its Medical Subject Headings (MeSH) vocabulary, its collections of literature, and its indexing and cataloging of databases. Access to the health services research information now available at the Library is also provided via NLM's online and other services. In response to the legislation that created the AHCPR, over the next few years the NLM will review and enhance as necessary these products and services.

NLM's recently established National Center for Biotechnology Information (NCBI) has had great success recruiting American and foreign scientists of international standing to work at NLM. In the last year, NCBI scientists have developed a new fast algorithm for sequence similarity searches of protein and nucleic acid databases. One outcome of this development was the

identification by an NCBI scientist, in collaboration with a group of researchers at the Howard Hughes Medical Institute at the University of Michigan, of the gene causing von Recklinghausen's neurofibromatosis (or "Elephant Man's" Disease). This is a major breakthrough in understanding this bewildering disorder that affects about one in 3,000 people. The NCBI is also creating a new biosequence database, the GenInfo Backbone, that includes MEDLINE records which contain sequence data, integrates DNA and amino acid sequence information, and maximizes the use of standard nomenclature and official gene names. These features enable GenInfo to serve as a valuable data resource in its own right as well as a foundation to which the rapidly increasing number of specialized biology databases can be linked.

The Next Generation

The Unified Medical Language System (UMLS) project continues as a longterm NLM research and development effort to facilitate retrieving information from multiple computerized sources of biomedical information. Such sources include descriptions of the biomedical literature, clinical records, databanks, knowledge-based systems, and directories of people and organizations.

The goal of the project--to create tools that can establish a link between the user's question and relevant computerized information--came a step closer in FY 1990 with the release of the initial versions of the Metathesaurus and the Semantic Network, two machine-readable "knowledge sources developed as part of the UMLS. They provide relatively modest, although potentially powerful, enhancements to existing machine-readable

biomedical vocabularies and classifications.

They will grow in scope and

complexity as NLM learns about the experiences of those who are now attempting

to apply these first versions to a variety of information problems.

A new initiative just under way concerns medical images. The first "Visible Human" project would yield a computer data set of unprecedented detail and form the basis for a virtually unlimited number of image renderings of the human body.

The medical importance of such work comes in the abilities it will bring to transmit and understand medical images such as x-ray studies and computerized tomographic images, and the new capability to craft prosthetic devices that are customized to fit the precise needs of an individual patient's hip, knee, or mandible. In addition, there will be tremendous gains in teaching anatomy, and doubtless additional gains that only the future will

reveal.

The usefulness of such an image library would be dependent on the existence of a high-bandwidth computer network capable of transmission speeds thousands of times faster than the current commercially available networks that provide access to MEDLINE. NLM has taken leadership role for medicine in the new OSTP multi-agency High Performance Computing and Communications Program. The Federal Coordinating Council on Science Engineering and Technology (FCCSET) recommended an increased expenditure during 1992-97 within a number of agencies on behalf of this initiative. Of this, an additional $150 million of increased expenditures are included in the President's budget for FY 1992. NLM's portion of this increase is $3 million. A part of this initiative is to develop a National Research and Education Network, a sort of computer superhighway. NLM's is the only biomedical element in the

initiative. NLM is to help the American research and then the medical practice communities to prepare for the major changes that this initiative will bring to their medical practices, to the expectations patients will have for up to date modern treatment, and for the actual improvements in care that the new network will make possible.

In closing, I would like to thank you and the Committee for your support in making the National Library of Medicine a true international center for biomedical communications.

In my tenure as director, you have steadfastly

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.

BIOGRAPHICAL SKETCH OF DR. DONALD LINDBERG

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., Amherst College, (bon. caus.) 1979; Sc.D., State University of New York (hon. caus.) 1987; LL.D., University of Missouri-Columbia, (bon. 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-Columbia; 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, Amberst 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); US. 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

QUESTIONS SUBMITTED BY THE SUBCOMMITTEE

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:]

QUESTIONS SUBMITTED BY THE SUBCOMMITTEE

OUTREACH

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.

NEW SERVICE

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

"Loansome Doc."

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