1973 U.S. House of Representatives Appropriations Committee Budget Testimony, 92nd Congress 2nd Session, March 24, 1972
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DEPARTMENTS OF LABOR AND HEALTH, EDUCATION, AND WELFARE APPROPRIATIONS FOR 1973 HEARINGS BEFORE A SUBCOMMITTEE OF THE COMMITTEE ON APPROPRIATIONS HOUSE OF REPRESENTATIVES NINETY-SECOND CONGRESS SECOND SESSION SUBCOMMITTEE ON DEPARTMENTS OF LABOR AND HEALTH, EDUCATION, AND WELFARE APPROPRIATIONS DANIEL J. FLOOD, Pennsylvania, Chairman WILLIAM H. NATCHER, Kentucky ROBERT H. MICHEL, Illinois NEAL SMITH, Iowa GARNER E. SHRIVER, Kansas W. R. HULL, Jr., Missouri SILVIO O. CONTE, Massachusetts BOB CASEY, Texas J. KENNETH ROBINSON, Virginia EDWARD J. PATTEN, New Jersey Robert M. Moyer and Henry A. Neil, Jr., Staff Assistants PART 4 NATIONAL INSTITUTES OF HEALTH Printed for the use of the Committee on Appropriations U.S. GOVERNMENT PRINTING OFFICE 76-024 O WASHINGTON : 19728407375_000002.txt

Page  2 1493 Friday, March 24, 1972. NATIONAL LIBRARY OF MEDICINE WITNESSES DR. MARTIN M. CUMMINGS, DIRECTOR DR. JOHN F. SHERMAN, DEPUTY DIRECTOR, NATIONAL INSTITUTES OF HEALTH DR. G. BURROUGHS MIDER, DEPUTY DIRECTOR, NATIONAL LIBRARY OF MEDICINE DR. LEROY L. LANGLEY, ASSOCIATE DIRECTOR, EXTRAMURAL PRO- GRAMS, NATIONAL LIBRARY OF MEDICINE KENT A. SMITH, EXECUTIVE OFFICER, NATIONAL LIBRARY OF MEDICINE LEON M. SCHWARTZ, ASSOCIATE DIRECTOR FOR ADMINISTRATION, NATIONAL INSTITUTES OF HEALTH LELAND B. MAY, ASSISTANT DIRECTOR OF FINANCIAL MANAGE- MENT (BUDGET), NATIONAL INSTITUTES OF HEALTH CHARLES MILLER, DEPUTY ASSISTANT SECRETARY, BUDGET OBJECT CLASSIFICATION [In thousands of dollars] 1971 actual 1972 estimate 1973 estimate Personnel compensation: Permanent positions...................._________________..... Positions other than permanent...................______........ Other personnel compensation................__________________ Total personnel compensation................_________...... Personnel benefits: Civilian.........______......___________________ Travel and transportation of persons_______.............___________ Transportation of things__________.................________________ Rent, communications, and utilities..........._______....._........ Printing and reproduction................._........________________ Other services___________...................______________________ Supplies and materials....................................________ Equipment_____..................._..............________________ Grants, subsidies, and contributions.............____________________ Total costs, funded................................__________ Changes in selected resources.............._________.....__________ Total obligations............___________....._............... PERSONNEL SUMMARY Total number of permanent positions..______________........_._..... Full-time equivalent of other positions_____........................ Average paid employment......_________.......____________________ Average GS grade............................______......_________ Average GS salary.............____..............._________________ Average salary of ungraded positions_______..........._______....... 6,125 6,906 7,362 299 203 317 84 89 87 6,508 7,198 7,766 534 599 665 168 167 176 21 33 30 1,379 1,704 1,732 285 317 322 4,573 4,844 6,177 277 272 298 694 705 698 4,998 6,681 7,970 19,437 1,944 21,381 22,520 1,585 24,105 25,834 2,270 28,104 467 484 491 26 18 25 488 494 508 8.5 8.7 8.5 $12,476 $12,906 $13,042 $7,838 $7,938 $8,096 8407375_000003.txt

Page  3 1494 PROGRAM AND FINANCING (IN THOUSANDS OF DOLLARS) 1971 actual 1972 estimate 1973 estimate Program bv activities: 1. Medical library assistance____________________________________ 4,998 2. Direct operations: (a) Lister Hill National Center for Biomedical Communications. 1,177 (b) National Medical Audiovisual Center—......--------- 2,096 (c) Library operations------......----------------------- 7,404 (d) Toxicology information.........______________________ 1,246 (e) Review and approval of grants-----........----------- 639 (f) Program direction____...................------------ 1,877 Total program costs, funded1.....------------ Change in selected resources1..............-.......------ Total obligations______________............------------ Financing: Unobligated balance available, start of year_____________________ Unobligated balance available, end of year........------------- Unobligated balance lapsing................------------------ Budget authority_________________.....---------------- Budget authority: Appropriation_________.........______.....------------- Transferred to other accounts................------------- Transferred from other accounts.....______.....---------- Appropriation (adjusted)......__________________________ Relation of obligations to outlays: Obligations incurred, net........_________________________ Obligated balance, start of year.........._________________ Obligated balance, end of year____________________________ Adjustments in expired accounts_____________............. Outlays_____............................____________....... 25,574 6,681 7,970 1,589 2,428 2,164 2,522 7,957 8, 241 1, 211 1, 508 716 676 2, 202 2, 489 19,437 1,944 22, 520 1,585 25, 834 2,270 21,381 24,105 -45 28,104 45 10 26 .... 21,436 24, 086 28,104 20,769 -4 24, 086 28,104 671 ... 21,436 24,086 28,104 21,381 21,900 -17, 554 -153 ... 24,105 17, 554 -18,024 28,104 18,024 -21,362 23,635 24,766 1 Includes capital outlays as follows: 1971, $694,000; 1972, $705,000; 1973, $698,000. 2 Selected resources as of June 30 are as follows: Unpaid undelivered orders, 1970, $6,847; 1971, $8,791,000; 1972, $10,376,000; 1973, $12,646,000. Note: Includes $112,000 in 1972and 1973 for activities previously financed from: National Institute of Dental Research 1971, $112,000. Excludes $38,000 in 1972 and 1973 for activities transferred to Office of the Director, 1971, $68,000. Mr. Flood. Continuing with the National Institutes of Health, we have the National Library of Medicine. The presentation will be made by Dr. Martin M. Cummings, the Director. introduction of supporting witnesses You have some people you would like to introduce ? Dr. Cummings. I have Mr. Kent Smith, Dr. Mider, and Dr. Leroy Langley. biographical sketches or witnesses (The biographical sketches follow:) Name: Martin Marc Cummings. Position : Director, National Library of Medicine. Birthplace and date: Camden, N.J., September 7,1920. Education : B.S. Buckneil University, 1941; M.D., Duke University, 1944. Experience: Director, National Library of Medicine, 1964-present; Associate Director for Research Grants, National Institutes of Health, 1963-64; Chief, Office of International Research, National Institutes of Health, 19€«1-1963; professor of microbiology and Chairman, Department of Microbiology, Univer- sity of Oklahoma School of Medicine, 1959-1961; Director, Research Services, Veterans' Administration Central Office, 1953-1959; special lecturer in micro- biology, George Washington University School of Medicine, 1953-1959; Chief.8407375_000004.txt

Page  4 1495 Tuberculosis Research Laboratory, Veterans' Administration Hospital of At- lanta, 1949-1953; associate professor of bacteriology, Emory University, 1953; instructor through associate professor of medicine, Emory University, 1948- 1953; Director, Tuberculosis Evaluation Laboratory, Communicable Disease Center, U.S. Public Health Service, 1947-19*9; assistant resident, Boston Ma- rine Hospital, 1945-1946; intern, Boston Marine Hospital, 1944-1945; and U.S. Army, private first class, 1942-1944. Association memberships: American Academy of Microbiology, Inc.; Ameri- can Board of Microbiology; American Federation for Clinical Research (emeri- tus) ; American Society for Clinical Investigation (emeritus) ; Association for American Medical Colleges; Medical Library Association; Society of Sigma XI; American Clinical and Climatological Association; American Association for the History of Medicine; board of directors, Gorgas Memorial Foundation; and board of visitors, Medical Center of Dukf University. Special awards, citations, or publications: Veterans' Administration Excep- tional Service Medal; DHEW Superior Service Award; DHEW Distinguished Service Award; honorary degree, doctor of science, Bucknell University; distin- guished alumnus award, Duke University; honorary degree, doctor of science, University of Nebraska, 1971; honorary degree, doctor of humane letters, George- town University, 1971; honorary degree, doctor of science, Emory University, 1971; and honorary member, Alpha Omega Alpha. Name: G. Burroughs Mider. Position : Deputy Director, National Library of Medicine. Birthplace and date : Windsor, N.Y., August 9,1907. Education: A.B., Cornell University, 1930; M.D., Cornell Medical College, 1933. Experience: Deputy Director, National Library of Medicine, January 1970- present; Special Assistant to Director for Medical Program Development and Evaluation, National Library of Medicine, 1968-69; Director of Laboratories and Clinics, National Institutes of Health, 1960-68; associate director in charge of research, National Cancer Institute, 1952-60; professor of cancer research, University of Rochester School of Medicine and Dentistry, 1948-52; research associate in surgery, University of Rochester School of Medicine and Dentistry, 1945-48; associate professor of pathology, University of Virginia School of Medicine, 1944-45; assistant pathologist, New York Hospital, 1941-44; instructor in pathology and assistant professor of pathology, Cornell Medi- cal College, 1941-44; research fellow, National Cancer Institute, 1938-41; in- structor in surgery, fellow in surgery, assistant in surgery, University of Roch- ester School of Medicine and Dentistry, 1936-39; assistant resident surgeon and resident surgeon, Albany Hospital, 1934-36; and intern, Albany Hospital, 1933-34. Association memberships: American Association of Pathologists and Bacteriol- ogists ; American Society for Experimental Pathology; Harvey Society; James Ewing Society; American Association for Cancer Research; American Cancer Society ; American Association for the Advancement of Science ; Society of Alpha Omega Alpha ; Society of Sigma XI; Board of Directors, Gorgas Memorial Insti- tute; Committee on Federal Laboratories (Federal Council for Science and Tech- nology), 1964—68; Washington Academy of Medicine; Washington Academy of Sciences ; and the Federal Professional Association. Speciai awards, citations, or publications: Distinguished Service Award, DHEW, 1960; James Ewing Lectureship and Award, 1968; and publications principally in biomedical journals. Name : Leroy Lester Langley. Position: Associate Director, Extramural Programs, National Library of Medicine. Birthplace and date : Philadelphia, Pa., December 12,1916. Education: A.B., University of California, 1938; M.A., Stanford University, 1939; Ph. D.. Yale University, 1942: and LL.B., Birmingham School of Law, 1954. Experience: Associate Director, Extramural Programs, National Library of Medicine, 1970-present; Chief. Training Grants and Awards Branch, National Heart and Lung Institute, 19W-70; assistant professor through professor of8407375_000005.txt

Page  5 1496 physiology, University of Alabama School of Medicine, 1949-64; and lieutenant (s.g.), U.S. Naval Reserve, 1943-16. a.«.,*,.!«, Association memberships: American Physiological Society; Americani Associa- tion for the Advancement of Science; Sigma XI; Alabama Bar Association; and Medical Library Association. T . .f..f„ Special awards, citations, or publications : Honorary Research Fellow, institute de Biofisica. Rio de Janeiro, 1946-48; Best Basic Science Teaching Award, Uni- versity of Alabama School of Dentistry, 1961, 1964; Victor E. Hall. lectureship. University of California at Los Angeles, 19*70; and author of 17 textbooks and 4 scientfic articles. Name: Kent Ashton Smith. Position: Executive officer, National Library of Medicine. Birthplace and date: Boston, Mass., September 3, 1938. Education: B.A., Hobart College, 1960; M.P.A., Cornell University, 1962. Experience: Executive Officer, National Library of Medicine, March 1971- present; executive officer, Division of Research Resources, June 1968-March 1971; acting executive officer, Division of Research Facilities and Resources, February-June 1968; assistant executive officer, Division of Research Facilities and Resources, October 1967-February 1968; administrative officer, Division of Research Facilities and Resources, November 1965-October 1967; management analyst, Office of the Secretary, Office of Management Policy, July 1962-Novem- ber 1965. Association memberships: Sigma Phi Society; Society for Advancement of Management; and American Society for Public Administration. Mr. Flood. You have a statement, I see. Dr. Cummings. With your permission I would like to read the statement. Mr. Flood. Go ahead. General Statement Dr. Cummings. Mr. Chairman, members of the committee, the Na- tional Library of Medicine is responsible for acquiring, organizing, and disseminating information materials in the health sciences. In carrying out this mission, the Library has built up the most important collection of biomedical literature ever assembled, now numbering over 1,300,000 items. In recent years the Library has been faced with an ever-increasing workload as it strives to keep pace with the information explosion that has occurred in the health sciences. When the NLM be*ran in 1836, only 11 medical journals were being published in the United States. Those 11 have multiplied to the more than 6,000 U.S. medical journals published annually today—a staggering increase. More new and useful medical knowledge has been acquired in the lifetime of the NLM than in all other ages of the past. Whereas the cost of acquiring the medical literature has increased steadily at 10 to 12 percent for several years, the rate more than dou- bled in calendar year 1971. This causes some concern not only because of the increase in acquisition costs but also because requests for loan of books and monographs have doubled during the last 6 months. It is much more costly to loan books than photoconies of journal articles. I am pleased to report that the National Librarv of Medicine met its production goals and objectives last year. We have continued to provide competent and efficient library services to a constituency of users which includes health science practitioners, educators, and scien-8407375_000006.txt

Page  6 1497 tists. In addition, we have continued to implement the specialized medical information and communications programs which we de- scribed last year. MEDLINE Specifically, our new on-line reference retrieval system Medline has been operating efficiently since December 1971. It replaces the earlier version called AIM-TWX which was used successfully by more than 80 institutions throughout the country. Whereas AIM-TWX con- tained citations to little more than 100 journals, Medline will cover approximately 1,000 periodicals, which includes more than 400,000 reference material, one-half of our entire Medlars file. A Medline search costs approximately $9 as compared to $60 for the Medlars search which it replaces. Searches are completed in 10 to 15 minutes in contrast to 10 to 15 days required by the older system. A commercial communications network will make Medline available to major medical schools, hospitals, and research institutions at low cost. Approximately 200 institutions can join the network during fiscal year 1973. Whereas the Library fully subsidized all domestic Medlars searches, the user pays the line charges for Medline. This development should reduce the need for the longer Medlars searches. Thus, most of the Medlars centers in the United States will be phased out, and the funds that have supported their operations will be used to maintain the Medline communications network. We would emphasize that this net- work will be available to transmit data other than bibliographic cita- tions and in time should encourage dissemination of other information in a variety of other computerized data bases. As I informed this committee last year, the Library is actively en- gaged in redirecting the development of the new system Medlars II. It will be completed by the end of fiscal year 1973. lister hill center The Lister Hill Center's satellite communications project has been critically tested and found to be most useful in improving medical communications to remote villages in Alaska. On at least two occa- sions it provided information which proved to be lifesaving. It has served to bring medical assistance to persons who previously could not be reached by telephone or radio communications. It has helped physi- cians determine when patients need to be evacuated to district or re- gional hospitals for emergency care. On the other hand, it has cut down on unnecessary bush plane evacuation when the patient could be man- aged by a health aide or local nurse after satellite consultation with a physician. Mr. Flood. How did you get physicians to go up there? Dr. Cummings. There are about 250 physicians practicing in Alaska. About half of them are associated with the military services and the Native Indian health service program; the others are in private practice. As in the other States, they are concentrated in the larger cities. This system is attempting to make available the expertise of physicians to remote villages where we only have health aides or nurses.8407375_000007.txt

