MLA News: Selected Articles

January 1999

Legislative Update

Edited by Priscilla Stephenson

Submitted by Marianne Puckett, AHIP, Chair, Governmental Relations Committee, and Mary M. Langman, MLA Manager, Information Issues and Policy

Each year, the Joint MLA/Association of Academic Health Sciences Libraries (AAHSL) Legislative Task Force establishes legislative priorities for issues impacting medical libraries. For 1998/99, these priorities include funding for the National Library of Medicine (NLM), telemedicine programs, and Next Generation Internet (NGI); developing guidelines and regulations for computerized patient records; restructuring of the Federal Depository Library (FDL) program and revision of U.S.C. Title 44; reforming intellectual property and copyright law; and monitoring of the Communications Decency Act.

The following update addresses legislation enacted on these issues during the second term of the 105th Congress. Next month, the conclusion of this update will address issues of importance to MLA and AAHSL that were addressed by Congress but for which legislation was not passed.

Omnibus Appropriations Bill

In late October, Congress had not voted on several key pieces of legislation including eight appropriations bills, various emergency aid measures, and other authorizing bills. In order to bring these issues to closure before the conclusion of the 105th Congress, several of these bills were combined into one omnibus package, which was signed by the president on October 21, 1998. The Omnibus Appropriations Bill, H.R. 4328, includes several bills of interest to the medical library community including the Fiscal Year (FY) 1999 Labor, Health and Human Services, and Education (LHHS) Appropriation for the National Library of Medicine (NLM); the Child Online Protection Act; the Children’s Online Privacy Protection Act of 1998; and the Internet Tax Freedom Act.

National Library of Medicine Appropriation
Title II of the Omnibus Appropriations Bill provides $181,309,000 for NLM in FY99, a 12.7% increase over FY98. The recommendations found in the House and Senate Appropriations Committee reports remain valid under the final bill. Both the House Report (105-635) and the Senate Report (105-300) recognized NLM’s role in developing medical applications for NGI, and the committee encouraged NLM to continue ensuring that proper attention is given to health care applications within the NGI program. The report also recommended that NLM continue its outreach efforts aimed at medical librarians, health care professionals, and the general public; that the library continue to expand its successful telemedicine program; and that the library continue to publicize its information services to the consumer more widely than in the past by disseminating its annual reports, planning documents, catalogs of its exhibitions, and other appropriate materials.

Children’s Online Protection
Title XIII, the Children’s Online Privacy Protection Act of 1998, establishes a framework for the regulation of unfair and deceptive acts and practices in connection with the collection and use of personal information from and about children on the Internet. An amended version of S. 2326 introduced by Senator Bryan (D-NV) in July, Title XIII responds to the concerns expressed by the library community that the original bill would restrict access to information on the Internet by children, including some types of medical and scientific information. Title XIII requires that children under the age of thirteen must have parental consent or notice before giving away any personally identifiable information to commercial Websites targeted to children. Nonprofit organizations are excluded from the scope of the bill.

Title XIV, the Child Online Protection Act, amends the Communications Act of 1934 to require commercial distributors of material through the Web that is harmful to minors to restrict access to such material by minors.

Internet Tax Freedom Act
Title XI, the Internet Tax Freedom Act, bans state or local taxation of the Internet through FY2001. Commercial providers are excluded from this provision if they knowingly and with knowledge of the character of the material make information available to minors that is considered harmful.

Copyright Reform

Digital Millennium Copyright Act
After several years of intense debate among Congress and members of the content and user communities, Congress passed H.R. 2281, the Digital Millennium Copyright Act in October. H.R. 2281 updates the Copyright Law by making provision for the use of digital copyrighted materials and brings U.S. law into compliance with international law and the treaties negotiated by members of the World Intellectual Property Organization (WIPO) in December 1996. MLA along with its library partners—the American Library Association (ALA), American Association of Law Libraries (AALL), Association of Research Libraries (ARL), and Special Libraries Association (SLA)—continues to address the implications of various sections of H.R. 2281 for the library and education community, including, but not limited to, issues of online service provider liability, distance education, and the impact that restriction of anticircumvention devices would have on fair use.

An executive summary of the new copyright provision that established limitation of liability for online service providers in H.R. 2281 and a brief analysis of the provision that called for a study on distance education as it relates to copyright have been developed. These documents were distributed to the MEDLIB-L, AAHSL, MLA leaders, MLA Governmental Relations Committee (GRC), and Legislative Task Force e-mail discussion lists in November 1998.

Copyright Term Extension

The Copyright Term Extension Act, was signed by the president in October 1998. The legislation creates a twenty-year extension of the current life-plus-fifty-year copyright term. It provides an exemption for libraries and archives—including nonprofit educational institutions—to reproduce, distribute, display, or perform works for purposes of preservation, scholarship, or research.

National Guideline Clearinghouse Website Goes Live

Edited by Melissa L. Just

Submitted by Allan Braslow, Ph.D., Center for Practice and Technology Assessment, Agency for Health Care Policy and Research, Rockville, MD

The National Guidelines Clearinghouse (NGC), an exciting new free Web-based library resource for up-to-date evidence-based clinical practice guidelines, went live on the Internet on December 15, 1998. Developed by the Agency for Health Care Policy and Research (AHCPR), in partnership with the American Medical Association and the American Association of Health Plans, the NGC is designed to promote quality health care by making available the latest clinical practice guidelines that are based on scientific evidence, all in one easy-to-access location on the Web.

