# Presentation: 098483

## Libraries: meeting the needs of today’s users

- Eve-Marie Lacroix
- Chief, Public Services Division
- Joyce E.B. Backus
- Head, Reference and Web Services Section
- U.S. National Library of Medicine
- National Institutes of Health
- Dept of Health and Human Services

**Notes:**
I am very pleased and honored to be able to make this presentation to you this morning on behalf of Eve-Marie Lacroix and the National Library of Medicine. 

## Libraries: meeting the needs of today’s users

**A place?  **
**A service?**

**In whose opinion?**

**How do we know the needs?**

**How well did we meet them yesterday? **
**How will we do better tomorrow?**

**How do we know who they are?**

**Notes:**
This morning I’m going to be looking at various aspects of the title for our presentation, “Libraries: meeting the needs of today’s users” because there are many questions to be answered in what seems like a very straightforward title.  Just defining library could take us quite awhile. Is ‘library” a place?  A service?  I’m going to suggest to you that it is and will remain both.
Then, we have the concept of “meeting” and “needs.”  We all have opinions and experiences of our own that tell us what needs our users have and whether or not we are meeting those needs.  I will show you this morning one way the NLM measures whether or not we are meeting user needs, by asking them their opinions.  
The concept of today is interesting – we all know that today becomes tomorrow soon enough, so meeting user’s needs “today” really means constantly looking into the future and anticipating tomorrow.
Lastly, the users.  We once had less trouble knowing our users because they actually showed up to look at journals and books.  If they didn’t show up, we knew in which labs and offices and classrooms to find them.  Today, our users can be more mysterious and require some creativity to identify, find, and serve.
So, you can see that in this one title, there are many concepts that I will only begin to explore.
CLICK – let’s first talk about the library as a place.

## Library: place or a service?

**Notes:**
Your library may have begun much like ours, a room with journals and books as it looked in a downtown Washington DC building in about 1950.  Then, if you are a large library, you may be fortunate enough to have your own lovely building such as ours in Bethesda, Maryland.  These are original “libraries as place.”  Then, the computer came along, in our library before 1971, and of course, the Internet and the library could transcend its place.

## Library: place or service?

**Notes:**
And allow a large, national library like NLM to extend its mission to collect, organize and disseminate information beyond its fixed place in a suburb of Washington DC, to serving users around the entire, internet-connected world with new and familiar resources such as these.

## Libraries: meeting the needs of today’s users

**A place?  **
**A service?**

**In whose opinion?**

**How do we know the needs?**

**How well did we meet them yesterday? **
**How will we do better tomorrow?**

**How do we know who they are?**

**Notes:**
Let’s take a look at our users’ needs and what we know about them.

## Internet growing

**Notes:**
What are some of the key factors and trends affecting how “libraries are meeting the demands of today’s users?”  One of the major factor, of course, is the Internet, which by any measure, including this annual estimate of “domain hosts” is growing tremendously.

## The worldwide number of Internet users will reach nearly 935 million in 2004 and will top 1 billion in mid 2005. 

| Top 15 Countries in Internet Use |  |  |
| --- | --- | --- |
| Year-end 2004 | Internet Users (000s) | Share % |
| 1. U.S. | 185,550 | 19.86 |
| 2. China | 99,800 | 10.68 |
| 3. Japan | 78,050 | 8.35 |
| 4. Germany | 41,880 | 4.48 |
| 5. India | 36,970 | 3.96 |
| 6. UK | 33,110 | 3.54 |
| 7. South Korea | 31,670 | 3.39 |
| 8. Italy | 25,530 | 2.73 |
| 9. France | 25,470 | 2.73 |
| 10. Brazil | 22,320 | 2.39 |
| 11. Russia | 21,230 | 2.27 |
| 12. Canada | 20,450 | 2.19 |
| 13. Mexico | 13,880 | 1.49 |
| 14. Spain | 13,440 | 1.44 |
| 15. Australia | 13,010 | 1.39 |
| Top 15 Countries | 662,360 | 70.88 |
| Worldwide Total | 934,480 | 100 |

- The worldwide number of Internet users will reach nearly 935 million in 2004 and **will top 1 billion in mid 2005**.

**Notes:**
This table gives an estimate of the number of internet users and the share of internet users for country at the end of 2004.  By this estimate, the number of users on the internet should have reached 1 billion by about this time this year.  Among the top 15 countries for internet use, include the US, china, japan, germany, india, the UK, south korea, italy, france and so on.

