments have electronic communications protocol, "user friend- and will continue to influence the means by which ly" search systems, and the establishment of links individuals access information. To date, the RMLP with many libraries, publishers, database vendors, has capitalized on such developments, thus creating institutions, and agencies. a responsive network capable of providing access to Research into the nature and use of health and delivering information rapidly and effectively. information, its value to the health care delivery Much, however, still needs to be done. system, and its relation to the improvement of Although it is now possible to retrieve quickly health must receive high priority, so that informa- citations for articles on a particular topic, and to tion delivery mechanisms can effectively address transmit requests for copies of these articles rap- user needs. The RMLs, in collaboration with insti-

48 Bull. Med. Libr. Assoc. 75(3) Supplement July 1987 NATION'S HEALTH INFORMATION NETWORK tutions and libraries in their regions, can be active vol. 3. Chicago: Medical Library Association, participants in the conduct of such research. Data- 1987. 2. U.S. President's Commission on Heart Disease, bases of pertinent health sciences library manage- Cancer and Stroke. Report to the President. A ment information should be created and main- national program to conquer heart disease, can- tained, and trends and developments analyzed and cer, and stroke. 2 vols. Washington, D.C.: U.S. reported in the literature. Government Printing Office, 1964-65. None of these proposed projects can be accom- 3. Miles WD. A history of the National Library of Medicine. The nation's treasury of medical plished without a coordinated national effort and knowledge. Washington, D.C.: U.S. Government effective leadership. The NLM and the RMLs Printing Office, 1982. working in concert have created a model national 4. Bloomquist H. The status and needs of medical information access and delivery network. They are school libraries in the United States. J Med Educ 1963 Mar;38(3):145-163. well qualified and possess the skills to transform 5. Adams S. Medical library resources and their devel- the RML network in the future environment, so as opment. J Med Educ 1963 Jan;38(2):20-27. to continue to fulfill the national need for health 6. Esterquest RT. Regional plans for medical library information so eloquently described by President service. Bull Med Libr Assoc 1964 Jul;52(3):497- John F. Kennedy: 523. 7. DATAGRAM. Medical library needs. J Med Educ The accumulation of knowledge is of little avail if it is not 1965 Apr;40(4):396-397. brought within reach of those who can use it. Faster and 8. Guidelines for medical school libraries. J Med Educ more complete communication from scientist to scientist 1965 Apr;40(1):5-64. is needed, so that their research efforts reinforce and 9. Wilson MP. The National Library of Medicine: complement each other; from researcher to practicing relationships to medical education and research. J physician, so that new knowledge can save lives as swiftly Med Educ 1965 Mar;40(3):225-232. as possible; and from the health professions to the public, 10. Cummings MM. The edge of husbandry: the role of so that people may act to protect their own health [252]. the NLM. In: McCord D, ed. Biblioteca medica: physician for tomorrow. Boston: Harvard Medi- ACKNOWLEDGEMENTS cal School, 1966. Authorship of The Nation's Health Information Net- 11. Adams S. MEDLARS: performance, problems, work: A History of the Regional Medical Library Pro- possibilities. Bull Med Libr Assoc 1965 gram, 1965-1985 would not have been possible without Apr;53(2)139-151. the support of Wade Bunting, who cheerfully tolerated 12. U.S. Public Law 89-291. Medical Library Assis- my long absences on research trips and at the computer, tance Act. 89th Congress. October 22, 1965. and Louise Darling, who brought me into the exciting and 13. U.S. Public Law 91-212. Medical Library Assis- challenging world of health sciences librarianship and tance Act Extension. 91st Congress. March 13, continues to provide sage advice and counsel. Special 1970. thanks are due to Maryann Elbaum, for her expertise in 14. U.S. Public Law 93-45. Health Programs Extension editing this history; the staff of the UCLA Biomedical Act. 93rd Congress. June 18, 1973. Library who accomplished our work with professionalism 15. U.S. Public Law 93-353. Health Services Research, and dedication despite my divided attention; to many staff Health Statistics and Medical Libraries Act of at the National Library of Medicine who willingly 1974. 93rd Congress. July 23, 1974. assisted me in verifying information, especially Becky 16. U.S. Public Law 99-158. Health Research Exten- Lyon-Hartmann, Frances Johnson, and Sheldon Kotzin; sion Act. 99th Congress. November 20, 1985. to Raymond Palmer and Rita Shafer of the Medical 17. Cummings MM. Plans for the development of a Library Association who collaborated in the preparation medical library network. In: Simonton W, Mason of this history; and to Mark Hodges, who carefully read C, eds. Information retrieval, with special refer- every draft and supplied much valuable information. ence to the biomedical sciences. Second Institute Many others assisted in the verification of historical on Information Retrieval, Minneapolis: Univer- details through personal recollection or written documen- sity of Minnesota, 1966. tation; their names are listed in Appendix 4. Also included 18. National Library of Medicine. Annual report. Fis- in Appendix 4 are the names of the expert reviewers who cal year 1966. Bethesda: National Library of read early drafts, and made excellent suggestions on Medicine, 1967. content and format; their efforts were greatly appre- 19. Herner and Company. A recommended design for ciated. The most rewarding aspect of this undertaking the United States medical library and informa- was the opportunity to talk with some of the distinguished tion system. 2 vols. Washington, D.C.: Herner professionals in the field of health sciences librarianship and Company, 1966. and information science. It is an experience I would 20. Oppenheimer GJ. Regional medical library service highly recommend to my colleagues. in the Pacific Northwest. Proceedings of an invi- tational conference, May 12-13, 1966, University REFERENCES of Washington. Seattle: University of Washing- 1. Horres MM, Bunting A. Interlibrary cooperation ton, 1967. among health science libraries. In: Darling L, ed. 21. National Library of Medicine. Board of Regents Handbook of medical library practice. 4th ed., minutes. November, 1966.

