1977 U.S. Senate Appropriations Committee Budget Testimony, 94th Congress 2nd Session, February 4, 1976
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DEPARTMENTS OF LABOR AND HEALTH, EDUCATION, AND WELFARE AND RELATED AGENCIES APPRO- PRIATIONS FOR FISCAL YEAR 1977 HEARINGS BEFORE A SUBCOMMITTEE OF THE COMMITTEE ON APPROPRIATIONS UNITED STATES SENATE NINETY-FOURTH CONGRESS SECOND SESSION Printed for the use of the Committee on Appropriations PART 3—Pages 879-1572 DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE National Institutes of Health 67-311 O U.S. GOVERNMENT PRINTING OFFICE WASHINGTON : 19768407674_000002.txt

Page  2 National Library of Medicine STATEMENT OF DR. MARTIN M. CUMMINGS, DIRECTOR, NATIONAL LIBRARY OF MEDICINE ACCOMPANIED BY: DONALD S. FREDRICKSON, DIRECTOR, NATIONAL INSTITUTES OF HEALTH MELVIN S. DAY, DEPUTY DIRECTOR, NATIONAL LIBRARY OF MEDICINE KENT A. SMITH, ASSISTANT DIRECTOR FOR ADMINISTRATION, NATIONAL LIBRARY OF MEDICINE FRANK B. POH, FINANCIAL MANAGEMENT OFFICER, NATIONAL LIBRARY OF MEDICINE LEON M. SCHWARTZ, ASSOCIATE DIRECTOR FOR ADMINISTRA- TION, NATIONAL INSTITUTES OF HEALTH NORMAN D. MANSFIELD, DIRECTOR, DIVISION OF FINANCIAL MANAGEMENT NATIONAL INSTITUTES OF HEALTH CHARLES MILLER, DEPUTY ASSISTANT SECRETARY COMP- TROLLER BUDGET REQUEST Senator Magnuson. Our next witness will be Dr. Martin Cummings of the National Library of Medicine. The budget request for this program in fiscal 1977 is $35 million. Congress provided $29 million in fiscal 1976. The witness list has been included in the record. Please begin your testimony. STATEMENT OF DR. MARTIN M. CUMMINGS Dr. Cummings. Mr. Chairman and members of the committee, in this nation's bicentennial year, the National Library of Medicine takes great pride in its many achievements accomplished over the past 140 years. Since its modest beginning in 1836, the National Library of Medicine has become an outstanding national resource which contains the most important collection of health sciences literature in the world. As part of the Surgeon General's Office of the Army, the Library originally consisted of a small collection of 30 books and journals. An Army surgeon, Dr. John ShaAv Billings, developed and fostered the philosophy that the ever-increasing and important collection of biomedical publications was a resource that should be organized and utilized by health professionals in their efforts to promote the progress of medicine. That philosophy permeates the establishing legislation that authorized the creation of the National Library of Medicine in 1956. Today the NLM's total collection of over 1.5 million items is orga- nized in a most efficient manner consistent with facilitating timely (1513)8407674_000003.txt

Page  3 1514 dissemination of medical information to researchers, educators, and practitioners. In the last 140 years, NLM has expanded well beyond its traditional role of curator of the published medical record to that of an active institution concerned with sustaining and operating a national bio- medical communication network employing the latest communication technology and information science techniques. Fiscal year 1977 at NLM will continue to be marked by new initia- tives, innovation and significant challenges in the application of com- puter and telecommunications technologies to medical information transfer. Substantial support for NLM's basic library services becomes a bigger challenge with each succeeding year. Demand for access to the literature is increasing at a rate of 25 percent in fiscal year 1976 and the cost of acquiring such materials will rise approximately 15 to 20 percent. Rising acquisition costs have forced more local hospital and clinical libraries to rely on NLM as a medical library backstop. A second major challenge will be the difficult task of rapidly trans- lating research results into clinical practice and public health, on assignment which we share with all of the Institutes and Divisions of NIH. Whereas the Institutes assume the responsibility for the accu- racy of the content of the information we are preparing to providing the communications channels through which the messages reach the practitioners, patients and other members of our society who have a need for this information. The full resources and power of the national biomedical communi- cations network will be brought to bear on the problem through the involvement of each NLM operating component. bibliographic services NLM continues to meet its traditional responsibilities of improv- ing the flow of biomedical information by storing, retrieving, and disseminating the world's biomedical literature. To facilitate access to the literature, NLM produces bibliographies employing both manual search techniques and computer searches of online data bases; provides reference and loan services; prepares and publishes various materials for use by health science researchers and practitioners; and manages the Nation's on-line information retrieval network. NLM will provide approximately 400,000 reference and loan services during fiscal year 1976, an increase of 80,000 over fiscal year 1975. It is antici- pated that the NLM will satisfy a requirement for 500,000 during fiscal year 1977. Perhaps the prime tool of modern technology is the computer, and NLM has pioneered its use for bibliographic information storage and retrieval. A computerized reference retrieval system was installed in 1964 to help cope with increasing amounts of biomedical literature. This system, known as Medlars I, permitted both computerized pro- duction of Index Medicus and automated searches of the entire bibliographic data base by health professionals. Last year a more8407674_000004.txt

Page  4 1515 sophisticated bibliographic processing system, Medlars II, was imple- mented successfully which has enabled NLM to develop new services and extend its existing services to a larger segment of the health community. Medline (Medlars online) is now available in some 388 institutions at home and abroad. It facilitates rapid communication between the health professionals and the NLM's Medlars data base, which contains references to relevant medical literature. Some 400,000 searches were performed last year by this system, and it is anticipated that approxi- mately 500,000 searches will be performed in fiscal year 1976. The net- work will be expanded to provide access to many smaller hospitals and community-based academic institutions with preclinical and para- medical training programs. I am pleased to report that one of the newer capabilities has permitted the inclusion and searching of abstracts. It is anticipated by fiscal year 1977 over 100,000 author abstracts will be in the data base, thereby significantly augmenting the usefulness of Medline. medical library assistance The programs of medical library assistance form a vital component of the biomedical communications network. Through assistance to the network's regional medical libraries and grants to smaller medical libraries in hospitals and medical centers, NLM creates and fosters the institutional linkages which make the biomedical communications net- work a reality and the sharing of resources possible. The regional medical libraries provide numerous services which have clearly demonstrated that cooperative library networking among health institutions is not only feasible but economically imperative. The foundation of the developing network has been the successful interlibrary loan program. Over 92 percent of the interlibrary loans made by the RML network are provided within 4 days. The number of loan services provided has been increasing at approximately 15 percent per year. By making its advanced on-line systems, such as Medline, available to the RML network, NLM greatly increases the availability of research results to all parts of the Nation. To further enhance the capabilities of the RML network, the NLM awards resource project grants, which are intended to make current scientific literature readily available to the Nation's health profes- sionals. Medical library resource grants have supported cooperative programs in which a strong library undertakes to provide training, consultation and loan services for small community hospitals and clinics and studies ways of expediting the delivery of information through modern communications devices and automation techniques. In this manner resources are dedicated to upgrading the facilities and materials of local libraries within each region. Two other significant programs are: (1) Research grants which investigate and develop more effective information science and biomedical communications sys- tems; and (2) training grants which provide assistance to health science information specialists in the application of computer tech- nology to medical education and practice.8407674_000005.txt

Page  5 1516 lister hill national center for biomedical communications The Lister Hill National Center for Biomedical Communications is the primary research and development arm of the NLM. The center provides technical information, support and consultation to the health agencies and the health community on matters related to the broad ap- plication of computer and communication technology. It continues to develop and coordinate experimental communication networks and systems to improve health education, medical research, and the delivery of health services. In the past we have reported to this committee the successes we have had with increasing the effectiveness of health care delivery and health education in remote areas of the Nation. We have developed and supported experimental interactive television networks in the New England area and have fostered demonstration projects which apply satellite communications technology in the native villages of Alaska. New England's network is now completely supported through user fees, private contributions, and other sources of funding. This is a measure of its success. The Alaska experiment demonstrated it was possible to extend the services of a hospital based physician to distant villages by the use of telemedicine conferences. The closely linked Washington/Alaska/ Montana/Idaho (WAMI) program demonstrated the benefits of regional sharing of resources in the medical education process. The communications network permitted faculty and students located on multiple campuses and at remote clinical training locations to partake of an integrated medical education program operated by the Uni- versity of Washington in Seattle. Based upon these early successes the LHC program has now begun a national experiment in broadband communication with the NASA launch in January of the joint Canadian American Communications Technology Satellite (CTS). There is a great need to share manpower in health education, in accessing medical consultative services, and in disseminating the results of biomedical research. The health experi- ments which are planned for the CTS satellite afford the health agen- cies an opportunity to develop models and design systems for sophisti- cated teleconferencing, for developing regional education programs, and for improving the transfer of biomedical information. These experiments and demonstrations will permit us to identify those com- munication and information transfer modes which are best suited for a national health broadband communications network. An additional center activity which holds great promise is the devel- opment within the National Library of Medicine of a modest learning resource laboratory designed to consolidate computer-based educa- tional resources in a single area. It is desirable to have the power of the computer available to libraries, computer-based education, and medical practice at those locations where providing access to large com- puters is presently either not feasible or very costly. Within this modest laboratory, we plan to develop and test relatively inexpensive combinations of various minicomputers and terminals which are easy to access and can manipulate data to satisfy individual application needs at costs which the user can afford.8407674_000006.txt

