The literature on CD-ROM technology is replete with success stories of its application in libraries. Librarians have written numerous articles on the benefits of this research tool. We are aware of the power, popularity, and efficiency of CD-ROM. As responsible librarians we must examine the impact of this technology. Information Technology has enables us "...to analyze the reference process and redefine reference service" (Shera, 1964). This paper has been written so that we may better understand CD-ROM and current reference practices. Therefore the purpose of this paper is to focus on some of the problems associated with CD-ROM in the public service environment. Through an objective examination of some issues facing reference librarians my aim is to develop solutions, but also force us to redefine our purpose. Change is the only constant, any crisis is a unique opportunity to forge a better work environment, and examine our directions. Objective examination of some issues facing reference librarians my aim is to develop solutions, but also force us to redefine our purpose. Change is the only constant, any crisis is a unique opportunity to forge a better work environment, and examine our directions.

Naturally reference services are important to the academic medical center. All departments, schools, offices, and related components of the center utilize the library. CD-ROM is a highly utilized source in my library. The library is certainly the "growing organism" that Ranganathan made his fifth law of Library Science(Ranganathan, 1961). Our Reference Service is certainly devoted to the user, yet this is not a stagnant concept. In order to improve this service we must examine current developments.

The thoughts expressed in this paper are those of the author. These views do not represent an institution or group of persons with whom the author is associated. One's aim is to contribute to discussion, and stimulate the reader's interest in current reference practices and CD-ROM.

Included in this paper is an examination of the popularity of the CD-PLUS MEDBASE sys-tem, the problems caused by its application, contemporary library problems, the philosophy of reference service and its application in the medical center, some solutions to the shortcomings of CD-ROM, legal considerations, and concluding comments.

2. THE POPULARITY OF CD-ROM

With the installation of a CD-ROM CD-PLUS MEDLINE system in November 1988 our library made a commitment to this technology. Library users immediately began to use the system to execute their own searches, and engage in other typical end-user activities. To put it simply, this system generated numerous praises and enabled public service librarians to demonstrate instruc-tional expertise in this area.

This system is used by the entire medical center. Users immediately recognized the advan- tages of CD-ROM technology: search flexibility, time-saving, and ease of use. Many computer-phobic users experienced a sense of profound self- accomplishment through using the system. The CD-ROM terminal is open access. Users sign themselves up for thirty minute sessions, and run their own searches. Instruction is provided by the public services staff on an individual basis.

Users also discovered that although they may be able to run their own searches, comments from the reference librarians were always solicited. A truly great development of the CD-ROM system has been its integration into the traditional reference process. It has encouraged greater library use.

The remainder of this paper shall examine the nature of reference service, examine current problems of CD-ROM, and other serious issues that adversely affect library services.

3. REFERENCE SERVICE AND CD-ROM

Before examining the problems associated with CD-ROM it is useful to recall the philosophy of reference service. This philosophy defines our work, it is very important. Some librarians have no use for such philosophy, this is most unfortunate because the library user is cheated.

Reference service in the academic medical center is an intellectual challenge. Communicative skills are highly essential. I firmly believe that the use of CD-ROM has enhanced this intellectual process. This research tool has become an important addition to the library process, however it is not the only resource in our possession. This paper would not have been written had problems with CD-ROM use not appeared. CD-ROM has influenced reference service. Thus the nature of this influence is of professional concern.

The library user will always interact with the library collection, and the librarian. Because of the large amount of literature and technological options, users are confused at the amount they must digest. As Katz wrote: "The average user has no pre-knowledge of the bibliographical characteristics, including the existence, of the type of item that will answer his question. And from this lack of knowledge he must express his interests in language familiar to him, not necessarily in language compatible with the system" (Katz, 1974). No matter how many "user-friendly" systems are created, this quote shall remain a fundamental truth for many years. No more than ever the librarian is the "mediator" or "middleman" between the inquirer and the sources, whether they are bibliographic or electronic. Shera's words are relevant: "This implies that the librarian not only knows sources, but also work closely with those who ask questions. A matter of communication and translation" (Shera, 197O). If we are competent as librarians we should be well equipped to solve our current problems.

