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National Network of Libraries of Medicine
Pacific Northwest Region

Annual Report

May 1, 2002- April 30, 2003


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.

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 2002 through April 2003, the second year of the NN/LM PNR 2001 - 2006 contract.

Highlights this year include:

  • The regional group subscription to 142 Lippincott Williams & Wilkins electronic journals was successfully renewed. Twenty-two libraries from four states and one Canadian province are participating, serving a population of 17,878 FTE with access to a large collection of high quality e-journals. Once again, just as last year, negotiations -- led by Susan Barnes, Resource Sharing Coordinator, on behalf of the participants -- regarding participation and cost sharing continued until almost the last minute. The Washington Medical Librarians Association is acting as the fiscal agent for this agreement.
  • Participation in the Electronic Funds Transfer System (EFTS) began in this region in November, with Virginia Mason Medical Center of Seattle, WA, the first library to join. Since then, four additional libraries have joined: Willamette Falls Hospital in Oregon City, OR; Swedish Medical Center-First Hill and Swedish Medical Center-Providence in Seattle, WA; and Linfield College Portland Campus, Portland, OR.
  • The DOCLINE Tutorial at -- and linked from the DOCLINE Help section -- was updated to reflect version 1.4 improvements plus changes in PubMed and LOCATORplus. Most of the tutorial required revision.
  • The Tribal Connections project Web site -- -- was redesigned to become more of a portal for AI/AN health information resources with a focus on NLM resources. Work continued on refining and organizing the content.
  • Gail Kouame, the new Consumer Health Coordinator, joined the staff in January 2003.

A. Network Programs

1. Health Professional Access to Information Services
Susan Barnes, Resource Sharing Coordinator led a conference call between members of the Washington Medical Librarians Association board and two nationally-recognized experts on consortial purchasing in libraries: John Helmer of the ORBIS consortium, and Ann McKee of the Greater Western Library Alliance. Mr. Helmer and Ms. McKee were very generous in sharing their experience and insights. The discussion resulted in important logistical decisions regarding the management of the WMLA group subscription to 140 Lippincott Williams & Wilkins ejournals from Ovid: each participating institution will sign its own contract with Ovid, and each participant will also sign a memorandum of agreement with WMLA. This memorandum of agreement documents willingness to pay the amount that is determined to be the participant's share. This was valuable in the continuing development of local experience and knowledge about consortial buying arrangements.

The Pacific Northwest Chapter, Medical Library Association, decided to explore whether consortial purchasing of electronic journals and databases could be part of its functions. A committee has been named to begin this investigation, with Susan Barnes as a member. This effort would replace the Washington Medical Library Association consortial purchasing, which has been regional from the beginning because more libraries than just those in Washington were needed to bring more purchasing power. Participants in the existing WMLA consortial subscription to 142 Lippincott Williams & Wilkins titles are enthusiastic about being able to provide access to this content for their users. They report that the titles are not only important for their institution's work, but that providing access to the titles is also excellent public relations for the libraries in the group.

2. Assess Needs of Health Science Librarians
A question-and-answer session at the Washington Medical Librarians' Association Internet Users' Group revealed information needed by potential participants in the Electronic Funds Transfer System (EFTS).

The Technology Committee of the Pacific Northwest Chapter of the Medical Library Association, chaired by Susan Barnes, developed and administered a Web-based survey to learn about how libraries are using electronic document delivery (EDD), the positive and negative aspects of these libraries' experiences with EDD, how patrons have reacted to EDD, and what issues stand in the way of other libraries' using EDD. 119 libraries responded to the survey and provided more than just straight answers to the survey's multiple-choice questions -- they also graciously contributed a wealth of valuable comments. In summary, two-thirds of respondents were from hospital libraries and the most common ways to receive documents via EDD are by:

  • receiving pdfs via email (79 libraries)
  • picking up pdfs on the Web (49 libraries), and
  • receiving tiffs via email (44 libraries).The survey results revealed the following needs among libraries in the region:
  • information on EDD in general
  • information on inexpensive ways to begin offering EDD
  • information on free software for EDD
  • information on selecting scanners
  • assistance with Ariel and firewalls
  • assistance with copyright and license questions
  • funding support for startup costs, and
  • strategies for staff development.

