the future of medical libraries

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P E R S P E C T I V E

The past 20 years have witnessed computer andcommunications revolutions, rapid progress in ge-netics research, increasing public interest in person-al health decisions, and corresponding expansionsin the services provided by the National Library ofMedicine. These concomitant and linked develop-ments have upset the infor-mation marketplace and in-spired policy debates abouttelecommunications, intel-lectual property, and accessto the results of government-funded research. The Inter-net and the World Wide Webhave transformed the waylibraries deliver informationservices and have createdperceived alternatives to li-braries. What will happen tomedical libraries in the post-Google world?

Today, most medical li-braries exist within hospitals or academic institu-tions. Their primary purpose is to provide scholar-ly information to support health care, education,and the research conducted at these institutions.Given that scholars and researchers continue torely on information, the work now performed bymedical libraries will not disappear. But how,where, and by whom will it be done? Here is oneevolutionary scenario for the medical libraries of2015. Everything we envision exists in some formtoday.

In our 2015, health care professionals, patients,educators, students, researchers, and administra-tors expect easy access to electronic informationfrom their homes, offices, wards, clinics, and librar-ies, not to mention while they are en route betweenthese places. People use a constantly changing ar-ray of desktop, portable, and wearable computingand telecommunications devices. Most desktop ma-

chines and many portable devices support easy tele-conferencing and distance education. Everyonecraves access to more electronic information, nomatter how much is available, but people treasureefficient methods for extracting pertinent informa-tion from the fire-hose effect of undifferentiated

electronic text (and unwantedcommercial offers). Most cli-nicians, patients, and healthypeople use electronic healthrecords. Like basic research-ers, clinical researchers de-pend on electronic data sys-tems. When using suchsystems, practitioners and re-searchers expect instant con-nection to related knowledge,including guidelines, proto-cols, clinical alerts, and rele-vant published dicta. Patientsand families demand thesame information that is

available to physicians, nurses, and public healthdepartments.

Despite ubiquitous access to electronic infor-mation, however, the “library as place” is still highlyvalued and heavily used (unless the facility is phys-ically decrepit, outmoded, or inconveniently locat-ed). Users flock to library buildings and spaces thatare attractive, centrally located, technologically cur-rent, and arranged to meet the needs of groups aswell as of solitary users.

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In addition to serving cof-fee, the best facilities support small-group study andlarger-group training, provide well-wired space forinterdisciplinary collaboration involving complexelectronic data sets, and welcome those seekingtemporary work space, individual assistance, or qui-et places away from wards or waiting rooms. Withno printed

Index Medicus

and fewer physical volumes,there is more space for people.

Our future library’s “virtual” collection — theset of electronic information it makes available —is much vaster than the physical collection ownedand housed in library space. By 2015, many publi-cations are issued only in electronic form, thou-

2015 — The Future of Medical LibrariesDonald A.B. Lindberg, M.D., and Betsy L. Humphreys, M.L.S.

Dr. Lindberg is the director and Ms. Humphreys is thedeputy director of the National Library of Medicine, Na-tional Institutes of Health, Bethesda, Md.

2015 — The Future of Medical Libraries

The New England Journal of Medicine Downloaded from nejm.org on October 25, 2011. For personal use only. No other uses without permission.

Copyright © 2005 Massachusetts Medical Society. All rights reserved.

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sands of back runs of journals have now been digi-tized, and electronic copies of books, manuscripts,and images abound. Many libraries store and man-age access to electronic scientific and health-relateddata. The flood of patient-specific data generated bylarge-scale, prospective, normal-cohort studies pre-sents special problems. Preservation of unique elec-tronic content requires a serious commitment andsubstantial funding.

In this future, journals are still an important ve-hicle for disseminating peer-reviewed research re-sults, but many individual articles have electroniclives of their own. Much scientific information isavailable free over the Internet — thanks in part toearlier efforts to make information about clinicaltrials

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and government-funded research

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availableto the public — though many sources of electronicinformation require paid licenses. Greater relianceon electronic-publication standards and a mix ofpayment and publication models keep annual priceincreases relatively low.

