The Medical Library Assistance Act: An Analysis of the NLM Extramural Programs, 1971
Page  1

the medical library assistance act an analysis of the nlm extramural programs 1965-1970 by martin m cummings m.d director mary e corning special assistant to the director national library of medicine bethesda maryland introduction the medical library assistance act pl 89-291 mlaa was enacted by the us congress in october 1965 in the five fiscal years fy 1966-1970 which have elapsed 40.8 million dollars have been made available to the medical library community from the national library of medicine under a competitive grant and contract mechanism the length of time and the amount of money expended justify an assessment of 1 the fundamental concepts embodied in the act 2 the allocation of resources to fulfill the expectations of the act 3 the impact on the national library of medicine 4 the performance and level of accomplishment by the medical library community which received these funds and 5 the impact on users presented at the annual meeting of the medical library association new york city may 30 june 3 1971

Page  2 2 status of the medical library community prior to the mlaa the concepts developed and embodied in the mlaa reflected both the strengths and weaknesses of the u.s medical library community in 1964 the national library of medicine nlm was serving as a national resource it had a budget of 4 million a staff of 350 provided services nationwide and was an innovator in the use of technology to develop a computer-based information storage and retrieval system medlars which had just become operational the weak status of the medical libraries in this country had been described by deitrick and berson ' and bloomquist . in 1962 the 3 surgeon general held a conference on health communications the recommendations related to the need for improved communications research training and the use of libraries as communications centers and resources the national academy of sciences—national research council nas-nrc 4 studied communication problems in biomedical research in 1963 the nas-nrc conclusions and recommendations emphasized the responsi bilities of the biomedical community facilities and services research and development training and coordination of the biomedical information complex the u.s president's commission on heart disease cancer and stroke assessed communications problems within the context of three ' specific diseases and its communications recommendations were specifically addressed to the need for better facilities resources and legislation thus significant studies and evaluations from

Page  3 3 professional user groups highlighted the need for improved biomedical communication activity in the medical library world was reflected in the substantive articles of the 1964 issues of the bulletin of the medical library association which reviewed the national library of medicine's new computer-based system medlars medical subject headings mesh , and the nlm bibliographic services the relative service roles of both the nlm and individual libraries in inter library lending and photocopying and the establishment of an mla committee on the nlm were treated in editorials and news notes other articles in the bulletin described an international congress on medical librarianship operating aspects of individual medical libraries mechanization library statistics the growth of the literature in specialized areas of health a special section was devoted to regional plans for medical library service with representatives from six states assessing independently their current and potential scope of services there was a recurring theme librarians were interested in responding to more than their immediate local clientele but they were hampered by lack of facilities equipment staff and money this can be expressed as the imbalance between library resources and users demands for services this imbalance can be traced to the greatly increased funding of medical research and education with no attendant increase for library resources during 1964 nlm examined the great disparity between the present and potential roles of a

Page  4 4 medical library problems existed in meeting the needs of the professional user whether he worked in health research education or practice these problems were traceable to the fundamental issues of the nature availability and utilization of resources—both human and materiel some physicians and scientists geographically distant from modern library facilities were found to be isolated from current information sources some libraries could be characterized not only by inadequate funding but by a low level performance the nlm com missioned studies to be done by the association of american medical colleges v°j v-o viu on needs of medical school libraries and requested assistance from the medical library association to crystalize data and statistics on problems facing medical libraries ' nlm also re-examined the nlm mandate from the u.s congress to serve as a national resource and to assist the advancement of medical and related sciences and to aid the dissemination and exchange of scientific and other information important to the progress of medicine and to the public health as a result of these examinations cummings recommended that the future role of the national library of medicine should include programs to upgrade the nation's medical libraries and recommended regional and local inter-relationships in which the constituent elements would have clearly defined roles and responsibilities the totality would then be a strong entity which would encompass a sharing of talent and resources to achieve the primary objective of responding more effectively to the information needs of the health professional

