1977 U.S. House of Representatives Appropriations Committee Budget Testimony, 94th Congress 2nd Session, March 2, 1976
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~EP~TMENTS OF LABOR AND H~LTH, EDUCATION, AND WELF~E APPROPRIATIONS FOR 1977 HEARINGS SUBCOMMI~EE OF THE COMMITTEE ON APPROPRIATIONS HOUSE OF REPRESESJTATIVES BEFORB) A NINETY-FOURTH CONGRESS SECOND SESSION SUBCOMMITTEE ON THE DEPARTMENTS OF LABOR AND HEALTH, EDUCATION, AND WELFARE DANIEL J. FLOOD, Pennsylvania, Chirman WILLIAM H. NATCHER, Kentucky NEAL SMITH, Iowa EDWARD J. PATTEN, New Jersey DAVID R. OBEY, Wisconsin EDWARD R. ROYBAL, California LOUIS STOKES, Ohio JOSEPH D. EARLY, Massachusetts ROBERT H. MICHEL, Illinois UARNER E. SHRIVER, Ransas SILVIO 0. CONTE, Massachusetts HENRY A. NEIL, Jr., FREDERICK E'. PFLOOER, ROBEBT L. KNISELP, NICHOLAS (3.' CAVAROCCHI, and GEMMA M. WEIBLINGEB, Bubcommtttsa Stag PART 4 DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE : NATIONAL INSTITUTES OF HEALTH 0-536 0 Printed for the use of the Committee on Appropriations U.S. GOVERNMENT PRINTING OFFICE WASHINGTON : 1976

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1066 TUESDAY, MARCH 2, 19'76. NATIONAL LIBRARY OF MEDICINE WITNESSES DR. MARTIN M. CUMMINGS, DIRECTOR, NATIONAL LIBRARY OF DONALD S. FREDRICKSON, DIRECTOR, NATIONAL INSTITUTES OF MELVIN S. DAY, DEPUTY DIRECTOR, NATIONAL LIBRARY OF MEDICINE HEALTH MEDICINE TIONAL LIBRARY OF MEDICINE LIBRARY OF MEDICINE NATIONAL INSTITUTES OF HEALTH AGEMENT, NATIONAL INSTITUTES OF HEALTH KENT A. SMITH, ASSISTANT DIRECTOR FOR ADMINISTRATION, NA- FRANK B. POH, FINANCIAL MANAGEMENT OFFICER, NATIONAL LEON M. SCHWARTZ, ASSOCIATE DIRECTOR FOR ADMINISTRATION, NORMAN D. MANSFIELD, DIRECTOR, DIVISION OF FINANCIAL MAN- CHARLES MILLER, DEPUTY ASSISTANT SECRETARY, COMPTROLLER Mr. NATCTTER. Doctor, yon have appeared before this committee in the past. Who do you have with -yo11 this time? Dr. CU;\~MINGS. Tcent Smith and Me1 Day. Mr. NATCHER. With your permission we would like to insert this statement in its entirety in the record and proceed with the questions. Dr. CUXMIXGS. That is a11 right. BIOGRAPHICAL SKETCH Name : Martin Marc Cummings. Position : Director, National Library of Medicine. Birthplace and date : Camden, N.J., September 7,1920. Education : B.S., Bucknell University, 1941 ; M.D., Duke University, 1944. Experience : Health. Health. biology, University of Oklahoma School of Medicine. Present, Director, National Library of Medicine. 1963-64, Associate Director for Research Grants, National Institutes of 1961-62, Chief, Office of International Research, National Institutes of 1959-61, Professor of microbiology and chairman, department of micro- 195.3-59. Director, Research Services, Veterans' Administration Central Office. School of Medicine. tion Hospital of Atlanta. University. Disease Center, U.S. Public Health Service. 1953-59, Special lecturer in microbiology, George Washington University 1953, Associate professor of Bacteriology, Emory University. 1949-53, Chief, Tuberculosis Research Laboratory, Veterans' Administra- 1948-53, Instructor through associate professor of medicine, Emory 194749, Director, Tuberculosis Evaluation Laboratory, Communicable 1945-49, Assistant resident, Boston Marine Hospital. 1944-45, Intern, Boston Hospital. 194244, US. Army, Pfc.

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1067 Associahion memberships : Americlan scademy of Microbiology, Inc., American Board of Microbiology. American Federation for Clinical Research (emeritus). American Society for Clinical Investigation (emeritus). Association for Amer- ican Medical Colleges. Medical Litbrmry Aasoaiation. Society of Sigma XI. Amer- ican Clinical and Climatological Association. Memberships : American Society for the History of Medicine. Board of Dim tors, Corgas Memorial Foundation. American Documentation Institute. Amcia- tion of Research Libraries. Society of Medical Administrators. Special awards, citations, or publications : Veterans Administration Excep tiom1 Service Medal. DHEW Superior Service Award. DHEW Distinguished Service Award. Honorary doctor of wience, Bucknell University, 1969. Distin- guished Alumnus Award, Duke University. Honorary doctor of science, Univer- sity of Nebraska, 1971. Honorary doctor of science, Emory Universi,ty, 1971. Honorary doctor of Humane letters, Georgetown University, 1971. Honorary member, Alpha Omega Alpha. Honorary doctor of medicine, Karoilinska Institute, Stockholm, Sweden, 1972. Honorary fellowship, College of Physicians, Phila- delphia, 1973. Rockefeller Public Service Award, 1973. One hundred scientific and historical publications. E GENERAL STATEMENT Mr. Chairman and members of the committee, in this Nation's Bicentennial year, the National Library of Medicine takes great pride in its many achieve- ments accomplished over We pcst 140 years. Since its modest beginning in 1836, the National Library of Medicine has become an .outstanding national resource which contains the most important colleation of health sciences literature in the world. As part of the Surgeon General's Office of the Army, the Library originally consisted of n small collection of 30 hooks and journals. An Army surgeon, Dr. John Shmw Billings, developed and fostered the philosophy that the ever- that should be organized and utilized by health professionals in their efforts to promote the progress of medicine. That philosophy permeates the establishing legisbation that authorized the creation of the National Library of Medicine in Today lthe NLM'fs total collection of over 1.5 million items is organ8zed in a most efficient manner consistent with facilitating timely dissemination of medical information to researchem, educators, and practitioners. In the last 140 years, NLM has expanded well beyond its traditional role of curat'or of the published medical record to that of an active institution con- cerned with sustaining and operating a national biomedical communication net- work employing the latest communication technology and information science techniques. Fiscal year 1977 at NTAf will continue to he marked by new initiatives, inno- munications technologies to medical information transfer. Substantial support for NLWs hasic library services becomes a bigger chal- lenge with each succeeding year. Demand for access to the literature is increas- materials wikl rise approximately 15 (to 20 percent. Rising acquisition costs have forced more local hospital and clinical libraries to rely on NLM as a medical li brarv backstop. A second major challenge will he the difficult task of rapidly translating research results lint0 clinical practice and public health, an assignment which we share with all of Qhe Institutes and Divisions of NIH. Whereas the Institutes assume the responsibility for the amunacy of the content of the information we are preparing to provide the communications channels through which the mes- sages reach the practitioners, patients, and other members of our society who hare a need for ithis Information. The full resoiirces and power of the national biomedical communications net- work will he brought to bar on the problem through the involvement of earth NLhi operating comlponent. L % ! 1 t increasing and impolttant collection of biomerlioal publications was a resource ! t 1956. ! i i t I vation and significant challenges in the application of computer and telecom- s , ing at a rate of 25 percent in fiscal year 1976 and the cost of acquiring such i t i i i I BIBLIOGRAPHIC SERVICES NJX continuw to meet its 'traditional responsihilities of improving the flow of biomedical information by storing, retrieving. and disseminating the world's bio- mdical literatiire. To facilitate access to the literature, NLM produces bibliog-

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1068 raphies employing both manual search techniques and computer searches of online data bases ; provides reference and loan services ; prepares and publishes various materials for use by health science researchers and practitioners ; and manages the Nation's online information retrieval network. NLM will provide approximately 400,000 reference and loan services during fiscal year 1976, an increase of 80,000 over fiscal year 1975. It is anticipated that the NLM will satisfy a requirement for 500,OOO during fiscal year 1977. Perhaps the prime tool of modern technology is the computer, and NLM has pioneered itls use for bibliogrnghic information storage and retrieval. A mm- piitelTized reference retrieval system was installed in 1964 to help corpe with increasing amounts of biomedical literature. This system, known as Xedlars I, permitted both computerized production of Index Jledicus and automated seamhes of the entire bibliographic dah basee by health professionals. Last year a more sophisticated bibliographic processing system, Medlars 11, was imple- mented successfully which has enabled NLII to develop new services and extend itIs existing services to a 1,arger .segment of the health community. Medline (Medlars on-line) is now available in some 388 institutions at home and abroad. It facilitates rapid communication between the health professionals and the NLN's Medlars data base, which contains references to relevant medi- cal literature. A total of 400,000 searches were performed last year through the NLM online system, and it is anticipated that approximately 500,OOO searches will be performed in fiscal year 1976. The network will be expanded to provide access to many smaller hospitals and community-based academic institutions with preclinical and paramedical training programs. I am pleased to report that one of the newer capabilities has permitted the inclusion and searching of ? will be in the data base, thereby significantly augmenting the usefulness of Medline. 1 , abstracts. It is afnticipated by fiscal year 1977 over 100,000 author abstracta MEDICAL LIBRARY ASSISTANCE The programs of medical library assistance form a vital component of the biomedical communications network. Through assistance to the network's regional medical libraries and grants to smaller medical libraries in hospitals and medical centers, NLM creates and fosters the institutional linkages which make the biomedical communications network a reality and the sharing of re- sources possible. The regional medical libraries provide numerous services which have clearly demonstrated that cooperative library networking among health institutions is not only feasible but economically imperative. The foundation of the developing network has been the successful interlibrary loan program. Over 92 percent of the interlibrary loans made by the RJIL network are provided within 4 days. The number of loan services provided has been increasing at approximately 13 percent per year. By making its advanced online systems, such as Med'ine, avail- able to the RML network, NLM greatly increases the availability of research ~ results to all parts of the Sation. To further enhance the capabilities of the RML network. the NLM awards resource project grants, which are intended to make current scientific literature readily available to the Nation's health professionals. Medical library resource grants have supported cooperative programs in which a strong library under- takes to provide training, consultation, and loan services for small community hospitals and clinics and studies ways of expediting the delivery of information through modern communications devices and automation techniques. In this manner resources are dedicated to upgrading the facilities and materials of local libraries within each region. Two other significant programs are : (1) Research grants which investigate and develop more effective information science and biomedical communications systems ; and (2) training grants which provide assistance to health science information specialists in the application of com- puter technology to medical education and practice. LISTER HILL NATIONAL CENTER FOR BIOMEDICAL COMMUNICATIONS The Lister Hill National Center for Biomedical Communications is the primary research and development arm of the NLM. The Center provides technical infor- mation, support, and consultation to the health agencies and the health com- munity on matters related to the broad application of computer and communica- tion technology. It continues to develop and coordinate experimental communi- cation networks and systems to improve health education, medical research, and ,

