College and Research Libraries


ELEANOR G. STEINKE and ROBERTS. TANNEHILL, JR. 

Regional Medical Library Planning in 
the Southeastern United States 

Planning for expanded, and more effective, information services in the 
United States has been stimulated by the provision for the establish-
ment of regional medical libraries under the Medical Library Assist-
ance Act of 1965. A description is given of a proposed decentralized, 
cooperative regional biomedical information system to serve the South-
eastern United States. 

THE CoNGRESS of the United States 
passed into law on October 22, 1965, an 
act that has far-reaching .consequences 
for medical libraries in the United States. 
The Medical Library Assistance Act of 
1965 authorized funds for: construction 
of new, and the renovation, expansion, 
or rehabilitation of existing, medical li-
brary facilities; training of medical li-
brarians and other information specialists 
in the health sciences; special fellow-
ships to practitioners in the sciences re-
lated to health for the preparation of 
special literature projects; conducting re-
search and investigations in the field of 
medical library science and related ac-
tivities; improvement and expansion of 
the basic resources of medical libraries 
and related facilities; and the develop-
ment of a national system of regional 
medical libraries. 

Never before has federal financial sup-
port of this magnitude been available to 
the medical library profession. Yet nev-

Miss Steinke was librarian and Mr. Tan-
nehill information scientist in the Vander-
bilt University Medical Center Library in 
Nashville, Tennessee. This paper was pre-
sented before the 3rd International Con-
gress of Medical Librarianship, May 1969, 
in Amsterdam, the Nether lands. 

er before have medical libraries had to 
cope with such an expansion of knowl-
edge in the health sciences, an expan-
sion that has resulted in an explosive 
growth in the quantity of, and major 
changes in the nature of, biomedical in-
formation, materials, and publications. 
Coupled with this problem is the lack 
of a "corresponding growth in the facil-
ities and techniques necessary adequate-
ly to coordinate and disseminate among 
health scientists and practitioners the 
ever-increasing volume of knowledge 
and information which has been devel-
oped in the health science field. . . . "1 

Faced with these considerable problems, 
medical libraries are beginning to re-
ceive the benefits of this legislation 
which was enacted to stimulate new ac-
tivity in the field of biomedical informa-
tion. 

Prior to the legislative establishment 
of a national regional library program, 
health scientists and practitioners across 
the United States received regional type 
services officially from the National Li-
brary of Medicine at Bethesda, Mary-
land. This function of NLM is based on 
one of its primary responsibilities, which 

1 U.S. Congress. Public Law 89-291, S.597, October 
22, 1965 (Medical Library Assistance Act of 1965). 
p. l. 

I 327 



328 I College & Research Libraries • July 1969 

is to serve "as a national medical infor-
mation resource for medical education, 
research, and service activities of federal 
and private agencies, organizations, in-
stitutions, and individuals."2 However, 
the primary sources of such services to 
health scientists and practitioners have 
been the larger medical libraries, which 
have for years provided limited, de facto 
regional library services to their immedi-
ate geographic regions. The additional 
funds resulting from the Medical Library 
·Assistance Act of 1965, and its accom-
panying provisions of designating spe-
cific medical libraries as official regional 
medical libraries, have permitted these 
libraries to engage in programs which 
will improve traditional services, devel-
op new services, reach a larger user pop-
ulation, improve a region's health sci-
ences information resources and informa-
tion personnel, develop more effective 
cooperative mechanisms among medical 
libraries, and improve region-wide com-
munication networks. 

