U.S. Department of Health and Human Services 

National Institutes of Health 

September 2006

U.S. Department of Health and Human Services

National Institutes of Health

NLM Board of Regents

Charting a Course

for the 21st Century

NLM’s Long Range Plan 2006-2016

NLM Board of Regents

Charting a Course

for the 21st Century

NLM’s Long Range Plan 2006-2016
National Library of Medicine Cataloging in Publication 

National Library of Medicine (U.S.). Board of Regents. 

Charting a course for the 21st century : NLM’s long range plan 2006-2016 / NLM 

Board of Regents. – [Bethesda, Md.] : U.S. Dept. of Health and Human Services, Public 

Health Service, National Institutes of Health, National Library of Medicine, 2006. 

NLM’s Long Range Plan 2006-2016 

Charting a course for the twenty-first century 

“September 2006.” 

Includes index. 

1. Libraries, Medical. 2. Information Services. 3. Information Systems. 4. Research 

Support. 5. Training Support. 6. United States. I. National Library of Medicine (U.S.) 

02NLM: Z 675.M4 N2782c 2006 
NLM Board of Regents

Charting a Course Charting a Course

for the 21 for the 21st Century st Century

NLM’s Long Range Plan 2006-2016

September 2006

U.S. Department of Health and Human Services

National Institutes of Health 
For access to all of NLM’s previous planning documents, see: 

http://www.nlm.nih.gov/pubs/plan/index.html 

For more information about the National Library of Medicine, see: 

http://www.nlm.nih.gov 
Table of Contents

Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Strategic Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

1986-2006: Two Decades of Progress . . . . . . . . . . . . . . . . . . . 16

Plan for 2006-2016. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Goal 1: Seamless, Uninterrupted Access to Expanding Collections . . . . . . . . . . . . . . . 24

of Biomedical Data, Medical Knowledge, and Health Information

Goal 2: Trusted Information Services that Promote Health Literacy, . . . . . . . . . . . . . . . 32

Improve Health Outcomes, and Reduce Health Disparities Worldwide

Goal 3: Integrated Biomedical, Clinical, and Public Health Information Systems that . . . . . . 40

Promote Scientific Discovery and Speed the Translation of Research into Practice

Goal 4: A Strong and Diverse Workforce for Biomedical Informatics . . . . . . . . . . . . . . . 46

Research, Systems Development, and Innovative Service Delivery

Closing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

Appendices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53

1. Planning Process. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53

2. Planning Panel Participants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

3. NLM Board of Regents Planning Subcommittee . . . . . . . . . . . . . . . . . . . . . . . . 59

4. Strategic Visions Working Group Participants . . . . . . . . . . . . . . . . . . . . . . . . . . 60

5. Four Planning Panel Reports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63

Table of Contents

1
Foreword

The National Library of Medicine has a very successful history of long range planning dating back to 

1985, when the NLM Board of Regents undertook to develop a 20-year Plan to guide the Library in 

using its human, physical, and financial resources to fulfill its mission. Supplemental reports in the years 

following addressed specific topical areas, such as outreach to underserved health professionals and 

electronic imaging, that required a fresh look due to dramatic changes in the social and technological 

landscape in which the NLM operates. The Library’s planning efforts have led to major new programs 

— such as the National Center for Biotechnology Information, Outreach, and the Visible Human. They 

have guided the Library in resource allocation and program direction. Of course, the Board recognizes 

that as time passes, the Library must maintain the flexibility to take advantage of new opportunities and 

changing circumstances. As with any strategic plan, it is sensible to allow for mid-course corrections 

as events unfold. 

The Board wholeheartedly endorses this new ten year Long Range Plan and is grateful to the Planning 

Panels for formulating the ideas contained herein and to the Director and the staff of NLM for preparing it. 

William Stead, M.D.

Professor of Medicine and Biomedical Informatics 

Director of the Informatics Center 

Associate Vice Chancellor for Health Affairs 

Vanderbilt University 

Chair, NLM Board of Regents, 2004-5 

Thomas Detre, M.D.

Distinguished Service Professor of the Health Sciences 

University of Pittsburgh 

Chair, NLM Board of Regents, 2005-6 

Holly Buchanan, Ed.D.

Associate Vice President of Knowledge Management and IT 

Health Sciences Library and Informatics Center 

The University of New Mexico 

Chair, NLM Board of Regents, 2006-7 

2

Foreword
Preface

NLM has bridged the gap from the 

muskets and square rigged ships of its 

origins to the growing understanding of 

the innards of human heredity today. 

For this transition, gratitude is due to 

steady and generous support by the 

Congress - throughout all the ups and 

downs of our country since 1836 when 

NLM began. NLM has had the help 

and advice of countless physicians, 

scientists, medical librarians, and public 

persons over all these years. For all this, 

I am grateful. Special thanks to all who 

contributed ideas, hopes, and criticisms 

to this latest NLM Long Range Plan. 

A word about dates. The Long Range Plan of 

1985 was a 20 year plan (supplemented by five 

important addenda). It helped us immensely over 

these years in many many ways. The current 

plan has a slightly more modest planning time 

frame: namely, ten years from 2006 to 2016. The 

diminution may be interpreted as the onset in the 

Director of age, caution, or wisdom. In any case, 

few will fail to see the rapidity with which our local 

science world and our larger geo-political world is 

changing. Hence the ten year planning goal. 

In contrast, NLM’s advisers felt strongly that 

our planning should begin with a longer, broader, 

quite unconstrained view of all these matters. 

A Strategic Vision, in other words. This effort was 

chaired by the Hon. Newt Gingrich and Dr. Bill 

Stead and had many distinguished collaborators. 

It examined the broader time range: 2005 to 2025, 

and thus set each planning panel into high gear 

immediately. 

For my part, I offer my sincere admiration of our 

institution and my confidence it will continue in 

this new century to serve with distinction. I offer 

also my personal assessment of NLM’s strengths 

and potential problem areas - without any blame 

falling on our Board or our advisers. 

NLM’s major strengths are in its understandable 

mission, its excellent staff, its historically generous 

funding, and its fast friends. 

Mission: To acquire, organize, disseminate, and 

preserve the biomedical knowledge of the world 

for the benefit of the public health. 

Staff: NLM has a highly educated multidisciplinary staff of more than 1300 employees and 

contractors who are innovative, productive, and 

dedicated to the Library’s mission. 

Preface

3
Funding: NLM’s funding increases have frequently been even better than the NIH’s. Like the 

US in 1941 we have been building a “two ocean 

Navy.” The added efforts focused both on the 

rapidly growing corpus of genomic measurements and data, and at the same time, on the 

fast growing appetite of patients, families, and 

the public for access to improved understanding 

of information relevant to personal health and 

health care. Unfortunately the needs for extra 

budgetary growth are still present. 

Friends: NLM has retained strong, stable, and 

long lasting connections with many relevant 

professional constituencies and organizations. 

These include the Medical Library Association, 

the American Association of Medical Colleges, 

the Association of Academic Health Sciences 

Libraries, the Institute of Medicine, the Computer 

Science and Telecommunications Board, the 

International Committee of Medical Journal 

Editors, the National Science Foundation, 

the American Medical Informatics Association, 

the Friends of the National Library of Medicine, 

and others. 

Two dangers are impossible to miss: lack of 

proper space, and major external factors 

outside NLM’s control. 

Space

A great strength and advantage for NLM has been 

the collegial working relationships that have been 

maintained between its several operating divisions. 

There are numerous examples, but all have been 

facilitated and enhanced by physical facilities that 

provided close housing. 

Similar happy working relationships have been 

maintained between NLM and numerous NIH 

research groups and a great number of outside 

professionals and organizations who have been 

hosted by NLM for conferences and collaborations. 

NIH has been very helpful and supportive by 

reassigning new space to NLM, especially to help 

accommodate the growing duties and services 

from the National Center for Biotechnology 

Information, and all NLM Divisions have made 

every effort to maintain close working relationships. 

Yet we currently rent 92,000 square feet of space 

outside the two NLM buildings. The Congress 

approved a new building in appropriation language 

on many occasions, and Congress provided funds 

for complete architectural plans for the new building. In fact, these full architectural plans were completed in 2003. What remains - and it is increasingly 

critical - is an appropriation of funds to get on with 

the building itself. 

External Threats to

Be Considered

Without descending to “the nightmare scenario” 

so popular with our film makers, I believe that 

NLM’s Long Range Plan must acknowledge some 

external factors that are beyond our control. 

For example, 

1. If the threat of terrorist attacks on the US 

increases so as to become “normal”, and 

perhaps ultimately once again successful? 

The Plan urges we establish research work in 

Disaster Management Information. NLM has 

already been in the vanguard of working from 

home, and we keep a very capable remote 

computing facility. But in spite of threats, 

we operate an “open” shop and deliver 

uncensored information. Will we need to do 

differently in the future? 

2. If the US were no longer to remain the world’s 

superpower and richest nation? Might our 

range of users, sources of information, sources 

of innovation, and languages also change? 

Might free information services for the world 

cease to be a popular plan? 

4

Preface
3. If the US population were to become divided 

in its trust of government services, including 

the provision of scientific information, especially the great changes in medicine that are 

already presaged by the Human Genome 

Program’s successes, can NLM remain a 

trusted source? How? 

The Board might consider at its meetings during 

2006 and 2007 if supplementary planning meetings could be organized to work out an informed 

view of some of the major external influences 

upon the NLM’s work. We must wonder, what 

will be the best course of action for NLM under 

adverse circumstances. 

A Good Prognosis

I am confident that given well meaning, 

reasonable management, and given encouraging 

Congressional support, that NLM will continue 

into the distant future to perform well for medical 

professionals, scientists, and the public. It’s a 

grand institution. It deserves all the help and 

support it has gotten over 170 years, and it 

deserves and will justify all our help for yet 

another ten years and more! 

Donald A.B. Lindberg, M.D. 

Director 

Preface

5

Executive Summary

In a world that is increasingly digital, the National Library of Medicine (NLM) already plays a pivotal role 

in enabling biomedical research, supporting health care and public health, and promoting healthy behavior. By connecting and making the results of research — from scientific data to published literature to 

patient and consumer health information —readily available, the Library magnifies the positive impact of 

the country’s investment in the creation of new knowledge. In the next ten years, NLM’s programs and 

services will become even more central to scientific discovery, treatment, and prevention. Careful planning and visionary thinking are critical to the pursuit of that future. 

This Long Range Plan contains four overall goals: 

Goal 1. Seamless, Uninterrupted

Access to Expanding Collections

of Biomedical Data, Medical

Knowledge, and Health Information

Recommendation 1.1. Ensure adequate space 

and storage conditions for NLM’s current and 

future collections to guarantee long term access 

to information and efficient service delivery. 

Recommendation 1.2. Preserve NLM’s collections in highly usable forms and contribute to 

comprehensive strategies for preservation of 

biomedical information in the U.S. and worldwide. 

Recommendation 1.3. Structure NLM’s electronic information services to promote scientific 

discovery and rapid retrieval of the “right” information by people and computer systems. 

Recommendation 1.4. Evaluate interactive publications as a possible means to enhance learning, 

comprehension, and sharing of research results. 

Recommendation 1.5. Ensure continuous 

access to health information and effective use of 

libraries and librarians when disasters occur. 

Recommendation 1.6. Establish a Disaster 

Information Management Research Center at 

NLM to make a strong commitment to disaster 

remediation and to provide a platform for demonstrating how libraries and librarians can be part of 

the solution to this national problem. 

Goal 2. Trusted Information

Services that Promote Health

Literacy and the Reduction of

Health Disparities Worldwide

Recommendation 2.1. Advance new outreach 

programs by NLM and National Network of 

Libraries of Medicine (NN/LM) for underserved 

populations at home and abroad; work to reduce 

health disparities experienced by minority populations; share and actively promote lessons learned. 

Recommendation 2.2. Work selectively in 

developing countries that represent special 

outreach opportunities, such as improving access 

to electronic information resources, enhancing 

local journal publications of high quality, and 

developing a trained librarian and IT workforce. 

Recommendation 2.3. Promote knowledge of 

the Library’s services through exhibits and other 

public programs. 

Recommendation 2.4. Test and evaluate 

digital infrastructure improvements (e.g., PDAs, 

intelligent agents, network techniques) to enable 

ubiquitous health information access in homes, 

schools, public libraries, and work places. 

Recommendation 2.5. Support research on the 

application of cognitive and cultural models to 

facilitate information transfer and trust building 

and develop new methodologies to evaluate 

impact on patient care and health outcomes. 

Executive Summary

7
Goal 3. Integrated Biomedical,

Clinical, and Public Health

Information Systems that

Promote Scientific Discovery

and Speed the Translation of

Research into Practice

Recommendation 3.1. Develop linked databases 

for discovering relationships between clinical data, 

genetic information, and environmental factors. 

Recommendation 3.2. Promote development 

of Next Generation electronic health records to 

facilitate patient-centric care, clinical research, 

and public health. 

Recommendation 3.3. Promote development 

and use of advanced electronic representations 

of biomedical knowledge in conjunction with 

electronic health records. 

Goal 4. A Strong and Diverse

Workforce for Biomedical

Informatics Research, Systems

Development, and Innovative

Service Delivery

Recommendation 4.1. Develop an expanded 

and diverse workforce through enhanced visibility 

of biomedical informatics and library science for 

K-12 and college students. 

Recommendation 4.2. Support training programs that prepare librarians to meet emerging 

needs for specialized information services. 

Recommendation 4.3. Continue support for 

formal, multidisciplinary education in biomedical 

informatics to increase the supply of informatics 

researchers who can work at the intersections of 

molecular science, clinical research, health care, 

public health, and disaster management. 

8

Executive Summary
Strategic Vision

What Might the Next What Might the Next

Twenty Years Hold? Twenty Years Hold?

Special Working Group 

April 11-12, 2005 
Strategic Vision

This section was derived from the meeting of the Strategic Vision Working Group at the Cosmos Club in 

Washington, D.C., on April 11-12, 2005. See appendix 4 for names of participants. The group met to provide 

the broadest view of NLM’s mission, current situation, and its potential future contributions to the health and 

well-being of America. It was asked to articulate a view of the principal features of the biomedical information 

landscape in the 20 year period 2005-2025. Subsequently, the four planning panels were asked for recommendations for the next 10 years (2006-2016) that will be shaped by a more distant view of the next 20. 

In a world that is increasingly digital, the NLM already plays a pivotal role in enabling biomedical research, 

supporting health care and public health, and promoting healthy behavior. By connecting and making the 

results of research — from scientific data to published literature to patient and consumer health information 

— readily available, the Library magnifies the positive impact of the country’s investment in the creation of 

new knowledge. 

In the years ahead, NLM’s programs and services will become even more central to scientific discovery and 

the treatment and prevention of disease. Continuing advances in biology, clinical research, health care, 

computer science, and telecommunications - and changes in the way information is produced, stored, 

and accessed - will combine to change the nature of biological and medical knowledge. 

Genomic Research

By 2025, key elements of the success of the 

Human Genome project – distributed, high 

throughput and increasingly inexpensive data 

acquisition, publicly available curated databases, 

and advanced computational methods for relating 

new data to multiple levels of existing information - will have led to an enormous shared pool of 

data about genetic variation in humans, animals, 

viruses, and other pathogens. The systematic 

study of human genetic variation and its relationship to disease and response to drugs, environmental hazards, and behavior will yield new 

opportunities and new ethical dilemmas for health 

care and prevention. Current efforts to catalog 

the variants in the human population including 

changes at the single nucleotide level (SNPs) 

and larger blocks of sequences up to 60,000 

bases that tend to be inherited together (haplotypes) will continue. Additional work in analyzing 

genetic variation in cases and controls for a range 

of clinical conditions and tracing the development of new virus strains through whole genome 

analysis will be accomplished. High throughput 

bioassays to determine the biological activity of a 

large number of chemical compounds in order to 

identify those useful for biological research and 

potential drug development will challenge NLM 

to manage the data for a large set of chemicals 

and to link these appropriately to the continuously growing host of biomedical reports and 

further published commentary in the literature. 

NLM’s involvement in planning and supporting 

basic biomedical research will continue to grow 

as the cycle continues. Investment in shared data 

will lead to more rapid scientific discovery, which 

will in turn lead to more publications and more 

shared data, which will in turn lead to more 

scientific discovery. 

As the amount of data and information increases, 

researchers – not to mention health professionals 

– will need assistance in identifying where new 

scientific opportunities lie. Sophisticated “discovery” systems will lead researchers to scientifically 

interesting connections and patterns in the huge 

quantities of available data, thus speeding new 

scientific insights. The public will demand their 

individual genetic fingerprints, and incorpora10

Strategic Vision
tion of such information into practice will present a major challenge to health care providers. 

Health professionals and the general public will 

need help to use and interpret the flood of data. 

Genome research will have completed the shift 

from the initial sequencing of the genomes of 

organisms (viruses to humans) to figuring out how 

to apply this new knowledge to understanding biological systems and ultimately improving human 

health. Experimental blocking of gene translation 

and protein transcription with small molecules 

Strategic Visions Working Group Meeting

from shared repositories will have simplified 

the task of filling the gaping holes in scientific 

understanding of the range of protein products 

of genes, their interactions, and the pathways 

through which cellular and tissue metabolism is 

conducted. This will greatly increase the circumstances under which genetic testing of individual 

patients can reliably predict clinical response or 

side effects of specific drugs. Better understanding of “metabolomics”1 combined with prospective 

cohort studies will significantly expand understanding of the circumstances in which genetic 

susceptibility plus exposure to environmental 

toxins is likely to yield certain disease states. 

Ultimately, we may see developed a classification 

of disease based on molecular characterization 

rather than traditional empirical and organ classification systems. Such a molecular taxonomy 

could provide the basis for earlier detection 

and more effective and less costly treatment. 

Clinical Research

Clinical research and genomic research will 

overlap in studies that attempt to determine the 

interaction between genetic make-up, behavioral 

and environmental risk factors, disease resistance, 

drug response, and clinical outcomes. Clinical trials that would have been limited to a small number 

of academic centers will be carried out in partnership among organized patient communities, community-based health care providers, and academic 

researchers. These teams collectively will care for 

groups of well-characterized patients that are large 

enough to reliably predict whether new interventions are safe and effective. They will be able to do 

work that required physical collocation in the past 

– using robust, standards-based clinical research 

infrastructure which began to emerge in 2005 as a 

result of the NIH Roadmap. 

This 21st century approach will leverage electronic 

records used for health care and public health 

reporting and employ new ways to capture clinical 

research data, standards for clinical research protocols, new models of cooperation between NIH 

and patient advocacy alliances, and new strategies to strengthen the clinical research workforce. 

