MedlinePlus®: the National Library of Medicine®

Brings Quality Information to Health Consumers

Naomi Miller, Senior Systems Librarian

Public Services Division

National Library of Medicine

8600 Rockville Pike

Bethesda, MD 20894

301-496-0240

<millern@mail.nlm.nih.gov>

Rebecca J. Tyler, Systems Librarian

Public Services Division

National Library of Medicine

8600 Rockville Pike

Bethesda, MD 20894

301-435-4888

<tylerr@mail.nlm.nih.gov>

Joyce E.B. Backus, Lead Systems Librarian

Public Services Division

National Library of Medicine

8600 Rockville Pike

Bethesda, MD 20894

301-496-7732

<backusj@mail.nlm.nih.gov>

Abstract

The National Library of Medicine's (NLM®) MedlinePlus is a high-quality
gateway to consumer health information from NLM, the National Institutes
of Health (NIH), and other authoritative organizations. For decades, NLM
has been a leader in indexing, organizing, and distributing health
information to health professionals. In creating MedlinePlus, NLM uses
years of accumulated expertise and technical knowledge to produce an
authoritative, reliable consumer health web site. This article describes
the development of MedlinePlus\--its quality control processes, the
integration of NLM and NIH information, NLM's relationship to other
institutions, the technical and staffing infrastructures, the use of
feedback for quality improvement, and future plans.

NLM begins direct service to consumers

The legislation establishing the National Library of Medicine (2000) as
a component of the National Institutes of Health (NIH) in 1956 describes
the mission of the library as collecting, preserving and disseminating
medical literature as well as making "available its bibliographic,
reference, or other services, to public and private entities and
individuals." NLM fulfilled this mission for many years by primarily
serving health professionals, especially through the MEDLINE® database
of references to millions of biomedical research publications. In recent
years, NLM's governing Board of Regents encouraged NLM to expand its
services to the general public of health consumers (National Library of
Medicine, 2000).

When the MEDLINE database became free to the Internet public in 1997,
NLM embarked upon this expanded mission of serving the general public.
Early studies showed that many MEDLINE users were not professionals and
researchers, but were members of the general public seeking health
information for themselves, family members, and friends ("Free MEDLINE,"
1997). MEDLINE began indexing a few consumer-level publications in early
1998 ("MEDLINE to index," 1998) but it was clear that NLM could do more
to provide quality health information for the public. In 1998, NLM began
a project with the National Network of Libraries of Medicine® (NN/LM®)
to work with public libraries to better serve health consumers (Wood et
al., 2000). This project found that public librarians needed training to
become more comfortable providing health information and a trusted place
to turn for the health content.

With the advice of public libraries and customer feedback from users of
other NLM products, NLM released MedlinePlus on October 22, 1998. In
creating MedlinePlus, NLM drew upon the skills of medical librarians and
information technology professionals to make consumer-level
authoritative medical information available to anyone with access to the
World Wide Web. Combining this expertise with the strength and authority
of NIH and other government and non-government organizations,
MedlinePlus has become a source of health information to millions of
health consumers as well as their health care providers.

Health Topics: Quality at the core of MedlinePlus

Initially, MedlinePlus provided consumers with authoritative health
information from the federal government and other organizations. These
lists of links, or Health Topic pages, remain the core of MedlinePlus.
Health Topic pages are highly selective collections of links to web
documents, not comprehensive lists of everything on the Web. They point
consumers to the best web resources and minimize redundant listings. The
experienced biomedical librarians who create and maintain the Health
Topic pages organize them into categories such as overviews, diagnosis,
treatment and prevention. They also identify the publishing
organization, easy to read materials and other special features such as
pictures, diagrams, and flowcharts. The Health Topic pages function like
a table of contents to a virtual Internet book broken down into
chapters. This organization helps consumers easily scan the page and
provides them with a refuge from the overwhelming amounts of information
or varying quality of Internet health information.

