1974 U.S. Senate Appropriations Committee Budget Testimony, 93rd Congress 1st Session, June 27, 1973
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DEPARTMENTS OF LABOR AND HEALTH, EDUCATION, AND WELFARE AND RELATED AGENCIES APPRO- PRIATIONS FOR FISCAL YEAR 1974 HEARINGS % "vjw; ***•* BEFORE A **•*-• ***«.*50i SUBCOMMITTEE OF THE COMMITTEE ON APPROPRIATIONS UNITED STATES SENATE NINETY-THIRD CONGRESS FIRST SESSION ON H.R. 8877 AN ACT MAKING APPROPRIATIONS FOR THE DEPARTMENTS OF LABOR AND HEALTH, EDUCATION, AND WELFARE AND RELATED AGENCIES, FOR THE FISCAL YEAR ENDING JUNE 30, 1974, AND FOR OTHER PURPOSES Printed for the use of the Committee on Appropriations PART 3 (Pages 2111-3358) DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE National Institutes of Health DEPARTMENT OF LABOR PRESIDENT'S COMMITTEE ON EMPLOYMENT OF THE HANDICAPPED U.S. GOVERNMENT PRINTING OFFICE 97-228 0 WASHINGTON : 19788409740_000002.txt

Page  2 National Library of Medicine STATEMENT OF DR. MARTIN M. CUMMINGS, DIRECTOR ACCOMPANIED BY: DR. JOHN F. SHERMAN, DEPUTY DIRECTOR, NATIONAL INSTI- TUTES OF HEALTH KENT A. SMITH, ASSISTANT DIRECTOR FOR ADMINISTRATION, NATIONAL LIBRARY OF MEDICINE DR. ERNEST ALLEN, ASSOCIATE DIRECTOR, EXTRAMURAL PROGRAMS, NATIONAL LIBRARY OF MEDICINE LELAND B. MAY, ASSISTANT DIECTOR OF FINANCIAL MAN- AGEMENT (BUDGET), NATIONAL INSTITUTES OF HEALTH CHARLES MILLER, DEPUTY ASSISTANT SECRETARY, BUDGET BUDGET REQUEST Senator Magnuson. All right. Dr. Cummings, you are here to tell us about the request for $24,- 994,000 to operate the National Library of Medicine. This is nearly $3 million less than what Congress provided in 1973, and the House has recommended a level of $25,871,000. Is that correct ? Dr. Cummings. That is correct, sir. Senator Magnuson. All right. So that would make it about $150,000 less than last year in round figures, wouldn't it? Dr. Cummings. In round figures, yes. Mr. Miller. $156,000, Mr. Chairman. Senator Magnuson. $156,000, yes. In other words, in 1972 you had $24 million. The continuing resolution gives you $28 million, and the spending plan has been $25 million. That's $3 million under again. Here we go again; $24,994,000 and the House made it $25,871,000. an increase of $877,000. Dr. Cummings. Yes. Senator Magnuson. All right. Go ahead. You have a statement. Dr. Cummings. Well, Mr. Chairman, I would like to introduce--- Senator Magnuson. Yes, put in the record those that are here. Dr. Cummings. Mr. Kent Smith, Assistant Director for Administra- tion of the National Library. I'm also accompanied by Dr. Ernest Allen, our new Associate Director for extramural programs. Senator Magnuson. We're glad to have them here. PREPARED STATEMENT Your prepared statement will be made a part of the record at this point. [The statement follows:] (2363)8409740_000003.txt

Page  3 2364 Mr. Chairman, Members of the Committee: This year marks the 137th anniversary of the National Library of Medicine. It has grown from modest beginnings in 1836 to become a great national resource holding the most important collection of health sciences literature ever assembled. It continues to perform its legislative responsibilities for acquiring, organizing, and disseminating printed and ? audiovisual informational materials in the biomedical sciences. Additionally it has actively sought to develop a national biomedical communications network utilizing the latest technological advances in the information sciences to increase the quality and timeliness of the infor- mation services to the health community. These new initiatives for the National Library of Medicine, coupled with sustained support for its basic program, enable the Library to successfully serve our Nation's health professional community. Challenges The NLM is faced with several significant challenges. First is the increasing cost of literature acquisitions which is having a debilitating impact on all medical libraries. The subscription cost increases have forced many local hospitals and clinic libraries to reduce medical journal subscriptions increasing the demands placed on the NLM and on the supporting regional and resource library components of the National Biomedical Communi- cations Network. As the Nation's central comprehensive library collection, I the NLM must maintain the completeness of its holdings for servicing these domestic needs for medical literature that cannot otherwise be satisfied. Adequate funds are included in this estimate to provide for this need. The second challenge the NLM is faced with is the extent of the enthus- iastic response of the health community to MEDLINE, our new computerized on-line bibliographic service, has surpassed our own optimistic expectations. . MEDLINE is providing immediate identification of medical articles for use in clinical and research activities. Whereas the NLM provided 740,000 units of service to the public in FY 1972, it expects to provide 1,000,0008409740_000004.txt

Page  4 2365 units in FY 1973 and even more in FY 1974. These levels of service can be maintained within budget levels requested for the NLM in FY 1974. Finally, the NLM is faced with the problems presented by a copyright suit that may result in the prohibition of the NLM and all other libraries from reproducing single copies of journal articles for use by health professionals and students. If libraries are required to pay for licences and royalties for photocopying, it would tremendously increase the operational costs for the NLM and other libraries throughout the country. The following is a brief account of some of the NLM's efforts to meet the above challenges and to facilitate the flow of information in the health sciences. Library Services The recently inaugurated MEDLINE, an on-line interactive bibliographic service, has been expanded by adding multi-file capability. Full operation of these files will be achieved in FY 1974 providing the added capability of: (1) locating which libraries in each of the eleven regions holds any of approx- imately 5,000 medical serials; (2) in addition to searching of current infor- mation in MEDLINE (1,200 serials containing approximately 500,000 citations), more extensive searching, when required, of the complete MEDLARS data base of approximately 1,500,000 citations contained in 2,300 serials; and (3) rapid access to cataloging information on medical monographs and books. The MEDLINE service is now available in 140 health institutions. It is expected that by FY 1974 the number of MEDLINE centers will increase to 200. The number of searches performed has risen from 20,000 in FY 1972 to 140,000 in FY 1973, and estimated 150,000 in FY 1974. The cost of providing this greatly increased service is largely borne by the users. The NLM cost is minimal because of the efficiencies and economies resulting from the use of an advanced on-line computer communications system. This exemplifies NLM policy of shared responsibility and funding with the biomedical community in the development and implementation of the Biomedical Communications Network. NLM develops and maintains information systems while the user pays the cost of accessing the system. 97-228 (Pt. 3) O - 73 - 18409740_000005.txt

Page  5 2366 Other more conventional medical library services, such as, reference services and interlibrary loans will continue to be provided by the NLM in FY 1974 through its Regional Medical Library Network. Emphasis will be placed on streamlining and improving these services to achieve maximum productivity levels and greater outreach to the practicing health professional. The MEDLARS II development project is proceeding satisfactorily and the / current schedule calls for system testing at the end of this year. / Toxicology Information The Library's Toxicology Information Program (TIP) continues to build computerized toxicology data bases with information obtained from cooperating Governmental, industrial, and academic institutions. The NLM provides a variety of toxicology information services to the scientific and medical community from these data bases. In carrying out this program, the Library collaborates closely with the Atomic Energy Commission, utilizing, under contract, its information processing facilities at the Oak Ridge National Laboratory to assist in providing these services. These services can be classified into three categories: (1) responses to queries; (2) publications; and (3) an on-line interactive information retrieval system, TOXICON. TOXICON became operational late in September 1972. Its operation is supported by the user in accordance with the principles detailed earlier. In responding to requests for service, the TIP has provided several hundred comprehensive literature searches and has initiated the preparation of many important critical reviews of drug and chemical applications. We have supported the preparation of Drug Interactions - An Annotated Bibliography of Selected Excerpts; Abstracts on Health Effects of Environmental Pollutants, and numerous state of the art reviews. These activities will continue in FY 1974. Lister Hill National Center for Biomedical Communications This Center has conducted many innovative efforts in health communica- tions research. The potential payoffs from this type of development is strikingly illustrated by the success of the MEDLINE system which grew out of a pilot developmental on-line system, AIM-TWX, supported by the Lister Hill Center. This is a good example of the fruits of applied new technology.8409740_000006.txt

Page  6 2367 We believe that the Lister Hill Center is supporting other projects that have similar potential for significantly improving and modernizing current communications practices in biomedicine. One of these is the satellite communications project which has demon- strated its effectiveness in remote geographical areas where mountainous terrain or atmospheric conditions make normal communications difficult. Utilizing the NASA ATS-1 satellite, the Center is completing its experiment in Alaska to demonstrate the potential of satellite communications in this environment. It has already been credited by Alaskan physicians with helping save the lives of several seriously ill patients in remote areas of that State. The Center is also testing the feasibility and effectiveness of other advanced communication systems. Examples of these are: (1) The Northern New England Interactive TV Network where a number of small community hospitals are linked with a medical school so that medical expertise of the university faculty can be made available to these less-specialized hospitals. The network is now providing twenty instructional hours per week. Steps are underway to increase this to forty. The average number of professional medical viewers per program hour was twenty-three for a total of 460 instructional hours per week at distances from thirty to one hundred- fifty miles. Without this network, no practical opportunity for continuing education of physicians in this area was possible. (2) Computer-assisted instruction projects to modernize health education. These include simulations of clinical situations, more than fifty short courses on a variety of medical topics, and more than 2,500 multiple choice questions arranged by specialty and subspecialty to afford opportunity for self- assessment by students and physicians. Fifty institutions are now using this material. In the thirty days beginning January 15, 1973, a total of 1,529 hours of use was logged. Eighty percent of use is by medical students at the present time and more than 7,000 health science students are involved. Five percent of use is by physicians and the remainder is divided among nurses, dental students and allied health workers. These innovative projects8409740_000007.txt

Page  7 2368 can be thought of as investments in the future which could provide returns worth many times more than their original cost. National Medical Audiovisual Center (NMAC) The NMAC program has made important advances in its attempt to foster and increase the use of audiovisuals and multi-media teaching techniques in health education. The use of audiovisuals, especially when coupled with other modern communications mediums, such as, tape recorders and TV in self-instructional teaching packages, holds great promise for significantly improving present practices in medical education. Specialists at NMAC, in collaboration with the Bureau of Health Manpower Education, are developing prototypes of instructional packages and have embarked on a major training, consultative, and distribution program to increase the use of these packages and other high-quality health audiovisuals in the Nation's health professional schools. This new technology can multiply the effectiveness of the individual instructor enabling him to reach large numbers of audiences with better presentations and at the same time reduce the length of the academic curricula in the health sciences. But most important and compelling is the hope that this improved technology may enable schools of medicine, and related bio- sciences, to produce graduates of higher quality in a shorter time and in greater numbers than is possible today with conventional teaching procedures. For example, a series of neuro-anatomy teachning materials are now used in 80 medical schools by over 10,000 medical students. This represents more than 90,000 instruction hours. The film distribution system supplied 64,500 films to health science education institutions providing more than 500,000 student hours of instruction. The video tape distribution system makes possible a sharing of materials between educational institutions and provides approximately 100,000 instruc- tional hours per year. Studies indicate that instructor time requirements are reduced by more than fifty percent through the use of these materials. Thus, a topic presentation which traditionally required twenty hours of instructor time (exclusive of preparation time) may require less than ten8409740_000008.txt