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1069 the delivery of health services. In the past we have reported to this committee the successes we have had with increasing the effectiveness of health care delivery and health education in remote areas of the Nation. We have developed and supported experimental interactive television networks in the New England area and have fostered demonstration projects which apply satellite communi- cations technology in the Native villages of Alaska. New England's network is now completely supported through user fees, private contributions, and other sources of funding. This is a measure of its success. The Alaska experiment demonstrated it was possible to extend the services of a hospital-based physician to distant villages by the use of telemedicine confer- ences. The closely linked Washington-Alaska-lontana-Idaho ( WAMI ) program demonstrated the benefits of regional sharing of resources in the medical edu- cation process. The communications network permitted faculty and students located on multiple campuses and at remote clinical training locations to par- take of an integrated medical education program operated by the University of Washington in Seattle. Based upon these early successes the LHC program has now begun a national experiment in broadband communication with the NASA launch in January of the joint Canadian-American communications technology satellite ( CTS ) . There is a great need to share manpower in health education, in accessing medical consultative services, and in disseminating the results of biomedical research. The health experiments which are planned for the CTS satellite afford the health agencies an opportunity to develop models and design systems for sophisti- cated teleconferencing, for developing regional education programs, and for im- proving the transfer of biomedical information. These experiments and demon- strations will permit us to identify those communication and information trans- fer modes which are best suited for a national health broadband communications uetwork. An additional Center activity which holds great promise is the development within the National Library of Medicine of a modest Learning Resource Labora- tory designed to consolidate computer-based educational resources in a single urea. It is desirable to have the power of the computer available to libraries, computer-based education, and medical practice at those locations where provid- ing access to large computers is presently either not feasible or very costly. Within this modest laboratory, we plan to develop and test relatively inexpen- sive combinations of various minicomputers and terminals which are easy to access and can manipulate data to satisfy individual application needs at costs \vhich the user can afford. As one looks to fiscal year 1977, efforts will be targeted at developing new and improved uses of technology for scientist to practitioner communications. The Center's expertise in telecommunications and Mtellite communications offers a unique opportunity for televised clinical conferences and for demonstration and staff services between NIH and other centers within the biomedical community. These same networks will improve continuing medical education, public educa- tion, and remote patient presentation for diagnosis and recommended treatment. TOXICOLOGY INFORMATION PBOOBAM The toxicology information program (TIP) collaborates extensively with other Federal agencies, such as lthe Food and Drug Administration and the Environ- mental Protection Agency, to develop, organize, and operate a computer-based tosicology data bank. Through its information services, TIP makes results of toxicological investigations readily available to those engaged in conducting research, and monitoring the environment. During the past year, TIP continued to expand its highly successful online bibliographic retrieval service Toxline. The data base was expanded to include special literature files which serve to improve coverage in specific areas of muta- genesis, teratology, and heavy metal toxicology. Toxline contains literature puh- lished during the most recent 5 years and is available online through the NLRl computer. The data base currently contains 420,000 citations and is expected to 25,000 online searches will be performed, an increase of 25 percent over fiscal year 1975. In planning for fiscal year 1977 we have projected a 20-percent growth factor in online searches and a 10-percent increase in the number of pages of offline prints. , reach 590,000 by the end of fiscal year 1977. In fiscal year 1976 approximately 1

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1070 TIP will develop plans for an infornuition system which will attempt to identify the potential hazards of products about to enter the marketplace. Such a system when developed should assist in efforts to protect the public from en- vironmeiital hazards prior to public marketing of commercial products. AUDIOVISUAL SERVICES The National Medical Audiovisual Center (NMAC ) continues to serve health professionals by acquiring, developing and digtrilbuting audiovisual instructional materials which are utilized in the teaching and practice of medicine, dentistry, and the allied health professions. Materials developed by NRlAC with the co- operatioln of professional societies and academic health centers are currently used throughout the Nation's biomedical community. The audiovisual teaching packages developed by NMAC for sale increased threefold from 36 packages in fiscal year 1975 to a total of 108 in fiscal year 1976. For the last 5 years, NMAC and the Bureau of Health Manpower, Health Resources Administration, have cosponsored a collaborative program called the learning resources program to improve the use and effectiveness of learning materials in health science schools. This program has recently heen enhanced by the development of an educational research activity which will complement the audiovisual development, evaluation, training, and advisory service functions which have heen carried out over the past several years. These activities study and promote learning programs which make full use of modern instructional media and systems. NMAC has also established ,a regional center to design, develop and test teach- ing strategies through cooperative efforts with regional educational institutions. In addition, NMAC has implemented its Avline (audiovisuals online) system which facilitates access by health professionals to the most effective instruc- tional material for classroom and self-instructional use. Recently initiated with the entry of more than 700 references to effective instructional materials, the data base should eventually contain over 10,000 items. By (the close of fiscal year 1976 apyrc~ximately 2,000 references will have been entered. SUMMARY As the Sational Library of Medicine prepares to meet the ckallenges of the future it is keenly aware of the ever-growing biomedical information require- ments of the health community. We remain committed to disseminating medical information to the Sation's health professionals in the most efficient and timely manner. SLJI programs have ,and will continue to be characterized by innovation ' and technological advancements. Significant progress in biomedical commiinica- tions technology and networking wili le markedly enhanced with the construc- tion of the new Lister Hill Building. We are pleased to report to the commit- tee that the architectual and engineering drawings are ready to be issued for construction bids. In summary, Mr. Chairman, our request for fiscal year 1977 is $35,231,000, an increase of $5.990,000 over the amount available ?or obligation in fiscal year 1976. The net increase reflects $1,575,000 for mandatory requirements and $4,- 415,000 for the expansion of NLM programs. I shall he pleased to answer any cluestions and supply additional information desired for the record. . BUDGET INCREASES Mr. NATCHER. You propose an increase of 70 percent in your request. Can you explain why these increases are necessary this year? Dr. CUXMINGS. First. I should like to point out, if you examine the budget of the National Library of Medicine over a 5-year period, this is the first time I have been privileged to come before this committee with a significant increase in our budget. I think in part we owe this support to the Director of NIH. Specifically the increases proposed re to cover the following activi- ties. The Lister Hill National Center for Biomedical Communications is now poised to make significant contributions to the transfer of medi-

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1071 cal information to the community at large using new communications technology. With respect to het extramural program which you men- tioned, this is the first time in recent years that the Naional Library will have an opportunity to fund more than 15 percent of the approved grants which have come before it. There have been many very fine pro- posals which, in our judgment, will support the national base for im- proved library services which have gone unfunded in the past. We hope to partially rectify that situation. We have also within this increase a program for our National Medi- cal Audiovisual Center providing for evaluation and distribution of educational materials used by the health professions generally. The most important increase in my judgment is for the basic support of library operations within our institution where for many years we have been struggling with a rather large annual increase in demands for service. These demands average 20 to 25 percent per year and we believe we need to reinforce this direct service operation from this budget. One special program I should identify also which would bene- fit from the overall increase is the toxicology information program which is planning in the near future to develop a computer based in- formation system which ve hope will assist in an early warning sys- tem to identify potential hazards in products before they are marketed. These are the activities which will share in the increases which you have identified. RESEARCH DISISEMINATION Mr. NATCHER. With respect to your request for increase in grant and contract funds for the Lister Hill Center, can you be more specific as to the type of activities you plan to support with the $2 million for research dissemination ? Dr. CUNMINGS. Yes, sir. The principal one is to put in place, the ground terminals which will be necessary to capitalize upon the new communications technology satellite which has been launched by our Government and the Canadian Government. This satellite known as CTS will be used principally for the linkage and dissemination of health information to a large se,gment of our country which are either somewhat deprived or unusually rich in sources of medical informa- tion. Specifically, we are planning to provide stations in Alaska, Wash- inqon, Montana, Kentucky, and Colorado, with a base in Bethesda, which will permit the NIH staff to translate and disseminate new in- formation useful to health practitioners. This is the largest program of this type we have even undertaken and it will require most of the fund requested. MEDICAL LIBRARY ASSISTANCE Mr. NATCHER. You are also requesting a large increase for medical library assistance. Again, what kind of grants and contracts are you planning for ? Dr. CUMMINGS. With the exception of support of the regional medi- cal libraries, all the support through the Medical Library Assistance Act is provided through the grants mechanism. In extramural program funds will be used for resource grants to smaller community and large medical institutions throughout the coun-

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1072 try to improve their library services. It will also assist in the training of health professionals in the utilization of com uter technology and provide the basic support for the 10 regional medical libraries which are part of our national medical library network. These are the princi- pal areas of program utilization of these funds. will provide support for special information tec K nology. Also it will INTEGRATION OF SYSTEMS Mr. NATCHER. Over the last several years you have established a rather elaborate array of different systems for serving the scientific community. How integrated are these systems both at the input and service end of the line? Dr. CUMXINGS. Mr. Chairman, the computer-based systems operated by your national library of medicine are coordinated centrally. We pre- pare the data bases and the information put into the system and operate the central computer f acility. The computer-based systems use stand- ardized programs so that we can share the various data base informa- tion through a common set of programs. Also we use a common com- munications network so that a user searching for information goes to one point of entry land can search the various data bases avdahle to him. In the satellite communications our role is somewhat different. We don't operate the satellite in space, of course, but we do coordinate the network use through which the health programs will be transmitted, We work with the other health agencies, particularly those in the health service areas who determine t.he content of the information to be transmitted through the system. USER CHARGES Mr. NATCHER. I know you charge a small fee for certain of your services. Does this fee represent a significant source of income and is there a possibility of putting the system ,on more of a fee-for-service basis ? Dr. CUJIJIISGS. It is correct that me have a user charge for our spe- cialized computer services. The user is expected to pay for the com- munication costs to access the system. In fact, this provides recovery of all the communication costs and this year will provide approximate- ly $100,000 to be returned to the Treasury. TVe don't believe at this juncture at least, that it is appropriate for us to increase these charges. I believe I have reported to this committee previously that me have doubled our charge for computer services during the past year from $8 an hour to $15 an hour for prime time. We feel this is an ,appropriate charge sufficient to inhibit any frivolous or trivial requests for serv- ices but not too high preventing a user in need of this service to obtain it. Mr. NATCHER. How much in user fees do you expect to collect in Dr. CUMMINGS. I will ask Mr. Smith to answer that. fr. SMITH. Around $800,000 in 1976 and a little over $1 inillion Mr. NATCHER. Thank you. 1976 ; and how much in 1977 ? in 1977.

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1073 Following up on this, can you tell me what average user chargc would be for a Medline request if there \vas 100 percent passthrough based on cost ? Can you give me some idea on this ? Dr. CUNJIINGS. I can give you an idea now and provide further information for the record. The average Medline charge is ap roxi- rnately $2. In the old batch mode system a comparable cost was g60 to $75 a search. The power of new technology is reflected by this tremend- oils drop in cost. This represents about half of the total cost of the search since we pay to acquire the literature analyzed and process it for subsidy in terms of cost. The total cost associated with providing the estimated 400,000 Med- line searches in fiscal year 1976 is $1,472,000. If the library operated on a 100-percent passthrough basis, the unit cost would be $3.68 per search. Of the total costs, user charges offset approximately $712,000 or $1.78 per search. The library appropriation provides funds for the in-house processing requirements associated with operating Medline services. This will equate to approximately $760,000 in fiscal year 19'16 or $1.90 per search. I should add that the national library would have to index and catalog literature to provide the users with our publications, the various indexes and biblographies. So, we are really charging the cus- tomer only for entry into the computer system. I the computer store. So roughly I would say we have about a 50-50 f I 8 EXPANSION OF NEDLINE Mr. NATCHER. I have heard some discussion in past years as to the possibility of expanding the Medline bibliography to include more information on problems of delivery of service as opposed to strictly clinical problems. Do you feel the present indexing is sufficient to cover these issues ? Dr. CUMMINGS. Mr. Natcher, we believe within the present data base, there is a comprehensive coverage of the scope of medicine including basic science, clinical medicine, public health and health care delivery. That is not to say that everything which is published in these various fields is included in the data bases. Some selection is made by a critical review board to identify those makerials thought to be of original, substantive content and not repetitive. It is my view that in almost any mea of medicine, with the rapid growth of medicine, that we could enlarge the data base to achieve more coverage. However, there is no evidence that such an increase in coverage would better serve the needs of health care delivery as your query suggests, Overall, I think oiir users are qaite pleased with the services we are providing. The tradeoff is whether we want to make this an enormoiis data base which would be costly and difficult to manage or one sufficiently comprehensive so as to respond to a large percent of queries. 1 i 1 i i i REGIONAL MEDICAL LIBRARY PROGRAM Mr. NATCHER. As to the reqional medical library, your expansion into more isolated areas, is this more of the same or are there special 1 7 problems in serving these institutions, Doctor ?