And, the top 15 countries account for 71% of the worldwide use.

## PubMed use by country

| May 2005 | Visits (000s) | Share % |
| --- | --- | --- |
| 1. United States | 122,556 | 46.54 |
| 2. Japan | 16,283 | 6.18 |
| 3. United Kingdom | 12,771 | 4.85 |
| 4. Germany | 10,401 | 3.95 |
| 5. Canada | 9,761 | 3.71 |
| 6. France | 8,710 | 3.31 |
| 7. China | 7,119 | 2.70 |
| 8. Italy | 6,187 | 2.35 |
| 9. Australia | 5,903 | 2.24 |
| 10. South Korea | 5,902 | 2.24 |
| 11. Brazil | 5,382 | 2.04 |
| 12. Taiwan | 4,722 | 1.79 |
| 13. Spain | 4,626 | 1.76 |
| 14. Netherlands | 4,391 | 1.67 |
| 15. Sweden | 3,447 | 1.31 |
| Top 15 Countries | 228,160 | 86.64 |
| Worldwide Total Visits | 263,339 | 100 |

**Notes:**
Locally at NLM, our use by country for PubMed, based on last month’s data shows that nearly 50% of the PubMed use comes from the United States.  US visitors are followed in the top 15 countries by Japan, the UK, Germany, Canada, France, China, Italy and so forth, to conclude the 15 with Spain, the Netherlands, and Sweden.

For PubMed, the top 15 countries account for 87% of its use.

## MedlinePlus use by country

| 2004 | Visits (000s) | Share % |
| --- | --- | --- |
| 1. United States | 60,514 | 73.47 |
| 2. Canada | 4,379 | 5.32 |
| 3. United Kingdom | 4,226 | 5.13 |
| 4. Australia | 2,120 | 2.57 |
| 5. Spain | 752 | 0.91 |
| 6. Mexico | 642 | 0.78 |
| 7. Uruguay | 589 | 0.71 |
| 8. India | 561 | 0.68 |
| 9. Philippines | 423 | 0.51 |
| 10. Germany | 417 | 0.51 |
| 11. Singapore | 372 | 0.45 |
| 12. Netherlands | 343 | 0.42 |
| 13. Western Europe - unspecified | 330 | 0.40 |
| 14. New Zealand | 283 | 0.34 |
| 15. Japan | 254 | 0.31 |
| Top 15 Countries | 76,203 | 92.52 |
| Worldwide Total Visits | 82,362 | 100 |

**Notes:**
MedlinePlus shows a more US-centric use by country pattern.  This data is based on our 2004 use and includes the English-language original and MedlinePlus en español.  For the MedlinePlus consumer-oriented site, the US accounts for 73% of the visits, followed by Canada, the UK, Australia, Spain, Mexico, Uruguay, India, Philippines, Germany, Singapore, the Netherlands, Other Western Europe countries, New Zealand and Japan.  

For MedlinePlus, these top 15 countries account for 93% of the use.

## MedlinePlus en español use by country

| Visits in 2004 | Visits (000s) | Share % |
| --- | --- | --- |
| 1. Spain | 3,442 | 18.90 |
| 2. Mexico  | 3,039 | 16.69 |
| 3. Uruguay | 3,006 | 16.51 |
| 4. United States | 1,774 | 9.74 |
| 5. Chile | 1,217 | 6.68 |
| 6. Peru | 1,067 | 5.86 |
| 7. Argentina | 856 | 4.70 |
| 8. Colombia | 765 | 4.20 |
| 9. Venezuela | 631 | 3.46 |
| 10. Bolivia | 318 | 1.74 |
| 11. Brazil | 284 | 1.56 |
| 12. Puerto Rico | 238 | 1.30 |
| 13. Ecuador | 167 | 0.92 |
| 14. Dominican Republic | 164 | 0.90 |
| 15. Costa Rica | 129 | 0.71 |
| Top 15 Countries | 17,096 | 93.86 |
| Worldwide Total Visits | 18,214  | 100 |

**Notes:**
For one last look at which countries use another NLM resource, we’ll look lastly at MedlinePlus en español.  The top countries on this list are Spain, Mexico, Uruguay, the US, Chile and so on through many Spanish-speaking nations.