Page  8 2369 hours of instructor time when augmented by these multi-media teaching packages. Medical Library Assistance Act The Nation's health sciences libraries have made great strides towards strengthening their collections, the competency and make-up of their professional staff and have significantly improved and extended medical library services as a result of grant and contract support provided by the NLM under the authority of the MLAA. Probably the most significant of the many accomplishments resulting from this Act is the past and continuing support provided to a National network of medical libraries. Within this network the library resources and services of the small community libraries have been strengthened and the larger medical libraries have been induced to share their collection with these local libraries. Any attempt to introduce technological innovation into medical communications must be directed in a large part of this extramural library community because this is where the majority of the use takes place. Therefore, funds are requested for the continuation of these programs and I want to lend them my strong support. Summary In summary, our request for FY 1974 is $24,994,000 approximately the same as in FY 1973.8409740_000009.txt

Page  9 2370 NATIONAL LIBRARY OF MEDICINE [In thousands) 1973 Continuing Spending 1972 resolution plan 1974 Overall funding.........................______...... $24,111 $28,488 $25,150 $24,994 Items of special concern: House mark, $25,871,000, an increase of $877,000 over the budget. LIBRARY ACHIEVEMENTS Dr. Cummings. The National Library of Medicine has grown from its modest beginning 137 years ago to a national resource holding the most important collection of health sciences information ever assem- bled. While continuing to acquire, organize, and disseminate this vast store of printed and audiovisual materials, the NLM also is actively developing a national biomedical communications network, utilizing the newest technologies to increase the timeliness and quality of in- formation delivery to the health community. Our principal commitment is quality service, responsive to the di- verse information needs of medical and health related researchers, practitioners, and academicians. Our productivity continues to rise and although continuing innovation is basic to the success of our oper- ating programs, we are are beginning to find that our productivity gains are being more than offset by an increase in service demands placed on the system. Successful service engenders greater demands for the service. For example, such a problem arises, paradoxically, from the en- thusiastic and almost overwhelming response of the health community to our recently introduced computerized on-line bibliographic service, Medline. By providing immediate references to medical articles for re- search and health care at 244 remote terminals in 165 organizations across the country, Medline has greatly increased the demand for ac- cess to the literature and for NLM services in general. We provided 700,000 units of service to the public in fiscal year 1972; 7r?>r„eX?f I to suPP]y * milli°n in 1973 and even more in fiscal year 1974. Although the fiscal year 1974 funding requests will be sufficient to maintain required services, our staff may be overtaxed in doing so. Senator Magnuson. Now, you're talking—obviously, you've got to have a lot of Medline machines, and computers. Here, you're talking about your staff. 6 Dr. Cummings. Yes, sir. Senator Magnuson. All right. Dr. Cummings. Another challenge is posed by the rapidly increasing cost of literature acquisition. This has forced some libraries in hospi- tals and clinics to cancel many of their medical journal subscriptions, and has placed a greater interlibrary loan demand on the National library of Medicine and the local and regional libraries to which we provide support. In fiscal year 1972, the NLM's network provided 340,000 interlibrary loans. We expect this service level to increase to over a half a million in fiscal year 1974.8409740_000010.txt

Page  10 2371 A copyright suit pending against the Government may ultimately prohibit the NLM and all other medical libraries from reproducing single copies of journal articles for use by health science students and professionals. If libraries are required to pay royalties for photo- copying, operational costs will increase significantly. Senator Magnuson. Is that being brought by some of the contrib- utors to the medical magazines ? Who brought the suit ? Dr. Cummings. The suit is being brought against the libraries. Senator Magnuson. I know who it's against, but who brought it? Dr. Cummings. It was brought by a commercial publishing firm in Baltimore, the Williams & Wilkins Co. Senator Magnuson. Who reproduces these things themselves ? Dr. Cummings. The Williams & Wilkins Co. receives manuscripts from scientists, and publishes them in formal journals. Senator Magnuson. Oh, and they don't want you to use it. Dr. Cummings. The authors do not receive any payment for their contribution. The publishers sell the journals, but they do not want us to disseminate photocopies of articles without paying them a li- censed royalty. Senator Magnuson. That's what I was thinking. For most articles in medical journals, the people that write them don't get paid, and don't expect to be paid. Dr. Cummings. That is correct. Senator Magnuson. They're making a contribution from their own expertise. Dr. Cummings. Moreover, I would add, Mr. Chairman, that more than half of the articles published in the American medical literature comes from studies supported by the Federal Government. Thus, sponsorship of research which leads to a publication, we believe would be in the public domain. Senator Magnuson. Yes. It would be like giving a grant to do certain things, but part of the grant would include making a report to the Federal Government. Dr. Cummings. That is correct. Senator Magnuson. We make sure that an article is written on what is found out for the journals. Dr. Cummings. His research, in fact, is incomplete until it is pub- lished and the results are made known. Senator Magnuson. Yes. Dr. Cummings. The following are some highlights of NLM efforts to meet the above challenges and to provide for the information needs of the Nation's health professionals through innovative approaches to biomedical communications. library services During fiscal year 1973 there will be more than a sevenfold in- crease in Medline literature searches, with operating costs remaining essentially"afthe same level as last year. In 1974 Medline will be available in 40 additional institutions and we expect the number of computer searches to surpass 200,000, an in- crease of 50,000 over the number performed in this fiscal year. Part8409740_000011.txt

Page  11 2372 of the cost of providing this greatly improved service will be borne by the users. This is consistent with NLM's policy of sharing with the biomedical community the responsibility for maintaining the Bio- medical Communications Network. Senator Magnuson. I saw at the orthopedic hospital in Seattle where they put something in the computer on a particular case, and then in- formation comes out. . Dr. Cummings. Well, I know we have several terminals m Seattle. I am not sure that we can say there is one in the orthopedic hospital, but it is a terminal that is used to make a query. You describe the prob- lem and you get an immediate---- Senator Magnuson. And then in a few minutes it comes back? Dr. Cummings. That is correct. Senator Magnuson. With the knowledge you may have, do you put it through a computer? Dr. Cummings. It is a computer which is responding to your query, and we are the institution that puts the information in the computer to be responsive. Senator Magnuson. I see. Well, the day I was there thev had some query—it was a burnt child, burnt very badly—about whether they should use a certain drug or medicine or even a salve, and they did not quite know enough about it. So they used the computer and in about 2 minutes it came back with information from you people. Dr. Cummings. That is correct. Senator Magnuson. And they could make their own judgment. You do not tell them what judgment to make. toxline Dr. Cummings. No. We merely give them the information that has been published on that problem, and then the physician has to make the decision on what to do. It may well have been, in the case you cite, that the information came from another information system that we have developed which I will describe briefly. It is called Toxline, a recently introduced computerized information system for the field of drugs and toxicology. Senator Magnuson. That is what this was about. It was about what thev thought about using, and then they got all of the dope on it. Dr. Cummings. The data base of this system now encompasses information on over 70,000 chemical substances including drugs, pesti- cides, environmental pollutants, and general pharmaceuticals iden- tified selectively from more than 10,000 medical journals. The operation of this service, like Medline, is largely supported by its users. It is one of several specialized information services initiated by the NLM specialized information service. lister hill national center for biomedical communications With regard to our Lister Hill National Center for Biomedical Communications, I can report that the center has made many innova- tive efforts in health communications research. The potential payoff from such research is strikingly illustrated by the success of Medline,8409740_000012.txt

Page  12 2373 which grew out of a Lister Hill Center pilot project. The center is supporting other projects that we believe have similar potential for significantly improving communications practices in biomedicine. One example is the Alaskan satellite communications experiment, which has demonstrated its effectiveness in geographically remote areas where rugged terrain or atmospheric conditions make ordinary com- munications difficult. This project, which utilizes the NASA ATS-1 satellite, already has been credited by Alaskan physicians with help- ing to save the lives of several critically ill patients in remote areas of their State. Senator Magnuson. Now, under the amount you have suggested here, or supposing we agreed with the House figure, can you continue this Alaskan line, or is there some problem about that ? ats-f satellite Dr. Cummings. Well, we have projected the introduction of a more sophisticated health communications system using a new NASA satel- lite, and with the funds in this budget, we will not be able to imple- ment the program on the scale originally planned. Instead of having coverage in some 25 districts of the Northwest and Alaska, we will restrict the experiment to about 5 or 6 communities. This will scale down the effort to fit the budget. Senator Magnuson. Well, why was it scaled down ? Did you recommend that it be scaled down through the budget? Dr. Cummings. I think the history of the budget has been---- Senator Magnuson. Do not give me the history. Did you recommend that it be scaled down ? Dr. Cummings. No, I did not recommend that it be scaled down. Senator Magnuson. All right. And if you had the money to keep it going you could use it advan- tageously. Dr. Cummings. If we had the funds, we would implement the plan originally---- Senator Magnuson. If you have not got the funds, why did you mention it here ? Why did you not say it is cut out ? You mention it is one of the fine things that is being done, but you have not any money to do it. Dr. Cummings. Well, in fairness, Mr. Chairman---- Senator Magnuson. You are trying to justify what you spent last year. Dr. Cummings. I have mentioned the successful prototype experi- ment which we believe justifies our going ahead with a more elaborate demonstration. Senator Magnuson. I hear it has been very successful. If it is, we should keep it going. I know of two or three cases in Alaska where it really did something. I knew that from the doctors involved. They happened to be down in Seattle, and---- Dr. Cummings. Yes. The doctors in Seattle act as a backstop or consultation group to the doctors in remote areas. Senator Magnuson. Yes.8409740_000013.txt

Page  13 2374 I do not like you to talk how nice these things are and not have any money for it. You should not mention them, just say that we had a good program and it was cut out, fini. Mr. Miller. They have got money to do a partial program, Mr. Chairman. Senator Magnuson. He says they have no funds to go ahead with it. Mr. Miller. He said they cannot go ahead on the full basis that they planned, but they could do it on a partial basis. Senator Magnuson. I know, but he has not got the money that they think it is good to go ahead and plan. You fellows cut them out, abdicating a good program. Dr. Cummings. Mr. Chairman, the Center also supports---- Senator Magnuson. You should have shifted it from some program that was not so good to one that is good. Dr. Cummings. Well, that is a judgment that someone at a level higher than my own will have to make. Senator Magnuson. Yes; I understand that, but we do not neces- sarily have to follow the higher level in this field. Dr. Cummings. I can observe that. Senator Magnuson. And we do not sometimes. We like their advice, but then that is about it. All right. Go ahead. two-way television Dr. Cummings. Lister Hill Center also supports computer aided instruction experiments in medical education and has demonstrated the successful use of two-way television for teaching and patient care in New Hampshire and Vermont. Senator Magnuson. All right. Have you got the money to keep that going ? Dr. Cummings. Yes, that program is entering its---- Senator Magnuson. You had better say you have it or you are going to hear from somebody here on this committee. Dr. Cummings. I am aware of that, particularly since I know that Senator Cotton participated in a demonstration of the two-way tele- vision activity several months ago. Our plan for that experiment, Mr. Chairman, is to provide a termi- nal year's support as a demonstration and then hope that it will be picked up as an ongoing service operation by the users. Senator Magnuson. Well, you still do not answer my question. Have you got the money to continue it and go ahead within this budget ? Dr. Cummings. We have the money in this budget to provide the terminal year's support that we have committed. Senator Magnuson. OK. But the Alaskan one, no. Dr. Cummings. That is correct. Senator Magnuson. All right. NATIONAL MEDICAL AUDIOVISUAL CENTER Dr. Cummings. With regard to the National Medical Audiovisual Center, this segment of the library is continuing to foster the develop- ment and use of audiovisual and multimedia technology in health pro-8409740_000014.txt