Page  5 5 specifications were then developed for legislation which would create new programs directed at both the individual and the insti 12 tution and at local regional and national levels cummings described nlms proposed supporting functions and activities at the dedication of the countway library in 1965 he presented the philosophy underlying the pending legislation which was subsequently enacted by the us congress in october 1965 as the medical library assistance act pl 89-291 it is my view that the time has come for rapid expansion of library resources locally continued dependency of the more than 6,000 medical libraries upon the services of the national library of medicine would lead ultimately to the evolution of a monolithic medical library resource in this nation for the convenience of the user for the inspiration which the presence of the local library gives to its own community for the serendipity which accompanies browsing and search strong medical libraries must exist wherever there are strong biomedical interests in my view our country requires the development of a complex of regional medical libraries with adequate facilities resources and personnel to serve those sections of the nation with underdeveloped library facilities nlm has submitted legislative specifications to congress and the administration requesting authority and funds to provide assistance to local and regional libraries for 1 library construction 2 training of librarians 3 research in the field of information sciences 4 library resources 5 development of regional libraries 6 publications and translations support i am encouraged by the favorable reaction of librarians physicians and scientists ; to these proposals during this same year 1965 articles published in the mla bulletin showed a continued preoccupation with medlars activities and the medical library assistance act occupied the editorial and news notes sections

Page  6 6 by contrast in 1970 25 of the papers published in the mla bulletin described activities funded by the medical library assistance act subjects included educational needs of health sciences library manpower information needs of specialty groups mechanization of library procedures automated serials accession systems library management data and regional medical libraries - their services and functions inter-relationship of nlm and medical library community fy 1966-1970 during the period of the mlaa july 1965-june 1970 the total five-year cumulative budget of the nlm was approximately 87.6 million of this nlm provided 49 or 43 million to the u.s medical library community 40.8 million under the mlaa and 2.2 million through con tracts for medlars centers and other library-based activities this sum is relatively large when viewed against a prior base of no federal support for medical libraries it is small in comparison with the total national expenditures for health care medical research and communications the total extramural and intramural efforts of the national library of medicine in 1969 represented only 0.03 of the overall national funding for health activities figure i however the very existence of these funds is significant because they are unique and are the principal existing mechanism for the exclusive improvement of the resources and services of us medical libraries

Page  7 7 in any federal grant program the funding institution cannot dictate the usage of these funds it can only present the philosophy the objectives the criteria and then respond to the submitted proposals which are evaluated by an external review group for technical merit and priority accordingly the usage of the nlm funds essentially reflects the perspective and priorities of the medical library community programs executed under the mlaa the underlying purpose of the mlaa is to improve biomedical information services this assumes a conversion from traditional attitudes and mechanisms to emphasize that 1 the modern medical library is part of the communication process and 2 improved communication is necessary for advances in medical research education and practice the mlaa 1965 authorized the following programs 1 construction of facilities 2 training in medical library sciences 3 special scientific projects 4 research and development in medical library science and related fields 5 improvement and expansion of the basic resources of medical libraries and related instrumentalities 6 establishment of regional medical libraries 7 biomedical publications and 8 regional branches of the national library of medicine

Page  8 8 the nlm has acted to implement all of these programs with the exception of establishing our own regional branches we decided instead to try to improve existing resources rather than to create competitive federal entities comparison of the level of funding authorized by congress under the mlaa and the funds actually appropriated table ia indicates that only 397o of the total authorization was made available to the nlm the distribution of authorized and appropriated funds by program illustrates two program areas received 507 or more of funds authorized training grants and resources grants the nlm has maintained records of those projects which have been approved but could not be supported due to inadequate funding the amount of monies represented by these xmfunded projects table ib are identified by program areas only in the construction program does the sum of the funded and unfunded projects total more than the original estimate of needs as reflected in the basic congressional authorization in all other program areas the level of unfunded t projects does not equal and oftentimes is a small percentage of what had been originally estimated as needed by the medical library community there are three interpretations for this 1 the original estimate in the act was not realistic 2 the scarcity of funding tempered the number of requests received by the nlm or 3 the medical library community was unable to convince those who authorized appro priations of its needs we believe the interpretations 2 and 3 are the primary reasons for the failure to achieve more adequate funding