It is in the expansion of de facto re-
gional library services into fully devel-
oped, effective programs that the chal-
lenging question of "how to do it" must 
be grappled with, and a decision made. 
At the time of this writing, four regional 
medical library applications have been 
approved and funded, with approximate-
ly six others to be activated. These four 
are the Francis A. Countway Library of 
Medicine at Harvard University, Boston, 
Massachusetts; the University of Wash-
ington, Health Sciences Library, Seattle, 
Washington; the Library, College of 
Physicians, Philadelphia, Pennsylvania; 
and the John Crerar Library, Chicago, 
Illinois. In each instance the decision as 
to what the organizational system for 
the regional library would be, has re-
quired serious study and analysis of the 

2 "Public Health Service: statement of organization 
functions and delegations of authority." Federal Regis-
ter, 33:5, Thursday, 9 January 1968. 

proposed region's library user population, 
information resources, information ser-
vices, cooperative networks, geographic 
size, and available communication re-
sources. Only after these parameters 
were defined could a general philosophy 
of operation be developed, and from this 
philosophy, bounds set for services, re-
sources, administrative structure, and 
other needs. 

The philosophy chosen for determin-
ing a regional library's service and ad-
ministrative structure falls somewhere 
within the limits set by the extremes of 
complete decentralization and complete 
centralization. That complete centraliza-
tion is not presently feasible for medical 
libraries providing service to large user 
groups is indicated by the National Li-
brary of Medicine's operation of the na-
tional regional library network, its de-
centralized indexing network, and its ex-
perimental shared cataloging network. 
Complete, total decentralization has not 
been attempted in regional medical li-
brary structures, because the disadvan-
tages of duplication, increased cost of op-
eration, and lack of effective adminis-
trative control are difficult to relate to a 
viable operation. 

The Southeastern United States has 
also offered a challenge in the planning 
of a regional medical library. It is the 
purpose of this paper to describe the 
basic concepts developed at Vanderbilt 
University for a decentralized-coopera-
tive regional library structure in the 
Southeastern section of the United 
States. 

The Vanderbilt University Medical 
Center Library has for years provided 
limited library services outside of its im-
mediate area of service responsibility, 
thus assuming the function of a de facto 
regional medical library. The Medical 
Library Assistance Act of 1965 stimulat-
ed Vanderbilt to produce a plan that 
would adhere to the goals of the Act in 



Regional Medical Library Planning I 329 

bringing improved and expanded bio-
medical information services to the large 
health sciences user population in the 
Southeastern United States, this area 
encompassing the states of Alabama, 
Florida, Georgia, Mississippi, South Car-
olina, Tennessee, and the Common-
wealth of Puerto Rico. Guidelines pub-
lished by the National Library of Medi-
cine led to a series of meetings begin-
ning in 1966, which brought representa-
tives of the region's health sciences ed-
ucational and library community into the 
active development of the regional plan 
and of the natural and feasible service 
configuration for the region. 

It became evident early in Vander-
bilt's planning for a regional medical li-
brary system that conditions existed in 
the Southeastern United States not com-
mon to the geographic regions of the re-
gional medical libraries already estab-
lished. Demographic data for the pro-
posed region shows 9 per cent of the 
nation's health manpower located in the 
Southeast (Appendix 1). Yet to serve 
this large user population with medical 
library services, there is no single, strong, 
general medical information resource. 
Rather, the Southeastern United States 
has twelve medical school libraries, each 
having a collection of information re-
sources that is qualitatively and quanti-
tatively similar to the collections of the 
other eleven medical school libraries 
(Appendix 2). 

With the existence of fairly equivalent 
medical information resource strengths 
in the Southeast as a parameter that 
could not be ignored in the design of a 
regional biomedical information system, 
a pertinent question is, "What aspects 
should be considered for an effective re-
gional medical library?" The support of 
the school administration, library staff 
capability, available physical space, 
available computer resources, support of 
regional health sciences groups and li-

braries, and availability of health related 
information resources are important to 
the overall capability of a library to serve 
as a regional library, and should be in-
cluded in the aspects to be evaluated. 

