Free MEDLINE access worldwide.

When Donald A.B. Lindberg M.D. was sworn in as Director of the National Library of Medicine (NLM) in 1984, MEDLINE, NLM's online database of citations and abstracts to biomedical journal articles, was searched primarily by librarians trained to use its command language interface. There were fees for searching, primarily to recover the cost of using commercial value-added telecommunications networks. Thirteen years later, in 1997, MEDLINE became free to anyone with an Internet connection and a Web browser. This chapter provides an insider's view of how Dr. Lindberg's vision and leadership - combined with new technology, astute handling of policy issues, and key help from political supporters and influential advocates - enabled a tremendous expansion in access to biomedical and health information for scientists, health professionals, patients, and the public.

Don Lindberg's home library and leadership traits.

This chapter introduces the importance and some of the multidisciplinary diversity in Donald A.B. Lindberg M.D.'s home library. The latter collection minimally suggests his varied interests, which often inspired a multidisciplinary approach to tackling problems and managing the U.S. National Library of Medicine (NLM). Dr. Lindberg converted the ideas he picked up from reading into administering projects as well as to set aspirational goals for NLM and for himself. The chapter suggests Dr. Lindberg's home library was an enduring reservoir of knowledge, judgment, planning, and creativity. The chapter also discusses two of Dr. Lindberg's leadership traits: the cultivation of discovery and project development in educational administration and the need for leaders to determine and act in the greater public interest. The chapter suggests the latter two traits defined Dr. Lindberg's NLM leadership.

Promoting new and expanded roles for librarians and information specialists.

This chapter describes how the U.S. National Library of Medicine (NLM), under the leadership of Donald A.B. Lindberg M.D., promoted new and expanded roles for librarians and information specialists in response to advances in technology and public policy. These advances brought information services directly to all potential users, including health professionals and the public and stimulated NLM to expand its programs, policies, and services to serve all. Dr. Lindberg included librarians and information specialists in all of NLM's new endeavors, helping both to recognize and establish new or expanded roles. The involvement of librarians and information specialists in multidisciplinary healthcare research teams, in underserved communities, and in research data management and compliance has helped to redefine the health sciences information profession for the 21st century.

The biomedical informatics short course at Woods Hole/Georgia: Training to support institutional change.

The US National Library of Medicine's Biomedical Informatics Short Course ran from 1992 to 2017, most of that time at the Marine Biological Laboratory in Woods Hole, Massachusetts. Its intention was to provide physicians, medical librarians and others engaged in health care with a basic understanding of the major topics in informatics so that they could return to their home institutions as "change agents". Over the years, the course provided week-long, intense, morning-to-night experiences for some 1,350 students, consisting of lectures and hands-on project development, taught by many luminaries in the field, not the least of which was Donald A.B. Lindberg M.D., who spoke on topics ranging from bioinformatics to national policy.

Something new and different: The Unified Medical Language System.

Donald A.B. Lindberg M.D. arrived at the U.S. National Library of Medicine in 1984 and quickly launched the Unified Medical Language System (UMLS) research and development project to help computers understand biomedical meaning and to enable retrieval and integration of information from disparate electronic sources, e.g., patient records, biomedical literature, knowledge bases. This chapter focuses on how Lindberg's thinking, preferred ways of working, and decision-making guided UMLS goals and development and on what made the UMLS markedly "new and different" and ahead of its time.

The multiple dimensions of expanded access to health information: Don Lindberg and the U.S. National Library of Medicine.

When Donald A. B. Lindberg M.D. became Director of the U.S. National Library of Medicine in 1984, trained searchers, primarily librarians, conducted less than three million searches of NLM databases. They paid for their fair share of the commercial telecommunications costs to reach NLM's computer system. In 2015 when Lindberg retired, millions of scientists, health professionals, patients, members of the public, and librarians conducted billions of free searches of NLM's greatly expanded electronic resources via the Internet. Lindberg came to NLM intending to expand access to biomedical and health information along multiple dimensions: reaching more users, providing more types and volumes of information and data; and improving the conceptual, technical, and organizational connections needed to provide information to users when and where it is needed. By any measure he and NLM were spectacularly successful. This chapter discusses some key decisions and developments that contributed to that success.