During the coming year, the committee will develop training, beginning with the approaches of supporting receipt of documents. Encouraging use of EDD for sending documents will be a goal to be addressed later.

Maryanne Blake, Education/Communication Coordinator, conducted the joint Pacific Northwest Chapter of the Medical Library Association and NN/LM PNR professional development survey of librarians in the region. The survey was Web-based for the first time and many of the questions were different from previous versions. A total of 68 people completed the survey, a 28% increase over last year. The top suggestions for classes were digital libraries and electronic resources, including journals, and how to market to administration and other user groups.

Staff attended the annual meeting of the Washington Medical Librarians Association in April, held on the Bastyr University campus in Kenmore, WA.

3. Network Membership Program


4. Document Delivery
The Directory of Health Science Libraries is being printed and is due for delivery at the end of May, 2003.

SERHOLD Participants
DOCLINE Participants

Susan Barnes was selected as the ILL Liaison from MLA to ALA, and following the ALA annual meeting she submitted an ILL news update to the Medical Library Association's MLA News.

Four libraries in the region (Seattle Children's Hospital, Intercollegiate College for Nursing Education, Tuality Community Hospital, and Tuality Health Information Resource Center) participated in the pilot project to test batch transfer of SERHOLD data into OCLC WorldCat, and helped NLM and OCLC determine that their records should be upgraded with identification numbers from each.

The Electronic Funds Transfer System (EFTS) was a focus for the NN/LM PNR exhibit at the annual meeting of the Pacific Northwest Chapter of the Medical Library Association and was also the topic for two presentations on the meeting program. Ralph Arcari from the University of Connecticut brought the exhibit and made the presentations, for a successful introduction of the system to the region that resulted in several libraries' deciding to join.

Susan Barnes made a presentation about DOCLINE at the first annual Northwest Resource Sharing Conference. The presentation focused on benefits of DOCLINE for non-medical libraries, and also summarized ILL options for access to medical publications for non-DOCLINE libraries.

An effort to encourage libraries in this region to use electronic document delivery (EDD) began, based on results from the survey conducted by the Pacific Northwest Chapter/Medical Library Association Technology Committee, chaired by Susan Barnes. The library at the Intercollegiate College of Nursing -- a resource library -- is sending a test TIFF file to libraries so that they can learn whether they can open and read this standard format used by the Ariel EDD software. This ability to receive documents is the first, least complicated step toward EDD participation. The test was announced on our regional e-mail discussion list, HLIB-NW on January 23. By the end of the quarter, 26 libraries had requested test TIFF files to be sent (this includes two Canadian libraries, a library in Wyoming, and a library in North Dakota -- evidence of the broad reach of our regional discussion list). Libraries that open this test file successfully will be encouraged to change their DOCUSER records to indicate that they can receive via e-mail in TIFF format. The PNC/MLA Technology Committee will conduct further educational efforts to help DOCLINE libraries in this region expand their EDD capacities.

5. Resource Libraries
We have added Bastyr University, a natural health sciences university in Kenmore, Washington, to our Resource Libraries Group. Current Resource Libraries are:

Alaska: University of Alaska Anchorage, Health Sciences Information Service
Idaho: Idaho State University (Pocatello), Idaho Health Sciences Library
Montana: Montana State University (Bozeman), MSU Libraries; University of Montana (Missoula), Mansfield Library
Oregon: Oregon Health & Science University (Portland), Library
Washington: 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, Bastyr University Library (Kenmore).

In addition to the PNR'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.

The next meeting of Resource Libraries is planned for June, 2003.

At the Pacific Northwest Chapter of MLA annual conference in Vancouver, BC. Neil Rambo, Associate Director, and Ms. Barnes, met with the Resource Library representatives who were attending the conference. This included Jim Morgan (Oregon Health & Science University), Kathy Murray (University. of Alaska Anchorage), and Vicki Croft (Washington State University). Resource library issues, particularly budget cuts and e-journal management, were discussed.

