When Good Enough—Isn’t

On the importance of librarians in the age of Google

“Why do we need librarians when we have Google?”

“What is the role of a librarian now that we can google anything?”

How often have you heard that?

Let’s face it: We have all become enticed by the immediacy of the answers that search engines provide, and we’ve come to accept the good-enough answer—even when good enough isn’t.

When I ask a librarian for help, I am tapping not only into his or her expertise, but also into that of countless others behind the scenes.

From the staff who purposefully and thoughtfully develop the collection—guided by a collection development manual other librarians have carefully crafted and considered—to the team of catalogers and indexers who assign metadata to the items we acquire, to the technical staff who design the systems that make automated search possible, we’ve got a small army of librarians supporting my personal act of discovery…and yours.

Put another way, the public services librarian is just the tip of the spear, the point of contact, between me and the phalanx of librarians and library resources behind her.

And like the tip of a spear, the librarian is sharp, targeted, and precise—a stark contrast to the smothering deluge a web search commonly delivers. The reference interview alone, when done well, is a master stroke no search engine can replicate as it refines and clarifies the perfect item for my needs.

Blending my input with her own knowledge of how medical information is described and organized, the librarian lays out a carefully structured query, one that marries logic with skill and experience to yield an answer I can trust, whether that’s a specific answer to a question or the oftentimes equally valuable “no results found.”

So why don’t more people consult librarians?

Simplicity is one reason. In the smart-phone/search-engine age, we don’t often need help with factual, direct questions like “When did Marshall Nirenberg win the Nobel Prize?” (Answer: 1968) or “How many chromosomes do humans have?” (Answer: 23 pairs, for a total of 46).

Immediacy also drives the DIY researcher. Many would rather take what they can get right now than wait the couple of hours or couple of days a librarian might need to perform thoughtful and thorough research.

Then there’s the psychological or emotional toll of bringing someone into our research. We have to admit we don’t know something, and we have to find the words to communicate what we need. In that way, working with a librarian is not an energy-free exchange.

Of course, neither is sifting through pages and pages of imprecise results. But that, at least, we can do in our own time and at our own pace, convincing ourselves that we can find the kernels of wheat in the mountain of chaff.

But can we?

When the outcome really matters—when you’re seeking treatment options, developing a research protocol, analyzing genetic mutations—how confident are you in your ability to find the answers you need?

Let me offer a challenge: The next time you have a substantive question, ask a librarian and then report back here about how it went.

I’ll bet your results will be better than good enough.

Photo credit (Test of Strength, top): Steve Snodgrass [Flickr (CC BY 2.0) | cropped, added puck]

Mining for Treasure, Discovering MEDLINE

Reusing a noteworthy dataset to great result

Guest post by Joyce Backus and Kathel Dunn, both from NLM’s Division of Library Operations.

As shrinking budgets tighten belts at hospitals and academic institutions, medical libraries have come under scrutiny. In response, librarians have had to articulate the value they bring to the institution and to the customers—students, researchers, clinicians, or patients—they serve.

In 2011-2012, as such scrutiny swelled, Joanne Marshall and her team set out to study the very question these medical institutions faced: Do libraries add value? They collected 16,122 individual responses from health professionals at 118 hospitals served by 56 health libraries in the United States and Canada. The team sought to determine whether physicians, residents, and nurses perceived their libraries’ information resources as valuable and whether the information obtained impacted patient care.

The resulting article, “The Value of Library and Information Services in Patient Care,” published in 2013, gave medical librarians strong talking points, including the overall perceived value of libraries as time-savers that positively impact patient care.

Now the datasets from that study are being reused to great result.

Over the last year we teamed up with Joanne Marshall and Amber Wells, both from the University of North Carolina-Chapel Hill, to dive into the data.

Our goal: to understand the value and impact of MEDLINE in medical libraries.

We re-discovered (as has been written about before) the value of MEDLINE in changing patient care. We also found its preeminent role shines even more brightly in a dataset like this one that includes other sources. We saw the significance of MEDLINE as a single source of information but also as a source used in combination with full-text journals, books, drug databases, websites, and colleague consultations.