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1074 Dr. CUMMINGS. I would say the new dimension of the regional medical library program can be characterized as outreach. We are persuading each of the regional libraries that their responsibility is to provide equal access to qualified users no matter where they may reside. I think we have good evidence that a determined effort is being made to see that the isolated user has the same entry into the system as someone who resides close to the center. CONTINUING MEDICAL EDUCATION COORDINATION Mr. NATCHER. I am interested in your role in the field of continu- ing medical education. Can you tell me specifically how your efforts are coordinated with other HEW organizations and with the profa- sional organizations and institutions 1 Dr. CUMMINGS. We don't have a primary role in the generation of materials for continuing health professional edixcattion, but we do maintain a strong supportive role for all professional organizations and associations and educational institutions whlch need special information for their own operations. In this context, we work very closely with the Health Resources Administration through our Na- tional Medical Audiovisual Center where teaching materials are acquired, evaluated and loaned to professional groups or individuals for their use. The Lister Hill Center has an extensive program with institutions which use computer-assisted instruction as a new ma- dality for continuing education. I can summarize my answer by saying we are involved in the provision of educational materials but don't assume the responsibility for selecting those materials which should be studied. NATIONAL MEDICAL AUDIOVISUAL CENTER, Mr. NATCHER. All right, Doctor. With respect to your audiovisual indexing and information system, is this restricted to materials for professional information or are you coordinating this activity with the general health activities of the department? Dr. CUMMINGS. Our National Medicail Audiovisual Center is pri- marily concerned with materials judged to be useful to the health professional community and only secondarily are we concerned with the provision of materials to the public at large, or health education more generally. We do coordinate our activities with other organ- izations in the same field, but I think it is fair to say that I know of no other institution which has the same capacitv and the same facility through which to serve the audiovisual needs of the health professionals. FOREIGN USERS Mr. NATCHER. Your justification refers to the foreign medlar cen- ters. What role do these centers play and how well established are they? Dr. CUMMINGS. We have a number of bilateral agreements with institutions at home and abroad. In sophisticated countries we allow selected institutions access to our data bases in return for which they

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1075 provide the indexing and cataloging of Nan enormous amount of litera- ture which is generated abroad. In fact, there is a quid pro quo relationship though which the national library gains input into its system and eight countries which are partners in this arrangement, gain access to our data bases. TOXICOLOGY INFORMATION PROORAM Mr. NATCHER. Now, Doctor, turning to your toxicology activities, could you ex lain to me how the new early warning system works and specifical P y what costs are associated with it ? Dr. CUMMINGS. First I should say there is no such early warning system in being. We have suggested that we might develop such 8 sys- tem, and that this be based on the knowledge available to chemists, pharmacologists, and toxicoIogists who can examine chemical strrrc- tures and families of related structures and predict that certain toxicity or a+dverse reaction might occur in a number of related compouncts. Because the toxicology data bank is building to a point where we now have a sufficient number of materials as pesticides, for exam le, sophisticated, knowledgeable, pharmacologist or toxicologist could query the systelm and get data which might provide a clue that c?, new product miglt be expeoted to have some adverse etfect on man or his environment. I do want to point out that this is a plan. It is not a reality. Tho budget before you request funds with which we could go ahead if they were made !available. Mr. NATCIIER. Can ~UTIWI the committee who the users of the labom- tory and animal data bank are and how many requests for this informa- tion are you currently receiving? Dr. CUMMINGS. The present parties interested in the development of this data bank are principally Government agencies such as PDL~, EPA, the Nakional Cancer Institute, and a large number of our drug and pharmaceutical companies, which are generously providing data for input into the system. The system is still in the building phase and the data are being stored in the data bank. We anticipate that the same organizations which lare putting their information into the system will, in fact, be thc principal users of the system. The National Academy of Sciences through a specialized advisory group has assumed the responsibility for the advisory and evaluative role of the performance of this svstem, and I think perhaps at this time next year, Mr. Natcher, I would be in a better position to tell you about iiser reaction and iiser response, which we believe is the most important element in evaluation. Mr. NATCI~ER. PI.. Michel? we believe that we can organize these data in a manner in whic K tl LIBRARY REFERENCE AND LOAN SERVICES Mr. MICHEI,. How do you account for the 25-percent increase per year in requests for your reference and loan services? Dr. CVMMTNGS. The establishment of n network of niedirnl centers providing on-line reference services to the world's most important medical literature has resulted in increased demands for copies of arti-

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1076 cles cited. This growth in cleniands parallels the growth of on-line bibliographic services. Mr. MICHEL. Is this rate increase likely to continue for the foresee- able future ? Dr. CUMMINGS. The rate of growth in demand for interlibrary loans will probably recluce somewhat since the on-line services are now in- creasing at a lesser rate. We are projecting that further growth Over the next 5 years will level off to an annual rate of about 10 percent or less. LIBRARY ACQUISITTON COSTS Mr. MICHEL. Are acquisition costs likely to continue to riw at a 15- to %)-percent rate, or do you expect a stabilization ? Dr. CUMMINGS. At the present time the largest percent of increase is in the area of journal subscriptions. Publishers' costs continue to rise at approximately 15 percent per year. This is the result of increased paper and procluction costs, and increased cost of niailin9 which has recently added another 3- to 5-percent increase in subscription costs. We believe that f~ 10- to 15-percent rate of increase for acquisitions will probably continue. TOXICOLOGY PROGRAM Mr. MICHEL. You indicate that the toxicology information pro- gram is developing plans for an information system which will attempt to identify the potential hazards of products about to enter the marketplace. Who is going to provide the input in such a system? Dr. CUXMIKGS. The toxicology information program will not be evaluqting or commenting on products either by their commercial or brand names. The evaluation activity will not be consumer oriented. Reports will be macle by chemical substances and not by product for- mulations. Reports will be based on contents of scientific studies being publishecl in scientific jollrhals. Chemical substances will be discussed by scientific names. Reports will not deal with new products as a class but only with general chemicals which might be in old products, con- sidered for new products, or as yet not used in products. Input for this activity will come from scientific journals, monographs, papers presented at national scientific meetings and studies carried out by Government agencies. Mr. MICHEL. What guidelines will you be establishing to protect against the abuse of such (z system? We certainly want to mako certain that products are not unfairly brandished as a hazard to one's health, do we not ? Dr. CU~WXIXGS. The system will be protected against abuse because the reports will be clisse-minatecl primarily to Federal agencies through the DHRW Committee To Coordinate Toxicology 2nd related pro- grams. This committee is staffed by scientists representing the health agencies of the Department and-as observers-health agencies from other Government departments. The committee would evaluate :e- Ports furnished by the toxicology information program before dls- semination to the agencies represented.

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P 1077 DISTRIBUTION 01" ISCREASES IN PROGRAM BUDGETS 1 3Ir. MICEIEL. Which programs are budgeted to reccirc most of the illcrease you are recriiwting in 1077 over this year? Dr. CUXMISGS. The $5.9 million increase which the library is re- questing will be used in three areas. Approximately $1.6 million of the increase will support medical library development of resources nnci systems necessary to bring the latest health science information to researchers and clinicians throughout the Nation. This mill be ac- coni plished in part by strengthening the regional medical library net- lyork and by extending library services to smaller and more remote institutions. An additional $2 million mill be used by the Lister Hill National Center for Biomedical Communications in its efforts to im- prove the effectiveness and efficiency of biomedical communications and improve the dissemination of NIH research results. Primary efforts will be targeted at developing new and improved iises of technology for scientists to practitioner commnnications. The reninining $2.5 million will be used to support NLM's basic library services which have stiflered the most during the previous years of level budgets. DTSSEXTKATTON OF RESEARCH RESULTS i Mi. MICHEL. Have yon had maximiim cooperation from other in- stitutions in your dissemination efforts ? Dr. CUMMTNGS. Contact with all Institutes has taken place. In addi- tion, at the direction of the Director, NIH, a task force for implemen- tation has been estd~lished. The Director of the Lister Hill Center is a member of this task force. These efforts are, therefore, being pursued ngqressively on a NIH-wide basis. Mr. MICIIEL. Are some of the Institutes a little slower than othcrs in their efforts to disseminate their research findings? If so, which ones? Dr. CUXMIXGS. The problems of disseminating research results are not uniform for all the Institutes, nor are the organizations and re- soiirces available for this purpose. The manifest progress varies from Institute to Institute also ns a function of level of interest or concern. As a, result of these considerations, the Director of NIH is vigorously pnrsuinq the implementation of a total NIH effort to improve clis- semin,ztion of research results. 1.1 ...- i XEW LISTER HILL BUILDING Mr. MICHEL. Will you have any extra space in the new Lister Hill Builcling or will it all be iitilized at the outset? Dr. CUXMINGS. At the time of occupancy in the fall of 1975 we ex- pect to he at 75 percevt of capacity. This is based on the assumption that employment at the National Library of Medicine will increase by 80 positions during the next 3 years. These additional positions mill he required in order to optimally utilize the new specialized functions and facilities that will be in the new building. Special pixrpose space and facilities will he used by other health-related agencies for com- rniinications conferences, experiments and demonstrations. , 1 f

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1078 RESEARCH AND DEVELOPMENT PROJECT CONTRACTS Mr. MICHEL. I note in your justification a sizable increase, from $4 million to $6.7 million, for ``Project Contracts" under "Other Services." What is that for, and why the substantial increase? Dr. CUXMINGS. The Library has placed increased emphasis on pur- suing research and development within the Lister Hill Center. Two laboratories, one related to the general areas of computer technology, and the other to the general area of broadband communications tech- nology are being developed. The first is the Learning Resources Laboratory which will be used by the Computer Technology staff to investigate the potential for using small and less expensive computers, minicomputers, to make available substantial computer power to a large number of widely dispursed users at affordable costs. The second laboratory is an experimental broadcast studio which will enable the Center's Communication Engineering staff to explore advanced tech- nology as a medium for extending effective educational programs to the health community; for improving health care delivery; and for enabling more effective dissemination of research results. PROCEDURES FOR COMPUTER REQUESTS Mr. ROYBAL. How would an individual practitioner go about request- ing information you have in your computer files? In what form is the information sent to him? What is the cost of requesting such information ? Dr. CUMXINGS. Physicians interested in searching the Medline sys- tem reach our files through their nearest Medline Center. The search will usua.lly be performed by a trained analyst and the practitioner will receive a computer printout listing the citations to journal articles which match his information need. The exact procedure varies from one Center to another; some receive requests in written form, others by telephone, and in some cases the requester is present for the refer- ence interview and the actual search. Costs vary as well, ranging from free service to a maximum charge of $8.50. MEDLINE ACCESS Mr. ROYBAL. How do you choose the institutions that are linked into your computer system ? What countries outside the United States are linked into the system? Do they contribute money to finance the system ? Dr. CUMMINW. Institutions with a substantive need for health- related information and appropriate resources to provide on-line serv- ice may apply to become a Medline Center. Foreign Medline Centers exist in Canada, Germany, Sweden, Australia, France, England, and Japan. The World Health Organization also operates a Medline Cen- ter. The Library has quid pro quo arrangements with these countries which provide indexing of foreign literature in return for access to the Library's Medlars data base.

