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Minutes of the Board of Regents, September 28 - 29, 1999

DEPARTMENT OF HEALTH AND HUMAN SERVICES

NATIONAL INSTITUTES OF HEALTH

NATIONAL LIBRARY OF MEDICINE

MINUTES OF THE BOARD OF REGENTS

September 28-29, 1999

The 122nd meeting of the Board of Regents was convened on September 28-29, 1999, 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 3:15 p.m., followed by the closed session for consideration of grant applications until 3:35 p.m. On September 29, the meeting was reconvened and open to the public from 9:00 a.m. until adjournment at 11:45 a.m. Dr. Enriqueta Bond presided as Chair.

MEMBERS PRESENT
Dr. Enriqueta Bond, Chair
Dr. Alison Bunting
Dr. Jordan Baruch
Ms. Michele Klein Fedyshin
Dr. Raymond Fonseca
Dr. Henry Foster
Mr. John Gage
Dr. Joshua Newhouse
Dr. Herbert Pardes

EX OFFICIO AND ALTERNATE MEMBERS PRESENT
Ms. Pamela Q.J. Andre
Ms. Wendy Carter representing Dr. Kenneth Kizer
Colonel David Houglum representing Brigadier General Klaus O. Schafer
Rear Admiral Kenneth Moritsugu representing Dr. David Satcher
Colonel Kristen Raines representing Lt. Gen. Ronald Blanck
Dr. Richard Rowberg representing Dr. James Billington
Captain William Wurzel representing Vice Admiral Richard Nelson

CONSULTANTS TO THE BOR PRESENT
Dr. Tenley Albright, Vital Sciences
Dr. Marion Ball, First Consulting Group
Dr. Kenneth Walker, Emory University School of Medicine

MEMBERS OF THE PUBLIC PRESENT
Dr. Ralph Linsker, IBM T.J. Watson Research Center
Mrs. Celia Boyer Walther, Swiss Institute of Bioinformatics
Mr. James Delaney, Institute for Defense Analyses

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
Ms. Nancy Allmang, NLM Associate
Ms. Susan Anderson, Presidential Management Intern
Ms. Suzanne Aubuchon, Office of the Director, NLM
Ms. Pat Bosma, Division of Library Operations, NLM
Ms. Susan Buyer, Office for Health Information Programs, NLM
Ms. Patricia Carson, Office of the Director, NLM
Dr. Milton Corn, Associate Director for Extramural Programs, NLM
Ms. Chandra Doby, NLM Associate
Ms. Carmen Dee Harris, NLM Associate
Ms. Betsy Humphreys, Associate Director for Library Operations, NLM
Mr. Joseph Hutchins, Office of Computer and Communications Systems, NLM
Ms. Bonnie Kaps, Committee Management Office, NLM
Ms. Debbie Katz, Lister Hill National Center for Biomedical Communications, NLM
Dr. Lawrence Kingsland III, Assistant Director for Applied Informatics, NLM
CAPT James E. Knoben, Division of Specialized Information Services, NLM
Ms. Taneya Koonce, NLM Associate
Ms. Kathy Kwan, NLM Associate
Ms. Eve Marie Lacroix, Division of Library Operations, NLM
Dr. David Lipman, Director, National Center for Biotechnology Information, NLM
Ms. Becky Lyon, National Network Office, LO/NLM
Ms. Dianne McCutcheon, Division of Library Operations, NLM
Dr. Alexa McCray, Director, Lister Hill National Center for Biomedical Communications, NLM
Mr. Robert Mehnert, Office of Public Communications and Public Liaison, NLM
Mr. Julian Owens, Specialized Information Services, NLM
Dr. Sharee Pepper, Office of Extramural Programs, NLM
Mr. Donald Poppke, Executive Officer, NLM
Mr. Aaron Redalen, NLM Associate
Ms. Nancy Roderer, Division of Library Operations, NLM
Ms. Julia Royall, Office for Health Information Programs, NLM
Ms. Alberta Sandel, Office of the Director, NLM
Mr. John Seachrist, Division of Extramural Programs, NLM
Mr. Ed Sequeira, Office of Computer and Communications Systems, NLM
Dr. Melvin Spann, Associate Director for Specialized Information Services, NLM
Dr. Elliot Siegel, Associate Director for Health Information and Program Development, NLM
Mr. Roy Standing, Acting Director, Office of Computer & Communications Systems, NLM
Ms. Anita Tannenbaum, Office of the Director, NLM
Ms. Heather Wilder, NLM Associate
Dr. Fred Wood, Office for Health Information Programs, NLM