We were reminded, too, of the importance of the National Network of Libraries of Medicine (NNLM) to our work; the trust in the NNLM; each library’s connectedness to the other; and how the everyday web of relationships prompts cooperation and collaboration, including the successful implementation of the value of libraries study itself.

For us this re-discovery comes at a key time, when we’re examining NLM products and services as part of the strategic planning process. We are actively identifying methodologies and tools to elevate all our collections—from datasets to incunabula—and make them greater engines of discovery in service of health.

But what about your library’s resources?

The data mining challenge we gave ourselves is our guide for medical librarians everywhere: look at your data, what’s in front of you, and then others’ data. What can they tell you about what’s happening now, what will likely happen in the future, what’s being used, and how it’s being used?

If you don’t know where to start, check out the Medical Library Association’s Research Training Institute, recommended research skills, and mentoring program. In addition, the NNLM’s site on program evaluation includes tools for determining cost benefit and return on investment.

Librarians positively impact health care and health care research. Now it’s time to have that same impact on our own profession. The data are there. It’s time we see what they have to tell us.

More information

Value of Library and Information Services in Patient Care Study


Lindberg DA, Siegel ER, Rapp BA, Wallingford KT, Wilson SR. Use of MEDLINE by physicians for clinical problem solving. JAMA. 1993; 269: 3124-9.

Demner-Fushman D, Hauser SE, Humphrey SM, Ford GM, Jacobs JL, Thoma GR. MEDLINE as a source of just-in-time answers to clinical questions. AMIA Annual Symposium Proceedings. 2006:190-4.

Sneiderman CA, Demner-Fushman D, Fiszman M, Ide NC, Rindflesch TC. Knowledge-based methods to help clinicians find answers in MEDLINE. Journal of the American Medical Informatics Association. 2007 Nov-Dec; 14(6):772-80.

Joyce Backus serves as the associate director for Library Operations at NLM. Kathel Dunn is the NLM Associate Fellowship coordinator.

Photo credit (ammonite, top): William Warby [Wikimedia Commons (CC BY 2.0)]

Is NLM Building a Library on Mars?

Safe, productive human space travel requires more than sophisticated spacecraft. From environmental conditions to the physiological and psychosocial impacts, NASA’s astronauts face unique challenges while living in space.

To help address those challenges, NIH and NASA established a research partnership in January 2016. The research opportunities arising from this partnership and through NASA’s Human Research Program are expected to improve health both for the population on Earth and for those who travel to Mars and beyond.

What’s the Library’s role?

Well, we’re not getting ready to build an NLM outreach-to-Mars program (yet!), but we are involved in issues related to informatics and health information technology.

We’re expanding our collections and the standard health care terminologies (MeSH, SNOMED, LOINC, RxNorm) to address new environments (i.e., space) and the health concerns faced there (e.g., long-term muscle wasting, bone loss, space radiation exposure). MeSH, for example, already includes terms related to space flight, such as hypogravity and weightlessness; PubMed offers a subset of content focused on space life sciences; PubMed Central houses peer-reviewed papers resulting from NASA-funded research; and our History of Medicine Division holds a unique collection of scientific studies, technical reports, books, and pamphlets received from NASA in 2015.

We’ll also work to fully identify the information and resources needed to support biomedical research and to deliver health services to humans who may be light years away. We can potentially build upon NLM’s current work with machine learning and image recognition to speed diagnosis, and enhance our telemedicine efforts to account for an interplanetary communications delay approaching 42 minutes between Earth and Mars. We’ll further refine our emerging data science methodologies to accelerate discoveries in real time during manned missions. And perhaps most important to me, we’ll imagine—and plan for—a future without the internet.

No internet?!

Astronaut and moon reflected in the window of the space stationCurrently the internet is essential for the delivery of NLM’s most-used services, but there is no internet in space. We need to anticipate an independent technological infrastructure that will allow us to support research and medical care without it.

Such foresight, planning, and commitment can yield great results. Indeed, because of NLM’s leadership of the High Performance Communication and Computing Program 24 years ago (1992), we had satellite communication services in place to support the long-distance conversation between NIH Director Francis Collins and Astronaut Kate Rubins last October (2016).