Bull. Med. Libr. Assoc. 75(3) Supplment July 1987 49 ALISON BUNTING

22. Rules and Regulations. National Library of Medi- 42. Annual report on the library. Trans Stud Coll cine grants. Fed Regist 1966 Jul Physicians Phila 1964 Apr;3 1(4):351-362. 1 3;3 1 (134):9499-9505. 43. Annual report on the library. Trans Stud Coll 23. Wilson MP, Douglass CD, Kefauver DF. Extramu- Physicians Phila 1967 Apr;34(4):177-189. ral programs of the National Library of Medi- 44. Annual report on the library. Trans Stud Coll cine: program objectives and present status. Pho- Physicians Phila 1968 Apr;35(4):212-228. tocopied paper. Bethesda: National Library of 45. Annual report of the committee on the library. Medicine, 1966. Trans Stud Coll Physicians Phila 1969 24. Fact Sheet. The Regional Medical Library grant Apr;36(4):263-279. program. Bethesda: National Library of Medi- 46. MLA area group meets. Natl Libr Med News 1968 cine, March, 1966. Oct;23(10):6. 25. Public Health Service grants for regional medical 47. National Library of Medicine. Annual report. Fis- libraries. Information and policy statement. cal year 1968. Bethesda: National Library of Bethesda, MD: National Library of Medicine, Medicine, 1969. Revised, July 1967. 48. Pings VM. Kentucky, Ohio, Michigan Regional 26. Grants for regional medical libraries. Information Medical Library Program. A discussion of its and policy statement. Bethesda, MD: National formation. Detroit: Kentucky-Ohio-Michigan Library of Medicine, revised, August 1968. Regional Medical Library, April, 1969. (Papers 27. Grants for regional medical libraries. Information and Reports, no. 3). and policy statement. Bethesda, MD: National 49. Pings VM. Regional medical libraries: a concept Library of Medicine, revised, January 1969. and a necessity. Bull Med Libr Assoc 1971 28. Cummings MM, Corning ME. The Medical Apr;59(2):242-6. Library Assistance Act: an analysis of the NLM 50. Crawford H. Regional plans for medical library extramural programs, 1965-1970. Bull Med Libr service. Proposal for an expanded medical library Assoc 1971 Jul;59(3):375-91. extension service for Wisconsin. Bull Med Libr 29. Douglass CD. The regional medical library grant Assoc 1964 Jul;52(3):514-520. program of the National Library of Medicine. 51. A brief history of the Midwest Health Sciences Bull Med Libr Assoc 1968 Jan;56(1):49-51. Library Network. Chicago: John Crerar Library, 30. Wilson MP. Implications of planning for regional June, 1974. Mimeographed paper. libraries: our underlying philosophy. Bull Med 52. Hetzner BM. The Midcontinental Regional Medi- Libr Assoc 1968 Jan;56(l):46-48. cal Library: a decentralized service. Bull Med 31. Sloan MH. The relationships of medical libraries to Libr Assoc 1971 Apr;59(2):247-53. regional medical program planning. Bull Med 53. Application for a regional medical library grant. Libr Assoc 1968 Jan;56(1):56-8. Omaha: University of Nebraska, August 19, 32. Hodges TM, Colby CC, Bloomquist H. NERMLS: 1969. the first year. Bull Med Libr Assoc 1969 54. Hendricks DD. TALON-the first five years. Bull Oct;57(4):329-37. Med Libr Assoc 1976 Apr;64(2):203-1 1. 33. Stearns NS, Ratcliff WW. A core medical library 55. South Central Regional Medical Library Program. for practitioners in community hospitals. New Status review. Dallas: TALON, Summer, 1971. Eng J Med 1969 Feb 27;280:474-480. Photocopied paper. 34. Stearns NS, Bloomquist H, Ratcliff WW. The 56. Application for a regional medical library grant. hospital library-part 1. Hospitals 1970 March Los Angeles: University of California, August 30, 1;44(5):55-59. 1968. 35. Stearns NS, Bloomquist H, Ratcliff WW. The 57. Waters ST. The regional medical library and the hospital library-part 2. Hospitals 1970 March hospital library. Bull Med Libr Assoc 1971 16;44(6):88-90. Apr;59(2):337-9. 36. Annan GL, Felter JW, Meyerhoff E, Ash L. 58. National Library of Medicine. Annual report. Fis- Regional plans for medical library service: New cal year 1968. Bethesda: National Library of York State and the New York metropolitan area. Medicine, 1969. Bull Med Libr Assoc 1964 Jul;52(3):503-508. 59. Kefauver DF. Coordination of regional libraries 37. Esterquest RT. Strengthening medical library with Regional Medical Program projects. Bull resources in New York State. Albany, NY: Uni- Med Libr Assoc 1970 Jul;58(3):325-9. versity of the State of New York, 1963. 60. Pings VM. KOMRML, the first year's experience. 38. Minutes of the meeting to discuss plans for a Detroit: Kentucky-Ohio-Michigan Regional regional medical library in New York. New York Medical Library, March 1970. (Papers and Academy of Medicine, April 21, 1969. Reports, no. 5). 39. Minutes of the meeting of the advisory council for 61. Gomes SS. The nature of the use and users of the the regional medical library grant. New York Midwest Regional Medical Library. Bull Med Academy of Medicine, April 22, 1969. Libr Assoc 1970 Oct;58(4):559-77. 40. Gibbon JH Jr. A note on the Philadelphia regional 62. Summary of a meeting held by NLM on September medical library committee. Bull Med Libr Assoc 25, 1969 to discuss implementation of a new 1965 Oct;53(4):559-62. policy on "qualified users." Bethesda: National 41. Morse EH. Regional plans for medical library ser- Library of Medicine, 1969. vice. Medical library cooperation in the Philadel- 63. Sawyer WA. The Southeastern Regional Medical phia area. Bull Med Libr Assoc 1964 Library: services for health practitioners. SC Jul;52(3):509-5 13. Dent J 1969 Sep;27(9):4-5. 50 Bull. Med. Libr. Assoc. 75(3) Supplement July 1987 NATION'S HEALTH INFORMATION NETWORK

