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Minutes of the Board of Regents - February 2001

DEPARTMENT OF HEALTH AND HUMAN SERVICES
NATIONAL INSTITUTES OF HEALTH
NATIONAL LIBRARY OF MEDICINE
MINUTES OF THE BOARD OF REGENTS
February 27-28, 2001

The 126th meeting of the Board of Regents was convened on February 27, 2001, at 9:00 a.m. in the NLM Board Room, Building 38, National Library of Medicine (NLM), National Institutes of Health (NIH), Bethesda, Maryland. The meeting was open to the public from 9:00 a.m. to 4:45 p.m., followed by the closed session for consideration of grant applications until 5:15 p.m. On February 28, the meeting was reopened to the public from 9:00 a.m. until adjournment at 11:30 a.m.

MEMBERS PRESENT

  • Dr. Jordan Baruch
  • Ms. Alison Bunting
  • Dr. Henry Foster [Chair]
  • Ms. Michele Klein Fedyshin
  • Dr. Joshua Lederberg
  • Dr. Ralph Linsker
  • Dr. Joseph Newhouse
  • Dr. Herbert Pardes

ABSENT MEMBERS:

  • Ms. Eugenie Prime
  • Gov. Lowell Weicker

EX OFFICIO AND ALTERNATE MEMBERS PRESENT

  • Ms. Pamela Andre, U.S. Department of Agriculture
  • Dr. Mary Clutter, National Science Foundation
  • Rear Admiral Kenneth Moritsugu representing Dr. David Satcher, Public Health Service
  • Colonel Kristen Raines representing Lieutenant General James Peake, Dept of the Army
  • Dr. Richard Rowberg, representing Dr. James Billington, Library of Congress
  • Brigadier General Klaus Schafer, representing Lieutenant General Paul Carlton, Dept of the Air Force
  • Captain David Wade representing Vice Admiral Richard Nelson, Dept of the Navy
  • Dr. James Zimble, Uniformed Services University of the Health Sciences

CONSULTANTS TO THE BOR PRESENT

  • Dr. Tenley Albright, Vital Sciences
  • Dr. Marion Ball, The Johns Hopkins School of Nursing and Healthlink
  • Dr. Kenneth Walker, Emory University School of Medicine

MEMBERS OF THE PUBLIC PRESENT

  • Dr. Conrade Jaffe, Yale University
  • Dr. Patricia Brennan, University of Wisconsin
  • Ms. Natalie Proctor, American Indian Cultural Center

FEDERAL EMPLOYEES PRESENT

  • Dr. Donald A.B. Lindberg, Director, NLM
  • Mr. Kent A. Smith, Deputy Director, NLM
  • Dr. Steven Phillips, Assistant Director for Research and Education, NLM
  • Dr. Michael Ackerman, Assistant Director for High Performance Communications & Computing, NLM
  • Ms. Stacey Arnesen, Specialized Information Services, NLM
  • Ms. Suzanne Aubuchon, Office of the Director, NLM
  • Dr. Simon Baatz, History of Medicine, Division of Library Operations, NLM
  • Dr. Carol Bean, Division of Extramural Programs, NLM
  • Ms. Susan Buyer, Office of Health Information Program Development, NLM
  • Dr. Milton Corn, Associate Director for Extramural Programs, NLM
  • Mr. Johnie Sullivan, Office of Computer & Communications Systems, NLM
  • Ms. Kathleen Cravedi, Office of Communication and Public Liaison, NLM
  • Mr. Jason Donaldson, Office of the Executive Officer, NLM
  • Ms. Gale Dutcher, Division of Specialized Information Services, NLM
  • Ms. Martha Fishel, Division of Library Operations, NLM
  • Dr. Valerie Florance, Division of Extramural Programs, NLM
  • Ms. Jane Bortnick Griffith, Assistant Director for Policy & Legislative Development, NLM
  • Ms. Nakita Harris, Division of Extramural Programs, NLM
  • Mr. Joseph Hutchins, Office of Computer & Communications Systems, NLM
  • Ms. Betsy Humphreys, Associate Director for Library Operations, NLM
  • Ms. Bonnie Kaps, Division of Extramural Programs, NLM
  • Dr. Lawrence Kingsland III, Assistant Director for Applied Informatics, NLM
  • Mr. James Knoben, Specialized Information Services, NLM
  • Ms. Eve-Marie Lacroix, Division of Library Operations, NLM
  • Dr. David Landsman, National Center for Biotechnology Information, NLM
  • Dr. Simon Liu, Office of Computer & Communications Systems, NLM
  • Ms. Irene Liu, National Center for Complementary & Alternative Medicine, NIH
  • Ms. Becky Lyon, Deputy Associate Director for Library Operations, NLM
  • Mr. James Marcetich, Division of Library Operations, NLM
  • Dr. Alexa McCray, Director, Lister Hill National Center for Biomedical Communications, NLM
  • Mr. Robert Mehnert, Director, Office of Communication and Public Liaison, NLM
  • Mr. David Nash, Equal Opportunity Officer, NLM
  • Mr. Dwight Mowery, Division of Extramural Programs, NLM
  • Mr. Donald Poppke, Executive Officer, NLM
  • Dr. Merlyn Rodrigues, Division of Extramural Programs, NLM
  • Ms. Julia Royal, Office of Health Information Program Development, NLM
  • Dr. Angela B. Ruffin, Division of Library Operations, NLM
  • Mr. Wes Russell, Office of Computer & Communications Systems, NLM
  • Ms. Alberta Sandel, Office of the Director, NLM
  • Dr. Elliot Siegel, Associate Director for Health Information Program Development, NLM
  • Dr. Stephen Straus, Director/National Center for Complementary & Alternative Medicine, NIH
  • Mr. Ronald Stewart, Deputy Executive Officer, NLM
  • Ms. Martha Szczur, Division of Specialized Information Services, NLM
  • Mr. Winston Tabb, Library of Congress
  • Ms. Maryann Tatman, Department of Veterans Affairs
  • Dr. Fred Wood, Office of Health Information Program Development, NLM

