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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.
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 11brary. 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 11brary.
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
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.
include descriptions of the biomedical literature, clinical records,
databanks, knowledge-based systems, and directories of people and
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
bionedical 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 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
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
NLM's is the only biomedical element in the
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.
I would like to thank you and the Committee for your support
in making the National Library of Medicine a true International center for
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
I shall be pleased to answer any questions you may have.
BIOGRAPHICAL SKETCH OF DR. DONALD LINDBERG
Seplember 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., State Valversity of New York (hon. caus.) 1989; LL.D. C'niversity of Missouri-Columbia, (hon. aus.) 1990.
Professional History: 1984-present, Director, National Library of Medicine; 1988-present, Adjunct Professor of Pathology, Volversity of Maryland School of Medicine; 1971-1984, Director, Information Scleoce Group, Volversity of Missouri School of Medicine; 1969-1984, Professor of Pathology, University of Missouri School of Medicloe; 1976-1980, Director, Health Services Research Center with Special Empbasis Health Care Tabpology Center, University of Missourl-Columbia; 1972-1973, Consultant for Health Sciences to Vice President for Academic Affairs; 1969-1971, Professor and Chairman, Department of loformation Science, University of Missouri School of Library and Information Science; 1970-1971, Sunt, Vice President for Academic Affairs, University of Missourt; 1967-1970, Director, Regional Medical Program Information Systems; 1968-1970, Stall, Executive Director for Health Affairs, University of Missouri; 1962-1970, Director, Medical Ceater Computer Program, University of Missourt; 1962.1970, Director Medical Center Computer Program, University of Missourt; 1967-1969, Director, Missouri Regional Automated Electrocardiography System; 19661969, Associate Professor of Patbology, University of Missouri School of Medicine; 1963-1966, Assistant Professor of Pathology, University of Missouri School of Medicne; 1962-1963, Instructor in Pathologi University of Missouri School of Medicine; 1960-1963, Director, Diagnosic Microbiology Laboratory, University of Missouri Medial Ceoler, 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 lo Patholog, Columbia University College of Physiclans and Surgeons; 1958-1959, latero in Pibolog, Columbla-Presbyterian Medical Center, June 1955-Sept. 1985, June 1954-Sept. 1934, Research Assistant to Dr. O.E. Scbotte, Amherst College.
Honors: Phi Bela Kappa; Simpson Fellow of Amberst College (1954.55); Markle Scholar la Academic Medicine (1964-19); Distinguisbed Procutioner In Medicine, National Academles of Practice lo Medicine (1983); Member, lostitute of Medicine, National Academy of Sciences (1983); Member of IOM Council (1990-93); Fellow, American College of Medical Informatics (1983); Surgeon Gedenal'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: Sigmas XI; American Society of Cbolcal Pathologists; College of Armerican Pathologists (Telecommunication Network Committee, Committee on Emerging Tecbaology); American Association for Advancement of Science; American College of Medical Informatics; Saluus Valias; National Board of Medical Examiners, Board Member, Wasblogton Society for the History of Medicine; Editor, laformation Methods lo Medicine, Lecture Noles lo Medical Informatics, and Journal of Medical Systems; National Academy of Practice in Medicine Distinguished Practitioner, Computer Science and Englneering Board, National Academy of Sciences (1971-1974); U.S. Representative to International Medical løformatics Association and Trustee (1978-1984); Board on Health Sciences Policy, lastlute of Medicine; President, American Medical Informatics Association (1988-present).
Dr. Lodbery is the author of 4 books and more than 150 articles, reports, and cooplen al monographs.
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. 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:)