Page  14 2375 fessional education and practice. This new technology is increasing the effectiveness of individual instructors, enabling them to reach larger audiences with more informative presentations. For example, a series of neuroanatomy teaching materials is now being used in 80 medical schools by approximately 10,000 students, representing a total of more than 90,000 instruction hours. The National Medical Audiovisual Center will continue the distri- bution of medical audiovisual instructional materials to educational institutions with almost 70,000 film loans and the transmission of tele- vision tapes to be provided in fiscal year 1974. Senator Magnuson. All right. Is that down from last year ? Dr. Cummings. That is an increased number of loans to be made to the educational institutions with a stable budget. Senator Magnuson. So that program can continue on with this budget. Dr. Cummings. That program can continue on with this budget, Mr. Chairman, but that program will be---- Senator Magnuson. Curtailed. Dr. Cummings. Heavily damaged by having inadequate staff, to be very frank. We are really not hurting for money so much as we are for personnel. Senator Magnuson. Well, you have got to have the money to hire the staff. Dr. Cummings. Well, I want to make a distinction between having an adequate budget to provide services which do not require more staff, such as our computer operations. Senator Magnuson. I understand that. Dr. Cummings. And those that require humans to engage in a given service. Senator Magnuson. What you are saying is you have not got enough in the 1974 budget to have an adequate staff. Dr. Cummings. That is correct. Senator Magnuson. All right, fine. The House figure will help you a little. Dr. Cummings. Well, the House increase is earmarked for support- ing training grants and would not be of any assistance in the direct operations. Senator Magnuson. Your direct, day-to-day operations. Dr. Cummings. That is correct. It is for the extramural program, as I understand it. Senator Magnuson. All right. MEDICAL LIBRARY ASSISTANCE ACT Dr. Cummings. Under the Medical Library Assistance Act, the NLM has provided support to a national network of medical libraries. With- in the network, the resources and services of small community li- braries have been strengthened and larger medical libraries have been induced to share their collections, thereby eliminating much waste- ful duplication. One of the major priorities for new grant awards in fiscal year 1974 will be for cooperative networking proposals that benefit large numbers of health professionals. These involve the co-8409740_000015.txt

Page  15 2376 operation of several institutions in the provision of library services and therefore foster an economy of library resources and personnel. In summary, Mr. Chairman, to continue the NLM's service and de- velopmental activities, our request for fiscal year 1974 is $24,994,000. This is approximately the same amount available as in fiscal year 1973. Senator Magnuson. The House figure put it up a half. Dr. Cummings. The House added $877,000 for training. Senator Magnuson. Would that make it over 1973 ? Dr. Cummings. That would be an increase over 1973. Senator Magnuson. Not the appropriation but what they allowed you to spend. Dr. Cummings. Yes, it would. Mr. Smith. The 1973 level under the continuing resolution is ap- proximately $25 million which includes mandatory pay cost increases Senator Magnuson. Now, put in the record how much of this budget you would spend for buying materials, books or whatever you may have to buy. What is the percentage ? Can you give us that ? Dr. Cummings. Well, I can tell you that the National Library of Medicine spends about $700,000 to acquire the world's biomedical in- formation in printed and audiovisual form. Senator Magnuson. Now, the costs of those, if they are pamphlets or materials, have gone up considerably, have they not? Dr. Cummings. The rise in cost of these materials averages 13 per- cent per year. Senator Magnuson. If they are in book form, the cost has gone up greatly. Dr. Cummings. Thirteen percent per year. Senator Magnuson. So if you have the same amount in 1973, you have to absorb that increase in cost. Dr. Cummings. That is correct. Senator Magnuson. You have to take it away from something else, staff or something else, do you not ? Dr. Cummings. That is correct. Senator Magnuson. You have to have these things in order to have an adequate library. You do not want to stand still out there. Dr. Cummings. That is correct. Senator Magnuson. All right. Thank you very much. Oh, you mentioned a court battle. That has been going on for a long time, has it not ? Dr. Cummings. That has been under litigation for about 5 years, and we hope there will be a legislative resolution of that problem sometime soon rather than a judicial one. REGIONAL MEDICAL LIBRARIES Senator Magnuson. There is one other thing. You spoke about re- gional libraries. Are they going to be broken up by States or regions ? Dr. Cummings. No. sir, they will not be changed at all. Each of the 10 existing regional libraries will continue to serve a number of States.8409740_000016.txt

Page  16 2377 Senator Magnuson. I would think that you could do a better job with a regional institute than to try to get one in every State. Dr. Cummings. We do not have any intention of doing that. Senator Magnuson. All right. And the House increase was for training grants and fellowships. Dr. Cummings. That is my understanding. Senator Magnuson. Can you put in the record how many people will take part in those programs ? Dr. Cummings. Yes, we can provide that information. [The information follows:] Pursuant to recommendations of the Board of Regents of the NLM that greater attention be given to the training of specialty fields of Library interest rather than to the training of additional librarians as such, the NLM would plan to use the $877,000 to provide support of trainees in computer technology, information sciences, and to a more limited degree, the history of medicine. The following table depicts the current plan of support: Specialty field Number of grants Number of trainees Cost Computer technology......................... ............. 6 48 32 2 82 1600,000 250,000 27,000 877,000 Information sciences......................... ..................... 4 History of medicine........................... ................... 1 Total................................. ............. 11 JUSTIFICATION Senator Magnuson. We'll put your justification material in the record. [The justification follows:]8409740_000017.txt

Page  17 2378 Justification Appropriation Estimate NATIONAL LIBRARY OF MEDICINE To carry out, to the extent not otherwise provided for, section 301 with respect to health information communications and part I and J of title III of the Public Health Service Act, [$28,818,000 of which $2,902,000 shall remain available until June 30, 1974J $24,994,000.— Explanation of Language Change 1/ Two year authority for the Regional Medical Library Grant no longer required. Amounts Available for Obligation 1/ Appropriation ......................... Comparative transfers to: "Office of the Director" ............ "Departmental Management" ........... Subtotal, budget authority ....... Unobligated balance start of year Total obligations ................ 1/ Excludes the following amounts for reimbursable activities carried out by this account: 1973, 1,200,000; 1974, 1,500,000 1973 Revised 1974 $25,074,000 $24,994,000 -74,000 -6,000 — $24,994,000 $24,994,000 54,808 __ $25,048,808 $24,994,000 8409740_000018.txt

Page  18 2379 Obligations by Activity Page Ref. 1973 1974 Appropriation Estimate Pos. Amount Pos. Amount Increase or Decrease Pos. Amount Medical Library Assistance: 88 Training............. 89 NLM Distinguished Scholar Program.... 89 Research............. 90 Library Resources 90 Regional Medical Libraries.......... 91 Publications Support. Subtotal........... 1,080,000 95,000 650,000 2,305,000 2,206,808 340.000 1,080,000 60,000 700,000 2,005,000 2,337,000 340,000 — - 35,000 — + 50,000 — -300,000 — +130,192 6,676,808 — 6,522,000 — -154,808 Direct Operations: 92 Lister Hill National Center for Biomedi- cal Communications: (a) Project contracts. — 1,425,000 — 1,425,000 (b) Other direct...... 18 505,000 16 505,000 -2 93 National Medical Audio- visual Center: (a) Project contracts. — 276,000 « 276,000 — — (b) Other direct...... 104 2,290,000 99 2,290,000 -5 94 Library Operations: (a) Project contracts. — 1,560,000 — 1,560,000 (b) Other direct...... 246 6,811,000 242 6,911,000 -4 +100,000 97 Toxicology Information: (a) Project contracts. — 710,000 — 710,000 (b) Other Direct...... 16 813,000 15 813,000 -1 — 98 Review and Approval of Grants................ 32 769,000 27 769,000 -5 99 Program Direction....... 54 3,213,000 53 3,213,000 -1 — Subtotal.............. 470 18.372,000 452 18,472.000 -18 +100,000 Total obligations....... 470 25,048,808 452 24,994,000 -18 -54,8088409740_000019.txt

Page  19 2380 Obligations by Object 1973 Appropriation 1974 Estimate Increase or Decrease Total number of permanent positions...................... 470 Full-time equivalent of all other positions...................... 25 Average number of all employees.. 507 Personnel compensation: Permanent positions............ $ 7,186,000 Positions other than permanent. 266,000 Other personnel compensation... ______115.000 Subtotal, personnel compen- sation..................... 7,567,000 Personnel benefits............... 666,000 Travel and transportation of persons........................ 187,000 Transportation of things......... 18,000 Rent, communications, and utilities...................... 1,892,000 Printing and reproduction........ 447,000 Other services: Project contracts.............. 4,071,000 Payment to NIH Management Fund. 1,139,000 Other.......................... 1,455,000 Supplies and materials........... 314,000 Equipment........................ 616,000 Grants, subsidies and contri- butions ........................ 6,676.808 Total obligations by object.... 25,048,808 452 25 494 -18 -13 $ 7,291,000 + 105,000 278,000 + 12,000 115.000 _ 7,684,000 + 117,000 674,000 + 8,000 176,000 - 11,000 23,000 + 5,000 1,892,000 « 455,000 + 8,000 3,971,000 1,283,000 1,376,000 277,000 661,000 - 100,000 + 144,000 - 79,000 - 37,000 + 45,000 6,522.000 - 154.808 24,994,000 - 54,8088409740_000020.txt

Page  20 2381 Summary of Changes 1973 estimated obligation 1974 estimated obligation Net Change . $25,048,808 24,994,000 54,808 Base Pos. Amount Change from Base Pos. Amount Increases: A. Built-in: 1. Within grade pay increases .... 2. FTS rate increase ............. — Subtotal, built-in increases .. B. Program: 1. Research grants ............... 2. Regional Medical Library grants ........................ — 3. Library Operations ............ 246 Subtotal, program increases ... — C. Payment to "National Institutes of Health Management Fund" for centrally furnished services ...... — Total, increases .................. — Decreases: A. Program: 1. NLM Distinguished Scholar Program ..................... 2. Library Resources grants .... 3. Lister Hill Center for Biomedical Communications ... 4. National Medical Audiovisual Center ...................... 5. Library Operations .......... 6. Toxicology Information ...... 7. Review and Approval of Grants 8. Program Direction ........... Total, decreases ................ Total, net change ..................... 650,000 2,206,808 8,371.000 1,139,000 +125,000 + 10,000 +135,000 + 50,000 +130,192 +100.000 +280,192 +144,000 +559,192 — 95,000 — - 35,000 — 2,305,000 — -300,000 18 1,930,000 - 2 - 5,000 104 2,566,000 - 5 - 25,000 246 8,371,000 - 4 - 60,000 16 1,523,000 - 1 - 10,000 32 769,000 - 5 - 10,000 54 3.213,000 - 1 -169,000 __ -18 -614,000 „ -18 - 54,808 Explanation of Changes Increases: Built-in: These increases will provide: $125,000 for within grade pay increases, incentive awards in FY 1974 and $10,000 for increased cost in 1974 of using the Federal Telecommunication System. 'J7-228 (Pt. 3) O - 73 - 188409740_000021.txt