Page  9 9 the total number of grants awarded through the mlaa was 604 and the distribution by programs and funds is shown in table ia figure ii gives the percentage distribution of mlaa funds by program areas i resource grants utilized 29 construction 28 research and development 15 regional medical libraries 12 training/fellow ships 11 publications 67 and special scientific projects 0.57 we have triwarded through the mlaa was 604 and the distribution by programs and fwarded through the mlaa was 604 and the distribution by programs and funds is shown in table ia figure ii gives the percentage distribution of mlaa funds by program areas i resource grants utilized 29 construction 28 research and development 15 regional medical libraries 12 training/fellow ships 11 publications 67 and special scientific projects 0.57 we have triwarded through the mlaa was 604 and the distribution by programs and funds is shown in table ia figure ii gives the percentage distribution of mlaa funds by program areas i resource grants utilized 29 construction 28 research and development 15 regional medical libraries 12 training/fellow ships 11 publications 67 and special scientific projects 0.57 we have tried to estimate how the mlaa funds have been utilized in terms of personnel materiel services and techniques these figures are shown in figure iii althought there needs to be some refinement of the data the gross picture is clear assistance for materiel has been provided within the construction resources publications and regional medical libraries rml grants the training program emphasis has been on people and salaries have been provided for medical library staff through both the resources and regional medical libraries programs techniques development and utilization of technologies are made possible through both the resources and the research and development programs the service function is primarily reflected within the rml program overall it is clear that emphasis has been overwhelmingly on materiel 55 with relatively little emphasis on new services 87 some specific details on the individual programs follow research and development the research and development program was intended to encourage research in medical library science and the development of new

Page  10 10 techniques systems and equipment for information storage and retrieval the projects have been grouped in three categories 1 library services operations and manpower - projects concerning development and evaluation of information activities in libraries and studies of manpower needs and training to provide these services 2 biomedical communications usage and tools - projects studies publications in the broad field of biomedical communications 3 history of medicine and the life sciences - historical studies of matters related to health and medicine the distribution of the number of grants and contracts and funds among the three program categories is given in table ii library services accounted for 137o of the projects and 357o of the funds biomedical communications 427 of the projects and 4 9 of the funds and history of medicine 45 of the projects and 167o of the funds projects supported have included surveys on health library manpower an on-line computer serials control system studies of communication patterns among medical researchers development of standard nomenclatures evaluation of self-instruction materials and language analysis for information retrieval there has been heavy emphasis within the program on history of medicine projects new research methodology was not a prominent feature of grant applications by librarians and information specialists thus few

Page  11 11 research projects to date have led to the application and implemen tation of new modes of biomedical communications training the training program included both training grants and fellowships as follows a traineeships and fellowships for advanced academic degrees in library or information science b retraining or special training for health science librarians or information specialists c institutional programs for training in library science and communication d establishment of internship programs in medical libraries a summary of the training grants and fellowships is shown in table iii the training funds made available by the nlm for fy 1966-70 will have provided for the training of approximately 350 individuals the average cost per trainee is 8,100 of which 57 covers stipend and trainee expenses and 43 is non-trainee expenditures insufficient emphasis was place on retraining existing librarians in modern information-handling methods and there were no grants to train library assistants

Page  12 12 publications forty three scientific health publications s critical reviews atlases compendia and abstracting and indexing tools were supported with an expenditure of 2.3 million under this program many secondary literature services and specialized subject series have resulted and these would not have been supported by commercial ventures table iv special scientific projects this program provided 10 special fellowships for preparing scholarly studies in topics such as discovery regulation and use of drugs and interorganizational aspects of urban community health approximately 200,000 was expended for this program although the quality of work seems uniformly good the small number of partici pants who applied has been disappointing it is evident that few scholars accepted this opportunity to do creative writing and study the deficiency rests with the u.s medical community and not with librarians * construction construction grants were made to 11 institutions 9 medical schools 1 school of optometry and 1 school of veterinary medicine specifics are given in table v it is clear that this program will have a profound impact on improving library resources in those areas where they are being constructed there is a great need to expand this program to other needy institutions approximately 25-40

