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J Med Libr Assoc. Apr 2003; 91(2): 173–177.
PMCID: PMC153158

Tracing technology in the Association of Academic Health Sciences Libraries

J. Roger Guard, Assistant Senior Vice President, Academic Information Technology and Libraries, and Chief Information Officer, College of Medicine1 and Wayne J. Peay, Director2

Abstract

From the beginning of the association, technology and the Association of Academic Health Sciences Libraries (AAHSL) have been intertwined. Technology was the focus of one of the first committees. Innovative applications of technology have been employed in the operations of the association. Early applications of mini-computers were used in preparing the Annual Statistics. The association's use of network communications was among the first in the country and later applications of the Web have enhanced association services. For its members, technology has transformed libraries. The association's support of the early development of Integrated Advanced Information Management Systems (IAIMS) and of its recent reconceptualization has contributed to the intellectual foundation for this revolution.

It may be no coincidence that the formation of the Association of Academic Health Sciences Libraries (AAHSL) took place at a true watershed in the development of information technology and of libraries. In any consideration of the history of the association, technology emerges as a dominant theme because of its extraordinary impact on its members and because of its ability to facilitate collaboration, a hallmark of AAHSL. While it would be intriguing to explore the impact of technology on academic health sciences libraries over the last twenty-five years, this ambitious project is far beyond the scope of this article. The objectives of this article are to examine the innovative applications of technology in the operations of AAHSL and the ways the association encouraged technological development by its members.

BACKGROUND

Information technology, at the time of the formation of AAHSL, was dominated by very large, mainframe computers. The capabilities of these computers, while modest when compared to the desktop systems now taken for granted, had been explored by libraries for more than a decade. While the capabilities of these computers were not particularly impressive, they did occupy extensive space and required rigorous environmental controls. Initially, data input was managed through the laborious production of eighty-column punch cards, which subsequently fed data into the system, a procedure usually described as batch processing. Various library applications including serials records, circulation, and cataloging were explored using this challenging technology.

By the mid '70s, batch processing was being replaced by dedicated, but dumb, terminals for data input to mainframe computers. The first applications of these terminals supported computer-assisted instruction, but their most extensive impact certainly was their use for cataloging in OCLC. Computing was amply demonstrating its potential, but, in the mainframe environment, access and management were centralized institutional functions. Too often library applications were considered “Category W” or the lowest priority. However, this would change with the advent of mini-computers, and no one could have guessed what the potential of the computer would turn out to be.*

TECHNOLOGY IN THE BEGINNING

The importance of technology to AAHSL was first demonstrated by the formation of the Committee on Information Control and Technology at the initial meeting of the AAHSL Board in 1979. The charge to the committee was:

The committee shall study trends in national information control planning and in developing information technologies, specifically, their implications for academic health sciences libraries. Particular attention shall be given to information networks, National Library of Medicine programs, including those of the Lister Hill National Center for Biomedical Communications, and to the effect of internal automation procedures of parent institutions on medical school libraries. It is expected position statements will be developed. [1]

The members of this first committee were Chair James Williams, Wayne State University; Naomi Broering, Georgetown University; Robin LeSueur, Harvard University; James Morgan, Oregon Health & Science University; and Elizabeth Sawyers, Ohio State University.

The preeminent accomplishment of this committee was to engage in a project led by Marjorie Wilson, M.D., director of the Department of Institutional Development at the American Association of Medical Colleges (AAMC). The initial objective of this project was to update “Guidelines for Medical School Libraries” published in the Journal of Medical Education in 1965. The committee developed several reports on aspects of this project. By early 1980, it was apparent that AAHSL recognized the opportunity that was at hand. On February 14, a meeting was convened by Dr. Wilson and held at the headquarters of the AAMC to discuss a new direction for this project. Daniel Tosteson, M.D., dean of the Harvard Medical School, chaired the meeting, which included AAHSL President Samuel Hitt and AAHSL Board Member Nina Matheson. The outcome of the meeting was an agreement to refocus the report to address information management in the 1980s. The ultimate result was clearly the single most important publication for health sciences libraries in the last half of the twentieth century, what has become known as the Matheson/Cooper report or “Academic Information in the Academic Health Sciences Center: Roles for the Library in Information Management” [2].