I. OPENING REMARKS

Board Chair Dr. Enriqueta Bond welcomed the Regents and guests to the 122nd meeting of the Board of Regents of the National Library of Medicine. Dr. Bond welcomed new members: Alison Bunting, Associate University Librarian for Science at UCLA, and Dr. Joseph Newhouse, Director of the Harvard University Division of Health Policy Research and Education. She also noted the presence of guests Dr. Ralph Linsker of the IBM Research Division, T.J. Watson Research Center and Celia Boyer Walther of the Swiss Institute of Bioinformatics, and three consultants to the Board: Dr. Marian Ball, Dr. Tenley Albright, and Dr. Kenneth Walker. Several Regents were unable to attend the meeting; also Dr. Francis Collins, Director of the National Human Genome Research Institute/NIH, who was scheduled to speak to the Board, was unable to attend.

II. CONSIDERATION OF MINUTES OF PREVIOUS MEETING

The Regents approved without change the minutes from the May 4-5, 1999, meeting.

III. FUTURE BOARD MEETINGS

The Board of Regents will meet next on January 25-26, 2000. The BOR meeting next spring will be May 16-17, 2000. The date of September 26-27, 2000, was adopted for the meeting next fall.

IV. REPORT OF THE NLM DIRECTOR

Dr. Lindberg reported that the NLM's FY 1999 appropriation was $181 million. The President's request for 2000 was $185+ million. The House mark-up for 2000 is $202 million; the Senate's is $210 million. The future of the NLM (and NIH) appropriations for FY 2000 is uncertain at this time. The NLM Director reported a number of recent personnel actions: the retirements of Dr. Harold Schoolman, Dr. Mel Spann (who recently had the Public Health Training and Information Resource Center in Atlanta, Ga., named in his honor), and Frances Humphrey Howard; and the appointment of Dr. Steven Phillips, Assistant NLM Director for Research and Education, Betsy Humphreys as Associate Director for Library Operations, and Kathy Cravedi as the Public Liaison Officer in the Office of Communications and Public Liaison. Also introduced to the Regents were Capt. James E. Knoben and Mr. Julian Owens (Specialized Information Services), Pat Bosma (Head of the Selection/Acquisitions Section), and Dianne McCutcheon (Head of the Serial Records Section). Three new appointments were announced in the Lister Hill Center Medical Informatics Training Program: Dr. Lingland Edwards, Dr. Dongwook Shin, and Dr. Richard Martinoff. Ms. Nancy Roderer introduced the 1999-2000 Library Associates: Nancy Allmang, Chandra Doby, Carmen Dee Harris, Taneya Koonce, Kathy Kwan, Aaron Redalen, and Heather Wilder, and also Susan Anderson, a Presidential Management Intern. Dr. Lindberg noted that there is little new to report on two legislative matters frequently reported in the past: medical data confidentiality and copyright as it applies to databases. In May 1999, Representative Bailey of Virginia introduced the "Consumer and Investor Access to Information Act" that balances the interests of companies that create databases and the individuals who require access to them. This bill has support in the library community. The "Networking and Information Technology Research and Development Act," introduced in the Congress in June 1999, would amend the original High Performance Computing and Communications (HPCC) Act of 1991 and authorize funding for Next Generation Internet (NGI) activities through FY 2004. Dr. Lindberg briefly reported on the status of the HPCC competitive research projects program currently being funded by the NLM, primarily in the area of telemedicine. An NLM telemedicine conference originally scheduled for January 2000 has been postponed for a year because many of the awardees requested no-cost extensions of their contracts. The NLM Next Generation Internet program is being conducted in a three-phase scheme: Phase I awards (primarily for planning) were made in October 1998; Phase II will be for test-bed projects; and Phase III will be a scale-up to regional or national level of successful Phase II projects. The NLM Director reported briefly on the annual conference of NLM-supported informatics training programs, this year hosted by Columbia University. Dr. Lindberg was impressed with the quality of the fellows and the papers they presented.

