1982 U.S. House of Representatives Appropriations Committee Budget Testimony, 97th Congress 1st Session, April 7, 1981
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DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, EDUCATION, AND RELATED AGENCIES APPROPRIATIONS FOR 1982 HEARINGS BEFORE A SUBCOMMITTEE OF THE COMMITTEE ON APPROPRIATIONS HOUSE OF REPRESENTATIVES NINETY-SEVENTH CONGRESS FIRST SESSION SUBCOMMITTEE ON THE DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, EDUCATION, AND RELATED AGENCIES WILLIAM H. NATCHER, Kentucky, Chairman NEAL SMITH, Iowa SILVIO O. CONTE, Massachusetts DAVID R. OBEY, Wisconsin GEORGE M. O'BRIEN, Illinois EDWARD R. ROYBAL, California CARL D. PURSELL, Michigan LOUIS STOKES, Ohio ROBERT L. LIVINGSTON, Louisiana JOSEPH D. EARLY, Massachusetts JOHN E. PORTER, Illinois BERNARD J. DWYER, New Jersey Henry A. Neil, Jr., Frederick F. Pfluger, Robert L. Knisely, Michael A. Stephens, and Bettilou Taylor, Subcommittee Staff PART 4 NATIONAL INSTITUTES OF HEALTH Printed for the use of the Committee on Appropriations U.S. GOVERNMENT PRINTING OFFICE 78-6330 WASHINGTON : 19818209675_000002.txt

Page  2 Tuesday, April 7, 1981. NATIONAL LIBRARY OF MEDICINE WITNESSES DR. MARTIN M. CUMMINGS, DIRECTOR, NLM DR. DONALD S. FREDRICKSON, DIRECTOR, NIH KENT A. SMITH. DEPUTY DIRECTOR, NLM DR. HAROLD M. SCHOOLMAN, DEPUTY DIRECTOR FOR RESEARCH AND EDUCATION, NLM KENNETH G. CARNEY, EXECUTIVE OFFICER, NLM NORMAN D. MANSFIELD, DIRECTOR, DIVISION OF FINANCIAL MANAGE- MENT, NIH ELLEN S. WORMSER, DIRECTOR, HEALTH BUDGET ANALYSIS. OS-DHHS NATIONAL LIBRARY OF MEDICINE Mr. Natcher. The subcommittee will be in order. We take up at this time the National Library of Medicine. We have before the committee Dr. Martin M. Cummings, the Director. Dr. Cummings, you have appeared before our committee on a number of occasions. We are delighted to have you back. Dr. Cummings. Thank you, Mr. Chairman. Mr. Natcher. Tell us who you have with you? Dr. Cummings. I have with me today Mr. Kent Smith, Deputy Director and Dr. Harold Schoolman, Deputy Director for Research and Education. Mr. Natcher. We are delighted to have you gentlemen before the committee. Doctor, we have had an opportunity to examine your statement. You have a good statement. We will insert your statement in the record in its entirety. [Statement of Dr. Cummings follows:] (1539)8209675_000003.txt

Page  3 1540 DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service, National Institutes of Health Biographical Sketch NAME : Martin Marc Cummings POSITION : Director, National Library of Medicine BIRTHPLACE AND DATE : Camden, New Jersey, September 7, 1920 EDUCATION B.S., Bucknell University, 1941 M.D., Duke University, 1944 HONORARY DEGREES : Honorary Doctor of Science, Bucknell University, 1969 Honorary Doctor of Science, University of Nebraska, 1971 Honorary Doctor of Science, Emory University, 1971 Honorary Doctor of Humane Letters, Georgetown University, 1971 Honorary Doctor of Medicine, Karolinska Institute, Stockholm, Sweden, 1972 Doctor Honoris Causa, Academy of Medicine, Lodz, Poland, 1977 EXPERIENCE 1964 to Present : Director, National Library of Medicine Associate Director for Research Grants, National Institutes of Health Chief, Office of International Research, National Institutes of Health Professor of Microbiology and Chairman, Department of Microbiology, University of Oklahoma School Director, Research Services, Veterans Administration Central Office Special Lecturer in Microbiology, George Washington University School of Medicine Associate Professor of Bacteriology, Emory Unverslty Chief, Tuberculosis Research Laboratory, Veterans Administration Hospital of Atlanta Instructor through Associate Professor of Medicine, Emory University 1963-1964 1961-1963 1959-1961 1953-1959 1953-1959 1953 1949-1953 1948-19538209675_000004.txt

Page  4 1541 EXPERIENCE (Cont'd) 1947-1949 1945-1947 1944-1945 1942-1944 PROFESSIONAL ASSOCIATIONS SPECIAL AWARDS & HONORS Director, Tuberculosis Evaluation Laboratory, Communicable Disease Center, U.S. Public Health Service Assistant Resident Medicine, Boston Marine Hospital Intern, Boston Marine Hospital U.S. Army (ASTP) American Academy of Microbiology, Inc. American Association for the Advancement of Science, Board of Directors American Board of Microbiology American Clinical and Climatological Association American Federation for Clinical Research (Emeritus) American Osier Society, President American Society for Clinical Investigation (Emeritus) Association of Research Libraries Gorgas Memorial Foundation, Board of Directors Institute of Medicine, National Academy of Sciences Medical Library Association Society of Sigma XI Washington Society for the History of Medicine Veterans Administration Exceptional Service Medal DHEW Superior Service Award DHEW Distinguished Service Award Distinguished Alumus Award, Duke University, 1969 Honorary Member, Alpha Omega Alpha Honorary Fellowship, College of Physicians, Philadelphia, 1973 Rockefeller Public Service Award, 1973 Honorary Member, American Medical Writers Association, 1974 Alumus Membership, Phi Beta Kappa, 1974 Modern Medicine Distinguished Achievement Award, 1976 Distinguished Service Award and Honorary Fellowship, College of Cardiology, 1978 Honorary Member, Academy of Medicine of the Institute of Chile, 1978 Certificate of appreciation for outstanding contributions to medical communication and to the American Medical Writers Association, 1978 John C. Leonard Award, Association for Hospital Medical Education, 1979 Harold Swanberg Distinguished Service Award, American Medical Writers Association, 1979 Fellow, American Association for the Advancement of Science, 1980 105 scientific and historical publications, co-author of textbook in the field of tuberculosis8209675_000005.txt

Page  5 1542 DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health Statement by the Director, National Library of Medicine on "National Library of Medicine" Mr. Chairman and Members of the Committee: Civilization advances through the communication of knowledge. The storage, retrieval and processing of information is an essential resource for all social, cultural and economic progress. Writing about the social frame- work of the present information society Daniel Bell (a professor of Sociology at Harvard University) describes four revolutions — Speech, Writing, Printing, and Telecommunications — that have changed the way people live: Speech was central to the hunting and gathering bands - the signals that allowed men to act together in common pursuits. Writing was the foundation of the first urban settle- ments in agricultural society - the basis of record keeping and the codified transmission of knowledge and skills. Printing was the thread of industrial society - the basis of widespread literacy and the foundation of mass education. Telecommunications - the ties of cable, radio, tele- graph, telephone, television, and now, newer technologies are the basis of an "information society." Each of these revolutions was based on new ways of exchanging information - adapting new technologies for this purpose . Knowledge is the source of progress and power. The library - from the earliest collection of stone tablets to the modern computerized information center - is the reservoir and repository of knowledge, and therefore, is a critical resource for the functioning of society. The modern library also organizes and disseminates information in a socially acceptable way where rich and poor alike may share Its benefits.8209675_000006.txt

Page  6 1543 This has never been more true than in the late twentieth century, as we move into an era where information and knowledge, rather than agriculture or manufacturing, are becoming the strategic resources of our society. The information industry accounts for half of the U.S. labor force and 462 of the gross national product. Burgeoning high technology makes possible the transition to an information society. This is particularly important in the sciences. The National Library of Medicine is in the forefront in the transition from the printed word to computer-based communications technology which makes it easier to store, find, and retrieve medical information. The Library serves as the nation's principal resource for information needed in biomedical research, health professional education, and the delivery of health care ser- vices in both the private and the public sectors. Users of the NLM include commercial and industrial organizations, hospitals, clinics and nursing homes, and academic institutions for medical, dental, and nursing education and research. The results of research must be disseminated if they are to be of bene- fit to society. In fact, research is incomplete until it is documented and published. Research projects culminate in published results almost all of which are acquired, indexed, organized, and distributed by the NLM. The research scientist uses NLM resources to locate scientific and technical information. Access to the information is available either as a direct user of NLM or thorugh its Regional Medical Library Network. Computerized data bases such as MEDLINE and TOXLINE inform the scientist, educator, and prac- titioner where information exists. The NLM saves health professionals from tedious thumbing of textbooks and journals by providing systematic, computer assisted scans of the latest available information no matter where it has been published. When a doctor,8209675_000007.txt

Page  7 1544 nurse, dentist or veterinarian wants the latest information on a specific topic, the computerized bibliographic systems of the NLM stand ready to comb the current literature and extract a list of references and abstracts that guide the seeker swiftly to the most relevant articles for his purposes. Let me give you an example. Recently I decided to test our system myself, and what I am going to report to you is what I found when I requested a search for information on a currently important topic: the management of coronary artery spasm. This is a condition that produces severe chest pain in individuals with coronary artery disease, even at rest. I asked the MEDLARS system what it could tell me about the latest in treatment and patient management. It took 10 minutes to formulate the search and have the computer examine over 400,000 citations, resulting in an immediate retrieval of 16 references and 13 abstracts on the management of coronary artery spasm. It took about 20 minutes to read them and I was pretty sure that I wanted to read two of tie articles in their complete form. So I made another request of the Library asking for photocopies of these two articles. Twenty minutes later I had them. Last year NLM alone provided 1.8 million such computer searches and 250,000 articles or entire books were sent to health professionals through their libraries. That's what the services of NLM are all about: providing rapid, thorough, convenient and economic ways of selection from the great mass of medical literature, those relevant items that serve the needs of an individual health professional who has a specific question. I point out that not all questions can be answered, only those for which the information has been published and indexed accurately. We are constantly improving these services. A new and improved information system, called MEDLARS III is currently being developed by NLM staff.8209675_000008.txt

Page  8 1545 MEDLARS III will include important new services for the biomedical community such as a fully automated online interlibrary loan service which will ultimately allow the nation's medical libraries to request journal articles online through our computer. Bibliographic searching will be simplified greatly; the user will be able to enter a single search to be run against multiple files using common English commands rather than artificial computer language. NLM also provides specialized information services in toxicology and environmental health through online data bases such as TOXLINE and CHEMLINE, specialized search services at the Oak Ridge National Laboratory, and inter- agency projects such as the Chemical Substances Information Network. These services allow the producers of drugs and chemicals as well as health pro- fessionals to have rapid access to information about the effects on humans and the environment of drugs, chemicals and other toxic substances. In addition to its resources in Bethesda, NLM supports and coordinates a national network of eleven Regional Medical Libraries. They in turn are linked to 103 Resource Libraries, and more than 3,000 local health science libraries. The Network provides services such as lending materials between libraries, searching NLM's online bibliographic data bases, and providing acquisition and cataloging information to other libraries. In addition it provides training and consultation to small institutions and encourages resource sharing among libraries. NLM shares the products of its labor- intensive cataloging efforts with libraries in the Network, thus saving these libraries the cost of cataloging. Each of the eleven Regional Medical Libraries coordinates information delivery services within its own region and cooperates with libraries throughout the Network to provide nearly 2 million interlibrary loans annually.8209675_000009.txt

Page  9 1546 NLM's grant programs under the Medical Library Assistance Act provide support for the establishment, development, and enhancement of health infor- mation services for health professionals. Grant assistance is used to maintain and improve the biomedical information network; to support research into new ways of representing, transmitting and utilizing biomedical information; and to train information specialists and computer scientists. A special initiative within this grant program known as Computers in Medicine supports research and training in the computer sciences related to how biomedical knowledge can be organized so that clinicians faced with decisions about patient care can obtain information in an easy-to-use format. The NLM dedicated the new Lister Hill Center Building in May 1980. It provides sophisticated resources for the Lister Hill National Center for Biomedical Communications and the National Medical Audiovisual Center (recently moved from Atlanta) a well as for several other NLM and NIH programs. The architectural and engineering plant; for the renovation of the present library building have been completed and will improve the protection of the collec- tion and safety of the readers. The Lister Hill National Center for Biomedical Communications is the research and development arm of the National Library of Medicine. One major objective of the Center is to improve the manner in which books, journals and audiovisual media are stored, retrieved and used. A principal effort of the Center is to develop "knowledge-based systems" which would provide specific, current information useful for patient care and health care delivery. The National Medical Audiovisual Center's primary mission is to improve the transfer of health science information from research into practice through the use of audiovisuals. NMAC lends audiovisual materials to be used8209675_000010.txt

Page  10 1547 in health professional education and also supports an online data base of audiovisual materials known as AVLINE. The Center conducts workshops to train health science educators in the use of advanced educational technologies, assists in preparing educational materials, provides consultation on audiovisual facilities planning, and conducts research In how to improve the use of audio- visuals in health professional education. The rapid growth of computer and communications technologies in our society presents challenges and opportunities for new ways for communicating knowledge. In addition to our present use of available technology, we are actively working to investigate many newly emerging technologies, such as: o Telefacsimile - which would allow copies of articles from journals or other documents to be sent across the country almost instantly; o Electronic mail - enabling scientists to communicate with each other through computer terminals; o Video disc technology for improved storage and retrieval of information; o Computer-generated printing - to save money and increase the time- liness of the scientific literature; o Education through audiovisual devices - improving the training of health science students, scientists and practitioners. Mr. Chairman, our request of $47,677,000 for FY 1982 represents an increase of $2,489,000 over the FY 1981 level. I shall be pleased to answer questions and supply anj additional inforation desired for the record.8209675_000011.txt

