1976 U.S. Senate Appropriations Committee Budget Testimony, 94th Congress 1st Session, July 20, 1975
Page  1

DEPARTMENTS OF LABOR AND HEALTH, pDUCATION, AND WELFARE AND RELATED AGENCIES APPRO- PRIATIONS FOR FISCAL YEAR 1976 HEARINGS BEFORE A SUBCOMMITTEE OF THE COMMITTEE ON APPROPRIATIONS UNITED STATES SENATE NINETY-FOURTH CONGRESS FIRST SESSION ON H.R. 8069 AN ACT MAKING APPROPRIATIONS FOR THE DKPARTMENTS OF LAP.OR AND HEALTH. EIHCATION, AND WELFARE AND RELATED AGENCIES, FOR THE FISCAL YEAR ENDING JUNE 30, 1970, AND FOR OTHER PURPOSES Printed for the use of the Committee on Appropriations PART 2—Pages 735-2189 ALCOHOL, DRUG ABUSE, AND MENTAL HEALTH ADMINISTRATION DEPARTMENT OF HEALTH, EDI (ATION, AND WELFARE Assistant Secretary for Health Health Resources Administration Health Services Administration National Institutes of Health 64-798 O U.S. GOVERNMENT PRINTING OFFICE WASHINGTON : li'Tr.8409741_000002.txt

Page  2 National Library of Medicine STATEMENT OF DR. CTTMMINGS, DIRECTOR BUDGET REQUEST Senator Magnuson. Now, the next one, National Library of Medi- cine, who is here for that ? Dr.Cummings, the. Administrator for the National Library of Medicine, the Director. For the record, you had $28,448,000 last year: you have $28,815,000, that's plus $367,000, is that correct? Dr. Cummings. That's correct, Mr. Chairman. Senator Magnuson. You don't have much to talk about, then, do you ? [Laughter.] Dr. Ccmmings. Well, I would like to talk about a few accomplish- ments and highlights of our program. Senator Magnuson. Off the record. [Discussion off the record.] Senator Magnuson. Go ahead. Dr. Cummings. I do want to start by thanking vou for the acknowl- edgement in your new book "How Much for Health", that gives credit to our library for providing some resource material. I would also like to inform the committee that after 2y2 years of system development the Medlars II computerized bibliographic ap- paratus is operational, and we are now serving 350 institutions throughout the country. LISTER HILL NATIONAL CENTER FOR BIOGRAPHICAL COMMUNICATIONS Importantly, however, Mr. Chairman, I would like to briefly men- tion some of the work being done at the Lister Hill, National Center for Biomedical Communication. As you probably know, the implenta- tion of the interactive satellite communications between the various elements of the WAMI consortium has been operational for some months. We believe the program is highly successful both from the point of view of assisting in patient care in Alaska, and, I think has an even greater, long-term potential, for the delivery of medical edu- cation to students who are based in Fairbanks, and Omak, and several other distant and remote settings. The Lister Hill Center has also recently concluded an agreement with the National Health Service Corps, through which we hope we will be able to provide informational material to the physicians who are accepting assignments in rural communities. We have already benin to improve the library resources within these communities, and are developing informational packages so that these young men won't feel isolated while practicing in rural settings. (1979)8409741_000003.txt

Page  3 1980 CANCERLINE Finally, I should mention that the National Cancer Institute has successfully transferred some of their data bases to our communica- tions network, so that the new system, which we call Cancerline, is now operational and providing services to cancer researchers not only in this country, but in several important settings abroad. I will be glad to answer any questions that you may wish to address. Senator Magnuson. Well, I just hope you have enough out there to assure the orderly development, stability of the communication sys- tem, the biomedical communications network. You do have enough? Dr. Cummings. We are not in a bad posture. Senator Magnuson. Well, I don't mean too much, but you'll get along with it. PERSONNEL Dr. Cummings. Our situation is not different from those of the Insti- tutes, I believe; our personnel requirements are greater today than the budget requirements. Senator Magnuson. Put in the record how much personnel you have. Dr. Cummings. Yes, sir, that data will be provided in the testimony of Dr. Lamont-Havers. Senator Magnuson. And how much on the outside, if you have any. Dr. Cummings. Those figures, will be provided, also. facilities Senator Magnuson. Now, what about your housing situation out there, are you pretty tight? Dr. Cummings. Yes, sir, the facilities of the National Library of Medicine are bulging because of an explosion of medical literature, and we are reaching the point where we require some major renova- tion or construction to accommodate our collection. lister hill building Senator Magnuson. What are your plans for a new building ? Inci- dentally, Doctor, I sent that reply down to Lister today. Dr. Cummings. You know, Mr. Chairman, this committee has for several years pressed me for the answer to the question when the architectural and engineering plans would be completed, and I can report to you that the final drawings have been completed. Senator Magnuson. That's the new Center; I sent that down to Lister. Dr. Cummings. That was an appropriate note. We will have these final drawings delivered to us next week, and they will be reviewed by my colleagues at NIH during the month of May. So, we are very pleased that that task is completed. Senator Magnuson. Yes; I think that's all right, you will be very pleased with it. But I do think you will have to be thinking about that because, golly, I haven't been out there for a long time, but when I was there in the place, it was bulging then.8409741_000004.txt

Page  4 1981 L)r. Cummings. I would be very pleased to have you come back Senator Magnuson. This committee has been concerned about the growing space problem within the National Library of Medicine and the need for a special-purpose communications facility. What is the current status of the architectural and engineering drawings for the Lister Hill Center Building? & & a What is the estimated cost for construction, and are there funds available in the fiscal year 1976 President's budget for this facility? Dr. Cummings. The final architectural and engineering drawings will be completed in May 1975. The $20 million necessary to construct this facility is not included in the fiscal year 1976 budget. Senator Magnuson. This committee has been deeply concerned that the need to quickly and effectively disseminate the results of research findings. As an information dissemination organization within the National Institutes of Health, what can the National Library of Medicine do to improve the current situation, and what additional resources would be required ? Dr. Cummings. In pursuing its overall objectives of assembling, analyzing, and distributing biomedical literature and audiovisuals, the National Library of Medicine has long been aware of the diffi- culties involved in bringing the fruits of research to health science professionals in a timely and efficient manner. NLM has been a pioneer in the systematic application of computer and communications tech- nology to facilitate the dissemination of such information. Advanced technology offers immense potential, but NLM realizes that people engaged primarily in health science research, education, or patient care do not generally have the time or resources needed to seek techni- cal solutions to their information problems. Accordingly, NLM's Lister Hill National Center for Biomedical Communications has attempted to act as an interface between the health professional on one hand and the computer or communications specialist on the other. The Cen- ter has many contacts with the medical community, and it has gained valuable experience in the development of communications networks for health care and the primary and continuing education of health practitioners. Starting from this base, and with appropriate funding and staffing levels, the Center would be in an excellent position to develop broadband interactive systems to carry NIH research sum- mary conferences to professional audiences in medical schools and .hospitals; assist in broadcasting "state-of-the-art" conferences to regional academic health centers; help implement effective campaigns for public health applications of research findings in areas such as high blood pressure and cancer detection; and assist in developing computer-assisted instructional programs for the continuing education of health professionals. The CAI programs, with content based on a systematic review of professional knowledge and patterns of practice, could be particularly useful in connecting NIH-supported regional demonstration centers with area health education centers and large community hospitals. To undertake initiatives such as the ones out- lined above, the Lister Hill Center would require at least $2 million8409741_000005.txt

Page  5 19182 additional funding in fiscal year 1976, and three additional specialized personnel to coordinate the increased effort. Senator Magnuson. The fiscal year 1976 budget for the National Library of Medicine shows a decrease of 7 positions from 475 to 468. In an organization that continues to have rising service require- ments and a need to increase its research and development efforts, what will be the effect of such a reduction ? Dr. Cummings. The reduction of seven positions will adversely affect NLM's ability to provide service. Before information can be of use to the biomedical community, it must be identified for acquisition, pur- chased, indexed, cataloged, and stored for easy retrieval. Over the past 8 years the number of volumes per each employee involved in these steps has gone from 18,500 volumes in 1968 to a projected 23,500 volumes in 1975. In the area of interlibrary loans, the workload per employee has risen from 3,600 in 1971 to 4,300 in 1973. These trends are likely to continue at an accelerated pace as budget and personnel restriction on libraries throughout the Nation force even greater reli- ance on the NLM. The reduction of these positions will reduce the quality and quantity of library information services which can be made available and thus have an impact on the national health effort. Senator Magnuson. Last year you informed us about the status of the copyright suit against the Government. Could you give us an update on that situation and your views on the current Senate copy- right legislation as it relates to your particular situation at the Na- tional Library of Medicine ? Dr. Cummings. In February 1975 the U.S. Supreme Court reviewed on appeal the copyright infringement suit brought against the Na- tional Library of Medicine and the National Institutes of Health by a publisher of medical and scientific journals. Since the Court divided equally and failed to write opinions either pro or contra, the effect was to let stand the ruling delivered bv the U.S. Court of Claims in 1973. That court held that NLM and NIH were not in violation of copyright by photocopying journal articles and disseminating them to interested health professionals. At the same time, the court suggested that a meaningful resolution of the broad issues involved in the case would best come from a comprehensive revision of the Copyright Act of 1909 to take into account the modern development of photo- copying technology. In January 1975 identical bills were introduced in both houses of Congress (S. 22 and H.R, 2223) which, although allowing very limited photocopying, apparently would prohibit the systematic reproduction of biomedical literature which is the founda- tion of the national medical library network. As it now stands, sec- tion 108(g) (2) of both bills would seem effectively to interdict the making of interlibrary loans through the use of photocopies. We think that such a. result would do incalculable harm to the national effort to advance thy arts and sciences and particularly would inhibit efforts to bring clinical and basic research findings rapidly and economically into the mainstream of health care- Senator Magnuson. Your medical library assistance program has made a very positive input to many health researchers. What are your plans for this in fiscal 1976 as compared to fiscal years 1975 and 1974?8409741_000006.txt

Page  6 1983 Dr. Cummings. We wish to continue our efforts to improve informa- tion access for health researchers. Such efforts include support for im- proved access to relevant data bases. We also wish to expand research and development to adapt and explore the capabilities of the new in- formation science and computer technologies for more rapid, more accurate access to information in all formats. We also wish to learn more about the fundamental process of communication among scien- tists. Research we have supported to date indicates that there is a strong, dynamic character in the formation of scientific research areas, and the clustering of researchers working on a common problem has implications for responsive information systems. However, stimulating appropriate research projects in the health information field has been a difficult task. Thus we are seeking the assistance of eminent information scientists to help define what re- search needs to be done as well as to identify persons and institutions where such projects could best be undertaken. Our efforts to aid the health research community must, of course, be seen in the context of our related responsibilities and interests in im- proving access to health information for clinical practitioners in medi- cine, dentistry, and the allied health professions. Here again, through research and development as well as resource project support, we hope to relate information access to growing needs for clinical data, re- search information, and health education materials. Our plan for fiscal year 1976, with the funding level proposed in the President's budget, is to make medical library and information re- sources more readily accessible to the health practitioners, educators, as well as to the health scientists. Senator Magnuson. Regarding the training programs within the medical library assistance programs and the Lister Hill Center: On what factual basis do you claim that by 1974 the critical shortage of medical librarians had been eliminated? Dr. Cummings. We have given considerable attention to medical librarianship as a subset of librarianship generally and have also con- ducted a study of our earlier medical librarianship training program. with particular reference to needs for training for the future. For at least a year now. it has been clear that in the field of librarian- ship, applicants exceed the number of jobs available. Recently the Civil Service Commission closed its register of applicants for librar- ianship positions in the Federal Government. Libraries, particularly science libraries, are for the most part supported by public authorities or academic institutions. Thev are forced to meet their growing fiscal difficulties by reducing budgets and staffs; the library activity seems to be particularly vulnerable. \ study we completed in December 19,3. showed that while our triinino- had been effective, many of the medical librarianship gradu- ates ha7l some difficulty finding positions in the medical field. This situation is likely to continue for the foreseeable future. We believe tliat our training funds should support projects to in- troduce new computer technologies to health professional education and clinical practice. In this important area, we have not yet reached as many individuals or institutions as desired. It is our ultimate goal8409741_000007.txt

Page  7 1984 to make modern information science and the use of the computer a part of every clinician's educational experience. Senator Magnuson. Is there any duplication of the National Li- brary of Medicine's information system with other NIH or HEW programs? Dr. Cummings. There is no duplication of the National Library of Medicine's information system with other NIH or HEW programs. The Library maintains continuing liaison with all NIH components to insure that the National Library of Medicine information programs support and complement those of the other institutes and bureaus. In the case of the National Cancer Institute and the National Institute of Neurological Diseases and Stroke, the National Library of Medicine's information processing and national network capabilities are used directly by them in support of their own information programs. The National Library of Medicine produces a series of continuing bibli- ographies for a number of NIH institutes. The National Library of Medicine chairs the DHEW interagency information committee which coordinates the toxicological informa- tional programs within the Department. This new committee has been a successful forum for precluding unnecessary duplication and for integrating the numerous toxicological information activities within the Department into a cohesive program that support all DHEW needs in this area. Senator Magnuson. You plan to increase user costs for your online services? How high will they go, and will these charges put a hardship on the small-scale user? Dr. Cummings. In response to the desire of Congress the National Library of Medicine initiated in 1973 user charges for its online serv- ices. The user charge is a nominal fee which is based on the concept of equal access and cost sharing. The user pays the communications costs to access our systems while appropriated funds are used to develop and maintain the data bases. It provides an appropriate degree of management control over the growth of the system thereby enabling the library to sustain the quality and performance of the system. At the same time it makes it possible for the continued growth by outside users to be largely independent of the library budget. Effective Julv 1, 1975, it is planned to implement a new fee schedule with variable rates of $15 per connect hour during prime time hours, and $8 per connect hour during nonprime hours. This rate schedule should help distribute more evenly the workload and insure continued acceptable perfor- mance. This newT fee schedule reflects full recovery of those costs out- side the walls of the library chargeable to the National Library of Medicine providing online services. If there are any future increases in fees, they would be based solely on this principle. The library is sensitive to the needs of the small-scale user and we are pleased to report that we have no evidence that the fees have put a hardship on small-scale users. Senator Magnuson. Are you working with all of the National In- stitutes of Health to use your programs for better health information dissemination ? Dr. Cummings. The National Library of Medicine has developed cooperative programs with several of the institutes of NIH for better8409741_000008.txt

