Objective: This poster examines how academic medical libraries have presented their web sites over the past decade: 1) How have advances in web technologies influenced the “look and feel” of the web site? 2) What other developments contributed to the evolution of medical library web sites? 3) How has the librarian's role in web development changed in the last ten years? Method: Reviewing the history of the web and developments in new technology, we will note significant turning points in the design of our own library web site and that of other institutions of a similar size and mission. Using data and images from the Way Back Machine at www.archive.org we will plot how changes in technology effect: what information is presented, page layout and usability. We will examine how changes in librarianship and the “information explosion” have helped the medical library web site progress. Results: From examining our own web site history we have determined that we were slow to implement new design technologies. Many of the technologies that were initially incorporated into the web page design improved on graphical elements at first. Improvements on layout, searching and form design soon followed. In 2000 a new underlining database structure (Cold Fusion) was added to the web site that allowed staff to better manage the large number of e-resources the Library provided. Once a full time position dedicated to web management was created our web site was able to focus on layout and usability. Conclusion: From looking at other web sites of similar size we have determined that many Libraries web sites progressed first as an “online directory” providing basic information, to a page that started to offer services such as request forms and links to an OPAC and/or Medline, to finally a dynamic page with electronic books, journals and databases. Many institutions offer customized pages for individual users. Additional research is recommended.