Health Sciences Library Highlights Annual Report
FY 2000-2001

Introduction

The Health Sciences Library (HSL) supports the University's mission by providing the highest quality information and knowledge management services to advance health and health care. This mission statement is deceptively simple. It indicates the Library's long term commitment to evaluating the benefit of its products and services in terms of clear outcomes: advancing health and health care. It assumes that information access at one's fingertips, typically provided by technology, makes information more useful. It calls for HSL to select or develop knowledge resources and services based on its knowledge of users' information needs; and to integrate information published in traditional ways (print and online) with unpublished information from within the institution and outside, to support better decision making. Further, it calls for HSL to build the knowledge management competencies its users need to support decision making throughout their lifetime. The mission links library services to the core processes of education, research and service that are the cornerstones of the University's mission. The activities of the HSL during the past year led to progress in each of these areas.

Library Services That Meet User Needs

Renovation Planning

Planning for the total renovation of the Health Sciences Library has been underway since the latter part of 1997. Our goal is to create a state-of-the-art facility to support the information needs of our users well into the 21st century. The pace of change in information technology is so rapid that it is difficult to predict all that will be needed in a library in the next decade or so. Therefore we are planning to achieve as much flexibility as possible and to provide "rapid reaction" technology. Through an extremely efficient design we will be able to house our physical collections for some years while still providing the learning, research and study spaces that our users tell us they will need.

• Space for groups to study and learn around innovative technology applications
• Individual work space provided with ubiquitous network connections; areas for teaching and demonstrating the latest in information seeking and management techniques and technology
• Full access to the recorded knowledge of biomedical and scientific endeavors in every format and from any location
• A facility which recognizes and makes accessible the rich tradition of the literature of the sciences

HSL 2001 planning focused on preparing for the upcoming renovation of the library building, now scheduled to begin in the first quarter of 2002. During renovation, the library will be open, but space for services, collections and study will be limited. The goal is to offer online alternatives to as many library services as possible. The HSL web site was redesigned to be easier to use and more robust. It offers easy access to staff via direct email and email reference service. Virtually all services now are accessible electronically, including forms to request responses or documents when they are needed. A new "virtual reference desk" will be implemented this summer providing real time online access to a librarian, and the ability to "synch" two web browsers, allowing the librarian to "drive" a user around the web. HSL offers access to online document request and delivery to the desktop (still in test mode); online training modules; electronic course reserves; online Focus Guides (two new guides on alternative medicine and national health statistics were produced); and access to a large collection of full text books, journals, and databases. Use of the Library's web site for these and other services continues to increase, along with the number of repeat users. More information about renovation planning is available at the Library renovation web site: http://www.hsl.unc.edu/renovation/renovation.cfm

Distance Education

The HSL increased the prominence of its role in Health Affairs distance and distributed education. An updated promotional flyer distributed to faculty) and a link from the HSL website describe library services supporting distance education courses (www.hsl.unc.edu/services/DE/disted.cfm) The Distance Learning Specialist who guides campuswide library services for distance education has been successful in promoting an expanded library role in planning and supporting off campus learning. She develops information packets for distance learners customized to their program of study. Services include links to online journal articles in faculty course web pages; online modules in key areas like health statistics and drug information; electronic course reserves; assistance converting course content to web-based form; online article delivery services; and more. With the rapid growth of direct web links to online journals and increased use of electronic course reserves, the number of separate article requests from Health Affairs distance education students declined 45% from the previous year. The number of classes using E-reserves doubled in that time, however, from 33 to 64, and the number of articles placed on E-reserves also doubled from 652 to 1326 articles. A survey conducted in the spring suggests that a high percent of instructors using E-reserves intended them for distance education students.