A proposal was filed for a Southeastern 
Regional Biomedical Information Sys-
tem ( SERBIS) based on a balance be-
tween the extremes of complete central-
ization and complete decentralization. 
The regional medical library system was 
to be organized around a centralized ad-
ministrative and triage structure located 
at Vanderbilt University, and a coopera-
tive services structure which would uti-
lize the information resource strengths 
at selected locations throughout the re-
gion. The philosophies which were pro-
pounded at the series of meetings held 
during the period 1966-1968, and which 
were analyzed and combined with Van-
derbilt's concepts and set forth in its pro-
posal, received support throughout the 
Southeast. Many of these concepts also 
found ready acceptance in the compet-
ing applications for a regional medical 
library. All told, three applications were 
filed with the National Library of Medi-
cine for a regional medical library in the 
Southeastern United States. 

The concept of the Southeastern Re-
gional Biomedical Information System 
as developed by Vanderbilt University 
included the following objectives: 

1. coordination of the strengths and 
competencies of health sciences in-
formation resources, personnel, and 
services which were available in the 
region; 

2. the development of health sciences 
library materials and other informa-
tion resources capable of meeting at 
least 90 per cent of all information de-
mands from within the region; 

3. provision for advanced training for 
individuals seeking careers in health 
science information; 



330 I College & Research Libraries • July 1969 

4. availability of continuing education 
for persons already in the field of 
health science information; 

5. cooperation with national libraries, 
other regional medical libraries, and 
biomedical information systems for 
the maximum utilization of health 
science information resources and 
services; 

6. continuing evaluation programs to as-
sure the effective dissemination of 
health science information to the re-
gion's users. 

In addition to the preceding objec-
tives, the Vanderbilt philosophy was 
based on a number of other factors, pri-
mary of which were: ( 1) the non-exist-
ence of a single, strong, medical library; · 
( 2) the expressed support of medical 
librarians in the Southeast for a coopera-
tive, decentralized approach to the re-
gional medical library; ( 3) the existence 
of a national Regional Medical Program; 
and ( 4) the existence of the Joint U ni-
versity Library system in Nashville, in 
which the Vanderbilt Medical Center Li-
brary represents one of five divisions. 
The JUL were cited as an operational 
model of a decentralized, cooperative 
library system. 

The developers of the Vanderbilt pro-
posal for a regional medical library con-
sidered the feasibility of a highly cen-
tralized, large collection of the informa-
tion resources necessary for effective re-
gional service. Though such a resource 
structure has a number of advantages, 
the disadvantage of cost precluded fur-
ther consideration. 

The average size of the collection of 
ten medical school libraries in the South-
eastern United States is slightly less than 
65,000 bound volumes, with four librar-
ies below · the average. To attempt to 
bring any one of these libraries up to a 
collection strength necessary for highly 
centralized services to the Southeast 
would be financially prohibitive, the cost 
of the material being but one part of a 

financial picture that includes space to 
house the material, and personnel for 
processing and maintenance of the col-
lection. 

In terms of information resources, the 
philosophy of decentralized cooperation 
for the Southeastern Regional Biomedi-
cal Information System was to be carried 
out by the Regional Cooperative Acqui-
sitions Plan (RECAP). Under this plan, 
twelve medical school libraries in the 
Southeastern region, each being desig-
nated a sectional library, would be re-
sponsible for in-depth collecting of in-
formation materials in specific subject 
fields. These subject areas were to be de-
termined by the expressed interests of 
the libraries and the needs of the users 
with final approval being awarded b; 
the Regional Medical Library system's 
Executive Council. Under such an ar-
rangement, it should have been possible 
to make available within the region at 
least one copy of every scholarly bio-
medical publication. This concept was 
inspired by the Farmington Plan of 1948, 
which provides for the acquisition of 
foreign material by American libraries 
on .a subject area basis. 