64. Ekendahl JE. Information action at the Pacific 88. National Library of Medicine. Board of Regents. Northwest Regional Health Sciences Library. Minutes. June, 1971. PNLA Quarterly 1969 Spring;33(3):25-26. 89. National Library of Medicine. Biomedical Library 65. Darling L. The Pacific Southwest Regional Medical Review Committee. Summary of recommenda- Library and MEDLARS service. Ariz Med 1970 tions of the RML committee. Bethesda: National Jul;27(7):22-4. Library of Medicine, July-December 1971. Pho- 66. Gilman NJ. The Pacific Southwest Regional Medi- tocopied paper. cal Library Service. Calif Med 1971 90. National Library of Medicine regional medical Oct;l 15(4):67-8. library program policy statement. Bull Med Libr 67. Gilman NJ. The Pacific Southwest Regional Medi- Assoc 1972 Apr;60(2):271-273. cal Library Service. Calif Nurse 1971 Jul/ 91. Pings VM. Regional medical library program devel- Aug;67(5):5. opment. Bull Med Libr Assoc 1972 68. Gilman NJ. The Pacific Southwest Regional Medi- Apr;60(2):274-83. cal Library Service. Hawaii Med J 1971 Jul/ 92. Davis RM. The national biomedical communica- Aug;30(4):274-5. tions network as a developing structure. Bull Med 69. Gilman NJ. The Pacific Southwest Regional Medi- Libr Assoc 1971 Jan;59(1):1-20. cal Library Service. J South Calif State Dent 93. Schoolman HM. National Library of Medicine Assoc 1971 Jan;39(1):49-50. regional medical library program. Bull Med Libr 70. Countway Medical Library first to operate region- Assoc 1972 Apr;60(2):284-5. ally. Libr J 1967 Nov;92(19):3954. 94. Kotzin named to new RML post. Natl Libr Med 71. Crerar named Midwest Regional Medical Library. News 1978 Jul/Aug;33(7-8):3. ALA Bull 1968 Dec;62(1 1):1328. 95. RML Directors' Meeting. Minutes. Dallas, TX, 72. Establishment of the East Central Regional Medi- Nov. 8-9, 1979. cal Library at the Wayne State University. Libr 96. Hospital librarians, NLM staff discuss mutual Congr Inf Bull 1969 Jan;28(5):62-63. interests. Natl Libr Med News 1978 73. John Crerar Library joins medical net. Libr J 1968 Feb;33(2):4. Nov;93(19):4084. 97. Summary statement of hospital librarians. Natl 74. Nation's fifth regional medical library, serving the Libr Med News 1978 Feb;33(2):5. health professions in Michigan, Ohio, and Ken- 98. RML Directors' Meeting. Resume. New York tucky has been established. Wilson Libr Bull Academy of Medicine, May 27, 1971. 1969 Mar;43(7):598. 99. RML Directors' Meeting. Minutes. Bethesda, MD, 75. Regional medical library established. Ky Libr Nov. 30-Dec. 1, 1978. Assoc Bull 1969 Apr;33(2):26-7. 100. Mission for Regional Medical Library Program. 76. Steinke EG, Tannehill RS. Regional medical Draft mission statement developed at NLM/ library planning in the Southeastern United RML Planning Session, April 19-21, 1979. States. Coll Res Libr 1969 Jul;30 (4):327-34. 101. RML Planning Session. Summary minutes. Reston, 77. Two medical libraries get regional grants. Libr J VA, April 19-21, 1979. 1968 Aug;93 (14):2786. 102. NLM announces network reconfiguration. Natl 78. UCLA Biomedical Library designated Pacific Libr Med News 1981 Nov;36(11):1-3. Southwest Regional Medical Library. Hawaii 103. National Library of Medicine. Board of Regents Libr Assoc J 1969 Jun;26(1):25-6. Meeting. Minutes. June, 1972. 79. Announcement of services: the Midcontinental 104. RML Directors' Meeting. Minutes. Cleveland, OH, Regional Medical Library, Omaha. Kans Libr May 29, 1975. Bull 1970;39(2):21. 105. RML Directors' Meeting. Minutes. Minneapolis, 80. Darling L. Regional services for medical libraries. MN, June 12-13, 1976. Calif Libn 1970 Jan;31(1):46-52. 106. New plan to subsidize document delivery. Natl Libr 81. Ekendahl JE. Serving a million square miles with Med News 1977 Jul/Aug;32(7-8):1. health information: Pacific Northwest Regional 107. Spencer CC. Unit costs of interlibrary loans and Health Sciences Library. Libr News Bull 1970 photocopies at a regional medical library. Prelim- Jan;37(1):22-5. inary report. Bull Med Libr Assoc 1970 82. Hodges TM. Southeastern and the national medical Apr;58(2): 189-90. library network. Tenn Libr 1971 Apr;23(3):133- 108. Oppenheimer G. The Pacific Northwest Regional 7. Health Sciences Library: a centralized operation. 83. McCullough FS. Regional medical libraries. Cathol Bull Med Libr Assoc 1971 Apr;59(2):237-41. Libr Wkly 1970 Mar;41(7):472-6. 109. Pings VM. Improved document delivery services. 84. Medical reference service: new tie-in with Pacific Libr Trends 1974 July;23(1):89-107. Northwest Regional Health Sciences Library, 110. RML Directors' Meeting. Minutes. Bethesda, MD. Seattle. Idaho Libr 1969 Oct. 10-11, 1971. Oct;21:163. 111. Bunting A. Region XI Cooperative Serials Acquisi- 85. Regional medical libraries for Texas and Nebraska. tions Program (COSAP). Terminal progress Libr J 1970 May;95(9):1695. report. Los Angeles: Biomedical Library, 86. Walkington RA, Herron EW. The regional medical PSRMLS, January 1, 1979. library 1 970-a status report. Bethesda: Na- 112. NLM's national biomedical holdings data base. tional Library of Medicine, June 1970. Natl Libr Med News 1981 May;36(5):1-3. 87. National Library of Medicine. Board of Regents. 113. Olson PE, Pletzke CJ. Analysis of the Midwest Minutes. November, 1970. Medical Union Catalog. Final report. Chicago: Bull. Med. Libr. Assoc. 75(3) Suppiment July 1987 51 ALISON BUNTING