Page  7 1498 Mr. Flood. Go ahead. ... , -, •. , Dr. Cummings. We are pleased with the accomplishments and plan to extend the system to other regions of our Nation wheregreat distances and rugged terrain make patient-physician contact dimcuit. The National Aeronautics and Space Administration plans to launch a sophisticated satellite late in fiscal year 1973. The stall of the Lister Hill National Center for Biomedical Communications has been working closely with NASA to define a series of experiments using the new satellite to test the utility of interactive programs in im- proving health care. The experiments are being designed to meet the needs of a number of selected locales. Experience with the inter- active television system operating successfully m New England strong- ly indicates the desirability of expanding that network through Ver- mont and New Hampshire and conducting similar studies via the new satellite in other parts of the country. OPERATION OF SATELLITE SYSTEM Mr. Flood. There is a satellite up there. How do the people on the ground not identified now or heretofore with NASA get this informa- tion ? What happens ? Dr. Cummings. What we have done is to place small taxicab-type receivers in the health aides' homes and clinics of the villages to be served. With a very inexpensive small diameter land-based antenna, it is possible to have reliable two-way voice communication between the health aide in the village and the doctor in the hospital. Mr. Flood. Who owns the hardware you are talking about ? Dr. Cummings. The satellite was put up many years ago by NASA for other purposes. It has outlived its projected useful life, and I should admit to the chairman that this small satellite could go down at any time. It has been up about 2Vs> years past its normal life expectancy. Mr. Flood. Why don't you put another one up? Dr. Cummings. That would cost more money than we have available. Mr. Flood. Cost who ? Dr. Cummings. The Government. Mr. Flood. Which part of the Government ? Dr. Cummings. NASA. Mr. Flood. Are you going to put up another one ? Dr. Cummings. They are planning to put up a new one called ATS-F. Mr. Flood. What decade ? Dr. Cummings. There will be another one to replace the small one in 1973. Mr. Flood. When the one goes up in 1973, will this hardware you have in Alaska and other places be available and usable to connect with the new one ? Dr. Cummings. We believe we can use the same ground stations and terminals for voice communications and have more power and broader bandwidth. I should say we are operating the small satellite at half power, and thanks to solar energy, we still are operating. It has been a very important experience for us and has shown the utility of this kind of health communication.8407375_000008.txt

Page  8 1499 INTERACTIVE TELEVISION SYSTEM • *r -^i000' What do you mean by the interactive television system in New England? Is it so remote they have to have satellites? 'tuIMMINGS: ^nere are no satellites being used in that experi- ment. That is a simple two-way interactive television communication system. Mr. Flood. What is an interactive television communication system ? Dr. Cummings. Interactive means there can be two-way communica- tion. Mr. Flood. Between whom and where ? Dr. Cummings. Between medical school physicians and those in rural hospitals treating patients. This program was started by the National Institute of Mental Health for psychiatric consultation. Mr. Flood. Somebody has a contract with somebody like General Electric who will set up and operate a telecommunications system ? It is a complicated thing. So here is town A in a remote part of a State in New England and it needs psychiatric information from point B in Boston. What happens ? Dr. Cummings. The points involved should be identified. The sender or the prime base is the Dartmouth Medical Center. The receivers are the community hospitals in the area. Mr. Flood. There is a point for disseminating the information ? Dr. Cummings. Yes. Mr. Flood. Do you have a contract with somebody like General Electric to run the telecommunications ? That calls for hardware. Dr. Cummings. The contractor who engineered this program was Jansky and Bailey. Mr. Flood. But there is a contract. Dr. Cummings. Yes; there was a contract. Mr. Flood. What do you mean there was ? Dr. Cummings. The contractor engineered the system and installed the equipment, and it is now being managed by Dartmouth. Mr. Flood. Who * owns the equipment? Isn't Dartmouth the contractor ? Dr. Cummings. Yes. Mr. Flood. Then we have a contract between Dartmouth and who ? Dr. Cummings. The National Library of Medicine. Mr. Flood. We have similar systems in other parts of the country I suppose ? Dr. Cummings. We are not actively involved in any others. Mr. Flood. Why? Dr. Cummings. These are the only two, New England and Alaska, which we felt we could fund and had the opportunity to do the pilot work. Mr. Flood. Is it important, does it work, is it a good idea ? Dr. Cummings. Yes; I believe it is a good idea. Mr. Flood. Is it expensive beyond reason ? Dr. Cummings. The entire cost of this TV system over a 4-year period is $863,000. Mr. Flood. I don't know whether that is excessively expensive or not. Dr. Cummings. I would say its cost effectiveness is reasonable in light of the health care delivered.8407375_000009.txt

Page  9 1500 Mr. Flood. Do you want to do it someplace else? Should you do it someplace else if it is that good ? Dr. Cummings. We believe that the Rocky Mountain States afford another possible test place. Mr. Flood. What are you waiting for I Dr. Cummings. We have an appropriations request in our budget which would permit us to begin to design a system in cooperation with NASA and OE to do this in the Rockv Mountain States. Mr. Flood. What does NASA have to do with this tettecommimica- tions? Dr. Cummings. Because of the distances involved the Rocky Moun- tain interactive system would be handled through a NASA satellite rather than through long lines and microrelays. Mr. Flood. Which is the best ? Dr. Cummings. It depends on the geography and the terrain of the area. We believe for the vast area of the West it is more efficient to use a satellite than it is to use microrelay stations. Mr. Flood. We spend a great deal of time and hear a great deal of talk about the importance of delivery of all sorts of medical health care which includes medical information in emergencies to rural areas and remote areas. We have had a good deal of that in conjunction with the same sort of service to the ghetto. We have heard so much about the ghettos, and properly so. But we are feeling that there are other places in the country besides the ghettos that need this delivery of medical service. Now you come up with exhibit A where there is hardware telecom- munications and satellites. You have the answer, the other people are just talking. Dr. Cummings. I agree with what you have said and I think we should---- Mr. Flood. The regional medical programs. I can't imagine this wouldn't be important to a regional medical program. It strikes us what you are talking about would go hand in glove with the services of the regional medical programs in certain remote areas. Dr. Cummings. I believe that to be true. Mr. Flood. Go ahead with your statement. GROWTH OF MEDICAL LITERATURE Dr. Cummings. The medical literature continues to grow at a rate of 6 percent a year. At this rate of growth our facilities will be over- flowing by 1975. It is therefore essential that the building authorized by Congress for the Lister Hill Communication Center be completed by that date so that we may move personnel and communications ac- tivities into the new facility and restore the space they presently oc- cupy to conventional library functions. NATIONAL MEDICAL AUDIOVISUAL CENTER The National Medical Audiovisual Center continues to serve Amer- ican medicine by acquiring, producing, cataloging and distributing audiovisual materials which are used in the teaching and practice of medicine, dentistry and the allied health professions. It makes its re-8407375_000010.txt

Page  10 1501 sources available to professional societies and academic health centers through collaborative arrangements. Mr. Flood. What do you mean by academic health centers? Dr. Cummings. That would be medical school in a university or a consortium of academic health institutions. The National Medical Audiovisual Center offers a variety of highly successful workshops through which it teaches the fundamentals .of audiovisual technology utilization. Mr. Flood. Do you use television in your telecommunications ? Dr. Cummings. Yes, we do. Mr. Flood. If a surgeon in a remote area such as for instance Alaska has an emergency need for information, such as how to do an emer- gency operation which he has never done, can he call you up and can you send him a picture through the satellite and let him watch this ? Dr. Cummings. No. The satellite we are presently using does not have the capability for individual video transmission. It is used for audio transmission and only slow-scan television. We can send, for ex- ample, a photograph of a patient with a lesion, a skin rash or fracture. Mr. Flood. Why don't you ? Dr. Cummings. There is not enough power and band width in the satellite to do that. Mr. Flood. Why not ? Why don't you get a more powerful one ? Dr. Cummings. We would love to have a more powerful one but we were using one that was in essence bequeathed to us by NASA. Mr. Flood. In 1973 you are going to have a new one. Mr. Michel. The one going up in 1973 won't be exclusively for your use. Dr. Cummings. That is correct. Mr. Michel. It is simply a satellite that you are plugging into ? Dr. Cummings. That is correct. Mr. Flood. I understand that but I was wondering why this doctor up there can't have that picture he needs to help him successfully operate. Dr. Cummings. The new satellite will have sufficient band with capability to permit that. Mr. Flood. Then you have to have hardware on the ground to receive it. Dr. Cummings. We will have to upgrade the ground hardware for two-way video. Mr. Flood. You had a great idea, it has been working, but it is obsolete at the present time. Dr. Cummings. It is obsolete and we look forward to upgrading the system with the increases provided in the fiscal year 1973 budget re- quest and in collaboration with NASA which can provide for most of the hardware requirements. Mr. Michel. They don't have the kind of money to play around with that they do in national defense. Mr. Flood. If you take a look at the budget for HEW vis-a-vis the one for national defense, you are doing pretty well in the last 10 years. This kind of thing impresses us. Dr. Cummings. I am delighted to have that reaction. Mr. Flood. Here apparently is one of the best things in the whole lot to get improved medical service to remote areas. We shouldn't be timid about it.8407375_000011.txt

Page  11 1502 Dr. Cummings. I don't mean to leave vou with the impression that we are timid about this. We are proud of this program and look forward to expansion of these demonstration projects, as they prove their cost-effectiveness. Mr. Flood. Go ahead with your prepared statement. COOPERATIVE EFFORTS IN EDUCATION OF HEALTH PROFESSIONALS Dr. Cummings. One of the most significant developments of the past year has been the merging of interests in advancing the education of health professionals bv the Bureau of Health Manpower Education and the National Library of Medicine. The Bureau interacts constantly. with a variety of educational interests, has intimate knowledge of cur- ricular content, and closely monitors educational trends. The Library, on the other hand, has extensive expertise in the development of audio- visual materials which enhance the learning process and become in- creasingly important in restructuring of the academic experience. Moreover, the Library has long experience with development and management of computerized files and has developed the concept of networking to increase utility and cost-effectiveness. The melding of these different skills on the basis of mutual interests should create a more progressive and cohesive program than could possibly result from each organization going its separate way. I want to report, as the sequel to the statement, that we have recently signed an agreement with the Bureau to join our resources in Atlanta to produce educational materials to help meet the needs of im- proving the health manpower problem in our Nation. This is working out very well. MEDICAL LIBRARY ASSISTANCE ACT Through the Medical Library Assistance Act we have been able to improve significantly library and information services at local and regional levels. Better library resources for community hospitals. teaching hospitals and academic health centers have been made avail able to more than 600 institutions in the 50 States. The Regional Medical Library network is fully operational and now provides 500,000 interlibrary loans annuallv. Several hundred young medical librarians have been trained to fill the gaps within the profes- sion and to assume its leadership in the very near future. The training program is being strengthened by phasing out support for training in conventional librananship to emphasize the specialized needs of medi- cal libraries and communications science and to develop management capabilities. Mr. Flood. Are you identified or tied into these very well-known old established national library associations, State library associations? They have a lot of clout and appear here and testify every year. We get that every year and properly so. They exist in municipalities and universities and so on. Are you identified in any way with these organi- zations. Dr. Cummings. We are institutional members of the Medical Library Association and the Association of Research Libraries We are not members of the most powerful and largest library association the American Library Association. '8407375_000012.txt

Page  12 1503 TOXICOLOGY INFORMATION PROGRAM . The toxicology information program collaborates extensively with °u ^ • al agencies> such as the Food and Drug Administration and the Environmental Protection Agency, to collect, organize, and auto- mate toxicology data from diverse and previously uncoordinated sources. It is developing a toxicology information query response cen- ter at the Oak Ridge National Laboratory (AEC), which draws as needed on the capabilities of their scientists to provide special analyses and evaluations of toxicological data for Federal agencies, industry, and the scientific community in general. Mr. Flood. What is toxicology ? Dr. Cummings. It is the study of the effects of drugs and chemicals on living cells and organs. It is the study of the noxious or adverse effect of drugs and chemicals. The increase of over $300,000 in fiscal year 1973 for this program will be utilized primarily to place this Query Response Center into full operation. Toxicologists generally prefer to use abstracts as alerting systems. Therefore, the toxicology information program has negotiated with such organizations as Chemical Abstracts Service and Biosciences In- formaton Services (Biosis) to purchase abstracts at modest costs and repackage them to suit the needs ctf toxiocologists. In collaboration with Biosis a new abstract journal, "Health Effects of Environmental Pollutants," has begun regular publication this year. An on-line inter- active toxicology information system will be expanded through the addition of more terminals and the creation of additional data bases. summary As we prepare for the future, we remain sensitive to the informa- tion and communications needs of American medicine. A library can only be responsive to its clients through an intimate understanding of their requirements. We believe that the progress of medical science is reflected in our enlarging information base and we are committed to share this information rapidly and efficiently with all those who have a need to know. In summary, our request for fiscal year 1973 is $28,104,000, an in- crease of $3,998,450 over the amounts available for obligation in fiscal year 1972. The net increase reflects program increases of $2,907,450 and $1,091,000 for mandatory incerases, such as within-grade in- creases, additional NIH Management Fund assessments ifor centrally furnished services, and increases associated with noncompeting con- tinuation grants supported under the Medical Library Assistance Extension Act of 1970. I will be pleased to attempt to deal with any questions you may have. NATIONAL BIOMEDICAL COMMUNICATIONS NETWORK Mr. Flood. Suppose you give us a little more detail on this national biomedical communications network. What is its status now and what do you envision it will be when it is fully implemented ? How much are you spending on it nowT and how much will it cost in the future ? It fl94 r»_79—i,i 4.-P.S8407375_000013.txt

Page  13 1504 Dr. Cummings. I will be verv pleased to deal with that question. First, may I sav that we have submitted a report to the Congress which 1 hope wilf reach this committee in the very near future which gives the current status of our biomedical network planning and opera- tions. . , , Essentiallv, Mr. Chairman, the network that we have conceived and designed will have four major elements. There is a library network which is already in being where the National Library of Medicine is joined to 11 regional libraries and they in turn are joined to some 500 or 600 local libraries throughout the Nation. Mr. Flood. Are these existing private libraries ? Dr. Cummings. These are existing private libraries. Mr. Flood. Thev don't belong to you ? Dr. Cummings.'They do not belong to us but we attempt to backstop their service by making available to them the materials that they may need to give local service. That network has been in being about 3 years and we are quite pleased with its responsiveness and its service. Mr. Flood. Who do you serve? Dr. Cummings. We serve 290,000 physicians, dentists, nurses, educa- tors, and the health professional students of the Nation. We serve other professionals who have a need to know medical information, such as lawyers interested in forensic medicine, the pharmaceutical industry, and Federal agencies. OPERATION OF THE NETWORK Mr. Flood. I suppose they have a card and go to the library and go to the front desk just like getting a history book. Dr. Cummings. That is the way they used to do it. The libraries in our network, if they know what they are looking for, send materials to the user. Some may go to the institution and sit down at a terminal and make a search for the subject they are seeking. Mr. Flood. At a terminal ? Dr. Cummings. A terminal that is linked to a computer, the Medline system which I described. Mr. Flood. That is in this library in town X? Dr. Cummings. That is in the national library, the 11 regional li- braries, and in some 49 libraries disseminated throughout the country. Mr. Flood. Dr. Jones has a problem with a patient with some middle ear problem. He goes there and hooks up. Then what ? Dr. Cummings. He can go there if there is one in the community or he can make a telephone call to the library and make the request Mr. Flood. To what library ? Dr. Cummings. To the library that has the terminal. If Dr. Jones has a terminal, he can sit in his office. Mr. Flood. Can he have one himself in the office ? Dr. Cummings. He may. Mr. Flood. Who pays for that ? Dr. Cummings. He pays for the terminal and the line charges. Mr. Flood. It is hooked up to what ? D.r-Cu>rM_IXGS; Tt is hooked up through a telecommunications net- work to the data base in our library, that is the computer store that has all of the information.8407375_000014.txt