UNCLE

UNCLE is the HSL presentation of online resources. Use of UNCLE has increased dramatically each year since its inception in the early 1990's. During that time, it has evolved from the first campuswide networked access to a major database, MEDLINE; to a sophisticated web searchable collection of journals, databases and other electronic resources. It includes several special collections such as "clinical quick reference" that are consulted heavily. Last year a new UNCLE strategic plan was created that calls for broader content, increased customization and other new features, and a more robust database infrastructure. A major redesign of the database architecture and organization for UNCLE got underway this year. Preliminary activities focused on gathering data to define new functional requirements. Staff are analyzing the results of an UNCLE user survey and usability study. The decision was made to integrate the stand-alone UNCLE library with the HSL web site to present an integrated source of health knowledge resources and services for users. HSL is moving to a new UNCLE user authentication process using the campus PID identification. This identification allows access by users off campus to virtually all licensed online library resources via the libraries' proxy server. This process will be completed before the start of the fall semester. UNCLE access will be maintained throughout the renovation, and system redesign will proceed next year. Electronic resources will continue to be added to UNCLE during its redesign.

AHEC Digital Library

The library of electronic resources serving health professionals throughout North Carolina is the AHEC Digital Library (ADL). This digital library is unique in its ability to match an individual in one of the AHEC regions with the regional AHEC library and the affiliated academic health sciences library serving its needs (Wake Forest University Carpenter Medical Library; Duke University Medical Center Library; East Carolina University Laupus Health Sciences Library; and UNC-Chapel Hill Health Sciences Library). This feature will allow customized information products and services to be made available to clientele throughout the state. An excellent collection of core biomedical databases and full text resources is available now; and there are plans to add extensively to the resources and services. Duke Endowment and the AHEC Program provided funding for ADL. This year ADL also began to sell individual memberships in the library to health care providers in the state. HSL provides leadership and host services for the AHEC Digital Library, which is a cornerstone of the statewide AHEC electronic network.

North Carolina Health Information Online

A small grant from the National Library of Medicine launched a cooperative project between the HSL, the School of Information and Library Science, and the National Library of Medicine to create a local database of consumer health information resources accessible over the web, and linked to the NLM national consumer health database called MedlinePlus. The hope is that a citizen in Hickory (or anywhere) who needs to find a local diabetes support group, information about local clinical trials, the name of an in-patient drug treatment facility, or other local health information can search this database and find that information, while at the same time having access to the full range of information on topics of national interest that are part of MedlinePlus. The initial feasibility project has been successful and HSL is negotiating for support to develop the project in full. This project has a consumer advisory committee and the support of the NC State Library and the North Carolina Health Information and Communications Alliance (NCHICA). It has the potential to provide significant benefit to citizens of the state who have access to the web at home or through their public library. It also promotes the value of health information professionals (librarians) to a much wider audience than heretofore. This year project staff helped gain access to a suite of consumer health information resources through NC-LIVE, the statewide electronic library reaching public libraries and schools in the state; and created a consumer health information listserv for information sharing. The health resources on NC-LIVE show increasing popularity among its users.

New and Emerging User Needs

HSL strives to stay abreast of new and emerging user information needs. During the year the question arose as to whether the HSL building should be renovated where it stands, or replaced by a new building in a more suitable location. Input was sought from a wide variety of faculty, students and administrators on this question. The overwhelming conclusion was that the current location is the most suitable one at present, and the renovation should proceed. Academic associate deans in all of the health affairs schools also shared their plans for curriculum revision, enrollment growth, and other factors that will influence both the location and the nature of services expected from the library in the near future. The HSL is using this information to plan appropriate services for each of the schools. One area under consideration is the adequacy of educational technology support services for schools in Health Affairs. Each school and the HSL has dedicated staff, space and resources for this support, but they are not well coordinated. The renovated library will provide more space for this online learning support, but improved coordination has yet to be addressed. Questions concerning the long term need for a combined "life and health sciences" library also have arisen. Planning has begun to define the scope of collections and services for this new library, and a future location has been proposed in the "science corridor" in the campus master plan.

