A b s t r a c t , the National Library of Medicine (NLM) assembled a large multidisciplinary, multisite team to work on the Unified Medical Language System (UMLS), a collaborative research project aimed at reducing fundamental barriers to the application of computers to medicine. Beyond its tangible products, the UMLS Knowledge Sources, and its influence on the field of informatics, the UMLS project is an interesting case study in collaborative research and development. It illustrates the strengths and challenges of substantive collaboration among widely distributed research groups. Over the past decade, advances in computing and communications have minimized the technical difficulties associated with UMLS collaboration and also facilitated the development, dissemination, and use of the UMLS Knowledge Sources. The spread of the World Wide Web has increased the visibility of the information access problems caused by multiple vocabularies and many information sources which are the focus of UMLS work. The time is propitious for building on UMLS accomplishments and making more progress on the informatics research issues first highlighted by the UMLS project more than 10 years ago.Ⅲ JAMIA. 1998;5:1 -11.Over the past 10 years the Unified Medical Language System (UMLS)* 1 has captured the time, talents, and attention of many informatics investigators from a broad range of disciplines. The project is focused on overcoming two important barriers to the development of information systems that can help health professionals make better decisions. These barriers are the disparity in the terminologies used in different in- formation sources and by different users, and the sheer number and distribution of machine-readable information sources that might be relevant to any user inquiry. The UMLS supports the development of userfriendly systems that can effectively retrieve and integrate relevant information from disparate machinereadable sources. To accomplish this objective, the UMLS project has produced and widely disseminated four multipurpose knowledge sources designed for system developers: the Metathesaurus, the Semantic Network, the Information Sources Map, and the SPE-CIALIST Lexicon and associated lexical programs.

The Institute of Medicine, United States Preventive Services Task Force (USPSTF), and national healthcare organizations recommend screening and counseling for intimate partner violence (IPV) within the US healthcare setting. The Affordable Care Act includes screening and brief counseling for IPV as part of required free preventive services for women. Thus, IPV screening and counseling must be implemented safely and effectively throughout the healthcare delivery system. Health professional education is one strategy for increasing screening and counseling in healthcare settings, but studies on improving screening and counseling for other health conditions highlight the critical role of making changes within the healthcare delivery system to drive desired improvements in clinician screening practices and health outcomes.This article outlines a systems approach to the implementation of IPV screening and counseling, with a focus on integrated health and advocacy service delivery to support identification and interventions, use of electronic health record (EHR) tools, and cross-sector partnerships. Practice and policy recommendations include (1) ensuring staff and clinician training in effective, client-centered IPV assessment that connects patients to support and services regardless of disclosure; (2) supporting enhancement of EHRs to prompt appropriate clinical care for IPV and facilitate capturing more detailed and standardized IPV data; and (3) integrating IPV care into quality and meaningful use measures. Research directions include studies across various health settings and populations, development of quality measures and patient-centered outcomes, and tests of multilevel approaches to improve the uptake and consistent implementation of evidence-informed IPV screening and counseling guidelines.

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The AMIA 2001 Spring Congress brought together members of the the public health and informatics communities to develop a national agenda for public health informatics. Discussions of funding and governance; architecture and infrastructure; standards and vocabulary; research, evaluation, and best practices; privacy, confidentiality, and security; and training and workforce resulted in 74 recommendations with two key themes-that all stakeholders need to be engaged in coordinated activities related to public health information architecture, standards, confidentiality, best practices, and research; and that informatics training is needed throughout the public health workforce. Implementation of this consensus agenda will help promote progress in the application of information technology to improve public health.

A b s t r a c t Objective:To determine the extent to which a combination of existing machine-readable health terminologies cover the concepts and terms needed for a comprehensive controlled vocabulary for health information systems by carrying out a distributed national experiment using the Internet and the UMLS Knowledge Sources, lexical programs, and server. Methods: Using a specially designed Web-based interface to the UMLS Knowledge Source Server, participants searched the more than 30 vocabularies in the 1996 UMLS Metathesaurus and three planned additions to determine if concepts for which they desired controlled terminology were present or absent. For each term submitted, the interface presented a candidate exact match or a set of potential approximate matches from which the participant selected the most closely related concept. The interface captured a profile of the terms submitted by the participant and for each term searched, information about the concept (if any) selected by the participant. The term information was loaded into a database at NLM for review and analysis and was also available to be downloaded by the participant. A team of subject experts reviewed records to identify matches missed by participants and to correct any obvious errors in relationships. The editors of SNOMED International and the Read Codes were given a random sample of reviewed terms for which exact meaning matches were not found to identify exact matches that were missed or any valid combinations of concepts that were synonymous to input terms. The 1997 UMLS Metathesaurus was used in the semantic type and vocabulary source analysis because it included most of the three planned additions. Results: Sixty-three participants submitted a total of 41,127 terms, which represented 32,679 normalized strings. More than 80% of the terms submitted were wanted for parts of the patient record related to the patient's condition. Following review, 58% of all submitted terms had exact meaning matches in the controlled vocabularies in the test, 41% had related concepts, and 1% were not found. Of the 28% of the terms which were narrower in meaning than a concept in the controlled vocabularies, 86% shared lexical items with the broader concept, but had additional modification. The percentage of exact meaning matches varied by specialty from 45% to 71%. Twenty-nine different vocabularies contained meanings for some of the 23,837 terms (a maximum of 12,707 discrete concepts) with exact meaning matches. Based on preliminary data and analysis, individual vocabularies contained <1% to 63% of the terms and <1% to 54% of the concepts. Only SNOMED International and the Read Codes had more than 60% of the terms and more than 50% of the concepts. Conclusions: The combination of existing controlled vocabularies included in the test represents the meanings of the majority of the terminology needed to record patient conditions, providing substantially more exact matches than any individual vocabulary in the set. From a technical and organizational perspec...