Following the publication of the Matheson/Cooper report, technology dominated the activities of the association. At the 1982 meeting of the AAMC, John A. D. Cooper, M.D., coauthor of the Matheson/Cooper report moderated a panel on the topic “Academic Medical Centers Confront the Information Age.” The panel was only one of several programs that considered the Matheson/Cooper report at the meeting.

The following year, the National Library of Medicine (NLM) launched its Integrated Advanced Information Management Systems (IAIMS) program to help academic health sciences centers and their libraries achieve the recommendations of the Matheson/Cooper report. In 1985, the Committee on Information Control and Technology was reconstituted as the Committee on Library Information Management Technology. The committee took up the challenge of trying to track the rapid development of technology in member libraries. In the fall of 1987, the committee conducted an extensive survey of the membership to identify library systems used, amount of end-user database searching, and participation in local area networks. The resulting 188-page report provided a snapshot of library technology at that time, but regrettably it was out of date by the time it was published [3].

More often than is recognized or often acknowledged, luck enters the equation. Certainly, this was the case with the establishment of AAHSL. The association had the great good fortune to have Richard Lyders as one of its founders and then to have its first administrative home at the Houston Academy of Medicine-Texas Medical Center Library (HAM-TMC). Lyders brought two invaluable factors to technology development in AAHSL. First, he had a genuine interest in use of computers, and, second, the resources of the HAM-TMC library were available to explore these technologies. These state of the art resources were a substantial contribution to the association, supporting the production of the AAHSL Annual Statistics (as documented elsewhere in this symposium) and association administration. HAM-TMC served as the administrative headquarters of AAHSL until 1993.

ELECTRONIC COMMUNICATIONS

The association began its exploration of the use of technology to provide member services and support early in its development. The first issue of the AAHSLD Newsletter in 1981 contained two references to email. The first was a brief reference to the use of the Telenet TELEMAIL to develop a questionnaire and conduct a survey on the education, research, and development activities of libraries. This note was followed by a brief “Cut here and mail today” survey to determine if the members would use TELEMAIL. The brief survey was then followed by a note on “Using TELEMAIL,” which stated that “Any searcher will find TELEMAIL simple.” While these early email systems obviously had at their core a revolutionary concept, these first implementations exemplified most of the really bad facets of early computing—hostility, cumbersomeness, unreliability, expense. Clearly, these difficulties were not easily overcome, because three years later, at the 1984 AAHSL annual meeting, a handout on cost-effective use of email was distributed. As late as 1989, a BITNET demonstration was included in the annual meeting program. To the credit of the early leadership of the association, they recognized the really good idea in spite of technological impairments.

In April 1989, electronic communications in the association were transformed with the establishment of the AAHSL electronic discussion list at the University of Utah. The discussion list used locally developed software based on the model of the PACS-L electronic discussion list that was developed and hosted at the University of Houston. Again, the software would never have been mistaken for user friendly, and it required a significant amount of manual support. While it took several years before all AAHSL directors participated on the list, it did attract a critical mass early on, and it became both a useful communication device and an interesting new expression of community among association members. The utility of posing questions to colleagues was quickly appreciated. In addition, announcements of new directors, changes of position, retirements, and deaths added significantly to the sense of community.

By the spring of 1990, the AAHSL electronic discussion group had grown to fifty members. In the fall of 1990, after discussing a request from the Medical Library Association (MLA) Medical Informatics Section that their membership be included in the AAHSL electronic discussion group, the AAHSL Board decided that the AAHSL electronic discussion group would remain separate from MLA. The print newsletter was discussed vis-à-vis the electronic discussion group in 1990. James Pat Craig, Louisiana State University at Shreveport, the AAHSLD News editor, believed that the electronic discussion group had an “adverse impact on the newsletter.” This prescient concern played itself out four years later as the AAHSL Board, in 1994—acting on the recommendation of Brett Kirkpatrick, University of Texas Medical Branch at Galveston—voted to discontinue AAHSLD News. By the fall of 1990, the AAHSL electronic discussion group had increased to seventy-eight participants, and the list was no longer restricted to library directors.

