DEPARTMENT OF HEALTH AND HUMAN SERVICESNATIONAL INSTITUTES OF HEALTHNATIONAL LIBRARY OF MEDICINE
Bethesda, Maryland
A G E N D A
105th Meeting of the
BOARD OF REGENTS
9:00 a.m., January 25-26, 1994
Board RoomMezzanine of
National Library of Medicine
MEETING OPEN: 9:00 a.m. to 4:30 p.m. on January 25 and from 9:00 a.m. to adjournmenton January 26.
MEETING CLOSED: 4:30 to 5:00 p.m. on January 25 for the review of grant applications.
1. CALL TO ORDER AND INTRODUCTORY REMARKS 9:00-9:10 Ms. Rachael K. Anderson
2. CONSIDERATION OF SEPTEMBER MINUTES TAB I 9:10- 9:15 Ms. Rachael K. Anderson
3. FUTURE MEETING DATKS
Spring Meeting:Fall Meeting:Winter Meeting:
May 24-25, 1994 (T-W)--CONFIRMEDSept. 27-28, 1994 (T-W)-CONFIRMEDJan. 24-25, 1995 (T-W)--PROPOSED
(Subcommittees meet, when necessary, the day before the full Board.)(On Jan. 24: Extramural Programs Subcommittee—2:00-3:30 p.m.)
PLEASE NOTE:(Potential conflictswith Jan. 1995 dates.)
American Library AssociationMidwinter Meeting Jan. 20-26,Cincinnati
1995,
4. REMARKS BY THE DIRECTOR, NLM TAB II
a. Budget Tab Ab. Personnel Tab Bc. Legislation Tab Cd. HPCC-Broad Agency Announcement Tab De. 50 Years of American Medicine Tab E
Discussion
9:15-10:20 Dr. Donald A.B. Lindberg
10:20-10:40 Board Members
COFFEE BREAK 10:40-11:00
1/21/94
Agenda, Board of Regents' Meeting, January 25-26, 1994
5. OUTREACH PROJECT: NIH HIV/AIDSINFORMATION SERVICES CONFERENCEFINAL REPORT
Discussion
TAB III 11:00-11:45
11:45-12:00
Dr. Elliot SiegelMr. A. Cornelius Baker
Ms. Naomi C. BookerCol. Jacqueline MorganDr. Lois E. DeBakeyOther Board Members
CATERED LUNCHEON 12:00- 1:15
6. NETMENU AND THE UMLS INFORMATIONSOURCES MAP—YALE UNIVERSITYSCHOOL OF MEDICINE
Discussion
TAB IV 1:15- 2:00
2:00- 2:15
Ms. BetsyHumphreysDr. Perry L. MillerDr. Seth Powsner
Dr. Carol M. NewtonOther Board Members
7. NIH DIRECTOR'S ADVISORY COMMITTEEMEETING
2:15- 2:30 Ms. Rachael K. Anderson
8. BIENNIAL REPORT OF THE BOARD OFREGENTS (Board action necessary.)
Discussion
2:30- 2:35 Dr. Elliot Siegel
2:35-2:50 Ms. Rachael K. AndersonOther Board Members
9. REPORT FROM THE TOXICOLOGYAD HOC COMMITTEE
2:50-3:00 Dr. H. Kenneth Walker
COFFEE BREAK 3:00- 3:15
10. HSTAR DATABASE TEST
Discussion
TAB VII 3:15- 3:45 Ms. Lois Ann ColaianniMs. Marjorie Cahn
3:45- 4:00 Dr. H. Kenneth WalkerOther Board Members
11. REPORT FROM EXTRAMURAL PROGRAMS
a. Budget Overviewb. Board Responsibilities for the
Grant Programc. Review of BoardOperating
Procedures (Board action necessary.) Tab
Discussion
TAB VIII
Tab A
Tab B
4:00-4:15 Dr. Milton Corn
4:15-4:30 Ms. Rachael K. AndersonEP Subcommittee MembersOther Board Members
Agenda, Board of Regents' Meeting, January 25-26, 1994
MEETING CLOSED FOR THE REVIEW OF GRANT APPLICATIONS, January 25, 4:30 P.M.
12. REVIEW OF GRANT APPLICATIONS
(Conflict-of-interest instructions in frontof workboook for your information and review.)
4:30-5:00 Dr. Roger W. Dahlen
R E C E S S * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
Dinner Bethesda Naval Officers' Club"Bridge Room"
co*cktails 6:30 p.m.Dinner 7:30 p.m.
SPEAKER: H. Kenneth Walker, M.D., Member, Board of Regents,and Professor of Medicine, EmoryUniversity School of Medicine
TITLE: 'Teaching Medicine: 1600to 1993."
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
R E C O N V E N E : Wednesday, 9:00 a.m., Board Room
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
13. UPDATE ON PLANNING PANEL ON THEEDUCATION AND TRAINING OF HEALTHSCIENCE LIBRARIANS
Discussion
14. REPORT FROM THE BOARD OF SCIENTIFICCOUNSELORS, NCBI
Discussion
FAB X
9:00- 9:20 Dr. Elliot SiegelMs. Susan M. Buyer
9:20-9:45 Ms. Rachael K. AndersonMs. Beverly AllenOther Board Members
9:45-10:05 Dr. Robert T. Sauer
10:05-10:15 Dr. Carol M. NewtonOther Board Members
COFFEE BREAK 10:15-10:30
15. REPORT FROM THE BOARD OF SCIENTIFIC TAB XICOUNSELORS, LHNCBC
Discussion
10:30-10:50 Dr. James J. Cimino
10:50-11:00 Dr. Robert E. KahnOther Board Members
Agenda, Board of Regents' Meeting, January 25-26, 1994
16. APPOINTMENT OF NOMINATING 11:00-11:05 Ms. Rachael K. AndersonCOMMITTEE FOR BOARD CHAIR
17. DISCOVERING HIDDEN TREASURES IN 11:05-11:35 Dr. Emilie Savage-SmithNLM'S HISTORICAL COLLECTION
18. ADJOURNMENT 11:35 Ms. Rachael K. Anderson
DEPARTMENT OF HEALTH AND HUMAN SERVICES
NATIONAL INSTITUTES OF HEALTH
NATIONAL LIBRARY OF MEDICINE
BOARD OF REGENTS
MINUTES OF THE 105TH MEETING
JANUARY 25-26, 1994
BOARD ROOM
NATIONAL LIBRARY OF MEDICINE
BETHESDA, MARYLAND
DEPARTMENT OF HEALTH AND HUMAN SERVICESPUBLIC HEALTH SERVICE
THE BOARD OF REGENTS OF THE NATIONAL LIBRARY OF MEDICINE
Minutes of MeetingJanuary 25-26, 1994
The Board of Regents of the National Library of Medicine was convened for its one-hundred-and-fifth meeting at 9:00 a.m. on Tuesday, January 25, 1994, in the Board Room of theNational Library of Medicine, Bethesda, Maryland. Ms. Rachael K. Anderson, Director of theHealth Sciences Center Library at the University of Arizona, chaired the meeting. Inaccordance with P.L. 92-463 and the Determination of the Director, NIH, as announced in theFederal Register on December 17, 1993, the meeting was open to the public from 9:00 a.m.to 3:45 p.m. on January 25 and from 9:00 to 11:50 a.m. on January 26. The meeting was closedfrom 3:45 to 4:15 p.m. on January 25 for the review, discussion, and evaluation of grantapplications. A Board roster is enclosed under Attachment A.
Board members present were:
Ms. Rachael K. Anderson, Chair Dr. Robert E. KahnMs. Beverly E. Allen Dr. Carol M. NewtonDr. Mary E. Clutter (1/25) Dr. H. Kenneth WalkerDr. John T. Farrar (1/25) Dr. James A. ZimbleDr. Robert J. Joynt
New members-designate present were:
Dr. Edwin M. Cortez Dr. Steven J. Phillips
Alternates to ex officio members present were:
Ms. Wendy Carter, representing Dr. John T. Farrar.Col. Emmanuel Cassimatis, representing Lt. Gen. Alcide M. LaNoue.Capt. Bart Hogan, representing Vice Adm. Donald F. Hagen.Capt. Kathleen A. McCormick, representing Dr. M. Joycelyn Elders.Col. Jacqueline Morgan, representing Lt. Gen. Alexander M. Sloan.
Board Members Absent:
Ms. Naomi C. Booker Mr. Joseph H. HowardDr. Lawrence J. DeNardis Dr. Richard E. Rowberg
_!/ For the record, it is noted that members absent themselves from the meeting when theBoard is discussing applications (a) from their respective institutions or (b) in which a conflictof interest might occur. This procedure applies only to individual discussion of an applicationand not to "en bloc" actions.
2/ The Board of Regents, when considering the extramural programs of NLM, also constitutesand serves as the National Libraries Assistance Advisory Board.
1
National Library of Medicine staff members attending this meeting included:
Dr. Donald A. B. Lindberg, DirectorMr. Kent A. Smith, Deputy DirectorDr. Michael Ackerman, Acting Associate Director, SISMr. Fernando Burbano, Director, Information SystemsMs. Marjorie Cahn, Special Expert, National Information Center on Health Services
Research and Health Care Technology, LOMr. Kenneth Carney, Executive Officer, ODMs. Lois Ann Colaianni, Associate Director, LODr. Milton Corn, Acting Associate Director, EPDr. George J. Cosmides, Deputy Associate Director, SISDr. Roger W. Dahlen, Chief, Biomedical Information Support Branch, EPMr. Earl Henderson, Deputy Director, LHNCBCDr. Richard Hsieh, Director, International Programs, ODMs. Betsy Humphreys, Assistant Director for Health Services Research InformationDr. Lawrence Kingsland III, Assistant Director for Applied InformaticsMr. Sheldon Kotzin, Chief, Bibliographic Services Division, LOMs. Eve Marie Lacroix, Chief, Public Services Division, LOMs. Susan N. Levine, Chief, Office of Financial Management, ODDr. David Lipman, Director, National Center for Biotechnology InformationDr. Daniel R. Masys, Director, Lister Hill National Center for Biomedical CommunicationsMr. Robert B. Mehnert, Chief, Office of Inquiries and Publications Management, ODDr. Elliot R. Siegel, Associate Director, Health Information Programs DevelopmentMr. Richard T. West, Chief, Office of Program Planning and Evaluation, EP
Others present included:
Dr. A. Cornelius Baker, Director of Public Policy,National Association of People with AIDS, Washington DC
Dr. James J. Cimino, Assistant Professor of Medicine, Center for MedicalInformation, College of Physicians and Surgeoons, Columbia University
Dr. Perry L. Miller, Director for Center for Medical Informatics andProfessor of Anesthesiology, Yale University School of Medicine
Ms. Anne Petruske, "The Blue Sheet"Dr. Seth M. Powsner, Associate Professor of Psychiatry, Yale University
School of MedicineDr. Emilie Savage-Smith, Welcome Unit for the History of Medicine, Oxford,
United Kingdom
I. OPENING REMARKS
Ms. Rachael Anderson, Chair, welcomed the Regents and guests to the 105th meeting ofthe Board of Regents of the National Library of Medicine. She introduced two new Regents-designate, Edwin M. Cortez, Ph.D., and Steven J. Phillips, M.D.
II. CONSIDERATION OF MINUTES OF PREVIOUS MEETING
The Regents approved the minutes of the September 30-October 1, 1993, meeting, withoutchange.
III. REPORT FROM THE DEPARTMENT OF VETERANS AFFAIRS
John T. Farrar, M.D., Acting Undersecretary of the Department of Veterans Affairs,reported that the VA and the NLM have similar interests in a number of areas. One ofthese is computer networks, another is the computerized patient record. The VA isinterested in working with other Federal agencies (including the NLM) and privateorganizations in pursuing both. NLM Director, Donald A. B. Lindberg, M.D., commentedthat Ms. Wendy Carter, the head of the VA's library programs, was a valuable ex officiomember of the Board of Regents. Dr. Lindberg said that Dr. Farrar recently wrote to theHigh Performance Computing and Communications Office asking that the VA become amember of the HPCC interagency team. The VA has been granted "visitor status" in theHPCC effort as a precursor to full membership.
IV. DATES OF FUTURE MEETINGS
The Board will meet next on May 24-25. The next fall meeting will be September 27-28. Theproposed dates of January 24-25, 1995, were accepted and confirmed for the next wintermeeting.
V. REMARKS BY THE NLM DIRECTOR
Dr. Lindberg reported that, although overall NIH is facing what is essentially a flat budgetfor FY 1994, a few individual programs are faring better. High Performance Computing andCommunications, in which NLM has a prominent role, is one such exception. AlthoughNLM's budget is up about 25 percent, Library Operations-NLM's service operation-isabout $4 million under what would be required to maintain a "current service" level. Inaddition to increases for HPCC, NLM has earmarked increases for information activitiesrelating to both health services research and to AIDS. Dr. Lindberg briefly described NLM'sexpanded programs in HPCC and health services research. There will be a presentation and
press briefing later in this meeting about NLM's plans to provide free access to its AIDS-related databases. In the area of personnel, Dr. Lindberg reported that as part of agovernment-wide effort to reduce the number of Federal employees, the Library's ceilingfor FTEs ("full- time equivalents") is being substantially reduced. There are also freezes onnew hiring and on higher-level promotions. On the positive side, the NLM Directorannounced the appointment of Fernando Burbano as Director of Information Systems andhead of the Office of Computer and Communications Systems. Dr. David Lipmanintroduced to the Board several new scientists on the staff of the National Center forBiotechnology Information: Dr. Thomas Madej, Dr. Colombe Chappey, Dr. Jean-FrancoisGibrat, and Dr. Thomas Madden.
Dr. Lindberg reported briefly on the status of HPCC-related legislation. Legislation,introduced in 1992 by Mr. Gore, was reintroduced in 1993 in the Senate (S.4) by SenatorRollings and in the House (HR.1757) by Representative Boucher. The bills introduce twonew ideas. First is a commitment to HPCC applications in the areas of health care,education and lifelong learning, digital libraries, advanced manufacturing, and (in the Housebill) public access to government information. The second new idea is a commitment to theconcept of a National Information Infrastructure (Nil). Funds have been requested in the1994 and 1995 budgets to begin to implement the NIL In addition, there was money in thePresident's budget for the National Institute of Standards and Technology (Department ofCommerce) to award grants to communities to become wired as part of the Nil and toorganize various committees to discuss and set public policy concerning the NIL At Dr.Lindberg's invitation, Board member Dr. Robert Kahn commented that the NationalAcademy of Sciences (NAS) is close to having a draft report addressing the issue of whereresearch and education fit into the NIL Also, he said, Vice President Gore recently talkedabout the possibility of a Title 7 modification of the Communications Act of 1934 that wouldallow the telecommunication carriers to escape the "tangled web" of state and localregulations. Dr. Kahn talked briefly about the IITF~a Federal Task Force chaired by theCommerce Secretary with three committees: information policy, government policy, andapplications. The IITF also has a 27-member advisory committee on which Dr. Kahn sits.Dr. Kahn reported that a small company (Internet Inc.) had filed for and been granted atrademark for the name Internet. No one knows yet how this will play out. In response toa question, Dr. Kahn said that the upcoming NAS report will deal with: the need to involveK-12 schools in networking; the need to get the "last mile" of connection out to users; issuessuch as cryptography and international access; and openness in network interfacing andinteroperability.
Dr. Lindberg reported that Paul Rogers, Chairman of the Board of the Friends of theNational Library of Medicine, will testify as a citizen witness on behalf of NLM before theAppropriations Committee. He noted that NLM will be making HPCC awards in responseto proposals it received under the aegis of last year's Broad Agency Announcement. Oneaward was made with FY 1993 funds (to West Virginia); more awards, as many as 11, willbe made later in FY 1994. These awards will be primarily for testbed networks and
telemedicine. Finally, Dr. Lindberg described a December 9, 1993, program sponsored byNLM in honor of the 50th anniversary of its History of Medicine Division. The program,"Medicine and Health Since World War II: Four Federal Achievements," featuredpresentations on the Federal role in chemotherapy for tuberculosis (Dr. Martin M.Cummings), the thalidomide affair (Dr. Frances Kelsey), advances in burn treatment (Dr.Basil A. Pruitt, Jr.), and the eradication of smallpox (Dr. Donald A. Henderson).
VI. REPORT FROM EXTRAMURAL PROGRAMS
Dr. Milton Corn, Acting Associate Director for Extramural Programs, announced that theCooperative Agreement for the Electronic Medical Record (the concept was approved bythe Board last May) is ready to proceed. One million dollars was transferred to ExtramuralPrograms from NLM's National Information Center on Health Services Research andHealth Care Technology and $300,000 from the Agency for Health Care Policy andResearch (AHCPR). The National Institute for Nursing Research has expressed an interestin joining the effort, but no commitment has been received yet. The February 4 edition ofthe NIH Guide to Grants and Contracts will carry the announcement, and the Board willreview applications in time for funding this fiscal year.
Dr. Corn discussed the responsibilities of the Board of Regents when reviewing grantapplications. NIH has a two-tiered review of applications. The first review, the "scientificmerit" review, is performed by an initial review group(IRG). In the case of NLM almost allapplications are reviewed by the Biomedical Library Review Committee. The second andfinal review is done by the Board for all applications except Fellowships and Small BusinessInnovation Research grants (SBIR). The day before the regular Board meeting, the Board'sExtramural Programs Subcommittee meets to go over "special" applications in an intensivereview. Applications are assigned as "specials" if they meet the following criteria: programrelevance and/or policy issue; "split" vote by the IRG, i.e., at least two members of the IRGdissented from the majority vote; amount is $150,000 or more; foreign application, or aconference grant application. The Subcommittee makes its recommendations to the Boardon the first day of the meeting. The Board has the following options: Concur, recommenddeferral for rereview (on scientific and nonscientificissues), refuse to concur with the IRG(without rereview), modify IRG recommendations (e.g., adjust budget items, alter length ofaward), and advise NLM Director on policy/relevance issues. The Board cannot alter apriority score. No grant can be funded by NLM unless the Board has concurred with theIRG recommendation. In addition, the Board must approve the concept of any new NLMprograms. NLM usually asks the Board to vote on the other applications "en bloc." Dr.Cornemphasized, however, that Board members have the right at any time to request discussionof any application.
For a better understanding of "relevance and policy" issues, Dr. Corn defined the terms.While NLM has seldom used this method, it is commonly used at other NIH Institutes. AnyRegent or NLM staff may call attention to an application that has either "high" or "low"
relevance for any of NLM's programs and there is a lack of congruence between theprogram relevance and the priority score; e.g., a project is technically outstanding with ahigh priority score, but is not relevant to the NLM mission. At the same time, anotherapplication with a priority score that would normally not be funded, is especially appropriatefor NLM. The Board could recommend that this project be considered for funding becauseof high program relevance. Policy issues, Dr. Corn noted, would be handled similarly.
