1984 U.S. Senate Appropriations Committee Budget Testimony, 98th Congress 1st Session, 1983
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S. Hrg. 98-389 Pt. 2 DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, EDUCATION AND REUTED AGENCIES APPROPRIATIONS FOR FISCAL YEAR 1984 HEARINGS BEFORE A SUBCOMMITTEE OF THE COMMITTEE ON APPROPRIATIONS UNITED STATES SENATE NINETY-EIGHTH CONGRESS FIRST SESSION Part 2—(Pages 1-1218) Department of Health and Human Services Printed for the use of the Committee on Appropriations 18-040 0 U.S. GOVERNMENT PRINTING OFFICE WASHINGTON : 19838409743_000002.txt

Page  2 National Library of Medicine STATEMENT OF DR. MARTIN M CUMMINGS, DIRECTOR ACCOMPANIED BY: DR. JAMES B. WYNGAARDEN, DIRECTOR, NIH KENT A. SMITH, DEPUTY DIRECTOR, NLM H. RICHARD MILLER, ASSISTANT DIRECTOR, BUDGET, DIVISION OF FI- NANCIAL MANAGEMENT, NIH ANTHONY ITTETLAG, DEPUTY ASSISTANT SECRETARY, BUDGET, DHHS BUDGET REQUEST Senator Weicker. Next, we will hear from the National Library of Medicine. Dr. Martin Cummings, the Director, is hack to testify on be- half of the Library. The budget request for the Library of Medicine is $49.6 million. This is the same as the request made in January, but is $2.5 million more than the fiscal year 1983 appropriation level. So you may proceed, Dr. Cummings. Dr. Cummings. Thank you, Mr. Chairman. Your National Library of Medicine is the Nation's principal resource for biomedical literature. Its collection is unrivaled in the world, con- tains more than 3 million books, journals, in 70 languages, and a large collection of related nonprint materials. The National Library is charged with the responsibility of not simply acquiring and holding onto these materials, but indexing them, catalog- ing them, and announcing their availability to the biomedical com- munity broadly. Twenty years ago, the National Library of Medicine pioneered in harnessing computers in the service of medical bibliography. Today, modern communications technology has been introduced into all areas of the library services. Literally, any health professional can access our information because it is available at his fingertips through terminals. We have computer ter- minals in more than 2,200 medical institutions in our country and several hundred abroad. These provide on-line access to the library's highly successful information service known as MEDLARS. Last year, more than 2 million computer searches were performed on NLM data bases. MEDLARS is the most widely used information resource in biomedicine, and some suggest it is the most widely used data base in all of science and education. These bibliographic services are important not only because they provide access to our own collections, but because they avert the un- necessary duplication of such bibliographic processing by others. One (929)8409743_000003.txt

Page  3 930 example of this is our centralized cataloging, which each year saves the U.S. medical library community more than $3 million. The efficient dissemination of medical information in this country is aided by the NLM regional medical library network. This network un- derwent a major reconfiguration last year, reducing the number of re- gional libraries from 11 to 7. In the 15 years since the regional medical library network was formed, more than 15 million books and journal articles have been loaned, and more than 10 million computer searches have been pro- vided for health professionals. An important element in the success of the regional medical library network has been the grants program administered by NLM. These grants have been invaluable for improving library services and for developing resource-sharing consortia of local health science libraries. This support has led to increased self-sufficiency to the point where 80 percent of the estimated 2 million interlibrary loans each year are now filled at the local or regional level. We have a strong international relationship maintaining exchanges of materials with more than 90 nations. And we have 13 bilateral agree- ments with other nations who share in the access to our system. The library's research component, the Lister Hill National Center, continues to develop new and improved methods for handling biomedi- cal information. Similarly, our toxicology information program uses new technologies to organize and make available important services in the fields of toxicology, pharmacology, and environmental health. The library's programs continue to unite modern technology with its century-old tradition of providing authoritative literature-based informa- tion for the advancement of biomedical research, education, and patient care. I would be glad to answer any questions you may have, Mr. Chairman. CATALOGING BACKLOG Senator Weicker. Thank you very much. I notice that you are hoping to reduce your backlog of uncataloged items to about 4,000 from 18,000. If your computer system is in such great shape, why is there any backlog at all? Dr. Cummings. That backlog was reduced last year. The backlog re- sulted many years ago from the lien that the library had, not having sufficient staff to intellectually catalog a lot of foreign language books. But stimulated by support from this committee, that backlog has been reduced to a nominal working level. Senator Weicker. So there is nothing you feel that needs to be done further in terms of funding or equipment that would bring it to the point where it would stay current? Dr. Cummings. No; I think what we have to do is hold onto the very good people who are required to actually read the text and then put the information, the cataloging, and indexing information into the com- puter.8409743_000004.txt

