DOCLINE: Connecting Medical Libraries for 35 Years

Guest post by Lisa Theisen, Head of NLM’s Collection Access Section and Elisabeth (Lis) Unger, NLM DOCLINE Team Lead

It’s been 35 years since NLM’s interlibrary loan (ILL) request routing system, DOCLINE®, was launched with a goal of enabling medical libraries to get biomedical literature into the hands of people who need it as efficiently and quickly as possible. Today, DOCLINE continues to be used daily by nearly 2,000 hospital, academic, military, public, and other libraries that place approximately one million requests a year, including requests for newly published research not freely available online.

DOCLINE’s foundation and success stems from NLM’s collaboration with the Regional Medical Libraries of the Network of the National Library of Medicine (NNLM) to support resource sharing among the medical library community. Resource sharing through ILL means that participating libraries don’t have to own as many books and journals or collect as broad a range of topics because they can borrow from each other. Full participation is limited to libraries in the NNLM and Canada, but some international libraries use the system to place requests directly with NLM.

DOCLINE service is fast and use of the system is free. This service allows a wide range of libraries, including hospital libraries (which account for 60% of DOCLINE participants), to obtain articles for their patrons that are not in their own collections.

This is where DOCLINE fills a critical gap by connecting a wide network of librarians who are always ready to help each other out, often without charge. Without DOCLINE, access to literature outside of a library’s collection is severely curtailed.

When DOCLINE first launched on mainframe computers in 1985, finding a ‘copy’ of an article or a library with the right issue of a print journal was not as easy as performing a simple search online. If you had a modem and access to an NLM account, you might check SERHOLD, the NLM database of medical libraries’ serial holdings – or journal titles libraries report subscribing to. Then you could mail, or maybe fax, an ILL form to the library and request that they mail your library a photocopy of the article. 

Over the decades, DOCLINE evolved in response to technological advancements and user needs. Features and enhancements have been added to DOCLINE throughout the years to make the system faster and easier to use. DOCLINE has grown to include new ways to send copies of articles, such as emailing PDFs, and adapted to new ways that publishers offer content, including electronic journals and “epub ahead of print” articles found in NLM’s PubMed biomedical literature citation database, and borrowers now see alerts to free, full-text articles found in NLM’s PubMed Central (PMC) digital archive.

Around the turn of the century, DOCLINE 1.0 moved to the world wide web – at the same time email use was becoming more widespread. In 2003, DOCLINE 2.0 was released with a new user-friendly look and feel; in 2006 it was updated to allow a library to indicate “Urgent Patient Care” to expedite service for use in emergencies in the hospital setting. The latest version, DOCLINE 6.0, debuted in November 2018. The three core system components, 1) the user library records, 2) their collective biomedical journal listings, and 3) ILL requests, would still be familiar to a user of the original system, even though the website looks very different today. DOCLINE also includes indicators for supplementary data sets and journal embargoes which didn’t exist in its early days.

What made DOCLINE remarkable in 1985 and remains its most intricate, complex feature, is the efficient way in which requests are automatically matched to appropriate lenders based on their reported journal holdings. This ensures that DOCLINE’s average length of time to fill a request and the percentage of filled requests continues to be high compared to other ILL systems – advancing NLM’s mission of enabling biomedical research and supporting health care and public health. This means that clinicians who rely on medical librarians to obtain the most relevant and latest research articles cited in PubMed, for instance on COVID-19 treatments, can rely on DOCLINE.

Continued updates to DOCLINE underscore the commitment to advance NLM’s strategic goals to reach more people in more ways through enhanced dissemination and engagement, and to engage a wide range of audiences to ensure the “right information gets delivered to them at the right time.” For instance, in April of this year, a ‘Print Resources Available’ filter was added to the system to enable user librarians working remotely from home to connect with libraries that still had access to their physical collection.

In its 35-year history, over 65 million ILL requests have been completed by libraries using DOCLINE. NLM is proud to provide the system and values the work of libraries that generously and unflaggingly share with one another, making DOCLINE a system that has been widely embraced by the user community over the years. We are looking forward to what the next 35 years mean for DOCLINE – teleporting articles anyone?

Are you a part of the DOCLINE community? How has ILL helped you?

Lisa Theisen began serving as Head of the Collection Access Section in the Public Services Division in March 2020. Ms. Theisen has been at NLM for 13 years, supporting DOCLINE and NLM’s Interlibrary Loan (ILL) operation.

