BOARD OF REGENTS - National Library of Medicine · BOARD OF REGENTS National Library of Medicine 9:00 a.m. Marc, h 2U-25, 1969 Board Room (v' I. II. III. IV. V. •I. CALL TO ORDER

AGENDA

Thirty-second Meeting of theBOARD OF REGENTS

National Library of Medicine9:00 a.m., March 2U-25, 1969

Board Room (v'

I.

II.

III.

IV.

V.

•I.

CALL TO ORDER AND INTRODUCTORY REMARKS

CONSIDERATION OF MINUTES OF LAST MEETING TAB I(orange book)

DATES OF FUTURE MEETING TAB II1969-70 Calendars in all booksNext meeting - June 19-20, 1969Subsequent Meeting - November 20-21, 1969

Selection of Meeting Date - March 1970Date circled is one preferred -^Possible dates: 19-20, 23-21*, (26-27J

REMARKS BY THE ASSISTANT SECRETARY FORHEALTH AND SCIENTIFIC AFFAIRS

REPORT OF THE DIRECTOR, NLMTAB III

VII.

CONFERENCE ON COMMUNICATIONS FOR MEDICAL TAB IVEDUCATION AND RESEARCHa. Historyb. Purpose

ASSOCIATION OF AMERICAN MEDICAL COLLEGES/COUNCIL OF ACADEMIC SOCIETIES - REPORT ONNLM CONFERENCE

VIII. REPORT ON ORAL HISTORY PROGRAM TAB V

LUNCH

EXTRAMURAL PROGRAMS

IX. REPORT OF THE ASSOCIATE DIRECTOR, EP

DRG Administrative Report

CONSIDERATION OF PENDING APPLICATIONS

A. RESEARCH AND PUBLICATION GRANTS

B. TRAINING GRANTS

TAB I(gray book)

TAB II

TAB III

REPORT OF THE TECHNICAL ADVISORYCOMMITTEE, NATIONAL MEDICALAUDIOVISUAL CENTER

TAB VI(orange book)

Dr. Stewart Wolf

Dr. Stewart Wolf

Dr. Stewart Wolf

Dr. Martin Cummings

Dr. Stewart Wolf

Dr. Cheves Smythe

Dr. Peter Olch

Mr. David Kefauver

Mr. Edward McClellan

XI. INTRODUCTION OF DR. MARSHALL W. NIRENBERG Dr. Martin Cummings(Nobel Laureate for 1968)

Film Showing: "DNA: Blueprint for Life"

Presentation of: "The Genetic Code - and How it Works" (Exhibit ondisplay in NLM Lobby)

ADJOURNMENT

DINNER (DUTCH TREAT) - Ballroom of the Walter Reed Army Medical CenterOfficers Open Mess

Bus departs Library 6:30 - stopping at three Bethesda motels enrouteand for return.

Cocktails 7:00 p.m. Dinner 8:00 p.m.

REGENT SPEAKER - MR. ALFRED ZIPF - Subject: "The Cashless Checkless Society"

RECONVENE - 9:00 a.m. - March 25, 1969

XII. LISTER HILL NATIONAL CENTER FOR BIOMEDICAL TAB VIICOMMUNICATIONS

INTRODUCTION Dr. Ruth Davis

CONTRACTOR REPORTS:

A. Systems Development Corporation Dr. C,. Cuadra

B. Massachusetts Institute of Technology/ Mr. J. NolanLincoln Laboratory

C. Stanford Research Institute Mr. C. Rosen

D. EDUCOM Mr. J. Becker

E. Rand Corporation Dr. S. Koslov

DISCUSSION

LUNCH (For Members of Board of Regents and NLM Key Staff - Catered -Billings Conference Room)

XIII. EXECUTIVE SESSION

XIV. OTHER BUSINESS

ADJOURNMENT

USERS PRESENT;

MBERS ABSENT;

IERNATES;

ESTSt

THE BOARD OF REGENTSof the

NATIONAL LIBRARY OF MEDICINE

MINUTES OF THE 32ND MEETING

March 24-25, 1969 - Bethesda, Maryland

Dr. William G. Anlyan, Mr. Bruno W. Augensteln, Dr. William B. Bean,Vice Admiral George M. Davis, USN, Dr. Robert H. Ebert,Dr. Max Michael, Jr., Dr. L. Qulncy Mumford, Dr. Kathryn M. Smith,Dr. George W. Teuscher, Dr. Frederick H. Wagman, Dr. Stewart G. Wolf, Jr.,Mr. Alfred R. Zlpf

Dr. Harve J. Carlson, Dr. H. Martin Engle, Lt. General L. D. Heaton, USA,Lt. General Kenneth E. Fletcher, USAF, Dr. William H. Stewart

Dr. Burton W. Adklnson represented Dr. Harve J. Carlson, NationalScience Foundation, first day only

Colonel William G. Dunnlngton represented Lt. Gen. L. D. Heaton, USA,both days

Colonel Gerrlt Hekhuls, USAF represented Lt. Gen. Kenneth E. Fletcher,USAF, both days

Dr. Harold Schoolman represented Dr. H. Martin Engle, VeteransAdministration, both days

Captain Charles L. Walte, USN, attended with Vice Admiral George Davis,USN, first day, and represented Vice Admiral George Davis on thesecond day

Dr. Robert Marston, Director, National Institutes of Health

Dr. John F. Sherman, Deputy Director, National Institutes of Health

Dr. Donald Chill, Office of Program Planning and Evaluation, NIH,representing Dr. Thomas Kennedy

Mrs. Ileen Stewart, Executive Secretary, History of Life SciencesStudy Section and Blomedlcal Communications Study Section, DRG, NIH

Miss Cecelia Conrath, Acting Chief, Continuing Education and TrainingBranch, Regional Medical Programs, Health Services and Mental HealthAdministration, PHS

Dr. Marshall W. Nlrenberg, First NIH Nobel Laureate

Professor Sune Bergstrom, Professor of Biochemistry at KarollnskaInstitute! and the Medical School of Stockholm, Sweden

Dr. Cheves Smythe, Associate Director for Association of AmericanMedical Colleges, Evanston, Illinois

UESTS: (Cont'd) Dr. Jordan Baruch, President, Inter-University CommunicationsCouncil, (EDUCOM), Boston, Massachusetts

Mr. Joseph Becker, Vice President, Inter-University CommunicationsCouncil, (EDUCOM), Bethesda, Maryland

Mr. Tad Mayeda, Research Associate, Inter-University CommunicationsCouncil, (EDUCOM), Bethesda, Maryland

Dr. Samuel Koslov, Research Council, RAND Corporation, Washington, D.C.

Mr. Lee Attaway, Associate Head for Public Studies, System SciencesDepartment, RAND Corporation, Santa Monica, California

Dr. Carlos Cuadra, Department Manager, Library & DocumentationSystems Department, System Development Corporation, Santa Monica,California

Dr. Robert Katter, Senior Research Leader, Library and DocumentationSystems Department, System Development Corporation, Santa Monica,California

Mr. Jack Nolan, Massachusetts Institute of Technology, LincolnLaboratories, Lexington, Massachusetts

Mr. Charles Rosen, Manager, Artificial Intelligence Group, StanfordResearch Institute, Menlo Park, California

Dr. Fred Cole, President, Council on Library Resources, Inc.,Washington, D. C.

Mr. Lawrence Livingston, Council on Library Resources, Inc.,Washington, D. C.

Mr. John Sherrod, Director, National Agricultural Library,Washington, D. C.

'AFFi Dr. Martin Cunnings, Mr. Scott Adams, Mr. Alfred Asch,Dr. Clifford Bachrach, Dr. John Blake, Dr. Jeanne Brand,Mr. Huly Bray, Mr. Arthur Broering, Mr. Kenneth Carney,Mr. Peter Clepper, Mr. Lawrence Coffin, Mr. Salvatore Costabile,Miss Mary Corning, Dr. Ruth Davis, Mr. Donald Dennis, Mr. Allan Doris,Dr. Malcolm Ferguson, Mr. Herbert Fockler, Mr. Joseph Foley,Mrs. Louise Carnage, Mr. James Hill, Mr. David Kefauver,Dr. Joseph Leiter, Mr. Davis McCarn, Mr. Edward McClellan,Dr. G. Burroughs Mider, Miss Marilyn Miller, Mr. Dan Mills,Dr. Peter Olch, Mr. Ben Parker, Mrs. Rita Pusey, Dr. Charles Rice,Mr. George Russell, Mrs. Ann Sabin, Dr. Norman Shumway,Mr. Ralph Simmons, Mr. Stanley Smith, Mr. Kenneth Styers,Mr. Zane Thornton, Mr. Samuel Waters.

NEW STAFF MEMBER INTRODUCED

Dr. Cunnings introduced Mr. Donald D. Dennis, Chief of Reference ServicesDivision in Library Operations. Mr. Dennis was formerly the Health SciencesLibrarian with the University of Michigan.

NOVEMBER 1968 MINUTES APPROVED. FORTHCOMING MEETINGS SCHEDULED

The minutes of the November 25-26, 1968 meeting were approved. The dates ofJune 19-20, 1969 and November 20-21, 1969were reaffirmed. The dates ofMarch 26-27, 1970were tentatively selected for the second meeting inFY 1970.

REPORT OF DIRECTOR. NLM

Dr. Cummings reviewed the NLM budget submission for FY 1970,noting thatLibrary construction money had been transferred to the Bureau of HealthProfessions Education and Manpower Training. In the event of reductions inthe FY 1970 budget, the MEDLARS II commitments would be protected, and requiredcuts absorbed by other components of NLM. The Library will have four appear-ances before Congressional Committees this year rather than two,since theMedical Library Assistance Act is due for renewal.

Staffing at NLM,including the National Medical Audiovisual Center (NMAC),at the end of this fiscal year is projected at 485 positions. It was notedthat the NLM strength, less personnel in the new programs (Lister HillNational Center for Biomedical Communications, Specialized InformationServices, NMAC), was comparable to that of twenty years ago—when the budgetwas much smaller and services considerably less in volume than now.

Dr. Cunnings reported on the efforts of the National Medical AudiovisualCenter to develop a solution to media distribution workload problems. Withdemands for loan services exceeding existing manpower resources to handlethem, non-health related groups now receive lowest priority. Loan servicesto high schools, service organizations, etc., are due to be transferred tothe General Services Administration after July 1, 1969.

The Director stated that as a result of strong representations from Georgiainterests, the Audiovisual Center will not be moved from Atlanta, Georgiato Bethesda, Maryland.

Following the general recommendations of the President's Commission onLibraries, bills have been introduced in Congress calling for the establish-ment of a National Commission on Libraries and Information Science.

At a recent Committee on Scientific and Technical Information (COSATI) meeting,it was proposed that the National Agricultural Library, National Library ofMedicine, National Aeronautical and Space Administration and the Atomic EnergyCommission be named the first group of responsible agencies to coordinate andimprove the handling of scientific and technical information within theirareas of mission interest. MARC II standards were adopted for the format ofmachine-readable bibliographic information relating to technical reports.

The Director reported progress by the National Libraries Task Force onsystems development relating to compatibility in machine-readable cata-loging, but that comparable progress was not being made towards a nationalserial data bank.

Dr. Cunmings called on Dr. Burton W. Adkinson, National Science Foundation,who reported that the Committee on Scientific and Technical Communications(SATCOM) of the National Academy of Sciences has recommended the creationof a broadly representative and high prestige non-Governmental body tostimulate greater national coordination of Information handling effortsamong both profit and non-profit private interests. Such a body couldserve as a channel for their interaction with public policy making groupsana should operate within the Academy structure.

Mr. Scott Adams, Deputy Director, NLM, reporting on some aspects of theLibrary's International activities, stated that the proposal for a consortiumto develop a MEDLARS system in Europe, under sponsorship of the Organizationfor Economic Cooperation and Development, has been abandoned. Bilateralagreements will be concluded between NLM and specific organizations at therate of one per year. The first will be the Institut National de le Santeet Recherche Medicale (INSERM) in France. An agreement for a MEDLARS systemhas been concluded with Australia.

Mr. Adams reported on the International Council of Scientific Unions (ICSU) -UNESCO Joint Project for studying the feasibility of a World Science Informa-tion System. Attention will be focused on the interconnections between largedeveloping systems, both national and internatlon; on standardization ofbibliographic descriptions; and on problems of natural and artificial language.