Finally, Dr. Corn explained the technical terms used by the NIH in the review process:priority score, percentile score, payline, success rate. Priority scores are used in tenths from1 to 5, with one being the best. NLM, in general, funds all "outstanding" and half of the"excellent" applications. From the priority score NIH arrives at the percentile score. Theactual scores of any given IRG for the last three sessions are pooled to come up with apercentile rating. The NLM Director, with the advice of the Board, may pay grants out oforder. Last year about one in 14 grants at NIH was paid out of order, because of policy orrelevance issues. The success rate is determined by how many people get funded relative tothe number of applications considered. At NLM the success rate is one out of five.
As required annually, Dr. Corn presented for review the Board Operating Procedures,"Guidelines for Adjustments by Staff in Time or Amount of Grant Award." The Guidelineswere reaffirmed unanimously.
VII. OUTREACH: NIH HIV/AIDS INFORMATION SERVICES CONFERENCE
Dr. Lindberg introduced the topic by noting that NLM has over the past few years receivedearmarked funds to devote to its AIDS information services. These services had been startedout of NLM's existing budget. The NIH HIV/AIDS Information Services Conference, heldin June 1993, was an attempt to assess these and other NIH-sponsored AIDS informationservices: Are they useful? Accessible? Can they be improved? Are we missing targetaudiences? To address these issues, more than 180 scientists, clinicians, journalists,community workers, patients, etc., were assembled for the conference in NLM's Lister HillCenter Auditorium.
Next, the Conference's organizer, Dr. Elliot Siegel, NLM Associate Director for HealthInformation Programs Development, introduced his report to the Board by playing anaudiotape of a National Public Radio news item broadcast nationally that morning (January25, 1994). The broadcast announced the NLM's decision to make its three AIDS-relateddatabases and DIRLINE available to all users without charge. This action was in responseto one of 60 recommendations made at the Conference. Last June's Conference, Dr. Siegelsaid, is a good example of the Administration's order that Federal agencies get closer totheir publics to find out how well they are meeting public needs. In this case, five categoriesof AIDS information users were built into the Conference in the form of five panels: clinicalresearchers, health care providers, allied health care providers, news media and the generalpublic, and the patient community. A most important component of the Conference was the
presence of individuals from the affected community; they were represented on each of thefive panels. A Guide to NIH HIV/AIDS Information Services was prepared by NLM anddistributed at the Conference. The Guide, which also is an appendix in the ConferenceReport provided to the Regents, will be updated and made widely available. Dr. Siegelbriefly described the agenda and how the discussions were stimulated by "case studies"presented at the five panels. The first draft of the Conference Report, with its findings andrecommendations, was outlined by the co-chairs of the five panels with the assistance ofNLM staff. The final version was reviewed by all panel participants. The Report is in effecta statement by the participants directed to the NIH and contains 61 specificrecommendations. Dr. Siegel briefly described the case studies presented at each panel andthe flavor of some of the panels' recommendations. An NLM interdivisional committee islooking at how best to implement those recommendations that pertain to the Library.
Following Dr. Siegel's presentation, one of the Conference's organizers, Cornelius Baker,Director of Public Policy and Education of the National Association of People with AIDS,gave his perspective on the meeting. Mr. Baker said that it is important that HIV-positiveindividuals have direct access to simplified, streamlined, and coordinated informationsystems so they can make responsible decisions in the management of their health care. Henoted that many HIV-positive people do not have a traditional doctor-patient relationshipnor do they have access to traditional sources of health information. In some of the affectedcommunities there is deep suspicion of the medical and scientific world. Therefore it isimportant that NIH develop new routes of providing the information that these individualsneed, for example, through social service agencies, human welfare organizations, and publiclibraries. Concerning this last category, Mr. Baker said there is only one public library in theWashington, D.C., area with an extensive health information center. Of the many collegeand university libraries in the area with health and medical information, only oneencourages the public to utilize it. Community AIDS groups, especially those serving ruraland minority populations, need support and technical assistance from NIH to make themproficient in information dissemination. NIH needs better ways of getting usableinformation-synthesized and interpreted~to these communities. Information about themental health, psychosocial, and behavioral aspects of HIV/AIDS are also sorely neglected.Mr. Baker said that his organization would be pleased to work with NLM and NIH indisseminating information needed by the affected community.
Board of Regents member Col. Jacqueline Morgan, who attended the Conference,commented on the worldwide scope of HIV/AIDS~some 14 million cases at present,estimated to be 26 million by the turn of the century. She briefly described the military'sAIDS research program at Walter Reed and other facilities. Prevention and publiceducation programs are crucial, and information activities are an important component ofthese. The Conference sponsored by NLM and NIH, with its diversity of participants, issomething the military could not have done. She congratulated the organizers for sponsoringa meeting that will have important and positive effects.
The Board of Regents endorsed the decision to provide free access to the AIDS databases.
VIII. PRESS CONFERENCE
A press briefing to announce the NLM decision to provide free access to its AIDS-relateddatabases was held in conjunction with the Board's luncheon (January 25).
IX. YALE'S NETMENU AND THE UMLS INFORMATION SOURCES MAP
Ms. Betsy Humphreys, Deputy Associate Director for Library Operations, noted that theBoard has in the past heard presentations on the subject of the Unified Medical LanguageSystem. The goal of the UMLS is to make it easy for users to connect to needed machine-readable information regardless of where that information resides. One aspect of the UMLSis the development of new knowledge sources to help overcome two major obstacles to easyaccess: the variety of ways the same concepts are expressed in the many informationsourcesand the sheer amount and distribution of potentially relevant information across thousandsof different databases. NLM is developing three UMLS knowledge sources: theMetathesaurus, the Semantic Network, and the Information Sources Map. The UMLS iscalled a "distributed national experiment," that is, although NLM has its owninterdisciplinary UMLS research team, there are more than half a dozen contracts withdistinguished medical informatics research groups around the country and more than 400UMLS users at commercial, university, government, and other sites around the world. Oneof the UMLS contract collaborators is the Yale School of Medicine with Dr. Perry Miller,principal investigator. She introduced Dr. Miller and his colleague Dr. Seth Powsner.
Dr. Miller described "Netmenu," which is now fully operational at both the Yale School ofMedicine and its hospital, and a pilot Information Sources Map (ISM). Netmenu allowsusers to have easy access to a set of frequently used local information sources; ISM casts amuch broader net for external information sources. Dr. Miller and Dr. Powsner conducteda live demonstration of Netmenu for the Regents. Among the Netmenu choices is a varietyof bibliographic databases (including MEDLINE), full-text databases, grant and researchinformation, e-mail capabilities, and several clinical advice-giving systems. The networkmenu is deployed operationally within the School of Medicine on about 70 machines-manyof them publicly available. The Information Sources Map (available through the Netmenu)is designed to allow the user to cast a much wider information-seeking net. Dr. Miller andDr. Powsner conducted an ISM search on "cancer," showing how the system utilized theUMLS Metathesaurus to convert cancer to neoplasm and then identified a number ofpotential sources of information categorized by how closely the source matched "cancer."The user can regroup the lists to review them from a different perspective, for example,those that have broad subject coverage and those that are more focused~on the history,genetics, drug therapy, nursing-related issues, etc. With the multiplicity of informationsources, it is important that a system such as this not only identify the sources, butcategorize them so that the user has a good feel for what is available. In the searchconducted on cancer, NLM's AIDSLINE was one of the potential sources identified anddescribed. The system could then be used to connect to AIDSLINE. There are two ISM
8
versions-one focuses on sources of information at Yale, the other, a generic version, focuseson widely distributed Internet sources and is available to anyone. The Yale ISM is alsobeing customized to access local information sources at the University of Utah. In summary,Dr. Miller said, the Netmenu is extensively used (20,000 sessions per month), the Yale ISMis currently deployed on a more limited pilot basis (about 300 sessions per month).
Following the presentation and demonstration, Dr. Carol Newton noted that clearly no onegroup, no matter how competent, can anticipate how systems will operate in differentenvironments. That is why a partnership such as that of Yale and NLM, combining local andnational development, can be very productive. She commented that the ability to categorizethe information sources discovered in an ISM search is a very powerful tool. She asked whatwas being learned about the end users of these systems. Dr. Miller replied that they will bemaking the system available to some power users for their feedback and evaluation and theyalso plan to survey ordinary users. In response to another question, he said that the ISM andthe Yale Gopher were linked. NLM's Dr. Richard Rodgers noted that the Library is workingon a "registry tool" that will be an Internet-accessible forms-based interface that would allowpeople to register their information sources remotely. He agreed with a comment by Dr.Miller that systems like Gopher and World-Wide Web are essentially open marketplacesand ideal for browsing; the ISM tries to provide a focused way to get information on aspecific subject. There was a general discussion about whether and how users of systems likeISM should be able to customize the systems and to create individual user profiles.
X. NIH DIRECTOR'S ADVISORY COMMITTEE MEETING
Board Chair, Rachael Anderson, reported on the December 1, 1993, NIH Director'sAdvisory Committee Meeting, which she attended on behalf of the Board of Regents. Thenew NIH Director, Dr. Harold Varmus, will maintain a lab on the campus in addition toleading the organization. Dr. Varmus reported on his many meetings with key people inCongress while he was awaiting confirmation. Issues high on his agenda are intramuralresearch and the Clinical Center, making high-level NIH appointments, the role of womenand minorities in science, peer review within a climate of financial constraint, streamlininggovernment procedures, the need for guidelines for human embryo research, and therelation between the intramural and extramural communities. Concerning this last item, theNIH Director is considering appointing an ombudsman to serve as a link to extramuralscientists. Two prominent items on the agenda were to discuss intramural research programreviews that were being conducted and, as a response to recent criticisms, to discuss equalemployment opportunity activities at NIH. Ms. Anderson made available to the Boardbackground material, including statistics, on the EEO issue, and also a fact-finding reportfrom an internal review of the intramural program.
XI. BIENNIAL REPORT OF THE BOARD OF REGENTS
Dr. Elliot Siegel described the biennial NIH report as made up of reports from both thedirectors of the various NIH components and from their advisory boards. A draft report forthe NLM Board of Regents has been prepared for the Board's review and comment. Itcontains descriptions of the planning activities that the Board has undertaken in such areasas toxicology/environmental health and librarian education, and also descriptions of newNLM programs that have resulted from previous planning efforts (specifically outreach andbiotechnology). The draft report also contains sections on supporting basic library servicesand High Performance Computing and Communications. Dr. Siegel said that Regents shouldget their comments and suggestions to him by February 15. Ms. Anderson and Dr. Walkersuggested that a section on NLM's response to suggestions from the NIH HIV/AIDSInformation Services Conference might be added as an example of how the Library isresponding to wishes from the user community. Dr. Siegel agreed and said that the sectionin the draft report on outreach could be enriched to include this information. The Boardagreed that the present draft, with the addition of the items just mentioned, would besuitable. Dr. Siegel will give a revised report to the Board Chair for her approval on behalfof the full Board.
XII. REPORT FROM THE TOXICOLOGY AD HOC COMMITTEE
At the last Regents' meeting, Board member Dr. H. Kenneth Walker was appointed to chaira small subcommittee to review the recommended plan of action to implement therecommendations made by the Long-Range Planning Panel on Toxicology andEnvironmental Health. Dr. Walker reported that after meeting with Dr. Ackerman, thesubcommittee has decided that it will review the toxicology and environmental healthdatabases in more detail and make a formal report about the toxicology initiative at the nextBoard meeting.
XIII. HSTAR DATABASE TEST
Ms. Marjorie Cahn of NLM's newly created National Information Center on Health ServicesResearch and Health Care Technology, said that HSTAR (Health Services and TechnologyAssessment Research) is a new "one-stop shopping" database. It contains MEDLARS-basedmaterials related to health service research and also materials that appear in no otherMEDLARS database. At the time of the test it contained about one million records toprimarily post-1984 materials, and MEDLINE was the source for the bulk (93%) of therecords. There were three objectives of the database test: (1) How well does it answerqueries about health services research? (2) Would a Grateful Med input form screen workfor HSTAR? (3) Does the Medical Subject Headings vocabularyneed further revision in thisarea? Eighty-three volunteer users were enlisted in the test, which lasted from April throughAugust 1993. Ms. Cahn described the test~who the typical testers were, the number of
10
searches conducted, the access software used, etc. Using slides to illustrate the variousfindings, she reported that: The test users used the system heavily; they felt they got "aboutthe right amount of information" 55% of the time; there were few problems in usingGrateful Med as the access mode; and almost all of the users (more than 90%) used, andwere satisfied with, the Medical Subject Headings (MeSH). She said that the users expressedthe need for more nonjournal literature in HSTAR, especially technical and governmentreports, industry and trade publications, and news items. Ms. Cahn said that NLM wasaware of this need and the gap for this material is already being filled. Users also said theywanted more medical-related information from the fields of business, economics,engineering, insurance, law, management, medical informatics, and telemedicine. NLM isnow focusing on filling those gaps. In summary, HSTAR is now available on the NLMnetwork and contains 1.3 million records. An NLM work group has been convened to devisenew Grateful Med screens tailored for health services researchers. A MeSH group is lookingat the suggestions from the testers to see what should be added for the 1995 vocabulary. Atraining plan is being developed in cooperation with the National Network of Libraries ofMedicine to look at how we can better train librarians (and those who train librarians) onhow to make best use of HSTAR.
Following Ms. Cahn's presentation, Dr. Walker commented that HSTAR illustrates one ofNLM's traditional strong points, that is, to anticipate the needs of new groups (which healthservice researchers are) and then devise ways to meet those needs. To develop such asophisticated database to this degree is a remarkable accomplishment, he said.
MEETING CLOSED FOR THE REVIEW OF GRANT APPLICATIONSJANUARY 25, 1994, 3:45 TO 4:15 P.M.
XIV. REVIEW OF PENDING APPLICATIONS
Before proceeding with the consideration of pending applications, Dr. Roger W. Dahlen,Chief, Biomedical Information Support Branch, EP, asked Board members to be aware ofconfidentiality and conflict-of-interest procedures included in the grant applicationworkbook. He reminded them to sign at the conclusion of the grant applications review thestatement noting that they had not participated in the discussion of any applications whichpresented a conflict of interest.
The Board reviewed 32 applications, requesting $11,187,538 and recommended for furtherconsideration 28 applications in the amount of $9,194,738 for the total requested. Fourapplications in the amount of $1,389,863 were not recommended for further consideration.Grant applications recommended for further consideration by the Board are listed in the
11
summary action (Attachment C). Interim actions taken by Extramural Programs staff sincethe September meeting were considered by the Board's Extramural Programs Subcommitteeand noted and concurred with by the Board of Regents.
MEETING OPEN-JANUARY 26, 1994, 9:00 A.M. TO ADJOURNMENT
XV. UPDATE ON PLANNING PANEL ON THE EDUCATION AND TRAINING OFHEALTH SCIENCE LIBRARIANS
Dr. Elliot Siegel reported that the Board's Planning Panel on the Education and Trainingof Health Science Librarians has met twice; a third and final meeting will be held in March.Both the original Long-Range Plan and the later planning panel report on Outreachenvisioned the need to prepare health science information professionals for theopportunities and challenges that will be presented by new communications technology. TheMedical Library Association has posited a "platform for change" for the profession and hascalled on NLM to support it. Dr. Siegel introduced Ms. Susan Buyer of the NLM Office ofHealth Information Programs Development, who is serving as Executive Secretary for thePlanning Panel. Ms. Buyer said that the Panel's chairman, Dr. Thomas Detre, spoke at thelast Board meeting. She characterized the panel membership as being made up of librarians,health professionals, educators, and prospective employers of health science librarians. Attheir first meeting, last September, the Panel laid out a list of issues and concerns; theseissues and concerns were then dealt with at their second meeting in December. At thesecond meeting, the Panel focused on: changes foreseen in the health care delivery and howthat will impact what medical librarians do; the special needs of hospital librarians; and therelationship between medical librarianship and medical informatics. Working groups wereformed to draft findings and recommendations that will be assembled into a report. At theupcoming March meeting, the Panel will consider this draft report and a final report willbe submitted to the Board for consideration at a future meeting. Ms. Buyer briefly describedsome of the issues discussed at the last meeting of the Planning Panel.
Board Chair Rachael Anderson, liaison for the Regents to the Planning Panel, said thatthere is great interest in the Panel's work on the part of medical librarians. Current concernwith the training and education of medical librarians goes back to the first LAIMS grants adecade ago when questions were raised about whether a cadre of skilled informationprofessionals would be available to work in the new LAIMS milieu. The Medical LibraryAssociation and the profession in general is eagerly anticipating the Panel's report. ThePanel's work may well affect not just medical librarianship but the entire library profession.In that connection, Ms. Anderson noted, she is pleased that new Regent Dr. Edwin Cortezhas joined the Board and will bring a more general perspective to the Board's deliberations.Regent Beverly Allen commented that there is a group in the profession that feels somewhatdisenfranchised-African-American health science librarians. She asked that representativesof this group be invited to the next Panel meeting so that their views could be included in
12
the Panel's deliberations. There followed a general discussion on the subject of trainingmedical librarians, touching on such subjects as the profession's role outcomes research, thehealth of library schools, the profession and its role with the computerized medical recordand with technology-based opportunities generally.
XVI. REPORT FROM THE NCBI BOARD OF SCIENTIFIC COUNSELORS
Dr. David Lipman, Director of NLM's National Center for Biotechnology Information,substituted for Dr. Robert T. Sauer, Chairman, who was unable to make his scheduledreport on the NCBI Board of Scientific Counselors. The BOSC meets twice a year, with onemeeting focusing on database and software issues and the other on reviewing NCBIpersonnel. Permanent NCBI scientists must have their work reviewed at least once everyfour years, with the results affecting promotion, tenure, and resource allocation. All NCBIreports go to Dr. Lindberg, the Board of Regents, and to the NIH Director's Office (wherethey are presented to the NIH Board of Scientific Directors). Dr. Lipman said that the mostrecent BOSC meeting focused on the Center's service functions, specifically on the wayinformation for GenBank is handled. Previously, GenBank sequence information had beensubmitted by scientists to the Los Alamos National Laboratories (LANL); this informationis now being sent directly to the NCBI. This has resulted in a significant saving that is beingtransferred to the Center's intramural program. Dr. Lipman said that they have alreadynoted a major improvement in quality control of the sequence information being enteredinto the database. As a result of NCBI's action, the Department of Energy has set up anindependent sequence database at LANL. Unfortunately, some scientists have not yetbecome aware of the change and are still submitting their data to LANL. This will changeslowly as journals change their instructions for sequence submission to authors. Dr. Lipmannoted that sequence data is being exchanged between NCBI and LANL, so that regardlessof where it was submitted it does end up in GenBank. In response to a suggestion from theBOSC, the NCBI is now taking steps to get more feedback from users. Finally, Dr. Lipmanreported that the Center's commercial affiliates group~the Industrial Advisors Group-willbe meeting in the near future.