Standard clinical research infrastructure will facilitate the production of comprehensive registries of 

clinical trials and more prompt and thorough 

reporting of their results. 

Metabolomics— the study of all the metabolites in a cell, tissue or organism. This science includes carbohydrates, lipids, signaling molecules, etc. 

See www.metabolomicssociety.org/. Metabolomics has the promise to enable detection of disease states and their progression, monitor response 

to therapy, stratify patients based on biochemical profiles and highlight targets for drug design. 

Strategic Vision

11

1 
Health Care System

A fundamental observation guiding this vision for 

the Library in coming decades is that publication 

and reading are necessary but insufficient mechanisms to turn knowledge into effective action in 

the 21st century. A healthcare enterprise that 

depends principally upon the cognitive capacity 

and reliability of autonomous individual practitioners and their interpretations of what they read 

will continue to be error-prone and have unacceptably high rates of suboptimal disease prevention, diagnosis and treatment. In the future the 

informed and “activated” consumer will play an 

increasingly important role in error prevention. 

A systems approach to health care and public 

health, like the systems approaches to aviation 

safety and knowledge management in other 

complex industries, will depend increasingly 

upon “executable knowledge” in the form of 

computerized logic that embodies the collective 

best understanding and best practice for healthrelated practices. 

Stated differently, in addition to patients, families, 

and the public, the Library’s newest and fastest 

growing group of users may be intelligent devices. 

By 2025, we will have left behind a world of very 

expensive, personally held knowledge in which 

people with trained intuitions based on years of 

education and practice could produce acceptable 

results in either health care or research. A worldwide Internet based cyber-infrastructure of knowledge provided in real time and mediated by expert 

systems exploring massive databases will be useful tools for healthcare and research. The health 

sciences will likely share some of the infrastructure with other scientific disciplines as part of the 

new world of e-science, both within the U.S. 

and internationally. 

This infrastructure will support ubiquitous telemedicine capability allowing a trained community health 

aide anywhere on the globe to obtain and transmit 

diagnostic image and test information and obtain 

timely expert advice on appropriate handling and 

immediate treatment of patients with a wide range 

of conditions. Using wireless diagnostic tools produced at commercially sustainable costs, this 

trained aide may be able to identify and treat an 

increasing number of problems locally. 

Patient Health Records and 

Personal Knowledge Bases

Patient health records will have evolved into multimedia Personal Health Knowledge Bases including 

individual preferences and directives, genetic 

make-up, best practices applicable to the individual, 

self tracking, and a record of care delivered and 

received. And the patient will always have a complete copy of his or her medical record. All of this 

information will be in a form permitting understanding by the individual and execution by computer 

programs. These Personal Health Knowledge 

Bases will integrate dynamically or interact with 

care provider systems – and selected data from 

them will feed public health and clinical research 

systems. As the knowledge of biology and health 

evolves in ways useful to the individual, the 

Personal Health Knowledge Base will link automatically to pertinent new information. 

By 2025, every patient will be a potential Visible 

Man or Woman, with imaging data that can be 

viewed interactively. As the Visible Human project 

begins to incorporate physiology, biochemistry, 

and other necessary components of life, scientists 

Strategic Visions Working Group Meeting

12

Strategic Vision
and healthcare practitioners will be able to see proteins unfolding, DNA in operation, the nanoscale 

activities that are at the very heart of life. The life 

processes that will become visible will be based on 

the data collected in one’s own electronic health 

record. This record will include one’s personal 

genome. The Visible Human could become not 

only a general teaching and research tool, but a 

personal instructional and diagnostic tool. This 

system will operate in both real time and be capable of speeding up and slowing down the time 

sequences compared to reality. 

Lifelong Learning

Lifelong just-in-time professional learning will 

replace the combination of discipline-specific 

just-in-case education and continuing education 

programs of the 20th century. Learning resources 

will be on line, 24-7 and pulled forward on demand 

by the professional who needs them. Integrated 

models of learning will support all health professionals and include an ascending series of complexities in language so individuals and their 

families can use the basic level while sophisticated 

advanced specialists use the most complex layer. 

Simulations will greatly lessen our reliance on trial 

and error on patients and will be used routinely to 

check the limits of individual ability. Immersion 

facilities and personalized simulations will help in 

experiencing the hard to imagine. Holographic 

immersion, tailored based on an individual’s PET 

scan and MRI, may allow visualizing individual 

patients with a breathtaking degree of accuracy. 

Because these resources are used to enhance 

entertainment and in advanced education, they 

will also be accessible over the network for use in 

K-12 education. Exposure during K-12 will prepare future consumers to be active participants in 

decisions about their care and prepare people 

coming into health education programs for more 

effective approaches to learning. 

Community Health

Despite some residual “last mile” problems, in 

2025, the “digital divide”, i.e., persistent uneven 

access to high-speed computers and telecommunications, will have virtually disappeared in the 

U.S. However, disruptions in telecommunications 

during emergencies and disasters will continue to 

be problematic, due to ever increasing societal 

reliance on digital information. Even though technical telecommunications barriers will be greatly 

diminished, a sizeable fraction of the population 

will continue to lack the education and training 

necessary for the most effective use of information technology. Knowledgeable and sympathetic 

human beings will still be essential to helping 

underserved populations make effective use of 

information and decision support resources that 

are available and relevant to them. The NLM and 

the National Network of Medical Libraries will provide services to help minority and other underserved populations, and the health professionals 

who serve them, make the most effective use of 

Warm and Healthy Alaskan Girl

Strategic Vision

13
information and decision support resources that 

hold the promise of promoting healthy behaviors, 

preventing costly and debilitating illness, and 

improving health outcomes when disease occurs. 

Services essential to preserving the community’s 

health, e.g., disease surveillance, environmental 

monitoring, food and water inspection, emergency 

response, will continue to be provided through 

many different organizations and by widely dispersed people with different types and levels of 

training and education. The National Network of 

Libraries of Medicine will continue to be essential to 

NLM’s ability to reach both underserved populations 

and the varied workforce attempting to serve them. 

Global Health

Whole genome analysis will be increasingly applied 

to new pathogens and emerging diseases. The 

NLM will facilitate a global system aggregating and 

facilitating access to information produced around 

the globe. 

At the same time, declining costs and increasing 

robustness of wireless communication and portable/wearable computing devices will make reliable delivery of education and information much 

more feasible in even remote and very poor parts 

of the world. Although it cannot address the underlying problems of extreme poverty, joblessness, 

and lack of access to medicines, near ubiquitous 

access to NLM’s knowledge resources will provide 

new opportunities for partnerships with international organizations and foreign governments to 

aide efforts to improve health and prevent the 

spread of emerging infections. 

Publishing, Libraries, and 

Information Delivery

Beyond the development of increasingly sophisticated ways to connect scientific publications to 

underlying data and interactive multimedia appendices, by 2025 research will have greatly increased 

our understanding of visual reasoning and how 

different types (e.g., text, numbers, pictures, sound) 

and methods of interaction with information (e.g., 

ability to request transformations or additional 

details) affect identification, understanding, and 

retention of useful information. As a result, digital 

publications will have learned how to adjust on the 

fly to user learning styles and preferences. 

As new items are added to libraries’ digital collections they will be automatically connected to 

related information already present, expanding on 

techniques currently used at NLM to relate information across a wide array of Entrez databases. 

In this environment, books and other types of information and data will literally “talk to each other” 

and report any interesting findings back to human 

beings for further consideration and analysis. 

Across all types of biomedical and health-related 

information – and all types of users – there will be 

a continuing demand for ever more sophisticated 

computer-based systems that can understand a 

specific user’s information need and deliver a concise and appropriate response that is readily understood by that user. There will be a thriving market 

for products and services tailored to the information needs of individuals - and more than enough 

work for skilled people who will use increasingly 

sophisticated software to select, organize, analyze, 

link, and synthesize the information in the digital 

libraries that feed individualized services. Thus 

medical libraries and medical librarians will continue 

to be essential, although with a host of new duties. 

In a sense the role of the medical library may 

change from housing and archiving information 

to more of an essential intellectual place of collaboration and constant information analysis, and in 

some cases, synthesis. 

As the published knowledge base continues to 

expand incrementally, it should be possible to 

create computationally-aided “ripple effects” in 

research, health care, and public health systems – 

reducing the lag time between the discovery of 

important new knowledge and its application in 

real world settings. 

14

Strategic Vision
The majority of new scientific research results will 

be freely available in permanent digital archives 

shortly after initial production or publication, thus 

fueling additional scientific discovery and encouraging the development of a wide range of valueadded commercial products and services. 

Preservation

Preservation, version control, and continuity of 

access to digital information will be critical. As a 

result of collaborative work involving NLM, other 

libraries and archives, and a broad array of 

publishers, many formally published digital works 

Strategic Visions Working Group Meeting

will be released in standards-based formats that 

facilitate permanent access. There will be tools to 

assist organizations and individuals to generate 

records and papers that are inherently archivable. 

NLM will be part of an international network 

of trusted digital repositories in libraries and 

archives supported by governments, universities, 

and private organizations. By 2025, the network 

of repositories will have made some progress on 

establishing a rational division of labor for the 

expensive initial acquisition of content in a 

complete archivable format. They will have robust 

agreements and procedures to ensure that at 

least some important digital content is archived 

at multiple independent sites in geographically 

dispersed locations. 

Digital technology will have provided the infrastructure necessary to make progress on another 

great preservation challenge of the 21st century – 

preserving and providing permanent access to 

the physical papers, records, and images that 

document the huge explosion in biomedical discovery and health policy developments that 

occurred in the latter half of the previous century. 

These great shifts will create a 21st Century 

Intelligent Health System. The NLM can play a 

catalytic role in this transformation by identifying 

and embracing new opportunities - while also 

paying careful attention to preserving its reputation as a credible source of reliable knowledge 

and a leader in biomedical informatics. 

Strategic Vision

15

A Brief Report: Major Elements of NLM’s 

Work Since its Long Range Plan of 1986

1986-2006: Two Decades of Progress

The 1986 Long Range Plan stimulated a variety of expanded responsibilities for the National Library of 

Medicine. Some of these required action by the U.S. Congress. Others are the result of recommendations 

by the Library’s Board of Regents and various advisors. One gauge of this expansion is the increase in the 

NLM budget, from $57.4 million as reported in the 1986 annual report, to $323 million in 2006. 

Some highlights from the past 20 years: 

Internal Library Processes. Twenty years ago, 

NLM relied primarily on mainframe computers and 

commercial telecommunications networks. The 

Library Operations staff already used relatively 

sophisticated systems to carry out acquisitions, 

cataloging, indexing, preservation, and document 

delivery tasks, but the 1986 plan emphasized the 

need to rationalize, integrate, and greatly expand 

automated support for basic library processes. 

There were no electronic journals in the NLM 

collection. All MEDLINE citations and abstracts 

were keyed in from print journal issues, although 

NLM was talking to publishers about their ability 

to supply this information electronically. NLM’s 

Reading Room patrons filled out document 

requests by hand, copies of articles provided in 

response to inter-library loan requests were delivered by surface mail, and the majority of offsite 

reference and customer service inquiries came 

by telephone to several different service points. 

In 2006, NLM’s computers are connected to the 

world via the Internet. 82% of the now more than 

600,000 citations and abstracts are received electronically from publishers. The rest are captured 

via a precisely tailored scanning and optical character recognition system developed by the Lister 

Hill Center. Onsite patrons generate document 

requests as a by-product of searching NLM’s 

online catalog or PubMed, but only if the material 

they are seeking is not available in electronic 

full-text. NLM fills 96% of roughly 274,000 annual 

interlibrary loan requests electronically. The 

Library’s now consolidated customer service 

operation receives 67% of its requests via email 

and the Web. 

MEDLINE.2 In 1986, NLM enabled users to use 

personal computers to connect to MEDLINE via 

GratefulMed (now MEDLINE via PubMed). There 

was a modest fee for searching to cover commercial telecommunications charges and there were 

slightly more than 3 million online searches that 

year. In the 1990s NLM reinvented its legacy 

computer systems and was supported by 

Congress in making Web access to NLM services 

free via the Internet. The reinvention effort also 

supported efficient use of NLM data by external 

computer systems. The current rate of searching 

is almost one billion searches annually. 

National Network of Libraries of Medicine.3 

What was formerly called the Regional Medical 

Library Network was renamed and enlarged. 

Funding for the network increased from $2.2 

million to $12 million annually. The NN/LM now 

has some 6,000 member institutions that cooperate to equalize and improve access to information 

in universities, hospitals, and communities across 

the nation. The Network has broadened its 

responsibilities to serve the general public as well 

as health professionals, researchers, and 

2 PubMed [Internet]. Bethesda (MD): National Library of Medicine (US). 1996 Jan - [cited 2006 Oct 26]. Available from: http://pubmed.gov/. 

3 National Network of Libraries of Medicine [Internet]. Bethesda (MD): National Library of Medicine (US); [updated 2006 Sep 15; cited 2006 Oct 27]. 

Available from: http://nnlm.gov/. 

A Brief Report: Major Elements of NLM's Work Since its Long Range Plan of 1986

17
information specialists and is a major part of 

NLM’s strategy to reach minority groups and 

underserved communities. 

National Center for Biotechnology

Information.4 The NCBI, created by act of 

Congress in 1988, has become an international 

leader in assembling, organizing, and making 

available the kinds of biological and genomic data 

that drive modern life sciences research. The 

Center works closely with researchers and institutions at NIH and around the world who contribute 

sequence and other data to GenBank and other 

molecular biology databases. In recent years, the 

NCBI has been tapped to develop PubChem 

databases that store and link data about biologically active small molecules. This is a key element 

in the trans-NIH Roadmap Initiative. 

Outreach.5 Prompted by a special-focus Long 

Range Planning report in 1989, the NLM launched 

a vigorous program of outreach to ensure that 

health professionals and the public were aware of 

the information resources available from NLM. 

Early efforts focused on letting physicians know 

that they could search MEDLINE from their home 

or office via personal computer software developed by NLM and on alerting the HIV/AIDS community to several free data resources. Today NLM 

and the NN/LM support hundreds of community 

outreach demonstrations, events, and projects 

every year, with special emphasis on groups with 

major health disparities, such as African 

Americans, Native Americans, and Latinos. Since 

1996, the Library’s major historical exhibitions and 

their accompanying Web sites, K-12 educational 

materials, and touring versions have also helped 

to introduce NLM’s collections and health 

information services to wider audiences.6 

Consumer Health Information. When 

MEDLINE became free on the Internet in 1997, 

the general public arrived at NLM’s online door, 

and the Library began to create a series of health 

information resources expressly for this audience. 

MedlinePlus7

, the largest and most prominent of 

NLM’s consumer health services, is used by millions each month. MedlinePlus has free health 

information, in both English and Spanish8

, from 

the NIH Institutes and other reliable sources of 

health information. Thanks to the efforts of health 

sciences librarians across the country and their 

state and local partners, many users can “Go Local” 

to find neighborhood health services related to 

topics they view on MedlinePlus. As of 2006, 

15 MedlinePlus Go Local sites were operational, 

with more in the pipeline. 

PubMed Central.9 In February 2000, NLM 

launched PubMed Central, a digital archive of 

full-text articles from biomedical and life sciences 

journals, on behalf of the NIH. Starting from just two 

journals and a few thousand articles, PubMed 

Central now provides free public access to more 

than three quarters of a million articles cited in 

PubMed/MEDLINE. PubMed Central has had a 

major impact on policy and technical developments 

related to electronic biomedical journals. It is the 

repository specified in the NIH public access policy 

and by other major research funders in the U.S. and 

4 National Center for Biotechnology Information [Internet]. Bethesda (MD): National Library of Medicine (US); [rev. 2006 Oct 26; cited 2006 Oct 27]. 

Available from: http://www.ncbi.nlm.nih.gov/ 

5 Training & outreach [Internet]. Bethesda (MD): National Library of Medicine (US); 2004 May [updated 2006 Sep 6; cited 2006 Oct 27]. Available 

from: http://www.nlm.nih.gov/training.html 

6 A recent example is: Changing the face of medicine: celebrating America’s women physicians [Internet]. Bethesda (MD): National Library of 

Medicine (US), History of Medicine Division; 2003 Oct [cited 2006 Oct 27]. Available from: http://www.nlm.nih.gov/exhibition/changingthefaceofmedicine/. Changing the Face of Medicine is on display as a traveling exhibit in 61 libraries across the United States through November 2010. 

7 MedlinePlus [Internet]. Bethesda (MD): National Library of Medicine (US). 1988 Oct - [cited 2006 Oct 26]. Available from: http://medlineplus.gov/. 

8 MedlinePlus en Español [Internet]. Bethesda (MD): National Library of Medicine (US). 2002 Sep - [cited 2006 Oct 26]. Available from: http://medlineplus.gov/spanish/. 

9 PubMed Central: a free archive of life sciences journals [Internet]. Bethesda (MD): National Library of Medicine (US), National Center for 

Biotechnology Information. 2000 Feb - [cited 2006 Oct 26]. Available from: http://pubmedcentral.gov/.

18

A Brief Report: Major Elements of NLM's Work Since its Long Range Plan of 1986
other countries. Its standard electronic format for 

archiving articles has been endorsed by the Library 

of Congress and the British Library and widely 

adopted by publishers. A modified version of the 

PubMed Central system is being used to establish 

similar cooperating archives in other countries. 

ClinicalTrials.gov.10 In response to a mandate in 

the FDA Modernization Act of 1997, NLM worked 

with NIH and FDA to develop ClinicalTrials.gov to 

allow prospective patients and their doctors to 

locate ongoing human research studies in which 

they might participate. First released in 2000 with 

4,000 NIH-funded studies, the site now contains 

information on more than 33,000 federally and privately supported trials in more than 130 countries. 

The number of trials registered received a boost 

from a decision of the International Committee of 

Medical Journal Editors in September 2005 to 

require, as a precondition for subsequent publication of results in their journals, that clinical trials 

be registered before they begin. 

Toxicology and Environmental Health 

Information.11 In the past 20 years, NLM’s toxicology and environmental health services have 

broadened their focus from toxicologists, chemists, and pharmacologists to provide services 

more usable by health professionals, emergency 

responders, and the public. Innovative services 

released within the past few years include: the 

Household Products Database, which provides 

information for consumers about potentially harmful substances in widely purchased products; 

ToxMap, which allows communities to determine 

what toxic substances have been released in their 

vicinity; and a hand-held hazardous substance 

information resource used in the field in the aftermath of Hurricane Katrina. 

High Performance Computing and 

Communications.12 The multi-agency HPCC 

program was established by Congress in 1991 

to advance computing and communication and 

provide a platform for a national information 

infrastructure in the US. NLM was the initial 

federal representative for biomedicine and health, 

and the NLM Director was appointed the first 

Director of the HPCC National Coordination Office 

by the President’s Science Advisor. 