Dr. Lindberg and scholarly publishing.

Donald A.B. Lindberg M.D., Director of the U.S. National Library of Medicine (NLM) from August 1984 to March 2015, had a remarkable vision for NLM's scope, goals, and function. This vision resulted in many external partnerships and initiatives with the publishing industry, commercial and non-profit, journal editors, and professional organizations. These partnerships ranged from ongoing collaboration and dialogue, such as the NLM Publisher's Committee and the International Committee of Medical Journal Editors (ICMJE). to the more practical, such as the creation of HINARI and the Emergency Access Initiative (EAI). Dr. Lindberg fostered partnerships outside the NLM to expand the use and reach of Library resources, including MEDLINE and ClinicalTrials.gov to support innovations in the processes that build them, and to improve the quality of biomedical journals. Dr. Lindberg also encouraged the use of technology to enhance medical information and supported the early development of fully interactive publications. Attitudes that contained a measure of skepticism and distrust faded as collaborators came to have a better understanding of both NLM and their partners. This chapter discusses these relationships and accomplishments that NLM achieved working with publishers and other creators and disseminators of medical information under Dr. Lindberg's leadership.

Grateful Med: Direct access to MEDLINE for health professionals with personal computers.

Donald A.B. Lindberg M.D. arrived as Director, U.S. National Library of Medicine (NLM) in late 1984 with the intention of implementing a physician-friendly interface to MEDLINE, a prime example of his interest in making NLM information services more directly useful in medical care. By early 1986, NLM's Grateful Med, an inexpensive PC search interface to MEDLINE useful for health professionals, had joined the group of end-user systems for searching MEDLINE that emerged in the 1980s. This chapter recounts Grateful Med's rapid iterative development and the subsequent campaign to bring it to attention of health professionals. It emphasizes Lindberg's role, the challenges faced by those introducing and using the interface in a pre-Internet world, and some longer-term effects of the effort to expand health professionals' use of MEDLINE during the decade from 1986 to 1996.

An active contributor: Dr. Lindberg and NLM's historical programs and services.

Donald A.B. Lindberg M.D.'s interests extended far beyond his scientific expertise into the arts and humanities, as evidenced, for example, by his love of opera, his talents in photography, and his affection for history. It is therefore not surprising that he had a strong interest in the National Library of Medicine's historical programs and services, going beyond supporting these activities to becoming actively involved in some of them. The subject of this essay is Dr. Lindberg's contributions to these programs and services, which may be grouped under three main headings: placing greater emphasis on more contemporary history, promoting the digitization of historical materials to increase access, and enhancing outreach through an exhibition program.

Partnering for education and career development of librarians and information specialists.

Donald A.B. Lindberg M.D. was a strong proponent of self-improvement for all professions. He believed it was imperative for health sciences librarians to embrace lifelong learning as the Internet and networked information radically changed their work and opened new opportunities to increase their scope and impact. During Dr. Lindberg's 1984-2015 tenure as its Director, the U.S. National Library of Medicine (NLM) became an even more dominant influence on education and career development of health sciences librarians. This chapter focuses on the way NLM partnered with other institutions and organizations to ensure that education and training were consistently part of the roll-out of new NLM programs and services as they were implemented.

Providing health information for patients, families and the public.

When Dr. Lindberg was sworn in as Director, the National Library of Medicine (NLM) was providing few resources with information useful to the public, having concentrated efforts towards health professionals and scientists. With his arrival, and that of the Internet in the 1990s, NLM embarked on a research and user-focused path towards providing authoritative health information for patients, families and the public. MedlinePlus, NIHSeniorHealth, and MedlinePlus en espanol delivered health information in a variety of formats using text, still images, audio and video. These resources were supported by NLM advisors and Dr. Lindberg's strong belief that patients and families needed easy access to medical information to be able to effectively care for themselves in illness and maintain the best health possible throughout their lives.

