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National Network of Libraries of Medicine
Pacific Northwest Region

Annual Report

May 1, 2001 - April 30, 2002


Introduction

The mission of the National Network of Libraries of Medicine is to advance the progress of medicine and improve the public health by: 1) providing all U.S. health professionals with equal access to biomedical information; and, 2) improving the public's access to information to enable them to make informed decisions about their health. The Program is coordinated by the National Library of Medicine and carried out through a nationwide network of health science libraries and information centers.

Network goals are:

  1. To develop collaborations with NN/LM libraries to improve access to and sharing of biomedical information resources throughout the nation;
  2. To promote awareness of and access to biomedical information resources for health professionals and the public; and
  3. To develop, promote, and improve access to electronic health information resources by network member libraries, health professionals, and organizations providing health information to the public.

  4. The Statement of Work focuses on:
    Continuing to work with the libraries in the network in establishing connections with health professionals in rural and inner city locations who still do not have adequate access to information;
    Working with the NN/LM and other organizations to increase public awareness of and access to health information via the Internet, with particular focus on senior citizens, minority populations and persons of low socioeconomic status; and
    Strengthening network capabilities through collaborations and by implementing national support centers in key areas of need, such as outreach evaluation, training and distance education.

This annual report covers the period May 2001 through April 2002, the first year of the NN/LM PNR 2001 - 2006 contract.

Highlights this year include:

  • A major redesign of the Pacific Northwest Region's web site -- http://nnlm.gov/pnr/ -- sharpened the focus on our services for our primary user groups: the assistance we provide to health librarians and others delivering health information, the training and referral we provide health professionals, and the orientation and referral we offer to the general public.
  • The PNRML facilitated the subscription to a bundle of e-journals offered through Ovid, for a group of 25 libraries in the Pacific Northwest region that would not have been able to gain access to these titles otherwise (A.2.)
  • Continuing to expand partnerships with community-based organizations to heighten awareness of the role of health information in decisions affecting individual and community health; and, fostering innovative health information outreach projects through these partnerships. (B.1. and B.2.)
  • Funding three new projects that reach out to different segments of the community: multicultural health education resources for care providers, elders, and high school students. (B.1. and B.2.)
  • Implementing our proposed community-based outreach approach through our work with three American Indian reservation communities. (C. Enhancements.) Initial indications are that community-based work blends outreach to health professionals and outreach to the general public. The same effort involves both.
  • Work began on planning to map the activities of the NN/LM nationally, through the newly constituted National Outreach Mapping Center. (C. Enhancements.)

A. Network Programs

1. Health Professional Access to Information Services
Videotapes of the CDC satellite teleconferences on bioterrorism that were held in November and December 2001 were acquired and added to the lending library. We publicized their availability and received 14 requests from Pacific Northwest libraries to borrow them.

A study to examine how staffs of state public health agencies use the literature was planned at the end of the previous contract, to be implemented during this Year 1 contract year. S. Barnes drafted objectives for the study. Funds (from the preceding contract) were allocated to the University of Alaska, Idaho State University, Montana State University, and Oregon Health & Science University.

As part of this study, Nancy Griffin of the Idaho Health Sciences Library (Idaho State University) distributed a survey to public health professionals in Idaho on information uses and needs; and Cindy Cunningham of the Oregon Health & Science University learned of the Web portal that the Oregon State Library provides to state employees. Forty percent of document delivery provided by the Oregon State Library is to state public health employees.

One of the original objectives of this project was to underwrite the costs of providing document delivery to state public health staff, through the primary resource libraries in 4 of the 5 states of the region (all except Washington State). We then learned that this objective may run counter to existing relationships between state libraries and state health departments. We have also learned that state health department staffs are, for the most part, unaware of this service. It is also unclear how much of a need there is for this service. The study objectives were adjusted from document delivery to assessing needs and planning appropriate services with state health departments, state libraries, and resource libraries. This will be continued in Year 2.