Page  11 1548 OPENING STATEMENT HIGHLIGHTS Mr. Natcher. Maybe you want to highlight it for us. Dr. Cummings. Thank you very much. I will attempt to summa- rize some of the highlights of our report this year. Mr. Chp; ~aan, we have tried to design the services of the Na- tional Lib .y of Medicine to serve people equally in rural as well as urban areas, to serve the rich and poor alike. This is the 25th anniversary of the conversion of the Army Medical Library to the National Library of Medicine. Although we have been a national library for 25 years, you will recall that we have served as a national medical information resource for more than a century. We believe that the results of research should be published and disseminated if they are to benefit society and, because of this, we attempt to index and catalog the world's published literature. We index more than a quarter of a million medical articles and catalog approximately 17,000 new medical books each year. We produce a monthly printed index and current catalog, which are sold to institutions throughout the world. About 7,000 subscrib- ers purchase these products. Users of the National Library of Medicine include commercial and industrial organizations, hospitals, clinics, private practition- ers, nursing homes, academic institutions, as well as students con- cerned with health professional education. The Library attempts to save the time of health professionals from the tedious thumbing of textbooks and journals by providing systematic computer-assisted scans of the latest available medical information, no matter where it has been published. The computer- ized systems of the Library comb the current literature and extract lists of references and abstracts that guide the user to the informa- tion most relevant to their needs. In addition to our resources in Bethesda, NLM supports and coordinates a national network of 11 Regional Medical Libraries. They in turn are linked to 130 resource libraries and more than 3,000 local health science libraries. The network provides services such as interlibrary loans, com- puter searching of our bibliographic data bases and advice on the acquisition and cataloging of medical materials. Last year we provided more than 1.8 million computer searches to users upon demand. We expect to exceed 2 million searches this year. The requester pays for these services. Two hundred thousand articles or books were sent to health professionals directly by the NLM; another 1 million loans were made through our local and regional libraries in the network. NLM also provides specialized information services in toxicology and environmental health through on-line data bases, such as Tox- line and Chemline. These services allow the producers of drugs and chemicals as well as health professionals to have rapid access to information about the effects of drugs, chemicals, and other poten- tially toxic substances on man and his environment. We are constantly trying to improve these services. A new and improved information system, which we call MEDLARS III, is cur- rently being developed by the NLM staff.8209675_000012.txt

Page  12 1549 We share the products of the labor-intensive cataloging efforts with other libraries, saving the Nation several million dollars per year by eliminating redundant cataloging. We cooperate with the Library of Congress in standardizing and sharing cataloging practices. Our grant programs, which are au- thorized by the Medical Library Assistance Act, provide support for the establishment, development, and enhancement of health infor- mation services for health professionals. Grants also support the training of health professionals in utilization of computer technol- ogy, in medicial information transfer and in clinical decision- making. The NLM dedicated the Lister Hill Center building in May of 1980. We are pleased to report that the building was completed only a few months after schedule and several million dollars under the projected budget. This facility provides sophisticated resources for our research and development program, which is now busily engaged in developing new knowledge-based systems to assist in the provision of current information useful for patient care and health care delivery. The Center has also developed technical processing systems which may be used on mini-computers in hospital, college, and university libraries. These programs may be leased through the National Technical Information Service of the Department of Commerce. This is a brief summary of our program activities. I hope it reflects the diverse and energetic effort that we are making to improve the national medical information system. I would be pleased to answer any questions, Mr. Chairman. AUTHORIZATION Mr. Natcher. Thank you, Dr. Cummings. Now, Doctor, the Library of Medicine is authorized under section 381, and sections 390 through 397 of the Public Health Service Act and the latter sections expire, I believe, on September 30, 1981. If you could, explain to the committee which of your programs would be affected by the expiring authorization. Dr. Cummings. I would be very pleased to do that. The Medical Library Assistance Act provides authorization for the support of research, for training, for the support of special scientific projects, resource building in community hospitals and other libraries, special publications, and finally, for the support of the Regional Medical Library program, which is a most direct extension of the NLM services. The Act is now being reviewed by a committee of the House, Mr. Waxman's committee, which has proposed a one-year extension of its present authority in the amount of the present budget, and by a committee of the Senate which is proposing a three-year extension of the Act with the deletion of several of the authorities. The Administration, I understand, is reviewing its draft of a bill and it has been expressed to me informally that the Administra- tion will be supporting the renewal of the Medical Library Assist- ance Act, in its present form and with retention of all its authorities. Mr. Natcher. For a term of how many years?8209675_000013.txt

Page  13 1550 Dr. Cummings. I have heard informally they are proposing a three-year extension, but I do not cite that as a position confirmed by the Department. Is that correct? Ms. Wormser. Three years. Mr. Natcher. Three years. Tell us if you will how many dollars of your program are subject to the expiring authorization? Dr. Cummings. $8.9 million of the overall appropriation fall within the authorities of the Medical Library Assistance Act. PUBLIC ACCESS TO LIBRARY Mr. Natcher. Dr. Cummings, can the National Library of Medi- cine be used by the public in the same way as the Library of Congress? Dr. Cummings. The local public, that is to say the communities near the National Library of Medicine, are free to use its facilities for their interest in science or health or medicine, but it is not a library like the great Library of Congress that satisfies interests which extend beyond health and medicine. However, we do serve the public. LIBRARY COLLECTION Mr. Natcher. Doctor, we have asked you from time to time how many books are we talking about, items, periodicals, manuscripts; how many are we talking about now as far as the Library of Medicine is concerned? Dr. Cummings. The National Library of Medicine has about 2 million items. Among these items are 1,096,844 books or bound journals; a print and photography collection relevant to health and medicine of some 73,000 items; and a fabulous collection of theses and pamphlets relating to research not only in this country but the world at large. We acquire each year approximately 22,000 serials in some 70 different languages. We acquire approximately 16,000 new books each year. PRIMARY USERS Mr. Natcher. Who are the primary users of the National Li- brary of Medicine? Dr. Cummings. Members of the health professional community, broadly defined, are the principal users. That is to say the pharma- ceutical and drug industry are heavy users of our service along with other government agencies concerned with health, such as the Veterans Administration, FDA, the Public Health Service; among principal users are the research and education and practice com- munity in the private sector. Physicians, dentists, nurses, all health professionals are free to access the Library as are teachers in the academic setting and health professional students in all fields. About 40 percent of all of our services, I should say, go to hospitals. We think that is a marvelous statistic because as recent- ly as 15 years ago the physicians in hospitals were not heavily represented as users of this institution.8209675_000014.txt

Page  14 1551 Mr. Natcher. Are your on-line information services used more by researchers than by practicing physicians not in research? Dr. Cummings. Well, it is a paradox to report that the research community, as reflected by research institutions, are not the great- est users of the National Library of Medicine. About 14 percent of the use of the Library comes from research institutions, 41 percent from hospitals and clinics, 23 percent from the commercial sector, and 20 percent from the academic sector. Mr. Natcher. If the average citizen wanted to use the National Library of Medicine to do a literature search, how would he go about it? Dr. Cummings. Well, I wouldn't recommend that the average citizen use the National Library of Medicine for this purpose, be- cause the information that we provide is highly technical, scientif- ic, and would probably not be very helpful to the average citizen. But any citizen who has a specific interest in a problem of health or medicine is eligible to reach us through the nearest local library; that is to say, it might come from a college library, a hospital medical library, or in some cases even through the public library if it is the only library available in the community. So we are reached through another library, except for the envi- ronment of Bethesda, where we receive readers and researchers on site. computer searches Mr. Natcher. You mentioned that the National Library of Medi- cine provides 1.8 million computer searches of its data bases each year. Dr. Cummings. That is correct. Mr. Natcher. Are these searches provided by the National Li- brary of Medicine staff? Dr. Cummings. No. What we do, Mr. Chairman, is to examine the world's biomedical literature, in order to select from that mass those items that are thought to be most substantive, most creative, most original, and to contain the most useful information. Those judgments are made by an external advisory group. Then the staff of the Library, supplemented by contractors in the United States and some scientific communities abroad, analyze that literature, and put it into an appropriate format for computer storage and retrieval. We then train librarians and others around the country to access the data bases through terminals which they themselves provide. They reach us then by long lines or by satellite communications, if from overseas; they pay for the access to the system on the basis of the number of hours of use made. A normal hour of use would provide the answer to six to eight questions; about six or eight searches are done per hour. lister hill center Mr. Natcher. Now, Dr. Cummings, I want to direct your atten- tion to the Lister Hill Center for just a few moments. Could you tell us, if you will, please, what the Lister Hill Center does7 In the justifications to the committee, you state, and I quote, "conducts research and development in the application of computer8209675_000015.txt

Page  15 1552 and communications technology for improved health care deliv- ery." What does that mean, Doctor? Dr. Cummings. With your permission, Mr. Chairman, I would like to invite Dr. Schoolman to respond to your questions since the Lister Hill Center comes directly under his area of responsibility. Mr. Natcher. Go right ahead, Doctor. Dr. Schoolman. The Lister Hill Center, Mr. Chairman, like the rest of the Library, is concerned with the problem of getting to the appropriate health practitioner the information he needs when he needs it, in order that it may be used for the ultimate benefit of the patient. Dr. Cummings has described to you the bibliographic data bases which help identify documents which may contain this informa- tion. One of the contributions that the Lister Hill Center originally made was to put those bibliographic data bases on-line and the on- line computer system that has been described originally was de- signed in the Lister Hill Center. Those documents contain informa- tion from which the answers to the questions may be derived. One still has to locate the document, and there are many such docu- ments. The Lister Hill Center is interested in trying to create data bases which contain not references to articles that may contain answers to your question, but the answers themselves; and in formulating and maintaining in an updated fashion the available knowledge as represented by a consensus of experts on important and dynamic medical subjects in which there is a great deal of research being done. It is therefore very difficult for health practitioners to keep up with the field. This knowledge base activity and development must deal also with methods for maintaining the currency of the information and effective ways of retrieving information from the data base. In addition to that, the Lister Hill Center is engaged in other uses of available technologic advances to promote and facilitate the delivery of information. Among these are the utilization of new technology called video-disc, in which it is possible to store on one record the size of an ordinary phonograph record as many as 108,000 images or slides. So, for example, the 73,000 prints and photographs in the Li- brary's collection that are relevant to medicine could be put on one video-disc which could then be used as a mechanism for publica- tion. The National Library of Medicine's entire file of prints and photographs could thus be made available to libraries all over this country at a very nominal charge. In addition, it is possible to encode on video-disc, instead of images, digital information which would allow an enormous amount of storage. In fact, the whole Library of Medicine, if it were converted to video-disc in a digital fashion, could probably be stored on about 100 video-discs in a relatively small space. We are also engaged with the problem of the preservation of the literature through conversion to electronic storage, which also would permit the possibility of retrieval and, ultimately, electronic dissemina- tion.8209675_000016.txt

Page  16 1553 In addition, the Lister Hill Center has been involved, as Dr. Cummings mentioned, in the development of an integrated and highly versatile computerized system that supports all functions of libraries of any size, and which can be operated on small machines that may be possible for small libraries to afford. Those are the main activities of the Lister Hill Center at the moment. There are some others that I could add for the record if you wish, Mr. Chairman. Mr. Natcher. Doctor, thank you very much. Mr. Livingston? impact of rescission on operating budget level Mr. Livingston. Thank you, Mr. Chairman. Dr. Cummings, obviously I am sure you are aware these are tight budgetary times. I understand that your very worthwhile network is undergoing some revisions to the tune of $341,000 for fiscal year 1981. I just wonder what you believe the impact would be if this committee saw fit to maintain fiscal 1982 at the fiscal 1981 revised level, which is about $45,188 million. Dr. Cummings. First let me deal with the rescission figure. I am fully prepared to say that the rescission will have no serious adverse effect on the National Library of Medicine and its programs; the $341,000 can be dealt with prudently without any adverse impact on services, the most important product that we render. With regard to the second part of your question, namely, wheth- er we could operate in fiscal year 1982 at a fiscal year 1981 level, I think a more thoughtful response would suggest that we would have to sacrifice some elements of the Library's ongoing activities. I think with the inflation in libraries being greater than the national inflation factors, we would be very much concerned whether we could continue to maintain high quality services. Since the highest priority would be given to protection of service, I would then have to examine whether the reduction should be taken in our intramural research programs or in our extramural grant programs. I would want to have a little more time to make that determination, Mr. Livingston. Mr. Livingston. Thank you. Feel free to complete your answer in the record if you would. Dr. Cummings. Thank you. [The information follows:] Should the NLM be required to operate in fiscal year 1982 at the revised fiscal year 1981 level, both extramural and intramural activities would have to be re- duced. The NLM would have to reduce part of the research program of the Lister Hill Center. In addition, the National Medical Audiovisual Center would reduce its level of program activity. The Toxicology Information Program would defer a por- tion of the development of the Chemical Substances Information Network Project. The number of Regional Medical Libraries currently being supported would be reduced. This action might have an adverse effect on the delivery of library and information services to physicians, scientists and health professional educators. PERSONNEL RESOURCES Mr. Livingston. Breaking that down, looking at your budget authority as itemized in our justification booklet, I see that the total number of positions in 1981 is actually going up from 571 to8209675_000017.txt