Midwest Health Science Library Network, May, consortium in a rural setting. Bull Med Libr 1975. Assoc 1978 Apr;66(2):185-189. 114. Hammell KA. Regional online union catalog of the 133. Goodchild EY, Furman JA, Addison BL, Um- Greater Midwest Regional Medical Library Net- barger HN. The CHIPS project. A health infor- work: development and operation. Bull Med Libr mation network to serve the consumer. Bull Med Assoc 1984 Apr;72(2):155-61. Libr Assoc 1978 Oct;66(4):432-436. 115. MEDLINE network shifts into high gear. Natl Libr 134. Gartenfeld E. Community Health Information Net- Med News 1972 Mar;27(3):1-3. work (CHIN). Atlanta, GA: U.S. Dept. of 116. DeSchryver V, Pings V. Detroit MEDLINE consor- Health and Human Services, Center for Health tium: an interim report. Detroit: Kentucky-Ohio- Promotion and Education, August, 1981. Michigan Regional Medical Library, July 1973. 135. Pride RB, Keiter L, Bub K. Development of a (Papers and Reports, no. 14). state-wide health sciences information network: a 117. Standardized charges for MEDLINE searches. cooperative effort. Bull Med Libr Assoc 1983 Natl Libr Med News 1974 Jan;29(l):2. Jul;71(3):287-98. 118. Role of the regional medical library in on-line 136. Sekerak RJ. Cooperation strengthens small hospital search operation. Report of a subcommittee of libraries in a rural area of New England: a Regional Medical Library Directors, May, 1974. five-year experience. Bull Med Libr Assoc 1979 119. RML-NLM Working Committee On-Line Net- Jul: 67: 322-329. work Management. Draft report. October 31, 137. Hodges TM. NERMLS and the community hospi- 1974. tal: service, education and advice. Bull Med Libr 120. RML-NLM Working Committee on Reference Assoc 1970 Jul;58(3):320-4. Services. Report. October 28, 1974. 138. Bloomquist H, Rees AM, Stearns NS, Yast H, eds. 121. Dobroski CH, Hendricks DD. Mobilization of Library practice in hospitals: a basic guide. duplicates in a regional medical library program. Cleveland: Press of Case Western Reserve Univ., Bull Med Libr Assoc 1975 Jul;63(3):309-18. 1972. 122. Journal clearinghouse to serve region. Supplement 139. Colaianni LA, Mirsky PS. Manual for librarians in News Pac Northwest Reg Health Sci Libr 1976 small hospitals. Los Angeles: Biomedical Library, Aug: 1. University of California, 1969. 123. RML-NLM Working Committee on Cooperative 140. Midwest Health Science Library Network. Basic Acquisitions and Cataloging, Serials Rationaliza- library management for health science librarians. tion, Resource Sharing and Cooperative Storage. Chicago: MHSLN, 1975. Report. November 15, 1974. 141. Holtum EA, McKloskey J, Mahan R. Coordinators 124. Kronick DA. A regional cooperative acquisition for health science librarians in the Midwest program for monographs. Bull Med Libr Assoc Health Science Library Network. Bull Med Libr 1979 Jul;67(3):297-301. Assoc 1977 Apr;65(2):224-30. 125. Bowden VM, Comeaux EA, Eakin D. Evaluation of 142. Pings VM. The medical library consultant-a pro- the TALON Cooperative Acquisitions Program posal for investigation and evaluation. Detroit: for monographs. Bull Med Libr Assoc 1984 Kentucky Ohio Michigan Regional Medical Jul;72(3):241-50. Library, April 1972. (Papers and Reports, no. 126. Fink WR, Bloomquist H, Allen RG. The place of 12). the hospital library consortium in the national 143. RML Working Committee on Training, Continuing biomedical communications network. Bull Med Education and Extension Services. Preliminary Libr Assoc 1974 Jul;62(3):258-265. report of recommendations. December, 1974. 127. Moulton B, Fink WR. Components for consider- 144. Bunting A. Interlibrary loan manual for users of the Bull Med Libr Assoc Pacific Southwest Regional Medical Library Ser- ation by emerging consortia. vice. Los Angeles: PSRMLS, UCLA Biomedical 1975 Jan;63(1):23-28. Library, 1973. 128. Bailey AS, Tibbetts P. The Twin Cities Biomedical 145. Beamish BS. Reference materials for a health Consortium. Bull Med Libr Assoc 1975 sciences core library. Los Angeles: PSRMLS, Jul;63(3):252-258. UCLA Biomedical Library, 1972. 129. Koplan SM, Chewning CJ, Bumgarner J. Coopera- 146. Lamkin CC. Cataloging policies and procedures for tive library services for Atlanta's hospitals. J Med the hospital library. Los Angeles: PSRMLS, Assoc Georgia 1976 Feb;65(2):55-57. UCLA Biomedical Library, 1976. 130. Gillikin P, Price L, Lee S, Sprinkle MD. A self- 147. Snelbecker GE, Timour JA, Vick K. The supporting library service in a rural region: a new MERMLS leadership institute for hospital look at hospital consortia. Bull Med Libr Assoc librarians: a new concept in extension service. 1982 Apr;70(2):216-223. Bull Med Libr Assoc 1977 Jan;65(1):31-9. 131. Jensen MA, ed. Proceedings of a forum sponsored 148. Revised position paper on education responsibilities by the Coastal Health Library Information Con- of NLM, RMLs and MLA. Memo from Robert sortium. Exploring opportunities for cooperation Berk, MLA Director of Education, July 10, 1978. in California: a forum exploring cooperation Photocopied memo. among health science library consortia, Shore 149. Gorman M, Winkler PW, eds. Anglo-American Cliff Lodge and Inn, Pismo Beach, California, cataloguing rules. Prepared by the American Nov. 13, 1981. Fresno, CA: California Area Library Association. 2nd ed. Chicago: American Health Education Center System, 1982. Library Association, 1978. 132. Bolef D, Fisher JS. A health sciences libraries 150. Accreditation manual for hospitals. 1978 edition. 52 Bull. Med. Libr. Assoc. 75(3) Supplement July 1987 NATION'S HEALTH INFORMATION NETWORK