The reference librarian in the health sciences library must possess several important attri-butes. This librarian practices "...in the environment of some aspect of health care: clinical research, policy-making, education. Workplace populated by practitioners, researchers, educators, administrators involved in public health and the delivery of health care" (Zachert, 1982). We work in a society in which much emphasis is placed on health care. Current problems such as AIDS, drug addiction (among many others), occupy much attention. The biomedical literature is very great. Thus the aim of the reference librarian in this environment is to "...respond to the needs of these users" (Zachert, 1982). Ethical standards are of crucial importance. This is very interesting because all questions are regarded with equal weight, without prejudice. An important aspect of reference work is the individual skill of the librarian. Communication and attention to detail is essential. We should also remember that "All of this service is dependent to an astonishing degree on the personality, knowledge and willingness of the reference librarian" (McClure, 1982). The ideal librarian should know the mission of his/her library and institution. The reference librarian is inseparable from the new technological developments. What Ranganathan wrote many years ago still holds true: "Even supposing that the Laws of Library Science stood united and triumphed over the onslaughts of the Law of Parsimony and the undermining of the mental inertia of the public, it is doubtful if a general reader could help himself in tracing out such hidden books without the help of the reference librarian" (Ranganathan, 1961). In today's expanded environ-ment one could add databases, CD-ROM, LANS, etc. to his mention of books.

4. SOME PROBLEMS ASSOCIATED WITH CD-ROM USE

The greatest single problem associated with the installation of CD-ROM is that of rising user expectations. Furthermore some users become frustrated with the existing framework of library operations and services. Some may say that frustration leads to change and better services, this is our aim and wish. However we are caught in the dilemma of rising expectations, but not rising library budgets. Later in this paper I shall discuss the economic problems and the effect on reference services. The problem of rising expectations is best remedied by a larger budget (for more services), yet this comes down to one question: Who shall pay?

Our CD-ROM service is free of charge. Is this a mistake? Naturally we wish to conform to the tradition of open access, yet access has been virtually unlimited. The response to the CD-ROM has been overwhelming. This positive response was welcome, but it brought its own trouble. We possess only one terminal. This is inadequate for a large, very busy medical center.

A second problem is that users do not read menus, tutorials, or instructions on the CD-ROM. Many demand quick answers to their questions. In some cases their questions do not warrant a database search. Some searchers execute their searches incorrectly. All of these factors make the reference librarian indispensable.

The third complication of CD-ROM is that too much information is printed out at the ter-minal. The downloading of citations and abstracts is strongly encouraged by the library staff. However many continue to print too many citations. Related to the issue of rising expectations and large printouts is the question of interlibrary loan. Through the database search users become aware that their library does not subscribe to some of the journals on their printout. This problem has always existed, however with the advent of CD-ROM many more users use a search system, so the collective awareness of the library-s resource is heightened. Document delivery has become an issue of concern. I have spoken with many users who are frustrated that the library system does not contain X, Y or Z documents. Will librarians become document suppliers? One arrogant commentator predicts that librarians shall become the document retriever, while the secretary and office assistant executed MEDLINE searches (Huth, 1989). Is this really the future we shall accept? future that is dictated to us by highly influential non-librarians who display dubious motives?

Several other problems exist. No matter how many times we remind users that they should familiarize themselves with the Medical Subject Headings (MeSH) of the National Library of of Medicine, users mainly ignore them and conduct ill-conceived searches. The system is designed to give users an answer to their search strategy, however effective use has not been achieved by most users. This remains a challenge for us librarians. Related to this is our own superb knowledge of MeSH and database searching. We must instruct in such a manner as to convey the basic message. In other words we must think like the user and refrain from the verbose explanations that confuse and frustrate. Finally their is the existence of an attitude that Charles McClure has referred to as "technophoria." This term, roughly defined, refers to the high expectations users(and even some librarians) place on technological objects. It includes the use of technical jargon, and very high expectations. As we know, not all questions are answered by computers. Certainly CD-ROM is one of our powerful research tools.

5. SOME CONTEMPORARY LIBRARY PROBLEMS

An examination of CD-ROM technology and reference service would not be complete with-out an overview of some of our most serious problems. These include: serial pricing, library budgets, and the world economy. The serial pricing issue has become a grave crisis for virtually all libraries, whether they are academic, public or even special. Within the health care field there have been drastic changes throughout the 1980's. The US economy, particularly regions like New England has experienced much uncertainty. The recent Persian Gulf crisis has added to the fears of many. These developments have either directly or indirectly had an impact on libraries. I would like to focus on two areas: the serials question and health care costs.

One issue that has generated much activity within the library community is the price of serials. Serial prices have adversely influenced the medical center library in which I work. This issue has had an impact on all aspects of library service because of its relation to the budget. This issue has been included in this paper because of its relationship with CD-ROM.