Addressing the need for quality

The number and popularity of sites providing health information to
consumers constantly increases. This growth heightens concern in the
medical profession about the importance of reliable, quality information
(Fox & Fallows, 2003; Licciardone, Smith-Barbaro, & Coleridge, 2001).
One study shows that only a quarter of health information seekers check
the quality of the Web resources they use (Lewis & Behana, 2001). Many
consumers consider a professional-looking Web design with
scientific-looking touches to be sufficient assurance of the high
quality of the information on the web site (Eysenbach & Köhler, 2002).
Rather than appearance, health information experts know that consumers
should look for key characteristics when evaluating a health information
web site. These criteria include: author and author affiliation,
attribution of sources and references used, information about funding,
ownership, and sponsorship of the web site (Gagliardi & Jadad, 2002), as
well as clear labeling of advertising (Karp & Monroe, 2002).

For MedlinePlus, NLM uses written guidelines to identify and select
high-quality information produced by other NIH Institutes, government
organizations and non-government health information providers. The
librarians building MedlinePlus Health Topic pages follow the same model
that collection development librarians have used for years to create
print reference collections. But, the Web format creates additional
challenges to collection evaluation and selection. MedlinePlus publishes
these guidelines so that organizations can evaluate themselves against
the selection standards. These guidelines assure users that the
information they find on Health Topic pages is reliable and up to date.
They cover four main areas:

1.  Quality, authority and accuracy of content

> Sites must provide the names of their advisory board members or be
> published by a government agency. MedlinePlus staff check Board
> members' names in MEDLINE and other databases to ascertain whether
> they have published on the subjects covered by the web site. If the
> medical authority of the site is not evident, the MedlinePlus team
> contacts the site's Webmaster requesting for information or
> clarification.

2.  Purpose of site

> The site's primary purpose must be to provide health information, not
> to sell a product or service. Intrusive or content-linked
> advertisements disqualify pages from inclusion. Most of the content
> must be free and the not require registration.

3.  Maintenance

> The site must be consistently available, without broken links, and
> provide a Webmaster address. Pages must display dates.

4.  Quality, non-redundant content

> Because MedlinePlus is selective, not comprehensive, links on Health
> Topic should have minimal redundancy. Each linked document provides
> unique information to the consumer using that Health Topic page. Some
> links bring users a clear summary of an entire disease or condition,
> while others bring unique features, such as different reading levels,
> clear diagrams, illustrations, or interactive programs.

As a government web site, MedlinePlus offers consumers an Internet
experience free from advertisements. The site also uses no cookies and
does not request any personal information.

The language of health consumers

Studies of NLM web site search logs from the mid-1990s revealed that
over 70% of the searches were for medical information (Miller, 1997).
The logs of user terms provided a valuable window into consumers'
interests and the vocabulary they used to express their information
needs. The Lister Hill National Center for Biomedical Communications
used Unified Medical Language System® (UMLS®) tools to further analyze
search logs, and created a ranked list of search terms organized by
NLM's Medical Subject Heading (MeSH®) vocabulary (McCray, Loane, Browne,
& Bangalore, 1999). These studies of the language of users' searches
gave direction for developing the vocabulary terms MedlinePlus uses to
direct users to Health Topic pages.

To best serve consumers, MedlinePlus terminology reflects users'
expectations as expressed in their own search words. Once again, NLM
staff experience in medical terminology is a key factor in making the
MedlinePlus vocabulary work well for consumers. MedlinePlus developers
examine a number of vocabularies to create Health Topic names and "see
references." NLM's own MeSH vocabulary, developed for health
professional literature, provides background for the structure of
medical knowledge, but is often too scientific for consumers. Other
medical thesauri that provide inspiration include the Planetree
Classification (Planetree Health Resource Center, 1991), the CINAHL
Thesaurus (CINAHL Information Systems, 2003) and the terms used on other
consumer health web sites. The final Health Topic page names are based
on considering all these sources.

