History of Medicine
Commentary by Dr. Martin M. Cummings on his testimony before the U.S. Senate Appropriations Subcommittee concerning the National Library of Medicine, for fiscal year 1973
From interviews with Dr. Cheryl Dee, 2010
Excerpts of U.S. Senate subcommittee testimony concerning the National Library of Medicine, followed by an interview with Dr. Martin M. Cummings, Director Emeritus, National Library of Medicine, reflecting upon the testimony
DEPARTMENTS OF LABOR AND HEALTH, EDUCATION, AND WELFARE AND RELATED AGENCIES APPROPRIATIONS FOR FISCAL YEAR 1973
MONDAY, MAY 1, 1972
Senator Fong: Next, the National Library of Medicine....
Dr. Martin Cummings, Director of the Library, present your request.
Our new on-line reference retrieval system MEDLINE has been operating efficiently since December 1971. It replaces the earlier version called AIM-TWX which was used successfully by more than 80 institutions throughout the country. Whereas AIM-TWX contained citations to little more than 100 journals, MEDLINE will cover approximately 1,000 periodicals which provide more than one-half of the entire MEDLARS file. A MEDLINE search costs approximately $9 as compared to $60 for the MEDLARS search which it [MEDLINE] replaces. Searches are completed in 10 to 15 minutes in contrast to 10 to 15 days required by the older system. A commercial communications network will make MEDLINE available to major medical schools, hospitals and research institutions at low cost. Approximately 200 institutions can join the network during fy 1973.
Whereas the Library fully subsidized all domestic MEDLARS searches, the user pays the line charges for MEDLINE. This development should reduce the need for the longer MEDLARS searches. Thus most of the MEDLARS centers in the United States will be phased out and the funds that have supported their operations will be used to maintain the MEDLINE communications network. We would emphasize that this network will be available to transmit data other than bibliographic citations and in time should encourage dissemination of other information in a variety of other computerized data bases. As I informed this committee last year, the Library is actively engaged in redirecting the development of the new system MEDLARS II. It will be completed by the end of fy 1973.
LISTER HILL CENTER FOR BIOMEDICAL COMMUNICATIONS
The Lister Hill Center's satellite communications project has been critically tested and found to be most useful in improving medical communications to remote villages in Alaska. On at least two occasions it provided information which proved to be life-saving. It has served to bring medical assistance to persons who previously could not be reached by telephone or radio communications. It has helped physicians determine when patients need to be evacuated to district or regional hospitals for emergency care. On the other hand, it has cut down on unnecessary bush plane evacuation when the patient could be managed by a health aide or local nurse after satellite consultation with a physician. We are pleased with the accomplishments and plan to extend the system to other regions of our nation where great distances and rugged terrain make patient-physician contact difficult.
The National Aeronautics and Space Administration plans to launch a sophisticated satellite late in fy 1973. The staff of the Lister Hill National Center for Biomedical Communications has been working closely with NASA to define a series of experiments using the new satellite to test the utility of interactive programs to improve health care. The experiments are being designed to meet the needs of a number of selected locales. Experience with the interactive television system operating successfully in New England strongly indicates the desirability of expanding that network through Vermont and New Hampshire and conducting similar studies via the new satellite in other parts of the country.
TOXICOLOGY INFORMATION PROGRAM
The Toxicology Information Program collaborates extensively with other federal agencies, such as the Food and Drug Administration and the Environmental Protection Agency, to collect, organize, and automate toxicology data from diverse and previously uncoordinated sources. It is developing a Toxicology Information Query Response Center at the Oak Ridge National Laboratory (AEC), which draws as needed on the capabilities of their scientists to provide special analyses and evaluations of toxicological data for Federal agencies, industry, and the scientific community in general. ...
Senator Fong. Doctor, what is the Query Response Service at Oak Ridge? Give us an example of how it works.