Chicago: Joint Commission on Accreditation of biomedical communications network. Bull Med Hospitals, 1978. Libr Assoc 1974 Oct;62(4):343-347. 151. Gadzikowski C. Appraisal and evaluation of the 171. Evans A, Mirsky PS, de Victoria MJ. Evaluation of workshop instruction program for untrained a library program in a Carnegie model Area health sciences library managers in Region VIII: Health Education Center. Bull Med Libr Assoc 1976-1978. Bull Med Libr Assoc 1982 1978 Apr;66(2):190-199. Apr;70(2):207-1 5. 172. Bandy CR. Area Health Education Center libraries 152. Van Toll F, McNamara ME. Accountability in a and medical school libraries. Establishing an regional medical library consultant/extension interface. Bull Med Libr Assoc 1978 program: the evolution of documentation proce- Oct;66(4):426-43 1. dures. Detroit: Kentucky Ohio Michigan Re- 173. Gillikin P, Parker CF, Lee S. Planning and manage- gional Medical Library 1980. (Papers and ment of a regional learning resource network: the reports, no. 17). library can do it. J Biocommunication 1978 153. Van Toll F, McNamara ME. Data assessment in a Nov;5(3):9-16. regional medical library consultant/extension 174. Ettl L. The North Dakota AHEC library system. program: indicators of institutional change. Atlanta, GA: U.S. Dept. of Health and Human Detroit: Kentucky Ohio Michigan Regional Med- Services, Center for Health Promotion and Edu- ical Library, 1980. (Papers and reports, no. 18). cation, August 1981. 154. Bunting A. Evaluation report: impact of PSRMLS 175. Davidson RW. The library/learning resource center extension service. Los Angeles: PSRMLS, network of the North Carolina AHEC program. UCLA Biomedical Library, April, 1980. Atlanta, GA: U.S. Dept. of Health and Human 155. Guidelines for interaction between the National Services, Center for Health Promotion and Edu- Library of Medicine, Biomedical Library Review cation, August 1981. Committee, and Regional Medical Library 176. Jensen MA, Maddalena B. The AHEC library Directors. December, 1972. program and consortia development in Califor- 156. Matheson NW, West RT. NLM Medical Library nia. Bull Med Libr Assoc 1986 Jul;74(3):222- Resource Improvement Grant Program: an evalu- 226. ation. Bull Med Libr Assoc 1976 Jul;64(3):309- 177. Ovitsky MM. Report of cooperation meeting. 19. Region VII regional medical library program and 157. Ad Hoc RML Committee on Requirements for a state library agencies. October 4-5, 1979, Chica- Training Program for RML Media Consultants. go, IL. Chicago: Midwest Health Science Library Recommendations. October, 1973. Network, November 1979. 158. RML Working Committee on AV and CAI Net- 178. Fulton JH. The Mid-Eastern Regional Medical works. Draft report. 1974. Library Service. Natl Libr Med News 1978 Jul/ 159. Report of the MHSLN Planning Committee. Chi- Aug;33(7/8):4-5. cago: MHSLN, April 1977. 179. Gadzikowski C. Octanet/PHILSOM: using a 160. Ovitsky MM. Evaluation report. Long range plan- serials control system for interlibrary loan. Tech ning program, 1975-1979. Chicago: MHSLN, Serv Q 1984 Spring;1(3):45-53. September 1979. 180. Crawford S, Johnson MF, Kelly EA. Technology at 161. RML Directors' Meeting. Minutes. Bethesda, MD. Washington University School of Medicine Feb. 11-12, 1976. Library: BACS, PHILSOM, and Octanet. Bull 162. Bishop D. Activities for a regional medical library: a Med Libr Assoc 1983 Jul;71(3):324-7. view of priorities by users and librarians. Bull 181. Weaver CG. Electronic document delivery: direct- Med Libr Assoc 1975 Jul;63(3):247-51. ing interlibrary loan traffic through multiple elec- 163. Van Toll F. The role of basic-unit librarians in tronic networks. Bull Med Libr Assoc 1984 RML decision making: an evolutionary process. Apr;72(2):1 87-92. Bull Med Libr Assoc 1983 Apr;72(2):210-2. 182. Algermissen V, Billings P, Grace S, Guidry B, Blair 164. Regional medical library network development. J. Subminute telefacsimile for ILL document National Library of Medicine, November, 1973. delivery. Inf Tech Libr 1982 Sept;1(3):274-77. Unpublished report. 183. Feeney ME. The Regional Medical Libraries- 165. Gilman NJ. RMLs and local resources. Bull Med Region I. Natl Libr Med News 1974 Libr Assoc 1972 Jan;60(1):148-9. May;29(5):3-5. 166. Rollins JG. The interface of NYSILL and the 184. Brandon AN, Bruette VR. The Regional Medical regional medical library program in New York Libraries-Region II. Natl Libr Med News 1974 state. Bookmark 1985 Fall;44(l):50-53. Jul;29(7):3-4. 167. RML-NLM Working Committee on Network Interface/Document Delivery. Report. Novem- 185. Timour JA, Beautyman KV. The Regional Medical ber, 1974. Libraries-Region III. Natl Libr Med News 168. Jones P, Budington WS. Midwest Health Science 1974 Oct;29(10):4-5. Library Network. Natl Libr Med News 1979 186. Rustigian J. The Regional Medical Libraries- Jan;34(1):5-6. Region IV. Natl Libr Med News 1974 169. West RT, Howard FH. Area Health Education Dec;29(1 2):3-4. Centers and health science library services. Bull 187. Monroe J. The Regional Medical Libraries- Med Libr Assoc 1977 Jul;65(3):368-376. Region V. Natl Libr Med News 1975 170. Sawyer WA, Mangiaracina J. Area Health Educa- Feb;30(2):3. tion Centers as the foundation for a statewide 188. Foster EC. The Regional Medical Libraries-

Bull. Med. Libr. Assoc. 75(3) Suppiment July 1987 53 ALISON BUNTING

Region VI. Natl Libr Med News 1975 A comprehensive evaluation of the Regional May;30(5):4-5. Medical Library (RML) network. Volume I: 189. Pletske CJ. The Regional Medical Libraries- Technical Report. Cambridge, MA: Abt Asso- Regional VII. Natl Libr Med News 1975 ciates, Inc., March 20, 1981. Jul;30(7):6-7. 212. Wender RW, ed. Organizing and administering the 190. Petgen E. The Regional Medical Libraries- small hospital library. Dallas: TALON, 1979. Region VIII. Natl Libr Med News 1975 213. Wakeley PJ, May RS. Herususaiensu toshokan-in June;30(6):5-6. no kiso chishiki (Basic library management for 191. Hendricks DD. The Regional Medical Libraries- health science librarians). Tokyo: Nichigai Aso- Region IX. Natl Libr Med News 1975 chieetsu Kabushiki Kaisha, Jan. 1976. Sep;30(9):3-4. 214. National Library of Medicine. Programs and ser- 192. Oppenheimer GJ. The Regional Medical Li- vices. Fiscal year 1982. Bethesda: National braries-Region X. Natl Libr Med News 1975 Library of Medicine, 1983. Dec;30(12):3-4. 215. RML network review. Natl Libr Med News 1981 193. Mirsky PS. The Regional Medical Libraries- Aug;36(8):3. Region XI. Natl Libr Med News 1976 216. New regional medical library configuration an- Jan;31 (1):3-5. nounced. Natl Libr Med News 1983 Jan;38(1):1- 194. LeSueur CR. The New England Regional Medical 3. Library Service. Natl Libr Med News 1979 Jul: 217. RML Directors' Meeting. Minutes. Baltimore, 34(7):4-6. MD, Nov. 29-30, 1984. 195. Kasner L. The New York and New Jersey Regional 218. RML Directors' Meeting. Minutes. Houston, TX, Medical Library. Natl Libr Med News May 29, 1983. 1978;33(6):3-4. 219. New regional medical library contracts awarded. 196. Mikail J. The Mid-Atlantic Regional Medical Natl Libr Med News 1986 Feb;41(2):12. Library Program. Nati Libr Med News 1978 220. New NLM interlibrary loan policies. PSRMLS Sept;33(9):4-5. Newsletter 1983 Jul/Aug;142:2. 197. Van Toll F. Kentucky-Ohio-Michigan Regional 221. NLM announces ILL changes to begin in October. Medical Library Program. Natl Libr Med News Natl Libr Med News 1983 Jun;38(6):1. 1978 Oct/Nov;33(10-11):7. 222. March 15th marks first official DOCLINE trans- 198. Torrente MJ. Southeastern Regional Medical mission. Natl Libr Med News 1985 Apr;40(4):3. Library Program. Natl Libr Med News 1978 223. DOCLINE marks first year of service. Natl Libr Dec;33(12):5-6. Med News 1986 Apr;41(4):11-12. 199. Petgen E. The Midcontinental Regional Medical 224. RML Directors' Meeting. Minutes. Denver, CO, Library Program. Natl Libr Med News 1979 May 27, 1984. Feb;34(2):5-6. 225. Fishel MR. National biomedical serials holdings 200. Miller JK. South Central Regional Medical Library database (SERHOLD). Natl Libr Med News Program. Natl Libr Med News 1979 1984 Sep;39(9):1-4. Mar;34(3):4-5. 226. The basics of searching MEDLINE: a guide for the 201. Oppenheimer GJ. The Pacific Northwest Regional health science professional. Bethesda: National Health Sciences Library. Natl Libr Med News Library of Medicine, 1985. 1979 Apr/May;34(4-5):6-7. 227. Teaching MEDLINE to health professionals. Natl 202. Mirsky PS. Pacific Southwest Regional Medical Libr Med News 1984 Dec;39(12):4. Library Service. Natl Libr Med News 1979 228. National Library of Medicine domestic MED- Jun;34(6):4-5. LARS subset policy. Natl Libr Med News 1984 203. Batterton DL, Horvath SM. The regional medical Jul/Aug;39(7-8):9-1 1. library program. Am J Med Technol 1971 229. Due KM. The role of the regional medical library Aug;37(8):332-7. program in the delivery of health care informa- 204. Hendricks DD. The regional medical library pro- tion. Bookmark 1985 Fall;44(1):41-44. gram. Libr Trends 1975 Oct;24(2):331-45. 230. 1984 collection development funds available...read 205. Kasner L. The regional medical library program: a on. 3 Sources 1984;2(2):2. national medical information network. Sci Tech 231. RML Directors' Meeting. Minutes. Chicago, IL. Libr 1980 Winter;1(2):43-51. February 9-10, 1984. 206. Robertson WO. Letter: regional medical libraries. 232. Change in RML review of library grant applica- JAMA 1976 Mar 1;235(9):908. tions. Natl Libr Med News 1983 Jul/Aug;38(7- 207. Gilman NJ. Library services for health profession- 8):2. als. Calif Libr 1972 Apr;33(4):110-13. 233. RML Directors' Meeting. Minutes. New York, 208. Darling L. Changes in information delivery since NY, May 26, 1985. 1960 in health science libraries. Libr Trends 1974 234. TALON hospital library survey. Synergy Jul;23(1):31-62. 1986;16(3):4. 209. National Library of Medicine. Regional medical 235. Results of the 1983 survey of hospital libraries. library program evaluation. Bethesda: National Seattle: Pacific Northwest Regional Health Library of Medicine, April 12, 1974. Sciences Library Service, March, 1985. 210. Regional Medical Library Program Evaluation. 236. Results of the 1985 survey of hospital libraries. Preliminary report of results. Bethesda: National Seattle: Pacific Northwest Regional Health Library of Medicine, October 22, 1979. Sciences Library Service, December, 1985. 211. Abt Associates Inc., Exploratory evaluation report. 237. Graham E, Van Vuren DD, Flack V. Impact of the