Page  14 1505 Mr. Flood. In your library ? Dr. Cummings. Yes. an^i'o^?00;^0^ ^av? a telecommunications system that any doctor S? ^mihe U?lte4 States who wante to Pay for setting up this piece of hardware in his office and pays for the lines---- -ur. Cummings. There are constraints. The system can only carry a finite number of concurrent users. Mr. Flood. Why don't we have more ? onn f* CYMMINGS- The system is not capable of handling more than 200 terminals at one time. Mr. Flood. Why ? Dr. Cummings. It is just that the computer hardware and the soft- ware programs are not able to handle more than that. Mr. Flood. Why don't you get another one ? ±iPV-' C™MINGS- J should point out, Mr. Chairman, that we believe this is the largest, most sophisticated library system of its kind avail- able and we think---- Mr. Flood. Are you going to get another one? You mean available today? Dr. Cummings. Yes, we believe it is the most sophisticated system available today. Mr. Flood. What about tomorrow. What about all of these doctors who should be served and can't be served ? Dr. Cummings. The way we envision this network, a doctor in a remote town---- Mr. Flood. It doesn't have to be in a remote town. Is this restricted to doctors in remote areas ? Dr. Cummings. No. I was trying to give an example of how a physician or scientist who does not have a terminal could get access to it and that is through a local telephone call. The system is multiplexed. Mr. Flood. Where is the telephone call hooked in ? Dr. Cummings. Suppose we are in Peoria. He would make a tele- phone call to the nearest node which would be Chicago. Mr. Flood. How does he know that ? Dr. Cummings. We have announced the availability of this service. We have described medline through the medical journals of our coun- try, through our own bulletins---- Mr. Flood. You are using the best system available to disseminate the information to these doctors ? Dr. Cummings. Any doctor who is interested in learning what is available should be able to find out. Mr. Flood. If they don't know about it, that is their fault ? Dr. Cummings. Yes, although it should be pointed out that it is al- most impossible for health professionals to keep abreast of all the information made available to them today. Mr. Flood. There is the phone and he dials the phone and what happens? Where does he dial? He wants information to help him with a middle ear problem a patient has. Dr. Cummings. He dials the library number that allows him to ask the computer for all the literature that deals with middle ear infec- tion in children. He gets a response that will print out the leading titles. Mr. Flood. What do you mean print out ?8407375_000015.txt

Page  15 1506 Dr. Cummings. References appear on the teletypewriter in the library. Mr. Flood. He is on the telephone, he hasn't a telety jm*writer. Dr. Cummings. They are provided by the nearest node. Mr. Flood. What is a node ? . Dr. Cummings. A node is an institution that has a teletypewriter connected to the system. This might be his public library incidentally He will make the request, the search will be made and it wiJl be sent to him as a print out. Mr. Flood. Mailed? Dr. Cummings. Mailed if he is distant from the node. Mr. Flood. He is on the telephone now. Dr. Cummings. He can have the librarian read it to him over the telephone. / Mr. Flood. Go ahead with your description of the network. ' OTHER COMPONENTS OF THE NETWORK Dr. Cummings. The second part of the network is the audiovisual component and I described that in my testimony. It is built around the National Medical Audiovisual Center which is trying to share its resources with universities, medical schools, and hospitals throughout the country. What we do is make and replicate packages of information in video type format, short motion pictures, slide—sound series and distribute these to institutions or individuals who have a need for this kind of information. More than 70,000 such loans were made last year. The third part of the network is what we call the special informa- tion services, and this is characterized by the toxicology program I described. If you need information in depth about a pesticide or drug with unfortunate adverse reactions---- Mr. Flood. Let me ask you this: Joe Zilch is drunk in some barroom and gets in an argument with somebody about the middle ear. Can he go to the pay station in the barroom and call into this network ? Dr. Cummings. No. Mr. Flood. Suppose he says I am Dr. Zilch ? Dr. Cummings. I suppose that you can break the system if you say I am Dr. Zilch and caU in and ask for this. But every node, every ter- minal has essentially a coded telephone number. We try to control it in that way. There is no denying someone could enter the system illegally. Mr. Flood. You have not had much trouble so far. It is unlikely. Dr. Cummings. Yes. Mr. Flood. Go ahead. Dr. Cummings. The last part of our communications network dea^ with computer communications that are associated with data process- ing. This is the matrix of MEDLINE, MEDLARS, the toxicology information program, all of which have their data on computer tape or disk files. This in essence is the concept. We don't profess at the moment to have completed everything. FUNDING OF LISTER HILL CENTER Mr. Flood. How much are you spending on it now ? Dr. Cummings. The budget for the Lister Hill Center, the part of8407375_000016.txt

Page  16 1507 the library which is managing the network is $1,855,000 in fiscal year Mr. Flood. Is that a lot for what is being done ? Dr. Cummings. No, that is not a lot for what is being done. Mr. Flood. What are you going to spend next year and the next 4 or 5 years ? Dr. Cummings. This budget calls for an increase of $1,217,000 to advance---- Mr. Flood. Is that $1,200,000 plus ? Dr. Cummings. Yes. The total budget for this component is $2,475,- 000 for contracts and $597,000 for our own direct operations. Mr. Flood. Is that extravagant? Dr. Cummings. No. I view this as the takeoff point for the Lister Hill Center. It is the first significant increase for this important pro- gram and I think it gives us an opportunity now, Mr. Chairman, to take off. I do not consider it extravagant. REGIONAL MEDICAL LIBRARIES Mr. Flood. You are requesting an increase from $2,147,000 to $2,902,- 000 for the regional medical libraries. What is a regional medical library and what are you going to do with that money? Dr. Cummings. A regional medical library is one that has been selected by the Board of Regents and our staff to serve the medical literature needs of a group of States. Mr. Flood. What is the Board of Regents ? Dr. Cummings. The Board of Regents is the senior advisory body to the Director of the National Library, to Dr. Marston, and the Sec- retary. Mr. Flood. Who appoints them ? Dr. Cummings. They are appointed by the President of the United States and confirmed by the Senate. The Board selects the regional libraries who have the governance of the library in their hands. Our congressional statute provides for that. After careful review they made a selection of 10 existing good medical libraries such as the Philadelphia College of Physicians in Philadelphia and the John Crerar Library in Chicago. We supplement their resources to provide better access to their collection. These re- gional libraries are intermediaries between the NLM in Bethesda and the local library. Mr. Flood. How long has this been going on? Dr. Cummings. Five years. Mr. Flood. Is it working ? Dr. ( Cummings. Very successfully. Mr. Flood. What is wrong with them ? Dr. Cummings. Nothing. They need more money because the costs of doing business have gone up, the costs of acquiring materials have gone up. As we have requested more money for these materials at NLM, we feel we must provide more funds to the regional libraries. Mr.' Flood. On page 106 you say, "In 1972, the mechanism of support for the service components of these regional medical libraries was completely converted from grants to contracts," but your justifications don't say whv. They just say it happened.8407375_000017.txt

Page  17 1508 Dr. Cummings. I would be pleased to review this again with this committee. . , . We believe that when you ask an institution to provide service, tins should be on a businesslike basis on a unit cost per service, Inrougn the grant mechanism we were never sure that we could price out the cost, of an interlrbrary loan or a reference service. Mr. Flood. Interlibrary loan ? Dr. Cummings. Yes. That is, for example, a regional library lend- ing something to a local library or to a physician. Mr. Flood. Do vou mean a book ? Dr. Cummings. A book or journal or audiovisual format of some sort. Mr. Flood. Actual physical transfer of the book ? Dr. Cummings. Yes, in some cases. More often, a photocopy of the journal article requested is provided. Therefore, to standardize the unit costs, we have converted all of these from grants to service contracts, and we are pleased that wye can now account, on a dollar and penny basis, for every- unit of service given. It is also fairer to the institution, I believe, Mr. Chairman, because they now for the first time can calculate the accurate indirect costs involved in running a regional medical 'library program. COMPETITIVE GRANT PROGRAM Mr. Flood. What is this new competitive grant program that you also refer to on page 106 of your justifications ? Dr. Cummings. In addition to awarding a contract for routine or conventional services, regional libraries in great institutions some- times wish to innovate and develop a new service for their com- munity. Therefore, we are launching a program whereby these insti- tutions can compete for funds through a regular grant review mech- anism to develop innovative services. Mr. Flood. You don't run around building these things, bricks and mortar ? Dr. Cummings. No, sir. We have not constructed any regional li- braries. They were selected from among existing centers of excellence. MEDLARS PROGRAM Mr. Flood. Your request for 1973 includes $3,571,000 and 52 posi- tions to continue work on Medlars II. You began working on this way back in 1968. Dr. Cummings. The budget and personnel are used to operate Medlars and Medline, as well as for developing Medlars II. Mr. Flood. We heard volumes of talk about this thins; across the table. I am beginning to wonder if it won't be time for Medlars III before you get Medlars II in full operation. Tell us about the prob- lems you have had, what are the prospects for finishing this job? Dr. Cummings. In all fairness, Mr. Chairman, Medlars I was con- ceived in 1963 and has been operated successfully since 1964 to the present. Medlars II was conceived, as you pointed out, in 1968 and since 1969 has been under development. '8407375_000018.txt

Page  18 1509 As I reported to this committee last year, we were not satisfied with tne progress which was being made in the systems design by our first contractor. As I reported also, we completed that contract and trans- Mr. Flood. You got a new contractor ? Dr. Cummings. We have a new contractor who is performing ad- mirably, and we believe we will come in with Medlars II within the budget that I told this committee it would take to complete this job. Mr. Flood. The night before you start Medlars III ? Dr. Cummings. I would be less than frank if I didn't tell you that when Medlars II is up and running, we hope it will have a life expect- ancy as long as Medlars I, about 7 or 8 years. During that period of time, I believe we should be thinking about what the next generation system should look like, and we undoubtedly will. CHARGING OF FEES Mr. Flood. You told us a lot about all these great services that you provide and are going to provide. Who do you charge for what and what are the fees ? Dr. Cummings. We charge $2 for an interlibrary loan that is made to any point outside of the United States, and $10 for the lending of an audio-visual outside of the United States. We make no charges to American medicine for the conventional services that we provide, interlibrary loans, reference services and the like. Mr. Flood. What about that doctor making a telephone call about that middle ear problem ? He dials that secret number ? Dr. Cummings. To get into the on-line system, the institution or individual must pay the line charge involved. Mr. Flood. What does that amount to ? Dr. Cummings. That can be anywhere from a 10 cent telephone call to perhaps an $8 or $9 call if there is a long dialog between the requester and the computer. Mr. Flood. Are there any complaints about the charges so far ? Dr. Cummings. No, sir; we have had no complaints. Mr. Flood. Are you charging enough ? Dr. Cummings. I believe the charges which are being assessed are fair, if you weigh the desire to transfer information freely against the benefit. However, I wouldn't say that we might not come back and want to change the level of the charge. Mr. Flood. But as of now ? Dr. Cummings. As of now, it seems reasonable. Mr. Flood. Mr. Michel ? Mr. Michel. Thank you, Mr. Chairman. Dr. Cummings, members of this committee have known for the last several years, but I doubt very much whether the general public really is aware that the National Library of Medicine is certainly much more than what one traditionally considers to be a library. When he reads about the National Library of Medicine he thinks, I am sure, in terms of what he has in his hometown, a nice building, a lot of bookshelves, a place you can go to get films and a few other audio-visual aids in addition to books. I must confess, even after read- ing about it and having been told by you, and our association over a8407375_000019.txt

Page  19 1510 number of years, I couldn't help but be impressed when I made my own personal visit to the library last year. REGIONAL LIBRARY SYSTEM I would like to get more clearly in mv mind and for the record too, how we are funding this activity of actually tying together through- out the country this system of intercommunications. We are funding all the activities out of the National Library with Federal funds, ex- cept for some of the fees you get; is that correct ? Dr. Cummings. That is correct. Mr. Michel. There are 11 regional libraries around the country? Dr. Cummings. Yes, sir. Mr. Michel. Funded by whom ? Dr. Cummings. The institution that owns the library maintains the basic library. We pay that institution a fee to provide service beyond its normal constituency, so that National Library of Medicine gives each of these institutions, say, $2.50 for lending material to someone distant from the site. We also, of course, pay for the additional man- power required to maintain the additional workload. Mr. Michel. Do we have a contract then? Is it an institutional contract ? Dr. Cummings. It is an institutional contract in each case. Mr. Michel. Are those pretty uniform throughout the country or do they vary widely ? Dr. Cummings. There are minor variations, Mr. Michel, between institutions, but on the average they are reasonable, in our judgment, and we think compatible. We are not paying, for example, someone twice as much money to give the same service as another institution. Mr. Michel. Beyond the regional libraries, there are what, 49 termi- nals beyond the regional libraries? Dr. Cummings. Yes, sir. At the moment we have 64 terminals in institutions scattered throughout the country, including the regional libraries. Mr. Michel. Would the 64 include the 11 ? Dr. Cummings. Yes. Mr. Michel. So we are talking about 49 then, aren't we ? Dr. Cummings. Right. In these cases the institution provides its own terminal. It either buys one for approximately $2,000 or $3,000 or leases one, and the lease costs are between $65 and $170 a month. They put in their own terminal. Mr. Michel. Is there any Federal assistance ? Dr. Cummings. There is no Federal assistance, that I am aware of. We also expect the institution or the user to pay the cost of the teleo^one lines between that terminal and the nearest node in the network. The network is a commercial network such as Western Union which al- ready exists. We have not run lines around the country, but we have selected from two existing sets of lines, those that fit the pattern of use best. We subsidize the cost of using those lines. The library pays for that. I can provide you with a list of our current users for the record, if you wish.8407375_000020.txt

Page  20 1511 LOCATION OF LIBRARIES AND TERMINALS Mr. Michel. That is what I would like to have. Spell out in the rec- ord where these 11 regional libraries are, and then these 49 additional terminals are where ? (The information follows:) Listing of Medline Terminals institution and location 1. University of Alabama, Birmingham, Ala. 2. University of California, Irvine, Calif. 3. Loma Linda University, Loma Linda, Calif. 4. University of California,* Los Angeles, Calif. 5. University of Southern California, Los Angeles, Calif. 6. University of California, San Francisco, Calif. 7. Systems Development Corp., Santa Monica, Calif. 8. Veterans' Administration Hospital, Sepulveda, Calif. 9. Stanford University Medical Center, Stanford, Calif. 10. University of Colorado, Denver, Colo. 11. Yale University, New Haven, Conn. 12. Bureau of Narcotics and Dangerous Drugs, Washington, D.C. 13. Environmental Protection Agency, Washington, D.C. 14. George Washington University Hospital, Washington, D.C. 15. Georgetown University Medical Center, Washington, D.C. 16. Joint Medical Library USA-USAF, OSG, Washington, D.C. 17. Veterans' Administration Hospital, Washington, D.C. 18. Walter Reed Army Institute of Research, Washington, D.C. 19. Washington Hospital Center, Washington, D.C. 20. University of Florida, Gainesville, Fla. 21. Emory University,* Atlanta, Ga. 22. John Crerar Library,* Chicago, 111. 23. University of Iowa, Iowa City, Iowa. 24. University of Kansas, Kansas City, Kans. 25. University of Kentucky, Lexington, Ky. 26. Johns Hopkins University, Baltimore, Md. 27. National Institutes of Health, Bethesda, Md. 28. National Cancer Institute, Bethesda, Md. 29. National Library of Medicine,* Bethesda, Md. 30. Health Services and Mental Health Administration, Rockville, Md. 31. Harvard University,* Boston, Mass. 32. University of Michigan, Ann Arbor, Mich. 33. Wayne State University,* Detroit, Mich. 34. University of Missouri, Columbia, Mo. 35. Washington University, St. Louis, Mo. 36. University of Nebraska,* Omaha, Nebr. 37. University of Nevada, Reno, Nev. 38. College of Medicine and Dentistry of New Jersey, Newark, N.J. 39. University of New Mexico, Albuquerque, N. Mex. 40. New York Academy of Medicine,* New York, N.Y. 41. University of North Carolina, Chapel Hill, N.C. 42. Duke University School of Medicine, Durham, N.C. 43. Bowman Gray School of Medicine, Winston-Salem, N.C. 44. Ohio State University, Columbus, Ohio 45. Medical College of Ohio at Toledo, Toledo, Ohio 46. Pennsylvania State University, Hershey, Pa. 47. Co'lege of Physicians of PhPadelphia,* Philadelphia, Pa. 48. University of Pittsburgh, Pittsburgh, Pa. 49. Medical University of South Carolina, Charleston, S.C. 50. University of Tennessee. Memphis, Tenn. 51. Vanderbilt University, Nashville, Tenn. 52. University of Texas at Dallas,* Dallas, Tex. 53. University of Texas Medical Branch, Galveston, Tex. •Regional Medical Library.8407375_000021.txt