Bioinformatics is a high profile priority for the university. The key players in this new field are multi-disciplinary, covering life and physical sciences and information science. The campus commitment to developing strength in genomics,proteomics and bioinformatics is extraordinary. The HSL is keenly interested in assuring that information competencies are developed by faculty and students in this area, and in providing the best possible knowledge management services to support innovation, discovery and learning. The HSL is participating in proposal for federal funding to develop a bioinformatics training program, including support for librarians to develop specialized bioinformatics skills. A Bioinformatics Library Fellow is currently being recruited, funded by the National Library of Medicine (NLM), in cooperation with the School of Medicine Medical Informatics Training Program and the School of Information and Library Science.

Another emerging area is the use of personal digital assistants (PDAs), hand held palm-top computers. These have become popular tools for health professionals and students, due to their portability and the wide variety of electronic content available for them. Students want to use them in clinical areas to record and transmit data about patients; to send and receive email in a wireless environment; consult E-texts and diagnostic aids; manage personal schedules; and more. The HSL is equipping its systems and services staff with PDAs to learn about their uses and be prepared to help students and faculty use them most effectively. An Applied Health Informatics Library Fellow based in HSL and funded by NLM will conduct research this fall to learn more about how medical students are using PDAs (required for 3rd and 4th year students). While this may be a transitional technology, it is one that the library must invest in and support while it is in demand.

• Overall use of UNCLE continues to increase; access via Ovid is being supplanted by access via the proxy server, PubMed, and other means.
• The monthly average number of repeat users to HSL web site has more than doubled since last year.
• Use of the Library facilities, as measured by gate count, increased slightly over last year.
• Circulation, in-house use of print collections, and the number of photocopies made decreased from last year, while use of electronic resources increased.
• Information services overall (consultations and questions answered by all means of access) increased 110% over last year.
• AHEC Digital Library has about 6,000 registered users and about 900 online resources.

Electronic and Print Library Collections That Meet User Needs

Renovation Planning

Providing online access to resources to the fullest extent feasible is a key strategy during and after renovation, to enable "access at one's fingertips". It will be necessary for a large portion of the collection to be stored off site during the renovation, although most items will be accessible upon request. Current and highly used items will be kept on site. HSL staff view the renovation as an opportunity to gauge the future need for many print resources, and to plan accordingly. Aggressive weeding of out of scope and duplicate materials is nearly complete. It is unlikely that everything in the current print collection will be accessible online, even in the future, unless demand warrants it. But there are alternatives that will be considered. The newly renovated library will have less square footage dedicated to collection storage than the current facility has; so decisions about what will be permanently archived on site will be necessary. The Library will continue to seek and value input from users regarding these decisions.

Expanding Access to Print and Electronic Resources

During the past year significant growth occurred in electronic access to journals and books. This growth is due primarily to HSL's ability to take part in multi-library licenses with Academic Affairs Library, TRLN, and other research libraries in the area. Some of the significant titles added include: Alt-Health Watch; AMED (alternative medicine database); Journal Citation Reports; and journals from Springer, Kluwer, and Wiley Interscience. HSL also "took the plunge" by converting 39 titles from print to "online only" format, and adding 23 new online titles. A total of 47 new journal titles were added this year in all formats. Some of the major challenges to continuing this move to digital information are funding; availability of convenient access terms; and permanent access. HSL, along with other libraries, continues to press in its license agreements for affordable access, as unrestricted as possible, and a commitment from the publisher to ensure permanent access to digital information. With other TRLN libraries, HSL agreed not to purchase Nature online this year, in objection to its pricing and restrictive access requirements. Nature Publishing agreed to rethink its pricing policies because so many libraries took this stand. The cost of online information in the sciences continues to increase about 10% per year. HSL carefully evaluates every online title it licenses, and leverages funds whenever possible to achieve greater access to a greater number of titles.