Page  21 2382 B. Program: 1. Research Grants - An increase of $50,000 is requested in order to pro- vide for the funding of a few additional grants for this promising program. 2. Regional Medical Library Grants - An increase of $130,192 will defray the increased costs of this program resulting from increased service demands for interlibrary loans. 3. Library Operations - The increase of $100,000 coupled with expected productivity increases resulting from the NLM's on-line communication systems will permit modest increases in library services. C. Payment to "National Institutes of Health Management Fund" - The increase of $144,000 is for increased costs for centrally furnished services such as patient care, receipt and initial review of all grant applications, computer services, communications, and transportation Decreases: A. Program : 1. NLM Distinguished Scholars Program - This activity reflects a decrease of $35,000. Since general resources for aid to students are available for the support of information specialists, this program supporting training will be terminated after the training under previously approved grants is completed. 2. Library Resource Grants - A decrease of $300,000 in this grant category reflects the reprogramming of funds to the basic NLM service oriented components. Some of the more future-oriented programs have been reduced in order to provide additional funds for the maintenance of conventional library services. 3. Lister Hill Center - A decrease of $5,000 is required to cover mandatory within grade personnel costs for 1974. In addition a decrease of two positions is reflected. 4. National Medical Audiovisual Center - A decrease of $25,000 is required to cover mandatory within grade personnel costs in 1974. In addition a decrease of five positions is reflected. 5. Library Operations - A decrease of $60,000 is required to cover mandatory within grade personnel costs in 1974. In addition a decrease of four positions is reflected. 6. Toxicology Information - A decrease of $10,000 is required to cover mandatory within grade personnel costs in 1974. In addition a decrease of one position is reflected. 7. Review and Approval of Grants - A decrease of $10,000 is required to cover mandatory within grade personnel costs in 1974. In addition a decrease of five positions is reflected. 8. Program Direction - A decrease of $169,000 is required to cover mandatory within grade personnel costs, FTS rate increases and provide for the increased cost of centrally furnished services by the NIH Management Fund. In addition a decrease of one position is reflected.8409740_000022.txt

Page  22 2383 Significant Items in House and Senate Appropriations Committee Reports Action taken or to be taken 1973 Senate Report Lister Hill Center for Biomedical Communications 1. Committee stated that "these accomplishments are a fine and las- ting tribute to Senator Lister Hill, who played an important role in creating the National Library of Medicine. However, it is disappointing that funds made available in FY 1970 for architectural and engineering studies to construct the Lister Hill building have not as yet been obligated by the Department. The Library's present facilities will soon be over- flowing and the need for a building to house the staff and sophisticated equipment of the advanced communication components of the NLM is imperative. Therefore, the Committee directs that planning for this building get underway at onee and it expects the Department of Health, Education, and Welfare to request funds for the construction and equipment of this critically important facility in its FY 1974 budget estimates. It will take several years, at best, for comple- tion of this much needed resource and It is therefore highly desirable that the construction contract be awarded before the end of FY 1974." 1. The General Service Admini- stration negotiated a contract on November 1972 with the firm of Carroll, Grlsdale and Van Allen for the architectural and engineering design of the Lister Hill Center building. The completion of this design is scheduled for April 1974. Authorizing Legislation 1974 Authorization Requested Appropriation Requested Legislation Public Health Service Act Section 381 - Purpose and Establishment of Library............................ Section 394 - Grants for Training in Medical Library Sciences.............. Section 395a - Assistance for Special Scientific Projects................... Section 395b - Research and Development in Medical Library Sciences and Related Fields........................ Indefinite 18,472,000 1,080,000 60,000 700,000 ♦Legislation Pending8409740_000023.txt

Page  23 2384 1974 Authorization Requested Section 396 - Grants for Improving and Expanding the Basic Resources of Medical Libraries and Related Instrumentalities..................... * Section 397 - Grants for Establishment of Regional Medical Libraries......... * Section 398 - Financial Support for Biomedical Publications............... * legislation Pending Explanation of Transfers 1973 Estimate Appropriation Requested 2,005,000 2,337,000 340,000 Purpose Comparative transfers to: Departmental Management Office of the Director 6,000 Transfer of funds to support the purchase of Library mate- rials by the Office of the Secretary. These items are now budgeted in the Depart- mental management appropri- ation. 74,000 Transfer of funds and posi- tions to support the Upward Mobility program in the Of- fice of Personnel Management, NIH. Budget Estimate House Senate Year to Congress Allowance Allowance Appropriation 1964 $ 4,074,000 $ 4,074,000 $ 4,074,000 $ 4,074,000 1965 3,678,000 3,858,000 4,058,000 3,958,000 1966 9,185,000 9,185,000 9,685,000 9,685,000 1967 19,231,000 20,092,000 20,192,000 20,192,000 1968 21,162,000 18,662,000 21,162,000 19,912,000 1969 19,172,000 17,149,000 19,172,000 18,160,500 1970 22,882,000 19,682,000 19,682,000 19,682,000 1971 19,769,000 19,769,000 22,233,000 20,769,000 1972 21,981,000 22,781,000 25,086,000 24,086,000 1973 24,994,000 1974 24,994,000 8409740_000024.txt

Page  24 2385 Justification Pos Personnel compensation and benefits........... 470 Other expenses........... Total................ TW 1973 Appropriation Amount $ 8,233,000 16,815,808 1974 Estimate Pos. 452 Amount $ 8,358,000 16.636.000 Increase or Decrease Pos. -18 Amount +$ 125,000 - 179,808 25.048.808 452 24.994.000 -18 54,808 General Statement The National Library of Medicine (NLM) serves as a national resource for bio- medical information. Traditionally one of the world's most important research libraries, the NLM has in recent years become the principal focus within the Federal Government for national planning to improve communications in the health sciences. In order to accomplish this goal, the NLM has been coordinating the development of a national Biomedical Communications Network (BCN) being built upon the existing health communication system but incorporating the latest advances in space-age communication technology. These modern systems are necessary to organizing and disseminating the enormous amounts of health information in an efficient manner for the Nation's health professionals. The NLM, through congressional mandate, has assumed the role as central resource for this health information system and is, therefore, in a unique posi- tion to facilitate the flow of information to the end-users. Two of the most important areas of this health information system that have been significantly affected by the NLM are the provision of bibliographic information and loans of books and journals. The first, bibliographic material, is usually the entry point for most health professionals. Here the NLM, over the years, has computerized this information and finally in FY 1972 made it more easily and economically accessible through the installation of a nation-wide on-line interactive system of biblio- graphic retrieval called MEDLINE. This system will have 130 institutional users in FY 1973 and 250 in FY 1974 thereby extending its availability to most of the Nation's biomedical professionals. In the document delivery area the Library has fostered and supported a nationwide network of medical libraries that has capita- lized upon the potential of modern photocopying techniques. Through this network, selected participating institutions serve as major Regional Medical Libraries (RML'8) throughout the country to improve document delivery. Numerous local libraries in hospitals and schools of the health professions can use the library resources of these RML's and thereby preventing much of the duplication of collections by these smaller libraries and, more importantly, make larger amounts of biomedical information readily available to the Nation's health professionals. In addition to improving the accessibility of general health information, the NLM is supporting efforts to improve the in-depth availability of selected types of information such as toxicology data and also is introducing and encour- aging the use of more innovative communications techniques such as audiovisuals and multi-media instructional packages. The potential of these types of communi- cation has already been proven in other fields and has great potential for impro- ving health education. The Library is also conducting, through its Lister Hill National Center for Biomedical Communications, developmental experiments to deter- mine what other types of existing communications technology, such as satellites and cable TV, can be exploited efficiently and effectively in support of national health programs. The FY 1974 budget request will allow progress to be made in improving the Nation's biomedical communications, especially in improving the manner in which conventional medical library services are performed. This achievement, will be primarily the result of increases in productivity that are the pay-off from earlier experimental efforts of the Lister Hill Center. Additionally, it is a reflection of a modest reprogramming of funds from more future oriented programs to activities that support on-going basic operational services. Construction of the Lister Hill Center Annex that will house the new communications programs of the NLM is in the final architectural and engineering design stages. This design is scheduled for completion in the spring of 1974.8409740_000025.txt

Page  25 2386 GRANTS The programs authorized by the Medical Library Assistance Act of 1965 (Public Law 89-291) and the Medical Library Assistance Extension Act of 1970 (Public Law 91-212) are designed to meet national needs for better health information services through improved health library resources and facilities trained manpower and improved health communications technology. Specifically, the Act authorized support of projects to develop resources and techniques necessary to collect, preserve, store, process, retrieve, and facilitate the dissemination and use of health science information. Training and Fellowships 1973 Appropriation No. of Awards Amount Non-competing continu- ation grants......... New grants............. Total............. 13 3 $1,037,150 42,850 1974 Estimate No. of Awards Amount 12 $1,080,000 Increase or Decrease No. of Awards 16 1,080,000 12 1,080,000 Amount +$ 42,850 - 42,850 The continuation of a special program of Federal funding to train Communica- tions specialists in the biomedical sciences cannot be justified. Graduate stu- dents in other fields do not benefit from a targeted special Federal program in the information sciences for Federal aid and singling out graduate students and distin- guished scholars is inequitable. Further, there is no evidence that a shortage of trained information scientists exists or is projected. The use of Federal funds for student aid can be justified when they assist students in financial need and are available to students in all fields. Benefici- aries of training support are generally qualified for jobs with substantial future income potential. Such persons are generally able to afford the cost of loans and other general financial assistance to the same extent to which society expects other students to finance their professional training. Students in the informa- tion sciences who need financial help have access to the general student assis- tance programs of the Federal Government and to indirect training opportunities available for students and scholars working on grants and contracts received through NIH. For these reasons, programs supporting training will be phased out after all current commitments have been fulfilled. The budget request for this program in 1974 is $1,080,000 and will provide for appoximately 12 continuation awards. NLM Distinguished Scholars Program 1973 1974 Increase or Appropriation Estimate Decrease No. of No. of No. of Non-competing continu- Awards Amount Awards Amount Awards Amount 3 $ 95,000 3 $ 60,000 -$ 35,000 3 95,000 3 60,000 - 35,000 The continuation of a special progaam of Federal funding to train Communica- tions specialists in the biomedical sciences cannot be justified. Graduate stu- dents in other fields do not benefit from a targeted special Federal program in the information silences for Federal aid and singling out graduate students and distin- guished scholars is inequitable. Further, there is no evidence that a shortage of trained information scientists exists or is projected.8409740_000026.txt