2. Assess Needs of Health Science Librarians
A discussion on group purchasing of e-journal subscriptions that started with the Washington Medical Librarians Association Internet Users' Group spread to many other librarians in the region. S. Barnes was able to broker a group subscription to Lippincott Williams & Wilkins journals from Ovid for 25 libraries in the region. Librarians in the region, both participants in this group purchase and others, indicated that they want to pursue other group subscription opportunities.

M. Blake conducted the 2002 Pacific Northwest Chapter/Medical Library Association (PNC/MLA) Continuing Education survey. This annual survey has been conducted in the region since 1983 and is a cooperative effort between PNC/MLA and the PNRML. Nancy Press conducted the survey since its inception until this year. The leading topics for desired CE offerings were: PDAs (Personal Digital Assistants), current copyright issues, including what role libraries should play in their institutions; e-journal licensing, access and group purchasing issues; and Internet document delivery. The results can be seen at http://depts.washington.edu/pncmla/ce/02results.html.

3. Network Membership Program

MEMBERS
2001-02
2000-01
Full
160
280
Affiliate
143
0
TOTAL
303
280

Total network members at the end of the year were 303, an increase of 23 members during the year. Full members account for 160 of these and affiliate members for 143. Since the affiliate member category was new this year, 114 existing full members (non-DOCLINE participants) were converted from full member to affiliate.

A network membership request form for the Pacific Northwest Region was added to our Web site. This form facilitates applications for funding from us, since we provide funding to network members only.

DOCUSER records for network members were updated. All members were contacted and given four opportunities to check and correct their directory data: a general e-mail via the PNRNews mailing list; an individualized e-mail to those who did not respond to the general e-mail; individualized letters to those who did not respond to the e-mails; and phone calls to the remainder.

4. Document Delivery

2001-02
2000-01
SERHOLD Participants
160
150
DOCLINE Participants
163
159

A Web site to assist library staff in using PubMed's LinkOut service to connect users to electronic journals was developed by S. Barnes. It may be viewed at http://nnlm.gov/libinfo/ejournals/linkout/. The site has been well received by librarians and has received favorable comments from the LinkOut service team.

Developed a mechanism to update SERHOLD data at the Pacific Northwest Region's public SERHOLD Web site, using DOCLINE/SERHOLD data. Recruited four member libraries to participate in a pilot project. In this project, NLM and OCLC would use these libraries' SERHOLD data to test algorithms for transferring holdings information from SERHOLD to WorldCat, and the libraries would then evaluate the result.

S. Barnes updated the DOCLINE Tutorial to incorporate the changes brought with version 1.3 introduced during the year. The update was so extensive that it is essentially a new edition. The tutorial continues to be popular with library staff learning to use DOCLINE effectively.

S. Barnes and M. Boer actively participated in the DOCLINE Interface Review Team throughout the year.

5. Resource Libraries
The Resource Libraries from the previous contract continued during this fist year of this contract. They are:

University of Alaska Anchorage, Health Sciences Information Service
Idaho State University (Pocatello), Idaho Health Sciences Library
Montana State University (Bozeman), MSU Libraries
University of Montana (Missoula), Mansfield Library
Oregon Health & Science University (Portland), Library
Washington State University (Pullman), Health Sciences Library
Intercollegiate College of Nursing/Washington State University, College of Nursing (Spokane), Betty M. Anderson Library
Fred Hutchinson Cancer Research Center (Seattle), Arnold Library

In addition to the RML's host institution (University of Washington), OHSU is the only other medical school in the region. This is unique among NN/LM regions. The other Resource Libraries support various health professional education programs. Many also provide outreach services to practicing health professionals.

There was no meeting of Resource Libraries during the year.

At the end of the year Memoranda of Agreements were sent to the existing Resource Libraries for renewal of their agreement to serve throughout the 2001-2006 contract. Resource Library directors/representatives were asked if there were other libraries in their state that they thought should be considered for Resource Library status. There were no suggestions for any additions.

6. Communication
The PNRML's main communication mechanisms are a quarterly Web-based newsletter-the Dragonfly-and an e-mail list-PNRNews-that is used to issue NLM and NN/LM related announcements. Approximately 100 announcements were distributed via PNRNews in the year.