Page  6 1517 As one looks to fiscal year 1977, efforts will be targeted at develop- ing new and improved uses of technology for scientist to practioner communications. The center's expertise in telecommunications and satellite communications offers a unique opportunity for televised clinical conferences and for demonstration and staff services between NIH and other centers within the biomedical community. These same networks will improve continuing medical education, public educa- tion, and remote patient presentation for diagnosis and recommended treatment. TOXICOLOGY INFORMATION PROGRAM The toxicology information program (TIP) collaborates extensively with other Federal agencies, such as the Food and Drug Administra- tion and the Environmental Protection Agency, to develop, organize, and operate a computer-based toxicology data bank. Through its infor- mation services, TIP makes results of toxicological investigations readily available to those engaged in conducting research, and moni- toring the environment. During the past year, TIP continued to expand its highly succesf ul on-line bibliographic retrieval service Toxline. The data base was expanded to include special literature files which serve to improve coverage in specific areas of mutagenesis, teratology, and heavy metal toxicology. Toxline contains literature published during the most recent 5 years and is available on-line through the NLM computer. The data base currently contains 420,000 citations and is expected to reach 590,000 by the end of fiscal year 1977. In fiscal year 1976 approxi- mately 25,000 on-line searches will be performed, an increase of 25 percent over fiscal year 1975. In planning for fiscal year 1977 we have projected a 20 percent growth factor in on-line searches and a 10 per- cent increase in the number of pages of off-line prints. TIP is currently developing a system which will effectively estab- lish an "early warning system" on the potential hazards of products about to enter the marketplace. A pre-market alert would attempt to protect the public from any environmental hazards prior to public marketing. AUDIOVISUAL SERVICES The National Medical Audiovisual Center (NMAC) continues to serve health professionals by acquiring, developing and distributing audiovisual instructional materials which are utilized in the teaching and practice of medicine, dentistry, and the allied health professions. Materials developed by NMAC with the cooperation of professional societies and academic health centers are currently used throughout the Nation's biomedical community. The audiovisual teaching pack- ages developed by NMAC for sale increased threefold from 36 pack- ages in fiscal year 1975 to a total of 108 in fiscal year 1976. For the last 5 years, NMAC and the Bureau of Health Manpower, Health Resources Administration, have co-sponsored a collaborative program called the learning resources program to improve the use and effectiveness of learning materials in health science schools. This pro- gram has recently been enhanced by the development of an educational B7-3H O - 76 - pt.3 - 418407674_000007.txt

Page  7 1518 research activity which will complement the audiovisual development, evaluation, training and advisory service functions which have been carried out over the past several years. These activities study and pro- mote learning programs which make full use of modern instructional media and systems. NMAC has also established a regular center to design, develop and test teaching strategies through cooperative efforts with regional edu- cational institutions. In addition, NMAC has implemented its Avline (audiovisuals on- line) system which facilitates access by health professionals to the most effective instructional material for classroom and self-instruc- tional use. Recently initiated with the entry of more than 700 references to effective instructional materials, the data base should eventually contain over 10,000 items. By the close of fiscal year 1976 ap- proximately 2,000 references will have been entered. SUMMARY As the National Library of Medicine prepares to meet the challenges of the future it is keenly aware of the ever-growing biomedical infor- mation requirements of the health community. We remain committed to disseminating medical information to the Nation's health profes- sionals in the most efficient and timely manner. NLM programs have and will continue to be characterized by innovation and technological advancements. Significant progress in biomedical communications technology and networking will be markedly enhanced with the con- struction of the new Lister Hill Building. We are pleased to report to the committee that the architectural and engineering drawings are ready to be issued for construction bids. In summary, Mr. Chairman, our request for fiscal year 1977 is $35,234,000, an increase of $5,990,000 over the amount available for obligation in fiscal year 1976 revised President's budget. The net in- crease reflects $1,575,000 for mandatory requirements and $4,415,000 for the expansion of NLM programs. I shall be pleased to answer any questions and supply additional information desired for the record. TOXICOLOGY INFORMATION Senator Magnuson. It seems that everywhere we turn, someone has a toxicology program. How effective has the Toxicology Information Subcommittee been in reducing duplication ? Dr. Cummings. The subcommittee has been successful in this effort to the extent that interagency coordination can be accomplished on a voluntary basis. The subcommittee has grown in size to extend its membership beyond the Department of Health, Education, and Wel- fare to include as observers representatives from: Environmental Pro- tection Agency, Consumer Products Safety Commission, Energy Research and Development Administration, the Council on Environ- mental Quality, Department of the Interior, and the Department of Defense. These Federal agencies have elected to sit in on the monthly meetings of the subcommittee as observers and to participate in its projects. There is clearly a willingness among many agencies to co-8407674_000008.txt

Page  8 1519 operate in order to avoid duplicative efforts. However, there may be agencies who will choose to build their own information systems be- cause of mandates which require a custom-made system to satisfy specific needs. Some of these subcommittee projects are designed specifically to eliminate duplication. For example, a new current awareness bulletin, to be called Toxicology Testing in Progress will be issued by the Library's toxicology information program under the aegis of the subcommittee. It will contain brief statements about plans for the long-range biological testing of certain chemicals. Input will come from agencies and industrial organizations. The bulletin will go to the managers of testing programs in government and industry. Hopefully this service will avoid the unnecessary replication of the same toxicological tests on a given substance. This would not only save money but also scarce testing resources such as laboratories and animals. Another subcommittee project, operated by the Consumer Product Safety Commission, is a Chemical Monograph Referral Center which collects information from agencies on monographs or criteria docu- ments about to be prepared or commissioned. This will avoid dupli- cation in the creation of costly similar monographs covering the same compound. user charge Senator Magnuson. A couple of years ago you placed a user's charge on all information from the computer. What impact has this had on people using this national information network? Dr. Cummings. While it is true that users of the Library's national information network are now paying: for services Avhich they received free of charge prior to August 1973, the implementation of user charges has, in my view, been beneficial for three reasons. First, user charges provided to the Library's management a mechanism which allowed for a more rational expansion of services. Had demands for our services continued unchecked by any constraints the continued operation of the system would have been jeopardized. Second, user charges enabled the Library to develop a schedule of charges which enabled all users to have equal access to the network independent of their distance from the Library's computer. Lastly, user charges were established at rates which are sufficiently modest so as not to discourage bonafide use but at a level adequate to discourage trivial use of the network. In the aggregate the number of services provided increased from an annual rate of approximatelv 165,000 in fiscal year 1973 to an estimated 500,000 in fiscal year 1976. The continued growth of the network after the introduction of user charges has proven that the services provided are satisfactory and timely. LISTER HILL CENTER Senator Brooke. Dr. Cummings, what kind of progress can I tell Senator Lister Hill we are making on his building? Dr. Cummings. The Lister Hill Center will soon become a reality now that the Congress has appropriated $26 million for its construc- tion. The architectural and engineering drawings were completed last8407674_000009.txt

Page  9 1520 July and the General Services Administration is prepared to advertise for construction bids as soon as the funds are apportioned and neces- sary environmental impact statements have been processed. We expect construction to commence in the fall of 1976. The initiation of this project will not only alleviate the severe space problem within the present Library but will provide specialized facilities in order to enhance communications systems for health education, research and practice in this Nation. BIOMEDICAL INFORMATION Senator Brooke. Your budget for the whole Library has been pretty constant for the past few years. What kind of constraints or problems has this created in terms of information dissemination ? Dr. Cummings. The demand for many of the Library's principal methods of disseminating information such as on-line services, inter- library loans, and reader and reference services have been increasing at rates of 20 to 30 percent per year. Given the static funding and staffing during the past few years we have been able to maintain the levels and quality of services required only by reallocating manpower and fiscal resources to those functions directly providing services to the health community. This has resulted in liens against all other pro- grams. Further reallocations are impossible without causing irrepar- able harm to the other important Library programs all of which are also in support of health care, education, and research. For example, the input to our computerized Medlars data base has remained essentially constant since 1967 in spite of the so-called literature explosion. As a result a progressively diminishing fraction of the relevant literature is being included in Medlars. The use- fulness of the Medlars system has been compromised which de- tracts from the quality of the service that should be provided to the health community. The National Library of Medicine is charged with the responsibility of developing specialized information data bases particularly in the broad field of toxicology including such areas as drug information, pesticides, and environmental pollutants. To process material for such data bases specialized manpower is required. For example, for some chemical compounds, 2 man-years are required to prepare the required data. Thus, a data base of 1,000 com- pounds would require 2,000 man-days or about 9 man-years to develop. It is estimated that there are approximately 2 million compounds now known, and that new compounds are created at the rate of approxi- mately 200,000 per year. A data base does not need to contain every compound, however, it should contain enough compounds to cover most of the inquiries to be of value to its user. Our constrained man- power and budget levels have severely restricted our ability to fill this need. The Library through its Lister Hill National Center for Biomedical Communications is charged with the repsonsibility of coordinating the development and application of existing and emerging computer and communications technology to the medical information transfer prob-8407674_000010.txt

Page  10 1521 lem. While technology always cannot be assumed to be a substitute for manpower, it does offer some potential relief in our efforts to meet increasing demands for services. To use new technology to help resolve the rapidly growing logistical problems requires competent staff both in the technical and substantive areas. Although this has always been part of the plan for the Lister Hill Center, and is clearly the congres- sional intent, funding levels have never been sufficient to carry out these objectives. The past 4 years constitute a start-up phase which will soon lead to an accelerated growth phase for the Center. Clearly, a constrained manpower and budget ceiling would be most deleterious to this relatively new program. The three program areas cited above are but examples of a number of critically important Library programs whose effectiveness has been seriously limited by constrained budget and manpower ceilings. The Library's budget request for fiscal year 1977 does provide adequate relief from fiscal constraints, however, the decrease of four positions will only serve to further hinder the ability of the Library to effectively fulfill its responsibility to disseminate appropriate and timely infor- mation to the Nation's health community. RURAL INFORMATION Senator Brooke. What types of programs are you developing to get health care information to rural and medically underserved areas? Dr. Cummings. The Lister Hill National Center for Biomedical Communications, the primary research and development component of the Library, is developing a number of programs that will assist in the dissemination of health care information to rural and medically underserved areas. For a number of years, the Lister Hill Center has been applying computer and communication technology to the problem of increasing the effectiveness of health care delivery and health education in re- mote areas of the Nation. Based upon our early successes in the Pacific Northwest and in the New England area, the Lister Hill Center has now begun a national experiment in broadband communications utilizing the joint Canadian/American Communications Technology Satellite. The experiments planned for this satellite provide the health agencies with an opportunity to develop systems and models for tele- conferencing throughout the country, for developing regional health education programs, and for improving the transfer of health care information across the Nation, including rural areas. The Lister Hill Center is also exploring the potential for using minicomputers to make available information to a larger number of widely dispersed users at an affordable cost. This promotion of wide application of distributed computer processing is essential to extend- ing computer-assisted instructional programs to practicing health professionals around the country. A specific effort involving the Health Services Administration is the development of an informa- tion-consultation-education program for physicians in rural areas, especially those serving in the National Health Service Corps.8407674_000011.txt