With substantial additional HPCC funding 

beginning in 1993, NLM has funded competitive 

research contracts for prototype advanced 

biomedical and health applications of computing 

and communications, initially focusing on 

telemedicine and more recently on scaleable 

networks and disaster information management. 

The Indianapolis Network for Patient Care,13 now 

a national model for regional health information 

exchange among independent hospitals, pharmacies, laboratories, physician practices, and public 

health departments, was originally funded by this 

NLM program. Currently funded projects are 

looking at self-healing networks and smart 

triage tags for use in coping with casualties in 

large-scale emergencies. 

Visible Human Project.14 Initiated by the 1990 

long range plan for electronic imaging, this widely 

publicized Lister Hill Center program generated 

two large and totally novel datasets of highly 

detailed anatomical information, created by MRI, 

CT, and cryosection imaging of male and female 

cadavers released in 1994 and 1995 respectively. 

10 ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). 2000 Feb - [cited 2006 Oct 26]. Available from: http://clinicaltrials. 

gov/. Developed in collaboration with the US Food and Drug Administration. 

11 SIS: Specialized Information Services [Internet]. Bethesda (MD): National Library of Medicine (US), Specialized Information Services Division; 2005 

Apr [updated 2006 Oct 4; cited 2006 Oct 27]. Available from: http://www.sis.nlm.nih.gov/. 

12 Office of High Performance Computing and Communications [Internet]. Bethesda (MD): National Library of Medicine (US), The Office; [updated 

2003 Oct 23; cited 2006 Oct 27]. Available from: http://lhncbc.nlm.nih.gov/ohpcc/. 

13 INPC: Indiana Network for Patient Care [Internet]. Indianapolis (IN): Regenstrief Institute, Inc.; c2000-2006 [cited 2006 Oct 27]. Available from: 

http://www.regenstrief.org/medinformatics/inpc/. 

14 The Visible Human Project® [Internet]. Bethesda (MD): National Library of Medicine (US); 2003 Sep [updated 2006 Jul 28; cited 2006 Oct 27]. 

Available from: http://www.nlm.nih.gov/research/visible/visible_human.html 

A Brief Report: Major Elements of NLM's Work Since its Long Range Plan of 1986

19
Licensed at no charge by 2,000 individuals and 

institutions in some 50 countries, the Visible 

Humans have enabled a wide range of educational, 

diagnostic, treatment planning, virtual reality, 

artistic, and industrial applications. An NLMsponsored partnership between university and 

industry research groups produced the open 

source National Library of Medicine Insight 

Segmentation and Registration Toolkit (ITK) for 

use with the Visible Humans and other image 

datasets. ITK is heavily used in imaging research, 

including work by two of the NIH-funded National 

Centers for Biomedical Computing. 

Unified Medical Language System. 15 In 1990, 

NLM released the initial experimental version of 

the UMLS Metathesaurus, including 64,000 concepts and 125,000 unique terms from less than 10 

biomedical vocabularies, and the UMLS Semantic 

Network, a high level representation of medical 

common sense. The intent of the UMLS effort was 

to provide structured electronic knowledge 

sources that would aid the development of computer programs that would behave as if they 

“understand” medical meaning. Today, the UMLS 

Metathesaurus contains more than 1.3 million 

concepts and 6.4 million unique terms from 119 

vocabularies in 17 languages. NLM is now the 

designated central coordinating body for clinical 

terminology standards within the Department of 

Health and Human Services (HHS). The Library 

funds, licenses for U.S.-wide use, and builds three 

core clinical vocabularies, and the UMLS 

Metathesaurus is the official distribution vehicle 

for U.S. standard administrative code sets, 

required to bill electronically for health services, 

and vocabulary standards for electronic health 

records. The full set of UMLS components, which 

also includes advanced lexical tools, is used in 

most serious natural language processing, data 

mining, and ontology research and applications in 

the biomedical domain. Many NLM services, such 

as PubMed, ClinicalTrials.gov, and Genetic Home 

Reference, use UMLS knowledge to enhance 

retrieval, and the UMLS is integral to the system 

that provides automated assistance to NLM’s 

expert human indexers. 

Grants for Research and Resource 

Development.16 The NLM has had a program 

of grants since 1965. NLM’s grants today are 

awarded primarily for projects in biomedical informatics, information management, and artificial 

intelligence. Resource grants now focus on a 

broad variety of knowledge management projects 

that utilize telecommunications and computers to 

improve information access and utilization by professionals and consumers. Approximately half of 

NLM’s grant budget is expended in support of 

informatics research projects and research infrastructure such as databases and tools. Clinical 

informatics, the predominant theme of NLM’s 

research grants in earlier years, continues to 

receive strong support, but a significant portion 

of NLM’s informatics research budget is now 

allocated to bioinformatics and computational 

biology as the importance of computing to basic 

and translational science increases. NLM’s grant 

programs are also heavily involved in such panNIH initiatives as Roadmap and the Biomedical 

Information Science and Technology Initiative 

(BISTI), programs designed to address the 

burgeoning needs of clinical and basic science 

for computation and for computationally 

sophisticated scientists. NLM has program 

responsibility for one of the seven National 

Centers for Biomedical Computing supported 

by Roadmap grants. 

15 Unified Medical Language System [Internet]. Bethesda (MD): National Library of Medicine (US); 1999 Jan [updated 2006 Oct 6; cited 2006 Oct 26]. 

Available from: http://www.nlm.nih.gov/research/umls/. 

16 Grants & funding [Internet]. Bethesda (MD): National Library of Medicine (US); 2004 May [updated 2006 Aug 21; cited 2006 Oct 27]. Available from: 

http://www.nlm.nih.gov/grants.html 

20

A Brief Report: Major Elements of NLM's Work Since its Long Range Plan of 1986
National Information Center on Health 

Services Research and Health Care 

Technology.17 Congress first assigned NLM 

special responsibility for improving information 

services and resources for health services 

research and technology assessment in 1989 and 

established a formal Center at the Library in 1993. 

In response, NLM developed databases including 

the full-text of clinical and public health practice 

guidelines and evidence summaries, information 

about health services and public health research 

in progress, and information about research datasets and tools. The Center coordinates NLM’s 

activities related to health services research, 

including health data standards, and also many of 

its services for the public health workforce. In 

1997, NLM worked with the Center for Disease 

Control and Prevention (CDC) to establish the 

Partnership in Information Access for the Public 

Health Workforce to bring federal agencies, the 

National Network of Libraries of Medicine, and 

public health associations together to improve 

information services for public health workers. 

Since that time, the Library has worked with the 

Partners to develop a range of new information 

services, training programs, and outreach projects 

directed at the public health sector and has promoted greater public health participation in existing funding and training opportunities. 

Education and Training.18 The NLM has greatly 

expanded the training opportunities it offers—in 

biomedical informatics (for example, the course 

given at the Marine Biology Laboratory at Woods 

Hole, Massachusetts), biotechnology (through the 

NCBI), and for medical librarians and information 

specialists. There has also been an emphasis on 

increasing, through training grants, the cadre of 

biomedical informaticians. In 1986, NLM supported five academic sites training a total of 29 

students; two decades later, the Library supports 

18 sites around the nation, with 270 students. The 

NLM/AAHSL (Association of Academic Health 

Sciences Libraries) Leadership Fellows Program 

has been focused since 2002 on preparing emerging leaders for director positions in academic 

health center libraries. Grant support is available 

for informationist fellowships as well. 

The Library’s innovations and achievements 

of the past 20 years have helped to inspire the 

visions of a positively transformed future for 

medical practice, public health and research. 

A new climate for change has been fueled by 

the power of electronic communications, the 

embrace of the World Wide Web by health professionals and consumers alike, and some deficiencies. These include inadequate health care safety 

and quality, the need for better disaster response 

capabilities, increased political support for the 

electronic health record, and the promise of individualized treatment building on genomic research. 

The centrality of NLM to the biomedical sciences -

and to health information delivery - will not 

change. This plan for 2006-2016--the next 

decade--is organized around four key goals that 

will help NLM to enable the desirable future: 

1. Seamless, Uninterrupted Access to 

Expanding Collections of Biomedical Data, 

Medical Knowledge, and Health Information 

2. Trusted Information Services that Promote 

Health Literacy, Improve Health Outcomes, 

and Reduce Health Disparities Worldwide 

3. Integrated Biomedical, Clinical, and 

Public Health Information Systems that 

Promote Scientific Discovery and Speed 

the Translation of Research into Practice 

4. A Strong and Diverse Workforce for 

Biomedical Informatics Research, Systems 

Development, and Innovative Service Delivery 

17 Health Services Research & Public Health Information Programs [Internet]. Bethesda (MD): National Library of Medicine (US); 2004 May [updated 

2006 Oct 23; cited 2006 Oct 27]. Available from: http://www.nlm.nih.gov/hsrph.html 

18 Training & outreach [Internet]. Bethesda (MD): National Library of Medicine (US); 2004 May [updated 2006 Sep 6; cited 2006 Oct 27]. Available 

from: http://www.nlm.nih.gov/training.html 

A Brief Report: Major Elements of NLM's Work Since its Long Range Plan of 1986

21
Figure 1. NLM Budget Chronology

Budget Chronology FY86-06 (Dollars in Thousands)

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22

A Brief Report: Major Elements of NLM's Work Since its Long Range Plan of 1986
NLM’s Long Range Plan

for 2006-2016

NLM’s Long Range Plan

for 2006-2016
GOAL ONE
Plan for 2006-2016

Goal 1. Seamless, 

Uninterrupted Access to 

Expanding Collections of 

Biomedical Data, Medical 

Knowledge, and Health 

Information

“The digital era, far from ending the

physical library, will free it to facilitate

learning rather than to house shelves —

and will free those who work within

library spaces to do less book processing and more learning facilitation.”19 

Building and maintaining the world’s most comprehensive collection of biomedical literature is 

the one aspect of NLM’s mandate that John Shaw 

Billings, the towering 19th century figure 

in the Library’s history, would find most familiar. 

It was Dr. Billings who articulated the idea that a 

“national medical library” should aggressively collect and preserve the record of medicine. Today, 

the stream of printed books and journals being 

cataloged and shelved would reassure Billings, 

but he would no doubt be amazed by the digital 

publications and data that form an essential part 

of modern science and of NLM’s collection. The 

Library’s collection, in all its forms, is the bedrock 

on which today’s information services rest and on 

which future services will be built. 20 

Recommendation 1.1. Ensure adequate space 

and storage conditions for NLM’s current and 

future collections to guarantee long term access 

to information and efficient service delivery. 

Inherent in the mandate of the world’s preeminent 

medical library—to acquire, organize, preserve, 

and disseminate biomedical information—is the 

need for space to house its ever-expanding physical and electronic collections of biomedical information. These critical resources, many of which 

do not exist anywhere else in the world, continue 

to grow. Unfortunately, the shelves are filled, special collections are out of space, and computer 

rooms have no place to expand. Developing an 

expanded facility for the NLM is a small investment compared to the potential benefits of bringing the latest in biomedical science out of the 

laboratory and into the daily lives of millions to 

promote health and cure disease. 

Despite great promises on the horizon, all of 

NLM’s information-handling capabilities are being 

jeopardized by a lack of adequate space. Present 

facilities predate 1987 when Congress established 

the National Center for Biotechnology Information 

(NCBI). Built to hold fewer than 650 staff, the 

buildings must now accommodate more than 

NLM Construction c. 1955

19 Deanna Marcum, Associate Librarian for Library Services, Library of Congress in: Libraries in the digital age. NLM Newsline [Internet]. 2005 Spring 

[cited 2006 Oct 24];60(Spec Issue):1-20. Libraries as place; p. 4-5. Available from: http://www.nlm.nih.gov/pubs/nlmnews/spring05/60sp_newsline.pdf 

20 National Library of Medicine (US). Collection development manual of the National Library of Medicine [Internet]. 4th ed. Bethesda (MD): The 

Library; 2004 [cited 2006 Oct 24]. Available from: http://www.nlm.nih.gov/tsd/acquisitions/cdm

NLM's Long Range Plan for 2006-2016: Goal 1

25
Plans for NLM Expansion

1300 with much of the increase coming from 

NCBI. Physical collections are overflowing the 

stacks, digital collections are outgrowing data center capacity and stressing electrical power and airconditioning systems, and space for the serious 

multidisciplinary collaboration that underpins 21st 

century biomedical science is non-existent. 

Architectural plans for a new NLM building were 

completed in 2003. The new facility would provide 

the Library with needed space for the biomedical 

archive of last resort, research on how to make 

information available, the work of the NCBI in 

molecular genetics, and a “collaboratory” that will 

assist in putting together teams of experts with 

different backgrounds to engage in large-scale 

multidisciplinary science. 

Recommendation 1.2. Preserve NLM’s collections in highly usable forms and contribute to 

comprehensive strategies for preservation of biomedical information in the U.S. and worldwide. 

NLM has made significant progress in preserving 

its traditional physical collections through microfilming and (more recently) digitizing brittle books 

and journals, conservation of rare historical materials, and implementation of an onsite disaster 

prevention and response program. NLM should 

continue to use digital technology to preserve and 

provide permanent access to additional portions 

of the NLM print collection as well as its pictorial, 

multimedia, and archival materials. 

When NLM owns both print and digital versions of 

the same biomedical journals, the Library should 

not quickly - nor unilaterally - consider abandoning its physical journal collection. NLM holds one 

of the world’s major archival collections. It has an 

obligation to work in partnership with appropriate 

scholars and institutions worldwide to develop 

prudent preservation and access plans that serve 

science and health well in the long term future. 

Because preservation of the NLM collection is 

necessary, but not sufficient to ensure continuing 

access to the complete record of biomedical and 

health sciences, these plans must encompass 

unique and important historical materials held 

elsewhere. Particular attention should be paid to 

preserving documentary evidence of the traditional healing practices of indigenous peoples. 

The great preservation challenge of the 21st century is ensuring permanent access to digital information. Perhaps counter intuitively, acquiring and 

preserving digital data is more complex, more difficult, and more expensive (in people, space, and 

materials) than acquiring and preserving paperbased materials. Licensing arrangements provide 

current access to electronic information without 

transferring an actual copy that can be preserved. 

26

NLM's Long Range Plan for 2006-2016: Goal 1
Few institutions can match NLM’s record of 40 

years of successful preservation of the digital data 

it holds. Indexing citations created in the 1960s in 

the original batch Medical Literature Analysis and 

Retrieval System (MEDLARS) are searchable in 

PubMed/MEDLINE today, as well as available to 

other computer systems in fully tagged XML 

(Extensible Markup Language) format. The NLM 

experience with MEDLINE, GenBank, and many 

other databases shows that continual public 

access ensures that digital data are preserved in 

usable format. 

NLM’s PubMed Central21, recently developed 

by NLM’s National Center for Biotechnology 

Information on behalf of NIH, has led to national 

and international partnerships with publishers, 

societies, research funders, and libraries to promote and enable permanent public access to the 

electronic full-text of biomedical journals, including 

papers resulting from NIH-funded research. Thus 

NLM has appropriately extended its preservation 

plans to include information held elsewhere. 

The PubMed Central team led the definition of a 

widely adopted standard XML format for electronic 

articles,22, 23 now extended to include books, 

and has developed an exportable version of the 

PubMed Central system to aid the development 

of similar archives in other countries. This work— 

and perhaps more like it—should be used by 

NLM as a start of efforts to assist in worldwide 

arrangements to guarantee the preservation of 

key biomedical information. 

NLM must continue to work in partnership with 

the Library of Congress, the National Archives, 

other U.S. national and international government 

organizations, academia, publishers, and industry 

to develop workable long-term solutions to protect 

the full range of electronic materials, including 

scholarly publications, datasets, Web documents, 

interactive publications and other formats on 

which 21st century research, health care, and 

education depend. Such arrangements will almost 

certainly include collaboration among geographically dispersed trusted repositories. While contributing to long-term solutions, NLM should pursue 

immediate opportunities, including agreements 

with interested publishers and international peering partners for PubMed Central and other digital 

holdings. 

Recommendation 1.3. Structure NLM’s 

electronic information services to promote 

scientific discovery and rapid retrieval of the “right” 

information by people and computer systems. 

Over the past decade, NLM “reinvented” its data 

creation, retrieval, and dissemination systems to 

support effective Web access, efficient interaction 

with external computer programs and Web applications, and output in standard formats. Improving 

the efficiency and effectiveness of NLM’s systems 

is a journey - not a destination. To keep pace with 

the increasing flood of knowledge and data, NLM 

must continue to enhance the efficiency of its internal data creation and library processing systems 

and to provide ever more sophisticated automated 

assistance to the human experts who create and 

curate the Library’s authoritative bibliographic and 

scientific data. 

Millions of individuals and many external computer 

systems now retrieve terabytes of high quality 

health information and scientific data from NLM 

databases and services every day. Users of NLM 

services report relatively high satisfaction, and use 

continues to grow dramatically.24 But most users of 

NLM databases fail to take advantage of the rich 

variety of linkages that already exist among NLM’s 

related data sets and rely on a simple question and 

21 PubMed Central: a free archive of life sciences journals [Internet]. Bethesda (MD): National Library of Medicine (US), National Center for 

Biotechnology Information. 2000 Feb - [cited 2006 Oct 26]. Available from: http://pubmedcentral.gov/.

22 Library of Congress and British Library to support common archiving standard for electronic journals. Inf Stand Q. 2006 Apr;18(2):13. 

23 The NLM standard is available at: Archiving and interchange DTD [Internet]. Version 2.2. Bethesda (MD): National Library of Medicine (US), National 

Center for Biotechnology Information; 2006 Jun 8 [cited 2006 Oct 27]. Available from: http://dtd.nlm.nih.gov/. 

24 For example, MedlinePlus in both the English and Spanish versions score consistently in the 86 range on the American Customer Satisfaction 

Index (ACSI) user survey, highest among Federal Web sites and tied with the best of the commercial offerings. 

NLM's Long Range Plan for 2006-2016: Goal 1

27
answer mode of querying, sorting through a short 

list of results and exiting. Many important discoveries may never be realized because of this query 

method. The problem will become more substantial 

as databases expand with new and different data 

types. Enhancements that improve automated 

assistance to facilitate discoveries are badly needed. 

To address this problem, NLM should harness the 

combined strengths of its research and service 

divisions to improve its ability to lead users to the 

information already available in NLM resources 

and to provide just-in-time information delivery. 