Sherrilynne Fuller, Director, Neil Rambo, Associate Director, and Susan Barnes, conducted the first of a planned series of site visits to resource libraries by traveling to the Oregon Health & Sciences University library in Portland, OR, for a 1-day visit. Wide-ranging discussions included research into information needs of county public health workers; access to electronic content from remote locations; an Internet Access to Digital Libraries grant-funded project to provide e-journal and e-book access to licensed nurses in Oregon, and issues in adopting EFTS by large libraries whose document delivery operations depend on cost recovery.

6. Communication
171 NN/LM and NLM related announcements were distributed via PNRNews this year, a 71% increase from last year.

HLIB-NW, the regional e-mail list for health information community, had 904 messages sent, about a 3% increase over the previous year.

18 articles were published in the Dragonfly newsletter. Topics included:

  • Complementary and Alternative Medicine (CAM) research using MEDLINE
  • Parts 1 and 2 of "Focus on Funding", a new three part series on consumer health outreach projects: Access to Wellness Project by the African Americans Reach and Teach Health Ministry in Seattle and Computer Health Literacy for Seniors in Northern Idaho, sponsored by the Kootenai Medical Center Library in Coeur d'Alene
  • Electronic Funds Transfer System (EFTS) participants in our region
  • a profile of Gail Kouame, the new PNR Consumer Health Coordinator
  • the second part of an article by Drexie Malone, a U. of Washington Information School student, describing a usability study of participants with visual impairment using the NN/LM PNR Website
  • an article on the new LinkOut-SERHOLD interface

Articles in other publications about PNRML or related activities:

The December 2002 issue of Medicine on the Net featured an article on the newly launched Indian Health Service Consumer Health Information page which was developed by PNR staff. The page can be accessed at

The March 2003 issue of Brainstorm, the City of Seattle's Community Technology E-zine featured the EthnoMed Project in the "What's Hot" section:

An article appeared in the Clearwater (ID) Tribune, February 13, 2003, following a demonstration of MEDLINEplus and PubMed conducted by Linda Milgrom. Later in the quarter, Pam McBride, manager of an IADL-funded project based at Clearwater Valley Memorial Hospital, forwarded to us an e-mail from a physician who attended the session. Dr. McGrath commented, "The patient page MEDLINEplus through the NLM is a great resource in patient care. I probably give patients info from it 5 -8 times/day. I am glad we got turned onto it at that meeting."

7. Regional Advisory Committee
Although the Consumer Health Advisory Group did not meet in person this year, the members continued to offer guidance and advice to the PNRML on serving consumers. The email discussion list for the group remains active.

8. Monitor Region's Programs
Although the Consumer Health Advisory Group did not meet in person this year, the members continued to offer guidance and advice to the PNRML on serving consumers. The email discussion list for the group remains active.

9. User Feedback
Drexie Malone, a University of Washington Information School student who has been working with the PNR Web committee, concluded her usability study of the regional web site for blind users, and reported on the results, which were generally positive: the site is fairly easy to use via a screen reader. A few minor difficulties were revealed through this study, including the screen reader's pronunciation of initialisms and unfamiliar terms such as MEDLINEplus, and problems caused when the screen reader is set to "links only" mode and skips any textual explanations of links. All users completed their assigned tasks successfully, but tasks involving location of information below the top level page took noticeably longer.

10. Training Facility
The training facility was used by the NTCC trainers for PubMed and Gateway classes on March 11 and 12. Thirty-eight students participated.

11. NLM User/Non-User Needs Assessment
Nothing to report.

12. NLM Grants

Linda Milgrom was named to an NLM Special Emphasis Panel for Internet Access to Digital Libraries (IADL) grants and reviewed IADL proposals July 22-23, in Chevy Chase, MD. In addition, she consulted with many applicants for the PNRML Outreach Project Awards and IADL grants.

Linda Milgrom, Roy Sahali, and Susan Usitalo traveled to the Nez Perce reservation (Lapwai and Kamiah, ID) June 4 and 5, to begin discussions of Tribal Connections activities. The team attended a staff meeting of the tribe's Community Health Department and had discussions with individuals from the information technology and clinical departments of Nimiipuu Health (the Nez Perce health department).