The past 20 years have witnessed computer and communications revolutions, rapid progress in genetics research, increasing public interest in personal health decisions, and corresponding expansions in the services provided by the National Library of Medicine. These concomitant and linked developments have upset the information marketplace and inspired policy debates about telecommunications, intellectual property, and access to the results of governmentfunded research. The Internet and the World Wide Web have transformed the way libraries deliver information services and have created perceived alternatives to libraries. What will happen to medical libraries in the post-Google world?Today, most medical libraries exist within hospitals or academic institutions. Their primary purpose is to provide scholarly information to support health care, education, and the research conducted at these institutions. Given that scholars and researchers continue to rely on information, the work now performed by medical libraries will not disappear. But how, where, and by whom will it be done? Here is one evolutionary scenario for the medical libraries of 2015. Everything we envision exists in some form today.In our 2015, health care professionals, patients, educators, students, researchers, and administrators expect easy access to electronic information from their homes, offices, wards, clinics, and libraries, not to mention while they are en route between these places. People use a constantly changing array of desktop, portable, and wearable computing and telecommunications devices. Most desktop ma-chines and many portable devices support easy teleconferencing and distance education. Everyone craves access to more electronic information, no matter how much is available, but people treasure efficient methods for extracting pertinent information from the fire-hose effect of undifferentiated electronic text (and unwanted commercial offers). Most clinicians, patients, and healthy people use electronic health records. Like basic researchers, clinical researchers depend on electronic data systems. When using such systems, practitioners and researchers expect instant connection to related knowledge, including guidelines, protocols, clinical alerts, and relevant published dicta. Patients and families demand the same information that is available to physicians, nurses, and public health departments.Despite ubiquitous access to electronic information, however, the "library as place" is still highly valued and heavily used (unless the facility is physically decrepit, outmoded, or inconveniently located). Users flock to library buildings and spaces that are attractive, centrally located, technologically current, and arranged to meet the needs of groups as well as of solitary users. 1 In addition to serving coffee, the best facilities support small-group study and larger-group training, provide well-wired space for interdisciplinary collaboration involving complex electronic data sets, and welcome those seeking temporary work space, individual ...

In 1986, the National Library of Medicine began a long-term research and development project to build the Unified Medical Language System® (UMLS®). The purpose of the UMLS is to improve the ability of computer programs to “understand” the biomedical meaning in user inquiries and to use this understanding to retrieve and integrate relevant machine-readable information for users. Underlying the UMLS effort is the assumption that timely access to accurate and up-to-date information will improve decision making and ultimately the quality of patient care and research. The development of the UMLS is a distributed national experiment with a strong element of international collaboration. The general strategy is to develop UMLS components through a series of successive approximations of the capabilities ultimately desired. Three experimental Knowledge Sources, the Metathesaurus®, the Semantic Network, and the Information Sources Map have been developed and are distributed annually to interested researchers, many of whom have tested and evaluated them in a range of applications. The UMLS project and current developments in high-speed, high-capacity international networks are converging in ways that have great potential for enhancing access to biomedical information.

The American Medical Informatics Association 2001 Spring Congress brought together the public health and informatics communities to develop a national agenda for public health informatics. Discussions on funding and governance; architecture and infrastructure; standards and vocabulary; research, evaluation, and best practices; privacy, confidentiality, and security; and training and workforce resulted in 74 recommendations with two key themes: (1) all stakeholders need to be engaged in coordinated activities related to public health information architecture, standards, confidentiality, best practices, and research and (2) informatics training is needed throughout the public health workforce. Implementation of this consensus agenda will help promote progress in the application of information technology to improve public health.