PNRML staff also manage a regional e-mail list for health library related issues-HLIB-NW. All PNRNews messages are broadcast over HLIB-NW as well. There were 365 subscribers to HLIB-NW at year's end, about the same as the year before (361); and 878 messages were sent during the year, a decline from the previous year of nearly one-third (1,317 a year before).

Twenty articles were published in the Dragonfly in the year. Each article is distributed as a message in PNRNews, then compiled with other articles appearing during the quarter on the Web. Topics included:

  • Tribal Health Connections, the Gates Foundation funded outreach project in the Four Corners region of the southwest
  • An update on SERHOLD and the public's access to health information
  • Funding opportunities
  • An update on a consumer health outreach project in Idaho by the project P.I.
  • Connecting the county library branches in Wallowa County, OR, to the Internet.
  • How to cite Web pages
  • How to propose a project for regional outreach funding
  • Examples of successful outreach projects carried out by regional network members
  • Outreach to the public health workforce
  • How to serve the health information needs of the general public
  • Health information literacy
  • Regional libraries successfully complete group subscription of e-journals package
  • Highlight of regional outreach project awardees
  • How to place Holds in DOCLINE
  • CDCynergy: an evidence-rich method for public health communication
  • Low literacy health information
  • PubMed search strategy selection tips
  • Web access for the disabled
  • Examples of network member outreach to new audiences

Articles by PNRML staff that appeared in other publications during the year:

Hart G, Larson E., Tarczy-Hornoch P, House P, Masuda D, FULLER S, Dyck S, Norris T. Low-Bandwidth, Low-Cost Telemedicine Consultations in Rural Family Practice. Journal of American Board of Family Practice, 15(2): 123-127, 2002.

Hoskins RE, O'Connor C, Johnson C, O'Carroll P, FULLER S. EpiQMS: An Internet Application for Access to Public Health Data for Citizens, Providers, and Public Health Investigators. Journal of Public Health Management and Practice, 8(3):30-36, 2002.

Stewart BK, FULLER SS, Ramey JA, Lober WB, Chou D, Langer SG, et al. Regional Collaborative Cancer Care Using the Next Generation Internet. Radiology, 221P, 375, 2001.

Stewart BK, FULLER SS, Ramey JA, Lober WB, Chou D, Weghorst SJ, Langer SG, Martin KP, Ketchhell DS, Robinson TA, Maberry R, Li H. Tumor Conferencing Tools for Regional Collaborative Cancer Care Using the Next Generation Internet. Proceedings, American Medical Informatics Association, Annual Symposium, 836, 2001.

RAMBO N. Adventures in outreach: what we know and what we don't. PH/HA News (newsletter of the Public Health/Health Administration Section of the Medical Library Association), Summer/Fall 2001.

RAMBO N, Zenan JS, Alpi KM, BURROUGHS CM, Cahn MA, Rankin J. Public health outreach forum: lessons learned. Bull Med Libr Assoc 2001 Oct;89(4):403-406.

Zenan JS, RAMBO N, BURROUGHS CM, Alpi KM, Cahn MA, Rankin J. Public health outreach forum: report. Bull Med Libr Assoc 2001 Oct;89(4):400-403.

Articles about PNRML or related activities:

Alaska Airlines Magazine, June 2001 (p. 26-31, 84-88), had an article entitled "Wellness on the Web." Carolyn Latteier, the author, interviewed N. Press, Consumer Health Coordinator, for the piece. N. Press is quoted several times, as is Eve-Marie LaCroix from NLM. Written for the traveling public, the article discusses how to evaluate health websites, and presents what the author describes as "a sampling of Websites that provide good health information."

The PNR outreach funding to Wallowa County, Oregon was described in "Chance meeting in Troy yields high speed Internet," Wallowa County Chieftain, May 10, 2001.

An article based on presentations to rural nurses (funded by a PNRML outreach project award) by Bob Pringle, Director of Library Services at the Intercollegiate College of Nursing, was published in the Online Journal of Nursing Informatics. Pringle, R. (January 2002). What Rural Nurses Hope to Find on the Internet. Online Journal of Nursing Informatics (OJNI). Vol. 6, No. 1. [Online]. Available at http://www.hhdev.psu.edu/nurs/ojni/article_part_i.htm.

