Republican Scientific-Medical Library, The Republic of Armenia: progress and programs.

In 1990, the Republican Scientific-Medical Library (RSML) of the Ministry of Health of Armenia in collaboration with the Fund for Armenian Relief created a vision of a national library network supported by information technology. This vision incorporated four goals: (1) to develop a national resource collection of biomedical literature accessible to all health professionals, (2) to develop a national network for access to bibliographic information, (3) to develop a systematic mechanism for sharing resources, and (4) to develop a national network of health sciences libraries. During the last decade, the RSML has achieved significant progress toward all four goals and has realized its vision of becoming a fully functional national library. The RSML now provides access to the literature of the health sciences including access to the Armenian medical literature, provides education and training to health professionals and health sciences librarians, and manages a national network of libraries of the major health care institutions in Armenia. The RSML is now able to provide rapid access to the biomedical literature and train health professionals and health sciences librarians in Armenia in information system use. This paper describes the evolution of the RSML and how it was accomplished.

"Patient informatics": creating new partnerships in medical decision making.

The amassing of health information on the Internet and World Wide Web continues unabated. Patients anxious to participate in decisions about their own treatment have turned to the Internet to confirm diagnoses, validate physician-recommended treatment, or seek alternative therapies. While increased information for patients has been linked to improved outcomes, there are inherent dangers associated with the kind of unauthenticated information available on the Web. The authors discuss the nature of these dangers as well as review the advantages for patients of "information therapy" (improved access to health information). They also examine how the Internet has begun to affect the physician-patient relationship, and describe how the Internet and information technology can be effectively used by physicians in patient care. They recommend that the academic health sciences community seize the opportunity to take the lead in ensuring that patients have access to reliable health information, and suggest that "patient informatics" be integrated by academic physicians and educators into the teaching of clinical skills.

A medical librarian's progress.

The author describes how four medical librarians influenced his career and his values. Louise Darling, Brad Rogers, Estelle Brodman, and Bernice Hetzner became a professional extended family, each one contributing to different aspects of his career path, socialization to the profession, priorities, and principles of management. The lessons they imparted directly and by example are followed through the development of the author's career. Although the norms of the profession are different today, there remains a place for mentors.

On the origin of a species: evolution of health sciences librarianship.

The basic role of the health sciences librarian has not significantly changed throughout history. It has been- and remains-to collect information and organize it for effective use. What has changed is the environment in which this role is carried out and the tools used to accomplish the tasks. Over the one hundred-year history of the evolution of health sciences librarianship, we have used specialty education as the mechanism for differentiating ourselves from other types of librarianship and for acquiring the knowledge and skills to succeed in our profession. Changing conditions require a continual review of our specialty education and a willingness to modify it in order to prepare ourselves for changing environments. A review of specialty education for health sciences librarianship reveals that we have always adapted to new and changing conditions and will continue to do so in the future.

Managing information in the academic medical center: building an integrated information environment.

The strategic importance of integrated information systems and resources for academic medical centers should not be underestimated. Ten years ago, the National Library of Medicine in collaboration with the Association of Academic Medical Centers initiated the Integrated Advanced Information Management System (IAIMS) program to assist academic medical centers in defining a process for addressing deficiencies in their information environments. The authors give a brief history of the IAIMS program, and they describe both the characteristics of an integrated information environment and the technical and organizational structures necessary to create such an environment. Strategies some institutions have used to implement integrated information systems are also outlined. Finally, the authors discuss the role of librarians in integrated information system design.

From strategic planning to TQM: a complete management approach.

Organizations can no longer rely on a single management solution as they respond to a complex world. Biomedical communications managers need to employ a variety of management tools as they cope with a rapidly changing landscape and an increasing set of business pressures. This article describes two management strategies, strategic planning and total quality management, which can be used to achieve success in the 21st century.

Educating physicians to use the digital library.

Skill in creating, finding, managing, and using biomedical information is a vital component of modern medical practice. Medical schools recognize the revolutionary implications of computing technology and use a number of different strategies to integrate "informatics education" into their curricula. In many institutions, leadership for this effort rests with the health sciences library and/or the department of medical informatics. Examples are presented of how nine medical schools have implemented informatics education; no single informatics-education strategy prevails, and these schools' strategies do not exhaust the possibilities. Informatics education programs will require better planning and integration in the future because of the need to keep pace with curriculum reform, the changing context of medical practice, and the speed of technological innovation.