Page  11 1522 NATIONAL LIBRARY NETWORK Senator Brooke. How successful has your National Library net- work program been ? Wouldn't this be a good area to have a stronger initiative? What could be done if the funds were made available? Dr. Cummings. We believe that the Regional Medical Library net- work is the most successful information network for the dissemination of scientific and technical information in the country. It provides on-line access to a computerized data base of 500,000 citations from nearly 3,000 biomedical journals of the current 3 years through more than 400 terminal locations throughout the country. We estimate that approximately 100,000 health professionals are served by our on-line services each year. In fiscal year 1977, it is anticipated that more than 600,000 literature searches will be done. To back up the identification of pertinent literature, the 11 regional libraries and their associate resource libraries will provide more than 1 million documents to practitioners, teachers, and researchers throughout the Nation. More than 90 percent of these documents are dispatched in 4 working days or less. The National Library of Medicine, in its role as backup library for this national network, will deliver more than 300,000 documents in fiscal year 1977. The effective and efficient delivery of documents to practitioners, teachers, and researchers throughout the country will, however, be seriously impaired if the proposed revision of the copy- right bill, which precludes single copy delivery to individuals in a "systematic fashion," becomes law. Your second question relates to what could be done if additional resources were made available. The administration's budget for fiscal year 1977 anticipates the need for additional resources and provides an additional $1.2 million for network support. Approximately one- half of this amount will be used through resource grants to upgrade the resources of community hospital libraries throughout the Nation. Through the sharing of resources, and cooperation in technical serv- ices, the Library hopes to extend the benefits of the Regional Medical Library network to smaller and more remote health care institutions. Funds will be used to extend the reference and consultative serv- ices and the continuing education program of the Regional Medical Library network for community hospitals throughout the country. However, the increasing demand for services of the National Li- brary of Medicine as a backup library for this network cannot be met indefinitely without increased manpower. LIBRARY SERVICES Senator Brooke. Has there been an increased demand for medical library services? If so, why and what resources would you need to properly handle this increase ? Dr. Cummings. The establishment of the Regional Medical Library network in the late sixties and the growth of the Library's on-line user network to more than 400 institutions since 1972 has expanded the Library's capabilities to respond to the biomedical community's infor-8407674_000012.txt

Page  12 1523 mation needs with increasing effectiveness. As a result, service de- mands have risen sharply, at an annual rate of increase exceeding 20 percent. Document delivery7 requests rose from 100,600 in fiscal year 1970 to 250,000 in fiscal year 1976. At the present rate of increase, the request for loans would exceed 320,000 during fiscal year 1977. In fiscal year 1973, 165,000 on-line reference and bibliographic searches were provided to users by NLM. In fiscal year 1976, we will process more than 500,000 on-line reference searches. For fiscal year 1977, this rate of increase could bring the number of searches to 600,000. The processing of audiovisual materials for the creation of a new on- line data base—Avline—has brought on an additional workload. Some 2,000 audiovisuals are being added per year, requiring support of skilled technical and professional library personnel. Even though the increased cost of materials will account for sub- stantial budgetary increases, the critical requirements for these activities are chiefly manpower resources. In order to sustain this con- tinuing growth in service demand on the Library to provide the backup for the entire biomedical network, we will require substantial increases in authorized manpower ceilings. A minimum of 10 posi- tions for document delivery, 5 positions for reference and biblio- graphic services, and 3 positions for audiovisual cataloging will be required for the continued successful operation of library services. JUSTIFICATION Senator Magnuson. Thank you, Dr. Cummings. Your justification material will be placed in the record at this point. Dr. Cummings. Thank you, Mr. Chairman. [The justification follows:]8407674_000013.txt

Page  13 1524 Justification Amounts Available for Obligation 1/ 1976 Estimate 1977 Appropriation........................... $29,065,000 $35,234,000 Comparative transfer from: "Office of the Director" for standard level user charge........... 179,000 Total Obligations............... $29,244,000 $35,234,000 1/ Excludes the following amounts for reimbursable activities carried out by this account: 1976 - $2,000,000; 1977 - $2,000,000.8407674_000014.txt

Page  14 1525 Summary of Changes 1976 Estimated Obligations........................................ $29,244,000 1977 Estimated Obligations........................................ 35,234,000 Net Change.............................................. 5,990,000 1976 Base Change from Base Pos. Amount Pos. Amount Increases: A. Built-in: 1. Annualization of 1976 Pay Cost Increases....................... — 519,000 -— +165,000 2. Within-Grade Pay Increases........ --- 200,000 -- +235,000 3. FTS Rate Increases................ —- 160,000 --- + 21,000 4. Literature Acquisition............ -- 775,000 -- +100,000 5. Increase Cost of Service and Supply.......................... — 120,000 --- + 22,000 6. Computer Rental Increase.......... -- 1,842,000 --- +138,000 7. Postage Cost Increase............. -- 318,000 -- + 99,000 8. Non-Competing Continuation Costs.. --- 5,203,000 -- +417,000 9. Payment to NIH Management Fund___ -- 1,620,000 -- +356,000 10. Standard Level User Charge........ --______179,000 ______56,000 Subtotal, Built-in Increases___ -- -- -- +1,609,000 B. Program: 1. MLAA - to provide support for scholarly research and continuing medical education___ -- 6,433,000 -- +1,150,000 2. Lister Hill Nat'l Center for Bio- medical Communications - for the application of advanced computer and communication technology to the solution of biomedical com- munication and information dis- semination problems............. 24 2,760,000 -1 +1,945,000 3. Nat'l Medical Audiovisual Center - for the development of instruc- tional media in a variety of health science disciplines...... 100 2,981,000 --- + 495,000 4. Library Operations - for the continuation of basic library services and the modest expansion of services to the biomedical community............ 252 10,014,000 -2 + 551,000 5. Toxicology Information - for the modest expansion of the Toxi- cology data base to include an "early warning" system on potential hazards of chemicals about to enter the market place. 17 1,866,000 -1 + 275,000 Subtotal, Program Increases... -- -- -4 +4,416,000 Total Increases............... -- -- -4 +6,025,0008407674_000015.txt

Page  15 1526 Summary of Changes (cont'd) 1976 Estimated Obligations....................................... $29,244,000 1977 Estimated Obligations....................................... 35.234,000 Net Change............................................. 5,990,000 1976 Base ' Change from Base ____________________________________________Pos. Amount_____Pos, Amount Decreases: A. Built-in: 1. Employment savings - effect of one day less pay in FY 1977..... 472 11,088,000 — - 35,000 Total Decreases............... --- --- -- - 35,000 Total Net Change.............. --- -- -4 5,990,0008407674_000016.txt

Page  16 Obligations by Activity 1976 Revised President's Budget Pos. Amount Medical Library Assistance Total.................... --- Direct Operations: Lister Hill Nat'l Center for Biomedical Communications.... 23 Nat'l Medical Audiovisual Center....................... 100 Library Operations............ 250 Toxicology Information........ 16 Program Management............ 79 Standard Level User Charge--- --- Subtotal............ 468 Total Obligations... 468 6,333,000 2,740,000 3,096,000 10,169,000 1,873,000 5,066,000 179,000 23,123,000 1976 Appropriation Pos. Amount 1977 Amount 6,433,000 8,000,000 24 2,760,000 23 4,730,000 100 2,981,000 100 3,551,000 252 10,014,000 250 10,933,000 17 1,866,000 16 2,166,000 79 5,011,000 79 5,559,000 179,000 --- 235,000 472 22,811,000 468 27,234,000 Increase or Decrease as. Amount 29,456,000 472 29,244,000 468 35,234,000 — +1,567,000 -1 1,970,000 — + 570,000 -2 + 979,000 -1 + 300,000 — + 548,000 — + 56,000 -4 +4,423,000 -4 +5,990,000 to8407674_000017.txt

Page  17 1528 Obligations by Object Increase 1976 1977 or Estimate Estimate Decrease Total number of permanent positions...... 472 Full-time equivalent of all other positions.............................. 40 Average number of all employees.......... 531 Personnel compensation: Permanent positions.................... 8,877,000 Positions other than permanent......... 424,000 Other personnel compensation........... 116,000 Subtotal, personnel compensation.. 9,417,000 Personnel benefits....................... 936,000 Travel and transportation of persons..... 170,000 Transportation of things................. 30,000 Rent, communications and utilities....... 2,372,000 Printing and reproduction................ 479,000 Other services: Project contracts...................... 4,000,000 Payment to NIH Management Fund......... 1,799,000 Other.................................. 2,189,000 Supplies and Materials................... 314,000 Equipment................................ 330,000 Literature............................... 775,000 Grants, subsidies and contributions...... 6,433,000 Total obligations by object....... 29,244,000 468 40 527 9,607,000 474,000 116,000 10,197,000 1,021,000 175,000 34,000 2,609,000 496,000 2,232,000 314,000 330,000 875,000 730,000 +50,000 +780,000 +85,000 +5,000 4,000 +237,000 +17,000 6,740,000 +2,740,000 2,211,000 +412,000 +43,000 +100,000 8,000,000 +1,567,000 35,234,000 +5,990,0008407674_000018.txt