REPORT ON CONFERENCE "COMMUNICATIONS FOR MEDICAL EDUCATION AND RESEARCH"

Dr. Stewart Wolf, Moderator of this Conference designed to assist planningfor the Lister Hill Center and held at the Library in December 1968,expressedsome disappointment in the meeting due to the emphasis on modern technology.It was recommended by the group that the Lister Hill Center's BiomedlcalCommunications Network (BCN) become involved first In continuing medicaleducation as a means of helping physicians broaden their knowledge and under-standing of clinical problems. It was agreed that a national advisory groupon content, and a pilot program were needed as first steps. In Board discus-sion, the urgency for action rather than immobilization was stressed. Aunifying force was required around which efforts of many organizations andagencies could be coordinated.with regard to production costs, distributionmechanisms and utilization systems. The Library could be such a force, andan experimental model should be developed with the BCN as an essential partof this venture.

REPORT ON "CONFERENCE ON POTENTIAL EDUCATION SERVICES FROM A NATIONALBIOMEDICAL COMMUNICATIONS NETWORK"

This conference, designed to provide guidance to NLM in providing educationalservices through the BCN, was held in February 1969. It was arranged by theCouncil of Academic Societies, Association of American Medical Colleges(AAMC), and reported on by Dr. Cheves Smythe, Associate Director, AAMC.

Unqualified support for a Biomedical Communications Network was expressedby the participants, with emphasis to be placed on undergraduate and post-graduate medical education. The conference had eight well-defined objectivesrelating to educational materials, technologies, distribution mechanisms,and effective utilization of media and equipment. The need for a "floor"rather than a "core" of professional knowledge was stated. Comment wasmade on the disordered fashion of collecting medical data, and on the potentialof computers and modern communications technology. There was heavy emphasison the need for evaluation of services offered by the BCN, with attentionbeing paid to behavioral changes in people using them.

It was agreed that there is the body of knowledge, skills, and conceptscommon for all medical schools which constitutes a national resource. Notall medical schools can provide ready access to this body of knowledge;modern techniques and technology can assist in such provision, and informationshould be made available with local option as to its use within any institution.

A communications model was again called for in the development of improvedinformation transfer. It was finally suggested that methods of extendingthis information*transfer to continuing education would evolve from theexperience with undergraduate and postgraduate education.

REPORT ON ORAL HISTORY PROGRAM

Dr. Peter Olch, Deputy Chief, History of Medicine Division, and in charge ofthis Program, reported on this two-year old activity at NLM. Two hundredhours of history are on audio tape. Five in-depth histories have beencom-pleted and there are several shorter tape recordings of historical signifi-cance. Dr. Olch concluded his report by playing excerpts from statements byDr. A. Baird Hastings, Senator Lister Hill, and Dr. Denton Cooley.

CEREMONY HONORING DR. MARSHALL NIRENBERG

The Board participated in an informal ceremony during the first afternoon,when as a body they congratulated Dr. Marshall Nirenberg of NIH who wasrecently awarded the Nobel Prize for his work on the definition of thegenetic code. A bound citation from the Board was given to Dr. Nirenberg.Dr. Sune Bergstrom, Karolinska Institutet, Stockholm, and Chairman of theNobel Committee for Medicine or Physiology, was present for the occasion.Dr. Robert Marston, Director of NIH,commented on the good feeling that theNobel award had generated at NIH. A film "ENA: Blueprint for Life" wasshown and the Board members Inspected the new exhibit on the "Genetic Code"that was located in the lobby. This included the British-made fifteen foothigh DNA model erected in the catalog area.

REPORT OF TECHNICAL ADVISORY COMMITTEE. NMAC

Mr. Edward McClellan, Deputy Director, NMAC, reported on the November 1968meeting of this five-man committee authorized by the Board earlier in theyear. The members were asked to address themselves to a series of problemsrelating to audiovisual systems planning, recruitment and career development

of personnel, effective use of educational media, color television production,and establishment of a videotape distribution center. They were furtherasked to make recommendations regarding services that will utilize technologyat the lowest possible cost and to concern themselves with the technicalquality of NMAC operations.

The Committee recommended that NMAC develop publications on learning facili-ties, frame multi-media teaching packages, and make use of contracts andconsultants in supporting communications development in biomedical institutions.

In Board discussion, it was noted that the Committee did not consider broadissues relating to design of learning materials for specific groups, but hadrather limited its discussion to facilities, equipment and technology. It wasrecognized, however, that the committee could not be expected to addressitself to the content or substance of audiovisual communication, and thatanother mechanism needed to be developed for this. It was noted that evalua-tion was a "missing link" in the NMAC program. The role of the Center as acentral facility and its relationship to regional centers required definition.It was recognized that NMAC could play a valuable role as custodian and dis-tributor of media. The need for individuals with knowledge of subject matter,production methods, and technology to stand at the interface between mediaproduction agencies and the educator-learner groups was emphasized.

REPORT ON DISCUSSION OF THE ROLE OF LISTER HILL NATIONAL BIOMEDICALCOMMUNICATIONS CENTER IN MEDICAL EDUCATION

As a result of the Reports in Sections III and IV above, there was a lengthydiscussion of the area of medical education toward which the Lister HillCenter should first channel its efforts — continuing, or undergraduate andpostgraduate, medical education. The Board appeared to favor emphasis onsupport for medical school instructional programs. Students are highlymotivated, and adapt to the new approaches that are available and necessary,and the educator groups are used to working with Federal Governmental agencies.It was brought out that we are now in a "continuous learning society" andthat medical school education could also relate to continuing education, theneeds of which are difficult to define. The desirability of a close workingrelationship between NLM and the AAMC, both with regard to substance andtechnical aspects of medical education, was emphasized. The sources of ideasfor new approaches received considerable attention and it was agreed theycame not from committee action but from individuals in diverse groups andinstitutions. Board members confirmed the need to develop a "model" forevaluation, an explicit demonstration that there is a need for learningmaterials and knowledge transmission facilities and that there are means offilling these needs.

LISTER HILL NATIONAL CENTER FOR BIOMEDICAL COMMUNICATIONS CONTRACTSORIENTATION

Dr. Ruth Davis, Director of the Center, stated that the Lister Hill Centerhas four main functions: establishment of a biomedical communicationsnet-work (BCN), application of communications technology to purposes of the

medical community, serving as a focal point for coordination of various typesof communications activity in DREW, and to provide liaison for DREW regardingthese matters with other Governmental agencies. The efforts of the Center'scontractors relate primarily to the development of the BCN, determination ofexisting'resources, and the use of communications technology in organizingand transmitting medical knowledge. These activities are concerned withsystems technology, communications technology, computer technology and contentproduction.

Reports were given by representatives of five of the Center's contractors:

1. Systems Development Corporation (by Dr. C. Cuadra)Efforts under this contract relate to assisting the Lister Hill Centerin developing performance criteria and specifications for the user-systeminterface and those components of the BCN involving on-line informationretrieval.

The NLM - ORBIT resource will be used as an experimental facility bypersonnel skilled in literature searches. From this and other studieswill result a set of empirically-based guidelines to assist the Centerstaff in development of on-line retrieval interface aspects of the BCN.

2. Lincoln Laboratory. Massachusetts Institute of Technology (by Mr. J. Nolan)This project takes advantage of MIT hardware capability to begin theevolutionary development of an interactive capability to use and manipulatethe vocabulary of MeSH (Medical Subject Readings).

A data base has been constructed containing MeSH terms that permitsearching for alphabetical terms on all or a fraction of a word or theentry at a node in the hierarchial structure. Vocabularies from otherinformation systems can be input to the system and it will be possibleto enter a word from one of those systems and find the equivalent MeSHterm, thus allowing access to the MEDLARS system.

3. Stanford Research Institute (by Dr. C. Rosen)The purpose of this contract is the development of capabilities forremote viewing and manipulation of textual and graphical materials, andremote interrogation of stored information by means of question-answer-ing techniques.

Studies to date have resulted in the following preliminary design conceptfor implementing remote viewing: use of microfische, video images to betransmitted by television channels devoted to the BCN, a capability forlocal storage of a complete video frame, and a display that would handletext and simple graphical information and ultimately "browsing" featureswhen technology and economics permitted. One program has been writtenfor a drug information system.

4. EDUCOM (by Mr. J. Becker)This is a study of the total environment in which the BCN might function,and an attempt to anticipate the needs of the information systemsdesigner with respect to the characteristics of the medical community,and elements of the new technology applicable to a multimedia network.

8

The information network for farmers set up many years ago and involvingthe Land Grant Colleges, Agricultural Experiment Stations, 4-H Clubs,and with the cooperation and substantial financial support of the Depart-ment of Agriculture was cited as a model for development of the BCN.The Lister Hill Center has been provided with a series of research memo-randa on such topics as: a survey of health science libraries, need fora medical information network to service physicians, communicationscapabilities in medical schools, and the role of audiovisual materialsin enhancing the learning process.

5. Rand Corporation (by Dr. S. Koslov and Mr. D. L. Attaway)Rand's contract calls for providing the Lister Hill Center with systemsdesign and management support services in selecting, defining, anddesigning educational and other public benefit services falling primarilywithin the responsibility of DHEW.

This study involves ascertainment of present formal continuing educationactivities, the economics and feasibility of extending existing activitiesof national importance, and attempting to determine what role technologymight play in the future in continuing education.

Board discussion of the presentations pointed up the need for the contractorsto enlist the assistance of knowledgeable physicians and other subject matterspecialists in developing their models. It was questioned as to whether therewas free communication between the contractors and professional groups workingon clinical decision systems. The sophistication of the technology for acommunications network was contrasted with the inadequacies of much of presentday medical practice. The raising of the level of productivity of thephysician through BCN activity had been mentioned by contractors and thequestion was asked "Would he see more patients, or do a better job of diag-nosis and treatment?" The Board considered improved patient care to be theprimary goal of continuing medical education. There was recognition of theproposition that the physicians must be introduced to and helped to feel com-fortable with the changing communications technology. The most importantaspect of continuing medical education is a cultivation of the physician'sskill in eliciting evidence regarding the health of his patients.

EXTRAMURAL PROGRAMS I/ 21 31

Council Operating Procedures

Reaffirmed by the Board at its June 1968 meeting. We will conform to reviewingthese procedures beginning November 1969.

\J Proceedings of meetings are restricted unless cleared by the Office of the~" Director, National Institutes of Health. The restriction relates to all

material submitted for discussion at the meetings, the agenda for themeetings, the supplemental material, and all other official documents.

"ll For the record, it is noted that members absent themselves from the meeting~" room when the Board has under Individual discussion applications (a) from

their respective institutions, (b) in which a conflict of interest might occur.3/ The Board of Regents, when considering the Extramural Programs of the NLM,~~ also consists of the Board of Regents Advisory Council for Extramural Programs

and National Medical Libraries Assistance Advisory Board and concurrentlydischarges the responsibilities of all three bodies.

REPORT OF THE EXTRAMURAL PROGRAMS

Mr. David F. Kefauver, Associate Director for Extramural Programs, reportedon the status of the reorganization of the construction program In PHS. Headvised the Board of the redelegation of authority by the Director, NIH, ofthis program to the Bureau of Health Professions Education and ManpowerTraining (formerly Bureau of Health Manpower). Other than the redelegationof authority and transfer of funds, we have not as yet received Instructionsas to how It will be organized or how It relates to the centralized program.He did assure the Board of Regents that they will continue to have finalreview of all construction projects reviewed under the Library AssistanceAct.

Mr. Kefauver spoke briefly about the preparation of the extensions of authorityunder the Medical Library Assistance Act, that It had been presented toCongress In January, but as yet had not been Introduced. He spoke of hisIntentions of submitting the final "black book" Justification for continuationof the program and as a matter of Interest he advised the Regents that thisBill was sent back to DHEW by the new Administration.

Attention was called to the latest legislative developments and the recentchanges In the administration of grants as outlined In the DRG AdministrativeReport. The Board was reminded of the confidentiality of the proceedings.

Mr. Kefauver stated that he didn't see the need for calling a meeting ofthe Subcommittee for Extramural Programs for this Board meeting. He did,however, state that he gave review assignments to the members of the Subcom-mittee by mall and that they would be noted In the order that they would betaken up In the book.