Page  26 2387 The use of Federal funds for student aid can be justified when they assist students in financial need and are available to students in all fields, Benefici- aries of training support are generally qualified for jobs with substantial future income potential. Such persons are generally able to afford the cost of loans and other general financial assistance to the same extent to which society expeets other students to finance their professional training. Students in the informa- tion sciences who need financial help have access to the general student assis- tance programs of the Federal Government and to indirect training opportunities available for students and scholars working on grants and contracts received through NIH. For these reasons, programs supporting training will be phased out after all current commitments have been fulfilled. The budget request for this program in 1974 is $60,000 and will provide for approximately three continuation awards. Research 1973 Appropriation No. of Awards Amount Non-competing continu- ation grants......... New grants............. Total............. 10 12 $294,203 355,797 1974 Estimate No. of Awards 15 22 650,000 Amount $480,000 220,000 Increase or Decrease No. of Awards +5 -4 Amount +$185,797 - 135,797 23 700,000 +1 50,000 In 1974, the Library is requesting $700,000 in new obligational authority which will support approximately 8 new or competing renewal research projects and continue the support of 15 non-competing continuation projects, a total of 23 awards. The continuing high level of the national effort in health-service education and research produces a constantly growing amount of biomedical infor- mation. More effective transmission, storage, and retrieval of this information at realistic cost-benefit ratios is imperative. Projects will be supported in (1) defining information-seeking practices of health professionals. (2) improve- ment of the biomedical vocabulary for written and mechanized information handling, (3) development of Improved information systems, and (4) experimental testing of audio-visual information media. The increase in funds in FY 1974 will allow this program to sustain prior levels of activity and make a few selective new awards to promising applicants. Library Resources Non-competing continu- ation grants......... New grants............. Total............. 1973 App rop r ia t ion No. of Awards Amount 1974 Estimate No. of Awards Amount 56 98 $1,327,320 977,680 37 60 $1,200,000 805,000 Increase or Decrease No. of Awards Amount -19 -$127,320 -38 - 172,680 154 2,305,000 97 2,005,000 -57 300,000 The 1974 budget estimate will be used to award 33 grants to establish basic collections and 27 grants to improve local library services. The total request will permit the library to support 37 non-competing continuation grants and to make 60 new awards. Medical Library Resource grants are designed to assist in the establishment, improvement, and expansion of the Nation's health science libraries, and to encourage increased community support for the local library. Grants for a one- year period are made to health institutions which demonstrate a need to establish basic collections and services. Grants are also made to institutions with existing health science libraries for the support of projects designed to make the growing8409740_000027.txt

Page  27 2388 scientific literature more rapidly accessible to health professionals throughout the United States. Funded applications include cooperative programs in which a strong resource library undertakes to provide training, consultation and loan services for the small community hospitals, clinics and other health facilities; projects which seek to speed the delivery of services through the use of modern communication devices and automation techniques; and projects which, after an assessment of needs of the health professionals, strengthen the information resources of an institution as required to fill their needs. This program is also important in complementing the service activities of the Regional Medical Library Program. The Regional Medical Libraries (RML'S) and the major resource libraries which participate in the network can operate most efficiently and economically in a backup role for regional informational needs rather than as prime sources for all needs. Only if local library resources and services are selectively improved can the network function effectively and the full benefits of the Regional Medical Library Program be realized. Regional Medical Libraries 1973 1974 Increase or Appropriation i Estimate Decrease No. of No. of No. of Awards Amount Awards Amount Awards Amount Non-competing continu- 18 $2,206, 808 17 $2,337,000 -1 +$130,192 — — — - — 18 2,206, 868 17 2,337,000 -1 + 130,192 The FY 1974 request for $2,337,000 represents an increase of $130,192 over the 1973 level. This amount will allow the Library to maintain the contract support for the 10 active regional medical libraries (RML'S) plus the additional costs of operations caused by increased user service demands and greatly increased cost of journal materials. In addition, support will be provided for continuing grant projects which (1) analyze existing methods, (2) establish new services or methods, and (3) improve and expand existing services. The goal of this program is to develop a national network of regional medical libraries with the necessary depth and scope to supplement the services of other medical libraries in their designed region. Backup library services' in the form of interlibrary loans and sophisticated reference services are now available. In FY 1974 an Increase in service demands is expected due primarily to two factors: 1. Greatly increased reliance on the RML's by health professionals have resulted in their becoming increasingly aware of the availability of inter- library loan service from these regional libraries now that they are fully oper- ational ; and 2. The continued development of the NLM's on-line bibliographic retrieval service, MEDLINE, will afford direct and greatly improved access by RML clients to a data base which is most relevant to a health professional's re- quirements . Providing rapid access to biomedical literature by health professionals is vital to the well-being of the citizens of the U.S. The Regional Medical Library Network can make a large contribution to this goal. In FY 1973 approximately 400,000 interlibrary loan requests have been filled by the contract RML's and it is anticipated that there will be a 20% increase in loan activity during FY 1974.8409740_000028.txt

Page  28 2389 Publications Support 1973 Appropriation No. of Awards Amount 1974 Estimate No. of Awards Amount Non-competing continu- ation grants....... New grants............ Total............ 10 6 $212,070 127,930 10 6 16 340,000 $215,000 125,000 16 340.000 Increase or Decrease No. of Awards Amount — +$2,930 -- - 2,930 The 1974 request of $340,000 will allow the continued support of 10 projects and will support six new or renewal projects. The development of selected publica- tions to help American health professionals digest and utilize the tremendous out- put of new information in the biomedical sciences contributes to the NLM's over- all effort to facilitate biomedical communications. Such publications Include abstracts, bibliographies, handbooks, and critical reviews, as well as monographs and translations which condense, snythesize, evaluate, or otherwise repackage Information for health scientists, educators, and practitioners. Only products that are commercially not feasible are undertaken. Among the projects funded in 1973 is an atlas of ophthalmic pathology that describes and illustrates the important diseases of the eye which will be of great value to researches and practitioners in the areas such as comparative pathology, experimental ophthalmology, veterinary pathology and toxicology. Also the NLM has provided support to an index of scientific papers presented at the Biomedical Congress Symposia Proceedings, which is a valuable source for in- creasing the dissemination of biomedical information. In FY 1974 the program will continue to support selected publication projects that are directed to meet major reference information needs for U.S. health pro- fessionals and also to encourage the production of reference tools needed by and useful to librarians and information specialists in the health sciences. DIRECT OPERATIONS Personnel compensation and benefits.......... 1973 Appropriation Pos. Amount 470 $8,233,000 10,139,000 1974 Estimate Pos. Amount 452 $8,358,000 10,114,000 Increase or Decrease Pos. Amount -18 +$125,000 — - 25,000 470 18,372,000 452 18,472,000 -18 + 100,000 Lister Hill National Center for Biomedical Communications 1973 1974 Appropriation Estimate Decrease Pos. Amount Pos. Amount Pos. Amount Personnel compensation and benefits........... 18 $ 368,000 16 $ 373, ,000 -2 +$5,000 Other expenses........... 1,562,000 — 1,557, ,000 — - 5,000 Total................. 18 1,930,000 16 1,930, ,000 -2 — The Lister Hill National Center for Biomedical Communications has been designated the focal point for coordinating biomedical communications systems for the Department of Health, Education and Welfare. The Center operates a number of experimental and operational communications systems, and has been assigned, within DHEW, the responsibility for coordinating the health experiments investigating the use of satellite communications for health care delivery and education. The Lister Hill Center manages an operational Data Communications Service as a component of the Biomedical Communications Network. This service uses contracted wire-line communication services linking more than forty cities and is used by8409740_000029.txt

Page  29 2390 the National Library of Medicine for its on-line interactive computerized biblio- graphic search and retrieval service, MEDLINE. Moreover, this same communications service is used in an experiment to evaluate the effectiveness of computer- assisted instruction in the training and education of medical and dental students, and practicing physicians. This experiment makes available, to a constituency of medical and dental schools and teaching hospitals, computer-assisted instructional materials developed at three major medical teaching centers. A medical network linking 26 native villages with service unit hospitals and medical centers in Alaska is now operating seven days a week using the NASA Applications Technology Satellite (ATS-1). This network provides reliable voice consultation between village health aides and physicians, thus Improving the primary health care in remote areas of the state. Experiments are planned to provide continuing education to village health aides and to investigate techniques to provide emergency notification to hospital personnel 24 hours a day. FY 1973 funds have been used to continue development of a medical microwave television network linking two medical schools and two community hospitals in New Hampshire and Vermont in an experiment to determine the cost-effectiveness of the medium. A van-mounted mobile unit is being built to extend the network to three smaller institutions where valid needs exist for better health care, consultation and education, but where the expenses of a fixed installation are not economically justifiable. This network can eventually link some 15 hospitals and care delivery and education. The Center has begun to explore the use of cable television (CTV) as a means of reaching the urban dwellers who, in part because of inadequate communica- tions, suffer from poor health care and health education. FY 73 funds were used to develop a plan for two-way interation between a sophisticated urban health center in New York and the elderly residents of low-cost public housing in an effort to educate them in their own personal health care and to bring them more actively into the health care system. A major share of the Center's efforts and resources during the next two years is being devoted to planning and managing a jointly funded experiment in the use of a satellite for health care delivery and education. The satellite is NASA's Application Technology Satellite, ATS-F, to be launched in April, 1974, Organiza- tions whose efforts are being coordinated are the Bureau of Health Manpower Education, the Health Services and Mental Health Administration and the Veterans Administration. This efiorc is a logical continuation of experience gained in Alaska with the ATS-1 sate1lite and the New England medical interactive tele- vision network. Funds provided in 1973 will be used to begin procurement and installation of two-way satellite terminals, to continue the detailed planning and scheduling of experiments required to be ready for operation when the satellite is made available, and to begin to develop the management procedures required to coordinate the health experiments to be performed. This satellite will provide an opportunity to explore the utility of a variety of interactive health programs, and to bring the expertise of major medical centers to rural communities in select regions. This is part of a larger DHEW program to define public service functions of satellite communications and establish the needs for shared and/or dedicated domestic communication satellites. The FY 74 budget request represents an expansion or continuation of the programs listed above. Items included are costs for the computer-assisted- instruction network; procurement, installation and maintenance of satellite terminals and other hardware in order for system checkout to be completed in time to perform the ATS-F health experiments; detailed planning, program and content development and procurement for the CTV program and possible expansion of the New England interactive television network. The Center is becoming recognized as a major technology transfer element between the computer and communications communities and the biomedical community. Effective accomplishment of this role requires a balance of contractual efforts and in-house expertise.8409740_000030.txt