In 1988 scholarly journal prices increased by more than 2.5 times the US rate of inflation as measured by the Consumer Price Index. Journal prices rose more than five times the US inflation rate in 1987(Knapp, 1988). Clearly these facts have contributed to a poor environment. Anxiety exists not only among library administrators, but also among reference/serial librarians, faculty, and other library users. The negative impact has been felt at the reference desk. Users display frustration, and sometimes anger over this issue.

Some very good writing has appeared on the subject of serial prices and the adverse conse-quences for libraries. Since this paper has been prepared for an inter-American audience, it is appropriate to review some of the literature. Naturally librarians in all parts of the Western Hemisphere have experienced this problem. More cooperation is needed among our national library associations.

Much of the library literature has focused on the issue of scholarly communication and serials pricing. The issue has caused so much concern that two newsletters are now published: Against the Grain, and Newsletter of Serials Pricing Issues (Davis, 1990). This issue is of great concern for the reference librarian. After all, we must work and cooperate with our colleagues in technical services. Its relation to CD-ROM is obvious: lack of available journals, and library budget problems.

The serials crisis has already compounded some existing tensions within the academic world. The serials issue has had an impact on the faculty-librarian relationship. Scholars who do not experience the journal price increases are always annoyed and angered with librarians, and not the journal publisher (White, 1990). We librarians compound this problem by "collectively insisting" on comprehensive collections and ".unlimited free access for any and all potential users" (Byrd, 199O). At the same time publishers treat us not as customers, but mere purchasing agents who perform tasks that others have assigned to us (White, 1990). White correctly summed up the end result of these developments: "Only the exhaustion of our collective budget resources will bring an end to the spiraling growth in scholarly journal numbers and prices" (White, 199O).

The crisis will deepen. Monopolies have been created. Librarians are not the only ones who know that information is an essential item (commodity). One author pointed out that one single publisher is a monopolist if he/she publishes a unique title (Hafner, 1990). Five commercial database vendors account for more than 90% of the sales and uses of database services (Mead Data, Knight-Ridder, Maxwell, STN, West Publishing). Eighty-five percent of all existing databases are in the Northern Hemisphere, 70% in the United States (Schuman, 1990). These are ominous facts. The future will be dominated by this trend. Maxwell even had the nerve to state: "It's no use trying to compete with me." Maxwell is determined to have a very great (or sole) voice concerning the future of information (Schuman, 1990)

This crisis in serials is an opportunity for change. Although most authors believe that these problems will become worse, we should prepare ourselves for the future. As the Spanish philosopher Ortega y Gassett believed, man improves through crisis. Through crisis man is transformed, and a new order emerges. Our libraries are living organisms. They shall respond to the crisis. Some signs of this transformation are already here.

A few tangible solutions have been proposed. Hafner believes that we need a partnership between librarian, publisher, and faculty (Hafner, 1990). This is simply a list of the players. Obviously the brunt of this arrangement will fall on the librarians because they are in the middle. A different proposal was put forth by Dougherty. He espouses the marriage of University publisher, computer center, and library. Information may be published at cheaper cost, while it will demons-trate to publishers that librarians can put forth a realistic proposal (Dougherty, 199O). A similar idea was put forth in an Association of Research Libraries report. ARL believes that "...the most cost effective course for the entire research community is to publish by preference in lower-price journals, such as those published by societies" (Association of Research Libraries, 1989).

The problem of pricing will not go away Resolution of this crisis will enable us to better serve our users and organize our work environment in an efficient manner.

The second economic concern is that of health care costs. This issue has enormous signifi-cance for the medical center library. The problems within the health care field have also had an impact on medical libraries.

Throughout the past two decades American business has been at war with medicine. The medical field has lost important battles, and is still in retreat. Those that have triumphed over medicine have power, and they are expert at using this newly acquired power (Berghold, 1990). A plethora of articles has appeared in both American and Canadian health care journals. Cost is a motivating force that determines patient length-of-stay, high-tech medicine and Medicare/Medicaid. To put it simply, health care costs have escalated.

This economic crisis has led to new developments in hospitals, notably "downsizing." Organizational downsizing is a managerial attempt to reduce expenses. Hospital libraries are not immune to this process. Libraries have had to justify their existence in some cases. My library has experienced a gradual increase in reference inquiries from hospital librarians who cannot afford to search various online databases or OCLC. Downsizing has negatively impacted hospital libraries. It has caused anxiety among hospital administrators, physicians, nurses, librarians, and patients.

