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); U.S. Representative to International Medical Informatics Association and Trustee (1975-1984); Board of 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.

MEDLINE USERS

Mr. NATCHER. Doctor, what percentage of American physicians are currently using your data systems on a regular basis, as a part of their medical practices?

Dr. LINDBERG. It is hard to get exact numbers. We tried very hard to get that particular number, and we believe it is between 15 and 20 percent.

OUTREACH NEEDS

Mr. NATCHER. The DeBakey report two years ago reported that the Library had been successful in building its data bases, and library networks, but it had not been successful in bringing individual practitioners into the system.

What steps have you been taking now, Dr. Lindberg, to address this problem?

Dr. LINDBERG. I think that statement is accurate, Mr. Natcher, Dr. DeBakey was quite right, and since that time, largely through the use of GRATEFUL MED, a program one runs on his personal computer, plus outreach projects that help people learn how to understand and use that and be aware of it, we have been able to go from zero individual users to 50,000.

At the moment, the majority of inquiries on our system, which were around 5,000,000 last year, the majority of those inquiries are done by individual doctors using GRATEFUL MED. They account for roughly 62 percent of the users, and that is about 42 percent of the actual cycles used.

I would say we are making very good headway in that particular problem.

MEDLINE-USERS

Mr. NATCHER. Now, Dr. Lindberg, what are the characteristics of a typical physician who uses a system, compared to a non-user? What would you say about that?

Dr. LINDBERG. Well, I would have to confess to you we know a great deal more about the users than the non-users. I regret that. We do, however, know something about both of them.

We think that the differences are not what the man on the street might guess. The common explanation is that the young doctors know how to use our systems because they grew up with computers. That really isn't true.

Our users-the best studies were done by Stanford University, but the users fall out pretty well according to the ages of the licensed physician population. Some specialists are underusers. Surgeons don't use them quite as much as internists, but age is not the explanation.

What seems to be the explanation is whether the individual has ever had a demonstration or course in the use of a computer. There is a second aspect that perhaps ought to be mentioned in answer to your question that I didn't anticipate directly. I am afraid it is true, that minorities and rural physicians don't actually have as ready access to these systems as one would have hoped.

Certainly, literally anyone with a computer and telephone can make a call upon our computer system. But more is necessary.

Often one must get hold of the journal article itself. NLM has a system called Loansome Doc. In order to use that system easily, a person has to be part of a hospital staff. In many parts of the country, the Midwest particularly, virtually every physician is a member of one or more hosptial staffs.

In some parts of the country, this is not true. In Brooklyn, as I remember it, 45 percent of the doctors did not have hospital privileges. In Southern California, we are doing a feasibility study on the Loansome Doc. There the persons who don't have hospital affiliations appear to be minority physicians or physicians caring for minority populations.

If that proves true, it becomes part of our outreach problem. We are working with Dr. Jim Naughton, who has, as you perhaps know, left New York, and Chicago where he was Director of Cook County Hospital and now is on the faculty of Drew Medical School.

He thinks he can identify what we call unaffiliated physicians whose lack of hospital affiliation, may be connected with minority status, but in any case their unaffiliated nature makes it hard to use computers, even though they can be hooked up. Mr. NATCHER. Mr. Stokes, I yield to you.

MEDLINE AVAILABILITY

Mr. STOKES. Thank you, Mr. Chairman.

Dr. Lindberg, last year you will probably recall that you and I had some discussion about availability of services, such as MEDLINE GRATEFUL MED, to historical black institutions. Can you tell us what, if anything, more we have done in that area of our discussion?

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