Page  30 2391 National Medical Audiovisual Center 1973 1974 Increase or Appropriation Estimate Decrease Pos. Amount Pos. Amount Pos. Amount Personnel compensation 104 $1,685,000 99 $1,710,000 -5 +$25,000 88,000 856,000 — - 25,000 104 2,566,000 99 2,566,000 -5 The National Medical Audiovisual Center (NMAC) In Atlanta, Georgia, administers programs to improve the quality and increase the use of biomedical audiovisuals in schools of the health professions, and in the continuing educa- tion of health professionals. Development of pilot units is accomplished through curriculum based pro- jects for which specific educational objectives have been determined. These units are designed to increase the impact and decrease the effort and cost of beginning and maintaining the health educational process. In FY 1973, the NMAC identified, organized, cataloged, and indexed effective audiovisual medical instructional materials as a Clearinghouse to facilitate access by the biomedical community. The NMAC produced and acquired for distribution, or for sale through GSAi instructional materials not otherwise available from professional or commerical sources. By development of prototype modular Instructional units, and provision of advisory, training, and information services, it also stimulated the develop- ment of new instructional methodology at a wide range of health science educational institutions. The NMAC and the BHME initiated support of an agreement with the Association of American Medical Colleges, under which that organization helps determine curriculum relevancy and identifies and coordinates subject matter for review, design, and development of instruction. This will help insure the active involve- ment of the educational community. In FY 1974, the NMAC will improve the responsiveness and relevancy of services offered by its Clearinghouse program. Reference to available media services will be continued and enhanced through the computerized bibliographic retrieval system of the NLM. Distribution of audiovisual materials will be more closely concen- trated on those highly effective in the health educational process, whether of traditional or experimental instructional technology. A one-way videotape transmission alternative to the film loan system will be explored, as will the low-cost sale of multi-media instructional packages. The NMAC will continue its educational development programs, including the production and field-testing of educational materials. It will also continue to explore the many facilities and, staffs available through health sciences instructional centers, in cooperative media development programs, and the sharing of data and results from each center's Innovative efforts. Library Operations 1973 1974 Increase or Appropriation Estimate Decrease Pos. Amount Pos. Amount Pos. Amount Personnel compensation and benefits........... 246 $4,057,000 242 $4,117,000 -4 +$60,000 Other expenses........... 4,314,000 -- 4,354,000 -- + 40,000 Total.................. 246 8.371.000 242 8.471.000-4 +100.000 Library Operations selects, acquires, catalogs, and preserves biomedical publications; indexes and provides access to the material through manual and machine produced bibliographies; furnishes reference and loan services; pre-8409740_000031.txt

Page  31 2392 pares and publishes indexes, catalogs and other publications for the use of the biomedical community; and manages the Library component of the Biomedical Communications Network, and acts as a Regional Medical Library for the Mid- Atlantic Region of the United States. In FY 1973, Library Operations will provide approximately 270,000 services to the public in its capacity as a component of and a central backup for the National Library Network. In addition, regional libraries funded by NLM will provide more than 450,000 document delivery and MEDLARS services. (MEDLARS is the NLM's computerized Medical Literature Analysis and Retrieval System). The Library also will index 200,000 articles from biomedical periodicals for inclusion into the MEDLARS data base from which the NLM prepares and publishes a monthly Index Medicus and a yearly Cumulated Index Medicus. In addition, the MEDLARS system produces over 24 specialized bibliographies in the field of medi- cine in collaboration with federal agencies and professional medical societies, and the Abridged Index Medicus, which has been developed for the individual practitioner and small hospital libraries. The Library also collects and catalogs serials in the medical and allied health sciences. Through the MEDLARS system, the Library produces and publishes semiweekly, monthly, quarterly, and annual cumulations of cataloged material for the use of medical libraries around the world in carrying out their cataloging and acquisition functions. During FY 1973, NLM will continue to strengthen the resources of the Library in its role as a central backup to the Medical Library Network. This will include filling gaps in the collection, preservation filming of deteriorating serials, a more intensive maintenance of the collection, and further implementation of the MEDLARS II System. Efforts will be continued to provide more timely and comprehensive service through the development and implementation of a computerized in process file for control of the acquisitions and cataloging of monographic and serial material coming into the Library's collection; development of an expanded machine readable indexing vocabulary to simplify the indexing process; participation in the Library of Congress's Cataloging in Publication Program (CIP) to provide rapid bibliogra- phic information to the nation's medical libraries by providing professional cataloging data in each new book at the time of publication. In FY 1973, multi- file search capability was added to MEDLINE, the Library's on-line bibliographic service. The MEDLINE service is now operational and provides users from 130 institu- tions rapid access to a data base of 500,000 citations to medical literature. By FY 1974, 120 additional institutions will become MEDLINE Centers. MEDLINE provides 140,000 searches per year to professionals in health care delivery medical education and biomedical research, whereas the computerized system it replaces only provided 20,000 searches per year. The unit cost per search has been reduced to 10% of the cost in the reduced system. The new data bases addeded to MEDLINE will provide information that will help speed up document delivery and reduce the efforts of the Regional Medical Libraries in identifying and locating library materials. This is a real increase in productivity of about 700% with only a modest increase in cost. The request for Library services in FY 1974 is $5,200,000 and 190 positions. These funds will allow the processing of 100,000 interlibrary loan requests; 84,000 reader requests (direct use of the collection), indexing of 200,000 articles, publications of 24 recurring bibliographies, acquisition of 80,000 serial pieces and 50,000 monographs, binding of 30,000 volumes and microfilming of approximately 1,500,000 pages of deteriorating documents. Increased require- ments from other Federal health agencies are also anticipated in view of sub- stantial retrenchments in library services projected in such agencies. Further Development and Implementation of On-Line Services and a Second-Generation MEDLAR (MEDLARS II) The National Library of Medicine began the current development of a second-generation Medical Literature Analysis and Retrieval System (MEDLARS II) in 1971 through a major contract.8409740_000032.txt

Page  32 2393 This current phase of MEDLARS II development, which consists of an improved file generation/maintenance system, a new set of programs to produce output for photocomposition, and additional search capability is expected to be completed toward the end of 1973. Much of the programming has been completed and initial testing is underway. In full operation, MEDLARS II will incorporate the following technical elements: increased processing capability; on-line storage devices permitting direct access to data bases from remote terminals. Translated into program capa- bilities, the new features will provide a greatly improved retrieval capability through an expanded and more flexible vocabulary for both input and search thus making the system more useful to students, researchers, and health care professionals. The programming and analytical staff at NLM specialize in the field of information storage and retrieval. Because of the success of on-line interactive service, MEDLINE, increasing emphasis has been placed on the design of interactive time-sharing systems and on the interface of the computer with communications systems. The 1974 budget request includes $3,271,000 and 52 positions to continue the development, implementation and operation of MEDLARS II and the computer support operations required for the operational MEDLARS I and MEDLINE. Toxicology Information 1973 1974 Increase or Appropriation Estimate Decrease Pos. Amount Pos. Amount Pos. Amount Personnel compensation and benefits ....... 16 $ 406,000 15 $ 416,000 -1 +$10,000 Other expenses ....... 1,117.000_________ 1.107.000 — - 10.000 Total.............. 16 1.523.000_________15 1,523.000 -1__________— The mission of the Toxicology Information Program (TIP) is to select, analyze, and organize into computerized storage and retrieval systems, toxicological in- formation now available only from numerous scattered and diverse sources. The effective implementation of the program provides to the health community easy and rapid access to toxicology information from the published scientific litera- ture and from the files of governmental, industrial and academic organizations. Collaborative Activities with Other Organizations The TIP is participating in a joint effort with several federal agencies to enhance for the use of these agencies, the capabilities of an on-line interactive computer system originally developed by NASA and kept in the public domain by this interagency effort. In this system is being stored TIP's own data bank as well as those acquired from cooperating organizations. For example, in collabo- ration with FDA, the TIP is working on the storage in this on-line system of data from the handbook Clinical Toxicology of Commercial Products. TIP also has con- tracted with a large chemical company for the delivery of nonproprietary toxi- cology information on its products. Tape files from two commercial information services, one on chemicals and another on pharmaceuticals, have also been obtained. TIP's efforts to extract toxicology data from pesticide petitions submitted to FDA and EPA continue. Computerized literature searches in various areas of toxicology are being performed by TIP routinely for over 20 government organiza- tions and in 1974 efforts will continue to support additional agencies with toxicology information on request. TIP will expand its efforts to collaborate with industrial organizations to obtain non-proprietary toxicology data from their files for use by the scientific community.8409740_000033.txt

Page  33 2394 Development of Specialized Products and Files Based on the Published Literature In 1973, TIP completed the preparation of several publications and other information services, including a two-volume Drug Interaction Bibliography and a thesaurus of toxicology terminology. Work was also continued on the publica- tion of an abstract journal and companion computer tape service on the Health Effects of Environmental Pollutants. The "Common Data Base," a computerized file containing structural and nomenclature information and Chemical Abstracts Service registry numbers for some 35,000 biomedically important compounds was maintained and regularly updated in collaboration with FDA. Plans for 1974 include the publication of additional state-of-the-art reviews and bibliographies in various toxicology subject areas. Automated Systems In 1973, the TIP made a Toxicology Information Conversational On-line Network (TOXICON) available to the public. More than 20 organizations signed up during the first few months to use this service on a pay-as-you-use basis. The system uses government-owned computer software and a nationwide communications network. The system contains citations, abstracts and data taken primarily from the published toxicology literature. It covers the toxicology of pesticides, chemi- cal products, environmental toxins, pharmaceuticals, hazardous household and industrial products, and general toxic substances, as well as information on analytical methodology and treatment of poisoning, including overdosage due to drug abuse. A streamlined form of the Chemical Abstracts Service's computerized "Name Match" system for chemical substances was installed at the NLM for support of the construction of MEDLARS and TIP data bases. A study was conducted to determine the feasibility of developing in TIP a drug toxicology data base and of delivering this information as a service to physicians and other members of the biomedical community. In 1974 efforts will be made to update and improve the existing TOXICON data base on a regular basis and to introduce enhancements to the TOXICON system. Toxicology Information Response Center The Toxicology Information Response Center (TIRC) at the Oak Ridge National Laboratory continued to be supported via an NLM/AEC agreement. The Center per- forms literature searches on request in various areas of toxicology for the scientific community. A fee-per-search system was implemented to recover part of the costs for this service via the National Technical Information Service of the Department of Commerce. Completed searches on topics having widespread scientific interest were also distributed to the public through that agency. Through small contracts, the Center has sponsored a number of state-of-the- art reviews and one-time or recurring bibliographies on toxic agents of current interest, prepared by experts. These reviews are either published in scienti- fic journals or distributed through the NTIS. Review and Approval 1973 1974 Increasi » or Appropi riation Estimate Decrease Pos. Amount Pos. Amount Pos. Amount Personnel compensa- tion and benefits. . 32 $649,000 27 $659,000 -5 +10,000 _ 120,000 110,000 _ -10,000 . 3? 769,000 27 769,000 -5 — 8409740_000034.txt

Page  34 2395 This activity provides support for staff to manage the six grant programs authorized by the Medical Library Assistance Act of 1970, as well as interna- tional activities of the NLM funded by the Scientific Activities Overseas appropriation. The functions of this office include the processing of approximately 950 grant applications and their review by program officers; staff assistance to reviewing committees and the Board of Regents of the National Library of Medicine; grants management and direction; and program review and evaluation. During fiscal year 1973 this activity is continuing to provide administra- tive support to the NLM's grant-in-aid program. Approximately 230 grants are being awarded, including support of research and development in new methods of making biomedical information more accessible. In FY 1974 this activity will continue at the 1973 level as described above. Program Direction Personnel compensation and benefits ........ Other expenses ........ Total ............... 1973 1974 Increase or Appropriation Estimate Decrease Pos. Amount Pos. Amount Pos. Amount 54 $1,068,000 53 $1,083,000 -1 +$15,000 2,145,000 2,130,000 ---- 15.000 54 3,213,000 53 3,213,000 -1 This activity provides the program leadership and centralized administra- tive support necessary for the coordinated operation of the various NLM activities. Program Direction provides support for the immediate office of the Director, Office of Administrative Management, Office of Public Information and Publications Management, and payment to the National Institutes of Health Management Fund for centrally furnished services. In fiscal year 1973 this activity has continued to provide the overall scientific and administrative management of the NLM programs. Emphasis is being placed on conducting meaningful program analyis and evaluation of the impact of NLM support, as well as publications management and program planning activities. Efforts in coordinating and developing biomedical communications systems and network prospects for DHEW are being expanded and assigned high priority. Included under this activity for 1973 is $72,000 for program evaluation. Efforts will continue in 1974 as described in FY 1973. EXTRAMURAL PROGRAMS Program Purpose and Accomplishments Activity: Training Grants (Medical Library Assistance Extension Act, Section 394) 1974 1973 Pos. Amount $1,080,000 Budget Estimate Authorization 1/ Pos. Amount $1,080,000 Purpose: The objective of the training program was to train medical librarians, information specialists, and biomedical personnel trained in the utilization of computer technology for education and patient care. - Authorization expires June 30, 1973; extension legislation is proposed.8409740_000035.txt

