Toxicology and Environmental Health Information Resources

The Role of the National Library of Medicine

Catharyn T. Liverman, Carrie E. Ingalls, Carolyn E. Fulco, and Howard M. Kipen, Editors

Committee on Toxicology and Environmental Health Information Resources for Health Professionals

Division of Health Promotion and Disease Prevention

INSTITUTE OF MEDICINE

NATIONAL ACADEMY PRESS
Washington, D.C.
1997



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Toxicology and Environmental Health Information Resources The Role of the National Library of Medicine Catharyn T. Liverman, Carrie E. Ingalls, Carolyn E. Fulco, and Howard M. Kipen, Editors Committee on Toxicology and Environmental Health Information Resources for Health Professionals Division of Health Promotion and Disease Prevention INSTITUTE OF MEDICINE NATIONAL ACADEMY PRESS Washington, D.C. 1997

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NATIONAL ACADEMY PRESS 2101 Constitution Avenue, N.W. Washington, DC 20418 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competencies and with regard for appropriate balance. This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy’s 1863 congressional charter responsibility to be an advisor to the federal government and its own initiative in identifying issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine. Support for this project was provided by the National Library of Medicine, National Institutes of Health, under Contract No. N01-OD-4-2139. The views presented are those of the Institute of Medicine Committee on Toxicology and Environmental Health Information Resources for Health Professionals and are not necessarily those of the funding organization. International Standard Book No. 0-309-05686-1 Additional copies of this report are available for sale from the National Academy Press, Box 285, 2101 Constitution Avenue, Washington, DC 20055. Call (800) 624-6242 or (202) 334-3313 in the Washington metropolitan area, or visit the NAP’s on-line bookstore at http://www.nap.edu. Copyright 1997 by the National Academy of Sciences. All rights reserved. Printed in the United States of America.

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COMMITTEE ON TOXICOLOGY AND ENVIRONMENTAL HEALTH INFORMATION RESOURCES FOR HEALTH PROFESSIONALS HOWARD KIPEN, (Chair), Associate Professor and Director, Division of Occupational Health, Environmental and Occupational Health Sciences Institute, University of Medicine and Dentistry of New Jersey—Robert Wood Johnson Medical School, Piscataway, New Jersey PAUL FRAME* Family Physician, Tri-County Family Medicine, Cohocton, New York MARK FRISSE, Associate Dean, Washington University School of Medicine, St. Louis, Missouri SHERRILYNNE FULLER, Acting Director, Informatics, School of Medicine, and Director, Health Sciences Libraries and Information Center, University of Washington, Seattle, Washington FRED HENRETIG, Pediatric Emergency Physician, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania DAVID McNELIS, Chief Scientist, Environmental Science and Engineering, Research Triangle Institute, Research Triangle Park, North Carolina KATHLEEN REST, Associate Professor, Department of Family and Community Medicine, Occupational and Environmental Health Program, University of Massachusetts School of Medicine, Worcester, Massachusetts BARBARA SATTLER, Director, Environmental Health Education Center, University of Maryland at Baltimore School of Medicine, Baltimore, Maryland ROSE ANN SOLOWAY, Administrator, American Association of Poison Control Centers, and Clinical Toxicologist, National Capital Poison Center, Washington, D.C. ROBERT E. TAYLOR, Chairman, Department of Pharmacology, Howard University College of Medicine, Washington, D.C. P. IMANI THOMPSON, Behavioral Scientist, Centers for Disease Control and Prevention, Atlanta, Georgia Institute of Medicine Staff CATHARYN T. LIVERMAN, Study Director CAROLYN E. FULCO, Senior Program Officer CARRIE E. INGALLS, Research Associate THOMAS WETTERHAN, Administrative Assistant/Research Assistant AMELIA MATHIS, Project Assistant MICHAEL STOTO, Director, Division of Health Promotion and Disease Prevention (through December 1996) KATHLEEN STRATTON, Interim Director, Division of Health Promotion and Disease Prevention (from January 1997)

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Preface The environment is increasingly recognized as having an impact on human and ecological health, as well as on specific types of human morbidity, mortality, and disability. Since the publication of its landmark report in 1988, Role of the Primary Care Physician in Occupational and Environmental Medicine, the Institute of Medicine (IOM) has conducted two additional studies that have examined the need to integrate environmental and occupational health into the education and practices of nurses and physicians. The recommendations from these reports are currently being implemented. In 1995, the National Library of Medicine (NLM) asked the IOM to explore a related topic by requesting a study of NLM's Toxicology and Environmental Health Information Program (TEHIP). Specifically, NLM was concerned that health professionals were not fully using the information available in the 16 online databases comprising the TEHIP program. The IOM formed the Committee on Toxicology and Environmental Health Information Resources for Health Professionals. One of the committee's first goals was to seek input from a wide range of health professionals to more thoroughly understand health professionals' toxicology and environmental health information needs. Several mechanisms were used to receive input, including a workshop, during which attendees participated in focus group sessions; a questionnaire, designed to solicit information about health professionals' information needs; and discussions with representatives from federal agencies, health care, and academia. During the course of the study, the committee reached several conclusions that it viewed as pivotal in advising NLM on how best to provide health professionals with toxicology and environmental health information. First, the committee believes that as environmental health concerns continue to increase, it is important for health professionals and other communities to have ready access