6. SOLUTIONS TO SOME CD-ROM PROBLEMS IN OUR LIBRARY

We must remember that every problem has a solution! I will offer a few options. More terminals are needed within the library and the medical center. An ideal situation would be a Local Area Network (LAN) throughout our medical center. Some medical center libraries have already done this. Indiana University in Bloomington installed a CD-PLUS LAN within their library. The description of this was given at an American Library Association pre-conference in Chicago this year.

If we had a larger staff it would be advantageous to offer short classes on the use of MeSH, downloading, and other search techniques. Currently we offer a search clinic on Tuesday and Thursday. A time is reserved for users with problems to come in and receive our expertise. The problem with this is that it is held only twice a week, and only at specific time periods.

Since the interlibrary loan volume has increased, partly because of CD-ROM use, it may be advantageous to charge more for Ill requests. This may be an alternative if volume outstrips the subsidized cost. The fee for service issue is not a cure all for our problems. Libraries are not businesses. We must adhere to the mission of our institutions. However the fee for service argument offers some interesting options. It may be possible to sharpen reference skills, and broaden the understanding of how information is used (Downing, 1990). Librarians cannot continue to dodge this issue, or debate it through passionate, emotional responses based on deep ideological cleavages. If we don't address this issue, then others (non-librarians) shall do it for us. Then we will have to adjust to a work environment dictated by others.

Perhaps the most creative solutions to CD-ROM issues, and the other questions mentioned in this paper, will come from individual libraries on their own. Decentralism is a very common characteristic of our libraries. One author wrote that no one organizational style dominated during 1989. Experimentation based on a library's personnel, organizational and technological needs will stimulate change (Kaplan, 1990).

7. AN OVERLOOKED ASPECT OF REFERENCE SERVICE: LIABILITY

Although the Scope of this paper is CD-ROM, it is still necessary to examine the legal impli-cations of our work. Throughout the past ten years there has been a proliferation of databases and new technology products. As competent professionals we are expected to master our resources and keep up with changes. We must also be aware of the liability issue.

The issue of malpractice liability and negligence should be the concern of all public service librarians. We live in a litigation-prone society. Naturally we wish to avoid litigation. Perhaps lawsuits are not common in our field (at least not to-date), however our professional responsibi-lities warrant attention to this matter. Our collective professional knowledge and expertise has grown tremendously. Many users perceive us for what we are: competent experts in our field. The information profession should not debate whether liability/negligence is a valid concern (Pritchard, 1989).

The health sciences librarian has an obvious interest in personal and organizational liability. Regarding personal liability the tort of negligent representation exists. A potential plaintiff (in this case a library user of client) could use this tort in a lawsuit. A plaintiff could use one of two other Common Law theories involving organizational liability: the vicarious liability doctrine of respon-deat superior or the direct liability negligent hire theory of recovery (Gray, 1989).

To avoid malpractice we should consider two other forms of negligence: Parameter and omission. Parameter negligence involves the issue of not consulting the correct source or sources. Therefore, in answering reference questions it would be foolish to simply send a patron to the CD-ROM terminal without providing a list of other research sources, and databases. The other form of negligence is omission. Here the negligent party fails to perform an accurate, thorough search. A possible CD-ROM issue for my library might be whether we should provide access to more than one CD-ROM service.

The issue of negligence is a cause for professional concern, even though it may not present itself to us at the moment. We should take necessary steps within our institutions to counteract potential problems. As a reference librarian it is even more important to conduct a thorough, specific interview with the user. As stated earlier in this paper, we are "mediators" and "middle-men." Our patrons rely on us to possess knowledge of the most current methods of information retrieval. Because of the immense popularity and mass appeal of CD-ROM we should seriously think about the reference interview. The problem with open access CD-ROM is that a user may avoid an interview with the librarian and waste his/her time on the system. Communication is really one of our most important assets. The problems of CD-ROM will be solved through our intuition, collegial cooperation and knowledge.

8. CONCLUSION

The aim of this paper was to provide an overview of some problems related to the use of the CD-ROM CD-PLUS MEDLINE system in a medical center library. Primarily written with a public service aspect, I have attempted to examine current developments in reference service. The issues of serial pricing, health care costs, liability, and a philosophy of reference service have been examined. I hope that this will encourage both discussion and solution to the problems presented in this paper.

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