Maryanne Blake, Roy Sahali, and Joan LaFrance traveled to the Confederated Tribes of the Umatilla Indian Reservation ( Pendleton, OR) on June 11 and 12 to begin discussions of Tribal Connections activities. The team was invited to attend a meeting of the Tribal Health Commission and had discussions with individuals from the information technology and clinical departments of Yellowhawk Clinic.

13. Follow-up with NLM-funded Projects
In February, Linda Milgrom, Outreach Coordinator, visited three outreach sites in north central Idaho, accompanying Pam McBride, manager of an IADL-funded project in the Orofino area. Ms. Milgrom presented information about NLM resources at a local hospital, a community technology center and at the Clearwater Memorial Public Library.

Linda Milgrom and Gail Kouame visited Ferry County Memorial Hospital in Republic, WA, while on an outreach trip to the north east section of the state in March. This small frontier hospital is completing an Internet Connections project funded by NLM. During their visit, Ms. Milgrom and Ms. Kouame presented an overview of MEDLINEplus, PubMed, and other NLM resources to an audience of hospital staff, community members, and the local public librarian.

Linda Milgrom surveyed the project managers of recently completed projects funded by the PNR to learn if relationships fostered by outreach projects were sustained and how they reflected on their experiences. We were also interested in if we should reconsider procedures and parameters for regional funding opportunities. The article can be accessed at

  • The lessons learned by project participants were:
    Work with the community from the very beginning, including when outcomes are defined.
  • Offer noontime trainings, offer lunch, make it fun!
  • Equipment purchased for outreach has had lasting utility throughout the institution.
  • Short duration of outreach projects is beneficial because activities remain focused. (Quarterly reports also help!)
  • Conversely, for community-based work, long time frames are required because active members of the community are often over-committed and group dynamics slow down any project.
  • Plan evaluation to measure progress "as you go," rather than trying to wrap it all up at the end.
  • Find a good contact person/collaborator, someone with power in partner agency.
  • Need more money.
  • Don't bite off too much.

These findings will drive a modification of the funding opportunities we offer. We are planning to offer a continuum of support -- from needs assessment prior to a full-fledged project to support to assess follow-up -- as well as funding for new directions (e.g., hardware/software for electronic document delivery and professional development).

B. Expanded Outreach Programs

1. Outreach to Health Professionals

Presentations and training sessions by PNR included:

  • PubMed and NLM Gateway workshop for staff and affiliates of the HIV/AIDS section of Public Health -- Seattle & King County.
  • "Tips and Tricks: Hints for Searching PubMed and Arctic Health" at the Association of American Indian Physicians annual conference in Anchorage.
  • "PDA Users Circle", at the AAIP meeting in Anchorage.
  • Hands-on session on searching the web for public health information for participants in the Northwest Summer Institute for Public Health Practice, on the UW Seattle campus.
  • Local services, state and national resources for public health workers at the Montana Public Health Association annual conference in Helena, MT
  • Semi-annual steering committee meeting for the Partners in Information Access for the Public Health Workforce at NLM.
  • PubMed update to the Washington Medical Librarians Association Internet Users Group in Seattle, WA
  • "Navigating the Web: Internet Resources for School Nurses" -- at a University of Washington-sponsored Continuing Nursing Education Conference
  • "Only the Best Health Information: Medlineplus and PubMed" for staff of the Sno-Isle Regional (Public) Library, in Oak Harbor, WA.
  • "Finding Accurate Health Information" at the Nimiipuu Health Men's Cancer Awareness and Healthy Lifestyles Conference in Lewiston, ID.
  • "Measuring the Difference" evaluation class at MLA in Dallas on May 18 and in Bozeman, MT to the Tribal College Librarians Workshop.

Maryanne Blake, Education/Communication Coordinator, was asked to review and comment on a new Web site for the Medical Home project based at the University of Washington. She is also working with the project's staff to explore ways to promote health information resources to the Medical Home teams in the state of Washington. On March 18 th Ms. Blake and Ms. Kouame were invited guests at a Medical Home Project Board of Director's meeting. Ms. Kouame was able to talk about NLM and the Regional Medical Library's resources for consumer health information with meeting attendees. This was advantageous since the concept of Medical Home relies on both parents and health professionals working together to care for children with special health care needs.