Page  4 931 We are not restricted by technology there. It has been the human labor-intensive effort that has been the lien on the library over decades. NEW LEGISLATION Senator Weicker. You are asking us to approve bill language to per- mit you to use funds received in payment for certain services provided to the private sector to offset general costs of operating the library. The payments currently go to the Treasury. Is that not authorizing legislation? And if so, why don't you go through the appropriate authorizing committee? Dr. Cummings. Well, in truth, Mr. Chairman, we have not asked for that special authority. We have reported to this committee each year on the revenues that we have earned from the sale of our services or from the leasing of our tapes. And those revenues, when they have been in excess, have been returned to the Treasury. I believe that this is a technical amendment to accommodate for that budget that has been established. But perhaps Mr. Itteilag can elaborate on that. Senator Weicker. How about it, Mr. Itteilag? Have you got a little piece of legislation here? Mr. Itteilag. No, we don't, Mr. Chairman. I don't believe legislation is necessary for this. In other words, the money is being collected at this time consistent with legislative au- thority. This proposed language change would allow it to go to the Na- tional Library directly, and offset a small part of the appropriations which would otherwise be requested, rather than go to the Treasury. I think it would be quite reasonable for the Appropriations Commit- tee to accommodate us in this matter. And I don't think that the authorizing committees would feel as if you had acted outside of your normal sphere. Senator Weicker. Well, you have your proposed language here and your justification, right, legislative language? Mr. Itteilag. We have the language and justification. We would hope that the committee would consider it as something that could be accomplished through the appropriations process. Senator Weicker. No. 1, I don't like to do it No. 2. the authorizing committee would, I think, take offense if this were done without their OK. I would have to go through the authoriz- ing committee. Mr. Itteilag. Mr. Chairman, we would be happy to consult with the authorizing committees formally on this matter. I will also consult with counsel within the Department to see if it is authorizing-type language, and will report my findings to the subcommittee staff. Senator Wocker. Well, you would just love to have this little prece- dent, and I don't think I want to set it This one might seem very in- offensive, but once we get into this, then there is no end to it. You can talk with counsel on it, but it clearly to me is authorization legislation on appropriation bills. And as such, I would reject it unless by some chance I have a misreading of what is going on there.8409743_000005.txt

Page  5 932 REGIONAL MEDICAL LIBRARIES You indicated in your presentation the great success of the regional medical libraries. If they are such a great success, why are you reducing them from 11 to 7? Dr. Cummings. We are doing that for two reasons, Mr. Chairman. One, to reduce the overhead and the indirect cost to manage these libraries. Also new technology now makes it possible for a lesser num- ber of regional libraries to serve a greater geographic area. We do not believe that this reduction will have any adverse affect on the delivery of services to the various regions. Senator Whcker. What are the regions that are being knocked out? Dr. Cummings. Well, the regions have been consolidated as follows: In New England, Harvard has withdrawn as a regional library and did not wish to compete for the new configuration. The New York Academy of Medicine now serves as the regional library for the North- east with a number of subregional libraries in the various States of New England. We ourselves served as a regional library for the Mid-Atlantic States. And we have withdrawn. This region will now be served by the Univer- sity of Maryland, and it will cover the entire Southeast. There is another consolidation that took place in the North Central States where Wayne State withdrew from the competition of being a re- gional library and that region is now served by the University of Illinois in Chicago. So, in fact, we have reduced our contracted medical libraries by three. But I think the regions are relatively strong. And the services, I think, have been maintained. Senator Weicker. I have certainly no dispute with the regional library being in New York. I don't think that is inconvenient. And certainly New York is a great center of learning in the areas of medicine, sci- ence, research, et cetera. I am sorry that apparently Harvard University decided to back off. Dr. Cummings. Yes; we in fact had regional libraries at Harvard, the New York Academy of Medicine, and Philadelphia College of Physi- cians. When we advertised for competition of the consolidated region, Harvard chose not to compete. Senator Whcker. Did anybody from New England compete? Dr. Cummings. The University of Connecticut. They are now in- volved as a resource library for the New York Academy, but they did at one time include Harvard in their proposal. The College of Physicians in Philadelphia also withdrew. Excuse me, the College of Physicians competed, but did not win the competition. I want to correct that statement.8409743_000006.txt