For Health Topic pages, MeSH terms are preferred when they coincide with
consumer use in search logs, consumer-focused documents and other
sources. For example, MedlinePlus has Health Topic pages that use MeSH
terms for cataract, fibromyalgia, and multiple sclerosis. In contrast,
there are Health Topic pages for Heart Attack, not Myocardial
Infarction, Breast Cancer, not Breast Neoplasms, and High Blood
Pressure, not Hypertension. In other cases, MeSH does not have certain
consumer concepts, such as club drugs or men's health. In these cases,
MedlinePlus uses the consumer term. MedlinePlus includes liberal "See
references," so more technical versions or synonyms become links in
alphabetic topic lists. This process of using customer suggestions and
search behavior to improve MedlinePlus keeps the quality, usability and
customer satisfaction at the highest level possible.

[Integrating Medical Subject Headings into MedlinePlus]{.underline}.
Although MedlinePlus displays a unique consumer vocabulary, the links
from MedlinePlus to other NLM resources depend on MeSH. Behind the
scenes, software allows MedlinePlus staff to link MeSH vocabulary with
Health Topic pages. The MedlinePlus management system generates the
files which allow MedlinePlus to link to MeSH-based NLM resources. For
example, one file creates the links between ClinicalTrials.gov and
MedlinePlus. These links allow users of ClinicalTrials.gov to learn more
about medical conditions in research trials and MedlinePlus users to
find clinical trials on a particular condition. Another file enables
PubMed/MEDLINE to link from biomedical article references to MedlinePlus
Health Topics. These PubMed/MedlinePlus mappings allow users to select
the "Consumer Health" LinkOut text from PubMed/MEDLINE and immediately
explore that Health Topic page on MedlinePlus. Librarians maintaining
MeSH in MedlinePlus keep it up-to-date with annual changes and
improvements to MeSH and the systems themselves.

> Relationships with NIH Institutes and other organizations

As a part of the NIH, NLM is an important partner in bringing the
knowledge of the United States' premier biomedical research organization
to the public. NLM staff work with the staff of other NIH Institutes who
write and publish unbiased, well-reviewed information for consumers. NLM
provides feedback from MedlinePlus users to the Institutes which they
consider as they determine priorities and policy direction.

Leveraging NLM's strengths as an NIH Institute

[NIH content and collaboration]{.underline}. NIH consumer health
documents are an integral part of MedlinePlus. Each MedlinePlus Health
Topic page features a link to the Institute with primary research
responsibility for that disease, condition or health issue. These
Institute links connect users to a premier research organization for
additional resources as they seek information.

The NIH MedlinePlus Advisory Group is key to ensuring the quality and
direction of MedlinePlus ("MEDLINEplus counts on input," 2003). This
group consists of public information office managers who are responsible
for information dissemination to the public from the NIH Institutes,
such as the National Cancer Institute and the National Institute of
Diabetes and Digestive and Kidney Diseases. The advisory group meets
three times a year to learn about new MedlinePlus developments, advise
on future directions, and inform each other about new projects and
resources. This group ensures good coordination and communication
between NIH organizations providing health information to consumers and
contributes to the quality of all the NIH consumer web information.
Staff from these offices interact with NLM staff throughout the year to
improve NIH content linked from MedlinePlus.

[Non-NIH Organizations.]{.underline} The MedlinePlus Health Topic Pages
link to documents from hundreds of organizations. These organizations
include well-known professional organizations (American Academy of
Family Physicians, American Academy of Orthopaedic Surgeons), large
voluntary associations (American Heart Association, American Diabetes
Association), and groups dealing with a specific problem (Lupus
Foundation of America, Macular Degeneration Partnership) and well-known
healthcare organizations (Mayo Clinic, National Jewish Research and
Medical Center.) While selecting and maintaining these links,
MedlinePlus staff often contact these organizations encouraging them to
follow the MedlinePlus selection guidelines on their health web sites.
Requests range from dating pages to updating older documents to removing
registration from sites. By working directly with these health
information producers, MedlinePlus serves the public by encouraging as
many as possible to adhere to the selection guidelines. Many of these
contacts have evolved into ongoing cooperative relationships and link
exchanges.