But thinking systematically about how to deliver scientific knowledge in space will yield benefits long before the Orion spacecraft sets course for Mars.

While we don’t expect the internet here on Earth to go away, we must be prepared to deliver 24/7 access to NLM resources in the event of an interruption in internet service, whether due to natural disasters, construction failures, cyberterrorism, or even solar flares.

So, the next time you hear that NLM is working on human space exploration, remember that, while we’re planning for an information-rich future, we’re also ensuring an information-available present.

The library on Mars will come later.

Read Vint Cerf’s reply to this post, There Is an Internet in Space.

Co-authored by Dianne Babski, Deputy Associate Director for Library Operations, who serves as the NLM representative to the NIH/NASA Biomedical Research Partnership.

Photo credit (Mars in space, top): Composite NASA Hubble Space Telescope Image (October 19, 2014) | cropped

NLM’s Contributions to Healthy Communities

Public health lies at our core.

I’ve been on the job for eight months now, and I’m still learning more about the National Library of Medicine and its vast resources. These days, I’m broadening my understanding of how NLM  supports communities, population health, and public health.

The library has long had public health as an area of focus, both for its collection and its work. In 1993, the NIH Revitalization Act formalized some of our efforts by creating at NLM the National Information Center on Health Services Research and Health Care Technology (NICHSR).

Health services research (HSR) helps improve the quality and equity of health care for individuals and communities. NICHSR (pronounced “nik-H-S-R”) supports and promotes these efforts through its tools and by disseminating high-value information for the public health and health services workforce.

For example, in support of Healthy People 2020, a national program of specific objectives to improve the health of all Americans, NICHSR helps those in public health easily find the most up-to-date published evidence through a suite of preformulated PubMed search strategies. Their HSR and public health web portals deliver high-quality datasets, analyses, guidelines, and news, and the HSRProj database provides information about in-progress research before published results are available. And thanks to the newly-released NICHSR ONESearch, you can search across all NICHSR databases from a single point.

Committed to integrating resources for research and practice, NICHSR works closely with many of our sister federal agencies, such as the Centers for Disease Control and Prevention (CDC) and the Agency for Healthcare Research and Quality (AHRQ). Through the Partners in Information Access for the Public Health Workforce (PHPartners), which is a consortium of US government agencies, public health organizations, and health sciences libraries, NICHSR also works with national organizations such as the American Public Health Association, the National Association of County and City Health Officials, and the Association of Schools and Programs of Public Health. Together these collaborations deepen NLM’s work across the areas within public health while also promoting NLM’s public health resources to the communities who might benefit from them.

But NICHSR is not alone at NLM in working to ensure the health of communities and the people who live in them.

The NCBI Pathogen Detection System uses whole-genome sequencing to uncover potential sources of contamination during the outbreak of foodborne diseases. By comparing sequence data for bacterial pathogens obtained from food, the environment, and human patients to sequences in the NCBI database, we can determine if the bacteria are from the same outbreak, helping public health scientists trace the source of the contamination and target their response to the outbreak.

TOXNET, the flagship resource on toxicology and environmental health from the NLM Specialized Information Services (SIS) Division, delivers a collection of databases covering chemicals, drugs, occupational safety and health, poisoning, and toxicity risks, while SIS’s Disaster Information Management Research Center (DIMRC) supports disaster preparedness, response, and recovery by connecting people to quality disaster health information and fostering a culture of community resiliency.

Our landmark exhibition, Native Voices, preserves the healing cultures of American Indians, Alaska Natives, and Native Hawaiians and explores, among other things, how community lies at the center of Native conceptions of health. Through audio, video, photos, and stories, the exhibition—which is now traveling across the country—looks at how wellness of the individual is inseparable from harmony within the family and community and pride in one’s heritage.

This list, while far from comprehensive, gives a sense of the myriad ways this great library contributes to healthy communities. In fact, one could argue that everything we do ultimately has that impact.

And now we are looking for new and different ways to impact community health, this time through data and data-driven discovery. What ideas do you have about the types of data we should be collecting?