Dr. Carol Newton asked whether data submission for GenBank from LANL was goingsmoothly. Dr. Lipman replied that although the Center gets submissions from LANL, theyare sometimes missing critical information. Dr. Newton commented about the many errorsin LANL data and asked whether they used the same error-checking tools that NCBI staffdid. Dr. Lipman said that more important than the tools being used is the fact that theLANL staff who work on the records are not highly trained molecular biologists. Dr. Newtonconcluded by saying that it was exciting to see how the NCBI is maturing as an informationresource-how the Center is developing the scientific tools to extract and transforminformation for the scientific community.
13
XVII. REPORT FROM THE LHC BOARD OF SCIENTIFIC COUNSELORS
Dr. James J. Cimino, member of the LHC Board of Scientific Counselors, reported on theBoard's two recent meetings in May and October 1993. At the May meeting the Boardreviewed two projects--the Color Medical Imaging System (CMIS) and the Digital ImagingSystems for Human Anatomy. In the CMIS project, full color microscope slides are digitizedusing a low resolution camera and a high-power microscope and displayed on a high-resolution workstation. The reviewers were "stunned" by the quality and seamlessness of theimages. However, it is very expensive to capture and produce the images. The Board madesuggestions in a number of technical areas for speeding up the process and, since this wasa final evaluation, asked that summary documentation be prepared by the investigators.They would also be interested in seeing follow-on projects that would address such issuesas how to scale up the prototype and would evaluate image quality for clinical diagnosis andwhether somewhat lower quality images (that would be cheaper and easier to store) mightsuffice for purposes like education and testing. The Board also reviewed the concept planfor the Digital Imaging Systems, for Human Anatomy project. This will involve the collectionof MRI and CT images and cryosectioned photographs from the "Visible Human" projectand then creating an electronic image library that may be used on compact disk or sent overnetworks. The BOSC looks forward to seeing specific research proposals on how these thingswill be carried out. They recommended that minimal requirements be established for howto index, retrieve, and display the images. At the October meeting, the Board reviewed thecurrent scope and future plans of the Lister Hill Center Educational Technology Branch.Dr. Cimino briefly described the current projects of the Branch and its Learning Center forInteractive Technology. He said that the BOSC, in response to an agenda of four questions,determined that: (1) Educational technology is an appropriate activity for the Lister HillCenter; (2) a partnership with a local medical school would be very valuable; (3) theresources of the ETP and The Learning Center should be available via the Internet; and (4)a research plan should be established for a program in human-computer interaction. TheBOSC concluded its review of the ETB by saying that its development over the last severalyears under Dr. Alexa McCray has been remarkable and that the Library should be proudof it.
Following Dr. Cimino's presentation, Dr. Robert Kahn suggested that the LHC should lookinto new digitization technology being developed by Kodak. He also noted that a crucialissue as one magnifies images is what happens at the edges between images-avoiding the"jaggies." Overall, he is impressed with the LHC program in educational technology.
XVIII. APPOINTMENT OF NOMINATING COMMITTEE
Ms. Anderson appointed Ms. Wendy Carter (Chair), Col. Emmanual Cassimatis, and Dr.Kathleen McCormick to nominate a Board Chair for 1994-95. They will report at the nextmeeting.
14
XIX. DISCOVERING HIDDEN TREASURES IN NLM'S HISTORICAL COLLECTION
Dr. Emilie Savage-Smith, a historian at the Welcome Unit for the History of Medicine andon the Faculty of Oriental Studies at Oxford University, has been studying NLM's Arabicmedical manuscripts. Using slides, she showed the Board a number of treasures from theNLM History of Medicine Division, a collection of Arabic historical materials she describedas the most important in the world outside Cairo and Istanbul.
XX. ADJOURNMENT
The meeting was adjourned at 11:50 a.m., Wednesday, January 26.
Subcommittee Meeting on Monday, January 24:
Extramural Programs Subcommittee--2:00-3:45 p.m.(Attachment B)
ACTIONS TAKEN BY THE BOARD OF REGENTS
1. The Board reaffirmed the Operating Procedures.2. Ms. Anderson appointed a nominating committee for Board chair: Ms. Wendy
Carter (Chair), Col. Emmanuel Cassimatis, and Dr. Kathleen McCormick.3. The Board endorsed the decision to provide free access to AIDS databases.4. The Board concurred with the recommendations of the Extramural Programs
Subcommittee. Grant applications recommended for further considerationsare listed in the summary actions (Attachment C).
I hereby certify that, to the best of myknowledge, the foregoing minutes andattachments are accurate and complete.
Donald A. B. Lindberg,-M.D. (bate) / Rachael K. Anderson (Date)Executive Secretary Chair
15
ATTACHMENT "A"
BOARD OF REGENTS OF THE NATIONAL LIBRARY OF MEDICINE
CHAIRMAN
(8/3/94)ANDERSON, Rachael K.DirectorHealth Sciences Center LibraryUniversity of Arizona1501 N. Campbell Avenue 602-626-6121Tucson, AZ 85724 FAX 602-626-2922
EMAIL rachaela(5)ccit.arizona.edu
ALLEN, Beverly E. (8/3/95)Director, Multi-Media CenterMorehouse School of Medicine720 Westview Drive S.W.Atlanta, GA 30310-1495 404-752-1530
FAX 404-755-7318
BOOKER, Naomi C. (8/3/96)Chair and PresidentMarketing and Management
Innovations, Inc.Village of Cross Keys/Suite 314Quadrangle East/2 Hamill RoadBaltimore, MD 21210 410-433-0400
FAX 410-433-0478
DeNARDIS, Lawrence J., Ph.D. (8/3/94)PresidentUniversity of New Haven300 Orange AvenueWest Haven, CT 06516 203-932-7276
FAX 203-937-0756
JOYNT, Robert J., M.D.,Ph.D. (8/3/96)Vice President and Vice Provost
for Health AffairsUniversity of RochesterSchool of Medicine and Dentistry601 Elmwood Avenue 716-275-3407Rochester, NY 14642 FAX 716-256-1131
KAHN, Robert E., Ph.D. (8/3/94)PresidentCorporation for National
Research Initiatives1895 Preston White DriveSuite 100Reston, VA 22091 703-620-8990
FAX 703-620-0913EMAIL rkahn(5)cnri.reston.va.us
NEWTON, Carol M., M.D., Ph.D. (8/3/96)ProfessorDepartment of BiomathematicsSchool of MedicineUniversity of California10833 Le Conte AvenueLos Angeles, CA 90024-1766 310-825-5800
FAX 310-825-8685EMAIL cnewton(5)biomath.medsch.ucla.edu
WALKER, H. Kenneth, M.D. (8/3/95)Professor of MedicineEmory University School of Medicine69 Butler StreetAtlanta, GA 30303 404-616-3420
FAX 404-525-2957EMAIL [emailprotected]
1/18/94
Roster, Board of Regents, NLM
EX OFFICIO MEMBERSPrimary
BILLINGTON, James H., D. Phil.Librarian of CongressLibrary of Congress10 First Street, S.E.Washington, DC 20540 202-707-5205
FAX 202-707-1714
CLUTTER, Mary E., Ph.D.Asst. Director, Biological SciencesNational Science Foundation4201 Wilson Blvd., Room 605Arlington, VA 22230 703-306-1400
FAX 703-306-0343EMAIL mclutter(5)note.nsf.gov
HAGEN, Donald F., Vice Adm., MC, USNSurgeon GeneralBureau of Medicine and SurgeryDepartment of the NavyWashington, DC 20265-1280 202-653-1144
FAX 202-653-1280
FARRAR, John T., Jr., M.D.Acting Under Secretary for HealthDepartment of Veterans Affairs810 Vermont Avenue, N.W. (10)Washington, DC 20420Delivery Address:801 I Street N.W., Room 710Washington, DC 20001 202-535-7010
FAX 202-535-7630
HOWARD, Joseph H.Director, National Agricultural LibraryU.S. Department of Agriculture10301 Baltimore BoulevardBeltsville, MD 20705 301-504-5248
FAX 301-504-7042
LANOUE, Alcide M, Lt. Gen, MC, USAThe Surgeon GeneralDepartment of the Army5111 Leesburg PikeFalls Church, VA 22041-3258 703-756-0000
FAX 703-0025
Alternate
ROWBERG, Richard E., Ph.D.ChiefScience Policy Research DivisionCongressional Research ServiceLibrary of Congress101 Independence Aveune, S.E.Madison Bldg., Rm. 413Washington, DC 20540 202-707-7040
FAX 202-707-/
KEMP, David G, Capt., MC, USNSpeciality Advisor for theSurgeon General for Internal MedicineDepartment of Internal MedicineBethesda National Naval Medical CenterBethesda, MD 20889-5000 301-295-4630
FAX 301-295-5389EMAIL kemp(S)usuhsb.ucc.usuhs.nnmc.navy.mil
CARTER, Wendy, M.L.S.Asst. for Library ProgramsDept. of Veterans Affairs810 Vermont Avenue, N.W. (142D)Washington, DC 20420Delivery Address:801 I Street, N.W., Room 454Washington, DC 20001 202-535-7337
FAX 202-535-7539carter.wendy(5)forum.va.gov.
CASSIMATIS, Emmanuel G., Col., MC, USAChiefGraduate Medical Education BranchU.S. Army Health Professional SupportAgency (SGPS-EDM)5109 Leesburg PikeFalls Church, VA 22041-3258 703-756-8036
FAX 703-756-8044
Roster, Board of Regents, NLM
ELDERS, M. Joycelyn, M.D.Surgeon General, PHS200 Independence Avenue, S.W.Washington, DC 20201 202-690-6467
FAX 202-690-5810
McCORMICK, Kathleen A., R.N., Ph.D.Director, Office of the Forum
for Quality and Effectivenessin Health Care
6000 Executive Blvd., Suite 310Rockville, MD 20852 301-594-4015
FAX 301-594-4027
SLOAN, Alexander M., Lt. Gen., USAF, MCSurgeon GeneralDepartment of the Air ForceBoiling Air Force BaseWashington, DC 20332-6188 202-767-4343
FAX 202-767-6208
ZIMBLE, James A., M.D.Pres., Uniformed Services University
of the Health SciencesF. Edward Hebert School of Medicine4301 Jones Bridge RoadBethesda, MD 20814-4799 301-295-3013
FAX 301-295-3542EMAILzimble(5)usuhsb.usuhs.mil
MORGAN, Jacqueline, Col., USAF, MCAssociate DirectorAir Force Medical Operations AgencyHQ AFMOA/SGP170 Luke Avenue, Suite 400Boiling Air Force BaseWashington, DC 20332-5113 202-767-1849
FAX 202-404-8089EMAIL morgja(5)sg-usaf.mednet.af.rnil
GARY, Nancy E., M.D.Dean, School of MedicineF. Edward Hebert School of Medicine4301 Jones Bridge RoadBethesda, MD 20814-4799 301-295-3016
FAX 301-295-3542
EXECUTIVE SECRETARY
LINDBERG, Donald A.B., M.D.DirectorNational Library of Medicine8600 Rockville PikeBethesda, MD 20894 301-496-6221
FAX 301-496-4450EMAIL lindberg(5)hpcc.gov
ATTACHMENT "B"
B O A R D O F R E G E N T S
EXTRAMURAL PROGRAMS SUBCOMMITTEE MEETING
January 24, 1994
2:00 to 3:45 p.m.
A T T E N D E E S
Subcommittee Members Present:
Dr. H. Kenneth Walker, ChairMs. Rachael K. Anderson, Ex OfficioMs. Beverly E. AllenMs. Wendy CarterDr. Robert J. JoyntDr. Kathleen A. McCormick
NLM Staff Present:
Dr. Milton Corn, Acting Associate Director, EPMrs. Ruth Bortz, Grants Specialist, EPMrs. Shelly Carow, Grants Management Specialist, EPMr. Peter A. Clepper, Program Officer, EPMrs. Karin K. Colton, Committee Management Specialist, EPDr. Roger W. Dahlen, Chief, Biomedical Information Support Branch, EPMs. Andrea Epstein, Grants Assistant, EP, EPMrs. Rose Marie Holston, Program AnalystMrs. Frances H. Howard, Special Assistant, Office of the Associate Director, EPMrs. Frances Johnson, Program Officer, EPMr. Richard T. West, Chief, Office of Program Planning and Evaluation, EP
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DEPARTMENT OF HEALTH AND HUMAN SERVICESNATIONAL INSTITUTES OF HEALTHNATIONAL LIBRARY OF MEDICINE
Bethesda, Maryland
A G E N D A
106th Meeting of the
BOARD OF REGENTS
9:00 a.m., May 24-25, 1994
Board RoomMezzanine of
National Library of Medicine
MEETING OPEN: 9:00 a.m. to 3:15 p.m. on May 24 and from 9:00 a.m. to adjournmenton May 25.
MEETING CLOSED: 3:15 to 3:45 p.m. on May 24 for the review of grant applications.
1. CALL TO ORDER AND INTRODUCTORY REMARKS 9:00- 9:05 Ms. Rachael K. Anderson
2. REMARKS BY THE SURGEON GENERAL, PHS 9:05-9:20 Dr. M. Joycelyn Elders
3. REMARKS BY THE DIRECTOR, NIH 9:20- 9:40 Dr. Harold Varmus
4. CONSIDERATION OF JANUARY MINUTES TAB I 9:40- 9:45 Ms. Rachael K. Anderson
5. FUTURE MEETING DATES
Fall Meeting: Sept. 27-28, 1994 (T-W)—CONFIRMEDWinter Meeting: Jan. 24-25, 1995 (T-W)--CONFIRMEDSpring Meeting: May 23-24, 1995 (T-W)—PROPOSED
(Subcommittees meet, when necessary, the day before the full Board.)(On May 23: Extramural Programs Subcommittee~2:00-3:30 p.m.
Toxicology Ad Hoc Committee—3:45-5:00 p.m.)
6. REMARKS BY THE DIRECTOR, NLM TAB II 9:45-10:30 Dr. Donald A.B. Lindberg
a. Budget Tab Ab. Personnel Tab Bc. Legislation Tab Cd. AIDS Database Tab De. Reinvention Lab Tab E
Discussion 10:30-10:45 Board Members
COFFEE BREAK 10:45-11:005/19/94
Agenda, Board of Regents' Meeting, May 24-25, 1994 2
7. HPCC BROAD AGENCY ANNOUNCEMENT TAB III 11:00-11:15 Dr. Daniel R. Masys
Discussion
8. MEDIA OUTREACH TAB IV
11:15-11:30
11:30
Dr. Robert E. KahnDr. Steven J. PhillipsOther Board Members
Mr. Robert B. Mehnert
Discussion -11:50 Board Members
9. FRANK B. ROGERS' AWARD 11:50-11:55 Dr. Donald A.B. Lindberg
10. DIRECTOR'S AWARD 11:55-12:00 Dr. Donald A.B. Lindberg
LUNCHEON CATERED IN CONFERENCE ROOM B. 12:00- 1:00(Photograph of Board Members in front of Library.)
11. VISIBLE HUMAN TAB V
Discussion
12. INTERIM REPORT FROM THE PLANNING TAB VIPANEL ON THE EDUCATION AND TRAININGOF HEALTH SCIENCE LIBRARIANS
Discussion
1:00-1:30 Dr. Michael AckermanDr. Alvy Ray SmithDr. David G. WhitlockDr. Victor M. Spitzer
1:30-1:45 Dr. Carol M. NewtonOther Board Members
1:45- 2:15 Dr. Elliot SiegelDr. Thomas Detre
2:15- 2:30 Ms. Rachael K. AndersonOther Board Members
13. REPORT FROM EXTRAMURAL PROGRAMS
a. Budgetb. Proposed Reforms of NIH
Grant Proceduresc. Miscellaneous
Discussion
COFFEE BREAK
TAB VII
Tab A
2:30- 2:45 Dr. Milton Corn
2:45- 3:00 Ms. Rachael K. AndersonEP Subcommittee MembersOther Board Members
3:00- 3:15
MEETING CLOSED FOR THE REVIEW OF GRANT APPLICATIONS, MAY 24, 3:15-3:45 P.M.
Agenda, Board of Regents' Meeting, May 24-25,1994
14. REVIEW OF GRANT APPLICATIONS(Conflict-of-interest instructions in frontof workbook for your information and review.)
3:15- 3:45 Dr. Roger W. Dahlen
MEETING OPEN 3:45 p.m.to ADJOURNMENT
15. LEITER LECTURE on "TWENTY-FIRSTCENTURY SCIENCE" (Lister HillCenter Auditorium)
TAB VIII 4:00- 5:00 Dr. M.R.C. Greenwood
R E C E S S * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
DINNER Uniformed Services University of theHealth Sciences
co*cktails at 6:30 p.m. in the Courtyard.Dinner at 7:30p.m. in the Dining Room.
SPEAKER: Dr. Richard M. SatavaSpecial Assistant, Biomedical Technology, ARPA
TITLE: "Medicine 2001: A Framework for the Future Medicine."
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
R E C O N V E N E : Wednesday, 9:00 a.m., Board Room
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
16. HISTORY OF THE REGIONALMEDICAL PROGRAM
Discussion
TAB IX 9:00-9:30 Dr. Stephen StricklandDr. Alexa McCray
9:30- 9:45 Dr. John ParascandolaDr. H. Kenneth WalkerOther Board Members
17. REPORT FROM THE TOXICOLOGYAD HOC COMMITTEE
TAB X 9:45-10:15 Dr. H. Kenneth WalkerDr. James A. Zimble
Discussion
18. REPORT OF THE NOMINATING COMMITTTEE
10:15-10:30 Ms. Beverly AllenMs. Naomi BookerOther Board Members
10:30-10:35 Ms. Rachael K. Anderson
COFFEE BREAK 10:35-10:45
DEPARTMENT OF HEALTH AND HUMAN SERVICES
NATIONAL INSTITUTES OF HEALTH
NATIONAL LIBRARY OF MEDICINE
BOARD OF REGENTS
MINUTES OF THE 106TH MEETING
MAY 24-25, 1994
BOARD ROOM
NATIONAL LIBRARY OF MEDICINE
BETHESDA, MARYLAND
DEPARTMENT OF HEALTH AND HUMAN SERVICESPUBLIC HEALTH SERVICE
THE BOARD OF REGENTS OF THE NATIONAL LIBRARY OF MEDICINE
Minutes of Meeting ^May 24-25, 1994
The Board of Regents of the National Library of Medicine was convened for its one-hundred-and-sixth meeting at 9:00 a.m. on Tuesday, May 24, 1994, in the Board Room of theNational Library of Medicine, Bethesda, Maryland. Ms. Rachael K. Anderson, Director of theHealth Sciences Center Library at the University of Arizona, chaired the meeting. Inaccordance with P.L. 92-463 and the Determination of the Director, NIH, as announced in theFederal Register on April 15, 1994, the meeting was open to the public from 9:00 a.m. to 3:15p.m. on May 24 and from 9:00 to 11:30 a.m. on May 25. The meeting was closed from 3:15 to3:35 p.m. on May 24 for the review, discussion, and evaluation of grant applications. A Boardroster is enclosed under Attachment A.