Page  8 1985 health information dissemination. These include the National Cancer 1 "st jtute for information services related to cancer chemotherapy and carcinogenesis; National Institute of Neurological Diseases and Stroke, in fields of neurology, speech and communications disorders, and m Parkinsonism; National Institute of Arthritis, Metabolism and Digestive Diseases, in endocrinology, diabetes and gastroenterology, and artificial kidney; National Heart and Lung Institute, in cerebro- vascular diseases and hematologic diseases; and the National Institute of Child Health and Human Development, in reproduction physiology. AVe also work cooperatively with the Health Resources Administra- tion, the Health Services Administration, Food and Drug Adminis- tration, Veterans' Administration, and a number of other Federal health related agencies. Senator Magnuson. What projects do you presently support directly wtih other NIH Institutes? Dr. Cummings. The National Library of Medicine has a number of projects sponsored directly with NIH Institutes. These result in either the generation or dissemination of specialized data bases avail- able for specialist groups as well as published bibliographies in a num- ber of specialized areas. These include data bases such as cancerline, an online data base for carcinogenesis and for chemotherapy; the brain information service for neurology; speech, hearing, and com- munication disorders. In addition, the National Library of Medicine produces the following publications in cooperation with NIH Insti- tutes: Cerebrovascular bibliography; fibrinolysis, thrombolysis, and blood clotting; artificial kidney bibliography; Parkinson's disease and related disorders; and endocrinology index. The National Library of Medicine also produces 15 additional publications in cooperation with medical and professional societies. reduction in operating levels Senator Magnuson. Dr. Cummings, will the reduction in the operat- ing levels for 1975 and 1976 from that of earlier years adversely affect the biomedical information resources required as a part of our plans to improve health care delivery ? Dr. Cummings. The inflationary aspects of acquisitions, indexing, cataloging, etc., have been averaging about 12 percent per year. The effect of a level operating budget is a 10-12 percent cut in funds for the direct provision of services to the health community. The budg- etarv restriction combined with the equally important personnel re- striction puts us in the position of each year trying to meet a greater demand for services with relatively less money and unfortunately less people. Our ability to absorb through readjustment and reallocation is all but exhausted and from now on the net effect of inadequate fund- ing will be a deterioration in service to the health care delivery community. biomedical communications network Senator Magnuson. What additional grant funds would the Na- tional Library of Medicine require in order to assure an orderly devel- opment and stability of the biomedical communications network as8409741_000009.txt

Page  9 1986 more and more physicians turn to this source for aid in diagnosis, treat- ment, and other medical care ? Dr. Cummings. The biomedical communications network requires new nodes at the level of the health practitioner. Grants to support the organization of community hospitals for efficiently sharing resources and provide greater service are critical. In addition, grant money is needed to support the training of biomedical scientists in the disci- plines of computer and communications sciences so that available tech- nology can be more effectively used to meet the increasing need for information by the health practitioners. The strengthening of these resources both human and material are prime requisites in reducing the time between research discovery and application. justification Senator Magnuson. All right, thank you very much. We'll put your budget justification in the record. [The justification follows:]8409741_000010.txt

Page  10 1987 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 Parts I and J of Title III of the Public Health Service Act, [$28,450,000] $28,815,000. For the National Library of Medicine for the period July 1, 1976, through September 30, 1976, $6,572,000. Amounts Available for Obligation 1/ 1975 Estimate 2/ 1976 Appropriation....................... $28,450,000 $28,815,000 Comparative transfer to: "Office of the Director" (Trans- fer of Institutional Relations Branch from the Division of Research Grants, NIH Management Fund)............................ -2,000 -- Total Obligations............ $28,448,000 $28,815,000 1/ Excludes Che following amounts for reimbursable activities carried out by this account: 1975 - $1,500,000; 1976 - $2,000,000 2/ Excludes 1973 restoration in the amount of $182,0008409741_000011.txt

Page  11 1988 Summary of Changes 1975 Estimated obligations. 1976 Estimated obligations. Net Change....... 28,448,000 28,815,000 +367,000 1975 Base Pos. Change from Base Pos. Amount Increases: A. Built-in: 1. Annualization of 1975 Pay Cost Increases............. 2. Within-Grade Pay Increases... 3. FTS Rate Increase............ 4. Literature Acquisition....... 5. Increased Cost of Services and Supplies............... Subtotal Increases. B. Program: 1. MLAA - New Grants............ Total, increases...... Decreases: — $4,743,000 +125,000 +165,000 + 21,000 +100,000 + 15,000 +426,000 +334,000 760,000 A. Built-in: 1. Payment to National Institutes of Health Management Fund............ -- -- B. Program: 1. MLAA - Non-Competing Continuation Grants............................ --4,743,000 2. Lister Hill Nat'l Center for Biomedical Communications......... 26 -- 3. Nat'l Medical Audiovisual Ctr...... 102 -- 4. Library Operations................. 252 Total, decreases............ ---_____--- Total net change....... ________--- -7 •59,000 -334,000 -393,000 +367,0008409741_000012.txt

Page  12 1989 Explanation of Changes Increases: A. Built-in: 1. These increases will provide $125,000 for annualization of 1975 pay cost increases ($6,000 for the Lister Hill National Center for Biomedical Communications, $22,000 for the National Medical Audiovisual Center, $5,000 for the Office of Computer and Com- munications Systems, $30,000 for Library Operations, $6,000 for the Toxicology Information Program, and $56,000 for Research Management and Program Services); 2. $165,000 for within-grade pay increases ($10,000 for LHNCBC, $35,000 for NMAC, $85,000 for LO, $10,000 for TIP, and $25,000 for RM&PS); 3. $21,000 (RM&PS) for increased cost in 1976 for using the Federal Telecommunications System; 4. $100,000 (LO) for literature acquisition; 5. $15,000 (RM&PS) for increased costs of services and supplies; B. Program: 1. $334,000 (MLAA) for eleven new grants for training specialists to integrate computer technology into all phases of clinical medicine. A. Built-in: 1. A decrease of $59,000 in the assessment to the NIH Management Fund for centrally furnished services. B. Program: 1. A decrease of $334,000 for eight grants in the area of Medical Library Resources.8409741_000013.txt

Page  13 1990 Obligations by Activity 1971 1976" " Increase or Estimate Estimate Decrease _______________Pos. Amount Pos. Amount Pos. Amount Medical Library Assistance Total.............. --- 6,333,000 -— 6,333,000 --- Direct Operations: Lister Hill Nat'l Ctr. for Biomedical Com- munications : (a) Project contracts. -- 2,025,000 -- 2,025,000 -- -- (b) Other direct...... 26 669,000 23 685,000 -3 + 16,000 Nat'l Medical A/V Ctr: (a) Project contracts. — 325,000 --- 325,000 --- (b) Other direct...... 102 2,599,000 100 2,656,000 -2 +57,000 Library Operations: (a) Project contracts. --- 1,920,000 --- 1,920,000 --- (b) Other direct......252 8,094,000 250 8,314,000 -2 +220,000 Toxicology Information: (a) Project contracts. -- 940,000 -- 940,000 -- (b) Other direct...... 16 890,000 16 906,000 -— + 16,000 Research Management & Program Services: (a) Project contracts.-- -- -- -- -- -- (b) Other direct...... 79 4,653,000 79 4,711,000 — + 58,000 Subtotal....... 475 22,115,000 468 22,482,000 -7 +367,000 Page Ref. 307 309 312 313 315 317 Total Obligations... 475 28,448,000 468 28,815,000 +367,0008409741_000014.txt

Page  14 1991 Obligations by Object 1975 ___________ ^_______________Estimate Total number of permanent positions........ ^75 Full-time equivalent of all other positions................................ 40 Average number of all employees............ 534 Personnel compensation: Permanent positions...................... 8,246,000 Positions other than permanent........... 529,000 Other personnel compensation............. 117,000 Subtotal, personnel compensation...... 8,892,000 Personnel benefits......................... 814,000 Travel and transportation of persons....... 160,000 Transportation of things................... 24,000 Rent, communications and utilities......... 2,307,000 Printing and reproduction.................. 369,000 Other services: Project contracts........................ 5,210,000 Payment to NIH Management Fund........... 1,755,000 Other.................................... 1,346,000 Supplies and Materials..................... 298,000 Equipment.................................. 940,000 Grants, subsidies and contributions........ 6,333,000 Total obligations by object........ 28,448,000 1976 Estimate Increase or Decrease 468 40 527 -7 8,506,000 529,000 117,000 9,152,000 844,000 160,000 24,000 2,307,000 369,000 5,210,000 1,696,000 1,382,000 298,000 1,040,000 6,333,000 +260,000 +260,000 + 30,000 - 59,000 + 36,000 +100,000 28,815,000 +367,0008409741_000015.txt

Page  15 1992 Authorizing Legislation 1976 Legislation Public Health Service Act Section 381 - Purpose and Establishment of Library.............................. Health Services Research, Health Statistics, and Medical Libraries Act of 1974 Section 394 through 398................... Total.................... Appropriation Authorized Requested Indefinite $22,482,000 2/ $20,000,000 6,333,000 2/ $28,815,000 2/ Funding estimate only Budget Comparable Estimate House Senate Year to Congress Allowance Allowance Appropriation 1966 9,185,000 9,184,000 9,684,000 9,684,000 1967 19,231,000 20,154,000 20,254,000 20,254,000 1968 21,162,000 18,662,000 21,162,000 19,912,000 1969 19,172,000 16,997,000 19,020,000 18,008,500 1970 22,882,000 19,682,000 19,682,000 19,682,000 1971 19,769,000 19,843,000 22,307,000 20,843,000 1972 21,981,000 22,781,000 25,086,000 24,086,000 1973 24,994,000 28,488,000 28,988,000 28,488,000* 1974 24,994,000 25,796,000 25,796,000 25,426,000** 1975 27,738,000 28,048,000 29,348,000 28,448,000 1976 28,815,000 *Note: This appropriation authority was the continuing resolution. The appropriations amount was the House Allowance, which was the lower of the House or Senate amounts in the first vetoed bill. **Appropriation after reduction.8409741_000016.txt

Page  16 1993 National Library of Medicine Actual Budget Year Estimate to Congress House Allowance Senate Allowance Appropriation 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 21,440,000 1972 21,981,000 22,781,000 25,086,000 24,127,000 1973 28,568,000 28,568,000 29,068,000 28,568,000 1/ 1974 24,994,000 25,871,000 25,871,000 25,871,000 2/ 1975 27,738,000 21,768,000 3/ 29,350,000 28,450,000 1976 28,815,000 JL/ This appropriation authority was the continuing resolution. The appropriations amount was the House Allowance, which was the lower of the House or Senate amounts in the first vetoed bill. 2/ Appropriation after reduction. 3/ Excludes Medical Library Assistance Grants not considered by House due to lack of legislative authorization.8409741_000017.txt

Page  17 1994 Justification National Library of Medicine 1975 1976 Increase or Estimate Estimate Decrease Pos.____Amount_____Pos.____Amount_____Pos.____Amount Personnel compensation and benefits........ Other expenses........ Total............ General Statement The National Library of Medicine operates as the nation's principal national medical information resource by acquiring, organizing and distributing health related information in all forms. In order to adequately share this valuable health science information, NLM has developed a National Biomedical Communications Network to link major health care facilities, medical education centers and research institutions. It also has the specific responsibility to strengthen the nation's medical libraries and information services through resource, research, training and publication support. The NLM collects materials exhaustively in 40 broad biomedical areas and, to a lesser degree, in related subjects such as general chemistry, zoology, botany, and psychology. The Library continues to expand its on-line biblio- graphic retrieval system MEDLINE (MEDLARS on-line) to more fully serve the health community. This national and international telecommunication-based science information network now serves about 250 institutions throughout the United States and at points abroad. Additionally, CANCERLINE, an on-line data base of cancer related citations and abstracts provided by the National Cancer Institute, has been added to facilitate worldwide cancer research. The first half of FY 1975 saw the completion and acceptance of NLM's second generation computerized information system, MEDLARS II. This system is a greatly improved successor to the pioneering MEDLARS I, which had been in operation since 1963. With a much enhanced vocabulary capability, MEDLARS II will provide more efficient, specific, and rapid bibliographic information retrieval. It also will permit the entry of author abstracts of journal literature into the MEDLINE data base. Plans have been developed to increase the user charges from $8 to $15 per connect hour. This is being done to moderate growth of the system. Any excess proceeds will be returned to the U. S. Treasury. NLM's Lister Hill National Center for Biomedical Communications was established in 1968 with a mandate to develop networks and information systems to improve health education, medical research, and the delivery of health services. An additional role assigned was to serve as the focal point within DHEW for the development and coordination of biomedical communications networks. In attempting to perform these functions, the Center has been confronted with the question of how to produce the most benefit from its limited resources. This has not been an easy question to answer. The need for improved biomedical communications is great, and the Center is acutely 475 9,706,000 — 18,742,000 475 28,448,000 468 9,996,000 --- 18,819,000 468 28,815,000 -7 +290,000 + 77,000 -7 +367,0008409741_000018.txt