Appropriate steps include development of more 

effective mechanisms for: retrieving across NLM’s 

disparate resources, displaying related content 

from disparate resources, providing interfaces that 

accommodate the varying needs of individual 

users and external computer systems that require 

access to NLM data, and measuring the impact 

of new features on usability, user behavior, and 

retrieval success. NLM should also pursue ongoing work with leading commercial information 

technology companies to systematically probe 

NLM databases via sophisticated algorithms that 

dynamically deliver search results aimed at individual users’ interests and requirements. 

NLM should continue to conduct and support 

research and development in advanced information retrieval, synthesis, and display, including 

new ways to structure biomedical knowledge in 

electronic form; use of natural language processing techniques and software agents to integrate, 

access, and repackage information across multiple information resources; advanced database 

probing algorithms; and shareable software tools 

that aid customization for particular types of users 

(e.g., researchers, clinicians, and health care 

consumers). 

Recommendation 1.4. Evaluate interactive publications as a possible means to enhance learning, 

comprehension, and sharing of research results. 

New forms of “interactive” publications are 

emerging from the “multi-media” attachments25 

of some current journal articles. Despite major 

challenges in implementation, management, and 

preservation, interactive publications have the 

potential to enhance understanding, learning, 

and retention of scientific and health concepts.26 

Such publications could allow the reader (or 

hearer) to “point and-click” or gesture appropriately at a text passage and elicit a true multimedia response appropriate to the context. For 

example, the text reference to a clinical coronary 

angiogram might lead to a short video. Other 

examples might include breath and heart sounds, 

access to full CAT scans or MRIs in place of still 

illustrations, visualization of patient gait, and 

access to the data observations behind published 

summary tables and graphs. Where this supplementation is possible, one imagines a better 

comprehension and heightened credibility for the 

expert viewer, and a better learning opportunity 

for the less than expert viewer. These approaches 

might well enable more effective presentation of 

full results of clinical trials for both experts and the 

interested public. 

Lister Hill Center research has developed and 

demonstrated a prototype system for publications 

with tabular data. The National Center for 

Biotechnology Information already is processing 

early examples of multimedia publications into 

PubMed Central, storing the multi-media and/or 

data attachments physically at NLM. As yet there 

are no generally agreed-upon standards for the 

format of the attached files, which complicates 

their management and long-term use. For those 

articles that are available primarily at publishers’ 

or contractors’ computer sites, the non-standard 

multi-media attachments may physically be stored 

in many different places around the world. 

25 Santos C, Blake JD, States DJ. Supplementary data need to be kept in public repositories. Nature [Internet]. 2005 Dec 8 [cited 2006 Oct 

24];438(7069):738. doi:10.1038/438738a. Available from: http://www.nature.com/nature/journal/v438/n7069/full/438738a.html 

26 Lindberg DAB. Research opportunities and challenges in 2005. Methods Inf Med. 2005 Apr;44(4):483-6. 

28

NLM's Long Range Plan for 2006-2016: Goal 1
Research on enabling useful interactivity in scientific publications requires partnerships between 

NLM and commercial and academic journal publishers. The research agenda should address such 

topics as: appropriate technical formats; tool 

development for authoring, downloading, and 

viewing; thorough evaluation of the technology 

at various stages to ensure that the participating 

groups (authors, publishers, health professionals, 

researchers, students) benefit from this type of 

publication; and, after much more is learned, the 

development of recommended standard formats 

and practices. 

Recommendation 1.5. Ensure continuous 

access to health information and effective use of 

libraries and librarians when disasters occur. 

It is a distressing aspect of our era that society 

faces a variety of potential large-scale threats, 

both acts of nature and acts of humans. NLM has 

a significant track record in building information 

resources and networks that are resilient and 

valuable in the face of disasters from Bhopal, 

India, to the U.S. Gulf Coast. 

The Library’s first responsibility is to ensure that 

NLM critical information services remain available 

during emergencies and disasters - and it takes 

this responsibility seriously. NLM devotes a staff 

of six experts to computer security measures that 

prevent, detect, and minimize the effects of hostile attacks on the Library’s computer systems. An 

offsite computer facility on a different power grid 

with multiple Internet access providers supports 

uninterrupted service from NLM’s key systems. 

Some services are actively served by both sites, 

each acting as a hot standby for the other. For the 

warm and cold standby services, NLM cooperates 

with the National Network of Libraries of Medicine 

(NN/LM) to regularly test rerouting requests for 

service and assistance from one facility to 

another. In addition, some NLM datasets are mirrored at other sites around the world. 

NLM should continue to strengthen and test its 

already excellent emergency response capabilities. NLM should work with the Regional Medical 

Libraries to establish more extensive NN/LM 

disaster response plans, possibly including library 

pairing to provide personnel and other services 

during emergencies. NN/LM planning should take 

advantage of relevant expertise and mission 

within HHS and military agencies, including the 

Uniformed Services University. 

In the aftermath of Hurricanes Katrina and Rita, 

the NN/LM was highly effective in obtaining useful 

information from affected communities, rerouting 

requests for services, and getting equipment 

and personnel to locations serving evacuees 

and temporary health care facilities. Many public 

libraries served as communication and social 

service centers for evacuees. 

Library emerges as information

hub in shattered Mississippi town

“Library cards may have been washed away by

Hurricane Katrina, but it doesn’t really matter.

Patrons in Pass Christian, Mississippi, are making

do with a makeshift library that was set up in

a 28-by-72-foot trailer in November. Although

small, the temporary library has 17,000 volumes,

wireless internet access, computers and laptops,

group meeting space, and three full-time staff

to help people find whatever they need....”

Oakland (Calif.) Tribune, Aug. 26, 2006

Building on this experience, NLM should work 

with appropriate federal, state, and local agencies 

to ensure that libraries and librarians are included 

in disaster response information plans and to 

identify more specifically the kinds of information 

they should be prepared to supply. Local 211 

agencies that provide directories of essential 

community services, health organizations and 

other agencies are identifying resources in their 

own areas. 

NLM's Long Range Plan for 2006-2016: Goal 1

29
Veterans Administration Hospital, Gulfport, MS after Hurricane Katrina

NLM should work with relevant stakeholders to Recommendation 1.6. Establish a Disaster 

determine how this information can be organized Information Management Research Center at 

and integrated into a national structure, analogous NLM to make a strong commitment to disaster 

to the expanding MedlinePlus Go Local service remediation and to provide a platform for demonthat links information about locally available health strating how libraries and librarians can be part of 

services to authoritative disease, treatment, and the solution to this national problem. 

prevention information. NLM should investigate 

the potential for expanding its services to encompass additional information relevant to disaster 

management. 

NLM does not actually treat patients, investigate 

disease outbreaks, clean up toxic spills, or conduct clinical trials. Nonetheless, the Library’s intramural and extramural research programs have 

produced innovative and robust information systems and services that assist all of these activities. In recent years, NLM has conducted and 

supported selected research and development 

projects related to disaster information management, which have been similarly useful to those 

involved in disaster planning and management. 

30

NLM's Long Range Plan for 2006-2016: Goal 1
Work undertaken or sponsored by NLM has produced portable devices with toxic chemical information used by emergency responders after 

Hurricane Katrina, software tools for robust DNA 

identification of victims of 9/1127 and Katrina, 

prototype self-healing wireless networks to restore 

connectivity and smart tags to track patients during 

triage, transportation, and treatment, and new 

insights into the evolution of flu viruses derived 

from the analysis of genomic data which suggest 

more effective strategies for vaccine development. 

There is ample evidence of the enormous communication and information dissemination problems 

that arise in large scale disasters. The area is ripe 

for additional research that builds on NLM’s existing strengths and research portfolio. To complement and support the activities of the federal, 

state, and local agencies responsible for disaster 

planning and response, NLM should formally 

expand its research and development agenda in 

this arena and establish a Disaster Information 

Management Research Center within the Library. 

This new Center should: 

• Maintain close collaboration with appropriate federal agencies and initiatives that aim 

at disaster prevention and remediation. 

• Alert staff at NLM, NIH, and HHS to 

progress, experiments, and failures in 

this field, with special focus on information and communication systems. 

• Operate across NLM Divisions so that all 

potential contributions to disaster remediation, including outreach and training, are coordinated and enhanced. 

• Identify critical research and development opportunities, and initiate and/or collaborate in these. 

 Biesecker LG, Bailey-Wilson JE, Ballantyne J, Baum H, Bieber FR, Brenner C, Budowle B, Butler JM, Carmody G, Conneally PM, Duceman B, 

Eisenberg A, Forman L, Kidd KK, Leclair B, Niezgoda S, Parsons TJ, Pugh E, Shaler R, Sherry ST, Sozer A, Walsh A. Epidemiology. DNA identifications after the 9/11 World Trade Center attack. Science. 2005 Nov 18;310(5751):1122-3. doi: 10.1126/science.1116608. 

NLM's Long Range Plan for 2006-2016: Goal 1

31

27
GOAL TWO
Plan for 2006-2016

Goal 2. Trusted Information 

Services that Promote Health 

Literacy, Improve Health 

Outcomes, and Reduce 

Health Disparities Worldwide

“Health literacy is the degree to which

individuals can obtain, process, and

understand the basic health information 

and services they need to make appropriate

health decisions. But health literacy goes 

beyond the individual. It also depends upon 

the skills, preferences, and expectations of

health information and care providers...”28 

Contributing to improved health literacy is a 

foundational goal for the NLM. For the Nation it is 

both good social policy and sound fiscal policy to 

increase health access and improve outcomes.29 

As stated in the Board of Regents Policy on 

Consumer Health, NLM’s primary role is “to ensure 

that all people in the U.S. have a known, accessible, understandable, and affordable source of 

current, authoritative health information.” Ready 

access to information will not ensure understanding yet alone behavior modification, but it is often 

a prerequisite, and should continue to be a primary 

objective of NLM outreach programs. Furtherance 

of user understanding presents a greater challenge, 

and will require imaginative efforts to use user 

feedback, evaluation, and cognitive science principles to inform system development. Services 

intended for use by minority populations must also 

employ culturally appropriate design elements that 

invite and reinforce effective use. 

NLM’s free, high quality consumer information 

services are heavily used by members of the public 

and by clinicians as aids to patient education, but 

they reach only some of their intended users. At a 

time when the amount of doctor-patient “face 

time” for discussing and explaining health conditions is short and there is intensified emphasis on 

self-informed patients and healthy lifestyles as 

keys to improving health and reducing costs, the 

Library must continue to strengthen its efforts to 

promote awareness of and ability to use electronic 

information sources among all segments of the 

population. To this end, NLM must strive to provide information in forms that can help increase 

understanding, reduce health disparities, and promote health literacy. 

NLM Director Lindberg at Smudging Ceremony opening

the “Native American Concepts of Health and Disease”

Consultation, December 2006, Santa Fe, New Mexico,

with Mr. George Horse Capture, Curator Emeritus,

National Museum of the American Indian.

28 Nielsen-Bohlman L, Panzer AM, Kindig DA, editors. Health literacy: a prescription to end confusion [Internet]. Washington: National Academies 

Press; 2004 [cited 2006 Oct 23]. Available from: http://www.nap.edu/catalog/10883.html#toc 

29 Cutler DM, Lleras-Muney A. Education and health: evaluating theories and evidence [Internet]. Cambridge (MA): National Bureau of Economic 

Research (US); 2006 Jul [cited 2006 Oct 26]. 37 p. (NBER working paper; no. 123520). Available from: http://papers.nber.org/papers/w12352 

System requirements: Adobe Acrobat. 

NLM's Long Range Plan for 2006-2016: Goal 2

33
Recommendation 2.1. Advance new outreach 

programs by NLM and NN/LM for underserved 

populations at home and abroad; work to reduce 

health disparities experienced by minority populations; share and actively promote lessons learned. 

NLM’s core mission includes a vigorous outreach 

program to help assure that its users, including 

researchers, health professionals, and the lay 

public, are aware of and make effective use of 

health information available from NLM. NLM’s 

active outreach program began when the Medical 

Library Assistance Act (MLAA) of 1965 mandated 

the formation of the Regional Medical Library 

(RML) Network to strengthen medical information 

service across the country. In 1989, encouraged 

by the Congress, the NLM Board of Regents 

issued a specific Long Range Plan Report on 

Outreach30, known as the “DeBakey” report after 

Dr. Michael E. DeBakey who chaired the Planning 

Panel and had also been influential in the passage of MLAA. The 1989 Outreach Plan recommended a new name and an expanded outreach 

role for what is now called the National Network 

of Libraries of Medicine (NN/LM). In FY 1990, 

funding increases from the Congressional 

Appropriations Sub-Committee chaired by Mr. 

William Natcher enabled hundreds of locallydirected outreach projects to reach underserved 

health care professionals nationwide. 

Beginning with emphases on physicians not 

directly affiliated with an institution having a medical library, and on the HIV/AIDS community, NLM 

and NN/LM outreach efforts promoted access to 

the newly emerging Internet and the electronic 

resources that increasingly became NLM’s most 

efficient mode of dissemination.31 The elimination 

of charges for MEDLINE in 1997 (due to the switch 

from commercial telecommunications networks to 

the Internet) and the development of MedlinePlus 

and other NLM services directed toward the general public enabled the expansion of outreach to 

public health professionals (via the Partners in 

Information Access for the Public Health Workforce), 

public libraries, and a growing range of communitybased organizations serving minority and underserved populations. 

Over the past 15 years, numerous projects have 

addressed infrastructure improvements in minority 

and rural communities and academic institutions 

(e.g., Historically Black Colleges and Universities 

and Tribal Colleges); training minority health professionals, librarians and other information professionals, and community members to use health 

information resources (e.g., Promotoras de Salud 

and Hispanic student peer tutors32, 33); outreach 

partnerships with community-based and profesDecember 2006 NLM visit to Jemez Indian Pueblo, New Mexico,

Traditional Bread Making.

30 National Library of Medicine (US), Board of Regents. Improving health professionals’ access to information. Bethesda (MD): The Library; 1989. 

31 Wood FB, Sahali BA, Press N, Burroughs C, Mala TA, Siegel ER, Fuller SS, Rambo N. Tribal connections health information outreach: results, 

evaluation, and challenges. J Med Libr Assoc [Internet]. 2003 Jan [cited 2006 Oct 24];91(1):57-66. Available from: http://www.pubmedcentral.gov/ 

picrender.fcgi?artid=141188&blobtype=pdf 

32 Bowden VM, Wood FB, Warner DG, Olney CA, Olivier ER, Siegel ER. Health information Hispanic outreach in the Texas Lower Rio Grande Valley. J 

Med Libr Assoc [Internet]. 2006 Apr [cited 2006 Oct 24];94(2):180-9. Available from: http://www.pubmedcentral.gov/picrender.fcgi?artid=1435849& 

blobtype=pdf 

33 Olney CA, Warner DG, Reyna G, Wood FB, Siegel ER. MedlinePlus and the challenge of low health literacy: findings from the Colonias project. J 

Med Libr Assoc [Internet]. Forthcoming 2006. 

34

NLM's Long Range Plan for 2006-2016: Goal 2
sional organizations (e.g., through “listening circles” and other consultations with American 

Indians, Alaska Natives and Native Hawaiians); 

and the development of culturally sensitive 

information (e.g., special population Web sites 

for Native Americans and Pacific Islanders). 

“By many measures, America has an exceptional

health care system. Tremendous advances

have made the U.S. health system the most

technologically advanced in the world. Yet that

system is in trouble. Basic quality care is

beyond the reach of far too many Americans.

As the population has become increasingly

diverse, glaring disparities in the quality of

care, especially for racial and ethnic minorities,

have led to thousands of premature deaths

each year and incalculable hours of lost productivity, pain, and suffering.”34 

Public libraries, schools, public health departments, and a range of community based organizations are natural allies in the campaign to improve 

health literacy and eliminate health disparities. 

NLM and the NN/LM must continue to work in 

partnership with all of these groups to develop 

new models and strategies for promoting sustainable access to, and use of, health information 

in minority and underserved communities. Expansion of the NN/LM to include 

new members such as community-based 

organizations should be attempted. 

Experience gleaned from outreach demonstration 

projects must be evaluated in context and disseminated widely in the interest of furthering participatory research that strengthens community-based 

July 2006 NLM visit to Miloli’i Village Big Island, Hawaii,

Computer Room in Village Library.

organizations, and fosters productive partnerships 

with libraries and health professionals.35 NLM 

should consider hosting a Web site as a primary 

resource center and point of entry for locating 

health information literacy tools and materials, 

perhaps employing collaboration tools such as 

Wikis and blogs to provide dynamic reports of 

outreach outcomes and lessons learned. An effective practices database, modeled upon those produced for the Corporation for National Service, 

could reach the broader outreach community and 

benefit from their input. 

Recommendation 2.2. Work selectively in 

developing countries that represent special 

outreach opportunities, such as improving 

access to electronic information resources, 

enhancing local journal publications of high 

quality, and developing a trained librarian 

and IT workforce. 

At its most fundamental level, global health 

is America’s business both on humanitarian 

grounds and on national security grounds. 

The dire health conditions in some developing 

nations are part of the heart-wrenching scenes 

of distress broadcast via TV, cable, and the 

34 Missing persons: minorities in the health professions. A report of the Sullivan Commission on Diversity in the Healthcare Workforce [Internet]. 

[place unknown]: The Sullivan Commission; 2004 [cited 2006 Oct 23]. Available from: http://www.aacn.nche.edu/Media/pdf/SullivanReport.pdf 

35 Siegel ER, Wood FB, Dutcher GA, Ruffin A, Logan RA, Scott JC. Assessment of the National Library of Medicine’s health disparities plan: a focus 

on Native American outreach. J Med Libr Assoc [Internet]. 2005 Oct [cited 2006 Oct 24];93(4 Suppl):S10-20. Available from: http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1255749&blobtype=pdf 

NLM's Long Range Plan for 2006-2016: Goal 2

35
Internet around the globe. Diseases in one part 

of the world can quickly spread. Collaboration 

with partners in developing regions is essential 

to help establish means for accessing and disseminating disease surveillance data that may 

be used to identify and contain new outbreaks 

that also become a threat to the American people. 

This outreach should be pursued in concert with 

a new NLM research agenda in disaster information 

management, coupled with efforts to strengthen 

national and local public health systems. 

Installing the satellite dish for the Multilateral Initiative on

Malaria communication network in Gabon.

NLM has been a significant contributor in international activities for at least half a century,36 in part 

through the International MEDLARS Centers and 

through participation in international conferences 

on medical librarianship and medical informatics. 