Collections that Meet User Needs

HSL strives to involve users in the selection and evaluation of knowledge resources of all types. The library is currently building a small database of user contacts, individuals who have voluntarily evaluated resources under consideration, and shared their opinions with the Library. HSL staff conducted a major user evaluation this year comparing Ovid and PubMed, two sources of MEDLINE, the major biomedical database. This information will affect the library's decision about the extent of its support for each source in the future. Staff collaborated with Academic Affairs Library staff to merge records to produce one comprehensive list of electronic journals for the campus. This has been a frequent user request. Staff completed a major project to create links from PubMed citations directly to the journal article online when owned by HSL. This feature saves the user time and provides true fingertip access at the desktop to the full content of articles.

Maintaining High Quality Collections

As part of the UNCLE redesign project a new "Content Development Policy" has been drafted. It defines a broader scope for library collections, including locally developed or unpublished resources. This will enable UNCLE to become a fully integrated information service that links multiple data sources and types at the desktop. An example of unpublished resources made available this year electronically are community health assessments prepared by students in public health and other schools. These resources are used heavily by students doing rotations in communities throughout the state.

Frank Netter, MD, Gift

HSL received a significant gift during the year from Francine Netter Carlson, daughter of Frank Netter, MD. Frank Netter was a noted medical illustrator whose work primarily was done under the auspices of Ciba Geigy Pharmaceutical Corporation. Ciba published a multi-volume anatomy series of Netter's illustrations that is well known by students and faculty in the health sciences. The gift includes sketches and correspondence related to these illustrations, the originals of which now are owned by Novartis. HSL plans an exhibit in the fall showcasing materials from the gift.

• Price increases of 10% over last year for collection resources in all formats are expected.
• Over the past five years, collection costs have increased 43%.
• In a recent study of journal availability in HSL, users found 80% of the items needed; a success rate better than other academic libraries having done similar studies.
• Fewer items were borrowed for users from other libraries last year. The decline in interlibrary borrowing can be explained by the institution of a $5 per item borrowing fee this year; and/or by the increased availability of electronic journals through consortium license agreements with neighboring libraries.
• HSL consistently ranks in the top quartile of academic health sciences libraries in collection expenditures and number of current serials titles per student.

A Leader in Teaching Knowledge Management Competencies

The HSL has a longstanding reputation as a leader in teaching information and knowledge management skills to students. In preparation for renovation, key strategies this year focused on increasing the availability of online instruction; developing and using knowledge management competency measures; and improving curriculum-integrated instruction. HSL also continued its commitment to collaborative approaches to instruction. Librarians, in consultation with Health Affairs faculty, identified six core information competencies needed by all health care providers. Librarians teach these competencies through in-class instruction, distance education, web-based tutorials, and free-standing library workshops. Three new modules were developed this year: Using Dreamweaver, Introduction to Photoshop; and Drug Information. Distance education funds supported a project to evaluate all HSL online learning modules and to make revisions to include more interactivity. Modules on Finding Health Legislation and Evidence-Based Medicine were revised.

The impact of HSL instruction is probably greatest when it is linked to other courses in the curriculum. This year librarians taught 1st year medical students to find demographic information and health statistics on the web, which students later used to create community profiles prior to their scheduled rotations. Librarians also used opportunities to teach competencies in other courses. First year Pharmacy students demonstrated their ability to use online resources effectively to complete lab requirements. Library staff also worked directly with staff in the department of Pediatrics and in the Emergency Room to create easy online access to resources for residents. Librarians devote significant time to support the 2001 IBM Curriculum Enhancement Grants on campus, reviewing proposals, providing needed training to faculty, and consulting on individual projects.

Librarians also offered a problem-based learning course for faculty and teaching assistants in conjunction with the Center for Instructional Technology; and created a case-based learning module on breast cancer that was reported to be "extremely successful". Staff weeded the old AV collection and are working with 14 faculty to digitize old slide sets leading to improved access. HSL librarians serve as the campus experts in bibliographic formatting software, offering regular instruction and consultations.

