Providing health information for patients, families and the public.

When Dr. Lindberg was sworn in as Director, the National Library of Medicine (NLM) was providing few resources with information useful to the public, having concentrated efforts towards health professionals and scientists. With his arrival, and that of the Internet in the 1990s, NLM embarked on a research and user-focused path towards providing authoritative health information for patients, families and the public. MedlinePlus, NIHSeniorHealth, and MedlinePlus en espanol delivered health information in a variety of formats using text, still images, audio and video. These resources were supported by NLM advisors and Dr. Lindberg's strong belief that patients and families needed easy access to medical information to be able to effectively care for themselves in illness and maintain the best health possible throughout their lives.

Providing Health Information for Patients, Families and the Public.

When Dr. Lindberg was sworn in as Director, the National Library of Medicine (NLM) was providing few resources with information useful to the public, having concentrated efforts towards health professionals and scientists. With his arrival, and that of the Internet in the 1990s, NLM embarked on a research and user-focused path towards providing authoritative health information for patients, families and the public. MedlinePlus, NIHSeniorHealth, and MedlinePlus en espanol delivered health information in a variety of formats using text, still images, audio and video. These resources were supported by NLM advisors and Dr. Lindberg's strong belief that patients and families needed easy access to medical information to be able to effectively care for themselves in illness and maintain the best health possible throughout their lives.

Interlibrary loan in US and Canadian health sciences libraries 2005: update on journal article use.

PURPOSE: The authors analyzed 2.48 million interlibrary loan (ILL) requests entered in the National Library of Medicine's (NLM's) DOCLINE system from 3,234 US and Canadian medical libraries during fiscal year (FY) 2005 to study their distribution and nature and the journals in which requested articles were published. METHODS: Data from DOCLINE and NLM's indexing system and online catalog were used to analyze all DOCLINE ILL transactions acted on from October 2004 to September 2005. The authors compared results from this analysis to previous data collected in FY 1992. RESULTS: Overall ILL volume in the United States and Canada is at about the same level as FY 1992 despite marked growth in online searching, knowledge discovery tools, and journals available online. Over 21,000 unique journal titles and 1.4 million unique articles were used to fill 2.2 million ILL requests in FY 2005. Over 1 million of the articles were requested only once by any network library. Fifty-two percent (11,022) of journals had 5 or fewer requests for articles from all the years of a journal by all libraries in the network. Fifty-two percent of the articles requested were published within the most recent 5 years. CONCLUSION: The overall ILL profile in the libraries studied has changed little since FY 1992, notable given other changes in publishing. Small changes, however, may reveal developing trends. Total ILL traffic has been declining in recent years following a peak in 2002, and fewer of the articles requested were published in the most recent five years compared to requests from 1992.

Use of Internet audience measurement data to gauge market share for online health information services.

BACKGROUND: The transition to a largely Internet and Web-based environment for dissemination of health information has changed the health information landscape and the framework for evaluation of such activities. A multidimensional evaluative approach is needed. OBJECTIVE: This paper discusses one important dimension of Web evaluation-usage data. In particular, we discuss the collection and analysis of external data on website usage in order to develop a better understanding of the health information (and related US government information) market space, and to estimate the market share or relative levels of usage for National Library of Medicine (NLM) and National Institutes of Health (NIH) websites compared to other health information providers. METHODS: The primary method presented is Internet audience measurement based on Web usage by external panels of users and assembled by private vendors-in this case, comScore. A secondary method discussed is Web usage based on Web log software data. The principle metrics for both methods are unique visitors and total pages downloaded per month. RESULTS: NLM websites (primarily MedlinePlus and PubMed) account for 55% to 80% of total NIH website usage depending on the metric used. In turn, NIH.gov top-level domain usage (inclusive of NLM) ranks second only behind WebMD in the US domestic home health information market and ranks first on a global basis. NIH.gov consistently ranks among the top three or four US government top-level domains based on global Web usage. On a site-specific basis, the top health information websites in terms of global usage appear to be WebMD, MSN Health, PubMed, Yahoo! Health, AOL Health, and MedlinePlus. Based on MedlinePlus Web log data and external Internet audience measurement data, the three most heavily used cancer-centric websites appear to be www.cancer.gov (National Cancer Institute), www.cancer.org (American Cancer Society), and www.breastcancer.org (non-profit organization). CONCLUSIONS: Internet audience measurement has proven useful to NLM, with significant advantages compared to sole reliance on usage data from Web log software. Internet audience data has helped NLM better understand the relative usage of NLM and NIH websites in the intersection of the health information and US government information market sectors, which is the primary market intersector for NLM and NIH. However important, Web usage is only one dimension of a complete Web evaluation framework, and other primary research methods, such as online user surveys, usability tests, and focus groups, are also important for comprehensive evaluation that includes qualitative elements, such as user satisfaction and user friendliness, as well as quantitative indicators of website usage.

Positive attitudes and failed queries: an exploration of the conundrums of consumer health information retrieval.

Several studies have found that consumers report a high level of satisfaction with the Internet as a health information resource. Belied by this positive attitude, however, are other studies reporting that consumers were often unsuccessful in searching for health information. In this paper, we present an interview and observation study in which we asked health consumers to search for health information on the Internet after first stating their search goals. Upon the conclusion of the session they were asked to evaluate their searches. We found that many consumers were unable to find satisfactory information when performing a specific query, while in general the group viewed health information retrieval (HIR) on the Internet in a positive light. We analyzed the observed search sessions to determine what factors accounted for the failure of specific searches and positive attitudes, and also discussed potential informatics solutions.

A frequency-based technique to improve the spelling suggestion rank in medical queries.

OBJECTIVE: There is an abundance of health-related information online, and millions of consumers search for such information. Spell checking is of crucial importance in returning pertinent results, so the authors propose a technique for increasing the effectiveness of spell-checking tools used for health-related information retrieval. DESIGN: A sample of incorrectly spelled medical terms was submitted to two different spell-checking tools, and the resulting suggestions, derived under two different dictionary configurations, were re-sorted according to how frequently each term appeared in log data from a medical search engine. MEASUREMENTS: Univariable analysis was carried out to assess the effect of each factor (spell-checking tool, dictionary type, re-sort, or no re-sort) on the probability of success. The factors that were statistically significant in the univariable analysis were then used in multivariable analysis to evaluate the independent effect of each of the factors. RESULTS: The re-sorted suggestions proved to be significantly more accurate than the original list returned by the spell-checking tool. The odds of finding the correct suggestion in the number one rank were increased by 63% after re-sorting using the authors' method. This effect was independent of both the dictionary and the spell-checking tools that were used. CONCLUSION: Using knowledge about the frequency of a given word's occurrence in the medical domain can significantly improve spelling correction for medical queries.

The US National Library of Medicine in the 21st century: expanding collections, nontraditional formats, new audiences.

From the early 1960s, the US National Library of Medicine (NLM) has been a leader in applying computer technology to accomplish traditional bibliographic and reference functions. medline, in the early 1970s, was the first large-scale online medical bibliographic reference system. That role has been altered by today's Web environment, which has increased the number and extent of NLM services and the audience for them. The NLM has formally declared that it will seek to serve the general public after over a century of serving the library and medical communities exclusively. In the last several years, many new services have been introduced to fulfil this mandate, including medlineplus and ClinicalTrials.gov. Also a part of the NLM's vision for the 21st century is the need to ensure that the proliferating forms of electronic health information-bibliographic, full text, graphic, audiovisual-are captured and preserved for posterity. A national library such as the NLM has as much an archival responsibility for this electronic information as for centuries-old printed and manuscript historical treasures.