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66th IFLA Council and General

Jerusalem, Israel, 13-18 August


Code Number: 008-153-E
Division Number: II
Professional Group: Biological and Medical Sciences Libraries
Joint Meeting with: -
Meeting Number: 153
Simultaneous Interpretation:    Yes

Innovations in Networking to Provide Electronic Delivery of Documents to Health Professionals in the Western Pacific

Arlene Cohen
Circulation/Outreach Services, University of Guam, RFK Library, Guam
E-mail: acohen@uog9.uog.edu

Claire Hamasu

Health Information Services, Pacific Southwest Region
National Network of Libraries of Medicine,
E-mail: chamasu@library.ucla.edu

Irene M. Lovas

Pacific Hospital of Long Beach Library,
E-mail: Irene.Lovas@phlb.org


Initiated by the University of Guam's Robert F. Kennedy Memorial Library (RFK Library), access to biomedical literature for health professionals located throughout Guam and the Western Pacific has changed drastically over the past five years. One of the reasons for the tremendous change has been the emerging capability to transfer documents electronically using the Internet.

This paper will discuss the growth of technologies, such as electronic scanners, telecommunications capabilities, and new methods of electronic document delivery using the Internet, such as ARIEL, to drastically reduce the time to deliver documents to the health professionals, while also reducing costs for this service.

It will also outline RFK Library's partnering with various United States government agencies, OCLC, institutions throughout the Western Pacific, and local health professionals in the area to achieve this goal.

The paper will provide statistics about interlibrary loan activity, documents scanned and turn-around time for delivery of articles to health professionals as well as expectations for future innovations.


Over the past decade, the University of Guam's Robert F. Kennedy Memorial Library (RFK Library) initiated expanded and timely access to biomedical information for health professionals on Guam and throughout the Western Pacific. To understand the significance of the accomplishment of transferring documents electronically, it is important to be aware of the geographic distances, the history and the political diversity of the area. Stretched across 4,500,000 square miles of the central and western Pacific Ocean, over 2,200 small volcanic and coral islands make up the region of Micronesia, which means "tiny islands".

Lying west of Hawaii, south of Japan, east of the Philippines and north of Australia and the equator, the total landmass of all these tropical islands is less than 1,200 square miles with a total population base estimated at approximately 300,000. The expanse of water approaches the size of the contiguous United States, but the total landmass is less than that of the state of Rhode Island. To make this area ever more complex, not only are the islands of Micronesia spread over a large geographic area, but each island group has its own unique culture, language and government structure. "The inhabited areas vary from idyllic villages with no cars or electricity to the high rise resort developments of Guam and Saipan." 1

During World War II, Japanese forces occupied most of the Micronesian islands. After the war, all the islands except for Guam were placed under the administration of the United States by the United Nations and called the Trust Territory of the Pacific Islands. During the ensuing years, each island group negotiated its political status with the United States. Today, Micronesia can be divided into five separate political entities. The United States Commonwealth of the Northern Mariana Islands (CNMI) includes the populated islands of Saipan, Tinian and Rota, and after World War II were placed under Trust Territory administration. The Federated States of Micronesia (FSM), consisting of the island states of Pohnpei, Chuuk, Kosrae, and Yap, are in the Caroline Islands group. They too were administered as part of the Trust Territory of the Pacific Islands from 1947 to 1986 and are now an independent country under a compact of free association with the United States. The Republic of the Marshall Islands is another independent island group in the central Pacific Ocean, which also were part of the Trust Territory of the Pacific Islands until 1979 when the Marshalls Constitution was ratified and the Republic of the Marshall Islands was created. The independent Republic of Palau is another group of volcanic islands and islets in the Western Caroline Islands under Japanese administration until the end of World War II. In 1996, the islands of Palau were the last of the Trust Territory islands to negotiate a relationship and signed a Compact of Free Association with the United States. On the other hand, Guam has remained an U.S. territory since 1898, except during the months of Japanese occupation in World War II. Now, within the region, it is considered to be the gateway to Micronesia and is the most economically developed of the Micronesian islands.

Given the varying governmental frameworks and the changing political leadership and status, obtaining consistent and reliable services funding for information, not only to health professionals, but for the population in general, has been a constant challenge. Under the administration of the Trust Territory of the Pacific, all the islands qualified for United States federally funded programs. Now, with their change in political status, several island nations have lost various United States federally funded programs, although they now qualify for aid programs from other countries such as Australia and Japan.