Elisabeth Unger, MLIS, joined NLM’s Public Access Division, Collection Access Section, Systems Unit in 2008 to support DOCLINE and NLM ILL after working at the National Agricultural Library. In 2005 she became DOCLINE Team Lead where she was responsible for the latest redesign and relaunch of the esteemed system.

10 Tips After 10 Months of Video Calls

Like most of the world, staff at NLM has been engaging with others through various technologies – video conferencing, virtual daily work huddles, and conference-inspired meetings that require screen sharing, virtual breakout rooms, chat features and instant messaging. I’ve gone from a 30-minute commute, including a short walk and a metro ride, to a 3-minute walk from my bedroom to my home office. Those lovely, long walks across the NIH campus that formed the bridges between meetings three or four times a day are now replaced by 60-second coffee refills between almost-non-stop video calls between 8 a.m. and 6 p.m. And where before I only had to make sure that I looked professional and polished, I must now make sure that there’s no clutter or distracting pictures or items in the background – the camera sees everything!

Fortunately for me, I regard meetings as a high art. For the past 15 years, meetings have been one of the main mechanisms through which I work. Early on I learned two great tips from a great biomedical informatics guru, John Glaser –

Never walk out of a meeting with more to do than you came in with, and never close a meeting without knowing who is taking the next steps on every item.

This comes in handy when your days are lived on camera! I can’t match the wisdom of John, but I can share some ideas that are proving helpful to me as I (virtually) meet with NIH colleagues, the NLM leadership team, individuals with whom I’m collaborating, and NLM staff through “brown bag” lunch sessions.

I’d like to share a few of my own tips garnered from my years of in-person and virtual meetings.

Call people by name, often.

This is particularly helpful if you are leading a meeting, for it acknowledges people and engages them in the moment. It is also important when you are a participant. Using names helps compensate for the lack of communication cues in video calls, such as eye contact and head nodding, and fosters engagement and stimulates participation.

Start on time and end on time.

I know I’m not the only one whose days are lived through conference calls and video chat. By starting and ending on time, you demonstrate respect for everyone on the call, as well as those in the prior and subsequent calls. In addition, it saves you from having to start every next call with the “sorry I was finishing up a previous call” apology.

Allow for pauses.

This is important for the leader of the meeting and is also equally relevant for participants. It can be difficult to pick up on visual and audio cues, gestures, and conversational threads, such as someone leaning back, leaning in, shifting their gaze, or changing their tone of voice. So, it becomes particularly important to let pauses stand an extra second or two to allow someone to come off mute or organize their thoughts.

Keep your camera on when possible.

Keeping your camera on provides visual evidence that you are present and attentive during the conversation and meeting discourse. It’s courteous to others, and yes, it does mean that you have to attend to the image being displayed, but it allows your colleagues to see that you’re not reading email or distracted by other issues. It also reinforces the connection between the speaker and the audience and enhances a sense of group engagement. Although some may worry about excessive bandwidth consumption, the social value is worth it!

Keep your microphone off unless speaking!

Visual cues are important; auditory cues are distracting. Until technology advances, microphones (mics) often create distortion, pick up background noise, contribute to audio feedback, and generally degrade the conversational experience. Remaining on mute signals respect for the speaker and gives them a non-competitive platform for discussion. It helps to learn the steps of muting and un-muting to keep up with the rhythm of the conversation.

Check your mic often and use a headset with a good mic.

Get to know your mic, how it works, and the indicators that it’s live. Poor audio quality can affect the experience of the video call for everyone. Many of us forget that the mic is on our laptop and the further away we are from the mic, the poorer the audio. I’ve found that using a headset helps because it puts the mic close to your mouth and will help minimize background noise. It is key to your personal happiness and professional survival that you make sure you know how to troubleshoot basic mic issues, particularly knowing when your mic is on, when it’s NOT on, and to stay alert so it’s never on when you don’t realize it! 

Use chat features judiciously.

Most video conferencing software has some type of text support, usually called “chat.” I find this feature to be very useful when I’m NOT the speaker and very annoying when I am. Sometimes, in a big and exciting meeting, sidebar conversations held through the chat feature can provide clarification and enhance the shared experience. However, every thought appears on the screen and it can be distracting to the speaker. If you really want to chat your way through a video call, consider setting up a parallel channel in a different platform for that purpose or consult with your speaker beforehand. Your speakers will thank you!

Watch your backgrounds!

Video conferences introduce us to the private lives of our colleagues in ways never before anticipated, often by having the opportunity to look over the shoulder of your colleague and into their background. Some video conferencing platforms allow you to customize the image projected on your screen – a blessing and a bane. Remember that some backgrounds may best be left for personal calls with friends or family, and professional engagements do best with a more subdued background where the interest can focus on the person, not the background.