Page  21 1512 54. Texas Medical Center, Houston, Tex. ".. University of Texas at San Antonio. San Antonio, Tex. 56. University of Utah, Salt Lake City, Utah 57. University of Virginia. Charlottesville, Va. 58. University of Washington,* Seattle, Wash. 59. West Virginia University, Morgantown, W. Va. 60. University of Wisconsin, Madison, Wis. CONSTRAINTS PLACED ON SYSTEM Mr. Michel. Of course, if it is of their own volition, to be a party to this system at their own expense, the system obviously is inhibited by the capacity of an institution or an area or community to fund what- ever participation they want. We don't grant money or say, "Look, wc are going to blanket the country now, here, there and everywhere,*' and set up « system that will cover all the geographical areas of the country. Di. Cummings. I think that statement is correct. The way we have tried to meet that constraint is to allow this multiplexing of the tele- phone calls, so that no one really has to make a long distance call to get into the system. That was the only way our engineers and systems people felt we could equalize access, without placing an undue burden on one particular group of institutions or people, and I believe that is working very well. I should also point out, Mr. Michel, that we are sharing this system with sister Federal agencies, such as the Department of Defense which has large hospitals with great needs and the Veterans' Administration. We also have a few terminals on the campus at NIH, so that we are serving the Federal as well as the private sector. USE OF CABLE TELEVISION Mr. Michel. What do you envision in the future by way of cable television ? Somewhere I read in the justifications that this was being explored. Dr. Cummings. Yes. Mr. Michel. I was curious whether my home area of Peoria is going to have it, and if so who is going to get the contract? What have you done in that area ? Dr. Cummings. We have one study underway, which suggests that we should test and demonstrate the effectiveness of cable television linking a large ghetto area in New York City with Mount Sinai Medical School and Hospital. They have a cachement that contains about a quarter of a million ghetto residents, that relate to this par- ticular medical environment. The study is designed to tell us whether it would be efficient to put lines into the low-cost housing units that are gomg up there now. I believe that the data so far suggests that we should try this, and so our first involvement will be in this inner- city area of New York. Mr. Michel. Is there any way in which public broadcasting chan- nels would be brought into the act ? Dr. Cummings. I would want to give this more thought before I make any recommendation. I would think it is possible to do this if one could find adequate time economically. '8407375_000022.txt

Page  22 1513 Mr. Michel. Is it your view that if it took the television cable route it would be exclusively 24 hours a day devoted to that purpose? Dr. Cummings. Yes. Mr. Michel. As against broadcasting? Dr. Cummings. Yes. Mr. Michel. Where they have to have a certain amount of sexy programing time for good viewer participation, and then a limit- ed amount to the thing you are interested in here ? Dr. Cummings. Yes. The notion here is that a disadvantaged person, say an elderly person living alone, who needed health care, who might not be able or willing to go to the clinic, would be able to reach the clinic and have contact with, say, the emergency health care unit, Also I should point out that, the University of Colorado at Denver has an interesting plan which they are asking us to consider supporting to do the same thing, connecting some of their neighborhood health clinics with the university hospital and clinic. We are quite intrigued with the prospect of doing that. Mr. Shriver. Relating to this, I think you have probably answered it, but if this is contemplated to be information that would go into im- poverished areas, it could also be used in rural areas at the same time, could it not ? Dr. Cummings. Yes, sir. I see no reason why there has to be any distinction between urban and rural areas, except for the cost of laying the lines. As we commented earlier, the Library has spent a good bit of its time determining how to capitalize on something that is being developed for other purposes. We would not spend funds to lay the lines ourselves. Mr. Michel. Of course, on that point in a really concentrated public housing unit, you are serving many people as against the very few in an equal rural area. Dr. Cummings. Exactly. Mr. Michel. We run up against the same thing in providing electricity. Dr. Cummings. Exactly. TELEVISION AVAILABILITY IN POOR AREAS Mr. Shriver. My other question is, what does your survey reveal as to television sets in the impoverished area, the availability of them ? Do these people who are so poor have television? Dr. Cummings. I don't have the data before me, but Mount Sinai Medical School has been studying this long before our involvement with them, and I gather from conversations with them that no mat- ter how poor a family may be ,they seem to have a television set. This is one of the things we are taking adavntage of. In a low-cost housing unit, there is often also a lobby containing a TV for viewing by groups. We believe that the hardware is going to be there, whether we put it in or not, EXPERIMENTAL NATURE OF TELEVISION PROJECT Mr. Michel. This is really being thought of, though, in a very experimental way.8407375_000023.txt

Page  23 1514 Dr. Cummings. Yes, sir; it is definitely an experiment and we would not wish to claim this to be an operational and long-sustained system. We really think it needs to be critically evaluated. Mr. Michel. I am glad to hear you say that. I think we have got to be thinking all the time how we can broaden our horizon and get this information out. I can see, just reading a scant piece of this in the record, that we might get some flak from people on the floor. How- ever, I think, it helps a great deal when you give us the assurance that it would be limited in this case to an experimental kind o± thing and be critically evaluated before any wide-scale program would be started. That is the plan, isn't it ? Dr. Cummings. Yes, sir. PERSONNEL INCREASES Mr. Michel. Doctor, what kind of personnel increases are you re- questing? Dr. Cummings. We are requesting seven additional positions, Mr. Michel, five for the Lister Hill Center which is terribly understaffed. With only 13 people presently on board in that program and two for the National Medical Audiovisual Center in Atlanta. Mr. Michel. How many people did you ask for in fiscal year 1972 ? Dr. Cummings. I don't recall that figure. Can you help me with that, Mr. Smith? Mr. Smith. I believe the authorized budgeted position figure was 17. However, restrictions on hiring have prevented us from filling any of these positions. SATELLITE UTILIZATION Mr. Michel. One final observation here. You spoke of developing satellite communications. This was just a bonanza for you in the sense that it had outlived its usefulness with NASA. Dr. Cummings. Yes, sir. Mr. Michel. And rather than just flying up there uselessly, it was offered to the National Library for whatever purpose you might use it, is that correct ? Dr. Cummings. That is correct, and I think credit should be given to my staff who uncovered this opportunity. They knew there was a live satellite available and made a request for it. They sold the idea to our department, which is very supportive of this program, and to NASA, and that is how it came into being. Mr. Michel. To make the record very clear, the new one that will be launched at the end of fiscal 1973 by NASA is principally an operation of the Space Administration ? Dr. Cummings. Yes, sir. Mr. Michel. And that here again you are just going to try and tie in as best you can ? Dr. Cummings. That is correct. Mr. Michel. I won't ask you as to how much money is involved in the launching of that kind of satellite, but those on our full committee whose SDecial area is NASA, of course, can very easily tell us what the total is. To budget that kind of a thing in your shop would be an astronomical amount compared to the budget you have before us.8407375_000024.txt

Page  24 1515 Dr. Cummings. Yes, sir. Mr. Michel. There is no question of that, so I don't think we have any grounds for being critical of you or your associates for doing what you are doing by simply getting in as best you can on what is a good thing, and funded in considerable sums over at the Space Administration, is that right ? Dr. Cummings. That is correct. Mr. Michel. Thank you, doctor. That concludes my line of questioning. Mr. Flood. Mr. Shriver. information available from library systems Mr. Shriver. Dr. Cummings, so that I may better understand Med- lars, AIM-TWX, could you, in layman's language, tell me what kind of information is available from these various systems for a teaching hospital, a hospital in my hometown, or a private physician or clinic? I am from Kansas in the middle of the country. Dr. Cummings. Let me tell you what is available as I know it, through these systems, Mr. Shriver. First, let me start with Medlars, which is essentially the big data base, that has all of the references to the medical literature since 1964 stored in it. It is used not only to give information upon demand, but it is used to produce all of our publications. An institution in your State can request a Medlars search, and have sent to it a listing of all the articles by subject. That would take about 2 weeks to process. In addition, all of the libraries in your State receive our current awareness publications that tells them what has been published in dentistry, nursing, medicine, and so forth. For the next level of service several institutions in Kansas have terminals tied to the predecessor of Medline, which we called AIM- TWX. This contains clinically oriented information. They have been able to reach into this data base and get immediate response to ques- tions of a clinical nature. Since that time we have enlarged the system to include a larger amount of information, so Medline is 10 times more powerful than AIM-TWX, having 10 times as much information in it. To answer your question then, a physician in your State could get these services through the University of Kansas or through some of the larger hospitals that are part of the network. There are local hospitals in all of the States that are part of the network. Mr. Shriver. That is a good summary of it. interactive television systems What areas of the country are being considered for the interactive television systems for fiscal year 1973 ? Dr. Cummings. The only one that we are actively involved in now is the one that has been developed in New Hampshire and Vermont. Additionally, I understand that WICHE, the Western Interstate Conference for Higher Education, is planning a network for the Rocky Mountain-Plain States with the Office of Education and other elements of HEW. We are only a small part of the planning effort there, so I would have to say that in 1973 I know of no library plan to develop and operate a new interactive television system.8407375_000025.txt

Page  25 1516 toxicology information program Mr. Shriver. Would you explain further the working relationships the toxicology information program has with the other agencies, such as Food and Drug, Environmental Protection Agency, Division of Biologic Standards, any other Federal Government agency active in this field. Dr. Cummings. Mr. Shriver, with your permission I would like to ask Dr. Mider to respond to that. He has played a very intimate role in its construction and management, and I think can give you a very good view of the question. . . Dr. Mider. Mr. Shriver, for some years the Food and Drug Adminis- tration controlled the use of pesticides in the sense that they granted petitions for its uses. Some years ago they started producing a Health Aspect of Pesticides Abstract Bulletin. This has been converted to tape, so it is searchable. Instead of having a controlled vocabularly as does Index Medicus and Medlars, this permits free text search. For example, it contains roughly 800 abstracts on Carbaryl. 200 of those abstracts contain material using the synonym Sevin as well. You can search it by author, by title, by text, and combination of words. This is not a proprietary system, but a system developed by NASA for other Federal agencies. Dr. Cummings described the publication of Health Effects of En- vironmental Pollutants. That came about through the realization that with the growth of the environmental and consumer protection move- ments, many of the participating people knew nothing about Medlars or Index Medicus, but had a need for some of the same types of infor- mation in these systems. The first thing that we did was produce a small publication, a bibliography, on the health aspects of environmental pollutants. It sells for $4 a year, produced by the Medlars system. Within 10 months we had 700 subscriptions. We don't give it away but provide camera ready copy to the Government Printing Office; they price it and then dis- tribute it. The Office of Management and Budget stipulated that we might do this for 1 year and at the end of the year we would have to present evidence that other Federal agencies and consumers were interested. We had no difficulty whatever in getting fine testimonials from the Food and Drug Administration and the Environmental Protection Agency and the National Institute for Environmental Health Sciences. Realizing that toxicologists in particular like to have abstracts avail- able to them on a periodic basis, as determined in the survey made about 1968 when we were setting up the toxicology information program, we joined forces with Biological Abstracts to produce this new publica- tion, "Health Effects of Environmental Pollutants." That must be- come self-supporting within 2 or 3 years; if not, that is the end of it. Mr. Shriver. Who can get that ? Dr. Mider. Anybody for $95 a year. The Environmental Protection Agency has actually come to the Library and asked help in retrieving 5,000 documents. They were willing to give us people to do the job and it took about 18 months.8407375_000026.txt

Page  26 1517 We have produced a compilation on drug interactions which should appear within a month or two, by a contract with Paul de Haen, be- cause we are recognizing that two drugs given simultaneously may have adverse effects by competing for enzyme sites. This recent de- velopment has generated a great deal of interest. The Library started this program, but we hope it will be taken over completely by the Food. and Drug Administration as they need it badly. We can provide information to may interests, especially environ- mental interests but there are other things that they need. Things medical, that is the.Art and Science of Medicine and the scientific base on which medicine exists is the NLM's responsibility. We are interested in those insects which are vectors of disease, but we would not be interested in covering literature on the insects that are important to the farmer. That would come under the National Agricultural Library Act. We use the query response center of the Na- tional Laboratory to enrich the scope of our literature in providing more adequate responses to scientists, to industries, to any interest, in order to give them better service. You understand that the toxicology information program is based on a document produced by the Presi- dent's Science Advisory Committee in 1966 which said all toxicological information should be computerized. A committee of the National Re- search Council advised us to start on pesticides. Pesticide toxicology is now pretty well organized and we are getting into other fields. construction plans Mr. Shriver. Dr. Cummings, you may have answered this before, but is there a construction timetable for the Lister Hill Center ? Dr. Cummings. Yes, sir. We have a construction timetable, but I should point out that this has not yet been approved by all of the ad- ministrative points along the way between the NLM and the Office of Management and Budget. However, I am pleased to report to this committee, since you raised this question last year, that the planning money which you appropriated in fiscal year 1970 has been released to the National Library of Medicine, and it is my understanding that the Department will soon select an architectural and engineering firm to develop the detailed specifications. library research grants Mr. Shriver. You are requesting $2.7 million, an increase of $200,000 for library research grants. How much are the average grants for the different categories of libraries which you support ? Dr. Cummings. We have, in essence, two levels of grants for re- source building. The money that we are requesting this year is primar- ily to be used for upgrading local libraries in community hospitals. I believe that the average size of these grants is $2,000 to $3,000. These grants provide support for a basic library core, the leading journals in biomedicine. It is not an extensive set of documents that we provide, but they are mainly dinically oriented so that the doctor with a patient problem can zoom in and obtain information from this very small library.8407375_000027.txt

Page  27 1518 Mr. Shriver. Thank you, Dr. Cummings. Mr. Flood. Thank you very much. COMMENDATION OF DR. MIDER Dr. Cummings. Mr. Chairman, may I just take a moment to make one additional comment that has nothing to do with our budget. This will be the last year for Dr. Mider, who appeared before this committee and other committees as an official of the National Institutes of Health, and I would like the record to show, with your permission, that he has not only been a distinguished science administrator, but that since he joined the National Library of Medicine several years ago, he has been a profound leader of men and an innovative program planner in behalf of the Nation's health. I wanted to call this to your attention. Mr. Flood. We are glad you did. We think you have understated the case. Dr. Cummings. I have, in the interest of time. I could elaborate consderably. Mr. Flood. We hasten to join with you in these words of tribute, and you can be sure that the committee is fully aware of his con- tribution, and we are pleased to say so. Dr. Mider. Thank you, gentlemen. Mr. Flood. Thank you, gentlemen. This concludes our hearings with the National Institutes of Health.8407375_000028.txt

Page  28 1519 JUSTIFICATION OF THE BUDGET ESTIMATES DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE NATIONAL INSTITUTES OF HEALTH National Library of Medicine Amounts Available for Obligation 1972 1973 Appropriation.................................... $24,086,000 $28,104,000 Unobligated balance start of year................ 45,550 --- Unobligated balance lapsing...................... - ____26,000 ---____ Total obligations........................... $24,105,550 $28,104,000 76-024 0-72—pt. 4—968407375_000029.txt

