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protected the integrity of the Library's collections and services and you have supported several initiatives important to the future of American medicine.

Mr. Chairman, the FY 1992 request for the National Library of Medicine is $100,554,000. I shall be pleased to answer any questions you may have.


September 21, 1933. New York, New York

Education: A.B., Biology, Amherst College, magna cum laude, 1954; M.D., College of Physicians and Surgeons; Columbia University, 1958; Sc.D., Amberst College, (bon. caus.) 1979; Sc.D., State University of New York (hon. caus.) 1987; LL.D., University of Missouri-Columbia, (hon. caus.) 1990.

Professional History: 1984-present, Director, National Library of Medicine; 1988-present, Adjunct Professor of Pathology, University of Maryland School of Medicine; 1971-1984, Director, Information Science Group, University of Missouri School of Medicine; 1969-1984, Professor of Pathology, University of Missouri School of Medicine; 1976-1980, Director, Health Services Research Center with Special Emphasis Health Care Technology Center, University of Missouri-Columbla; 1972-1973, Consultant for Health Sciences to Vice President for Academic Affairs; 1969-1971, Professor and Chairman, Department of Information Science, University of Missouri School of Library and Information Science; 1970-1971, Staff, Vice President for Academic Affairs, University of Missouri; 1967-1970, Director, Regional Medical Program Information Systems; 1968-1970, Staff, Executive Director for Health Affairs, University of Missouri; 1962-1970, Director, Medical Center Computer Program, University of Missouri; 1962-1970, Director Medical Center Computer Program, University of Missouri; 1967-1969, Director, Missouri Regional Automated Electrocardiography System; 19661969, Associate Professor of Pathology, University of Missouri School of Medicine; 1963-1966, Assistant Professor of Pathology, University of Missouri School of Medicine; 1962-1963, Instructor in Pathology, University of Missouri School of Medicine; 1960-1963, Director, Diagnostic Microbiology Laboratory, University of Missouri Medical Center; 1960-1962, Resident Physician in Pathology, University of Missouri School of Medicine; 1959-1960, Assistant Resident in Pathology, Columbia-Presbyterian Medical Center; 1958-1960, Assistant in Pathology, Columbia University College of Physicians and Surgeons; 1958-1959, Intern in Pathology, Columbia-Presbyterian Medical Center, June 1955-Sept. 1955, June 1954-Sept. 1954, Research Assistant to Dr. O.E. Schotte, Amherst College.

Honors: Phi Beta Kappa; Simpson Fellow of Amberst College (1954-55); Markle Scholar in Academic Medicine (1964-69); Distinguished Practitioner in Medicine, National Academies of Practice in Medicine (1983); Member, Institute of Medicine, National Academy of Sciences (1985); Member of 10M Council (1990-93); Fellow, American College of Medical Informatics (1985); Surgeon General's Medallion, Public Health Service (1989); Nathan Davis Award for Outstanding Member of Executive Branch in Career Public Service, American Medical Association (1989); Walter C. Alvarez Memorial Award, American Medical Writers Association (1989).

Professional Memberships: Sigma Xi; American Society of Clinical Pathologists; College of American Pathologists (Telecommunication Network Committee, Committee on Emerging Technology); American Association for Advancement of Science; American College of Medical Informatics; Salutis Unitas; National Board of Medical Examiners, Board Member, Washington Society for the History of Medicine; Editor, Information Methods in Medicine, Lecture Notes in Medical Informatics, and Journal of Medical Systems; National Academy of Practice in Medicine Distinguished Practitioner, Computer Science and Engineering Board, National Academy of Sciences (1971-1974); U.S. Representative to International Medical Informatics Association and Trustee (1975-1984); Board on Health Sciences Policy, Institute of Medicine; President, American Medical Informatics Association (1988-present).

Dr. Lindberg is the author of 4 books and more than 150 articles, reports, and chapters of monographs.

February 1991


Senator HARKIN. Dr. Lindberg, thank you and I am sorry that I have to leave. This is, I hope, the last vote of the day, but I just did not want to hold you all here again.

The Library of Medicine is extremely important. This committee supports it strongly. I do have some questions I want, ask you about Loansome Doc and other things, but we will do it in writing and find out more about that.

Dr. Raub, thank you very much. Thank all of you for your kind patience in waiting all day. This was informative for me. I look forward to working with you this year and beyond.

Dr. Raub.

Dr. RAUB. Thank you, sir. As always, we appreciate your detailed attention and support.

Senator HARKIN. Thank you. I look forward to working with you. Thank you all very much.

[The following questions were not asked at the hearing, but were submitted to the Department for response subsequent to the hearing:]



Question. For a number of years the Committee has urged the National Library of Medicine to increase its outreach effort to doctors and health practitioners in rural areas. Your budget request includes $6,183,000 for outreach activities, an increase of $650,000 from the fiscal year 1991 level.

How many doctors are now subscribed to Grateful Med and how much has this increased since last year?

Answer. There are 6,698 or 75% of the doctors who have personal accounts for searching NLM's online system that use GRATEFUL MED. The number of doctors using GRATEFUL MED to search has increased 53% since February of 1990.

Question. What has your research shown about what works and what doesn't work to encourage doctors to use your system?