Neil Rambo attended the Partners in Information Access for Public Health Professionals steering committee meeting at NLM, the American Public Health Association annual conference in Philadelphia, and the Northwest Regional Public Health Network steering committee meeting in Seattle.

Mr. Rambo also chaired the NN/LM Public Health Outreach Evaluation Task Force and participated in several task force conference calls. Work on the logic model defining the plan for outreach to the public health workforce was largely complete by December.

New Outreach Project Awards were made to Washington State University (Pullman, WA) for information support for professionals who see migrant and seasonal workers in Central Washington; the EthnoMed project group at Harborview Medical Center (Seattle, WA) to work with PEI to create an interactive tutorial in Vietnamese on breast cancer; and to the Oregon Pacific AHEC (Corvallis, OR) for internet training for rural mental health professionals.

2. Consumer Health Information Services
Linda Milgrom met with the ad hoc committee on foreign language patient education materials, convened by Liz Workman ( University of Utah) at MLA and continued to participate in e-mail and conference calls with the group. The group discussed existing projects in the regions that provide consumer health materials in languages other than English and inherent technical difficulties and access issues. Since identifying, describing and evaluating these materials is so labor-intensive, the group is considering development of a proposal to NLM, possibly to integrate efforts with MEDLINEplus.

Collaboration with the Samish Tribe began -- as part of the Tribal Connections project -- with attendance at cultural gatherings and meetings with tribal representatives and the tribal health committee, creation of a health planning resource notebook and Web site, and an initial needs assessment of how tribal members currently obtain health information.

Continuing her involvement with the ad hoc committee on foreign language patient education materials, Ms. Milgrom facilitated a meeting of Elizabeth Comstock of the Health Education Materials Center, Public Health - Seattle & King County, and Don Martin of the Health Education Resource Exchange, Washington State Department of Health ( Elizabeth and Don subsequently submitted a joint response to the Access to Electronic Health Information RFP.

The Easy to Read Health and Medical Sites page was completed. Next, content for a Consumer Health Information page was recommended to the Indian Health Service so that an appropriate section within the HIS Web site structure would be available for the Easy-to-Read page. These pages went into production and were announced to the NN/LM consumer health coordinators and on MEDLIB-L in mid-October.

Staff provided referral information to NLM for the office of Representative George Nethercutt, Jr. of the 5th Legislative District in eastern Washington. Constituents were seeking specialists to provide treatment for their child. Using the relevant MeSH (CHOLANGITIS, SCLEROSING) combined with geographic terms (SPOKANE or SEATTLE) revealed U. of Washington clinicians who work in this area; MEDLINEplus revealed a local consumer health library; and the U. of Washington Medical Center Web site led to the UW's MEDCON referral service.

Neil Rambo participated in the review of proposals for the Electronic Access to Health Information awards held in Chicago, IL, in November. As with other Associate Directors, he served as a resource person to answer questions about the region's proposals. The Pacific Northwest Region had eight proposals that were reviewed.

Mr. Rambo was appointed chair of the newly approved Medical Library Association Task Force on Health Information Literacy and began recruiting members for the task force in November and December. A focus of the task force is defining roles for librarians in health literacy and improving health information service to patients and the general public.

Funding for five Electronic Access to Health Information proposals was awarded effective March 2003. The projects will run for 18 months and will be monitored by Gail Kouame.

As part of the Tribal Connections (phase 3) project, Susan Barnes developed a health information Web site for the Samish tribe in collaboration with the tribal health committee. Priority topics included Arthritis and Musculoskeletal Disorders; Cancer; Food and Herbs; Heart Disease, Stroke, and Diabetes; Immunization and Infectious Disease; Mental Health, Substance Abuse, and Tobacco; Oral Health; and Respiratory Disease. (The categories are grounded in the Healthy People 2010 areas of emphasis, with additions to accommodate the community's needs.) MEDLINEplus, Just for You: American Indian and Alaska Natives, Easy-to-Read Health and Medical Sites, Information for Elders,, and Tox Town round out the offerings, providing a large collection of links for those whose needs or curiosity extends beyond the priority topic selections.

