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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 Hill National Center for Biomedical Communications and two academic year assignments under the guidance of their academic instructors. The 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 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


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

biomedical 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 Program. 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 computer superhighway. NLM's is the only biomedical element in the

initiative. 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.

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

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.


September 21, 1933. New York, New York

Education: A.B., Biology, Amherst College, magna cum laude, 1954; M.D., College of Physicians and Surgeons; Columbia University, 1958; Sc.D., Amherst College, (hon. caus.) 1979; Sc.D., State University of New York (hon. caus.) 1987; LL.D., University of Missouri-Columbia, (hon. caus.) 1990.

Professional History: 1984-present, Director, National Library of Medicine; 1988-present, Adjunct Professor of Pathology, University of Maryland School of Medicine; 1971-1984, Director, Information Science Group, University of Missouri School of Medicine; 1969-1984, Professor of Pathology, University of Missouri School of Medicine; 1976-1980, Director, Health Services Research Center with Special Emphasis Health Care Technology Center, University of Missouri-Columbia; 1972-1973, Consultant for Health Sciences to Vice President for Academic Affairs; 1969-1971, Professor and Chairman, Department of Information Science, University of Missouri School of Library and Information Science; 1970-1971, Staff, Vice President for Academic Affairs, University of Missouri; 1967-1970, Director, Regional Medical Program Information Systems; 1968-1970, Staff, Executive Director for Health Affairs, University of Missouri; 1962-1970, Director, Medical Center Computer Program, University of Missouri; 1962-1970, Director Medical Center Computer Program, University of Missouri; 1967-1969, Director, Missouri Regional Automated Electrocardiography System; 19661969, Associate Professor of Pathology, University of Missouri School of Medicine; 1963-1966, Assistant Professor of Pathology, University of Missouri School of Medicine; 1962-1963, Instructor in Pathology, University of Missouri School of Medicine; 1960-1963, Director, Diagnostic Microbiology Laboratory, University of Missouri Medical Center; 1960-1962, Resident Physician in Pathology, University of Missouri School of Medicine; 1959-1960, Assistant Resident in Pathology, Columbia-Presbyterian Medical Center; 1958-1960, Assistant in Pathology, Columbia University College of Physicians and Surgeons; 1958-1959, Intern in Pathology, Columbla-Presbyterian Medical Center, June 1955-Sept. 1955, June 1954-Sept. 1954, Research Assistant to Dr. O.E. Schotte, Amherst College.

Honors: Phi Beta Kappa; Simpson Fellow of Amherst College (1954-55); Markle Scholar in Academic Medicine (1964-69); Distinguished Practitioner in Medicine, National Academies of Practice in Medicine (1983); Member, Institute of Medicine, National Academy of Sciences (1985); Member of IOM Council (1990-93); Fellow, American College of Medical Informatics (1985); Surgeon General's Medallion, 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: Sigma Xi; American Society of Clinical Pathologists; College of American Pathologists (Telecommunication 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 on 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.

February 1991


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 Ďoc 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.

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:]

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