Multimedia “digital libraries” feature rich inter-connections among genetics research data, aggre-gated clinical and public health data, published liter-ature, and high-quality health information in manylanguages. It is easy to navigate among the differentlevels of explanation that are useful to patients, clini-cians, and researchers. Tutorials and current healthnews include links to information about relevantlocal health services and open clinical trials. De-scriptions of clinical trials, in turn, link to summa-rized results and relevant scientific papers. Digitallibraries derive much of their value from the selec-tion, organization, analysis, and linking performedby highly skilled human beings aided by increas-ingly advanced software systems — in other words,digital libraries still need librarians.

National use of standards-based electronichealth records provides enhanced opportunities todeliver customized information when and where itis needed. There are many “smart” programs thatmatch relevant published knowledge to the diag-noses and circumstances of individual patients, asthese are represented in their electronic records.Simple mechanisms, such as preformed expertsearch queries, still suffice in some contexts. The useof electronic health records also facilitates remoteconsultations with information specialists. For ex-ample, a physician can include a pointer to the pa-

tient’s electronic record when sending a request forsynthesized evidence to a clinical librarian (who isbound by the same privacy requirements as the restof the health care team). This pointer allows the li-brarian to tailor summarized evidence to the spe-cific patient. Similar approaches are used to request,document, and deliver educational materials to pa-tients.

Unfortunately, the true integration of multimediainformation is still neither simple nor cheap. Tech-nology that supports ready, online access to fulltext, pictures, sound, and video continues to evolvequickly. Technology companies derive more incomefrom selling services than from selling hardware.Decisions about telecommunications consortia(grandsons of Internet2) and the expensive “lastmile” of electronic infrastructure (granddaughter ofWi-Fi) to homes, hospital wards, classrooms, andlibrary spaces must be revisited periodically. Ensur-ing uninterrupted access during natural or man-made disasters is a daunting challenge. Changinguser environments, information products, and li-censing provisions are the norm. In 2015, a librarycontinues to be the logical entity to manage thiscomplexity on behalf of the institution, to make de-cisions about inevitable and substantial expendi-tures, to adapt information services to new realities,and to provide essential user training and support.

Just as access to electronic information is morepervasive, so in 2015 more librarians and informa-tion specialists are deployed “in context” outside thelibrary to improve quality, to reduce the risks asso-ciated with inefficient or incomplete retrieval of theavailable evidence, and to do community outreach.Many librarians have advanced training in both sub-ject-matter disciplines and information science. It iscommon to find librarians working as part of healthcare teams, writing grant proposals, serving on in-stitutional review boards, working as bioinformat-ics database specialists within science departments,serving as faculty members in evidence-based med-icine courses, and being involved in multilingualhealth-literacy programs and community partner-ships.

Of course, ours is just one vision of medical li-braries in 2015. The history of libraries, computing,and telecommunications is filled with notoriouslybad predictions. In one famous example from 1977,Ken Olson, president and founder of Digital Equip-




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ment Corporation, proclaimed that “there is no rea-son for any individual to have a computer in hishome.” Perhaps some of our predictions will beequally off the mark. Be that as it may, today’s med-ical libraries have unprecedented opportunities tocontribute to better quality and efficiency in healthcare, education, and research. Those who supportand lead medical libraries should seize these op-portunities. The future is in their hands.

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Shill HB, Tonner S. Does the building still matter? Usage pat-terns in new, expanded, and renovated libraries, 1995–2002. Col-lege & Research Libraries News. Vol. 65. No. 2. March 2004:123-50. (Chicago: Association of College & Research Libraries.)

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De Angelis C, Drazen JM, Frizelle FA, et al. Clinical trial reg-istration: a statement from the International Committee of Med-ical Journal Editors. N Engl J Med 2004;351:1250-1.

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Enhanced public access to NIH research information. Be-thesda, Md.: National Institutes of Health, 2004. (Accessed Feb-ruary 24, 2005, at http://grants.nih.gov/grants/guide/notice-files/NOT-OD-04-064.html.)




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