I. OPENING REMARKS

Board Chair Dr. Henry Foster welcomed the Regents, alternates, and guests to the 126th meeting of the Board of Regents of the National Library of Medicine. The Chairman noted especially the presence of consultants Dr. Marion Ball, Dr. Tenley Albright, and Dr. Kenneth Walker. He acknowledged Dr. Jordan Baruch, who informed the Board that NLM Director Lindberg had recently received the prestigious Cosmos Club Award.

II. REPORT FROM THE OFFICE OF THE SURGEON GENERAL, PHS

Rear Admiral Kenneth P. Moritsugu, Deputy Surgeon General, said that the Surgeon General of the Public Health Service, Dr. David Satcher, has a 4-year term appointment that still has one year to run, and he will continue to serve under the new Administration. Dr. Moritsugu said that his office is working closely with NLM to identify, collect, and catalog all past Surgeon General's Reports and other publications; NLM librarians are advising his office so that future Reports will conform to good bibliographic practice. He mentioned several recent publications issued by the Surgeon General's office: children and mental health, and youth violence. Upcoming publications include women and smoking, national suicide prevention strategy, minorities and mental health, and conference on the integration of primary care and mental health. Dr. Moritsugu said that Surgeon General's Reports are not considered "new science," but are a compilation and review of the best available science on a subject. He then gave some highlights from the most recent Surgeon General's Report on Youth Violence. There continues to be a high level of Congressional interest in this subject. The PHS will continue its efforts in youth violence and issue supplemental reports.

III. REPORT FROM THE DIRECTOR OF THE NATIONAL CENTER FOR COMPLEMENTARY AND ALTERNATIVE MEDICINE

Dr. Stephen Straus, Director of NIH's National Center for Complementary and Alternative Medicine (NCCAM), began by defining complementary and alternative medicine as "those modalities that primarily are consumer-driven, unproven, and not extensively incorporated into the training or practice of main-stream American physicians." These modalities (and there are thousands of them) are increasingly pervasive and used by an estimated 83 million U.S. adults (1997). Approximately $30 billion were spent on them in the last year. The NCCAM Web site gets a half million hits per month. Dr. Straus divided the modalities into five areas: alternative medical systems ("parallel universes" of health care, such as traditional Chinese medicine), mind-body interventions (biofeedback, hypnosis, art therapy), biologically based treatment (such as herbs), manipulative body-based methods (chiropractic and osteopathic manipulation, massage), and energy therapies (flows of energy through the body). There is a general lack of scientific tradition in the field, and there are few competent scientific investigators. In 1998 Congress mandated the establishment of a Center at NIH to address these modalities by supporting basic and applied research and research training. Increasing funds have been appropriated to do this ($89 million in FY 2001). NCCAM has developed a strategic plan that includes emphasis on training investigators, engaging in education and outreach activities to the public, and facilitate the integration of complementary and alternative medicine best practices with mainstream practices. NCCAM is investing large dollar amounts in prospective controlled trials (primarily clinical research) in promising areas. Many of the projects are collaborative in nature with other NIH components. There have been a series of databases, including the Center's CAM Citation Index, and, earlier this month, NCCAM and NLM announced a new service, "CAM on PubMed." This is a PubMed/MEDLINE subset of about 220,000 references that is accessible through the Web sites of both institutions. Dr. Straus showed how a literature search on chelation therapy via Cam on PubMed retrieved 85 citations, 68% of which would be of interest to the public.

Following Dr. Straus's presentation, he was asked how NCCAM was dealing with the anti-science culture in which many alternative health modalities, such as the nebulous claims about pathways of energy, are promulgated. How is research conducted in this milieu? He said there is a spectrum of views of alternative medicine, ranging from those who are anti-science and have no use for NCCAM to hard-bitten skeptics who likewise have no use for the Center. Fortunately, most of the public sits between those two extremes. For example, NCCAM is funding clinical studies on the effects of acupuncture while ignoring the paths of energy known as "chi" posited by traditional Chinese practitioners as the agency responsible for its efficacy. There are currently five large, placebo-controlled, multicenter Phase 3 trials on such subjects as acupuncture and St. John's wort. These are collaborative projects with other NIH institutes.

IV. CONSIDERATION OF MINUTES OF PREVIOUS MEETING

The Regents approved without change the minutes from the September 26-27, 2000 meeting.