Dr. Cummings. The Toxicology Information Response Center Service at the Oak Ridge laboratories is a specialized information service operated under contract to the National Library of Medicine to provide in-depth information dealing with drugs, chemicals, and other materials. It provides to industry, to physicians, scientists, and educators detailed listings of substantive information on these various toxicological agents. It is a new service, and is a service which will be paid for by the users because it is something over and beyond normal library service.
Senator Fong. Why was it established at Oak Ridge?
Dr. Cummings. We chose Oak Ridge for two reasons. First, they have an outstanding professional staff with long-standing interest in this professional field. Second, Oak Ridge established the first large-scale series of information analysis centers in other fields, so the management at Oak Ridge was very much interested in providing this kind of service.
CONSTRUCTION STATUS OF LISTER HILL CENTER
Senator Fong. What is the current status of the proposed construction for the Lister Hill National Center for Biomedical Communications?
Dr. Cummings. The Congress provided to the Library, funds for planning this new facility some 2 years ago. The program of requirements has been written and approved at NIH and approved by the Department. I am informed that the Department will select an architectural and engineering firm sometime during the month of May to begin the detailed design, and as I indicated in my opening statement, we hope to be able to come back to the Congress, through the Department, with a request for the building funds in the near future.
Senator Fong. How would a health professional at the local level make use of the library service supported by the National Library of Medicine?
Dr. Cummings. The health professional at the local level merely goes to the nearest medical library, which may be in his community or near his community and makes a request for the information he seeks at that level. If they do not have it locally, it is then transmitted to one of 11 regional libraries that are in the network. They are usually able to respond to about 85 percent of all such queries.
However, if the regional library does not have this material, ... , it is then transferred to the National Library of Medicine and sent back to the requestor directly.
Eleven of the regional libraries exist in freestanding academic settings or in private libraries. They are not part of NLM, but we fund their regional services. We provide support to them to give local services.
INFORMATION FOR ENVIRONMENTALISTS
Senator Fong. What is the NLM doing to provide an information base for use by environmentalists?
Dr. Cummings. We are very proud that last year we were able to develop a new monthly alerting service which announces all of the health related aspects of the environment.
Dr. Mider was responsible for this development and with your permission I would like him to elaborate on that.
Mr. Mider. Chairman, we suddenly realized that we have a lot of information that environmentalists needed, and while medical people know about our publications, many environmentalists did not, so we went through our files and found those items which seemed to be of most interest to environmentalists, and put out a publication which was called Selected References on Environmental Quality as it relates to health. We provide the Government Printing Office with a camera-ready copy each month, and it is sold by subscription for $4 a year.
Lister Hill National Center For Biomedical Communications
Signed Into Law By The U.S. President
On August 3, 1968 the President of the United States signed into law the House-Senate Joint Resolution 193 of the 90th Congress supporting a proposed center for biomedical communications and designating it as the Lister Hill National Center for Biomedical Communications. In September 18, 1968 the Secretary, DHEW, established the Center as an organizational entity of the National Library of Medicine implementing that resolution. The purpose of the Center is to adapt existing techniques and develop new computer and communication technologies for incorporation into operational biomedical communications networks in support of health care delivery, education, and research.
In recognition of the importance of the Center services, the following statement was included in the Report of the Committee on Appropriations of the July 29, 1971, HEARINGS ON THE DEPARTMENT OF LABOR AND HEALTH, EDUCATION, AND WELFARE, AND RELATED AGENCIES APPROPRIATIONS BILL, 1972: "As the success of the Center's efforts will ultimately depend on their acceptance and support by the medical and scientific communities, the Director of the National Library of Medicine and the staff of the Lister Hill Center should prepare an informative report on its prototype experiments -- such as the satellite communications link with remote regions in Alaska and the two-way television network in New England -- and its plans for the future. One of the purposes of the report should be to stimulate awareness of an the ways in which medical modern communications techniques can be adapted and expanded to serve all facets of health services with medical research in the training of health professionals."