Answer. Early indications are that the special Outreach projects undertaken by individual libraries to introduce doctors and other health professionals in rural and underserved areas to online searching via Grateful Med will be particularly successful. Some 30 contracts were awarded to institutions such as community hospitals to provide innovative training programs. Other approaches that appear to work include: special rates that encourage medical students to begin searching while in medical school, free searching to allow those opening accounts to become familiar with the system, free Grateful Med demonstration disks distributed at the NLM exhibit booth at health professional meetings, toll free numbers for ordering Grateful Med and getting search assistance, and articles by health professionals in local newspapers or professional journals describing the usefulness of Grateful Med searches. Health professionals also appreciate the ability to use credit cards to purchase Grateful Med. Special "master account" billing for all individuals searching from a single institution and flat-rate per code billing experiments have encouraged institutions to obtain large blocks of search codes for the health professional and researchers they employ. We expect NLM's new "Clinical Alert" service to be an added inducement to doctors to become online searchers, but it is too early to assess its impact on system use.

NLM has found that advertisements are not particularly successful in encouraging doctors to use Grateful Med. Distribution of free copies of Grateful Med and designation of specific "free online use days" have not been effective with doctors either.


Question. You have started a new service this year called "Loansome Doc." What is this new service?

Answer. Loansome Doc is a new feature of GRATEFUL MED, NLM's microcomputer based user-friendly system for searching NLM's MEDLARS databases. Through software enhancements to GRATEFUL MED

and DOCLINE, NLM's automated interlibrary loan request and referral system, individual health professionals can place an order online for a photocopy of the full article for any reference retrieved in a GRATEFUL MED search. Loansome Doc provides a valuable link between the GRATEFUL MED user and a medical library. From the GRATEFUL MED menu, a user may select the Loansome Doc function, perform a search, select items to order, and send the orders to a previously designated medical library. Each user can select one of three delivery methods for receipt of his or her documents (mail, fax or pickup). Through a new DOCLINE function, a library receives the requests, fills them if the items are available, or transfers the requests to DOCLINE where they will route to a library that reports owning the requested documents.

Loansome Doc is intended to serve all health professionals, not just those currently affiliated with a medical library. It will be available to all GRATEFUL MED (IBM) users by January 1992. A phased implementation will occur beginning in May 1991 when Loansome Doc disks will be sent to all GRATEFUL MED users in the two western regions. Additional institutions will have Loansome Doc by late summer or fall, 1991.


Question. I understand you have decided to increase your regional libraries from seven to eight. Why was this necessary? Why was the new regional library put in the Northeast?

Answer. The decision to increase the number of regions and regional medical libraries from seven to eight was made in direct response to the request of the Congress that NLM expand its outreach efforts and to a recommendation of the Outreach Planning Panel chaired by Dr. Michael DeBakey. The regional medical libraries (RML) are a key element in NLM's strategy to reach all U.S. health professionals, and particularly those in rural and inner city areas. In the seven region configuration, the Northeast region contained 10 states, served both large urban centers, such as New York City, and isolated rural areas, for instance upstate Maine, and had the largest number of physicians, dentists, and nurses of any of the seven regions. Dividing this area into two smaller regions will enable NLM and the RMLS to intensify efforts to reach these health professionals. Contracts for the new eight region configuration are expected to be awarded on May 1, 1991.


Question. Your budget includes a requested increase of approximately three million dollars for a new program for high performance computing. I understand this is the biomedical component of the High Performance Computing and Communications initiative proposed by the President's Office of Science and Technology Policy.

How will this program assist the medical community?

Answer. The Office of Science and Technology Policy (OSTP), and its Federal Coordinating Council on Science, Engineering, and Technology (FCCSET) Committee on Physical, Mathematical, and Engineering Sciences has formulated a Presidential initiative for

High Performance Computing and Communications (HPCC), which is to begin in FY 1992. There is a growing impetus for strengthening the capabilities of the biomedical community in high performance computing and networking. Grand Challenges in biomedicine, such as the analysis of the human genome, prediction of biological structure and function from genetic code, and rational drug design, will require new and faster computers, advanced software, a national research and education computer network, and expanded training of scientists in the use of computer-based tools. The overall FCCSET plan recommends additional resources for NLM to address these Grand Challenges in biomedicine as part of this multi-agency coordinated initiative. NLM's plans include applications in molecular biology computing, creation and transmission of digital electronic images, the linking of academic health centers via computer networks, the creation of advanced methods to retrieve information from life sciences databases, and training in biomedical computer sciences. In years to come the HPCC and what it creates will be of enormous importance to medicine. At the moment, medicine is a tiny part of the HPCC.

Specifically, NLM will expand its grants program to connect medical institutions to the high speed network and to train scientists in the use of new computer capabilities. The Library will proceed with a "Visible Human" project that will result in the ability to compute, display, and transmit the enormous amount of digital information that comprise three-dimensional images of the human body at millimeter-level resolution. The availability of such a tool will have significant implications for medical education, research, and practice.

NLM will also make its databases available over the evolving high-speed research network. In order to facilitate linkages between dissimilar databases, the Library will accelerate development of the Unified Medical Language System, a research effort to build computer systems which "understand" medical concepts and overcome differences in terminology.

Lastly, NLM will expand its development of advanced software and biotechnology information retrieval methods and the implementation of the "backbone" sequence database of molecular structure that will contain key linkages to the scientific literature and to existing biological databanks. This database, called GenInfo, will be made available to researchers over the high-speed computing network being expanded under the HPCC Initiative.

Question. Why should it be located at the National Library of


Answer. Within the Department of Health and Human Services, the focal point for the HPCC Program is the National Institutes of Health and, specifically, NLM. The NLM has a long and productive history of innovation in the use of computers and computer networks. In 1964, NLM created MEDLARS to automate Index Medicus. MEDLINE (MEDLARS On-Line) was the world's first large-scale successful online bibliographic system, and the first international telecommunications-based science information network. The success of MEDLARS and MEDLINE was a milestone in the evolution of modern libraries.

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