CONSIDERATION OF PENDING APPLICATIONS

The Board of Regents acting concurrently as the Board of Regents AdvisoryCouncil for Extramural Programs and as the National Medical LibrariesAssistance Advisory Board, reviewed the following grant applications:

Research and Publication Grants Reviewed 27 $ 689,267Approved 13 299,663Disapproved 13 364,874Deferred 1 24,730

Training Grants Reviewed 1 $ 108,000Approved 1 108,000DisapprovedDeferred

Summaries of Board actions on all Extramural Grant Programs are appended tothese minutes.

Respectfully submitted,

/>?.(LMartin M. Cunnings, M.D.Executive Secretary to the Board of RegentsNational Library of Medicine

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BOARD OF REGENTSNATIONAL LIBRARY OF MEDICINE

MINUTES OF EXECUTIVE SESSIONMarch 25, 1969

I. Dr. WOLF appointed a Nominating Committee consisting of Dr. BEAN,Chairman, Mr. AUGENSTEIN and Dr. MICHAEL. The Nominating Committeewill bring in nominations for Chairman and Vice-chairman forelection of new officers by the Board at its June 19 and 20meeting, 1969.

II. Dr. CUMMINGS announced Mr. ADAMS' plans for early retirement. Hereviewed his search for a replacement and asked for the Board'sopinion on whether it believed a graduate degree in Library Scienceessential for the position. The Board believed the graduate degreeof less consequence than the aptitudes and qualifications of individualcandidate. Members of the Board were requested to submit suggestionsindividually.

III. Toxicology Information Program. Dr. Charles RICE, AssociateDirector, Special Information Systems, reviewed critical pointsof the communication from the National Research Council AdvisoryCommittee (Committee's Report of January, 1969,and Mr. Dunham'sletter to Dr. Rice of February 12, 1969. He raised the followingspecific questions to the Board.

1. The need, in accordance with NRC's comments, to look at programsof other Federal Executive Agencies.

2. The need for in-house competence in the SIS programs.

3. The problem of bringing resources for systems analyses tobear on the problem of accessing multiple toxicologic informa-tion stores.

In the Board's discussion, it was brought out:

1. That the initial PSAC Report gave no clear sense of prioritiesof need or attack.

2. That the program has no statutory base.

3. That priorities should be given, first, to ascertain the contentsand file organization of other Federal files of toxicologicinformation (Patent Office, Navy, Agriculture) and secondarily,to the problem of design access to these files.

4. Funds were not the principal problem.

5. No other Federal agency was in a position to acceptresponsibility for the program.

2.

As a resolution, the Board recommended giving priority to the morelimited objective of exploring Federal resources and designing accessto them and of enlisting assistance from the Lister Hill NationalCenter for Biomedical Communications in systems analyses necessaryto this latter function. During this discussion, Dr. CUMMINGS leftto attend hearings of the House Appropriations Subcommittee withthe Director, NIH.

IV. MEDLARS II. Mr. ADAMS described briefly the slippage of the contractor'sschedule, the personnel problems in OCES, and problems of interfacewith NLM operating programs. Dr. WOLF asked the R & D Subcommittee(Mr. AUGENSTEIN, Mr. ZIPF and Dr. ANLYAN) to review the MEDLARS IIprogress with the Library.

V. Mr. ADAMS reported, for information, the possible reduction inAdministration expenditures which would affect the scheduling ofconstruction of the Lister Hill National Center for BiomedicalCommunications .

VI. Mr. AUGENSTEIN, reviewing the contractor presentations of the Board'smorning session, expressed a need to bring advice from the medicalcommunity to the Library through a new subcommittee of the Boardwhich would counterbalance the R & D Subcommittee. He was concernedwith the better provision of information to the Library and itscontractors concerning the substance of medicine and the changingrequirements of the medical community. He quoted Dr. EBERT to theeffect that technology was moving so fast that there was a dangerthat systems to meet the requirements of the community might befrozen prematurely. Dr. WOLF named Captain Charles WAITE, MC, USN,and Drs. EBERT and SCHOOLMAN to this new Subcommittee, with Dr. Ebertas Chairman.

Martin M. Cummings, M. D.Executive Secretary, Board of RegentsNational Library of Medicine

Bethesda, MarylandApril 9, 1969

AGENDA

Thirty-third Meeting of theBOARD OF REGENTS

National Library of Medicine9:00 a.m., June 19-20, 1969

Board Room

I. CALL TO ORDER AND INTRODUCTORY REMARKS Dr. Stewart Wolf

II. CONSIDERATION OF MINUTES OF LAST MEETING TAB I(orange book)

III. DATES OF FUTURE MEETINGS1969-70 Calendars in all books TAB IINext Meeting - November 20-21, 1969Subsequent Meeting;March 19-20 (Thursday-Friday)March 23-24 (Monday-Tuesday)March 26-27 (Thursday-Friday)--This date was selected at the March, 1969

meeting; however, it falls on Good FridaySelection of Meeting Date - June 1970Date circled is one preferred15-16, 48-1 22-23 (AMAmeets 6/21-25)M-T. Th.-F. M-T

IV. REMARKS BY THE DIRECTOR, NIH Dr. Robert Marston

V. REPORT OF THE DIRECTOR TAB III Dr. Martin Cummings

VI. REPORT OF THE RESEARCH AND DEVELOPMENT TAB IV Mr. Bruno AugensteinSUBCOMMITTEE REVIEW OF MEDLARS II Mr. Alfred Zipf

VII. SELECTED LITERATURE SEARCHES TAB V Dr.. G. Burroughs Mider

Photograph of Board of Regents on FrontSteps of National Library of Medicine

LUNCH

EXTRAMURAL PROGRAMS

VIII. REPORT OF THE ASSOCIATE DIRECTOR TAB VI Mr. David Kefauver

IX. EXAMINATION OF THE SPECIAL TAB VII Dr. Jeanne BrandFOREIGN CURRENCY ACTIVITIES

X. CONSIDERATION OF PENDING APPLICATIONS Mr. David Kefauver

DRG Administrative Report TAB I(gray book)

A. CONSTRUCTION GRANTS TAB II

B. REGIONAL GRANTS TAB III

C. RESOURCE GRANTS TAB IV

D. RESEARCH AND PUBLICATION GRANTS TAB V

E. TRAINING GRANTS TAB VI

ADJOURNMENT

DINNER (DUTCH TREAT) - COMMISSIONED OFFICERS CLUB, NATIONAL NAVAL MEDICALCENTER

Cocktails 6:30 p.m. Dinner 7:30 p.m.

REGENT SPEAKER - MR. BRUNO AUGENSTEIN - Subject: "Rand's Experiences inWorking on Urban Problems for New York City"

RECONVENE - 9:00 a.m. - June 20, 1969

XI. REVIEW OF THE DISTRIBUTION OF TAB VIII Dr. James LiebermanAUDIOVISUAL MATERIALS

XII. USER CHARGES - Current Status TAB IX Mr. Scott Adamsof Government Position

XIII. EXECUTIVE SESSION

XIV. OTHER BUSINESS

ADJOURNMENT

iKMBERS PRESENT;

MEMBERS ABSENT;

hLTERNATES;

GUESTS:

THE BOARD OF REGENTSat the


MINUTES OF THE 33RD MEETING

June, 19- 0, 1969 - Bethesda, Maryland

Dr. William G. Anlyan, Mr. Bruno Augensteln, Drf William B. Bean,Dr. Harye J. Carlson, Dr. Max Michael, Jr,, Dr. Kathryn M. Sm^th,Dr. William H. Stewart, Dr. George W. Teuscher, Dr. Stewart G. Wolf,Mr. Alfred Zipf

Vice Admiral George M. Davis, USN, M.C., Dr. Robert H. Ebert,Dr. H. Martin Engle, Lt. General L. D. Heaton, USA, M.C.,Dr. L. Qulncy Mumford, Lt. General Kenneth B. Fletcher, USAF, M.C.,Dr. Frederick H. Wagman

Dr. Burton W. Adkinson represented Dr. Harve J. Carlson, NationalScience Foundation, first day only.

Colonel William G. Dunnington, USA,represented Lt. General L. D. Heaton,USA, both day*.

Colonel Gerrit Hekhuis, USAF, represented Lt. General Kenneth E. Fletcher,USAF, both days.

Dr. Harold Schoolman represented Dr. H. Martin Engle, VeteransAdministration both dayp.

Captain Charles L. Waite, USN,represented Vice Admiral George M. Davis,USN, both days.

Dr. Robert Marston, Director, National Institutes of Health

Dr. Joseph F. Caponio, Scientific and Technical Communications Officer,National Institute of Neurological Disease and Stroke (attending forDr. Thomas J. Kennedy, OD, NIH)

Miss Cecelia Conrath, Acting Chief, Continuing Education and TrainingBranch, Regional Medical Programs, Health Services and Mental HealthAdministration, PHS

Mrs. Ileen Stewart, Executive Secretary, History of Life SciencesStudy Section and Blomedical Communications Study Section, DRG,NIH

Dr. William G. Cooper, Director of Educational Resources, Universityof Colorado (Consultant to the Litter Hill Blomedical CommunicationsCenter)

Dr. Fred Cole, President, Council of Library Resources, Inc.,Washington, D. C.

Mr. John Sherrod, Director, National Agricultural Library, Washington,D.C.

STAFF; Dr. Martin Ctimmings, Mr. Scott Adams, Mr. Jerrold Alexander,Mr. Alfred Ascli, Dr. Clifford Bachrach, Dr. John Blake,Dr. Jeanne Brand, Mr. Arthur Broerlng, Mr. Raymond Brown,Mr. Kenneth Carney, Dr. Ralph P. Christenson, Mr. Peter Clepper,Mr. Lawrence Coffin, Dr. Ruth Davis, Mr. Donald Dennis,Dr. Malcolm Ferguson, Mr. Herbert Fockler, Mr. Joseph Foley,Mrs. Louise Carnage, Miss Frances Hasemeier, Dr. Elmer W. Herron,Mr. James Hill, Mr. David Kefauver, Dr. Joseph Leiter,Dr. James Lieberman, Mr. Davis McCarn, Dr. G. Burroughs Mider,Miss Marilyn Miller, Mr. Peter Monk, Mrs. Rita Pusey,Mr. George Russell, Mrs. Ann Sabin, Dr. Norman Shumway,Mr. Ralph Simmons, Mr. Stanley Smith, Mr. Kenneth Styers,Mr. John Waiden, Mr. Robert Walkington, Mr. Alfred Weissberg,

NEW STAFF MEMBERS INTRODUCED

Dr. Ralph P. Christenson, Chief of Customer Products and Services Branch,Lister Hill National Center for Biomedical Communications. Dr. Elmer W. Herron,Regional Medical Library Officer, Extramural Programs.

The minutes of the March 24-25, 1969 meeting were approved. The dates ofNovember 20-21, 1969 and March 26-27, 1970 were reaffirmed. The dates ofJune 18-19, 1970 were tentatively selected for the third meeting In FY 1970.

REMARKS BY SURGEON GENERAL. PHS(Acting Assistant Secretary for Health and Scientific Affairs, DHEW)

There have been phenomenal changes in the health budget picture duringDr. Stewart's four years as Surgeon General—from a figure of 4 billiondollars to one this year of 12% billion dollars. The new programs, Medicareand Medicald, are now the dominant forces In DHEW and account for 78% of thebudget. The cost of personal health services Is an uncontrollable item andalmost 2/3 of the money In the FY 69 budget for Medicare and Medicald wasconsumed by Inflation. The remainder went for Increased utilization of theseservices. With regard to Medicare, 1/3 of the money goes for nursing homecare and several states have been forced to move funds Into this area andaway from the attack on other Important problems such as mental retardation.

DREW Is seeking a long-range plan for developing health resources as a meansof managing and controlling its functions, and enphasis Is on planning andrestructure of health services. Medicare and Medicald have potent politicalramifications. Other matters of concern are such unanswered questions as:What is a healthy growth rate for the biomedical research establishment andhow to develop a national policy on health problems relating to the environment.