Page  13 13 resources under the resource grant program 401 grants have been made totaling 11.8 million dollars the distribution and utilization of these grants provides us with an interesting commentary on medical library operations approximately 50 of the number of resource grants went to hospital libraries whereas 63 of the funds went to medical libraries within academic institutions figures iv and v over 50 of the funds expended under the resource grants were used to acquire journals books and informational materials approximately 24 of the monies enabled the medical libraries to increase the number of their staff and 16 was for the purchase of equipment thus this program has had a major impact on the enlargement of collections more than 400 local libraries have been assisted but most did not use the funds to improve the nature and scope of services through increased manpower or by the application of new technology regional medical libraries as noted earlier the nlm decided not to establish its own regional branches but chose to support regional services through existing libraries of excellence or those with potential we tried to develop a network to achieve the goal of responding more effectively to the needs of the health professionals we did not define the network as a rigid unchanging snare of interconnections we visualized a planned sharing of resources systematically so that improved services could be provided with maximum efficient

Page  14 14 utilization of available resources—manpower fiscal and technological thus the underlying principle was cooperative lee in order to assist the local institutions in a systematic and constructive manner we established a regional link to interrelate the national and local institutional levels this link was the regional medical library regional medical libraries were principally university-based were selected competitively from libraries with strong collections well-trained staffs and a good record of providing medical library services the first regional medical library was established at harvard in 1967 today there are eleven such regional medical libraries with the national library of medicine itself designated as a regional library for a geographic area in the mid-atlantic united states table vi the hierarchical concept for the medical library network figure vi is as follows 1 the nlm is the comprehensive national resource which can assist other medical libraries in terms of material not in their collection as well as serving as the medical indexing and cataloging center for the nation 2 the regional libraries are to improve and expand their reference and interlibrary loan services to medical and hospital libraries in a broad geographic area and

Page  15 15 3 the local libraries arc to assist individual health professionals as the closest point for library service designation as a regional medical library required the recipient institution to increase its scope and nature of services to health professional users in a broader geographic area since the operation of the first regional medical library in 1967 4.7 million dollars have been expended and all eleven of the regional medical libraries are in various stages of operational activity if one examines the last year of operations for 7 regional medical libraries with 4 of them operational for less than one year the distribution of 1.65 million dollars in grant funds in terms of service is 427c for interlibrary loan services 17 medlars demand search services 97o education and consultation primarily for local hospital libraries 77 preparation of union lists 67 orientation and information programs 47o reference services 157 other management and overhead prior to the establishment of the regional medical libraries in 1967 the national library of medicine was receiving on a national basis approximately 175,000 interlibrary loan requests annually figure vii in the subsequent 3 years with the regional medical libraries in various stages of operational capability

Page  16 16 the total national interlibrary loan activity for both the national library of medicine and the regional medical libraries has more than doubled this is a real measurement of successful performance if one excludes interlibrary loan requests which nlm receives in its role as a regional medical library and from foreign sources then the level of interlibrary loan requests nlm receives in its capacity as a national resource has dropped to approximately 48,000 although fewer in number these requests are for the most inaccessible and rare items in the medical literature overall however we still provide more than 100,000 loans annually the establishment in 1964 of the nlm's computer-based bibliographic storage and retrieval system medlars generated considerable demand for medlars demand searches throughout the u.s and abroad accordingly decentralized medlars centers were established in the united states some of these centers are part of the regional medical libraries others are located in different institutions in1 the same region and they work cooperatively with the regional medical library in the last year there were 22,000 medlars demand searches released of these approximately 167c were performed by nlm 48 were by u.s centers and 367o by foreign centers the interlibrary loan and the demand search services are thus two functions of the national library of medicine which have been decentralized successfully in an effort to make these services