In 1992, Wayne Peay, University of Utah, forecast the challenges of the next decade when he said:

The radical changes of the last decade are only a prelude to the revolution that libraries will experience in this next decade. The combination of new technologies and high-speed networks will result in a true information explosion. Academic health sciences libraries will continue to act as a front-end to this increasingly complex information environment, fulfilling their education, research, and service responsibilities. To be effective in this role, librarians must refine and expand their skills in order to meet current challenges and to anticipate future opportunities. [4]

PRECURSORS TO THE WEB

At the time of the Web's creation in 1992, AAHSL's technology focus was on improving electronic communications and strengthening the use of computers in AAHSL libraries. The use of computers in medical education and the promise of the “clinical workstation” were among the topics discussed by AAHSL directors in business and program sessions. Personal computer ownership among the 1993 medical school entering class grew, even though no AAMC/AAHSL institution required students to own personal computers. To many observers, integrated library systems (ILS) had clearly gone through a growth and maturation phase, and second generation integrated systems were beginning to bloom. In the fall of 1993, the AAHSL Information Technology Committee, chaired by Mark Frisse, M.D., Washington University in St. Louis, proposed an AAHSL Gopher. By spring 1994, an AAHSL Gopher was established at Washington University, but, by the end of that year, the AAHSL Gopher was cancelled due to lack of use. This was a classic case of a superior technology (the Web) shifting the paradigm almost overnight. At this point in time, the Web had been in existence for over two years and had begun to take root at NLM and at some AAHSL member libraries.

AAHSL on the Web.

The Web's integration of electronic communication, desktop and server computing, graphical user interface, ease of use, and relatively low costs thrust it into the forefront of all AAHSL technology discussions nearly overnight. Almost miraculously, the hostile, cumbersome, unreliable, and expensive aspects of early computing had disappeared. In the fall of 1995, the AAHSL Library Information Management Committee, chaired by Susan Jacobson, Columbia University, investigated the feasibility of creating an AAHSL Web page to be hosted by the AAMC. Forming partnerships with AAMC on information technology became an important initiative for AAHSL in 1996, and the Web became the major focus area. By June 1996, AAHSL Information Management Technology Committee Representatives Jacobson and James Bingham, University of Kansas, negotiated with AAMC's vice president for information technology, Tom Moberg, to host AAHSL's home page on the AAMC Website. Security was a major concern, and Moberg believed that AAMC would need to impose write access restrictions for any home pages hosted on the AAMC system.

The AAHSL Board decided that it would be important for AAHSL to have editorial control of the Web page, and the possibility of a member institution hosting the Web page was discussed. Both Bingham and Roger Guard, University of Cincinnati, indicated a willingness to host such a Web page. The AAHSL Board recommended that the AAHSL home page be started at an AAHSL institution, with the possibility that it be transferred to the AAMC Website at a future time. The board still believed that there were advantages of Web collaboration with the AAMC if the terms and conditions could be worked out. AAHSL made a strong effort to secure this Web technology linkage with AAMC, but AAHSL was the first “outside” organization to seek this type of collaboration. The Web linkage concept gradually faded because of the inability of AAMC and AAHSL to find mutually beneficial terms and conditions.

The initial AAHSL Web page was hosted at the University of Kansas and developed for AAHSL by the Cincinnati Web development team led by Josette Riep. A three-tier architecture was selected for the AAHSL Website. This architecture, stress tested during the deployment of NetWellness, consisted of a relational database (Microsoft SQL Server), middleware (Cold Fusion), and a browser (Internet Explorer or Netscape).

As early as February 1997, the AAHSL Board planned for a robust AAHSL Web presence, proactive Web management, and ongoing Web development. The initial Web challenge had shifted from an almost pure issue of technology in the early and mid-1990s to the realization that technology was only one leg of a three-legged Web stool. The other two legs were content and art/design/architecture. At this juncture, the board decided that an AAHSL Web editor position, based on the Annual Statistics editor model, would add great value to the AAHSL Web presence. The Web editor would be responsible for overall Website design and content and would report to the board.

In May 1998, Audrey Powderly Newcomer, St. Louis University, was named Web editor. A new AAHSL Web server was installed at the University of Cincinnati, and more Website planning was under way. Surprisingly, as of spring 1998, at least two AAHSL institutions still did not have Internet access.