REMARKS OF DIRECTOR. NIH

Dr. Marston discussed the activities of the recently appointed DHEW HealthTask Force, with its several teams, that have been exploring plans for developingthe nation's health resources and services. An attempt was made to go acrossorganizational entitles to look at problems broadly and to seek strategies forattacking them, rather than to engage in a 5-year budget exercise. The implica-tions to NIH of a "mid-level ceiling" In planning and budgeting would be essen-tially a holding operation with little or no growth in programs or services.The greatest problem confronting NIH is the growing anti-research climate withthe viewpoint of some that research is wasteful and not relevant to problemsof theday.

The Board questioned Dr. Marston on the apparent failure of the Task Forceto recognize the contributions communications technology might make to healthobjectives. Of concern were savings to be made possible through the sharingrather than the duplication of resources between institutions. Nationalavailability of standardised educational materials would enable all medical•ohools to share resources developed with Federal assistance for the educationof phyiioians.

Dr. Marston suggested that t lu. FY 1970 NUi budget-cut resulted from a lackof administrative distinction between NLM and libraries of different typessupported by the Office of Education, and that a special case must be madefor the NLM. He stated that the Lister Hill Center had developed a moreclearly defined approach to biomedical communications and that this shouldbenefit NLM budgetwise. He further suggested that the emphasis at NIH onthe importance of projects had caused a credibility gap with Congress becausemoat problems are not solved. Budget requests should be related to achievingcertain results, such as increasing the number of physicians. Dr. Stewartcommented that DREW was not being asked to spend less money, but to provethat funds were being used in the most efficient way.

REPORT BY DIRECTOR. NLM

Dr. Cunnings reported that a bill for extension of the Medical LibraryAssistance Act for three years, with amendments for Improvement, had beenreported favorably by the House Subcommittee on Public Health and Welfare.A variety of public witnesses—health professionals, other elements of thehealth community, library associations, and lndividuals--had come forward toexpress strong support for extension of the Act.

The NLM FY 1970 budget cut of 2\ million dollars was absorbed by the ListerHill Center, the Toxicology Information Program, NMAC, and the ExtramuralPrograms.

Five-year budget levels projected for NLM by the DHEW Health Task Forceseem satisfactory although below original projections. The PPB approach tobudgeting Is suited to NLM's service-oriented program. A special documenton NLM communications projects has been prepared for submission to the TaskForce Chairman.

The report of the President's Advisory Commission on Libraries, created in1966, has resulted in bills Introduced In Congress, and hearings on thesehave been held by the House and Senate. A House-passed bill calls for thecreation of a new National Commission on Libraries and Information Scienceauthorized to engage in planning, carry out functions, contract for projects,and publish and disseminate reports. It would be an independent componentin the office of the Secretary, DHEW, and the Secretary's influence on thework of the Commission would be limited. Its major emphasis would be onoverall planning.

The Committee on Scientific and Technical Information (COSATI) has recommendedto the Federal Council on Science and Technology that it recognize the nationalstatus of four agencies with operational specialized area information systems—the National Agricultural Library, National Aeronautical and Space Administra-tion, Atomic Energy Commission and NLM, and that the National Science Foundationis a Federal spokesman to the private sector with particular emphasis ondisciplinary, rather than mission-oriented information tytti

The National Libraries Task Force has developed standards for compatiblemachine-readable cataloging systems based on the Mark II format of theLibrary of Congress. It is expected that significant progress will bemade toward establishment of a pilot national serials data bank, now thatthe Association of Research Libraries will manage this effort under a grantfrom the National Agricultural Library.

Mr. Scott Adams, Deputy Director, NLM reported that a bilateral agreementfor a MEDLARS system with the Instltut National de la Sante'et RechercheMedicale (INSERM) has been implemented in Paris. Applications for MEDLARSagreements have been received from the Bundesministerium for Health inWest Germany and from a Consortium between Belgium and the Netherlands.

An NLM sponsored MEDLARS operating group meeting was held in AmsterdamMay 9, with the purpose of attempting to work out a commonality of manage-ment policy between the international participants in MEDLARS—Sweden,Great Britain, France, and others Intending to submit applications.

The Joint Feasibility Study of Information systems by the InternationalCouncil of Scientific Unions (ICSU) and UNESCO is proving to be a long-rangeaction program with three major components: (1) Improvement of the interfacesand technical compatibility among large information systems, (2) standardizationthat will permit national Information centers in countries lacking resourcesto exploit existing data bases in other countries, (3) exploitation of existingmethodology for placing the products of these systems at the disposal of thescientific communities.

Mr. Adams reported briefly on the development of the Excerpta Medlca AutomatedStorage and Retrieval Program of Blomedical Information centered in Amsterdam.A meeting has been held with Excerpta Medica technical personnel and agreementreached on an effort to develop some common standards between MEDLARS andthis new system. NLM is not primarily interested in avoiding competitionwith MEDLARS and achieving economy, but in improving both systems so thatbetter services are rendered.

Mr. George Russell, Executive Officer, NLM reported that with the current7 for 10 personnel replacement ratio, the NLM loss rate had been 27. as comparedto 4% throughout NIH. The Library had identified 48 positions that might haveto be eliminated or not filled in order to bring the NLM staff down to 455positions by the end of FY 1970. Reduction in manpower will be by attritionrather than through reduction-in-force.

Dr. Burton W. Adkinson, National Science Foundation, reported on Househearings held on the Puclnskl bill that would convert his National ScienceFoundation (NSF) office into a National Science Research Data Processing andInformation Retrieval System. No further action has been taken on the billIn Congress, but it is an expression of the strong feeling through thecountry that the various large information handling and processing efforts--blomedlcal, space, military, atomic energy, etc.—must be integrated.

REPORT OF THE RESEARCH AND DEVELOPMKMT SUBCOMMITTEE REVIEW OF MEDLARS II

In March 1969 NLM Management and the Research and Development Subcommitteeof the Board of Regents (Mr. Augensteln and Mr. Zlpf) were alerted tothe serious slippage of the MEDLARS II contract (performance and schedule)by the contractor, Computer Sciences Corporation (CSC). The failure tomeet contract requirements appeared to be aggravated by some communicationgaps between NLM and CSC.

At a meeting called by the R&D Subcommittee, CSC and NLM presented statusbriefings and prospective plans. Answers provided by CSC to most of thequestions raised regarding its progress appeared unsatisfactory or highlyincomplete, including an explanation of why the costs have escalated byover 50%. In a subsequent meeting between the Director, NLM and higherlevel CSC management, the Corporation officials appreciated more fullythe magnitude of the problems, and assigned new administration and technicalleadership to the project. It was decided to develop a new and tighter CSCcontract, which was more explicit on the roles and interactions of NLM andCSC. This contract accepted newer cost estimates as being commensurate withthe more detailed description of the required work. It also contains penaltyclauses for overruns.

The R&D Subcommittee of the Board discussed the new arrangement during ameeting on June 18, 1969 following a detailed briefing by the new MEDLARSII management of NLM (Mr. Simmons). CSC management was invited to discuss afew residual concerns expressed by the Subcommittee. The Subcommittee thendecided that the proposed arrangement (new contract, new management on partof both NLM and CSC, and more explicit work statement) was a most significantImprovement, and recommended that NLM formally sign the contract.

REPORT ON SELECTED LITERATURE SEARCHES

Dr. G. Burroughs Mlder, Office of the Director, NLM reviewed the developmentof the MEDLARS Selected Literature Search activity since Its initiation inAugust 1965. A total of 120 searches have been produced, 87 are currentlyavailable, and over 45,000 copies of the searches have been distributed upthrough FY 1968. There were 137 requests from foreign countries. Somesearches are extremely popular, while for others there is little demand.One-half of the requests came from libraries and the rest from varied groupsand Individuals. About 40 percent of the requests are from medical schoolenvironments, 25 percent from Governmental medical activities, 16 percentfrom other hospitals, 10 percent from practitioners, and the remaining8 percent from various medically related associations and groups. Requestsfrom the dental area amounted to less than 1 percent.

The availability of searches is announced in several medical journals,library journals, in Index Medicus, and elsewhere. Additional distributionhas been given individual searches where libraries reproduce them for localuse.

Dr. Cummlngs commented that while the cost of producing a Selected LiteratureSearch by computer is estimated at $60.00, the printing of large numbers ofcopies of a search drives the unit cost down to about 10 cents. He looksupon the production of searches as being an important contribution to continu-ing medical education.

REVIEW OF THE DISTRIBUTION OF AUDIOVISUAL MATERIALS

Dr. James Lieberman, Director, NMAC, outlined the development of the audio-visual distribution program in Atlanta from a level of 2,404 loans in FY 1948to 100,000 in FY 1969. During the past decade the average yearly increasein distribution has been 23 percent. FY 1969 budget and manpower constraintshave necessitated development of a policy in recent months whereby distribu-tion is made only to health-related groups.

Dr. Lieberman placed emphasis on the great need for biomedical teachingand informational materials, and as he sees it, the responsibility restingupon NMAC to develop a national distribution program to meet this need.This might involve alternatives such as subcontracting for distributionservices, establishment of regional library resource facilities, and othermeans. The recent initiation of a sales, audiovisual information and distri-bution point in the National Archives, General Services Administration offersa mechanism for relieving the pressure on NMAC'a distribution services due tomanpower shortages. However, Dr. Lieberman feels they are encroaching uponhis program area. Effective July 1, 1969 GSA will contract to handle 40,000-50,000 loans for NMAC during FY 1970at a cost of $2.50 per shipment.Dr. Lieberman stated that, in the interest of economy and efficiency, hesought and finally obtained in June a DHEW policy directive designating NMACas the centralized coordination agency for audiovisual distribution in theDepartment. All requests for NMAC film loans will be received by NMAC andthose for non-health related audiences will generally be forwarded to GSA forprocessing.

Dr. Lieberman has serious reservations about the distribution arrangementswith GSA and the effectiveness of the statement that encourages PHS agenciesto use NMAC as the centralized distribution service in DHEW. He did notthink GSA would perform well at first, he feared damage to the present NMACdistribution program in terms of good will and efficiency, and to thelong-range status of his audiovisual distribution program. The fact that theGSA audiovisual facility has been named the National Audiovisual Center willcreate confusion.

Board discussion of Dr. Lieberman1s presentation was held in Executive Session.

REPORT ON USER CHARGES - CURRENT STATUS OF GOVERNMENT POSITION

Mr. Scott Adams reviewed the issue of user charges as it relates to the Librarysince its establishment as the National Medical Library by the Hill-KennedyBill. He noted that in 1959the Bureau of the Budget developed a general

8

policy for Executive agencies of Government regarding charges for servicesof special benefit to individual recipients, but Executive agencies makevarious interpretations of this policy. The Board of Regents has consideredthe matter of user charges three times since 1965, and on two occasionsauthorized the Director, Nil! to employ charges only as a means of controlon the volume of requests for services. The BOB has again become interestedIn imposition of user charges by agencies involved In scientific and techni-cal Information programs. The draft report of the COSATI Task Force workingon a common policy regarding user charges leans toward imposition of thesecharges, NLM must, therefore, prepare for pressure to impose such charges;and its Program Planning and Evaluation Group (PPEG) is identifying servicesthat might bear a charge, e.g., publications, interlibrary loans, searchservices, recurring bibliographies and specialized photographic services.The PPEG has developed the concept that Imposition of user charges for routineservices should be resisted and that if pushed into them, the Library shouldseek legislation authorizing a revolving fund with provisions for flexibilityregarding manpower.

EXTRAMURAL PROGRAMS I/ 21 $1

REPORT OF THE EXTRAMURAL PROGRAMS


Reaffirmed by the Board at its June 1968 meeting. We will conform to review-ing these procedures beginning November 1969.

EXAMINATION OF THE SPECIAL FOREIGN CURRENCY ACTIVITIES

Dr. Jeanne L. Brand, Chief of the Publications and Translations Division,gave an illustrated review of the Special Foreign Currency Program, whichis administered through the Extramural Programs. Dr. Brand discussed theorigin* of the Library's P.L. 480 activities ten years ago, which followedpassage of an amendment to the Agricultural Trade Development and AssistanceAct, authorizing U.S. Government agencies to collect, collate, translate, anddisseminate scientific and technological information, as well as to conductresearch and support activities overseas with special foreign currencies de-rived from Public Law 480.