Page  17 17 available moire efficiently to the professional health user we are now planning to decentralize aim-twx our successful on-line bibliographic service in a similar way an analysis of the distribution of funds by program according to regions presently defined for the regional libraries figure viii indicates that each of the regions was funded in the 3.4 — 4.4 million dollar range with two exceptions region vi southeastern and region x pacific northwest although the funding would appear to have a fairly consistent distribution overall the constituent elements vary considerably from region to region construction funds increase the level of funding for each region however regions vii midwest and xi pacific southwest which had no construction monies still maintain a high overall figure because of emphasis on research and training in these two areas only the research and training funds totaled more than resource funds by contrast in regions i new england ii new york and vi southeast the sum spent for both research and training was t less than one-half that spent for resources assessment of the medical library assistance act fundamental concepts embodied in the act the fundamental concept of the medical library assistance act is to develop a cooperative sharing of resources in order to improve library and information services to the health community the act provides the mechanism and the authorization for funding to achieve

Page  18 18 this goal we continue to believe that this is a firm and constructive basis for developing a national medical library network with clearly delineated responsibilities at the national regional and local levels allocation of resources the appropriation of resources to fulfill the expectations of the act has been 39 of what had been authorized accordingly we have fallen short of goals which we had originally identified for example we had hoped to reach 600-700 medical libraries through our resource program instead we were able to assist only 400 we were informed in 1964 of immediate construction needs for 86 health sciences libraries but we have been able to assist only 11 our training program has served to stimulate and encourage specialization in medical librarianship but it cannot begin to fulfill overall manpower requirements thus in both the specific and overall programs we have made a beginning but the limited availability of funds has prevented more substantial accomplishments impact on the national library of medicine the mlaa has affected nlm both organizationally and functionally 1 nlm has become part of a national medical library network instead of serving as every institutions library 2 nlm has decentralized to date two information service functions interlibrary loans and medlars to regional centers with an accompanying provision of funds to these regions for increased resources

Page  19 19 3 nlm has expanded its efforts to identify not only the needs of the professional health user but also of the medical library community and to seek appropriate solutions . a considerable nlm staff time and resources are devoted not to the nlm daily operations but to the administra tive support of programs directly relating to the medical library community it was anticipated that the development of a national medical library network would indeed shift workloads so that maximum efficiency would be achieved this in fact has occurred with nlm assuming greater workloads in some technical areas and lesser ones in others nlm's service level in 1964 is compared with 1967 and 1970 in table vii the mlaa programs have reduced interlibrary loan and medlars demand services from nlm but they have altered significantly the kind and scope of other services provided by nlm this is reflecttd in new products such as current catalog abridged index medicus aim the on-line time sharing system of aim-twx and audiovisual services impact on the u.s medical library community it is true that the period of our experience with regionalism is short however definitive trends are becoming evident medical libraries seem to have been most interested in improving

Page  20 20 their collections or physical resources before improving medical library services this appears logical if one has clearly in mind the level and scope of the services to be performed however the time has come for primary emphasis on providing improved service we are not convinced that there is a sharp delineation of functions at the national regional and local levels as portrayed in figure vi nor does there seem to be a clear understanding of this division of responsibilities „ in some cases we find a local library with regional aspirations and a regional library with national inclinations with limited resources every library cannot be of equal size and status the national library of medicine has unique national responsi bilities not only to serve as a resource library but to acquire index and catalog comprehensively it should also encourage the establishment of library standards union serial lists and cooperative cataloging some of these tools and procedures are best developed cooperatively on an overall basis with subsequent availability to all otherwise uncorrelated independent efforts will consume the limited available resources and produce few overall advances impact on the user our experience with the medical library network has convinced us that a medical library network is no longer a concept but a reality this is particularly important now when the workloads continue to increase at national regional and local levels