Page  6 933 PREPARED STATEMENT AND SUBMITTED QUESTIONS Senator Whcker. I have a few other questions which I would ap preciate having you respond to for the record. Thank you very much. I appreciate it. Dr. Cummings. Thank you. [The information follows:]8409743_000007.txt

Page  7 934 Statement of Martin M. Cummings What perceptive observers have been predicting has gradually occurred: computers and communications technology have transformed us from an industrial into an information society. Computers as extensions of the human brain have, in many respects, become more important than machines as extensions of human muscle. Nowhere is this more evident than in the handling of biomedical information. The National Library of Medicine, which 20 years ago pioneered in harnessing computers in the service of medical bibliography, has since introduced modern communications technology to all areas of its responsibility. It has been applied to many library services, where a vast amount of medical bibliographic information is avail- able, literally, at the user's fingertips. It affects our grant programs, where special emphasis has been placed on funding projects that make use of technology's potential; the Library's research and development programs, where mini-computers, micro- processors, and interactive videodisc units are now in daily experimental use; and the toxicology information program, where files of specialized bibliographic information and drug and chemical data have been created and made available. These applica- tions not only have increased the range and quantity of information services offered by the Library, they have also greatly improved the quality and cost-effectiveness of the services. Library Services The National Library of Medicine is the nation's principal resource for biomedical literature. Its collection, unrivaled in the world, contains more than three million holdings in 70 languages. The NLM is charged with the responsibility to organize this vast literature through cataloging, indexing, and biblio- graphical listing and to publish and otherwise make this informa- tion available. Without such organization and processing, the world's literature would be inaccessible and of limited usefulness. Moreover, by performing these functions, N1M not only provides access to its own collection, but averts the repeated duplication of this processing throughout the biomedical library community. One example of this is NLM's cataloging, which saves the medical library community more than three million dollars annually in the United States alone. The Library has developed a highly successful computerized bibliographic search and retrieval system known as MEDLARS, of which MEDLINE is the largest and most frequently used online file. MEDLARS databases are accessible at some 2,000 institutions in the U.S. In addition, there is access at a number of foreign centers and through domestic commercial vendors of information services. Each year more than two million searches are performed using MEDLINE and the other NLM online databases that supplement it. These databases, collectively, and the online network through which access is provided, constitute the world's largest scientific bibliographic retrieval system. In 1982, the capability of the MEDLARS computer was extended to provide NLM patrons with a fully online catalog, searchable— without training or special instruction—from computer terminals placed in a public area of the Library. The online catalog has proved to be very popular with our users, and makes it possible for them to locate materials that would be difficult or time- consuming to locate using the traditional card catalog.8409743_000008.txt