• 2,665 persons participated in face to face library workshops or classes through 05-01.
• 16,894 persons accessed course web pages and online modules via the HSL web site.
• 86% of 1st year Pharmacy students who evaluated HSL instruction preferred using its online learning modules to written assignments.
• HSL librarians are recruited to participate in campus instructional initiatives (Technology in Context; FITAC; Blackboard; Portal groups)
• HSL librarians are co-editors of Informatics Education column of Medical Reference Services Quarterly, and wrote Health Care Informatics chapter in forthcoming Information Technology in Health Care textbook for nurses.
• HSL librarians are consulted by peers at other institutions about educational support services and have papers and posters accepted at national meetings.

Practicing Evidence-Based Librarianship

HSL's goal is to make decisions about its programs and services based on indicative data describing user needs and satisfaction, feasible services, and real or projected outcomes. During the renovation all library services will change somewhat, but some measure of the impact of temporary change is nonetheless important. New data indicators are being developed to measure the impact of changes in services during the renovation.

• Interviews with associate Health Affairs deans
• UNCLE usability studies (UNCLE users for functional redesign)
• Product comparisons (298 users responded to a web based survey evaluating their impressions of two vendors of MEDLINE and online products)
• Environmental scans (determining uses of PDAs)
• User input was collected in many more informal ways.

Sustaining a Strong Infrastructure

Preparing for Renovation

Sustaining the infrastructure that enables us to design and provide the highest quality information and knowledge management services is one of the most significant challenges we face. This challenge is even more critical during a period of extensive renovation. Planning is now underway to ensure that reasonable facilities, security, and telecommunications support will be available both to users and staff during the renovation, even though their physical locations will change several times during the project. The Library Renovation Project Manager is leading a renovation team of staff who are developing detailed plans for services, collections, IT systems, facilities, staff morale, and communications.

Improving the library's technology infrastructure is a key strategy that will maximize online access to collections and services. Wireless access was successfully implemented. HSL purchased a larger server, streamlining operations and enhancing efficiency by consolidating resources and services. Systems staff are using an object oriented approach to developing new systems architecture and reusing components. Staff were trained in cold fusion, SQL development and database administration, Windows 2000, XML, and project management. New laptops were provided to staff, providing more mobility and flexibility during building renovation. Library staff migrated to using Netscape calendar for individual and group scheduling. A new file structure for internal documents archiving was implemented. Preparing for renovation, the Library has committed to supporting staff and user mobility where possible.

Outstanding Staff

Renovation also will have an impact on rapidly changing staff roles and responsibilities, which will be addressed in the Library renovation plan. This was an active year for recruitment at HSL, but it also was a year of active retention of excellent staff through in-range salary increases for SPA staff, salary increases using tuition increase funds for EPA librarians, temporary wage increases, and position reclassifications. Staff were singled out for recognition both on and off campus. The Library's Award of Excellence was presented to Pinkey DuBose, who went on to win the Chancellor's Award. Francesca Allegri served as President of the University Managers Association. Carol Jenkins assumed the presidency of the Medical Library Association and was named a lifetime Fellow.

• 49% of permanent SPA positions became vacant and were filled with new hires or promotions
• 27% of permanent SPA positions were reclassified
• 100% of permanent SPA staff are now paid 80% or more of their qualifying salary
• Average salary increase over 9% for EPA librarians using tuition increase funds to correct chronic salary inequity
• 4 EPA librarians were reappointed
• 5 EPA librarian positions were filled
• 4 new positions were created (3 SPA, 1 EPA)
• 84% of students hired were retained for the entire year; hourly rate was increased

Demonstrating Our Value

The value of HSL can be examined in terms of its impact on advancing health and health care; and in terms of its contribution to the institution's major programs supporting its mission. Often the indicators of this value are subjective; or they measure input factors such as size of budget or collection rather than outcomes. It is an HSL goal eventually to create some outcome measures that will link the library's role with achievement of university priorities and mission; and to find ways to measure progress. This year several measures are noteworthy. Library users found two major occasions this year to voice their support for the library. First was during the reconsideration of whether to renovate or replace the library. Faculty, students and administrators described the importance of the library to their daily work not only in terms of its convenient location, but also the accessibility of its staff and services. Later, when a potentially drastic 45% cut in library acquisitions funding had been proposed, library users again spoke up about the devastating effect this would have on their ability to work productively. In both cases, campus administrators wisely forestalled the potential changes.