V. FUTURE BOARD MEETINGS

The Board of Regents will meet next on May 22-23, 2001. The Board meeting this fall will be September 11-12, 2001. The dates of February 12-13, 2002, were adopted for the meeting next winter.

VI. REPORT OF THE NLM DIRECTOR

Dr. Lindberg reported that the bottom line for the current FY 2001 NLM appropriation is $247 million versus $214 million in FY 2000, an increase of 15%. The campaign to double the NIH budget within 5 years is in its third year and on track. The NLM Director introduced to the Board several recent senior appointments: Jane Bortnick Griffith, Assistant Director for Policy and Legislative Development; Dr. Carol Bean, Special Expert; Dr. Merlyn Rodrigues, Scientific Review Administrator; and Dr. Valerie Florance, Grants and Contracts Specialist, all in the Division of Extramural Programs; and Johnie Sullivan, Chief of the Systems Technology Branch in Office of Computer and Communications Systems. Dr. Alexa McCray, Lister Hill Center Director, introduced several new Center scientists: Dr. Olivier Bodenreider, Dr. Anita Burgun, Dr. Hemant Shah, Dr. Jeff Spaeder, Dr. Marc Weeber, and Laura Slaughter. Dr. Lindberg next brought the Board's attention to the NLM Long Range Plan (2000 2005), which was discussed at the Planning Subcommittee meeting earlier this morning. The Subcommittee Chair, Dr. Foster, will bring it to the full Board for action later in the meeting. Dr. Lindberg announced that on March 13-14 there will be an NLM-sponsored conference on telemedicine that will bring together NLM-sponsored investigators to discuss their work. A recent conference, "The Public Library and Consumer Health," sponsored jointly by the NLM, the Medical Library Association, and the Public Library Association, was a great success and the first such meeting of these two professions. Another outstanding conference was the Health Information Infrastructure that the NLM Friends held in December. Highlights of the conference were presentations by Senator Tom Harkin (IA), Human Genome Institute Director Francis Collins, Dr. Amitai Etzioni, and NIMH Director Steven Hyman; Senator Ted Stevens (AL) and Representative Bill Young (FL) were honored by the NLM Friends. On March 16, the NLM will open a new public display called "Turning the Pages." This is technical tour de force, invented at the British Library, that uses computer animation, high-quality digitized images, and touch screen technology to simulate the action of turning the pages of a book. A beautifully illustrated book from NLM's historical collection, Elizabeth Blackwell's Curious Herbal, published between 1737 and 1739, is the first work to be available this way. The Director updated the Board on the status of "Profiles in Science," the NLM online Web resource that makes available the public and private papers of notable American scientists. The papers of Nobelist Christian Anfinsen were recently added. A new Office of Outreach and Special Populations was created within the Division of Specialized Information Services. This office will conduct and manage outreach programs, especially those that involve minorities and minority institutions. Related to this, Dr. Lindberg reported that the NIH Health Disparities Plan is being reviewed by the Board of Regents, and comments will go to the newly formed NIH National Center for Minority Health and Health Disparities. By the next meeting of Board, he said, NLM will announce the results of recompeting the eight Regional Medical Library contracts.

VII. SPECIAL AWARDS FROM THE NLM DIRECTOR

Dr. Lindberg presented a special award to Mr. Stanley Jablonski, who retired some years ago as head of NLM's Index Section, but who has kept an office at the Library and since his retirement made many contributions to medical scholarship, including compiling dictionaries and creating databases. His most recent contribution is "Online Multiple Congenital Anomaly and Mental Retardation Syndromes," which he made freely accessible on the NLM Web site.

The NLM Director also presented a special award to Bonnie Kaps, NLM's Committee Management Officer, who is retiring this spring. She has done a splendid job in serving the needs of the Regents and members of other NLM advisory groups.

Dr. Lindberg also presented an inscribed volume of the works of John Shaw Billings (NLM's first director) to Dr. Richard Rowberg of the Library of Congress. He is retiring from government service and his contributions as an alternate member of the Board of Regents will be missed. Mr. Winston Tabb will be replacing Dr. Rowberg.

VIII. ACTION BY THE BOARD LONG RANGE PLAN

Dr. Henry Foster, Chair, reported that the Board's Planning Subcommittee met this morning and recommended that the Regents approve the 5-year budget plan. It was moved, seconded, and unanimously voted to accept the plan as presented.

IX. LEGISLATIVE UPDATE

Jane Bortnick Griffith, NLM Assistant Director for Policy and Legislative Development, presented updates to the Board on several legislative matters of interest, including the Health Insurance Portability and Accountability Act of 1996. She noted that there has been much controversy surrounding the HIPAA privacy regulations that were released in December, and that Secretary Thompson has announced an extension of the effective date of the regulation until April 14. This will include another period for commenting on the regulation. Both the President and the HHS Secretary have said that they would prefer legislation on this important subject. Ms. Griffith also noted that in the Omnibus Appropriations Act there was a provision for reimbursement of telemedicine charges in certain rural areas. Subjects that may be revisited in the new Congress include database protection legislation and the Next Generation Internet. Hot topics, on which there may well be hearings, are Internet privacy, genetic discrimination, expanding broadband communications access in rural areas, and government information practices. She distributed to the Regents a list of members of Committees of interest to NLM.