I/ Proceedings of meetings are restricted unless cleared by the Office of the~~ Director, National Institutes of Health. The restriction relates to all

material submitted for discussion at the meetings, the agenda for themeetings, the supplemental material, and all other official documents.

2J For the record, it is noted that members absent themselves from the~" meeting room when the Board has under individual discussion applications

(a) from (heir respective institutions, (b) in which a conflict of interestmight occur.

3/ The Board of Regents, when considering the Extramural Programs of the NLM,"~ also consists of the Board of Regents Advisory Council for Extramural

Programs and National Medical Libraries Assistance Advisory Board andconcurrently discharges the responsibilities of all three bodies.

Initially, the Library's P.L.480 program was devoted to the translation ofRuaaian and Eastern European biomedical literature, primarily carried outthrough overseas contractors of the National Science Foundation. Subsequently,a variety of abstracting and digesting programs were added.

Today, the Library's P.L.480 programs, carried out in Poland, Yugoslavia andIsrael, with other projects pending In Israel and India relates broadly toall the Library's activities, and represents a major component of the Library'sover-all activities in support of international communication. It includescover-to-cover Journal translation and publication, translation of monographs,abstracting projects, preparation of scientific handbooks and directories,critical reviews, histories of medicine, publication of conference proceedings,one audiovisual demonstration project and an Indexing program for MEDLARS.

The Board discussed evaluation procedures in the program and noted, in parti-cular, the potential of the critical review program as a uniquely valuablemedium of drawing upon expert foreign scientists in collaborative advancementof International communication.

REPORT OF THE ASSOCIATE DIRECTOR

The Associate Director for Extramural Programs addressed his comments to theBoard of Regents on the following subjects:

Library Support by the Regional Medical Programs

Mr. Kefauver compared objectives of the Regional Medical Programs (RMP) andNLM as they relate to support of library services and their implementation.He advised the Board regarding program coordination, the exchange of Informa-tion, participation in review functions, and technical advice and consulta-tion on a national basis between the NLM Regional Medical Library Program(RMLP) and the RMP Information Activities. He also reported on RMP and RMLPplanning with regard to coordination of library services, exchange of Informa-tion and joint support of selected projects on a regional basis, e.g., in theMid-Atlantic Region and the New England Region.

Mr. Kefauver further reported that the audiovisual support by the RMP in 38regions had exceeded $21 million and that of this amount, approximately$4 million, or 191, was earmarked for equipment. Efforts at cooperationbetween NLM and RMP are continuing.

"Year in Neutral" - Extramural Program Accomplishment and Budget Review

Mr. Kefauver reviewed the development of the Extramural Programs followingpassage of the Medical Library Assistance Act in October 1965, to show howthe support authorized by this legislation will have been allocated duringPY 1966-1970. The beneficial effects of these programs on the nation'smedical libraries and their services were described.

The Medical Library Assistance Act authorized seven programs to remedy thethree principle areas of need which have been defined: (1) facilities andresources, (2) manpower, and (3) tools and technology. In reviewing the

10

budget history, Mr. Kefauver noted that appropriations will be only about44% of the authorized $95 million during the five-year period. This limitedfunding has particularly slowed the development of the construction, regionalmedical library, and the resource grants programs.

During the five-year period, approximately 532 projects In all health areastotalling $41.64 million will have been supported. This support Includes11 projects for the construction of new health science libraries, awardsfor approximately 20 training grants, the support of some 9 special scienti-fic projects, 64 research grants, 392 medical library resource grants, 8regional medical library programs, and 29 projects for blomedlcal scientificpublications activities.

Mr. Kefauver reported that fiscal 1970 will be a year without further growth,with total funds available for these seven grant programs substantially belowthe funds available In fiscal 1969. He also noted that, during the yearscovered by the extension of the legislative authority now under consideration,a major planning and analysis activity across all programs and in all threeareas of need should be Instituted.

Mr. Kefauver then called attention to the latest legislative developmentsand recent changes in the administration of grants as outlined In the DUGAdministrative Report. The Board was reminded of the confidentiality ofthe proceedings.

Extramural Programs Staff Change

Mr. Kefauver introduced to the Board Members Dr. Elmer W. Herron, RegionalMedical Library Officer who was newly appointed to the Extramural Programs.

Review of Applications Needing SpecialConsideration by the Board of Regents Subcommittee

for Extramural Progri

The Subcommittee met with the Extramural staff on June 18, 1969 to discusscertain research, training, medical library resource, regional medical library,and construction grant applications which required special consideration, suchAS those applications requesting more than $50,000 per year, all split voterecommendations from initial review, applications for conference support andall foreign grant applications.

Consideration of Pending Applications

The Board of Regents, acting concurrently as the Board of Regents AdvisoryCouncil for Extramural Programs and as the National Medical LibrariesAssistance Advisory Board, reviewed the following grant applications:

Construction Grants Reviewed 4 $7,071,795Approved 3 3,129,745Deferred 1 3,942,050

11Regional Grants

Resource Grants

Training Grants

ReviewedApproved

ReviewedApprovedDisapprovedDeferred



11

403811

2513111

10532

195,857122,901

Research and Reviewed 25 888,597Publication Grants Approved 13 420,505

409,99231,600

740,433220,25697,364325,879

Summaries of Board actions on all Extramural Grant Programs are appendedto these minutes.

Respectfully submitted.

7~Martin M. Cunnings, M.D.Executive Secretary to the Board of RegentsNational Library of Medicine

APPLICATION NUMBER

1 JD6 LM 00448-01


RESUME OF CONSTRUCTION GRANT APPLICATIONS

Reviewed by Board of Regents

June 19-20, 1969

INSTITUTION

State University of IowaIowa City, Iowa

RECOMMENDATION& PRIORITY

$ 2,605,987 *(171)

1 J06 LM 00483-01 Iowa State University ofScience & Technology

Ames, Iowa

314,214 *(204)

1 J06 LM 00516-01 University of IllinoisLibrary of Medical SciencesChicago, Illinois

DEFERRAL

SPECIAL ACTION

1 J06 LM 00348-01A1 Southern School of Phaof Mercer University

Atlanta, Georgia

cy 209,554 *(195)

*Recomnended Maximum Amount

o

•*4 4.a an 6. .Qj co HT4 a •

o

S cS§5

NATIONAL LIBRARY OF MEDICINERESUME OF BOARD OF REGENTS RECOMMENDATIONS

JUNE 19-20, 1969

Resource Grants

APPLICATION NO.GDI - LM -

00735-01

00737-01

00738-01

00740-01

00741-01

00742-01

00743-01

00744-01

00745-01

RECOMMENDATION

00746-01

00747-01

00748-01

INSTITUTION - ADDRESS

Bronx State HospitalBronx, New York

Pontiac Osteopathlc HospitalPontlac, Michigan

Washington UniversitySchool of MedicineSt. Louis, Missouri

New England InstituteRidgefieId, Connecticut

Marlcopa County General HospitalPhoenix, Arizona

Mercy HospitalSchool of NursingWilkes-Barre, Pennsylvania

University of Wisconsin 10,097School of PharmacyMadison, Wisconsin

Missouri Institute of Psychiatry 9,658University of MissouriSt. Louis, Missouri

Hunter College of the City 10,315University of New York

Nursing LibraryNew York, New York

Lutheran Hospital and Medical Center 1,769Wheat Ridge, Colorado

Will Rogers Hospital TO BeSaranac Lake, New York Determined

United Hospitals Medical Center 2,371Newark, New Jersey

OR

$

ENTITLEMENT

7,482

1,623

47,412

6,355

3,461

1,646

PRIORITY

336

321

123

404

286

373

209

209

227

364

236

335

Resource Grants

APPLICATION NO.GDI - Mi

00750-01

00751-01

00753-01

00754-01

00756-01

00759-01

00771-01

00775-01

00776-01

00777-01

00778-01

00779-01

00781-01

RECOMMENDATION

00782-01


Monroe Community CollegeRochester, New York

Provident HospinalBaltimore, Maryland

Children's Hospital of theDistrict of Columbia

Washington, D.C.

Conemaugh Valley Memorial HospitalJohnstown, Pennsylvania

South Baltimore General HospitalBaltimore, Maryland

Saint John HospitalDetroit, Michigan

Mendota State HospitalMadison, Wisconsin

St. Joseph's HospitalMilwaukee, Wisconsin

Hackley HospitalMuskegon, Michigan

Amarillo Hospital DistrictNorthwest Texas HospitalAmarillo, Texas

Columbus HospitalGreat Palls, Montana

Marion County General HospitalIndianapo1is, Indiana

Purdue UniversitySchool of TechnologyDepartment of NursingLafayette, Indiana

St. Joseph HospitalMt. Clemens, Michigan

OR ENTITLEMENT

To BeDetermined

To BeDetermined

$ 6,967

6,163

2,289

6,137

1,409

2,985

2,830

4,550

PRIORITY

258

254

200

273

309

227

300

264

305

255

DISAPPROVAL

13,330

1,073

2,170

236

373

320

- 2 -

Resource Grants

APPLICATION NO.001 - LM

00783-01

00784-01

00786-01

00787-01

00788-01

00789-01

00790-01

00791-01

00792-01

00793-01

00794-01

00795-01

00796-01

00797-01


Chestnut Hill HospitalPhiladelphia, Pennsylvania

Cornell UniversityNew York State Veterinary CollegeIthaca, New York

Southern College of OptometryMemphis, Tennessee

Orthopaedic HospitalLos Angeles, California

St. Joseph HospitalHouston, Texas

Mercer HospitalTrenton, New Jersey

University of Illinoisat Urbana-Champalgn

College of Veterinary MedicineUrbana, Illinois

Mercy HospitalRockville Centre, New York

St. Joseph's InfirmaryAtlanta, Georgia

University of MissouriSchool of Veterinary MedicineColumbia, Missouri

Normandy Osteopathic HospitalSt. Louis, Missouri

Santa Ana Community HospitalSanta Ana,California

Colorado State CollegeSchool of BursingGreeley, Colorado

Osteopathic HospitalAlbuquerque, New Mexico

RECOMMENDATIONOR ENTITLEMENT

$ 2,656

18,158

PRIORITY

310

180

8,189

To BeDetermined

5,299

1,945

7,220

2,358

3,532

8,118

To BeDetermined

5,262

5,547

255

300

255

380

230

330

340

200

350

330

289

DEFERRAL

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AGENDA

Thirty-fourth Meeting of theBOARD OF REGENTS

National Library of Medicine9:00 a.m., November 20-21, 1969

Board Room

I. CALL TO ORDER AND INTRODUCTORY REMARKS

II. CONSIDERATION OF MINUTES OF LAST MEETING TAB I(orange book)

Mr. Alfred Zipf

Mr. Alfred Zipf

III. DATES OF FUTURE MEETINGS TAB II1970 Calendars in all booksNext Meeting - March 26-27, 1970Subsequent Meeting;June 18-19, 1970

Selection of Meeting Date - November 197016-17 (M-T) 19-20 (T-F) 23-24 (M-T)

IV. REMARKS BY THE ASSISTANT SECRETARY FORHEALTH AND SCIENTIFIC AFFAIRS

V. REMARKS BY THE DIRECTOR, NLM TAB III

Mr. Alfred Zipf

Dr. Roger Egeberg

Dr. Martin Cummings

VI.

VII.

PRESENT STATUS OF LHNCBC--PROJECTS ANDPLANS TAB IV

Dr. Ruth Davis

LUNCH

REEXAMINATION OF LISTER HILL NATIONAL CENTER FOR BIOMEDICALCOMMUNICATIONS

TAB V

A. THE REASONS FOR AND THE ADVANTAGESOF HAVING A BIOMEDICAL COMMUNICATIONSNETWORK TO SUPPORT

(1) Medical education at the undergraduateand graduate level

(2) Postgraduate and continuing medicaleducation

(3) Education for other professionalpersonnel

(a) The nursing profession

(b) The dental profession

Mr. Alfred Zipf

Dr. William Anlyan

Dr. Max Michael

Dr. Kathryn Smith

Dr. George Teuscher

(A) Medical research

B. FUNDING OF THE BIOMEDICAL COMMUNICATIONSNETWORK

(1) Government resources

(2) Private medical and health relatedprofessional societies

(3) Private, technical and industrial sources

C. NEED FOR COORDINATION OF DHEW FUNDEDBIOMEDICAL COMMUNICATIONS PROJECTS

(1) Inventories and Analysis -- MedicalCommunications Projects in DHEW

(2) Possibility of savings by replacingthe construction of traditionalmedical libraries with new types ofinformation resources based on commu-nications technology.