Take notes.

Many of the mental mechanisms we use in human discourse add meaning and interpretation to the words that are exchanged. We remember how a colleague smiled when bringing up a new idea, or the worried look when your words weren’t well understood. Note taking (I use a fountain pen and write in long hand) helps keep me focused during video calls, aids me in organizing thoughts, and often provides a reminder for the next meeting or conversation.

Take a break!

This tip is for you; not about using the technology. Technology is unrelenting and always demanding. The immediacy of work, the pull of people waiting for a meeting to begin, and our tendency to overschedule can lead to very packed days. As an industrial engineer with human factors training, I know that performance degrades over time and short breaks help! Schedule breaks – at least every two hours – even if only for five minutes. Take a walk, hug your child or someone you love, or start a load of laundry. The goal is to refocus and refresh!

What have you learned from 10 months of video conferencing? Please share your tips and ideas here – we are all in this together.

Building Bridges Throughout My Career

Last month, I had the pleasure of hosting a fireside chat with Anthony S. Fauci, MD, director of the National Institute of Allergy and Infectious Diseases (NIAID) at NIH and our nation’s top infectious disease expert. This event took place as part of the American Medical Informatics Association (AMIA) 2020 Virtual Annual Symposium and was shared with almost 1,000 AMIA attendees.

I will share a few key points of wisdom that Tony provided a little later in this post, but first I want to share the experience of bridging my life-long affiliation with a dynamic professional society and my current responsibilities as NLM director.

Making Connections

As NLM director, I support the work of the 1,700 women and men who conduct research, enable access to the vast biomedical literature, and accelerate data-driven discovery. I understand the importance of professional societies, like AMIA, that advance the field by nurturing and supporting health information professionals, providing platforms for sharing research findings, and creating spaces that inspire discoveries and improve health through information technologies. Rarely has the critical importance of the field of biomedical informatics been more sharply focused than during the COVID-19 pandemic.

Moments of joy with Dr. Fauci during our fireside chat.
 
AMIA Fireside Chat
Top row (L to R): Dr. Anthony Fauci, Dr. Patricia Flatley Brennan
Bottom row: Dr. Eneida Mendonça, Chair of the AMIA 2020 Scientific Program Committee

During the hour spent with Tony, I was reminded that engaging with domain experts can elevate awareness of where biomedical informatics challenges exist and the potential solutions that could have a broad impact. Taking part in this event with a giant in the field, like Dr. Fauci, was like taking a tour through the fields of microbiology, immunology, chemistry, pharmaceutical development, public health, and science education, highlighting the many points of impact open to biomedical informatics interventions.

It was wonderful to be able to introduce AMIA to Dr. Fauci, and vice versa. Tony spoke passionately about the importance of data sharing — emphasizing that peer review brings trust to data, and that data should be shared in ways that people can easily access and use. In his closing remarks, Tony expressed his appreciation for the opportunity to talk with the biomedical informatics community and acknowledged the benefits of building bridges to learn from each other.

Sharing What We Learned Together

Shared with permission: evan.william.orenstein@emory.edu

Through this interaction with Tony, I developed a deeper sense of his passion for science as well as his confidence in science. In considering how to best understand the long-term effects of COVID-19, Tony advocated for the effective use of patient registries – an area where biomedical informatics could make considerable contributions. When asked about how to better infuse science into our educational system, he enthusiastically responded that introducing children to science and scientific concepts in early childhood can foster a lifelong love of science, adding that “science can be love at first sight!”

I learned that preparedness is more important than prevention when it comes to pandemics. I was inspired by many of his views, including that supporting local public health authorities is the best first step to strengthening the national public health infrastructure. Finally, I developed a new perspective on the importance of scientific communications during emergencies and the challenges that can emerge when mixed messages and differing perspectives create confusion and uncertainty. 

The AMIA audience also shared what they learned from this session. Dr. Fauci’s clear explanation of the current trend that 75 percent of emerging infections originate through zoonotic transmission (i.e., disease that is passed from animals to humans) put into perspective his advice to prepare for — not try to prevent future pandemics. As one AMIA attendee offered, “It takes everyone to beat back this pandemic, and informatics has a role to play.” Another attendee shared of learning about new opportunities for biomedical informatics in global health.

