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To protect NLM's reasonable prices and ensure the quality of its databases, the NLM needs either an exclusion in the Paperwork Reduction Act itself, or specific authority in the basic NLM Act to enter into license agreements that provide for quality control and full recovery of access costs.

AGENCY FOR HEALTH CARE POLICY AND RESEARCH

Question. What is the status of NLM collaboration with the Agency for Health Care Policy and Research (AHCPR) to provide information services in the field of health services research? How are these activities being funded?

Answer. In response to the December 1989 legislation that created the AHCPR, AHCPR and NLM have entered into an interagency agreement to improve information services in the field of health services research. As a result of this agreement, the Library has:

(1)

established a new Office of Health Services Research
information that is currently providing special
literature searches and back-up document delivery service
for the AHCPR panels charged with developing practice
guidelines;

(2) begun to enhance coverage of health services research in

the NLM collection, its Medical Subject Headings, and its online databases of indexed citations;

(3)

initiated a research and development project to make the full-text of approved guidelines available to users of NLM's online services;

(4) begun expanding the Unified Medical Language System

(UMLS) Knowledge Sources to make them more useful to
health services researchers;

(5) developed a special workshop and training materials

designed to inform health services researchers of the
utility of NLM's current online services.

The Institute of Medicine is assisting NLM and AHCPR by conducting a study of information needs related to health services research, including technology assessment, and by recommending new or expanded services that NLM should provide to meet these needs.

Under the terms of its legislation, AHCPR is authorized to support NLM's health services research information program through FY 1992. AHCPR is providing support to NLM at the level of about $1,000,000 per year.

QUESTIONS SUBMITTTED BY SENATOR DALE BUMPERS

NATIONAL RESEARCH AND EDUCATION NETWORK

Question. Three million dollars of your 1992 budget have been earmarked for advancements in the National Research and Education Network (NREN) efforts of NLM, one-quarter of which is to be spent on connecting medical institutions with the NREN network

and the rest of which is to be "apportioned among other performance computing projects."

Would you please specify what some of these "related" projects are?

Answer. 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. Three million dollars has been made available to NLM for this High Performance Computing initiative in FY 1992. The National Research and Education Network (NREN) is one component of the overall FCCSET plan. NLM's related HPCC 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.

Question. Do any of these planned projects involve the medical or health science libraries or librarians in the NREN network?

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Answer. A major portion of NLM's HPCC effort will be in assisting and encouraging biomedical and health care institutes to attach to and use new high speed networks and additional national information resources. In the case of major medical centers, the medical librarians are already central to the institutions planning for information systems. The IAIMS grant sites are examples of this. We also plan for experimental sites in rural areas and areas serving minority or otherwise underserved populations. In such cases, NLM will continue to work through the Regional Library Network realizing that most hospitals do not have medical librarians on staff.

Question. NLM's budget proposal expresses the clear intention to use the NREN network to improve health care practitioners' direct access to GRATEFUL MED. While this effort is laudable, it appears to have certain limitations, as practitioners are sometimes intimidated by the technology and may not use it to its fullest capacity.

In order to maximize the NREN program's capabilities, what steps are you taking to involve health science libraries and librarians in your NREN efforts?

Answer. The DeBakey Outreach Panel calls for the Regional Medical Libraries to serve as NLM's "field force" for introducing health care practitioners to the products and services available through the NLM.

Question. What will be the impact of this expanded outreach effort on health sciences libraries and librarians?

Answer. The NREN will provide faster, better access to national information sources for the libraries in the RML network.

Question. Will there be increased outreach funds available for the institutions which become part of the NREN program?

Answer. NLM's efforts to improve health care practitioners' access to biomedical information, including access to GRATEFUL MED, are being carried out through the Regional Medical Library network, a national network of over 3,000 health science libraries.

Question. Will any of the NREN funds be used for training or retraining of health science librarians?

Answer. Under the HPCC initiative, the Library's recently released RFA announcement for grant support to informatics training centers at a variety of academic health science institutions specifically provides for the inclusion of medical librarians who may avail themselves of these training opportunities.

OUTREACH

Question. In 1989 NLM widely publicized the recommendations of its outreach planning panel. If those recommendations had been enacted and fully funded, the 1991 outreach funding level would have been around $35 million. What is the current outreach funding level?

Answer. NLM's FY 1992 budget request includes approximately $6.2 million for outreach activities. These funds will be utilized to support the Regional Medical Libraries; hospital access, training and demonstration grants; and the development of information projects and services.

Question. Considering the DeBakey panel recommendations and the fact that outreach has been a high priority for NLM in the past, why does the budget request for outreach reflect funding for activities at current services level? Does this reflect a shift in priorities for NLM away from outreach?

Answer. Outreach continues to be NLM's highest priority. NLM continues to invest both its fiscal and intellectual resources not only to acquiring scientific information but in devising new and more efficient and effective methods for making it readily available to the health and science community. NLM is in complete accordance with the stated Congressional position that the benefits of our nation's investment in biomedical research can be maximized only if there are effective channels for disseminating research results.