Page  17 1554 582, a net gain of 11. And yet there seems to be a reduction in permanent positions, personnel compensation, from $12,782 million to $12,779 million, a net reduction of $3,000 out of a $12 million budget. That strikes me as odd. Can you explain that for me? Dr. Cummings. No, I would have difficulty explaining that be- cause I am not sure I have the same figure that you have cited with regard to our personnel ceilings. My understanding is that our full-time permanent personnel ceiling is 495 positions, and we have 481 on board now; in addition, we have other part-time and special appointments which bring the overall total to 578, an increase of 7 over the part-time, full-time present ceiling of 571. I do not understand how we can increase our positions by 7 with a decrease of budget of $3,000; I simply don't understand that. Mr. Livingston. Do you think we might be able to correct the record then because these—I am looking at the justification here. Dr. Cummings. Yes, I will provide information for the record that explains that apparent discrepancy. [The information follows:] The NLM in developing its fiscal year 1982 personnel compensation levels took into consideration the change in grade mix which occurred in the transfer to the National Medical Audiovisual Center activity in fiscal year 1980. The reduction of 50 employees who chose not to make the move from Atlanta to Bethesda and the subsequent re-staffing of this activity with lower graded personnel resulted in a total pay cost savings which exceeded mandatory pay increases project- ed for fiscal year 1982 by $3,000. Mr. Livingston. Thank you. Mr. Natcher. Mr. Early? BIOMEDICAL INFORMATION NETWORK Mr. Early. Thank you, Mr. Chairman. Doctor, you have suggested the National Library of Medicine is in the forefront in the transition from the printed word to comput- er-based technology, and that the Library serves as the nation's principal resource for information needed in biomedical research. How is that communicated with the medical schools? Dr. Cummings. Mr. Early, every medical school in our country is a member of the Medical Library Network. We now have 120 medical schools involved with the medical information services that we provide. Some of these institutions have been selected as regional medical libraries. They commit themselves to give services beyond their normal local environment. For example, in your region, the Countway Library at Harvard serves the entire New England region, all of the health profession- al community of New England is served by that regional library. So they are connected to us in a formal way. In the area of provision of services, the Regional Medical Librar- ies give loans that can be provided from their collections but when they do not have material they refer the requests to us. We are the back-stop to that particular regional library. In turn, they are the back-stop to the community hospitals and smaller institutions that are in the network. That is the hierarchical arrangement through8209675_000018.txt

Page  18 1555 which the Medical Library gives services to the medical profes- sions. Mr. Early. Wasn't it the idea that new medical schools wouldn't need extensive libraries because of the computerized tapes that would be able to be dispatched by your group? Dr. Cummings. It is true that, since we have in place a national bibliographic apparatus, libraries don't need to compete to have the great collections that they were forced to acquire in the past. With present locator tools the national resources can be shared. For example, in your area we know which libraries have the great collections in nursing literature, which in dental literature, which in medical literature. They have organized themselves into consor- tia so there is a sharing of resources which I think leads to a national economy. Importantly, knowing where information is lo- cated not only leads to economy but it leads to efficiency because you don't have to bounce a request around until you find the source document, you know where to ask for it on the first pass. Mr. Early. The consortium approach always sounded so real; giving the 127 medical schools much more information and being done at a minimum of expense. How many of the 127 medical schools utilize the Library of Medicine? Dr. Cummings. Well, I think I can safely say all of them use the National Library of Medicine. Not only the medical schools in this country but also most of the medical schools around the world, at one time or another, come to the National Library of Medicine for information. Mr. Early. I think that is great. With all this research, are we getting it disseminated quickly enough? I have seen several books on what we do in the cancer area regarding scientists and research and how it is disseminated. Does the Library expedite that in any way? Dr. Cummings. Yes. With particular reference to cancer, I can tell you that we share our network resources with the National Cancer Institute. They have for many years generated and main- tained specialized information services dealing with things like chemotherapy, carcinogenesis, and other areas of importance to the cancer field. We take their information on tapes and distribute them national- ly and internationally so that these very highly specialized data bases are available to any physician or scientist anywhere in the world. Mr. Early. You say you take them on tape, Doctor? Dr. Cummings. Yes. Mr. Early. Let's use cancer field as an example, because it is the most talked about. Dr. Cummings. Yes. Mr. Early. Several different regions treat cancer somewhat dif- ferently. I saw a medical journal in which material was compiled on how each area was treating it. How does that get to the Li- brary? Is the input as good as the output? Dr. Cummings. Well, we in the Library do not make the judg- ment as to the quality of the information. In the cancer field, the National Cancer Institute delegates that responsibility to organizations and individuals that they believe are8209675_000019.txt

Page  19 1556 competent and qualified to adequately abstract and index that material. So it is a professional judgment that is compressed, put on tape in a highly organized structure, mounted on our comput- ers, and shared with the various institutions that use the Library's online services. But I would add immediately that I think, as in every field, Mr. Early, the reader must beware. No one can guarantee that the information which is transmitted is always absolutely precise and accurate; particularly in a field like health and medicine, I think we believe that the readers have to be on the lookout for--- Mr. Early. When it is on computerized tape, aren't we minimiz- ing the chance of an error? Dr. Cummings. Yes. If the information originally placed on tape is precise, accurate, it stays that way. But if, by chance, there is an error on the input side, just as there are in personnel systems and budget systems, that information which may have been erroneous on the first input will stay that way until somebody discovers the error. Mr. Early. Do you have enough money in your budget to com- puterize and store what you think you need to store? Dr. Cummings. Yes. We presently have sufficient money to index and store what our professional advisers judge to be the most important elements of the world's output of medical literature in many different languages. Mr. Early. I think NIH has really improved that situation, in the past several years that I have been here. At least in their effort to disseminate the information. It doesn't do anyone any good if we develop information and don't get it out around the country and around the world. So, I really think there is probably no better conduit than to disperse that information through your Library. Dr. Cummings. Thank you. The gentleman on my right here feels the same way, I think, and I want to personally acknowledge the tremendous support we have had from the Director of NIH in this effort. Mr. Early. He doesn't favor too may things financially, Doctor. He is not a big spender in any way. Thank you, Mr. Chairman. RELATIONSHIP WITH PRIVATE SECTOR Mr. Natcher. All right. Several of your programs, such as training, biomedical communi- cations, improvement of biomedical audiovisuals for health profes- sional education, and programs which provide information to medi- cal schools and health professionals sound as though they could be picked up by the private sector. Can you give us some reasons Doctor, why these programs could not be done by anyone but the National Library of Medicine? Dr. Cummings. Well, let me start by saying that I would be pleased if the private sector could and would pick up some of these programs because there is a national need that exceeds our ability to satisfy the requirements. With regard to training for computers in medicine, the recent meeting sponsored by the National Science Foundation, at which we were represented by Dr. Schoolman and Dr. Riecken, suggests8209675_000020.txt

Page  20 1557 that one of the greatest needs in a modern information society, which now represents about 50 percent of the gross national prod- uct of our country, is a requirement for more trained personnel who are competent and qualified to use computer technology. Medicine is no different than other fields. There has been for a number of years a deficiency in the number of highly-qualified health professionals who know how to capitalize upon the new opportunities offered by computers. We have a modest program which presently supports the train- ing of about 60 health professionals per year in how to organize and represent knowledge and to transmit this knowledge better through the use of computer technologies. These programs exist in 10 institutions throughout the country. They are turning out very highly qualified specialist insofar as we have followed their success. Nearly all of these people are being engaged either as teachers, scientists, or as workers in health-related industries. So there is a market waiting for these people. With regard to the audiovisual aspect of your question, there is in place now a small program at the National Library of Medicine which attempts to acquire and organize the output of many differ- ent health institutions that generate audiovisual materials for teaching and for other purposes. We treat audiovisuals as we treat books and journals. That is to say, we acquire them, we announce their availability, we lend them when they are requested, and on rare occasions, when no such material exists, we collaboratively, with health professional organi- zations, produce them. But we are not major audiovisual producers. We only fill gaps upon request. It is my view, Mr. Chairman, that as modern education develops, more and more learning will take place through audiovisual tech- nology. Medical education is no different from the rest of society in this regard. Therefore, I think that an audiovisual library such as the one that we manage will actually have more use required of it than the present audiovisual facility. I do not see any competitive situation with regard to the private sector. If there are other pertinent parts of your question you would like me to address, I would be glad to know about them. MEDICAL AUDIOVISUAL PROGRAM Mr. Natcher. Now, Doctor, in your justification you mentioned that the National Medical Audiovisual Center has recently moved from Atlanta to the Bethesda campus. How many employees were involved in that move and what will be the effect of having them at Lister Hill? Dr. Cummings. Well, I would start by telling you that I wish that all of the employees who were engaged in the National Medical Audiovisual Center program in Atlanta had moved to Bethesda. It would have made our job a lot easier. In fact, only about 20 of some 70 staff members chose to leave Atlanta to come to Bethesda. So we have been working very hard to recruit highly competent pro- fessional staff to fill the vacancies which existed as a result of that We have now rebuilt the staff of the Center to a level of 58. We think we have, in fact, improved the quality of staff through this8209675_000021.txt

Page  21 1558 effort. We did lose some time during the transition but I should point out that all of our lending services were maintained; we managed to provide audiovisual information throughout the time of the move. Other activities, such as our training, consultation and research activities, did suffer for a period of six or eight months. LISTER HILL CENTER FACILITY Mr. Natcher. Who occupies the new Lister Hill Center at NIH? Is it completely filled now, and tell us if you will, is anyone else other than the National Library of Medicine using this space? Dr. Cummings. I will be pleased to answer those questions. First, the occupants of the Lister Hill Center building include the research and development staff of the Library, which is the Lister Hill Center program; the National Medical Audiovisual Center; our Specialized Information Services which deal with toxicology and pharmacology and the specialized data bases I cited earlier; our extramural program; our grants management team; the Office of Computer and Communication Systems; our large Computer Center is in the new facility; and we have offered the hospitality of that building to the Fogarty International Center. This is a natural thing, I believe, because the Fogarty Interna- tional Center also has a deep involvement with communications and information transfer internationally. We are pleased to be able to share with them one floor of our building. We share the common facilities of our conference rooms, our auditorium and the like. In answer to your question, are we completely full? I would say we are probably 90 to 95 percent fully occupied. There is a small amount of space yet to be developed, but it is a busy place. I would like to offer an invitation to the members of this commit- tee to come visit us to see how it is being utilized. It is a marvelous building. TRAVEL AND TRANSPORTATION COSTS Mr. Natcher. Doctor, turning next to travel, your budget shows a decrease of $7,000 in travel and transportation of persons. Most other agencies and offices are showing an increase in travel. Why a decrease, Doctor? We want to pass this on to the others. Maybe they will follow suit. You know Dr. Fredrickson is here and he will carry the message. What about it, Doctor? o Drl Cummings. I think I will ask, with your permission, Mr. bmith, if he can explain that. Mr. Natcher. Go ahead, Mr. Smith, tell us about that, please? Are you riding second-class now instead of first-class or some- thing? Mr. Smith. Last year when we were in the throes of the move from the National Medical Audiovisual Center, we did have some additional travel that doesn't occur this year and, as a result, we have been able to take that reduction. In addition, I think it is clear this will be a tough travel budget, but we will do the best we can to live within that. Mr. Natcher. All right.8209675_000022.txt

Page  22 1559 On the other hand, the request for transportation of things, that is the way you express it, transportation of things increased over 80 percent, from 31,000 to 57,000. Why this increase in transporta- tion of things? What things are we talking about, Mr. Smith, or any of you gentlemen that want to try that one? Dr. Cummings. I would have to offer a guess and immediately say we will provide it for the record, but I would guess that this is in some way related to the transfer of the materials from our Atlanta facility to Bethesda, but I really don't know the answer. Mr. Natcher. All right. Put that in the record for us. [The information follows:] The increase of $26,000 is related to the costs of relocating the audiovisual materials at the National Medical Audiovisual Center previously located in Atlanta, Georgia. The movement of these materials will be completed in early fiscal year 1982. Mr. Natcher. You are requesting $936,000 for fiscal year 1982 for equipment. This is a 41 percent increase over the fiscal year 1981. Why do you need this for fiscal 1982? Dr. Cummings. This particularly relates to the item I mentioned in my opening statement, called MEDLARS III. We are improving our information services and in the course of doing that we do require new types of equipment which may be used for the han- dling of the information within the National Library of Medicine and for the building of the new system, requirements such as new terminals to access the computer and the like. That is all really related to the new information systems development. GRANTS Mr. Natcher. All right. Now your Library of Medicine grant awards, the request for grants, subsidies and contributions for fiscal year 1982, is $6,770 million. How do you award these grants, Doctor? Dr. Cummings. These grants are awarded in exactly the same way that all NIH grants are awarded: Investigators make application for support of their interests, whether it is research or training. These applications are reviewed by a special study section known as the Biomedical Library Review Committee. They are judged for their technical and scientific merit by this Review Committee. They are then reviewed a second time by the Board of Regents, which examines them for relevance to NLM programs and other related matters. So in essence the small grant program of the NLM simply uses the well-established procedures of the NIH itself. SERVICES FOR PUBLIC HEALTH Mr. Natcher. In the report last year, as you will remember, the committee expressed its desire that more emphasis be given to services which may benefit the public health and less to highly specialized data which only serve the interest and needs of small groups. Could you explain what you have done to carry out the wishes of the committee, Doctor? Dr. Cummings. Well, we have had very extensive relationships develop with the Health Resources Administration and the Health8209675_000023.txt

Page  23 1560 Services Administration to identify literature that they judge to be relevant to public health. We now include within the data bases of the National Library of Medicine more articles and abstracts that are concerned with matters such as public health administration, hospital administration, and the like. We have not reduced the literature-based services because the demands for those services continue to increase. We continue to provide data bases related to pharmacology and toxicology particu- larly, but there is one specialized data base in that category that we are dropping. That is the data base which was designed to bring together information about experimental animals used in science. Because of a lack of support for that data base, it will be aban- doned this year. It is the first data base that we have ever attempt- ed that will be dropped. All others have had steady or rising demands as measured by the user services. Mr. Natcher. Mr. Early? Mr. Early. What would your assessment be of your computer system? Would you say it is poor, fair, good, excellent, or the very best? Dr. Cummings. Last year I would have told you it was in the poor category. I would say it is in the moderately good category now. We have acquired an improved computer system from the Division of Computer Research and Technology at NIH, two and a half times more powerful than the system we had for the past ten years. We believe we can live with this system for another two or three years but it is not the best. Mr. Early. So we have a long way to go? Dr. Cummings. We have a way to go, yes. BIBLIOGRAPHIC ACCESS TO NEGATIVE RESEARCH RESULTS Mr. Early. One other question. In the area of health medicine, regarding storage of knowledge, do we store research that is a failure? The reason for the question is, to me, it would seem to eliminate some research. Dr. Cummings. We store in our data bases those studies that have been reviewed and published. Most of them purport to con- tain new and positive information. Some of them contain negative findings. We treat both kinds of information equally; we don't pass judgment on it. Mr. Early. The failures don't get as much---- Dr. Cummings. I was going to say that most people are not inclined to publish their failures so I would think as, in all disci- plines of science, the literature contributes mostly new information that is a building block to something larger. But one can, I think, examine the literature carefully and good scientists do this to avoid repeating someone else's work. Mr. Early. If someone wanted to experiment with a particular drug and finds out it has already been tried on a specific disease, can you run that through your computers? Dr. Cummings. You can search our files and find the recorded evidence of the use of a drug in a particular disease, but it has to be recorded in some formal way. We can't put in the files what is in the doctor's desk drawer. But if it is in a local or state or8209675_000024.txt