Page  21 21 without a corresponding increase in fiscal and personnel resources conceptually we believe that the value of the network is clearly demonstrated by the rising number of service requests made to local and regional libraries and by the increasing number of responses made by these libraries we do not have however a quantitative measure of user reaction practically the linkage aspect of the network should permit a more effective redistribution of functions and workloads at all levels and an overall increase in both the number and kinds of services to users the most tangible evidence we have noted is in the shift from the national level to the regional level in the provision of interlibrary loan and medlars demand services to the individual the nlm's role particularly with regard to inter library loan service is now primarily to respond to those interlibrary loan requests which the regional medical libraries cannot fill we are disappointed however that there have not been adequate funds for an increase in reference services for emphasis on con sultation and educational programs and the inclusion of multi-media informational services the consultation and educational role of the regional medical libraries should be developed so that they become demonstration and training centers this does not mean that regional medical libraries will vie with academic institutions for formal training programs but they can be a unique resource for internships and specialized work experiences

Page  22 22 we are convinced that audiovisual materials as well as the printed word are important media to convey medical information it must be determined whether the regional medical library can become a multi-media information center as a depository for the collection and dissemination of audiovisual materials conclusions we believe that in the aggregate the medical library assistance act and the extramural programs of the national library of medicine have had a significant beneficial effect on the improvement of library and information services to physicians scientists and other related health personnel the impact of these programs obviously would be more profound had the appropria tions been larger this is particularly true with respect to medical library construction where the funds made available were only sufficient to support the building of 11 new medical libraries funds invested in support of research were probably the least rewarding for several reasons 1 most medical librarians were not trained in the scientific method nor had they had a previous experience with research 2 the so-called information scientist competed most successfully for the lion's share of these funds and thus made contributions which were only peripherally relevant to the improvement of library services funds appropriated for training of medical librarians have been well spent graduates from these programs may well be our library leaders of the future

Page  23 23 more emphasis on retraining of existing librarians seems indicated resource grants have expanded the collection of many small libraries but there remains a need to use these funds for improved services historical studies and special publications have enriched the literature of medicine eleven regional medical libraries including nlm are now operational as the first step toward a medical library network in summary the mlaa has done much to upgrade medical library services to the nation's health community however we have not done well enough there is a need for financial resources to reach all medical libraries who lack personnel to serve adequately health personnel requiring medical information we believe that through creative resource sharing we can improve our collective performance as the nlm now enters the period of administering extramural programs under a three-year extension of this act we shall be in a better position to allocate resources which arc more realistically attuned to library performance and user needs

Page  24 references 1 deitrick j e and berson r c medical schools in the united states at mid century new york mcgraw-hill 1953 2 bloomquist harold the status and needs of medical school libraries in the united states a report prepared for the national library of medicine jo med educ 38 145-163 march 1963 3 surgeon generals conference on health communications november 1962 us department of health education and welfare public health service february 1963 4 national academy of sciences-national research council division of medical sciences communication problems in biomedical research report of a study washington dc october 1963 supplement washington dc march 1964 5 presidents commission on heart disease cancer and stroke a national program to conquer heart disease cancer and stroke volume i december 1964 volume ii february 1965 superintendent of documents us government printing office washington dc 6 bulletin of the medical library association 52 148-180 414 545 645 1964 7 bulletin of the medical library association 52 442 795 1964

Page  25 8 datagram needs j med educ 40 396-397 april 1965 9 guidelines for medical school libraries special issue j med ed 40 64 1965 10 library study committee of the association of american medical colleges mer k duval m d director and seymour alpert m director the health sciences library its role in education for the health professions j med ed part 2 august 1967 11 committee on surveys and statistics of the medical library association library statistics of schools in the health sciences part i bull med libr ass 54 206-229 july 1966 part ii bull med libr ass 55 178-206 april 1967 12 cummings martin m the edge of husbandry the role of the national library of medicine biblioteca medica physician for tomorrow ed by david mccord harvard medical school boston mass 1966

Page  26 list of tables table i comparison of nlm authorization appropriations and unfunded projects under the medical library assistance act of 1965 for fy 1966-1970 table ii nlm research and development program grants and contracts awarded fy 1966-70 table iii nlm training programs fy 1966-70 table iv nlm publications program grants and contracts fy 1966-70 table v list of institutions receiving nlm construction grants fiscal years 1967-1970 table vi libraries receiving nlm grants to serve as regional medical libraries in eleven geographic regions table vii comparison of scope and level of nlm's services fy 1964 1967 1970