Page  8 935 As a consequence of the trend toward increased data processing requirements for such services and for internal library operations, the NLM in early 1982 determined that additional computer capacity was needed to meet projected demands. A competitive procurement was conducted which resulted in the purchase—at about 40% of the commercial list price—and installation of a large multi-processor system previously used by the National Institutes of Health central computer facility. The new system doubles NLM's processing capabilities and should meet the Library's requirements well into the 1980's. The Regional Medical Library (RML) Network, through which the nation's health-science libraries cooperate in sharing their resources, underwent a major reconfiguration in 1982. The Network which was reduced from eleven to seven Regional Medical Libraries, involves more than 100 Resource Libraries in academic medical centers, and 3,000 libraries in hospitals and other health-related institutions. The goals of the RML program remain dedicated to providing health professionals, regardless of where they are located, with timely access to reference services and to the books, journal articles, and audiovisual materials they need in carrying out their professional duties. What the new configuration will accomplish is to reduce the costs of administering the Network while maintaining the high level and quality of services that U.S. health professionals have come to expect from their libraries. In the 15 years since the Regional Medical Library Network was formed, more than 15 million books and journal articles have been loaned and 10 million computer searches have been provided for health professionals at member institutions. Grant Programs The Medical Library Assistance Act authorizes the NLM to award grants and contracts to strengthen the nation's health-science libraries and to increase the range and quality of information services available to health professionals. Training grants have promoted the integration of computer technology into clinical practice, teaching, and research. Research grants have supported the study of ways to improve biomedical communications; resource project grants have expedited the expansion of health-science library resources and services; and publication grants have supported the preparation of certain scientific works that, although they may not be commercially viable, are nevertheless judged to be important to the national health effort. The results of the nation's investment in its biomedical libraries are evident. As a result of training grants, the shortage of qualified medical librarians had decreased noticeably by 1971. The training program was redirected to meet a new shortage peculiar to our information society. It concentrated on supporting training for talented individuals who would apply computer technology to information problems in the health sciences. Some 350 profes- sionals have undergone doctoral level training in the field of computers-in-medicine. Although a modest number, it represents a cadre whose influence will be multiplied as they move into responsible positions in medical centers. Similarly, the research grants program has been redirected to emphasize investigations of computer applications in medicine. Resource grants have been used to build library collections, institute audiovisual education services, and develop consortia of local health science libraries to improve the information resources8409743_000009.txt

Page  9 936 available to health professionals. Our support has led to increas- ing self-sufficiency, to the point where 80 percent of the estimat- ed two million loans each year are filled at the local and regional level. Research and Development The Library's research and development component, the Lister Hill National Center for Biomedical Communications, applies computer and communications technology to handling biomedical information. One of the Center's most important projects has been to design and test an Integrated Library System that can be used by other libraries. It utilizes a minicomputer to control circula- tion, public catalog searching, serials check-in, patron registra- tion, and several other functions. Much of the research and design effort has gone into making such a system easy for patrons and librarians to use. The Integrated Library System is now success- fully operating in libraries of the Army (Pentagon), University of Maryland, Johns Hopkins University, Naval Research Laboratory, and Carnegie-Mellon University. Several commercial companies assist users to install the system and provide support for time-shared access to it. Another project is investigating the potential of the optical videodisc as a medium for handling archival material in the National Library of Medicine's own collections. The Library has an estimated 30 million pages of deteriorating books and journals that it is seeking to preserve. Videodisc technology has the potential to store great amounts of published literature and make it avail- able for rapid recall and retrieval. Toxicology Information The Library's Toxicology Information Program concentrates on collecting and organizing toxicological data and using computer- based retrieval systems to make this information easily accessible. TOXLINE, the first such online file developed, now contains more than 1.3 million bibliographic records. Other computerized files contain information about drugs and chemicals which may be harmful to man or his environment. A number of the responsibilities of the Toxicology Information Program are interagency in nature. One of these, new in 1982, is to develop the Hazardous Substances Information Services for the Environmental Protection Agency. These services will provide critical information to health officials responsible for assessing the hazards from chemicals present in waste disposal sites or major accidental spills. Summary In the information age, NLM will continue to apply advances in modern communications technology as it seeks to carry on its century-old tradition of providing accurate bibliographic control of the world's biomedical literature. The Library's programs continue to unite innovation and technological advancements with the health sciences literature to assist biomedical research, education, and practice. Mr. Chairman, this concludes my opening statement. I shall be pleased to answer any questions you may have.8409743_000010.txt