Page  18 1529 Authorizing Legislation 1977 Legislation Public Health Service Act Section 381 - Purpose and Establishment of Library............................. Health Services Research, Health Statistics, and Medical Libraries Act of 1975 Section 393 through 397___.............. Total................. 2/ Funding estimate only Comparable Budget Estimate House Year to Congress Allowance 1967 19,231,000 20,154,000 1968 21,162,000 18,662,000 1969 19,172,000 16,997,000 1970 22,882,000 19,682,000 1971 19,769,000 19,843,000 1972 21,981,000 22,781,000 1973 24,994,000 28,488,000 1974 24,994,000 25,796,000 1975 27,738,000 28,048,000 1976 28,815,000 28,994,000 1977 35,234,000 Appropriation Authorized Requested Indefinite $27,234,000 2/ $20,000,000 8,000,000 2/ Senate Allowance 20,254,000 21,162,000 19,020,000 19,682,000 22,307,000 25,086,000 28,988,000 25,796,000 29,348,000 29,744,000 $35,234,000 Appropriation 20,254,000 19,912,000 18,008,500 19,682,000 20,843,000 24,086,000 28,488,000 1/ 25,426,000 2/ 28,848,000 1/ Note: This appropriation authority was the continuing resolution. — The appropriations amount was the House Allowance, which was the lower of the House or Senate amounts in the first vetoed bill. 2/ Appropriation after reduction as authorized by P.L. 93-192.8407674_000019.txt

Page  19 1530 Actual Year Budget Estimate to Congress House Allowance Senate Allowance Appropriation 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 21,440,000 1972 21,981,000 22,781,000 25,086,000 24,127,000 1973 28,568,000 28,568,000 29,068,000 28,568,000 1/ 1974 24,994,000 25,871,000 25,871,000 25,871,000 2/ 1975 27,738,000 21,768,000 3/ 29,350,000 28,850,000 1976 28,815,000 28,815,000 29,565,000 1977 35,234,000 1/ This appropriation authority was the continuing resolution. The appropriations amount was the House Allowance, which was the lower of the House or Senate amounts in the first vetoed bill. 2/ Appropriation after reduction as authorized by P.L. 93-192. 3_/ Excludes Medical Library Assistance Grants not considered by House due to lack of legislative authorization.8407674_000020.txt

Page  20 1531 Justification National Library of Medicine 1976 1976 Revised President's Budget Appropriation Amount Amount 1977 Amount Increase Medical Library Assistance ........... 6,333,000 Positions........... --- Direct Operations: Lister Hill National Center for Biomedi- cal Communications. 2,740,000 Positions........... 23 National Medical Audiovisual Ctr___ 3,096,000 Positions........... 100 Library Opera- tions.............. 10,169,000 Positions........... 250 Toxicology Informa- tion............... 1,873,000 Positions........... 16 Program Management.. 5,245,000 Positions........... 79 Subtotal.......... 23,123,000 Positions......... 468 Total Obliga- tions............ 29,456,000 Positions......... 468 6,433,000 8,000,000 +1,567,000 2,760,000 4,730,000 +1,970,000 24 23 - 1 2,981,000 3,551,000 + 570,000 100 100 10,014,000 10,993,000 + 979,000 252 250 - 2 1,866,000 2,166,000 + 300,000 17 16 - 1 5,190,000 5,794,000 + 604,000 79 79 22,811,000 472 27,234,000 +4,423,000 468 - 4 29,244,000 472 35,234,000 +5,990,000 468 - 4 General Statement The National Library of Medicine is the world's largest research library devoted to a single scientific or professional discipline and the prime resource in the United States for biomedical information. In addition to acquiring, organizing, and disseminating such information through the use of computerized systems, interlibrary loans, and more conventional library services, NLM has developed a National Biomedical Communications Network to link major health care facilities, medical education centers and research institutions. Through assistance to the network's Regional Medical Libraries, as well as grants to smaller medical libraries in hospitals and centers, NLM applies computer and communications technology to the improvement of nationwide health information transfer. The primary research and development arm of the NLM is the Lister Hill National Center for Biomedical Communications. The Center provides technical8407674_000021.txt

Page  21 1532 information, support and consultation to the health agencies and health care professionals on matters related to the broad application of computer and communications technology. An additional role which has evolved in recent years is the conduct of research and development predicated on anticipated future needs of the health agencies and the health community. In the performance of these functions the Lister Hill National Center for Biomedical Communications^ has provided the resources necessary to support the planning and development of experiments and prototype models in applying computers and communications to facilitating health education, health care delivery and health research. The Center will continue to concentrate its efforts on developing communications support for health professional education where a small investment can have the largest impact on the quality of health care. Specifically, these activities fall within five programmatic areas: broadband biomedical communications; computer- based education; computer technology research and development; postgraduate education for the practicing health professional; and coordination of biomedical communications for DHEW. NLM continues its traditional responsibilities of improving the flow of biomedical information by storing, retrieving and disseminating the world's biomedical literature. To facilitate access to the literature, NLM produces bibliographies employing both manual search techniques and computer searches of on-line data bases; provides reference and loan services; prepares and publishes various materials for use by health science researchers and practi- tioners; and manages the national on-line information retrieval network. In addition, NLM serves as the Regional Medical Library for the five-state Mid-Atlantic Region and provides back-up services for the national Regional Medical Library Network. A computerized bibliographic retrieval system was installed in 1964 to help cope with increasing amounts of biomedical literature. This system is known as MEDLARS (Medical Literature Analysis and Retrieval System). In 1971 a refinement of the system became operational and it is now known as MEDLINE (MEDLARS On-Line). A whole new lexicon has sprung up around the NLM's computerized on-line bibliographic retrieval services: SDILINE, TOXLINE, CANCERLINE, CATLINE, and SERLINE. The most important service for the practicing health professional, however, is MEDLINE. Briefly, MEDLINE is a system for making accessible a data base of recent journal article references indexed from 3,000 biomedical journals. The references are stored in the Library's computer and are accessible through terminals in approximately 350 hospitals, medical schools, and medical research institutions throughout the country and abroad. Of special interest to health educators is a collection of health science audiovisuals housed at the National Medical Audiovisual Center in Atlanta, Georgia. The Center which has been part of the Library since 1967, is engaged in developing a program that will have an important influence on health science teaching, recertification, and continuing education programs. With the assistance of panels of medical educators and specialists, the Center is attempting to identify, collect, and evaluate audiovisuals used in medical and dental education. Citation of instructional materials judged to be sound in content and high in technical quality will become part of a new on-line fretrieval system known as AVLINE.8407674_000022.txt

Page  22 1533 Each citation in AVLINE will contain subject headings, an abstract, physical description of the material, identification of intended audience, information on where and how audiovisuals may be obtained, names of principle authors and producers, teaching effectiveness data and a rating of "recommended" or "highly recommended." The Center also lends health science motion pictures or videotapes to insti- tutions of higher learning and to individual health professionals. The Center anticipates filling in excess of 50,000 requests for film loans during FY 1976. The Toxicology Information Program (TIP) established in 1966, collects toxicology data from published scientific literature and the files of govern- mental, industrial, and academic organizations; organizes and enters the infor- mation into computerized storage and retrieval systems; and provides on-line computer searches. Various publications are compiled including annotated bibliographies, directories, and reviews. TIP also functions as the coordina- tor for toxicology activity for the Department. The FY 1977 budget request which represents approximately a $6,000,000 increase over the FY 1976 level will allow significant progress to be made in improving basic library services and information transfer capabilities. A major effort will be made to translate new knowledge that is generated and disseminate these findings to the practicing physician. Medical Library Assistance Program Authorizing Legislation: Health Services Research, Health Statistics and Medical Libraries Act of 1974. 1976 1976 1977 Revised Increase President's or Budget Appropriation Estimate ' Decrease Amount Amount Amount Amount Medical Library Assistance Program... 6,333,000 6,433,000 8,000,000 +1,567,000 92 97 135 +38 NLM's programs of Medical Library Assistance are designed to meet the national need for more effective information services. The Act authorizes a number of grant and contract programs to support the training of professional personnel in health information; research in health science information and the application of computer and communications technology; the development of medical reviews and other publications to improve information accessibility; and the improvement of the resources and services of medical libraries. In addition, contracts assist in the development and maintenance of a nationwide coordinated network of Regional Medical Libraries that provide services and resources to medical libraries throughout the United States. Training grants have supported the education of medical librarians, biomedical communications specialists, and other professionals essential to the health-sciences information system. In recent years the program has concentrated on a new kind of specialist who is able to integrate computer technology into all phases of medicine, including patient care. The major obstacle to progress in the use of computers in medicine has been lack of appropriately trained personnel. By training a core of specialists in the interface between computer technology and biomedicine, NLM hopes to facilitate the application of com- puters in the medical setting. Fifty-five individuals are presently receiving training in nine programs. There have been twenty-one graduates to date and all are utilizing their computer training in a variety of settings, with the majority on the faculty of medical schools or in teaching hospitals. Research grants have supported projects in medical library science, infor- mation science, biomedical communications systems, and advanced educational8407674_000023.txt