An interview with R. Sahali and N. Press, entitled "Project Helps Native American Communities Get Online; Tribal Connections Helps Address Health-Care Disparities," appeared in the 2001 University of Washington Academic Medical Center Dean's Report, which was published in April, 2002 http://depts.washington.edu/drrpt/2001/outreach/tcp.html.

An interview with N. Rambo, R. Sahali, and N. Press, entitled "Tribal Connections in the Pacific Northwest" appeared in the Winter 2002 issue of the University of Washington Libraries' Library Directions newsletter. http://www.lib.washington.edu/about/libdirections/ldwin02-web2.pdf.

The Library Directions article was highlighted for a day on the University of Washington's home page, on Mar. 15.

The first major redesign of the PNRML Web site was unveiled in Dec. 2001 following an extensive review, development, and testing process by the PNRML staff, with input from several network members. Emphasis was put on ensuring that the site functions well as a communications tool with network members, in particular, and to aid anyone who comes upon the site to get where they want to go as easily as possible. Reaction to the redesign was immediate and positive.

7. Regional Advisory Committee
Although there was not a face-to-face meeting during the year, the Consumer Health Information Advisory Group continued to provide expert guidance to the PNRML. N. Press worked with the Group to consider the question: How can public librarians safely help the public find health information? The Group's creative and extensive response was summarized by N. Press and published in the Dragonfly newsletter.

The advisor roster is at http://nnlm.gov/pnr/hip/advisors.html.

N. Rambo enlisted the Distance Learning Coordinators (DLC) at the state health departments in all five states in the region to be advisors to the PNRML on health information training of the public health workforce. The group came together once during the year in conjunction with a meeting of the Northwest Regional Public Health Network, a combined 6-state Public Health Training Center (HRSA) and Public Health Preparedness Center (CDC) network. As a faculty member of the network coordinating body-the NW Center for Public Health Practice-Mr. Rambo was able to meet with the DLCs at the NRPHN meeting. The DLCs are enthusiastic about advising and working with the PNRML in the future.

The Distance Learning Coordinators for the region are:

Pat Carr (interim), Alaska Division of Public Health
Scott Cantor, Central District Health Department (Idaho)
Christina Hingst, Montana Public Health and Human Services
Tim Engle, Oregon Public Health Services
Janice Taylor, Washington State Department of Health

8. Monitor Region's Programs
In response to a request from the National Library of Medicine about special library services for people with disabilities, N. Press surveyed the region's libraries, of all kinds, using the library discussion lists for all five states. Ms. Press summarized the results, presented them on the discussion lists, and forwarded the results to NLM.

9. User Feedback
Network member feedback regarding Dragonfly articles:

Thank you, thank you! For the good information in this email! It's helpful and very timely. I'm in the process of budget planning for next year and we all know that administrators need convincing news to back our requests!! Once again, Dragonfly comes through.

Outstanding _Dragonfly_ article on making the web accessible for the disabled. May I make 12 copies to pass along to [our institution's] web committee? Yes, I'll add the URL, but I want to know the members have a copy.

There was much positive feedback from network members in Dec. 2001 after the new look of the PNRML Web site appeared.

10. Training Facility
PNRML staff conducted four training sessions in the Learning Teaching Lab in the University of Washington Health Sciences Library. The groups trained were from: the Pacific Northwest Chapter of the Society for Public Health Educators, the University of Washington School of Medicine's Native American Center of Excellence, and the librarians and staff at the University of Washington Health Sciences Library. Thirty-seven people were trained. The subjects included PubMed and other NLM resources, other Internet training, and also CDCynergy.

We advertised the National Training Center online classes to librarians over the state and regional library association e-mail lists in the region. Before the advertisement went out not many people had registered for the classes that were scheduled in the region, but shortly after the announcement was made, the classes filled up. There was a good response from public, community college, and special librarians.