54 Bull. Med. Libr. Assoc. 75(3) Supplement July 1987 NATION'S HEALTH INFORMATION NETWORK

Pacific Southwest Regional Medical Library Ser- brary loan requests received by the National vice on hospital library development. Bull Med Library of Medicine: 1959 and 1984. Bull Med Libr Assoc 1987 Jul;75(3):214-220. Libr Assoc 1987 Jan;75(1):7-13. 238. Van Vuren DD, Graham E, Flack V. Hospital 245. Fazzone N, DeSimone MG. MEDLARS utilization library development and the impact of PSRMLS profile in New England. Bull Med Libr Assoc services: report of an evaluation project. Los 1984 Jan;72(1):6-1 1. Angeles: PSRMLS, 1985. 246. Region V librarians featured in a newspaper article. 239. Van Vuren DD, Johnson DEP. Getting started with Natl Libr Med News 1981 Oct;36(10):6. electronic mail. Bull Med Libr Assoc 1985 247. McClatchey WM. The computer as a medical tool. Jul;73(3):267-70. J Med Assoc GA 1985 May;74(5):290-291. 240. Graham DL. Simultaneous remote search: a tech- 248. Topper JM. The RMLP and hospital librarians nique or providing MEDLARS services at remote [letter]. Bull Med Libr Assoc 1982 Jan;70(1):61. locations. Bull Med Libr Assoc 1980 249. Cheshier RG. The limits of the comprehensible: Oct;68(4):37 1. reflections on medical librarianship. Bull Med 241. GMRMLN serials exchange pilot study. 3 Sources Libr Assoc 1981 Oct;69(4):373-381. 1985 Feb;3(1):1. 250. RML Directors' Meeting. Minutes. Minneapolis, 242. Braude RM. National networking-the regional MN, May 18, 1986. medical library model. Res Sharing Infor Net- 251. Palmer RA. Effect of federal programs on health works 1984 Spring/Summer;1(3/4):107-124. sciences libraries. J Am Soc Inf Sci 1987 243. Kurth WH. Survey of the interlibrary loan opera- Jan;38(1):40-47. tion of the National Library of Medicine. Bethes- 252. Kennedy JF. Special message to the Congress on da, MD: U.S. Dept. of Health, Education Wel- national health needs. In: Public papers of the fare, Public Health Service, 1962. Presidents: John F. Kennedy, Washington, DC: 244. Lacroix EM, Dutcher GA. A comparison of interli- U.S. Government Printing Office, 1963.

Bull. Med. Libr. Assoc. 75(3) Suppiment July 1987 55 ALISON BUNTING

GLOSSARY OF ACRONYMS AND INITIALISMS AACR2 Anglo American Cataloguing MLA Medical Library Association Rules, 2nd edition MLAA Medical Library Assistance Act AAMC Association of American Medical MLCNY Medical Library Center of New Colleges York AHEC Area Health Education Center MLGSC Medical Library Group of South- AIM-TWX Abridged Index Medicus on Tele- ern California typewriter Exchange MRML Midwest Regional Medical Li- AMA American Medical Association brary ASCLA Association of Specialized and Co- NBHDB National Biomedical Holdings operative Library Agencies Data Base Online AVLINE Audiovisuals National Biomedical Serials Hold- Net- NBSHDB BCN Biomedical Communications ings Data Base work BHSL Basic health sciences libraries NEMIS Network Management Informa- BISI Biomedical Information Services tion System Institute NERMLS New England Regional Medical BLRC Biomedical Library Review Com- Library Service mittee NLM National Library of Medicine BRS Bibliographic Retrieval Services NMAC National Medical Audiovisuals CAI Computer assisted instruction Center CAP Cooperative Acquisitions Program NY/NJ RML New York/New Jersey Regional CATLINE Cataloging Online Medical Library CMLS Central Medical Library Service NYAM New York Academy of Medicine COSAP Cooperative Serials Acquisitions NYSILL New York State Interlibrary Loan Program Program DOCLINE Documents Online OCLC Online Computer Library Center EMP Extramural Programs (NLM) Octanet Automated interlibrary loan net- GMRMLN Greater Midwest Regional Medi- work cal Library Network PHILSOM Periodical Holdings in Libraries of GNRMLP Greater Northeastern Regional Schools of Medicine Medical Library Program PMI Postgraduate Medical Institute ILLINET Illinois Library and Information Network PNRHSL Pacific Northwest Regional JCAH Joint Commission on Accredita- Health Sciences Library tion of Hospitals PNRHSLS Pacific Northwest Regional KOMRML Kentucky-Ohio-Michigan Re- Health Sciences Library Ser- gional Medical Library vices LO Library Operations (NLM) PPM Program Planning Model LTI Library Training Institute PSRMLS Pacific Southwest Regional Medi- MARML Mid-Atlantic Regional Medical cal Library Service Library RECBIR Regional Coordination of Biomed- MCRMLP Midcontinental Regional Medical ical Information Resources Library Program RFP Request for Proposal MEDLARS Medical Literature Analysis and RL Resource Library Retrieval System RML Regional Medical Library MEDLINE MEDLARS Online MERMLS Mid-Eastern Regional Medical RMLP Regional Medical Library Pro- Library Service gram MHSLN Midwest Health Sciences Library RMP Regional Medical Programs Network SEARML Southeast Atlantic Regional Med- MICIS Michigan Interinstitutional Com- ical Library mittee for Information Science SERHOLD Serials Holdings Database