Page  29 1520 ______________________________Obligations by Activity___________ 1972 1973 idi-f Appropriation Estimate Ref.___________________________Pos. Amount_______Pos. Amount Medical Library Assistance: 103 Training................. — 1,200,000 — 1,500,000 104 Special Scientific Projects............... ~ 95,000 — 95,000 104 Research................. — 650,000 -- 900,000 105 Library Resources........ — 2,505,000 — 2,705,000 105 Regional Medical Libraries.............. -- 2,147,550 ~ 2,902,000 106 Publications Support.....340,000 -- 390,000 Subtotal............... -- 6,937,550 — 8,492,000 Direct Operations: 107 Lister Hill National Center for Biomedi- cal Communications: (a) Project contracts.. — 1,375,000 — 2,475,000 (b) Other direct....... 19 480,000 24 597,000 109 National Medical Audio- visual Center: (a) Project contracts.. — (b) Other direct....... 108 2,350,000 110 2,677,000 110 Library Operations: (a) Project contracts.. -- 2,091,000 — 1,891,000 (b) Other direct....... 249 6,390,000 249 6,779,000 112 Toxicology Information: (a) Project contracts.. -- 564,000 -- 715,000 (b) Other direct....... 20 754,000 20 933,000 113 Review and Approval of Grants................. 32 710,000 32 746,000 114 Program Direction........ 56 2,454,000 56 2,799.000 Subtotal............... 484 17,168,000 491 19,612,000 Total obligations........484 24,105,550 491 28,104,000 Increase or Decrease Pos. Amount + 300,000 + 250,000 + 200,000 + 754,450 + 50,000 +1,554,450 +1,100,000 +5 + 117,000 +2 + 327,000 - 200,000 + 389,000 + 151,000 + 179,000 + 36,000 + 345,000 +7 +2,444.000 +7 +3,998,4508407375_000030.txt

Page  30 1521 ___________________________Obligations by Oliject________________________________ Inc-casf; 1972 1973 or ___________._________________________________Appropriation_____Estimate _ __5£Lr_Pi;*iL Total number of permanent positions..... 484 491 -1-7 Full-time equivalent of all other positions............................. 18 25 +n Average number of all employees......... 495 508 +13 Personnel compensation: Permanent positions................... $6,906,000 $7,362,000 + 456,000 Positions other than permanent........ 203,000 317,000 + 114,000 Other personnel compensation.......... _____89,000__________87,000___ 2,000- Subtotal, personnel compensation.... 7,198,000 7,766,000 + 568,000 Personnel benefits...................... 599,000 665,000 + 66,000 Travel and transportation of persons.... 167,000 176,000 + 9,000 Transportation of things................ 33,000 30,000 - 3,000 Rent, communications, and utilities..... 1,704,000 1,732,000 + 28,000 Printing and reproduction............... 468,000 478,000 + 10,000 Other services: Project contracts..................... 4,030,000 5,081,000 +1,051,000 Payment of NIH Management Fund........ 1,062,000 1,119,000 + 5/,000 Other................................. 934,000 1,544,000 + 610,000 Supplies and materials.................. 310,000 363,000 + Iv'.Lv Equipment............................... 663,000 £?8,000 - :rL'-: Grants, subsidies and contributions..... 6,937,550_______8,492,000 __+1,554,450 Total obligations by object............ 24,105,550 28,104,000 +3,998,' if-8407375_000031.txt

Page  31 1522 Summary of Changes 1972 estimated obligations................................................... $24,105,550 1973 estimated obligations................................................... 28.104,000 Net change................................................... + 3,998,450 Base Change from Base Pos.______Amount Built-in: 1. Annualization of new positions in 1972..... 2. Wage board pay Increases................... 3. Within grade pay increases................. 4. FTS rate increase.......................... 5. Annualization of commissioned officers quarters allowance....................... 6. Non-competing continuation grant increases. Subtotal, built-in increases.......... Program: 1. Training grants............................ 2. Research grants............................ 3. Library Resources grants................... 4. Regional Medical Libraries grants.......... 5. Lister Hill National Center for Biomedical Communications................ 6. National Medical Audiovisual Center........ 7. Library Operations......................... 8. Toxicology Information..................... 9. Upward Mobility Program.................... 10. Program Direction.......................... Subtotal, program Increases........... Payment to "National Institutes of Health Management Fund" for centrally furnished services..................................... Total, increases................. 1,062,000 105,000 5,000 270,000 5,000 5,000 700,000 " " " +1,090,000 __ 1,200,000 .. 100,000 -- 650,000 -- 200,000 — 2,505,000 — 100,000 -- 2,147,550 — 499,450 19 1,855,000 5 1,125,000 108 2,350,000 2 265,000 249 8,481,000 — 105,000 20 1,318,000 -- 250,000 — -- — 138,000 56 2,454,000 — 125,000 +7 +2,907,450 57,000 +7 +4,054,450 Decreases: A. Built-in: 1. Two days less pay in FY 1973............. 2. Annualization of savings from employment reduction in 1972...................... Total, decreases............... Total, net change.......................... 50,000 6,000 56,000 +3,995.4508407375_000032.txt

Page  32 1523 Explanation of Changes iuilt-in Increases — These increases will provide $105,000 for the annualization of seven new positions requested in fiscal year 1973, $5,000 for pay increases for wage board personnel, $270,000 for within grade pay increases and also includes $5,000 for the annualization of commissioned officers quarters allow- ance increase authorized in fiscal year 1972. $5,000 Is provided for increased costs in fiscal year 1973 of the Federal Telecommunications System. $700,000 is for increases associated with the sustaining of non-competing continuation grants awarded under the Medical Library Assistance Extension Act of 1970. Training grants -- 'A program increase of $100,000 will permit the funding of three additional grants bringing to twenty the number of active grants used to sup- port approximately one hundred forty individuals studying the applications of• medical science information. Research grants — A program increase of $200,000 will allow the awarding of five additional grants bringing to twenty-six the number of grants supporting the development of new methods of processing biomedical knowledge. Library Resource grants -- A program increase of $100,000 will be used to support 47 additional awards with emphasis being placed on using the funds to stimulate local community support for upgrading medical library resources and services. Regional Medical Library grants — A program increase of $499,450 will permit the support of the increased number of interlibrary loans that will result from the new on-line bibliographic retrieval system, MEDLINE. Additionally, new services and methodology to improve existing services will be supported through the grant mechanism. Lister Hill National Center for Biomedical Communications — A total of $3,072,000 and 24 positions is requested in 1973, a program increase of $1,125,000 and 5 new positions. The increase will provide for: (1) Additional communication costs which will be incurred in providing access to an expanded user population on the new MIDLINE system; (2) planning and hardware costs of the new satellite communication experiment; (3) training of health personnel in techniques of providing health care and education via cable television; and (4) expanding the New England Interactive Network. National Medical Audiovisual Center — A program increase of $265,000 and two new positions is requested in 1973. This increase will permit a modest expansion in the development of multimedia instructional packages which will aid medical d'lu.- acors in restructuring curricula and condensing the educational process by using novel pedagogical techniques. Library Operations — A total of $8,670,000 and 249 positions is requested in 1973, a program increase of $105,000. This increase will aid in maintaining th>; Library's literature resources and allow for the continuance of the Gap F-lling Program for missing materials, particularly in the heavily used periodica] collections. Toxicology Information — A program increase of $250,000 will be directed towards the continuation and expansion of the on-line toxicology information and data system through the creation of additional software modules. This increase will also permit the preparation of additional state-of-the-art reviews and improved information evaluation services furnished to the biomedical community. Upward Mobility Program — A program increase of $138,000 is to fund the costs of NLM employees participating in the DHEW's Upward Mobility Program. Program Direction — A program increase of $125,000 is to fund the support of in- creased efforts in developing, coordinating, and evaluating a national biomedi- cal communications network.8407375_000033.txt

Page  33 1524 Significant Items in House and Senate Appropriations Committee Reports Item Action taken or to be taken 1972 Senate Report Lister Hill Center for Biomedical Communications 1. Committee stated that, "As the 1. The Director of the NLM and the success of the Center's efforts will staff of the Lister Hill Center are ultimately depend on their acceptance preparing for submission the subject and support by the medical and scienti- report to the Senate Appropriations fie comnunities, the Director of the Committee. National Library of Medicine and the staff of the Lister Hill Center should prepare an informative report on its prototype experiments--such as the satellite communications link with remote regions in Alaska and the two-way television network in New England-- and its plans for the future. One of the purposes of the report should be to stimulate awareness of and interest in ways in which modern communications techniques can be adapted and expanded to serve all facets of health services, biomedical research, and the training of health professionals." (pages 65-66 of Senate Report).8407375_000034.txt

Page  34 1525 Authorising Legislation 1973 Authorization Appropriation __Requested Requested Legislation Public Health Service Act Section 371 - Purpose and Establishment of Library............................ Indefinite 19,612,000 Section 394 - Grants for Training in Medical Library Sciences.............. 2,000,000 1,500,000 Section 395a - Assistance for Special Scientific Projects.................. 500,000 95,000 Section 395b - Research and Development in Medical Library Sciences and Related Fields.........,.............. 3,000,000 900,000 Section 396 - Grants for Improving and Expanding the Basic Resources of Medical Libraries and Related Instrumentalities..................... 4,500,000 2,705,000 Section 397 - Grants for Establishment of Regional Medical Libraries......... 3,500,000 2,902 000 Section 398 - Financial Support for Biomedical Publications............... 1,000,000 390 000 National Library of Medicine Budget Estimate House Senate Year to Congress Allowance Allowance Appropriation $ 3,335,000 1963 $ 3,335,000 $ 3,335,000 $ 3,335,000 1964 4,074,000 4,074,000 4,074,000 4,074,000 1965 3,678,000 3,858,000 4,058,000 3,958,000 1966 9,185,000 9,185,000 9,685,000 9,685,000 1967 19,231,000 20,092,000 20,192,000 20,192,000 1968 21,162,000 18,662,000 21,162,000 19,912,000 1969 19,172,000 17,149,000 19,172,000 18,160,500 1970 22,882,000 19,682,000 19,682,000 19,682,000 1971 19,769,000 19,769,000 22,233,000 20,769,000 1972 21,981,000 22,781,000 25,086,000 24,086,000 1973 28,104,000 8407375_000035.txt

Page  35 1526 Justification National Library of Medicine 1972 Appropriation Pos. Amount Personnel compensation and benefits........... 484 Other expenses........... — Total................ 484 $ 7,797,000 16.308,550 1973 Estimate Pos. Amount 491 $ 8,431,000 19.673,000 Increase or Decrease Pos. Amount +7 +$ 634,000 + 3.364.450 24.105,550 491 28.104.000 +7 + 3.9987450 General Statement The National Library of Medicine, the world's most important resource for bio- medical documents, facilitates the application of biomedical Information to the treatment and prevention of diseases by acquiring, organizing and disseminating informational materials to health professionals. The NLM actively explores ways in which technological advances in the communications field can be applied to organi- zing that knowledge and making it available where and when it is needed. For example, the Library is experimenting using a NASA satellite to make the expertise of local hospitals available for the health care of remote Alaskan villagers with no professional health personnel. Also, it Is making its computerized bibliogra- phic data base available to users in biomedicine throughout the country through the use of on-line computer terminals, linked by a commercial land wire network. The NLM has a congressional mandate to coordinate the development of a National Biomedical Connunicatlons Network (BCN) which, when fully established, will further enhance the flow of information to health professionals. The individual programs of the Library which are described herein are all facets of the Library's efforts to fulfill this charge. For library services, such a network already exists wj.th selected participating institutions serving as major Regional Medical Librariejs throughout the country to facilitate document delivery and reference services. Numerous smaller local libraries in hospitals and schools of the health professions are also linked into the network. These libraries receive support from the NLM through direct financial assistance and by interlibrary loans and specialized ref- erence services which the NLM, as the Nation's central biomedical resource, pro- vides as backup to the system. Implementation of a complete communications network is currently in its formative stages. Projects will be continued to determine what new communications technology can be utilized most efficiently and effectively to encourage and coordinate networking efforts of medical schools, hospitals, and other components of the Nation's health-care system to expand the overall coverage of the network. The FY 1973 budget request provides some of the funding necessary to usher in a modern era in biomedical commur.ici'.tion. An increase of over $1,200,000 has been asked for the innovative programs of the Lister Hill Certev 'or Biomedical Commu- nications. Also $1,534,450 additional has been re'iuestec for the grai■■. \: Cframs authorized by the Medical Library Assistance Act (as amenced) . r.-ils i i~rease v_l" enable the extramural participants of the nationwide health ir.fonna~.ion networkto8407375_000036.txt

Page  36 1527 provide expanded and more timely service to the Nation's health professionals. Construction of the Lister Hill Center building that will house the new comm- unications programs of the NLM is still in the planning stages. However, an impor- tant step forward recently occurred with the apportionment of planning funds for this important facility. The programs authorized by the Medical Library Assistance Act of 1965 (Public Law 89-291) and the Medical Library Assistance Extension Act of 1970 (Public Law 91-212) are designed to meet national needs for better health information services through improved health library resources and facilities, trained manpower, and improved health communications technology. Specifically, the Act authorizes support of projects to develop resources and techniques necessary to collect, pre- serve, store, process, retrieve, and facilitate the dissemination and use of health science information. Training and Fellowships 1972 Appropriation No. of Awards Amount 1973 Estimate No. of Awards Amount lion-competing continu- ation grants......... New grants............. Total.............. $523,463 676,537 13 7 $972,598 527,402 17 1,200,000 20 1,500,000 Increase or Decrease No. of Awards Amount +3 +$449,135 -- - 149,135 +3 + 300,000 This program helps meet the Nation's need for medical librarians, information specialists and biomedical personnel trained in the utilization of computer tech- nology for health education and patient care. The emphasis is on training for creative leadership in positions of major responsibility. In FY 1973 an increase of $300,000 is requested to support 20 projects, 13 of which will be continuations. Training programs in computer technology will be stressed as the necessity for making computer technology a part of the armamen- tarium of tomorrow's health personnel becomes clear. The more information at the inmediate disposal of the physician, the better the diagnosis and the more rational the treatment. The computer is ideally suited for providing data to the knowledge- able health professional. Support of programs which provide further and specialized training for indivi- duals already possessing the basic library degree will be expanded and modified. Ph.D. programs, rather than master's degree and non-degree programs, will be stres- sed in FY 1973 with a strong emphasis on training for management. These training grinLi and fellowships are one of the most productive extramural programs supported by the NLM. Many graduates occupy leadership positions in major medical libraries which are becoming active centers for biomedical communication. The increasing complexity of library practice brought about by the introduc- tion of advancer1 ter.hnnlog;? anc bi'.ciae'.ii.ml. :ie-_-'0-.\i.n:j arrtMgemrnts requt-es that l:.brar?'.an!i ucqaire /.hese now conim —icat Lor. skills and applv ,uhem .o facilitate .l.e o-j oi health informaticn. Similarly, health professionals must learn to use con-ju'ur technology in education and patient care. The $300,000 increase in 7Y 1973 wi'-I provide some of the resources required to produce the medical librari- ans and information specialists trained in modern methods of information transfer.8407375_000037.txt