11. NLM User/Non-User Needs Assessment
As part of our effort to redesign the PNR Web site, we solicited a small number of network members to volunteer for some usability testing. We developed a list of tasks and questions for each participant, who looked at our existing Web site and two versions of the new design, and provided feedback. Some of the findings were:

  • Brief annotations are preferred over no annotations.
  • Brevity is preferred over wordiness.
  • Our jargon is unclear to many ("RML," "Evaluation," "Outreach," "Finding Information," "ProvidingInformation," etc.), reinforcing the need for brief annotations.
  • Repetition of terms in annotations where the terms appear in other category headings is confusing.
  • Intended audience should be made clear.
  • Those who were familiar with the existing Web site and used it regularly preferred it over the new one, others preferred the new one.

12. NLM Grants
The announcement of NLM's additional June 22, 2001, submission date for Internet Connections Grants generated more interest in our region than any other previous NLM funding announcement. L. Milgrom responded to 13 inquiries or requests for sample proposals.

The new Internet Access to Digital Libraries grant program also generated interest from many network members and other organizations. L. Milgrom responded to many e-mail and telephone inquiries and reviewed several proposal drafts.

13. Follow-up with NLM-funded Projects
L. Milgrom contacted new NLM Connections grantees in the region to offer assistance. Since two are in Alaska, she discussed training opportunities through the Alaska Health Sciences Information Service, based at the University of Alaska Anchorage.

N. Press met with and will be working with the EthnoMed/Immigrant Communities Grants Program, Harborview Medical Center (Seattle, WA) that has received grant funding from NLM. She prepared a draft curriculum for the project to use and she will be involved in carrying out training, especially with the Latino community.

N. Press worked with the NLM-funded consumer health project EthnoMed/Immigrant Communities at Harborview Medical Center in Seattle. N. Press developed the curriculum and then taught a session to representatives of the communities on Jan. 5.

N. Press arranged for and participated in an evaluation of community health organizations' consumer information policies and practices in Yakima, WA. The evaluation was carried out as part of research being conducted by Dr. Karen Pettigrew and her research associates at the University of Washington Information School. The community health organizations reviewed were those that participated in the Central Washington Health Information Network project funded by the PNRML in 2000.

Wallowa County Library won the Public Library Association's Small and Rural Library award, based on work funded in 2001 by the PNRML for a consumer health information outreach project in Wallowa County, the northeastern most county in Oregon. The award was highlighted at the NLM booth at the Public Library Association conference in Mar. and will be presented to Conni Curry, the Wallowa County Library director, at the 2002 ALA annual meeting.

B. Expanded Outreach Programs

1. Outreach to Health Professionals
PNRML staff conducted 15 sessions (presentations and/or trainings) for 220 health professionals throughout the year. This compares to 22 sessions and 453 participants the previous year.

Subcontractors conducted 4 sessions reaching 28 health professionals.

Another three sessions for 29 medical librarians were conducted.

We funded one outreach subcontract directed to health professionals: Cross Cultural Health Care Program Resource Center (Seattle, WA; Project Director: Alison Alfonzo Pence; Nov. 2001-May 2003): The goal of the Cross Cultural Health Care Program Resource Center is to provide current and often difficult to obtain resources and to improve users' access to relevant content. The Resource Center is a small "special library" with a valuable and sizable collection, primarily serving CCHCP staff and training participants, health care providers, students, consultants, and members of community service agencies. The Resource Center has not conducted outreach in the past, and external users have typically discovered it through CCHCP staff, the web site, or word of mouth. This project will support outreach efforts to increase visibility and services to health care providers, institutions, and providers-in-training through the region. With the increasing growth of immigrant and refugee communities, providers will benefit from access to the services and resources.

2. Consumer Health Information Services

PNRML staff conducted eight sessions (presentations and/or trainings) for 122 consumers throughout the year. This compares to 11 sessions and 290 participants the previous year.

Subcontractors conducted 4 sessions reaching 53 consumers.