D. CONCLUDING SUMMARY AND COMMENT

ADJOURNMENT

Capt. Charles Waite, USN

Dr. Harold Schoolman, VACol. Gerrit Hekhuis, USAFCol. William Dunnington, USA

Dr. C. H. William Ruhe, AMA

Mr. Bruno AugensteinDr. Douglas Knight, RCA

Dr. Ruth Davis

Dr. Frederick Wagman

Dr. Robert Ebert

DINNER (DUTCH TREAT) - COMMISSIONED OFFICERS CLUB, NATIONAL NAVAL MEDICALCENTER

Cocktails 6:30 p.m. Dinner 7:30p.m.

REGENT SPEAKER - DR. MAX MICHAEL, Jr. - Subject: "The Ivory Tower Crumbles"

RECONVENE - 9:00 a.m. - November 21, 1969

VIII. REPORT OF THE ASSOCIATE DIRECTOR FOREXTRAMURAL PROGRAMS

Mr. David KefauverTAB I

(gray book)

a. Review of Council Procedures"Guidelines for Negotiated Adjustmentsby Staff in Time or Amount of Grant Award"

b. DRG Administrative Reportc. Legislative Developments

3

IX. CONSIDERATION OF PENDING APPLICATIONS Mr. David Kefauver

A. REGIONAL GRANT TAB II

B. RESOURCE GRANTS TAB III

C. RESEARCH AND PUBLICATION GRANTS TAB IV

D. TRAINING GRANTS TAB V

X. FIVE YEAR REVIEW OF MEDLARS OPERATIONS TAB VI Dr. Clifford Bachrach(orange book)

XI. PROGRESS REPORT ON MEDLARS II TAB VII Mr. Ralph Simmons

LUNCH - Conference Room 5, Building 31A-Executlve Session will be held there.

XII. EXECUTIVE SESSION

XIII. OTHER BUSINESS

ADJOURNMENT

THE BOARD OF REGENTSof the


MINUTES OF THE 34TH MEETING

November 20-21, 1969 - Bethesda, Maryland

MEMBERS PRESENT; Dr. William G. Anlyan, Mr. Bruno W. Augenstein, Dr. William 0. Baker,Dr. Robert H. Ebert, Dr. Jack M. Layton, Dr. Max Michael,Jr.,Dr. Kathryn M. Smith, Dr. George W. Teuscher, Dr. Frederick H. Wagman,Mr. Alfred R. Zipf

MEMBERS ABSENT;

ALTERNATES:

KJESTS;

Dr. Harve J. Carlson, Vice Admiral George M. Davis, USN, M.C.,Dr. H. Martin Engle, Lt. General Hal B. Jennings, Jr., USA, M.C.,Dr. L. Quincy Mumford, Lt. General Kenneth E. Fletcher, USAF, M.C.,

Dr. Harold M. Schoolman represented Dr. H. Martin Engle, VeteransAdministration both days.

Col. William G. Dunnington, USA,represented Lt. Gen.Hal B. Jennings,USA,both days.

Col. Gerrit L. Hekhuis, USAF, represented Lt. Gen.Kenneth E. Fletcher,USAF, both days.

Capt. C. L. Waite, M.C., USN,represented Vice Admiral George M. Davis,USN, both days.

Mr. Henry Dubester, Deputy Head, Office of Science Information Services,National Science Foundation, both days.

Dr. Roger 0. Egeberg, Assistant Secretary for Health and ScientificAffairs, DREW

Dr. C. H. William Ruhe, Director, Division of Medical Education, AMA

Dr. Douglas Knight, Vice President, Radio Corporation of America

Dr. Stewart Wolf, Regents Professor of Medicine and Psychiatry,Oklahoma Medical Research Foundation

Mr. John Sherrod, Director, National Agricultural Library

Dr. Leroy Langley, National Heart Institute, NIH

Mr. Donald Chill, Office of the Director, National Institutes ofHealth

Dr. William G. Cooper, University of Colorado (Consultant to theLister Hill Biomedical Communications Center)

Dr. C. G. Gunn, University of Oklahoma (Consultant to the ListerHill Biomedical Communications Center)

GUESTS; Mrs. Ileen Stewart, Executive Secretary, History of Life Sciences Study(cont*d.) Section and Blomedlcal Communications Study Section, DRG, NIH

STAFF;

Dr. James Dyson, Division of Regional Medical Programs, DRG, NIH

Mrs. Roberta Downes, Office of Management Policy and Review, OD, NIH

Mr. Jim McAllister, Office of Management Policy and Review, OD, NIH

Dr. Martin Cunnings, Dr. Clifford Bachrach, Dr. Jeanne Brand,Mr. Arthur Broering, Mr. Peter Clepper, Mr. Lawrence Coffin,Miss Mary Corning, Dr. Ruth Davis, Mr. Donald Dennis, Dr. Malcolm Ferguson,

Joseph Foley, Mr. Herbert Fockler, Dr. Wayne Herron, Dr. Ann Kaufman,David Kefauver, Dr. Joseph Leiter, Dr. James Lieberman, Mr. Davis McCarn,G. Burroughs Mider, Miss Marilyn Miller, Dr. Peter Olch, Dr. Charles Rice,George Russell, Mrs. Ann Sabin, Mr. Richard See, Dr. Norman Shumway,Ralph Simmons, Mr. Ken Styers, Mr. M. Zane Thornton, Mr. John Waldren,

Mr.Mr.Dr.Mr.Mr.Mr. Robert Walkington

NEW STAFF MEMBERS INTRODUCED

Dr. Leroy Langley of the National Heart Institute was introduced to theBoard as the replacement for Mr. David F. Kefauver, Associate Directorfor Extramural Programs at the time he transfers to the Mental HealthInstitute.

JUNE 1969 MINUTES APPROVED. FORTHCOMING MEETINGS SCHEDULED

The minutes of the June 19-20, 1969meeting were approved. The datesof March 26-27, 1970 and June 18-19, 1970were reaffirmed. The dates ofthe November 19-20, 1970 were tentatively selected for the first meetingin FY 1971.

OPENING REMARKS OF THE CHAIRMAN OF THE BOARD AND INTRODUCTION OF THEASSISTANT SECRETARY FOR HEALTH AND SCIENTIFIC AFFAIRS. PHEW

Mr. Zipf expressed great concern on behalf of the Board of Regents for therecent budget cuts which have affected service to foreign institutions andthreaten to curtail some domestic services as well. The curtailment of theBiomedical Communications Network (BCN) development is looked upon as along term detriment to the health care system of this country. The Boardof Regents considers the implementation of BCN imperative to the improvedproductivity and distribution of health manpower; important for optimizingChe investments of future private as well as public health programs; ameans for improving diagnostic and treatment capabilities; a means forgreater opportunities for more effective independent learning and greaterproductivity of faculty; and an aid in the relief of soaring educational costs.

REMARKS BY ASSISTANT SECRETARY FOR HEALTH AND SCIENTIFIC AFFAIRS . PHEW

Dr. Egeberg assured the group of his full support and concern for theimportance of libraries as focal points for information. He is wellaware of the financial stringency to which the Library has been subjected.He presented his overview of the present health scene and rated the distri-bution of health care as the most urgent problem. He stressed the importanceof population control, the need for environmental control, and listed alco-holism as a major disease to be attacked along with the.drug abuse problem.For improvements in all of these areas, better biomedical communications andbetter biomedical libraries are obviously important.

He felt that the absence of a physician from his post in the Administrationfor some six months was an important factor in the poor support of the bio-medical community in the 1970 budget. He indicated that some 300 milliondollars is needed immediately to be roughly divided between health manpower,research support, and to develop some muscle in selected new and ongoingprograms. Without this, he stated, it may take ten years to catch up toour present position; the NLM might expect to share in any increases whichhe succeeded in acquiring.

REPORT BY DIRECTOR. NLM

Dr. Cummings presented the first National Library of Medicine Director'sHonor Award to Mr. Ralph Simmons, the manager of the NLM MEDLARS IIcon-tract in recognition of his superior handling of an extremely difficultcontractual arrangement pertaining to the development of MEDLARS II.

Following reference to the 1969NLM Annual Report and the new NLM publi-cation, Abridged Index Medicus, the Director discussed the current statusof the extension of the Medical Library Assistance Act of 1965. TheAdministration's position was a one-year extension of the Medical LibraryAssistance Act with no modification. Different bills which would extendthe Act for three years with certain technical and clarifying amendmentshave been passed by the Senate and the House. No conference has yet beencalled to reconcile the differences.

(1) Budget Hearings - Budget Hearings In the House were heldApril 3, 1969 and reported out July 24, 1969 essentiallysup-porting every element in the President's budget for NLM,some19.6 million dollars.

Budget Hearings in the Senate were held November 7, 1969andhave not been reported as yet. Dr. Mlder reported that thehearings were generally friendly towards NLM.

(2) NLM Budget Information - The Office of Computer and EngineeringServices, the Toxicology Information Service, and the NationalMedical Audiovisual Center have all been adversely affected bybudget cuts in 1970. In recent years, there has been essentiallyno Increase in the budgets of National Medical Audiovisual Center(NMAC), Lister Hill National Center for Biomedical Communications(LHNCBC), and the Toxicology Information Program and only amodest increase in the direct Library Operations budget. Themajor commitment is to complete MEDLARS II. Funds provided todate for the Medical Library Assistance Act have been less thanhalf of the funds authorized by Congress. A review of Libraryservices and personnel over a period of about 20 years, from1951 to 1969 has shown a marked increase in services to the publicwith a decrease in personnel!

(3) NMAC Fee-for-Servlce Issue - In August 1969,DHEW proposed thatNMAC be closed in the Interest of economy. This move wassuc-cessfully appealed by NIH, but was followed by a directive fromDHEW that NMAC be placed on a fee-for-servlce basis. Almostconcurrently the Subcommittee of the Board of Regents on NMACrecommended a de-emphasis on production and an emphasis on acquisi-tion, cataloging, and distribution of audiovisual materials. Abacklog in film requests forced a reluctant turn to GSA for assis-tance in the distribution of films at the cost of $50,000 per annum.This was an unfortunate move because GSA was unable to provide

timely service. The agreement has been terminated by the Director,NLM. Meanwhile, a plan for adoption of fee-for-service for audio-visual loans at NMAC was developed by the staff at NLM and NMACfor consideration by DREW.

Extended discussion by the Board of the fee-for-service issuefollowed. The majority expressed grave concern on the institutionof fee-for-service as the first impingement on the free libraryservice concept. It was felt of sufficient importance to call fora statement of concern to be drafted by the Board for presentationto the Assistant Secretary for Health and Scientific Affairs, DHEW.It was also agreed that the substance of the Board's deliberationson this matter be available in some detail for the AssistantSecretary's examination, if requested. A transcript of this discus-sion was therefore prepared. The statement of concern or Resolutionpassed by the Board is appended to the Minutes as Attachment I.

(4) COSATI Activities - A major activity has been the effort to imple-ment the "Responsible Agent" concept, under which selected FederalAgencies assume responsibility for specialized National Systems ofInformation relevant to their missions. A recommendation to formallyrecognize the national status of four such systems (including bio-medicine) was submitted to the Federal Council for Science andTechnology.

Dr. Cumnlngs concluded his report with a discussion of the National LibrariesTask Force activities, the renegotiation with the National Science Foundationfor use of PL 480 funds, the PAHO Regional Library of Medicine, and hisconcern for the need of discontinuing interlibrary loan services, MEDLARS andother reference services, and film loans to foreign countries which are notcovered by the Agency for International Development (AID) agreement.

PRESENT STATUS OF LISTER HILL NATIONAL CENTER FOR BIOMEDICAL COMMUNICATIONS -DR. RUTH DAVIS

Dr. Davis pointed out that the funds available to date for the three fiscalyears involved are approximately 48 percent of those funds initially approvedby DHEW. The LHNCBC staffing for FY '70 is 22 percent of that requested inthe NLM five year plan. Progress is therefore about 35 percent of thatanticipated by mld-FY '70.

