BACKGROUND: Facing a growing workload and dwindling resources, the US National 
Library of Medicine (NLM) created the Indexing Initiative project in 1996. This 
cross-library team's mission is to explore indexing methodologies for ensuring 
quality and currency of NLM document collections. The NLM Medical Text Indexer 
(MTI) is the main product of this project and has been providing automated 
indexing recommendations since 2002. After all of this time, the questions arise 
whether MTI is still useful and relevant.
METHODS: To answer the question about MTI usefulness, we track a wide variety of 
statistics related to how frequently MEDLINE indexers refer to MTI 
recommendations, how well MTI performs against human indexing, and how often MTI 
is used. To answer the question of MTI relevancy compared to other available 
tools, we have participated in the 2013 and 2014 BioASQ Challenges. The BioASQ 
Challenges have provided us with an unbiased comparison between the MTI system 
and other systems performing the same task.
RESULTS: Indexers have continually increased their use of MTI recommendations 
over the years from 15.75% of the articles they index in 2002 to 62.44% in 2014 
showing that the indexers find MTI to be increasingly useful. The MTI 
performance statistics show significant improvement in Precision (+0.2992) and 
F1 (+0.1997) with modest gains in Recall (+0.0454) over the years. MTI 
consistency is comparable to the available indexer consistency studies. MTI 
performed well in both of the BioASQ Challenges ranking within the top tier 
teams.
CONCLUSIONS: Based on our findings, yes, MTI is still relevant and useful, and 
needs to be improved and expanded. The BioASQ Challenge results have shown that 
we need to incorporate more machine learning into MTI while still retaining the 
indexing rules that have earned MTI the indexers' trust over the years. We also 
need to expand MTI through the use of full text, when and where it is available, 
to provide coverage of indexing terms that are typically only found in the full 
text. The role of MTI at NLM is also expanding into new areas, further 
reinforcing the idea that MTI is increasingly useful and relevant.