Yvan Souares, in a recent article appearing in Pacific Health Dialog, a publication of the Pacific Basin Medical Association, summed up well the challenging reality. In his words: "These islands are scattered over 30 million square kilometers of the Pacific, an area almost four times that of Australia. Ninety-eight percent of that area is water, leaving a total land area only half that of the Northern Territory of Australia. For seven million Pacific people, the development of human networks in these conditions is both a challenge and a prerequisite to socio-economic development." 2

The Beginnings

The driving force to this expanded access for health professionals had it beginnings in the early 1990's when the Pacific Islands Association of Libraries and Archives (PIALA) was established in 1991. The establishment of this multi-type library network grew out of the need to address the serious lack of information resources and human networks for resource sharing within the region, due in no small part to the lack of reliable funding and a commitment to library and archival development. From the beginning, this regional association was committed to fostering awareness, cooperation and resource sharing among libraries, archives, museums and related institutions of the Pacific islands.

With funding provided by the United States Office of Territorial and International Affairs, an organizational meeting was held at the University of Guam in February 1991 with participants from the Micronesian entities. At this meeting, the group named itself the Pacific Islands Association of Libraries and Archives (PIALA). Through the years, membership has expanded to encompass many other Pacific islands and countries worldwide. During the past ten years, conferences have been held annually to discuss the information needs of the area.

PIALA identified medical and allied health professionals within the region as one of the many groups of users with serious unmet needs. It found a partner to address these needs in the medical library network set up by the National Library of Medicine (NLM). One of the goals of the National Library of Medicine (NLM) is to provide access to and the delivery of information to health professionals, including those in rural areas and those serving minority populations. Another is to foster information access and resource sharing among not only health science libraries, but libraries of all types. These goals are carried out through its National Network of Libraries of Medicine (NN/LM) and within its eight regions, through its Regional Medical Libraries (RMLs). The Pacific Southwest Regional Medical Library (PSRML), with headquarters at the Louise M. Darling Biomedical Library at the University of California, Los Angeles, is the Regional Medical Library for the region that includes Micronesia. To this end, PSRML staff have been active in PIALA, presenting workshops and joint sessions at five PIALA conferences covering basic healthcare resources, health reference resources3, consumer health resources4, resource sharing 5, and most recently accessing Western medical information 6.

In 1996, the University of Guam Robert F. Kennedy (RFK) Memorial Library was designated as a NN/LM Resource Library, further supporting the delivery of information and local resource sharing to all areas of Micronesia. This designation was fitting, as the University of Guam is the major post-secondary educational institution in the Western Pacific with the mission that states "The University exists to service its learners and the communities of Guam, Micronesia, and the neighboring regions of the Pacific and Asia." 7

Electronic Document Delivery

Prior to 1998, all document delivery and Interlibrary Loan (ILL) activity throughout the Western Pacific was done either by using the postal system or FAX. Typically, documents would take from 2-3 weeks to arrive from the time the request was initiated. Moreover, the cost of Faxing materials was, and in many cases still is, prohibitively expensive. Additionally, the significant use of electronic mail and the Internet throughout the region did not begin until early in 1998. For the RFK library, the spring and summer of 1998 saw the revolutionary improvement to its document delivery service.

The journey toward electronic document delivery began at the RFK Library in May 1998 with the help of Dr. Joe Iser, then the Director of the Office of Pacific Health and Human Services of the United States Public Health Service in San Francisco when their office permanently loaned a document scanner to the library. Although the scanner was provided to support the provision of medical and allied health information to the Pacific region, in essence it revolutionized the entire ILL operation in the RFK Library. Document scanning is one of the essential elements in electronic document delivery in that the scanned material can then be electronically sent to requesters attached to an e-mail message. With this scanner, the RFK Library ILL department now was able to scan materials held at both the RFK Library and the Pacific Collection of the Richard F. Taitano Micronesian Area Research Center (MARC) at the University of Guam and then electronically send them both throughout the region and worldwide.

At the same time that plans for the loan of the scanner were in process, the University of Guam College of Education's Communicative Disorders Program and the Government of Guam Department of Education entered into an agreement with San Francisco State University in California to provide a summer distance education graduate program for students residing on Guam. To support the program, a rapid and widely used Internet electronic document delivery system was required. This requirement presented the opportunity for acquiring ARIEL, an Internet based software package used by a significant number of libraries to electronically deliver documents; and to also establish a publicly accessible Internet (IP) address for the RFK Library Circulation Department to use with ARIEL. ARIEL was purchased and installed in May 1998, thereby putting another essential element in place for efficient electronic document delivery. Finally, the last essential elements, a laser printer and another computer faster than the old "286" model, were purchased.

During the summer of 1998, working with San Francisco State University Library's ILL department in the first use of ARIEL, the RFK Library delivered a total of 79 documents to students in the program. Of the total number requested, 41% (32 actual articles) were received at the RFK Library within 24 hours, with the majority of the remaining articles received within 2-3 days. This is particularly significant since there is an eighteen-hour time difference between the West Coast of the United States and Guam.