In spite of the fact that the LHNCBC is supposed to be a focal point forbiomedical communications in DHEW, there are some 29 different health organi-zations in DHEW spending some 74.9 million dollars on 711 different identi-fiable biomedical communications projects compared to 1.6 million dollarsspent by the LHNCBC In FY '68-'69. These are not coordinated at any level.

Extensive planning activities of the LHNCBC, including a Technical Develop-ment Plan for the BCN, and a Fiscal Planning Document for Selected InformationServices have been prepared and lie fallow for lack of funding and personnel.

The forced posture of Che LHNCBC in FY '70 has been to protect its invest-ment in ongoing cooperative efforts with the biomedical community and theother limited activities it has been able to get under way with its restrictedstaff and funding. Some 85 groups outside of DHEW have approached the LHNCBCfor technical assistance and cooperative efforts. These have been in the areasof systems technology, communications technology, content, and computer tech-nology (in descending order of frequency).

The Lister Hill National Center for Biomedical Communications has devotedconsiderable effort to the collection, analysis and interpretation of costdata for selected biomedical communications services. Careful analysis andstudy reveals substantial duplication of effort around the country at agreat cost to individual institutions with a low yield of high quality audio-visual products.

REEXAMINATION OF LISTER HILL NATIONAL CENTER FOR BIOMEDICAL COMMUNICATIONS

This full afternoon session featured individual members of the Board address-ing themselves to three basic problems. First, the reasons for and advan-tages of having a biomedical communications network to support professionaleducation at undergraduate, graduate, and continuing education levels;second, the funding of the BCN through Government and private sources, andthird, the need for coordination of DHEW funding of biomedical communicationsprojects.

This series of presentations was summarized by Dr. Robert Ebert. He pointedout that the growing need for physicians and the newer members of the healthteam, such as physician assistants, etc. demanded quality education at atime when there is a severe shortage of teaching personnel. This coupledwith the unevenness of teaching quality within varying programs indeedincreases the need for some packaged high quality teaching programs for useof institutions throughout the country. The varying quality and high costsof individual university audiovisual programs supports the need for a cen-tralized or unified effort to produce such packaged programs.

In the area of continuing education, it was stressed that the physicianmust consider the material relevant to his daily needs in the care of patientsand should be involved in the planning of such materials. More continuingeducation courses are not the answer, but rather an opportunity for continuingeducation through daily problem-solving in working with his patients. Oneenvisions the opportunity for the physician at the community hospital levelto react individually and privately with a terminal in response to his dailypatient care problems.

In the area of research, though investigators have their own intimate chan-nels for keeping up-to-date in their own fields, a network could assist inan infusion and transfer of knowledge across research disciplines.

In consideration of funding for the BCN, it was agreed that this should bea partnership of private and public sectors. The immobility of fundswithin the Government was cited as a problem. Interesting figures were

presented that 8 percent of Government funding In biomedical communicationsis in industry and 75 percent in universities, though the abundance ofcom-munications talent in industry is obvious. The only way for better coordi-nation in distribution of Government funds is for the decisions to be madeat the Assistant Secretary level.

It was pointed out that private physicians are accustomed to paying for con-tinuing education. The initiation of programs should come from medicalschools and medical societies, etc., though there is some fear in somesec-tors of centralized program planning being tantamount to centralized control.The latter Is not believed to be an insurmountable problem, however. It wassuggested that the cost of continuing education for the physician may wellapproach several million dollars annually in the near future, but the growingconcern for reexamination or relicensing of physicians will undoubtedly bringabout a receptive user audience.

There is little question that the science and technology of industry can andwill assist in the biomedical communications problem. It is important,however, that specific problems be isolated and identified for the applica-tion of Industry's technology. It was agreed that software is the major prob-lem rather than hardware.

The two major questions which arose from the afternoon's session were:

(1) How to coordinate Government activities in biomedical communications?(2) How to utilize a biomedical communications network in support of the

educational process?

In response to the first question, there was agreement that the Lister HillNational Center for Biomedical Communications in its present posture andlocation could do little to fulfill the needs. A letter expressing thecon-cerns of the Board was drafted by the Board and reviewed during the ExecutiveSession prior to being mailed to the Assistant Secretary from the Chairman ofthe Board at the close of the Regents' meeting. A copy was also sent to theDirector, NIH. In response to the second question, Dr. Ebert presented histhoughts on a "university on loan" concept which briefly would call upon anumber of universities providing faculty members "on loan" to the LHNCBC forthe development of core curriculum programs which could then be utilized bythe network. He envisioned faculty being assigned to the LHNCBC for a threeto nine month period to permit them to devote their undivided attention tothis matter. Such faculty members coupled with the technical staffs of NMACand the LHNCBC could develop a series of packaged programs to fill the needsand overcome the duplicity of effort mentioned above. In the long haul, thesavings to individual universities would be most substantial. A similararrangement could be made in the field of continuing education packages.

PROGRESS REPORT ON MEDLARS II - MR. RALPH SIMMONS

Mr. Simmons reviewed the history of the NLM contract with Computer SciencesCorporation (CSC). Because of slippage and poor performance, it was neces-sary to revise the original contract in June 1969 with stipulations designed

8

to encourage Incentive and timeliness and penalties for the lack of same.There is now an agreed target cost of $3,200,000 and the designation oftwo operational phases. The initial phase is to be operational by May 1970and the extended phase by June 1971.

He reviewed the major areas of weakness in the contractor's performanceto date and the steps the Library has taken to correct these. A numberof major issues remain unsolved, particularly in the area of hardwareselection, photocomposition (in house vs. GSA), vocabulary design, andfinal system design. The "modularity" of the search program is still notknown and will, of course, affect the use by the MEDLARS search centersaround the country and abroad.

By the current schedule, the contractor believes there has been a four weekslippage; Mr. Simmons thinks an eight week slippage is more realistic. Theoverall quality of work and the personnel problems were discussed at length.It was agreed that CSC should be asked (specifically Mr. Nashman,ST.,Vice President) to present a major review of the project to the BoardSubcommittee on Research and Development in January 1970. NLM would thendocument any deficiencies in writing. Mr. Nashman would then respond tothis NLM communication to the MEDLARS II Subcommittee of the Board of Regentsbefore the scheduled March meeting of the full Board. A decision will bemade if Mr. Nashman should then address the full Board, or whether theSubcommittee will report on their meeting with Mr. Nashman.

FIVE YEAR REVIEW OF MEDLARS OPERATIONS (1964-1969) - DR. CLIFFORD BACHRACH

In this period, the annual number of articles indexed has risen from144,057 to 210,602. Initially, all articles were indexed at NLM,but anIncreasing number are now Indexed at other U.S. and foreign centers.

NLM Indexing staff now spends more time reviewing quality of outside index-ing, training outside indexers, and in network management. All indexers nowreceive training in MEDLARS search formulation to give them better apprecia-tion of uses to which their indexing is put. Overseas indexing is now approxi-mately 15 percent of total. This is performed in the United Kingdom, Sweden,Japan, and Israel.

There has been a similar growth pattern and decentralization of MEDLARSdemand search services. Searches released in FY 1965 numbered 621; inFY 1969, 15,495. Domestic MEDLARS centers are networked and are an inter-dependent group. There are now 12 centers operational, not counting NLM.Semiannual workshops and a monthly technical bulletin keep everyone up-to-date.

There are currently 17 Recurring Bibliographies and continued demands fornew ones. Abridged Index Medicus is the newest NLM publication designed forthe use of the Individual physician and for the libraries of small hospitalsand clinics.

Two international MEDLARS centers are operational - United Kingdom and Sweden.Two were activated in 1969, but are not yet operational - France and Australia.

Agreements are pending with Germany, WHO and Japan, and negotiations havebeen initiated with Canada. NLM is pleased with the performance of theongoing international centers.

EXTRAMURAL PROGRAMS \l .2/ /

REPORT OF THE ASSOCIATE DIRECTOR FOR EXTRAMURAL PROGRAMS - MR. DAVID KEFAUVER


Mr. David F. Kefauver brought to the attention of the Board that CouncilOperating Procedures should be reviewed annually at the November meeting.After reviewing the Guidelines for Adjustments by Staff in Time or Amountof Grant Award, the Board unanimously reaffirmed these guidelines.

Review of Applications Needing SpecialConsideration by the Board of Regents Subcommittee

for Extramural Programs

The Subcommittee met with the Extramural staff on November 19, 1969 to dis-cuss certain research, training, medical library resource and regional medi-cal library applications. The Subcommittee reviews those applications request-ing more than $50,000 per year, all split vote recommendations by initialreview groups, applications for conference support, and all foreign grantapplications.

Consideration of Pending Applications

The Board of Regents acting concurrently as the Board of Regents AdvisoryCouncil for Extramural Programs and as the National Medical LibrariesAssistance Advisory Board, reviewed the following grant applications:

_!/ Proceedings of meetings are restricted unless cleared by the Office of~~ the Director, National Institutes of Health. The restriction relates

to all material submitted for discussion at the meetings, the agenda forthe meetings, the supplemental material, and all other official documents.

"il For the record, it is noted that members absent themselves from the meetingroom when the Board has under individual discussion applications (a) fromtheir respective institutions, (b) in which a conflict of interest mightoccur.

_3/ The Board of Regents when considering the Extramural Programs of theNLM,~~ also consists of the Board of Regents Advisory Council for Extramural

Programs and National Medical Libraries Assistance Advisory Board andconcurrently discharges the responsibilities of all three bodies.

10

Regional Medical Reviewed 1 $ 190,670Library Grant Approved 1 128,450

Resource Grants Reviewed 32Approved 31Disapproved 1

Research Grants Reviewed 30 1,060,438Approved 8 102,447Deferred 4 194,755Disapproved 18 757,353

Training Grants Reviewed 6 682,305Approved 4 300,150Disapproved 2 331,328

Mr. Kefauver called to the Board's attention the list of interim actionswhich were negotiated by the staff subsequent to the June 1969 Board meeting.

Summaries of Board actions on all Extramural Grant Programs are appended tothese minutes.

ACTIONS TAKEN BY THE BOARD

1. The Board adopted a resolution (Attachment I) expressing concernfor the institution of user charges at NMAC by direction of theAssistant Secretary for Health and Scientific Affairs.

2. The Board drafted a letter to the Assistant Secretary for Health andScientific Affairs expressing concern for the present posture andstatus of the LHNCBC relative to its mission. The letter was sentto the Assistant Secretary by the Chairman, Board of Regents at theclose of the meeting, with a copy forwarded to Director, NIH.

3. The Board accepted the Progress Report on MEDLARS II of Mr. Ralph Simmonsand requested a major review of the project be presented by CSC(Mr. Nashman, Sr. Vice President) to the Subcommittee on Research andDevelopment in January 1970,following which a decision will be madeif Mr. Nashman should then address the full Board at the March meeting.

Respectfully submitted,

7"Martin M. Cunnings,M.D.Executive Secretary to the Board of RegentsNational Library of Medicine

ATTACHMENT I

RESOLUTION PASSED BY BOARD OF REGENTS

November 21, 1969

The Board of Regents takes note of the Assistant Secretary'sdirective (copy attached) that user charges be instituted by the NationalMedical Audiovisual Center in its distribution of audiovisual materials.

The Regents wish to go on record that this administrative actionshould not be interpreted as indicating any change in the Regents' firmposition that widest possible dissemination of biomedical informationshould not be constrained by user charges or other procedures or controls.Further, the Regents take occasion to resassert their support of the freelibrary services concept.

Should the Assistant Secretary or his staff wish to consider thedeliberations of the Regents, the full minutes of the discussion arereadily available.

COPY

UNITED STATES GOVERNMENT

Memorandum

COPY

DEPARTMENT OF HEALTH, EDUCATION AND WELFAREOffice of The Secretary

COPY

TO : Robert Q. Marston, M.D.Director, National Institutes of Health

FROM : Roger 0. Egeberg, M.D.Assistant Secretary for Health and Scientific Affairs

SUBJECT: Fiscal 1971 Budget Allowance for NIH

Date Oct 20 1969

Your September 19 memorandum to the Secretary recommended certainmodifications in the 1971 budget allowance for NIH which had beencommunicated to you several days earlier. Due to the time pressuresimposed in submitting our 1971 budget request to the Bureau of theBudget, the decisions on each of your appeal items have already beencommunicated at the staff level. Therefore, rather than repeating thedeterminations on dollar amounts, I would like to confine my remarks totwo policy areas—adoption of a fee-for-service arrangement for theNational Medical Audiovisual Center and substitution of loan guaranteesor direct loans for grant-in-aid assistance in the construction ofuniversity teaching hospitals.