In recent years NLM has supported intensive 

capacity-building projects in selected developing 

countries. In partnership with the National Institute 

of Allergy and Infectious Diseases and the Fogarty 

International Center at NIH, the Centers for Disease 

Control and Prevention and numerous research 

agencies in the US and abroad, NLM developed 

and implemented a communications model for the 

Multilateral Initiative on Malaria that provides 

affordable and reliable satellite access to the 

Internet and electronic information resources 

in malaria research laboratories in 19 African countries.37 Subsequent partnerships were established 

to improve the quality of African medical journals, 

leading ultimately to their being indexed in 

MEDLINE; to train IT personnel to provide local 

user support; and to strengthen a cadre of medical 

librarians to meet local needs and partner with 

NLM in future outreach efforts. 

In Central America, an area particularly prone to 

natural disasters, NLM collaboration with the Pan 

American Health Organization (PAHO) is providing 

prevention and preparedness training, materials 

and communications infrastructure for disaster 

information centers in Chile, Nicaragua, Honduras, 

and El Salvador. 

The medical library community has also actively 

pursued useful international partnerships. “Sister 

library” arrangements have been established by the 

Medical Library Association (MLA) in Latvia and 

Antigua in which more than 100 US and Canadian 

libraries jointly provided ad hoc training, material 

and communications. A more typical model pairs 

libraries one-on-one and fosters closer ties, but 

may be more difficult to sustain over time due to 

the intensive commitments required. An excellent 

example of this approach is the award-winning 

“two Georgias” partnership established between 

Emory University in Atlanta and the National 

38 Information Learning Center in Tbilisi. 

36 Corning ME. National Library of Medicine: international cooperation for biomedical communications. Bull Med Libr Assoc [Internet]. 1975 Jan [cited 

2006 Oct 24];63(1):14-22. Available from: http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=198850&blobtype=pdf 

37 Royall J, van Schayk I, Bennett M, Kamau N, Alilio M. Crossing the digital divide: the contribution of information technology to the professional 

performance of malaria researchers in Africa. Afr Health Sci [Internet]. 2005 Sep [cited 2006 Oct 24];5(3):246-54. doi: 10.5555/afhs.2005.5.3.246. 

Available from http://www.atypon-link.com/MMS/doi/pdf/10.5555/afhs.2005.5.3.246 

38 Burns CA, Kirtava A, Walker HK. The role of information access in sustainable healthcare in Georgia: The Atlanta-Tbilisi Health Partnership model. 

Inf Serv Use [Internet]. 2005 [cited 2006 Oct 24];25:125-35. Available from: http://iospress.metapress.com Free registration required to view this 

article. 

36

NLM's Long Range Plan for 2006-2016: Goal 2
NLM should continue its current special initiatives 

and identify promising new collaborative opportunities in selected countries. NLM should also investigate ways to promote effective library-peering and 

support models, including the Medical Library 

Association’s emerging international visitation program “Librarians without Borders.” 

NLM should also explore opportunities to work 

with foundations that address global health 

needs. It may be possible to improve the capacity 

to access and use electronic health information in 

conjunction with their international endeavors. For 

example, the development of a Woods Hole-type 

informatics training program might help raise 

international medical informatics literacy and 

practical skills.39,40 

Recommendation 2.3. Promote knowledge of 

the Library’s services through exhibits and other 

public programs. 

Exhibits and public programs can play an important role in increasing science literacy, promoting 

awareness of health information services, and 

enhancing interest in careers in science, biomedical informatics, and librarianship. Both Changing 

the Face of Medicine and Visible Proofs, the most 

recent members of NLM’s acclaimed series of 

major historical exhibitions41, directly address these 

objectives. In addition to the onsite installation, 

which attracts busloads of children and seniors, 

each exhibition has an extensive, permanent Web 

with K-12 curriculum materials developed in consultation with educators. NLM should also develop 

strategies for promoting wider use of K-12 curriculum materials in schools across the country. 

An excellent collaboration with the American 

Library Association (ALA) has resulted in the production of highly successful traveling versions of 

some of the exhibitions, which have appeared in 

dozens of public, college, and health sciences 

libraries in communities across the country. All of 

NLM’s exhibitions should travel. 

Board of Regents members Dr. Thomas Detre

and Dr. Tenley Albright visit the NLM exhibition

Visible Proofs: Forensic Views of the Body.

NLM should continue its excellent collaboration 

with ALA and work with other organizations to 

travel appropriate exhibitions to non-library sites. 

NLM should also explore collaborations with 

science museums, including joint development 

of exhibitions and related programs. Museums 

could serve as additional important dissemination 

points for resources maintained and developed 

by the NLM and assist the Library in developing 

interactive resources that assist formal and 

informal learning across a broad range of topics 

relevant to biomedicine. 

Primarily via the Regional Medical Libraries and 

other members of the National Network of Libraries 

of Medicine, NLM’s products and services are 

exhibited and, in some cases featured in Continuing 

Education classes and program sessions, at more 

39 Patel VL, Branch T, Cimino A, Norton C, Cimino JJ. Participant perceptions of the influences of the NLM-sponsored Woods Hole medical informatics course. J Am Med Inform Assoc [Internet]. 2005 May-Jun [cited 2006 Oct 26];12(3):256-62. Epub 2005 Jan. doi: 10.1197/jamia.M1662 

Available from: http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1090455&blobtype=pdf 

40 Marine Biological Institute; National Library of Medicine (US). BioMedical Informatics: a course for health professionals. Woods Hole (MA): 

MBLWHOI Library; c2006 [cited 2006 Oct 26]. Available from: http://courses.mbl.edu/mi/. 

41 Online exhibitions and digital projects [Internet]. Bethesda (MD): National Library of Medicine (US); 2004 May [updated 2006 Mar 20; cited 2006 

Oct 27]. Available from: http://www.nlm.nih.gov/onlineexhibitions.html 

NLM's Long Range Plan for 2006-2016: Goal 2

37
than 250 national, regional, and local association 

meetings for health professionals, librarians, health 

educators, and consumer groups every year. NLM 

should continue this program, adjusting the number and the roster of meetings attended based on 

feedback from the exhibit staff and attendees. 

NLM uses a wide range of techniques to reach the 

American public with the message that NLM has 

free, reliable Web-based information about health 

matters. The Library attempts to use a variety of 

media outlets, for example, public service 

announcements (PSAs) on television and radio and 

in magazines, public formal press releases to newspapers and journals, personal contacts with reporters and writers, announcements on the NLM Web 

site, and, most recently, weekly NLM Director’s podcasts that highlight information sources relevant to 

a currently newsworthy health topic. 

NLM has also developed programs to encourage 

doctors to refer their patients to NLM information 

services. In the “Information Prescription” program for physicians, patients and libraries, 

patients are given an Rx scrip and referred by 

their doctors to MedlinePlus content that is 

directly relevant to newly diagnosed or chronic 

health conditions.42 The American College of 

Physicians Foundation, the Fisher Center for 

Alzheimer’s Research, the Medical Library 

Association, the National Network of Libraries of 

Medicine, and the hospital library community have 

helped to promote physician participation. 

Similarly NLM and other NIH Institutes, in collaboration with the Friends of the NLM, have recently 

launched the NIH MedlinePlus magazine43 for 

distribution in doctors’ waiting rooms. 

NLM must broaden and intensify current efforts 

to reach consumers and health professionals, 

so they know how to access this information, 

continue to experiment with new media and 

new approaches, and assess the cost-benefit 

of different methods. 

Recommendation 2.4. Test and evaluate digital 

infrastructure improvements (e.g., PDAs, intelligent agents, network techniques) to enable 

ubiquitous health information access in homes, 

schools, public libraries, and work places. 

Continuing proliferation of portable and wearable 

digital devices, sensors, and wireless telecommunications options will offer new opportunities for 

ubiquitous access to both personal health data 

and authoritative information about health conditions and therapies. Many organizations will hold 

electronic personal health data (governments, 

health insurance companies, disease or condition 

specific organizations) in addition to patients and 

individual and networked health care providers. 

Developing the effective rules of the road for this 

degree of complexity is a formidable task. NLM 

should be a significant participant in ongoing 

technical research and policy making, which will 

necessarily involve many agencies and groups. 

Much work remains to be done to define the privacy and technical standards and guidelines for 

transmitting private health information over the 

Internet and other electronic pathways. 

Use of a wireless PDA in a disaster drill as part of the

Wireless Internet Information System for Response in

Medical Disasters (WIISARD) project, funded by NLM.

(Photo credit: Barbara Haynor, UCSD) 

42 Siegel ER, Logan RA, Harnsberger RL, Cravedi K, Krause JA, Lyon B, Hajarian K, Uhl J, Ruffin A, Lindberg DAB. Information Rx: evaluation of a 

new informatics tool for physicians, patients and libraries. Inf Serv Use. 2006;26(1):1-10. 

43 NIH MedlinePlus Magazine [Internet]. Bethesda (MD): National Library of Medicine (US). Vol. 1, No. 1, 2006 – [cited 2006 Oct 26]. Available from: 

http://www.nlm.nih.gov/medlineplus/magazine.html 

38

NLM's Long Range Plan for 2006-2016: Goal 2
Remote Inupiat Eskimo village in the Arctic — Buckland, Alaska.

NLM should actively explore innovative technology, implementation, and policy alternatives for 

providing ubiquitous, appropriate access to health 

information. For example, an illustrative alternative 

approach to universal broadband would be a 

staged approach to access, where 

the availability of information could be explored 

through access media such as cell phones or 

PDAs in locations with problematic terrestrial 

communications, and followed up through health 

information access nodes at libraries, clinics or 

community-based organizations. Resolving the 

issues of direct consumer access to health information should be complemented with changes in 

the way health information is delivered. For example, it may be more effective to work toward the 

development of intelligent agents that can recommend actions, guided by the values, preferences 

and expectations of the patient and clinicians. 

Recommendation 2.5. Support research on 

the application of cognitive and cultural models to 

facilitate information transfer and trust building 

and develop new methodologies to evaluate the 

impact of health information on patient care and 

health outcomes. 

NLM has compiled an extensive record of deploying 

robust, multidimensional evaluation research that 

has been instrumental in creating and continually 

improving its database and Web site offerings for 

researchers, educators and the general public. 

These methodologies include usability testing, 

qualitative user feedback and customer satisfaction 

surveys, automated quantitative data collections and 

Web log analyses, and Internet performance and 

connectivity monitoring.44 More research is needed, 

particularly in the area of documenting impacts on 

health behavior and health outcomes that are 

attributable to information use. 

The trust patients and other health consumers 

place in health information, sources, and providers 

may be a key factor affecting consumer use of 

such information, and ultimately the impact of 

such information on their health decisions, behaviors, 

and outcomes. Research on health information 

transfer and trust building needs to draw new 

insights from interdisciplinary approaches. The 

proposed applied research emphases would benefit 

greatly and should draw from and utilize cognitive 

science principles and cultural translation strategies. 

The research should identify and assess the varied 

elements that go into effective health communication, including types of messages and channels, 

use of natural and understandable language, role 

of information intermediaries, supporting and 

enabling community or peer groups and organizations, diversity and characteristics of persons 

receiving the information. The research also should 

consider the elements affecting overall consumer 

trust, such as sources, sponsors, reviewers and 

review process, selectors and selection process, 

public access channels, interpreters and screeners. 

44 Wood, F.B., Siegel, E.R., Lacroix, E., Lyon, B.J., Benson, D.A., Cid, V., and Fariss, S.: A Practical Approach to E-Government Web Evaluation. IEEE 

IT Professional Magazine, May/June 2003, 22-28. 

NLM's Long Range Plan for 2006-2016: Goal 2

39
GOAL THREE
Plan for 2006-2016

Goal 3. Integrated 

Biomedical, Clinical, and 

Public Health Information 

Systems that Promote 

Scientific Discovery and Speed 

the Translation of Research

into Practice

“The physician of the future will meet

with a patient and his family members,

access the patient’s data in real time,

including importing data from the

patient’s personal health record, integrate it with a host of NLM resources,

access available tutorials and other

educational and explanatory materials,

identify relevant clinical trials, and

finally export all of this just-in-time,

patient-relevant information back into

the personal health record – all within

the space of an office visit.” 45 

NLM has been working to enable the potential 

research, health care, and public health payoffs of 

integrated access to electronic scientific data, 

patient records, and medical knowledge at least 

since the 1980s, when it launched both the 

Integrated Advanced Information Management 

Systems (IAIMS) initiative46 and the Unified 

Medical Language System (UMLS) project.47 

NLM’s Specialized Information Services Division 

has worked on connecting various types of data 

and knowledge needed by toxicologists and the 

environmental health community for decades, 

most recently in the TOXNET system. The Lister 

Hill Center has conducted research and development focused on integration of image databases 

(the Visible Humans are the most spectacular 

example) with other types of information and on 

gateway access to disparate NLM resources. 

When the rise of the World Wide Web solved 

many of the significant technical incompatibility 

and telecommunications problems of the 1980s, 

NLM supported new demonstration projects 

under its High Performance Computing and 

Communications initiative48 and actively participated in federal efforts to promote health data 

standardization and address public policy issues 

(e.g., privacy, security, telecommunications, intellectual property, public access to government 

information) that affect the ability to integrate data 

and knowledge.49 

Today the National Center for Biotechnology 

Information’s Entrez system already enables a 

type of traversal from underlying biological data 

(at multiple levels of granularity and aggregation) 

to published scientific papers to synthesized 

45 National Library of Medicine (US), Board of Regents. Panel 1 report: NLM resources and infrastructure for the 21st century [Internet]. [Bethesda 

(MD)]: The Library; 2006 May [cited 2006 Oct 23]. Available from: http://www.nlm.nih.gov/pubs/plan/lrp06/panel1report.doc 

46 Matheson NW, Cooper JA. Academic information in the academic health sciences center: roles for the library in information management. J Med 

Educ.1982 Oct;57(10 Pt 2):1-93. 

47 Lindberg DA, Humphreys BL, McCray AT. The Unified Medical Language System.

Methods Inf Med. 1993 Aug;32(4):281-91.

48 Lindberg DA, Humphreys BL. The High-Performance Computing and Communications program, the National Information Infrastructure, and health 

care. J Am Med Inform Assoc [Internet]. 1995 May-Jun [cited 2006 Oct 24];2(3):156-9. Available from: http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=116249&blobtype=pdf 

49 Humphreys BL. Electronic health record meets digital library: a new environment for achieving an old goal. J Am Med Inform Assoc [Internet]. 2000 

Sep-Oct [cited 2006 Oct 24];7(5):444-52. Available from: http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=79039&blobtype=pdf 

NLM's Long Range Plan for 2006-2016: Goal 3

41
information in monographs for specialists to summarized information written for the lay public.50 A 

wealth of potentially useful information remains 

locked away in patient records. NLM should 

strengthen its efforts to hasten the day when electronic health records are linked to digital libraries 

in systems that promote scientific discovery and 

bring research results directly to bear on health 

care and public health. 

“Bingo! We knew we had nailed it.” This was the 

enthusiastic comment by a Minnesota lab director 

who used an NLM DNA sequence database to 

identify the first case of polio in the U.S. in the 

21st century. The exponential growth of molecular 

data generated by scientists around the world will 

continue and present opportunities we are just 

beginning to imagine, for example, studying 

human genetic variation and its relation to disease 

and learning how to create personalized drugs for 

optimum effectiveness. 

Recommendation 3.1. Develop linked databases for discovering relationships between 

clinical data, genetic information, and environmental factors. 

Molecular biology and understanding derived 

from genomics are clearly primary drivers of medical progress in the 21st century. The quantity of 

genomic data has grown exponentially with the 

mapping of the human genome and projects that 

have built upon it. NLM’s National Center for 

Biotechnology Information (NCBI) is the information hub in this biomedical revolution, developing 

databases and sophisticated software tools that 

enable researchers to make the connections that 

are vital to the discovery process. 

Knowledge emerging from genomics has brought 

hope to families stricken by hereditary diseases. 

The Human Genome Project is transitioning from 

its initial emphasis on basic research on DNA 

sequences to activities with increasing clinical relevance. NCBI has always worked in close collaboration with the National Human Genome Research 

Institute. As genomics evolves from the domain of 

biological research into the realm of diagnosis, 

treatment, and prevention of disease, NCBI has 

increased its active partnership with other NIH 

components, e.g., the flu genome project with the 

National Institute of Allergy and Infectious 

Diseases, the trans-NIH PubChem development, 

and whole genome association studies with the 

National Heart Lung and Blood Institute. 

NCBI should lead the development of repositories 

of information on human variation that will be 

essential tools for discovering the associations 

between genes and disease. These databases will 

need to capture in a systematic fashion a wide 

array of clinical and laboratory information and 

couple these data with genotypes and environmental factors, including pathogens and chemicals. 

NCBI should continue to be the computational 

and database focal point in a trans-NIH program 

to connect clinical and genotypic data from large, 

long-term studies. Scores of case-control studies, 

such as the Framingham Heart Study, are rich 

sources of detailed, longitudinal phenotypic data. 

Genotyping for large-scale genetic mapping studies.

(Photo credit: National Institutes of Health) 

50 Wheeler DL, Barrett T, Benson DA, Bryant SH, Canese K, Chetvernin V, Church DM, DiCuccio M, Edgar R, Federhen S, Geer LY, Helmberg W, 

Kapustin Y, Kenton DL, Khovayko O, Lipman DJ, Madden TL, Maglott DR, Ostell J, Pruitt KD, Schuler GD, Schriml LM, Sequeira E, Sherry ST, 

Sirotkin K, Souvorov A, Starchenko G, Suzek TO, Tatusov R, Tatusova TA, Wagner L, Yaschenko E. Database resources of the National Center 

for Biotechnology Information. Nucleic Acids Res [Internet]. 2006 Jan 1 [cited 2006 Oct 24];34(Database Issue):D39-45. doi:10.1093/nar/gki062. 

Available from: http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=540016&blobtype=pdf 

42

NLM's Long Range Plan for 2006-2016: Goal 3
For the many studies without genotype data, 

initiatives are underway to genotype participants 

and to add that information to databases housed 

at NLM. These resources will offer investigators an 

unprecedented opportunity to study the complex 

interactions of genes, the environment, and health 

in large populations. The findings will lay the 

foundation for the development of therapies and 

prevention strategies that can be targeted to a 

patient’s genetic makeup, ushering in an era of 

personalized medicine. 

NLM’s publicly accessible tools for the analysis 

and integration of data across disciplines, and its 

funding of informatics research and training programs, place it at the center of the search for 

genomic discoveries that promise improved health 

for all. However, implementing this knowledge 

within the framework of the current health care 

system will require significant effort to address 

privacy concerns, to deliver the necessary data 

efficiently, to create and maintain decision support 

tools, and to inform the public. Families affected 

by hereditary diseases may wish to facilitate 

access to their clinical and genomic data to speed 

research discoveries. There should be easy mechanisms for them to do so. 

NLM has an opportunity to assume a leadership 

role in this effort and thus contribute to the transformation of clinical, genomic, and environmental 

information into better evidence-based medicine 

and improved patient care. 