As two of the 27 Institute and Center Directors at NIH, Tony and I share many responsibilities and have many opportunities to collaborate. Certainly, our mutual regard provides a strong platform for a discussion. What I didn’t expect from this discussion was to walk away with new insights about the importance of NLM’s support for open data, data sharing, and outreach to the public through our highly trusted information resources. I am delighted that we may have inspired AMIA attendees to answer some of the many challenges Tony described in guiding science and society through this pandemic.

Bridges are built by the concerted efforts of many people.

For this event, the AMIA Board of Directors brainstormed to come up with a set of questions that allowed for a lively discussion. AMIA members posed additional questions through a crowdsourcing strategy. Staff from NLM, NIAID, and AMIA collaborated to coordinate logistics, technology, messaging, and outreach to support the success of this conversation between two colleagues.

Did you attend the fireside chat at AMIA with Dr. Fauci? If so, what new planks on the bridge of your life did you discover?

One NLM: I Am Thankful for How Far We Have Come!

In the spirit of Thanksgiving, I am excited to share what I am grateful for this year. In years past, I’ve used this space to reflect with gratitude on the efforts of the 1,700 men and women who work at NLM. Other times, I’ve reflected on the impact of individuals who have contributed to my life in a meaningful way over the previous year. This year, I want to use this opportunity to reflect with gratitude on the progress we’ve made as an organization in our journey towards “One NLM.”

On January 3, 2017, only four months into my new role as NLM director, I introduced the concept of One NLM through this blog. At the time, I proposed …

One NLM emphasizes the integration of all our valuable divisions and services under a single mantle, and acknowledges the interdependency and engagement across our programs. Certainly, each of our stellar divisions – for example, the Lister Hill Center for Biomedical Communications, Library Operations, or Specialized Information Services – have important, well-refined missions that will continue to serve science and society into the future. The moniker of One NLM weaves the work of each division into a common whole. Our strategic plan will set forth the direction for all of the National Library of Medicine, building on and augmenting the particular contributions of each division.

So why do we need One NLM?

Achieving excellence as a resource for discovery and science demands that we efficiently leverage the work of each division toward common goals. Additionally, One NLM encourages sharing the expertise found in any one division across all our efforts. Finally, the idea of One NLM entreats us to bring together all the Library’s resources to meet the key challenges of the future across biomedical knowledge collection, curation, and dissemination – ensuring a talented workforce, enabling every staff member to work at the top of his or her skill set, creating collections that accelerate discovery and address global health needs, and anticipating (and resolving!) the health information challenges of the future.

Now, 4 YEARS into this role, I look back on these words with gratitude and recognition of the awesome naivety that led me to make the bold statement: One NLM – many parts, many people – but One NLM!

Strategic Report

I  am writing today as part of our efforts to assess the implementation of the NLM Strategic Plan. We’ve received more than 100 responses to a request for information to ensure that implementation of the strategic plan continues to be relevant and resonate with the needs of our stakeholders. We solicited and received input from NLM’s Board of Regents, Board of Scientific Counselors, and the Literature Selection Technical Review Committee. We polled our leadership and our own staff, as well as colleagues across NIH, asking them to respond to three questions:

  1. Major opportunities or challenges that have emerged over the last five years and have implications for the future of NLM in the areas of:
  • Science 
  • Technology 
  • Public health, consumer health, and outreach  
  • Library functions  
  • Modes of scholarly communication  
  • Perspectives, practices, and policies  
  • Workforce needs 
  1. Major opportunities or challenges that have emerged in the last five years and have implications for the future of NLM in other areas or areas not well captured above.
  2. Opportunities or challenges on the horizon over the next five years that fall within the purview of the NLM’s mission.

Not surprisingly, in many cases we received guidance that would be best addressed by one of our many stellar divisions – to increase investments here or to expand efforts there.

The NLM of 2020 shares many features with the NLM of 2017, and yet it is a whole new operation. Our budget has grown by over $50 million and we’ve put it to good use! We released a new version of PubMed, and moved some of our critical molecular resources into commercial cloud services. We expanded both our extramural and our intramural research programs — adding two new investigators, developing new artificial intelligence and machine learning analytics — and pivoted some of our research efforts to the computational biology challenges of COVID-19. We’ve aligned our consumer education efforts into a single platform, streamlined our outreach, education and training initiatives, and this year alone approved 50 new journals for MEDLINE indexing. We’ve also launched major updates to our physical and technical operations. Whew!