Page  10 937 Biography of Martin M. Cummings NAME: Martin Marc Cummings POSITION; Director, National Library of Medicine BIRTHPLACE AND DATE: Camden, New Jersey, September 7, 1920 EDUCATION: B.S., Bucknell University, 1941 M.D., Duke University, 1944 HONORARY DEGREES: Honorary Doctor of Science, Uucknell University, 19fa9 Honorary Doctor of Science, University of Nebraska, 1971 Honorary Doctor of Science, Emory University, 1971 Honorary Doctor of humane Letters, Georgetown University, 1971 Honorary Doctor of Medicine, Karolinska Institute, Stockholm, Sweden, 1972 Doctor Honoris Causa, Academy of Medicine, Lodz, Poland, 1^77 EXPERIENCE: 1964 to Present: Director, National Library of Medicine 1963-1964: Associate Director for Research Grants, National Institutes of Health 1961-1963: Chief, Office of International Research, National Institutes of Health 1959-1961: Professor of Microbiology and Chairman, Department of Microbiology, University of Oklahoma School of Medicine 1953-1959: Director, Research Services, Veterans Administration Central Office 1953-1959: Special Lecturer in Microbiology, George Washington University School of Medicine 1953: Associate Professor of Bacteriology, Emory University 1949-1953: Chief, Tuberculosis Research Laboratory, Veterans Administration Hospital of Atlanta 1948-1953: Instructor through Associate Professor of Medicine, Emory University 1947-1949: Director, Tuberculosis Evaluation Laboratory, Communicable Disease Center, U.S. Public health Service 1945-iy47: Assistant Resident Medicine, Boston Marine Hospital 1944-1945: Intern, Boston Marine Hospital 1942-1944: U.S. Army (ASTP) PROFESSIONAL ASSOCIATIONS: American Academy of Microbiology, Inc. American Association for the Advancement of Science, Board of Directors American 3oard of Microbiology American Clinical and Climatological Association American Federation for Clinical Research (Emeritus) American Osier Society, President American Society for Clinical Investigation (Emeritus) Association of Research Libraries Gorgas Memorial Foundation, Board of Directors Institute of Medicine, National Academy of Sciences Medical Library Association Society of Sigma XI Washington Society for the History of Medicine8409743_000011.txt

Page  11 938 SPECIAL AWARDS & HONORS: Veterans Administration Exceptional Service Medal, 1959 DHEW Superior Service Award, 1966 DHEW Distinguished Service Award, 1968 Distinguished Alumnus Award, Duke University, 1969 Honorary Member, Alpha Omega Alpha Honorary Fellowship, College of Physicians, Philadelphia, 1973 Rockefeller Public Service Award, 1973 Honorary Member, American Medical Writers Association, 1974 Alumnus Membership, Phi Beta Kappa, 1974 Modern Medicine Distinguished Achievement Award, 1976 Distinguished Service Award and Honorary Fellowship, College of Cardiology, 197b Honorary Member, Academy of Medicine of the Institute of Chile, 1976 Certificate of appreciation for outstanding contributions to medical communication and to the American Medical Writers Association, 1978 John C. Leonard Award, Association for Hospital Medical Education, 1979 Harold Swanberg Distinguished Service Award, American Medical Writers Association, 1979 Fellow, American Association for the Advancement of Science, 1980 108 scientific and historical publications, co-author of textbook in the field of tuberculosis Questions Submitted by the Subcommittee BACKLOG Question: We are glad to note that you plan to reduce your backlog of uncataloged items to about 4,000 in 1983 from 18,000 in FY 1982. Do you anticipate reducing the backlog still further, or will it continue to stand at around 4,000? Answer: NLM expects to reduce the backlog of uncataloged books to a working level of about 3,000 items by the end of FY 1984. The Cataloging Section will maintain this level as a work-in-process inventory. Question: You indicate that coverage of medical litera- ture on your major computer system ("MEDLINE") goes back about 18 years to 1966. Is it volume that prevents you from going backward in years at a faster rate — or is there some other reason? Answer: The machine readable file of indexed citations from the journal literature began in 1966. These citations have been the basis of the retrieval system (MEDLARS) since 1966; however, it was not until 1983 that all the citations were available for access online. In the early 1970's when MEDLINE (MEDLARS Online) was initiated only the citations from the most recent 2-3 years of the literature were made available online. The recent years contain the literature of most use to health professionals. Searches of the older literature were requested online, searched and printed offline and mailed8409743_000012.txt