Page  18 1995 aware that many aspects of biomedicine could benefit from the application of advanced communications technology and programming. Constrained by limited levels of funding and manpower, however, the Center has been forced to choose projects carefully. Broadly speaking it will concentrate its major efforts in the area of communications for health professional education, with an emphasis on improving clinical proficiency and therefore the quality of health care. Also because of limited resources, the Center will continue to stress exploration and demonstration rather than sustained operational support. An educational mission lends itself far more naturally to such an emphasis than does any direct intervention in health care delivery or basic biomedical research. An added benefit of concentration in this area is that a small investment can have a proportionately greater impact. By "education" we do not mean merely the relatively brief span of time which a health practitioner spends obtaining his or her professional credential. The maintenance of proficiency in the health professions requires a lifetime of learning, and the Center will devote particular attention to the communications support for continuing education of practicing health professionals. In February 1975, the Lister Hill Center took a further step towards ful- filling its role as coordinator of a national biomedical communications network. In anticipation of a satellite to be launched jointly by the American and Canadian governments in December 1975, the Center hosted a meeting of representatives from all of DHEW's health agencies. The purpose was to inform them of the impressive capabilities of the new satellite and to stimulate planning in the health agencies for suitable programming. The satellite will provide nationwide, coverage and require relatively small ground terminals, thus offering a high degree of flexibility for two-way audiovisual programs between broadcasts. The National Medical Audiovisual Center (NMAC), located in Atlanta, Georgia, administers programs to improve the quality and facilitate the use of bio- medical audiovisuals in support of health care and education. In its efforts to enhance educational efficiency and innovation in schools of the health pro- fessions, NMAC seeks the advice of major national health professional organi- zations to ensure that its programs focus on the areas of greatest relevance to the biomedical community. Through its programs of medical library assistance, NLM provides grants for training, research, special scientific projects, publications, and medical library resources, and contracts for a national network of Regional Medical Libraries. Emphasis in the training program is on producing specialists who can integrate computer technology into all phases of clinical medicine—teaching, practice, and research. Research grants are intended to help medical libraries find more efficient means of meeting the biomedical information needs of the clinical, research, and academic communities which they serve. Resource grants support the establishment, expansion, and improvement of the basic collections and services of medical libraries. With this assistance, for example, libraries can acquire a core collection of monographs and journals most frequently needed by local health practitioners. This permits the small local library to meet the bulk of its users' information needs without the delays involved in borrowing from a more distant facility. In those few instances where the local library does not have the material requested, it can call on the nearest Regional Medical Library (RML). By helping to support a network of such RML's covering the entire nation, NLM guarantees smaller community medical libraries access to health science literature on the same basis as the larger libraries. Services provided by the RML's include document delivery and reference assistance. All of NLM's programs are based on the premise that effective communication and exchange of information among the world's scientists and health care8409741_000019.txt

Page  19 1996 practitioners will lead to better research and patient care with minimal dupli- cation of effort. More importantly, improved information transfer will narrow the gap between the generation of new knowledge in the laboratory and the application of that knowledge to the treatment and prevention of illness. The FY 1976 budget request will permit the National Library of Medicine to continue at approximately the same level of program activity as in the previous year. The areas in which there would be a shifting of emphasis and, in some cases, a modest expansion of on-going activity, are detailed below. Medical Library Assistance Programs Authorizing Legislation: Health Services Research, Health Statistics, and Medical Libraries Act of 1974 1975 1976 Increase or Estimate Estimate Decrease_____ No. of No. of No. of Awards Amount Awards Amount Awards Amount Non-competing Continuation Grants.. 63 4,743,000 55 4,409,000 - 8 -334,000 New Grants............. 59 1,590,000 70 1,924,000 +11 +334,000 Total............. 122 6,333,000 125 6,333,000 +3 NLM's programs of Medical Library Assistance are designed to meet the national need for more effective health information services. They provide grants to train professional personnel, improve resources and services of libraries, produce medical reviews and conduct research for improved application of infor- mation and communication technology. In addition, contracts assist in the development of a network of Regional Medical Libraries with the necessary resources and services to provide backup support locally for other medical libraries throughout the United States. Training grants have supported the education of medical librarians, bio- medical communications specialists, and other professional personnel essential to the health sciences information system. Over the past eight years the grants have supported the training of approximately 650 such individuals, most of whom now occupy positions of leadership throughout the country. By 1974 the critical shortage of medical librarians had been eliminated and program emphasis was shifted to the training of specialists who can effectively integrate computer technology into all phases of clinical medicine—teaching, practice, and research. Of the 11 grants funded in FY 1975, which supported the training of 55 individuals, all but two were in this area of interface between computers and medicine. In FY 1976 the emphasis will continue to be on training to involve health scientists in the medical applications of computers. Research grants support projects in medical library science, information science, biomedical communications, and educational technology. In FY 1975, for example, a team of physicians and information specialists was supported in the investigation of computer-aided decision making. Another research team studied the information needs of practicing physicians, particularly as related to their continuing education requirements. Approximately 30 more Research grants will be funded in FY 1976. Potential projects include studies8409741_000020.txt

Page  20 1997 of the impact of new information systems on health practitioners; the development of new information handling systems; and an analysis of educational technology and curriculum design as applied to the health sciences. Special Scientific Project grants support distinguished health scientists in the full-time analysis of major findings in their respective fields. Their results are published in monographs that facilitate the accessibility of their findings. Four awards were made in 1974 and three will be made in 1975. One review will cover the biologic and therapeutic aspects of one of the very few types of cancer for which chemotherapy has proven successful. The work suggests new theoretical insights which may be applicable to other types of malignancies. Another will provide a comprehensive, critical review of all literature con- cerned with hepatitis, a major cause of disability and death. Medical Library Resource grants are designed to assist in the improvement of the nation's health science libraries. These awards are not given to provide operating subsidies to libraries or to supplant existing support but are in fact intended to encourage increased financial support for the libraries by the institutions that they serve and the communities in which they are located. One-year, non-renewable improvement grants for up to $3,000 are made to health institutions—usually hospitals—which can demonstrate a need to establish basic collections and services. The FY 1976 budget estimate will support the award of 15 such grants. In addition to the one-year improvement grants, NLM awards a second type of Medical Library Resource grant. These project grants are funded for up to three years with a ceiling of $200,000 for any budget period. They are intended to make the growing scientific literature more readily accessible to health professionals throughout the nation and to introduce or demonstrate new information science technology. In FY 1976 NLM will fund an estimated 45 grants of this type. In FY 1975 Medical Library Resource grants have supported cooperative programs in which a strong library undertakes to provide training, consultation, and loan services for small community hospitals and clinics; studies on speeding the delivery of information through modern communications devices and automation techniques; and projects which, after an assessment of the actual information needs of health professionals, strengthen the information resources of an institution accordingly. In FY 1976 the grants will continue to complement NLM's Regional Medical Library program by upgrading the resources of local libraries within each region. In particular, NLM will support formal agreements among local hospitals to promote greater cooperation. The Library's Publication Grant Program provides support for non-profit studies in the biomedical sciences. One recent publication was the first of a series of collaborative reviews of allied health education and research, prepared by outstanding authorities in health care disciplines. Modern developments in medicine have created a need for new allied health specialists trained in increasingly complex technologies. This new series of collaborative reviews constitutes a timely appraisal of the situation and evaluates innovative programs for meeting the serious need for specialized health personnel. NLM contracts provide support for a national network of ten Regional Medical Libraries (RML's). The RML's, selected because of the depth and scope of their resources, provide an array of services which have clearly demonstrated that cooperative networking among health institutions of all types and sizes is not only feasible but economically imperative. The foundation of the developing network is the successful interlibrary loan program. Over 92 percent of the interlibrary loans made by the RML network are provided within four days of the receipt of the request. Reference, bibliographic, educational, and con- sultative services are also important activities of the RML's. The National8409741_000021.txt

Page  21 1998 Library of Medicine provides back-up service for the RML's and also serves as the RML for the Mid-Atlantic Region. By making available to the RML network its advanced on-line systems such as MEDLINE, SERLINE, and CATLINE, NLM considerably broadens the availability of bibliographic information in all parts of the country. The number of interlibrary loans supported by the RML's in FY 1975 remained at approximately the FY 1974 level of 500,000. The leveling off is indicative of strengthened resources at smaller, local libraries and increased sharing among them, which are important objectives of NLM's Medical Library Assistance programs. Utilization of and participation in the network by the health community is expected to increase substantially in FY 1976 for four major reasons: (1) health professionals have become increasingly aware of the utility and availability of interlibrary loans; (2) the continued development of MEDLINE will afford direct and greatly improved access by RML clients to a data base which is most relevant to a health professional's requirements; (3) many of the proposed national health care and health education systems, such as Health Maintenance Organizations, Area Health Education Centers, and Professional Standards Review Organizations, will place additional information requirements on health pro- fessionals; (4) the prohibitively high cost of purchasing biomedical literature will force smaller libraries to form local consortia which will satisfy a significant portion of the health information demands placed on them. While it is not anticipated that the federally subsidized interlibrary loans will increase in FY 1976, the main thrust of the program will be directed at refining the network at the local levels so that information needs can be met without sacrificing quality of service. Lister Hill National Center for Biomedical Communications 1975 1976 Increase or Estimate Estimate Decrease Pos . Amount_____Pos. Amount_____Pos. Amount Personnel compensation and benefits...,......... 26 541,000 23 557,000 -3 +16,000 Other expenses............. 2,153,000 -- 2,153,000 _______--- Total................. 26 2,694,000 23 2,710,000 -3 +16,000 The Lister Hill Center encourages the application of advanced computer and communication technologies to the solution of biomedical information problems. Microwave, cable television, data communications, computer-assisted instruction and satellite relay networks are among the experimental and operational technologies applied by the Center. 1. Satellite Communications: For the last several years the Center has supported an experimental satellite communications network in Alaska, where sparse settlement, rugged terrain, and severe climate make conventional com- munications difficult or impossible. The network, which utilizes a NASA Applications Technology Satellite (ATS-1), links remote native villages with Indian Health Service hospitals and medical centers in Alaska. A careful evaluation has shown a fourfold increase in the number of patients being treated with a doctor's advice since the network began. On the basis of that success, the Center has provided the Indian Health Service with projections for other telecommunications projects aimed at improving health care delivery and medical education.8409741_000022.txt

Page  22 1999 In FY 1975 the Center expanded the ATS-1 remote medical consultation network to support a series of experiments made possible by the recently launched ATS-6 satellite, which has greater capabilities than its predecessor. The ATS-1 com- munications link was broadened to connect native village clinics, medical centers and the Tanana, Alaska Hospital with the Indian Health Service information service in Arizona. Through this link-up the village clinics are able to obtain up-to-date medical records on all listed village residents, thereby greatly assisting the health professional in patient care. In addition, five of the ATS-1 voice terminals have been made into operational audio links for the ATS-6 experiments, which already have proven to be a major improvement to the Alaskan biomedical communications network. With the advent of the ATS-6 satellite, the communications network has acquired the capability for two-way live television transmission. Under the Center's direction, seven satellite telecommunications terminals have been installed and operated in the states of Alaska and Washington to support the ATS-6. Some of the studies are evaluating the effectiveness of live television consultation between physicians at Indian Health Service hospitals and small, remote clinics manned by health aides and other "physician-extender" personnel. Others are studying the use of interactive television communications in support of medical education. For example, interactive video, audio and physiological data transmissions have been used to link basic science students at the University of Alaska with students and faculty at the University of Washington Medical School. A similar linkup has connected the school with medical students receiving clinical training under physicians some distance away at Omak, Washington. The transmissions have included lectures and demonstrations, administrative and educational conferences, computer-assisted evaluation, medical consultation, grand rounds, and other continuing medical education programming. In FY 1976 the Center will continue its experimental use of satellite com- munications to promote more effective dissemination of medical information among students, practitioners, and research scientists. The ATS-6 medical education program will be extended to other institutions to support the decentralized medical school project and provide continuing education for physicians, residents, and allied health care personnel at remote sites. 2. New England Interactive Television Network: From June 1970 to October 1973, the Center supported a medical interactive TV network in New Hampshire and Vermont. The purpose was to evaluate the effectiveness of interactive TV for bringing formal classroom instruction, continuing education, and improved health care to rural settings. Now that its effectiveness has been demonstrated, the Center has been working to place the network on a self-sustaining basis. A management consulting firm has been retained to determine whether the individual and institutional users of the network value its services sufficiently to support them financially. In FY 1975 the network has continued to provide 40 hours of interactive programming per week to between 1,000 and 2,000 viewers at seven institutions. Emphasis during this period has been on beginning the transition to a fully self-sustaining operation, which has involved negotiations with the Federal Communications Commission, seven user institutions, and the primary contractor, Dartmouth Medical College. Although FY 1976 will be the last year of NLM funding for the network, information produced by the project will be invaluable in planning broadband biomedical communication networks in the future. 3. Computer-Assisted Instruction (CAI): In FY 1972 the Lister Hill Center initiated an experimental computer-assisted instruction (CAI) network. The network has connected computer data bases at Ohio State University, Massachusetts General Hospital and the University of Illinois Medical Center, with 80 other8409741_000023.txt

