MedlinePlus[R]: the National Library of Medicine[R] brings quality information to health consumers.

ABSTRACT

The National Library of Medicine's (NLM[R]) MedlinePlus[R] is a high-quality gateway to consumer health information from NLM, the National Institutes of Health (NIH), and other authoritative organizations. For decades, NLM has been a leader in indexing, organizing, and distributing health information to health professionals. In creating MedlinePlus, NLM uses years of accumulated expertise and technical knowledge to produce an authoritative, reliable consumer health Web site. This article describes the development of MedlinePlus--its quality control processes, the integration of NLM and NIH information, NLM's relationship to other institutions, the technical and staffing infrastructures, the use of feedback for quality improvement, and future plans.

THE NATIONAL LIBRARY OF MEDICINE BEGINS DIRECT SERVICE TO CONSUMERS

The legislation establishing the National Library of Medicine (NLM) (42 U.S.C. [section] 286) as a component of the National Institutes of Health (NIH) in 1956 describes the mission of the library as collecting, preserving, and disseminating medical literature as well as making "available its bibliographic, reference, or other services, to public and private entities and individuals." NLM fulfilled this mission for many years by primarily serving health professionals, especially through the MEDLINE[R] database of references to millions of biomedical research publications. In recent years, NLM's governing Board of Regents encouraged NLM to expand its services to the general public of health consumers (NLM, 2000).

When the MEDLINE database became free to the Internet public in 1997, NLM embarked upon this expanded mission of serving the general public. Early studies showed that many MEDLINE users were not professionals and researchers but rather were members of the general public seeking health information for themselves, family members, and friends (Free MEDLINE, 1997). MEDLINE began indexing a few consumer-level publications in early 1998 (MEDLINE to index, 1998), but it was clear that NLM could do more to provide quality health information for the public. In 1998 NLM began a project with the National Network of Libraries of Medicine (NN/LM) to work with public libraries to better serve health consumers (Wood et al., 2000). This project found that public librarians needed training to become more comfortable providing health information and a trusted place to turn for health content.

With the advice of public libraries and customer feedback from users of other NLM products, NLM released MedlinePlus on October 22, 1998. In creating MedlinePlus, NLM drew upon the skills of medical librarians and information technology professionals to make consumer-level authoritative medical information available to anyone with access to the World Wide Web. Combining this expertise with the strength and authority of NIH and other government and nongovernment organizations, MedlinePlus has become a source of health information to millions of health consumers as well as their health care providers.

HEALTH TOPICS: QUALITY AT THE CORE OF MEDLINEPLUS

Initially, MedlinePlus provided consumers with authoritative health information from the federal government and other organizations. These lists of links, or Health Topic pages, remain the core of MedlinePlus. Health Topic pages are highly selective collections of links to Web documents, not comprehensive lists of everything on the Web. They point consumers to the best Web resources and minimize redundant listings. The experienced biomedical librarians who create and maintain the Health Topic pages organize them into categories such as overviews, diagnosis, treatment, and prevention. They also identify the publishing organization, easy to read materials, and other special features such as pictures, diagrams, and flowcharts. The Health Topic pages function like a table of contents to a virtual Internet book broken down into chapters. This organization helps consumers easily scan the page and provides them with a refuge from the overwhelming amounts or varying quality of Internet health information.

Addressing the Need for Quality

The number and popularity of sites providing health information to consumers constantly increases. This growth heightens concern in the medical profession about the importance of reliable, quality information (Fox & Fallows, 2003; Licciardone, Smith-Barbaro, & Coleridge, 2001). One study shows that only a quarter of health information seekers check the quality of the Web resources they use (Lewis & Behana, 2001). Many consumers consider a professional-looking Web design with scientific-looking touches to be sufficient assurance of the high quality of the information on the Web site (Eysenbach & Kohler, 2002). Rather than appearance, health information experts know that consumers should look for key characteristics when evaluating a health information Web site. These criteria include author and author affiliation; attribution of sources and references used; information about funding, ownership, and sponsorship of the Web site (Gagliardi & Jadad, 2002); and clear labeling of advertising (Karp & Monroe, 2002).

For MedlinePlus, NLM uses written guidelines to identify and select high-quality information produced by other NIH Institutes, government organizations, and nongovernmental health information providers. The librarians building MedlinePlus Health Topic pages follow the same model that collection development librarians have…