Illustration (top): Giovanni Maki, Public Library of Science (CC BY 2.5) | cropped, text removed

Building a 21st Century Archival Collection at the National Library of Medicine

Guest post by Rebecca Warlow and Christie Moffatt, both of the Library’s History of Medicine Division.

Across NLM, strategic planning is underway and many of our colleagues are thinking about what the next century will bring for the Library. Among the many questions in mind is “what is a 21st-century collection?”

In the Images and Archives Section in NLM’s History of Medicine Division we have seen our archival collections, and our profession, grow and evolve over the past few decades as the archival records of individuals, organizations, and other communities in health and medicine are increasingly created and communicated electronically and online.

But there is more to building a 21st century collection than being digital.

Before we dive into what NLM’s archival collections look like in the 21st century, we realize some readers of this blog may be thinking, “NLM has archives?”  Indeed we do.  Our archival collections consist of over 12,000 audio-visual titles, over 150,000 prints and photographs, 18,000 linear feet of archival and manuscript collections, 6.8 terabytes of born digital content, and 5.1 terabytes of web archives that document, among other things, biotechnology; drugs; health policy; public health; and the research of leading biomedical scientists such as Marshall Nirenberg, Joshua Lederberg, and Michael E. DeBakey.

We consider three broad areas relevant to building 21st-century archival collections:

  1.  Acquiring materials that document both the past and current history of medicine and the health sciences;
  2.  Preserving those materials; and
  3.  Providing access to those materials.

These are not new areas of consideration for archivists, but what we acquire and how we preserve it and provide access to it has been rapidly changing, which means our thinking has to change as well.

So what makes a 21st-century collection different from one from just 50 years ago?

Expanded formats

While we continue to collect analog materials, we have expanded the formats and types of records we collect to include born-digital files—everything from email to word processing documents to digital photographs and videos.  NLM, through its web archiving program, also collects online materials such as blogs, government web sites, online news, and others related to topics such as Ebola, Zika, and bioethics.

Long-term access

The addition of born-digital materials brings preservation and access challenges. To understand the scope of these challenges, consider how you would access a file today you had saved on a floppy disk in 1992. You’d need both the right hardware—a computer with a floppy disk reader—and the right software to read the file. Neither is easy to find. To overcome these types of challenges, archivists are collaborating with IT professionals and others on ways to preserve born-digital content so it will be accessible for decades or even centuries from now.

Enhanced utility

Until recently, access to archival collections has primarily meant being able to read or view content, but we envision a 21st century collection that offers new forms of access that allows for running queries across many items and collections. Researchers may be looking for the initial occurrence of something, for patterns in how it was applied, for the response to it or impact of it. By providing tools and systems that allow this kind of analysis, we will not only accelerate discovery and glean insights; we will also deepen the collection’s usefulness.

How can we make all this happen?

Building 21st-century archival collections ideally means working with the creators of content to acquire and preserve materials before they disappearWeb and social media content in particular is in a constant state of change and at high risk for loss. We will also need tools and systems that support collecting and managing this content on a large scale, and policies and processes for making this content available to researchers who not only want to dive into individual documents, but also run queries across collections. Interestingly, these issues and others parallel those faced by data scientists, ranging from provenance to stewardship, intellectual control, privacy, and long-term access for both anticipated and unanticipated research needs.

As we collect and preserve these archival materials, we aim make them broadly accessible to researchers, medical professionals, educators, students, and the general public.

We invite you to learn more about the NLM’s archival collections and explore some of our online resources from the History of Medicine Division, including the following:

Rebecca Warlow works in the Images and Archives Section, History of Medicine Division, Library Operations Christie Moffatt works in the Images and Archives Section, History of Medicine Division, Library Operations 

Guest bloggers Rebecca Warlow and Christie Moffatt work in the Images and Archives Section, History of Medicine Division, Library Operations.

Further readings

Embracing the Future as Stewards of the Past, A View from NLM’s History of Medicine Division, Jeffrey S. Reznick, PhD, Chief of the NLM History of Medicine Division

Responding to a Call to Action: Preserving Blogs and Discussion Forums in Science, Medicine, Mathematics, and Technology, post on the Library of Congress’ The Signal by Christie Moffatt

National Digital Stewardship Alliance 2015 National Digital Agenda