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BUDGET REQUEST Senator HARKIN. Dr. Lindberg, I hate to ask you to stay. Well, let's see. I have 8 minutes left.

Dr. Lindberg, your request is $100.5 million, 10 percent more than last year. Could you just give us a brief summary? I would hate to have you sit here for another 15 minutes while I go vote.

Dr. LINDBERG. I would be happy to be brief. I am very pleased to be here, Senator Harkin.

The National Library of Medicine's task is to acquire, organize, and disseminate the information that results from the discoveries and the funding of the rest of NIH and the biomedical community.

Our work has gone very well in the last year. Compared with previous years, there were more papers published and indexed, more books published and cataloged, and more online computer inquiries. There are now 5 million such inquiries a year.

OUTREACH In addition, there are certain initiatives that this committee and the House have encouraged that I should report to you. In 1988, this committee gave us specific language that said I should publicize the products and services of the National Library of Medicine. That has been tremendously helpful to us. That, combined with an outreach study by Dr. Michael DeBakey and 20 colleagues, has set us on a course of putting to excellent use the additional funds that the Congress has provided specifically for outreach. There are now about 50 programs in 38 States. So, we are trying our level best to make sure all of those products and services become available to every health care professional in the United States.

NATIONAL CENTER FOR BIOTECHNOLOGY INFORMATION Even though time is short, I should report to you about the National Center for Biotechnology Information (NCBI), also created by congressional action. Among other things, the NCBI has the responsibility to be sure that the sequencing and mapping information that results from the human genome program is available as quickly and as efficaciously as possible to the investigators who participate in the program and to those health care practitioners who will ultimately use and benefit from it. All that has been going extremely well. There are now 28 remarkably talented young professionals in the center doing this work under Dr. David Lipman's direction.

In terms of breakthroughs, I think it is interesting that in the course of the last year, the NCBI staff have been able to move from

use of the Cray supercomputers at Frederick, which happily the National Cancer Institute let us use, to do the same extensive calculations on smaller machines, silicon graphics microparallel processors. The net result is that in the NCBI laboratory, they can take any sequence and compare it against the entire 40 million sequences that are held in the data bank and get an answer in 5 seconds. Even better, they can offer to any collaborator across the country who is attached to the Internet this same service-log-in, printout, and so forth in 15 seconds.


Now, that brings me to the last point, Mr. Chairman. Probably the most exciting thing that has happened for us in the last year has been our participation last summer in the Office of Science and Technology Policy's White House program on High Performance Computing and Communications. That is one of the Presidential initiatives. Accompanying the President's budget is this publication that describes the program. I will leave you one.

This is a major effort, $150 million of new money this year on top of $680 million a year already being spent by the four major science agencies: DARPA in the Department of Defense, Department of Energy, NASA, and NSF. During this last year we have joined that effort, I am proud to say. In fact, NLM is the only biomedical component. So, in a sense we are representing as strongly as we can, a token for NIH, a token for HHS, and a kind of a pale representation of what should be the entire biomedical enterprise. But at least we are participating and trying to develop biomedical applications and uses for these new systems. Dr. Bromley, head of the Office of Science and Technology Policy, and Eric Block, the former head of NSF, have said that we must plan for community benefits from computers that have not been invented yet using networks that have not been developed. But, of course, there are prototypes in both cases that are very much better than anything most investigators have. It is our task to be sure that the biomedical institutions get ready to use the new capabilities and use them wisely.


The High Performance Computing and Communications initiative will also work effectively with the human genome project. The rapid analyses that I described as possible today will have to be 1,000 times faster in the future, as Dr. Watson pointed out. We are not really behind now in analytic capability, but we know we have to do 1,000 times better in the future or the whole system won't work.

I do appreciate the past support of the Congress for NLM. This year's President's budget is $100,554,000, as you mentioned.

I would be pleased to respond to questions if your time permits. [The statement follows:]


Mr. Chairman and members of the Committee: I welcome the opportunity to tell you about the National Library of Medicine (NLM) and its increasing ability to provide American health professionals with the sophisticated information services they needed to treat patients and carry out biomedical


This year the NLM celebrates the twentieth anniversary of its online database, MEDLINE. In 1971, the Library made available for searching some 300,000 references; two dozen major medical libraries made up the network at that time. Today, 20 years later, more than 13 million records are offered to a still-growing network of health professionals. physicians, scientists, and others about how MEDLINE can provide information vital to treating patients and conducting research.