Page  23 1534 technology. One recent study involves ascertaining the preferences of physicians for the various forms of continuing education modalities available to them. The study focuses on the mechanisms and techniques by which a physician learns and/or prefers to learn. Another project is to establish and test a model for retrieval, analysis, and dissemination of medical information utilizing television monitors for immediate feedback. The particular model is trans- mitting drug information to patient-care areas. The approximate $400,000 increase will be dedicated to two potentially rewarding areas targeted for study in FY 1977. The first is an investigation of the efficacy of using computers in various areas in the health care delivery system. The Review will include an analysis of the computer's potential in the academic and continuing education of all health care professionals, as well as the educa- tion of the patient. The second area of interest is research on the mechanisms by which the information is delivered to health professionals and the responsible roles to be played by the National Library of Medicine, the local academic science libraries, and the local hospital libraries in this activity. Special Scientific Project grants support distinguished health scientists in the full-time analysis of major findings in their respective fields. The studies are published as monographs which make the results of biomedical research widely available. An example is the support of a comprehensive monograph devoted to the discovery, classification, and treatment of infectious diseases and the development of the scientific base for preventive medicine and public health measures to control these diseases. Scientific achievements in microbiology and immunology will emphasize the discovery and classifications of microbes responsible for diseases, mechanisms underlying the causes of illness, and the emergence of the disciplines to further our understanding of these mechanisms. The Library's publication grants provide support to biomedical scientific publications which would not be profitable projects for commercial publishers to undertake. One recent publication on community medicine synthesizes the manifold experience gained in the diagnosis and solution of community health problems on several continents. The authors of the book are representative of the multi-disciplinary nature of modern comprehensive health care. They seek a rational solution of health problems in the context of all its physical, biological, social, economic, and cultural aspects. The universal usefulness of the study and applicability of the approach to different areas, our own rural problem sectors included, become clearly evident in light of the changes taking place in the health field today. Another project has been responsive to the need for information on the role of women in modern society by supporting a comprehensive bibliography of women in medicine. The bibliography includes approximately 3,500 references to books,articles, reports, and a thesis of scholarly value on the subject. Medical Library Resource grants assist in the improvement of the nation's health science libraries. The awards are intended to encourage increased financial support for libraries from the hospitals or other institutions that they serve and from the local community. One type of resource grants, the Improvement Grant, traditionally has been a one-year non-renewable grant for up to $3,000 to health institutions, usually hospitals that can demonstrate the need to establish basic collections and services. In FY 1977, this program will expand its support of consortium activities. In addition to these Improvement Grants, NLM awards resource project grants, which are intended to make the growing scientific literature more readily accessible to health professionals throughout the nation and to introduce or demonstrate new information science technology. In FY 1976 medical library resource grants have supported cooperative programs in which a strong library undertakes to provide training, consultation, and loan services for small community hospitals and clinics; studies on ways of expedit- ing the delivery of information through modern communications devices and automation techniques and projects which, after an assessment of the actual information needs of health professionals, strengthen the information of an institution. In FY 1977, an additional $600,000 will be provided th^^h Resource Grants to upgrade the resources of local libraries wit-h-i,,__u rouSn *-» wj.Luin eacn region.8407674_000024.txt

Page  24 1535 NLM Library Assistance program provides support for a national network of ten Regional Medical Libraries (RML's). The RML's provide an array of services which have clearly demonstrated that cooperative library networking among health institutions of all types and sizes is not only feasible but economically imperative. The foundation of the developing network is the successful interlibrary loan program. Over 92 percent of the interlibrary loans made by the RML network are provided within four days of the receipt of the request. The overall demand for loan services has been increasing at almost 15 percent per year. The RML's through interactive planning with state medical and hospital associations, state library networks and other potential sources for supporting inter-regional information demands can keep Federal support for loans at a reasonable level. The National Library of Medicine serves as back-up resource for the entire RML network. By making available to the RML network its advanced on-line systems, such as MEDLINE, NLM considerably increases the dissemination of research results to all parts of the nation. Utilization of the network by the health community is expected to increase substantially in FY 1977 for three major reasons: (1) health professionals have become increasingly aware of the utility and availability of interlibrary loans; (2) the continued development of MEDLINE will afford direct and greatly improved access by RML clients to a data base which is most relevant to a health professional's requirements; (3) many of the proposed national health care and health education systems, such as Health Maintenance Organizations, Area Health Education Centers, and Professional Standards Review Organizations, will place additional information requirements on health professionals. Although the RML network has proved itself useful and effective, many isolated health care facilities remain unreached by its services. In FY 1977 NLM will allocate an additional $600,000 to extend RML benefits to smaller and more remote, institutions, and on sponsoring cooperative programs. By encouraging cooperative efforts to analyze specific information needs, coordinating acquisition of medical journals, and developing programs for sharing collections, NLM hopes to maximize the dissemination of the latest medical research findings to health professionals.8407674_000025.txt

Page  25 1536 Lister Hill National Center for Biomedical Communications 1976 Revised President's Budget Amount 1976 Appropriation Amount 1977 Estimate Amount Increase Decrease Amount Lister Hill Nat'l Ctr. for Biomedical Communica- tions..................... 2,740,000 Positions................. 23 2,760,000 24 4,730,000 23 +1,970,000 - 1 The Lister Hill National Center for Biomedical Communications facilitates, through the application of advanced computer and communications technology, the transfer of biomedical information and the sharing of human and physical resources to enhance the effectiveness of health manpower, of health and medical services, and the translation of research results into practice norms. The activities of the Center fall in the following programmatic areas: 1. Broadband Biomedical Communications 2. Computer-Based Education 3. Computer Technology Research and Development 4. Continuing Education for the Practicing Health Professional 5. Focal Point and Coordination Role, DHEW 1. Broadband Biomedical Communications: Since July 1,1970, the Lister Hill Center has worked with Dartmouth College and the University of Vermont in planning, building, and helping support the operations of the New Hampshire/Vermont interactive television network known as INTERACT. The experience with this network clearly shows that educa- tional institutions can pool human resources and jointly meet an educational objective which neither can achieve alone. The long-planned phase-out of support by the Center in November, 1975, necessitated the network users assuming total responsibility for its operations. In a related area, the Lister Hill Center has been engaged in a series of experiments and demonstration projects which apply satellite communications technology to the solution of recognized problems in health education and the delivery of health services. Two satellites in the National Aeronautics and Space Administration (NASA) Application Technology Satellite (ATS) series have been involved, namely ATS-1, which was designed for voice and data transmission, and ATS-6, which provided television images as well. Valuable lessons have been learned from these two major health experiments using satellite-based communications and information exchange systems. The satellite system is highly reliable and avoids most of the interference which plagues conventional high frequency radio communications in Alaska. In the Alaskan bush, it was possible to extend the services of a hospital- based physician to distant villages by the use of telemedicine conferences supported by a good medical records system. The village-based health aid felt more secure and less isolated; the patients were more confident of the quality of the service received; travel by patients and physicians could be reduced to that which is medically indicated; and the community as a whole improved its understanding of health and the delivery system. The Washington/Alaska/8407674_000026.txt

Page  26 1537 Montana/Idaho (WAMI) Program demonstrated the possibility inherent in regionr' sharing of people and facilities in the medical educational process. The interactive video, audio, and data communications network allowed faculty and students located on multiple campuses and at remote clinical training locations to partake of one coordinated and integrated medical education program. Continuing this experience and expanding to a national experiment, a program is being planned for the joint Canadian-American Communications Tech- nology Satellite (CTS). The CTS biomedical communications experiment can be divided into three areas of activities. The first is the coordination of program and evaluation planning, technical and engineering supports, and pro- gram management for PHS health agencies. The second area of planning involves an expansion of the University of Washington WAMI experiment. The third area is planning for facilities within the National Library of Medicine to provide the staff of the Lister Hill Center with a temporary laboratory. Although this laboratory lacks the sophistication that will be available in the new Lister Hill Center Building it offers an opportunity to make a small beginning in video experiments and demonstrations. This will enable the Center's communications engineering staff to explore advanced technology as a medium for extending effective educational programs to the health community; for improving health care delivery; and for enabling more effective dissemination of research results. 2. Computer-Based Education: The current year is the terminal year of a project to foster the interinstitutional sharing of computer assisted instruction (CAI) resources among medical schools, hospitals, and other health related organizations. One of the current activities which holds great promise is the development within the National Library of Medicine of a training laboratory designed to consolidate computer-based educational resources in a single area. This learning laboratory will be the place where potential users can gain an opera- tional understanding of the many alternative modes available to the generator and sponsor of programs in computer assisted instruction (CAI). The laboratory will permit the staff to be active participants in selected experimental projects, and thus become a focus for the entire health community. Another major objective of the Center is to facilitate educational activities which are designed to preserve professional competence through postgraduate education. As a part of this effort, the Center's Computer Technology Branch is planning collaborative projects with the Association of American Medical Colleges (AAMC) so that the expanding body of computer- based educational materials can be reviewed, organized, and regulated to con- form to orderly library procedures. 3. Computer Technology Research and Development: The cost of large host computers needed by many current CAI and library applications programs is a significant deterrent to expanded use of these programs. The Center's computer technology staff is investigating the potential for using smaller and less expensive computers, i.e., minicomputers, to make available substantial computer power to a large number of widely dispersed users at affordable costs. However, the more widespread use of minicomputers will aggravate a problem which is already serious. Computer-based education programs cannot be shared readily because they are written in many languages and dialects. The Center is actively supporting language standard- ization so that existing and future clinical programs can find greater use, especially in the continuing education of health professionals.8407674_000027.txt

Page  27 1538 Using the new technology laboratory in the Library, the staff is exam- aning how best to provide more effective and efficient user access to com- puters through the use of interactive terminals. This examination includes several advanced terminals, terminal configurations, and terminal functions. The full potential of such laboratory experiments cannot be fully realized until specially designed space is available in the new Lister Hill Center Building. 4. Activities in Continuing Education for the Practicing Health Professional: There exists a vast array of educational opportunities in continuing medical education (CME) having varied sponsorship and effectiveness. There also exists a disturbing sense that current efforts are relatively ineffectual, inefficient, or of less than desirable quality or applicability. It is recog- nized that the benefits of biomedical research results become reflected in the accepted norms of health professional practice through the process of effective and efficient biomedical communications. This important process is in need of considerable improvement if it is to become a significant factor in CME, including conventional programs designed to maintain professional competence of the practitioner. In the practice arena, the information which is disseminated must be analyzed for its accuracy and relevance to clinical problems, must be snythe- sized from the total biomedical information pool, and must be translated into a language and format which is understood by the practitioner. The Center is emphasizing the development of strategies in analysis, synthesis and translation as a new approach for improving continuing medical education activities. A specific effort involves collaborative planning with the Health Services Administration (HSA) and the Health Resources Administration (HRA) with the goal of developing an information-consultation-education program for physicians in rural areas, especially physicians serving in the National Health Service Corps. 5. Focal Point and Coordination Role: The Center has assumed an active coordination and technical support role in two broad areas. The first is to undertake planning, experimentation, and evaluation programs which will lead to the development of a coordinated plan for a broadband biomedical communications network responsive to the current and evolving needs of the health agencies. This activity is planned for accomplishment during the next three years, and will require correlating evaluation of experimental results with requirements studies and technical systems options to result eventually in a proposed design for a national network. The second area is the development within the National Library of Medicine, temporary laboratory capabilities for exploring the potential communication and computer technologies. 6. Dissemination of Research Results: The approximate $2,000,000 increase for the Center will enhance its efforts to improve the effectiveness and efficiency of biomedical communica- tions and improve the dissemination of research results. Primary efforts will be targeted at developing new and improved uses of technology for scientist to practitioner communications. The Center's expertise in tele- communications and satellite communications offers a unique opportunity for televised clinical conferences, demonstration and staff seminars between NIH and other centers within the biomedical community. These same communication links will be developed for improving continuing medical education, public education, and remote patient presentation and diagnosis.8407674_000028.txt