X. LISTER HILL CENTER BOARD OF SCIENTIFIC COUNSELORS

Dr. Conrade C. Jaffe, former Chair of the Lister Hill Center Board of Scientific Counselors, said that the BOSC meets twice a year to review the scientific and technical programs conducted by staff of the LHC. Today, there are many sources of new health information for teaching and reference, including sources that we do not normally think of as peer-reviewed journals (for example, The New York Times and other public media). The BOSC, at its October 2000 meeting, was asked to address three main topic areas: acquiring, organizing, and accessing information; the uses and users of information services; and the distribution of information. As to the first, Dr. Jaffe said the discussions focused on issues of language and speech/image recognition as continued opportunities for NLM. In addition, NLM has the opportunity to develop and maintain new non-commercial data repositories those generated by publicly funded science and not occurring in the literature. As to access technology, the BOSC discussed the potential of speech-enabled health information by the lay public, the potential of improved indexing techniques (for example, relying on author help, structured reporting), and the idea of a "visible patient." The second main topic area, the uses and users of information services, brings up the issue of the democratization of information and knowledge resources. There are more kinds of users today. Changed reading levels must be dealt with and learning how to customize information to different kinds of users and varying levels of understanding becomes quite important. On the issue of information distribution, Dr. Jaffe said that an important focus of Next Generation Internet technology will be quality of service, so there would be a more reliable and steady delivery of data. Biosensors, network-based patient records, and personal genomics are examples of things that will evolve out of the electronic patient record. The last issue he discussed was the future of research publications. Scientific publishing is quite different from commercial publishing in that scientists (and their sponsoring agencies) often give away the rights of publication and receive no financial reward. There is a movement to have scientific authors retain copyright in their works and simply to allow the publishers to have "first use." The term "disintermediation" is applied to this, that is, there would be a direct relationship between the author and consumer. Summing up, he said that the NLM will not be able to stand still: indexing the literature is not enough; citations are no longer the currency of science full text is. Who "owns" that text is crucial.

Following Dr. Jaffe's presentation, Dr. Lederberg said that the effort to develop "intelligent agents" and natural language processing techniques for the literature is at an impasse. We need to change the literature, to develop a "language" for formal expression of scientific concepts so that authors have a mathematically precise way to describe their work. Dr. Jaffe agreed that such a development would be a solution to the problem; the problem would be how to impose it on the scientific community. Dr. Baruch commented that an engineering solution would be to approach the issue based on a "problem" point of view rather than on an information or "solution" point of view. Dr. Jaffe said that a full-length report of last October's BOSC meeting was available.

XI. HEARTCARE

Dr. Milton Corn, NLM Associate Director for Extramural Programs, introduced Dr. Patricia Brennan of the University of Wisconsin, a nurse and President of the American Medical Informatics Association, who has been conducting research for 15 years in using information systems to extend nursing care to patients. She has received a number of NIH grants and a current grant, from NLM, focuses on heart disease. Dr. Brennan described "HeartCare," a program of "custom computerized homecare for coronary artery bypass graft surgery (CABG) recovery." The project involves researchers, undergraduates, and post-docs at the University of Wisconsin (Madison), Case Western Reserve University, and the Cleveland Clinic Foundation. CABG is one of the most common types of surgery in the U.S. Patients formerly stayed in the hospital for 2 to 3 weeks; today patients are sent home within several days after surgery. There is much complex information they have to absorb if their follow-up care is to be optimum. A heart care system was designed to use electronic technologies that are available to the consumer in the home to help with the recovery process. It is a Web-based service (based on the Web/TV device) that provides professional communication in the form of email and public bulletin board type discussions, and also tailored, sequenced health information targeted to sequential periods of recovery. The premise is that if you tell people what to expect and how to manage what they experience, they will handle it better. Dr. Brennan described how the program was conducted with 140 adults who were randomly assigned to one of three treatment options: usual care, video and audiotape intervention, and the HeartCare Web service. They focused on five key outcomes: sickness effect (dysfunction experienced), symptom inventory, depressive symptomatology, family function, and risk factor modification. She showed the Regents a number of sample individualized information pages from the HeartCare Web site. Patient use of the system was excellent; the average session was 20 minutes. The bottom line was that patients who had the HeartCare intervention got better faster: the impact of their symptoms dropped earlier and stayed lower (although there was no change in the ultimate recovery rate). The project plans to move from a patient-targeted home service to "technology-enhanced practice," and expand its study of outcomes to consider the project's impact on the care delivery system. The researchers also plan to move from an acute population to a home-based population with chronic heart disease. Questions yet to be answered: How to scale up the project nationally? How to solve the cookie problem? Should the tailored information be at the patient's level, or a little bit above it? Can we have secure computer interaction devices that match patient lifestyles? A key next step is to generalize this work so that it can be easily and widely adapted to a much broader array of surgical and medical conditions for which post-hospitalization home care can benefit from information and interaction. Finally, we need a public health information infrastructure that has (1) strong security and authentication strategy and (2) better links between consumer health information resources and clinical information systems.