Page  23 2000 institutions, primarily medical schools. Programs offered over the network have been used for undergraduate, graduate, and continuing medical education for a variety of purposes: as an introduction to CAI, a complement to local CAI activities, a resource for experimentation in education, and a tool for remedial instruction. Users of the network have always had to provide their own computer terminals, communications costs to the nearest access point in the network, and salaries of participating faculty members. In February 1974, users began sharing com- munications costs more broadly, paying $5.00 per connect hour. The implementation of user charges has produced only transitory decreases in both the number of institutions and the hours of usage. The experiment in network distribution of particular computer-assisted instructional materials is scheduled to terminate in May 1975. Forty-five of the user institutions have formed the Health Education Network Users Group. This organization is working with the Lister Hill Center and the network contractors to make a transition to a network managed and financed by the users. At the same time, the Center is planning a broader involvement with the many problems inherent in using computer-assisted instruction in medical education. This will include translation and standardization of CAI formats, and evaluation both of the content of computer-assisted programs and of their educational effectiveness. 4. Continuing Education of Health Professionals: Continuing education is now recognized as an important means of conserving health manpower, upgrading the quality of medical care, and promoting the flow of new information to the health care community. There is general awareness that continuing education and the benefits derived from it occur most readily in the university setting. The problem is that the majority of health care professionals and the populations they serve are not located near academic health centers. There are however, latent educational resources available in .local community hospitals. The Lister Hill Center has postulated that continuing education can be improved by structuring programs among groups of hospitals to mobilize this latent resource. The Lister Center is encouraging the development of such hospital educational consortia, and is interested in developing appropriate communications systems for their most efficient operation. As a first step the Center has completed a study of several of the more effective consortia in current operation. It now plans to test selected communications systems and computer-assisted instruction programs in the community hospital environment. Goals will include: determining the critical mass of a functioning system and optimal mix of local, regional or national networks; selecting and testing appropriate communications modalities; and studying the administrative structure necessary for effective operation. The Center also will be participating with the Health Services Administration (HSA) in the creation of a Continuing Medical Education Program for the medical officers of the National Health Service Corps. The Center will support the development of an interactive communication system to make possible (1) the acquisition of new information and technical skills in family medicine, internal medicine, pediatrics, obstetrics and the treatment of trauma; (2) the periodic reassessment of cognitive knowledge; (3) consultative services for specific problems in the day to day practice of medicine; and (4) the development of a process for auditing the quality of patient care appropriate to both the ambulatory and the hospital setting. Another objective is to reduce the degree of professional isolation experienced by these physicians by developing rewarding patterns of self-learning, consultation, and evaluation. A third objective is to experiment with new methods of assessing the quality of professional services.8409741_000024.txt

Page  24 2001 National Medical Audiovisual Center 1975 1976 Increase or Estimate Estimate Decrease Pos. Amount______Pos. Amount Pos. Amount Personnel compensation and benefits............. 102 1,956,000 100 2,013,000 -2 +57,000 Other expenses............. ---_______968,000 _______968,000 ---_______--- Total................. 102 2,924,000 100 2,981,000 -2 +57,000 The National Medical Audiovisual Center (NMAC), located in Atlanta, Georgia, applies audiovisual technology to the special needs of biomedical scientists, practitioners, and educators. The Center's primary focus is to stimulate the development and use of effective audiovisual media in schools of the health professions and in the continuing education of health professionals. In FY 1975 NMAC worked closely with schools of the health professions and national professional organizations, such as the Association of American Medical Colleges (AAMC), to identify and develop applicable models of instructional media. By seeking the advice of informed professionals at the earliest stages of development, NMAC hopes to assure that the resulting products will be appropriate and actually utilized by the health professional community. Significant projects already have been carried out in anatomy, dentistry, and other disciplines. During FY 1975 NMAC responded to 3,000 inquiries for instructional media information and provided 65,000 film loans and 2,000 videotape duplicates of instructional programs. Technical assistance in the development or use of audio- visual media, equipment, and communications systems included 3,000 technical reports and instructional monographs; 280 site consultations and in-house working sessions; and 15 audiovisual technology workshops. The Center continued to develop its on-line bibliographic information retrieval system, AVLINE (Audio- visuals on-line), for operation on NLM's computer to be made available on NLM's nationwide on-line retrieval network. AVLINE will contain records of audiovisuals which have been evaluated as highly effective for instructional purposes. It will permit the health science educator to make a rapid, comprehensive search to locate the particular materials most appropriate to his needs. In FY 1976 the Center will study the latest developments in medical, dental, and allied health professional education as they relate to needs for more effective instructional systems. Close cooperation will continue with other Federal agencies, health professional school faculties, and professional organizations such as the AAMC and the Association of American Dental Schools. The Center also plans to initiate the development of an integrated series of medical course outlines. These will cover testing, teaching and learning of psychomotor skills, diagnosis of educational problems, and design of appropriate media and facilities. Courses to be offered using these curriculum guidelines will extend the potential reach of workshop programs to all health sciences professional schools. In an ongoing effort to develop, improve, and evaluate the products of audiovisual educational technology, the Center works closely with the Bureau8409741_000025.txt

Page  25 2002 of Health Resources Development, HRA. Specific program collaborations have in- cluded the production of instructional media for dentistry. Under the auspices of dental professional organizations, dental schools, and government agencies, this project has developed exceptionally effective instructional materials in operative dentistry which are now in use at most dental schools. Library Operations 1975 1976 Increase or Estimate Estimate Decrease Pos. Amount_____Pos. Amount_____Pos. Amount Personnel compensation and benefits............ 252 4,743,000 250 4,863,000 -2 +120,000 Other expenses............ 5,271,000 --- 5,371,000 — +100,000 Total................ 252 10,014,000 250 10,234,000 -2 +220,000 Library Operations is responsible for selecting, acquiring, indexing, cataloging, preserving and disseminating the world's output of biomedical literature. It provides access to the material through manual and machine produced bibliographies; furnished reference and loan services; prepares and publishes indexes, catalogs, and other publications for use by the biomedical community; and manages a national on-line information retrieval network. It also serves as the Regional Medical Library for the five-state Mid-Atlantic Region, and provides back-up service for the national Regional Medical Library Network as a whole. The FY 1976 budget request will allow Library Operations to provide basic services at approximately the same level as in FY 1975: acquiring 110,000 serial pieces and 20,000 monographs; indexing 225,000 biomedical articles for inclusion in the computerized MEDLARS data base; publishing 30 recurring bibliographies; binding 32,000 volumes; and providing 176,000 interlibrary loans, 97,000 reader services, 300,000 MEDLINE searches, and 175,000 off-line prints of MEDLINE searches. In support of the National Cancer Institute, the National Library of Medicine has agreed to add CANCERLINE, an on-line data base of cancer-related citations and abstracts to existing NLM on-line data bases. CANCERLINE data provided by NCI is now accessible via NLM's telecommunications network, thus facilitating worldwide exchange of information on cancer research. The Library's second generation computerized information system, MEDLARS II, was completed and accepted during the first half of FY 1975. MEDLARS II is a greatly improved and more sophisticated successor to the MEDLARS I system which had been in operation since 1963. Under MEDLARS II a greatly expanded vocabulary capability will make possible improved specificity for retrieving bibliographic information. The system also will provide more rapid access, improved programs for maintaining files, and greatly enhanced on-line retrieval. It stores profiles of users' information needs and provides monthly printouts directly from the computer of the latest literature on these subjects.8409741_000026.txt

Page  26 2003 In November of 1974 NLM's computer resources were expanded, making possible the extension of its on-line services to a broader segment of the health care community. Beginning in February 1975, direct access to the MEDLINE data base is being made available to over 70 of the largest pharmaceutical and health related chemical organizations. Approximately half of these companies have already been accessing NLM's TOXLINE data base. In addition, the increased resources make possible the further extension of on-line services to local and community hospitals as well* as to most of the major Veterans Administration and Armed Forces hospitals. A use connect charge ($8.00 non-prime time and $15.00 prime time) has been assessed in order to cover the added costs to the Library of providing on-line services. A new billing agreement has been established with the Commerce Department's National Technical Information Service (NTIS) to act as the billing and collecting agent for these services. The fees collected will be used by NTIS to offset the added costs incurred in making equal access and use of the on-line data bases available to any part of the United States. Any excess collections will be returned to the U. S. Treasury. During FY 1975 the Library renewed its agreements with eight international MEDLARS centers. Such centers have been established in the United Kingdom, Sweden, Germany, France, Canada, Australia, Japan and at the World Health Organization. These agreements have been updated to reflect the expanding capabilities available under the MEDLARS II system. In the past the Library has been receiving quid pro quo in the form of indexing of the foreign literature, which had been an important component of its computerized on-line MEDLARS system. In the new agreements the value of this quid pro quo has been increased from $30,000 to approximately $50,000 per year to reflect the increased capabilities which the MEDLARS II system provides. In addition to the indexing of scientific publications, the foreign centers are providing the necessary keyboarding of indexed material for input into NLM's computerized system. The foreign centers also provide subscriptions to the scientific publications which they are indexing. In addition, they will be providing author abstracts, which are being included for the first time in the MEDLARS data base and which will provide more definitive information to the user. The total value of this cooperative input which the foreign centers are providing is in excess of $400,000. In a number of instances the centers have opted to access the NLM computer directly through the biomedical communications network which now extends to several locations in Western Europe. Because of the time zone difference, such access from Western Europe occurs at different time intervals (3 a.m. to 9 a.m., E.S.T.) than the use requirements for domestic users, and thus does not impair NLM's ability to provide such services in the United States. NLM has expanded its cooperative cataloging program. Presently, five partners in the United States are contributing to NLM's cataloging data base, and NLM expects to include additional major medical libraries in the future. This will allow the Library to increase the amount of bibliographic and cataloging information announced to the biomedical community through its publi- cation, Current Catalog. The following are highlights of other major developments in FY 1975-1976: 1) In FY 1975 Library Operations has fully implemented its new INPROC file, which provides management information on acquisition and catalog production. During FY 1976 NLM hopes to make the data base available to the Regional Medical Library network and to book dealers throughout the nation. 2) In FY 1976 the Library will begin to index selected monographic literature for input into the MEDLINE data base. This will provide bibliographic access to individual chapters in addition to the customary entry provided by standard cataloging practices. 3^ NLM Plans to enhance its bibliographic data base further by entering approximately 100,000 English language abstracts into MEDLINE. This will greatly8409741_000027.txt

Page  27 2004 augment the utility of a system which already has gained wide and rapid acceptance in the health sciences community. 4) An on-line data base (AVLINE) on selected biomedical audiovisual materials is under development in cooperation with NLM's National Medical Audiovisual Center. Audiovisual material will be cataloged according to NLM cataloging standards and MEDLARS indexing rules. An abstract describing the material will be provided and a printed catalog of audiovisual citations will appear as a section in Current Catalog. Toxicology Information 1975 1976 Increase or Estimate Estimate___ Decrease Pos. Amount Pos. Amount Pos. Amount Personnel compensation and benefits............. 16 491,000 16 507,000 -— +16,000 Other expenses............. 1,339,000 --- 1,339,000 ______— Total................. 16 1,830,000 16 1,846,000 --- +16,000 The Toxicology Information Program (TIP) is responsible for collecting and organizing toxicology data from diverse sources and making the relevant infor- mation more readily accessible. TIP obtains information from the published scientific literature and the files of governmental, industrial, and academic organizations; organizes and enters the information into computerized storage and retrieval system; and where appropriate, provides products such as literature searches in specific areas of toxicology. On-Line Systems In FY 1975, TIP operated and maintained TOXLINE, its on-line bibliographic retrieval service. The system, which employs the NLM computer and MEDLARS software, achieved a file size of over 350,000 searchable citations, index terms, and abstracts derived from the published literature. The information included data on pesticides, pharmaceuticals, environmental toxins, and hazardous house- hold and industrial chemicals. A use fee of $15 per hour was charged for TOXLINE service, which in FY 1975 produced over 20,000 on-line searches and 145,000 pages of off-line print. This fulfills our commitment to pass on to the user those charges which result from transmission of information from the NLM to the user. TIP also operated CHEMLINE in FY 1975. This on-line file aids TOXLINE users by providing Chemical Abstracts Service Registry numbers and chemical nomenclature information for substances mentioned in the TOXLINE file. In addition, signifi- cant progress was made in building a third on-line retrieval file, the'Toxicology Data Bank, covering hazardous chemicals to which it is known that people are being exposed. TIP completed the basic design for this system, began extracting evaluated data from the literature, and entered records on 1,000 chemical com- pounds into a computer file.8409741_000028.txt

Page  28 2005 In FY 1976, TIP will enrich the TOXLINE file with additional references in areas of speciai significance, such as chemicals causing birth defects and cancer. Emphasis will be to service and assist more users from the health services community. Since existing NLM computer resources will limit the size of the TOXLINE file, TIP will reduce the number of years of literature searchable on-line to five and will provide the remainder for off-line batch searches. TIP will continue to operate CHEMLINE and to enhance it with additional on-line retrieval capabilities. The Toxicology Data Bank will be offered as a new on-line service with an initial file covering a broad spectrum of information on 1,000 chemical substances. This new service will allow scientists to coordinate widely differing attributes (e.g., chemical, biological, usage, and manufacturing) of hazardous compounds during on-line search. Through data exchange agreements worked out under the aegis of the Organi- zation of Economic Cooperation and Development (OECD), several European countries will contribute data in a common format to TIP's data bank, in an experiment on the cost-effectiveness of international collaboration in data base construction. TIP will conduct negotiations with institutions in several foreign countries in order to provide them with access to TOXLINE and CHEMLINE on a quid pro quo basis. In exchange for this service, the NLM will also receive specific toxicology data collected in these foreign countries for use in the Toxicology Data Bank. Specialized Services and Products In FY 1975 TIP provided input for the monthly abstract journal and companion tape service, Abstracts on Health Effects of Environmental Pollutants published by Biological Abstracts. TIP assigned Chemical Abstracts Service Registry Numbers to chemicals contained in its own files and those of several other Federal agencies, for the purpose of facilitating the use of such files for toxicology information retrieval. In collaboration with other agencies, TIP is maintaining a table linking the names (and CAS Registry Numbers) of over 1,200 hazardous compounds to the names of the agencies (e.g., NCI, DOT, and EPA) that are interested in specific compounds. The table is being made available to agencies in order to foster interagency coordination in scientific and regulatory activities. The computerized Name-Match system which TIP used in this effort was developed by it in cooperation with the Chemical Abstracts Service and the Computer Sciences Division of the Oak Ridge National Laboratory. Plans for FY 1976 call for the continued input of selected references from the NLM's MEDLARS data base for the abstract journal. TIP also will provide Name-Match services to other Federal agencies as needed. Toxicology Information Response Center In FY 1975, TIP supported the operation of the Toxicology Information Response Center (TIRC) at the Atomic Energy Commission's Oak Ridge National Laboratory. The Center, which partially recovers its operational costs by charging $50 per search, performed over 400 bibliographic literature searches in all areas of toxicology for the scientific community. The Center also sponsored several state-of-the-art reviews on topics of particular current interest in toxicology. The reviews were prepared by selected experts and published in Environmental Health Perspectives or other journals. In FY 1976 TIP will support the publication of reviews and annotated bibliographies. The emphasis will be on compounds of particular current importance in toxicology such as asbestos, arsenic, vinyl chloride, etc. Through the facilities of TIRC, TIP is establishing an extensive collection of published and unpublished documents on the biological effects of vinyl chloride and related compounds such as chloroprene, vinylidene chloride and epichlorohydrin.8409741_000029.txt

