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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 rezults.

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. 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:

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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?

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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.)

LIST OF WITNESSES, COMMUNICATIONS, AND

PREPARED STATEMENTS

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Adams, Hon. Brock, U.S. Senator from Washington, questions submitted by ... 70
Alexander, Duane É., Director, National Institute of Child Health and Human

Development, National Institutes of Health, Department of Health and
Human Services

923 Biographical sketch

930 Prepared statement

925 Archer, William R., M.D., Deputy Assistant Secretary for Population Affairs,

Office of the Assistant Secretary for Health, Department of Health and
Human Services ...

361 Barnhart, Hon. Jo Anne B., Assistant Secretary, Family Support Administration, Department of Health and Human Services

77 Biographical sketch

82 Prepared statement

81 Bart, Kenneth J., M.D., M.P.H., Deputy Director, National Vaccine Program,

Office of the Assistant Secretary for Health, Department of Health and
Human Services

361 Bowen, Dr. G. Stephen, Acting Director, Bureau of Health Resources Develop

ment, Health Resources and Services Administration, Department of Health and Human Services

587 Briggs, Ethel, Executive Director, National Council on Disability

657 Biographical sketch

671 Broder, Dr. Samuel, Director, National Cancer Institute, National Institutes of Health, Department of Health and Human Services

739 Biographical sketch

746 Prepared statement

742 Burdick, Hon. Quentin N., U.S. Senator from North Dakota, questions submitted by:

920, 1130 Bumpers, Hon. Dale, U.S. Senator from Arkansas, questions submitted by 428,

523, 803, 886, 939, 1028, 1076, 1180, 1138 Byrd, Hon. Robert C., U.S. Senator from West Virginia, questions submitted by....

..... 520, 884 Clinton, Dr. J. Jarrett, Acting Administrator, Agency for Health Care Policy and Research, Department of Health and Human Services

439 Prepared statement

442 Cochran, Hon. Thad, U.S. Senator from Mississippi: Prepared statement

4 Questions submitted by

654 Diggs, Dr. John, Deputy Director, Extramural Research, National Institutes of Health, Department of Health and Human Services

685 Dyer, John R., Deputy Commissioner for Finance, Assessment, and Management, Social Security Administration, Department of Health and Human Services ...

291 Biographical sketch

320 Enoff, Louis D., Deputy Commissioner for Programs, Social Security Administration, Department of Health and Human Services

291 Biographical sketch

319 Evans, Willard B., Jr., Acting Director, Office of Planning and Resource

Management, Agency for Health Care Policy and Research, Department of Health and Human Services

....................... 439

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Page Fauci, Dr. Anthony S., Director and Associate Director for HIV Research,

National Institute of Allergy and Infectious Diseases, National Institutes of Health, Department of Health and Human Services

685, 855 Biographical sketch

862 Prepared statement

857 Gall, Mary Sheila, Assistant Secretary, Office of Human Development Services, Department of Health and Human Services

131 Biographical sketch

133 Letter from

139 Prepared statement

132 Gannon, John, Chairperson, Health Insurance Committee, National Council on Disability

657 Biographical sketch

670 Gaston, Dr. Marilyn, Director, Bureau of Health Care_Delivery and Assist

ance, Health Resources and Services Administration, Department of Health and Human Services

587 Goldstein, Dr. Murray, Director, National Institute of Neurological Disorders

and Stroke, National Institutes of Health, Department of Health and Human Services

973 Biographical sketch

981 Prepared statement

976 Goodwin, Frederick K., M.D., Administrator, Alcohol, Drug Abuse, and Men. tal Health Administration, Department of Health and Human Services 531 Biographical sketch

540 Prepared statement ...........,

535 Gorden, Dr. Phillip, Director, National Institute of Diabetes and Digestive

and Kidney Diseases, National Institutes of Health, Department of Health and Human Services

893 Biographical sketch

900 Prepared statement

895 Gordis, Enoch, M.D., Director, National Institute on Alcohol Abuse and Alco

holism, Alcohol, Drug Abuse, and Mental Health Administration, Department of Health and Human Services

531 Gorton, Hon. Slade, U.S. Senator from

Washington, questions submitted by 1051 Gramm, Hon. Phil, U.S. Senator from Texas, questions submitted by

127 Harmon, Dr. Robert G., Director, Health Resources and Services Administra. tion, Department of Health and Human Services

587 Biographical sketch

595 Prepared statement

590 Hatfield, Hon. Mark O., U.S. Senator from Oregon, questions submitted by 115,

175, 287, 357, 731, 942, 990 Hinshaw, Dr. Ada Sue, Director, National Center for Nursing Research, National Institutes of Health, Department of Health and Human Services 1117 Biographical sketch

1124 Prepared statement

1119 Hoel, Dr. David, Acting Director, National Institute of Environmental Health

Sciences, National Institutes of Health, Department of Health and Human
Services

945 Biographical sketch

951 Prepared statement

948 Hollings, Hon. Ernest F., U.S. Senator from South Carolina, questions submitted by.

67, 796 Hutchins, Dr. Vince L., Acting Director, Maternal and Child Health Bureau,

Health Resources and Services Administration, Department of Health and
Human Services

587 Inouye, Hon. Daniel K., U.S. Senator from Hawaii, questions submitted by

419, 885, 1113, 1136 Itteilag, Anthony L., Deputy Assistant Secretary for Health Management

Operations, Office of the Assistant Secretary for Health, Department of
Health and Human Services

361 Johnson, Elaine M., Ph.D., Director, Office for Substance Abuse and Preven.

tion, Alcohol, Drug Abuse, and Mental Health Administration, Department of Health and Human Services

531

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