Page  35 2396 Explanation: Grants were made to nonprofit institutions qualified to conduct the proposed training activities. Grants were also made to individuals in the form of fellowships. Accomplishments and objectives for 1973 and 1974: Since general resources for aid to students are available for the support of information scientists, this program supporting training will be terminated after the training under previously approved grants is completed. The NLM will fund 13 continuation grants in 1973 and 12 continuation grants in 1974. Activity: Distinguished Scholar Program (Medical Library Assistance Extension Act, Section 395(a).) 1974 1973 Budget Pos. Amount Authorization Estimate Pos. Amount $95,000 1/ --- $60 "'0 Purpose: The Distinguished Scholar Program supported outstanding Individuals in the full-time analysis and documentation of major advances in the health sciences. The results are published as booklength monographs. Thus, these grants serve to make more accessible selected areas of biomedical information. Explanation: Grants were awarded to scholars and public or nonprofit institutions on behalf of such scholars. Accomplishments and Objectives for 1973 and 1974: Since general resources for aid to students are available for the support of information scientists, this program supporting training will be terminated after the training under previ- ously approved grants is completed. The NLM will fund three continuation grants in 1973 and three continuation grants in 1974. —' Authorization expires June 30, 1973: extension legislation is proposed. Activity: Research and Development (Medical Library Assistance Extension Act, Section 395(b).) 1974 1973 Budget Authorization Estimate Pos Amount $650,000 i/ Pos. Amount $700,000 Purpose: The purpose of the research grants program is to develop new and better methods of processing information and making accessible the rapidly growing body of biomedical knowledge. If such information is to have the maximum amount of impact on further research in the health-related sciences and ultimately on health care, an enhanced capability for processing, storing, retrieving, and delivering of the data is essential. Explanation: Grants are awarded to public or private nonprofit institutions on behalf of a principal investigator. Accomplishments in 1973: 22 awards were made in 1973, of which twelve were new or competing renewal projects. Projects supported in 1973 include studies on the information seeking practices of health professionals and simplification of the biomedical vocabulary for written and mechanized testing of various infor- mation media. expires June 30, 1973; extension legislation is proposed.8409740_000036.txt

Page  36 2397 Objectives for 1974: This activity's increase is due to the high potential of future pay off from the fruits of this research. Knowledge leading to more effective transmission storage and retrieval of information at realistic cost benefit ratios is an important goal of research supported by NLM. Twenty-three awards will be made in 1974, eight of which will be new or competing renewal pro- jects. Activity: Medical Library Resource Grants (Medical Library Assistance Extension Act, Section 396) 1974 1973 Budget Pos. Amount Authorization Estimate -- $2,305,000 Pos. Amount 1/ --- $2,005,000 Purpose: Funds are used to assist in the establishment, improvement, and expansion of the Nation's health science libraries, and to encourage commu- nity support for the local library. Explanation: One year, non-renewable Improvement Grants for $3,000 are made to establish basic health information units, usually in hospitals. Project Grants up to three years duration are made to facilitate the dissemination of health information to students, educators, researchers and practitioners and to introduce or demonstrate new technologies in librarianship and infor- mation and communication sciences. Resource Grants complement the expanding service activities of the Regional Medical Library Program, the foundation of a communications network designed to improve access to all health information resources by all health professionals. The network can function efficiently only if local resources and services are improved. Accomplishments in 1973: The Library made 154 awards in FY 1973 of which fifty-six were continuation awards and ninety-eight were new grants. These grants were awarded on the basis of local need and in consideration of how the project for the improvement of local services would strenghten the regional area, promote cooperation among institutions, and benefit the entire regional network. Sixty-nine of the ninety-eight new grants awarded during FY 1973, supported the acquisition of core libraries and other basic materials in first level libraries, usually in community health-care institutions. These institutions will have made a firm commitment to maintain, with local funds, a meaningful level of library suppport during and after the grant period. The remaining twenty-nine new grants during FY 1973 are to primary and secondary resource libraries, usually in larger hospitals or academic health institutions. These grants include such projects as cooperative programs in which relatively strong resource libraries undertake to assist the first level libraries through consultation, training, and other services; projects which seek to expedite the delivery of library services through the use of modern communication devices and automation techniques; and projects which improve the physical facilities of the library to provide for efficient storage and retrieval and for improved studying and learning. Oblectives for 1974: The estimates for 1974 provide for ninety-seven grants, of which thirty-seven will be continuations and sixty will be new awards. Continued emphasis will be placed on improving the strengthening the national Biomedical Communications networks as described in the FY 1973 accomplishments. —' Authorization expires June 30, 1973; extension legislation is proposed.8409740_000037.txt

Page  37 239S Activity: Regional Medical Library Grants (Medical Library Assistance Extension Act. Section 397) ______________1974____________ Budget Estimate 1973_____ Authorization Pos. Amount Pos. Amount 57 — $2,337,000 --- $2,206,808 Purpose: Regional Medical Library (RML) awards (grants and contracts) provide funds to support a national network of medical library services. Contracts sustain the regional service operations of ten regional libraries and their subcontractors. Competitive grants complement the contracts by providing the support for projects which analyze existing methods, establish new services or methods, and improve existing services in the RML's. Explanation: The regional services of the Regional Medical Library contracts include interlibrary loans, basic reference service, network management and planning, and educational and consultative activities. The ten insti- tutions were selected because of the scope and coverage of their collections and the potential strength of their regional service compenents. Grants are available to institutions within each region for improving or expanding the regional services and are reviewed and evaluated by the Biomedical Library Review Committee and the Board of Regents of the National Library of Medicine. Accomplishments in 1973: The Library awarded ten renewal contracts in FY 1973, and over 400,000 interlibrary loans were made in 1973. Approximately 130 institutions entered into agreements with the National Library of Medicine for MEDLINE services through the RML systems. Eight Regional Medical Library continuation grants were awarded in 1973 to support regional activities which are not a part of the contract service. During FY 1973 the Regional Medical Libraries continued to provide improved document delivery and reference services and began to increase the scope of such services as; consultation and training support to the allied health professionals; demonstration of improved and more cost-effective methods of information transmissions; and aid in the decentralized management of the NLM's new on-line bibliographic service (MEDLINE). Each RML developed a regional on-line service plan. All of these services, which are provided in the context of a national Biomedical Communication Network, will result in greatly improved and more rapid and direct access to health information. Objectives for 1974: The estimate for FY 1974 provides for the continued support of the ten regional library contracts. A total of seven regional medical library grants will be made in FY 1974, all of which will be continuations. Continued emphasis will be placed on improving and strength- ening the national network and on making available health information to im- prove patient care and health education. An estimated 475,000 inter-library loans will be filled by these RML contractors. 1/ Authorization expires June 30, 1973; extension legislation is proposed.8409740_000038.txt

Page  38 2399 EXTRAMURAL PROGRAMS Program Purpose and Accomplishments Activity: Biomedical Scientific Publications (Medical Library Assistance Extension Act, Section 398.) ________________1974 _________ Budget 1973 Estimate Pos. Amount Authorization Pos. Amount $340,000 1/ --- $340,000 Purpose: Publication grants provide support for the preparation and/or publication of secondary tools, such as abstracts, bibliographies, hand- books, and critical reviews as well as monographs and translations which condense, synthesize, evaluate or otherwise repackage information for health scientists, educators and practitioners. Explanation: Grants are made to individual scientists or to public or nonprofit institutions of higher education on behalf of such scientists. Publications supported by the program are those of need and merit which cannot be financed by commercial publishers. Accomplishments in 1973: Sixteen awards were made in 1973, of which six were new or competing renewal projects. These new projects stress reviews, especially critical reviews, as well as reference tools needed by and useful to librarians and information specialists in the health sciences. Objectives for 1974: The requested funding level will permit the program to function at the 1973 level of activity. Sixteen awards will be made in 1974, six of which will be new or competing renewals. New projects in 1974 will continue the emphasis on critical reviews and reference tools. 1/ Authorization expires June 30, 1973; extension legislation is proposed. National Library of Medicine Program Purpose and Accomplishments Activity: Lister Hill National Center for Biomedical Communications (Public Health Service Act, Title III Part I ; Section 381) _________1974_________________ Budget Authorization Estimate " Pos. Amount Indefinite "¥ $1,930,000 Purpose: The Lister Hill National Center for Biomedical Communications applies communications and computer technology to improve health care delivery, medical education and biomedical research. Explanation: The Center matches high priority needs with technological capabilities to develop experimental services and evaluate their effectiveness. Accomplishments in 1973: An experimental voice network linking native villages, service unit hospitals and major medical centers continued to operate seven days a week in Alaska utilizing a NASA communications 1973______ Pos, Amount 18 $1,930,0008409740_000039.txt

Page  39 2400 satellite. Detailed evaluation of the experiment is being carried out by the Department of Communications Research, Stanford University. During 1973 detailed planning for the new ATS-F satellite experiment re- sulted in the preparation of a variety of experiments to be carried out in the Pacific Northwest, Alaska and the Rocky Mountain Regions, and the de- velopment of necessary satellite ground terminal equipment. The Center supported the construction and operation of a two-way inter- active microwave television network linking the medical schools of Dartmouth and the University of Vermont with two community hospitals. During 1973/1974 a mobile, van-mounted unit was placed in operation to extend the services of the network to three smaller institutions. Achieving cost-effective operation of such an extensive network is a major goal of this program. In 1972 the Center initiated a national computer-assisted instruction (CAI) network for the interinstitutional sharing of educational resources. Three university medical centers with strong computer-assisted-instruc- tional material development programs were connected to a national commu- nications network, and their services offered to institutions who would integrate the educational programs into their own curricula, evaluate them, and produce additional units of instruction. During 1973/1974 approxi- mately 60 institutions became users of these services, including medical, dental, nursing and allied health professions schools and hospitals. FY 1973 funds have been used to develop a plan for an interactive cable television link between a sophisticated urban medical center in New York City and the elderly residents of low cost housing in East Harlem in an effort to educate the residents in their own personal health care, and to bring them more actively and efficiently into the health care system. Areas of need have been identified and software to help meet those needs is being designed and developed. Emphasis was placed on extensions, evaluation and improved management of existing programs. Objectives in 1974: The requested funding level would allow for the con- tinuation of current developmental projects on a stretched-out schedule. These efforts are planned so that the results can be used to update biomedical communications as their feasibility and desirability are demonstrated. The following is a discussion of objectives by major program area: 1. Satellite: Estimated launch date for the powerful ATS-F satellite is April 1974. At that time the necessary satellite television receiving and transmitting stations must be in place, and experiments started to demonstrate the feasibility of interactive TV, voice and data trans- missions for health applications involving medical education and community health service for select rural population groups. Continued use of the ATS-1 satellite for consultative and educational purposes for Alaska will likely come to an end during this period. The experimental services provided via the satellite have become important to the Alaskan villages. Transition of the experimental services to opera- tional services is being discussed with the State of Alaska and the Indian Health Service. 2. Computer-assisted instruction: Funding will permit a modest expansion to include health institutions other than medical schools. Procedures and the organization for reviewing and updating CAI materials will be developed. 3. Interactive television: Initial evaluation of the effectivity of the network to support delivery of health care and to satisfy educational ob- jectives will be determined. Cost/benefit ratios for service/education components will be derived. Decisions will be made to continue the net-8409740_000040.txt

