The environment is increasingly recognized as having an impact on human and ecological health, as well as on specific types of human morbidity, mortality, and disability. Since the publication of its landmark report in 1988, Role of the Primary Care Physician in Occupational and Environmental Medicine, the Institute of Medicine (IOM) has conducted two additional studies that have examined the need to integrate environmental and occupational health into the education and practices of nurses and physicians. The recommendations from these reports are currently being implemented.

In 1995, the National Library of Medicine (NLM) asked the IOM to explore a related topic by requesting a study of NLM's Toxicology and Environmental Health Information Program (TEHIP). Specifically, NLM was concerned that health professionals were not fully using the information available in the 16 online databases comprising the TEHIP program. The IOM formed the Committee on Toxicology and Environmental Health Information Resources for Health Professionals. One of the committee's first goals was to seek input from a wide range of health professionals to more thoroughly understand health professionals' toxicology and environmental health information needs. Several mechanisms were used to receive input, including a workshop, during which attendees participated in focus group sessions; a questionnaire, designed to solicit information about health professionals' information needs; and discussions with representatives from federal agencies, health care, and academia.

During the course of the study, the committee reached several conclusions that it viewed as pivotal in advising NLM on how best to provide health professionals with toxicology and environmental health information. First, the committee believes that as environmental health concerns continue to increase, it is important for health professionals and other communities to have ready access to information resources in this field. The committee reaffirms the findings of the 1993 NLM Long Range Planning Panel on Toxicology and Environmental Health, which found that NLM's TEHIP program is an important information resource that needs to be strengthened.

Second, the committee believes that there is a large and diverse potential audience for toxicology and environmental health information. In attempting to understand the user communities, the committee discussed a broad spectrum of potential users ranging from emergency care personnel treating individuals affected by acute toxic exposures to local coalitions struggling to determine the environmental health hazards faced by their communities. Although each of the user communities in this broad spectrum has diverse information needs, there are methods of targeting training and outreach efforts and developing database interfaces that will more adequately meet those disparate needs.

Finally, the committee concluded that NLM, as the nation's premier biomedical library, can and should play a key role in organizing and providing pointers to all toxicology and environmental health information resources (including and beyond the TEHIP databases). NLM, given its library and medical informatics expertise, is well-positioned to further develop the tools that can link health professionals with the wide array of information resources that are available in this important field. Furthermore, this is an area where public-privatesector partnerships can play an important role as there are numerous sources of toxicology and environmental health information.

The committee is grateful to those who provided input to its deliberations including the individuals who contributed their ideas through the workshop and in discussions with the committee (see Appendixes A and C). Additionally, the committee thanks the individuals who took the time to respond to the committee's questionnaire (see Appendix B). The TEHIP program staff, including Jeanne Goshorn and Melvin Spann, provided thorough background materials, assisted in the committee's workshop, and responded promptly to the committee's many requests for additional information or clarification. The committee appreciates all of their efforts. The IOM staff of Cathy Liverman, Carrie Ingalls, and Carolyn Fulco are to be congratulated for their thorough research of the issues and for molding the committee's sometimes wandering deliberations into this report.

Although the committee has recommended some clear directions and mechanisms for implementation, much work remains to be done. The committee hopes that the conclusions and recommendations made in this report will prove to be useful as NLM moves forward in providing health professionals with toxicology and environmental health information.

Howard M. Kipen, M.D., Chair

Committee on Toxicology and Environmental Health Information Resources for Health Professionals