STATEMENT OF DR. DONALD LINDBERG

Mr. Chairman and members of the Committee: I welcome the opportunity to tell you about the National Library of Medicine (NLM) and its increasing ability to provide American health professionals with the sophisticated information services they needed to treat patients and carry out biomedical research.

This year the NLM celebrates the twentieth anniversary of its online database, MEDLINE. In 1971, the Library made available for searching some 300,000 references; two dozen major medical libraries made up the network at that time. Today, 20 years later, more than 13 million records are offered to a still-growing network of health professionals. We hear frequently from physicians, scientists, and others about how MEDLINE can provide information vital to treating patients and conducting research.

Current Activities

During 1991 the Library will add its 50,000th user code to the NLM online retrieval network. The growth of the network, as measured by the number of health professionals who have access to it, continues at a rate of about 50 percent a year. The increase is fueled by the continuing popularity of Grateful Med, NLM's software that allows users of personal computers to have rapid and easy access to MEDLINE and to NLM's other major databases. than 30,000 copies of the software have been distributed.

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Even these figures belie the extent of MEDLINE use within the American health community. Virtually all major and many smaller health-related organizations have access to NLM's databases, frequently through their institutional library. One "user code, then, can provide MEDLINE access to many health professionals. Other routes of access are the large commercial database vendors who lease MEDLINE from the NLM, and the rapidly growing number of people around the world who depend on commercial MEDLINE/CD-ROM products for searching NLM's database. Not counting MEDLINE access via commercial products, there were almost 4.8 million searches over the Library's online network centered on its computers in Bethesda, Maryland. This same network is now being used for the first time to disseminate NIH "clinical alerts so that health professionals can be notified of life-saving

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information well before formal publication in a journal. The NLM issued its first "clinical alert" on pediatric AIDS on January 18, 1991.

In response to recommendations from the Congress, NLM began a wide variety of outreach activities in FY 1990. The focus of these activities has been on improving access by individual health professionals to NLM's

information products and services, especially by persons presently

unaffiliated with an institution and/or who are located in rural or other medically underserved settings. Many of the latter locations are comprised of predominantly minority populations.

Through special enhancements to the existing Regional Medical Library (RML) contracts, NLM has funded demonstration projects in 12 states to test various means of increasing awareness of and access to NLM's information services by health professionals located in underserved areas. Some of the projects are being carried out directly by the RML; others involve the RML subcontracting with another network library. The 3,000-member Regional Medical Library Network itself is undergoing important changes in FY 1991. The seven RML contracts are being renegotiated with a new emphasis on outreach activities, and an eighth Regional Medical Library is being created for the

New England area.

Another recently developed outreach-related program provides for small competitive contracts awarded directly by NLM to network libraries for the purpose of introducing online searching via Grateful Med to health professionals in rural and inner-city areas. Thirty such contracts were awarded in FY 1990 to network libraries from Hawaii to Maine.

NLM's Extramural Programs are also being oriented toward outreach. Two new grant categories--Information Access and Information Systems--foster access to information resources and services utilizing today's computer and communications technologies. Among some recently awarded Information Access Grants aimed at small-and medium-size hospitals are several in Appalachia to introduce Grateful Med to health professionals there. An Information Systems Grant which is directed towards larger hospitals and medical centers, was awarded to the University of Miami's medical center library to assist in developing an AIDS information service for health professionals in Southeast Florida. Both grant types have significant outreach potential.

These, as well as other innovative outreach activities have been

continued in FY 1991. The FY 1992 request includes increased resources for

outreach.

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 Hill 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.

The

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 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. Library already provides substantial coverage of health services research in

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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

edical vocabularies and classifications. They will grow in scope and

lexity as NLM learns about the experiences of those who are now attempting pply these first versions to a variety of information problems.

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

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

al.

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

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

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

In my tenure as director, you have steadfastly