Board members present were:
Ms. Rachael K. Anderson, Chair Dr. John T. Farrar (5/24)Ms. Beverly E. Allen Dr. Carol M. NewtonMs. Pamela Q. J. Andre Dr. Steven J. PhillipsMs. Naomi C. Booker Dr. Richard RowbergDr. Mary E. Clutter Dr. H. Kenneth WalkerDr. Edwin M. Cortez Dr. James A. ZimbleDr. Lawrence DeNardis
Alternates to ex officio members present were:
Ms. Wendy Carter, representing Dr. John T. Farrar.Lt. Col. Kristen Raines, representing Lt. Gen. Alcide M. LaNoue.Capt. David S. Kemp, representing Vice Adm. Donald F. Hagen.Capt. Kathleen A. McCormick, representing Dr. M. Joycelyn Elders.Col. Jacqueline Morgan, representing Lt. Gen. Alexander M. Sloan.
Board Members Absent:
Dr. Robert J. JoyntDr. Robert E. Kahn
I/ For the record, it is noted that members absent themselves from the meeting when theBoard is discussing applications (a) from their respective institutions or (b) in which a conflictof interest might occur. This procedure applies only to individual discussion of an applicationand not to "en bloc" actions.
2/ The Board of Regents, when considering the extramural programs of NLM, also constitutesand serves as the National Libraries Assistance Advisory Board.
National Library of Medicine staff members attending this meeting included:
Dr. Donald A. B. Lindberg, DirectorMr. Kent A. Smith, Deputy DirectorDr. Michael Ackerman, Acting Associate Director, SISMr. Harry Bennett, Deputy Director, OCCSMr. Fernando Burbano, Director, Information SystemsMs. Sally Burke, Deputy Executive Officer, ODMs. Marjorie Cahn, Special Expert, National Information Center on Health Services
Research and Health Care Technology, LOMr. Kenneth Carney, Executive Officer, ODMs. Lois Ann Colaianni, Associate Director, LODr. Milton Corn, Acting Associate Director, EPDr. George J. Cosmides, Deputy Associate Director, SISDr. Roger W. Dahlen, Chief, Biomedical Information Support Branch, EPMr. Earl Henderson, Deputy Director, LHNCBCDr. Richard Hsieh, Director, International Programs, ODMs. Betsy Humphreys, Assistant Director for Health Services Research InformationDr. Lawrence Kingsland III, Assistant Director for Applied InformaticsMs. Eve Marie Lacroix, Chief, Public Services Division, LODr. David Lipman, Director, National Center for Biotechnology InformationMr. James S. Main, Chief, Audiovisual Program Development Branch, LHNCBCDr. Daniel R. Masys, Director, Lister Hill National Center for Biomedical CommunicationsDr. Alexa McCray, Chief, Educational Technology Branch, LHNCBCMr. Robert B. Mehnert, Chief, Office of Inquiries and Publications Management, ODDr. Elliot R. Siegel, Associate Director, Health Information Programs DevelopmentMr. Richard T. West, Chief, Office of Program Planning and Evaluation, EP
Others present included:
Dr. Harold Varmus, Director, NIHDr. Thomas Detre, Sr. Vice Chancellor for Health Sciences, University of
PittsburghDr. Carol E. Hudgings, Actg. Dir., Office of the Forum for Quality and
Effectiveness in Health Care.Ms. Pam Moore, "Capital Publications"Dr. John Parascandola, Public Health Service Historian, HHSDr. Ann Scherzinger, Radiologist, Dept. of Radiology, Univ. of ColoradoDr. AIvy Ray Smith, Pres., Altamira Software Col, Mill Valley, CADr. Victor M. Spitzer, Asst. Prof., Dept. of Cellular and Structural
Biology and Radiology, Univ. of ColoradoMs. Liza White, "The Blue Sheet"Dr. David G. Whitlock, Prof., Dept. of Cellular and Structural Biology and
Radiology, Univ. of Colorado
I. OPENING REMARKS
Ms. Rachael Anderson, Chair, welcomed the Regents and guests to the 106thmeeting of the Board of Regents of the National Library of Medicine. Sherecognized a new ex officio member, Ms. Pamela Andre, Acting Director of theNational Agricultural Library.
II. DATES OF FUTURE MEETINGS
The Board will meet next on September 27-28. The next winter meeting will beJanuary 24-25, 1995. The proposed dates of May 23-24, 1995, were accepted andconfirmed for the next spring meeting.
III. REPORT FROM THE NLM DIRECTOR
Dr. Lindberg reported that the FY 1994 budget was subject to a government-widerescission of which NLM's portion was a reduction from $119,981,000 to$118,019,000. The FY 1995 President's budget has $138,521,000 for NLM. Theincreases are primarily in the area of High Performance Computing andCommunications (HPCC) and, to a lesser extent, AIDS. In the area of personnel,the Director reported that NLM is within the NIH-imposed 1994 ceiling (recentlyrecalculated to 614) for full-time employees (FTEs). The ceiling will be lowered to599 in 1995; NLM projects meeting that level by the end of the present fiscal year.NLM is participating in an Adopt-a-School program and is in the early phases ofmaking arrangements with Coolidge High School in Washington, D.C. In the areaof legislation, there are two versions of new HPCC-related legislation-one from theSenate, one from the House. They have in common a commitment to applicationsin health care, education and life-long learning, digital libraries, and advancedmanufacturing (the House added a fifth category-public access to governmentinformation). Even without final HPCC legislation, much has been done by thevarious agencies in anticipation. In a related matter, Dr. Lindberg reported onrecent hearings on the subject of telemedicine, held at NIH, at which he testified onbehalf of NIH and NLM. The Director said that NLM's decision to allow free accessto its AIDS-related databases (announced at the last Board meeting) has met withresounding approval on the part of the health science community. Usage of thosedatabases has risen dramatically. Finally, Dr. Lindberg said he was proud toannounce that Dr. Masys would be leaving as Director of the Lister Hill Center andtaking a position at the University of California at San Diego where he will bechairman of the new medical informatics department.
IV. REMARKS BY THE NIH DIRECTOR
Dr. Harold Varmus, making his first presentation to the NLM Board of Regents,remarked that the NLM has a remarkable vision of the future-supportingcomputerized information dissemination, improving health care, compiling widelyused databases and networks. He frequently uses NLM's information services. Muchof the NIH Director's time is spent dealing with budgetary matters. The Presidenthas shown his support for NIH by proposing a 1995 budget that can only beconstrued as generous~a 4.7% overall increase. NIH will probably not end up withthat amount, however, and will likely ultimately receive an increase below the rateof inflation for biomedical research. To make available budgets go further, NIH isreevaluating its intramural research program which currently takes about 11% of thebudget. An advisory committee has made a number of recommendations about thatprogram-including how NIH scientists are formally evaluated and granted tenure,how resources are apportioned between intramural and extramural components, andthe future of the 40-year-old NIH Clinical Center. The NIH has been designated a"Reinvention Laboratory" for purposes of investigating the peer review system. Dr.Varmus mentioned several possibilities being looked at, including being able to triagegrant applications so that reviewers can spend more time with applications deemedmore competitive, making more extensive use of computers and e-mail, andpostponing required paperwork to arrive "just in time" during the review process.Following Dr. Varmus's presentation, Ms. Anderson expressed the Board's concernthat continuing financial constraints on the Library Operations budget couldjeopardize NLM's existing computerized network and database resources and thusadversely affect health care and research around the country. In response to aquestion from Dr. Walker about NLM's role within NIH, Dr. Varmus said that theLibrary had one great advantage in that what it does can be seen to be clearlyconnected to health care reform. The connection between medical research andhealth care reform is not as obvious to most people. Although when Mrs. Clintonrecently visited NIH, her remarks indicated that she had a real appreciation for therole of research in the Nation's medical and health care system.
V. CONSIDERATION OF MINUTES OF PREVIOUS MEETING
The Regents approved the minutes of the January 25-26, 1994, meeting, withoutchange. Dr. Walker complimented the Library on the excellence of the minutesprepared for each Board meeting.
VI. HPCC BROAD AGENCY ANNOUNCEMENT
Dr. Daniel R. Masys, Director of the Lister Hill Center, briefly summarized theLibrary's recent involvement in the Federal interagency High PerformanceComputing and Communications Initiative. As Dr. Lindberg earlier mentioned, twoversions of new HPCC-related legislation have passed the House and the Senate; Dr.Masys now reported to the Regents how NLM has just funded 12 institutions tosupport health care HPCC applications. There are six areas of health care namedin the HPCC legislation that merit support: testbed networks, visualizationtechnology, virtual reality technology, collaborative technology for the real-timetreatment of distant patients, database technology to provide access to medicalinformation, and database technology for storing and transmitting patient medicalrecords while protecting accuracy and privacy. Last year NLM solicited proposals forhealth care applications and received 137. Evaluation committees found 85 to bepotentially fundable; 12 were ultimately funded~the awards were just announced.The major focus of those funded (except two) is on developing and evaluatingtestbed networks. Dr. Masys briefly reported on what each project hopes to achieve.[Note: A descriptive list of the projects is available from the NLM Office of PublicInformation.]
Following Dr. Masys's presentation, Dr. Steven Phillips commented that a certainamount of caution is required to avoid becoming embroiled in the competitionbetween universities and others in the private sector to recruit patients. Dr. Masyscommented that cutthroat competition in the medical arena may not be healthy; itcertainly is valid, however, to raise the question of the relation between theseprojects and the economic aspects of health care reform, including networks ofproviders and referral patterns. He agreed that NLM management should keep inmind the effect of these projects-pernicious or salutary--on health care delivery. Inresponse to a question from Dr. Cortez, Dr. Masys said that issues of data securityand confidentiality are very important in the funded projects and we hope to learnmuch about these very important matters.
VII. MEDIA OUTREACH
Mr. Robert Mehnert, NLM's Public Information Officer, described the Library'srecent media outreach efforts, including exhibiting at major medical meetings,keeping the print media informed of important news from NLM by press releasesand press conferences, and working with radio and television to ensure that thosemedia also have the opportunity to carry news items about NLM. Since January 1,NLM and the Regional Medical Libraries have sponsored 23 NLM exhibits aroundthe country: 10 were staffed by NLM personnel, the remainder by the regions. The
conferences exhibited a variety of health disciplines, medical sciences, and geographiclocations. In the same span, the NLM has issued five press releases. Mr. Mehnertdisplayed on slides a number of clippings from newspapers and magazines resultingfrom those releases. He also described and showed several examples of a series offive public service announcements (PSAs) prepared several years ago by the Friendsof the National Library of Medicine and sent to several thousand health sciencejournals. Many inquiries have resulted. The NLM Friends is preparing a new seriesof PSAs; a slide of proposed examples was shown.
Following Mr. Mehnert's presentation, Ms. Rachael Anderson read a preparedstatement by Dr. Lois DeBakey, outreach consultant to the NLM, who was unableto attend this meeting. Dr. DeBakey said the Library has made remarkable stridesin its outreach program since the publication in 1989 of the Outreach Planning Panelreport. This can be seen in NLM's improving its relations with the members of theNational Network of Libraries of Medicine, strengthening hospital access to nationalinformation resources, training in health information management at all levels in thenetwork, and implementing a new generation of information products and services(examples are the free AIDS databases and COACH). Despite significant progress,Dr. DeBakey emphasized that there are still too many health professionals who arenot aware of or who do not avail themselves of the Library's outstanding services.She urged Board members who have not already done so to join the Friends of theNLM.
VIII. AWARDS
Dr. Lindberg made three awards to NLM staff. He presented the 1994 Frank B.Rogers Award to Dianne McCutcheon of the Technical Services Division. Ms.McCutcheon was cited for the "design and development of an online interactiveSERHOLD module which permits serial holdings of the National Network ofLibraries of Medicine to be updated directly online." The 1994 NLM Director'sAward was presented by Dr. Lindberg to Mr. Alvin Barnes of the Staff Library,Public Services Division. Mr. Barnes was cited for "furthering NLM's mission byapplying remarkable library skills on behalf of the people and of the Library staff."Mr. Barnes is retiring after 42 years of Government service, 34 with the NationalLibrary of Medicine. Dr. Lindberg also presented an NLM Director's Award to Dr.Milton Corn, Acting Associate Director for Extramural Programs, "for contributionsto the Nation's health through vigorous and exemplary leadership of NLM'sExtramural Programs."
Dr. Lindberg also presented certificates to retiring Board members Dr. Lawrence J.DeNardis and Ms. Rachael Anderson, who also received a gavel for her service asBoard Chair.
IX. THE VISIBLE HUMAN PROJECT
Dr. Michael Ackerman, Acting Associate Director for Specialized InformationServices, used slides to review the genesis of the Visible Human Project as anoutgrowth of the NLM Long Range Planning process. The goal of the project is tobuild a digital image library containing volumetric data representing the completenormal adult male and female. The data would consist of digitized photographicimages from cryosectioning and digital images derived from computerizedtomography and magnetic resonance imaging. A contract award for the project wasmade to the University of Colorado in August 1991. Since that time there have beenseveral presentations to the Board of Regents on this subject, most recently at theMay 1993 meeting. Before introducing Dr. David G. Whitlock and Dr. Victor M.Spitzer, the principal investigators, Dr. Ackerman briefly described the project's nextphase. This is the development of "contour maps" and boundary detection algorithmsby anatomy experts. The plan is to make available a public domain dataset that willserve as a common ground for comparing medical segmentation, imaging, andvisualization techniques. The long-term goal is to link the print library of functionalphysiological knowledge with the image library of structural anatomical knowledgeinto one unified resource of medical information.
Dr. David Whitlock used slides to show the Board how the project which was toidentify, acquire, and completely image a male cadaver was accomplished. The samewill now be done for a female cadaver. He described how a male cadaver of highquality-without trauma or deformity-was selected with the help of three stateanatomical boards (Texas, Colorado, Maryland); the cadaver selected was that of amale who died through court-ordered lethal injection. Dr. Whitlock next outlinedin some detail how the MRI and CT scanning was done on the whole fresh cadaverand, later, photographs made of the sectioned, frozen cadaver. Following Dr.Whitlock's presentation, Dr. Spitzer discussed the digital aspects of the project. A2048 x 2048 CCD array camera was used to capture the anatomical images. The CT,MRI, and anatomical cryosection images were captured digitally. The cryosectionswere also captured on 35mm and 70mm film. Altogether, the male dataset in itspresent form is 43 gigabytes. Dr. Spitzer said that various compression and reductiontechniques will result in a considerably smaller dataset. For example, when theperipheral non-information bearing parts of each image are eliminated, size of thearea of the image will be considerably smaller. As to applications, he noted that
simulation for education and training has received the most attention. However, thefirst tools and applications may be done by the entertainment industry. The VisibleHuman dataset has also frequently been compared in its potential to MEDLINE(because of MEDLINE's wide accessibility around the world) and the HumanGenome Project (because of the complexity of the data). Dr. Spitzer showed a videomade up of a series of still images from the dataset.
Dr. Alvy Ray Smith, former Regent and a consultant to the Board, said that the1990s will be the decade of the "flowering of graphics." Recent Disney animatedfilms (such as "The Lion King") are completely digital, he said. This kind of imageryconsists of 2-dimensional, nongeometric graphics. A second kind of imaging is thatrepresented by "Jurassic Park"--in which it is virtually impossible to tell what wasmade from computer and what is not. This kind of imaging is both 3-dimensionaland geometric. NLM's Visible Human Project has aspects of both types of graphics,Dr. Smith said. Each digitized MRI, CT, or digitized photographic slide is a 2-dimensional nongeometric-based image. Phase 2 of the project will be the "JurassicPark" phase-experts will extract 3-dimensional geometric organs or body systemsfrom the dataset. There is even a third kind of graphics, he said, for which there isno cinematic examplar: 3-dimensional nongeometric computer graphics. This iswhere the Visible Human Project will shine~the rendering of nongeometrical datadistributed evenly through 3-dimensionalspace is called "volume visualization." Whatis displayed on the screen is not just the surface but the contents of bodies. There arenow available volume visualization techniques that could be applied to the VisibleHuman dataset. Dr. Smith showed pictures illustrating volume visualizationtechniques applied to the inside of a human skull. Dr. Smith urged the Board tosupport strongly Phase 2 of the Visible Human Project, including applying presentvolume visualization techniques to the existing data.
Dr. Carol Newton complimented the NLM on the way it has systematicallyapproached the project-involving panels, committees, and teams of outside expertsas necessary. She endorsed Dr. Smith's call for volume visualization (and dissection)as the frontier toward which we should be moving. The analysis techniques andrapid algorithms developed for doing this will be extremely valuable.
X. INTERIM REPORT FROM THE PLANNING PANEL ON THEEDUCATION AND TRAINING OF HEALTH SCIENCE LIBRARIANS
Dr. Elliot Siegel, NLM Associate Director for Health Information ProgramsDevelopment, said that the third and final meeting of the Planning Panel on theEducation and Training of Health Science Librarians has been held. Issues discussedat the first two panel meetings were presented to the Board at its last meeting. He
8
introduced Dr. Thomas Detre, Senior Vice Chancellor for Health Sciences at theUniversity of Pittsburgh, who presented an interim report on the Planning Panel'sactivities. The Panel reached several conclusions. One of these is that spectacularchanges in technology now provide opportunities for the profession that wereundreamed of a decade ago. Dr. Detre enumerated a number of changes foreseenby the panelists: in the role of hospitals and regional health networks; the emergenceof health care alliances formed around major academic medical centers; the evolvingrole of primary care physicians, specialists, and other health care professionals suchas nurse practitioners; the expansion of outcome measures beyond morbidity andmortality to include level of functioning and quality of life; and the ability to usegenetic procedures to identify early who is at risk for certain disorders. This is theworld in which future health science librarians will have to operate. We clearly needa new model and professional development program-graduate library schools mustsomehow ensure that students acquire the knowledge and skills necessary to beleaders in using and applying the new communications technologies for health care.One recommendation that will emerge in the report is that NLM should collaboratewith the Medical Library Association and graduate schools of library and informationsciences to develop various education and training programs for health scienceslibrarians and information specialists.
Following Dr. Detre's presentation, Dr. Siegel reported that the Planning Paneldiscussed a new program concept called "challenge awards," the purpose of whichwould be to support innovative collaboration and planning for the implementationof specific recommendations of high priority. Four possible areas that might beappropriate for such awards are: those connected to health care reform, such asplanning for institutional information systems; proposing ways to maintain existingprofessional skills and learning new skills~"lifelong learning" in health scienceslibrarianship and experimentation with alternative delivery models to the traditionalMLS course of study; curriculum development in medical informatics and medicallibrarianship; and how to ensure that minority populations are better represented inmedical librarianship. Dr. Siegel mentioned a number of associations, societies, andother groups that might be interested in working with NLM in these areas. Dr.Siegel said that his office was assisting the Panel in preparing the recommendations;they have not yet been circulated to the members. A draft final report should beready for presentation to the Board of Regents at its next meeting.