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1079 COMMUNICATIOX TECHNOLOGY SATELLITE Mr. ROYBAL. What is the projected amount you will spend on Joint Canadian- American Communication Technology Satellite 8 Dr. CUMXINGS. It is currently estimated that during the period of fiscal year 1975 through fiscal year 1978 the Lister Hill Center will spend approximately $1,874,000 on the CTS program. AUDIOVISUAL PACH-4GES Bfr. ROYBAL. You indicated you developed 108 audiovisual packages for sale. How many were sold? What were the gross receipts from these sales? Dr. CUJIMING~. Approximately 8,018 packages have been sold since July 1973. The sales program is conducted by the National Audiovisual Center, General Services Administration. They make this material available at no profit to the biomedical community. It is estimated that the gross receipt from these sales has been approximately $260,000 since July 1973. MEDLINE Mr. CONTE. How much use does Medline get per year 8 Dr. CUMMINGS. Last fiscal year, more than 400,000 searches were performed throughout the Library's on-line network. This fiscal year, we expect searches fo pass the half million mark. Congressman CONTE. What are the current user charges for Med- line? How does this compare to mer charge of commercial computer time? Dr. CUNMINGS. The current charges for Medline are $15 per hour during prime time, which is defined as 10 a.m. to 5 p.m. eastern time, and $8 per hour at other times. In addition, there is a 10 cent per page charge for off-line printing and mailing of search results. The com- mercial charge for similar retrieval services costs from a low of $35 per hour, for access to the Educational Resources Information Center which is operated by the Systems Development Corp., to approxi- mately $100 per hour. Service from a data base of the size of Medline varies from $70 to $100 per hour from a commercial vendor depending upon costs, profit objective, and usage level. LISTER HILL CENTER BUILDIXGS Mr. CONTE. What progress has been made in construction at Lister Hill since last year? Dr. CUMMINGS. The Lister Hill Center Building will soon become a reality now that the Congress has appropriated $26 million for its construction. The architectural and engineering drawings were com- pleted last July and the General Services Administration is prepared to advertise for construction bids as soon as the funds are apportioned and necessary impact statements have been processed. Construction could commence in the fall of 19'76. The initiation of this project will

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1080 not An], alleviate the severe space problem within the present library but wilf provide specialized facilities in order to enhance communica- tions systems for health education, research and practice in this nation. THE LIBRARY% ROLE AS A NATIONAL INFORMATION RESOURCE Mr. CONTE. I have seen that partially because of the rapidly increasing demand for medical literature and because the costs of acquisition have risen 15 to 20 percent, your facility is increasingly bein relied on to be a national information resource. Is this a good deve Y opment or should the responsibility be spread out more geograph- ically and institutionally 8 Dr. CUMMINGS. The total service load for health. information services is substantially higher than that presently provided by the Library. Of about 750,000 interlibrary loans provided to the health care com- munity, two-thirds are provided through the Regional Medical Li- brary Network. Decentralization of services has been a significant factor in Regional Medical Library development. This effort has not only improved service at the local level, but has created more ready access to our services, which in turn has generated increasing work- loads. The Library will continue to share the workload with the majob medical libraries in the Regional Medical Library Network and to augment the resources in the regional and local libraries to sham these increasing workloads. NATIONAL MEDICAL AUDIOVISUAL CENTER USAGE Mr. CONTE. How much use does the audiovisual facility in Atlanta get ? Dr. CUMMINGS. A major workload of the National Medical Audio- visual Center relates to its distribution activities which provide the biomedical user community with access to relevant instructional mate- rials. During fiscal year I976 an estimate 60,000 audiovisual loans will be provided. Demand for these loans will increase about 10 percent during fiscal year 197'7. The Center also provides adviwry services which are designed to encourage direct interchange and assistance to the health professional community. This is accomplished through site siirveys, in-honse consultations, and training proerams in planning, design and application of audiovisual instructional technology to prob- lems of on-campus learning environments, systems and equipment. Di1rin.T fiscal vmr 1976 over 500 individuals will particinate in such workshops and 75 educational facilities and systems consultations will be undertaken. SATELLITE COMMUNICATIONS SYSTEM Mr. CONTE. Can you tell 11s what has hapnened since I talked to YOU last year with the Satellite Communication System ? Dr. CUMMINGS. The Lister Hill Center has been enpaged in a series of experiments and demonstration nrojects which apply satellite corn- municat ions technolow to the soliltion of recognized problems !n health ecliication and tJhe deliverv of health services. Two sntellites.in the Applications Technology Satellite (ATS) series have been in- volved, namely ATS-1 and ATS-6. The Lister Hill Center's active

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1081 t participation in the Satellite Communication System terminated with the expiration of all applicable contracts during the last calendar year. However, the State of Alaska has assumed responsibility for ATS-1 programing and with aid from the Indian Health Service has utilized the satellite to support the Alaskan native population. Mr. CONTE. Do you plan to expand upon the Washington/Alaska/ R/lontana/Iclaho program, which seems to have worked out well ? Dr. CUMMIXGS. Yes; we will continue to support the WAMI pro- gram through participation in a series of experiments which will ex- tend the ATS experience through the Joint Canadian-American Com- munications Technology Satellite (CTS) . i i 1 TOXLINE 1 1 Mr. CONTE. Who now has access to Toxline ? Dr. CUMMINGS. Toxline, the National Library of Medicine's Toxi- cology Information Retrieval Service On-line, is available domes- tically to any prof essional organization that signs an agreement with NLM for the service, and has been trained in toxline operation. There are 220 organizations subscribing to Toxline; of these, 111 are com- mercial ormnizations, 77 are academic institutions, and 28 are Govern- ment facilities. Approximately five new organizations subscribe to Toxline each month. LEARNING RESOURCES PROGRAM Mr. CONTE. Do you have any hard results from the collaborative learning resources program ? Dr. CUMMINGS. This program has provided a multidisciplinary em- phasis on the improvement of health sciences instruction that has led to the development of 260 new instructional media, training of over 2,500 faculty members in how to use instructional technology in schools, the screening of 11,200 instructional media to determine those most effective for faculty reference through computerized informa- tion systems. A large number of educational institutions participate in these efforts. These activities have increased the impact of educational t,echnology within health professional schools. Without this collabora- tion, the cooperation and interest of organizations such as the Associa- tion of American Medical Colleges, Association of American Dental Schools, Association of Pediatric Department Chairmen, and the American Physiology Society in the development and sharing of more effective instriictional nmtcrials could not have been gained. Mr. NATCHER. Dr. Cummings, we want to thank you and your as- sociates for appearing `before our committee at this time in behalf of your budget request for fiscal year 1977. It is always a pleasure to have 1 1 you.

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1082 JUSTIFICATION OF THE BUDGET ESTIMATES DEPARTMEW OF HEALTH, EDUCATION, AND WELFARE NATIONAL INSTITUTES OF HEALTH National Library of Medicine M 1977 Budget Page No. - Amounts available for obligation .................................... 230 Summary of changes.... .............................................. 231 Obligations by activity............. ................................ 233 Obligations by object ............................................... 234 Authorizing Legislation.. ........................................... 235 Tables of estimates and appropriations.. ............................ 236 Justification: A. Narrative: 1. General statement...................................... 238 2. Activities: (A) Medical Library Assistance...................... 241 (B) Direct Operations: (1) Biomedical Communications.............. 244 (2) National Medical Audioviaual Center...... 247 (3) Library Operations. ...................... 249 (4) Toxicology Information................... 251 (5) Program Management....................... 253 Lister Hill National Center for B. Program purpose and accomplishments. ......................... 254 C. Transition quarter analysis... ................................ 264

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1083 DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE NATIONAL INSTITUTES OF HEALTH National Library of Medicine Amounts Available for Obligation I/ 1976 Estimate 1977 - Appropriation. .......................... $29,065,000 $35,234,000 Comparative transfer from: "Off ice of the Director" for standard level user charge..,..... ... ..-* 179,000 Total Obligations. .............. $29,244,000 $35,234,000 . 1/ Excludes the following amounts for reimbursable activitlee -. carried out by this account: 1976 - $2,000,000; 1977 - $2,000,000. t

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1084 Summary of Changes 1976 Estimated Obligations.. ...................................... $29,244,000 1977 Estimated Obligations... ..................................... 35,234,000 Net Change .............................................. 5,990,000 1976 Base Change from Base pee. Amount POS. Amount Increases: ' A. Built-In: ___ _. 1. Annualization of 1976 Pay Cost Increases.................... ... --- 519,000 2. 3. 4. 5. 6. 7. 8. 9. 10. Within-Grade Pay Increases........ --- 200,000 Literature Acquisition ............ --- 775,000 Supply .......................... --- 120,000 FTS Rate Increases................ --- 160,000 Increase Cost of Service and Computer Rental Increase.......... --- 1,842,000 Postage Cost Increase............. --- 318,000 Non-Competing Continuation Costs.. --- 5,203,000 Payment to NIH Management Fund.... --- 1,620,000 Standard Level User Charge ........ --- 179,000 --- i- 165,000 --- + 235,000 --- + 21,000 --- + 100,000 --- i- 22,000 --- + 99,000 --- + 356,000 --- 56,000 --- + 138,000 --- + 417,000 Subtotal, Built-In Increases.... ... --- +l, 609,000 --- B. Program: 1. MLAA - to provide support for scholarly research and continuing medical education.... ... 6,433,000 --- +1,150,000 2. Lister Hill Nat'l Center for Bio- medical Communications - for the application of advanced computer and communication ,technology to the solution of biomedical com- munication and information dis- semination problems.. ........... 24 2,760,000 -1 +1,945,000 for the development of instruc- tional media in a variety of health science disciplines,..,.. 100 2,981,000 --- + 495,000 continuation of baeic library services and the modest expansion of services to the biomedical community ............ 252 10,014,000 -2 + 551,000 5. Toxicology Information - for the modest expansion of the Toxi- cology data base to include an "early warning" system on potential hazards of chemicals about to enter the market place. 17 1,866,000 -1 + 275,000 3. Nat'l Medical Audiovisual Center - 4. Library Operations - for the Subtotal, Program.Increases,.. --- --- -4 +4,416,000 ~ ~~ - Total Increases. .............. --- --- -4 +6,025,000

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1085 Summary of Changes (cont'd) 1976 Estimated OblLgetLons ....................................... $29,244,000 1977 Estimated ObligatLons ....................................... 35,234,000 Net Change .............................................. 5,990,000 1976 Base ' Change from Base POS. Amouni POS. Amount Decreases : A. Built-In: 1, Employment savings - effect of one day Total Total leas pay in FY 1977 ..... 472 11,088,000 .... 35,000 .................. --- - 35,000 ................. -4 5,990,000 --I Decrease! --- Net Change, I

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1086 Obligations by Activity 1976 1976 1977 Revised Increase or Page President's Budget A22ro2riation Estimate Decrease Ref. Pos. Amount Pos. Amount Pos. Amount Pos. Amount Medical Librar:z: Assistance 241 Total .. 6,333,000 6,433,000 8,000,000 --- +1,567,000 Direct 02erations: 244 Lister Hill Nat'l Center for Biomedical Communications .. 23 2,740,000 24 2,760,000 23 4,730,000 -1 1,970,000 247 Nat'1 Medical Audiovisual ..... Center 100 3,096,000 100 2,981,000 100 3,551,000 + 570,000 0 00 249 Library Operations . 250 10,169,000 252 10,014,000 250 10,933,000 -2 + 979,000 ~ 251 Toxicology Information16 1,873,000 17 1,866,000 16 2,166,000 -1 + 300,000 253 Program Management ...79 5,066,000 79 5,011,000 79 5,559,000 + 548,000 Standard Level User Charge 179,000 179,000 235,000 + 56,000 Subtotal ... 468 23,123,000 472 22,811,000 468 27,234,000 -4 +4,423,000 Total Obligations 468 29,456,000 472 29,244·,000 468 35,.234,000 -4 +5,990,000

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1087 Obligations by Ob je'ct Increase 1976 1977 or Estimate Estimate Decrease Total number of permanent positions ....... 472 468 -4 Full-time equivalent of all other ............................. --- positions. 40 40 Average number of all employees.. ........ 53 1 527 -4 personnel compensation: Permanent positions .................... 8,877,000 9,607,000 730,000 Positions other than permanent......... 424,000 474,000 +50,000 --- Other personnel compensation ........... 116,000 116,000 Subtotal, personnel compensation.. 9,417,000 10,197,000 +780,000 Personnel benefits....................... 936,000 1,021,000 i85.000 Travel and transportation of persons..... . 170,000 175,000 +5,000 Transportation of things ................. 30,000 Rent, conrmunications and utilities....... 2,372,000 Printing and reproduction. ............... 479,000 Other services: Project contracts....,.... ............. 4,000,000 Payment to NIH Management Fund......... 1,799,000 Other..................... ............. 2,189,000 Supplies and Materials.. ................. 314,000 Equipment. ................................ 330,000 34,000 4,000 2,609,000 +237,000 496,000 +17 , 000 6,740,000 +2 , 740,000 2,211,000 +4 12,000 2,232,000 t43,OOO 314,000 --.. 330,000 --- ........................ Literature....... 775,000 875,000 +loo , 000 Grants, subsidies and contributions..,.. . 6,433,000 8,000,000 +1,567,000 Total obligations by object ....... 29,244,000 35,234,000 +5,990,000 ,

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1088 Authorizing Legislation Legislation Public Health Service Act Section 381 - Purpose and Establishment of Library............................. Health Services Research, Health Statistics, and Medical Libraries Act of 1975 Section 393 through 397.................. 1977 Appropriation Requested Authorized Indefinite $20,000,000 $27,234,000 2_/ 8,000,000 11 Total ................. $35,234,000 21 Funding estimate only