Following Dr. Brennan's presentation, Dr. Pardes said that this presentation dramatically made the point as to how a carefully constructed information system, joined with a health care problem, works to our advantage. This project is a beautiful example of the notion that health care can be constructed so as to interfere less with people's lives. Intelligent approaches like this, that empower the patient, can have a positive impact on health care costs. Because we now have technology that can treat serious conditions, and because people are living longer, tertiary care centers are seeing a tremendous increase in patients. Ways of expediting patients' return to a normal home life, like the University of Wisconsin project described today, are very much needed.

XII. TRAVELING "BREATH OF LIFE" ASTHMA EXHIBIT

The Regents viewed the "Breath of Life" traveling exhibition in the NLM Visitors Center. Ms. Anne Altemus of the Lister Hill Center Audiovisual Production Branch showed them the DVD-based interactive exhibit about asthma. NLM is working with the National Heart, Lung, and Blood Institute and other NIH components to publicize and distribute "Breath of Life."

XIII. LIBRARY OF CONGRESS DIGITAL PRESERVATION INITIATIVES

Betsy Humphreys, NLM associate Director for Library Operations, said that the organization and preservation of digital information is one of the major challenges faced by libraries and archives in the 21st century. Success will depend on collaboration among many research institutions. NLM is engaged in a number of experiments related to digital information. Our approach is to use NLM's own products as test-beds and also to collaborate with organizations, especially our sister national libraries, to ensure that our work does not duplicate that of others. In this regard, she introduced Mr. Winston Tabb, Associate Librarian for Library Services of the Library of Congress.

Mr. Tabb described for the Board the Library of Congress's efforts to collect and archive digital information. The LC American Memory Project, the first he discussed, is entirely a retrospective conversion project successfully taking more than 5 million items from the library's collections and digitizing them for use by schools and others. Private funds were raised to assist in this effort. A Digital Futures Group was created within the LC in 1998 to plan how to deal with digital information. A budget request resulted in a Congressional appropriation of about $10 million for this purpose and the National Academy of Sciences agreed to provide an outside review. The NAS report has 54 recommendations dealing with issues like acquisitions, cataloging, metadata, preservation, and the need to provide leadership and to collaborate with others. It said that the LC was on the right track but that it should move beyond ad hoc projects and think strategically about the long term. Late last year, the Librarian of Congress and the Archivist of the U.S. discussed with a number of Senators what the two organizations were planning to do about "born digital" collections. Surprisingly, as a result, Congress appropriated $100 million to the LC to lead the National Digital Information Infrastructure Preservation Program. Mr. Tabb gave a few examples of how the LC has begun a few focused projects with willing and enthusiastic partners: an electronic repository with the Copyright Office (mostly textual works); a database of digital dissertations with UMI/Bell and Howell; a database of the eight journals published by American Physical Society that is sent to the LC weekly where they are made available electronically on a limited basis; and digital archives involving Elsevier and Ebsco publications. The LC is trying to acquire experience with many models of how digital preservation might work. As to preservation of information on the World Wide Web itself, LC is working with the Internet Archive in San Francisco. One aspect of this collaboration is to acquire and archive all the Web sites related to the recent presidential election. In a separate Web preservation project, the LC has chosen 25 disparate Web sites (different languages, subjects, etc.) and is cataloging and archiving them in an effort to gain experience in this new information medium. Mr. Tabb outlined LC plans for the $100 million that is being appropriated: $5 million is being used now for planning; $20 million will begin implementing the plan later in 2001; and the remaining $75 million is to be matched one-for-one by money raised from non-federal sources by March 31, 2003. An advisory structure is being formed; NLM will be one of the entities involved in the project. We expect that the advisors will recommend an approach that involves not a series of small grants, but a few large national programs. We hope the focus will be on archiving and preservation (as opposed to collecting).

Following Mr. Tabb's presentation, Pamela Andre thanked the Library of Congress for their leadership role in the critical area of preserving digital resources. The issue of long-term preservation and access of material is not on the minds of most library users. The legislative support received by the LC for preservation is crucial. The National Agricultural Library, which she heads, is also trying to ensure long-term access to information, and the Congressional support gives a context for the efforts of all librarians in this area. She was especially encouraged by the emphasis Mr. Tabb put on "partnership" and "collaboration." This will ensure consistent standards and, very important, that there is no duplication of effort.

XIV. INTERNATIONAL DOCUMENT DELIVERY

Eve-Marie Lacroix, Chief of NLM's Public Services Division, discussed NLM's program to provide interlibrary loans (document delivery) outside the U.S. This is especially timely since the Board in September 1998 issued a report, A Global Vision for the National Library of Medicine, which recommended that NLM expand its international partnerships and global activities. The demand for articles has risen dramatically with the 1997 introduction of free MEDLINE on the World Wide Web. Ms. Lacroix showed a map that located the 37 international partner institutions that use NLM's DOCLINE system to process interlibrary loan requests; 15 of them provide Loansome Doc service to PubMed users. Two years ago there were only 9 international libraries using DOCLINE. The present document delivery traffic among the present 37 partners is about 3,000 requests a month. However, this access is supplemented by 27 U.S. universities that are willing to serve foreign requesters. Ms. Lacroix, using graphics, then described how NLM's interdependent systems work together to provide Web users with bibliographic access to 11 million references (PubMed) and then with access to copies of the actual documents (DOCLINE and Loansome Doc). Loansome Doc (used primarily by end users in the U.S. and Canada) has been growing rapidly handling some 820,000 requests in the past year. Ms. Lacroix took the Regents on a "tour" of the 15 international partner institutions and described how the Loansome Doc service is being introduced to users in those countries. She noted that because many of the partner institutions serve individuals in neighboring countries, the global coverage is much more widespread than it otherwise appears. One problem faced by users in many countries is the difficulty in arranging payment across borders. From NLM's point of view, language presents a problem in providing customer services to users in other countries. Providing technical support to users in other countries is also difficult. Nevertheless, the participating libraries are enthusiastic about the service and we expect it to grow rapidly, both in number of countries served and the number of loans provided.