In March 1999, the AAHSL Annual Statistics were converted from electronic spreadsheet and paper to the AAHSL Website. This major milestone was achieved under the leadership, dedication, and hard work of James Shedlock, Northwestern University, the AAHSL Annual Statistics editor. At Shedlock's request, the board agreed to a contract with the University of Virginia to automate the AAHSL Annual Statistics input and reporting process. A second contract was signed to do the retrospective Annual Statistics on the Web. Shedlock, the AAHSL Board, and the contractor teamed to define the scope of work and the retrospective statistics design. Included in the scope of work was adding a database of descriptive data and inputting and analyzing the salary data.

The AAHSL Website was given a new look and feel by staff at AAHSL's business management firm, Shirley Bishop, Inc., and new content was added daily or weekly. In the fall of 1999, the AAHSL Board approved up to $10,000 to begin to move the Website to a commercial hosting site. A new Web editor position description, along the lines of the Annual Statistics editor position, was drafted. The Web editor would have a three-year term and report to the AAHSL Board.

In November 2001, the AAHSL Board dissolved the Information Management Technology Committee, and a new Web Editorial Board, chaired by Web Editor Edward Tawyea, Thomas Jefferson University, was formed. Members included Thomas Basler, Ph.D., Medical University of South Carolina; Regina Kenny Marone, Yale University; Connie Poole, Southern Illinois University; Judith Robinson, Eastern Virginia Medical School; and Etheldra Templeton, Philadelphia College of Osteopathic Medicine. In January 2002, the AAHSL Website was successfully moved to the Seattle-based commercial hosting service AdHost.

AAHSL'S TECHNOLOGY PARTNER: GROUP ON INFORMATION RESOURCES (GIR)

In 1996, Karen Brewer, Ph.D., New York University, reported on her discussions with David Rodbard, director, Information Resources Outreach and Liaison Activities for the AAMC, regarding the planned meeting, titled “Information Resources as an Integrating Strategic Asset in Academic Medicine,” to be held in Leesburg, Virginia, September 8 to 10, 1996. This meeting was one of the seeds that led to the AAMC's Group on Information Resources (GIR). In 1997, AAHSL offered AAMC President Jordan Cohen support in forming the GIR. By spring 1999, AAHSL had fifty-five members who were GIR institutional representatives. Bingham and Julie McGowan, Indiana University, have served as chairs of the GIR Steering Committee. Carol Jenkins, University of North Carolina; Lynn Kasner Morgan, Mount Sinai School of Medicine; T. Scott Plutchak, University of Alabama; and Guard have also served on the Steering Committee.

In January 2000, the AAHSL Board, chaired by Jenkins, met with the GIR Steering Committee, chaired by Bingham, to explore areas of information and knowledge collaboration. Likely candidates for collaboration were thought to be statistics, leadership, programming, and education (mainly at national meetings). AAHSL is an independent organization that has formal standing with the AAMC through its membership in the Council of Academic Societies. GIR is a subsidiary group of AAMC. Examples of the practical differences in the relationships are the respective Websites (AAHSL's Website is independent of AAMC; GIR's is part of the AAMC Website with other AAMC groups) and the differences in handling of governmental relations (AAHSL governmental relations are independent of AAMC; GIR has no separate governmental relations arm and so works through the AAMC). These structural and cultural differences plus different foci and priorities are among the reasons that few substantive information or knowledge domain initiatives have sprung from the AAHSL/GIR collaboration. Two notable exceptions are the cosponsorship of the annual Matheson Lectureship and the joint reception at AAMC annual meetings.

INTEGRATED ADVANCED INFORMATION MANAGEMENT SYSTEMS: THE NEXT GENERATION (IAIMS:TNG)

At the same time that AAHSL is celebrating its twenty-fifth anniversary, the Integrated Advanced Information Management Systems (IAIMS) program at the National Library of Medicine is celebrating its twentieth anniversary. AAHSL and IAIMS have been linked from the beginning, so it was certainly appropriate for the association and its members to contribute to NLM's review of the program. Begun in 1998, once again as a contract between NLM and the AAMC, the review was designed to examine what the impact of the program was, to determine if it should be continued, and, if so, to determine what its goals should be. The AAMC was fortunate to recruit two distinguished investigators to lead the project: Valerie Florance, Ph.D., previously the director of the Edward G. Miner Library at the University of Rochester Medical Center and a successful IAIMS principal investigator, and Daniel Masys, M.D., who had a distinguished career at NLM before leaving to become director of Biomedical Informatics at the University of California, San Diego.