Roy Sahali, Tribal Connections project manager and Community Resources Coordinator, provided technology consultation to the Samish tribe for telephone conversion to Voice-Over-IP and network security upgrades.

Gail Kouame arranged with a subcontractor to update the HealthInfoquest Web site, a previously funded project designed to provide librarians with pathfinders to health information.

3. Training to Support Electronic Access to Health Information
Mini-awards of $500 each were awarded to the following:

  • Melanie Jones of Kittitas Valley Hospital (Ellensburg, WA) to cover training costs for health professional and consumer groups in Central Washington. Mini-labs targeting university students, staff, physicians, nursing students and others were held at the Community Health Library in Ellensburg.
  • Sarah McCord, Washington State University (Pullman, WA) exhibited at a conference in Coeur d'Alene, ID: "Health and Safety in Western Agriculture -- Cultivating Collaborations."
  • Laurel Egan, librarian at St. James Hospital (Butte, MT) provided two training sessions at the Salish-Kootenai Tribal College. Ms. Egan taught a PubMed/Medlineplus class for nursing students and a more advanced session for faculty.
  • Vicki Croft, Washington State University (Pullman, WA) exhibited at the 4th Annual Inland Northwest Cancer Conference in Spokane, WA.
  • Steve Teich, Oregon Health Sciences University, exhibited and gave a presentation at the Oregon Academy of Family Physicians Annual meeting in Eugene, OR
  • Helen Guerrero-Randall, St. Charles Medical Center, demonstrated PubMed and provided training at the Office of Rural Health in Bend, OR
  • Bill Kehler, Rocky Mountain College, exhibited and offered training at the Montana Library Association in Butte, MT

Maryanne Blake provided a 1.5 hour one-on-one PubMed training for Kiki Tommila, a librarian from Salish Kootenai College. Ms. Tommila came to the RML office in Seattle for the training.

Linda Milgrom and Gail Kouame traveled to the remote northeast corner of Washington state. They gave presentations to public librarians, health professionals, parents of special needs children, and other consumers in five towns in three counties.

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.):


Public Health - Seattle -- King County, 6
Sno-Isle Regional Library, 9
Salish Kootenai College, 28
Montana Public Health Assc, 12
Pacific NW Chapter, MLA, 42
WMLA, 18
UW Continuing Nurses Education, 150
Orofino Public Library, 3
Clearwater Valley Hospital Library, 12
Kooskia , 3
Stevens County Public Library, 12
Cross Cultural Health Care Resource Center, 25
Stevens County Public Library, 5
Colville Community Technology Center, 6
Stevens County Public Library, 1
Ferry County Memorial Hospital, 8
Kitittas Valley Community Hospital, 6
Cross Cultural Health Care Resource Center, 5
Nez Perce Tribe Men's Wellness Program, 30
Cross Cultural Health Care Resource Center, 16
ESD #113, 12
Joint Conference on Health
Washington Library Association, 40
Montana Library Association, 23
Oregon Library Association, 37
Oregon Rural Health Conference, 35
Washington State Public Health Association, 82


American Academy of Otolaryngology, 205
American College of Emergency Physicians, 181
Society for Adolescent Medicine, 85
American Academy of Dermatology, 192
Association of American Indian Physicians, 102
American Diabetes Association, 432

5. Technology Awareness and Integration
Roy Sahali provided an orientation and overview of the network and available resources to new physicians at the Nisqually Tribe and the Tribal Health Department of the Muckleshoot Tribe.

6. Library Improvement
Nothing to report.

7. Connections
Roy Sahali began negotiations with American Indian Radio on Satellite ( to produce health information programming directed at Native American audiences for broadcast on Indian radio stations as well as via web and satellite radio.

He also provided continuing support to Affiliated Tribes of Northwest Indians (ATNI) technology director Elstun Lawsten and executive direction Mark Ufkas; discussion topics included possible health resources for a proposed mobile technology van and the setup on an Internet Café for the Feb. regional conference held in Portland.

We began discussions with Randy Ross of the American Distance Education Consortium (ADEC) -- -- for future satellite web cast and distribution of health information content for tribes.

