National Network of Libraries of Medicine

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INTRODUCTION

The Pacific Northwest Region of the National Network of Libraries of Medicine (NN/LM PNR) stretches across the northern Rockies and Cascades and on up to Alaska. It is the largest in size, and smallest in population, of the NN/LM regions. This environment fosters both independence and interdependence among the region's communities and libraries.

It is in this environment that the NN/LM PNR -- also known as the Regional Medical Library or RML -- has worked with hospital librarians as project coordinators to connect community hospitals to the Internet, the worldwide network of computer networks. This project has become known as the pilot connections project. Interconnected local area networks and wide area networks are relatively common in academic medical centers but scarce in community hospitals. Plans for this project were developed in 1991-92, when the importance of Internet for libraries and health care was beginning to be appreciated, but when access was still effectively limited to academic and research organizations.

The project has been conducted in partnership with NorthWestNet -- the mid-level regional Internet service provider for six states in the northwest. NorthWestNet is a membership- based organization closely allied operationally with the University of Washington. Member institutions pay for Internet "connectivity" as well as value-added services, including a sophisticated and user-friendly UNIX mail program (PINE), and access to databases (e.g., the University of Washington Libraries Online Catalog, and all years of MEDLINE). At the beginning of this project, NorthWestNet was one of the very few brokers of Internet access in the northwest. Now there are many choices of service providers, mostly those providing dial-up online access for individuals, but also including those providing full service institution-wide access.

PROJECT SUMMARY

The project began in October 1992 and was to end in April 1994, but has been extended one year to further examine the use of Internet resources in clinical settings. The choice of sites to participate in this project has been documented elsewhere [1]. The seven project sites range from a 360 bed hospital not far from the Seattle metropolitan area to a 22 bed hospital in Helena, Montana. The others, in the 100 to 200 bed range, are in Alaska, Idaho, Montana, Oregon, and Washington.

Based on discussions with site staff and on inventories of the computer and networking environments at the sites, the RML project planners selected three sites for direct Internet connections, requiring installation of network hardware and software and high-speed data circuits. The other four sites were selected to test dial-up access using relatively high-speed, full service SLIP (Serial Line Internet Protocol) connections.

Librarians from the sites were brought together for hands-on training at the University of Washington at the beginning of the project period. Although each had extensive experience using online database systems, and health sciences librarians in the region used an electronic mail system, none had any experience using the tools and resources of the Internet. Besides providing two full days of training and actual online exploration, it also brought the librarians and systems staff representatives from the sites together with the RML staff to plan the next steps.

Over the next several months the librarians became active and increasingly sophisticated Internet users. Each became experienced in making use of the typical tools available to them on the Internet at that time: e-mail, remote log-in to other computer systems (telnet), transferring files (ftp), and professional discussion groups (listservs). Some of the librarians became avid explorers of the Internet very quickly; others took longer to use it frequently and begin to find new uses for it on their own.

Communication between the project librarians and the RML staff was very active during this time of exploration and discovery; almost all of it was by Internet e-mail. The RML staff helped the project librarians figure out how to do things and how to find new resources. The librarians were very quick to incorporate this new technology into their normal work. It soon became the preferred way to use familiar resources (e.g., MEDLINE and DOCLINE). They quickly began to discover new resources of interest to them or, in some cases, the health professionals they serve.

One part of this project has been to examine the issues involved in establishing Internet connections in community hospitals -- and most of this paper addresses this question. Another part of the project has been to assess the application of Internet resources in community hospitals: once the connections are in place, what use is made of them and for what purposes? Both of these questions will continue to be posed over the remainder of the project.

We have learned a good deal regarding the first part (i.e., establishing connections) and this is reported in some detail in the following sections of this paper. We know less at this point about the use of these resources beyond that by the project librarians. As they have become more knowledgeable and adept at using Internet resources they have often been able to demonstrate Internet uses to interested staff. These opportunities to inform and educate community hospital staff have indicated to us that 1) there are as yet too few clinically relevant resources available to convince most clinicians that this is a resource worth their time, and 2) using the Internet for professional and personal communication is a much more immediate attraction for many in these settings. A clinician's use of the Internet to send e- mail to her son who is away at college may be an effective way to eventually introduce her to the use of information resources that can help her treat patients.

As of April 1994, nineteen months into the project, two of the three direct connection sites are only recently minimally functioning. The four dial-up access sites have been limited to low-speed online access. The reasons for the delays and limited service are examined below.

Go to Abstract / Introduction & Project Summary / Lessons Learned / Conclusion, Acknowledgements & Resources / References