Page  37 1528 Special Scientific Projects ---------------------------------1972 "1973 Increase or Appropriation Estimate Decrease NoTof -----~~ No. of No. of Awards Amount Awards Amount Awards Amount Non-competing continu- ftf. nno atlon grants.......... - ~ 3 $80,000 +3 +$80,°°° New grants.............. 3 $95.000 1 15,000-------* ' 80»000 Total............... 3 95.000 4 95r000 +1-------ZZ--- The 1973 request of $95,000 for Special Scientific Projects Is the same as 1972. These grants are intended to support outstanding scholars in the full-time analysis and documentation of major advances In the health sciences. The results are published as monographs. Health science information Is available from a bewildering number of sources and usually without post-publication review. Scholars, eminent in their fields, critically review the literature and present the state-of-the-art. These reviews are usually in broad fields and therefore require a competence not usually availa- ble in specialty areas; thus these grants serve to make more accessible selected areas of biomedical information. Research 1972 Appropriation No. of Awards Amount 1973 Estimate No. of Awards Amount Increase or Decrease No. of Awards Amount Non-competing continu- 12 9 $434,265 215,735 10 16 $340,000 560,000 -2 +7 -$ 94,265 + 344,265 21 650.000 26 900,000 +5 + 250.000 In 1973, the Library is requesting $900,000 in new obllgational authority which will support approximately 16 new or competing renewal research projects and continue the support of 10 non-competing continuation projects, a total of 26 awards. The continuing high level of the national effort in health-service educa- tion and research produces a constantly growing amount of biomedical Information. More effective transmission, storage, and retrieval of this information at realis- tic cost-benefit ratios is imperative. Projects will be supported In (1) defining information-seeking practices of health professionals, (2) improvement of the bio- medical vocabulary for written and mechanized information handling, (3) improved information systems, and (4) development and testing of various information media. The increase In funds will make it possible to support research and develop- ment projects involving complex technologies. For example, studies In retrieval of information often involve experimental machine-readable data bases. Transfer of information for educational purposes often involves electronic circuitry as well as extensive evaluative testing. Certain developmental activities, concerning medical library operations, have been successful and will be appropriate for sup- port as demonstration projects.8407375_000038.txt

Page  38 1529 Library Resources Non-competing continu- ation grants........ New grant s............ Total............. 1972 Appropriat ion No. of Awards Amount 1973 Estimate No. of Awards Amount Increase or Decrease No. of Awards Amount 167 240 $ 859,109 1,645,891 101 353 $1,205,000 1,500,000 - 66 +113 407 2,505,000 454 2,705,000 + 47 +$345,891 145,891 200,000 The 1973 request of $2,705,000 for Library Resource Grants represents an in- crease of $200,000 in the level of support from 1972. The increase will be used to award 20 grants to establish basic collections and 10 grants to improve local library services. The total request will permit the library to support 101 non- competing continuation grants and to make 353 new awards. Medical Library Resource Grants are designed to assist in the establishment, improvement, and expansion of the Nation's health science libraries, and to encour- age increased community support for the local library. Grants for a one-year period are made to health institutions which demonstrate a need to establish basic collections and services. Grants are also made to institutions with existing health science libraries for the support of projects designed to make the growing scien- tific literature more rapidly accessible to health professionals throughout the United States. Funded applications include cooperative programs in which a strong resource library undertakes to provide training, consultation and loan services for the small community hospitals, clinics and other health facilities; projects which seek to speed the delivery of services through the use of modern communication devices and automation techniques; and projects which simply increase the infor- mation resources of an institution after an assessment of needs of the health professionals. This program is also important in complementing the service activities of the Regional Medical Library Program. The Regional Medical Libraries and the major resource libraries which participate in the network can operate most efficiently in a backup role for regional informational needs rather than as prime sources for all needs. Only if local library resources and services are selectively improved can the network function effectively and the full benefits of the Regional Medical Library Program be realized. Regional Medical Libraries 1972 1973 Increase or Appropriation Estimate Decrease No. of No. of No. of Awards Amount Awards Amount Awards Amount Non-competing continu- ation grants.......... 9 $2,147,550 10 $2,302,000 + 1 +$1'V,450 New grants.............. —_______^_________15______600,000 +15 + 600,000 Total...............________9 2,147,550 25 2,902,000 +16 + 754,450 The FY 1973 request for $2,902,000 represents an increase of $754,450 over the 1972 level* This amount will allow the Library to maintain the contract iMiiort for C e 10 active regional medical libraries (RML's) and will cover the -duitior.al costs of operations caused by increased user service demands. In ..citic-., 15 new grants will be awarded for projects which, (1) analyze existing netho?s, (2) establish r.tv cervices it methods, (3) and improve and expand existing services.8407375_000039.txt

Page  39 1530 The goal of this program is to develop a national network of regional medical libraries with the necessary depth and scope to supplement the services of other medical libraries in their designated region. Backup library services In the form of interlibrary loans and sophisticated reference services are now available. In FY 1972 the mechanism of support for the service components of the RML's was com- pletely converted from grants to contracts. In FY 1973 an increase in service demands is expected due primarily to two factors: 1. Health professionals are becoming increasingly aware of the availa- bility of interlibrary loan service from these regional libraries now that they are fully operational. (From FY 1969 to FY 1972 the average yearly increase in these loans has been 35 percent). 2. The initiation of the NLM's new on-line bibliographic retrieval ser- vice, MEDLINE, will afford direct and greatly improved access by RML clients to a data base which is most relevant to a health professional's requirements and will cause an acceleration In interlibrary loans at the RML's. The new competitive grant program to be fully launched in FY 1973 will be available to all institutions participating in the network service plan. Improve- ments in service resulting from these grants should benefit operations in the respective regions and the network as a whole. Permitting ready access to biomedical literature by health professionals is vital to the well-being of the citizens of the U.S. The Regional Medical Library Network can make a large contribution to this goal. In FY 1972 it is estimated that 500,000 interlibrary loan requests will be filled by the RML's and 600,000 in FY 1973. Publications Support 1972 1973 Increase or Appropriation Estimate Decrease No. of No. of No. of Awards Amount Awards Amount Awards Amount Non-competing continu- 6 $142,660 9 $214,000 +3 +$71,348 9 197.340 8 176.000 -1 - 21 348 Total 15 340.000 17 390.000 +2 + 50.000 The 1973 request of $390,000 will allow the continued support of nine projects and will support 10 new or renewal projects. The development of selected publica- tions to help American health professionals digest and utilize the tremendous output to ^4^°^ a" ^6 biomedlcal sciences contributes to the NLM's overall effort to facilitate biomedical communications. Such publications include abstracts, bib- liographies, handbooks, and critical reviews, as well as monographs and translations which condense, synthesize, evaluate, or otherwise repackage Information for health fea^Jr^etdSlk^ »«"«~- *» **«*. ^ « —iSl^? Among the projects funded in 1972 is a periodically appearing aM-» „„ „- national molecular structure of proteins which is of vaL^reslrcners in a Ill's such as xnborn metabolic defects and protein replication in cancer A1«« „ ? a a are a translated book on ecology providing to u?S. scientists th^firt view of Russian thought on this important field, and a handbook condensing the lllZ ^aB of data on experimental pathology of the chick «mh™« „* i cne large mass effects and congenital malformations in the hLTretus! * ^'^ °n ^8407375_000040.txt

Page  40 1531 hh * ^ 1973 the program will continue to support selected publication projects tnat are directed to meet major reference information needs for U.S. health profes- sionals and also to encourage the production of reference tools needed by and useful to librarians and information specialists in the health sciences. DIRECT OPERATIONS 1972 Appropriation Pos. Amount Personnel compensation and benefits.......... 484 $7,797,000 Other expenses.......... 9,371,000 Total...........--- 484 17,168.000 1973 Estimate Pos. Amount 491 $ 8,431,000 11,181,000 Increase or Decrease +$ 634,000 + 1,810,000 491 19,612,000 +7 + 2,444,000 Lister Hill National Center for Biomedical Communications 1972 Appropriation Pos. Amount Personnel compensation and benefits.......... 19 Other expenses.......... -- Total............... 19 1973 Estimate Pos. Amount Increase or Decrease Pos. Amount $ 370,000 1,485,000 24 1,855,000 $ 497,500 2,574,500 +5 +$ 127,500 + 1,089,500 24 3,072,000 +5 + 1,217.000 The Lister Hill National Center for Biomedical Communications is the focal point for coordinating biomedical communications systems for the entire Department of Health, Education, and Welfare and is responsible for developing a Biomedical Communications Network. It has provided an experimental service (AIM-TWX) to over 65 hospitals and libraries using teletypewriter terminals to access bibliographic citations from 100 leading English language medical care journals in an on-line time-sharing computer. This successful service cutting retrieval time from weeks to minutes at reduced costs has encouraged a series of modifications for improving the system. The impro- ved system called MEDLINE has already become operational on the computer at the NLM. It will provide access for many more users to a data base of over 1,000 journals. MEDLINE is being connected to a commercial data communications network which will provide access on a toll-free basis in at least 35 cities throughout the Nation. The inauguration of the MEDLINE network makes it practical and economically attrac- tive to expand this service to a broader range of users among both the academic community and health-care practitioners. Therefore, additional computer-based data sources will be brought on-line which can eventually serve medical schools, schools of dentistry, many nursing schools and most other institutions that train allied health professionals. The augmentation provided by Congress in the 1972 budget is being used to bring into the network additional data bases to provide, for example, computer assis- ted instruction and diagnosis. These experiments are designed to evaluate the effectiveness of computer/communications technology in relieving the critical health manpower shortage by providing a means for students to learn at their own pace aid permitting faculty to handle a larger student population of diverse backgrounds. A medical network linking 26 native villages with service unit hospitals and medical centers is now operating seven days a week in Alaska using the NASA Appli- cation Technology Satellite (ATS-1). This network provides reliable daily voice consultation between village health aides and physicians thus improving the primary8407375_000041.txt

Page  41 1532 health care in remote areas of the State. Further efforts have been initiated to explore the use of two-way voice communication via satellite for community neaitn and education. Further experiments are planned which Include the transmission of electrocardiograms; and slo»*-scan TV to experiment with transmission of facsimiles such as simple x-ray pictures. With the cooperation of NASA, the Lister Hill Center plans to carry out tests of two-way TV satellite communications for health care delivery and education In other areas where health services are scarce. The satellite Is the Application Technology Satelllte-F (ATS-J) to be launched in May 1973. This effort Is a logical conse- quence of the experiments presently being conducted in Alaska and extends the range of services presently being explored. Funds provided In 1972 will be used to design and develop a two-way satellite terminal and to provide the start of detailed plan- ning and scheduling of experiments required to be ready for operation when the sate- llite is made available in June 1973. This satellite will provide an opportunity to explore the utility of a variety of interactive health programs, to bring the expertise of major medical centers to rural communities in several western states. This is part of a larger DHEW program to define the public service functions of satellite communications and establish the needs for shared and/or dedicated domes- tic communication satellites. Some of the 1972 funds have been used to speed devel- opment of a medical microwave network linking medical schools and hospitals in Vermont and New Hampshire. This New England Interactive Network brings the exper- tise of the Dartmouth and University of Vermont Medical Schools to community hospitals. Further experiments will explore the use of a mobile van to extend the network to institutions where a valid need exists for better care, but where expensive fixed installations are not justifiable economically. This network will eventually link some 15 hospitals and 3 university health centers in a mutually reinforcing program of improved health care delivery and education. The Center also has begun to explore the use of cable television (CATV) as a means of reaching the impoverished urban dwellers who, in part because of inadequate communications, suffer from poor health care and health education. One plan involves a two-way Interaction between a sophisticated metropolitan hospital and the resi- dents of low cost public housing In an effort to educate them in their own personal health and to bring them more actively into the health care system. Another possi- bility is to determine the usefulness of CATV in providing better service by making available the expertise in medical schools and hospitals to health care centers and to provide a learning experience for doctors, nurses and other health professionals in community care through participation in such a program. At the request of Congress a report is being prepared on the Lister Hill Center's prototype experiments and its plans for the future. The 1973 budget request represents a continuation of the programs outlined above and provides for the rapid development of these communications technologies to an operational state. New programs included are conmunication costs for the MEDLINE network; procurement of satellite terminals and other hardware in order for instal- lation and checkout to be completed in time to perform the ATS-F experiments; de- tailed planning, program development, and hardware procurement for the CATV programs; and expansion of the New England Interactive Network. The Center is becoming recognized as the major technology transfer element be- tween the computer and communications communities and the medical community. Effec- tive accomplishment of this role requires a balance of contractual efforts and ln- house expertise.8407375_000042.txt

Page  42 1533 National Medical Audiovisual Center 1972 1973 Increase or Appropriation Estimate Decrease Pos- Amount Pos. Amount Pos. Amount Personnel compensation ------ ---- ------ and benefits.......... 108 $1,631,000 110 $1,738,500 +2 +$107,500 Other expenses.......... 719,000 — 938,500 — + 219,500 ----Total............... 108 2.350,000 110 2,677.000 +2 + 327,000 The National Medical Audiovisual Center (NMAC) In Atlanta, Georgia, administers programs to improve the quality and increase the use of biomedical audiovisuals in schools of the health professions and in the continuing education of health profes- sionals. In FY 1972 the NMAC acquired and organized selected medical audiovisual materi- als and distributed them through a variety of methods. It provided advice and con- sultation on health instructional systems, media, and facilities. NMAC also develo- ped prototype modulated instructional media units and provided training to medical school faculty through workshops and seminars. Finally, NMAC catalogued and shared reference material in efforts to stimulate and facilitate the use of audiovisual materials by health professionals. In carrying out these tasks NMAC collaborated with the Bureau of Health Manpower Education (BHME) on furthering mutual objectives in health manpower education. During FY 1972, NMAC is conducting an active program of cooperation with national professional medical organizations to make useful instructional media available to the medical community. This program has two components: location and peer evaluation of existing instructional media and the development and production of pilot Instructional units. Those latter units are based upon instructional ob- jectives identified by cooperating groups and are designed in modules to permit economical modification. NMAC also is supporting a "university-on-loan" program where experienced medical educators, supported by their universities, are encouraged to participate in developing these prototype multi-media systems. These innovative teaching devices use voice, vision, and touch to give a live three-dimensional immediacy to a learning experience. New multi-media technology holds great promise for more efficient and less time-consuming medical education. In 1973 the Center will modestly expand: (1) its acquisition and distribution activities, (2) production and field-testing of educational materials in cooperation with health professionals, and (3) experimentation with self-instructional technology and modular audiovisual units which are valuable for their ease of updating and flexibility of use. Additionally, it will implement more fully its "university-on- loan" concept through inauguration of a program of acquiring, cataloging, and dis- tributing to the biomedical community highly selected collections of slides and other audiovisual materials for use in the continuum of medical education. Audio- visual instructional packages will be produced in cooperation with the BHME and health-sciences instructional centers located in universities throughout the country. The Center will utilize the MEDLARS system of NLM to disseminate infor- mation on the availability of evaluated audiovisual instructional materials, thereby serving a much needed clearinghouse function.8407375_000043.txt

Page  43 1534 Library Operations -----1972--------------I973 Increase or Appropriation Estimate Decrease Pos. Amount' Pos. Amount PoSj. Amount Personnel compensation ,«,oa nr,n and benefits.......... 249 $3,850,000 249 $4,048,000 -- +$l98'°™ Other expenses.......... - 4,631,000_____-____4,622,000-----~----' g»ggg Total............... 249 8.481.000 249 8.670.000 — + 189,000 Library Operations selects, acquires, catalogs, and preserves biomedical pub- lications; indexes and provides access to the material through manual and «»cnlne produced bibliographies; furnishes reference and loan services; prepares and pub- lishes indexes, catalogs and othei- publications for the use of the biomedical commu- nity; and manages the Library component of the Biomedical Communications Network. In FY 1972 Library Operations will provide approximately 260,000 services to the public in its capacity as a component of and a backup for the National Library Net- work. In addition, regional libraries funded by NLM will provide more than 327,000 document delivery and MEDLARS services. The Library also will Index 220,000 articles from biomedical periodicals for inclusion into the MEDLARS data base from which the NLM prepares and publishes a monthly Index Medicus and a yearly 9,000 page, eight volume Cumulated Index Medicus. In addition, the MEDLARS system produces over 21 specialized bibliographies in the field of medicine in collaboration with federal agencies and professional medical societies, and the Abridged Index Medicus, which has been developed for the indivi- dual practitioner and small hospital libraries. The Libraiy also collects and catalogs books and monographs and through the MEDLARS system produces and publishes semi-weekly, monthly, quarterly and annual cumulations of cataloged material for the use of medical libraries in carrying out their cataloging and acquisition functions. During FY 1972, an eight volume sexennial publication of the NLM catalog since 1965 was produced. The Library also negotiated a contract to provide for the com- mercial production and distribution of NLM catalog card sets to other libraries at moderate cost. The Library plans to publish, in collaboration with the American Public Health Association, a new publication called Current Bibliography of Epidemiology, which has been previously published on an experimental basis by the American Public Health Association. This represents the only index of Its kind and will contain vital references to epidemiologic aspects of all diseases. NLM has Implemented a new on-line bibliographic service called MEDLINE with a data base of more than 1,000 of the world's leading biomedical journals containing up to 500,000 citations. This access will be backed up by retrospective retrieval capacity for the entire machine-based data file at NLM which currently contains about 1,500,000 citations. This will represent an expansion of accessibility from the 11 MEDLARS centers to about 200 major installations and provide the base for ultimate plans for even more widely disseminated access for hospitals and directly to health science practitioners. A communications network has been established by the Lister Hill Center to make this data available to most major medical schools, hospitals, and research institu- tions on a toll free or low toll basis. This development _'...: _ld replace the needs for a major portion of the MEDLARS8407375_000044.txt