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1089 National Library of Medicine Comparable Budget' Estimate , House Senate Year to Congress Allowance Allowance , Appropriation 196 7 19,231,000 20,154,000 20,254,000 20,254,000 1968 21,162,000 18,662,000 21,162,000 19,912,000 1969 19,172,000 16,997,000 19,020,000 18,008,500 - 1970 22,882,000 19,682,000 19,682,000 19,682,000 1971 19,769,000 19,843,000 22,307,000 20,843,000 1972 21,981,000 22,781,000 25,086,000 24,086,000 1973 24,994,000 28,488,000 28,988,000 28,488,000 A/ 19 74 24,994,000 25,796,000 25,796,000 25,426,000 21 1975 27,738,000 28,048,000 29,348,000 28,848,000 1976 28,815,000 28,994,000 29,744,000 1977 35,234,000 - 11 Note: This appropriation authority was the continuing resolution. The appropriations amount was the House Allowance, which was the lower of the House or Senate amounts in the first vetoed bill. 21 Appropriation after reduction as authorized by P.L. 93-192. -

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Year 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 - 1/ 21 - 3/ . Budget Est ima t e to Congress 19,231,000 21,162,000 19,172,000 22,882,000 19,769,000 2 1,98 1,000 28,568,000 24,994,000 27,738,000 28,815,000 35,234,000 1090 National Library of Medicine Actual - use Allowance 20,092,000 18,662,000 17,149,000 19,682,000 19,769,000 22,781,000 28,568,000 25,871,000 21,768,000 2/ 28,815,000 Senate Allowance 20,192,000 2 1,162,000 19,172,000 19,682,000 22,233,000 25,086,000 29,068,000 25,871,000 29,350,000 29,565,000 Appropriation 20,192,000 19,912,000 28,164,500 19,682,000 2 1,440,000 24,127,000 28,568,000 I/ 25,871,000 21 28,850,000 This appropriation authority was the continuing resolution. The appropriations amount was the House Allowance, which was the lower of the House or Senate amounts in the first vetoed bill. Appropriation after reduction as authorized by P-L. 93-192. Excludes Medica'l Library Assistance Grants not considered by House due to lack of legislative authorization. P

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1091 Justification National Library of Medicine 1976 1976 1977 Rev is ed Increase Budget Appropriation Estimate Decrease Amount Amount Amount Amount President's or Medical Library Assistance ........... 6,333,000 6,433,000 8,000,000 +1,567,000 --- --- Positions........... --- --- Direct Operations: Lister Hill National Center for Biomedi- cal Communications. 2,740,000 2,760,000 4,730,000 +1,970,000 Positions........... 23 24 23 -1 National Medical Audiovisual Ctr.... 3,096,000 2,981,000 3,551,000. + 570,000 --- Positions........... 100 100 100 Library Opera- tions.............. 10,169,000 10,014,000 10,993,000 -+ 979,000 Positions........... 250 25 2 250 -2 Toxicology Informa- tion............... 1,873,000 1,866,000 2,166,000 + 300,000 Positions........... 16 17 16 -1 Program Management.. 5,245,000 5,190,000 5,794,000 + 604,000 --- Positions........... 79 79 79 .. ~ Subtotal. ......... 23,123,000 22,811,000 27,234,000 +4,423,000 Positions......... 468 47 2 468 -4 Total Obliga- Positions... tions............ 29,456,000 29,244,000 35,234,000 +5,990,000 ...... 468 472 468 -4 General Statement The National Library of Medicine is the world's largest research library devoted to a single scientific or professional discipline and the prime resource in the United States for biomedical information. In addition to acquiring, organizing, and disseminating such information through the use of computerized systems, interlibrary loans, and more conventional library services, NLM has developed a National Biomedical Communications Network to link major health care facilities, medical education centers and research institutions. Through assistance to the network's Regional Medical Libraries, as well as grants to smaller medical libraries in hospitals and centeis, NLM applies computer and communications technology to the improvement of nationwide health information transfer. The primary research and development arm of the NLM is the Lister Hill National Center for Biomedical Communications. The Center provides technical -. _..,

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1092 information, support and consultation to the health agencies and health care professionals on matters related to the broad application of computer and communications technology. An additional role which has evolved in recent years is the conduct of research and development predicated on anticipated future needs of the health agencies and the health community. the Lister Hill National Center for Biomedical Communications has provided the resources necessary to support the planning and development of experiments and prototype models in applying computers and communications to facilitating health education, health care delivery and health research. The Center will continue to concentrate its efforts on developing communications support for health professional education where a small investment can have the largest impact on the quality of health care. within five programmatic areas: broadband biomedical communications; computer- based education; computer technology research and development; postgraduate education for the practicing health professional; and coordination of biomedical communications for DHEW. In the performance of these functions Specifically, these activities fall NLM continues its traditional responsibilities of improving the flow of biomedical information by storing, retrieving and disseminating the world's biomedical lit6rature. To facilitate access to the literature, NLM produces bibliographies employing both manual search techniques and computer searches of on-line data bases; provides reference and loan services; prepares and publishes various materials for use by health science researchers and practi- tioners; and manages the national on-line infomation retrieval network. In addition, NLM serves as the Regional Medical Library for the five-state Mid-Atlantic Region and provides back-up services for the national Regional Medical Library Network. A computerized bibliographic retrieval system was installed in 1964 to help cope with increasing amounts of biomedical literature. is known as MEDLARS (Medical Literature Analysis and Retrieval System). In 1971 a refinement of the system became operational and it is now known as MIDLINE (MEDLARS On-Line). This system A whole new lexicon has sprung up around the NIX'S computerized on-line The most important service for the practicing health professional, bibliographic retrieval services: SDILINE, TOXLINE, CANCERLINE, CATLINE, and SERLINE. however, is MEDLINE. Briefly, MEDLINE is a system for making accessible 51 data base of recent journal article references indexed from 3,000 biomedical journals. The references are stored in the Library's computer and are accessible through terminals in approximately 350 hospitals, medical schools, and medical research institutions throughout the country and abroad. Of special interest to health educators is a collection of health science audiovisuals housed at the National Medical Audiovisual Center in Atlanta, Georgia. The Center which has been part of the Library since 1967, is engaged in developing a program that will have an important influence on health science teaching, recertification, and continuing education programs. With the assistance of panels of medical educators and specialists, the Center is attempting to identify, collect, and evaluate audiovisuals used in medical and dental education. content and high in technical quality will become part of a new on-line retrieval system known as AVLINE. Citation of instructional materials judged to be sound in /

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1093 Each citation in AVLINE will contain subject headings, an abstract, physical description of the material, identification of intended audience, information on where and how audiovisuals may be obtained, names of principle authors and producers,. teaching effectiveness data and a rating of "recommended" or "highly recommended. 'I The Center also lends health science motion pictures or videotapes to insti- tutions of higher learning and to individual health professionals. anticipates filling in excess of 50,000 requests for film loans during FY 1976. The Center The Toxicology Information Program (TIP) established in 1966, collects toxicology data from published scientific literature and the files of govern- mental, industrial, and academic organizations; organizes and enters the infor- mation into computerized storage and retrieval system$; and provides on-line computer searches. bibliographies, directories, and reviews. TIP also functions as the coordina- tor for toxicology activity for the Department. Various publications are compiled including annotated The FY 1977 budget request which represents approximately a $6,000,000 increase over the FY 1976 level will allow significant progress to be made in improving basic library services and information transfer capabilities. A major effort will be made to translate new knowledge that is generated and disseminate these findings to the practicing physician.

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1094 Medical Library Assistance Program Authorizing Legislation: Health Services Research, Health Statistics and Medical Libraries Act of 1974. ' 1976 1976 1977 Revised Increase Budget Appropriation Estimate * Decrease Amount Amount Amount Amount President's or Medical Library Assistance Progr am.... 6,333,000 6,433,000 8,000,000 +1,567,000 No. of Awards...... .... 92 97 135 +38 NLM's programs of Medical Library Assistance are designed to meet the i national need for more effective information services. The Act authorizes a I number of grant and contract programs to support the training of professional personnel in health information; research in health science information and the application of computer and communications technology; the development of medical reviews and other publications to improve information accessibility; and the improvement of the resources and services of medical libraries. In addition, contracts assist in the development and maintenance of a nationwide coordinated network of Regional Medical Libraries that provide services and resources to medical libraries throughout the United States. Training grants have supported the education of medical librarians, biomedical communications specialists, and other professionals essential to the ' health-sciences information system. on a new kind of specialist who is able to integrate computer technology into all phases of medicine, including patient care. in the use of computers in medicine has been lack of appropriately trained personnel. technology and biomedicine, NLM hopes to facilitate the application of com- puters in the medical setting. training in nine programs. There have been twenty-one graduates to date and all are utilizing their computer training in a variety of settings, with the majority on the faculty of medical schools or in teaching hospitals. In recent years the program has concentrated The major obstacle to progress By training a core of specialists in the interface between computer Fif ty-five individuals are presently receiving Research grants have supported projects in medical library science, infor- mation science, biomedical communications systems, and advanced educational technology. for the various forms of continuing education modalities available to them. The study focuses on the mechanisms and techniques by which a physician learns /os, prefers to learn. Another project is to establish and test a model for retrieval,'analysis, and dissemination of medical information utilizing television monitors 'for immediate feedback. mitting drug information' to patient-care areas. increase will be dedicated to two potentially rewarding areas targeted for study in FY 1977. computers in various areas in the health care delivery system. The Review will include an analysis of the computer's potential in the academic and continuing education of all health care professionals, as well as the educa- t tion of the patient. by which the information is delivered to health professionals and the responsible roles to be played by the National Library of Medicine, the local academic science libraries, and the local hospital libraries in this activity. One recent study involves ascertaining the preferences of physicians The particular model is trans- The approximate $400,000 The first is an investigation of the efficacy of using The second area of interest is research on the mechanisms

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Special Scientific Project. grants support distinguished health scientists in the full-time analysis of major findings in their respective fields. studies are published as monographs which make the results of biomedical research widely available. An example is the support of a comprehensive monograph devoted to the discovery, classification, and treatment of infectious diseases and the development of the scientific base for preventive medicine and public health measures to control these diseases. Scientific achievements in microbiology and immunology will emphasize the discovery and classifications of microbes responsible for diseases, mechanisms underlying the causes of illness, and the emergence of the disciplines to further our understanding of these mechanisms. The The Library's publication grants provide support to biomedical scientific publications which would not be profitable projects for commercial publishers to undertake. manifold experience gained in the diagnosis and solution of community health problems on several continents. the multi-disciplinary nature of modern comprehensfve health care. a rational solution of health problems in the context of all its physical, biological, social, economic, and cultural aspects. The universal usefulness of the study and applicability of the approach to different areas, our own rural problem sectors included, become clearly evident in light of the changes taking place in the health field today. Another project has been responsive to the need for information on the role of women in modern society by supporting a comprehensive bibliography of women in medicine. The bibliography includes approximately 3,500 references to books,articles, reports, and a thesis of scholarly value on the subject. One recent publication on community medicine synthesizes the The authors of the book are representative of They seek Medical Library Resource grants assist in the improvement of the nation's health science libraries. financial support for libraries from the hospitals or other institutions that they serve and from the local community. Improvement Grant, traditionally has been a one-year non-renewable grant for up to $3,000 to health institutions, usually hospitals that can demonstrate the need to establish basic collections and services. In FY 1977, this program will expand its support of consortium activities. The awards are intended to encourage increased One type of resource grants, the In addition to these Improvement Grants, NLM awards resource project grants, which are intended to make the growing scientific literature more readily accessible to health professionals throughout the nation and to introduce or demonstrate new information science technology. medical library resource grants have supported cooperative programs in which a strong library undertakes to provide training, consultation, and loan services for small community hospitals and clinics; studies on ways of expedit- ing the delivery ok information through modern communications devices and automation techniques and projects which, after an assessment of the actual information needs of health professionals, strengthen the information resources of an institution. In F'Y 1977, an additional $600,000 will be provided through Resource Grants to upgrade the resources of local libraries within each region. In FY 1976 NLM Library Assistance program provides support for a national network of ten Regional Medical Libraries (RML's). services which have clearly demonstrated that cooperative library networking among health institutions of all types and sizes is not only feasible but economically imperative. The foundation of the developing network is the successful interlibrary loan program. loans made by the RML network are provided within four daysof the receipt of the request. The overall demand for loan services has been increasing The RML's provide an array of Over 92 percent of the interlibrary .