To keep pace with the rapid increase in the volume 

of information generated in molecular biology and 

to respond to the new genetic, phenotypic, and 

environmental exposure data generated by NIH 

institutes, NCBI resources will need to continue to 

grow at a rate linked to the explosion of data, that 

will necessarily be greater than the rate of growth 

of the NIH overall. This is a direct consequence of 

the appearance of high throughput, high volume 

research technologies that produce tsunamis of 

data that require human intervention to covert data 

into information, and information into knowledge. 

A formula must be found for predictable and sustained resources consonant with the research support requirements of NIH initiatives. 

Recommendation 3.2. Promote development 

of Next Generation electronic health records to 

facilitate patient-centric care, clinical research, 

and public health. 

Current electronic health records typically resemble traditional paper-based patient charts. To a 

variable extent, today’s electronic health records 

provide some or all of the record-keeping functionality of paper-based systems (e.g., recording 

history and physical examination notes, progress 

notes, consultation notes, “written” orders, laboratory and imaging study results, and so on). In 

addition, current electronic health records may 

provide digital image storage and retrieval, limited 

decision support tools, some cross-record analysis capabilities useful in quality assessment and 

research, and some patient access to health data 

via the Web. 

Large parts of current electronic health records 

are still stored as free text. Even names of drugs, 

laboratory tests, diagnoses or therapies are often 

not unambiguously stored in standardized or 

coded form. Standardizing and structuring patient 

data in electronic health records are essential to 

enable a host of different uses, including: detection of data errors, unambiguous transfer of information between care providers and the public 

health system, automated connections to supporting knowledge in digital libraries, generation 

of alerts and reminders, automated decision support for complex cases, construction of longitudinal records for monitoring patients with chronic 

conditions, Web-enabled data entry by patients, 

and generation of databases for clinical and 

health services research and the assessment of 

health care. 

Through its Unified Medical Language System 

(UMLS) initiative, NLM has been a leading 

proponent in US government efforts to promote, 

develop, support, and disseminate key standard 

clinical vocabularies, align them with electronic 

message standards, and map them to billing codes. 

NLM's Long Range Plan for 2006-2016: Goal 3

43
For more than a decade, NLM has commissioned 

or contributed to studies by such organizations as 

National Academy of Sciences,51,52 the National 

Committee on Vital and Health Statistics, and 

the Presidential Commission on Systemic 

Interoperability53 that have shaped the strategy 

for advancing the development and adoption of 

electronic health records in the US. Through 

research and development work in the Lister Hill 

Center and NCBI, NLM has also gained direct 

experience with developing databases of clinically 

significant data, including high resolution images 

and clinical research data.54 

NLM must continue and enhance these efforts in 

response to specific US government priorities and 

feedback from those attempting to implement 

standards in current electronic health records and 

personal health records, regional health information exchanges, clinical research systems, and 

public health applications. 

In addition to facilitating incremental improvements 

in retrospective data, NLM should build on its long 

record of conducting and supporting research, 

development, and policy studies related to electronic health records by promoting work to define 

and develop the next generation of electronic health 

records (EHR). Areas ripe for further investigation 

include: sophisticated handling of images and 

sounds; identification of the key patient data that 

actually affect care and outcomes and the best way 

to store and use it; application of relevant developments in computer science and telecommunications 

to EHR problems; advanced methods for clinical 

and public health data acquisition from 

clinicians, patients, instruments, and manufacturers, 

with the goal of structuring data at the source; representation of genetic information in patient records; 

effective strategies for linking to a variety of ancillary 

knowledge and decision support tools; automated 

transmission of notifiable disease reports to the 

public health system; and generation of useful 

research datasets that protect patient privacy. 

Recommendation 3.3. Promote development 

and use of advanced electronic representations of 

biomedical knowledge in conjunction with electronic health records. 

For more than four decades, NLM has conducted 

and supported groundbreaking research and development related to the representation, interpretation, and use of biomedical knowledge in electronic 

forms. NLM grants funded much of the important 

research on artificial intelligence in medicine, clinical reminder and alert systems, decision rules, 

medical logic modules, and biomedical ontologies. 

NLM’s intramural research and service divisions 

have made leading contributions to defining useful 

structures for controlled vocabularies (e.g., MeSH, 

UMLS Metathesaurus, RxNorm) , medical publications, clinical trials descriptions,55 electronic knowledge bases (e.g., Hepatitis Knowledge Base, 

Hazardous Substances DataBank, Genetic Home 

Reference), high resolution anatomic imaging data 

(the Visible Humans), semantic networks, and 

effective semantic links between disparate information sources (e.g., TOXNET, Entrez). The Lister 

Hill Center has been a major contributor to understanding of natural language and medical images. 

51 National Research Council (US), Committee on Maintaining Privacy and Security in Health Care Applications of the National Information 

Infrastructure. For the record: protecting electronic health information [Internet]. Washington: National Academies Press; 1997 [cited 2006 Oct 24]. 

Available from: http://www.nap.edu/catalog/5595.html 

52 National Research Council (US), Committee on Enhancing the Internet for Health Applications: Technical Requirements and Implementation 

Strategies. Networking health: prescriptions for the Internet [Internet]. Washington: National Academies Press; 2000 [cited 2006 Oct 24]. Available 

from: http://www.nap.edu/books/0309068436/html 

53 Commission on Systemic Interoperability (US). Ending the document game: connecting and transferring your healthcare through information 

technology [Internet]. Washington: US Government Printing Office; 2005 [cited 2006 Oct 24]. Available from: US GPO, Washington, DC; ISBN 0-16-

072711-1. Available from: http://endingthedocumentgame.gov/. System Requirements: Adobe Acrobat. 

54 Ostchega Y, Long LR, Goh GH, Hirsch R, Ma LD, Scott WW Jr, Johnson W, Thoma GR. Establishing the level of digitization for wrist and hand 

radiographs for the third National Health and Nutrition Examination Survey. J Digit Imaging. 1998 Aug;11(3):116-20. 

55 McCray AT, Ide NC. Design and implementation of a national clinical trials registry. J Am Med Inform Assoc [Internet]. 2000 May-Jun [cited 2006 

Oct 24];7(3):313-23. Available from: http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=61435&blobtype=pdf 

44

NLM's Long Range Plan for 2006-2016: Goal 3
In some respects, these remarkable developments 

have been unavailable or under-used in routine 

medical practice. Now recent changes in computer technology, public awareness of the need to 

eliminate gross clinical errors, and emerging public policies seem to mark a new time and a new 

opportunity for NLM and colleagues to bring 

together many of the past technological breakthroughs for the benefit of U.S. health care and 

public health. 

The broad deployment and use of advanced electronic health records will provide expanded opportunities for access to biomedical knowledge and 

advanced decision support for the public, their 

care providers, and the public health workforce. To 

turn this potential into effective reality, NLM should 

continue to promote research and development on 

robust and scaleable approaches to synthesizing, 

representing, updating, and deploying electronic 

knowledge and decision algorithms for use in conjunction with electronic health records. Topics worthy of additional concentrated attention include: 

drug information structured to interact with personal health records, clinical trials results reporting, automated summarization of published 

evidence, representations of knowledge and rules 

that facilitate sharing and reuse, management and 

updating of digital libraries of clinical and public 

health support tools, and methods and timing for 

presenting knowledge and decision support that 

have the greatest probability of being used. 

Research should continue to exploit the information content of biomedical images and to develop 

algorithms for indexing and retrieving biomedical 

images by picture content and semantic meaning. 

Most important will be the incorporation of handy 

new imaging systems within clinical patient care. 

Whenever possible, intramural research should 

partner with allied research groups in other 

NIH Institutes. 

NLM's Long Range Plan for 2006-2016: Goal 3

45
GOAL FOUR
Plan for 2006-2016

Goal 4. A Strong and Diverse 

Workforce for Biomedical 

Informatics Research, 

Systems Development, and 

Innovative Service Delivery

“In health care as much as or more than

in other human endeavors, knowledge is

power, and the redistribution of access

to knowledge will mean an inevitable

redistribution of power over the decisions that affect the delivery of health

care and the makeup of the health care

workforce.” 56 

NLM has funded and shaped biomedical informatics education and training for 30 years. It currently 

supports eighteen university-based multidisciplinary informatics training centers with a total 

of 270 fellows in basic science, clinical medicine, 

public health, and information sciences. 57 Priority 

in selecting fellows is given to physicians and 

other health care professionals. 

NLM’s intramural research divisions also provide 

advanced post-graduate informatics training. 

The Library’s extensive programs to teach biology 

faculty, students, and library-based bioinformatics 

specialists to use molecular biology and genomic 

databases and tools reach more than 7,000 people each year. 58 NLM supports the Woods Hole 

“short course” in Biomedical Informatics. 59, 60 

NLM’s history of providing educational opportunities for librarians is even longer. In addition to the 

opportunities for librarians in its informatics training 

programs, NLM currently supports post-masters 

training of health sciences librarians through the 

NLM Associate Fellowship program, 61 and short 

courses in the use of NLM’s electronic services 

offered through the National Network of Libraries 

of Medicine and via the Internet. The Library provides individual fellowships for those interested 

in developing the combined subject matter and 

information science expertise required to serve as 

an advanced information specialist in a particular 

context, e.g., as a member of a clinical team, 

within a biological sciences department, or within 

a public health context. NLM partners with the 

Medical Library Association, the Association of 

Academic Health Sciences Libraries, the American 

Library Association, and the Association of 

Research Libraries to support educational symposia 

on specific topics, mid-career leadership training 

opportunities for librarians, and scholarships for 

library school students, with an emphasis on 

minority recruitment. 

Over the next ten years a greatly expanded and 

more diverse workforce of clinicians, informaticians and librarians will be needed to develop and 

deploy systems to support basic, clinical, and 

translational research in the genomic era, to 

56 Masys DR. Effects of current and future information technologies on the health care workforce. Health Aff (Millwood). 2002;21(5):33-41. 

57 Grants and funding: extramural programs [Internet]. Bethesda (MD): National Library of Medicine (US), Extramural Programs Division; 2003 Nov 

[updated 2006 Aug 31; cited 2006 Oct 27]. Available from: http://www.nlm.nih.gov/ep/Grants.html 

58 Education [Internet]. Bethesda (MD): National Library of Medicine (US), National Center for Biotechnology Information; [rev. 2006 Oct 3; cited 2006 

Oct 27]. Available from: http://www.ncbi.nlm.nih.gov/Education/index.html 

59 Special topics courses: BioMedical Informatics [Internet]. Woods Hole (MA): Marine Biological Laboratory; c2005 [cited 2006 Oct 27]. Available 

from: http://www.mbl.edu/education/courses/special_topics/med.html 

60 Bridges J, Miller CJ, Kipnis DG, Dee CR, Markwell LG, Bandy M. Librarians in the Woods Hole Biomedical Informatics course. Med Ref Serv Q. 

2006 Spring;25(1):71-81. doi: 10.1300/J115v25n01_07. 

61 Brewer J. Post-Master’s residency programs: enhancing the development of new professionals and minority recruitment in academic and research 

libraries. Coll Res Libr. 1997 Nov;58(5):528-37. 

NLM's Long Range Plan for 2006-2016: Goal 4

47
deliver just-in-time health and emergency 

response information, to link electronic health 

records, decision-support tools, and relevant 

knowledge, and to ensure permanent access to 

digital information.62 

NLM should help to meet this need by continuing 

to adapt its existing educational programs and by 

increasing its focus on K-12 education. Expanding 

the cadre of biomedical librarians and informaticians 

will depend on expanded science literacy in the 

population as a whole, a process that begins with a 

child’s first science and mathematics lessons, and 

on generating enthusiasm for careers in the biomedical information sciences at a much earlier age. 

Recommendation 4.1. Develop an expanded 

and diverse workforce through enhanced visibility 

of biomedical informatics and library science for 

K-12 and college students. 

The 21st century health infrastructure’s requirements for a diverse population of biomedical 

informaticians and biomedical librarians can 

be met only through an aggressive recruitment 

and retention program that targets K-12 and 

college students. 

NLM and its outreach partners have a natural 

opportunity to promote interest in careers in 

biomedicine in general and in librarianship and 

informatics in particular, while increasing awareness and use of health information services among 

K-12 students. There is anecdotal evidence that 

community-based outreach efforts are already 

helping to recruit minority candidates into librarianship. Encouraging young people to pursue careers 

in the sciences is already a stated goal of NLM’s 

exhibitions and its associated K-12 educational 

materials and programs. NLM should develop more 

systematic approaches to integrating recruitment 

with outreach and assess their impact. 

Currently most recruits to NLM-funded postgraduate training programs discover an interest 

in biomedical informatics or health sciences 

librarianship serendipitously. Serendipity must 

give way to the development of programs to 

inform young people about the exciting career 

opportunities that exist in health and biomedical 

informatics and librarianship in the early years of 

college and high school, including the high quality, 

rigorous training programs to which they can 

apply. The nature of these careers and the existence of the training programs may be largely 

unknown to college career development offices. 

Stimulating the recruitment of large numbers 

of underrepresented minorities into biomedical 

informatics remains an unanswered challenge. 

New initiatives are urgently needed, such as the 

formation of a national network for biomedical 

informatics recruitment, with participation sought 

from the NLM-funded graduate training programs. 

This existing training platform offers an exceptional opportunity to create an alliance of graduate 

training programs that could engage in special 

outreach activities to stimulate interest in and 

access to biomedical informatics careers among 

minority undergraduates. Existing national 

meetings that attract minority undergraduates 

in the life sciences are a fertile ground for experimenting with these efforts (e.g., Annual 

Biomedical Research Conference for Minority 

Students and the Society for Advancement of 

Chicanos and Native Americans in Science.) 

NLM Associate Fellows, 2005-2006.

62 Cohen JJ, Steinecke A. Building a diverse physician workforce. JAMA. 2006 Sep 6;296(9):1135-7. doi: 10.1001/jama.296.9.1135. 

48

NLM's Long Range Plan for 2006-2016: Goal 4
Training class at the University of Texas, El Paso, part of the NLM

Environmental Health Information Outreach Program (EnHIOP).

Recommendation 4.2. Support training programs that prepare librarians to meet emerging 

needs for specialized information services. 

As the amount and types of digital data relevant 

to biomedicine and health continue to grow and 

the sources and locations of relevant information 

continue to proliferate, finding, analyzing, and 

making efficient use of the best information for the 

task at hand becomes increasingly difficult. Many 

basic, clinical, and health services researchers are 

struggling to manage and keep track of their own 

electronic datasets, which are often inaccessible 

even to colleagues in the same institution. At the 

same time, nationally available research databases and computational tools are evolving and 

expanding so rapidly that research faculty and 

students are unable to keep up with resources 

that are directly relevant to their work. In health 

care settings, busy clinicians usually need quick 

access to current synthesized information that is 

directly relevant to specific patients - whose particular attributes (e.g., age, medications, other diseases, access to social services) may not match 

those in available guidelines or evidence sources. 

Public health workers often need to interpret 

health and medical information in the context of 

housing, economic, environmental, and other data 

that relate to multiple determinants of health. Their 

most appropriate source of information may be 

undocumented “lessons learned” in public health 

interventions in similar jurisdictions. Patients and 

other members of the public often need personal 

interaction and assistance in identifying and interpreting electronic information relevant to their 

questions. 

In all of these cases, there are opportunities for 

librarians to provide valuable and cost-effective 

services tailored to the needs of specific groups. 

Existing examples of such services include librarybased bioinformatics specialists who teach and 

participate on research teams within biological 

sciences departments,63 clinical informatics specialists or ‘informationists’ who synthesize information for other members of health care teams,64 

patient education specialists, and hospital librarians who serve on emergency response teams. 

NLM should continue to support training opportunities that prepare librarians to provide specialized 

services to meet emerging needs. The Library 

should also continue to support studies that 

explore new roles for librarians and evaluate the 

impact of the specialized services they develop 

and provide. 

Recommendation 4.3. Continue support for 

formal, multidisciplinary education in biomedical 

informatics to increase the supply of informatics 

researchers who can work at the intersections of 

molecular science, clinical research, health care, 

public health, and disaster management. 

The exponential growth in data generated by 

patient-specific genetic sequencing, large scale 

clinical research studies, electronic health records, 

and sensing devices provides new opportunities 

to speed scientific discovery, improve the efficiency of clinical research, enhance patient safety, 

and promote rapid translation of research results 

into improved health care and public health practice. Systems that integrate genomic data with 

63 Geer RC. Broad issues to consider for library involvement in bioinformatics. J Med Libr Assoc [Internet]. 2006 Jul [cited 206 Oct 26];94(3):286-98, 

E152-5. Available from: http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1525323&blobtype=pdf 

64 Giuse NB, Koonce TY, Jerome RN, Cahall M, Sathe NA, Williams A. Related Articles. Evolution of a mature clinical informationist model. J Am Med 

Inform Assoc [Internet]. 2005 May-Jun [cited 2006 Oct 26];12(3):249-55. Epub 2005 Jan 31. doi: 10.1197/jamia.M1726. Available from: http://www. 

pubmedcentral.nih.gov/picrender.fcgi?artid=1090454&blobtype=pdf 

NLM's Long Range Plan for 2006-2016: Goal 4

49
electronic health records to provide patient-specific decision support and to identify populations 

likely to benefit from specific public health measures are now conceivable. 

Turning these opportunities into usable information systems will require an expanding cadre of 

informatics researchers capable of crossing traditional boundaries between basic research, clinical 

research, health service research, health care, 

public health, and disaster management to conceptualize, build, and test informatics innovations 

that support a more integrated approach to all of 

these endeavors. Over the past 20 years, NLM 

has emphasized the importance of multidisciplinary informatics training, encompassing medicine, computer science, library and information 

science, linguistics, and engineering. The Library 

has promoted the expansion of biomedical informatics training and research programs to encompass expertise and problems in the biological 

sciences, health services research, public health, 

consumer health, and disaster management. 

In addition to continuing to strongly encourage 

informatics education and research in all of these 

areas, the Library should promote greater attention by its funded training programs to informatics 

that supports more efficient clinical research 

and more rapid translation from basic science 

to clinical research studies and from clinical 

research to practice. 

Other organizations have supported additional 

slots within NLM-funded informatics training programs. Several NIH institutes and the Department 

of Veterans Affairs have added capacity in this 

way from time to time. 

The Robert Wood Johnson Foundation currently 

supports public health informatics tracks in four of 

the training programs. Given the huge need for 

advanced informatics researchers across the 

spectrum from basic science to health information 

for the public, NLM should continue to look for 

additional opportunities to partner with other 

organizations interested in building the informatics 

research workforce. 