Enhancing MedlinePlus with licensed content

One goal of a collection development librarian is to cover a subject as
completely as needed by the patron. Biomedical librarians construct
MedlinePlus Health Topic pages to provide as complete a consumer
resource as possible on a disease or condition. However, topic coverage
depends on organizations to publish documents that meet the selection
criteria. Examinations of "zero hit" terms from MedlinePlus search logs
show that Health Topic page links do not cover all medical issues of
interest to consumers. Licensed content supplements the Health Topic
pages in areas where authoritative web content is not available.
MedlinePlus licenses drug information, a medical encyclopedia, health
news, a medical dictionary, and low-literacy interactive health
tutorials and makes them freely available to the public for personal
use. These materials supplement the information provided from the Health
Topic pages. They are kept up-to-date by the licensed content providers
and make up an important component of the web site. All MedlinePlus
licensed content is available at no charge. Users may read and print all
these materials; in addition, they may email single copies of many
materials to share with family and friends for personal use.

Leveraging NLM's strengths

The MeSH vocabulary is the key to linking MedlinePlus users to other NLM
products. Staff make these links behind the scenes in the systems that
manage the vocabulary. These systems create the links that provide
options for consumers to navigate between MedlinePlus, PubMed®/MEDLINE,
ClinicalTrials.gov and Genetics Home Reference.

Integrating NLM Products and Services into MedlinePlus

[PubMed/MEDLINE]{.underline}. Customer feedback and other research have
taught NLM that patients and families need information at a variety of
levels. For users who want to read research literature, MedlinePlus
integrates PubMed/MEDLINE searches of peer-reviewed biomedical journal
citations into the Health Topic pages. Expert searchers from the
Library's Reference and Customer Service Section create "pre-packaged"
searches tailored for consumers and review them twice a year to maintain
quality. These searches retrieve citations to English language review
articles, evidence-based medicine, and consensus practice guidelines,
and run on-demand when the user selects one. Patients and families
coping with a serious or chronic illness use this feature to learn more
advanced information or to keep up with the latest developments on a
disease or condition. Health practitioners report using the searches as
a quick start in areas outside their expertise.

### ClinicalTrials.gov. In February 2000, NIH launched the 

### ClinicalTrials.gov database ("National Institutes of Health," 2000) providing consumers with access to medical research studies that seek to evaluate the safety and effectiveness of new drugs, medical procedures, or other means of treating, diagnosing, or preventing diseases. The database is built by the NLM's Lister Hill National Center for Biomedical Communications. To deliver the most recent information to consumers, the MedlinePlus ClinicalTrials.gov link performs a new search each time a consumer uses it. These searches retrieve clinical trials currently recruiting patients on the subject of the MedlinePlus Health Topic pages. Once again, biomedical librarians use their well-honed search and retrieval skills to review links every six months and after the annual MeSH vocabulary changes. 

[Genetics Home Reference]{.underline}. The Genetics Home Reference (GHR)
is a recent addition to NLM's consumer health information web sites
("Genetics Home Reference," 2003). Produced by the Lister Hill National
Center for Biomedical Communications at NLM, the site provides in-depth
information on dozens of genetic conditions, such as Marfan's syndrome,
as well as other conditions with a genetic component, such as breast
cancer. Again, the GHR records link to MedlinePlus pages and vice versa
using MeSH and a mapping file maintained by MedlinePlus librarians.