The Lister Hill National Center For Biomedical Communications
Report To The Congress Of The United States
Rapid expansion of medical knowledge advances in technology led the public to expect and demand more accessible and better health care. To meet these expectations will place an increased demand on all components of the health system and will require more efficient utilization of manpower and facilities to keep down, and hopefully, reduce the cost of achieving the goal. Technology will be called upon more and more to assist in improving efficiency and extending the capabilities of the limited and already strained manpower resources.
The Congress early recognized the importance of communication and the need for a national center to give impetus and direction to a national program of biomedical communications. Its development was undertaken on the recommendation of the House and Senate Appropriations Committees in the House Special Subcommittee on the Investigation of the Department of Health, Education, and Welfare (1966). This subcommittee recommended that the National Library of Medicine establish a research center in biomedical communications and to establish a national biomedical clearinghouse and referral service. In August 3, 1968, the President signed a Joint Resolution 193 into Public Law 90 -- 456 creating this Center as the Lister Hill National Center for Biomedical Communications. On September 18 the Secretary of DHEW established the Center as an organizational entity of the National Library Of Medicine within the National Institutes of Health.
The Lister Hill Center is concerned with the use of computer and communication technologies to meet biomedical needs. The technologies involved -- computers, communications satellites, computer and communication networks, microwave and cable television -- are not new. They have required over 30 years and billions of research and development dollars to reach their present level. But these dollars were spent for defense, for space exploration, from business profits, not for healthcare delivery. A comparatively modest investment of the center is time and money required to modify, adapt, blend and apply these existing technologies to meet the Center's objectives:
- To assist the development of knowledge and to speed new knowledge to application;
- To improve training in all levels of health professional education: undergraduate, graduate, and continuing;
- To facilitate and reduce costs of health services delivery;
- To improve the public's understanding of preventative medicine and healthful living.
In anticipation of the establishment of the Lister Hill Center, the Associate Director for Research and Development of the National Library Of Medicine published a Technical Development Plan for the period 1969--1974, which contains the basic concepts of a Biomedical Communications Network and five basic components:
- The Library component
- The Specialized Information Services Component
- The Specialized Education Services Component
- The Audio And Audiovisual Component
- The Data Processing And Data Transmission Component
The Biomedical Communications Network provides the mechanism, the organizational structure, and the management vehicle for the informational and educational service responsibilities for these components. It is also the means for the transfer of technology into application within medical information and education systems. As such, the Network represents a combination of operational services, an experimental services and procedures, and the design and engineering of new improved communication services and techniques.
Interview with Martin Cummings, MD, Director Emeritus, National Library of Medicine, 1964-84; interviewed by Cheryl Dee, PhD, 2010.
The Lister Hill National Center for Biomedical Communications
Dr. Dee. Dr. Cummings: Please tell us the background information at this time of architectural drawings, etc. of the Lister Hill Center.
Dr. Cummings. The most important part of this testimony is the information about the Lister Hill Center.
The most important step taken after the Congress and the President of the United States approval for the creation of the Lister Hill National Center for Biomedical Communications was the recruitment of Dr. Ruth Davis as its first Director. Dr. Davis developed a small but highly sophisticated technical staff which prepared the outlines of the technical plan which laid the groundwork for the Centers' operations over the next decade.
Dr. Davis headed a team which included physicians, computer technologists and systems analysts. Together they identified the needs for biomedical communications and found the appropriate settings in which developmental work could be undertaken.
Notable among these early projects for the use of a satellite to establish communications were at the University of Washington in Seattle and a number of health units scattered throughout the vast state of Alaska. This experiment met the needs for improved communications to remote distant villages and small communities with medical centers and hospitals. The Lister Hill staff also supported the first interactive television communications between an American medical school and its affiliated hospitals located some distance from the University. The most important Lister Hill project led to the design and implementation of the first computer-based on-line medical information service, MEDLINE.