The organization of the digital library.

As digital information proliferates and the difficulties of managing it threaten to overwhelm traditional publication and information delivery processes, new visions of a digital library are forming. Exactly what a digital library is and how it is to be organized have not yet been determined, and bibliographic organization of digital information has not been sufficiently addressed. Bibliography is the systematic description or classification of writings or publications considered as material objects. In today's digital world, such material objects may no longer be relevant, but the need for systematic description remains. The important issue is not whether digital bibliography is needed but, instead, whether or not existing bibliographic techniques are appropriate for this new media. A second issue is the location of the responsibility for a new digital bibliography. Does it rest with medical informaticians, often the producers of this new digital information, or with librarians, traditionally the classifiers of information? Developments in both medical informatics and medical librarianship indicate a need for greater collaboration between these specialties in order to achieve their common purpose--the creation, classification, and dissemination of scholarly information.

Informatics and medical libraries: changing needs and changing roles.

Medical librarians play a crucial role in the evolution of institutional information policy. As information professionals, they share many similarities with their medical informatics counterparts. Both groups emphasize information delivery to the point of decision making; both groups serve as curators of institutional knowledge bases. If the term "publication" encompasses the delivery of clinical information relevant to individuals or populations, both librarians and medical informaticians have an immediate interest in the nature of biomedical publishing, particularly in areas of intellectual ownership, confidentiality, distribution, and access. Both groups also have been early leaders in applying information technology to solve pressing knowledge-management problems, and both groups have a strong commitment to educating colleagues in the effective use of information. Although the challenges faced by librarians and medical informaticians are sometimes different, the evolution of information technology and new forms of biomedical communication suggest that there is now a greater convergence between the two disciplines.

Impact of information technology on the role of health sciences librarians.

Information technology is transforming the nature of health sciences information and its management, thereby altering the traditional responsibilities of health sciences librarians. As a result, the traditional educational preparation for librarianship is no longer entirely relevant, and there is a real possibility that information management will be taken over by individuals with different educational backgrounds and skills. This paper explores four topics relevant to this issue: the emergence of new forms of health sciences information, the impact of technology on the practice of health sciences librarianship, the interaction of technology and the practice of health sciences librarianship, and the relationship among these three topics and the educational preparation of health sciences librarians.

A descriptive analysis of National Library of Medicine-funded medical informatics training programs and the career choices of their graduates.

The initial 13 National Library of Medicine-supported medical informatics training programs and their graduates were studied to determine the program objectives, trainee selection factors, and curriculum components of the programs and the backgrounds and career choices of the trainees. All 13 programs and over 60% of the available population of trainees were studied. The analysis indicated that 1) the major objective was to train individuals in the applications of computer and information science to medicine: 2) the most frequent selection factor was the MD degree; 3) course work in computer science and a research project were the most common curriculum components; 4) 52% of the graduates selected academic careers; and 5) personal reasons most frequently influenced career choices. There is now a baseline of data that can be used in future studies.

Variables influencing career choices of graduates of informatics programs funded by the National Library of Medicine.

Graduates of the National Library of Medicine-supported Medical Informatics (MI) training programs were studied to determine the variables influencing their choices of an academic or nonacademic career. More than 60% of the available population of trainees (171 of 272) were studied in 1986 and four of the nine variables measured by means of a questionnaire were significant in differentiating the choices the students made. The training programs located in a private institution, with the majority of the faculty from the medical school and with a small number of trainees who already had the M.D. or Ph.D. degree, generated the highest proportion of graduates seeking academic careers. Discriminant analysis was done to determine whether a combination of variables would discriminate between those who chose academic careers and those who did not. It indicated that the status of the institution (public or private); the entry degree of the trainee; and the productivity of the training program faculty were sufficient to correctly classify 75.3% (67 of 89) of the students who chose academics and 71.9% (59 of 82) of those who did not. There is now a baseline of data that can be used in future studies.