56 Bull. Med. Libr. Assoc. 75(3) Supplement July 1987 NATION'S HEALTH INFORMATION NETWORK

SERLINE Serials Online TRP Technical Resource Persons SERMLP Southeastern Regional Medical UCLA University of California, Los An- Library Program geles SCORE Standing Committee for On-Line UCMP Union Catalog of Medical Periodi- Retrieval Education cals TALON Texas, Arkansas, Louisiana, Okla- WILS Wisconsin Interlibrary Loan Net- homa, New Mexico work

Bull. Med. Libr. Assoc. 75(3) Suppiment July 1987 57 ALISON BUNTING

APPENDIX 1: DIRECTORS AND ASSOCIATE DIRECTORS OF REGIONAL MEDICAL LIBRARIES

The terminology used for the administrative Region V: Kentucky, Ohio, Michigan Regional heads of each RML varied among regions. For the Medical Library sake of consistency in this listing, the term director Director: Vern M. Pings, 1969-1975 is used for the director of the library responsible for James F. Williams, II, 1975-1982 providing RML services; the term associate director is used for the individual(s) responsible for Associate Jean Monroe, 1969-1977 the day-to-day operations of the RML. Director: Faith Van Toll, 1977-1982 Region VI: Southeastern Regional Medical ORIGINAL ELEVEN REGIONS Library Program Region I: New England Regional Medical Library Director: Miriam H. Libbey, 1970-1982 Service Associate Mark Hodges, 1970-1972 Director: Ralph T. Esterquest, 1967-1968 Director: Eloise C. Foster, 1973-1975 Harold Bloomquist, 1968-1975 Michael Torrente, 1976-1982 Foster M. Palmer (Acting), 1975-1977 Region VII: Midwest Regional Medical Library C. Robin 1977-1982 LeSueur, Director: William S. Budington, 1968-1979 Associate Mark Hodges, 1967-1970 Irwin H. Pizer, 1980-1982 Director: Mary E. Feeney, 1970-1976 Associate Richard Davis, 1968-1972 Arlee May, 1977-1982 Director: Chester Pletzke, 1972-1978 Ruby S. May, 1978-1982 Region II: New York/New Jersey Regional Medical Library Region VIII: Midcontinental Regional Medical Director: Gertrude L. Annan, 1969-1970 Library Program Thomas G. Basler, 1970-1972 Director: Bernice M. Hetzner, 1970-1973 Alfred N. Brandon, 1973-1978 David Bishop, 1973-1977 Brett A. Kirkpatrick, 1979-1982 Robert M. Braude, 1978-1982 Associate Ann Hutchinson, 1969-1971 Associate Elizabeth Petgen, 1971-1979 Director: Vernon R. Bruette, 1973-1978 Director: Richard B. Pride, 1980-1982 Lynn Kasner Morgan, 1978-1980 Kay Mills Due, 1981-1982 Region IX: South Central Regional Medical Library Region II:k Mid-Eastern Regional Medical Director: Donald D. Hendricks, 1970-1977 Library Service S. Joe McCord (Interim), 1977-1978 Jean Miller, 1979-1982 Director: Elliott H. Morse, 1968-1981 Anthony Aguirre, 1981-1982 Associate John A. Murphey, 1973-1981 Director: James Pat Craig, 1982 Associate Carol C. Spencer, 1970-1972 Director: John A. Timour, 1973-1975 Region X: Pacific Northwest Regional Health June H. Fulton, 1975-1982 Sciences Library Director: Gerald J. Oppenheimer, 1968-1982 Region IV: Mid-Atlantic Regional Medical Library Associate Dale R. Middleton, 1980-1982 Director: Director: Erika Love, 1977-1977 Carol C. Spencer, 1977-1978 Region XI: Pacific Southwest Regional Medical Maxine Hanke, 1978-1982 Library Service Associate Jackie Rustigian Mikail, 1974-1981 Director: Louise Darling, 1969-1979 Director: Peggy J. Beavers, 1981-1982 Gloria Werner, 1980-1982

58 Bull. Med. Libr. Assoc. 75(3) Supplement July 1987 NATION'S HEALTH INFORMATION NETWORK

Associate Nelson J. Gilman, 1969-1971 Region 4: Midcontinental Regional Medical Director: Phyllis S. Mirsky, 197 1-1979 Library Program Alison Bunting (Acting), 1979 Director: Robert M. Braude, 1983-1986 Robert Bellanti, 1979-1982 Nancy N. Woelfl, 1987- Associate Richard B. Pride, 1982-1983 SEVEN RECONFIGURED REGIONS Director: Carolyn Reid, 1983- Region 1: Greater Northeastern Regional Medical Region 5: South Central Regional Medical Library Program Library Director: Brett A. Kirkpatrick, 1983- Director: Jean Miller, 1982- Associate Kay Mills Due, 1983-1986 Associate James Pat Craig, 1982-1985 Director: Mary Mylenki, 1986- Director: Regina Harris Lee, 1985- Region 6: Pacific Northwest Regional Health Region 2: Southeastern/Atlantic Regional Sciences Library Service Medical Library Director: Gerald J. Oppenheimer, 1982- Director: Cyril C. Feng, 1983- Associate Dale R. Middleton, 1982- Associate Carol G. Jenkins, 1983-1986 Director: Director: Suzanne Grefsheim, 1986- Region 7: Pacific Southwest Regional Medical Region 3: Greater Midwest Regional Medical Library Service Library Network Director: Gloria Werner, 1982-1984 Director: Irwin H. Pizer, 1983- Alison Bunting, 1984- Associate Ruby S. May, 1983- Associate Darcy D. Van Vuren, 1982-1985 Director: Director: Elaine Graham, 1985-