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to information resources in this field. The committee reaffirms the findings of the 1993 NLM Long Range Planning Panel on Toxicology and Environmental Health, which found that NLM's TEHIP program is an important information resource that needs to be strengthened. Second, the committee believes that there is a large and diverse potential audience for toxicology and environmental health information. In attempting to understand the user communities, the committee discussed a broad spectrum of potential users ranging from emergency care personnel treating individuals affected by acute toxic exposures to local coalitions struggling to determine the environmental health hazards faced by their communities. Although each of the user communities in this broad spectrum has diverse information needs, there are methods of targeting training and outreach efforts and developing database interfaces that will more adequately meet those disparate needs. Finally, the committee concluded that NLM, as the nation's premier biomedical library, can and should play a key role in organizing and providing pointers to all toxicology and environmental health information resources (including and beyond the TEHIP databases). NLM, given its library and medical informatics expertise, is well-positioned to further develop the tools that can link health professionals with the wide array of information resources that are available in this important field. Furthermore, this is an area where public-private-sector partnerships can play an important role as there are numerous sources of toxicology and environmental health information. The committee is grateful to those who provided input to its deliberations including the individuals who contributed their ideas through the workshop and in discussions with the committee (see Appendixes A and C). Additionally, the committee thanks the individuals who took the time to respond to the committee's questionnaire (see Appendix B). The TEHIP program staff, including Jeanne Goshorn and Melvin Spann, provided thorough background materials, assisted in the committee's workshop, and responded promptly to the committee's many requests for additional information or clarification. The committee appreciates all of their efforts. The IOM staff of Cathy Liverman, Carrie Ingalls, and Carolyn Fulco are to be congratulated for their thorough research of the issues and for molding the committee's sometimes wandering deliberations into this report. Although the committee has recommended some clear directions and mechanisms for implementation, much work remains to be done. The committee hopes that the conclusions and recommendations made in this report will prove to be useful as NLM moves forward in providing health professionals with toxicology and environmental health information. Howard M. Kipen, M.D., Chair Committee on Toxicology and Environmental Health Information Resources for Health Professionals

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Contents     EXECUTIVE SUMMARY   1 1   INTRODUCTION   11     Health Professionals and Other User Communities   13     Public Health Impacts of Hazardous Substances   14     Changing Trends in Health Practice   15     Organization of the Report   16 2   THE NATIONAL LIBRARY OF MEDICINE'S TOXICOLOGY AND ENVIRONMENTAL HEALTH INFORMATION PROGRAM   19     National Library of Medicine   20     Division of Specialized Information Services   25     Toxicology and Environmental Health Information Program   26     TEHIP Databases   29     TEHIP Factual Databases   30     TEHIP Bibliographic Databases   47     Conclusions   52 3   OTHER TOXICOLOGY AND ENVIRONMENTAL HEALTH INFORMATION RESOURCES   55     Conclusion and Recommendation   58

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4   UNDERSTANDING THE INFORMATION NEEDS OF HEALTH PROFESSIONALS   69     Information Needs   69     Factors Affecting Information Seeking   71     Current and Potential Users of the TEHIP Databases   75     Conclusion and Recommendation   82 5   INCREASING AWARENESS: TRAINING AND OUTREACH   87     Training   88     Outreach   91     Future Directions and Recommendation   96 6   ACCESSING AND NAVIGATING THE TEHIP DATABASES   101     Access: Getting Connected to the Databases   101     Navigating the TEHIP Databases   105     Future Directions   114     Conclusions and Recommendations   116 7   PROGRAM ISSUES AND FUTURE DIRECTIONS   119     Program Issues   120     Future Directions   126     GLOSSARY AND ACRONYMS   131     APPENDIXES         A Acknowledgments   143     B Questionnaire   145     C Workshop on Toxicology and Environmental Health Information Resources: Agenda, Participants, and Summary of Focus Group Discussions   153

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Tables, Figures, And Boxes Tables 2.1   Timeline of Events and Changes in Computer Technology and Environmental Health   23 2.2   TEHIP Databases   31 2.3   Types of Information Available in the TEHIP Databases   35 2.4   TOXLINE Subfiles   48 3.1   Sample of Current Toxicology and Environmental Health Databases   59 6.1   Review Process for TEHIP Factual Databases   113 Figures 2.1   National Library of Medicine Organizational Chart   21 2.2   TEHIP Program Budget   28 2.3   Organization of the TEHIP Databases   29 3.1   Executive Branch Departments and Agencies Involved in Environmental Health Issues   57 5.1   National Network of Libraries of Medicine   93 6.1   Primary Access Points to the TEHIP Databases   104 7.1   NLM Advisory Committees   122 B.1   Toxicology and Environmental Health Information Resources Most Often Consulted   147 B.2   Primary Factors Limiting Use of the NLM Toxicology and Environmental Health Databases   147 Boxes 2.1   Locator Field in the ChemID Database   36 2.2   Major Categories of HSDB Data   37 2.3   Excerpt from the TRIFACTS Record on Toluene   45 2.4   DIRLINE Record for the Association of Occupational and Environmental Clinics   46 4.1   Examples of the Applicability of the TEHIP Databases for the Work of Health Professionals   78 5.1   Previous IOM Recommendations on the Training of Health Professionals in Occupational and Environmental Health   90 5.2   Howard University   95 6.1   Methods of Searching the TEHIP Databases   102 6.2   TOXNET Selection Menu   106

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6.3   Sample Search on HSDB   109 6.4   Initial TRI Menu   110 6.5   Experimental World Wide Web Search Interface: Criteria for Narrowing the Search Strategy   111

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