Development of clinical practice guidelines has grown rapidly over the last five years. This growth reflects increased interest in improving the quality of clinical practice, reducing uncertainty and variability in health care decision making, and stemming rapidly increasing health care costs. However, many health care practitioners, health care systems, and health care purchasers have difficulty gaining access to and keeping abreast of the many clinical practice guidelines currently in use. Moreover, existing clinical practice guidelines often differ in development methodology and content, further complicating their use.

Until the NGC, there has been no resource that provides free and comprehensive access to information on clinical practice guidelines. The goals of NGC are (1) to provide health professionals, health care providers, health care plans, integrated delivery systems, quality assurance programs, and others an accessible mechanism for obtaining objective, detailed information on clinical practice guidelines; and (2) to enhance health care quality by advancing the dissemination, implementation, and use of clinical practice guidelines based on scientific evidence.

In addition to its twenty-four-hour access on the Internet, the utility of the NGC is underscored by its features:

• Standardized abstracts containing information about each guideline and how it was developed
• Comparison of guidelines covering similar topic areas, listing major interventions addressed, recommendations made, and areas of agreement and disagreement
• Full text of guidelines (when available) or links to full text (when not)
• Topic-related electronic mail groups where registered users can exchange information about aspects of guideline development, content, and implementation

NGC is expected to have a broad professional audience. Health care systems (e.g., health plans, integrated delivery systems, hospital systems) are anticipated as an important audience for NGC. These organizations will be able to use the information contained in NGC to adopt or adapt nationally available guidelines into their systems. In addition, individual health care practitioners and medical specialty and professional societies are expected to make use of NGC. Because individual practitioners must sort through clinical practice guidelines from several different sources covering similar or same conditions, they will benefit from being able to obtain objective information on the similarities and differences among documents. Medical specialty and professional societies will find access to NGC useful in their own guideline development efforts. Clinicians may find NGC useful in their discussions of clinical options for their patients.

State and local governments in their role as health care providers and purchasers also require similar information as part of their quality assurance and oversight responsibilities. As these entities restructure their health care systems and move from purchasing and providing health care services under traditional fee-for-service plans to managed care systems, they face significant challenges in how they assure quality services through their contracting, regulatory, and oversight roles.

Employee benefits managers use information contained within clinical practice guidelines and similar documents to make better-informed purchasing decisions when negotiating with health plans for employee health care coverage. Medical and nursing educational institutions also have specific needs for information contained within clinical practice guidelines and related products for incorporation into academic curricula and continuing medical and nursing education programs.

The design of the NGC has incorporated previous research funded by the Department of Health and Human Services. The classification system for NGC is derived, in part, from NLM’s Unified Medical Language System (UMLS). Bidirectional links will exist between NLM’s PubMed and Health Services/Technology Assessment Text (HSTAT). The form of the structured abstracts of clinical practice guidelines in NGC was based on research funded collaboratively by AHCPR and NLM. The definition of what constitutes a clinical practice guideline was taken from work completed by the Institute of Medicine under the sponsorship of AHCPR.

The AHCPR is the lead agency charged with supporting research designed to improve the quality of health care, reduce its cost, and broaden access to essential services. AHCPR’s broad programs of research bring practical, science-based information to medical practitioners, consumers, and other health care purchasers. The NGC is an example of a program designed to make science-based clinical practice guidelines available to AHCPR’s constituent audiences.

We Watched It on the Web

Edited by Melissa L. Just

Submitted by Patricia M. Redman and Doreen Bradley, Taubman Medical Library, University of Michigan

More than 2,000 people attended the “Evidence-Based Health Care (EBHC) in Action” teleconference sponsored by MLA on September 16, 1998, at 110 sites around the country. An additional group of twenty-five volunteers watched an experimental live Webcast on their personal computers. Webcasting would allow MLA to broadcast future conferences and seminars over the Internet directly to participants’ desktops. If technology allows the content to be delivered without compromising the quality of the presentation, librarians would be able to “attend” conferences without leaving their office. This Webcast allowed testers to comment on the quality of the transmission in order to determine the pros and cons of Webcasting.

The staff at Taubman Medical Library, University of Michigan (UM)–Ann Arbor, coordinated the experiment in cooperation with MLA and the Greater Midwest Region (GMR) NN/LM. Volunteers were recruited from the boards and education or technology committees of MLA, GMR, and the Midwest Chapter of MLA.

To participate in the experiment, volunteers needed to have sound cards and speakers installed on their workstations. They also were required to have RealPlayer software in order to receive the audio and video of the teleconference. Taubman Library staff provided the volunteers with instructions for downloading and testing the free RealPlayer software and were available for technical assistance to help with installation. The satellite transmission was received by television services at the University of Michigan (UMTV). The transmission was run through video streaming software and a link to access the teleconference was provided on the UMTV homepage.

The volunteers provided excellent feedback on what worked well and what did not. The positive aspects of the Webcast included:

• the convenience of desktop access
• the quality of the audio transmission
• the ease of downloading and using RealPlayer software

The negatives included:

• the quality of the video, including distorted overheads and presenters
• the inability to participate in the discussion following the teleconference
• the absence of the syllabus provided to other teleconference participants

Most volunteers indicated they would watch a Webcast again and preferred it to traveling to a site. All were enthusiastic about the possibilities of this technology for future continuing education.

Those board and committee members who declined to volunteer were polled to see why they did not participate. Most had plans to attend a site or had other commitments at the time of the broadcast. Only a few indicated inadequate computer hardware as their reason for not participating.

MLA will review the evaluations completed by the volunteers and discuss how this technology might be used in future teleconferences and continuing education efforts. If you have questions or comments, please contact Kathleen Gaydos, continuing education coordinator, at 312.419.9094 x29.