In response to a question, Ms. Lacroix said that the primary delivery mechanism within the international library community is electronic mail. Most of the libraries use the Ariel system to scan articles and then send them by email. Allison Bunting commented that technology has solved some of the problems in serving the international community. The problems of international billing might be helped by an international fund of some sort against which libraries could place charges and then receive periodic bills. Dr. Walker said that he is pleased at the steady progress NLM has made in delivering information to other countries. It has done much to break down what he termed "information colonialism." He suggested that we should respect the information and education traditions that have evolved in other countries and we should also modify our programs to take into account that in many developing countries there is little diffusion of information it exists only in few places. This will change, however, and we should prepare for an exponential increase in demand for documents.

XV. UPDATE NCBI: ASSEMBLING THE HUMAN GENOME

Dr. David Lipman, Director of the National Center for Biotechnology Information, introduced new staff members Dr. Joana Carniero da Silva, Michael L. Feolo, and Dawn Lipshulz. He praised the extraordinary competence of the Center's staff and said that the NIH Institutes want NCBI staff to train intramural scientists in bioinformatics so that there can be closer coordination between the Institutes and NCBI; there is a plan to do similar training for members of the Regional Medical Libraries. Dr. Lipman said that the considerable hype and pressure associated with the publication of genome will taper off and we will be left with "an incredible scientific opportunity." The genome centers send to the NCBI two kinds of data: finished "chunks" of sequence in which there are almost no gaps and very few errors, and "draft" sequence that is fragmented and input in various stages of completion. He showed a graphic example of what a draft sequence looks like. Contamination of the data is a real problem in assembling the genome, for example, errors introduced from biotech vectors, lab hosts, from other species' genomes, and from other genome projects. The NCBI Director briefly described the different approaches taken by the private and public sectors in assembling the human genome. Some 85 percent of the human genome is "ordered and oriented."

Following Dr. Lipman's presentation, Dr. Lederberg said that for "public edification" there was a moment in time that was agreed upon as the completion of the human genome. It is, in fact, a moment to celebrate. He said that since the 1960s he had early misgivings about how the genome was characterized as the be-all and end-all of genetic investigation. The project has changed enormously over the years; the comparative aspects of the genome have developed and it is hard to think of anything more illuminating than, for example, being able to compare the genome of the mouse and the genome of the human. Dr. Lederberg emphasized that this is the beginning, not the end. Most revealing, for medical questions, is that we now have a framework in which the polymorphisms can be examined. Today we have an integrated view of what we mean by genomics structural, functional, and comparative. We have a good idea of where biology is going to be for the next 20 years. This would not be possible without informatics control of the dense information that has to be managed. He congratulated Dr. Lipman and the NCBI staff for their work in the overall processing of data and keeping the lines of communication open within the scientific community.

XVI. REPORT OF THE ASSOCIATE DIRECTOR, EXTRAMURAL PROGRAMS

The Regents approved the BOR Operating Procedures for the calendar year 2001. In addition to a briefing on the NLM Extramural Programs Budget, Dr. Milton Corn, Associate Director for Extramural Programs, reported on the Next Informatics Training Grant Competition; Informatics Grant Applications to NLM; and an Update on the Biomedical Information Science and Technology Initiative (BISTI).

Dr. Corn briefly reviewed NLM's 12 Institutional Informatics Research Training Programs and requested concept approval by the Board. These programs are supported by 5-year grants that expire in June 2002. In the spring, NLM will issue a new Request for Applications for informatics training programs requiring a more detailed description of curriculum. An expansion of the number of programs nationally, from 12 to 15, is expected. Thirdly, with the increased interest in the field of informatics for research over the past 5 years, it is expected that most of the programs will be offering tracks in informatics in large datasets and research as a complement to the heavy emphasis they have had in the past on clinical information systems and medical informatics. In an effort to increase the number of minorities among senior informaticians, NLM encourages applications to incorporate minority organizations that could be affiliated with the program. An additional feature proposed by Dr. Lindberg is to provide an opportunity for funding for faculty recruitment and embellishment of the program; this is not possible with the normal institutional allowance. Lastly, NLM recognizes that an important element in health information systems across the country is administration. Although the programs have focused primarily on the development of informatics researchers, NLM also recognizes the need for alternative training tracks in the field of information administration. The program concept was approved by the Board.