Libraries assisting consumers

NLM is the world's largest medical library, but depends on collaboration
with other libraries to provide consumer health information wherever
consumers need it. Sometimes that "location" is the Internet. Other
times, it is a local library. The public library pilot project showed
that consumers prefer that health sites provide full-text information
they can print on-demand. They also expect local access to libraries
where staff can help them find information when they need it. These
consumer expectations are why MedlinePlus Health Topic pages link,
wherever possible, to pages of full-text information, not to other
portals or lists of links. Today, public libraries throughout the U.S.
use MedlinePlus as a primary health resource for their patrons and
continue to provide valuable feedback.

[Linking consumers to libraries]{.underline}. From its inception,
MedlinePlus provided consumers with a single page of links to biomedical
libraries willing to serve consumers. This list was incomplete because
it depended on libraries contacting MedlinePlus staff to request a
listing. In the spring of 2003, MedlinePlus began to build the library
directory pages from a database of "Institutions" in NLM's Interlibrary
Loan system, DOCLINE®. NLM added the ability for DOCLINE libraries to
choose to be listed in the MedlinePlus directory of biomedical libraries
willing to serve consumers. Each library listing includes address, phone
number, and Web site URL. MedlinePlus library pages include over 600
libraries from the U.S., Canada, U.S. Territories and foreign countries.
Forty-nine states list at least one library (the smallest states, Rhode
Island and Delaware, each list three) and many states list dozens
(Colorado lists 41, Michigan lists 32.) Through DOCLINE and MedlinePlus,
every biomedical library can offer their expert services to health
consumers.

MedlinePlus en español

Public librarians in the pilot project as well as many others requested
that MedlinePlus expand and provide Health Topic pages entirely in
Spanish to assist them in providing information to Spanish-speaking
patrons. In response to these requests and to better serve the
Spanish-speaking populations, MedlinePlus en español
(http://medlineplus.gov/esp) made its debut in September of 2002
("MEDLINEplus goes Spanish," 2002).

MedlinePlus en español contains over 600 Health Topic pages with
thousands of links to information that meet the same selection
guidelines as those on the main site. The Spanish-language site also
includes drug information, encyclopedia, news, and Spanish-language
interactive tutorials. For non-Spanish speakers, a single click on the
español link leads from the English content to its corresponding Spanish
content.

The processes for developing Spanish Health Topic pages are designed to
maintain the same high-quality standards that govern the MedlinePlus
Health Topic pages in English. These parallel procedures manage
Spanish-language Health Topics and associated vocabulary. Bilingual
medical librarians select and review web site records, build new topics,
and update existing topics every six months. MedlinePlus en español uses
the same selection guidelines as the MedlinePlus site. However, the
Spanish-language site links to more information from local governments,
university departments, and international sources than the English
version because there aren't as many web documents available in Spanish
from national U.S. organizations. By using the same procedures and
guidelines that have proven vital to the success of MedlinePlus,
MedlinePlus en español provides authoritative, quality information.

MedlinePlus Staffing, Roles and Workflow

Staffing

Staff positions for MedlinePlus include librarians, computer
specialists, managers, and others. MedlinePlus is a collaborative effort
among several NLM departments. Medical librarians at medical schools and
hospitals contribute their expertise to MedlinePlus through several
contracts. Figure 2 provides an overview of staff functions of policy,
content, technical and feedback, all important aspects of maintaining a
quality site. \[Figure 2 here.\] MedlinePlus draws upon staff strengths
throughout NLM. MedlinePlus benefits from name authority and selection
expertise from the Technical Services Division, promotion and evaluation
expertise from its Office of the Director, health information expertise
from the Reference and Customer Services Section, programming and
technical skills from the information technology department. The
strength and quality of MedlinePlus comes from each NLM organization
contributing its best expertise to benefit the health consumer.

Keeping the content of the MedlinePlus Health Topics pages maintained to
high standards requires two primary categories of librarians: selectors
and reviewers. Selectors search the web for appropriate materials, apply
the selection guidelines, enter records into the database, and review
Health Topic pages every six months. Records include information such as
the name of the page, URL, type of site (NIH, other government agency,
or nongovernmental) MedlinePlus Health Topic, and the organization
responsible for the page. These selectors can work anywhere they have a
computer with a browser and an Internet connection.