Page  44 1535 bibliographic searches and provide more timely service by its on-line access to the system by a large proportion of the user population. It is thus proposed to phase out most of the MEDLARS centers. This phase out will provide the operational costs for maintaining the MEDLINE communication network. In late FY 1972 the capability of searching more than one data base will become available in the programs operating MEDLINE. The Library is building two additional data bases available in its computerized files for serials and for monographs. During FY 1973, these will become available on-line to all users in the MEDLINE network and will provide access to the catalog and serial files available at NLM. The serial files will also include information on the availability of publications in about 100 major medical libraries in the Regional Medical Library Network and will improve document delivery services. As a by-product of these efforts, the Library will be able to publish a series of library reference tools which should reduce greatly the efforts of libraries in Identifying and locating items. The emergence of the Library as the backup for a large network of libraries has required more critical attention for the need to build its physical resources to maintain the collection, fill gaps in the collection and for preserving the deterio- rating portions through microfilming. The FY 1973 increase in resources will be utilized to maintain the Library's collection at a level capable of providing this critical backup function In the face of rapidly rising costs for acquisitions. The request for Library services in 1973 is $5,099,000 and 197 positions. These funds will allow the processing of 100,000 interlibrary loan requests; 18,000 domestic computer-generated demand searches, 84,000 reader requests (direct use of the collection), indexing of 220,000 articles, publication of 21 recurring biblio- graphies, acquisition of 130,000 serial pieces and 14,000 monographs, binding of 28,000 volumes and microfilming of approximately 1,000,000 pages of deteriorating documents. Development and Implementation of a Second-Generation MEDLARS (MEDLARS II) The National Library of Medicine began the development of a second-generation Medical Literature Analysis and Retrieval System (MEDLARS II) in 1968 through a major contract which included responsibilities for a system conceived as a three to four year project of development and incremental upgrading. However, due to the increasing need for the planned Interactive capability and the great difficulty which the original contractor experienced in implementing the system, the project was given major redirection in April 1971. A proprietary software package which had already been in use by the Library was purchased for a nominal sum and a contract let to rebuild the MEDLARS II system around it. This current phase of MEDLARS II development, which consists of an improved file generation/maintenance system, a new set of programs to produce output for photocomposition and additional search capability is expected to be completed in 1973. In full operation, MEDLARS II will incorporate the following technical elements: increased processing capability; on-line storage devices permitting direct access to the data base; multi-programming capability which will permit several tasks to be performed by the computer simultaneously; and on-line access to data bases from ,-. mote terminals. Translated into program capabilities, the new features will prov.de for: a greatly increased file capacity to allow the maintenance of abstracts, summaries, and bibliographic service requests; the processing of more current dat-i through direct Input and on-line updating of the file; and automated acquisition end cataloging system with availability of cataloging data to and from medical librari >s; and development of specialized information files to support the Library's Toxicoloj-y Information Program through the addition of chemical name and structure search capa- bilities.8407375_000045.txt

Page  45 1536 Experience with the development of the HOURS nj-W iejt-J at although the 360/50 computer then in use was adequate for deyel°P«nt «ork, P~££ (MEDLInE) ation and particularly che requirements of the on-line J"^"^^^, to J would require a more powerful computer. Consequently,/^"^ "w71 IBM 370/155 was obtained and the computer was installed in December 19/1. The programming and analytical staff specialize in the field °f^nJ?™^rac. storage and retrievfl. Because of the recent implementatIon of J« « ^ J tlve portion of MEDLARS II (MEDLINE), increasing emphasis h"*«n Computer with desigTof Interactive time-sharing systems and on the interface of the computer vitn communications systems. The 1973 budget request includes $3,571,000 and 52 positions to continue the development, implementation and operation of MEDLARS II and the operations of MEDLARS I. Toxicology Information ------------------------------J972 1973 Increase or Appropriation Estimate Decrease Pos. Amount Pos. Amount Pos. Amount Personnel compensation and benefits.......... 20 $ 435,000 20 $ 490,000 - +$55,000 Other expenses.......... 883,000 - 1.158,000_____------+ 275. °9° Total............... 20 1,318.000 20 1.648.000 — +330.000 The mission of the Toxicology Information Program (TIP) Is to select, analyze, and organize Into automated storage and retrieval systems toxlcologlcal information now available only from numerous diverse sources. The effective implementation of the program requires close collaboration with other government agencies and the creation of a capability to respond to requests for Information. This in turn re- quires access to toxicology information from scientific literature and the files of government and industry. Collaborative Activities with Other Organizations The TIP is participating In a joint effort with several federal agencies to en- hance the capabilities of an interactive computer system (STIMS/RECON), originally developed by NASA and kept in the public domain by this Interagency effort. TIP's data banks are being stored on this sytem. TIP, in collaboration with FDA, also is working on the storage in the on-line system of data from the handbook Clinical Toxicology of Commercial Products. Literature searches in various areas of toxico- logy are being performed by TIP routinely for over 20 government organizations. TIP has also started a contractual effort with a large chemical company through which the toxicology information of that company's products will be extracted from company files and added to TIP's data banks. TIP's efforts to extract toxicology data from pesticide petitions submitted to FDA and EPA continues. In 1973, efforts to support other agencies with toxicology information and data on request will be expanded. TIP will also initiate activities with other organi- zations to obtain toxicology data from their files. Development of Specialized Files and Products Based on the Published Literature In 1972 TIP completed the preparation of several publications and other infor- mation services including: a drug interaction bibliography; a thesaurus of toxico- logy terminology; a new abstract journal and companion computer tape service on the "Health Effects of Environmental Pollutants"; and the "Common Data Base", a compu- terized file containing structural and nomenclature information as well as Chemical8407375_000046.txt

Page  46 1537 Abstracts registry numbers for some 35,000 blomedically important compounds, which Is being maintained and regularly updated in collaboration with FDA. Plans for 1973 include the publication of a supplementary volume on Drug Inter- actions; continuation of the publication of several state-of-the-art reviews in various toxicology subject areas; initiation of a continuing bibliography on drug metabolism; and publication of a supplemental volume listing compounds newly added to the"Common Data Base" since 1968. Automated Systems In 1972 the TIP has initiated an on-line interactive computer system containing toxicology information and data which will be available to users at a minimum cost via remote terminals. The system uses government owned computer software and a government leased communications network. During the initial period of operation, the system has contained citations and abstracts primarily from the published litera- ture. In 1973 efforts will be directed towards enlarging the scope of the system with toxicology data files to serve a larger, more diversified user community. Maintenance of the Roster of Toxicologists will be continued. TIP also plans to Implement at NLM the Chemical Abstracts Services' computerized "Name Match" system for chemical substance names to support both MEDLARS and the TIP data bases. Toxicology Information Response System A toxicology Information analysis and response center established by TIP via an NLM-AEC Interagency agreement at the Oak Ridge National Laboratory (ORNL) became operational in 1972. The Center has been performing literature searches in various areas of toxicology for government agencies, industry, universities, and private individuals, such as physicians, on a request basis. The Center also has initiated and sponsored state-of-the-art reports,' mostly on the health effects of environmental toxicants, by well-known experts. These reviews are being published In review journals or through the National Technical Information Service, Department of Commerce. The ORNL computer center is working with TIP on software development and data file building. Plans for 1973 include the development of additional review articles, expansion of the literature search services, and the creation of computerized data banks on the toxicology of pesticides and other environmental toxicants, hazardous household products, and chemicals posing a threat to occupational and public health. Review and Approval of Grants 1972 Appropriation Pos. Personnel compensation and benefits.......... 32 Other expenses.......... — Total............... 32 Amount $581,000 129,000 1973 Estimate Pos. Amount 32 710,000 $618,000 128,000 32 746,000 Increase or Decrease Pos. Amount +$37,000 - 1,000 + 36,f>0__ This activity provides the administrative staff and program direction for :iix grant programs authorized by the Medical Library Assistance Act of 1965 and its Extension Act of 1970, as well as for the International activities of the National Library of Medicine which are funded by the Scientific Activities Overseas appro- priation. The funds requested for this activity will provide the resources required to process, review and manage approximately 950 grant applications received per yea.. This office provides staff assistance in the areas of grants management, direction,8407375_000047.txt

Page  47 1538 program review and evaluation of applications and travel. Administrative support is also provided to the NLM Board of Regents and the various grant review committees. Program Direction 1972 1973 Increase or Appropriation Estimate Decrease Pos. Amount Pos. Amount Pos. Amount Personnel compensation and benefits.......... 56 $ 930,000 56 $1,039,000 — +$109,000 Other expenses.......... _zz______1,524,000 — 1.760.000 — + 236,000 Total............... 56 2,454,000 56 2,799,000 — + 345,000 This activity provides the program leadership and centralized administrative support necessary for the coordinated operation of the various NLM programs. It provides support for the Immediate Office of the Director, the Office of Administra- tive Management, and payment to the National Institutes of Health Management Fund for services furnished centrally. In 1972 efforts have been directed towards the devel- opment of new and the improvement of current systems for the dissemination of bio- medical information. Specific emphasis has been placed on systems design for the distribution of toxicity information utilizing MEDLARS II and the Lister Hill Center's Biomedical Communications Network. Additional emphasis also has been placed on providing overall program evaluation and analysis for the Library's pro- grams. Included under this activity for 1972 and 1973 is $66,000 for program evalu- ation. In 1973 the above activities will continue to receive emphasis, and in addition the Library's current efforts in coordinating and developing biomedical communications systems and network prospects for the entire Department will be assigned higher priority. This activity will also support the costs associated with the participation of NLM employees in the Upward Mobility Program.8407375_000048.txt

Page  48 1539 NATIONAL INSTITUTES OF HEALTH National Library of Medicine Program Purpose and Accomplishments Activity: Training Grants (Medical Library Assistance Extension Act of 1970, P.L. 91-212, Section 394) ________________19721_______________ Budget Estimate_____ Authorization Pos. Amount $1,200,000 $2,000,000 — $1,500,000 Purpose: The objective of the training program is to help meet the Nation's need for medical librarians, information specialists, and biomedical personnel trained in the utilization of computer technology for education and patient care. Recent data indicate that most librarians in health-related libraries (757.) have had little or no work in sciences related to health. Only 357. have had medical library training in the form of one course. These deficiencies impair infor- mation transfer and must be remedied. Explanation: Grants may be made to non-profit institutions qualified to conduct the proposed training activities. Grants may also be made to individuals in the form of fellowships. Accomplishments in 1972: A total of 17 grants which supported 123 trainees were active in Fiscal Year 1972; 4 new or competing renewal awards were made. In addition, three fellowship awards were made to individuals. These awards will upgrade the skills of personnel engaged in medical librarianship and the transfer of health information. Objectives for 1973: An increase of $300,000 over the Fiscal Year 1972 level will support 3 additional training programs. This will permit the Library to support 20 projects, 13 of which will be continuations. Emphasis will be placed on train- ing health professionals in the health applications of computer technology. Support of current programs which provide further and specialized training for individuals will also be continued and expanded. They will be modified to empha- size doctoral programs rather than Master's degree and on-the-job training including training for management. 1972 Pos. Amount8407375_000049.txt

Page  49 1540 NATIONAL INSTITUTES OF HEALTH National Library of Medicine Program Purpose and Accomplishment Activity: Special Scientific Project Grants, Medical Library Assistance Extension Act, Section 395 ____________1973_________________ Budget _____1972 Estimate_____ Appropriation Authorization $95,000 $500,000 $95,000 Purpose: Special Scientific Project grants support outstanding scholars in the full-time analysis and documentation of major advances In the health sciences. Explanation: Project grants are awarded to scholars and public or non-profit institutions on behalf of such scholars. Accomplishments in 1972: Three new project grants were awarded in 1972. Ob.iectives for 1973: This program will be funded at the 1972 level which will allow the support of 4 projects.8407375_000050.txt

Page  50 1541 NATIONAL INSTITUTES OF HEALTH National Library of Medicine Program Purpose and Accomplishments Activity: Research Grants (Medical Library Extension Act of 1970, PL 91-212, Section 395b) _______________1973________________ Budget Estimate______ Authorization Pos. Amount $650,000 $3,000,000 — $900,000 Purpose: The purpose of the Research Grants program is to develop new methods of processing information and making accessible the rapidly growing body of bio- medical knowledge. Explanation: Grants are awarded to investigators and public or non-profit private institutions on behalf of such investigators. Accomplishments in 1972: There were 21 grant awards in this year; 12 were non- competing continuations, and 9 were new or competing renewal projects. Of these, 3 had to do with medical library operations and techniques, 12 with biomedical communications, and 6 with history of medicine. Objectives for 1973: The Library will make 26 awards, of which 10 will be non- competing continuations and 16 will be new projects. The projects will include studies to evaluate effectiveness of library services, information-seeking behavior patterns of health professionals, and information services for clinical needs. Also included will be historical projects on themes relevant to current American health problems. 1972 Pos. Amount8407375_000051.txt

Page  51 1542 NATIONAL INSTITUTES OF HEALTH National Library of Medicine Program Purpose and Accomplishments Activity: Library Resource Grants (Medical Library Assistance Extension Act of 1970, P.L. 91-212, Section 396) _________________1973________________ Budget ______1972__________ Estimate_____ Pos. Amount Authorization Pos. Amount $2,505,000 $4,500,000 — $2,705,000 Purpose: The purpose of the grants is to provide financial assistance and incen- tive for improving the basic materials, equipment, and services of local medical libraries. The emphasis is on upgrading medical libraries in hospitals, educational institutions, and medical societies by supplementing rather than supplanting local resources. There are two types of resource grants. The first is a 1-year non-renewable award for the purpose of establishing a basic collection. The second type is of a. project nature and is awarded for a 1-3 year period to improve medical library services. This latter program complements the service activities of the Regional Medical Library Program. No resource grant may exceed $200,000 for any fiscal year. Explanation: Applications are submitted by a health science library or by an in- stitution for its library. They are evaluated by the Biomedical Library Review Committee and the Board of Regents of the National Library of Medicine using criteria which reflect the requirements of the legislation. Priority scores are assigned each approved application. Accomplishments for 1972: The Library made 407 awards in 1972, 167 were contin- uing projects and 240 were new grants. These grants will be awarded not only on the basis of local need but more importantly in consideration of how the improve- ment of local services will strengthen not only local services but the regional medical library area as well and, by extension, the entire RML network. Objectives for 1973: In 1973, the Library expects to support 101 continuing grants and 353 new ones for a total of 454 awards. The new awards in 1973 will raise the total to 667 institutions receiving support under the Extension. Five hundred of these awards will be for establishing basic resources in first level libraries. The balance of the awards will be to primary and secondary resource libraries for improving services.8407375_000052.txt