Ms. Anderson noted that the medical library world eagerly awaits the report of theNLM Planning Panel. Both the Medical Library Association and Association ofAcademic Health Science Librarians are interested in the Panel's work. The planto have "challenge awards" should be positivelyreceived by the community, she said,but that the interest in them is likely to exceed the resources available for funding.In response to a question from Dr. Mary Clutter, Dr. Siegel said that the first awards
would be made in Fiscal Year 1995. Dr. Lindberg said that NLM envisions fourcontracts, one in each area, presuming that good applications proposing partnershipsare received. Ms. Beverly Allen commented that she brought the Panel's work to theattention of the African American Medical Library Association. The Association willbe in touch with Dr. Siegel to express its views for the Panel's consideration. Dr.Lopez asked whether the Panel has reviewed existing models for revitalizing theprofession, such as several studies funded by the Council on Library Resources thatproposed partnerships within the profession. Dr. Lindberg responded that NLM,which funded that program, did not find the results useful. Ms. Anderson said thatalthough there may be diminishing opportunities for traditional hospital librarians,there are new opportunities~a new paradigm--for reinventing the profession, forexample, through regional care networks. Comments by Dr. Lindberg and Ms.Carter brought out that, at least in the Federal Government, personnel practices arenot geared up to recognizing a new and enhanced role for medical librarians.Finally, Dr. Detre said that it will be important to conduct a public information oroutreach campaign to the medical community about a revised and enhancedprofession of medical librarianship.
XI. EXTRAMURAL PROGRAMS
Electronic Medical Record Program
Dr. Milton Corn, Acting Associate Director, EP, summarized the progress to date ofthe Electronic Medical Record Program. The program was announced in January,allowing for a very a short turn-around time for the applicants to respond. The resultwas 120 letters-of-intent, realizing 93 completed applications by the April 27deadline. The initial review of the applications will take place the latter part of July.At this time NLM has set aside $1.0 million for a maximum of ten grants. TheAHCPR (Agency for Health Care Policy and Research) will participate withadditional funds and in the review process. The Board's Extramural ProgramsSubcommittee will do its review in August, and the entire Board will be asked tomake their recommendations by mail ballot.
Proposed Reforms of NIH Grant Procedures
Dr. Corn briefed the Board by presenting ten suggestions now under discussion:
1. A grant is an assistance mechanism, not a cost-reimbursable instrument, madefor the public good and not to keep the research community in business.
10
2. When making awards, attention should be paid to the Principal Investigatorby giving weight to track record and seniority.
3. A grant application is a dataset, not a bound volume, and it should bepossible to handle sections in discrete packages.
4. Applications should be received and processed throughout the year,eliminating deadlines for Principal Investigators and staff.
5. All applications would be considered to be "new," where the P.I. writes a newand better grant instead of patching up the old.
6. Grants would be processed under the "just-in-time" principle, eliminating theneed to submit information until needed by the review/administrative process.
7. Triage would be used to reduce workload for reviewers and staff, since not allapplications need receive the same degree of review.
8. The review committee would come up with a score by assigning to gradingclusters, analogous perhaps to school grades.
9. Because summary statements are primarily for NIH use, staff workload couldbe reduced by modifying current P.I. expectations that a tutorial will beprovided.
10. Oversight should be based on progress and on unusual circ*mstances, thusreducing meaningless reporting requirements and permitting concentration onproblems.
MEETING CLOSED FOR THE REVIEW OF GRANT APPLICATIONSMay 24, 1994, 3:15 to 3:35 P.M.
XII. REVIEW OF PENDING APPLICATIONS
Before proceeding with the consideration of pending applications, Dr. Roger W.Dahlen, Chief, Biomedical Information Support Branch, EP, asked Board membersto be aware of confidentiality and conflict-of-interest procedures included in the grantapplication workbook. He reminded them to sign at the conclusion of the grantapplications review the statement noting that they had not participated in thediscussion of any applications which present a conflict of interest.
11
The Board reviewed 78 applications, requesting $42,388,494 and recommended forfurther consideration 64 applications in the amount of $36,813,371 for the totalrequested. Fourteen applications in the amount of $5,575,123 were notrecommended for further consideration. Grant applications recommended forfurther consideration by the Board are listed in the summary action (Attachment C).
MEETING OPEN-MAY 24, 1994, 9:00 A.M. TO ADJOURNMENT
XIII. HISTORY OF REGIONAL MEDICAL PROGRAMS
Dr. Stephen Strickland, an NLM Visiting Scholar who has received support from theLibrary, reported on his 20 months of research into the history of the RegionalMedical Programs (RMP). He noted that several principals in the Program—MaryLasker, Richard Nixon, and former NIH Director James Shannon, have all diedrecently-since Dr. Strickland completed his manuscript last winter. The RMP,established in the mid-sixties, was based on the Heart Disease, Cancer, and StrokeReport prepared by a commission headed by Dr. Michael DeBakey. It had as itsgoal the elimination of killer diseases and reducing their toll on the Americanpopulation. It proposed to do this ensuring that citizens had access to the bestmedicine and most recent research by establishing new linkages between practitionersand medical centers of excellence. Dr. Strickland briefly recounted how thelegislation was debated and enacted. Within a year there were 50 Regional MedicalPrograms in the U.S. They had enormous latitude, not only in the kinds of programsthey developed, but in how they defined their geographic "regions." Although theyvaried greatly, certain themes recurred--many developed coronary care units oremergency medical services, for example. One of its most striking results was theextent to which it engendered cooperation among medical and health care providersand institutions. The RMP, however, never achieved a critical mass of support in theCongress and was, ultimately, vulnerable. The Program was ended in the NixonAdministration. Dr. Strickland said that the history of the Regional Medical Programhas obvious relevance to today's healthcare reform movement. There are lessons tobe learned about cooperation among health care providers, about the need torecognize regional and state differences and the need to allow time and adequatesupport for the development of any new healthcare program.
Following Dr. Strickland's presentation, Dr. Alexa McCray, Chief of the Lister HillCenter's Educational Technology Branch, used a Mosaic program to show a numberof images from the History of Medicine Division's collection related to the RMP.She also described how various materials are being scanned to create an onlinedatabase resource of information based on RMP materials. Data resulting from
12
scanning, even if it contains errors resulting from the scanning process, can be avaluable source of historical information. Dr. McCray described how the material(some 1500 documents) was indexed, including the need to create some 200 RMP-related headings. Lister Hill Center technical staff are interested solving qualityproblems related to the materials-some for example, are photocopies ofmimeographed documents. She also demonstrated the electronic filing system andhow RMP materials can be identified and retrieved.
Dr. John Parascandola, former chief of NLM's History of Medicine Division andpresently with the Public Health Service historical office, said he was pleased withthe results of the RMP project. Not only will we have the history written by Dr.Strickland, but we will have the extensive files and other historical resourcescollected during the project. As Dr. McCray has demonstrated, the materials will beavailable in a convenient and efficient way that few other historical resources canboast. Particularly because the decade of the RMP saw more important healthlegislation than perhaps any other; the collected materials will be invaluable to futurehistorians.
Dr. H. Kenneth Walker commented that he had much pleasure in reading themanuscript. The book will have important insights for today's health care reformers.The RMP demonstrates both the heights to which we can aspire in health care andthe self-serving depths to which those defending their turf-including his ownenvironment of the academic medical center-can descend. Dr. DeNardis, who wasinvolved with state government (Connecticut) in the 60s and 70s, commented that theComprehensive Health Planning Program, which predated RMP had, a consumerfocus and was in its early years a popular program. The RMP, however, had aprovider focus and was not as well connected to the communities through local andstate governments. Another early 1970's program, also little known at the time, wasthe Experimental Health Service Delivery System Program. Under this program,money was allocated to 16 U.S. sites to achieve integration among the many healthcare delivery components. This was an attempt to bring payers and public officialsinto the picture. When the 80s arrived, with severe inflation, high interest rates, anda growing deficit, Federal policymakers eliminated programs that attempted tointegrate all that had gone before.
XIV. REPORT FROM THE AD HOC TOXICOLOGY INFORMATIONCOMMITTEE
Dr. H. Kenneth Walker reported on the activities of the Board's Ad Hoc Committeeto review the Library's Toxicology and Environmental Health Program (members:Ms. Beverly Allen, Ms. Naomi Booker, Dr. James Zimble, and Dr. Walker). The
13
Committee met several times and was briefed by staff of the Specialized InformationServices who are responsible for the NLM Toxicology and Environmental HealthProgram. The Committee believes there are two areas of challenge: (1) the use ofan inadequate interface to NLM's databases in this area and (2) poorly formattedoutput for users in clinical medicine. Dr. Walker briefly recounted the history ofNLM's toxicology program, which dates back to 1967, and how the present suite oftoxicology-related databases evolved. He also presented usage statistics for theonline files. The problem, he said, is that "there are 21 complex, nonintegrated,multidisciplinary, subject-oriented databases." They contain disparate kinds ofinformation and various user interfaces provide access. The databases requireextensive and constant user training. Dr. Walker said that NLM must find out whatthe user community sees as its primary need in this area, create an intelligent user-oriented interface, and present to the community a virtual toxicology andenvironmental health information program.
Following Dr. Walker's report, Dr. Michael Ackerman, NLM Acting AssociateDirector for Specialized Information Services, said that the 1993 Planning Panel onToxicology and Environmental Health has directed NLM to refocus its efforts ingreater support of clinical medicine, environmental health, and occupationally relateddiseases. The NLM program that directs these efforts has been renamed theToxicology and Environmental Health (TEH) Information Program. Not only arethe TEH information resources very diverse, as Dr. Walker pointed out, but theyreside on two different computer systems-the IBM mainframe (ELHILL) system anda distributed system composed of a network of 486 PCs known as TOXNET. Thereis a transparent gateway between the two systems. In general the TEH bibliographicfiles are on ELHILL, the data files on TOXNET. Dr. Ackerman then listed thevarious TOXNET files and the cooperating organizations that provide the data toNLM. The TEH staff are now working to increase the relevance of the databasesto the health care community and to use high-speed networking and intelligentsearching algorithms to make access to the files easier for those involved in healthcare. A TEH Gopher that contains information about NLM products and serviceshas been developed and made available on Internet. Mosaic is also being exploredas a medium for transferring information to users. Dr. Ackerman, Mr. Bruno Vasta,and Dr. Tamas Doszkocs then demonstrated two experimental search interfacesystems. One is based on searching by concept across all files of the TOXNETsystem; the other demonstrates the utility of graphical geographic-based searching.The concepts being demonstrated are applicable not only for the TEH files butacross all of NLM's information files. A sample search involving chemicals andleukemia was performed that retrieved information from several of the TOXNETdatabases. This was followed by a demonstration of the TOXNET geographicinformation map using the Toxic Chemical Release Inventory file to retrieveinformation on chemicals released into the environment in Louisiana. Dr. Ackerman
14
concluded that it ultimately will be possible to extend the concept of the interfacesshown to create a virtual, single, unified NLM database.
Following these presentations and demonstrations, Dr. Zimble commented said thatthe existence of a sophisticated interface providing access to one "virtual database"is exciting. He can envision a time when a physician, during the course of taking ahistory, enters a patient's address in an electronic patient record and triggers a reportof possible exposure to environmental hazardous substances as reported in the NLMdatabanks. It will be important for the user to have an idea of the reliability of theinformation being retrieved, he added. Ms. Beverly Allen commented that they willbe introducing the new interface to the physicians and students at her institution(Morehouse School of Medicine in Atlanta) to get their reaction and to see if itreduces the level of intermediated searching. She looks forward to the time that thesystem is "invisible" to the user-when the user doesn't know whether he or she isconnected to TOXNET or to MEDLINE-it's seamless. Ms. Naomi Booker, the thirdmember of the Ad Hoc Committee, commented that by making the access very easyfor a variety of users it will be more likely that the information will be used more inthe areas of greatest need-in underserved urban and rural areas. Preventioninitiatives will particularly benefit from such a simplified system. In response to aquestion from Ms. Allen, Dr. Ackerman said that the prototype interface systemsdemonstrated are still some time away from being mature enough to be implementedfor general users. Ms. Rachael Anderson commented that the Board is pleased tosee the progress made in setting a direction to implement the Planning Panel'srecommendations. The Board looks forward to hearing progress reports as thesystems mature.
XV. REPORT OF THE NOMINATING COMMITTEE
Wendy Carter, who headed the committee to nominate a new chair for the Board ofRegents, placed in nomination the name of Dr. H. Kenneth Walker, Professor ofMedicine at the Emory University School of Medicine. Dr. Walker was electedunanimously.
XVI. THE DEVELOPMENT OF CLINICAL GUIDELINES BY THE AGENCYFOR HEALTH CARE POLICY AND RESEARCH
Dr. Carol E. Hudgings, Acting Director of the Office of the Forum for Quality andEffectiveness in Health Care, one of eight major components of the AHCPR, saidthat the AHCPR was established to enhance the quality, appropriateness, and theeffectiveness of patient care services through improved knowledge. NIH focuses on
15
biomedical research; AHCPR focuses on health services research. Key policy issuesaddressed by the AHCPR include enhancing medical practice, looking at the cost ofcare, access to care, and quality of care. There are four pillars of the medicaleffectiveness program: collection of data for outcomes research, research targeted toclinical effectiveness and patient outcomes, the development of clinical practiceguidelines, and the dissemination of research findings and practice guidelines. Theprogram focuses more on the outcomes of health care rather than the processes ofhealth care. Clinical guidelines, which are developed by her office, are defined assystematically developed statements designed for practitioners and patients that willbe helpful in making clinical decisions. Three products are derived from theguidelines: criteria statements that can be used to assess the appropriateness ofspecific health care decisions or services; performance measures by which we canmonitor the extent to which a provider has conformed to the statements within aclinical practice guideline; and standards of quality that relate to a range ofacceptable performance. These three products, taken together, may be consideredevaluation instruments for measuring the quality of care to see if it conforms to thecare specified in the practice guidelines.
Dr. Hudgings brought the Regents up to date as to the number and nature of clinicalguidelines so far prepared. More than 20 have produced, 10 have been released.They are acute pain management, urinary incontinence, prediction and preventionof pressure ulcers, cataracts, and depression and primary care, sickle cell disease,early HIV infection, benign prostatic hyperplasia, management of cancer pain, andunstable angina. The heart failure guideline will be released in the next few weeks,followed closely by otitis media in children, treatment of pressure ulcers and lowback problems. To be released over the next year are post-stroke rehabilitation,quality determinants of mammography, cardiac rehabilitation, and Alzheimer's.Panels just beginning their work are on smoking cessation and anxiety and panicdisorders in a primary care setting. Panels being planned are for screening forcolorectal cancer, chronic pain headache, prevention of osteoporosis, acutemyocardial infarction, and risk assessment in complicated pregnancies. Dr. Hudgingsdescribed how the guidelines are prepared in various print and electronic formats fordissemination to different audiences, professional and lay. To date, some 10 millioncopies have been distributed through the AHCPR clearinghouse and throughcooperative arrangements with other organizations. The most popular guideline ison the management of acute pain. The agency is exploring ways to use informationtechnologies creatively to develop, disseminate, and implement the guidelines. Someof these efforts are to create expert system algorithms for the guidelines, electronicfull-text retrieval, an electronic library of published guidelines on the Internet, andCD-ROMs with guidelines. It is clear that the development and dissemination ofclinical practice guidelines will have an important role as we move toward healthcare reform, Dr. Hudgings said. She said that she has been pleased with the
16
cooperation between AHCPR and NLM and the subsequent development of NLM'snew HSTAT database that carries the full text of the guidelines.
Dr. Daniel Masys, Director of the Lister Hill National Center for BiomedicalCommunications, described briefly NLM's working with the AHCPR to help createand disseminate information products of use to that agency. Dr. Masys showed theBoard a brief videotape prepared by the NLM about HSTAT (HealthServices/Technology Assessment Text) and how it can be accessed in various formsvia the Internet. He then used Mosaic to demonstrate how HSTAT may be searchedand clinical guidelines retrieved and displayed.
XVII. ADJOURNMENT
The meeting was adjourned at 11:30 a.m., Wednesday, May 25.
* * * * * * * * * * * * * * * * * * * * * *
Subcommittee Meeting on Monday, May 23:
Extramural Programs Subcommittee~2:00-3:45 p.m.(Attachment B)
ACTIONS TAKEN BY THE BOARD OF REGENTS
1. The Board concurred with the recommendations of the ExtramuralPrograms Subcommittee. Grant applications recommended for furtherconsiderations are listed in the summary actions (Attachment C).
Donald A.B. Lindberg,Executive Secretary
I hereby certify that, to the best of myknowledge, the foregoing minutes andattachments are accurate and complete.