With respect to the National Library of Medicine's audiovisualfacility, previous reductions in direct appropriations for both 1970 and1971 have been eliminated, as you proposed. This should not, however,be construed as a reversal of the intention to develop a workable planwhich, to the maximum possible extent, will convert financial supportfor the National Medical Audiovisual Center from a direct appropriationto a fee-for-service basis. We do not believe that such a transformationis inconsistent with the Secretary's commitment to members of theGeorgia congressional delegation that the audiovisual facility will bestrengthened to become a more effective instrument for producing badlyneeded physician and ancillary health manpower.

Obviously, a number of problems need to be resolved before thistransition in the source of support can be fully effective. Theconcurrent shift in emphasis within the Audiovisual Center fromproduction to distribution activities must be defined with someprecision. We need to focus on the issue of transferring authority fromthe General Services Administration to the Center to sell prints offilms and audiovisuals, with concomitant authority to deposit theresultant receipts to the credit of the National Library of Medicineappropriation. Finally, we need to explore the alternatives of seekingsubstantive legislation to achieve our objective, or attempting toutilize point-of-order appropriation language in the 1971 President'sbudget request.

2.

To help resolve these and any other questions, I am asking that youprepare and forward to both my office and Mr. Kelly's office within thenext three weeks a detailed, well thought out plan for revising thesource of financial support for the National MedicalAudiovisualCenter. I recognize that a complete conversion from present financialarrangements will probably not be possible in fiscal 1971. This,however, should not deter us from making a significant start.

Turning to the second policy item, use of grant funds appropriated underthe Health Professions Educational Assistance Act for the constructionof teaching hospitals, the Secretary's September 10 allowance memorandumto you indicated that beginning in fiscal 1971, teaching hospitalsshould obtain Federal construction assistance through the provisions ofthe modified Hill-Burton program now pending approval before theCongress. "You have urged that such a decision be deferred,principallybecause of concern that teaching hospitals will not be afforded anadequate priority under a guaranteed loan and interest subsidy (ordirect loan) program and because difficulties of coordination of Federalprograms may occur in meeting the total construction needs of medicalschools.

While I am sympathetic to the potential problems you have foreseen,they indicate a necessity to move promptly to formulate acceptablesolutions rather than a cause for abandoning the policy which theSecretary_has enunciated. Until the Hill-Burton extension legislationla finally enacted by the Congress, the specific details are stillsubject to change. Nevertheless, I would urge that NIH immediatelyInitiate a dialogue with appropriate parties in the Health Services andMental Health Administration looking to the resolution of any problemsof priority and program coordination before they occur. Certainly myoffice stands ready to assist in any way possible to see that the needsof teaching hospitals are adequately met through the mechanisms of themodified Hill-Burton program.

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BOARD OF REGENTSNATIONAL LIBRARY OF MEDICINE

MINUTES OF EXECUTIVE SESSIONNovember 21, 1969

The Executive Session of the Board of Regents meeting was calledto order by the Chairman, Mr. A. R. Zlpf, at 1 p.m., November 21, 1969.

The first order of business under consideration was Dr. Schoolman'sdraft of a Resolution regarding user charges for NMAC services. Thisdraft, initially prepared by Dr. Schoolman and reviewed by Dr. William 0.Baker, was further modified by the Board. The final Resolution to beforwarded to the Assistant Secretary for Health and Scientific Affairsis attached to the Minutes (Attachment I). It was agreed that an editedsummary, or more specifically that portion of the Minutes of the Board ofRegents meeting dealing with the pertinent discussion, would be availablefor the Assistant Secretary's examination on request.

The second order of business was a report of the NMAC Subcommitteeof the Board. Mr. Augensteln reviewed the modifications in goals andguidelines for NMAC set up by the Subcommittee of the Board In September.In general there is to be a deemphasis on production of audiovisual productswith an increased emphasis on cataloging of the collection and distributionof the audiovisual products. A modest and stable production capability isto be maintained for experimental and innovative productions. The Subcommitteefelt that the initial response to the reorlentation of NMAC prepared by theDirector, Dr. Lieberman, was a good first step in this direction. The intendedretirement of Dr. Lieberman in June 1970 was announced.

Mr. Dubester of the National Science Foundation raised the question ofthe deemphasis on production at NMAC on the "university on loan" conceptdiscussed in the general meeting of the Board. He expressed concern thatthis would interfere with the LHNC-NMAC-visiting faculty joint participationin the development of A-V products for the BCN. Mr. Augenatein respondedthat production would be curtailed, not stopped altogether.

The Minutes of the NMAC Subcommittee were approved.

Chairman Zipf recommended that the NLM staff conduct a study of thepossibility of transferring the R & D functions of NMAC to the LHNC, andthe cataloging functions of NMAC to NLM. It was stressed that this wasa functional move rather than a physical move for the present. The superbphysical production facilities would of course remain in Atlanta for thepresent.

2.

Following further discussion it was agreed that the components ofthe proposed study would be:

1. The possible transfer of the R & D production componentof NMAC to the LHNC.

2. The possible transfer of the cataloging function of NMACto NLM.

3. The functional component of NMAC to be transferred (R & Dproduction) is to be considered a prototype of the LHNC-BCNfunction utilizing the "university on loan" concept*

It was pointed out that a step had already been made toward thisfunctional transfer with the proposed move of Dr. Lieberman to NLM inApril of 1970.

The Board approved the Chairman's recommendation of the aforementionedstudy. The Director, NLM, indicated that the preliminary findings from thisstudy would be presented to the Board in March of 1970.

The next order of business was a recommendation by the Chairman thatDoctors Michael, Schoolman, Waite, and Layton constitute a Subcommittee ofthe Board to approach the AMA for an endorsement of the principles and pro-grams of the LHNC and to urge their active participation in the planningof the UINC for the BCN. It was pointed out that the AMA might function ina cooperative planning role for the continued education of physicians In thesame manner that the AAMC is now working with the UINC on undergraduate andgraduate program content.

Dr. Cunninga pointed out that it would be difficult to set up morethan these two cooperative ventures at this time because of the shortage ofpersonnel In LHNC.

Dr. Cummlngs provided the latest information on the Williams andWilkins copyright lawsuit. Although the suit against the NLM was to bedropped while continued against the NIH Library, the NLM plans to continueas an actively involved party in order to support the nation's libraries.

Arrangements were made for the next meeting of the Board to be heldin San Francisco March 26-27. Suggested items to be included on the agendainclude: review of regional medical libraries' program, contractor presenta-tion on the status of MEDLARS II, and further discussions of the NMAC andLister Hill National Center activities.

Respectfully Submitted,

Martin M. Cummings, M.D.Executive Secretary, Board of RegentsNational Library of Medicine

Attachment (1)

Bethesda, MarylandNovember 25, 1969

DEPARTMENT OF HEALTH, EDUCATION, AND WELFARECOPY PUBLIC HEALTH SERVICE ATTACHMENT I

NATIONAL INSTITUTE* Of HEALTH

NATIONAL LIBRARY OF MEDICINtMOO ROCKVILLE PIKE REFER TO:

KTHESDA. MD. 200M

November 21, 1969

Dr. Roger 0. EgebergAssistant Secretary for Health

and Scientific AffairsDepartment of Health, Education,

and WelfareWashington, D.C. 20201

Dear Dr. Egeberg:

The considered decision of the Congress and Office of the Secretary,HEW,in 1967was that the Department needed a focal point for functions ofcoordination of biomedical communications and for improved means ofresource sharing within the medical community. These Department needsare explicitly reflected by the language describing the functions of theLister Hill National Center published in the Federal Register, Volume 34,No. 3, of January 4, 1969.

On November 20, the Board of Regents of the National Library of Medicinemet virtually the full day in a special review of the progress and statusof the Lister Hill National Center for Biomedical Communications (LHNC)with a specific emphasis placed on the questions of acceptance by andImportance to the professional communities of the LHNC*

The major objectives of the LHNC as stated in the Federal Register are

(1) to design, develop, implement, and manage a BiomedicalCommunications Network;

(2) to assist the biomedical community In identifying anddeveloping products and services for disseminationthrough the network;

(3) to develop networks and information systems to improvehealth education, medical research, and the delivery ofhealth services;

(4) to apply technology to the Improvement of biomedicalcommunications;

(5) to represent DHEW in Federal activities related to biomedicalcommunication activities; and

(6) to serve as the focal point In the Department for developmentand coordination of biomedical communications, systems, endnetwork projects.

The Board's review was thorough and complete, as the discussion minuteswill indicate. Briefly, the Board concluded that the objectives leadingto the creation of the LHNC remain vitally important; that the purposesnnd functions of the LHNC promise major, significant services allowingthe DHEW to meet urgent public needs in health care; and that the technicaltools and planning/programming capabilities accessible to DHEW via thecurrent expertise of the National Library of Medicine clearly allow theaccomplishment of the LHNC objectives.

On the other hand, the Board is seriously concerned that the Lister HillNational Center for Biomedical Communications is currently unable, for avariety of reasons not under control of the National Library of Medicine,to carry out the responsibilities assigned to it under PL 90-456 and theSecretary of HEW'a memorandum of September 1968.

The Lister Hill National Center has neither the authority nor the resourceswithin the Department to perform these functions. It can be a focal pointwithin the Department as intended only if it speaks with the authorityinvested in your Office. With such authority, we are quite certain thatthe 74 million dollars now Identified as being spent by your three healthagencies and biomedical communications projects will produce substantiallymore meaningful and needed results by provision of overall direction andguidance through the LHNC. In fact, we are convinced that major stepsin this direction can be accomplished by redistribution of currently avail-able funding in DHEW to support such LHNC activities and would not in thefirst instance require additional DHEW funding requests. This would neces-sitate establishment of priorities based on needs and a planned applicationof technology. The Lister Hill National Center already has the nucleusof the planning and technological expertise demanded.

It is our strong conviction that the Lister Hill National Center could bestfulfill its mission, and that the ultimate delivery of health services tothe public could be most significantly enhanced, by assignment to and Imple-mentation of the appropriate DHEW management and operational functions tothe Center, together with the provision of the requisite resources commen-surate with such functions*

To emphasize the strength of our beliefs in these areas, the Board adoptedthe following Resolution:

RESOLUTION

1. The Board reaffirms its conviction that the development ofthe LHNC and its planned functions and programs will make avitally significant contribution to the purposes and objec-tives of DHEW;

2. The Board strongly urges you to utilize the Center as yourdelegated agent to coordinate biomedical communication projectsand to authorize direct liaison between the Center and yourstaff in appropriate activities.

3. The Board urges that the DHEW, and particularly through theOffice of the Assistant Secretary for Health and ScientificAffairs, consummate those necessary actions originally intendedin PL 90-456, and in the Secretary DHEW's memorandum ofSeptember 1966, to allow the NLM/LHNC to properly dischargeits assigned responsibilities. The background and circumstancesleading to this recommendation have been outlined earlier in thebody of this letter.

We strongly urge your favorable consideration of such actions and would bemost pleased to present our views and more detailed recommendations andconsiderations to you in person at your earliest convenience.

We are well aware that such actions, if they are to be properly effective,could possibly imply some restructuring or organizational adjustments,some within current NLM cognizance, others within NIH/DHEW, to allow theNLM/LHNC to accomplish its goals. We simply suggest that the centralemphasis should be given to consideration of the variety of means by whichthe NLM/LHNC can accomplish its goals - goals which we remain convincedare vital, exciting, and of great significance to the public and to themedical community.

Sincerely yours,

/ signedA? R. ZlpfChairman, Board of RegentsNational Library of Medicine

cc: Director, NIH

BOARD OF REGENTS - National Library of Medicine · BOARD OF REGENTS National Library of Medicine 9:00 a.m. Marc, h 2U-25, 1969 Board Room (v' I. II. III. IV. V. •I. CALL TO ORDER

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