Bull. Med. Libr. Assoc. 75(3) Supplment July 1987 59 ALISON BUNTING

APPENDIX 2: KEY NATIONAL LIBRARY OF MEDICINE STAFF INVOLVED WITH THE RML PROGRAM

Office ofthe Director Erika Love, 1971-1977 Director: James W. Barry, 1977-1980 Lois Ann Colaianni, 1980-1984 Frank Bradway Rogers, M.D., 1949-1963 Betsy L. Humphreys, 1984- Martin M. Cummings, M.D., 1964-1983 Donald A. B. Lindberg, M.D., 1984- RML Coordinator: Deputy Director: Sheldon Kotzin, 1978-81 Scott Adams, 1960-1969 Duane Arenales (Acting), 1982-1983 G. Burroughs Mider, M.D., 1969-1972 Becky Lyon-Hartmann, 1984- Melvin S. Day, 1972-1978 Kent A. Smith, 1978- Extramural Programs Deputy Director for Research and Education (for- Associate Director: merly Special Assistant to the Director for Medical Marjorie P. Wilson, M.D., 1964-1967 Program Development and Evaluation): David F. Kefauver, 1967-1970 G. Burroughs Mider, M.D., 1968-1969 Leroy Langley, M.D., 1970-1973 Harold M. Schoolman, M.D., 1970- Ernest M. Allen, M.D., 1973-1982 William Cooper, Ph.D., 1982-1985 Associate for Extramural Planning Arthur Broering (Acting), 1985- Estelle Brodman, Ph.D., 1960-1961 Deputy Associate Director: Library Operations Robert A. Walkington, 1970-1973 Associate Director: Arthur Broering, 1974- Joseph Leiter, Ph.D., 1965-1983 Facilities and Resources Division (1966-1973): Lois Ann Colaianni, 1984- Carl Douglass, 1966-1967 Deputy Associate Director: Louis S. Gerber, M.D., 1967-1968 James P. Riley, 1967-1968 Robert Walkington (Acting), 1968 Samuel T. Waters, 1969-1970 Arthur Broering, 1968-1973

60 Bull. Med. Libr. Assoc. 75(3) Supplement July 1987 NATION'S HEALTH INFORMATION NETWORK

APPENDIX 3: REGIONAL MEDICAL LIBRARY NEWSLETrERS Original IX Synergy. Newsletter of the TALON Regions Newsletter Regional Medical Library Program. I NERMLS News. Quarterly newsletter Dallas, TX, v. 1, Feb 1970-. of the New England Regional Medical X Supplement. Newsletter/Pacific North- Library Service. Boston, MA, no. 1, west Regional Health Sciences Library. Jan/Mar 1970-no. 56, Aug 1982. Seattle, WA, Mar 1970. II New York and Northern New Jersey XI Pacific Southwest Regional Medical Regional Medical Library News. New Library Service Newsletter. Los An- York, NY, v. 1, Aug 1971-no. 5, May geles, CA, no. 1, Oct 1969-. 1974. New York and New Jersey Regional Medical Library News. New York, NY, Reconfigured v. 1, Oct 1976-v. 6, Oct 1982. Regions III MERMLS News. Newsletter of the I Greater Northeastern Regional Medical Mid-Eastern Regional Medical Library Library Program Newsletter. New Service. Philadelphia, PA, v. 1, Jan York, NY, v. 1, Feb 1983-. 1970-v. Nov 13, 1982. 2 SEA Currents. Newsletter of the South- IV RML IV. Mid-Atlantic Regional Medi- eastern Atlantic Regional Medical Li- cal Library Program. Newsletter. Be- brary Service. Baltimore, MD, v. 1, Mar thesda, MD, no. 1, Apr 1974-no. 42, 1973. Nov/Dec 1982. 3 3 Sources. The Region 3 newsletter. V KOMRML Commentary. Detroit, MI, Greater Midwest Regional Medical v. 1, 1976. Library Network. Chicago, IL, v. 1, KOMRML. Kommentary. Detroit, MI, 1983-. v. 1, May 1977-v. 2, Mar 1979. 4 Octasphere. Newsletter of the Midconti- KOMmentary on the kentucky ohio nental Regional Medical Library Net- michigan regional medical library net- work. Omaha, NE, v. 1, Feb 1973-. work. Detroit, MI, no. 1, Summer 1979- 5 Synergy. Newsletter of the TALON no. 7, Winter 1982. Regional Medical Library Program. VI Program Notes. Southeastern Regional Dallas, TX, v. 1, Feb 1970-. (Effective Medical Library Program. Atlanta, GA, with v. 14, 1984 the subtitle changed to no. 1, Jan 1971 -no. 40, Dec 1982. Newsletter of the South Central Re- gional Medical Library Program.) VII News Notes. Midwest Regional Medical Library. Chicago, IL, no. 1, Aug 1969- 6 Supplement. Newsletter/Pacific North- no. 15, Dec 1972. west Regional Health Sciences Library. Seattle, WA, Mar 1970-. (Effective Resources. Midwest Health Science 1983 the subtitle changed to Newslet- Library Network. Chicago, IL, v. 1, ter/Pacific Northwest Regional Health Autumn 1973-v. 9, Dec 1982. Sciences Library Service.) VIII Octasphere. Newsletter of the Midconti- 7 Pacific Southwest Regional Medical nental Regional Medical Library Net- Library Service Newsletter. Los An- work. Omaha, NE, v. 1, Feb 1973-. geles, CA, no. 1, Oct 1969-.

Bull. Med. Libr. Assoc. 75(3) Supplement July 1987 61 ALISON BUNTING

APPENDIX 4: EXPERTS CONSULTED AND EXPERT REVIEWERS

Experts Consulted Elliott H. Morse Gertrude L. Annan Vern M. Pings Duane Arenales Harold M. Schoolman Thomas G. Basler Kent A. Smith Alfred N. Brandon Richard T. West Estelle Brodman Marjorie P. Wilson Arthur J. Broering William S. Budington Expert Reviewers Lois Ann Colaianni Duane Arenales William G. Cooper David Bishop Mary E. Corning Susan Crawford Martin M. Cummings Louise Darling Louise Darling June H. Fulton Myrl Ebert Suzanne Grefsheim Donald D. Hendricks Mark Hodges Bernice M. Hetzner Brett A. Kirkpatrick Samuel Hitt Sheldon Kotzin Mark Hodges C. Robin LeSueur Mary M. Horres Becky Lyon-Hartmann Ann P. Hutchinson Jackie Rustigian Mikail Frances E. Johnson Jean Miller Sheldon Kotzin Phyllis S. Mirsky Joseph Leiter Gerald J. Oppenheimer C. Robin LeSueur Raymond A. Palmer Erika Love Irwin H. Pizer Becky Lyon-Hartmann Carolyn Reid Lucretia McClure Kent A. Smith Erich Meyerhoff Faith Van Toll Jackie Rustigian Mikail Pat L. Walter

62 Bull. Med. Libr. Assoc. 75(3) Supplement July 1987