Trends in Academic Health Sciences Libraries and Their Emergence as the "Knowledge Nexus" for Their Academic Health Centers*

Article excerpt

Objectives: The objective of this study was to identify trends in academic health sciences libraries (AHSLs) as they adapt to the shift from a print knowledgebase to an increasingly digital knowledgebase. This research was funded by the 2003 David A. Kronick Traveling Fellowship.

Methods: The author spent a day and a half interviewing professional staff at each library. The questionnaire used was sent to the directors of each library in advance of the visit, and the directors picked the staff to be interviewed and set up the schedule.

Results: Seven significant trends were identified. These trends are part of the shift of AHSLs from being facility and print oriented with a primary focus on their role as repositories of a print-based knowledgebase to a new focus on their role as the center or "nexus" for the organization, access, and use of an increasingly digital-based knowledgebase.

Conclusion: This paper calls for a national effort to develop a new model or structure for health sciences libraries to more effectively respond to the challenges of access and use of a digital knowledgebase, much the same way the National Library of Medicine did in the 1960s and 1970s in developing and implementing the National Network of Libraries of Medicine. The paper then concludes with some examples or ideas for research to assist in this process.


In the summer of 2003, the author visited four academic health sciences libraries (AHSLs) by using funding from the David A. Kronick Traveling Fellowship, awarded by the Medical Library Association (MLA). The libraries were the Arizona Health Sciences Library at the University of Arizona (UofAZ), the Health Sciences Libraries at the University of Washington (UWash), the Health Sciences Library at the University of North Carolina (UNCCH), and the Medical Center Library at Duke University (Duke).

During my visits, I identified a number of trends that represented the transition AHSLs have been undergoing. In the past, AHSLs' primary focus was on their role as repositories of printed knowledge. This focus has changed to their role as the organizational unit that provides access to and use of an increasingly digital body of knowledge. The paper begins by looking at trends in the health care sector and their impacts on the knowledge needs and expectations of academic health centers (AHCs). This section is followed by a discussion of the need for a framework or model to facilitate the development and organization of the emerging, increasingly digital AHSL. I conclude with ideas for research that needs to be done to support AHSLs in this transition.


In an effort to control rapidly increasing health care costs, a strong shift occurred in the United States to managed care in the early 1990s. Despite these efforts, health care costs have continued to climb. Many employers are now unable to absorb increases in employee health care plans and are passing on the price increases to their employees. In the period 2000 to 2002, such increases ranged from 12% to 14% in large companies to 18% to 20% for small businesses [1]. In 2000, over 40 million Americans under the age of 65 did not have health insurance coverage [2]. The costs of the war on terror and the general economic downturn of the past several years have led to increasing pressures on federal and state budgets. The sum of these effects is even greater pressures on AHCs for cost controls, as their amount of uncompensated care, their reimbursements for care, and their institutional budgets are being squeezed. For public AHCs, the squeeze is in their state budget support, and, for private AHCs, it is in the losses in their endowments caused by the dramatic financial market downturns.

The last ten years have also seen a focus on the quality of health care. A series of recent reports from the Institute of Medicine (IOM) has focused attention on these quality issues. …