Page  24 1561 national or international journal, that would usually be available in our files. Mr. Early. Your computer is only as good as the knowledge put into it? Dr. Cummings. Exactly. Mr. Early. Again my question, would I be able to find out if the drug did not work in another area? Dr. Cummings. Yes, I think you would find that if you made a careful search of the files, if that had been recorded you would find it. Mr. Early. If it is not recorded, we can't find it. Dr. Fredrickson, are you satisfied that there is enough of that? Dr. Fredrickson. I think, Mr. Early, it is true many scientists do not want to report negative information, but in the instance of drugs, results snowing no effect or poor effect are available in the literature because the researchers are usually comparing one drug to another. Mr. Early. I think that is great. Thank you, Mr. Chairman. Mr. Natcher. Dr. Cummings, we want to thank you and your associates for appearing before our committee in behalf of your budget request for the National Library of Medicine. This has been a good hearing, Doctor. We appreciate your appearance. [The following questions were submitted to be answered for the record:]8209675_000025.txt

Page  25 1562 RESOURCE IMPROVEMENT GRANTS Mr. Natcher. National Library of Medicine awards resource improvement grants to health institutions that do not have adequate libraries and need to develop them. Could you tell us how much you expect to award under this program in FY 1981 and FY 1982? Dr. Cummings. The National Library of Medicine expects to award 37 Resource Improvement Grants for $630,000 in Fiscal Year 1981 and 23 Improvement Grants for $443,000 in Fiscal Year 1982 to individual institutions and to consortia of institutions. Mr. Natcher. Please supply for the record a list of institu- tions receiving support from you under this program and the amount of support for each. Dr. Cummings. Below is a listing of all currently active Resource Improvement Grants which includes awards to single insti- tutions and to consortia. The consortia listings also contain the names of all the participating institutions. MEDICAL LIBRARY RESOURCE IMPROVEMENT GRANTS ACTIVE AS OF APRIL 14, 1981 Single Institution Awards Inst. Name Grant No. City State Zip Total 7LM03200A1 St. Vincent Hospital Santa Fe NM 87501 $4,000 7LM03443 Intercommunity Hospital Fairfield CA 94533 2,500 7LM03453 Perry Memorial Hospital Princeton IL 61356 3,305 7LM03475A1 St. Mary Hospital Quincy IL 62301 4,275 7LM03481 Osteopathic Hospital Wichita KS 67203 4,000 7LM03504 Spencer Municipal Hospital Spencer IA 51301 3,910 7LM03516A1 Benewah Community Hospital St. Maries ID 83861 3,000 7LM03517 Camden Community Hospital Camden ME 04843 4,000 7LM03534 Titus County Memorial Hospital Mt. Pleasant TX 75455 4,400 8209675_000026.txt

Page  26 1563 7LM03561 7LM03566 7LM03567 7LM03598 7LM03604 7LM03620 7LM03628 7LM03672 7LM03676 7LM03716 7LM03717 7LM03718 7LM03729 7LM03731 7LM03752 Passavant Memorial Area Hospital Jacksonville IL 62650 Madera Community Hospital Madera CA 93639 Wilkes General Hospital North Wilkesboro NC 28659 Itasca Memorial Hospital Grand Rapids MN 55744 Fremont Cty. Memorial Hospital Riverton WY 52801 San Fernando Valley Men. Ctr. Van Nuys CA 91405 Fairbanks Memorial Hospital Fairbanks AK 99701 Delaware Valley Medical Center Bristol PA 19007 Memorial Hospital Bainbridge GA 31717 Southwest Washington Hospital Vancouver WA 98668 Elmore Memorial Hospital and Nursing Mountain Home ID 83647 Pittston Hospital Pitts ton PA 18640 Medical Center of Beaver Cty. Beaver PA 15009 Johnson Memorial Hospital Stafford Springs CT 06076 Jamestown Hospital James town ND 58401 $4,000 3,118 4,000 4,350 4,230 3,000 4,450 4,000 4,500 4,000 3,000 4,000 4,000 4,000 4,0008209675_000027.txt

Page  27 1564 CURRENTLY ACTIVE CONSORTIUM IMPROVEMENT GRANT PROGRAM Grant No. Inst. Name City State Zip Total 7LM03233-2 St. Ann's Hospital Watertown SD 57201 $11,982 St. Ann's Hospital Watertown SD 57201 Memorial Medical Center Watertown SD 57201 Jenkins Methodist Home Watertown SD 57201 7LM03237-2 Lake Area Voc. Tech. Inst. Watertown SD Canby Community Hospital Canby MN Canby Community Hospital Canby MN Appleton Municipal Hospital Appleton MN 57201 56220 56220 56208 Chippewa Cty-Montevideo Hospital Montevideo MN 56265 Divine Providence Hospital Ivanhoe MN 56142 30,000 Granite Falls Municipal Hospital Granite Falls MN 56241 Holy Trinity Hospital Graceville MN 56240 Johnson Memorial Hospital Dawson MN 56232 Ortonville Area Health Services Ortonville MN 56278 Stevens Cty. Memorial Hospital Morris MN 562678209675_000028.txt

Page  28 1565 7LM03239 Primary Children's Med. Ctr. Salt Lake City UT 84103 Primary Children's Med. Ctr. Salt Lake City UT 84103 LDS Hospital Salt Lake City UT 84143 Davis County Mental Health Center Farmington UT 84025 Granite Community Mental Health Salt Lake City UT 84115 Holy Cross Hospital Salt Lake City UT 84102 Lakeview Hospital Bountiful UT 84010 Valley West Hospital Granger UT 84120 $24,400 7LM03275 Somerset State Hospital Somerset PA 15501 Somerset State Hospital Somerset PA 15501 38,000 Somerset Community Hospital Somerset PA 15501 Memorial Hospital Bedford County Everett PA 15537 Meyersdale Community Hospital Meyersdale PA 15552 Bedford-Somerset MH/HR Somerset PA 15501 Somerset Co. Area Vo-Tech Sch. Somerset PA 15501 Bedford-Somerset Drug & Alco. Somerset PA 155018209675_000029.txt

Page  29 1566 7LM03297 St. Luke's Hospital Aberdeen SD 57401 $17,753 St. Luke's Hospital Aberdeen SD 57401 Dakota Midland Hospital Aberdeen SD 57401 Mobridge Community Hospital Mobridge SD 57601 Presentation College Library Aberdeen SD 57401 Northeastern Mental Health Center Aberdeen SD 57401 7LM03314 Bannock Memorial Hospital Pocatello ID 83201 60,485 Bannock Memorial Hospital Pocatello ID 83201 Consolidated Hospitals Idaho Falls Idaho Falls ID 83401 Magicvalley Men. Hospital Twin Falls ID 83301 Power County Hospital American Falls ID 83211 Host Rivers Memorial Hospital Arco ID 83213 Cassia Memorial Hospital Burley ID 83318 Bingham Memorial Hospital Blackfoot ID 83221 St. Anthony Community Hospital Pocatello ID 83201 Teton VAlley Hospital Driggs ID 83422 Blaine County Hospital Hailey ID 833338209675_000030.txt

Page  30 1567 Oneida County Hospital Malad City ID 83252 St. Benedicts Hospital Jerome ID 83338 Madison Memorial Hospital Rexburg ID 83440 Bear Lake Memorial Hospital Montpelier ID 83254 Franklin County Hospital Preston ID 83263 Fremont General Hospital St. Anthony ID 83445 Minidoka Memorial Hospital Rupert ID 83350 Moritz Community Hospital Sunvalley ID 83353 Carbou Memorial Hospital Soda Springs ID 83276 7LM03316 North County Res. Council Canton NY 13617 A Barton Hepburn Hospital Ogdensburg NY 13669 Clinton Community College Plattsburgh NY 12901 Edward John Noble Hospital Alexandria Bay NY 13607 $67,500 SUNY Plattsburgh Plattsburgh NY 12901 General Hospital/Saranac Lake Saranac Lake NY 12983 House of the Good Samaritan Watertown NY 13601 Jefferson Community College Watertown NY 13601 Lewis County General Hospital Louville NY 133678209675_000031.txt

Page  31 1568 Massena Memorial Hospital Massena NY 13662 Mercy Hospital of Watertown Watertown NY 13601 North Country Comm. College Saranac Lake NY 12983 Oswego Hospital Oswego NY 13216 St. Lawrence Psychiatric Ctr. Ogdensburg NY 13669 Samaritan-Keep Nursing Home Watertown NY 13601 Sunmount Developmental Center Tupper Lake NY 12986 SUNY Canton AG & Tech.College Canton NY 13617 Trudeau Institute Saranac Lake NY 12983 Walton Jones Cell. Sci. Ctr. Lake Placid NY 12946 7LM03323 Anaheim Memorial Hospital Anaheim CA Anaheim Memorial Hospital Anaheim CA American Red Cross Santa Ana CA Canyon General Hospital Anaheim CA Golden West College Huntington Beach CA Good Samaritan Hospital Anaheim CA Long Beach Neuropsych. Inst. Long Beach CA Martin Luther Hospital Anaheim CA 92801 92801 92705 92807 92647 92805 90805 92801 $21,5208209675_000032.txt

Page  32 1569 Mercy General Hospital Santa Ana CA 92704 Saddleback Community Hospital Laguna Hills CA 92653 St. Joseph & Childrens Hospital Orange CA Sant Ana - Tustin Com. Hosp. Santa Ana CA Santa Ana College Santa Ana CA UCI Medical Center Orange CA 92668 92705 92706 92668 U. California Irvine Sch. Med. Irvine CA 92717 7LM03324 Lincoln Medical Edu. Fdn. Lincoln NB 68510 VA Hospital Lincoln NB St. Mary's Hospital Nebraska City NB 68510 68410 Nemaha County Hospital Auburn NB 68305 Community Hospital, Inc. Falls City NB Beatrice Community Hospital Beatrice NB Pawnee City Memorial Hospital Pawnee City NB Annie Jeffrey Memorial Hospital Osceola NB Butler County Hospital David City NB Memorial Hospital, Inc. Schuyler NB Memorial Hospital - Dodge Cty. Fremont NB 68355 68310 68420 68651 68632 68661 68025 $23,2008209675_000033.txt

Page  33 1570 Saunders County Comm. Hosp. Wahoo NB 68066 Jefferson County Mem. Hospital Fairbury NB Fillmore County Hospital Geneva NB 68352 68361 York General Hospital York NB 68467 Memorial Hospital Seward NB 68434 Crete Municipal Hospital Crete NB 68333 Henderson Community Hosp., Henderson NB Inc. 68371 Beatrice Lutheran Hospital Beatrice NB 68310 7LM03326 Presbyterian Hospital Oklahoma City OK Presbyterian Hospital Oklahoma City OK Baptist Med. Ctr. of Oklahoma Oklahoma City OK Bethany General Hospital Bethany OK Community Hospital Kingfisher OK Deaconess Hospital Oklahoma City OK Edmond Memorial Hospital Edmond OK Hlllcrest Osteopathic Hospital Oklahoma City OK Logan County Health Center Guthrie OK 73104 73104 73112 73008 73750 73112 73034 73119 73044 $71,1508209675_000034.txt

Page  34 1571 Mercy Health Center Oklahoma City OK 73120 Midwest City Mem. Hospital Midwest City OK 73110 Norman Municipal Hospital Norman OK 73070 Oklahoma U. Hlth. Sci. Ctr. Oklahoma City OK 73125 Oklahoma Medical Research Fdn. Oklahoma City OK 73104 Saint Anthony Hospital Oklahoma City OK South Community Hospital Oklahoma City Ok VA Medical Center Oklahoma City OK 73102 73109 73104 Oklahoma Cerebral Palsy Center Norman OK 73070 7LM03451A2 Catawba-Wateree Health Educ. Rock Hill SC 29730 Catawba-Wateree Hlth. Educ. Rock Hill SC 29730 Chester County Hospital Chester SC 29706 Divine Saviour Hospital York SC 29745 Elliott White Springs Hospital Lancaster SC 29720 Kershaw County Memorial Hosp. Camden SC 29202 USC-Lancaster Lancaster SC 29730 Winthrop College Rock Hill SC 29733 York General Hospital Rock Hill SC 29730 $27,600 York Technical College Rock Hill 297308209675_000035.txt

Page  35 1572 7LM03452 St. Patrick Hospital Lake Charles LA St. Patrick Hospital Lake Charles LA Oakdale General Hospital Oakdale LA Allen Parrish Hospital Kinder LA Merryville General Hospital Merryville LA Welsh General Hospital Welsh LA 70601 70601 71463 70658 70653 70591 Jennings American Legion Hospital Jennings LA 70546 Lake Charles Memorial Hospital Lake Charles LA 70601 South Cameron Memorial Hospital Cameron LA Beauregard Memorial Hospital Deridder LA Moss Regional Hospital Lake Charles LA Dequincy General Hospital Dequincy LA 70631 70634 70605 70633 West Calcasieu-Cameron Hospital Sulphur LA 70663 $19,822 7LM03460-2 East End Memorial Hospital Birmingham AL 35206 East End Memorial Hospital Birmingham AL 35206 Brookwood Medical Center Birmingham AL 35209 6,883 South Highlands Hospital Birmingham AL 352058209675_000036.txt