These 15 countries account for 94% of the use of MedlinePlus en español 

## Who are the users? Health Information Seeking Americans

- Source: Pew Internet and American Life Project, Trends 2005,  _[http://pewresearch.org/trends/trends2005.pdf](http://pewresearch.org/trends/trends2005.pdf)_

- The internet has become the “new normal” in the American way of life; those who don’t go online constitute an ever-shrinking minority.

**Notes:**
So, the NLM knows which countries their users are coming from, and, that anywhere from 10% in the case of MedlinePlus en español to over 70% in the case of MedlinePlus in English of our users come from the US.  

Surveys such as this one help us to understand more about our users.  The Pew Foundation performs large scale surveys to identify behaviors and trends among internet users. This survey shows the “typical” profiles of an American health information seeker.  Their survey showed that 82% of female responders and 75% of male responders sought health information.  67% of those with a  High School Diploma sought health information and 86% of those with a college degree did so.  Broadband users were even more likely than dial-up connected users to seek health information.  The authors of the Pew report, concluded this year that The internet has become the “new normal” in the American way of life; those who don’t go online constitute an ever-shrinking minority.

## Physician Hours Online Per Week Online physicians - The universe of practicing physicians in the United States today. Essential Integrators: Online physicians who Strongly Agree/Agree the Internet is “essential” to their practice 

**Average**

**11.1**

**8.3**

**54%**

**51%**

**Average**

**How Many Hours Do You Spend Online?**

**What Percentage of Your Online Time is Professional?**

***Up from ***
***8 HRS ***
***in 2003***

- Source: Manhattan Research, 2004. “Taking the Pulse: Physicians and Emerging Information Technologies”

**Notes:**
Another data gathering organization, Manhattan Research surveys physicians about their electronic information use.  They divide physicians into two categories, all physicians in the US, all of whom are online, and an early adopter “essential  integrator” group who indicated that they believe “the Internet is ‘essential’ to their practice.”   The early adopters make up 43% of all physicians in the US.

The chart on the left shows how much time each of these groups spends online each week in any activity.  The “essential integrators spend a total average of 11 hours while the other physicians spend just over 8 hours.
When asked what proportion of their online time is for professional activities such as reading research and news, continuing education and other pursuits, the essential integrators spend slightly more of their online time in professional activities, but the differences in proportion of time is not that great between the two.

These figures tell us that physicians spend over half their online time in professional activities.

## Use Professional Journals Online

- Source: Manhattan Research, 2004. “Taking the Pulse: Physicians and Emerging Information Technologies”

**Notes:**
One activity we know physicians engage in is to use professional journals online.  This chart shows that the integrators use these online journals more often than the overall physician population with almost half of them using online journals daily or weekly.  For the overall physician population, 34% of them use the journals daily or weekly.  Clearly, online journals are an important component of online physician time.

## Gamer generation

- Growing up with sophisticated games
- Interactive, multitasking
- Virtual collaborative communities
- Best quality graphics available
- Personalization

- Source: The Gamer Generation in Today’s Library, http://www.oclc.org/capcon/segments/technologies/

**Notes:**
There are, of course, other ways to look at our users other than their profession, gender, and time spent on the internet.  A recent library conference sponsored by OCLC in Washington DC discussed the differences between the “gamer generation,” or those under 35 and the baby boomer generation.  Gamers have grow up with computers and sophisticated games that create different expectations of libraries and their services.  For example, they prefer to work in an interactive and multitasking environment.  To meet the needs of gamers, and older users, too, libraries may need to create quiet and social or interactive zones in the library as place.  Gamers are avid participants in virtual communities, so virtual reference and other interactive services, especially those that can be personalized to their liking will be important.  And, the gamer generation expects high-quality graphical experiences, so our information delivery will have to change to meet those realistic and useful expectation for health information. 

## Users – by role

| In what role are you visiting this site today? |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- |
|  | PubMed |  |  | MedlinePlus
 (in English) |  |  |
|  | Total | Non US | US | Total | Non US | US |
| Physician | 20% | 22% | 16% | 16% | 13% | 11% |
| Researcher or Scientist | 46% | 48% | 42% | 3% | 8% | 3% |
| Patient/health consumer | 3% | 1% | 4% | 42% | 43% | 53% |
| College or Graduate Student | 22% | 21% | 26% | 9% | 11% | 6% |
| Secondary student | n/a | n/a | n/a | 3% | 2% | 1% |
| Educator | 2% | 2% | 3% | 7% | 16% | 7% |
| Librarian | 2% | 2% | 3% | 4% | 0% | 4% |
| Other | 4% | 4% | 6% | 10% | 3% | 11% |
| News/media | n/a | n/a | n/a | 2% | 0% | 2% |
| Health care administrator | n/a | n/a | n/a | 4% | 4% | 1% |
| n/a -category not on PubMed survey |  |  |  |  |  |  |