Dr. Dee. Dr. Cummings, please explain the objectives of the Lister Hill Center.
Dr. Cummings. The overall objectives for the Lister Hill Center program were developed by the senior staff at the National Library of Medicine and were critically reviewed and endorsed by the Board of Regents of the National Library of Medicine. Conversations were held with leading voluntary health agencies and federal health-related agencies to determine their needs and the program plan was finalized. Contacts were made with leading systems development companies to seek a contractor who would perform the final system design and make the necessary arrangements for the implementation of the communications apparatus needed to carry out the purposes of the program.
The key to economic reality was the utilization of existing technologies such as the availability of new computers with advanced communications links and the availability of the NASA ATS (Advanced Technology Satellite) that could reach across the entire continent to create the Alaska Health Communication Service.
Dr. Dee. Dr. Cummings, will you tell us about the specific components of the Lister Hill Report.
Dr. Cummings. I will comment about the basic components.
A. The library component of the communications network operated the MEDLINE program which provided bibliographic services on-line.
B. The specialized information system operated a newly developed technology information system which dealt with the effects of drugs and chemicals on the environment.
C. Technologies were used to enhance medical education through linkages between medical centers, hospitals, and clinics affiliated with local or regional networks. The connection between the University of Washington and Alaska serves as a good example.
D. Audiovisual activities formerly located in Atlanta were transferred to the National Library of Medicine. The National Audiovisual Center made it possible for the National Library of Medicine to share these forms of information through its network of regional and local libraries.
E. Information processing is reflected largely through the publication of the library products such as Index Medicus, the NLM Catalog, and Specialized Bibliographies related to specific categories of disease and disability.
Dr. Dee. Dr. Cummings, please explain any background surrounding the fees for the MEDLINE charges covering the cost of communications for MEDLINE.
Dr. Cummings. When MEDLINE provided services through regional medical libraries or directly by the National Library of Medicine the user paid the full costs of the MEDLINE search which ran around $50. It became clear that the MEDLINE services were not only much faster but were more economical so it only made sense that the user only needed to pay the cost of communications which was less than $10. Management of the National Library of Medicine was uncomfortable with any user charges and at this stage in history, NLM began to seek support for the preparation of all the MEDLINE services at no cost to the user since it was a tax supported institution.
Oak Ridge Laboratories
Dr. Dee. Dr. Cummings, can you explain anything more about the Oak Bridge Laboratories?
Dr. Cummings. The Oak Ridge Laboratories serve the needs of the Department of Energy who are concerned with possible impacts of energy sources on man and his environment.
Dr. Dee. Dr. Cummings, please tell us any background information regarding the "Information for Environmentalists."
Dr. Cummings. Societies and citizens were finding pollutants in the air and water in the United States and therefore stimulated great interest on the part of the environmentalists. This interest led to search for scientific information which could be used for policy development by state and federal governmental agencies. The Library was able to provide its informational materials to those concerned with this huge national problem.
- For Lister Hill photographs see "Lister Hill." Encyclopedia of Alabama. https://www.encyclopediaofalabama.org/face/Article.jsp?id=h-1103.
Institutions and Programs
- Lister Hill National Center for Biomedical Communications. https://www.lhncbc.nlm.nih.gov/.
Articles and Oral Histories
- Lipscomb, Carolyn E. "Lister Hill and his influence." J Med Libr Assoc. 2002 January; 90(1): 109-110. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC64768/.
- McCarn, Davis B. "Planning for On-Line Bibliographic Access by the Lister Hill National Center for Biomedical Communications." Bull Med Libr Assoc. 1970 July; 58(3): 303-310. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC197466/.
- Smith, Kent. "Laws, leaders, and legends of the modern National Library of Medicine." The 2007 Joseph Leiter Lecture. J Med Libr Assoc. 2008 April; 96(2): 121-133. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2268223/.