The Biomedical Information Science and Technology Initiative (BISTI), as previously reported to the Board, called for NIH to consider ways of improving computing expertise and utilization in biomedical research. NIH has a multi-Institute response under development. Awards will be offered for planning to establish centers in biomedical computing. NLM plans to utilize the assets of the informatics training programs it already supports by improving and expanding current training efforts in biomedical computing. Dr. Corn reported that 27 applications have been received in response to two initiatives for planning grants and research proposals. Planning grants are the precursor to a Center. Of the 27 applications received, four were based on informatics training programs. A second round of applications is due March 27.

XVII. ON EAGLES' WINGS: AMERICAN INDIAN CULTURAL CENTER COMPUTER LABORATORY

Dr. Elliot Siegel, NLM Associate Director for Health Information Programs Development, reported on an NIH/NLM project called "On Eagles' Wings." This is a partnership between NLM, the NIH Office of the Director, and the American Indian Cultural Center in Waldorf, Md. The Cultural Center, which has a museum and a library, serves 8,000 Piscataway Indians living in Maryland. Dr. Siegel introduced several of the NIH/NLM staff who helped bring the project about: Hilda Dixon, who is EEO Director for the NIH Office of the Director, Dr. Fred Wood of NLM, and technical staff of NLM's Office of Computer and Communications Systems. Dr. Siegel described how the project came about, beginning with Dr. Yvonne Maddox, NIH Acting Deputy Director, who approached NLM and proposed that we work with the Center to create a Computer Laboratory with connection to the Internet. She was aware that NLM had previous experience in a "tribal connections" project for Native Americans in the Pacific Northwest and Alaska. On November 15, 2000, there was a ceremony at the Center, organized with the help of NLM's EEO Officer, David Nash, to mark the opening of the Computer Laboratory that was the result of the collaborative effort. The Lab has eight high-end workstations with 128-KB ISDN links to the Internet. Since the installation of the Laboratory, NLM has been conducting week-end training at the Center for members of the Piscataway Indian community. We hope to "train the trainers," youngsters and adults, who then can assist other members of the tribe with access. Dr. Siegel said that we plan both to evaluate the impact of the Computer Lab and to learn more about the information requirements of this community. After showing the Board a brief video of the ribbon-cutting ceremony on November 15, he introduced Natalie Proctor, Director of the American Indian Cultural Center, who gave the Board some background about the Piscataway Indians and their involvement with the NIH in the "On Eagles' Wings" project.

Ms. Proctor showed pictures of the museum at the American Indian Cultural Center and said that she conducts some 5,000 students through it each year. The exhibits depict the life of the indigenous people of Maryland at the time of the landing of Europeans on the shores of the Potomac in 1634. Influenza, smallpox, and measles, which were introduced by the Europeans, presented serious health problems for the Indians and killed many of them. Ms. Proctor described their traditional governmental system and the position of the medicine man in the tribal hierarchy. The Piscataway Tribe has three Clans; the American Indian Cultural Center, in Waldorf, Md., represents one of these Clans. The Cultural Center, which houses the Museum and the new Computer Laboratory, was a former Nike missile site. Ms. Proctor said that the equipment and connections all work, and that as a result of the training they feel comfortable in operating the systems. The laboratory is being used for education, health information, and information about job opportunities, among other uses, she said. "This wonderful gift has opened the door to creativity in both young and old."

Following Ms. Proctor's presentation, Board consultant Dr. Tenley Albright said this is a wonderful example of collaboration and shows what the Library can achieve in outreach to underserved communities. Dr. Jordan Baruch commented that this Computer Laboratory is much more than a way to access health information, but the pool of global knowledge sits on the Internet and is available at the terminals.

XVIII. OUTREACH AND PUBLIC INFORMATION SUBCOMMITTEE REPORT

Dr. Henry Foster, who chairs the subcommittee, gave a brief overview of yesterday's meeting. The members heard about the new daily news service on MEDLINEplus, recent NLM news announcements, major articles about NLM in the Wall Street Journal and the Journal of the American Medical Association, the upcoming ceremony to open the "Turning the Pages" exhibition (which Dr. Lindberg described yesterday), the next major exhibition ("The Once and Future Web") to be installed at the NLM to replace the current "Breath of Life" exhibit, the conference going on now about older Americans and the web and the upcoming telemedicine conference, NLM's involvement with the NIH health disparities initiative, and the MEDLINEplus-based health information kiosk in Iowa. Ms. Cravedi mentioned that a new video for visitors to NLM was being prepared for release this fall that would update the existing video about the Library. She announced that NLM was preparing one-page "backgrounders" about individual Board members. Ms Cravedi also distributed to the Regents a guide produced jointly by the NLM and the National Institute on Aging about how to design Web sites for senior audiences. Dr. Steven Phillips mentioned that the Subcommittee also heard about the ongoing NLM project with the Pan American Health Organization in Central America in which NLM is supplying computers and training so that health professionals and others there can access the Library's toxicology and environmental health databases. Dr. Elliot Siegel mentioned that NLM is conducting an extensive "Web metrics" evaluation project to survey the Library's Web-based services. This may be reported on at the next meeting of the Board. Dr. Marion Ball announced the publication of a new work, Advancing Federal Sector Health Care: A Model for Technology Transfer, that she co-edited. It is dedicated to Dr. Lindberg and several Regents and staff have contributed to it: Dr. Foster, General Schafer, Dr. Phillips, Dr. Zimble, and Ms. Carter, among others.