Three resource libraries submitted proposals to the PNRML for outreach project funding. The Oregon Health & Science University proposal-Finding It on the Internet: Health Access for Elders-with Dolores Judkins at P.I., was funded. The project began in early 2002. The purpose of this project is to provide easily accessible health information for elders through the Internet. Using a web page designed by elders and persons from the OHSU Division of Medical Informatics and Outcomes Research, OHSU Library and the OHSU Center for Healthy Aging, elders will be able to find information on health, illness, end of life issues, and other health-related topics of interest. The site will contain links to established health sites on the web as well as original content written by nursing faculty at OHSU. It will also contain information on local organizations that work with elders. In addition, the project will provide information regarding the relationship between what participants say is useful site design as compared with generally accepted best practice for usability. This research can be used by others to assist in their own web development, and the site can serve as a model for future sites.

We funded one outreach subcontract directed to health consumers: Southwest Oregon Area Health Education Center (Roseburg, OR; Project Director: Brendan L. Ashby; Nov. 2001-May 2003): The Cyber Health Camp seeks to provide high school youth and educators with a regional health career and medical issues information repository using the Internet and online resources, increasing knowledge of rural health opportunities through the development of an interactive web-based application. This application will allow students from disadvantaged backgrounds to develop Internet skills and to access information on health careers, rural healthcare opportunities, a healthcare calendar of events/programs, university and college healthcare related programs, scholarships, and regional healthcare institutions. The Cyber Camp program is the culmination of multiple collaborative relationships including partners from high schools, universities, hospitals and other community based organizations.

N. Press was approached by Theresa Cullen, MD, MS, National Informatics Consultant, Indian Health Service, Tucson, AZ, to develop a consumer health information page for the national HIS Web site. Ms. Press solicited topic suggestions widely from several American Indian/Alaskan Native health organizations, carefully chose quality sites (using criteria similar to that for MEDLINEplus selection) with a reading score no greater than 6th grade. HIS tested the page internally with positive results. Wider testing will be conducted prior to unveiling the site publicly.

3. Training to Support Electronic Access to Health Information
PNRML staff conducted 11 training sessions for 70 health professionals and 35 medical librarians. Subcontractors conducted one training session for seven health professionals.

4. Exhibits and Presentations at Meetings
During the year, PNRML staff and subcontractors exhibited at the following regional and cross-regional meetings (The number of people contacted at the exhibit is noted following the meeting name.):

SUBCONTRACTORS
Western Migrant Stream Forum, 61

REGIONAL
Affiliated Tribes of NW Indians, 75
Clark County Health Teachers, 44
Good Shepherd Community Hospital Health Fair, 35
Idaho Hospital Association, 85
Idaho Library Association, 47
National Alaska Native/American Indian Nurses Association Summit, 37
National Congress of American Indians, 246
National Indian Education Association, 310
Northwest Regional Primary Care Association/Community Health Association of Mountain/Plains States Fall 2001 Primary Care Conference, 35
NW Regional Primary Care Association, 70
NW Regional Rural Health Conference, 55
Oregon Library Association/Washington Library Association, 135
Pacific NW Library Association, 30
Pacific Northwest Chapter/Medical Library Association, 35
Washington State Joint Conference on Health, 99

TOTAL: 1338

NATIONAL
American Academy of Pediatrics, 215
American College of Rheumatology, 192
American Geriatrics Society, 107
Annual Conference on Patient Education, 77
Association for Professionals in Infection Control and Epidemiology, 140
Association of Public Health Laboratories/ Council of State and Territorial Epidemiologists, 54
Society of Public Health Education, 59

TOTAL: 844

We sent out many promotional items to librarians in the region for exhibits at community health fairs, for example, or for classes. MEDLINEplus tote bags, pens, bookmarks, and Health Hotlines. Librarians found out about our promotional items mainly through the exhibits we have held at various library meetings.

Health professional and public awareness of MEDLINEplus remains low. We note that the name is often confused by health professionals with MEDLINE.

5. Technology Awareness and Integration
R. Sahali participated in the 2001 Indian Health Service Technology and Program Support Conference in Albuquerque, New Mexico. He presented on the Tribal Connections project, including challenges faced and the issues related to computer training and factors contributing to the sustainability of this outreach effort. He emphasized that NLM is a potential funding source for Internet connectivity for tribal health programs. He advised the IHS Web team to link to the NLM Web site, especially to MEDLINEplus, and to the Tribal Connections site for references specific to Native American health.