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1096 at almost 15 percent per year. state medical and hospital associations, state library networks and other potential sources for supporting inter-regional information demands can keep Federal support for loans at a reasonable level. The National Library of Medicine semes as back-up resource for the entire RML network. By making available to the RML network itsadvanced on-line systems, such as MEDLINE, NLM considerably increases the dissemination of research results to all parts of the nation. The RML's through interactive planning with Utilization of the network by the health community is expected to increase substantially in FY 1977 for three major reasons: have become increasingly aware of the utility and availability of interlibrary loans; (2) the continued developmedof MEDLINE will afford direct and greatly improved access by RML clients to a data base which is most relevant to a health professional's requirements; (3) many of the proposed national health care and health education systems, such as Health Maintenance Organizations, Area Health Education Centers, and Professional Standards Review Organizations, will place additional information requirements on health professionals. (1) health professionals Although the RMI, network has proved itself useful and effective, many isolated health care facilities remain unreached by itservices. In FY 1977 NLM will allocate an additional $600,000 to extend RML benefits to smaller and more remote institutions, and on sponsoring cooperative programs. By encouraging cooperative efforts to analyze specific information needs, caordinating acquisition of medical Journals, and developing programs for sharing collections, NLM hopes to maximize the dissemination of the latest medical research findings to health professionals.

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1097 Lister Hill National Center for Biomedical Communications 1976 1976 1977 Revised Increase Budget Appropriation Estimate Decrease Amount Amount Amount Amount President's or Lister Hill Nat'l Ctr. for Biomedical Communica- I ! tions..................... 2,740,000 2,760,000 4,730,000 +1,970,000 Positions........ 23 24 23 -1 ......... The Lister Hill National Center for Biomedical Communications facilitates, through the application of advanced computer and communications technology, the transfer of biomedical information and the sharing of human and physical resources to enhance the effectiveness of health manpower, of health and medical I services, and the translation of research results into practice noms. I i I The activities of the Center fall in the following programmatic areas: 1. 2. 3. 4. 5. Broadband Biomedical Communications Computer-Based Education Computer Technology Research and Development Continuing Education for the Practicing Health Professional Focal Point and Coordination Role, DHEW 1. Broadband Biomedical Communications: I Since July 1,1970, the Lister Hill Center has worked with Dartmouth College and the University of Vermont in planning, building, and helping support the operations of the New Hampshire/Vermont interactive television network known as INTERACT. tional institutions can pool human resources and jointly meet an educational objective which neither can achieve alone. The long-planned phase-out 1 of support by the Center in November, 1975, necessitated the network users assuming total responsibility for its operations. The experience with this network clearly shows that educa- 1 In a related area, the Lister Hill Center has been engaged in a series of experiments and demonstration projects which apply satellite communications technology to the solution of recognized problems in health education and the delivery of health services. Space Administration (NASA) Application Technology Satellite (ATS) series have been involved, namely ATS-1, which was designed for voice and data transmission, and ATS-6, which provided television images as well. Valuable lessons have been learned from these two major health experiments using satellite-based communications and information exchange systems. The satellite system is highly reliable and avoids most of the interference which plagues conventional high frequency radid communications in Alaska. f 1 Two satellites in the National Aeronautics and 1 1 1 # i In the Alaskan bush, it was possible to extend the services of a hospital- based physician to distant villages by the use of telemedicine conferences supported by a good medical records system. The village-based health aid felt more secure and less isolated; the patients were more confident of the quality of the service received; travel by patients and physicians could be reduced to that which is medically indicated; and the community as a whole improved its understanding of health and the delivery system. The Washington/Alaska/

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1098 G MontanaIIdaho (WAMI) Program demonstrated the possibility inherent in region(.' ' interactive video, audio, and data communications network allowed faculty and sharing of people and facilities in the medical educational process. students located on multiple campuses and at rote clinical training locations to partake of one coordinated and integrated medical education program. The Continuing this experience and expanding to a national experiment, a program is being planned for the joint Canadian-American Communications Tech- nology Satellite (CTS). The CTS biomedical communications experiment can be divided into three areas of activities. The first is the coordination of program and evaluation planning, technical and engineering supports, and pro- gram management for PHS health agencies. an expansion of the University of Washington WAMI experiment. The third area is planning for facilities within the National Library of Medicine to provide the staff of the Lister Hill Center with a temporary laboratory. Although this laboratory lacks the sophistication that will be available in the new Lister Hill Center Building it offers an opportunity to make a small beginning in video experiments and demonstrations. communications engineering staff to explore advanced technology as a medium for extending effective educational programs to the health community; for improving health care delivery; and for enabling more effective dissemination of research results. 2. Computer-Based Education: The second area of planning involves This will enable Fhe Center's The current year is the terminal year of a project to foster the interinstitutional sharing of computer assisted instruction (CAI) resources among medical schools, hospitals, and other health related organizations. One of the current activities which holds great promise is the development within the National Library of Medicine of a training laboratory designed to consolidate computer-based educational resources in a single area. learning laboratory will be the place where potential users can gain an opera- tional understanding of the many alternative modes available to the generator and sponsor of programs in computer assisted instruction (CAI). will permit the staff to be active participants in selected experimental projects, and thus become a focus for the entire health community. , This The lrboratory Another major objective of the Center is to facilitate educational activities which are designed to preserve professfonal competence through postgraduate education. Technology Branch is planning collaborative projects with the Association of American Medical Colleges (AAMC) so that the expanding body of computer- based educational materials can be reviewed, organized, and regulated to con- form to orderly library procedures. As a part of this effort, the Center's Computer 3. Computer Technology Research and Development: The cost of large host computers needed by many current CAI and library applications programs is a significant deterrent to expanded use of these programs. for using smaller and less expensive computers, i.e., minicomputers, to make available substantial computer power to a large number of widely dispersed users at affordable costs. will aggravate a problem which is already serious. programs cannot be shared readily because they are written in many languages and dialects. The Center is actively supporting language standard- ization so that existing and future clinical programs can find greater use, especially in the contlnuing education of health professionals. The Center's computer technology staff is investigating2the potential However, the more widespread use of minicomputers Computer-based education

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Using the new technology laboratory in the Library, the staff is exam- This examination includes aning how best to provide more effective and efficient user access to com- puters through the use of interactive terminals. several advanced terminals, terminal configurations, and terminal functions. The full potential of such laboratory experiments cannot be fully realized until specially designed space is available in the new Lister Hill Center Building . 4. Activities in Continuing Education for the Practicing Health Professional: There exists a vast array of educational opportunities in continuing medical education (CME) having varied sponsorship and effectiveness. There also exists a disturbing sense that current efforts are relatively ineffectual, inefficient, or of less than desirable quality or applicability. It is recog- nized that the benefits of biomedical research results become reflected in the accepted norms of health professional practice through the process of effective and efficient biomedical communications. This important process is in need of considerable improvement if it is to become a significant factor in CME, including conventional programs designed to maintain professional competence of the practitioner. In the practice arena, the information which is disseminated must be analyzed for its accuracy and relevance to clinical problems, must be snythe- sized from the total biomedical information pool, and must be translated into a language and format which is understood by the practitioner. The Center is emphasizing the development of strategies in analysis, synthesis and translation as a new approach for improving continuing medical education activities. specific effort involves collaborative planning with the Health Services Administration (HSA) and the Health Resources Administration (HRA) with the goal of developing an information-consultation-education program for physicians in rural areas, especially physicians serving in the National Health Service Corps. A 5. Focal Point and Coordination Role: The Center has assumed an active coordination and technical support role in two broad =as. The first is to undertake planning, experimentation, and evaluation programs which will lead to the development of a coordinated plan for a broadband biomedical communications network responsive to the current and evolving needs of the health agencies. This activity is planned for accomplishment during the next three years, and will require correlating evaluation of experimental results with requirements studies and technical systems options to result eventually in a proposed design for a national network. Medicine, temporary laboratory capabilities for exploring the potential communication and computer technologies. The second area is the development within the National Library of 6. Dissemination of Research Results: The approximate $2,000,000 increase for the Center will enhance its efforts to improve the effectiveness and efficiency of biomedical communica- tions and improve the dissemin'ation of research results. Primary-efforts will be targeted at developing RW and improved uses of technology for scientist to practitioner communications. communications and satellite communications offers a unique opportunity for televised clinical conferences, demonstration and staff seminars between NIH and other centers within the biomedical community. These same communication links will be developed for improving continuing medical education, public education, and remote patient presentation and diagnosis. The Center's expertise in tele- 1 ! i i

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1100 National Medical Audiovisual Center 1976 1976 1977 Revised President's Increase or Budget Appropriation Estimate Decrease Amount Amount Amount Amount: National Medical Audio- 2,981,000 3,551,000 +570,000 Positions................ 100 100 100 --- - visual Center.. .......... 3,096,000 The National Library of Medicine and the Bureau of Health Manpower, HEW, have been carrying out a joint program now known as the Learning Resources Program to improve the use and effectiveness of learning materials in health sciences schools. NMAC and Bureau activities include research, audiovisual development, evaluation, distribution, training, consultation and related assistance to medical institutions through grants, demonstrations, contracts, and direct programs. Advances in educational technology in the last 15 years have provided a solid base for'transfowing health science education and. making it more responsive to the needs of students and practitioners. Recent approaches to education stress the benefits of the learner developing performance skills during training instead of the teacher traditionally "covering" course content. They emphasize that instructional programs should be tested and revised until each can consistently teach skills required for professional performance. Incorporation of these principles into learning programs which make full use of the capabilities of modern audiovisual media systems is the central goal of the National Medical Audiovisual Center in Atlanta, Georgia. Audiovisual techr.ology can promote significant changes in the training of health professionals. customized learning programs to make instruction more suitable and effective for individuals, then audiovisual educational technology can provide the necessary spaces, instructional media and other resources. In individualized programs, students will have greater flexibility in scheduling their learning experiences. It will become increasingly possible for students to assume responsibility ?or their own learning, both in undergraduate training and throughout their professional careers. competencies for health careers will enable the student to check on his progress and measure his profesaional growth. Research, development and training in these areas will lead to more effective health sciences education and better trained health professionals. Where the need is to recognize learning styles and for Validated criteria and learning Center-supported peer review panels evaluate health science teaching materials. base on audiovisuals known as AVLINE. quick access to comprehensive information on biomedical audiovisuals in much the same way that NLM's MFLINE system does for printed materials. 51 panels have reviewed 6,000 educational items, and found 3,600 suitable for inclusion in AVLINE. loan or duplication to schools for their use. approximatelylJ00 materials will be found suitable for inclusion into AVLINE. This on-going review process provides input for the Library's data The AVLINE system is designed to provide Since 1971, These materials are acquired for reference and direct In 1977, it is estimated that NMAC has launched an organized program of research and evaluation to develop, implement, anti measure the effectiveness of programs using audiovisual media and educational methodology in health sciences education. The Center

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1101 is planning to establish a regional focal point to accomplish the design, development, testing and evaluation of teaching approaches and strategies through cooperative effort of regional faculty and institutional resources. materials design, descriptive reviews of curricula, and development of audio- visual systems and production techniques are currently planned. Concepts and information coming from studies are used in instructional development and training programs assisting health professional faculty in improving instruc- tion. participants and is expected to increase to 640 in FY 1977. Studies on In FY'1976, the Center's training program attracted moie than 500 The approximate $600,000 increase in the program's FY 1977 funding level will modestly expand the acquisition and clearinghouse functions and other basic services of the Center. Preliminary developmental efforts will continue on the bibliographic information retrieval system AVLINE (Audiovisuals on- line). The utilization of the NLM's computerized nationwide information network in this manner acts as an offset to the nation's health manpower shortage by increasing the effective use of technology in the health education process.