The U.S. National Library of Medicine and standards for electronic health records: One thing led to another.

When Donald A.B. Lindberg M.D. became Director in 1984, the U.S. National Library of Medicine (NLM) was a leader in the development and use of information standards for published literature but had no involvement with standards for clinical data. When Dr. Lindberg retired in 2015, NLM was the Central Coordinating Body for Clinical Terminology Standards within the U.S. Department of Health and Human Services, a major funder of ongoing maintenance and free dissemination of clinical terminology standards required for use in U.S. electronic health records (EHRs), and the provider of many services and tools to support the use of terminology standards in health care, public health, and research. This chapter describes key factors in the transformation of NLM into a significant player in the establishment of U.S. terminology standards for electronic health records.

Don Lindberg's outreach legacy at the National Library of Medicine.

Friends and colleagues of Donald A.B. Lindberg M.D. came together to give tribute to his extraordinary contributions during his tenure (1984-2015) as Director of the U.S. National Library of Medicine (NLM). Dr. Lindberg died in 2019. The book, Transforming biomedical informatics and health information access: Don Lindberg and the U.S. National Library of Medicine. includes four sections. The ten edited chapters in section three (the Outreach section) are briefly summarized in this overview. As Associate Director for Health Information Programs Development, Elliot R. Siegel Ph.D. coordinated NLM's outreach programming under Dr. Lindberg's leadership from its inception in 1989 to his own retirement in 2010. Dr. Lindberg's legacy at NLM is one of new possibilities imagined, significant changes made in the mission and ethos of a venerable institution, and numerous successes achieved in a variety of settings and contexts. Like so much else Dr. Lindberg accomplished, these Outreach programs that profoundly changed the character of NLM would likely not have occurred without him. He made a difference.

NLM's revolution in consumer health information to improve patient outcomes.

Under the leadership of NLM Director Donald A.B. Lindberg M.D., the National Library of Medicine (NLM) continued to promote its services to the nation's health care professionals and scientists. With support of the U.S. Congress, it initiated new communications and outreach programs and services directed at the general public that revolutionized their access to information as well. Because effective health communication must be tailored for the audience and the situation, Lindberg supported the development of online health information tools designed to help consumers find free, comprehensive, timely, and trustworthy sources of health information that, ultimately, can improve patient outcomes. New and popular consumer-friendly websites were championed by Lindberg, including MedlinePlus, and ClincialTrials.gov, and he formed unique partnerships with national physician organizations to educate their patients about reliable sources of health information from the NLM. A new era of timely and trusted online health information for the general public began in 2006 under Lindberg's tenure culminating in the development, publication and distribution of NIH's first consumer magazine, NIH MedlinePlus, featuring the research and findings of the NIH. In his effort to improve patient outcomes, Dr. Lindberg revolutionized the Library's outreach capabilities and successfully expanded its mission to serve not only health professionals and scientists, but also consumers nationwide.

BITNIS - Bridging the information gap before the web.

Before the modern internet and World Wide Web drastically simplified our access to scientific information, accessing the authoritative information of the National Library of Medicine (NLM) from outside the U.S. was for many very difficult. Compared to the totality of people with access to computers globally at the time, only a privileged group of biomedical researchers and practitioners could afford this access. The NLM was making great contributions developing products and collaborations to reduce the information gap for many underserved communities. This article describes a remarkable initiative started from the other end, underserved information users creating a solution to help the international community reach the NLM resources. Donald A.B. Lindberg M.D., the NLM Director and health informatics pioneer, believed in letting users guide the NLM down its path of service. The BITNIS project is a successful example of his leadership philosophy at a turning point in health informatics history.

Environmental Health Information Partnership (EnHIP): Strengthening the capacity of minority serving institutions.