Page  36 1573 7LM03595 Indiana State University Terre Haute IN Indiana State University Terre Haute IN Union Hospital Terre Haute IN Terre Haute Regional Hospital Terre Haute IN Katherine Hamilton MH Center Terre Haute IN 47809 $20,225 47809 47804 47808 47804 7LM03597 Mercy Hospital Port Huron Mercy Hospital Port Huron MI MI Harbor Beach Comm. Hospital Harbor Beach MI Deckerville Comm. Hospital Deckerville MI 48060 48060 48441 48427 29,967 McKenzie Memorial Hospital Sandusky MI 48471 River District Hospital St. Clair MI 48079 Port Huron Hospital Port Huron MI St. Clair Comm. College Port Huron MI 48060 48060 7LM03615 Natividad Medical Center Salinas CA 93902 22,350 Natividad Medical Center Salinas CA 93902 Allsal Community Salinas CA 939028209675_000037.txt

Page  37 1574 Community HospitaL Santa Cruz Santa Cruz CA 95062 Eskaton Monterey Hospital Monterey CA 93940 George L Mee Memorial Hospital King City CA 93930 Hazel Hawkins Memorial Hospital Hollister CA 95023 Salinas Valley Memorial Hospital Salinas CA 93901 Watsonvllle Community Hospital Watsonvllle CA Cabrlllo College Aptos CA Gavilan College Gilroy CA Hartnell College Salinas CA Monterey Peninsula College Monterey CA U. California Santa Cruz Santa Cruz CA 95076 95003 95020 93901 93940 95064 U.S. Naval Postgraduate School Monterey CA 93940 Monterey Bay Area (Mobac) Salinas CA 93901 7LM03649-2 Peach County Hospital Fort Valley GA Peach Valley Hospital Fort Valley GA Houston County Hospital Warner Robins GA Memorial Hospital Wash Cty Sandersville GA Perry-Houston County Hospital Perry GA 31030 31030 31093 31082 31069 $14,0008209675_000038.txt

Page  38 1575 7LM03678 Cuesta College San Luis Obispo Cuesta College San Luis Obispo CA CA Atascadero State Hospital Atascadero CA 93406 $27,702 93406 93422 California Men's Colony San Luis Obispo CA California Polytechnic Univ. San Luis Obispo CA California Polytechnic Health San Luis Obispo CA French Hospital San Luis Obispo CA Sierra Vista Hospital San Luis Obispo CA Paso Robles Public Library Paso Robles CA San Luis Obispo City-Cty Lib. San Luis Obispo CA San Luis Obispo Cty. Gen Hosp. San Luis Obispo CA San Luis Obispo Cty Hlth Dept San Luis Obispo CA 93409 93407 93407 93406 93401 93446 93406 93401 93401 San Luis Obispo Comm. Men. Hlth. San Luis Obispo CA 93401 Twin Cities Comm. Hospital Templeton CA 93465 7LM03696 Rockingham Community College Wentworth NC 27375 Rockingham Community College Wentworth NC 27375 18,487 Morehead Memorial Hospital Eden NC 272888209675_000039.txt

Page  39 1576 Annie Penn Memorial Hospital Reidsville NC 27320 Rockingham County Men. Health Wentworth NC 27375 Rockingham County Health Dep. Eden NC 27288 Rockingham County Public Library Eden NC 27288 7LM03737-2 Saint Mary's Hospital Pierre SD 57501 $23,007 Saint Mary's Hospital Pierre SD 57501 Mid Dakota Hospital Chamberlain SD 57325 Faulk County Memorial Hospital Faulkton SD 57438 Hand County Memorial Hospital Miller SD 57362 Baptist Hospital of Winner Winner SD 57580 Maryhouse Incorporated Pierre SD 57501 Pierre Sch/Practical Nursing Pierre SD 57501 Missouri Valley Maternal Pierre SD 57501 River Park Incorporated Pierre SD 57501 7LM03738 Central Wyoming College Riverton WY 82501 11,400 Central Wyoming College Riverton WY 82501 Fremont Counseling Service Lander WY 825208209675_000040.txt

Page  40 1577 Wyoming State Training School Lander WY 82520 Bishop Randall Hospital Lander WY 82520 Fremont Cty. Memorial Hospital Riverton Wy 82501 7LM03744 Laramie County Community College Cheyenne WY 82001 $22,922 Laramie County Community College Cheyenne WY 82001 Family Pract. Residency Prog. Cheyenne WY Community Hospital Torrington Depaul Hospital Cheyenne WY WY Ivanson Memorial Hospital Laramie WY 82001 82240 82001 82070 Memorial Hosp. Laramie County Cheyenne WY 82001 Platte Cty. Mem. Hosp/Nursing Wheatland WY 82201 Southeast Wyom. Men. Hlth. Ctr. Cheyenne WY 82001 7LM03751-2 Eastern Oregon State College Lagrande OR Eastern Oregon State College La Grande OR Wallowa Memorial Hospital Enterprise OR Umatilla Hospital Umatilla OR Blue Mountain Comm. College Pendleton OR 97850 97850 97828 97882 97801 20,4898209675_000041.txt

Page  41 1578 Good Shepherd Hospital Hermiston OR 97838 Treasure Valley Comm. College Ontario OR 97914 Pendleton Community Hospital Pendleton OR 97801 Holy Rosary Hospital Ontario OR 97914 Malheur Memorial Hospital Nyssa OR 97913 Grande Ronde Hospital La Grande OR 97850 Pioneer Memorial Hospital Heppner OR 97836 St. Elizabeth Community Hosp. Baker OR 97814 MEDICAL LIBRARY ASSISTANCE GRANTS Mr. Natcher. The resource project grants, training grants, publication grants and special scientific projects seem to be geared to training and continuing education programs for health professionals. Is this type of training and education consonant with the research mission of the NIH? Dr. Cummings. Our grant programs contribute to the national health effort by facilitating access and distribution of health knowledge. These efforts are an invaluable adjunct to well-designed continuing education activities of many kinds, but only as a supportive resource for they serve other needs as well. Our Resource Project Grants strengthen health libraries by pro- viding funds for carefully designed, locally initiated information activities. In this way health practitioners everywhere potentially have the same access to the health literature as academic medical center faculty and staffs. Our grants have stimulated local support and have helped create an efficient, far-reaching network of medical library services. Our publication efforts (Publication Grants and Special Scienti- fic Projects) assist qualified individuals in the preparation of needed, useful scholarly materials. The results of these efforts — critical reviews, compendia, bibliographies, and major treatises — yield organized, integrated treatments of complex, expanding literatures that help readers make sense of a bewildering variety of knowledge. These grants support the intellectual labor of scholars whose completed manuscripts are welcomed by the publishing industry.8209675_000042.txt

Page  42 1579 Our Training Program Grants expedite the adaptation of the com- puter sciences to health needs by helping current and potential clini- cal leaders, among others, acquire in-depth knowledge of computer science and technology. The health computer sciences are emerging as a small but independent discipline. Our programs make it possible for talented individuals to acquire research skills in a disci- pline highly important to the future of health care. We believe that these efforts are entirely consistent with the goals of the National Institutes of Health; they serve to make the knowledge gained from national research efforts more rapidly and broadly available to the entire health community. They are a vital adjunct to research, education, and health care. Mr. Natcher. Couldn't these types of programs be supported by medical schools, professional societies, or physicians themselves, perhaps even on a reimbursable basis? Dr. Cummings. The initial Resource Project Grant support of $4,000 per library must be matched by one thousand dollars of institutional funds. In the training grant program the grantees have been providing support for approximately two-thirds of the institutional and indirect costs. In addition, industry is paying part of the costs of these programs which relate to their special needs; however, professional societies have been unable to support any of these costs. Mr. Natcher. Could you give us the FY 1981 and FY 1982 totals for each of these programs? Dr. Cummings. The National Library of Medicine has projected the following support levels for these programs for FY 1981 and FY 1982. , . 1981 1982______ (Dollars in thousands) No7~of No. of Programs Awards Amt. Awards Amt. Resource Projects.......... 27 $1,375 17 $746 Training Grants............ 10 879 8 754 Special Scientific Projects................. 31 820 24 690 Publication Support........ 5 178 3 918209675_000043.txt

Page  43 1580 LIBRARY SERVICE PRIORITY Mr. Natcher. Last year you told us that your budget reflected the fact that you had given the highest priority to the library service component of the National Library of Medicine. Is that priority the same for FY 1982? Dr. Cummings. Providing library services continues to be the most important function of the Library and maintains the highest priority. The impact of budget restraints and inflation on resources in medical libraries has resulted in greater dependence of small libraries and the health care practitioner on the National Library of Medicine's resources. In order to be responsive to these demands the Library has placed the highest priority on acquisitions, cata- loging and document delivery. It has also placed as a top priority the development of MEDLARS III which will automate and integrate many of the technical processing functions within the Library as well as providing better access for health practitioners to its resources. MEDICAL INFORMATION RESEARCH Mr. Natcher. You also told us that the computer industry is heavily involved in medical information systems research. Is it possible that much of what the National Library of Medicine stimulated in previous years in this field could be supported totally in the private sector? If not, why not? Dr. Cummings. The National Library of Medicine's research in medical information handling does not compete with the private sector nor would it be taken over by the private sector. Rather, they complement each other. Industry's interest is where there is a market for their products. Thus, in this broad arena they have invested heavily in hospital management systems, clinical laboratory data management and the development of high technology to support such endeavors; e.g., computerized axial tomography. American indus- try also develops the tools and equipment which we purchase to give service. The National Library of Medicine's program supports research in knowledge representation, data base management, interactive retrieval systems, medical nomenclature and natural language interfaces. This work is carried on both intramurally and at universities. The know- ledge gained by these investigations is widely and publicly reported and thereby contributes importantly to developments in the private sector.8209675_000044.txt

Page  44 1581 JUSTIFICATION OF BUDGET ESTIMATES DEPARTMENT OF HEALTH AND HUMAN SERVICES NATIONAL INSTITUTES OF HEALTH National Library of Medicine FY 1982 Budget Page No. Appropriat ion language.............................................. 236 Amounts available for obligation.................................... 237 Budget mechanism table.............................................. 238 Crosswalk tables.................................................... 239 Summary of changes.................................................. 241 Budget authority by activity........................................ 243 Budget authority by object.......................................... 244 Authorizing legislation............................................. 245 Table of estimates and appropriations............................... 246 Justification: A. Narrative: 1. General Statement........................................ 247 2. Activities: a. Medical library assistance........................... 249 b. Intramural research.................................. 252 c. Direct operations.................................... 261 d. Program management................................... 2628209675_000045.txt

Page  45 1582 Department of Health and Human Services National Library of Medicine To carry out, to the extent not otherwise provided for, section 301 with respect to health information communica- tions and parts I and J of title III of the Public Health Service Act, [$44,730,000] $47,677,0008209675_000046.txt

Page  46 1583 DEPARTMENT OF HEALTH AND HUMAN SERVICES NATIONAL INSTITUTES OF HEALTH National Library of Medicine Amounts Available for Obligation — 1980 Actual Appropriation.................. $44,000,000 Rescission (P.L. 96-304)....... - 21,000 Proposed Rescission............ --- Proposed supplemental (October 1980 pay raise)....... _____--- Total, adjusted appropriation.................. $43,979,000 1981 1982 Estimate Estimate $44,730,000 $47,677,000 -- -- - 341,000 -- + 799.000 __ $45,188,000 $47,677,000 1/ Excludes the following amounts for reimbursable activities carried ~ out by this account: 1980 - $2,468,000; 1981 - $3,500,000; 1982 - $3,800,000.8209675_000047.txt

Page  47 1584 NATIONAL LIBRARY OF MEDICINE Budget Mechanism 1981 Estimate 1982 Estimate No. Amount Medical Library Assistance Grants Noncompeting.................... Competing....................... Subtotal, MLA Grants............ Medical Library Assistance Contracts Noncompeting.................... Competing....................... Subtotal, MLA Contracts......... Total, MLA...................... Intramural...................... Lister Hill National Center for Biomedical Communications. National Medical A/V Center... Library Operations............ Toxicology Information........ Direct Operations............... Program Management.............. Total, Budget Authority...... 67 62 129 10 10 139 4,722,000 2,109,000 60 37 6,831,000 97 3,000,000 10 3,000,000 10 9,831,000 107 4,606,000 1,144,000 5,750,000 3,175,000 3,175,000 8,925,000 Pos. Pos. 421 30,413,000 421 33,485,000 (47) (5,150,000) (47) (5,485,000) (76) (4,193,000) (76) (4,163,000) (276) (17,847,000) (276) (20,142,000) (22) (3,218,000) (22) (3,695,000) 24 1,852,000 24 1,937,000 50 3,092,000 50 495 3.330.000 495 45,188,000 47,677,000 8209675_000048.txt

Page  48 DHHS - NATIONAL INSTITUTES OF HEALTH Crosswalk - 1981 Column of 1982 Congressional Justification National Library of Medicine (Dollars in Thousands) Mechanism Program Activity Medical Library Assistance...... Intramural...................... Lister Hill National Center for Biomedical Communications....... National Medical Audiovisual Center.......................... Library Operations.............. Toxicology Information.......... Direct Operations............... Program Management.............. Total, Budget Authority......... Medical Library Assistance Grants Contracts Intramural Direct Operations Program Mgmt. Total $6,831 $3,000 30,413 $9,831 30,413 (5,150) (5,150) CO C7» (4,198) (4,193) (17,847) (17,847) (3,218) 1,852 3,092 (3,218) 1,852 3,092 $6,831 $3,000 $30,413 $1,852 $3,092 $45,1888209675_000049.txt