Page  12 939 to the requestor. In 1981 NLM was able to expand online access to the literature for the period 1977 to date. This expansion of online access was very well accepted by the biomedical community and numerous requests were received for additional years online. The increased computer capacity acquired in 1982, enabled NLM to provide online access to all the machine readable files of the medical journal literature from 1966 to date. Citations to the years before 1966 are not presently being converted to a machine readable format. Health professionals may obtain references to the journal literature published before 1966 in Index Medicus, which NLM has published since 1879. MEDLARS III Question: MEDLARS is, of course, your computerized bibliographic search and retrieval system which contains a number of data bases. We note your continued work on the MEDLARS III software which is to automate more fully many of your internal functions such as ordering, receiving and cata- loging research materials. When will MEDLARS III be fully operational—and how will it increase your efficiency? Answer: The implementation of MEDLARS III was initiated in 1981. The major contract award for the development of the MEDLARS III software will be made by this summer. Although contractual effort will continue Into FY 1985, portions of MEDLARS III will begin to be operational in FY 1984. When complete in 1985, the full system will provide: - Automated acquisitions, cataloging, and indexing aids, now largely manual; - Fully computerized catalog at NLM, with cataloging data available to all libraries on the online network; - Fully automated system for online routing of requests for copies of articles, books, and audiovisuals, not essentially manual; - Improved retrieval of computerized bibliographic informa- tion so that health researchers and practitioners can directly access the system in a "natural English" language, without the need for a trained searcher as an intermediary. Question: Since MEDLARS III will take over many labor- intensive functions, to what extent will you save money and be able to reduce staff as a result? Answer: The implementation of MEDLARS III in 1981 will provide tangible benefits of as much as 40 million dollars over the ten year life of the system. These benefits fall into two categories, viz. 1) Savings due to improved processing and elimination of expensive manual systems, 2) Savings to the medical library community and to health practitioners by provi- ding improved access to NLM resources at reduced costs.8409743_000013.txt

Page  13 940 Examples of savings projected in improved internal pro- cessing over a ten year life of MEDLARS III include: 1. Closing of NLM manual card catalog eliminating expensive manual maintenance and replacing it with the current online computerized file at an estimated savings of $2.5 million. 2. Improved automated serial processing and maintenance eliminating manual checkin, subscription invoice process- ing, etc., at estimated savings of $700,000. 3. Automated Inventory Control with savings of $500,000. 4. Reduction of contractual services involved in keyboarding catalog records saving $350,000. 5. Reduced software maintenance resulting from a modern modularized MEDLARS III with savings of $1.4 million over the ten year life. Examples of savings to the medical libary and health practi- tioner community include: 1. By providing greater and more rapid access to NLM's cataloging data, repeated duplication of the cataloging function is averted at the local level resulting in a savings to the medical library community of an estimated $4.9 million. 2. Savings to the medical library community of up to $14 million over the life of MEDLARS III by replacing manual creation and processing of up to 2 million interlibrary loan forms annually with an online auto- mated document delivery system (DOCLINE). DOCLINE eliminates a major portion of processing required in a manual system. NLM does not anticipate any reduction in staff as a result of MEDLARS III. The improved efficiency of NLM's inter- nal production operations due to the new system will permit existing library staff to handle the steadily increasing demand for library and information services in a more timely fashion with improved quality. REVISED APPROPRIATION LANGUAGE Question: You are asking us to approve bill language to permit you to use funds received in payment for certain services provided to the private sector to offset general costs of operating the Library. The payments currently go to the Trea- sury. Isn't this authorizing legislation? If so, why don't you go through the appropriate authorizing Committee? Answer: The Department has consulted with its General Counsel which agreed that language contained in the proposed FY 1984 appropriation for NLM is not authorization language and would not be subject to point of order if adopted by the Senate Appropriations Committee. According to the General Counsel, the8409743_000014.txt