Page  27 table i compar is on j3f_nlm jjt hortz at 1 on attr oprj at tons and unfunded projects t " under the medical i crary assistance 7u;j7~of 1963 for py 1966-1970 july 1 19g5-~june 30 1970 million $) a b

Page  28 table ii nlm research and development program grants and contracts awarded fy 1966-70 july 1 1965 june 30 1970 category number of amount projects million library services operations and manpower 14 2.1 biomedical communications usage and tools 43 3.0 history of medicine 46 1.0 total 103 6.1

Page  29 table iii ni.m training programs fy 1966-70 july 1 1965 — june 30 1970 projects individuals — funded supported a training grants non-degree programs 6 77 degree programs masters 9 143 ph.d 5 33 total total 20 253 * b fellowships postdoctoral research history 6 6 biomedical communications .... 2 2 1 during 1966-70 some for more than one year * training programs funded during 1966-70 will have provided training for approximately 350 individuals some of whom will actually receive this training in fy 1971 funds awarded totaled 4.46 million

Page  30 table iv nlm publications program grants and contracts fy 1966-70 july 1 1965 june 30 1970 category no of projects abstracts 8 atlases 6 bibliographies 6 critical reviews 1 handbooks and catalogs 8 monographs 3 translation projects • 6 other media 5 total 43 total $ awarded 2.3 million

Page  31 table v list of institutions receiving nlm construction grants fiscal years 1967-1970 boston university boston massachusetts brown university providence rhode island rutgers the state university new brunswick new jersey jefferson university philadelphia pennsylvania george washington university washington d c wayne state university detroit michigan auburn university auburn alabama southern college of optometry memphis tennessee university of nebraska omaha nebraska university of utah salt lake city utah university of texas medical branch galveston texas rml region type of institution award i medical school i ii iii iv v vi vi viii viii ix totals medical school medical school medical school medical school medical school vet mad school optometry school medical school medical school medical school congressional appropriations were not made foi construction until fy 1967

Page  32 table vi regional medical libralti i cleven geographic regions 1 - new england new england regional medical library the francis a countway library of medicine boston massachusetts 2 - new york new york & northern new jersey regional medical library new york academy of medicine new york n y 3 - mid-eastern mid-eastern regional medical library college of physicians of philadelphia ph i 1 ad e 1 ph ia , pe nnsy lvania states connecticut maine massachusetts new hampshire rhode island vermont funds million $) operational 1.020 10/1/67 new jersey ' northern counties bergen essex hudson hunterdon , midd le sex morris passaic somerset sussex union & warren new york 336 2/16/70 delaware new jersey southern counties atlantic burlington caniden cape may cumberland gloucester mercer monmouth ocean & salem 715 7/1/68 4 - mid-atlantic mid-atlantic regional medical library p 0 box 30260 bethesda maryland - nlm maryland north carolina virginia washington d.c west virginia 5 east central kentucky ohio-michigan regional medical library wayne state university detroit michigan kentucky michigan ohio 256 4/1/69 6 - southeastern southeastern regional medical library a w calhoun medical library woodruff research building emory university atlanta georgia alabama florida georgia mississippi puerto rico south carolina tennessee 470 1/2/70

Page  33 table vi cont regions 7 midwest m i cl we s t r e g i o n a 1 mo d 1 c a 1 l i b r ar y the john crerar library chicago illinois states illinois indiana i owa minnesota north dakota wisconsin funds operational million $) 325 11/18/68 8 midcontinental mid-continental regional medical library university of nebraska medical center omaha negraska colorado ka n s a s missouri nebraska south dakota utah wyoming 228 7/1/70 9 south central univers ity of texas southwestern medical school at dallas dallas texas arkansas louis iana new mexico oklahoma texas 178 2/1/70 10 pacific northwest pacific northwest regional health sciences library university of washington seattle washington alaska idaho montana oregon washington 639 io/i/08 11 pacific southwest arizona pacific southwest regional medical california library center for health science hawaii university of california nevada los angeles california 512 9/1/69