Page  49 DHHS - NATIONAL INSTITUTES OF HEALTH Crosswalk - 1982 Congressional Justification National Library of Medicine (Dollars in Thousands) Program/Ac t ivi ty Medical Library Assistance.... Intramural.................... Lister Hill National Center for Biomedical Communications. National Medical Audiovisual Center........................ Library Operations............ Toxicology Information........ Direct Operations............ Program Management........... Total, Budget Authority...... Medical Library ____Assistance____ Grants Contracts $5,750 $3,175 Intramural $33,485 (5,485) (4,163) (20,142) (3,695) Direct Operations 1,937 Program Mgmt. 3.339 Total $8,925 33,485 (5,485) (4,163) (20,142) (3,695) 1.937 3.330 $5,750 $3,175 $33,485 $1,937 $3,330 $47,6778209675_000050.txt

Page  50 1587 Summary of Changes 1981 Estimated Budget Authority............................... $ 45,188,000 1982 Estimated Budget Authority............................... 47,677,000 Net Change............................... $ 2.489,000 1981 Base Change from Base __________________________________Pos._____Amount______Pos . Amount Increases: A. Built-in: 1. Within-grade pay increases.. - 2. Annualization of 1981 pay raise..............., 3. FTS rate increase....... 4. Increased costs of service and supply...... 5. Payment for centrally furnished services...... 6. Federal Employees Compensation Fund (FECF) Increase................ 7. Wage board salary increases............... 8. Senior Executive Service bonus pay............... Subtotal............. — — -- $ + 195,000 — 1,093,000 184,000 -- + + 18,000 2,000 — 248,000 -- + 52,000 — 3,516,000 -- + 248,000 — 178,000 -- + 2,000 77,000 -- + 5,000 __ 35,000 __ + 64,000 . — -- -- + 586,000 Program: 1. Medical Library Assistance - Noncompeting continuation cost increase.............--- 9,831,000 2. Intramural - Increased cost of ser- vices and supplies........--- 30,413,000 - Sycor terminals...........--- --- MEDLARS III...............--- --- - Chemical Substance Infor- mation Network............--- 3. Direct Operations - Increased cost of ser- vices and supplies........--- 1,852,000 4. Program Management - Increased cost of ser- vices and supplies........---_____3.092.000 Subtotal.................--- Total increases...........--- 499,000 1,273,000 20,000 1,345,000 341,000 72,000 172,000 3,722,000 4,308,0008209675_000051.txt

Page  51 1588 Summary of Changes (cont.) 1981 Base Pos. Change from Base Pos. Amount Decreases: B. Program: 1. Medical Library Assistance Resource Grants............ 2. Intramural - Lister Hill Center - Consultant Services.... - Nat'l Medical A/V Center - Personnel costs reduction.............. - Library Operations - Travel reduction....... Total decreases.......... Net Change............... $1,405,000 338,000 $ - 1,405,000 86,000 2,218,000 -- 321,000 __ 75,000 __ 7,000 — -- -- $ - 1,819,000 — -- -- $ 2,489,000 8209675_000052.txt

Page  52 1589 Budget Authority by Activity 1980 Actual 1981 Estimate Pos. Amount 1982 Estimate Pos. Amount Pos. Amount Medical Library Assistance............. --- $9,925,000 --- $9,831,000 --- $8,925,000 Intramural............ 421 29,496,000 421 30,413,000 421 33,485,000 Lister Hill National Center for Biomedical Communications........ (47) (5,554,000) (47) (5,150,000) (47) (5,485,000) National Medical Audiovisual Center___ (76) (4,350,000) (76) (4,198,000) (76) (4,163,000) Library Operations___ (276) (16,224,000) (276) (17,847,000) (276) (20,142,000) Toxicology Information........... (22) (3,368,000) (22) (3,218,000) (22) (3,695,000) Direct Operations..... 24 1,808.000 24 1,852,000 24 1,937,000 Program Management............ 50 2,750.000 50 3.092.000 50 3.330.000 Total, 1^ Budget Authority...... 495 43,979,000 495 45,188,000 495 47,677,000 (Standard Level Users Charge)......... (415,000) (383,000) (278,000) 1/ Includes a proposed supplemental of $799,000 for pay raise costs.8209675_000053.txt

Page  53 1590 Budget Authority by Object 1981 Estimate 1982 Estimate Increase or Decrease Total number of permanent positions.......................... 495 Full-time equivalent of all other positions................ 74 Total compensable work years..............................______571 Personnel compensation: Permanent positions............. $12,782,000 Positions other than permanent..................... 1,354,000 Other personnel compensa- tion.......................... 197,000 Subtotal, personnel compensation................. 14,333,000 Personnel benefits................ 1,469,000 Travel and transportation of persons........................ 226,000 Transportation of things.......... 31,000 Rent, communications and utilities......................... 1,214,000 Printing and Reproduction......... 744,000 Other services: Project contracts............... 8,680,000 Payment for centrally furnished services............ 3,133,000 Standard level users charge........................ 383,000 Other........................... 4,018,000 Supplies and materials............ 496,000 Equipment......................... 664,000 Literature........................ 1,946,000 Grants, subsidies & contributions................... 7,851,000 Total, budget authority by ob j ec t......................... $45,188,000 495 78 582 + 4 +11 $12,779,000 1,439.000 192,000 $14,410,000 1,473,000 219,000 57,000 1,436,000 846,000 10,400,000 3,486,000 278,000 4,727,000 601,000 936,000 2,038,000 6,770,000 $ - 3,000 + 85,000 5,000 + 77,000 + 4,000 7,000 + 26,000 + 222,000 + 102,000 +1,720,000 + 353,000 - 105,000 + 709,000 + 105,000 + 272,000 + 92,000 -1.081,000 $47,677,000 $2,489,0008209675_000054.txt

Page  54 1591 Authorizing Legislation 1981 1982 1982 Amount 1981 Amount Budget Authorized Estimate Authorized Request Public Health Service Act Public Health Service Act, Title III, Part I Sec. 381 - Purpose and Establishment of ... Library........... Indefinite $35,357,000 Indefinite $38,752,000 Public Health Service Act, 390-397 - Assistance to Medical Libraries............ S18.500.000 9.831.000_______1/--------8,925,000 Total, Budget Authority............ $45,188,000 $47,677,000 1/ Authorization legislation pending.8209675_000055.txt

Page  55 1592 National Library of Medicine Comparable Estimate House Senate Year To Congress Allowance Allowance Appropriation 1971 $19,769,000 $19,843,000 $22,307,000 $20,843,000 1972 21,931,000 22,781,000 25,086,000 24,086,000 1973 24,994,000 28,488,000 28,988,000 28,488,000 1/ 1974 24,994,000 25,796,000 25,796,000 25,426,000 1/ 1975 27,738,000 28,048,000 29,348,000 28,848,000 1976 28,815,000 28,994,000 29,744,000 29,244,000 Transition 6,572,000 6,572,000 6,572,000 6,572,000 1977 35,234,000 35,234,000 35,234,000 35,234,000 1978 36,746,000 37,619,000 36,619,000 37,619,000 11 1979 39,774,000 39,874,000 42,987,000 41,431,000 A/ 1980 41,431,000 42,431,000 44,000,000 44,000,000 5/ 1981 44,730,000 44,730,000 47,730,000 44,730,000 6/ Supplemental 799,000 Rescission 341,000 1982 47,677,000 1/ This appropriation authority was the continuing resolution. The appropria- tion amount was the House Allowance, which was the lower of the House or Senate amounts in the first vetoed bill. 2/ Appropriation after reduction as authorized by P.L. 93-192. 3/ This appropriation authority was the continuing resolution. The appropriation amount was the Conference Allowance, plus $873,000 for pay raise Supplemental. 4/ This appropriation authority was the continuing resolution. The appropria- tion amount was the Conference Allowance. 5/ This appropriation authority was the continuing resolution. The appropria- tion amount was the Conference Allowance. 6/ This appropriation authority was the continuing resolution. The appropria- tion amount was the Conference Allowance.8209675_000056.txt

Page  56 1593 Justification National Library of Medicine FY 1981 Revised FY 1982 Increase or Estimate Estimate Decrease Pos. B.A. Pos. B.A. Pos. B.A. Med'l Library Assistance......... --- 9,831,000 --- 8,925,000 --- - 906,000 Intramural......... 421 30,413,000 421 33,485,000 --- + 3,072,000 Lister Hill Nat'l Center for Bio- medical Communi- cations.......... (47) (5,150,000) (47) (5,485,000) --- + (335,000) Nat'l Medical A/V Center....... (76) (4,198,000) (76) (4,163,000) --- - (35,000) Library Operations....... (276) (17,847,000) (276) (20,142,000) --- +(2,295,000) Toxicology Information...... (22) (3,218,000) (22) (3,695,000) — + (477,000) Direct Operations......... 24 1,852,000 24 1,937,000 --- + 85,000 Program Management......... 50 3,092.000 50 3,330,000 --- + 238,000 Total............ 495 45,188,000 495 47,677,000 — +2,489,000 General Statement The National Library of Medicine serves as the nation's principal resource for information support of biomedical research, health professional education, and the delivery of health care services in both the private and the public sectors. Users include commercial and industrial organizations, hospitals and other health care institutions, academic institutions such as medical, dental, and nursing schools, and research organizations, as well as individual scientists, clinicians, and other health professionals. The National Library of Medicine (NLM) appropriations provide support for programs to assist the advancement of medical and related sciences through the collection, dissemination and exchange of information important to the progress of medicine and health. The mission of NLM is carried out through several programs: the Medical Library Assistance Act supports pro- grams throughout the country to improve the provision of information to health professionals, including the development of medical library resources, research and training in biomedical communications and biomedical librarian- ship, the Regional Medical Library Network and the publication of medical/ scientific works; the Lister Hill National Center for Biomedical Communica- tions conducts research and development in the application of computer and communications technologies for improved health care delivery and to aid health professional education; the National Medical Audiovisual Center improves the quality and use of biomedical audiovisuals for primary and continuing health professional education; Library Operations acquires, preserves, organizes and disseminates biomedical literature; and the Toxicology Informa- tion Program improves information transfer for the protection of health by developing communications systems for toxicological and pharmacological information.8209675_000057.txt

Page  57 1594 The research scientist uses NLM resources to locate scientific and technical information (either as a direct user of NLM or through the Regional Medical Library Network) through data bases such as MEDLINE and TOXLINE. The results of research must be disseminated to the scientific community if they are to be effectively utilized. Research projects culminate In published results which are acquired, organized and distributed by the NLM. The Library provides bibliographic references to the literature through printed indexes and special bibliographies and the actual article can be secured through a national document delivery network. As an example of these services, NLM provides 1.8 million computer searches of its data bases, such as MEDLINE, to over 1,500 user institutions each year. NLM online bibliographic search services account for roughly half of all the computer-based literature search- ing in the U.S. Its library network provides more than a million loans annually. In developing the 1982 budget request, special consideration was given to maintaining basic library services and developing a research program to improve information and knowledge transfer for biomedical scientists, practi- tioners and educators. The initiatives emphasized include the development of MEDLARS III, which will be a computer-based system for library and information services directed towards improving and enhancing NLM's services to the health professional community. The development of a research program to make optimal use of the capabilities afforded by the new Lister Hill Center is also a high priority.8209675_000058.txt

Page  58 1595 Medical Library Assistance Title III, Part J, Sec. 393-397 (most recently extended by P.L. 95-622) Title II, Biomedical Research and Research Training Amendments of 1978. FY 1981 FY 1982 Estimate Revised Budget Increase Estimate_____ Authority Or Decrease Pos. Amount Authorization Pos. Amount Pos. Amount $9,831,000 1/ --- $8,925,000 --- $ -906,000 Purpose and method of operation - The Medical Library Assistance Programs of the National Library of Medicine provide support for the establishment, development, and enhancement of health information services for health pro- fessionals throughout the country. Support is given to health professions educators, clinicians, researchers, and medical librarians to conduct activi- ties that will improve and promote the dissemination of health care information. The Regional Medical Library Program is a national network of libraries which provide information services to health care practitioners, biomedical research- ers, teachers, and students. Resource Improvement Grants support the develop- ment of basic book and journal collections and promote local resource sharing. Resource Project Grants complement the activities of the Regional Medical Library Program by assisting libraries to initiate, expand, or improve library services. Research Grants support investigations into more effective dissemina- tion of health knowledge, with current emphasis on the use of computers and other information technology by health care professionals. Training Grants promote the integration of computer technology into clinical medicine, teaching, research, and practice. Publication Grants support publication of non-profit works with significance to health efforts, Including critical reviews, historical studies of medicine, and bibliographic or other reference sources. Special Scientific Projects aid distinguished scholars in the writing of treatises on major health subjects. These seven programs have been the common net purpose of improving the communication of Information to health professionals throughout the country. Rationale for the Budget Request - The 1982 Budget Estimate for the Medical Library Assistance Program and awards represents a decrease of $906,000 and a decrease of 32 awards. Regional Medical Library Program - The National Library of Medicine has esta- blished the Regional Medical Library Network which consists of health science libraries throughout the country. This Interconnection of libraries makes it possible for health professionals to have access to the world's biomedical literature, as well as to obtain reference services and audiovisual materials. The Network provides library services such as lending materials between libraries, searching online bibliographic data bases to retrieve references to journal literature, and providing acquisition and cataloging information to other libraries. Each of the eleven Regional Medical Libraries coordinates 1/ Legislation pending.8209675_000059.txt