Budgetary constraints limited NLM's ability to substantially increase resources earmarked for outreach activities. The FY 1992 budget request of $6,183,000 for outreach does, however, include a modest increase of $429,000 over current services for outreach.

Question. What specific outreach activities did you initiate last year to respond to the increase in funding that the Congress provided which was above the President's 1991 budget request?

Answer. Large numbers of health professionals in our nation do not have easy access to biomedical information--because of geographic isolation, non-affiliation with a hospital or medical school library, or lack of information about NLM's products and services. with the increased funding available for outreach, we have identified institutions and individuals to help us reach out to these underserved health professionals; libraries in our own Regional Medical Library network have stepped forward, as well as other institutions, in response to NLM solicitations for help. It is clear that within the population of health professionals in underserved areas, there is a sub-group of health professionals serving minority populations who have a special set of problems in accessing information. NLM has geared a variety of new outreach initiatives to these rural and minority communities. Results of these outreach initiatives include:

Extensive efforts to train physicians and other health professionals on the use of GRATEFUL MED in 50 communities in 32 states. This is being accomplished through special projects at the Regional Medical Libraries, and awards to individual small-to-medium sized libraries in the network, with an emphasis on libraries in rural and inner city areas.

Faster and easier access to documents identified in online searches. For those health professionals who are not affiliated with a medical library, LOANSOME DOC, NLM's new link between the GRATEFUL MED user and a network library, allows electronic ordering of documents.

Demonstration projects in the Rio Grande Valley of South Texas and Meharry Medical College in Tennessee to identify impediments to use and test innovative strategies for improving access among health professionals serving predominantly minority populations in geographically isolated areas, including the use of a circuit librarian (Rio Grande Valley) and training residents in GRATEFUL MED use, who will go on to train their preceptors (Meharry). A total of 18 outreach projects have a minority focus.

A new initiative in NLM's Toxicology Information Program (TIP) is aimed at establishing a mechanism which would strengthen the capacity of historically black colleges and universities to train medical and other health professionals in the use of toxicological, environmental, and occupational information resources developed at NLM. This audience represents a group that would otherwise not get exposure to these valuable information sources and also is considered one of the high priority groups within NLM's outreach efforts.

Continuing efforts to publicize the programs and services of the Library. Publicity activities are targeted both to health professionals and to general audiences, and include exhibits at meetings as well as training kits, press releases, videos, and a campaign to inform dental professionals about the benefits of GRATEFUL MED.

These institutions that are collaborating with us now represent the most needy, and the projects are now being undertaken.

Question. Both the Long Range Planning Panel and the DeBakey report recommend increased training and retraining for health sciences librarians. However, the NLM budget justification appears to place primary emphasis training in medical informatics and biotechnology information in the disciplines of molecular biology and genetics.

Please comment.

Answer. Both the 1987 NLM Long Range Plan and the recent DeBakey Outreach Report recommended training health science librarians in the use of computer technologies in medicine. This is still of great interest to NLM. As NLM was beginning to formulate the issues for a planning panel on the training of medical librarians, the Medical Library Association convened a Knowledge and skills Task Force. This Task Force is attempting to define the knowledge and skills required of the health science librarians of the future, and the educational policies which will assure the maintenance of those abilities throughout a professional

The findings of this Task Force will be an important input into the NLM planning process.

NLM has been kept regularly apprised of the progress of the Task Force and intends to convene its own planning panel of health professionals, librarians, and other information professionals following the issuance of the Task Force Report. Meanwhile, NLM continues to address the problem that there are not adequate numbers of persons in biomedical fields, including medical librarianship, who have had training in the use of modern computer and communications systems. Such training is supported through medical informatics training grants. This is a key concept of the HPCC initiative.

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Question. The Integrated Academic Information Management System (IAIMS) Program appears to incorporate some of the goals of the NREN project; does the President's budget request reflect an increase over 1991 funding for IAIMS grants?

Answer. The IAIMS program is completely compatible with the NREN concepts. Indeed in many ways it directly exceeds these ideas. The IAIMS program is directed toward the institution-wide use of communications and information processing techniques to link and relate library systems with individual and constituent data bases and files

inside and outside the institution for patient care, research, education and administration. The goal is to create an organizational mechanism within health institutions to manage biomedical knowledge more effectively, and to provide for a system of comprehensive information access. This is indeed in line with the goals of the High Performance Computing Program.

Funding for IAIMS is sufficient to maintain the same level of funding as in FY 1991.

SUBCOMMITTEE RECESS

Senator HARKIN. Thank you. The subcommittee will stand in recess until 9:30 a.m., Tuesday, March 19, when we will meet in SD192 to hear from the Department of Education.

[Whereupon, at 5:36 p.m., Thursday, March 14, the subcommittee was recessed, to reconvene at 9:30 a.m., Tuesday, March 19.]

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