Page  28 1539 National Medical Audiovisual Center 1976 1976 1977 Revised Increase President's or Budget Amount Appropriation Amount Estimate Amount Decrease Amount National Medical Audio- 3,096,000 100 2,981,000 100 3,551,000 100 +570,000 The National Library of Medicine and the Bureau of Health Manpower, HEW, have been carrying out a joint program now known as the Learning Resources Program to improve the use and effectiveness of learning materials in health sciences schools. NMAC and Bureau activities include research, audiovisual development, evaluation, distribution, training, consultation and related assistance to medical institutions through grants, demonstrations, contracts, and direct programs. Advances in educational technology in the last 15 years have provided a solid base for' transforming health science education and making it more responsive to the needs of students and practitioners. Recent approaches to education stress the benefits of the learner developing performance skills during training instead of the teacher traditionally "covering" course content. They emphasize that instructional programs should be tested and revised until each can consistently teach skills required for professional performance. Incorporation of these principles into learning programs which make full use of the capabilities of modern audiovisual media systems is the central goal of the National Medical Audiovisual Center in Atlanta, Georgia. Audiovisual technology can promote significant changes in the training of health professionals. Where the need is to recognize learning styles and for customized learning programs to make instruction more suitable and effective for individuals, then audiovisual educational technology can provide the necessary spaces, instructional media and other resources. In individualized programs, students will have greater flexibility in scheduling their learning experiences. It will become increasingly possible for students to assume responsibility for their own learning, both in undergraduate training and throughout their professional careers. Validated criteria and learning competencies for health careers will enable the student to check on his progress and measure his professional growth. Research, development and training in these areas will lead to more effective health sciences education and better trained health professionals. Center-supported peer review panels evaluate health science teaching materials. This on-going review process provides input for the Library's data base on audiovisuals known as AVLINE. The AVLINE system is designed to provide quick access to comprehensive information on biomedical audiovisuals in much the same way that NLM's MEDLINE system does for printed materials. Since 1971, 51 panels have reviewed 6,000 educational items, and found 3,600 suitable for inclusion in AVLINE. These materials are acquired for reference and direct loan or duplication to schools for their use. In 1977, it is estimated that approximately 1,200 materials will be found suitable for inclusion into AVLINE. NMAC has launched an organized program of research and evaluation to develop, implement, and measure the effectiveness of programs using audiovisual media and educational methodology in health sciences education. The Center8407674_000029.txt

Page  29 1540 is planning to establish a regional focal point to accomplish the design, development, testing and evaluation of teaching approaches and strategies through cooperative effort of regional faculty and institutional resources. Studies on materials design, descriptive reviews of curricula, and development of audio- visual systems and production techniques are currently planned. Concepts and information coining from studies are used in instructional development and training programs assisting health professional faculty in improving instruc- tion. In FY 1976, the Center's training program attracted more than 500 participants and is expected to increase to 640 in FY 1977. The approximate $600,000 increase in the program's FY 1977 funding level will modestly expand the acquisition and clearinghouse functions and other basic services of the Center. Preliminary developmental efforts will continue on the bibliographic information retrieval system AVLINE (Audiovisuals on- line). The utilization of the NLM's computerized nationwide information network in this manner acts as an offset to the nation's health manpower shortage by increasing the effective use of technology in the health education process. Library Operations 1976 1976 1977 Revised Increase President's or Budget Appropriation Estimate Decrease Amount Amount Amount Amount ... 10,169,000 10,014,000 10,993,000 +979,000 250 252 250 - 2 Library Operations, the service arm of the National Library of Medicine providing both traditional and innovative services, is responsible for selecting, acquiring, indexing, processing, cataloging, preserving, and disseminating the world's output of substantive biomedical literature. In carrying out these responsibilities, Library Operations has developed rapidly expanding activities and services for the benefit of the entire biomedical community. It provides access to the Library's resource material through the utilization of advanced bibliographic retrieval services and a national on-line information retrieval network. (MEDLINE) Even as service workloads and the volume of literature increase, Library Operations estimates that it will keep abreast of its FY 1976 level of service operations; acquiring 140,000 serial pieces and 20,000 monographs; indexing 245,000 biomedical articles for inclusion in the computerized MEDLARS data base; publishing 32 recurring bibliographies, binding 32,000 volumes and pro- cessing approximately 250,000 interlibrary loan requests; processing 100,000 reader service requests; and delivering 500,000 on-line searches and two million pages of bibliographic citations from on-line searches. In FY 1975-76 the NLM installed a greatly improved successor to its Medical Literature Analysis and Retrieval System (MEDLARS), which provides the machine-readable data base for its publications and bibliographic search programs. This second generation system, known as MEDLARS II, enabled NLM to develop new and specialized services based on the system's greatly expanded capabilities, including the extension of MEDLINE and other on-line services to hospitals, pharmaceutical and other industrial educational organizations. The on-line network will be further expanded In FY 1977, providing access to many smaller hospitals and community-based academic institutions with pre- clinical and paramedical training programs. One of the newer capabilities has permitted the inclusion and searching of abstracts of articles in the MEDLARS II on-line data bases. In FY 1977 the number of author abstracts will exceed 100,000 abstracts from the most important journals, thus further augmenting the usefulness of MEDLINE and other NLM on-line data bas to the health sciences community.8407674_000030.txt

Page  30 1541 During the past year an experimental referral system, DOCLINE (Document Delivery On-Line), for interlibrary loans was initiated. DOCLINE has developed successfully into a computer-based interlibrary loan verification, routing, and management information system. Based on this experience, the Library is preparing to extend this pilot experiment to the Regional Medical Library Network. DOCLINE will interface with the NLM's successful systems SERLINE (Serial Locator File) and CATLINE (A file of catalog data). In order to optimize access to resources for the medical library community Library Operations has devoted a significant portion of its resources to participation in cooperative programs with the Library of Congress, the Ohio College Library Center, the State University of New York. During the next year Library Operations will play an active role in developing and improving its on-line systems capabilities. Requirements in shared-cataloging utilizing production of catalog card sets In individualized format also will be tested. It is expected that the cooperating libraries will begin inputting their bibliographic records for serials and monographs into the OCLC system during 1977. Major projects receiving allocations from the approximate $1,000,000 increase in Library Operations will have as their goal the transfer of more current Information in more suitable formats to the ultimate users of the Library's resources. More author abstracts will be added to the MEDLINE data base to allow MEDLINE users to improve the process of selecting only those articles which are timely and subject matter relevant. The program will initiate efforts to integrate DOCLINE with the existing bibliographic retrieval system of the Regional Medical Libraries. This effort will permit more rapid throughput time for interlibrary loan requests. Steps will be taken to Initiate a service based on the MEDLARS capability to store profiles of users information needs. The services known as Selective Dissemination of Information (SDILINE) will be provided to majro medical schools and hospitals and will furnish literature on the most recent advances in health care and health research to thousands of practitioners. Toxicology Information Program 1976 Revised President's Budget 1976 Appropriation Amount 1977 Estimate Amount Increase or Decrease Amount Amount Toxicology Information 1,873,000 16 1,866,000 17 2,166,000 16 +300,000 -1 The Toxicology Information Program (TIP) is responsible for collecting and organizing toxicology data from diverse sources and making the relevant information more readily accessible. TIP obtains information from the pub- lished scientific literature and files of governmental, industrial, and academic organizations in whatever form it is available. This information is then organized and entered into computerized storage and retrieval systems for the purpose of developing systems and services to make results of toxi- cological Investigations more readily available to those who make therapeutic decisions, conduct research, make regulatory decisions, and monitor the environment. ON-LINE SYSTEMS The TIP utilizes on-line information retrieval technology to make toxi- cology information more readily available to members of the biomedical community. During FY 1976, TIP continued to expand its bibliographic retrieval8407674_000031.txt