Rachael K. AndersonChair
17
ATTACHMENT "A"BOARD OF REGENTSOF THE NATIONAL LIBRARY OFMEDICINE
CHAIR
(8/3/94)ANDERSON, Rachael K.DirectorHealth Sciences Center LibraryUniversity of Arizona1501 N. Campbell Avenue 602-626-6121Tucson, AZ 85724 FAX 602-626-2922
EMAIL rachaela(5)ccit.arizona.edu
ALLEN, Beverly E. (8/3/95)Director, Multi-Media CenterMorehouse School of Medicine720 Westview Drive S.W.Atlanta, GA 30310-1495 404-752-1530
FAX 404-755-7318EMAIL beverly(5)msm.edu
BOOKER, Naomi C. (8/3/96)Chair and PresidentMarketing and Management
Innovations, Inc.Village of Cross Keys/Suite 314Quadrangle East/2 Hamill RoadBaltimore, MD 21210 410-433-0400
FAX 410-433-0478
CORTEZ, Edwin M, Ph.D. (8/3/97)Assoc. Professor, School of Library
and Information StudiesUniversity of Wisconsin600 North Park StreetMadison, WI 53706 608-263-2900
FAX 608-263-4845EMAIL cortez(5)macc.wisc.edu
DeNARDIS, Lawrence J., Ph.D. (8/3/94)PresidentUniversity of New Haven300 Orange AvenueWest Haven, CT 06516 203-932-7276
FAX 203-937-0756
JOYNT, Robert J., M.D., Ph.D. (8/3/96)Vice President and Vice Provost
for Health AffairsUniversity of RochesterSchool of Medicine and Dentistry601 Elmwood Avenue 716-275-3407Rochester, NY 14642 FAX 716-256-1131
KAHN, Robert E, Ph.D. (8/3/94)PresidentCorporation for National
Research Initiatives1895 Preston White DriveSuite 100Reston, VA 22091 703-620-8990
FAX 703-620-0913EMAIL rkahn(5)cnri.reston.va.us
NEWTON, Carol M., M.D., Ph.D. (8/3/96)ProfessorDepartment of BiomathematicsSchool of MedicineUniversity of California10833 Le Conte AvenueLos Angeles, CA 90024-1766 310-825-5800
FAX 310-825-8685EMAIL cnewton(5)biomath.medsch.ucla.edu
PHILLIPS, Steven J., M.D. (8/3/97)Senior Heart SurgeonIowa Heart CenterMercy Hospital Medical Center411 Laurel StreetDesMoines, IA 50314 515-243-1010
FAX 515-243-7046
WALKER, H. Kenneth, M.D. (8/3/95)Professor of MedicineEmory University School of Medicine69 Butler StreetAtlanta, GA 30303 404-616-3420
FAX 404-525-2957EMAIL kwalk04(5)emoryul.cc.emory.edu
5/18/94
Roster, Board of Regents, NLM
EX OFFICIO MEMBERSPrimary
BILLINGTON, James H., D. Phil.Librarian of CongressLibrary of Congress10 First Street, S.E.Washington, DC 20540 202-707-5205
FAX 202-707-1714
CLUTTER, Mary E., Ph.D.Asst. Director, Biological SciencesNational Science Foundation4201 Wilson Blvd., Room 605Arlington, VA 22230 703-306-1400
FAX 703-306-0343EMAIL [emailprotected]
HAGEN, Donald F., Vice Adm., MC, USNSurgeon GeneralBureau of Medicine and SurgeryDepartment of the NavyWashington, DC 20265-1280 202-653-1144
FAX 202-653-1280
FARRAR, John T., M.D.Acting Under Secretary for HealthDepartment of Veterans Affairs810 Vermont Avenue, N.W. (10)Washington, DC 20420Delivery Address:8011 Street N.W., Room 710Washington, DC 20001 202-535-7010
FAX 202-535-7630
ANDRE, Pamela Q. J.Actg. Dir., National Agricultural LibraryU.S. Department of Agriculture10301 Baltimore BoulevardBeltsville, MD 20705 301-504-5248
FAX 301-504-7042
LANOUE, Alcide M., Lt. Gen, MC, USAThe Surgeon GeneralDepartment of the Army5111 Leesburg PikeFalls Church, VA 22041-3258 703-756-0000
FAX 703-0025
Alternate
ROWBERG, Richard E, Ph.D.Senior Specialist in Science
and TechnologyCongressional Research ServiceLibrary of Congress101 Independence Aveune, S.E.Madison Bldg, Rm. 413Washington, DC 20540 202-707-7040
FAX 202-707-7000EMAIL drowberg(o)crs.loc.gov
KEMP, David G., Capt, MC, USNSpeciality Advisor for theSurgeon General for Internal MedicineDepartment of Internal MedicineBethesda National Naval Medical CenterBethesda, MD 20889-5000 301-295-4630
FAX 301-295-5389EMAIL [emailprotected]
CARTER, Wendy, M.L.S.Asst. for Library ProgramsDepartment of Veterans Affairs810 Vermont Avenue, N.W. (142D)Washington, DC 20420Delivery Address:8011 Street, N.W, Room 454Washington, DC 20001 202-535-7337
FAX 202-535-7539EMAIL carter.wendv(5)forum.va.gov.
CASSIMATIS, Emmanuel G, Col, MC, USAChiefGraduate Medical Education BranchU.S. Army Health Professional Support
Agency (SGPS-EDM)5109 Leesburg PikeFalls Church, VA 22041-3258 703-756-8036
FAX 703-756-8044
Roster, Board of Regents, NLM
ELDERS, M. Joycelyn, M.D.Surgeon General, PHS200 Independence Avenue, S.W.Washington, DC 20201 202-690-6467
FAX 202-690-5810
McCORMICK, Kathleen A., R.N., Ph.D.Senior Science AdviserAHCPR2101 East Jefferson St., Suite 401Rockville, MD 20852 301-594-1483
FAX 301-594-2333
SLOAN, Alexander M., Lt. Gen., USAF, MCSurgeon GeneralDepartment of the Air ForceBoiling Air Force BaseWashington, DC 20332-6188 202-767-4343
FAX 202-767-6208
ZIMBLE, James A., M.D.Pres., Uniformed Services University
of the Health SciencesF. Edward Hebert School of Medicine4301 Jones Bridge RoadBethesda, MD 20814-4799 301-295-3013
FAX 301-295-3542EMAILzimble(5)usuhsb.usuhs.mil
MORGAN, Jacqueline, Col., USAF, MCAssociate DirectorAir Force Medical Operations AgencyHQ AFMOA/SGP170 Luke Avenue, Suite 400Boiling Air Force BaseWashington, DC 20332-5113 202-767-1849
FAX 202-404-8089EMAIL morgja(5)sg-usaf.mednet.af.mil
GARY, Nancy E., M.D.Dean, School of MedicineF. Edward Hebert School of Medicine4301 Jones Bridge RoadBethesda, MD 20814-4799 301-295-3016
FAX 301-295-3542
EXECUTIVE SECRETARY
LINDBERG, Donald A.B., M.D.DirectorNational Library of Medicine8600 Rockville PikeBethesda, MD 20894 301-496-6221
FAX 301-496-4450EMAIL lindberg(5)hpcc.gov
ATTACHMENT "B"
B O A R D O F R E G E N T S
EXTRAMURAL PROGRAMS SUBCOMMITTEE MEETING
May 23, 1994
2:00 to 3:45 p.m.
A T T E N D E E S
Subcommittee Members Present:
Dr. H. Kenneth Walker, ChairMs. Rachael K. Anderson, Ex OfficioMs. Beverly E. AllenMs. Wendy CarterDr. Kathleen A. McCormick
NLM Staff Present:
Dr. Milton Corn, Acting Associate Director, EPMrs. Ruth Bortz, Grants Specialist, EPMrs. Shelly Carow, Grants Management Specialist, EPMrs. Karin K. Colton, Committee Management Specialist, EPDr. Roger W. Dahlen, Chief, Biomedical Information Support Branch, EPMs. Andrea Epstein, Grants Assistant, EPDr. Jack Hahn, Special Assistant to the Associate Director, EPMrs. Frances H. Howard, Special Assistant, Office of the Associate Director, EPMrs. Frances Johnson, Program Officer, EPMs. Arnita Miles, Clerk-typist, EPMr. Richard T. West, Chief, Office of Program Planning and Evaluation, EP
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DEPARTMENT OF HEALTH AND HUMAN SERVICESNATIONAL INSTITUTES OF HEALTHNATIONAL LIBRARY OF MEDICINE
Bethesda, Maryland
A G E N D A
107th Meeting of the
BOARD OF REGENTS
9:00 a.m., September 27-28, 1994
Board RoomMezzanine of
National Library of Medicine
MEETING OPEN: 9:00 a.m. to 4:30 p.m. on September 27 and from 9:00 a.m. to adjournmenton September 28.
MEETING CLOSED: 4:30 p.m. to 5:00 p.m. on September 27 for the review of grantapplications.
1. CALL TO ORDER AND INTRODUCTORY REMARKS 9:00-9:05 Dr. H. Kenneth Walker
2. REMARKS FROM THE OFFICE OF THESURGEON GENERAL, PHS
9:05- 9:15 Dr. Kathleen McCormick
3. CONSIDERATION OF MAY MINUTES TAB I 9:15- 9:20 Dr. H. Kenneth Walker
4. FUTURE MEETING DATES
Winter Meeting: Jan. 24-25, 1995 (T-W)—CONFIRMEDSpring Meeting: May 23-24, 1995 (T-W)—CONFIRMEDFall Meeting: Sept. 26-27, 1995 (T-W)—PROPOSED
(Subcommittees meet, when necessary.)(On September 27: Extramural Programs Subcommittee—8:00-9:00 a.m.)
PLEASE NOTE:(Potential conflictswith Sept. 1995 dates.)
AAHC Annual Meeting, Aspen, CO.Sept. 27-30, 1995FLICC Quarterly Meeting, Washington, DC.September 21, 1995
9/23/94
Agenda, Board of Regents' Meeting, September 27-28, 1994
5. REMARKS BY THE DIRECTOR, NLM
a. Budgetb. Personnelc. Legislationd. NLM Reinvention Labe. NLM Senior Staff Retreatf. NLM and Radiation Studies
Discussion
TAB II 9:20-10:00 Dr. Donald A.B. Lindberg
Tab ATab BTab CTab DTab ETab F
10:00-10:15 Board Members
COFFEE BREAK 10:15-10:30
6. REMARKS BY THE DEPUTY DIRECTOR FOREXTRAMURAL RESEARCH, NIH
10:30-11:00 Dr. Wendy Baldwin
7. MARKET FOR EDUCATIONAL TECHNOLOGY
Discussion
TAB III 11:00-11:45 Dr. Barry M. Horowitz
11:45-12:00 Board Members
8. REGENTS' AWARD 12:00-12:05 Dr. H. Kenneth Walker
LUNCHEON CATERED IN CONFERENCE ROOM B. 12:05- 1:00
9. REPORT ABOUT NLM FRIENDS' ACTIVITIES 1:00-1:30 Dr. Thomas R. Bryant
10. DRAFT FINAL REPORT OF THE PLANNINGPANEL ON THE EDUCATION AND TRAININGOF HEALTH SCIENCE LIBRARIANS(Board action required.)
Discussion
TAB IV 1:30- 2:10 Dr. Elliot SiegelDr. Thomas Detre
2:10- 2:30 Ms. Rachael K. AndersonOther Board Members
11. REPORT ON AIDS OUTREACH ACTIVITIES TAB V
Discussion
2:30- 3:00 Dr. Elliot Siegel
3:00- 3:15 Dr. Edwin CortezOther Board Members
Coffee Break—HPCC Training Room 3:15- 3:30
12. DEMONSTRATION OF TLC TAB VI 3:30-4:00 Dr. Alexa McCray
Agenda, Board of Regents' Meeting, September 27-28, 1994
13. REPORT FROM EXTRAMURAL PROGRAMS TAB VII 4:00-4:15 Dr. Milton Corn
a. Budget and Funding Plans Tab Ab. Electronic Medical Record Awards Tab B
Discussion 4:15- 4:30 EP Subcommittee MembersOther Board Members
MEETING CLOSED FOR THE REVIEW OF GRANT APPLICATIONS, September 27, 4:30-5:00P.M.
14. REVIEW OF GRANT APPLICATIONS(Conflict-of-interest instructions in frontof workboook for your information and review.)
4:30-5:00 Dr. Roger W. Dahlen
R E C E S S * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
Dinner. .Uniformed Services University of theHealth Sciences
co*cktails at 6:30 p.m.Dinner at 7:30 p.m.
SPEAKER: Michael E. DeBakey,M.D.Chancellor and ChairmanDepartment of SurgeryBaylor College of Medicine
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
R E C O N V E N E : Wednesday, 9:00 a.m., Board Room
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
15. PROMOTING INTERNET ACCESS TAB VIII
A. Connecting Medical Libraries—NN/LM Survey Tab A
B. Connecting Libraries in thePacific Northwest Tab B
C. Overview of Connections Grants Tab C
Discussion
COFFEE BREAK
9:00-9:30 Ms. Becky Lyon
9:30-10:00 Mr. Neil Rambo
10:00-10:15 Dr. Milton Corn
10:15-10:30 Dr. Paul R. YoungOther Board Members
10:30-10:45
Agenda, Board of Regents' Meeting, September 27-28, 1994
16. NEW NCBI TOOLS AND SYSTEMS
Discussion
10:45-11:15 Dr. David Lipman
11:15-11:30 Dr. Carol M. NewtonOther Board Members
17. ANALYSIS OF DOCUMENT DELIVERYREQUESTS
Discussion
TAB X 11:30-11:50 Ms. Eve Marie Lacroix
11:50-12:00 Dr. Edwin M. CortezOther Board Members
18. IMAGES FROM THE HISTORY OF MEDICINE TAB XI 12:00-12:30 Dr. Philip TeigenVIA INTERNET Dr. R.P.C. Rodgers
19. ADJOURNMENT 12:30 Dr. H. Kenneth Walker
DEPARTMENT OF HEALTH AND HUMAN SERVICES
NATIONAL INSTITUTES OF HEALTH
NATIONAL LIBRARY OF MEDICINE
BOARD OF REGENTS
MINUTES OF THE 107TH MEETING
SEPTEMBER 27-28, 1994
BOARD ROOM
NATIONAL LIBRARY OF MEDICINE
BETHESDA, MARYLAND
DEPARTMENT OF HEALTH AND HUMAN SERVICESPUBLIC HEALTH SERVICE
THE BOARD OF REGENTS OF THE NATIONAL LIBRARY OF MEDICINE
Minutes of MeetingSeptember 27-28, 1994
The Board of Regents of the National Library of Medicine was convened for its one-hundred-and-seventh meeting at 9:00 a.m. on Tuesday, September 27, 1994, in the Board Room of theNational Library of Medicine, Bethesda, Maryland. Dr. H. Kenneth Walker, Professor ofMedicine at Emory University School of Medicine, chaired the meeting. In accordance withP.L. 92-463 and the Determination of the Director, NIH, as announced in the Federal Registeron August 30, 1994, the meeting was open to the public from 9:00 a.m. to 4:15 p.m. onSeptember 27 and from 9:00 a.m. to 12:15 p.m. on September 28. The meeting was closed from4:15 to 4:45 p.m. on September 27 for the review, discussion, and evaluation of grantapplications. A Board roster is enclosed under Attachment A.
Board members present were:
Dr. H. Kenneth Walker, Chair Dr. Robert J. JoyntDr. Edwin Cortez Dr. Carol M. NewtonDr. Michael E. DeBakey (9/27) Dr. George H. NolanDr. John T. Farrar (9/28) Dr. Steven J. Phillips
Alternates to ex officio members present were:
Capt. David S. Kemp, representing Vice Adm. Donald F. Hagen.Capt. Kathleen A. McCormick, representing Dr. M. Joycelyn Elders.Lt. Col. Kristen Raines, representing Lt. Gen. Alcide M. LaNoue.Dr. Richard Rowberg, representing Dr. James H. Billington (9/27).Dr. Richard Sheridan, representing Dr. James A. Zimble.Ms. Mary Ann Tatman, representing Dr. John T. Farrar (9/27).Dr. Paul R. Young, representing Dr. Mary E. Clutter.Col. Theodore F. Yurkosky, representing Lt. Gen. Edgar R. Anderson.
Board Members Absent:
Ms. Beverly E. Allen Ms. Naomi C. BookerMs. Pamela Q.J. Andre
If For the record, it is noted that members absent themselves from the meeting when theBoard is discussing applications (a) from their respective institutions or (b) in which a conflictof interest might occur. This procedure applies only to individual discussion of an applicationand not to "en bloc" actions.
2/ The Board of Regents, when considering the extramural programs of NLM, also constitutesand serves as the National Libraries Assistance Advisory Board.
1
National Library of Medicine staff members attending this meeting included:
Dr. Donald A. B. Lindberg, DirectorMr. Kent A. Smith, Deputy DirectorDr. Harold Schoolman, Deputy Director for Research and EducationDr. Michael Ackerman, Acting Associate Director, SISMr. Harry Bennett, Deputy Director, OCCSMr. Fernando Burbano, Director, Information SystemsMr. Kenneth Carney, Executive Officer, ODMs. Lois Ann Colaianni, Associate Director, LODr. Milton Corn, Acting Associate Director, EPDr. George J. Cosmides, Deputy Associate Director, SISDr. Roger W. Dahlen, Chief, Biomedical Information Support Branch, EPMr. Charles Goldstein, Chief, Information Technology Branch, LHNCBCMr. Earl Henderson, Deputy Director, LHNCBCMs. Betsy Humphreys, Assistant Director for Health Services Research InformationDr. Lawrence Kingsland III, Assistant Director for Applied InformaticsMr. Sheldon Kotzin, Chief, Bibliographic Services Division, LOMs. Eve Marie Lacroix, Chief, Public Services Division, LOMs. Sue Levine, Chief, Office of Financial Management, ODDr. David Lipman, Director, National Center for Biotechnology InformationMs. Becky Lyon, Head, National Network Office, LODr. Alexa McCray, Chief, Educational Technology Branch, LHNCBCMr. Robert B. Mehnert, Chief, Office of Inquiries and Publications Management, ODMr. David Nash, Equal Opportunity Officer, ODDr. Elliot R. Siegel, Associate Director, Health Information Programs DevelopmentMr. Phillip Teigen, Deputy Chief, History of Medicine Division, LOMr. Richard T. West, Chief, Office of Program Planning and Evaluation, EP
Others present included:
Dr. Wendy Baldwin, Deputy Director, Extramural Research, NIHMs. Rachael K. Anderson, Director, Health Sciences Center Library, University of
ArizonaDr. Thomas R. Bryant, Chairman, Friends of the NLMDr. Thomas Detre, Sr. Vice Chancellor for Health Sciences, University of
PittsburghDr. Barry M. Horowitz, President and CEO, The Mitre Corporation, McLean, VAMs. Pam Moore, Capital Publications, Alexandria, VAMr. Neil Rambo, Associate Director, Pacific Northwest Region National Network of
Libraries of Medicine, University of Washington, SeattleMr. Karl Uhlendorf, "The Blue Sheet"
I. OPENING REMARKS
Dr. H. Kenneth Walker, Chair, welcomed the Regents, consultants, and guests to the 107thmeeting of the Board of Regents of the National Library of Medicine. He recognized threenew appointed members: Dr. Marion Ball, Vice President for Information Services at theUniversity of Maryland; Dr. Michael E. DeBakey, Chancellor of the Baylor College ofMedicine; and Dr. George H. Nolan, Director of Obstetrics and Gynecology at the Henry FordHospital in Detroit. Dr. Walker noted several new ex officio alternates: Col. TheodoreYurkosky, Associate Director of the Air Force Medical Operations Agency and Dr. Paul Young,attending for Dr. Mary E. Clutter; Dr. Michael Sheridan of the Uniformed Services Universityof the Health Sciences was attending for Dr. Zimble; Ms. Mary Ann Tatman was attending forMs. Wendy Carter of the Department of Veterans Affairs; and Lt. Col. Kristin Raines wasattending for Col. Emmanuel Cassimatis.
II. REPORT FROM THE SURGEON GENERAL'S OFFICE
Dr. Kathleen McCormick, representing the Surgeon General, reported briefly several items: thePHS Commissioned Corps is engaged in a 14-item "rejuvenation" plan; a PHS BicentennialCelebration is being prepared that will make use of NLM's historical resources; PHS is workingon implementing Executive Order 12839, which requires a reduction in senior level personnel;the Surgeon General's Office is currently involved in several legislative matters, including oneon the confidentiality of medical records; and finally, the Surgeon General's office is pleasedwith the greatly increased use of NLM's AIDS-related databases as a result of their being madefree of charge, and compliments the Library and the Board of Regents on taking that action.