At the same time, the RFK Library also became a member of LIVS (Libraries Very Interested in Sharing), 8 a group of libraries using the OCLC (Online Computer Library Center) ILL system who agree to share their resources at no cost to each other. The RFK Library had already been a full member of OCLC since 1992, using it for both cataloging and interlibrary loan.

In a paper currently in press submitted to the Fiji Library Association Journal in October 1999, Cohen wrote: "With our membership in LIVS and the use of ARIEL, both our ILL costs diminished significantly and periodical articles are delivered at a phenomenal speed."9

With the RFK Library using the emerging technology and fostering partnerships all over the world to share resources, the medical and allied health professionals and students in the Western Pacific were among those to reap the benefits. As a designated Resource Library of the Pacific Southwest Region, the RFK Library has the responsibility for facilitating document delivery throughout the region. However, even before this designation was established, in the early 1990's, the RFK Library began using DOCLINE, the National Library of Medicine document delivery system and tried to promote the use of Loansome Doc, the user interface for ordering medical and allied health documents locally and throughout the region. Prior to 1995, almost all DOCLINE activity emanated from University of Guam users. From January 1995 to December 1997, a total of 151 requests were processed through Loansome Doc and DOCLINE, with very few coming from outside the University of Guam. Although the viability of delivering documents as attachments to electronic mail was demonstrated between doctors on the island of Kosrae, Federated States of Micronesia, and the RFK Library, this mode of document delivery was now feasible with developments on the requester's end. First the significant use of electronic mail and Internet occurred throughout the region in 1998. Second was the availability of a free software program, DocView, from the National Library of Medicine. Now, with the scanner and ARIEL in place and requestors capable of receiving and viewing the documents, RFK Library began electronically delivering Loansome Doc and DOCLINE requests whenever possible as e-mail attachments. In the fall of 1998, working with the Pacific Basin Medical Association, procedures were developed for regional electronic document delivery for members of the association and a deposit account with the RFK Library was established. Subsequently, several other deposit accounts were established for medical and allied health users.

Providing documents for medical and allied health professionals using Loansome Doc and the DOCLINE system has soared. From June 1998 through March 2000, a total of 314 Loansome Doc and DOCLINE requests coming from patrons in Guam and several regional libraries including those on the islands of Pohnpei, Palau, Fiji and New Caledonia were received and filled. In the first year, from June 1998 through May 1999, there were 91 requests; however, as the word spread and area health professionals were trained, the numbers soared so that from June 1999 through March 2000, the ILL department received 223 requests.

Moreover, of those 314 Loansome Doc and DOCLINE requests received at the RFK Library since June 1998, 30 were filled from the collections of the RFK Library and MARC's Pacific Collection, using the scanner and sending them as e-mail attachments. Of the remaining 284 requests, 250 were received electronically through ARIEL and passed on as e-mail attachments.

Before using electronic document transmission, the usual time for documents to arrive was between a week to ten days, depending on the postal service. Today, requests are received within 2-3 days from the time they are entered into the DOCLINE system. During calendar year 1999, the average time to receive a document was 2.91 days. To appreciate the significance of this, one must consider that Guam is on the other side of the International Dateline and that DOCLINE is based at NLM, on the United States' East Coast. This means that when the RFK library opens on Monday morning, it is still Sunday in the Continental United States. An additional inconvenience, due to the time differences, is that because DOCLINE is not a 24-hour system, and the RFK Library staff can only use it during the morning hours of the workday, many of the requests might wait up to 24 hours or more before being sent.

Regional Resource Sharing Networks

With a viable, successful electronic document delivery service established at the RFK Library, serious efforts to expand resource-sharing networks throughout the Western Pacific are underway. In the past several years, resource-sharing relationships between librarians in the Micronesian region have been established, although communication between libraries was quite expensive and little activity occurred. However, now that electronic mail has become available to almost all the community college and public libraries in Micronesia as well as libraries on many other islands in the Pacific Basin, this is changing. Moreover, with the new modalities for electronically sending documents as e-mail attachments through the Internet, our outreach capabilities are greatly expanded.

In October 1998, a proposal that the RFK Library redefines the region in terms of resource sharing was implemented on an experimental basis. In the proposal's redefinition, the area of the region was expanded to include all the islands falling under the Secretariat of the Pacific Community, formerly the South Pacific Commission. With this experiment in place, the ability to provide lower cost document delivery to libraries in Fiji and New Caledonia has been implemented through the University of Guam. Plans to continue the experiment and promote the service are underway.