Decentralized cooperation was evi-
dent in other regional services to be of-
fered to health sciences personnel 
throughout the Southeast, including loan 
of material, photoduplication, reference 
services, and current awareness services. 
The primary role for Vanderbilt in the 
regional medical library system was to 
provide back-up support to the sectional 
libraries and to act as a triage, or trans-
fer, center, to administer the RML sys-
tem program, to provide and coordinate 
information services, training programs, 
continuing evaluation and monitoring 
programs; and to develop new and im-
proved methods of information transfer 
and new services as such became feasi-
ble. Each sectional medical library 
would act as the service center for its 
portiqn of the region, and as a develop-



Regional Medical Library Planning I 331 

er of its peculiar subject area strengths 
for the benefit of the entire region. Such 
a service structure was in keeping with 
the desired factor of cooperation as 
stated by the medical libraries in the 
region. 

In attempting to develop an effective 
regional service structure, Vanderbilt ap-
proached the problem from three differ-
ent directions. First, a mechanism for 
the involvement of the user in policy 
making was established in the proposal; 
second, procedures for the continumg 
evaluation of regional services would be 
initiated; and third, close relationships 
with Regional Medical Programs for 
Heart Disease, Cancer, and Stroke 
would be established. 

The administrative structure for the 
Regional Medical Library provided for 
an Advisory Council at each sectional 
library, each Advisory Council to com-
prise representatives of the health sci-
ences users in each sectional library's 
service area. An Executive Council 
would have representatives from each 
of the region's Advisory Councils, as well 
as an elected chairman and ex officio 
members of the regional medical library's 
administrative structure. The Executive 
Council would formulate regional medi-
cal library system policy. These adminis-
trative mechanisms would, it was felt, 
insure a continuous flow of constructive 
criticism, recommendations, and sugges-
tions on regional medical library policies, 
which would, in turn, make it possible 
to maintain a viable service structure. 

The administrative mechanism just de-
scribed is relatively subjective. Such was 
desirable, but objective data on services 
were also needed. This need was met 
by the evolution of a program of continu-
ing evaluation, utilizing appropriate 
statistical and survey data collection 
and processing techniques. Evaluation 
activities not only lead to the improve-
ment of operational services, but also 
to the development of new services. 

The services to be provided by the 
regional medical library must be avail-
able to the user in an optimal manner in 
order that the system be effective. Indi-
cated by this statement are such activ-
ities as an operable regional communica-
tions network, and trained information 
workers at all levels of the regional med-
ical library system. The regional medi-
cal library proposed to approach the lat-
ter via seminars and workshops for li-
brarians and other information person-
nel, a consultant service for hospital and 
medical libraries, the fostering of re-
cruitment programs for personnel at the 
professional level, and cooperation with 
educational institutions in the establish-
ment of new programs for the education 
and training of regional library and in-
formation specialists, and for non-pro-
fessional personnel. 

The development of a regional com-
munication network was well under-
way among the twelve medical school 
libraries, which already utilized teletype-
writer service connecting all but two of 
the proposed sectional libraries. In the 
future the communication network will 
be extended to lower levels of informa-
tion service, such as the hospital, and 
even the individual physician. A W A TS 
network will permit the use of the tele-
phone over regional distances at highly 
economical rates. When the techniques 
become technically and economically 
feasible, such communication modes as 
telefacsimile, television, and computer 
data transmission will be utilized. 

Especially important to the develop-
ment of a regional communication net-
work, as well as to other aspects of the 
regional medical library system, are the 
Regional Medical Programs for Heart 
Disease, Cancer, and Stroke (RMP). 
Each of the RMP's has the capability of 
establishing close, effective communica-
tion with health services personnel. It 
has been suggested that the regional 
medical library will be responsible for 



332 I College & Research Libraries • July 1969 

developing information services, and the 
RMP' s will assume the responsibility for 
disseminating information to the user 
and for developing communication 
methodologies. Such a cooperative ap-
proach is attractive, and was fundamen-
tal to the Vanderbilt regional medical 
library system proposal. Initial activity 
in this direction is underway now in a 
number of RMP's across the nation, and 
close relationships between Regional 
Medical Programs and regional medical 
library systems will continue to develop. 