HI. CONSIDERATION OF MINUTES OF PREVIOUS MEETING
The Regents approved the minutes of the May 24-25, 1994, meeting, without change.
IV. DATES OF FUTURE MEETINGS
The Board will meet next on January 24-25, 1995. The next spring meeting will be May 23-24.The proposed dates of September 26-27, 1995, were accepted and confirmed for the next fallmeeting.
V. REPORT FROM THE NLM DIRECTOR
Dr. Donald A. B. Lindberg reported first on budget matters. The FY 1995 President's budgetrequest was for $138,521,000; the House NLM budget was for $125,906,000; the Senate figurewas $129,906,000. The compromise figure was $128,906,000, a level that Dr. Lindberg ispleased with. As to personnel matters, he reported briefly on Federal efforts to downsizeagency staffs. Recruitment at NLM and NIH has been essentially frozen. One bright spot has
been the success of the National Center for Biotechnology Information in recruiting fellows toits program. Dr. David Lipman, NCBI Director, introduced several of the new fellows: Dr.Heidi Sophia, Dr. Myung S. Chung, Dr. Andreas Baxevanis, and Mr. Douglas Bassett. Mr.Roland Walker will be joining the staff soon as a pre-doctoral fellow. Mr. Fernando Burbano,head of the Office of Computer and Communications Systems, introduced new staff memberJon Rutherford, formerly of the Peace Corps; Dr. Richard Rodgers, of the Lister Hill Center,introduced John Kunze of the University of California (Berkeley) who is working with LHC forone year under the Intergovernmental Personnel Act. Dr. Lindberg, to the applause of theRegents, presented to Dr. Rodgers the Public Health Service Commendation Medal.
On the legislative front, Dr. Lindberg reported on the High Performance Computing andCommunications bill ("Gore II"). House and Senate versions have been passed but must bereconciled before enactment. It has since been derailed. Regardless, he said, there has beenwidespread acceptance of the concept of the National Information Infrastructure-theinformation superhighway. What has been moving forward, Dr. Lindberg reported, is theinteragency effort to "Reinvent Government." NLM has applied (and been approved) to be a"Reinvention Laboratory" within the Department, a distinction that allows the Library to operatemore efficiently by expediting procurement actions, budget reprogramming, personnel practices,publications clearances, and customer surveys. Dr. Lindberg told the Board that NLM seniorstaff held a two-day retreat in August to consider how successfully the Library was implementingthe 1986 Long-Range Plan (and its periodic updates) and whether any mid-course correctionswere needed. A more complete report on the retreat could be made to the Board at a futuremeeting. The NLM Director also reported on the work the Library is doing to identify andtrack down published literature related to human radiation studies during the approximateperiod 1945 to 1970. This is a government-wide effort involving the Public Health Service andthe Energy, Defense, Veterans, and other departments. Much of the pertinent literaturepredates the advent of online databases and requires extensive manual searching. One result,Dr. Lindberg said, is the decision by NLM to computerize the earlier (pre-1966) references.Dr. Michael DeBakey and Ms. Rachael Anderson both voiced their support for the decisionto build computerized files for earlier years of the medical literature.
VI. RESOLUTION HONORING THELMA CHAREN
Ms. Rachael Anderson proposed a resolution of the Board of Regents congratulating ThelmaG. Charen of the Medical Subject Headings Section on completing 50 years of service to theNLM. The Board unanimously approved the resolution (Attachment B).
VII. REPORT FROM THE NIH DEPUTY DIRECTOR FOR EXTRAMURALPROGRAMS
Dr. Wendy Baldwin spoke about "reinvention" and NIH's Extramural Programs. It is importantthat we have a clear vision of the ultimate purpose, which is, simply "to do good science." Tothis, for Extramural Programs, may be added "and adhere to proper stewardship of Federalfunds." There are, in addition, several precepts to reinvention: Processes have to be fair and
efficient; people outside should be able to deal with NIH as a single entity (since investigatorsfrequently are funded by several Institutes during their careers); and because the NIHcomponents vary greatly in size and mission (at any one time there are 30,000 grants beingfunded), we have the flexibility to experiment selectively in introducing new ways of doingthings. Several committees have been set up to study different aspects of the grant process-from preapplication to review to post-award activities. There is also an overarching "reinventioncommittee." Dr. Baldwin said that coverage in the science press about NIH's extramuralreinvention activities has for the most part been positive. She described a "reinventionroundtable" held by NIH Director Varmus on July 14, 1994, at which several topics served asdiscussion openers: structure and operation of study sections and review groups; the possibilityof "modular" grants-having fixed awards like grants-in-aid; retrospective review-basing decisionson an investigator's track record; noncompeting renewals; and electronic administration of thegrant process.
VIII. MARKET FOR EDUCATIONAL TECHNOLOGY
Dr. Barry M. Horowitz, President and CEO of The Mitre Corporation, spoke about the greatpotential technology-based education in K-12. Using it, teachers can spend more time givingindividual attention to students who are proceeding at their own pace through educationalsoftware programs. The explosion of such educational technology-based programs is changingthe way many teachers teach. Dr. Horowitz reviewed both the many advances in recent yearsand the problems they have brought. Americans are finally realizing that technology is animportant part of our national wealth, he said. In Massachusetts (where Dr. Horowitz islocated) 73 percent of the jobs being created use technology. The 1994 Technology Act callsfor the Department of Education to set up a "czar for educational technology," and it also setsup a fund of $400 million for projects related to educational technology. Approximately oneto two billion dollars are spent each year nationwide on educational technology in the schools,so the money contained in the bill is comparatively a substantial sum. An additional $400million is being spent on education projects by the various agencies-NASA, DOD, NIH, etc.With additional moneys being spent on the National Information Infrastructure, a total of about$1 billion is being funneled to educational technology by the Federal Government. There arealso many state and private sector initiatives in this area. The business community, however,is disorganized in how it approaches educational technology for the schools. One reason forthis is that the American educational system is so decentralized. Training remains a bigproblem-many of the teachers graduating from teachers colleges are not being trained in theuse of educational technology. Finally, Dr. Horowitz listed a number of things that could bedone to speed up the introduction of technology based education in the schools. Theseincluded: raising the public's interest through increased publicity, organizing volunteerworkforces (on loan from business, retirees, etc.), increased coordination through consortiumsand sharing, and centrally organizing school developments in technology so that business findsit easier to interact with the educational establishment.
IX. REGENTS' AWARD FOR SCHOLARSHIP OR TECHNICAL ACHIEVEMENT
Dr. H. Kenneth Walker presented the 1994 Board of Regents' Award for Scholarship orTechnical Achievement to Dr. Lawrence Hunter of the Lister Hill Center. Dr. LawrenceKingsland of the Lister Hill Center recounted the many accomplishments of Dr. Hunter,including his book, Artificial Intelligence and Molecular Biology, which represents a significantcontribution to science and points the way to new potential for computer science andinformatics to improve biomedical knowledge. The citation on the award reads "for outstandingachievements in the field of artificial intelligence and for conception, inspiration, andcontribution to the book Artificial Intelligence and Molecular Biology.
X. REPORT ON NLM FRIENDS'ACTIVITIES
Dr. Thomas R. Bryant, President of the Friends of the National Library of Medicine, recountedfor the Board how the Friends organization began back in the mid-eighties. Prime movers inits development, in addition to Dr. Bryant, were Paul Rogers, who had served in the House ofRepresentatives for many years, and Jack Whitehead, a successful businessman in the healtharea. Keith Krueger is the Executive Director. One of the first major challenges facing theFriends was to help the NLM organize and carry off its ambitious year-long 150th anniversaryin 1986. The Friends has sponsored a number of conferences on behalf of the NLM, the mostrecent being yesterday's conference on High Performance Computing and Communications,chaired by Dr. Michael DeBakey. At present, there are 75 corporate, 100 institutional, andseveral hundred individual members of the Friends organization. All the major pharmaceuticalmanufacturers are members. Mr. Krueger then brought the Board up to date on a number ofcurrent activities, including a series of print public service announcements the Friends will besending out next year on behalf of the NLM. He said that packets of information about theFriends would be sent to all Board members in the near future. Following the presentationsby Dr. Bryant and Mr. Krueger, Dr. DeBakey said the Friends organization is becoming evermore vital to the operation of the NLM. He suggested that the rapidly growing number ofHMO-type organizations be approached about membership. Dr. DeBakey added thatyesterday's conference on High Performance Computing and Communications was a fineexample of the kind of program the Friends does best.
XI. DRAFT FINAL REPORT OF THE PLANNING PANEL ON THE EDUCATION ANDTRAINING OF HEALTH SCIENCE LIBRARIANS
Dr. Thomas Detre, Senior Vice Chancellor for Health Sciences at the University of Pittsburgh,complimented Dr. Elliot Siegel and Ms. Susan Buyer of the NLM staff for their outstandingsupport during the entire planning process. They have done an outstanding job in pullingtogether in the draft report the views and recommendations of a wide variety of constituents.[Dr. Detre at the last Board meeting (May 24-25, 1994) described the evolving health caremilieu-health care alliances, academic medical centers, primary care patterns~and the role thatinformation professionals may be called on to play. Several of the major recommendations,including a new program concept of "challenge awards," were previewed at that meeting.] At
the last Board meeting, Dr. Detre said, we were still looking forward to some action on healthcare reform. It is clear there will be no action in the near future and he decried the fact that,as a result, many millions of Americans still have no health insurance, or have inadequatehealth insurance, and that many who have an antecedent history of health problems continueto be discriminated against. He warned that current trends may portend the decay of the"unique ecology that stimulated and nurtured the biomedical research enterprise," includingNLM's outstanding initiatives. The implementation of the Panel's recommendations will be onestep in protecting the infrastructure of the academic health centers that are the heart of thisenterprise.
Following Dr. Detre's presentation, former Board chair, Rachael Anderson, who participatedin the work of the Panel, said that the health science librarian community is eagerly anticipatingthe release of the report and its recommendations. The profession sees NLM as having a roleas catalyst in promoting cross-professional and other collaborations. In the future we are goingto see much more heterogeneity in the health science library professions—in the roles and skillsthat librarians need. Ms. Anderson perceives a growing recognition by employers and librariansof the importance of information services, especially as our health care environment changes.Librarians are recognizing that changes in the forms of medical information and in the healthcare environment call for significant changes in their training and also for intensive retrainingof those in the profession. The report includes initiatives for NLM in implementing variousrecommendations, including a program of "challenge grants." She urged the Board to approvethe report and to help publicize its findings.
Dr. Walker said that Dr. Detre's predictions for the health care delivery system of the future(page i.v. of the report) were wise and insightful. These are wide-ranging observations abouthospitals, health care networks, VA medical centers, the major academic medical centers, therole of the various health professions, clinical guidelines, outcome measures, and new tests andprocedures derived from genetics research. They set the stage very well for considering thehigh-technology roles of librarians in the health sciences. Dr. Walker said that one need of theprofession is an increased ability to "advertise itself-to let others know about their capabilities.Dr. Michael DeBakey said that health centers are being squeezed for funds-how could anexpanded role for biomedical librarians be financed? Dr. Detre said that joint actions thatcombine the strengths of various segments in the health community will be required, and thatlegislators, who hold the purse-strings, must be "educated." Dr. Richard E. Rowbergcommented that improved communication and information networks may actually help incontaining costs and be a stimulus to developing the innovations called for in the report. Dr.Robert J. Joynt said that the problem of medical librarians not "selling their goods" is a realone. They are in a key spot to play an important role not only in the development of newinformation systems, but in educating patients. In Iowa, Dr. Steven J. Phillips said, there is abill in the state legislature specifying that any new HMO-like organization approved for Iowamust be approved by the University. This offers a glimmer of hope for rationalizing the system.
The Board of Regents voted unanimously to approve the draft final report of the Panel aspresented.
XII. REPORT ON AIDS OUTREACH ACTIVITIES
Dr. Elliot R. Siegel, NLM Associate Director for Health Information Programs Development,recounted NLM's AIDS-related activities of the past year, several of which have already beenreported to the Board. NLM and NIH sponsored a June 1993 conference on AIDS informationservices, from which a report with a number of recommendations emanated. One result wasa press conference held by NLM in conjunction with last January's Board meeting, at which itwas announced that four of NLM's databases containing AIDS-related information would befree of charge to all users. Use of NLM's AIDS-related databases has increased 50 percent, asa result of the announcement of free access and the signing up of new users. Otherrecommendations in the report had to do with reaching out to groups who have not traditionallyused NLM's services-public libraries and community groups of various kinds. In May, NLMannounced that it would make small awards (up to $25,000) to local organizations (formingpartnerships was encouraged) to enable them to purchase computer and telecommunicationequipment, and to gain training in the use of NLM's and other databases. Of 87 applications,NLM was able to fund 19. A proposal from a multi-library and community consortium inDetroit was accepted by NLM that will help us learn how database access and use can beencouraged and supported in an inner-city environment. Dr. Siegel also described brieflyseveral other AIDS-related outreach collaborations, such as a training-the-trainer project inPhiladelphia and a peer training experiment to teach Hispanic teenagers about access toelectronic information systems in Springfield, Mass. Dr. Siegel summarized by saying that thesuccess of these projects with groups with whom NLM has not traditionally worked is by nomeans assured. They are in some sense, high risk. The results, however, should be interesting,and just might point the way to future directions for the NLM.
Following Dr. Siegel's presentation, Dr. Edwin M. Cortez made several observations on NLM'sbecoming involved with community-based organizations for HIV/AIDS outreach. It will becrucial for NLM to develop more user-friendly interface products (such as Grateful Med).NLM should cooperate with other database distributors that have popular databases and user-friendly interfaces, such as DIALOG'S "Target." He also emphasized the importance of usingthe Internet as a means of delivering information that is well organized. Dr. Cortez looked atthe recent non-biomedical literature on community support for outreach efforts and identifiedtwo items of special interest. The first is a retrospective comparison (1987) between the amountof HIV/AIDS literature published in popular journals (5000+ items) and the HIV/AIDSliterature published in library-science journals (2 items only). Updated to 1994, a search ofelectronic databases turned up 4,800 items in the popular literature and only one in the library-science literature. This apparent lack of enthusiasm on the part of librarians must be taken intoaccount by NLM when designing outreach programs, he said. The second study (1990)examined the policies adopted by public libraries in the area of HIV/AIDS information. Thestudy showed significant variance between the perceptions and attitudes of library directors andadministrators of community HIV/AIDS programs. It concluded that there were five areas ofpotential cooperation between public libraries and the HIV/AIDS agencies: joint collection ofresources; cooperative programming, e.g., cosponsorship of workshops; centralized circulationand inventory of resources by the library; human resource sharing and networking; andreference services by the libraries for end users.
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XIII. THE LEARNING CENTER FOR INTERACTIVE TECHNOLOGY
The Regents visited the The Learning Center for Interactive Technology in the Lister HillCenter Building and saw demonstrations of various interactive medical educational software.
XIV. REPORT FROM EXTRAMURAL PROGRAMS
Dr. Roger W. Dahlen, Chief of the Extramural Programs' Biomedical Information SupportBranch, reported briefly on EP's budget for FY 1994 and noted that all available funds will beused by September 30. He then asked Mr. Peter Clepper, EP Program Officer, to report onthe status of the Electronic Medical Record. In February of this year, Mr. Clepper said, a"Request for Application" was issued under the cooperative agreement mechanism for researchand development of electronic medical record systems. By late April, NLM had received 94applications. Because of the large number and short turn-around time, a triage process wasused with ten outside consultants to identify those applications that were fully responsive to theRFA. The remaining applications~36 in all-were reviewed in early August by a second groupof 15 outside consultants who agreed that eight proposals were of outstanding quality. With thecollaboration of AHCPR (Agency for Health Care Policy and Research) and individuallynegotiated budget cuts, it appears that all eight will be funded-five by the end of the fiscal yearand three in early FY 1995. The EP Subcommittee of the Board and the entire Boardconcurred with the initial review via a telephone conference call and mail ballot.
MEETING CLOSED FOR THE REVIEW OF GRANT APPLICATIONSSeptember 27, 1994, 4:15 to 4:45 P.M.
XV. REVIEW OF PENDING APPLICATIONS
The Board reviewed 66 applications, requesting $35,545,984 and recommended for furtherconsideration 56 applications in the amount of $31,979,262 for the total requested. Tenapplications in the amount of $3,566,722 were not recommended for further consideration.Grant applications recommended for further consideration by the Board are listed in thesummary action (Attachment D.)
MEETING OPEN-SEPTEMBER 27, 1994, 9:00 A.M. TO ADJOURNMENT
XVI. PROMOTING INTERNET ACCESS
A. Connecting Medical Libraries-NN/LM Survey
Ms. Becky Lyon, Head of NLM's National Network Office, described to the Board a two-partsurvey of the 4,000 member libraries in the National Network of Libraries of Medicine. The
survey, which was carried out in 1993 by the eight Regional Medical Libraries, had twoobjectives: to see how many members had access to a satellite downlink and to establish abaseline on the availability of Internet access to network libraries. The response rate was 83percent (2100, or 63 percent, from hospitals). Slightly less than half (48 percent) of thehospitals reported having satellite downlink facilities (58 percent of the academic institutionshad this). As to Internet access, Ms. Lyon reported the survey revealed that 24 percent (500)of the hospital libraries, 73 percent (383) of the academic institutions, and 37 percent (259) of"other" institutions had access. Ms. Lyon also reported other data collected: type of access-dial-up access versus leased line; whether libraries were charged for their access; and which of theavailable Internet capabilities they used (e-mail was the top vote-getter). They also hoped tofind out what NLM and the RMLs might do to help network members obtain or make use ofaccess. Among the reasons cited by those who were not connected: lack of funding (nearlyhalf), lack of knowledge about the Internet (21 percent), lack of knowledge about how theywould use it (17 percent), and no computer available (147 respondents). The respondents saidthey required more information about the Internet, training, and persuasive arguments topresent to administrators about the benefits of access. Ms. Lyon said that NLM has fundedthree major projects in this area. The first, in the Pacific Northwest,will be described by Mr.Neil Rambo. The second (recently funded in the Greater Midwest Region) is to connect onehospital librarian and one health professional in each of eight institutions to a variety of serviceproviders. NLM hopes to find out the costs, difficulties, level of service provided, applications,and need for training. The third project, just completed in Massachusetts, connected 20 hospitallibraries to the Internet. Ms. Lyon described some of the findings of that project. She alsosummarized what was being done network-wideby the RMLs: providing information such asnewsletters and fact sheets, maintaining awareness of what was happening in the various statesconcerning Internet connections, creating and maintaining regional "listservs," sponsoring"technology fairs," and developing regional training courses and training materials. An NN/LMWorld-Wide-Web server will soon be available, initially run out of the Pacific NorthwestRegional Medical Library. A video is also being procuded to assist librarians in convincinghospital administrators of the benefits of access. All RMLs provide a list of Internet serviceproviders in their areas. They also promote NLM's Internet "connections" grant program. Ms.Lyon concluded by saying that the academic health science libraries ("resource libraries" in theNN/LM) have been a great help to NLM in getting hospitals hooked up to the Internet.