The PNRML, the University of Washington Health Sciences Library and the Washington Medical Librarians Association (WMLA) cooperated to bring the MLA Satellite Teleconference Program "Sync or Swim: Managing the Flood of PDAs in Health Care" in Feb. 2002. Thirty-five people attended the broadcast.

R. Sahali worked with the Affiliated Tribes of Northwest Indians (ATNI), the Washington State Governors Office on Indian Affairs to develop a proposal to regional foundations to fund tribal telecommunications planning, infrastructure, hardware, training, and content. There is the potential to reach all 28 tribes in Washington State. ATNI is the lead (and fiscal) agent on this effort. ATNI has received a $462,000 award from the Seattle Foundation for tribal/consumer telecommunications education. The RML and Tribal Connections are partners in this effort. These efforts are related to Tribal Connection's continuing emphasis on e-health resources in tribal communities.

6. Library Improvement
L. Milgrom made site visits to hospitals in Omak and Republic, WA. Neither has a library nor institutional access to information resources. After the visits, Mid-Valley Hospital in Omak made arrangements for document delivery with network member libraries in Spokane and Wenatchee and decided to subscribe to MD Consult. Ferry County Memorial Hospital in Republic submitted a proposal for an NLM Connections Grant.

The region's first group purchase of electronic journals was finalized. Twenty-five libraries have subscribed to 140 Lippincott Williams & Wilkins e-journals from Ovid. Libraries are from 4 of the 5 states in the region, plus two libraries from British Columbia. Service started at the beginning of January.

C. Enhancements

Enhancement One
R.Sahali continued to support the four tribes in the 2nd phase of the Tribal Connections project: Taos and Jemez Pueblos in New Mexico, Colorado River Indian Tribes in Arizona, and Shoshone-Paiute in Nevada. Equipment installation, networking and Internet connections were completed. This enhancement from the prior RML contract supported a portion of larger projects at each site. Each tribe will continue to pursue grants and other support to close their telecommunication gaps. Internet search training is pending for all sites except Taos Pueblo, where Barb Hau, a former NLM Informatics Fellow, is working with La Plaza Telecommunity, to provide training. Taos has and will continue to provide training on NML products.

R. Sahali and Fred Wood, Tribal Connections project officer (Office of Health Information Programs Development Office/NLM) visited four Indian communities: Shoshone-Paiute in northern Nevada, Nez Perce in southern Idaho, Umatilla and Grand Ronde, both in Oregon. Three were Tribal Connections sites. The general purpose of the visits was to solicit feedback on: 1) how well Tribal Connections worked with the (project) tribes, 2) determine if and how NLM funded hardware was being used, 3) any hardware enhancements or upgrades after the Tribal Connections intervention. The feedback was uniformly positive.

PNRML staff (S. Fuller, N. Rambo, R. Sahali, and Molly McGetrick (funded by the Gates Foundation and based in New Mexico), attended a key meeting hosted by the Midcontinental RML at the University of Utah, Salt Lake City. The subject of the gathering was cross-regional outreach to Native Americans. Representatives from the four western RMLS and the Four Corners Resource Libraries participated in the meeting. Building on lessons learned from both the NLM- and Gates Foundation-funded segments of the Tribal Connections project, an action plan was developed that will ensure adequate communication among all parties, sharing of works in progress, and coordination of activities.

A 3rd phase of Tribal Connections was planned, funded (by the NLM Office of Health Information Programs Development), and implemented during this year. The stated purpose of this enhancement is to test a model for health information outreach in Native American communities. The model will be based on that developed and refined during the prior phases of Tribal Connections. A focus of the work during this phase is to determine appropriate evaluation criteria. This project phase will run two years.

R. Sahali has screened the communities from the 1st phase and identified three tribes to participate: the Samish, Anacortes, WA; Confederated Tribes of the Umatilla, Pendleton, OR; and the Nez Perce, Lapwai, ID. Mr. Sahali is the project lead for each of these sites. A different PNRML librarian will serve as a liaison to each of the three communities: The liaisons and Mr. Sahali, will comprise the community-specific project teams. Each 2-person team will determine, with their community representatives, how the outreach model will be implemented in their community. An evaluator will round out each of the 3 teams. Joan LaFrance, a Native American (Turtle Mountain band of the Chippewa tribe) with extensive program evaluation experience, particularly with tribes, will assist with this project.