Page  29 2006 Collaborative Activities with Other Organizations Under the Toxicology Information Subcommittee of the DHEW Committee to Coordinate Toxicology and Related Programs, TIP carried out its responsibility for coordinating and developing special toxicology information activities in the Department. The initial project to be sponsored under the collaborative effort was a feasibility study to develop a data bank on base line responses in laboratory control animals. This collaborative effort has also involved the establishment of several interagency agreements whereby TIP provides various information services to other agencies. Plans for 1976 include the continuation of TIP's role in directing the activities of the Toxicology Information Subcommittee and in implementing the system and services identified as needs by this Subcommittee. Information services will be provided to other agencies under cost recovery agreements. These include: (1) a DHEW Toxicology Project Information System, which will help the Department and the agencies in identifying research activities in toxicology carried out under grants, contracts or in intramural projects; and (2) a Toxicology Data and Document Depository which will include (for distri- bution) toxicology data files and documents that now do not become part of the normal scientific publications system because of format, size or complexity. All systems and services sponsored by TIS and implemented by TIP will be funded through interagency sources via transfer of fund mechanisms. Research Management and Program Services 1975 Estimate 1976 Estimate Increase or Decrease Pos Amount Pos Amount Pos. Amount Personnel compensation 79 1,975,000 2,678,000 79 2,056,000 2,655,000 +81,000 -23,000 79 4,653,000 79 4,711,000 +58,000 This activity provides program management and centralized administrative support necessary for the coordinated operation of all NLM activities. It also manages NLM's international activities funded by the Scientific Activities Overseas Appropriation. Primary functions include the preparation and processing of grant applications for review committees and NLM's Board of Regents; public information and and publications management; financial and personnel management; program analysis and contracts management; administrative services; and coordi- nation of NLM's equal employment opportunity activities. This activity also includes funds for NLM's payment to the National Institutes of Health Management Fund. NLM has developed an on-line computerized information system which contains data on all grants awarded by NLM. In FY 1975 this data was used for general reporting of program activity and for detailed analysis and evaluation. NLM categorized each grant by program objectives to facilitate measurement of past and future performance. In addition, it undertook formal evaluation of three Medical Library Assistance programs—Regional Medical Libraries, Training Grants, and Medical Library Resource Improvement Grants.8409741_000030.txt

Page  30 2007 .* a k\S° ln 1975, Research Management and Program Services conducted a workflow study for the entire NLM; performed a major analysis of NLM computer operations- network!:8anlZed ^ °perational arrangements of NLM's biomedical communications' system" ZIVJ'^-.T^^ °5 *?'" C°ntalned ln Che c""P^erized information system, combined with recommendations from public advisors, will be used to Program Purpose and Accomplishments Activity: Medical Library Assistance (Health Services Research, Health Statistics, and Medical Libraries Act of 1974) ___________________1976________________ ---------12Z5.-------- Budget Estimate Pos- Amount Authorization Pos. Amount 6,333,000 20,000,000 — 6,333,000 Purpose: NLM's programs of Medical Library Assistance provide grants to train professional personnel, strengthen library resources, produce medical reviews, and conduct research in ways of improving information transfer. In addition, contracts provide a network of Regional Medical Libraries with the necessary resources and services to provide backup support locally for medical libraries throughout the United States. Explanation: Awards are made to individuals directly or to public or non- profit institutions. Accomplishments in FY 1975: Of the eleven training grants funded in FY 1975, which supported the training of 55 individuals, all but two were in the area of computer applications to medicine. Biomedical Scientific Publication grants continued to support the preparation and publication of non-profit studies aimed at increasing the availability of information needed by health researchers, educators, and practitioners. Research grants provided assistance for investigative projects in medical library science, information science, biomedical communications, educational technology, and the history of medicine. Medical Library Resource grants are designed to assist in the establishment, expansion, and improvement of the nation's health science libraries and to encourage increased financial support for such libraries by the communities in which they are located. In FY 1975 Resource grants emphasized support for cooperative programs in which a strong library undertakes to provide training, consultation, and loan services for small community hospitals and clinics. Regional Medical Library (RML) contracts support a national network of ten Regional Medical Libraries which serve as a backup resource for smaller medical libraries. The number of interlibrary loans made through the RML's in FY 1975 remained at approximately 500,000. Objectives for FY 1976: In FY 1976, training grants will emphasize the uses of computers in the health sciences. Also in FY 1976 NLM will award approximately 20 Publication grants of which 10 will be new or competing renewals. Approximately 30 more Research grants will be funded. Potential areas of study include the cost-benefit analysis of computer based information systems; the impact of new information systems on health practitioners; and the development of new information handling systems.8409741_000031.txt

Page  31 2008 The FY 1976 budget estimate will support the award of 25 Medical Library Resource Improvement grants for core journals and other basic informational materials needed in community health care institutions. In addition, an estimated 45 Medical Library Resource Project grants will be funded. The grants will continue to complement the NLM's Regional Medical Library program by upgrading the resources of local libraries within each region. In particular, NLM will support formal agreements among local hospitals to promote greater cooperation. Utilization of the Regional Medical Libraries by the health community is expected to increase substantially in FY 1976 and beyond because health professionals have become increasingly aware of the availability of interlibrary loans; the continued improvement of MEDLINE will afford direct access by RML clients to a data base which is most relevant to health care; and the prohibitively high cost of purchasing literature will force smaller libraries to rely more on inter- library loans from the RML network. The main thrust of the RML program will be in attempting to cope with the expected demand for services while maintaining a high level of quality. Activity: Lister Hill National Center for Biomedical Communications (Public Health Service Act, Title III, Part I, Sec. 381) _____________1976__________________ 1975 Budget Estimate Pos. Amount Authorization Pos. Amount 26 2,694,000 Indefinite 23 2,710,000 Purpose: The Lister Hill Center encourages the application of advanced computer and communications technologies to the solution of biomedical information problems. Explanation: The Center matches high priority needs with technological capa- bilities to develop experimental services and evaluate their effectiveness and feasibility. Accomplishments in FY 1975: The Center continued to support an experimental satellite communications network in Alaska utilizing a NASA Applications Technology Satellite (ATS-1). The network, which links remote native villages with Indian Health Service hospitals, has produced a fourfold increase in the number of patients being treated with a doctor's advice. In FY 1975 the Center expanded the ATS-1 remote medical consultation network to support a series of experiments made possible by the recently launched ATS-6 satellite, which has greater capabilities than its predecessor. Five of the ATS-1 voice terminals have been made into operational audio links for the ATS-6 experiments, which already have proven to be a major improvement to the Alaskan biomedical commu- nications network^ With the advent of the ATS-6 satellite, the communications network had acquired the capability for two-way live television transmission. Under the Center's direction, satellite telecommunications terminals have been installed and operated in the states of Alaska and Washington to support the ATS-6. Current programs are evaluating the effectiveness of live television consultation between physicians at Indian Health Service hospitals and remote clinics manned by health aides as well as the use of interactive television in support of medical education. The Center's New England Interactive Television network continued to provide 40 hours of interactive programming per week to between 1,000 and 2,000 viewers at seven institutions. Emphasis in FY 1975 has been on beginning the transition to a fully self-sustaining operation. Users of the Center's Computer-Assisted Instruction (CAI) network have always had to provide their own computer terminals, communications costs to the nearest access point in the network, and salaries of participating faculty members. In February 1974, users began sharing communications costs more broadly, paying $5.00 per connect hour.8409741_000032.txt

Page  32 2009 Objectives for FY 1976: The Center will continue its experiments with satellite communications to disseminate medical information among students, practitioners and research scientists. The ATS-6 Medical education program will be extended to other institutions to provide continuing education for physicians, residents, and allied health practitioners at remote sices. Although FY 1976 will be the last year of NLM funding for the New England Interactive Network, information produced by the project will be invaluable in planning broadband biomedical communication networks in the future. The Center plans to test selected Computer-Assisted Instruction programs in the community hospital environment. The experiment in network distribution of particular Computer-Assisted Instruction materials is scheduled to terminate in May 1975. Some 45 of the user institutions have formed the Health Education Network Users Group. This organization will continue to work with NLM and the network contractors to make the transition to a network managed and financed by the users. The center will be participating with HSA in the creation of a Continuing Medical Education Program for the medical officers of the National Health Service Corps. The Center will support the development of an interactive communication system which, among many other goals, will make possible the acquisition of new infor- mation and technical skills in family medicine, internal medicine, pediatrics, obstetrics, and the treatment of trauma. A major objective will be to reduce the degree of professional isolation experienced by these physicians. Activity: National Medical Audiovisual CenCer (Public Health Service Act, Title III, Part I, Sec. 381) 1976 1975________ Budget Estimate Pos. Amount Authorization Pos. Amount 102 2,924,000 Indefinite 100 2,981,000 Purpose: The National Medical Audiovisual Center (NMAC), located in Atlanta, Georgia, applies audiovisual technology to the special needs of biomedical researchers, practitioners, and educators. Its primary mission is to stimulate the development and use of audiovisuals in schools of the health professions and in the continuing education of health professionals. Explanation: NMAC functions as a clearinghouse for assembling, cataloging, and disseminating information on available instructional media; evaluates, acquires, and distributes materials appropriate for biomedical education; provides con- sultation and training in the use of instructional audiovisual technology, conducts applied research in instructional technology and systems; and develops prototype instructional media programs. Accomplishments in FY 1975: NMAC continued to work closely with schools of the health professions and with national professional organizations to identify and develop appropriate instructional media. The Center already has completed significant projects in anatomy, dentistry, and other health science disciplines. NMAC responded to 3,000 inquires for instructional media information and provided 65,000 film loans and 2,000 videotape duplicates of instructional programs. Technical assistance included 3,000 reports and instructional monographs; 280 site consultations and in-house working sessions; and 15 audiovisual tech- nology workshops. The Center also continued to develop and implement its on-line bibliographic information retrieval system, AVLINE (Audiovisuals on-line). Objectives for FY 1976: NMAC will study recent developments ln medical, dental, and allied health professional education as they relate to needs for more effective instructional systems. Close cooperation will continue with other8409741_000033.txt

Page  33 2010 Federal agencies, health professional school faculties, and professional organi- zations. NMAC will continue to identify, catalog, and index instructional media for inclusion in AVLINE, which will be made available through NLM's computi and its on-line retrieval network. The Center also plans to initiate the development of an integrated series of medical course outlines. Courses to be offered using these curriculum guidelines will extend the potential reach of workshop programs to all health sciences professional schools. Activity: Library Operations (Public Health Service Act, Title III, Part I, Sec. 381) ______________1976________________ Budget Estimate Authorization Pos. Amount Indefinite 250 10,234,000 Purpose: Library Operations is the NLM activity responsible for selecting, acquiring, indexing, cataloging, and preserving the world's output of bio- medical literature. It also serves as the Regional Medical Library for the five-state Mid-Atlantic Region and provides back-up service for the national Regional Medical Library Network as a whole. Explanation: Library Operations provides access to the material through manual and machine-produced bibliographies; furnishes reference and loan services; prepares and publishes indexes, catalogs, and other publications for use by the biomedical community; and manages a national on-line information retrieval network. Accomplishments in FY 1975: The Library acquired 110,000 serial pieces and 20,000 monographs; indexed 225,000 biomedical articles for inclusion in the computerized MEDLARS data base; published 30 recurring bibliographies; bound 32,000 volumes; and provided 176,000 interlibrary loans, 97,000 reader services, 300,000 MEDLINE searches, and 175,000 off-line prints of MEDLINE searches. Under an agreement with the National Cancer Institute, NLM added CANCERLINE, an on-line data base of cancer-related abstracts and citations provided by NCI, to existing data bases available through NLM's on-line network. This develop- ment should greatly facilitate worldwide exchange of information of cancer research. NLM's second-generation computerized information system, MEDLARS II, was completed and accepted in FY 1975. A sophisticated successor to the older MEDLARS system in operation since 1963, the new system will make possible much more specific and rapid bibliographic information retrieval. A use connect charge was assessed to cover the added costs to the Library of providing on-line services. Under a new agreement with NTIS, that agency will act as the billing and collecting agent for these services, with any excess collections being returned to the U. S. Treasury. NLM renewed agreements with 8 international MEDLARS centers which have been providing NLM with quid pro quo indexing of the foreign literature. In the new agreements the value of this quid pro quo has been increased from $30,000 to approximately $50,000 per year to reflect the increased capabilities which the MEDLARS II system provides. The foreign centers will provide subscriptions to the scientific publications which they are indexing, as well as author abstracts, which are biasing included for the first time in the MEDLARS data base. The total value of thtm coofttZAfeiv* input is in excess of $400,000. 1975_______ Pos. Amount 252 10,014,0008409741_000034.txt