Page  14 941 Library has the authority to charge fees in its authorizing statute (section 382(c) of the Public Health Service Act, 42 U.S.C. 277(c)), and thus the proposed appropriations language does not have the legal effect of investing the Library with new authority. The amounts collected by the Library as user charges are deposited in the general fund of the Treasury and are available for appropriations to the Library, if provided for in an appropriations act, to the same extent as in any other money in the general fund. Question: what is the purpose of this new authority? Answer: Currently NLM, through the National Technical Information Service, collects revenues from its retrieval services. This revenue is used to pay accessing costs that are not included in the NLM appropriation. Any excess between revenues and expenditures is returned to the U.S. Treasury. The new legislation would permit NLM to use these funds to offset its operating costs rather than return the collections to the Treasury. Question: Why are you suddenly proposing to start charging for interlibrary loans, including photocopies of requested material? How much will you collect in FY 1983 and FY i984 — and is this action related to your request for new bill language to convert user charges to the Library's direct operations fund? Answer: There is no relation between the proposed bill language and the Library's consideration of a plan to institute charges for interlibrary loans. NLM has been considering instituting these charges for some time. American libraries have a tradition of free service. In recent years this approach has been undergoing a change due in part to a reduction in the financial support for libraries, a substantial increase in the amount, kinds, and costs of services provided, and a more widespread acceptance of charging for special services. NLM instituted cost-sharing for interlibrary loan service in the Regional Medical Library Network in the late 1970's. As a result most of the larger health sciences libraries have been charging for interlibrary loans for more than five years. The Library served as the final backup resource and thus provided loans on a free basis. NLM now believes that instituting a charge will provide both an incentive for libraries to acquire the materials their users need and to use local resources before using NLM's backup services. The National Agricultural Library and the Library of Congress charge for their loans. When the budget justification was written, it was NLM's plan to implement charges in FY 1983. Presently, the National Library of Medicine Board of Regents will discuss the proposed changes at their meeting in May. If approved, the Library would begin to charge for interlibrary loans filled by NLM late in FY 1983 or at the commencement of FY 1984. On an annual basis,8409743_000015.txt

Page  15 942 it is estimated that $400,000-$500,000 would be collected to recover the costs associated with providing the loans of the requested materials, but not the cost of acquiring the litera- ture. REGIONAL MEDICAL LIBRARIES Question: Last year you reduced the number of Regional Medical Libraries from 11 to 7. What necessitated this cutback— and has it reduced the effectiveness or impaired the services of these libraries in any way? Answer: In FY 1982 the Medical Library Assistance Programs were reduced from 9.8 to 7.5 million dollars and in that process the funding for the Regional Medical Library Program was also curtailed. NLM believes that the relative maturity of the network plus improvements in communication technologies effected over the past 18 years permit this conso- lidation without detriment to the program or the services it provides to health professionals. The experience NLM has had since the beginning of the program, indicates that the larger geographical areas can be administered effectively. Funding for overhead and administrative functions is being reduced and the resultant resources are being utilized for direct services. Question: Your library will no longer be the regional library for the Middle Atlantic States under the new arrange- ments. How much money will this save you — and to what use will you put the savings? Answer: An estimated $125,000 will be saved, in salaries and benefits. Personnel have been reassigned within NLM to meet the growing demands for basic library services. NLM will strengthen its role in planning, monitoring and providing backup services for the national Regional Medical Library Program. Question: What is the status of the reauthorization legislation for the Medical Library Assistance Act? Answer: Legislation authorizing funds through FY 1986 for several health programs administered by NIH, including the Medical Library Assistance Act, is pending in both houses of Congess. The Senate proposal would extend the Medical Library Assistance program at authorization levels of $10.5, $11,025, and $11,576 million for FY 1984, FY 1985 and FY 1986, respec- tively. A figure for FY 1983 is also included, for $9,763 million. The bill was ordered favorably reported by the Senate Committee on Labor and Human Resources on April 13, 1983. The House bill would extend authorization at levels of $10, $11, and $12 million in FY 1984, FY 1985 and FY 1986. The Subcommittee on Health and Environment approved the bill with amendments and referred it to the full Committee on Energy and Commerce on March 24, 1983.8409743_000016.txt