We are also recognizing that NLM is more than the sum of its parts – it’s a highly interdependent enterprise, one that now emphasizes mutual learning and cross-division engagement as a key strategy for the future. The NLM leadership team meets twice a month to devise strategies and evaluate alternatives that bring solutions to challenges faced across the entire NLM, including cybersecurity, creating an affirming and welcoming workplace where our team can perform to their maximum potential, and doing our part to respond to the COVID-19 pandemic.

As we face rapidly growing data science challenges, we hear the question from across NIH – “What can NLM do?” And the answer is, “A lot!”

One NLM means that we harmonize the expertise from each of our divisions in a way that lets us characterize problems and identify sustainable solutions. We bring together the very best that each of us has to offer – computational skills, large scale data management, indexing and cataloging strategies, application and use of health data standards – and unite them into a cohesive approach. We share the responsibility and the resources to extend the reach of NLM with innovative strategies to meet new challenges. We create pathways for growth and encourage staff to populate those pathways.

Becoming One NLM requires that we identify new ways of engagement to our well-established ways of doing business. Becoming One NLM means that we don’t simply fill jobs, we search for talented people with an eye to how they might contribute to the total enterprise – not just fulfill a set of tasks. Leading One NLM means that each member of our leadership team understands and integrates our goals into the activities of their divisions as they create plans to lead NLM into the future. Being One NLM means that we bring to science and society the talents and offerings of this great, nearly 200-year-old organization.

So, this year, I am thankful for the progress that we’ve made towards One NLM. I know it happened with the support of family and friends, through the efforts of everyone who works at NLM, and it is worthy of our many thanks!

Dr. Isaac Kohane: Making Our Data Work for Us!

Last weekend, Isaac Kohane, MD, PhD, FACMI, Marion V. Nelson Professor of Biomedical Informatics, and Chair of the Department of Biomedical Informatics at Harvard Medical School received the 2020 Morris F. Collen Award of Excellence at the AMIA 2020 Virtual Annual Symposium. This award – the highest honor in informatics – is bestowed to an individual whose personal commitment and dedication to medical informatics has made a lasting impression on the field.

Throughout his career, Dr. Kohane has worked to extract meaning out of large sets of clinical and genomic data to improve health care. His efforts mining medical data have contributed to the identification of harmful side-effects associated with drug therapy, recognition of early warning signs of domestic abuse, and detection of variations and patterns among people with conditions such as autism.

As the lead investigator of the i2b2 (Informatics for Integrating Biology & the Bedside) project, a National Institutes of Health-funded National Center for Biomedical Computing initiative, Dr. Kohane’s work has led to the creation of a comprehensive software and methodological framework to enable clinical researchers to accelerate the translation of genomic and “traditional” clinical findings into novel diagnostics, prognostics, and therapeutics.

Dr. Kohane is a visionary with a motto:  Make Our Data Work for Us! Please join me in congratulating Dr. Kohane, recipient of the 2020 Morris F. Collen Award of Excellence.

Hear more from Dr. Kohane in this video.

Video transcript (below)

The vision that has driven my research agenda is that we were not doing our patients any favors by not embracing information technology to accelerate our ability to both discover new findings in medicine, and to improve the way we deliver the medicine.

What does “make our data work for us” mean? It means that let’s not just use it for the real reason most of it is accumulated at present, which is in order to satisfy administrative or reimbursement processes. Let’s use it to improve health care.

Using just our claims data, we can actually predict – better than genetic tests – recurrence rates for autism. It’s the ability to show, with these same data, that drugs used for preventing immature birth in the genetic form are just as effective as those that are brand name; 40 times as expensive. It’s, as we’ve seen most recently, the ability to pull together data around pandemics within weeks, if and only if, we understand the data that’s spun off our health care systems in the course of care.

And finally, as exemplified by work on FHIR, which was funded by the Office of the National Coordinator and then the National Library Medicine, the ability to flow the data directly to the patient to finally allow patients’ access to their data in a computable format to allow decision support for the patient without going through the long loop of the health care system.

Because the NIH and NLM have invested in working on real-world sized experiments in biomedical informatics, on supporting the education of the individuals who drive those projects, and in supporting the public standards that are necessary for these projects to work and to scale, they’ve established an ecosystem that now is able to deliver true value to decision makers, to clinicians, and now to patients, as we’re seeing with a SMART on FHIR implementation on smartphones.

So, for those of you — the biomedical informaticians of the future who are clinicians — I strongly recommend that you don’t wait for someone else to fix the system. You have the most powerful tools to affect medicine, information processing tools. So, don’t wait to get old. Don’t wait to be recognized. You have the tools. Get in there, help change medicine. We all depend on you!