2006 Girls Basketball Champions of Buckland, Alaska, plus NLM visitors.

50

NLM's Long Range Plan for 2006-2016: Goal 4
Figure 2. University Medical Informatics Research Training Programs Supported by NLM

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1. Program in Biomedical Informatics, Harvard-MIT Division of Health Sciences & Technology 

2. Biomedical Informatics Research Training at Yale, Yale University 

3. Medical Informatics Research Training Program at Columbia, Columbia University Health Sciences 

4. Pittsburgh Biomedical Informatics Training Program, University of Pittsburgh at Pittsburgh 

5. Johns Hopkins Health Sciences Informatics Training Program, Johns Hopkins University 

6. Training of Toolmakers for Bio-Medical Informatics, Medical University of South Caro-lina 

7. Vanderbilt Biomedical Informatics Training Program, Vanderbilt University 

8. Regenstrief Informatics Research Fellowships, Indiana University - Purdue University at Indianapolis 

9. Computation and Informatics in Biology and Medicine, University of Wisconsin Madison 

10. Health Informatics Division, University of Minnesota Twin Cities 

11. Biomedical and Health Informatics Research Training, University of Missouri Columbia 

12. Training Program in Computational Biology and Medicine, Rice University 

13. University of Utah Medical Informatics Training. University of Utah 

14. Biomedical Informatics Training Program, University of California Irvine 

15. Training Program for Imaging-Based Medical Informatics, University of California Los Angeles 

16. Graduate Training in Biomedical Informatics, Stanford University 

17. Training Program in Health Informatics, Oregon Health & Science University 

18. Biomedical and Health Informatics Training Program, University of Washington 

NLM's Long Range Plan for 2006-2016: Goal 4

51
Closing

A closing word about priorities: 

In my opinion, the highest priority is construction 

of the third NLM building. Even without this new 

structure, the fastest growing component of NLM’s 

budgets is payment for the space to house its 

people and enhanced infrastructure to support 

growth of computer systems. In addition to the 

square-footage, the three year delay in starting the 

new building since completion of the construction 

plans has masked substantial “delayed maintenance” on the two existing buildings needed to 

comply with current fire and safety regulations. 

Second top priority is maintenance and expansion 

of the NCBI work with NIH institutes on the emerging genome/phenome studies using “whole 

genome analysis”. NCBI databases and systems 

will once again provide essential infrastructure 

for NIH and the biomedical research community 

worldwide. An increasing percentage of NIH 

resources is devoted to generating electronic data 

that increases the workload at NCBI. If this work is 

to continue successfully, a proportionate increase 

in resources is needed by NLM and should be 

included with the base of NLM’s budget allocation. 

Third top priority goes to maintaining and enhancing 

NLM’s prominent information services to the U.S. 

and abroad. Even without imagining brand new 

information services, the expected increase in the 

size and use of the numerous current services will 

undoubtedly need and deserve increased support. 

Fourth. As reflected in special Presidential and 

Departmental initiatives, the country badly needs 

and wants better electronic health records. NLM 

has contributed to this work by funding research, 

by development of the Unified Medical Language 

System, by development of Information Technology 

standards, and by purchasing national usage 

rights to appropriate proprietary standards. We 

expect the need for electronic record systems to 

become more acute in the future. NLM should 

continue to contribute significantly to the solution. 

Fifth. Disaster information management also looms 

large as a national problem. So far NLM - indeed 

medical libraries and librarians in general - have 

not been enlisted in efforts to do better. This is a 

serious mistake. I believe that NLM could assist in 

seeing that medical librarians nationally contribute 

to solution of this problem. We project the need for 

substantial increases in this area. 

Sixth. NLM contributes significantly to education 

and training programs for biomedical informatics 

professionals. We project the need for some 

increases, partly to allow for gradually increasing 

recipient costs, but also to fund a stepped up effort 

to achieve better workforce diversity, especially by 

recruitment of more minority students into the 

pools from which informatics professionals are 

drawn - e.g., medicine, nursing, pharmacy, biological sciences, engineering, computer science, 

library and information science. 

Seventh. NLM’s outreach programs have been 

successful, and gradual increases in funding are 

projected. The work is carefully integrated with 

improvements to community and individual access 

to electronic information, efforts to reduce health 

disparities, and also to recruitment efforts. 

I believe the Plan will provide genuine help and 

guidance to NLM over the next decade. Even 

great public institutions are surprisingly vulnerable 

- even fragile. I thank our Board and Advisers for 

their efforts on behalf of this great institution, the 

country, and for NLM’s future contributions to the 

country. 

My special thanks for good insightful work 

and midnight oil burning to Dr. Elliot Siegel and 

Ms. Susan Buyer. 

Donald A.B. Lindberg, M.D. 

Director 

52

Closing
Appendices

1. Planning Process

At the September 2004 meeting, the Board of 

Regents decided to develop a Long Range Plan 

for 2006-2016. A Subcommittee on Planning was 

appointed, and is co-chaired by the Honorable 

Newt Gingrich and Dr. William Stead; members 

include Dr. Holly Buchanan, Dr. Wallace Conerly, 

Dr. Thomas Detre and Dr. Kenneth Walker. 

In April 2005, a Strategic Visions Working Group 

comprised of outstanding leaders from all sectors 

of NLM’s diverse constituencies65 met to provide 

the broadest view of NLM’s mission, current situation, and its potential future contributions to the 

health and well-being of America in the 21st 

Century. A vision statement identified new scientific, medical, technical, social and economic 

developments that may impact national and 

global needs for research, clinical and patient data 

and information. It formed the basis for the creation of four long range planning panels that met 

twice each during the months of NovemberDecember 2005, and February-March 2006, 

named and chaired as follows: 

• Resources and Infrastructure: Dr. Edward 

Shortliffe and Ms. Gail Yokote 

• Health Information for Underserved 

and Diverse Populations: Dr. Louis 

Sullivan and Ms. Eugenie Prime 

• Support for Clinical and Public Health 

Systems: Dr. Reed Gardner 

• Support for Genomic Science: 

Dr. Daphne Preuss 

Nearly 100 panelists worked to identify the 

forward-looking strategies and infrastructure that 

will enable NLM to maintain its role as a premier 

national library and positive force for change in 

the US and abroad in the 21st Century. The panelists considered, among many relevant issues 

and trends, exciting changes in genomic and 

computer science, scientific publication models, 

and transformational changes in health care delivery, 

electronic health records, and quality and safety 

made possible by new information technology. 

The promise of new research correlating genotype, 

phenotype and environmental data figured prominently in their deliberations, as did the challenges 

posed by a critical lack of space needed to house 

NLM’s programs and collections; the existence of 

health disparities among the underserved; a lack 

of trust in societal institutions, including government; and the mitigation of threats to the public 

health from disasters and epidemics. 

For over six months the NLM planning panels members 

worked diligently to develop the key recommendations 

for the next 10 years.

See appendix 4 

Appendices: 1. Planning Process

53

65
2. Planning Panel Participants

Panel 1: NLM Resources and

Infrastructure for the 21st Century

Co-Chairs:

Dr. Edward Shortliffe 

Rolf H. Scholdager Professor & Chair, Department 

of Biomedical Informatics 

Deputy Vice President for Information Technology 

Columbia University Medical Center 

New York, NY 

Ms. Gail Yokote 

Associate University Librarian for Research 

Services & Collections 

Shields Library 

University of California at Davis 

Davis, CA 

Members:

Dr. Marion Ball 

IBM Fellow, Global Leadership Initiative 

Business Consulting Services, IBM 

Baltimore, MD 

Mr. Charles Carlson 

Director of Life Sciences 

The Exploratorium 

San Francisco, CA 

Dr. Ana Cleveland 

Professor 

School of Library and Information Sciences 

University of North Texas 

Denton, TX 

Ms. Rosalind Dudden 

Health Sciences Librarian 

National Jewish Medical & Research Center 

Denver, CO 

Dr. Nunzia Giuse 

Library Director 

Eskind Biomedical Library 

Vanderbilt University 

Nashville, TN 

Dr. James Gray 

Distinguished Engineer 

Microsoft Bay Area Research Center 

San Francisco, CA 

The Honorable Bruce James 

Public Printer of the U.S. 

U.S. Government Printing Office 

Washington, DC 

Mr. Donald Ward King 

Research Professor & Visiting Scholar 

School of Information & Library Sciences 

University of North Carolina-Chapel Hill 

Chapel Hill, NC 

Dr. Henry Lowe 

Chief Information Officer 

Stanford School of Medicine 

Stanford, CA 

Dr. Alexa McCray 

Lecturer on Medicine 

Harvard Medical School 

Boston, MA 

Dr. Scott Phillips 

Assoc. Clinical Professor of Medicine 

University of Colorado Health Sciences Center 

Lone Tree, CO 

Mr. T. Scott Plutchak 

Director 

Lister Hill Library of the Health Sciences 

University of Alabama at Birmingham 

Birmingham, AL 

Ms. Sarah M. Pritchard 

University Librarian 

Davidson Library 

University of California 

Santa Barbara, CA 

Dr. Barbara Ross-Lee 

Dean 

New York College of Osteopathic Medicine 

Old Westbury, NY 

Ms. Jean Shipman 

Director 

Tompkins-McCaw Library for the Health Sciences 

Virginia Commonwealth University 

Richmond, VA 

54

Appendices: 2. Planning Panel Participants
Ms. Sally Sinn 

Director of Administration 

Council on Library and Information Resources 

Washington, DC 

Mr. Kent Smith 

Consultant 

National Library of Medicine 

Bethesda, MD 

Ms. M.J. Tooey 

Director 

Health Sciences and Human Services Library 

University of Maryland at Baltimore 

Baltimore, MD 

Ms. Linda Watson 

Director of Health Science Libraries 

University of Minnesota, Twin Cities 

Minneapolis, MN 

Writing Assistance:

Ms. Duane Arenales 

Former Chief, NLM Technical Service Division 

Bethesda, MD 

Panel 2: NLM Health Information

for Underserved and Diverse

Populations in the 21st Century

Co-Chairs:

Dr. Louis Sullivan 

Office of the President 

Morehouse School of Medicine 

Atlanta, GA 

Ms. Eugenie Prime 

Director of Corporate Libraries (retired)

Hewlett-Packard

Orlando, FL

Members:

Dr. Jana Bradley 

Professor and Director 

School of Information Resources and Library 

Science, 

University of Arizona 

Tucson, AZ 

Dr. Patricia Flatley Brennan 

Professor, Departments of Biostatistics and 

Medical Informatics, Nursing, and Industrial 

Engineering 

University of Wisconsin-Madison 

Madison, WI 

Dr. Eduardo D. Crespi 

Director & Founder 

Central Latino De Salud Education Y Cultura 

Center 

Columbia, MO 

Dr. Hamish Fraser 

Director of Informatics and Telemedicine 

Partners In Health 

Boston, MA 

Ms. Carla Funk 

Executive Director 

Medical Library Association 

Chicago, IL 

Ms. Ruth Holst 

Associate Director, Greater Midwest Region 

National Network of Libraries of Medicine 

University of Illinois at Chicago 

Chicago, IL 

Ms. Michele Klein-Fedyshin 

Manager of Library Services 

Shadyside Hospital 

Pittsburgh, PA 

Prof. Casimir Kulikowski 

Board of Governors Professor of Computer 

Science 

Rutgers, The State University of New Jersey 

Piscataway, NJ 

Dr. Ted Mala 

Director of Tribal Relations 

South Central Foundation 

Anchorage, AK 

Dr. Elaine Martin 

Director, Lamar Soutter Library 

University of Massachusetts Medical School 

Worcester, MA 

Appendices: 2. Planning Panel Participants

55
Dr. Ruth Parker 

Professor of Medicine 

Emory University, School of Medicine 

Atlanta, GA 

Mr. Wayne Peay 

Director 

Spencer S. Eccles Health Sciences Library 

University of Utah 

Salt Lake City, UT 

Dr. Maxine Rockoff 

Director, Division of Information Management 

New York Academy of Medicine 

New York, NY 

Dr. William Tierney 

Research Scientist 

Regenstrief Institute 

Indianapolis, IN 

Writing Assistance:

Dr. Fred B. Wood 

Office of Health Information Programs 

Development, NLM 

Panel 3: NLM Support for Clinical

and Public Health Systems of the

21st Century

Chair:

Dr. Reed Gardner 

Professor of Medical Informatics (retired)

University of Utah

Salt Lake City, UT

Members:

Ms. Kristine Alpi 

Associate Library Director 

Samuel J. Wood Library 

Weill Medical College 

Cornell University 

New York, NY 

Dr. F. Charles Brunicardi 

DeBakey/Bard Professor and Chairman of the 

Michael E. DeBakey Department of Surgery 

Baylor College of Medicine 

Houston, TX 

Dr. Don E. Detmer 

President and CEO 

American Medical Informatics Association 

Bethesda, MD 

Mr. Stephen Downs 

Robert Wood Johnson Foundation 

Princeton, NJ 

Ms. Jacque Doyle 

Fletcher Library 

Arizona State University at the West Campus 

Phoenix, AZ 

Ms. Judy Faulkner 

Chief Executive Officer 

Epic Systems Corporation 

Madison, WI 

Dr. Henry Foster 

Professor Emeritus of Obstetrics and Gynecology 

Meharry Medical College 

Nashville, TN 

Dr. Henry Fuchs 

Frederico Gil Professor 

University of North Carolina at Chapel Hill, 

Department of Computer Science 

Chapel Hill, NC 

Dr. W. Edward Hammond 

Professor, Division of Medical Informatics 

Professor, Biomedical Engineering 

Durham, NC 

Prof. Casimir Kulikowski 

Board of Governors Professor of Computer 

Science 

Rutgers, The State University of New Jersey 

Piscataway, NJ 

Dr. John Lumpkin 

Senior Vice President for Health Care 

Robert Wood Johnson Foundation 

Princeton, NJ 

Dr. Clement McDonald 

Regenstrief Chair in Health Services 

Indiana University School of Medicine 

Indianapolis, IN 

56

Appendices: 2. Planning Panel Participants
Dr. J. Michael McGinnis 

Senior Scholar 

Institute of Medicine, The National Academies 

Washington, DC 

Dr. Randolph A. Miller 

Donald A.B. and Mary M. Lindberg University 

Professor of Biomedical Informatics, Medicine & 

Nursing 

Vanderbilt University 

Nashville, TN 

Dr. Alan H. Morris 

Director of Research 

Pulmonary Division, LDS Hospital 

Professor of Medicine 

Adjunct Professor of Medical Informatics 

University of Utah 

Salt Lake City, UT 

Dr. Pearl O’Rourke 

Director of Human Research Affairs 

Partners Healthcare Systems 

Boston, MA 

Dr. Herbert Pardes 

President and Chief Executive Officer 

New York Presbyterian Hospital 

New York, NY 

Dr. William O. Robertson 

Medical Director 

Washington Poison Center 

Seattle, WA 

Dr. David Ross 

Director, Public Health Informatics Institute 

Decatur, GA 

Dr. Jay Sanders 

President Emeritus 

American Telemedicine Association 

McLean, VA 

Dr. Richard Satava 

Professor, Department of Surgery 

University of Washington 

Seattle, WA 

Ms. Eileen Stanley 

Director, Library Services 

Allina Health System 

Minneapolis, MN 

Dr. George Stetten 

Department of Bioengineering 

University of Pittsburgh 

The Robotics Institute 

Carnegie Mellon University 

Pittsburgh, PA 

Dr. Cheryl Taylor 

Interim Chair, Graduate Nursing Programs 

REACH for Health Online 

Southern University 

New Orleans, LA 

Dr. Jan van Bemmel 

Professor of Medical Informatics 

Erasmus MC, Department of Medical Informatics 

The Netherlands 

Dr. Norman W. Weissman 

Professor and LR Jordan Endowed Chair in Health 

Services Administration 

University of Alabama at Birmingham 

Birmingham, AL 

Writing Assistance:

Mr. Thomas C. Rindfleisch 

Director Emeritus 

Lane Medical Library 

Stanford University 

Palo Alto, CA 

Panel 4: NLM Support for Genomic

Science in the 21st Century

Chair:

Dr. Daphne Preuss 

Professor of Molecular Genetics and Cell Biology 

HHMI Investigator 

University of Chicago 

Chicago, IL 

Members:

Dr. Russ B. Altman 

Professor of Genetics, Bioengineering and 

Medicine 

Dept. of Genetics 

Stanford University 

Stanford, CA 

Appendices: 2. Planning Panel Participants

57
Dr. Queta Bond 

President 

Burroughs Wellcome Fund 

Research Triangle Park, NC 

Dr. Charles deLisi 

Metcalf Professor of Science and Engineering and 

Dean Emeritus 

College of Engineering 

Boston University 

Brookline, MA 

Dr. Isaac S. Kohane 

Lawerence J. Henderson Associate Professor of 

Pediatrics and Health Sciences and Technology 

Harvard Medical School, Children’s Hospital 

Informatics Program 

Boston, MA 

Dr. Joshua Lederberg 

Raymond and Beverly Sackler Foundation Scholar 

The Rockefeller University 

New York, NY 

Dr. Yves Lussier 

Assistant Professor 

Department of Biomedical Informatics 

Columbia University 

New York, NY 

Dr. Daniel Masys 

Professor and Chair of Biomedical Informatics 

Vanderbilt University 

Nashville, TN 

Dr. Victor A. McKusick 

University Professor of Medical Genetics, Dept. of 

Medicine 

Johns Hopkins University School of Medicine, 

Institute of Genetic Medicine 

Baltimore, MD 

Dr. Perry Miller 

Center for Medical Informatics 

Yale University School of Medicine 

New Haven, CT 

Dr. Joyce Mitchell 

Chair, Department of Medical Informatics 

University of Utah School of Medicine 

Salt Lake City, UT 

Dr. Roberta (Bonnie) Pagon 

Professor of Pediatrics - Principal Investigator, 

GeneTests 

University of Washington 

Seattle, WA 

Dr. Peter Tarczy-Hornoch 

Associate Professor 

Division of Biomedical and Health Informatics 

Department of Medical Education and Biomedical 

Informatics 

University of Washington 

Seattle, WA 

Dr. Michele Tennant 

Bioinformatics Librarian 

University of Florida, Gainesville 

Gainesville, FL 

Ms. Beth Weil 

Head Librarian 

Marian Koshland Bioscience and Natural 

Resources Library 

Berkeley, CA 

Dr. Stephen Wong 

HNCR Center for Bioinformatics 

Harvard Medical School 

Boston, MA 

Writing Assistance:

Dr. Dennis Benson 

National Center for Biotechnology Information, 

NLM 

58

Appendices: 2. Planning Panel Participants
3. NLM Board of Regents

Planning Subcommittee

Co-Chairs:

The Honorable Newt Gingrich 

Chief Executive Officer 

The Gingrich Group 

Dr. William Stead 

Professor of Medicine and Biomedical Informatics 

Director of the Informatics Center 

Associate Vice Chancellor for Health Affairs 

Vanderbilt University 

Members:

Dr. Holly Buchanan 

Associate Vice President of Knowledge 

Management and IT 

Health Sciences Library and Informatics Center 

The University of New Mexico 

Dr. Wallace Conerly Sr. 