Page  34 table vii comparison of scope and level of klm's services fy 1964 1967 1970 1964 interlibrary loans . 130,555 reference requests . , 20 , 154 technical services items catalogued 14 157 publications added 91 105 history of medicine services reference . 281 index medico s articles indexed 144,057 issues distributed 7,600 abridged index medicus bibliographies prepared 1 102 medlars searches recurring bibliographies literature searches • • audiovisuals distributed 1967 175,000 25,514 14,52 9 112,301 1,338 1970 100,611 21,702 17,767 121,942 1,461 * includes nlm and u.s and foreign sources under contract + nlm 3520 u.s centers 10,560 foreign centers 7,920

Page  35 list of figure captions figure i national health expenditures in 1969 for health care medical research and communications figure ii percentage distribution of funds by program for the period july 1 1965 through june 30 1970 figure iii percentage distribution of program funds by personnel materiel techniques and services for the period july 1 1965 through june 30 1970 figure iv the number of resource grants distributed by type of institution figure v the funding distribution of resource grants by type of institution figure vi hierarchical structure of medical library network plan figure vii a comparison of the distribution of national inter library loan activity before and after the establishment of regional medical libraries figure viii p^egional distribution of mlaa funds provided by the research training resources construction and regional medical library programs of the nlm

Page  36 national health expenditures sg0.3 billion 1969 hospital care drugs & appliances nursing home care construction professional personnel other national library of medicine 17 million - 03 federal health communications 65 million - 1 medical research 2.7 billion - 4.5

Page  37 distribution of medical library assistance act funds by program - fy 1966 - fy 1970 july 1 , 1965 - june 30 1970 publications 1 6 | special scientific /| projects 5 training 11 regional medical libraries 12 research & ) development " 15 resources 29 construction * due to roundir.j pcrcenu^es may not add to 100

Page  38 distribution of program funds by personnel materiel techniques and services fy 1966 - 1970 - july 1 1965 - june 30 1970 regional medical \ libraries resources j research training resources l-31hj iiliihjp regional medical { iililliii't libraries ) m construction resources publications | regional medical { libraries * due to rounding pcrccntascs may not add to 100

Page  39 distribution of resource grants number of grants by type of institution dentistry 16 pharmacy - 2 veterinary medicine 7 other academic >" n1 uaj,|!i!|m institutions 31 j n hospitals 192 : includes schools of health science medical schools - 93 f { societies 16 other 10 \| state institutions - 8

Page  40 distribution of resource grants funds by type of institution dentistry s251.330 }_ pharmacy s364 81 veterinary medicine s154'217 other academic institutions s426.30 j medical schools s7.i61 048 societies s534>003 other ! si 98 222 state institutions s218,681 hospitals s2as6.656 * includes schools of health science

Page  41 medical library network plan or i.i,)m )) , i ]] kl ion m i 11 r ikii s looacadi'mir jjhra1ui-s \ 500-000 l0c7vl li i'il-l aries lospil;!)s i-kdieal socielics cic relations iil's » compatible with national information systems © compatible with other national libraries © assist specialized information centers © assist mission oriented groups federal and private

Page  42 national inter-library loan activity o 1966 1971 all regional i medical libraries nlm as mid atlantic regional library nlm foreign & domestic year

Page  43 ijistklbl t1on uk mkdical fir.kauy assistance act fixnds by regions defined for the regional medical libraries fy 1966thum;;h fy 1970 millions of dollars 4 ,-• 4.33 4.38 3.89 3.99 kxj :. x/vx'x.-vv m..vxx,.i mmmm x-x-x-.x.y y :¦'¦ v v x 1 y y..:.-:i ::-.:: i ! i lisp i ¦. v x 41 y 4.11 •:¦: :•:¦:•'•' ¦•'¦' x>xsj ';>:•:¦:¦;¦;¦; -^ i 94 ii iii iv v v vii viii ix x xi nrnm medical libraries construction resources training l_^j research * the national library of medicine serves as regional library for region iv estimated cost foi this nlm function does not include overhead