- Source: 2005 American Customer Satisfaction Survey of PubMed and MedlinePlus

**Notes:**
To bring the user perspective closer to my library home, let me share with you the professions and roles of two of NLM’s most used products, PubMed and MedlinePlus.  Some of you may have responded to this survey and I thank you for doing so.
[click]
As you can see, researchers and scientists, physicians and college/post-graduate students are the most frequent visitors to the PubMed site.  Only 3% of PubMed users are patients or health consumers.  In contrast, over 40% of the MedlinePlus users are consumers or patients and only 3% are researchers.  In the case of physicians, they tend to use these resources in more equal proportions with 16% of the MedlinePlus respondents and 20% of PubMed’s identifying themselves as physicians.

## Libraries: meeting the needs of today’s users

**A place?  **
**A service?**

**In whose opinion?**

**How do we know the needs?**

**How well did we meet them yesterday? **
**How will we do better tomorrow?**

**How do we know who they are?**

**Notes:**
Knowing the needs of our users can be difficult, especially for potential users we’re not currently serving, but one way that NLM gets a sense of some user needs is through online surveys.

## User needs – ask them

| What is your primary reason for visiting the PubMed site today? |  |
| --- | --- |
| Perform basic biological research | 49% |
| Find articles by specific authors | 37% |
| Perform clinical research | 37% |
| Education | 26% |
| Find articles in a specific journal | 26% |
| Check journal reference | 22% |
| Patient Care | 13% |
| Other | 6% |
| Own health care or that of family or friend | 5% |

| Why are you visiting the MedlinePlus site today?  |  |
| --- | --- |
| Find info on a  specific disease, condition, diagnosis, or treatment | 63% |
| Find info on medicines or prescription drugs | 39% |
| Find general health and wellness info | 33% |
| Keep up with breaking health news | 21% |
| For a project or presentation | 21% |
| Find info on alternative treatments, herbals, or vitamins | 16% |
| Search for health care products or services | 11% |
| Other | 9% |
| Find info on clinical trials | 8% |
| Obtain the opinion of a health care provider | 7% |
| Search for health care provider | 4% |
| Find health self-help groups | 3% |

- Source: 2005 American Customer Satisfaction Survey of PubMed and MedlinePlus

**Notes:**
NLM’s user surveys ask people to tell us why they are using PubMed and MedlinePlus today.  Users come to PubMed, in the left-hand chart, to do basic research, find articles by author and journal, perform clinical research, for education, to check references and for patient care.

MedlinePlus users come to the site to find information about a specific disease, medicines, health and wellness, for news, for a project, for complementary and alternative medicine and other purposes.
Knowing the primary reasons users come to these sites allows NLM to change and improve the resource to better meet these needs.

## Slide 18

| What best describes the result of your visit? | PubMed | MedlinePlus |
| --- | --- | --- |
| Conducted further research on disease, diagnosis or treatment | 23% | 27% |
| Discussed search results with my health care professional | 4% | 12% |
| Delivered search results to the requester | 6% | 29% |
| Improved understanding of a disease, diagnosis or treatment | 26% | 57% |
| Made decision about patient care | 9% | 16% |
| Other | 4% | 6% |
| Sought further information from library | 14% | 7% |
| Kept up to date about research in field of interest | 55% | n/a |
| Obtained full text of selected articles of interest | 50% | n/a |
| Learned about methods relevant to research | 27% | n/a |
| Obtained help in reporting research results | 17% | n/a |
| Determined viability of research area | 13% | n/a |
| Completed administrative responsibilities | 3% | n/a |
| Did not find what I wanted | 4% | n/a |
| Altered exercise or eating habits | n/a | 7% |
| Discussed a disease, condition, diagnosis, or treatment with family member of friend | n/a | 23% |
| Made a doctor's appointment for self or another | n/a | 7% |
| Nothing specific happened | n/a | 6% |
| Switched from one medicine or prescription drug to another | n/a | 4% |
| Used information for a project or presentation | n/a | 21% |

**Notes:**
In addition to asking why they came, we also ask users to tell us about the actual result or outcome of their visit to the resource.  Here, there is some overlap, but many differences.
[click] The most frequent outcomes for PubMed users are conducting research, improving understanding, keeping up to date and obtaining full text articles.  Also, note that 14% of pubmed users and 7% of MedlinePlus users sought additional information from a library.  We now assume, that’s a library as a place, but it may not be.
MedlinePlus users overwhelmingly reported improving understanding and conducting further research.  MedlinePlus also serves many surrogate searchers, whether family member, librarian, nurse or friend, 29% of the users report sharing the results with a requester.