Enhancement Four
National Outreach Mapping Center, Indiana University: This new Center, established as a subcontract through the Pacific Northwest Region to facilitate interaction with the PNR-based Outreach Evaluation Resource Center, is to serve as an aid to ensuring the effective distribution of outreach services by the NLM and the National Network of Libraries of Medicine. The Center is being developed by IU's Ruth Lilly Medical Library and the Polis Center (a multidisciplinary urban analysis organization), under the direction of Dr. Julie McGowan.

Now that the NLM and many NN/LM members have information services aimed at the general public (in addition to the traditional library services they provide to the biomedical community) it is important to be able to identify and track the special outreach efforts being made on behalf of both consumers and health professionals. The equitable geographic distribution of services and resources is one goal. Another is to be able to "see" which demographic groups are being served, including seniors, people with AIDS, rural citizens and their providers, inner city populations, minority populations, and other underserved groups.

With the establishment of the National Outreach Mapping Center, NLM will have enhanced ability to track and map these efforts. The information the Center will provide will aid us in evaluating our efforts and in identifying potential areas to target.

Planning and needs assessment formed the base of Year 1 activities. Planning meetings with NOMC staff were held with National Library of Medicine staff and PNR staff at the University of Washington. NOMC staff conducted structured interviews with staff at each RML and compiled results of these information gathering activities.

D. NN/LM Web Service

Michael Boer continued to manage the national NN/LM Web service from his base at the PNRML. Mar. 15, 2002 marked the 8th anniversary of the public launch of the NN/LM site.

"Reports" are how many searches are conducted on DOCUSER data for libraries that offer Loansome Doc and/or reference services. The reports generated indicate that this is a popular service and that it decreases the number of telephone calls for Loansome Doc referrals.

Month Visits Reports
May 2001 84,859 6,607
Jun. 2001 80,234 6,232
Jul. 2001 78,820 6,225
Aug. 2001 83,831 6,245
Sep. 2001 76,066 5,509
Oct. 2001 88,834 6,570
Nov. 2001 86,781 6,233
Dec. 2001 75,480 4,506
Jan. 2002 95,478 6,196
Feb. 2002 89,303 6,450
Mar. 2002 97,313 6,477
Apr. 2002 95,795 6,761

TOTAL VISITS: 1,032,794 (86,066 average/month)
TOTAL REPORT: 74,011 (6,168 average/month)

These totals and averages can be compared to an average of 81,042 visits per month and 7,993 reports per month during a 7 month period of 2000-2001 (from when data began to be collected). Visits increased during the current year by about 5,000 per month on average, or about 6%. Reports requested declined by 1,825 per month on average, or 23%.

The nnlm.gov search engine was re-programmed to refer more easily and directly to MEDLINEplus, based on an analysis of search terms entered that indicated the majority of words that people enter were related to health topics. This would indicate that many people are ending up at the NN/LM Web site looking for health information, rather than the primary constituencies of the NN/LM site. The use of site and search engine will continue to be monitored to make it easier for people to get to what they are looking for.

E. Administration, Staff, and Other

Molly McGetrick started as the Health Information Computing Trainer for the Tribal Health Connections project, funded by the Bill & Melinda Gates Foundation. M. McGetrick will be based in New Mexico (her home) and will be in residence with staff in Seattle on an as needed basis.

L. Milgrom's 20th anniversary with the University of Washington Libraries was recognized during a Health Sciences Library All-Staff meeting in Dec. 2001. Appreciation for Linda's contributions to NLM's online training and outreach programs was expressed in messages from several NLM staff members. PNRML staff provided some much needed irreverence to the observance.

M. Blake celebrated her 10th anniversary with the PNRML in Feb. 2002.

N. Press submitted her resignation, after having served 23 years in the RML program-at Harvard for three years, and at the University of Washington for 20 years. She will be Library Director at Mars Hill Graduate School in Bothell, Washington.