Selectors enter information for pages they choose to add to a Health
Topic page and also for Web pages that do not meet the MedlinePlus
selection guidelines. The MedlinePlus staff records these decisions for
several reasons: to record the decision for other selectors who find
that Web page later, to hold the information while staff contact the
organization and ask them to correct a problem, and to review the Web
site later during Health Topic Page review. Selectors and reviews make
notes that become a record of the decisions made regarding a Web page so
that the corporate memory retains this information even as the people
change.

Reviewers, the second category of users, release selector's work to the
public site or return it to selectors for revision. Their eyes provide
the last check before information appears to the public. These senior
librarians also perform overall management tasks which include: creating
new Health Topics, subcategories, and see references; releasing records
and Health Topics to the public, and performing system management
functions like adding new users and removing obsolete records. These
persistent review processes and daily link fixes keep MedlinePlus as
up-to-date and accurate as possible in the world of constantly changing
medical information and web sites.

\[Figure 1 here\]

A small team of NLM staff oversees the overall process of content
quality assurance. A content manager from the Public Services Division
Web team approves requests for new topics and resolves conflicts of
opinion as they arise. MedlinePlus en español has a corresponding
content manager who serves this role for that site. An acquisitions
librarian from the Selection and Acquisitions Section evaluates
organization information at least annually. A Topic Manager from the
Reference and Customer Services Section maintains the schedule of topic
reviews and identifies high-profile topics for quick review on an
as-needed basis. The MedlinePlus content team meets with all selectors
and reviewers monthly via teleconference and posts meeting summaries on
an internal listserv. Once again, each of these staff members
contributing their specific information skills adds to the quality and
accuracy of MedlinePlus.

Building a maintenance system for MedlinePlus

NLM staff created a few basic HTML pages for the MedlinePlus prototype
in the summer of 1998. While creating this prototype, staff quickly
realized there were many problems of consistency, reliability and
scalability if this simple approach were used for an entire health
information Web site. With manually-developed HTML pages, two staff
members might find the same Web page and describe it in two different
ways. Staff indexing a page called "Stroke Risks: High Blood Pressure
Can Lead to Stroke" might use both a title and subtitle on the High
Blood Pressure page but use only its title on the Stroke page. For
consistency and maintenance, Web document links need the same
description every place they appears on the site. A database was the
answer for developing a large web site and maintaining it in good
working order.

The MedlinePlus development team turned to NLM\'s Office of Computer and
Communications Systems (OCCS) to develop a system to create, review, and
maintain MedlinePlus. OCCS recommended using a database to ensure
consistency of vocabulary and descriptions. The database also allows
staff to create and maintain records centrally for display on multiple
MedlinePlus pages. They also recommended that the public Web site not
use the database directly, but an HTML version of the site. This
structure allows NLM to deliver pages quickly and securely to the public
and to use existing web management tools including a search engine, link
checker, and web statistics software. The MedlinePlus system combines an
Oracle database, which stores all data, with a Cold Fusion Web
forms-based system to control the data and workflow. Today, this
web-based system design ably serves the MedlinePlus public and allows
medical librarians at geographically dispersed sites to perform any
MedlinePlus update or maintenance task.

## Feedback drives future plans

Customer feedback of many types drives improvements to MedlinePlus. NLM
staff gather this feedback through both passive and active collection.
Passive collections of user behavior such as examining search engine and
web activity logs guide MedlinePlus toward better serving user needs.
The medical terms users type into the search box are a valuable source
of consumer feedback. These search terms suggest new MedlinePlus topics
and see references, requests to NIH Institutes to develop new materials,
and new variations for the list of misspelled words for the search
engine to map to correct spellings. Web traffic logs provide information
about the most used pages and those that consumers use less frequently.
Use statistics guide the list of frequently requested topics on the
Health Topics home page and suggest topics for MedlinePlus home page
features.