Page  34 2011 Objectives for FY 1976: Basic library services will continue at approximately the same level as in FY 1975. Work will proceed to augment CANCERLINE with information on cancer research still in progress and to increase the number of citations and abstracts in the data base. NLM plans to include additional major medical libraries in its ongoing cooperative cataloging program, thus allowing the Library to increase the amount of information made available to the biomedical community through its publication, Current Catalog. Utilizing the enhanced capabilities of MEDLARS II, NLM will enter approximately 100,000 English language abstracts of biomedical journal literature into the MEDLINE data base. This additional information will greatly augment the utility of a system which already has gained wide and rapid acceptance in the health sciences community. Library Operations will cooperate with NLM's National Medical Audio- visual Center in developing an on-line data base of selected biomedical audio- visual materials (AVLINE). Audiovisual material will be cataloged according to NLM standards and MEDLARS indexing rules, and an abstract describing the material will be provided. In addition a printed catalog of audiovisual citations will appear as a section of.Current Catalog. Activity: Toxicology Information (Public Health Service Act, Title III, Part I, Sec. 381) 1976 1975 Budget Estimate Pos. Amount Authorization Pos. Amount 16 1,830,000 Indefinite 16 1,846,000 Purpose: The Toxicology Information Program (TIP) is responsible for collecting and organizing toxicology data from diverse sources and making the relevant information more readily accessible. Explanation: TIP obtains information from the published scientific literature and the files of governmental, industrial, and academic organizations; organizes and enters the information into computerized storage and retrieval systems; and provides products such as literature searches in specific areas of toxicology. Accomplishments in FY 1975: In FY 1975 TIP continued to operate and maintain TOXLINE, its on-line bibliographic retrieval service. The system achieved a file size of over 350,000 searchable citations, index terms, and abstracts derived from the published literature on topics such as pesticides, pharma- ceuticals, and environmental toxins. A fee of $15 per hour was charged for TOXLINE service, which in FY 1975 produced over 20,000 on-line searches and 145,000 pages of off-line print. TIP also made significant progress in building a Toxicology Data Bank covering hazardous chemicals to which people are presently being exposed. The program completed the basic design for this on-line retrieval system, began extracting evaluated data from the literature, and entered records on 1,000 chemical compounds into a computer file. TIP continued to provide input for the monthly abstract journal and companion tape service, Abstracts on Health Effects of Environmental Pollutants, and maintained support for the Toxicology Information Response Center at the AEC's Oak Ridge National Laboratory. The Center, which partially recovers its operational costs by charging $50 per search, performed over 400 biblio- graphic literature searches and sponsored several state-of-the-art reviews on topics of particular current interest in toxicology. The reviews were prepared by selected experts and published in Environmental Health Perspectives or other journals. As part of the DHEW Committee to Coordinate Toxicology and Related Programs, TIP has helped develop special toxicology information activities for the8409741_000035.txt

Page  35 2012 Department. One of these is a feasibility study for developing a data bank on base-line responses in laboratory animals. The collaborative effort also has led to several interagency agreements under which TIP provides information services to other agencies. Objectives for FY 1976: In FY 1976 TIP will enr'ch the TOXLINE file with additional references in areas of special significance, such as chemicals causing birth defects and cancer. Since existing NLM computer resources will limit the size of the TOXLINE file, however, TIP will reduce the number of years of literature searchable on-line. The Toxicology Data Bank will be offered as a new on-line service with an initial file covering 1,000 chemical substances. Plans for FY 1976 also call for the continued input of selected references from the NLM's MEDLARS data base for the abstract journal, Health Effects of Environmental Pollutants. TIP will continue support for the Toxicology Infor- mation Response Center for the publication of reviews and annotated bibli- ographies. The emphasis will be on particularly important areas of toxicology such as asbestos and vinyl chloride. The program also will continue to direct the activities of the Toxicology Information Subcommittee and to provide infor- mation services to other agencies under cost-recovery agreements. Activity: Research Management and Program Services (Public Health Service Act, Title III, Part I, Sec. 381) ______________1976________________ 1975 Budget Estimate Pos. Amount Authorization Pos. Anoun: 79 4,653,000 Indefinite 79 4,711,000 Purpose: This activity provides the overall program management and administrative support necessary for the National Library of Medicine. It also manages NLM's international activities funded by the Scientific Activities Overseas Appro- priation and provides for NLM's payment to the NIH Management Fund. Explanation: Primary functions include the preparation and processing of grant applications for review committees and NLM's Board of Regents; public infor- mation and publications management; financiafand personnel management; program^. analysis and contracts managementj^adntihistrative services; and coordination 5f NLM's equal employment opportunity activities. Accomplishments in FY 1975: NLM has developed an on-line computerized infor- mation system containing data on all of its grant awards. In FY 1975 the data was used for general reporting of program activity and for detailed analysis. NLM categorized each grant by program objectives to acilitate evaluation of performance. In addition, it undertook formal evaluation of the Regional Medical Library program and grants for training and for Medical Library Resource Improvement. NLM also conducted a workflow study for the Library; performed a major analysis of NLM computer operations; and reorganized the operational arrangements of NLM's biomedical communications network. Objectives for FY 1976: The data contained in NLM's computerized information system, combined with recommendations from public advisors, will be used to refine grant program objectives. In particular the evaluation of Medical Library Resource Improvement grants will continue in order to determine the advisability of modifying the program. NLM will process in excess of 400 grant applications.8409741_000036.txt

Page  36 2013 Amounts Available for Obligation 1976 Estimate Appropriation................................ $28,815.000 Total, obligations...................... 28,815,000 Interim Period $6,572,000 6,572,000 Obligations by Activity 1976 Pos. Estimate Interim Period Pos. Estimate Medical Library Assistance Total......................... Direct Operations Lister Hill Nat'l Center for Biomedical Communications: (a) Project Contracts.......... (b) Other Direct............... Nat'l Medical Audiovisual Center: (a) Project Contracts.......... (b) Other Direct............... Library Operations: (a) Project Contracts.......... (b) Other Direct............... Toxicology Information: (a) Project Contracts.......... (b) Other Direct............... Research Management and Program Services: (a) Project Contracts.......... (b) Other Direct............... Subtotal............. 6,333,000 2,025,000 23 685,000 325,000 100 2,656,000 1,920,000 250 8,314,000 940,000 16 906,000 79 4,711,000 870,000 495,000 23 170,000 75,000 100 670,000 480,000 250 2,130,000 250,000 16 225,000 79 1,207,000 468 22,357,000 468 5,702,000 Total Obligations........ 468 28,815,000 468 6,572,0008409741_000037.txt

Page  37 201* Obligations by Object Total number of permanent positions......... Full-time equivalent of all other positions. Average number of all employees............. Personnel compensation: Permanent position........................ Positions other than permanent............ Other personnel compensation.............. Subtotal, personnel compensation..... Personnel benefits.......................... Travel and transportation of persons........ Transportation of things.................... Rent, communications, and utilities......... Printing and reproduction................... Other Services: Project contracts......................... Payment to NIH Management Fund............ Other....................................... Supplies and materials...................... Equipment................................... Grants, subsidies and contributions......... Total obligations by object............ 1976 Interim Estimate Period 468 468 40 40 527 527 8,506,000 529,000 117,000 9,152,000 844,000 160,000 24,000 2,307,000 369,000 5,160,000 1,696,000 1,307,000 298,000 1,040,000 6,458,000 2,120,000 131,000 32,000 2,283,000 209,000 41,000 4,000 603,000 99,000 1,300,000 424,000 402,000 72,000 265,000 870,000 28,815,000 6,572,000 NARRATIVE 1976 Interim Budget Period The 1976 Interim Budget estimate of $6,572,000 is a reflection of the National Library of Medicine's commitment to maintain its on^-going programs at the FY 1976 level for the same period. The elements of the budget estimate were developed accordingly.8409741_000038.txt

Page  38 Office of the Director STATEMENT OF MR. SCHWARTZ, ASSOCIATE DIRECTOR INCREASES IN MANDATORY PERSONNEL COSTS Senator Magnuson. And now, Mr. Schwartz, I told you alreadv we don't need much testimony on the Office of the Director, we'll take a look at it and cut it accordingly. [Laughter.] But, I want you to explain your increase, put it in the record, based upon the fact that all of the other NIH programs are being allowed funds for mandatory costs; and are there enough funds in the budget to give grantees the mandatory costs. Can you answer that? Mr. Schwartz. Yes, sir. I think you are probably aware that the only increases in the Office of the Director appropriations have to do with the mandatory personnel costs. There are no increases in staffing. I think the implication of your question was that in terms of our extramural program, with a reduction, there clearly has not been an allowance for increased mandatory costs that might arise because of inflation in the institutions that we deal with. Senator Magnuson. Well, you put all that in the record, and we will submit some questions for the Buildings and Facilities office, and the Office of the Director, it's accounts. The reason I'm doing that. I'd like to get out of here in about 4 or 5 minutes. Mr. Schwartz. I'll take your advice to previous witnesses. Senator Magnuson. Yes; well, even if I suggest that, the committee may not agree with me. Mr. Schwartz. I understand. Senator Magnuson. Thank you all very much. Dr. Lamoxt-Havers. Mr. Chairman, in view of your interest in our dissemination of knowledge, I think you should see a booklet we have prepared on research. Senator Magnuson. I'll be glad to have that, Dr. Lamont-Havers. We'll be pleased also to send copies to other members of the committee. Senator Magnuson. I'll be glad to have it. Out of all the programs at the NIH, your budget increase is the greatest. How can you make such a proposal in light of the drastic reductions which you are proposing for research programs? Mr. Schwartz. The increases requested are entirely for mandatory items and do not provide for any program expansion. One-half of the increase provides for increased payments to the General Services Ad- ministration for buildings occupied by the National Institutes of Health and administered by the General Services Administration; the other half is for increased costs for centrally furnished services by the National Institutes of Health Management Fund, a full year's cost of (2015)8409741_000039.txt

Page  39 20116 the increased employees' pay costs which went into effect in October 01 1974, periodic step increases for employees who have performed satis- factorily and have been in grade the prescribed period of time, ana other like mandatory items. These increases are mandatory and must be paid. , Senator Magnuson. There are constant complaints about the length of time it takes the NIH to process the payments of its bills. What have you done to speed this up ? Mr. Schwartz. In view of the significant increase in health pro- grams since 1968, NIH has experienced an increase of 170 percent in vendor claims during this period. We expect to receive 350,000 claims for payment in fiscal year 1975. Recognizing that backlogs in payments were developing which had a deleterious effect on vendors and our busi- ness relationships, we established a work station concept whereby spe- cific employees are assigned responsibility for the examination and payment of all claims pertaining to a group of vendors; we increased the number of employees of the voucher payment staff, even in the face of overall cutbacks and have established an automated accounts pay- able file. We have also awarded a contract to design and implement a comprehensive materiel management system which will result in a fully responsive method for ordering, receiving, and payment for goods and services of the National Institutes of Health. Senator Magnuson. On the average, how long does it take a com- pany to receive payment for an item purchased by the NIH ? Mr. Schwartz. As of March 31, 1975, the average number of days required for a vendor to receive payment following the date of the invoice is 45 days. This is a 5-day improvement since June 30, 1974. Based on various actions underway, we expect to be able to process payments on an average of 30 days from receipt of invoices by June 30, 1975. Senator Magnuson. How many positions does your office propose to have for fiscal 1976 as compared to 1975 ? Mr. Schwartz. The 1976 budget for the Office of the Director con- tains 546 positions compared to 549 in 1975. Senator Magnuson. Grounds and buildings maintenance is a grow- ing area of concern to the committee as well as police protection. How many positions are you proposing for the Office of Administrative Services in fiscal 1976 as proposed to fiscal years 1975,1974, and 1968? Mr. Schwartz. The operation and maintenance of the National In- stitutes of Health facilities is the responsibility of the Division of Engineering Services. In 1968, this Divison had 650 positions, and 503 positions are proposed for 1976. Providing housekeeping and sani- tation services as well as police protection is the responsibility of the Division of Administrative Service. The Division of Administrative Services also provides the National Institutes of Health with other services such as procurement and supply services, telephone and com- munications services, operation and maintenance of motor vehicles, printing and reproduction services, et cetera. In 1968, the housekeep- ing and sanitation area had 168 positions, and 141 are budgeted for in 1976; also in 1968 we had 123 guard positions and in 1976 we will have 93. It should be pointed out that in 1968 we had 34 buildings to be pro- tected and approximately 1,400,000 square feet of floor space to be8409741_000040.txt

Page  40 2017 cleaned, where today we have 41 buildings to be protected and. over 2,100,000 square feet to be cleaned. In the Division of Administrative Services, we are proposing 728 budgeted positions for 1975 and 1976 compared to 729 in 1974 and 887 in 1968. Senator Magnuson. How many positions would it require to prop- erly staff the Division of Administrative Services? Mr. Schwartz. There are many factors that have to be weighed when determining proper staffing in the Division of Administrative Serv- ices. Some of the factors that we have to consider are the quality and timeliness of the services to be rendered; the degree of protection to be provided; the increased number of square feet maintained; any increased workloads; new and efficient labor saving devices, such as the remote control system for operating exterior doors of buildings and implementation of the material management system; workload standards and measurable items of productivity. It is difficult, there- fore, to give any precise response; however, an increase of between 5 and 10 percent would be a conservative estimate of the additional positions required to properly staff the Division of Administrative Services. Senator Magnuson. Your request of $3 million for buildings and facilities is the same as we provided in fiscal 1975. Will this be enough in light of the age of some NIH buildings and the repairs which may be necessary ? Mr. Schwartz. Our request of $3 million will be sufficient in 1976, but as the NIH physical plant continues to age it may be necessary to request an increase in these funds in the future. Senator Magnuson. Are there projects which should be undertaken that is not provided for in this budget request ? Mr. Schwartz. Within our current fiscal constraints, we have con- tinued to give a higher priority to program operations rather than to facilities. Therefore, we have no construction projects in this year's program. There is no question, however, that modern facilities con- tinue to be a major constraint at NIH, and we will continue to examine our priorities to determine when these projects can be funded. This list of projects within NIH includes: Child Health and Human Development Research Facility.—A. lab- oratory building to conduct research in the developmental sciences with principal emphasis in the areas of reproductive biology. The building would contain approximately 189,000 gross square feet of Lister Hill National Center for Biomedical Communications.—-Will contain approximately 200,000 gross square feet of space housing com- munications equipment for worldwide transmitting and receiving of medical data, computer facilities for data storage and retrieval, audio- visual development programs, and conference and office space. National Environmental Health Sciences Center—This project pro- vides for the initial development of a virgin site at the Research Tri- angle Park, N.C. The site development will provide roads, parking, utilities, and support facilities. The program space will provide 310,450 gross square feet of laboratories, animal areas, offices, and cafeteria.8409741_000041.txt