Page  16 943 PROTECTING THE INVESTMENT Question: At a time when many budgets are going down, Congress has been increasing funding of the National Institutes of Health, including your Institute. We are concerned that these scarce resources be carefully and effectively used and that there be no basis for criticism of your management of this money. What assurances can you give us that your Institute is making careful and effective use of the appropriations we provide you? Answer: Management of the funds appropriated to the National Library of Medicine is governed by several tiers of review on a year-round basis. In allocating its resources, NLM relies upon several outside committees for counsel and recommen- dations with respect to the effectiveness of both ongoing and proposed intramural and extramural activities. These bodies, whose members are drawn from a variety of disciplines, include the Board of Regents of the National Library of Medicine, the Board of Scientific Counselors, the Biomedical Library Review Committee, and a committee from the National Academy of Sciences. Within NLM, management's most important concern in allocating resources is to provide higher quality services to the nation in a cost effective manner. It is the policy of the NLM to allocate the minimum amount of resources required to perform essential administrative functions. The highest prio- rity for funding is given to the support of library services and products. NLM management continually reviews methods to achieve organizational efficiencies and reduce redundant management costs. One recent outcome of this process where specific administrative savings will be realized is the integration of the Lister Hill and the National Medical Audiovisual Centers. Another is the reconfiguration of the Regional Medical Library Network, reducing the number of regions from 11 to 7 to achieve administrative savings. More efficient operations are also sought through the study and application of advanced technolo- gies for automating internal library processing functions, to handle NLM's ever-increasing workload. The MEDLARS III develop- ment project is an important effort in this direction. Question: Aside from the Peer Review system, what insti- tutional arrangements do you have that serve to deter waste, fraud or abuse in the handling of Federal funds? Answer: AT NIH, the current system of prospective and retrospective reviews is excellent. Each Bureau, Institute, and Division periodically must justify its budget requests to the Director, NIH and often to higher levels of the executive Branch. These justifications are assessed with respect to the merit of what is proposed and the accomplishments to date. Similarly, each grant application and contract proposal must pass through a rigorous series of evaluations by peer reviews and staff. Progress reports of awardees are reviewed at least annually by staff in terms of both scientific accomplish- ments and expenditure practices. Finally, awardee institutions are subject to independent audit by the cognizant Executive Department and the General Accounting Office.8409743_000017.txt

Page  17 944 MERGER OF ACTIVITIES Question: You indicate you have formal approval to make the National Medical Audiovisual Center a part of the Lister Hill Center for Biomedical Communications. What will this merger achieve - and what, if any, savings in money and staff are possible. Answer: Integration of the National Medical Audiovisual Center and the Lister Hill National Center for Biomedical Communications will permit the more efficient management of research and development programs and resources. Research projects increasingly require the participation of many disci- plines and technologies. Before the reorganization, these skills were found in one of the organizations and not the other limiting the effective conduct of major research activities. The reorganization will simplify project access to scarce research resources and facilities as well as focusing organiza- tional efforts on alternative technologies and their more effective use. Specific savings are possible through the elimination of management and administrative positions and redirecting resources in the direct suport of research. Question: A principal effort at Lister Hill is the Knowledge Base Program designed to make the latest medical research findings available to health care professionals in an easily usable format. When will this program be implemented and what areas will it cover? Answer: The Knowledge Base Research Program is princi- pally a research effort which experiments with methods for the computer acquisition, representation and modification of know- ledge structures, to be complemented by user-friendly access. Textual and visual materials, with associated references, are the substantive content exploring coordinated knowledge struc- tures, representations and retrieval strategies to aid in diagnosis, prognosis and treatment of disorders. The three medical domains currently being studied are human genetics (which covers more than several thousand disorders), viral hepatitis and human gastrin information. The pursuit of those basic questions of knowledge representation and retrieval will continue but the application over the broad subject of medicine will be done by others, largely the private sector.