## Connecting products

**Notes:**
Because we know that so many users are likely to need the level of information in both PubMed and MedlinePlus and other NLM products such as ClinicalTrials.gov, we try to link them as completely as possible.  Therefore, each MedlinePlus topic has a librarian-created PubMed search.  And millions of PubMed citations have linkouts back to the related health topic page.  By maintaining these links, NLM provides the various types of uses we described earlier ways to move among these resources.

## Meeting their needs?

**Notes:**
Another way that NLM measures user needs is through this standardized American Customer Satisfaction Survey or ACSI.  We gathered the user roles and goals numbers we just reviewed from this survey, but the core of it are these 10 point scale responses that feed back into overall satisfaction ratings for the entire website and allow us to compare the score against similar sites.
This is the questionnaire – thanks again to any of you who have responded to it.

## Meeting their needs?

- Source: 2005 American Customer Satisfaction Survey of PubMed and MedlinePlus

**Notes:**
The ACSI turns the responses to these questions back into scores that we can use to improve the product.  In this PubMed example, the overall customer satisfaction rating for PubMed was 80 out of 100.  The highest scoring web site is barnes and noble books and they stay in the high 80s.  MedlinePlus is the highest scoring federal web site for customer satisfaction, in the mid to high 80s.

## Satisfaction measures

- Source: 2005 American Customer Satisfaction Survey of PubMed and MedlinePlus

**Notes:**
This MedlinePlus report screen shows an example of the questions users are asked that feed into the overall satisfaction score.  For reliability and consistency, the ACSI uses the same questions across all the types of sites it measures.

## Libraries: meeting the needs of today’s users

**A place?  **
**A service?**

**In whose opinion?**

**How do we know the needs?**

**How well did we meet them yesterday? **
**How will we do better tomorrow?**

**How do we know who they are?**

**Notes:**
Now that I’ve addressed the users and their needs, [click] let’s look at the future of libraries.

## New England Journal of Medicine, 		March 17 2005. 
Libraries today
Within institutions
Providing scholarly information
Support health care, education, and research

Libraries in 2015. . . 

- Libraries today
- Within institutions
- Providing scholarly information
- Support health care, education, and research
- Libraries in 2015. . .

**Notes:**
As Giovanna Miranda told us in the May issue of the EAHIL Journal, in the March 17 issue of the New England Journal of Medicine, Dr. Donald Lindberg, NLM’s Director, and Betsy Humphreys, our Deputy Director published a brief perspective on medical libraries in the year 2015.

They first describe libraries today as existing within institutions, providing scholarly information to support patient care, administration, education and research.  But what do Lindberg and Humphreys say about 2015?

## Libraries in 2015

- Easy access from home, offices, wards, clinics, libraries and everywhere in between
- Electronic health records with connections to related knowledge
- “Library as place” valued and heavily used
- Individual articles have “lives of their own”
- Multimedia “digital libraries” with rich interconnections
- Digital libraries still need librarians
- Librarians are “deployed in context”
- Part of the health care team
- Grant writing and administration
- Institutional review boards
- Bioinformatic database specialists
- Evidence-based medicine courses
- Health literacy programs

- Source: Lindberg and Humphreys. “2015-The Future of Medical Libraries, New England Journal of Medicine, March 17, 2005.

**Notes:**
Lindberg and Humphreys include in users – health care professionals, patients, educators, students, researchers, and administrators.  They predict that users will have access to information anywhere they want it.  The electronic health record will link to related knowledge in as many ways as is useful.
They see the library as place growing beyond a physical collection into a collaboratory, where students, teachers, colleagues, researchers and other collaborators will gather and work in pairs, small, and larger groups.
In 2015, individual articles can have a life of their own, apart from journals issues.
As computers and graphics continue to improve, information will become increasingly multimedia – articles will routinely include high-resolution images and movies.
Digital collections will still need professional librarians to organize it all to truly be useful.  And, we librarians are much more likely to be “deployed in context” on multidisciplinary teams for health care, administration, review boards and many other activities. 