Page  59 1596 information delivery services within its own region and cooperates with libra- ries throughout the Network to provide a total of nearly 2 million interlibrary loans annually. The National Library of Medicine through the RML Network develops programs to improve network performance, to aid cooperation with other networks to reduce duplication of efforts, and to provide a continual evaluation of the network's effectiveness and direction. Resource Improvement Grants - This program is directed at those health institu- tions that do not have adequate libraries and need to develop them. Funds are made available for a core collection of biomedical literature that will support the information needs of the health professionals and education pro- grams of the institution. Another goal is to encourage the formation of consortia among local health-related institutions in order to promote resource sharing and thus avoid duplication of effort and enrich the Interchange of information among institutions. For example, a resource improvement grant to a California medical center is providing funds to aid in the development of a 15 member consortium of institutions located in four counties in a geographi- cally and demographically diverse area. This consortium is sharing health science information among its members: a public library system, two universi- ties, four colleges, and eight hospitals. Another improvement grant is helping to support the development of the Northern New York Health Information Coopera- tive (with state resources as well) which is benefitting health professionals in 18 institutions in a rural and isolated area by providing access to a variety of information services and resources that would not be readily available to single Institutions. Resource Project Grants - These grants support activities that initiate or improve information services provided by established health science libraries. Resource projects emphasize access to the full range of information media through resource sharing networks and facilitate improvements in library methods and technology which directly or Indirectly impact on direct services to users. For example, resource project grants are helping to establish statewide bio- medical information networks in Montana, Idaho, and Oregon. A recent report from the Ida-Heal-Net in Idaho indicates that in a year's time information disse- mination has grown considerably. MEDLINE searches increased two and one-half times (1,200 to 3,000) and interlibrary loans increased from 8,500 to 10,000 through network and resource sharing; 67% of the referrals can now be filled in the state and do not have to be sent to the Regional Medical Library or to the National Library of Medicine. A Medical Library Resource Project grant helped to establish the Upper Penin- sula Medical A.V. Consortium (U.P.M.A.C.) based in Marquette, Michigan. The activities of this consortium include the sharing of audiovisual materials in support of training and continuing education programs for health professionals, reference services to identify and obtain, either by purchase or loan, materials not owned by the group, and workshops to train and update the skills of the library managers. The eleven health institutions comprising the membership of this group are no longer receiving Federal funds but are con- tinuing the consortium with membership fees. Research Grants - This program supports research leading to new knowledge about health information transfer and new methods for making health information in8209675_000060.txt

Page  60 1597 various media conveniently accessible to the health community. A special initiative within this grant program — Computers-in-Medicine — supports research in the health computer sciences related to the organization of knowledge so that clinicians faced with decisions relating to patient care can obtain information in an easy-to-use format. Particular attention is given to the development of young research investigators in the fields of library/information science and Computers-in-Medicine. In FY 1980 NLM was able to initiate seven major studies and three grants for young investigators in the Computers-in-Medicine area. In FY 1981 NLM con- tinued support for these projects and initiated eight new research projects and three additional grants for young investigators. In FY 1982 NLM will continue to support these projects and several related efforts in health infor- mation science. Research grants contribute to more effective availability of health knowledge for the medical community by exploring new methods and tech- nologies and by gaining a better understanding of the health information transfer process. Training Grants - The Training Grants Program makes funds available to insti- tutions to develop programs that will teach health professionals how to exploit the computer. The goal is to promote a more effective integration of computer technology into all phases of clinical medicine such as teaching, patient care and research. This program will provide funds at approximately the same level as FY 1981. Special Scientific Projects - These awards make possible the preparation of major authoritative treatises on a variety of health topics by distinguished scholars. For example, in FY 1981 funds supported the preparation of books on communicating with patients and legal aspects of medical practice. In FY 1982, support will continue at approximately the same level. Publication Grants - The Publication Grant Program assists in the preparation and publication of scientifically meritorious publications needed by the U.S. health professional community, but which are not commercially feasible. The program includes studies directed toward the improvement of health care delivery, analytic reviews of present and past developments in medicine and scientific research, and publications in library and information sciences. In FY 1931, 25 Publication Grants were awarded. It is planned to continue at approximately the same level in FY 1982.8209675_000061.txt

Page  61 1598 Intramural Public Health Service Act, Title III, Part I. Sec. 381 1981 1982 Revised Estimate Revised Request Pos. Amount Pos. Amount Current request (Carter budget).. 421 $30,692,000 421 $33,485,000 Proposed change.................. ___ - 279,000 --- --- Revised request.................. 421 $30,413,000 421 $33,485,000 Justification for FY 1982 Revised Request - The Intramural Program of the NLM is devoted to the expansion and improvement of basic library and information services, improvement of information and knowledge transfer to biomedical scientists, practitioners and educators and for the protection of public health through the provision of environmental toxicology information. These objectives are conducted through four major NLM programs as outlined below. Lister Hill National Center for Biomedical Communications The Lister Hill National Center for Biomedical Communications (LHNCBC) is dedicated to improving the transfer of biomedical information to health care practitioners, researchers, students and educators. The work of the Center is directed toward two main areas: improving the manner in which books, journals and audiovisual media are stored, retrieved and used, and developing methods for presenting information from the scientific literature in a form that makes it immediately useful to health professionals who are making deci- sions about patient care. The Center is developing an automated, integrated library system which will greatly improve the manner in which librarians and patrons use libraries, and a document scanning, storage, retrieval and distribution system which would allow the contents of books and journals to be stored on videodiscs and transmitted electronically to health science libra- ries. It is exploring the use of the videodisc as an inexpensive means for mass publication of combined textual and graphic materials. Computerized Knowledge Bases that summarize information needed for patient care decisions in specific areas of biomedicine are being developed and tested. Integrated Library System - The goal of the Integrated Library System (ILS) is to develop an automated minicomputer-based system which could be adopted by health science libraries at all levels to improve their services, to allow better management of library collections, and to promote more effective resource sharing. The system will allow access and compatibility with NLM's planned MEDLARS III system, the automated library system for the 1980's. The initial phase of ILS now available to libraries through the National Technical Information Services (NTIS) includes capabilities for a master bibliographic file, a circulation system, serials check in, and limited searching capabilities of the online catalog. Future enhancements of the ILS which remain to be developed include serials control, acquisitions, online cataloging, authority file, generalized network access module, ease of use for patrons and a program of continuing improvements to existing modules. These enhancements will be funded at the same level as FY 1981.8209675_000062.txt

Page  62 ll>99 Document Storage and Retrieval - The goal of the document scanning, storage and retrieval system is to address the limitations of storing and transmitting biomedical information via printed books and journals; the limited life of paper and the inefficiency of sending books and journals to other libraries has led to an interest in new methods to store and transmit literature. The Lister Hill Center has initiated a program to design, develop and evaluate an experimental system that will electronically scan, store, retrieve and display books and journals acquired by the Library. The program will introduce appro- priate state-of-the-art technology to help the Library fulfill its mission to maintain a national archive for biomedical literature. As the project progresses, the feasibility of national dissemination of the stored documents will be investigated. A local distribution network will be developed in the Washington metropolitan area, while techniques are being investigated to achieve the long range goal of delivering information nationally. Accomplishing the latter goal will depend in part on the availability of a national telecommunication network of broadband channels, such as the ones proposed for the 1980's by various commercial carriers. Videodisc - The videodisc is an exciting new technology which can be used to store and distribute large amounts of biomedical information in the form of computerized data bases, audiovisuals, graphics and text for the use of researchers, practitioners, teachers, and students in the health sciences. It offers extremely high storage density, rapid random accessibility of any given subset of data, text, illustration or sound, ubiquity of display devices (television receivers) and the presence of another industry (entertainment) to share the burden of developmental costs and market penetration. The Center is developing a video processing laboratory necessary to create master tapes for videodisc production. With the National Medical Audiovisual Center, the Lister Hill Center is exploring the effective use of videodiscs in medical education. Knowledge Bases - The Lister Hill Center continues its interdisciplinary research program on the design, construction, update, retrieval and dissemina- tion of computerized knowledge bases. A knowledge base contains selected, current, highly reviewed, synthesized information on specialized areas of biomedical information. It may use integrated text and illustrations, and is designed to meet varying needs of health professionals. Experience with the Hepatitis Knowledge Base has now demonstrated the attractiveness of the con- cept and the usefulness of the content to the health professional. Preliminary assessments of the knowledge base program have also reinforced our conviction that existing retrieval methods and user Interfaces are inadequate to deliver or maintain current the useful information contained. Both the long and short range objectives of the knowledge base program are directed toward an ameliora- tion and ultimate elimination of these deficiencies. Interim solutions, though not entirely satisfactory, may permit early experimentation with more wide- spread access to this information dissemination mechanism. National Medical Audiovisual Center The National Medical Audiovisual Center (NMAC) administers a national program to improve the quality and expand the use of audiovisual instructional media in health professional education. NMAC enhances the educational efforts of health sciences institutions by sharing the latest knowledge in learning methods and technologies. NMAC moved from Atlanta to the new Lister Hill Center building in Bethesda In March 1980. Since the move, NMAC has acquired new staff members and reassessed its program objectives.8209675_000063.txt

Page  63 1600 Educational Research and Evaluation - NMAC's research and development objectives are to conduct: 1) research, development and demonstration of improved pro- duction, utilization, publication and distribution of biomedical information through applications of new technologies such as videodisc; 2) studies on the effective utilization of media; 3) development of efficient methods to assess the educational effectiveness of learning materials; and 4) research, develop- ment and demonstration of faculty training workshops in the utilization and potential impact of new technologies on learning and the educational process. Media Development - Using findings gained from its own programs and knowledge from collaborating with other health sciences agencies and teaching Institu- tions, NMAC develops model educational media and systems using the facilities of the Lister Hill Center Building. In its first full year in the new facili- ties in Bethesda, NMAC has been increasingly exposed to the information transfer activities of NIH. Collaborative projects using recent information from major seminars and conferences will identify new audiovisual methods for extracting and presenting up-to-date research information in educational and practice settings. In 1982, major projects will include development of a series of instructional materials in the history of medicine for videodisc systems, audiovisual compression techniques and various methods of distributing audiovisuals will also be explored. Training and Consultation - In 1981, NMAC's workshop/seminar program will develop and conduct workshops to demonstrate new and effective instructional techniques to teachers of health professionals. Approximately 1,000 health professionals are expected to participate in over 40 workshops in FY 1981. Expanded opportunities within evolving technologies can accelerate the impact of health professional instruction. Training materials developed in this pro- gram are provided to health sciences professionals throughout the nation by an expanding network of field training sites. These sites augment and develop additional training materials to be used at still other sites. Distribution of Audiovisuals - NMAC provides leadership in managing non-print library services as demonstrated by AVLINE (NLM's online data base of audio- visuals) which will include over 10,000 references by FY 1982. In addition, NMAC acquires and distributes a large number of instructional media packages to health professionals through a film rental program and an interlibrary loan program for selected video cassettes. In FY 1981, NMAC expects to receive as many as 30,000 requests for audiovisual materials for use by multiple viewers in classrooms, libraries, and in the review of material for local collections. A program of research into various methods of distributing audio- visuals such as the videodisc will be launched. In FY 1982, these activities will continue. Library Operations Library Operations (LO) is responsible for building, maintaining and provid- ing access to an extensive collection of biomedical literature. This involves the provision of critical library and information services to include acquisi- tion, preservation, organization and dissemination of biomedical literature. In addition to providing traditional library service, Library Operations has the responsibility for (1) improving library information service, (2) promoting cooperation among the national libraries, (3) automating the current card catalog file by developing an online computerized catalog system, and (4) developing MEDLARS III, a comprehensive library automation system to expand NLM's services provided by the current MEDLARS II system.8209675_000064.txt

Page  64 1601 Improvement of Library Information Services - The primary concern of Library Operations is the quality of bibliographic data and timeliness in making books, journals, and other materials available to the health science community. In FY 1980 approximately 17,000 books and 161,000 serial pieces were added to the collection. More than 266,000 articles were indexed and 14,000 books cataloged. In addition, 242,000 interlibrary loan requests, 43,000 reference inquiries, and 192,000 reader service requests for access to the general collection were received from the health sciences community. Although loan requests leveled off in FY 1980, the steady increase in the cpst of library materials and reduction in library budgets is expected to produce an increase in demand in the coming years. This will also be reflected in on-site reference and reader service demand. The Library also continues an ongoing program for identifying and filling gaps in the collection. The Library maintains 17 online data bases including MEDLINE which contains bibliographic citations to the biomedical literature and TOXLINE which provides references and abstracts in the fields of toxicology and pharmacology. More than 1,250,000 online and 500,000 offline searches were provided to over 1,500 domestic and non-U.S. user institutions. The Library continues to publish a variety of authoritative bibliographic indexes such as Index Medicus, the NLM Catalog and over twenty recurring bibliographies on specialized subjects. Four additional specialized biblio- graphies in new areas are under development. During the past several years, the Library has provided steadily improved services in document delivery. Approximately 85% of accepted requests are filled, close to 90% of filled requests for journal articles (over 85% of the total) are completed and mailed within a four-day period after the day of receipt. A national computerized data base containing information on the serial hold- ings of medical libraries throughout the country would improve the ability of libraries to find needed documents for their users. In FY 1981, a pro- ject was begun to expand the information in SERLINE, NLM's serials data base, from only the serials publications held in Bethesda to include actual holdings for serials held by medical libraries throughout the country. The basic approach is to provide an automated link between SERLINE and local or regional machine readable files with these data so that SERLINE may be updated auto- matically. In the future, smaller libraries will be able to add their data online even though they do not have machine readable data for their holdings. In FY 1982, the data collected by NLM will enable it to begin to generate a number of local and regional union list products; test programs Involving online update by some hospital libraries will begin. Data collected in this project is a necessary prerequisite for the development of automated routing of interlibrary loan requests. This program is a key component in the MEDLARS III development described later. In order to be retrievable by the user, the content of journal articles must be indexed, an intellectual process which is at present highly labor-intensive. The development of an online file containing information on approximately 25,000 chemicals and their direct search in MEDLINE and the use of computer aided techniques such as AID (Associative Interactive Dictionary) to promote greater indexing consistency in selecing relevant subject headings will provide greatly improved indexing. These developments will provide the transition from a manual indexing process to an automated operation under MEDLARS III.8209675_000065.txt