B. Connecting Libraries in the PacificNorthwest
Mr. Neil Rambo, Associate Director of the Pacific NorthwestRegional Medical Library (Region6) at the University of Washington (Seattle), reported to the Board about the InternetConnections Project carried out in the five-state Pacific NorthwestRegion by the RML. At thebeginning of the project (three years ago), not one communityhospital in the entire region hadaccess to the Internet. Very few teaching or research hospitals were connected. Because onefocus of Region 6 is to serve rural and underserved areas, the RML decided to embark on aspecial outreach project based on the Internet. NLM agreed that funds from the NationalNetwork of Libraries of Medicine program be invested in this, even before the NLM-NationalScience Foundation "Connections Grant" program was begun. The RML worked with librariansat selected hospitals; a mix of hospitals and a variety of locations was involved. Seven sites infive states were selected, ranging in size from 22 to 360 beds. NorthWestNet was the service
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provider for connecting the hospitals to the Internet. Along with physically connecting hospitals,the Project sought to find out what applications the librarians and other staff would find mostuseful. Could the librarian serve as a change agent for the entire institution? Mr. Rambobriefly reported how the hospitals were chosen and how their librarians were trained at theUniversity of Washington. Among the applications used, Mr. Rambo noted: e-mail, discussiongroups, and access to online databases. Transmission of actual documents will be tested in thefuture. After two years, hospital librarians at all seven sites now have access to and are usingthe Internet in various degrees. There has been widespread interest in the project throughoutthe region, Mr. Rambo said. Today, 45 percent of hospitals throughout Region six (comparedto 24 percent nationwide as reported by Ms. Lyon) now have some form of Internet access.The figure for the region rises to 75 percent when considering just those hospitals that have alibrarian on the staff. Only six percent of hospitals without a librarian have access. Thisdemonstrates the effectiveness of RML staff "barnstorming"around the region pushing Internetaccess. Mr. Rambo briefly characterized several problem areas that recurred-mostly technical,organizational, and budgetary in nature. In general, he said, Internet is "heaven" for librariansand "hell" for most clinicians. The latter find it difficult and time-consuming to navigate. Anextension of the present project began October 1, 1994. This will investigate the possibility ofusing SLIP/PPP connections at up to 20 different sites around the region, using various accessproviders. Mr. Rambo distributed a new brochure, "From Bench to Bedside," published by theRML, that describes the umbrella program that this pilot Internet connections project fits under.
C. Overview of Connection Grants
Dr. Milton Corn, Acting NLM Associate Director for Extramural Programs, referring to Mr.Rambo's comment that the Internet was "hell" for clinicians, said that the most important factorin getting health professionals to use the Internet will be the development of criticalapplications that are directly relevant to their work. Bibliographic searching, for example, whilecritical to the work of a librarian, is less central to the daily responsibilities of a busy clinician.What is needed is for similarly crucial applications to be developed for hospital administratorsand other health professionals. Dr. Corn described the NLM/National Science Foundationcooperative "Internet Connections" program. It is modeled on an existing NSF program and isfunded through an Interagency Agreement. Under the program, health care institutions mayapply to the NLM for two types of grants-up to $30,000 for an initial connection and up to$50,000 to encourage existing Internet-connected hospitals to extend services to affiliatedinstitutions. Because the program has been a success and will be continued, it will beadministered directly by the NLM beginning October 1, 1994. Dr. Corn presented a listing ofthe 43 academic institutions, hospitals, and professional organizations that received a total of$1.5 million in connection grants over the three years of the program. Because of the multipliereffect of the $50,000 grants, the number of institutions hooked up is at least three times thenumber of awards. The award rate is 66 percent. Dr. Corn said that it would be desirable tomake more awards to community hospitals; they traditionally are less familiar with the federalgrant application process and probably could benefit from assistance in filling out theapplication.
Dr. Paul Young, NSF, inquired, in light of the comments about clinicians finding the technologyto be formidable and of questionable utility, how effectiveness was measured. Dr. Lindberg said
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that the program was not aimed at major academic health science institutions, but at smallerinstitutions where much of the nation's health care is being delivered. NLM hopes to have aneffect on practice through these institutions. Dr. Walker commented that we do have reliableevidence, apart from the Internet, about how useful MEDLINE and other online services arein clinical practice.
XVII. NEW NCBI TOOLS AND SYSTEMS
Dr. David Lipman, Director of NLM's National Center for Biotechnology Information, said thatthe NCBI is a research component of the NLM and it also engages in providing services. Inthe last year, he said, more than 20,000 different sites accessed the NCBI system; more than10,000 electronic queries a day are received. New CD-ROM products are released every twomonths. Not only is access available by e-mail server and various client-server programs (e.g.,Mosaic), but also from commercial groups that sell software incorporating the client parts ofNCBI software. This greatly expands the potential user base. Dr. Lipman introduced severalof his colleagues who then helped him to conduct an online demonstration of the Entrezsequence information retrieval system. He showed several recent enhancements to the system,including a neighboring text search and retrieval capability. He used the example: "What arethe policy implications in the insurance industry regarding genetic testing?" In a matter ofseconds, 1.2 million MEDLINE records were searched and ranked for relevance. Identifiedrelevant articles may themselves be used as exemplars to retrieve more. In another example,Dr. Lipman "moused" a paragraph of interest (on otitis media) from the Physicians DeskReference into the system and quickly located articles on that subject.
Following Dr. Lipman's presentation, Dr. Carol Newton commented that what he showed is anexample of how when one becomes deeply immersed in a particular applications area (such asbiotechnology), one can sometimes develop ideas and products of more general application(such as the neighboring concept used to locate additional information). She is amazed by therapidity of progress by NCBI staff in instituting enhancements to the sequence database services.Dr. McCormick suggested the desirability of integrating information found from a search suchas that done by Dr. Lipman (on otitis media) with other information such as published clinicalguidelines, which also exist in an online form. Dr. Lipman said this was being done for the fullMEDLINE database and agreed this would be an exciting possibility in using the sequencedatabase.
XVIII. ANALYSIS OF DOCUMENT DELIVERY REQUESTS
Ms. Eve-Marie Lacroix, Chief of the Public Services Division, said that today's interlibrary loansystem has not changed much in 30 years. Although the requesting and delivery systems areimproving, libraries must still retrieve, photocopy and sent printed materials. It would bedesirable to have articles in electronic form so that transmission could be instantaneous. NLMhas conducted several studies over the years on the 200,000-300,000 ILL requests the Libraryreceives each year and found that NLM would need more than 12,000 different journals toprovide all the articles requested.
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Some three million requests are input each year into the DOCLINE ILL request and referralsystem now used by 2,700 libraries in the U.S. Using DOCLINE data (and data from othersources), NLM analyzed four million requests entered into the DOCLINE system in 1991 and1992. NLM found that nearly 20,000 unique journal titles were requested systemwide. Thereare approximately 24,000 biomedical serial titles extant. Very few of the journals are heavilyused (54 percent were requested fewer than 10 times in a year). Ms. Lacroix showed a list ofthe heavily used titles; they tend to have long runs (such as JAMA). Most requests for theheavily used titles are filled at the local and regional levels. The most remarkable finding wasthat 76 percent of the millions of articles requested each year are requested only once. Of the3700 journals currently being indexed for MEDLINE, only 104 were not requested during theyear under study. English-language articles accounted for 92 percent of those requested. Sixty-seven percent of the articles requested were published in the last five years. About 38 percentof the journals that were requested on ILL were in MEDLINE, however 84 percent of therequested articles were in MEDLINE. The results of this study should give pause to anyoneplanning to put journal articles in electronic form for purposes of interlibrary loan.
Dr. Cortez commented that the survey being reported is unique in its comprehensiveness. Thefindings are in line with other ILL studies in other fields. There is an observable constantbetween the number of ILL requests and the number of journal titles necessary to fill thoserequests. A large number of ILL requests can be filled with a small number of titles; but to fillall the requests requires a disproportionately large number of titles. The analysis supports theneed for NLM to have a continuing role as a repository for biomedical journals. What isimportant in looking at these data is not the low per capita use, but the high total volume ofinterlibrary loan transactions. This demonstrates that libraries are making wide use of theresearch literature and that the NLM has a crucial role. Finally, although it may not be feasibleto put articles in electronic form now, this may change as the technology advances.
XIX. ADJOURNMENT
The meeting was adjourned at 12:15 p.m., Wednesday, September 28.
* * * * *
Subcommittee Meeting on Tuesday, September 27:
Extramural Programs Subcommittee--8:00-9:00 a.m.(Attachment C)
ACTIONS TAKEN BY THE BOARD OF REGENTS
1. The Board approved a resolution congratulating Thelma G. Charen of MedicalSubject Headings Section on her 50 years of service to the National Library ofMedicine (Attachment B.)
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The Regents Award for Scholarship or Technical Achievement was presented to Dr.Lawrence Hunter of the Lister Hill National Center for Biomedical Communications"for outstanding achievements in the field of artificial intelligence and for conception,inspiration, and contribution of the book Artificial Intelligence and MolecularBiology."
The Board approved the draft final report of the Planning Panel on the Educationand Training of Health Science Librarians.
The Board concurred with the recommendations of the Extramural ProgramsSubcommittee. Grant applications recommended for further considerations are listedin the summary actions (Attachment D.)
I hereby certify that, to the best of my knowledge,the foregoing minutes and attachments areaccurate and complete.
Donald A.B. Lindberg; M.D. (DateExecutive Secretary
H. Kenneth Walker, M.D.Chair
(Date)
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ATTACHMENT "A"
BOARD OF REGENTS OF THE NATIONAL LIBRARY OF MEDICINE
CHAIR
WALKER, H. Kenneth, M.D. (8/3/95)Professor of MedicineEmory University School of Medicine69 Butler StreetAtlanta, GA 30303 404-616-3420
FAX 404-525-2957EMAIL [emailprotected]
ALLEN, Beverly E. (8/3/95)Director, Multi-Media CenterMorehouse School of Medicine720 Westview Drive S.W.Atlanta, GA 30310-1495 404-752-1530
FAX 404-755-7318EMAIL [emailprotected]
BALL, Marion, Ed.D. (8/3/98)Vice President for Information ServicesUniversity of Maryland at Baltimore100 N. Greene Street, 5th FloorBaltimore, MD 21201 410-706-2004
FAX 410 706-8459EMAIL [emailprotected]
BOOKER, Naomi C.Chair and PresidentMarketing and Management
Innovations, Inc.Village of Cross Keys/Suite 314Quadrangle East/2 Hamill RoadBaltimore, MD 21210
DeBAKEY, Michael E., M.D.Chancellor and ChairmanDepartment of SurgeryBaylor College of MedicineOne Baylor PlazaHouston, TX 77030
CORTEZ, Edwin M., Ph.D.Assoc. Professor, School of Library
and Information StudiesUniversity of Wisconsin600 North Park StreetMadison, Wl 53706
(8/3/96)
410-367-1435
(8/3/98)
713-790-3151FAX 713-790-2176
(8/3/97)
JOYNT, Robert J., M.D., Ph.D.Vice President and Vice Provost
for Health AffairsUniversity of RochesterSchool of Medicine and Dentistry601 Elmwood AvenueRochester, NY 14642
NEWTON, Carol M., M.D., Ph.D.ProfessorDepartment of BiomathematicsSchool of MedicineUniversity of California10833 Le Conte AvenueLos Angeles, CA 90024-1766
(8/3/96)
716-275-3407FAX 716-256-1131
(8/3/96)
310-825-5800FAX 310-825-8685
EMAIL [emailprotected]
NOLAN, George H., M.D.DirectorDept. of Obstetrics and GynecologyHenry Ford HospitalK-92799 West Grant Blvd.Detroit, Ml 48202-2689
PHILLIPS, Steven J., M.D.Senior Heart SurgeonIowa Heart CenterMercy Hospital Medical Center411 Laurel StreetDes Moines, IA 50314Mailing Address:5300 Woodland AvenueDes Moines, IA 50312-1946
(8/3/98)
313-876-2474
(8/3/97)
515-279-8203FAX 515-279-1654
608-263-2900FAX 608-263-4849
EMAIL [emailprotected]
9/23/94
Roster, Board of Regents, NLM
Primary
BILUNGTON, James H., D. Phil.Librarian of CongressLibrary of Congress10 First Street, S.E.Washington, DC 20540
CLUTTER, Mary £., Ph.D.Asst. Director, Biological SciencesNational Science Foundation4201 Wilson Blvd., Room 605Arlington, VA 22230
EX OFFICK) MEMBERS
202-707-5205FAX 202-707-1714
703-306-1400FAX 703-306-0343
EMAIL mclutterG).nsf.aov
Alternate
ROWBERG, Richard E., Ph.D.Senior Specialist In Science
and TechnologyCongressional Research ServiceLibrary of Congress101 Independence Aveune, S.E.Madison Bldg., Rm. 413Washington, DC 20540 202-707-7040
FAX 202-707-7000EMAIL drowberg(d)crs.loc.aov
HAGEN, Donald F., Vice Mm., MC, USNSurgeon GeneralBureau of Medicine and SurgeryDepartment of the NavyWashington, DC 20265-1280 202-653-1144
FAX 202-653-1280
FARRAR, John T., M.D.Acting Under Secretary for HealthDepartment of Veterans Affairs810 Vermont Avenue, N.W., Room 800Washington, DC 20420 202-273-5781
FAX 202-273-7090
ANDRE, Pamela 0. J.Actg. Dir., National Agricultural LibraryU.S. Department of Agriculture10301 Baltimore BoulevardBeltsville, MD 20705 301-504-5248
FAX 301-504-7042
KEMP, David G., Capt., MC, USNSpeciality Advisor for theSurgeon General for Internal MedicineDepartment of Internal MedicineBethesda National Naval Medical CenterBethesda, MD 20889-5000 301-295-4630
FAX 301-295-5389EMAIL kemp<fi>usuhsb.ucc.usuhs.nnmc.naw.mil
CARTER, Wendy, M.L.S.Asst. for Library ProgramsDepartment of Veterans Affairs810 Vermont Avenue, N.W. (142D)Washington, DC 20420Delivery Address:8011 Street, N.W., Room 454Washington, DC 20001 202-535-7337
FAX 202-535-7539EMAIL carter.wendv&forum.va.aov
LANOUE, Alcide M., Lt. Gen., MC, USAThe Surgeon GeneralDepartment of the Army5111 Leesburg PikeFalls Church, VA 22041-3258 703-756-0000
FAX 703-0025
CASSIMATIS, Emmanuel G., Col., MC, USAChiefGraduate Medical Education BranchU.S. Army Health Professional Support
Agency (SGPS-EDM)5109 Leesburg PikeFalls Church, VA 22041-3258 703-756-8036
FAX 703-756-8044
Roster, Board of Regents, NLM
Primary Alternate
ELDERS, M. Joycelyn, M.D.Surgeon General, PHS200 Independence Avenue, S.W.Washington, DC 20201 202-690-6467
FAX 202-690-5810
McCORMICK, Kathleen A., R.N., Ph.D.Senior Science AdviserAHCPR2101 East Jefferson St., Suite 401Rockville, MD 20852 301-594-1483
FAX 301-594-2333
ANDERSON, Edgar R., Jr., Lt. Gen., USAF, MCSurgeon General (Select)Department of the Air ForceBoiling Air Force BaseWashington, DC 20332-5113 202-767-4343
FAX 202-767-6208
YURKOSM, Theodore P., Col., USAF, MCAssociate DirectorAir Force Medical Operations AgencyHCt AFMOA/SGP170 Luke Avenue, Suite 400Boiling Air Force BaseWashington, DC 20332-5113 202-767-1849
FAX 202-404-8089
ZIMBLE, James A., M.D.Pres., Uniformed Services University
of the Health SciencesF. Edward Hebert School of Medicine4301 Jones Bridge RoadBethesda, MD 20814-4799 301-295-3013
FAX 301-295-3542EMAIL zimble&usuhsb.usuhs.mil
GARY, Nancy E., M.D.Dean, School of MedicineF. Edward Hebert School of Medicine4301 Jones Bridge RoadBethesda, MD 20814-4799 301-295-3016
FAX 301-295-3542
EXECUTIVE SECRETARY
UNDBERG, Donald A.B., M.D.DirectorNational Library of Medicine8600 Rockville PikeBethesda, MD 20894 301-496-6221
FAX 301-496-4450EMAIL lindbergt&hDcc.aov
ATTACHMENT "B"
RESOLUTION IN HONOR OF
THELMA GOLDEN CHAREN
COMMEMORATING FIFTY YEARS OF SERVICE TO
THE NATIONAL LIBRARY OF MEDICINE AND ITS PREDECESSORS
Adopted by the
Board of Regents of the National Library of Medicine
September 27, 1994
WHEREAS Thelma G. Charen has demonstrated unique talents of creativity, scholarship,and unflagging enthusiasm that have contributed to the pre-eminence of theNational Library of Medicine publications and databases; and
WHEREAS Thelma G. Charen has, through her knowledge and her wit, enriched the livesof all those whom she has instructed, both in formal and informal settings;and
WHEREAS Thelma G. Charen has given totally of herself professionally and personallyin her dedication to the National Library of Medicine and its missions; and
WHEREAS Thelma G. Charen has been throughout her career a staunch believer thatservice in the United States Government is a high honor; therefore
BE IT RESOLVED that the Board of Regents acknowledges on behalf of the NationalLibrary of Medicine and the biomedical community a debt of gratitude for thecontributions of Thelma G. Charen during her fifty years of U.S. Government serviceand wishes her continued success as she embarks on her second fifty years.
ATTACHMENT "C"
B O A R D O F R E G E N T S
EXTRAMURAL PROGRAMS SUBCOMMITTEEMEETING
September 27,1994
8:00 to 9:00 a.m.
A T T E N D E E S
Subcommittee Members Present:
Dr. H. Kenneth Walker, ChairDr. Robert J. JoyntDr. Kathleen A. McCormick
NLM Staff Present:
Dr. Milton Corn, Acting Associate Director, EPMrs. Ruth Bortz, Grants Specialist, EPDr. Roger W. Dahlen, Chief, Biomedical Information Support Branch, EPMs. Andrea Epstein, Grants Assistant, EPDr. Jack Hahn, Special Assistant to the Associate Director, EPMrs. Frances Johnson, Program Officer, EPMr. Richard T. West, Chief, Office of Program Planning and Evaluation, EP
ATTACHMENT «D"
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