C. Enhancements

Tribal Connections Project, Phase 3:

Susan. Barnes assisted with the Samish Tribe's (Anacortes, WA) development of a ten-year health plan by facilitating the Tribal Health Committee's discussions regarding priorities. Notes from these discussions were compiled and given to the director of the Samish Department of Health and Human Services for use in crafting the plan. These notes were accompanied by information and references from the health planning literature, especially that which related to Healthy People 2010.

Linda Milgrom continued to work with members of the community health staff of the Nez Perce Tribe in Lapwai, ID. The project was clarified to include: the production of short videos on diabetes topics, training for staff, and design of a health information space in the new clinic), and a memorandum of agreement was drafted.

Roy Sahali participated in discussions with Claire Hamasu, associate director of the MCR, regarding inter-regional collaboration and support for Tribal Health Connections, the NLM-funded School Mental Health (Molly McGetrick), and the MCR-based Tribal Connections Four Corners projects.

Ms. Milgrom, Roy Sahali, Community Resources Coordinator, and Joan LaFrance, project evaluator and chronicler, visited the Nez Perce Reservation in Idaho. They met with community health staff in Lapwai and Kamiah to finalize plans for making short videos on health and wellness topics starring tribal members and to investigate possibilities for training.

Other Tribal Connections: Roy Sahali p rovided support to MCR discussions about the TC Four Corners Project. He provided follow-up consulting with Jacarja Pueblo in New Mexico (was part of Phase 2); a referral from Larry Berry, a systems manger with the Indian Health Service.

Miles White, a UW Ph.D. candidate in ethnomusicology, was hired on an hourly basis as editor/writer to assist with the development of the Tribal Connections Web site.

D. NN/LM Web Service

Michael Boer continued to manage the national NN/LM Web service from his base at the PNRML.

Mr. Boer is participating in the National Outreach Mapping Center Technical Advisory Committee. In addition to weekly conference calls, his role includes work to assure that authentications can be passed between the NN/LM staff server and the NOMC Outreach Report Form system.

"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 2002 91,381 5,512
Jun. 2002 79,001 5,227
Jul. 2002 83,629 5,824
Aug. 2002 76,470 5,427
Sep. 2002 82,941 6,417
Oct. 2002 94,457 7,884
Nov. 2002 90,785 5,181
Dec. 2002 75,248 2,664
Jan. 2003 88,512 3,645
Feb. 2003 71,974 3,121
Mar. 2003 80,390 3,151
Apr. 2003 89,042 3,661

TOTAL VISITS: 1,003,830 (83,653 average/month)
TOTAL REPORTS: 57,714 (4,810 average/month)

In August, the NN/LM web services were moved from to a set of four new Linux-based servers. The public website is now transmitted from a pair of identical systems. A fail-over service has been implemented so that if the primary serer goes offline, the secondary can take over within a few seconds. The development site is now housed on a third system. These three servers are located at the UW Health Sciences Library in a room designed specifically to provide a safe and isolated environment for servers. A fourth system, located at the University of Illinois at Chicago, now houses the staff intranet/extranet server.

In February, we migrated three NN/LM servers to a new network subnet featuring gigabit Ethernet, a tenfold increase in bandwidth. This project involved changing the IP numbers of Alpha, Bravo, and Charlie, the three servers. The new subnet is dedicated to housing servers, so we believe it will be more stable and secure than subnets shared with labs and staff workstations. The increased bandwidth is also beneficial to the servers.

The Tribal Connections website was moved from to the new NN/LM Linux servers.

The Partners in Public Health website was migrated from a folder on to its own domain name, This site is housed on the same NN/LM servers as and

Several content management system (CMS) experiments were conducted to explore the potential for offering Weblog (blog) and Wiki services on the servers. Some of these prototypes will be presented at the May 2003 NN/LM Web Developers Conference.

E. Administration, Staff, and Other

After 20 years of exemplary service to two Regional Medical Library programs, Nancy Press left her position as PNR Consumer Health Coordinator in May. She will be assuming the role of library director for an independent school of theology in the Seattle area.

Gail Kouame began work in the position of Consumer Health Coordinator in January.

Neil Rambo assumed the office of Director of the Medical Library Association on May 21 at the annual meeting in Dallas.