In an attempt to reduce costs, some worldwide reciprocal relationships have recently been established. In August 1999, the RFK Library and the Chiang Mai University Medical Library in Thailand agreed to provide each other cost free document delivery, as a result of networking at the IFLA 1999 conference in Bangkok, Thailand. Most recently, the Savitt Medical Library in Nevada also agreed to provide reciprocal cost-free document delivery using DOCLINE, much the same as The LIVS relationships with OCLC libraries. From October 1999 through March 2000, RFK processed 7 cost free requests and hopes to develop more reciprocal relationships.

Although the outreach efforts of the RFK Library have successfully provided medical and allied health information to users in the region; sadly, only those islands with trained, professional librarians and/or motivated medical and allied health professionals have taken advantage of this new modality. More outreach and training must be done to reach those that still remain "out of reach!"


Although so much has happened in the last decade of the 1900's in the development and implementation of networking, both electronically and between people, and in resource sharing in Micronesia and throughout the Pacific, there is much more work to be done. The RFK Library's experiment with redefining the region to include those countries under the Secretariat of the Pacific Community can be viewed as the foundation for establishing a resource sharing network modeled after LIVS, the OCLC based group of libraries.

In the past, the greatest challenges to sharing resources were the great distances between islands, costly airmail delivery or very slow surface mail and a profound lack of cost-effective communications capabilities. Today, although telecommunications is still problematical on many islands, the biggest challenge is education and training about resource sharing: what is it, what's out there, and how it can be done.

In a recent publication by Mary E. Jackson 10 on measuring ILL performance, she wrote: "From listening to the libraries identified in this study as best performers, I have discerned four characteristics the successful have in common: They make intensive use of technology for every step in the process. ... They routinely question every step in their processes and regularly make improvements and adjustments (that is, they think about how they are working as the work). They value service more that control, and they are willing to risk occasional errors for faster and better service. Finally, their library directors are intensely interested in and enthusiastic supporters of their efforts." (1998, p. vii). It is no accident that all aspects of the ILL performance at RFK Library has surpassed expectations, since the staff has willingly experimented with change to provide a dynamic resource sharing service in a developing region.

By cultivating the human networks established within PIALA, and through working with the Secretariat of the Pacific Community (formerly the South Pacific Commission), the Pacific Basin Medical Association and other groups, it is hoped that these resource-sharing networks will continue to grow throughout the entire Pacific. Moreover, with the support of PIALA, local librarians can be encouraged to work with medical and allied health professionals in their efforts to advocate for and implement funding initiatives and training opportunities -- essential to in developing further access to information.

1 Bendure, G. and Friary, N. (1995). Micronesia, 3rd edition. Lonely Planet Publications, Australia, p.9

2 Souares, Y. PPHSN and PACNET: the Pacific islands are now tuned into the 21st century. Pacific Health Dialog 1998;5(1):200

3 Lovas, I. Selected health reference services for the non-health sciences library. In: PIALA 93 Proceedings of the 3rd Annual PIALA Conference, edited by Margaret Edmundson. Majuro, Marshall Islands: Pacific Islands Association of Libraries and Archives 1994; 21-29.

4 Lovas, I. Here's to your health: consumer health information resources. In: PIALA 94 Selected Papers from the 4th Pacific Islands Association of Libraries and Archives Conference, edited by Arlene Cohen. Mangilao, Guam: Pacific Islands Association of Libraries and Archives 1995; 65-92.

5 Crotts, J. Regional resource sharing and networking: A Union List of Serials for Pacific Islands. In: PIALA 95 Papers from the 5th Pacific Islands Association of Libraries and Archives Conference, edited by Arlene Cohen. Mangilao, Guam: Pacific Islands Association of Libraries and Archives 1996; 45-50.

6 Hamasu C. Accessing Western medical information. In: PIALA 96 Proceedings of the 6thAnnual PIALA Conference, edited by Arlene Cohen. Mangilao, Guam: Pacific Islands Association of Libraries and Archives 1997; 77-92.

7 University of Guam. 1999/2000 Undergraduate Catalog. Mangilao, Guam: University of Guam 1999. 12.

8 More information about LIVS (Libraries Very Interested in Sharing) can be found on the WWW at http://www.library.sos.state.il.us/ils/oclc/lvis_des.html.

9 Cohen, Arlene. Innovations in resource sharing at the University of Guam's Robert F. Kennedy Memorial Library. Fiji Library Association Journal, 1999. Accepted for publication. In Press.

10 Jackson, Mary E. (1998). Measuring the performance of interlibrary loan operations in North American research and college libraries: results of a study funded by The Andrew W. Mellon Foundation. Washington, D.C.: Association of Research Libraries.


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