The U.S. National Library of Medicine's (NLM) Environmental Health Information Partnership (EnHIP) collaborates with Historically Black Colleges and Universities (HBCUs) and other minority-serving academic institutions to enhance their capacity to reduce health disparities through the access, use, and delivery of environmental health information on their campuses and in their communities. The partnership began in 1991 as the Toxicology Information Outreach Panel (TIOP) pilot project, and through successive iterations it is NLM's longest running outreach activity. EnHIP's continued relevance today as an information outreach and training program testifies to the prescience of NLM director, Donald A.B. Lindberg M.D's initial support for the program. Dr. Lindberg's seeing to its continued success to benefit participating institutions and help achieve the societal goals of environmental justice serve as well to benefit NLM by increasing its visibility, and use of its resources in the classroom, for research, and in community outreach. NLM envisions an expanding role for EnHIP in advancing health equity as the impact of environmental exposure, climate change, and increasing zoonotic diseases disproportionately impact their communities.

Mentoring in Medicine (MIM): Motivating and enabling disadvantaged youth to become the next generation of minority health professionals.

Mentoring in Medicine, Inc. (MIM) is a nonprofit health and science youth development organization based in the Bronx, NY. Founded in 2006 by three physicians and an engineer- trained entrepreneur, MIM's organizational goal is to expose socioeconomically disadvantaged students to the wide variety of health and science careers and to increase the health literacy of their communities. It is aligned with the outreach mission of the U.S. National Library of Medicine (NLM) whose former Director, Donald A.B. Lindberg M.D., fostered an enduring relationship. Technical assistance, evaluation, and financial support provided under his leadership helped MIM to become a nationally recognized organization leading the field to diversify health careers and to increase health literacy in often hard to reach populations. Through live and virtual programming, MIM has impacted nearly 58,000 students, parents, and educators in urban epicenters in the U.S. The MIM Team has helped 503 students who were discouraged to build a competitive application and matriculate in health professional school. MIM has 88 press features highlighting its work in the community.

Reflections on Dr. Donald A.B. Lindberg and Native Voices.

Personal reflections on Donald A.B. Lindberg M.D. are offered by four Native American leaders who were instrumental in the successful development of the National Library of Medicine's (NLM) Native Voices Exhibition: Stories of Health and Wellness from American Indians, Alaska Natives and Native Hawaiians. A uniquely collaborative effort, the exhibition features nearly 100 videographed interviews conducted by Dr. Lindberg with Native elders, healers, leaders, and people. He is credited with the incorporation of indigenous peoples' healing knowledge in a personal and relational way, making for a wonderful journey together that was a very large chapter in his life and that of the authors.

HIV/AIDS community information outreach program (ACIOP): A landmark NIH conference and an enduring NLM role in meeting the affected community's need for information access.

In June 1993, the National Library of Medicine (NLM) joined with the National Institutes of Health's (NIH) Office of AIDS Research (OAR), and the National Institute of Allergy and Infectious Diseases (NIAID) to host a conference at a pivotal time in the HIV/AIDS epidemic to understand better the information needs of five major constituency groups: clinical researchers; clinical providers; news media and the public; patients; and the affected community. NLM's director, Donald A.B. Lindberg M.D., and staff sought to identify new program possibilities benefitting from the input of current and potential users of the Library's information services. Conference recommendations led to a key NLM policy change providing cost-free access to all AIDS data, and the establishment of the HIV/AIDS community information outreach program (ACIOP), which enabled new partnerships with local community-based organizations serving the affected community. Uniquely funded and long running, more than 300 ACIOP projects have been supported to-date. These projects have improved awareness and use of national HIV/AIDS information resources; enhanced information seeking skills; developed locally generated information resources; and enhanced the capacity of community-based organizations to use new information and computer technologies providing access to essential information resources and services.

NLM's library network: A force for outreach.

This chapter considers the transformation of U.S. National Library of Medicine's (NLM) national network of libraries into an effective force for spreading awareness of NLM's resources, services, and tools and increasing their use. Several examples of network programs and projects are recounted to illustrate the influence of NLM's longest serving Director, Donald A.B. Lindberg M.D. on the development and evolution of NLM's library network.