Page  52 1543 NATIONAL INSTITUTES OF HEALTH National Library of Medicine Program Purpose and Accomplishments Activity: Regional Medical Libraries Awards, (Medical Library Assistance Extension Act, Section 397) _______________1973_______________ Budget ______1221____ Estimate_____ Appropriation Authorization $2,102,000 $3,500,000 $2,902,000 Purpose: Regional Medical Library (RML) awards (grants and contracts) provide funds to support a national network of medical library services. Contracts sus- tain the regional operations of 10 Regional Libraries. Competitive Grants com- plement the contracts by providing support for projects which analyze existing methods, establish new services or methods, and improve existing services in the RML's. Explanation: The regional services of the Regional Medical Library contracts include interlibrary loans, on-line literature searches, and other reference services. The 10 prime contractors were selected because of the scope of their collections and the potential strength of their regional service components. Grants are available to institutions within each region for improving or ex- panding the regional contracted services and are reviewed and evaluated by the Biomedical Library Review Committee and the Board of Regents of the National Library of Medicine. Accomplishments in 1972: The Library awarded three new contracts and six renewal contracts in 1972. Approximately 500,000 interlibrary loans will be made in FY 1972. Additionally access to MEDLINE, the on-line bibliographic retrieval system, will be afforded to all the RML's. Objectives for 1973: In 1973 the Library expects to renew 10 contracts and 15 new grants for a total of 25 awards. These grants and contracts will support: (1) the provision about 600,000 Interlibrary loans; (?.) 50 continuing library education workshops for small hospitals; and (3) access to MEDLINE.8407375_000053.txt

Page  53 1544 NATIONAL INSTITUTES OF HEALTH National Library of Medicine Program Purpose and Accomplishments Activity: Publications Support Grants, Medical Library Assistance Extension Act, Section 399 ________________1973_______________ Budget ______1972 Estimate_____ Appropriation Authorization $340,000 $1,000,000 $390,000 Purpose: The Publications Support Grants provide support for the preparation and/ or publication of secondary tools such as abstracts, bibliographies, handbooks, and critical reviews, as well as monographs and translations which condense, syn- thesize, evaluate, or otherwise repackage information for health scientists, educators, and practitioners. Explanation: Grants are made to individual scientists or to public or non-profit institutions of higher education on behalf of such scientists. Publications supported by the program are those of need and merit which cannot be financed by commercial publishers. Accomplishments in 1972: Fifteen grants were awarded in 1972; 6 were continuing projects and 9 were new or competing renewal projects, including a comprehensive bibliography that will combine in one volume the references to the massive, widely dispersed literature on Chayas disease, one of the major diseases of the Western Hemisphere; a critical review on the controversial issue of the hereditary impor- tance of non-chromosomal substances, which is of major importance to the developing field of human genetics. Objectives for 1973: In 1973, the Library will continue the support of 9 continu- ation projects and will support 8 new or renewal projects. New projects in 1973 will stress reviews, especially critical reviews, as well as reference tools needed by and useful to librarians and information specialists in the health sciences.8407375_000054.txt

Page  54 1545 NATIONAL INSTITUTES OF HEALTH National Library of Medicine Program Purpose and Accomplishment Activity: Lister Hill National Center for Biomedical Communications ________________1973_____________ Budget Estimate Authorization Pos. Amount 19 $1,855,000 --- 24 $3,072,000 Purpose: The Lister Hill Center applies communications and computer technology to improve health care delivery, medical education and biomedical research. Explanation: The Center matches high priority needs with technological capabili- ties to develop experimental services and evaluate their effectiveness. Proof of utility and acceptance of costs by the consumer is justification for incorporation into an operational biomedical communications network. Accomplishments in 1972: The Center initiated a national network providing access to bibliographic citations to current medical information stored in an NLM computer. This network called MEDLINE (MEDLARS On-Line) contained an expanded data base and served more than 60 hospitals, libraries and medical research facilities. New data bases have been added to the MEDLINE network to provide experiment- computer assisted instruction and diagnosis. This powerful tool could eventually permit interchange of data bases between medical schools and other schools of the health professions (totaling approximately 2,300) permitting students to learn at their own pace and increasing the capabilities of their faculties. An experimental network linking native villages, service unit hospitals, and major medical centers is now operating seven days a week in Alaska utilizing a communications satellite. This network provides reliable dally voice consultation between village health aides and physicians. An operational network could signif- icantly upgrade the primary health care afforded the 55,000 natives in the remote reaches of Alaska. The network also indicates what could be done for millions of others in geographically Isolated regions of the United States. DHEW and NASA have agreed to explore the use of the powerful Application Technology Satellite (ATS-F) to provide two-way TV for health and education experiments. The Lister Hill Center has been designated to lead the health- oriented effort which could impact on the well-being of some 40,000,000 Americans in scarcity areas. In 1972 emphasis has been on the detailed planning and schedul- ing of experiments and design of an inexpensive tw6-way satellite terminal. The Center has supported a television microwave network linking the Medical Schools of Dartmouth College and the University of Vermont with community hospitals. In addition, construction of a mobile van was begun to extend the network to .visti- tutions where a valid need exists for better care and education but where it .* not economically justifiable to provide expensive fixed installations. The o-erall network will eventually link 15 hospitals and three university health centers in a mutually reinforcing program of improved health care delivery and education. The Center undertook two planning efforts to explore the use of cable television (CATV) to reach millions of urban dwellers who suffer from poor health care and health education by virtue of their socio-ecomic situation. 1972 Pos. Amount8407375_000055.txt

Page  55 1546 At the request of Congress a report is being prepared on the Lister Hill Center's prototype experiments and its plans for the future. It has responded to the Congressional request for development of a program of requirements for con- struction of the Lister Hill Center building. Objectives for 1973: The budget estimate for 1973 provides for the continuation of the programs described above. The approximately 1,200,000 funding increase in 1973 will support the following: (1) Communication costs which will be incurred In providing access by an eApanded user population to the new computer data bases placed on the MEDLINE network. (2) Initiation of ATS-F satellite terminal procurement; testing to determine equipment required to transmit information on patient needs, physiological data, and video transmission when necessary; and initiation of training for participating health personnel in the use of communication equipment. (3) Training of health personnel in techniques of providing health care and education via CATV. (4) Expansion of the New England Interactive Network. The five new positions will be utilized for the monitoring of the contracts efforts described above.8407375_000056.txt

Page  56 1547 NATIONAL INSTITUTES OF HEALTH National Library of Medicine Program Purpose and Accomplishments Activity: National Medical Audiovisual Center ________________1973_____________ Budget Estimate Authorization Pos. Amount 110 $2,677,000 Purpose: The National Medical Audiovisual Center (NMAC) administers programs to improve the quality and increase the use of biomedical audiovisuals in schools of the health professions and in the continuing education of health professionals. Explanation: NMAC acquires and distributes audiovisual instructional materials which have been reviewed by peer professional organizations for direct relevancy to contemporary education in the health professions; provides educational research and consultation on audiovisual systems and media; develops prototype instructional media units; supports education through workshops, seminars, training programs and site surveys; and catalogs and shares reference information on audiovisual Instructional media. Accomplishments in 1972: In 1972, NMAC provided about 90,000 units of educational service or assistance to over 35,000 health-science individuals or institutions. The services included: 68,000 film loans; 17,150 instructional media reference search requests; over 300 educational consultations; workshops and seminars attended by over 900 health professional students, faculty and practitioners; about 1,581 videotape professional teaching programs duplicated and furnished to schools. In collaboration with BHME's Office of Audiovisual Education Development, NMAC accomplished about 40 health education projects relating to medicine, dentistry, nursing and allied health professions. Cooperative evaluation programs with 12 national health professional organizations resulted in peer review of approximately 2,000 medical films and videotapes. More than a dozen prototype units of multi- media instruction were developed and tested in collaboration with schools of the health professions, national medical organizations, and other Federal health programs. The Center also initiated a "University-on-Loan" program, under which 30 medical educators, supported by their 28 universities, came to the NMAC to participate in cooperative programs to plan and develop media Instructional applications. Objectives in 1973: In 1973, NMAC will provide an estimated 115,000 units of health educational services to 36,000 health science professionals and institutions an increase of 25,000 over 1972. Of this total, there will be about 85,000 film loans; 23,000 instructional media reference searches; and 1,800 professional-level videotape replications distributed to schools and organizations. The NMAC also anticipates modest expansion of the media resource data collection and the develop- ment of a visual abstracting mechanism to meet teacher's needs in media selec ion. The "University on Loan Program" activity will expand slightly as will the utilization of peer professional groups in screening and selecting instructional media to be placed in the NMAC collections. Collaborative projects with the '.iHME will be continued on health education projects that satisfy mutual program go; Is. 1972 Pos. Amount 108 $2,350,0008407375_000057.txt

Page  57 1548 NATIONAL INSTITUTES OF HEALTH National Library of Medicine Program Purpose and Accomplishments Activity: Library Operations ______________ 1973 ___________. Budget Estimate Authorization Pos. Amount 249 $8,481,000 — 249 $8,670,000 Purpose: Library Operations provides bibliographic, reference and loan service as a central resource for a nationwide network of regional and local medical librar- ies. In addition, it compiles and publishes catalogs, indexes, and bibliographies of materials pertinent to biomedicine. Explanation: This activity of the Library acquires and catalogs materials and indexes biomedical literature for incorporation into MEDLARS, the Library's com- puterized medical literature analysis and retrieval system. From the MEDLARS data base the Library publishes Index Medicus, 21 specialized bibliographies in the field of medicine, Abridged Index Medicus, and the Current Catalog of current books and technical reports. The Library also manages and coordinates a network of domestic and foreign MEDLARS stations and Regional Medical Libraries. The History of Medicine Division acquires, organizes and maintains' historical source materials related to biomedicine. Accomplishments in 1972- NLM provided 260,000 services in its dual capacity as a central backup to the Regional Medical Libraries and as one of the components of the network. In addition, through the regional libraries it has provided more than 327,000 document deliveries and MEDLARS services. A 9,000 page, eight volume annual Cumulated Index Medicus, the 1,300 page Bibliography of the History of Medicine (1965-69), and the 7,000 page, eight volume Cumulated Current Catalog (1965-70) were published. 1972 saw the initial implementation of the Library component of the Biomedical Communications Network with a new on-line bibliographic service called MEDLINE. A communications network will make the data available to 200 major medical schools, hospitals, and research institutions on a toll free or low toll basis. The data base will contain 60% of the MEDLARS data base or citations to 1,000 of the world's leading biomedical journals. During the year a contract was negotiated to provide for the commercial production and distribution of NLM catalog card sets at a moderate cost. Objectives in 1973: Plans for 1973 call for full implementation of the MEDLINE system with a gradual phasing out of the present MEDLARS Search Centers. Con- ventional retrospective MEDLARS searches will be processed solely at NLM as a backup resource for the MEDLINE Operation. Other conventional library operations will continue at approximately the same level of activity as in FY 1971 and FY 1972. Specifically, the Library will process 100,000 interlibrary loans, publish 21 recurring bibliographies; acquire* 130,000 serial pieces and 14,000 monographs, bind 28,000 volumes and microfilm approximately 1,000,000 pages of deteriorating documents. ______1972 Pos. Amount8407375_000058.txt

Page  58 1549 NATIONAL INSTITUTES OF HEALTH National Library of Medicine Program Purpose and Accomplishments Activity: Toxicology Information __________1973 Budget X^72 Estimate p°s» A*"0"1* Authorization Pos. Amount 20 $1,318,000 ... 20 $1,648,000 Purpose: The Toxicology Information Program (TIP) is responsible for developing and operating a computer-based toxicology information storage and retrieval system. It also issues publications and other information packages and services to satisfy the needs of the scientific community, industry and other federal agencies. Explanation: The TIP services as a national resource for toxicological information by organizing data from diverse sources into computer-based files. It also provides state-of-the-art reviews, annotated bibliographies and literature search services. Accomplishments in 1972: In 1972 the TIP continued to support a Toxicology Infor- mation Response Center at the Oak Ridge National Laboratory, to provide expert con- sultation as necessary in specific areas of toxicology. The TIP continued to em- phasize collaborative efforts with other federal agencies as well as academic and industrial organizations, as part of its efforts to coordinate toxicological data from a wide variety of sources. In the development and maintenance of its data files, the TIP emphasized adverse drug reactions, pesticides, and environmental pollutants. These efforts resulted in several new publications and computer ser- vices, including the testing of an on-line interactive toxicology data system. Objectives for 1973: The on-line toxicology information system will be expanded through the addition of more terminals which, when the system is fully operational, will permit remote access to the centralized computer files by other federal agencies, universities, and industrial organizations on a "pay-as-you-use" basis through a government-leased communications network. The capabilities of the system also will be enhanced through the creation, in cooperation with other government agencies, of additional computer software modules. The Response Center at Oak Ridge will expand its services through the preparation of additional state-of-the-art reviews and other evaluation services. The TIP also will continue to build a computerized link between the NLM's MEDLARS data base and the computerized files of Chemical Abstracts Services. All of these activities are intended to provide an effective toxicological information component for the emerging National Biomedical Communications Network whose development the NLM is responsible for coordinating.8407375_000059.txt

Page  59 1550 NATIONAL INSTITUTES OF HEALTH National Library of Medicine Program Purpose and Accomplishments Activity: Review and Approval of Grants (Public Health Service Act, Title III, Part I) _________________1973_____________ Budget ______1972 Estimate Pos. Amount Authorization Pos. Amount 32 $710,000 — 32 $746,000 Purpose: This activity provides support for staff to manage the six grant programs authorized by the Medical Library Assistance Act of 1970, as well as international activities of the NLM funded by the Scientific Activities Overseas appropriation. Explanation: The functions of this office include the processing of approximately 950 grant applications and their review by program officers, staff assistance to reviewing committees and the Board of Regents of the National Library of Medicine, grants management and direction, and program review and evaluation. There are 3 Biomedical Library Review Committee meetings and 3 Board of Regents meetings a year. Accomplishments in 1972: In 1972 this activity provided the administrative support and program leadership necessary for a coordinated approach to the review of library and information oriented grants. Administrative support was also provided for the approximately 470 awards made in fiscal year 1972. Objectives for 1973: This activity will continue to provide administrative support to the NLM's expanded grant-in-aid program. Approximately 550 grants will be awarded in FY 1973. This Includes support of research and development of new methods of making accessible biomedical information. In the training area intern- ships, continuing education, and programs which lead to the Ph.D. will be strersed.8407375_000060.txt

Page  60 1551 1972 NATIONAL INSTITUTES OF HEALTH National Library of Medicine Program Purpose and Accomplishments Activity: Program Direction (Public Health Service Act, Title III, Part I) ________________1973_____________ Budget Estimate Authorization Pos. Amount 56 $2,799,000 Purpose: This activity provides the program leadership and centralized adminis- trative support necessary for the coordinated operation of the various NLM activities. Explanation: Program Direction provides support for the immediate Office of the Director, Office of Administrative Management, the Office of Public Information and Publications Management, and payment to the National Institutes of Health Management Fund for centrally furnished services. Accomplishments in 1972: Efforts in 1972 are being directed towards the develop- ment of new and the improvement of current systems being utilized in the dissemi- nation of biomedical information. Specific emphasis is being placed on the systems design for the distribution of toxicity information utilizing MEDLARS II and the Lister Hill Center's Biomedical Communications Network. There will be an additional emphasis on providing overall program evaluation and analysis for the Library programs. Objectives for 1973: This activity will continue to provide the overall scientific and administrative management of the NLM programs. Emphasis will be placed on conducting meaningful program analysis and evaluation of the impact of NLM support as well as publications management and program planning activities. Current efforts in coordinating and developing biomedical communications systems and network pro- spects for DHEW will be expanded and assigned high priority in FY 1973. Additional- ly, the costs of NLM employees participating in the Upward Mobility Program will be funded in this activity. Included under this activity for 1972 and 1973 is $66,000 for program evaluation.8407375_000061.txt

Page  61 1552 NEW POSITIONS REQUESTED Fiscal Year 1973 Annual Grade Number Salary Lister Hill National Center for Biomedical Communications Engineer GS-14 1 $ 21,960 Communications Specialist GS-13 1 18,737 Electronics Technician GS-13 1 18,737 Computer Programmer GS-12 1 15,866 Engineer GS-I1 1 13,309 National Medical Audiovisual Center Medical Officer Audiovisual Educational Specialist Total, New Positions GS-15 GS-12 25,583 15,866 $130,058