NLM also solicits active user feedback for advice on MedlinePlus
improvements. Customers send thousands of unsolicited comments each year
using the "Contact Us" link on every page. Other active methods include
online surveys, focus groups, and usability tests. Before each released
improvement to the site, focus groups and usability testing provide
staff with insight into how consumers use MedlinePlus and how it does or
does not meet their expectations. As the Internet and web change, so do
users' skills and expectations and MedlinePlus endeavors to change with
consumers. Gathering feedback via multiple methods and making
improvements suggested by consumers is an important key to maintaining
user confidence in the quality and reliability of MedlinePlus.

Into the future

NLM is undertaking several new initiatives to enhance MedlinePlus.
Linking consumers from authoritative health information to information
about health services in local geographic areas is the focus of the \"Go
Local\" project. The goal is that a MedlinePlus user on the Breast
Cancer page using the Go Local link is presented with a page listing
cancer clinics, oncologists, support groups, and other providers,
programs and services. The University of North Carolina at Chapel Hill
(UNC) developed the first Go Local site, NC Health Info
(http://www.nchealthinfo.org/). The NC Health Info team built a database
of local Web sites, an input and maintenance system, local and
MedlinePlus vocabulary mappings, and a Web interface. Since then the
University of Missouri has linked its Community Connection
(http://www.communityconnection.org/) Web site to MedlinePlus. Both
Missouri and North Carolina support all of the technical hardware and
software involved in providing a large-scale web site to the public.

NLM is releasing a Go Local hosting system, that it will maintain
centrally, to help states and regions make services available to
residents, their families and friends. Using this system, Go Local teams
will create and update content on a system where NLM maintains the
hardware, software, vocabulary mappings, user interface, and statistics
for the site. The NLM supported model will be available in 2004 for Go
Local sites to begin creating new Go Local resources to benefit
residents of their state or region. NLM will work with the local
sponsors to release these Go Local sites as they are ready.

### 

### MedlinePlus will also focus more on content for specific audiences. The Easy-to-Read pages were the first of these specialized pages. Released in November 2003, they gather together materials that sponsoring organizations identify as suitable for low literacy consumers and display them by health topic. MedlinePlus also displays pages that list links for low vision users. Using technologies developed for another NLM consumer health web site, NIHSeniorHealth, the low vision page brings together health information with enhanced accessibility features such as the ability to change the contrast and enlarge the font. In the future, other special pages will be developed.

Summary

Since its inception in 1998, MedlinePlus has evolved from a handful of
Health Topics linking to NIH, other government, and non government
consumer health information to over 650 Health Topics linking to
information from nearly a thousand organizations. To meet consumer needs
and expectations for health information, MedlinePlus licenses drug
information, interactive health tutorials, a medical dictionary and
illustrated encyclopedia. NLM has instituted computer system and human
processes which build on the strengths of staff at NLM and elsewhere to
create the highest-quality consumer health information portal possible
and consumers continue to respond by visiting the site by the millions.
The National Library of Medicine is committed to continuing to improve
MedlinePlus so that it will remain an authoritative, quality web site
for consumer health information.

![](media/image1.png){width="6.39375in" height="7.253472222222222in"}

Figure 1. MedlinePlus staffing.

![](media/image2.png){width="6.399305555555555in"
height="8.416666666666666in"}

Figure 2. MedlinePlus input system diagram.

References

CINAHL Information Systems. (2003). *CINAHL* \... *subject* *heading*
*list*: *Alphabetic list**,** tree structures, permuted list*. Glendale,
California: CINAHL Information Systems.

Eysenbach, G. & Köhler, C. (2002). How do consumers search for and
appraise health information on the world wide web? Qualitative study
using focus groups, usability tests, and in-depth interviews*. BMJ,
324,* 573-577.

