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The overarching informatics grand challenge facing society is the creation of knowledge management systems that can acquire, conserve, organize, retrieve, display, and distribute what is known today in a manner that informs and educates, facilitates the discovery and creation of new knowledge, and contributes to the health and welfare of the planet. At one time the private, national, and university libraries of the world collectively constituted the memory of society's intellectual history. In the future, these new digital knowledge management systems will constitute human memory in its entirety. The current model of multiple local collections of duplicated resources will give way to specialized sole-source servers. In this new environment all scholarly scientific knowledge should be public domain knowledge: managed by scientists, organized for the advancement of knowledge, and readily available to all. Over the next decade, the challenge for the field of medical informatics and for the libraries that serve as the continuous memory for the biomedical sciences will be to come together to form a new organization that will lead to the development of postmodern digital knowledge management systems for medicine. These systems will form a portion of the evolving world brain of the 21st century.

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The fundamental idea of the library must change. The nineteenth-century idea of the library as the embalming of dead genius and the twentieth-century idea of the library as the repository for second-hand knowledge must give way to the idea of the library as the owner and the librarian as the manager of first-hand knowledge. In the coming era of knowledge capitalism, those individuals and organizations will flourish who are able to apply knowledge to create knowledge and to organize it to produce knowledge. The roles of present-day librarians and libraries will begin to differentiate sharply over the next decade. Some must seize the opportunity to participate in the transformation of libraries into online knowledge servers.

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A common vision for an electronic management environment is emerging. Fundamental to this vision is a radical change in the way that knowledge is captured, stored, manipulated, visualized and accessed. To bring these visions to reality, partnerships need to be formed between authors, publishers, and libraries. Research and development in knowledge management is essential and universities must identify more clearly their roles as knowledge creators and distributors.

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This paper focuses on the creation of the IAIMS workstation in the context of the outcomes of a year-long IAIMS strategic planning process at the Johns Hopkins Medical Institutions (JHMI). These outcomes include a long-term institutional vision for a functional knowledge management environment, a JHMI IAIMS model, a strategic plan, and two model prototypes. The functional requirements and specific implementation strategies for the IAIMS workstation, the prototype for managing the knowledge base of the published biomedical literature, are discussed in detail.

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The technologies contributing to today's information world are profound. Electronic technologies are transforming the way we handle information and the medium used to pursue knowledge. What once seemed beyond reach--that computers, communications, information, and knowledge systems could be merged harmoniously to transmit information via networks--is reality today. The Integrated Academic Information Management System (IAIMS) approach for transfer of biomedical information within a medical center also offers opportunities for networks across institutional lines. The tradition of cooperation and resource sharing among libraries makes them logical facilitators of the emerging, universal information environment. The authors present a course of action based on visions of a new era, realities of the present, and strategies for the future.

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The classic function of health sciences libraries is to build and maintain a knowledge base and to provide timely access to that collective memory for the purpose of learning, teaching, caring for patients, conducting research or managing an organization. The formats and representation of that knowledge base are changing rapidly, as are the methods and techniques for gaining access to information. Medical libraries have long used computers for cataloging and controlling records but are now shifting to acquiring, managing and distributing bibliographic and full-text information to local library "networks."

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A survey of automated records management in the United States and Canada was developed to identify existing on-line library systems and technical expertise. Follow-up interviews were conducted with ten libraries. Tables compare the features and availability of four main frame and four minicomputer systems. Results showed: a trend toward vendor-supplied systems; little coordination of efforts among schools; current system developments generally on a universitywide basis; and the importance of having the cooperation of campus computer facilities to the success of automation efforts.

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A Delphi study was undertaken to identify the changes in library roles and functions that the directors of academic health sciences libraries believe will occur over the next decade. The methodology is described and the results are summarized. Two scenarios resulted: one, highly desirable; the other, highly probable. They overlap by 64%. Library directors expect moderate evolutionary changes in the next ten years. Users are perceived to be the force maintaining the status quo, while technology is the force advancing change. The adoption of technology is seen as desirable and within the libraries' span of control. Education and service roles of librarians will expand. Library and institutional priorities are seen as obstacles to change.

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A comparative study was undertaken to assess the reasons for the low rankings received by George Washington University Medical Center library in the Annual Statistics for Medical School Libraries in the United States and Canada. Although internal studies showed the library was successfully satisfying user needs and meeting its primary objectives, the rankings, which include the traditional measures of quality used by accrediting bodies, indicated the contrary. Three hypotheses were postulated to account for the discrepancy. In a matched group of similar libraries: (1) the rankings of an individual library would differ from the national rankings; (2) clustering the variables would change the rankings; and (3) libraries with similar staff size would tend to rank in the same quartile in service and resource variables. All hypotheses were invalidated. Further tests led to the conclusion that the Annual Statistics and other traditional measures of quality are inappropriate and inaccurate methods for evaluating library programs, since they only measure resource allocations and not the effectiveness of those allocations. Alternative evaluation methods are suggested.

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The Association of American Medical Colleges, under National Library of Medicine sponsorship, is conducting a study of the academic health sciences library's roles in education for the health professions as these may be affected by changes in health information handling and management. The study's aims, objectives, and methods are described. The study aims to develop guiding principles for the use of academic health center administrators, library administrators, federal agency personnel, and others involved in planning and policy decision making for health sciences libraries.

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Growing awareness of the transition from an industrial age to a communication- and knowledge-based economy appears reflected in some changing directions in libraries. Major trends include (1) a change in management practices, (2) a realignment of operational goals away from technical processing activities to client-oriented outreach services, and (3) the identification of educational functions as a primary professional role. The twin concepts of knowledge utilization and information brokering are beginning to have an impact on the definition of the librarian's role.

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The Extramural Programs, NLM, undertook a staff study to evaluate the Medical Library Resource Improvement Grant Program in order to determine impact on hospital library development and to assess factors significant to regional medical library (RML) network development. Initiated in fiscal year 1971, the improvement grant program provides one-year, one-time grant awards of a maximum of $3,000 to assist in establishing a basic collection of books, journals, and other health science information resources for community hospitals and comparable health facilities. Applicants who received grant awards were compared to applicants who did not receive awards and to nonapplicants, using nine dependent variables, four independent variables, and responses to an RML questionnaire. Results show that the applicants who received awards outperformed the other groups, and that the improvement grant program has been successful in stimulating library development. As a result of this study, the improvement grant program will be modified to support consortium arrangements as well as individual institutions, and to extend the period of grant support to two years. Future grant support will be a maximum of $4,000 in the first year, and up to $3,000 with a provision of $1,000 in matching funds from the grantee in the second year.

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The Missouri Institute of Psychiatry Library Current Contents Service offers free dissemination of ISI's Current Contents: Behavioral, Social and Management Sciences to 144 mental health professionals employed at twelve locations in the Missouri Division of Mental Health system. The service includes free document delivery of up to 100 articles per subscription. Sixty percent of the participants in the project are sharing copies of CCBSMS with their colleagues. Operation of the service is described, and data on degree of use are analyzed by user professional orientation and hospital location. The most frequently cited journal titles are compared to lists of heavily used titles derived from other sources. These lists of titles are offered as empirical guides to frequently consulted behavioral science journals. After six months experience participants appear to be highly satisfied. Ninetytwo percent responding to an evaluative questionnaire want to continue the service another year.

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