The Vanderbilt Medical Center Li-
brary, as mentioned earlier, is one part 
of an operational, cooperative, decen-
tralized library system known as the 
Joint University Libraries. In operation 
since 1936, it is a cooperative library 
project of Vanderbilt University, George 
Peabody College, and Scarritt College. 
It has been tested operationally, and has 
proven a number of the methodologies 
incorporated in the Vanderbilt philoso-
phy. These methodologies include a cen-
tralized coordinating administration of 
the five member libraries (equivalent to 
the sectional libraries in the proposed 
regional medical library); development 
and maintenance of a union catalog; the 
preparation of an automated serials un-
ion list; coordination and transfer of in-
formation services; and mechanized co-
ordination of acquisitions. The existence 
of successful operations such as were 
contemplated for the Southeastern Re-
gional Biomedical Information System 
lent support to the Vanderbilt proposal. 

This paper has not attempted to dis-
cuss specific details of the Vanderbilt 
proposal. To attempt such would merely 
result in a reiteration of the proposal it-

self. It attempts rather to record the de-
velopments leading up to the Vanderbilt 
proposal and the philosophies upon 
which the proposal was based. Vander-
bilt based its proposal for a regional med-
ical library on cooperation and decen-
tralization, for it is felt that the provision 
of effective, efficient health sciences in-
formation services, training services, 
evaluation services, cooperative acquisi-
tions policy, and, in the future, informa-
tion research services to the user re-
quire such a philosophy. 

Medical libraries in the Southeastern 
United States have an enviable record 
of informal sharing of resources, and a 
formal, cooperative region-wide struc-
ture is needed to achieve full benefits 
from the information resources. The 
emerging pattern is one of an inter-insti-
tutional cooperative system designed: 
( 1) to mobilize existing local resources; 
( 2) to expand and build on these 
strengths, by a program of coordinated 
in-depth collecting; ( 3) to offer rapid 
access to scientific information; and ( 4 ) 
to coordinate the Regional Medical Li-
brary with similar developments na-
tionally and internationally. A coopera-
tive structure among the Southeastern 
United States medical libraries would of-
fer the advantage of a system sufficiently 
large to take advantage of modern tech-
nological developments, and to instigate 
cooperative library research projects, in-
cluding the application of data process-
ing techniques for reference and re-
search, and to prevent unnecessary du-
plication of facilities and services. The 
sharing of resources is not a simple mat-
ter but once accomplished it will result 
in a greater wealth for all users. • • 



APPENDIX 1 

DEMOGRAPHIC DATA -SOUTHEASTERN UNITED STATES 

Data Category 

Biomedical research funds FY 1966 (in millions of $) 
Hospitals ( 1966) . . . . . l ' 
Total non-federal physicians ( 1966) 
Pharmacists ( 1965 ) 
Dentists, non-federal ( 1965) 
Dieticians and Nutritionists ( 1960) 
Chiropractors ( 1965) 

Physical Therapists ( 1965) . 
Psychologists ( 1964) . . . 
Nurses (professional) (1962) . . . 
Speech Pathologists, Audiologists ( 1965) 
Veterinarians (1964 ) . . . . 
Optometrists (1966 ) 
Podiatrists ( 1965) 
Medical students 

( full-time, part-time and special 1966-1967 ) 
TOTAL Health Sciences Personnel 

% Health Sciences personnel in the categories 
per state in Southeastern U.S. 

Alabama Florida 

4.525M 
119 

2,781 
1,581 
1,068 

505 
294 

55 
42 

5,252 
109 
411 
184 
28 

312 
12,622 

11.97% 

10.043M, 
142 

8,454 
3,679 
1,834 

703 
764 

223 
182 

16,809 
270 
664 
514 
170 

548 
34,814 

33.00% 

Georgia Mississippi 

6.792M 
120 

4,378 
2,414 
1,259 

799 
428 

81 
91 

7,942 
171 
535 
287 

49 

663 
19,097 

18.10% 

2.007M 
95 

1,735 
1,005 

628 
326 
150 

32 
29 

3,213 
56 

193 
130 

8 

298 
7,803 

7.40% 

NATIONAL DATA 

Puerto Rico 

1.345M 
47 

2,036 
852 

15 
(Includes other 
U.S. outlying 

areas) 
45 

4 

58 

215 
3,227 

3.06% 

I. Total health services personnel in the United States, 1960. Professional, technical, and kindred 
II. Percentage of the nation's health manpower in the Southeastern United States . 