Page  65 1602 National Library Cooperation - It becomes increasingly evident that signifi- cant progress in library and information services requires cooperative end collaborative efforts across all institutional levels. The U.8. national libraries have historically shared their collection resources end coordinated their collection development policies to minimize unnecessary duplication while still serving their primary user groups. They have had an effective interlibrary loan arrangement for many decades. The necessity for greater cooperation on planning and integration of services, however, becomes epparent in light of growing information needs which cross all areas of knowledge. In order to provide a proper foundation for meeting the information needs of the future, an integrated source for the U,S. national bibliography is required. To this end, the Library of Congress, (LC), the National Agricul- tural Library (NAL), and the National Library of Medicine have entered into a closer collaborative effort to support, integrate, and supplement the activities of each institution. This effort Implies continued cooperation In the sharing of collections and broadens earlier efforts to coordinate biblio- graphic control practices. Specific action initiatives include a more formalized sharing of the record authentication function between LC and NLM; staff level development of bibliographic policies and procedures; resource sharing especially In terms of LC language assistance to NLM and NAL; and LC access to NLM internal records. The successful implementation of the programs for bibliographic cooperation requires as its foundation mutual access to and coordination of local institu- tional machine-readable files at LC and NLM. The procedure which supports this cooperative exchange of information must not impose growing investment of human resources to make the system operate. Thereforef automated efforts must support and facilitate the program. It is essential that a computer- to-computer communication system permit cooperative building and maintenance of the bibliographic data base. At the NLM, the MEDLARS III effort will provide the mechanism for NLM to participate and support the program in this manner. The concurrent support of the LC Processing Department automation requirements is also essential in order to provide a two way linkage. It is our belief that the proper support of automated efforts will permit the establishment and development of a truly cooperative, shared resource of bibliographic data which will assist the national libraries in meeting the growing information demands in the 1980's. Automation of the Card Catalog - Manual card catalogs are bulky and difficult to use and maintain. In addition,a major revision of the rules by which English-speaking libraries all over the world catalog their collections became effective in January 1981. These two considerations have led to the decision to close NLM's manual card catalog in January 1981 without disrupting service to NLM's patrons. NLM is the first major library in the U.S. to automate its card catalog. A Computer-Output-Microfilm (COM) catalog will be available for onsite users until an online catalog file for users is developed. MEDLARS III - MEDLARS III will be NLM's third-generation computer-based system for library and information services. MEDLARS III Is designed to be responsive to the needs of the health professional community. MEDLARS III is intended to be an open-ended system, one that will build on the best features of the present MEDLARS II system as well as other systems, both internal and external to NLM.8209675_000066.txt

Page  66 1603 In FY 1981, the MEDLARS III development team will construct a detailed sys- tem development plan addressing the capabilities, technology considerations, alternative approaches, transition to the new system, testing, documentation, resources, and time tables required. The systems design plan will be com- pleted by the beginning of FY 1982. In FY 1982 an additional $1,345,000 will be utilized to begin the imple- mentation of this system. A Request for Proposal (RFP) for the design and implementation of MEDLARS III will be prepared. New user capabilities anti- cipated for FY 1982 include the installation of a MEDLARS III compatible ILS (Integrated Library System), originally developed by the Lister Hill Center for the use of smaller libraries throughout the nation. By the end of FY 1983, the basic MEDLARS III system will be Implemented. The new system will allow: o Retrieval: Enhanced user aids with natural English-like language queries will benefit not only the trained searchers, but will enable health practitioner users to have direct and effective access to the system. o Technical Processing: These functions will be more completely auto- mated and integrated. o Record and File Creation and Maintenance: Will be based on the concept of a master machine-readable record for each bibliographic entity and processing unit. o Card Catalog: Fully computerized and available online through MEDLINE network to users all over the U.S. o Network Access and Interface: Users will have access to bibliographic record creation capabilities and to national locator information and the retrieval system files. o Regional Medical Library Document Delivery System: Fully automated system for generating and routing requests. Toxicology Information Program The Toxicology Information Program (TIP) collects, organizes and dissemi- nates toxicology information for the prevention of disease and the protection of health. Its objectives are: (1) to create computer-based data banks from the scientific literature and from the files of collaborating industrial, academic and governmental organizations; and (2) to provide information about toxic substances and their effects to the biomedical community, including industrial organizations, government agencies, and universities. In the last year a major effort went into enlarging two computerized services, TOXLINE and CHEMLINE, and into extending the coverage of the Toxicology Data Bank (TDB). In addition, the program provided bibliographic and other information services to the National Toxicology Program (NTP) and continued to collaborate with the interagency Chemical Substances Information Network (CSIN). The principal emphasis in the latter project was on the Chemical Structure and Nomenclature System (CSNS) and the Chemical Information Resources Directory (CIRD) components.8209675_000067.txt

Page  67 1604 Online Services - CHEMLINE is an online chemical dictionary which allows the user to search for nomenclature and structural Information about chemical substances cited In other NLM online files. CHEMLINE now contains some 472,000 records for chemical substances known by some 940,000 different names. Included in this data base are the 34,981 chemicals listed in the Toxic Sub- stances Control Act (TSCA) Chemical Substances Inventory. TOXLINE is an online bibliographic retrieval service which searches an exten- sive collection of citations and abstracts derived in large part from published journal literature dealing with human and animal toxicology, bio- logical effects of drugs, pesticides, food additives, industrial and household chemicals, radioactive materials, and toxic pollutants. This service now encompasses over a million records. At the end of 1980, the Toxicology Document and Data Depository (TD3) was added to TOXLINE. TD3 has citations to government reports, along with associated abstracts, keywords, and ordering information. In FY 1980, there was a 30% increase in the total usage of TOXLINE over FY 1979 and demands for this service are expected to increase in FY 1981 and FY 1982. More than 4.5 million citations were requested to be printed offline in FY 1980 from TOXLINE. RTECS is an online, searchable version of the National Institute of Occu- pational Safety and Health (NI0SH) publication. Registry of Toxic Effects of Chemical Substances, which no" contains acute toxicity data for 49,967 substances. Chronic toxicity data are also included if a carcinogenic, mutagenic, or teratogenic effect was reported in the reference cited. The Toxicology Data Bank (TDB) is an online service for retrieving data about chemical substances that may be hazardous to humans. For each substance, TDB contains data on: chemical structure and nomenclature, chemical and biological properties, usage and potential effects on the environment and the workplace. By the end of FY 1980, the online file contained some 2,000 completed records and another 500 records were in various stages of develop- ment. In choosing compounds for the TDB, a high priority is given to those selected for testing by the National Toxicology Program. Each record is reviewed by experts who serve on a peer review committee comprised of members of the NIH Toxicology Study Section. Access to TOXLINE, RTECS (Registry of Toxic Effects of Chemical Substances), and TDB (Toxicology Data Bank) was expanded in 1980 when these data bases were made available through the computers of the State University of New York (SUNY) in Albany. Online services from these data bases are expected to continue to grow in FY 1981 and FY 1982. The Laboratory Animal Data Bank (LADB) provides baseline biomedical data from experimental control animals of species and strains commonly used in laboratory research and testing. This service became available in January 1980. At the end of 1980, this data base contained 893,908 observations from 27,313 animals of 66 species or strains. In FY 1981 and FY 1982, LADB will continue to provide biomedical investigators with rapid access to information on normal values on hematology, clinical chemistry, and pathology, as well as data on environment, animal care, growth and development. Fifty organizations have signed agreements to obtain the service and another twenty have applied and are being trained.8209675_000068.txt

Page  68 1605 Collaborative Projects - The Toxicology Information Program (TIP) continues to work on a number of important interagency projects. The Chemical Substances Information Network (CSIN) was proposed to Congress by the Council on Environ- mental Quality as a major step in filling the information requirements of the Toxic Substances Control Act of 1976. This project involves the develop- ment of a national network linking multiple online data bases, which contain information about chemical substances, their uses and effects. Among the CSIN-related projects supported by TIP are: the development of two online directories, the.Chemical Information Resources Directory, and the Chemical Structure and Nomenclature System (CSNS); and the testing and evaluation of a specialized terminal to make CSNS searching easier and more effective. The prototype Chemical Data Bases Directory, constructed in FY 1980, as a forerunner of the proposed Chemical Information Resources Directory, will be enlarged to a file describing the content, location, and accessibility conditions of about 150 information resources that cover subjects of con- cern to CSIN. Also in the initial development stage is the interim CSNS, the chemical directory of CSIN. This file will be built through augmentation of CHEMLINE, with additional search and structure display capabilities and with an increase in content to about 750,000 compound records. Another important area of interagency collaboration provided by TIP is information support services to the National Toxicology Program (NTP). TIP has already devised a numbering system for all NTP compounds which faci- litates the recognition and reference to chemicals to be considered and used by those involved in the NTP testing programs. A prototype NTP Chemical Registry Handbook was assembled to provide NTP scientists and administrators ready access to information about these chemicals. NLM/NTP staff participated in the preparation of the FY 1930 and FY 1981 Review of Current DHEW (DHHS) Research Related to Toxicology by identifying the chemical substances undergoing specific tests by the various agencies and preparing indexes to these data. TIP also continues to provide literature search services in toxicology through the Toxicology Information Response Center (TIRC) at the Oak Ridge National Laboratory. The demand for this service keeps increasing; most requests come from other Federal agencies who provide funds to NLM for the service. The publication TOX-TIPS (Toxicology Testing in Progress) continues to be pro- duced by TIP for the DHHS Committee to Coordinate Environmental and Related Programs. This publication reports new projects in toxicology testing of chemi- cals by governmental, industrial, and academic laboratories. Descriptions of epidemiological studies to determine toxic chemicals and their effects are now also included. The National Toxicology Program contributes notices of testing studies. The rapid publication of this information is designed to prevent the unknowing duplication of expensive toxlcological testing. TOX-TIPS is published monthly. Bibliographies on "Acid Rain" and "Asbestos in Air" were prepared by TIRC at the behest of the Interagency Information Response to Chemical Concerns (IRCC) Project. The primary objective of the IRCC Project is to provide sponsoring organizations with "express" literature searches on demand.8209675_000069.txt

Page  69 1606 Explanation of FY 1982 Revised Request Compared to FY 1981 Revised Estimate The 1982 revised budget estimate for the Intramural Program of $33,485,000 and 421 positions represents an Increase of $3,072,000 and no increase in positions from the 1981 revised level. The 1982 increases and decreases are as follows: Within-grade pay increases $ 183 ,000 Annualization of 1980 pay raise 12 ,000 Payment for centrally furnished services 248, ,000 Wage board salary increases 5, ,000 Senior Executive Service Bonus Pay 54, ,000 Literature Acquisition Support 292, ,000 Increased cost of services and supplies 1 ,006, ,000 MEDLARS III 1 ,345, ,000 Chemical Substances Information Network 341, ,000 Lister Hill Center Consultants - 86, ,000 National Medical Audiovisual Center personnel reduction -321, ,000 Library Operations travel reduction - 7, ,000 Total $3, ,072, ,000 8209675_000070.txt

Page  70 1607 Direct Operations Public Health Service Act, Title III, Part I, Sec. 381 1981 1982 Revised Estimate Revised Request Pos. Amount Pos. Amount Current request(Carter budget) 24 $1,857,000 24 $1,942,000 Proposed change........... — - 5,000 — - 5,000 Revised request........... 24 $1,852,000 24 $1,937,000 Justification for FY 1982 Revised Request - Direct Operations provide for the overall planning, administration, and direction of the NLM's Extramural Programs authorized by the Medical Library Assistance Act. The primary functions include the pre- and post-award review of all grants and contracts awarded under the Medical Library Assistance Act. In addition, this activity develops internal policies for the operation and administration of the program. Continuing emphasis is placed on the planning and evaluation of NLM's Extramural Programs and also includes the maintenance of a computerized information system for managing data relative to NLM-supported grants. Explanation of FY 1982 Revised Request Compared to FY 1981 Revised Estimate The 1982 revised budget estimate for Direct Operations of $1,937,000 and 24 positions represents an increase of $85,000 and zero positions over the revised 1981 estimate. The increases shown here are not program increases but mandatory increases to cover increased costs of performing the same functions in FY 1982 that were funded in FY 1981. The program plans for FY 1982 include continued administration of the MLAA programs within the functions cited above for the grant programs listed. The built-in mandatory increases are as follows: 1. Within-grade pay increases $ 6,000 2. Annualization of 1981 pay raise 2,000 3. Senior Executive Service bonus pay 5,000 4. Increased cost of services and supplies 72,000 Total $85,0008209675_000071.txt

Page  71 1608 Prograe Management Public Health Service Act, Title III, Part I, Sec. 381 1981 1982 Revised Estimate Revised Request Pos. Amount Pos. Amount Current request(Carter budget) 50 $3,102,000 50 $3,340,000 Proposed change............ — -10,000 — - 10,000 Revised request............ 50 $3,092,000 50 $3,330,000 Justification for FY 1982 Revised Request - Program Management provides the overall planning, administration, coordination and direction of the various programs of the National Library of Medicine. Amoung the functions carried out by this activity are NLM's planning and evaluation activities; financial and personnel management; contracts management; and the direction of NLM's international programs. With the dedication of the Lister Hill Center Building in 1980, NLM staff have begun to make full use of the facility. The laboratories, audltorla and other special purpose facilities will be equipped to support the technical uses for which they were envisioned. The Lister Hill Center conference facilities serve as a resource for the entire NIH; recently consensus development conferences on coronary bypass surgery and aging have been held there. With the completion of the new facility, modernization and safety modifications were initiated in the Library building. Renovations will include a fire sup- pression system, a modern heating, ventilation, and air conditioning system, and the conversion of office to needed book stack space. The design work was com- pleted in 1980; construction is underway and should take 18 months to complete. Explanation of FY 1982 Revised Request Compared to FY 1981 Revised Estimate The 1982 revised budget estimate for Program Management of $3,330,000 and 50 positions represents an increase of $238,000 and zero positions over the 1981 revised estimate. Increases shown here are not program Increases, but admin- istrative and mandatory Increases to cover increased costs of performing the same functions in FY 1982 that were funded in FY 1981. The built-in mandatory Increases are as follows: 1. Within-grade pay increases $ 6,000 2. Annualization of 1981 pay raise 4,000 3. FTS rate increase 2,000 4. Increased costs of services and supplies 219,000 5. Federal Employees Compensation Fund (FECF) 2,000 6. Senior Executive Service bonus pay ____5.000 Total $238,000