Page  41 2018 Ambulatory Care Facility.—An addition to the NIH Clincial Cen- ter to provide services for an increased number of outpatients. The addition is to be approximately 380,000 gross square feet of space. Master Utilities Extension.—Central utility systems to support the new facilities. Senator Magnuson. Last year, we asked about the environmental problems which the incinerator at NIH causes—how have you solved this? Mr. Schwartz. Well, we along with Walter Reed Army Medical Center are continuing our negotiations with Montgomery County re- garding the possible use of their proposed medical pathological in- cinerator. However, to alleviate the current problem, wre are planning to install a small packaged-type medical pathological incinerator on the NIH reservation which will take care of the disposal of this type of waste until the Montgomery County facility is in operation. PREPARED STATEMENT AND JUSTIFICATION Senator Magnuson. We will put your prepared statement in the record, together with the budget justification for the Office of the Director. [The statement and justification follow:]8409741_000042.txt

Page  42 2019 Mr. Chairman and Members of the Committee: The appropriation for the Office of the Director provides for the central executive direction and management of the various programs of the National Institutes of Health. Specifically, this appropriation includes: (X) The Director and his immediate staff and the offices responsible for program planning and evaluation and public and scientific communications; and (2) Supporting management functions, involving budget and financial management, personnel management, contracts and grants management, and management analyses and reviews. The functions and responsibilities of this appropriation are carried out through the offices of various associate, directors and their supporting staff. Research Management and Program Services The Director's immediate office includes his principal associates who assist him in policy development and coordination of the extensive extramural, intramural, and collaborative programs of ths Institutes and Research Divisions, and the programs of the National Library of Medicine. Staff offices responsible for program planning and evaluation and for public and scientific coramuuicatior.w surnort th'- Director in carrying out these responsibilities. The central management and program services financed by this appropriation support not only the overall management of the National Institutes of Health, but also provide a number of services to the individual Institutes and other operating components. Since most of the National Institutes of Health is located within a single geographical area, it is, therefore, expeditious and economical to provide a large number of management and program services on a consolidated central basis. These services financed through this appropriation include: budget formulation and execution, financial reporting and analysis;8409741_000043.txt

Page  43 2020 central accounting, voucher auditing and payment services for all of our appropriations and budget accounts; position classification and salary administration, equal employment opportunities, and a wide range of other personnel management services for over 11,000 employees; contracts and grants management services relating to more than 23,000 projects; and management studies and reviews which promote economies and efficiency of operations and insure effective application of policy and procedural controls throughout all of the operating components of the National Institutes of Health. The Office of the Director is talcing the lead in conducting manpower utilization studies to insure that, where measurable, productivity continues to increase as the complexity and size of the NIH program grows. Facility Rentals Included in this appropriation are funds to reimburse the GSA for NIH facility rentals in accordance with P. L. 92-313- This law provides that each agency occupying space assigned by GSA to reimburse the GSA for the space at a rate established by the Administrator and approved by 0MB. Appropriation Request Mr. Chairman, the appropriation request for the Office of the Director is $19,986,000 for 1976, an increase of $2,000,000 over the 1975 comparable level of $17,986,000. This requested increase of $2,000,000 does not provide for any program increase and is entirely- attributable to mandatory costs — that is, increased payments to GSA for facility rentals, increased payments to the NTH Management Fund, within-grade increases, annualization of the 1975 pay increases, and the like. Thank you. I shall be happy to respond to any questions you may have.8409741_000044.txt

Page  44 2021 The total 1976 increase for the Office of the Director is $2,000,000. This increase is entirely for mandatory items and consists of the following: (a) Increased payments to GSA for facility rentals......$1,010,000 (b) Increased payments to the NIH Management Fund to support common central services................... 493,000 (c) Annualization of pay increases...................... 191,000 (d) Within-grade pay increases........................*. 177,000 (e) Annualization of health benefits.................... 35,000 (f) Extra day of pay in 1976............................ 39,000 (g) Service and supply rate increases................... 39,000 (h) Bureau of Employment Compensation rate increase..... 2,000 (i) Postage increases................................... 9>000 (j) Federal Telecommunications System rate increase..... 5>000 Total mandatory increase $2,000,000 The NIH Institutes utilize the same strategy in budgeting for mandatory increases as the Office of the Director. Although the amounts will vary, many of the mandatory items for the Institutes and Office of the Director are identical. Justification Appropriation Estimate OFFICE OF THE DIRECTOB For expenses necessary for the Office of the Director, National Institutes of Health,C$17,000,000 3 $19,986,000 Funds advanced to the National Institutes of Health management fund from appropriations in this Act shall be available for the expenses of sharing medical care facilities and resources pursuant to section 328 of the Public Health Service Act and for the purchase of not to exceedCfourteen3thirteen passenger motor vehicles for replacement only. For "Office of the Director" for the period July 1, 1976, through September 30, 1976, $4,997,000.8409741_000045.txt

Page  45 2022 Office of the Director 1/ Amounts Available for Obligation 1975 1976 Estimate Estimate Appropriation............... $17,000,000 $19,986,000 Proposed supplemental.............. 326,000_________--- Subtotal, adjusted appropriation. 17,326,000 19,986,000 Comparative transfers from: "National Cancer Institute"........... "National Heart and Lung Institute"... "National Institute of General Medical Sciences"........................... "National Institute of Child Health and Human Development".............. "Fogarty International Center"........ (Transfer of funds for Public Affairs Reorganization) "National Cancer Institute"........... "National Heart and Lung Institute"... "National Institute of Dental Research" "National Institute of Arthritis, Metabolism and Digestive Diseases".. "National Institute of Neurological Diseases and Stroke"................ "National Institute of Allergy and Infectious Diseases"................ "National Institute of General Medical Sciences"........................... "National Institute of Child Health and Human Development".............. "National Institute of Aging"......... "National Eye Institute".............. "National Institute of Environmental Health Sciences".................... "Fogarty International Center"........ "National Library of Medicine"........ (Transfer of the Institutional Relations Branch from the Division of Research Grants, NIH Management Fund) Total obligations............... 17,986,000 19,986,000 l/ Excludes the following amounts for reimbursable activities carried out by this account: 1975 - $9,100,000; 1976 - $9,100,000. 55,000 37,000 30,000 25,000 45,000 78,000 111,000 9,000 65,000 44,000 37,000 58,000 36,000 4,000 17,000 6,000 1,000 2,0008409741_000046.txt

Page  46 2023 Summary of Changes 1975 Estimated obligations...................................... *17 Qgg qqq 1976 Estimated obligations...................................... 1Q qQ£ qqq Net change............................................ +2,000,000 1975 Base Change from Base Pos. Amount_____Pos. Amount Increases: Built-in: 1. Facility rentals............................. ___ +^ Q Q 00Q 2. Payment to NIH Management Fund............... ___ +493*000 3. Annualization of pay increases..............- ___ +191,000 4. Within-grade pay increases............. — __- ._. +177*000 5. Annualization of health benefits............. — +35*000 6. Extra day of pay................................ +39!oOO 7. Bureau of Employment Compensation, Federal Telecommunications System, postage, and service and supply rate increases............................ ...... _______+55,000 Total, increases............... ...... .._ +2,000,000 Decreases: Program: 1. Research management and program services............................. 5^9 $17,986,000 -3 Total, net change............................ — --- .3 +2,000,000 Explanation of Changes Increases: Built-in « The increase of $2,000,000 will provide $1,010,000 for increased payments to GSA for facility rentals; $493,000 for increased payments to the NIH Management Fund; $191,000 for annualization of the pay increases; $177,000 for within-grade pay increases; $35,000 for annualization of health benefits; $39,000 for an extra day of pay in 1976; and $55,000 for Bureau of Employment Compensation, Federal Telecommunications System, postage, and service and supply rate increases. ___________________________Obligations by Activity___________________________ 1975 1976 Increase or Page Estimate Estimate Decrease Ref. Pos. Amount Pos. Amount Pos. Amount_______ Research management and program services 549 $17.986,000 546 $19,986,000 -3 +$2,000,000 Total obligations....... 549 17,986,000 546 19,986,000 -3 +2,000,0008409741_000047.txt

Page  47 2024 Obligations by Object 1975 Estimate 1976 Estimate Increase or Decrease 549 546 -3 56 56 -- 579 579 Total number of permanent positions................. Full-time equivalent of all other positions........... Average number of all employees................. Personnel compensation: Permanent positions.......... $9,326,000 Positions other than permanent.................. 524,000 Other personnel compensation. 219»000 Subtotal, personnel com- pensation............... 10,069,000 Personnel benefits............. 940,000 Travel and transportation of persons...................... 129,000 Transportation of things....... 6,000 Rent, communications and utilities.................... 3,748,000 Printing and reproduction...... 323,000 Other services: Payment to NIH Management Fund....................... 1,952,000 Other........................ 585,000 Supplies and materials......... 132,000 Equipment...................... 102,000 Total obligations by object..................17,986,000 ),665,ooo +$339,000 532,000 +8,000 222,000 +3,000 10,419,000 +350,000 1,017,000 +77,000 129,000 — 6,000 — 4,772,000 +1,024,000 323,000 -- 2,445,000 641,000 132,000 102,000 +493,000 +56,000 19,986,000 +2,000,0008409741_000048.txt

Page  48 2025 Comparable Year Budget Estimate to Congress House Allowance Senate Allowance Appropriation 1970 $7,930,000 $7,930,000 $7,930,000 $7,930,000 1971 10,886,000 • 10,886,000 10,886,000 10,886,000 1972 11,324,000 11,324,000 11,324,000 11,324,000 1973 12,423,000 12,423,000 13,423,000 1/ 12,423,000 1974 12,993,000 12,993,000 12,993,000 12,993,000 1975 18,784,000 18,554,000 17,660,000 17,660,000 Proposed Supplemental 326,000 1976 19,986,000 l/ This appropriation was the continuing resolution. The appropriation amount was the House Allowance, which was the lower of the House or Senate in the first vetoed bill. Actual Year 1970 1971 1972 1973 1974 1975 Proposed Supplemental 1976 Budget Estimate to Congress $7,093,000 8,206,000 11,442,000 12,042,000 12,000,000 18,124,000 326,000 19,986,000 House Allowance $7,093,000 8,206,000 11,442,000 12,042,000 12,000,000 17,894,000 Senate Allowance $7,093,000 8,206,000 11,442,000 13,042,000 12,000,000 17,000,000 Appropriation $7,323,300 8,903,000 11,712,000 12,042,000 12,000,000 17,000,000 ±1 1/ This appropriation was the continuing resolution. The appropriation amount was the House Allowance, which was the lower of the House or Senate in the first vetoed bill.8409741_000049.txt

Page  49 2026 Justification Research management and program services 1975 1976 Increase or Estimate Estimate Decrease Pos- Amount Pos- Amount_____Pos. Amount Personnel compensation and benefits.......... 549 $11,009,000 546 $11,436,000 -3 +$427,000 Other expenses......... — 6,977,000 — 8,550,000 — +1,573,000 Total............. 549 17,986,000 546 19,986,000 -3 +2,000,000 General Statement The Office of the Director appropriation provides for: (l) the overall direction of the National Institutes of Health, including the immediate office of the Director and the offices responsible for program planning and evaluation, and scientific and public communications; and (2) supporting management services including financial management, personnel management, management policy and review, and grant and contract management. The 1976 budget provides for no program increases. The only increases requested are mandatory increases which will permit the Office of the Director to operate at the 1975 comparable level. Program Plans for 1975 and 1976 Executive direction of NIH will reflect a continuing emphasis on making the NIH organization an effective Instrument for furthering and coordinating programs in support of biomedical research. This involves the collection and evaluation of data, the review and analysis of program issues and proposals, the appraisal of on-going programs, the development of policy position papers and the preparation of long-range program plans, as well as the preparation of information and its dissemination to the scientific and educational communities and to the general public. The central management services financed by this appropriation support not only the overall direction and management of NIH but also provide a number of services to the individual Institutes and the other operating components of NIH. Financial management includes budget formulation and execution, financial reporting and analysis, grant payment and settlement, and accounting and voucher auditing for over 1,000 cost centers. Personnel management provides over 11,000 employees with a wide variety of personnel services, including training and employee development, classification and salary adminis- tration, employee and labor relations, equal employment opportunities, and recruitment and placement of a great variety of professional and support jobs. Management studies and reviews are undertaken to promote economy and efficiency of operations and to identify possible weaknesses in policy and procedural controls. The central contracts and grants office provides policy ■ leadership and guidance in the review and servicing of over 23,000 active on-going projects. The requested mandatory increase of $2,000,000 consists of $1,010,000 for increased payments to GSA for facility rentals; $493,000 for in- creased payments to the NIH Management Fund; $191,000 for annualization of the 1975 pay increases; $177,000 for within-grade pay increases; $35,000 for annualization of health benefits; $39,000 for an extra day of pay, and $55,000 for Bureau of Employment Compensation, Federal Telecommunications System, postage and service and supply rate increases.8409741_000050.txt