XIX. APPOINTMENT OF NOMINATION COMMITTEE

Dr. Foster appointed a committee to nominate a candidate to chair the Board of Regents after the next meeting, when his term as Regent expires. Dr. James Zimble will chair the nominating committee; members are Pamela Andre, General Klaus Schafer, and Colonel Kristen Raines.

XX. DEMONSTRATION OF THE NEW TOXNET SEARCH INTERFACE

Stacey Arnesen, of the NLM Division of Specialized Information Services (SIS), presented to the Board a report on the Library's Toxicology and Environmental Health Information Program. The SIS program traces its beginnings to 1966. The first database, a bibliographic file, TOXLINE, became available in 1972. CHEMLINE, a chemical dictionary, went up in 1974. Other databases followed and, in 1985, TOXNET was introduced to handle large amounts of text. Ms. Arnesen briefly described several of the other data files that go to make up TOXNET. In 1998, NLM introduced the first free Web interface to TOXNET. This was a just a front end to the existing search interfaces and was just a placeholder until a new, user-friendly interface was designed. In April 2000, an improved TOXNET Web-based system became available. Ms. Arnesen then used the new TOXNET system to show how a variety of information could be retrieved dealing with arsenic in the environment a current hot topic since arsenic has been discovered in the American University area of Washington, D.C., on the site of a World War I Army munitions depot. Using example posed by the Regents, she demonstrated the capabilities of several of the databases, including TRI, TOXLINE, and ChemID.

Following Ms. Arnesen's presentation, Dr. Kenneth Walker commented that in the future the toxicology and environmental health databases will become as important as the genome database. Dr. James Zimble, who has worked with the toxicology databases in the past, said that, although the current version is much improved over the earlier databases, user-friendliness "is in the eye of the beholder" and there is work yet to be done. NLM should make sure that FEMA (Federal Emergency Management Agency) and other "first responder" organizations are taught how to use the databases.

XXI. PERSPECTIVES ON NLM NETWORK COMMUNICATIONS SYSTEMS

Dr. Simon Liu, NLM Director of Computer and Communications Services, presented to the Board a description of the various connection paths within the Library and between NLM and the outside. The NLM network communications team consists of three primary NLM organizations the Lister Hill Center, National Center for Biotechnology Information, and Office of Computer and Communications Systems. He showed how the NLM's public network connections have grown from the 1970s (9600 bps) to today's T-3 lines (45 Megabits per second). This year the NLM local area network will be upgraded to 1 Gigabit per second and the Internet connection to 155 Megabits per second. Dr. Liu showed a graphic that depicted how NLM components were interconnected and how backup was built in so that traffic could be rerouted if one part of the system failed. NLM has connections to the university research network, the Next Generation Internet, and other high speed networks. He also briefly described how NLM protected its network from outside intrusion. NLM's network strategy is to follow best network management practices and to utilize state of the art software tools to monitor the network. Simulation tools allow us to review network usage, analyze traffic patterns, and plan for future capacity loads. He noted that his office is working with the NLM Office of Health Information Programs Development to reach rural and other underserved areas and thus expand the NLM network and improve delivery of services to end users.

Following Dr. Liu's presentation, Dr. Ralph Linsker said that the evolutionary path described by Dr. Liu will result in valuable improvements in such areas as security, increased bandwidth, and network monitoring and control. Looking further into the future, however, we can also foresee even more massive increases in bandwidth, increases in quality of service and the ability to select different qualities of service for different purposes, and improved ability to do multi-user sessions (conferencing, for example). Dr. Linsker asked about NLM's plans for quality of service on the general Internet, whether NLM is planning into areas relating to high-bandwidth telemedicine, and if NLM is looking at applications that envision massive database manipulation. Dr. Liu responded that NLM is closely monitoring industry standards to be established concerning quality of service issues. He said that some users of NLM's large databases, such as GenBank, attempt to download them and thus occupy much of our bandwidth. We are working on a policy that would apportion the bandwidth for different uses, thus ensuring that ordinary users would always have Internet access to NLM resources. Also, NLM is upgrading its network infrastructure by replacing routers and switches. Dr. Liu said that he believes that for many research applications, quality of service is more important than bandwidth.

XXII. ADJOURNMENT

The Board adjourned at 11:30 a.m.

ACTIONS TAKEN BY THE BOARD OF REGENTS

  • The Board of Regents concurred with the recommendations of the Extramural Programs Subcommittee
  • The Board of Regents approved the Budget for the NLM Long Range Plan 2000-2005
  • The Board of Regents approved the BOR Operating Procedures for Calendar Year 2001
  • The Board of Regents approved the Concept of the NLM Informatics Training Grant Program
  • Dr. Donald Lindberg presented the NLM Director's Award to Mr. Stanley Jablonski for his contribution to the NLM Web site and Bonnie Kaps for her outstanding work serving Board Of Regents and NLM advisory groups.

I certify that, to the best of my knowledge, the foregoing minutes and attachments are accurate and complete.

Donald A.B. Lindberg, M.D.
Director, National Library of Medicine

Henry Foster, M.D.
Chair, NLM Board of Regents