Current Activities

We hear frequently from

During 1991 the Library will add its 50,000th user code to the NLM online retrieval network. The growth of the network, as measured by the number of health professionals who have access to it, continues at a rate of about 50 percent a year. The increase is fueled by the continuing popularity of Grateful Med, NLM's software that allows users of personal computers to have rapid and easy access to MEDLINE and to NLM's other major databases. More than 30,000 copies of the software have been distributed.

Even these figures belie the extent of MEDLINE use within the American health community. Virtually all major and many smaller health-related organizations have access to NLM's databases, frequently through their institutional library. One "user code," then, can provide MEDLINE access to many health professionals. Other routes of access are the large commercial database vendors who lease MEDLINE from the NLM, and the rapidly growing number of people around the world who depend on commercial MEDLINE/CD-ROM products for searching NLM's database. Not counting MEDLINE access via commercial products, there were almost 4.8 million searches over the Library's online network centered on its computers in Bethesda, Maryland. This same network is now being used for the first time to disseminate NIH "clinical alerts" so that health professionals can be notified of life-saving

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information well before formal publication in a journal. The NLM issued its first "clinical alert" on pediatric AIDS on January 18, 1991.

In response to recommendations from the Congress, NLM began a wide variety of outreach activities in FY 1990. The focus of these activities has been on improving access by individual health professionals to NLM's information products and services, especially by persons presently

unaffiliated with an institution and/or who are located in rural or other medically underserved settings. Many of the latter locations are comprised of predominantly minority populations.

Through special enhancements to the existing Regional Medical Library (RML) contracts, NLM has funded demonstration projects in 12 states to test various means of increasing awareness of and access to NLM's® information services by health professionals located in underserved areas. Some of the projects are being carried out directly by the RML; others involve the RML subcontracting with another network library. The 3,000-member Regional Medical Library Network itself is undergoing important changes in FY 1991. The seven RML contracts are being renegotiated with a new emphasis on outreach activities, and an eighth Regional Medical Library is being created for the New England area.

Another recently developed outreach-related program provides for small competitive contracts awarded directly by NLM to network libraries for the purpose of introducing online searching via Grateful Med to health professionals in rural and inner-city areas. Thirty such contracts were awarded in FY 1990 to network libraries from Hawaii to Maine.

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NLM's Extramural Programs are also being oriented toward outreach. Two new grant categories--Information Access and Information Systems--foster access to information resources and services utilizing today's computer and communications technologies. Among some recently awarded Information Access Grants aimed at small-and medium-size hospitals are several in Appalachia to introduce Grateful Med to health professionals there. An Information Systems Grant which is directed towards larger hospitals and medical centers, was awarded to the University of Miami's medical center library to assist in developing an AIDS information service for health professionals in Southeast Florida. Both grant types have significant outreach potential.

These, as well as other innovative outreach activities have been

continued in FY 1991. The FY 1992 request includes increased resources for


Other continuing grant-supported activities are the Integrated Academic Information Management Systems (IAIMS) Program that assists health institutions to plan and develop computer and communication networks, and post-graduate training programs in medical informatics at leading institutions.

Although not supported by grants, in FY 1991 NLM is initiating a new training program. The Undergraduate Research Study Program provides 2-year scholarships and research assignments in bioengineering for sophomore engineering and computer-science students at historically black colleges and universities.


Participating students will complete two summer internships at the Lister Hill National Center for Biomedical Communications and two academic year assignments under the guidance of their academic instructors. purpose of this program is to stimulate undergraduate medical informatics research programs and to encourage graduate education.

New and Prototype Systems

Enhancements to existing products and services are also proceeding. "Loansome Doc," a link between the Grateful Med user and a network library, has been tested in four western states and will become available to Grateful

Med users in mid-1991. Using Loansome Doc, the health professional will be able to order electronically, documents identified in an online search from a designated Network library. This system in conjunction with a telefacsimile machine will greatly speed up the health professional's access to journal articles; the time will be measured in minutes rather than days and the system should also be especially helpful to rural and other isolated health professionals who do not currently have access to a medical library.

When the new Agency for Health Care Policy and Research (AHCPR) was created in 1989, the Congress directed it to collaborate with the National Library of Medicine to improve information systems in the field of health services research, encompassing health technology assessment and the development of practice guidelines. With funds transferred from AHCPR, the Library has created a new Office of Health Services Research Information. Library already provides substantial coverage of health services research in


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