Library value is also demonstrated in other ways that are not reactions to potential crises. HSL is sought after by other groups on campus for its staff expertise, commitment to innovation and high quality service, and vision. Staff contribute to Center for Instructional Technology initiatives to help faculty adopt and use new technologies. HSL was invited to participate in a major multi-disciplinary grant proposal in cancer communications involving communities and public libraries in NC. HSL is contributing to the development of new initiatives in bioinformatics training in recognition of its information leadership role. HSL collaborates with the School of Information and Library Science and the School of Medicine in supporting a competitive fellowship for librarians interested in advanced knowledge in medical informatics. This year the library competed successfully for a librarian associate fellow from the National Library of Medicine who will spend the 2002 year in the HSL, with NLM funding.

Staff contributed expertise to maintaining a web site of materials in Spanish for health professionals and consumers, under a Duke Endowment grant. Other staff contracted with the NC State Library to teach public and community college librarians how to find quality health information in online resources to answer questions from the public. HSL updates online resources for the public that are included in the www.unchealthcare.org website maintained by UNC Health Care.

Library value is demonstrated by successful fundraising outside the university. The HSL has had its own fundraising program since the early 1990's. It has hired its first Annual Giving/Public Relations Coordinator to manage a Friends of the Library organization that is growing; and currently is recruiting a Director of Development who will be shared with the Central Development Office. This year the library began planning to raise several million dollars as part of the Carolina First Campaign. Nearly one million dollars has been raised in total to supplement the $11 million in public funds (through the bond measure) earmarked for the library renovation.

Staff assume voluntary leadership roles on campus, some of them elected. Librarians serve on the Faculty Council, the Employee Forum, and as president of the University Managers Association. There are many other campus and school-based committees that are enriched by the participation of health sciences librarians. Librarians also actively support their profession in national and regional association activities and offices. They have a strong record of publications and presentations.

• Value of grant support for HSL projects this year: $244,971
• Funding from private gifts this year: $88,145

Conclusion: Future Challenges

• Continue to build support and sponsorship among campus leadership and the community. This is especially significant given the number of changes in leadership on campus.
• Launch major fundraising campaign. Fundraising is a challenge for HSL partly due to our small size, focused mission, and limited resources. HSL needs to build a sizeable endowment and to continue capital improvement fundraising.
• Begin major Library building renovation. This project is behind schedule by several months, and needs to move forward as quickly as possible. Plans are underway to relocate collections, staff and users beginning early in 2002.
• Sustain or improve the Library's level of excellence in services. Services undergo continuous change in the digital environment, and the challenge is to harness this potential to serve users' changing information needs successfully during the disruptive period of renovation, and afterwards in the 21st century library that will emerge.
• Provide adequate resources to support excellence. The cost of online information is high and demand for it is rapidly expanding, especially in the sciences. Technology has become the architect of change, and requires continual reinvestment. Funds saved through economies of scale and efficiencies are quickly captured to meet increasing user needs.
• Sustain a staff that possesses the skills to be effective health information providers in the 21st century. Staff retraining is continuous, and advanced expertise is needed to meet increasingly specialized needs, as in bioinformatics.

I am grateful for the support of the Library's staff, users, community supporters and campus leaders which has helped the Library succeed in its mission. I look forward to the progress we will make in the coming year.

Carol Jenkins, Director
Health Sciences Library
June 15, 2001