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1102 Library Operations 1976 1976 1977 Revised Increase Budget Appropriation Estimate Decrease Amount Amount Amount Amount 1 Library Operations ...... 10,169,000 10,014,000 10,993,000 +979,000 Positions............... 250 25 2 250 -2 President's or Library Operations, the service arm of the National Library of Medicine providing both traditional and innovative services, is responsible for selecting, acquiring, indexing, processing, cataloging, preserving, and disseminating the world's output of substantive biomedical literature. In carrying out these responsibilities, Library Operations has developed rapidly expanding activities and services for the benefit of the entire biomedical community. the utilization of advanced bibliographic retrieval services and a national on-line information retrieval network. , (MEDLINE) It provides access to the Library's resource material through Even as service workloads and the volume of literature increase, Library Operations estimates that it will keep abreast of its M 1976 level of service operations; acquiring 140,000 serial pieces and 20,000 monographs; indexing 245,000 biomedical articles for inclusion in the computerized MEDLARS 'data base; publishing 32 recurring bibliographies, binding 32,000 volumes and pro- cessing approximately 250,000 interlibrary loan requests; processing 100,000 reader service requests; and delivering 500,000 on-line searches and two million pages of bibliographic citations from on-line searches. In FY 1975-76 the NLM installed a greatly improved successor to its - Medical Literature Analysis and Retrieval %stem (MEDLARS), which provides the machine-readable data base for its publications and bibliographic search programs. This second generation system, known as MEDLARS 11, enabled NLM to develop new and specialized services based on the system's greatly dxpanded capabilities, including the extension of MEDLINE and other on-line services to hospitals, pharmaceutical and other industrial educational organizations. The on-line network will be further expanded in FY 1977, providing access to many smaller hospitals and community-based academic institutions with pre- clinical and paramedical training programs. One of the newer capabilities has permitted the inclusion and searching of abstracts of articles in the MEDLARS I1 on-line data bases. In FY 1977 the number of author abstracts will exceed 100,000 abstracts from the most important journals, thus further augmenting the usefulness of MEDLINE and other NLM on-line data bases to the health sciences comunity. During the past year an experimental referral system, DOCLINE (Document Delivery On-Line), for interlibrary loans was initiated. DOCLINE has developed successfully into a computer-based interlibrary loan verification, routing, and management information system. Based on this experience, the Library is preparing to extend this pilot experiment to the Regional Medical Library Network. DOCLINE will interface with the NLM's successful systems SERLINE (Serial Locator File) and CATLINE (A file of catalog data). In order to optimize access to resources for the medical library community Library Operations has devoted a significant portion of its resources to participation in cooperative programs with the Library of Congress, the

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1103 Ohio College Library Center, the State University of New York. year Library Operations Will Play an active role in developing and improving its on-line systems capabilities. production of catalog card sets in individualized format also will be tested. It is expected that the cooperating libraries will begin inputting their bibliographic records for serials and monographs into the OCLC system during 1977. Major projects receiving allocations from the approximate $1,000,000 increase in Library Operations will have as the`ir goal the transfer of more current infomation in more suitable formats to the ultimate users of the Library`s resources. data base to allow MEDLINE users to improve the process of selecting only those articles which are timely and subject matter relevant. efforts to integrate DOCLINE with the existing bibliographic retrieval system of the Regional Medical Libraries. throughput time for interlibrary loan requests. initiate a service based on the MEDLARS capability to store profiles of users information needs. The services known as Selective Dissemination of Information (SDILINE) will be provided to majro medical schools and hospitals and will furnish literature on the most recent advances in health care and health research to thousands of practitioners. During the next Requirements in shared-cataloging utilizing More author abstracts will be added to the MEDLINE The program will initiate This effort will permit more rapid Steps will be taken to

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1104 Toxicology Information Program - 1976 Revised President ' a 1976 1977 Increase or Budget - Appropriation Estimate Decrease Amount Amount Amount Amount Toxicology Information Program ................ 1,873,000 1,866,000 2,166,000 +300,000 Posittona.. 16 17 16 -1 .............. The Toxicology Information Program (TIP) is responsible for collecting and organizing toxicology data from diverse sources and making the relevant information more readily accessible. TIP obtains information from the pub- lished scientific literature and files of governmental, industrial, and academic organizations in whatever form it is available. is then organized and entered into computerized storage and retrieval systems for the purpose of developing systems and services to make results of toxi- cological investigations more readily available to those who make therapeutic decisions, copduct research, make regulatory decisions, and monitor the environment. This information ON-LINE SYSTEMS The TIP utilizes on-line information retrieval technology to make toxi- cology information more readily available to members of the biomedical community, service (TOXLINE) which was operated entirely on the NLM computer. base also was enriched with special literature files to improve coverage in the specific areas of mutagenesis, teratology, and heavy metal toxicology, During FY 1976, TIP continued to expand its bibliographic retrieval The data The usefulness of the service was enhanced by updating the TOXLINE data base on a regular monthly (instead of quarterly) basis. data base to over 400,000 records required a splitting of the file into two parts, TOXLXNE and TOXBACK. TOXBACK contains that portion of the data base covering the literature prior to 1971, and is only searchable off-line. TOXLINE contains literature published during the most current five years and is available on-line. During this period, users performed over 25,000 on- line searches and requested over 250,000 pages of off-line print. have also been made to allow TOXLINE access by foreign MEDLARS centers. The growth of the Provisions During FY 1976, TIP continued to operate and enhance its Chemical Dictionary On-Line (CHEMLINE). This service is an adjunct to TOXLINE, MEDLINE, and CANCERLINE and provides users with Chemical Abstracts Service (CAS) Registry numbers and chemical nomenclature information for substances mentioned in these files. Some 15,000 chemical substance records have been added to the file bringing the total size of CHEMLINE to 90,000 records. Data for an addi- tional 700-1,000 chemical substances will be added to the on-line data retrieval service, the Toxicology Data Bank (TDB). Support functions for TDB users such as training and technical assistance will be maintained. An initial file of 700 compound records for a new on-line dater retrieval The file is being developed and maintained by extracting data on the service referred to as the Toxicology Data Bank was mounted in NM's on-line system. chemical, physical, biological, usage and distribution attributes of com- pounds from a selected group of sources such as monographs, reviews and criteria documents. Compounds are chosen for input if they present known hazards to substantial population groups. o

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1105 TIP will continue to enrich TOXLINE with specialieed literature files TOXLINE will be updated on a covering areas such as drug interactions, drug interference with laboratory tests, and biological aspects of drug abuse. regular basis, and the oldest year of the file will be transferred to TOXBACK on an annual basis. . COLLABORATIVE ACTIVITIES WITH OTHER ORGANIZATIONS The Toxicology Information Subconmittee (TIS) of the DHEW Committee to coordinate Toxicology and Related Programs, which is responsible for coordi- nating toxicology information activity within and beyond the Department, is making significant progress on three major projects intended to improve the information transfer process. The National Library of Medicine, through its TIP, has been assigned operational responsibility for the Toxicology Information Subcommittee which was formally chartered by the Office of the Assistant Secretary for Health in 1973. These collaborative efforts include: . The TIP-supported Toxicology Information Response Centet (TIRC) at the Oak Qidge National Laboratory continued to fill an important need for query response and literature search services in toxicology. performs demand literature searches has processed over 700 searches in FY 1976 for the scientific community. print-outs containing bibliographic references and abstracts from on-line computer searches, copies of abstracts extracted from Chemical Abstracts, Biological Abstracta or other services, ,and typed citations of relevant articles. During FY 1976 this literature support service was provided to other Federal agencies including the National Center for Toxicological Research, Edgewood Arsenal, Food and Drug Administration, EPA, etc. via separate Interagency Agreements. This Center, which Search results normally consist of computer The Laboratory Animal Data Bank (LADE) project which is designed to make base line data on laboratory animals available, on-line, to research scientists. This data bank will contain etrain files for most species of laboratory animals. The species included will range from mice to primate. Data collected is related to environmental and handling conditions under which each colony is main- tained; also in sukh areas as blood chemistry, growth and development, behavior, and pathology. manipulation. and demonstration purposes. beagles and Qheeus monkeys) strains. An information center, known as the Toxicology Document and Data Materials such as Each strain is represented by a number of colonies (substrains). The data is stored for on-line retrieval and statistical The initial segment of this file was plaeed on-line for test This segment is a file on 10 key (mice, rats, Depository (TD3), has begun collecting and distributing toxicology materials not ordinarily published in professional journals. "negative" research results, data files, charts and photomicrographs, hearing transcripts, and committee reports will be included. This information will be on microfiche and distributed by the National Technical Information Service under an interagency agreement with NLM, The approximate $300,000 increase in funds will allow TIP to expand TOXLINE, CHEMLINE and the Toxicology Data Bank. develop an on-line "early warning" system on the potential hazards of products about to enter the market place. In addition TIP will take steps to make TTRC at Oak Qidge more sophisticated and versatile with increased iiee of machine search techniquesand access to all available on-line files relevant to toxicology. In particular the program will i

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P 1106 Program Management 1976 Revi sed Preeident ' 8 1976 1977 Increase .or Budget Appropriation Ertimate Decrearra Amount Amount Amount Amount Program Management ........ 5,245,000 5,190,000 5,794,000 +604,000 Poeitions................. 79 79 79 --- This activity provides support for the overall administration, coordination, and direction of the varied programs and activities of the National Library of Medicine. Within this activity the primary functions include the prepara- tion and processing of grant applications for review committees and q's Board of Regents; public informetion and publication management; financial and personnel management; program analysis and contracts management; administrative services, and coordination ,of NLM's equal employment opportunity activities. This activity includes a major effort, the architectural and engineering design of the Lister Hill Center, which was completed in July This facility when constructed will relieve the serious space shortage within the NL,M and providethenecessary special purpose facilities essential.to meet the needs of the Lister Hill Center programs' communications technology and network engineering activities. of 1975. Also in 1976, Program Management performed detailed analyses of Null As a means of analyzing work volume in relation to manpower computer and library services in order to optimize efficiency in these operations. utilized to perform that work, a productivity measurement system was developed and is tracking library services on a monthly basis. This activity will continue to emphasize introduction of new knowledge into current operating programs and for planning and review of new areas of focus and interest. The entire increase for this activity in this budget is required for mandatory items which include the annualization cost 'of recent pay increases and U's proportionate share of increased costs of NIH centrally furnished services such as maintenance of building and grounds, custodial services, communications and administrative services. *

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1107 workers in all fields and in all geographic areas can avail themselves of the benefits of the network; and (4) the greater and more direct involvement of the health professionals themselves not only from the standpoint of decision making in the library areas, but also in the continued identification of information needs, in the design of program which require information components and in the couuuunication linkages of a national Biomedical Communications Network.