Page  31 1542 service (TOXLINE) which was operated entirely on the NLM computer. The data base also was enriched with special literature files to improve coverage in the specific areas of mutagenesis, teratology, and heavy metal toxicology. The usefulness of the service was enhanced by updating the TOXLINE data base on a regular monthly (instead of quarterly) basis. The growth of the data base to over 400,000 records required a splitting of the file into two parts, TOXLINE and TOXBACK. TOXBACK contains that portion of the data base covering the literature prior to 1971, and is only searchable off-line. TOXLINE contains literature published during the most current five years and is available on-line. During this period, users performed over 25,000 on- line searches and requested over 250,000 pages of off-line print. Provisions have also been made to allow TOXLINE access by foreign MEDLARS centers. During FY 1976, TIP continued to operate and enhance its Chemical Dictionary On-Line (CHEMLINE). This service is an adjunct to TOXLINE, MEDLINE, and CANCERLINE and provides users with Chemical Abstracts Service (CAS) Registry numbers and chemical nomenclature information for substances mentioned in these files. Some 15,000 chemical substance records have been added to the file bringing the total size of CHEMLINE to 90,000 records. Data for an addi- tional 700-1,000 chemical substances will be added to the on-line data retrieval service, the Toxicology Data Bank (TDB). Support functions for TDB users such as training and technical assistance will be maintained. An initial file of 700 compound records for a new on-line data retrieval service referred to as the Toxicology Data Bank was mounted in NLM's on-line system. The file is being developed and maintained by extracting data on the chemical, physical, biological, usage and distribution attributes of com- pounds from a selected group of sources such as monographs, reviews and criteria documents. Compounds are chosen for input if they present known hazards to substantial population groups. TIP will continue to enrich TOXLINE with specialized literature files covering areas such as drug interactions, drug interference with laboratory tests, and biological aspects of drug abuse. TOXLINE will be updated on a regular basis, and the oldest year of the file will be transferred to TOXBACK on an annual basis. COLLABORATIVE ACTIVITIES WITH OTHER ORGANIZATIONS The Toxicology Information Subcommittee (TIS) of the DHEW Committee to Coordinate Toxicology and Related Programs, which is responsible for coordi- nating toxicology information activity within and beyond the Department, is making significant progress on three major projects intended to improve the information transfer process. The National Library of Medicine, through its TIP, has been assigned operational responsibility for the Toxicology Information Subcommittee which was formally chartered by the Office of the Assistant Secretary for Health in 1973. These collaborative efforts include: The TIP-supported Toxicology Information Response Center (TIRC) at the Oak Ridge National Laboratory continued to fill an important need for query response and literature search services in toxicology. This Center, which performs demand literature searches has processed over 700 searches in FY 1976 for the scientific community. Search results normally consist of computer print-outs containing bibliographic references and abstracts from on-line computer searches, copies of abstracts extracted from Chemical Abstracts, Biological Abstracts or other services, and typed citations of relevant articles. During FY 1976 this literature support service was provided to other Federal agencies including the National Center for Toxicological Research, Edgewood Arsenal, Food and Drug Administration, EPA, etc. via separate Interagency Agreements. The Laboratory Animal Data Bank (LADB) project which is designed to make base line data on laboratory animals available, on-line, to research scientists. This data bank will contain strain files for most species of laboratory animals. Each strain is represented by a number of colonies (substrains).8407674_000032.txt

Page  32 1543 The species included will range from mice to primate. Data collected is related to environmental and handling conditions under which each colony is main- tained; also in such areas as blood chemistry, growth and development, behavior, and pathology. The data is stored for on-line retrieval and statistical manipulation. The initial segment of this file was placed on-line for test and demonstration purposes. This segment is a file on 10 key (mice, rats, beagles and Rhesus monkeys) strains. An information center, known as the Toxicology Document and Data Depository (TD3), has begun collecting and distributing toxicology materials not ordinarily published in professional journals. Materials such as "negative" research results, data files, charts and photomicrographs, hearing transcripts, and committee reports will be included. This information will be on microfiche and distributed by the National Technical Information Service under an interagency agreement with NLM. The approximate $300,000 increase in funds will allow TIP to expand TOXLINE, CHEMLINE and the Toxicology Data Bank. In particular the program will develop an on-line "early warning" system on the potential hazards of products about to enter the market place. In addition TIP will take steps to make TIRC at Oak Ridge more sophisticated and versatile with increased use of machine search techniques and access to all available on-line files relevant to toxicology. Program Management 1976 Revised President's 1976 1977 Increase or Budget Appropriation Estimate Decrease Amount Amount Amount Amount Program Management........ 5,245,000 5,190,000 5,794,000 +604,000 Positions................. 79 79 79 This activity provides support for the overall administration, coordination, and direction of the varied programs and activities of the National Library of Medicine. Within this activity the primary functions include the prepara- tion and processing of grant applications for review committees and NLM's Board of Regents; public information and publication management; financial and personnel management; program analysis and contracts management; administrative services, and coordination of NLM's equal employment opportunity activities. This activity includes a major effort, the architectural and engineering design of the Lister Hill Center, which was completed in July of 1975. This facility when constructed will relieve the serious space shortage within the NLM' and provide the necessary special purpose facilities essential to meet the needs of the Lister Hill Center programs' communications technology and network engineering activities. Also in 1976, Program Management performed detailed analyses of NLM computer and library services in order to optimize efficiency in these operations. As a means of analyzing work volume in relation to manpower utilized to perform that work, a productivity measurement system was developed and Is tracking library services on a monthly basis. This activity will continue to emphasize introduction of new knowledge into current operating programs and for planning and review of new areas of focus and interest. The entire increase for this activity in this budget is required for mandatory items which include the annualization cost of recent pay increases and NLM's proportionate share of increased costs of NIH centrally furnished services such as maintenance of building and grounds, custodial services, communications and administrative services.8407674_000033.txt

Page  33 1544 National Library of Medicine Program Purpose and Accomplishments Activity: Medical Library Assistance Act, Title III, Part J, Sec. 393-397 (Extended by Health Services Research, Health Statistics, and Medical Libraries Act of 1974) _____________1977______________ Budget Estimate Authorization Pos. Amount --- 6,433,000 20,000,000 --- 8,000,000 Purpose: NLM's programs of Medical Library Assistance are designed to improve health information services by providing grants to train professional personnel, strengthen library resources, produce medical reviews, and conduct research in ways of improving information transfer. In addition, contracts provide a network of Regional Medical Libraries with the necessary resources and services to provide backup support for local medical libraries throughout the United States. Explanation: Awards are made to individuals directly or to public or non-profit institutions. Accomplishments in FY 1976: Training grants supported the training of 55 individuals in the area of the application of computer science to the teaching and practice of medicine. Scientific Publication grants supported the preparation and publication of non-profit studies aimed at increasing the availability of information needed by health researchers, educators, and practitioners. Research grants provide assistance for investigative projects in medical library.science, information science, biomedical communications, educational technology, and the history of medicine. Resource grants emphasized support for cooperative programs in which a strong library undertakes to provide training, consultation, and loan services for small community hospitals and clinics. Regional Medical Library (RML) contracts support a national network of ten Regional Medical Libraries which serve as a backup resource for smaller medical libraries. The number of interlibrary loans supported in FY 1976 remained at approximately 500,000. Objectives for FY 1977: Program activities in FY 1977 will focus on those elements which have been identified as priority efforts in the long range plans for medical library assistance: (1) the economics related to resource sharing, cooperative acquisitions and technical processing, and other factors which would allow a rechanneling of existing library expenditures; (2) a strate- gy which will maintain the present quality of document delivery services and at some time accommodate the issues which will impact on this service; (3) increased efforts, especially through the consortia grant, which will assure that health workers in all fields and in all geographic areas can avail themselves of the benefits of the network; and (4) the greater and more direct involvement of the health professionals themselves not only from the standpoint of decision making in the library areas, but also in the continued identification of information needs, in the design of programs which require information components and in the communication linkages of a national Biomedical Communications Network. 1976 Pos. Amount8407674_000034.txt

Page  34 1545 Activity: Lister Hill National Center for Biomedical Communications (Public Health Service Act, Title III, Part I, Sec. 381) ______1976 ____________1977_____________ Budget Estimate Pos. Amount Authorization Pos. Amount 24 2,760,000 Indefinite 23 . 4,730,000 Purpose: The Lister Hill Center facilitates, through the use of advanced computer and communications technology, the transfer of biomedical information and the interlnstitutional sharing of resources to enhance the effectiveness of health manpower, of health and medical services, and the transfer of research results Into practice norms. Explanation: The Center works closely with the health and medical community to determine high priority needs, and matches these needs with technological capabilities in order to develop experimental programs and evaluate their feasibility. Accomplishments in FY 1976: With the move of the ATS-6 satellite to India, the Center terminated its highly successful experiments with the Alaska bio- medical communications network for remote health care delivery and with the state of Washington in its program for decentralized medical education. Expanding on this base, the Center is now planning a major national broadband network experiment using the joint Canadian-American Communications Technology Satellite (CTS). The Lister Hill Center terminated its support of the experimental computer- assisted instruction (CAI) network as planned on May 30, 1975. Also, the Center's support for the New Hampshire/Vermont interactive television network (INTERACT) essentially terminated on November 30, 1975. The management and operation of both of these networks has been assumed by their respective users with the anticipation that they will be self-sustaining. In the area of computer-based education, a major effort is underway to develop a Learning Resources Center within the National Library of Medicine. This will provide a focal point for institutional representatives to access all computer-based education modalities. Additionally, it provides a temporary laboratory for developing advanced applications of small computers and interactive terminals for both computer-based education and library applications. Objectives for FY 1977: There are five broad areas in which the Center will take initiatives during FY 1977. A BROADBAND BIOMEDICAL COMMUNICATIONS NETWORK will be the foundation on which much of the resource sharing will be based. The CTS experiment complements a study which will be conducted by the Center and the National Aeronautics and Space Administration (NASA) to explore the potential use of satellite communications in support of health. This study will be the base on which to develop models and system designs for a national broadband biomedical communications network. The network could eventually support all communications and information transfer modes. DISTRIBUTED COMPUTER PROCESSING will make available at reasonable costs the power of the computer to support library activities, computer-based education, and medical practice in isolated locations. Research and development in distributed processing will be intensified during FY 1977 to minimize dependency on large central computer systems. ALTERNATIVE TECHNOLOGIES will be examined to provide options from which applications can be selected to best meet a particular set of requirements of an individual user. Efforts will continue to develop a strong in-house research development, demonstration, experimentation, and evaluation capability. Development of TRANSLATION METHODOLOGIES Is essential if the benefits of research are to be understood and applied by practitioners in a timely fashion. The Center will undertake a systematic examination of the parameters of the translation of research results to practice application. INFORMATION ACQUISITION AND EXCHANGE will promote current awareness on the part of the Center as it consults with its constituency In the health community in8407674_000035.txt

