PAPER PROCESSING

Mr. FARNUM. Dr. Shannon, let's stay out of the technical and scientific areas and let's talk about the area of paper processing the clerical end of it. Last year we had an exchange and I just wondered if you could tell me some of the progress you have made since the last time you were before the committee in this whole area of methods and systems and paper processes?

Dr. SHANNON. Unfortunately, we haven't gone as far as we had hoped. I think this is largely because the task we set in our contract with IBM to develop systems is turning out to be more complex than they had initially anticipated.

In addition, we have decided that the initial guidelines that we developed for them were not adequate for our problems. The main pile of paper, if you will, comes in the grants management process. This is a process that, as you know, is shared by three groups at the present time. There is the Division of Research Grants, there are the Institutes, and there is the fiscal group which processes grant payments. What we have done in the past year is to try clearly to identify where one group's responsibility leaves off and the other picks up so that we can look forward to an automated system that starts with the reception of the research grant application and produces an automatic input into the stored records as each action is taken along the line so that we end up with a magnetic tape which is used by the Treasury Department in writing the check. The progress we have made in the past year has been in that direction.

Mr. FOGARTY. I have some good friends in the National Association for Retarded Children. Elizabeth Boggs is one of the best in this business.

COLLABORATIVE PERINATAL PROJECTS

Here are four questions. They say: We know there is a long leadtime in the collaborative perinatal program. This is now beginning to show specific results. In addition to the main project which was carried out similarly in all cooperating hospitals, we understand that there were ancillary projects generated locally in a number of places. If you have any reports indicating the overall productivity of these projects and the ideas they have generated, we would like to have them. I don't know whether you have the answer to these questions. Dr. SHANNON. I would hope you could wait until Dr. Masland comes. A fair amount of this has been documented, Mr. Fogarty. This is one of the programs which I have asked an external group to examine in depth and Dr. Masland's group has prepared something on it.

Mr. FOGARTY. Is there anything else you want to say about the reorganization or the Bureau of the Budget, or anybody else?

Dr. SHANNON. I can report on our luncheon conversation with Dr. Stewart.

Mr. FOGARTY. Who won ?

Dr. SHANNON. I don't think anybody won, Mr. Fogarty. I have a clear idea of what the Saturday morning meeting is about. Mr. FOGARTY. Do you?

Dr. SHANNON. Dr. Stewart will attempt on Saturday to find out what are the precise areas of agreement and disagreement and have this information before he makes his recommendation to the Secretary. Mr. FOGARTY. That is not much of a report.

Dr. SHANNON. It was a short luncheon.

Mr. FOGARTY. Is there anything else you want to say?

Dr. SHANNON. No, sir.

Mr. FOGARTY. As we do each year, we will place in the record at this point several overall tables and statements that we have asked you to prepare. We will give first place to the professional judgment budgets.

(The material referred to follows:)

PROFESSIONAL JUDGMENT BUDGETS

SUMMARY

The Directors of the several Institutes and Chiefs of the program Divisions of the National Institutes of Health have submitted estimates for 1967 which reflect, in their best professional judgment, the total funds which could effectively be used for their individual programs.

These estimates have not been influenced by the Office of the Director, National Institutes of Health, the Office of the Surgeon General, or the Office of the Secretary through guidelines or review such as normally occur in the budgetary process. They do not, therefore, represent in the aggregate an NIH budgetary proposal. Consideration has not been given to those factors which normally influence budget proposals, such as

(1) The consistency of the proposals of individual Institutes with existing congressional directives and legislation.

(2) The appropriateness of relative emphasis among programs as for example between research grants and training grants.

(3) The adequacy of manpower, space, and other resources when the total budgets of all Institutes are added up.

(4) The effect of combined Institutes' proposals upon educational institutions.

(5) The sum total of all proposals in relation to fiscal feasibility and other broad policy considerations.

(6) The effect of projected program increases upon the central (NIH) management requirements.

The professional judgment of funds that could be effectively applied to all activities exceeds the President's budget by $147,170,000: $19,370,000 for the Division of Research Facilities and Resources which is included in the "General research and services" appropriation; $19,300,000 for general research support; and $108,500,000 for health research facilities construction.

1. Grants

DIVISION OF RESEARCH FACILITIES AND RESOURCES

A. Research, difference of $17,745,000

General clinical research centers, $8,300,000.-An amount of $3,800,000 would provide the necessary funds required for continuing support to existing centers at the ceilings set by the National Advisory Research Resources Committee in order to achieve the program objectives of clinical study of human disease and biological problems. This increase would also provide the funds required for 10 supplemental grants to active centers for equipment, personnel, and expansion. An amount of $4,500,000 would provide funds to support 14 new centers. This includes $2,500,000 which would provide support for 10 discrete ambulatory clinical research centers as institutional resources with the same basic administrative and organizational guidelines as the inpatient centers program. From the experience of the investigators who utilize the general clinical research centers, it has become quite evident that outpatient facilities are required for the study of many patients before and after admission to the inpatient centers. Just as inpatient clinical research centers have provided an environment which is superior to the general ward for the conduct of controlled clinical experimentation, so special outpatient research clinics apart from the overburdened service departments would provide an analogous resource. Under the present conditions in which personnel and space are inadequate, a large number of important studies such as therapeutic trials on ambulatory patients with adequate scientific supervision are not being initiated.

Scientific evaluation, $45,000.-The difference would provide the necessary funds required to support scientific evaluation grants for consultative committees used to provide scientific advice on grant applications.

Special research resources, $5,650,000.-The difference would be effectively utilized for continuations, supplementation, and expansion of the special research resources program: $1,991,000 to provide increased support for continuation of active grants and $3,659,000 to support 24 new grants. The new grants would include: 12 computer centers which are of special importance at this time since computers have been increasingly successful as process control tools in medical research and patient care; three biomedical engineering facilities; and 9 grants for analytical biochemistry instrumentation facilities and regional resources to provide materials which are otherwise unavailable to biomedical scientists in the region.

Scientific and technical information resources, $200,000.-The difference of $200,000 would provide support for on-going programs in the field of communication of information in biomedical and related sciences, research in new technology and concepts for gathering and handling biomedical scientific information, and development of scientific reference centers dealing with specialized fields of biomedical knowledge.

Animal resources, $1,900,000.-This difference would be used to provide support for 23 new grants. New resource grants would be made to facilitate the continuing development of institutional laboratory animal facilities programs by providing certain renovations, equipment, supplies and personnel as are required to meet optimal standards for care. Grants would also be made to include studies in the cause and control of natural occurring diseases, nutrition, genetics, behavior in relation to normalcy, and optimal environmental factors such as heat, light, humidity, cage size, exercise, etc. The development of more sophisticated equipment for housing animals should not only take into account the preceding factors, but also the efficiency of the operation in terms of manpower and other costs.

Standards, compliance, and certification, $250,000.-This difference would provide funds for the continuing study and improvement of existing standards for research animal facilities. To meet the requirements of sophisticated medical investigations and to provide the best possible research model, emphasis must be placed on optimum rather than minimum requirements. Concurrent with the development of standards, there must be a carefully formulated program to determine compliance and a system of certification to identify those institutions which meet standards previously agreed to.