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~ 1108 NATIONAL INSTITUTES OF HEALTH National Library of Medicine Program Purpose and Accomplishments Activity: Lister Hill National Center for Biomedical Communications (Public Health Service Act, Title 111, Part I, Sec. 381) 1976 Pos. Amount - 24 2,760,000 1977 Budget Estimate Authorization k. Amount Indefinite 23 . 4,730,000 Purpose: computer and communications technology,' the transfer of biomedical information and the interinstitutional sharing of resources to enhance the effectiveness of health manpower, of health and medical services, and the transfer of research results into practice norms. The Lister Hill Center facilitates, through the use of advanced Ex lanation: medical community ttdetermine high priority needs, and matches these need3ith technological capabilities in order to develop experimental programs and evaluate their feasibility. The Center works closely with the health a Accomplishments in FY 1976: With the move of the ATS-6 satellite to India, the Center terminated its highly successful experiments with the Alaaka bio- medical communications network ?or remote health care delivery and with the state of Washington in its program for decentralized medical education. Expanding on this base, the Center is now p1anning.a major national br-Jadband network experiment using the joint Canadian-American Communications Technology Satellite (CTS). The Lister Hill Center terminated its support of the.experimenta1 computer- assisted instruction (CAI) network as planned on May 30, 1975. Also, the Center's support for the New Hampshire/Vermont interactive television network (INTERACT) essentially terminated on November 30, 1975. The management and operation of both of these networks has been assumed by their respective users with the anticipation that they will be self-sustaining. In the area of computer-based education, a major effort is underway to develop a Learning Resources Center within the National Library of Medicine. This will provide a focal point for institutional representatives to access all computer-based education modalities. Additionally, it provides a temporary laboratory for developing advanced applications of small computers and interactive terminals for both computer-based education and library applications. Objectives for FY 1977: There are five broad areas in which the Center will take initiatives during FY 1977. NETWORK will be the foundation on which much of the resource sharing will be based. The CTS experiment complements a study which will be conducted by the Center and the National Aeronautics and Space Administration (NASA) to explore the potential use of satellite communications in support of health. This study will be the base on which to develop models and system designs for a national broadband biomedical communications network. A BROADBAND BIOMEDICAL COMMUNICATIONS The

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1109 -* ._-_- ._ - _.-. - - _-. - .- networt could eventually support all communications and information transfer modes. the power of the computer to support library activities, computer-based education, and medical practice in isolated locations. processing will be intensified during FY 1977 to minimize dependency on large central computer systems. options from which applications can be selected to best meet a particular set of requirements of an individual user. in-house research development, demonstration, experimentation, and evaluation capability. benefits of research are to be understood and applied by practitioners in a timely fashion. The Center will undertake a systematic examination of the parameters of the translation of research results to practice application. INFORMATION ACQUISITION ANI) EXCHANGE will promote current awareness on the part of the Center as it consults with its constituency in the health community in seeking the best technology for application to specific communication problems. An information base and methodology for maintaining its currency will be developed to provide up-to-date information on basic technology and its applications. Center will maximize the DISSEMINATION OF RESEARCH RESULTS and medical research findings to health professionals. DISTRIBUTED COMPUTER PROCESSING dl1 make available at reasonable costa Research and development in distributed ALTERNATIVE TECHNOLOGIES will be examined to provide Efforts will continue to develop a strong Development of TRANSLATION METHODOLOGIES is essential if the The

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1110 NATIONAL INSTITUTES OF HEALTH National Library of Mec'Lcine Program Purpose and Accomplishments Activity: National Medical Audiovisual Center (Public Health Service Act, Title 111, Part I, Sec. 381) 1976 1977 I_ Pos. Amount Budget Estimate Authorization poS. Amount 100 2,981,000 Indefinite 100 3,551,000 Purpose: The National Medical Audiovisual Center (NMAC) located in Atlanta, Georgia applies audiovisual technology to the instructional needs of the bio- medical community. Its primary mission is to stimulate the development and use of instructional media in schools of the health professions and in the continuing education of health professionals. Explanation: NMAC functions as a clearinghouse for assembling, cataloging, and disseminating information on available instructional material. acquires and distributes materials appropriate for health professional education, and provides consultation and training in the use of instructional audiovisual technology. It also conducts research in instructional technology and systems and develops prototype instructional media programs. It evaluates, Accomplishments in FY 1976: NMAC implemented its on-line bibliographic storage and retrieval system, AVLINE (Audiovisuals on-line). 65,000 films, videotapes and videocassette instructional programs were loaned to health professional schools. In 16 workship sessions, over 500 health science professionals were trained in methods of application of audiovisual educational technology to health sciences teaching. anatomy, nursing,physiology and neurology. In addition, an active research and evaluation program in instructional technology and its application to audiovisual systems and Enstructional applications was initiated. Objectives for M 19?7: development and services where audiovisual technology can, when properly applied, promote significant changes in the effectiveness of health professional training. Center-supported peer review panels will continue to identify additional effective materials for entering into the AVLINE system, an on-line system which will assist ' health science teaching professionals in identifyinR instructional materials for use in health professional schools. By the end of Fy 1977 an additional 3,000 audiovisual citations will have been added to the AVLINE file. NMAC will continue its services to the health professional community through direct loans of films, videotapes and videocassettes, through adding materials for sale through the General Services Administration's Sales Program, and by continuing a training program which increases health professional faculty competencies in development and use of materials designed to improve student performance. A number of demon- stration instructional slide series, videotape and audiotape programs will be produced in FY 1977 primarily as part of NMAC's research and development programs. NMAC suggested or developed teaching materials in the areas of dentistry, NMAC will continue to identify areaa for research, *'

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I" 1111 NATIONAL INSTITUTES OF HEALTH National Library of Medicine Program Purpose and Accomplishments Activity: Library Operations (Public Health Service Act, Title 111, Part I, See. 381) 1976 Pos . Amount 25 2 10,014,000 _. 1977 Budget Estimate Pos. Amount Authorization - Indefinite 250 10,993,000 Purpose: Library Operations is responsible for selecting, acquiring, processing, indexing, cataloging, preserving, and disseminating the world's output of sub- stantive biomedical literature. for the five-state Mid-Atlantic Region and provides back-up service for the national Regional Medical Library Network as a whole. responsibilities, Library Operations functions as the traditional service arm of the National Library of Medicine, It also serves as the Regional Medical Library In carrying out these Explanation: Library Operations, through manual and machine methods prepares bibliographies and publishes indexes, catalogs, and other publications for use by the biomedical community; manages a national on-line information retrieval network, and conducts an extensive educational program for its network participants. Accomplishments in FY 1976: service provided to the health community during FY 1976. FY 1976, the program was providing service to approximately 350 institutions and is expected to grow to 500 during FY 1977. The Library acquired 140,000 biomedical serial pieces and 20,000 monographs; indexed 245,000 biomedical articles to be entered into the Computerized MEDLARS data base; published 32 Recurring Bibliographies; bound 32,000 volumes; and processed approximately 250,000 interlibrary loan requests; filled 100,000 reader service requests; and produced two million pages of bibliographic citatiocs from 500,000 on-line searches. Library Operations continued to expand the on-line At the beginning of NLM's second-generation computerized Medical Literature Analysis and Retrieval system (MEDLARS 11) was installed in N 1975. A sophisticated successor to the older MEDLARS system in operation slnce 1963, the new system has made possible the development of additional bibliographic information services, and permitted the exteneion of MEDLINE and other on-line data bases to industrial, pharmaceutical and other health related institutions. NLM renewed agreements 'with eight international MEDLARS centers which have been providing NU¶ with guid pro quo indexing of the foreign literature. agreements reflect the new capabilities which the MEDLARS I1 system provides such as on-line access and additional data bases. These new Objectives for FY 1977: steadily rising demand will experience a considerable increase. FY 1977 requests for library loans alone increased by 27 percent. jections foresee a rise of 25 percent for the next two years. numbers, 71,000 more loan requests will be processed. levels this increase represents 8.7 man-years. Services provided by Library Operations in response to a For instance, in Current pro- Expressed in Based on current productivity

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1112 A major objective in FY 1977 will be to increase the responsiveness of the NLM and its Regional Medical Library Network to this existing service demand. To this effect, Library Operations has designed an on-line interlibrary loan referral system, DOCLINE, which has been operational on an experimental baeis between the British Library Lending Division (BLW) and the NLM since 1974, It is anticipated that by FY 1977 a significant portion of interlibrary loan requests as well as referrals to the National Library of Medicine will be automatically controlled by DOCLINE. be an integrated management information system. technology to document delivery in the same way in which MEDLINE and other on-line services of the NLM have applied it to information retrieval, NLM is responding to the needs of the health science community. An essential aspect of this service will By applying computer a

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1113 NATIONAL INSTITUTES OF HEALTH National Library of Medicine Program Purpose and Accomplishments . Activity: Toxicology Information (Public Health Service Act, Title 111, Part I, Sec. 381) 1976 Pos. Amount - 17 1,866,000 1977 Budget Estimate Authorization poS. . Amount Indefinite 16 2,166,000 Purpose: and organizing toxicology data from diverse sources and making it more readily accessible to the biomedical community. The Toxicology Information Program (TIP) is responsible for collecting Explanation: and files of governmental, industrial, and academic organizations in whatever form it is available; organizes and enters this information into computerized storage and retrieval systems; and provides specialized services and products. TIP plays a key role in coordinating toxicology information activities within DHEW. TIP obtains information from the published scientific literature Accomplishments in FY 1976: service (TOXLINE) which was operated entirely on the NLM computer. base was enriched with special literature files to improve coverage in the specific areas of mutagenesis, teratology, and heavy-metal toxicology. A major improvement was made to the usefulness of the service by updating the TOXLINE data base on a monthly basis. The data base grew to over 400,000 records. 250,000 pages of off-line print. TIP continued to operate and enhance its on-line Chemical Dictionary (CHEMLINE). Some 15,000 chemical substance records have been added to this file bringing its total size to 90,000 records. TIP continued to expand its bibliographic retrieval The data Users have performed over 25,000 on-line searches and requested over A new on-line tata retrieval service referred to as the Toxicology Data Bank was mounted in NLM's on-line system. contained extensive data on substances known to be hazardous to substantial population groups. CANCERLINE, an on-line file containing bibliographic information on cancer, was maintained for the National Cancer Institute. cancer research projects (CANCERPROJ) was added as a new subset of this service. TIP supported the Toxicology Information Response Center at the Oak Ridge National Laboratory where query response and literature search services in toxicology were carried out on a demand basis. bibliographic searches were processed. The initial file of 700 compound records A file describing on-going . During the year over 700 full

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1114 Objectives for FY 1977: literature files covering selected areas such as drug interactions, drug inter- ference with laboratory tests, biological aspects of drug abuse, etc. The TOXLINE data base will be updated on a regular monthly basis, with the oldest year of the file transferred to TOXBACK on an annual basis. TOXLINE will be modified to include an "early warning" system on the potential hazards of products about to enter the market place. The .CHEHLINE file will be maintained and improved. New software enhancements will enable users to increase on-line sub-structure searching capabilities. Date for 700-1,000 chemical substances will be added to the Toxicology Data Bank. As part of its expanded chemical file support services, a study will be conducted to determine the feasibility of creating an "agency" chemical registry system for the NIH. TIP will continue to enrich TOXLINE with specialized Plans for FY 1977 call for increased query response services from the Toxicology Information Response Center with the sale of selected search bibliographies through the National Technical Information Service. Steps will be taken to make TIRC more sophisticated and versatile with increased use of machine search techniques and access to all available on-line files relevant to toxicology.

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Activity: Program Part I, 1115 NATIONAL INSTITUTES OF HEALTH National Library of Medicine Program Purpose and Accomplishments Management (Public Health Service Act, Title 111, Sec. 381) 1976 Pos. Amount - 79 5,190,000 1977 Budget Estimate Authorization poS. Amount program provides support for the Office of the Director, Ex lanation: This dch has responsibility for overall administrative management and scientific direction of all NLM programs. Purpose: operating costs for the overall administration and direction of the National Library of Medicine programs. This activity provides the funds for salaries and other related Accomplishments in FY 1976: NLM grants awarded and administered under the Medical Library Assistance Act were continued to be analyzed and evaluated through an on-line computerized system. The final architectural and engineer- ing drawings for the new Lister Hill National Center building were completed. The construction of this specialized facility will allow NLM to apply advanced technology to the improvement of biomedical communications. Objectives for Fi 1977: coordination and administration of NLM programs. Particular emphasis is to be directed in the areas of new knowledge, and its evaluation and applicability relative to the methods and systems necessary for the dissemination of medical research results. The activity will continue to provide for the

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1116 Transition Quarter Analysis Obligations by Activity 1976 Interim Period Pos. Estimate Pos. Estimate Medical Library Assistance Total. ............................... --- 6,433,000 --- 870,000 Direct Operations Lister Hill Nat'l Center for Biomedical Comunicationa........... 24 2,760,000 23 665,000 National Medical Audiovisual Center. . 100 2,981,000 .loo 745,000 Library Operations.. ................. 252 10,014,000 250 2,610,000 Toxicology Information.... ........... 17 1,866,000 16 475,000 Program Management. .................. 79 5,190,000 79 1,207,000 Subtotal.. ................... 472 22,811,000 468 5,702,000 Total Obligations. ........... 472 29,244,000 468 6,572,000 NARRATIVE " WbF 1976 Interim Budget Period The 1976 Interim Budget estimate of $6,572,000 is a reflection of the National Library of Medicine's commitment to maintain its on-going programs at the E'Y 1976 level for the same period. The elements of the budget estimate were developed accordingly.