Page  35 1546 seeking the best technology for application to specific communication problems. An information base and methodology for maintaining its currency will be developed to provide up-to-date information on basic technology and its applications. The Center will maximize the DISSEMINATION OF RESEARCH RESULTS and medical research findings to health professionals. Activity: National Medical Audiovisual Center (Public Health Service Act, Title III, Part I, Sec. 381) 1976 '________19ZZ_______________ Pos. Amount Budget Estimate Authorization Pos. Amount 100 2,981,000 Indefinite 100 3,551,000 Purpose: The National Medical Audiovisual Center (NMAC) located in Atlanta, Georgia applies audiovisual technology to the instructional needs of the bio- medical community. Its primary mission is to stimulate the development and use of instructional media in schools of the health professions and in the continuing education of health professionals. Explanation: NMAC functions as a clearinghouse for assembling, cataloging, and disseminating information on available instructional material. It evaluates, acquires and distributes materials appropriate for health professional education, and provides consultation and training in the use of instructional audiovisual technology. It also conducts research in instructional technology and systems and develops prototype instructional media programs. Accomplishments in FY 1976: NMAC implemented its on-line bibliographic storage and retrieval system, AVLINE (Audiovisuals on-line). 65,000 films, videotapes and videocassette instructional programs were loaned to health professional schools. In 16 workship sessions, over 500 health science professionals were trained in methods of application of audiovisual educational technology to health sciences teaching. NMAC suggested or developed teaching materials in the areas of dentistry, anatomy, nursing .physiology and neurology. In addition, an active research and evaluation program in instructional technology and its application to audiovisual systems and instructional applications was initiated. Objectives for FY 1977: NMAC will continue to identify areas for research, development and services where audiovisual technology can, when properly applied, promote significant changes in the effectiveness of health professional training. Center-supported peer review panels will continue to identify additional effective materials for entering into the AVLINE system, an on-line system which will assist health science teaching professionals in identifying instructional materials for use in health professional schools. By the end of FY 1977 an additional 3,000 audiovisual citations will have been added to the AVLINE file. NMAC will continue its services to the health professional community through direct loans of films, videotapes and videocassettes,through adding materials for sale through the General Services Administration's Sales Program, and by continuing a training program which increases health professional faculty competencies in development and use of materials designed to improve student performance. A number of demon- stration instructional slide series, videotape and audiotape programs will be produced in FY 1977 primarily as part of NMAC's research and development programs. Activity: Library Operations (Public Health Service Act, Title III, Part I, Sec. 381) _____________1977________________ Budget Estimate Authorization Pos. Amount 252 10,014,000 Indefinite 250 10,993,000 Purpose: Library Operations is responsible for selecting, acquiring, processing, indexing, cataloging, preserving, and disseminating the world's output of sub- stantive biomedical literature. It also serves as the Regional Medical Library ______1976________ Pos. Amount8407674_000036.txt

Page  36 1547 for the five-state Mid-Atlantic Region and provides back-up service for the national Regional Medical Library Network as a whole. In carrying out these responsibilities, Library Operations functions as the traditional service arm of the National Library of Medicine. Explanation: Library Operations, through manual and machine methods prepares bibliographies and publishes indexes, catalogs, and other publications for use by the biomedical community; manages a national on-line information retrieval network, and conducts an extensive educational program for its network participants. Accomplishments in FY 1976: Library Operations continued to expand the on-line service provided to the health community during FY 1976. At the beginning of FY 1976, the program was providing service to approximately 350 institutions and is expected to grow to 500 during FY 1977. The Library acquired 140,000 biomedical serial pieces and 20,000 monographs; indexed 245,000 biomedical articles to be entered into the computerized MEDLARS data base; published 32 Recurring Bibliographies; bound 32,000 volumes; and processed approximately 250,000 Interlibrary loan requests; filled 100,000 reader service requests; and produced two million pages of bibliographic citations from 500,000 on-line searches. NLM's second-generation computerized Medical Literature Analysis and Retrieval system (MEDLARS II) was installed in FY 1975. A sophisticated successor to the older MEDLARS system in operation since 1963, the new system has made possible the development of additional bibliographic information services, and permitted the extension of MEDLINE and other on-line data bases to industrial, pharmaceutical and other health related institutions. NLM renewed agreements with eight international MEDLARS centers which have been providing NLM with quid pro quo indexing of the foreign literature. These new agreements reflect the new capabilities which the MEDLARS II system provides such as on-line access and additional data bases. Objectives for FY 1977: Services provided by Library Operations in response to a steadily rising demand will experience a considerable increase. For instance, in FY 1977 requests for library loans alone increased by 27 percent. Current pro- jections foresee a rise of 25 percent for the next two years. Expressed in numbers, 71,000 more loan requests will be processed. Based on current productivity levels this increase represents 8.7 man-years. A major objective in FY 1977 will be to increase the responsiveness of the NLM and its Regional Medical Library Network to this existing service demand. To this effect, Library Operations has designed an on-line interlibrary loan referral system, DOCLINE, which has been operational on an experimental basis between the British Library Lending Division (BLLD) and the NLM since 1974. It is anticipated that by FY 1977 a significant portion of interlibrary loan requests as well as referrals to the National Library of Medicine will be automatically controlled by DOCLINE. An essential aspect of this service will be an integrated management information system. By applying computer technology to document delivery in the same way in which MEDLINE and other on-line services of the NLM have applied it to information retrieval, NLM is responding to the needs of the health science community. Activity: Toxicology Information (Public Health Service Act, Title III, Part I, Sec. 381) 1976 ____________1977____________ Budget Estimate Pos. Amount Authorization Pos. . Amount 17 1,866,000 Indefinite 16 2,166,000 Purpose: The Toxicology Information Program (TIP) is responsible for collecting and organizing toxicology data from diverse sources and making it more readily accessible to the biomedical community.8407674_000037.txt

Page  37 1548 Explanation: TIP obtains information from the published scientific literature and files of governmental, industrial, and academic organizations in whatever form it is available; organizes and enters this information into computerized storage and retrieval systems; and provides specialized services and products. TIP plays a key role in coordinating toxicology information activities within DHEW. Accomplishments in FY 1976: TIP continued to expand its bibliographic retrieval service (TOXLINE) which was operated entirely on the NLM computer. The data base was enriched with special literature files to improve coverage in the specific areas of mutagenesis, teratology, and heavy metal toxicology. A major improvement was made to the usefulness of the service by updating the TOXLINE data base on a monthly basis. The data base grew to over 400,000 records. Users have performed over 25,000 on-line searches and requested over 250,000 pages of off-line print. TIP continued to operate and enhance its on-line Chemical Dictionary (CHEMLINE). Some 15,000 chemical substance records have been added to this file bringing its total size to 90,000 records. A new on-line data retrieval service referred to as the Toxicology Data Bank was mounted in NLM's on-line system. The initial file of 700 compound records contained extensive data on substances known to be hazardous to substantial population groups. CANCERLINE, an on-line file containing bibliographic information on cancer, was maintained for the National Cancer Institute. A file describing on-going cancer research projects (CANCERPROJ) was added as a new subset of this service. TIP supported the Toxicology Information Response Center at the Oak Ridge National Laboratory where query response and literature search services in toxicology were carried out on a demand basis. During the year over 700 full bibliographic searches were processed. Objectives for FY 1977: TIP will continue to enrich TOXLINE with specialized literature files covering selected areas such as drug Interactions, drug inter- ference with laboratory tests, biological aspects of drug abuse, etc. The TOXLINE data base will be updated on a regular monthly basis, with the oldest year of the file transferred to TOXBACK on an annual basis. TOXLINE will be modified to include an "early warning" system on the potential hazards of products about to enter the market place. The. .CHEMLINE file will be maintained and improved. New software enhancements will enable users to increase on-line sub-structure searching capabilities. Data for 700-1,000 chemical substances will be added to the Toxicology Data Bank. As part of its expanded chemical file support services, a study will be conducted to determine the feasibility of creating an "agency" chemical registry system for the NIH. Plans for FY 1977 call for increased query response services from the Toxicology Information Response Center with the sale of selected search bibliographies through the National Technical Information Service. Steps will be taken to make TIRC more sophisticated and versatile with increased use of machine search techniques and access to all available on-line files relevant to toxicology. Activity: Program Management (Public Health Service Act, Title III Part I, Sec. 381) ' 1976 ______________1977 Budget Estimate Pos. Amount Authorization Pos 79 5,190,000 Indefinite 79 Amount 5,794,000 Explanation: This program provides support for the Office of the D- which has responsibility for overall administrative manaeemenf ,„j o*?"0^ direction of all NLM programs. nd scientific8407674_000038.txt

Page  38 1549 Purpose: This activity provides the funds for salaries and other related operating costs for the overall administration and direction of the National Library of Medicine programs. Accomplishments in FY 1976: NLM grants awarded and administered under the Medical Library Assistance Act were continued to be analyzed and evaluated through an on-line computerized system. The final architectural and engineer- ing drawings for the new Lister Hill National Center building were completed. The construction of this specialized facility will allow NLM to apply advanced technology to the improvement of biomedical communications. Objectives for FY 1977: The activity will continue to provide for the coordination and administration of NLM programs. Particular emphasis is to be directed in the areas of new knowledge, and its evaluation and applicability relative to the methods and systems necessary for the dissemination of medical research results. Transition Quarter Analysis Obligations by Activity 1976 ' Interim Period Pos. Estimate Pos. Estimate Medical Library Assistance Total................................ --- 6,433,000 --- 870,000 Direct Operations Lister Hill Nat'l Center for Biomedical Communications.......... National Medical Audiovisual Center. Library Operations.................. Toxicology Information.............. Program Management.................. Subtotal.................... Total Obligations. 24 2,760,000 23 665,000 100 2,981,000 100 745,000 252 10,014,000 250 2,610,000 17 1,866,000 16 475,000 79 5,190,000 79 1,207,000 472 22,811,000 468 5,702,000 472 29,244,000 468 6,572,000 NARRATIVE 1976 Interim Budget Period The 1976 Interim Budget estimate of $6,572,000 is a reflection of the National Library of Medicine's commitment to maintain its on-going programs at the FY 1976 level for the same period. The elements of the budget estimate were developed accordingly.