## Users – today and tomorrow

- Lindberg and Humphreys - health care professionals, patients, educators, students, researchers and administrators
- Search engine users become library users
- 60% of MedlinePlus’s visits come from search engines
- Patients
- Physician Information Rx
- Electronic prescriptions through EMR
- Users by format
- RSS for PubMed
- Handheld/Palm – PubMed on Tap
- New Audiences AND Format
- WISER (Wireless Information System for Emergency Responders) -  fire fighters, police, emergency medical

**Notes:**
So, who are the users of today and tomorrow?
Lindberg and Humphreys suggest that they won’t change dramatically from today’s list.

At NLM, we’re finding that over 60% of the MedlinePlus visits come from search engines direct to internal pages, so we have to take that into account in our user design.

Physicians are beginning to give patients information prescriptions for health information on MedlinePlus and NLM is working towards the capability to provide this prescription for information directly to the patient though their Electronic Medical Record.  So, patients will continue to grow as users.

Tomorrow’s users may come because of a delivery method – PubMed just began offering an RSS service and NLM also has PubMed on Tap for wireless handhelds.

In some cases, the audience and the format may be new as in the case of NLM’s WISER handheld knowledgebase that assists police, fire and rescue staff to identify chemicals by physical characteristic using a handheld device.

## Function of place transformed
More electronic information
Serve greater numbers of users 
Negotiate licenses that meet user expectations
Training & education – new ways
As users change, services must change

- More electronic information
- Serve greater numbers of users
- Negotiate licenses that meet user expectations
- Training & education – new ways
- As users change, services must change

- Libraries: meeting the needs of today’s users by anticipating tomorrow

**Notes:**
So, what can libraries do to meet these changing needs?  First, transform our space into working space for collaborators
With more electronic information, we are able to serve more users than every, because they don’t need to walk through our doors.  As we negotiate electronic licenses we need to be sure that the terms will enable us to meet user expectations of a placeless library.
We must move into new ways of training and education, both with our intuitional education programs and for library instruction itself to meet user expectations, especially those of gamers.
Lastly, as the users continue to change, we must keep our ears, web logs, and surveying skills open to measure those changing expectations so that we can work to meet them.

## Changing user expectations

- Ross SE, Todd J, Moore LA, Beaty BL, Wittevrongel L, Lin C**Expectations of Patients and Physicians Regarding Patient-Accessible Medical Records**J Med Internet Res 2005;7(2):e13<URL: http://www.jmir.org/2005/2/e13/>

**“**Shared medical records are almost universally endorsed across a broad range of ethnic and socioeconomic groups. A majority of patients are also interested in Internet-accessible records, but a substantial minority is not. The primary determinants of support of Internet-accessible records are not age, race, or education level; rather, they are **previous experience with the Internet and patients’ expectations of the benefits and drawbacks of reading their medical records**. Physicians have more concerns about shared medical records and see less potential for benefit. The attitudes of patients and physicians may need to be reconciled for widespread adoption of shared medial records to be achieved.”

**Notes:**
I’d like to close with a quote from a recent article in the Journal of Medical Internet Research about medical records and information – They described user expectation for the integration in this way – [click]
“Shared medical records are almost universally endorsed across a broad range of ethnic and socioeconomic groups. A majority of patients are also interested in Internet-accessible records, but a substantial minority is not. The primary determinants of support of Internet-accessible records are not age, race, or education level; rather, they are previous experience with the Internet and patients’ expectations of the benefits and drawbacks of reading their medical records. Physicians have more concerns about shared medical records and see less potential for benefit. The attitudes of patients and physicians may need to be reconciled for widespread adoption of shared medial records to be achieved.”

As users continue to have positive experiences, that adoption will progress and expectations increase further.

## Libraries: meeting the needs of today’s users

**A place?  **
**A service?**

**In whose opinion?**

**How do we know the needs?**

**How well did we meet them yesterday? **
**How will we do better tomorrow?**

**How do we know who they are?**

**Notes:**
So, I hope I’ve given you some new ways to think about how we can meet the needs of today’s users by asking them who they are, what they want and anticipating their needs and preferences so that we can better serve them tomorrow by using information gathered today.
Thank you for your kind attention.