Fox, S. & Fallows, D. (2003, July 16). *Internet health resources:
Health searches and email have become more common place, but there is
room for improvement in searches and overall Internet access.* Retrieved
October 17, 2003, from
<http://www.pewinternet.org/reports/pdfs/PIP_Health_Report_July2003.pdf>

*Free MEDLINE*. (1997, June 26). Retrieved October 17, 2003, from
<http://www.nlm.nih.gov/news/press_releases/free_medline.html>

Gagliardi, A. & Jadad, A. R. (2002). Examination of instruments used to
rate quality of health information on the Internet: Chronicle of a
voyage with an unclear destination. *BMJ, 324*, 569-573.

*Genetics Home Reference makes genes, chromosomes, DNA easily
understood*. (2003, May 13). Retrieved October 17, 2003, from
<http://www.nlm.nih.gov/news/press_releases/GenhomeRefPR03.html>

Karp, S. & Monroe, A. F. (2002). Quality of healthcare information on
the Internet: caveat emptor still rules. *Managed Care Quarterly, 10,*
3-8.

Lewis, D. & Behana, K. (2001). The Internet as a resource for consumer
healthcare. *Disease Management & Health Outcomes, 9,* 241-247.

Licciardone, J. C., Smith-Barbaro, P., & Coleridge, S. T. (2001). Use of
the Internet as a resource for consumer health information: Results of
the second osteopathic survey of health care in America (OSTEOSURV-II).
*Journal of Medical Internet Research, 3,* e31.

McCray, A. T., Loane, R. F., Browne, A. C., & Bangalore, A. K. (1999,
November). *Terminology issues in user access to web-based medical
information.* Paper presented at the 1999 annual symposium of the
American Medical Informatics Association, Washington, DC. Retrieved
October 17, 2003 from <http://www.amia.org/pubs/symposia/D005626.HTM>

MEDLINE to index selected consumer health publications. (1998,
January-March). *NLM Newsline, 53(1).* Retrieved October 17, 2003, from
<http://www.nlm.nih.gov/pubs/nlmnews/janmar98.html#Consumer>

MEDLINEplus counts on input, insights from NIH advisors (2003, June 10).
*NIH Record,* *LV(12)*. Retrieved November 6, 2003, from
<http://www.nih.gov/news/NIH-Record/06_10_2003/story07.htm>

*MEDLINEplus goes Spanish*. (2002, September 9). Retrieved October 17,
2003, from
<http://www.nlm.nih.gov/news/press_releases/medplusspanish.html>

Miller, N. (1997). *Improving the NLM home page: from logs to links.*
Poster session presented at the 1997 annual meeting of the Medical
Library Association, Seattle, WA. Retrieved October 17, 2003 from
<http://www.nlm.nih.gov/psd/web_poster/web_poster.html>

*National Institutes of Health launches "ClinicalTrials.gov.\"* (2000,
February 29). Retrieved October 17, 2003, from
<http://www.nlm.nih.gov/news/press_releases/clintrlpr00.html>

National Library of Medicine, 42 U.S.C. § 286 (2000).

National Library of Medicine. (2000). *National Library of Medicine long
range plan, 2000-2005/report of the Board of Regents*. (NIH Publication
No. 00-4890). Bethesda, MD: Author. Retrieved October 17, 2003 from
<http://www.nlm.nih.gov/pubs/plan/lrp00/lrp00.html>

Planetree Health Resource Center. (1991). *The Planetree Classification
Scheme 5.0*. San Jose, California: Program Planetree.

Wood, F. B., Lyon, B., Schell, M. B., Kitendaugh, P., Cid, V. H., &
Siegel, E. R. (2000, October). Public library consumer health
information pilot project: results of a National Library of Medicine
evaluation. *Bulletin of the Medical Library Association, 88(4)*,
314-322.