( 105,483 -;- 1,167,218) X 100 = 9.3% 

S. Carolina Tennessee 

1.303M 
65 

2,046 
1,131 

578 
399 
156 

47 
27 

5,254 
47 

185 
166 
15 

308 
10,359 

9.82% 

10.587M 
115 

4,344 
2,242 
1,539 

607 
183 

76 
97 

6,497 
185 
317 
320 
42 

1,112 
17,561 

16.65% 

Total 

36.602M 
703 

25,776 
12,904 
6,906 
3,339 
1,990 

559 
468 

44,967 
842 

2,305 
1,659 

312 

3,456 
105,483 

100% 

t"-4 
~ 
~ 
~ 
~ 

§ 
1,167,218 :;:s 

~· 



334 I College & Research Libraries • July 1969 

APPENDIX 2 

RESOURCE DATA-SOUTHEASTERN UNITED STATES 

I. General Libraries 

University of Alabama (Tuscaloosa) 
Emory University (Atlanta) . . . 
University of Florida (Gainesville) . . . . . . . . . . 
University of Georgia (Athens) . . . . . . . . . . . 
Joint University Libraries (Peabody, Vanderbilt, Scarritt) (Nashville) 

Volumes 

1,039,536 
898,313 

1,213,855 
683,698 

1,047,193 
813,551 
313,053 
315,887 
599,404 
842,833 

University of Miami (Miami) . . 
University of Mississippi (Oxford) . . 
University of Puerto Rico (Rio Piedras) . 
University of South Carolina (Columbia) 
University of Tennessee (Knoxville) . 

II. Medical Libraries (March 1968) 
Current 

Bound Journal 
Vol. Titles 

University of Alabama 
(Birmingham) 82,379 1,800 

Emory University 
(Atlanta) 71,772 1,113 

University of Florida 
( Gainesville) 113,122 1,433 
Medical College of 
Georgia ( Augusta) . 
Meharry Medical College 

60,154 1,183 

( Nashville) 22,300 466 
University of Miami 
(Miami) 65,000 1,325 
University of Mississippi 
(Jackson) • • 0 • 57,000 1,700 
University of Puerto Rico, 
School of Med. and 
Dentistry (San Juan) 47,974 1,525 
Medical College of 
So. Carolina 
(Charleston) ( 1964-65) 38,281 625 
University of Tennessee 
(Memphis) . . 
Vanderbilt Univ. Med. 

72,062 1,582 

Center (Nashville) 72,868 1,321 

Collection: 
Subject Area 

Strengths 

medicine, 
dentistry, nursing 

general medicine, 
nursing, diabetes 

medicine, 
pharmacy 

general medicine 
neurophysiology, 
general medicine 

medicine, nursing 

medicine 
medicine, 
dentistry, nursing, 
public health 

anatomy, 
pharmacy 
cardiology, 
nuclear medicine, 
radiation 
biophysics, 
nursing 

(1966) 

Special 
Collections 

Reynolds Hist. 
Weinberger ( Hist. 
of Dentistry) 
Tye ( Hist. of Med. ) 
Rare Book Coil. 
Bowcock (Diabetes ) 

None 

Volumes 

6,000 

220 
1,800 
1,074 

80 

History of Med. 3,000 
Robert Hodes Memorial 102 
(neurophysiology) 
Weinstein College (books 

by and about physicians) 342 

None 

None 

None 

Hist. of Med. 3,000