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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 H111 National Center for Biomedical Communications and two academic year assignments under the guidance of their academic instructors. The 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.

"Loansone 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. The

Library already provides substantial coverage of health services research in

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 long

tern 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--cane 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

blonedical 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


The usefulness of such an image 11brary 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 Blomedical 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.


September 21, 1933. New York, New York

Education: AB., Biology, Amberst College, magna cum laude, 1934; M.D., College of Physicians and Surgeons; Columbia University, 1958; Sc.D., Amberst College, (bon. caus.) 1979, Sc.D., Suate University of New York (hon. cus.) 1989; LL.D, L'niversity of Missouri-Columbia, (hon. aus.) 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, Prolessor of Pathology, University of Missouri School of Medicine; 1976-1980, Director, Health Services Research Center with Special Emphasis Health Care Tabpology Center, Volversity of Missourl-Columbia; 1972-1973, Consultant for Healib Sciences to Vice President for Academic Affairs; 1969-1971, Professor and Chairman, Department of loformation Science, University of Missouri School of Library aod Information Scence; 1970-1971, Sualt, Vice President for Aademic Affairs, University of Missourt; 1967-1970, Director, Regional Medical Program Information Systems; 1968-1970, Sualt, Executive Director for Health Altairs, University of Missourt; 1962-1970, Director, Medical Ceater Computer Program, University of Missouri; 1962-1970, Director Medical Center Compuler Program, University of Missourt; 1967-1969, Director, Missouri Regional Automated Electrocardiograpby System; 1966 1969, Assoclate Professor of Patholog, University of Missouri School of Medicine; 1963-1966, Assistant Professor of Pathology, University of Missouri School of Medicine; 1962-1963, Instructor in Pathology, Valversity of Missouri School of Medicine; 1960-1963, Director, Diagnostic Microbiology Laboratory, University of Missouri Medical Center, 1960-1962, Resident Physician lo Pathology, University of Missouri School of Medicine; 1959-1960, Assistant Resident in Pathology, Columbia-Presbyterian Medical Center, 1958-1960, Assistant in Patholog, Columbia University College of Physicians and Surgeons; 1958-1999, latern in Pibolog, Columbla-Presbyterian Medical Center, June 1993-Sept. 1955, June 1954-Sept. 1934, Research Assistant to Dr. O.E. Schotte, Amherst College.

Honors: Phi Bela Kappa; Simpson Fellow of Amberst College (1954-59); Markle Scholar la Academic Medicine (1964-19); Distinguisbed Practitioner In Mediciae, National Academies of Practice la Medicine (1983); Member, Institute of Medicine, National Academy of Sciences (1983); Member of IOM Council (1990-93); Fellow, American College of Medical Informatics (1983); Surgeon General's Medallon, 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: Sigros XI; American Society of CBolcal Patbologists; College of American Pathologists · (Telecommunication Network Committee, Committee on Emerging Technology); American Association for Advancement of Science; American College of Medical Informatics; Salutis Valtas; National Board of Medical Examiners, Board Member, Wasblagton Society for the History of Medicine; Editor, Information Methods lo Medicine, Lecture Notes lo Medical Informatics, and Journal of Medical Systems; National Aademy of Practice in Medicine Distinguished Practitioner, Computer Science and Engineering Board, National Aademy of Sciences (1971-1974); US. Representative to International Medical loformatics Association and Trustee (1975-1981); Board on Health Sciences Policy, lastlute a Medicine, President, American Medical Informatics Association (1988-present).

Dr. Lodbery is the author of 4 books and more than 150 articles, reports, and ebaplen dl monographs.

February 1991

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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:)

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