Page  50 2027 Program Purpose and Accomplishments Activity: Research management and program services -i2Il 1975 Budget Estimate Pos- Amount Authorization PoTT Amount 5^9 $17,986,000 n/a 5U6 $19,986,000 Purpose: The purpose of this activity is to provide overall program direction and central management services to the Bureaus, Institutes and Divisions of the National Institutes of Health. Explanation: The functions and responsibilities of this activity are carried out through the offices of various associate directors and appropriate office directors with the aid of staff specialists and operating personnel. Accomplishments in 1975: (l) Completed and made available for distribution the NIH Equal Employment Opportunity Manual. (2) Developed a quarterly review and reporting of progress by organizational units in the Affirmative Action Plan. (3) Made the reorganized Public Affairs Office fully functional and carried out many of the activities which were formerly the responsibility of the BID's. (4) Improved liaison with grantee institutions. (5) Prepared testimony and reports to Congress and prepared background material on major legislative issues. (6) Developed legislative proposals for the following pieces of legislation that will expire on June 30, 1975: National Heart, Blood Vessel, Lung, and Blood Act; National Sickle Cell Anemia Prevention and Control Act; and National Cooley's Anemia Prevention and Control Act. (7) Studied the feasibility of developing a methodology for allocating national expenditures for biomedical research by disease category and health problems. (8) Initiated systematic assessment of the impact of NIH, other Federal, and non-Federal support upon the research and research training capabilities of major academic and research institutions. (9) Developed more effective mechanisms for projecting future manpower supply/demand relationships. (10) Planned for a solid framework for comparing U.S. funds for biomedical research with outlays of major industrial and developing nations, (ll) Developed and implemented a productivity and manpower measurement system. (12) Provided leadership in developing an improved strategy for dissemination of NIH research fundings. (l3) Nfaintained and expanded the Management Data Book. (l4) Established one centrally located office for all permanent changes of station, both civilian and Commissioned Corps, thus enabling all prospective travelers and administrative offices to obtain policy and current travel order 6tatu6 information in a more efficient manner. (15) Served as the Project Office for the design and implementation of the NIH Material Management System. Objectives for 1976: (l) To provide for comprehensive planning, priority setting, resource allocation, and reporting and evaluation of program results. (2) To continue to respond to intensified Congressional interest in health, greater participation on task forces, development of regulations for the protection of human subjects in biomedical research, and increased court activity on freedom of information. (3) To effect an increase in the total number of minority and women professional placements in each BID and to increase their participation in policy and decision making areas throughout NIH. (4) DFM will serve as the Project Office for a Service and Supply Fund Uniform Cost Accounting System scheduled to be on-going in 1976. (5) An attempt will be made to computerize Central Budget Office formulation data to assist in the completion of 0MB schedules and DHEW preliminary budget estimates. (6) Continued improvement in financial reporting by improving paper flow where possible and updating existing systems a6 new computer8409741_000051.txt

Page  51 2028 technologies are developed. (7) Expand the use of microfilm as a technique for internal data exchange and use for historical record keeping and to reduce the paper flow throughout DFM operations. (8) Coordinate systems programs with DHEW Regional Accounting Systems and Central Registry Systems for purposes of continued compatability. (9) Complete evaluation of the Upward Mobility Program and to redesign this program to meet the specific needs of NIH. (10) To complete development and implementation of a comprehensive Executive Development Program, (ll) To promote excellence in the NIH research contracting and grants management program by continuing review and evaluation of BID contracting operations to develop the highest level of quality and by an intensified program of appraisal of institutional management of NIH grant funds. Amounts Available for Obligation" 1976 Interim Estimate Period Appropriation............................... $19,986,000_______$4,997,000 Total, obligations..................... 19,986,000 4,997,000 1/ Excludes the following amounts for reimbursable activities carried out by this account: 1976 - $9,100,000; Interim Period - $2,275,000. Obligations by Activity 1976" Interim Estimate Period_____ Pos._____Amount______Pos._____Amount Research management and program services..... ^46 $19,986,000 546 $4,997,000 Total obligations......... 546 19,986,000 546 4,997,0008409741_000052.txt

Page  52 2029 Obligations by Object 1976 ______Estimate______ Total number of permanent positions......................... Full-time equivalent of all other positions................... 56 Average number of all employees..... 579 Personnel compensation: Permanent positions............... $9,665,000 Positions other than permanent.... 532,000 Other personnel compensation...... 222,000 Subtotal, personnel compensation................. 10,419,000 Personnel benefits.................. 1,017,000 Travel and transportation of persons........................... 129,000 Transportation of things............ 6,000 Rent, communications and utilities.. 4,772,000 Printing and reproduction........... 323,000 Other services: Payment to NIH Management Fund.... 2,445,000 Other............................. 641,000 Supplies and materials.............. 132,000 Equipment..........................._____102,000 Total obligations by object.... 19,986,000 Interim Period 546 14 145 $2,416,000 133,000 56,000 2,605,000 254,000 33,000 2,000 1,193,000 81,000 611,000 159,000 33,000 26,000 4,997,000 Justification The estimate for the three-month interim period reflects a continuation of the programs of the Office of the Director consistent with the 1976 estimate. Estimates for individual programs and mechanisms were based on historical accounting data for the first quarter of FY 1975 modified by program impact of the FY 1976 estimate.8409741_000053.txt

Page  53 2030 Justification Appropriation Estimate BUILDINGS AND FACILITIES For construction of, and acquisition of sites and equipment for, facilities of or used by the National Institutes of Health, where not otherwise provided, $3,000,000, to remain available until expended. For "Buildings and facilities" for the period July 1, 1976, through September 30, 1976, $750,000 to remain available until expended. Amounts Available for Obligation 1975 1976 Estimate Estimate Appropriation........................................... $ 3 ,000,000 $ 3,000,000 Unobligated balance, start of year...................... 17,517,553 8,423,976 Unobligated balance, end of year........................ -8.423.976 -4.446.976 Total, obligations.................................. 12,093,577 6,977,000 Summary of Changes 1975 Budget Authority................................................... $3,000,000 1976 Budget Authority................................................... 3.000.000 Net Change.......................................................... -- Increases: A. Program 1. Repairs and improvements, plant................................ +$1,000,000 2. Repairs and improvements, program.............................. +2.000.000 Total, increases........................................... +3.000.000 Decreases: A. Program 1. Repairs and improvements , plant................................. _1 QOO ,000 2. Repairs and improvements, program............................... -2.000.000 Total, decreases............................................ -3.000.000 Total, net changes8409741_000054.txt

Page  54 2031 Explanation of Changes ^Sr^e^es. The $3,000,000 increase includes: $1,000,000 for continuation ° the plant repairs and improvements program and $2,000,000 for renal™ a„,T improvements for program activities. repairs and l;0;;;;;;;";"' The fcrease °f $3,000,000 i8 cc^ed of new fUnding ProVided repaid aZ ** ! *«P™v««»t» *°* P^nt facilities and $2,000,000 for repairs and improvements related to program activities. ' ________________,____________Obligations by Activity __________________ Pafe 1975 1976 Increase or ML:----------________,___________________Estimate______Estimate______Decrease Research facilities................. $4,314,655 $ 180,000 -$4,134,655 Service and administrative facilities........................ 7.778.922 6.797.000_______-981.922 Total obligations......................... 12,093,577 6,977,000 -5,116,577 Obligations by Object Increase 1975 1976 or Estimate Estimate Decrease NATIONAL INSTITUTES OF HEALTH Other services................................ $11,334,053 $6,917,000 -$4,417,053 ALLOCATION TO GENERAL SERVICES ADMINISTRATION Other services................................ 759.524______60.000 -699.524 Total obligations by object................... 12,093,577 6,977,000 -5,116,5778409741_000055.txt

Page  55 2032 Buildings and Facilities Budget Estimate House Senate Year to Congress Allowance Allowance Appropriation 1966 $ 7,781,000 $ 9,431,000 $ 8,977,000 $ 8,977,000 1967 18,279,000 18,279,000 18,279,000 18,279,000 1968 10,715,000 10,715,000 15,075,000 10,715,000 1969 12,495,000 — 5,310,000 1970-' 1,000,000 1,000,000 1,900,000 1,900,000 1971 1972 3,565,000 3,565,000 5,065,000 3,565,000 1973 8,500,000 8,500,000 33,480,000 8,500,000 1974 8,000,000 8,000,000 8,000,000 8,000,000 1975 3,000,000 3,000,000 3,000,000 3,000,000 1976 3,000,000 - Prior to 1970, funds include all DHEW health activities. Separate NIH appropriation enacted in 1970. 2/ — This appropriation authority was the continuing resolution. The appropriation amount was the House Allowance, which was the lower of the House or Senate amounts in the first vetoed bill. Buildings and Facilities. NIH ~ 1975 1976 Increase or New Obligational Authority Estimate Estimate Decrease Research facilities............................ $ --- $ --- $ -- Service and administrative facilities.......... 3.000.000 3.000.000 ________^^ Total...................................... $3,000,000 $3,000,000 $ General Statement This appropriation includes all proposed direct construction items of the National Institutes of Health and all continuing projects including unobligated balances remaining from the Mental Health-Neurology Research Facility, which was originally appropriated under "Mental Health Activities" and "Neurology and Blindness Activities" in 1961 but excludes the John E. Fogarty International Center for Advanced Study in the Health Sciences, for which planning funds were appropriated in 1968 under "John E. Fogarty International Center for Advanced Study in the Health Sciences".8409741_000056.txt

Page  56 2033 Research Facilities Includes those facilities used directly by the research activities of the National Institutes of Health. Service and Administrative Facilities Those facilities which render administrative and service support to the research activities of the National Institutes of Health. Repairs and Improvements - Plant 1976 appropriation estimate............................................. $1,000,000 In 1976, $1,000,000 is requested to continue the program of major repairs and improvements to the various electrical, mechanical and structural components of the NIH facilities, many of which have been in service over 36 years. Repairs and Improvements - Program 1976 appropriation estimate............................................. $2,000,000 In 1976, $2,000,000 is requested to provide for capital improvements to laboratories and other research facilities which are necessary to adapt them to changes in research procedures, installation of new equipment or new programs. Program Purpose and Accomplishments Activities: Research Facilities and Service and Administrative Facilities _______1976_______________ 1975 Budget Amount Authorization Estimate $3,000,000 Indefinite $3,000,000 Purpose: The NIH direct construction program provides for the construction, improvement and major repair of the buildings and supporting facilities essential to the conduct of the mission of the National Institutes of Health. Explanation: Buildings and facilities funded under this appropriation include those required for both research programs and for supportive services at the main NIH reservation, Bethesda, Maryland; the NIH Animal Center, Poolesville, Maryland; the Research Triangle Park, North Carolina; the Rocky Mountain Laboratory, Hamilton, Montana; and other NIH field stations. Accomplishments in 1975: Construction Completed Incinerator - Rocky Mountain Laboratory, Hamilton, Montana Reproductive and Perinatal Biology Facility Construction Contracts Terminated NIH Tri-Service Incinerator Facility rrmsi-ruction Contracts Continued Correction of Electrical Deficiencies, Patient Bedroom Areas, Bldg. 10 Electrical and Air Conditioning Improvements, Building 108409741_000057.txt

Page  57 203* Improvements to Blue Collar Work Areas (part) Master Utilities Extension - Phase II (part) Modifications to Heating Plant Design Contracts Completed Lister Hill National Center for Biomedical Communications Design Contracts Continued or Awarded Ambulatory Care Facility Environmental Health Sciences Center, North Carolina Improvements to Blue Collar Work Areas (part) Master Utilities Extension - Phase II (part) Modifications to Waste Handling Facilities Repairs and Improvements Continuation of major repairs and improvements for both plant and program facilities. Objectives in 1976: Construction Completed Correction of Electrical Deficiencies, Patient Bedroom Areas, Bldg. 10 Improvements to Blue Collar Work Areas (part) Master Utilities Extension - Phase II (part) Modifications to Heating Plant Construction Contracts Continued Electrical and Air Conditioning Improvements, Bldg. 10 Master Utilities Extension - Phase II (part) Construction Contracts Awarded Improvements to Blue Collar Work Areas (part) Master Utilities Extension - Phase II (part) Modifications to Waste Handling Facilities Design Contracts Completed Improvements to Blue Collar Work Areas (part) Master Utilities Extension - Phase II (part) Modifications to Waste Handling Facilities Design Contracts Continued or Awarded Ambulatory Care Facility Repairs and Improvements Continuation of major repairs and improvements for both plant and prog: facilities.8409741_000058.txt

Page  58 2035 Amounts Available for Ohl^.n^ 1976 Estimate Interim Period ApproprluM^........... ............................ $3,000,000 $ 750,000 Unobligated balance, start of year. y................... 8,423,976 4,446,976 Unobligated balance, end of year. , ,, Y ..................... -4.446.976 -2.836.976 Total, obligations........ , „ ....................... 6,977,000 2,360,000 -----------------______ Obligations by Activity_____ 1976 Increase or ----------------—■-----------____________Estimate Interim Period Decrease Research facilities.................. $ 180,000 $ 320,000 +$ 140,000 Service and administrative facilities......................... 6.797.000 2.040.000 -4.757.000 Total obligations.......................... 6,977,000 2,360,000 -4,617,000 Obligations by Object 1976 Increase or _________________________________________Estimate Interim Period Decrease NATIONAL INSTITUTES OF HEALTH Other services............................ $6,917,000 $2,060,000 -$4,857,000 ALLOCATION TO GENERAL SERVICES ADMINISTRATION Other services............................ 60.000_______300.000______+240.000 Total obligations by object............... 6,977,000 2,360,000 -4,617,000 Justification New obligational authority of $750,000 requested for the interim period of July 1, 1976 through September 30, 1976, represents one-fourth of the 1976 requirements for both Repairs and Improvements - Plant and Repairs and Improve- ments - Program. SUBCOMMITTEE RECESS Senator Magnuson. The subcommittee will stand in recess subject to the call of the Chair. Now, this concludes the NIH. (Whereupon, at 4:10 p.m., Monday, April 28, the subcom- mittee was recessed, to reconvene at 10:05 a.m., Wednesday, April 30.)