Page  40 2401 work, terminate Lister Hill support, or to begin transmission to alternate funding source(s). 4. Cable Television: Funding will allow for the continued development of needed programs, the design and development of evaluation materials and methods and beginning procurement and installation of hardware. Pilot programs will be tested to evaluate the potential of a full, operational system. Activity: National Medical Audiovisual Center (Public Health Service Act, Title III Part I; Section 381) ____________1974_____________________ 1973 Budget Pos Amount Estimate______ 104 $2,566,000 Authorization Pos. Amount Indefinite 99 $2,566,000 Purpose: Resources of the National Medical Audiovisual Center, the audiovisual arm of the National Library of Medicine, are committed to the improvement of basic and continuing education in the health sciences through better use of audiovisual techniques and instructional methodologies. Developmental pro- grams are accomplished in close collaboration with the Office of Audiovisual Education Development of the NIH's Bureau of Health Manpower Education (BHME). Explanation: The Center's programs include: (1) the design and development of prototype instructional materials in conjunction with health professional school faculty and organizations; (2) the gathering and sharing of descrip- tive information and actual Instructional software among the schools and pro- fessions; (3) the identification and assessment of effective instructional approaches and materials and the dissemination of information on them through consultation and training programs. Accomplishments in 1973; The NMAC provided about 71,500 units of educational service or assistance to institutions and individuals in the health pro- fessional community. Services included 50,000 film loans, 4,800 responses to inquiries for instructional media information, 9,000 copies of specialized catalogs and training manuals, and 2,500 one-way videotape duplicates of in- structional programs. The NMAC also conducted 155 site consultations and in-house working sessions aimed at assisting educational institutions with problems relating to audiovisuals. Cooperation was continued with the 16 national professional organizations which provide the content expertise for the materials review process, and an additional 17 teaching institutions and professional organizations which provide similar assistance for current design and development projects in the area of mediated instruction. In conjunction with the BHME's Office of Audiovisual Educational Development, the NMAC initiated support to enable the Association of American Medical Colleges (AAMC) to become an involved participant in the review and develop- ment process. Finally, NMAC undertook support of nine new projects to begin design and development efforts in topic areas of high priority. Objectives for 1974: NMAC resources will be primarily directed towards high priority program efforts where experience makes increased success likely. It expects to provide the same level of educational service or assistance as in FY 1973. However, restructured emphasis will permit a greater interaction with professional teaching institutions and organizations by execution of an arrangement with the American Association of Dental Schools, (AADS) similar to the existing one with the AAMC; the involvement of up to 25 groups in instructional design and development projects; and the involvement of up to 25 additional groups in review projects which help to assure updated, relevant instructional input for the media collections. The NMAC will also explore the possibilities of a videotape-transmission alternative to the loan of films. Continuation of the 0AED/NMAC relationship will permit8409740_000041.txt

Page  41 2402 a number of active efforts within the health professional education community to increase the total output of innovative mediated instructional materials. Activity: Library Operations (Public Health Service Act, Title III Part I; Section 381) _________________________1974_____________________ 1973_________ Budget Estimate Pos Amount Authorization Pos- Amount 246 $8,371,000 Indefinite 242 $8,471,000 Purpose: Library Operations provides bibliographic, reference and loan services as a central resource for a nation-wide network for regional and local medical libraries. This network serves the health information needs of the nation's biomedical community. In addition, it compiles and pub- lishes catalogs, indexes, and bibliographies of published materials per- tinent to biomedicine. Explanation: This activity of the Library acquires and catalogs materials and indexes biomedical literature for incorporation into MEDLARS, the Library's computerized medical literature analysis and retrieval system. From the MEDLARS data base the Library publishes Index Medicus, 24 specialized bibliographies in the field of medicine, Abridged Index Medicus, and the Current Catalog of current books and technical reports. The Library also manages and coordinates a network of Regional Medical Libraries, domestic and foreign MEDLARS and MEDLINE stations. The History of Medicine Division acquires, organizes, and maintains historical source materials related to biomedicine. Accomplishments in 1973: The NLM provided 270,000 services in its dual capacity as a central backup to the Regional Medical Libraries and as one of the components of the network during FY 1973. In addition, through the regional libraries it has provided more than 450,000 document deliveries and MEDLARS services. It also published the Cumulated Index Medicus for 1972. In FY 1973, the implementation of domestic MEDLINE Centers continued and the phase out of the domestic MEDLARS Search Formulation Centers will be completed. The following additional on-line services will be provided by the MEDLINE system during Fiscal Year 1974: CATLINE (catalog on-line) will make NLM cataloging information available to the network; SERLINE (Regional Medical Library Network Serials Location File) will provide 5,000 biomedical serial titles, including location symbols, indicating their availability at over 100 libraries within the Medical Library Regions; SIDLINE (current month's citation to all journals indexed by NLM) will provide on-line searching of all citations from the forthcoming issue of Index Medicus several weeks before it is published and distributed. Retrieval of the full MEDLARS data base is being made possible in FY 1973 through supplementary MEDLINE files called Comfile and Backfile. Routine library services will continue at the level maintained in FY 1972. The Library will acquire 80,000 serial pieces and 50,000 mono- graphs, catalog 14,000 monographs, process 132,000 interlibrary loans (ILLS), publish 24 recurring bibliographies, bind 30,000 volumes and microfilm 1,500,000 pages of deteriorating documents. Objectives in 1974: The funding level and staffing for Library Operations has leveled ouf over the last few years. During FY 1974 Library Operations will continue evaluating and up-grading present procedures in an effort to increase productivity and insure more timely delivery of services. In FY 19748409740_000042.txt

Page  42 2403 the Library plans to process 132,000 ILL; 130,000 Regular Reference Services. The MEDLINE system will continue to grow in sophistication and number of users in the system. The Library plans to expand this service to every state in the Nation. Thus, the number of using institutions will be increased to 250 with a total of 140,000 searches performed. Activity: Toxicology Information (Public Health Service Act, Title III Part I; Section 381) ____________________1974____________________ ---- 1973----- Budget Estimate Pos Amount Authorization Pos Amount 16 $1,523,000 Indefinite 15 $1,523,000 Purpose: The Toxicology Information Program (TIP) Is responsible for developing and operating a computer-based toxicology information storage and retrieval system. It also issues publications and other information packages and provides services to satisfy the needa of other Federal agencies, universities and industry for toxicology information. Explanation; The TIP serves as a national resource for toxicological information by organizing data from diverse sources into computer-based files. It also provides state-of-the-art reviews, annotated bibliographies and literature search services. Accomplishments in 1973; In 1973, TIP made a new Toxicology Information Conversational On-line Network (TOXICON) available to the scientific community via terminals connected to a national communications system. Twenty organizations subscribed to the service on a pay-as-you-use basis. The data base of this system was substantially expanded in scope and now encompasses toxicology information on over 70,000 chemical substances including pesticides, environmental pollutants, and pharmaceuticals obtained selectively from over 10,000 journals. The Toxicology Information Response Center (TIRC) at the Oak Ridge National Laboratory, supported via an NLM/AEC agreement, completed over 500 literature searches for industrial, academic and governmental agencies. A fee-per-search charge was initiated, with payments being collected by the National Technical Information Service of the Department of Commerce, to recover part of the costs for this service. Completed search bibliographies having widespread scientific interest also were distributed to the public through the NTIS. TIP, through TIRC, released several new publications including state of the art reviews and a continuing bibliography. TIP also released an extensive "Drug Interactions Bibliography" in two volumes covering papers published from 1967-1971. Support was continued for the journal and com- panion tape service: Abstracts on the Health Effects of Environmental Pollutants. TIP also streamlined and brought in-house a major Chemical Abstracts Service's information system to improve the handling of data bases containing information about chemical substances. Objectives for 1974; The TIP will continue operation of the new-on-line system, TOXICON. The major information files now in this system will be updated quarterly but the rate of acquisition of new files will level off in order to stabilize operating costs. Efforts will be directed toward building toxicology data bases, with priority given to adverse drug reactions, drug interactions, environmental toxins such as pesticides and heavy metals, and hazardous household and industrial products. The activities of the Toxicology Information Response Center involving query response and preparation of reviews will be continued. Efforts will continue in 1974 as described in FY 1973.8409740_000043.txt

Page  43 2404 EXTRAMURAL PROGRAMS Program Purpose and Accomplishments Activity: Review and Approval (Public Health Service Act, Title III Part I; Section 381) 1974 ______1973______ Budget Estimate Pos Amount Authorization Pos Amount 32 $769,000 Indefinite 27 $769,000 Purpose: This activity provides support for staff to manage the six grant programs authorized by the Medical Library Assistance Act of 1970, as well as international activities of the NLM funded by the Scientific Activities Overseas appropriation. Explanation: The functions of this office include the processing of approximately 950 grant applications and their review by program officers; staff assistance to reviewing committees and the Board of Regents of the National Library of Medicine; grants management and direction; and program review and evaluation. Accomplishments in 1973; In 1973 this activity provided the administrative support and program leadership necessary for a coordinated approach to the review of library and information oriented grants. Administrative support was also provided for the approximately 230 awards made in fiscal year 1973. Objectives for 1974; The requested funding level is the same as the FY 1973 budget and would permit a continuation of activity close to the 1973 level. The reduction in positions will be accomplished by attrition. Activity: Program Direction (Public Health Service Act, Title III Part I; Section 381) _________________1974_______________ ■iiZl Budget Estimate pos. Amount Authorization Pos. Amount 54 $3,213,000 Indefinite 53 $3^137000 Purpose: This activity provides the program leadership and centralized administrative support necessary for the coordinated operation of the various NLM activities. Explanation: Program Direction provides support for the Immediate Office of the Director, Office of Administrative Management, Office of Public Information and Publications Management, and payment to the National Institutes of Health Management Fund for centrally furnished services. Accomplishments in 1973: In fiscal year 1973 this activity has continued to provide the overall scientific and administrative management of the NLM programs. Emphasis is being placed on conducting meaningful program analysis and evaluation of the impact of NLM support, as well as publica- tions management and program planning activities. Efforts in coordinating and developing biomedical communications systems and network prospects for DHEW are being expanded and assigned high priority. Included under this activity for 1973 is $72,000 for program evaluation. Objectives in 1974: Efforts will continue in 1974 as described in FY 1973.8409740_000044.txt

Page  44 2405 SUBCOMMITTEE RECESS Senator Magnuson. All right. Thank you very much. Tomorrow morning we are going to have the Secretary of Labor and on Friday morning we will try to finish up building and facilities and salaries and expenses, and then we are through with the review of NIH. [Whereupon, at 4:25 p.m., Wednesday, June 27, the subcommittee was recessed, to reconvene at 10 a.m., Thursday, June 28.]