The IAIMS review was conducted in three parts. First, various focus groups and surveys were conducted that included participation by the association and its members. A comprehensive survey of the IAIMS literature was performed. Site visits also took place at thirteen institutions. The results of these efforts were presented to the IAIMS: The Next Generation (TNG) Panel that assisted the investigators. The impact of the IAIMS program over the last ten years has clearly been significant. Major advances in the development of infrastructure, resources, and tools have been made possible by the IAIMS program. However, the larger goal of seamless integration of information resources and services has remained beyond reach. Similarly, the expansive vision of the role of libraries has not been realized. Of course, the extraordinary extent of technology in the academic environment and in society in general could not have been predicted. Nonetheless, the benefits of IAIMS to libraries have been demonstrable. Libraries have either led or directly contributed to technology leadership, which has increased the expectations. Libraries are now viewed as centers of innovation with services extending far beyond the walls of the traditional facility.

The final result of the IAIMS:TNG study was the publication of Next-Generation IAIMS: Binding Knowledge to Effective Action [5] by the AAMC. The clear conclusion is that while much has been accomplished, significant work remains. While the original IAIMS program was designed with a destination as its goal, this reconceptualization of IAIMS is more of a path and a process. The report provides a broad action agenda for this next generation of IAIMS. For libraries, the opportunities remain and are in their own way no less expansive than the original vision. They are summarized in two major challenges, “(1) implementing a set of methodologies for managing the institution's knowledge store and allowing people to manipulate the knowledge store retrospectively and prospectively, in real time, for their own purposes, and (2) building linkages from the institution's knowledge that is external (i.e., not owned by it)” [6]. In its conclusion, the report accurately describes the challenges that lie ahead, “IAIMS must further the use of the technology to move knowledge into action—to improve health to integrate local and distant information resources, to enable good decisions, to enhance learning to aid discovery and innovation” [7].

SUMMARY

AAHSL and technology have been intertwined from the beginning of the association. Technology was the focus of one of the first AAHSL committees, and innovative applications of technology have consistently been used in the programs and operations of the association. AAHSL was an early, proactive supporter of IAIMS and was again a key supporter of the IAIMS reconceptualization in the new millennium. AAHSL remains a central resource for academic health sciences libraries in the intelligent diffusion of knowledge. Technology is a valuable tool in enabling knowledge diffusion. In part because of the inexorable acceleration of technological change, AAHSL will continue to be a knowledge resource and sounding board for member ideas.

Note on naming: In 1978, the Association of Academic Health Sciences Library Directors (AAHSLD) was incorporated. In 1996, in response to IRS requirements, AAHSLD formed a new organization to carry on its work, under the name Association of Academic Health Sciences Libraries (AAHSL). In this article, unless otherwise stated, the newer name is intended to refer to the organization throughout its history.

Footnotes

* For the best history of first generation computing in medical libraries, see: Pizer IH. Looking backward, 1984–1959: twenty-five years of library automation—a personal view. Bull Med Libr Assoc 1984 Oct;72(4):335–48.

 Source materials for 1990 to 2002 are drawn from two main resources. From 1990 through 1994, the primary resource was AAHSLD News. AAHSLD News was discontinued in late 1994. From 1995 to 2002, the main resource was AAHSL Board Meeting Minutes, AAHSL Business Meeting Minutes, and AAHSL President's Reports.

REFERENCES

  • Association of Academic Health Sciences Library Directors first annual report. 1978/1979.
  • Matheson NW, Cooper JAD. Academic information in the academic health sciences center: roles for the library in information management. J Med Educ. 1982.  Oct; 57(10Pt 2:):1–93. [PubMed]
  • Association of Academic Health Sciences Library Directors. Report on automation activities of member libraries, 1987.
  • Peay W. AAHSLD News 1992;12(2):2.
  • Florance V, Masys DR. Next-Generation IAIMS: binding knowledge to effective action. Washington, DC: Association of American Medical Colleges, 2001.
  • Florance V, Masys DR. Next-Generation IAIMS: binding knowledge to effective action. Washington, DC: Association of American Medical Colleges, 2001, 36.
  • Florance V, Masys DR. Next-Generation IAIMS: binding knowledge to effective action. Washington, DC: Association of American Medical Colleges, 2001, 46.

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