Vice Chancellor Emeritus for Health Affairs 

Dean Emeritus, School of Medicine 

University of Mississippi Medical Center 

Dr. Richard H. Dean 

President and CEO 

Wake Forest University Health Sciences 

Dr. Thomas Detre 

Distinguished Service Professor of the Health 

Sciences 

University of Pittsburgh 

Dr. H. Kenneth Walker 

Professor of Medicine 

Emory University School of Medicine 

Appendices: 3. NLM Board of Regents Planning Subcommittee

59
4. Strategic Visions

Working Group Participants

Cosmos Club, Washington, D.C.,

April 11-12, 2005

Participants:

Board of Regents Subcommittee members 

(see appendix 3) 

Dr. Wade M. Aubry 

Senior Advisor 

Health Technology Center (HealthTech) 

Dr. Francis S. Collins 

Director, National Human Genome 

Research Institute 

National Institutes of Health 

Dr. Charles DeLisi 

Metcalf Professor of Science and Engineering and 

Dean Emeritus, College of Engineering 

Biomolecular Systems Laboratory 

Boston University 

Mr. Stephen J. Downs 

Senior Program Officer 

The Robert Wood Johnson Foundation 

Mr. Bob Dufour 

Director of Professional and 

Government Relations 

Wal-Mart Stores Inc. 

Ms. Judith R. Faulkner 

Chief Executive Officer 

Epic Systems Corporation 

Dr. Edward Feigenbaum 

Kumagai Professor Emeritus 

of Computer Science 

Stanford University 

The Honorable Bruce James 

Public Printer of the U.S. 

Dr. Clifford A. Lynch 

Executive Director, Coalition for Networked 

Information 

Dr. Ted Mala 

Director of Tribal Relations and 

Traditional Healing Southcentral Foundation 

Anchorage, AK 

Dr. Daniel R. Masys 

Professor and Chairman 

Department of Biomedical Informatics 

Vanderbilt University Medical Center 

Dr. J. Michael McGinnis 

Senior Scholar 

Institute of Medicine 

The National Academies 

Ms. Mychelle Mowry 

Vice President 

Global Health Industries 

Oracle Corporation 

Dr. Gilbert S. Omenn 

Professor of Internal Medicine, Professor of 

Human Genetics, and Professor of Public Health 

University of Michigan 

Dr. Raj Reddy 

Mozah Bint Nasser University Professor of 

Computer Science and Robotics 

Carnegie Mellon University 

Mr. Gary E. Strong 

University Librarian 

University of California at Los Angeles, 

Dr. Louis W. Sullivan 

President Emeritus 

Morehouse School of Medicine 

Ms. Linda Watson 

Director of Health Science Libraries 

University of Minnesota, Twin Cities 

Minneapolis, MN 

(formerly University of Virginia) 

Observers:

Dr. Michael Cowan 

Senior Vice President for Healthcare Solutions 

Oracle Corporation 

Mr. Vince Haley 

Project Director 

Center for Health Transformation 

60

Appendices: 4. Strategic Visions Working Group Participants
5. Four Planning Panel Reports

Available at http://www.nlm.nih.gov/pubs/plan/lrp06/reports.html 

Report of NLM Planning Panel 1 to the Board of Regents: NLM Resources and Infrastructure for the 21st 

Century, May 2006 

Report of NLM Planning Panel 2 to the Board of Regents: NLM Health Information for Underserved and 

Diverse Populations in the 21st Century, May 2006 

Report of NLM Planning Panel 3 to the Board of Regents: NLM Support for Clinical and Public Health 

Systems of the 21st Century, May 2006 

Report of NLM Planning Panel 4 to the Board of Regents: NLM Support for Genomic Science in the 21st 

Century, May 2006 

Appendices: 5. Four Planning Panel Reports

61

C

Index

A

ACSI (see American Customer Satisfaction Index) 

Africa, 36 

African Americans, 18 

AIDS (see Aquired Immunodeficiency Syndrome) 

Alaska Natives, 13, 35, 39, 50 

America, 10, 18, 35-36, 53 

American College of Physicians Foundation, 38 

American Customer Satisfaction Index, 28 

American Indians (see Indians, North American) 

Animals, 10 

Antigua, 36 

Aquired Immunodeficiency Syndrome, 18, 33-34 

Archives, 15, 19, 27 

Artificial Intelligence, 20, 44 

Association, Library 4, 36-38, 47 

B

Bioinformatics (see Computational Biology) 

Biology, 10, 12, 18, 20-21, 42-43, 47, 51 

Biomedical Information Science and Technology Initiative, 20 

Biomedical Research, 7-8, 10-12, 43-44, 48-50, 52 

Biotechnology, 2, 4, 18, 21, 25, 27-28, 41-42, 47 

BISTI (see Biomedical Information Science and 

Technology Initiative) 

Board of Regents, i-iii, 1, 2, 17, 33-34, 41, 53 

Books, 14, 25-27, 44 

California, 51 

Case-Control Studies, 42 

Catalog, 10, 17, 33, 44 

Cataloging, ii, 17 

CDC (see Centers for Disease Control and Prevention (U.S.)) 

Centers for Disease Control and Prevention (U.S.), 21 

Central America, 36 

Chicanos, 48 

Child, 48 

Chile, 36 

Clinical, 1, 8, 10-12, 19-21, 28, 30, 41-45, 47, 49-50, 53 

Clinical Data, 8, 42 

Clinical Research (see Biomedical Research) 

Clinical Trials, 11, 19, 28, 30, 41, 44-45 

ClinicalTrials.gov, 19-20 

Cognitive, 7, 12, 33, 39 

Cohort Studies, 11 

College (see Universities) 

Communication, 14, 19, 29, 31, 36, 39 

Communities, 11, 17-19, 29, 34-35, 37 

Computational Biology, 20, 47, 49, 51, 52 

Computer Systems, 7, 17, 27-29, 52 

Computers, 13, 17, 20, 29 

Computers, Handheld, 7, 38-39 

Construction, 25, 43 

Continuing Medical Education (CME), 13, 49 

Controlled Vocabularies, 45 

CT, 19 

Curriculum, 37 

D

Databases, 8, 10, 12, 14, 18, 20-21, 27-28, 41-44, 47, 49, 52 

Delivery of Health Care, 47 

Department of Health and Human Services (see United States 

Department of Health and Human Services) 

Developing Countries, 7, 35-36 

Digital Library, 41 

Directories, 29 

Disaster Information Management Research Center, 7, 30-31 

Disaster Planning, 30-31 

Disasters, 7, 13, 29, 31, 36, 38, 52-53 

Division of Library Operations, 17 

Division of Specialized Information Services, 8, 19, 41, 49 

DNA, 13, 31, 42 

DNA Sequence Database, 42 

Drug, 10-11, 19, 45 

E

Education, 8, 12-14, 21, 27, 33, 47-50, 52 

EHR (see Electronic Health Record) 

El Salvador, 36 

Electronic Health Record, 12-13, 21, 41-45, 52-53 

Emergencies, 13-14, 19, 29, 31, 48-49 

Emergency (see Emergencies) 

Ensure, 7, 15, 18, 25-26, 29, 33, 48 

Entrez, 14, 41, 44 

Environment, 8, 10-11, 14, 19, 41-43, 49, 53 

Environmental (see Environment) 

Executable, 12 

Exhibits, 7, 37 

eXtensible Markup Language (see XML) 

Extramural Programs Division, 47 

Index

63
F

FDA (see Food and Drug Administration)

Female, 19

Fogarty International Center (see John E. Fogarty

International Center)

Food and Drug Administration (see United States Food

and Drug Administration)

G

GenBank, 18, 27

Genes and Disease, 42

Genetic Susceptibility, 11

Genetic Variation, 10, 42

Genetics, 26

Genome, 5, 10-11, 13-14, 42, 52

Genome Analysis, 10, 14, 52

Genomic, 4, 10-11, 18, 21, 31, 42-43, 47, 49, 53

Genomics, 42

Genotype, 43

Georgia, 36

Global Health, 14, 35, 37

Governments, 14-15, 38

Grant, 20-21

H

Haplotypes, 10

Hawaii, 35

Health, 2, 3-4, 7-8, 10-15, 18-21, 25-30, 33-39, 41-45, 47-53

Health Care Costs, 12, 33

Health Care Delivery, 53

Health Care Providers, 11, 38

Health Disparities, 1, 7, 18, 21, 33, 35, 52-53

Health Literacy, 1, 7, 21, 33-35

Health Services, 18-21, 30, 43, 49-50

Health Services Research, 21, 43, 50

Healthcare, 12-13, 35-36, 43-44

Healthcare System, 43

Hepatitis Knowledge Base, 44

HHS (see United States Department of Health

and Human Services)

High Performance Computing and Communications, 19, 41

High School, 48

Hispanic, 34

HIV (see Human Immunodeficiency Virus)

HIV/AIDS (see Acquired Immunodeficiency Syndrome or 

Human Immunodeficiency Virus)

Honduras, 36

Hospital Library, 38

Household Products Database, 19

HPCC (see High Performance Computing and Communications)

HTML, iv, 18-21, 28, 33, 37-38, 44, 47

Human Genome Project, 10, 42

Human Immunodeficiency Virus, 18, 34

Humans, 10-11, 20, 29

Hurricane, 19, 29-31

I

IAIMS (see Integrated Advanced Information

Management Systems)

India, 29

Indiana, 19, 51

Indians, North American, 33-35

Infectious Diseases, 36, 42

Informatics, 1, 2, 4, 8, 15, 20-21, 36-38, 43, 47-52

Information Dissemination, 31

Information Management, 7, 19-20, 30-31, 36, 41, 52

Information Retrieval, 28

Information Rx, 38

Information Science, 20, 47, 50

Information Services, ii, 1, 4, 7-8, 18-19, 21, 25, 27, 29, 33,

37-38, 41, 48-49, 52

Information Specialist, 47

Information Systems, ii, 1, 8, 21, 30, 41, 50

Information Technology, 13, 28, 36, 44, 52-53

Institute of Medicine, 4

Integrated Advanced Information Management Systems, 41

Intelligent Agents, 7, 38-39

Interactive Publications, 7, 27-28

Interlibrary Loan, 17

International Committee of Medical Journal Editors, 4, 19

Internet, 12, 17-21, 25, 27-29, 33-39, 41-42, 44, 47, 49

Intramural (see Intramural Programs)

Intramural Programs, 30, 44, 47

Intramural Research, 44, 47

ITK (see National Library of Medicine Insight

Segmentation and Registration Toolkit)

J

John E. Fogarty International Center, 36

Journal, 4, 7, 17, 19, 26, 28-29, 35

K

K-12, 8, 13, 18, 37, 48

Knowledge Bases, 12, 44

Knowledge Management, 2, 12, 20

64

Index
L

Languages, 4, 20 

Latvia, 36 

Leadership, 21, 43, 47 

Learning, 7, 13-14, 25, 28, 36-37, 42 

LHNCBC (see Lister Hill National Center for 

Biomedical Communications) 

Librarians, 3, 7-8, 14, 18, 21, 29-30, 34, 36-38, 47-49, 52 

Libraries, 4, 7, 13-15, 17-18, 21, 25, 27, 29-30, 34-39, 42-43, 

45, 47, 52 

Libraries, Digital, 41 

Libraries, Medical, 4, 14, 17, 25, 34, 36-38, 47, 52 

Library of Congress, 19, 25, 27 

Library Operations (see Division of Library Operations) 

Library School, 47 

Library Science, 8, 48, 52 

Life Sciences, 18, 27, 48 

Lister Hill National Center for Biomedical Communications, 

17, 19, 28, 41, 44 

M

Magazine, 38-39 

Magnetic Resonance Imaging, 13, 19 

Malaria, 36 

Massachusetts, 21 

Medical Informatics, 4, 36-37, 51-52 

Medical Library Assistance Act, 34 

Medical Library Association, 4, 36-38, 47 

Medical Record, 12, 52 

Medical Subject Headings, 44 

Medicine, ii, iv, 2, 4-5, 7, 14, 17-21, 25, 27, 29, 34-38, 41, 

43-44, 47, 50-52 

MEDLARS, 27, 36 

MEDLINE, 17-18, 27, 34, 36 

MedlinePlus, 18, 27, 30, 34, 38 

MeSH (see Medical Subject Headings) 

Methods, 10, 14, 28, 38, 41, 44-45 

Minnesota, 42, 51 

Minority (see Minority Groups) 

Minority Groups, 7, 13, 18, 33-35, 47-48, 52 

Minority recruitment into healthcare, 47, 52 

Mississippi, 29 

MLA (see Medical Library Association) 

MLAA (see Medical Library Assistance Act) 

Molecular Biology, 18, 42-43, 47 

MRI (see Magnetic Resonance Imaging) 

Multimedia, 12, 14, 26, 28 

N

National Academy of Sciences, 44 

National Archives (see United States National Archives and 

Records Administration) 

National Center for Biotechnology Information, 2, 4, 18, 25-28, 

41-44, 47, 52 

National Centers for Biomedical Computing, 20 

National Human Genome Research Institute, 42 

National Information Center on Health Services Research and 

Health Care, 21 

National Institute of Allergy and Infectious Diseases, 36, 42 

National Institutes of Health (U.S.), 4, 11, 18-21, 25, 27, 31 

35-38, 41-45, 47, 49-50, 52 

National Library of Medicine (U.S), 2, 3-5, 7, 10, 13-15, 17-22, 

23, 25-31, 33-39, 41-45, 47-53 

National Library of Medicine Insight Segmentation and 

Registration Toolkit, 20 

National Medical Library, 25 

National Network of Libraries of Medicine, 7, 14, 17-18, 21, 29, 

34-35, 37-38, 47 

National Science Foundation, 4 

Native American (see Alaska Natives, Native Hawaiians, and 

Indians, North American) 

Native Hawaiians, 35 

Natural Disasters, 36 

Natural Language Processing, 20, 28 

NCBI (see National Center for Biotechnology Information) 

New Mexico, 2, 33-34 

Nicaragua, 36 

NIH (see National Institutes of Health (U.S.)) 

NIH Roadmap (see NIH Roadmap for Medical Research) 

NIH Roadmap for Medical Research, 11 

NLM (see National Library of Medicine (U.S)) 

NN/LM (see National Network of Libraries of Medicine) 

NNLM (see National Network of Libraries of Medicine) 

O

Operating Divisions, 4 

Organizations, 4, 14-15, 27, 29, 34-35, 37-39, 44, 50 

Outreach, 2, 7, 18, 21, 31, 33-36, 39, 48-49, 52 

Index

65
P

PAHO (see Pan American Health Organization) 

Pan American Health Organization, 36 

Patient Care, 7, 19, 39, 43, 45 

Patient Education, 33, 49 

Patient Health Records, 12 

Patients, 4, 11-13, 19, 30-31, 33, 38-39, 43-44, 49 

PDAs (see Computers, Handheld) 

Personal Computers, 17 

Personal Knowledge Bases, 12 

Phenotype, 53 

Physicians, 3, 18, 34, 38, 47 

Physiology, 12 

Polymorphism, Single Nucleotide, 10 

Population, 5, 10, 13, 33, 35, 48 

Poverty, 14 

Preservation, 7, 15, 17, 26-28 

Privacy, 38, 41, 43-44 

PSA (see Public Service Announcements) 

PubChem, 18, 42 

Public Access, 18, 27, 39, 41 

Public Health, 3, 7-8, 10-12, 14, 19, 21, 34-36, 41-45, 47, 

49-50, 53 

Public Service Announcements, 38 

Publishing, 14 

PubMed, 17-20, 27-28 

PubMed Central, 18-19, 27-28 

R

Recommendation, 7-8, 25-30, 34-35, 37-39, 42-44, 48-49 

Records, 8, 11-12, 15, 20, 41-45, 48-50, 52 

Regional Medical Libraries, 29, 34, 37 

Research, ii, 1, 4, 7-8, 10-14, 18-21, 26-31, 33, 35-36, 38-39, 

41-45, 47-53 

Research Support, ii, 43 

Researchers, 8, 10-11, 18, 28-29, 34, 36, 39, 42, 49-50 

RML (see Regional Medical Libraries) 

Robert Wood Johnson Foundation, 50 

S

San Francisco, 54 

Science, 3-4, 8, 10-11, 19-20, 25-26, 31, 33, 37, 39, 44, 

47-51, 53 

Semantic, 20, 44-45 

SNPs (see Polymorphism, Single Nucleotide) 

Software, 14, 18, 28, 31, 42 

Space, 4, 7, 25-26, 29, 41, 53 

Specialized Information (see Division of Specialized 

Information Services) 

Specialized Information Services (see Division of Specialized 

Information Services) 

Students, 8, 21, 29, 47-49 

Survey, 27, 44 

T

Teaching, 13 

Technology, 13, 15, 20-21, 26, 28-29, 36, 39, 44-45, 51-53 

Telecommunications, 4, 10, 13, 17, 20, 34, 38, 41, 44 

Telemedicine, 12, 19 

Terminology, 20 

Texas, 34, 49 

Toxicology Data Network, 41, 44 

TOXMAP, 19 

TOXNET (see Toxicology Data Network) 

Triage, 19, 31 

Trust, 5, 7, 39, 53 

U

U.S. (see United States) 

UMLS (see Unified Medical Language System) 

Understanding, 3-4, 11-12, 14, 28, 33, 42, 44 

Unified Medical Language System, 20, 41, 43-44, 52 

United States, 3-5, 7, 12-13, 17-21, 26-27, 29, 33-38, 41-42, 

44-45, 47, 52-53 

United States Department of Health and Human Services, 

20, 29, 31 

United States Food and Drug Administration, 19 

United States National Archives and Records Administration, 27 

Universities, 8, 15, 17, 34, 37-38, 48 

University of Washington, 51 

US (see United States) 

Utah, 51 

V

Visible Human Project, 12, 19 

Vocabulary, 20 

W

Washington, 10, 33, 44, 51 

Wisconsin, 51 

WISER, 19, 31, 38 

Woods Hole, 21, 37, 47 

World Wide Web, 21, 41 

X

XML, 27 

66

Index

U.S. Department of Health and Human Services 

Public Health Service 

National Institutes of Health 

National Library of Medicine 

NIH Publication No.: 07-4890