V. REPORT FROM THE PHS SURGEON GENERAL'S OFFICE

Rear Admiral Kenneth Moritsugu, Deputy PHS Surgeon General, said that the Surgeon General's priorities continue to be a balanced approach to community health, global health issues, and racial and ethnic health disparities. There are several recent and upcoming activities relating to the first of these--the balanced approach to community health: the Surgeon General's just-released call to prevent suicide; the publication this December of the Surgeon General's Report on Mental Health; a report is being prepared on youth and violence; and the Administration's initiative on destigmatization of mental disease. In other areas, Dr. Moritsugu said, there are Surgeon General's reports upcoming on oral health due in March 2000 (the first time that subject has been addressed by such a report) and women and smoking (Spring 2000). Health People 2010 will be released by the end of January 2000. The PHS Commissioned Corps just completed the celebration of its bicentennial and there is now a review of the Corps' mission for the next century. Following the report by Admiral Moritsugu, Dr. Pardes commented that the Surgeon General should consider convening a group to discuss the reduction of reimbursement benefits for mental health services on the part of managed care organizations.

VI. AWARDS

Dr. Bond presented to Dr. Eugene Koonin of NLM's National Center for Biotechnology Information the 1999 Regents Award for Scholarly or Technical Achievement in recognition of his creative approaches to large-scale analysis of bacterial genomes and to the classifications of protein sequences.

VII. REPORT FROM THE NATIONAL CENTER FOR BIOTECHNOLOGY INFORMATION

Dr. David Lipman, NCBI Director, introduced two new members of the NCBI staff: Dr. Stephen Edwards and Dr. Donna Maglott. With the assistance of Dr. James Ostell of the NCBI Information Engineering Branch, Dr. Lipman presented the redesigned NCBI home page and demonstrated several new features on the site (www.ncbi.nlm.nih.gov). Dr. Lipman said that the Center is engaged with such a range of human genome resources that an expert subcommittee of the Board of Scientific Counselors has been created: the Genome Resources Advisory Committee. Dr. Ostell demonstrated the interface to the new Entrez system, showing how the user could set up specialized views of the various kinds of data. He also showed to the Board an updated interface to PubMed with many new features and linking possibilities. Dr. Lipman described NIH plans for a new service, "PubMed Central" (earlier known as e-Biomed), that would provide barrier-free access in a central repository for life science research results. NIH Director, Dr. Harold Varmus first suggested the idea about a year ago and the proposal has since been the subject of much discussion. NIH would set up an electronic archive for articles from peer-reviewed journals. This would introduce both stability of the information and visibility for the journals. The revenue streams of some journals may require modification to make this economically feasible. An invitation to participate was sent out a month ago. Dr. Lipman briefly described some of the positive reaction the idea has received; a number of well-know journals have committed themselves to participate. By January, he said, PubMed Central will be able to accept articles. One of its first manifestations will be a link from PubMed/MEDLINE to the full text. Full-text search capability and other functionality will be added later.

Following Dr. Lipman's presentation, Dr. Lederberg said that once the new system is in full production and has reached a critical mass, "there is no reason in the world why anyone would publish any other way." He agreed wholeheartedly with Dr. Lipman's comment that the new system would be a "community resource" that would encourage the flow of critical discourse and the posteriori evaluation of scientific work. Dr. Lindberg asked about having video and audio as part of the information on PubMed Central; Dr. Lipman said that a range of such non-traditional formats could be accommodated.

VIII. PERMANENT ACCESS TO DIGITAL INFORMATION

Betsy Humphreys, Associate Director for Library Operations, said that this would be the first in what will no doubt be a series of periodic presentations on various aspects of how NLM can provide permanent access to digital information. Permanent access to digital information equals preservation, but preservation by itself does not necessarily guarantee permanent access. It will require a well-organized effort and sufficient funds to ensure that we have permanent access to digital information. There are a number of types of digital information and to ensure access to all of it will require different approaches. Among the types: "born digital" information such as databases and publications available only in electronic form, and unpublished electronic records such as e-mail. NLM began capturing digital information in the mid-sixties and it has been accessible ever since. Ms. Humphreys showed several early MEDLINE records and described how, although preserved, the records have undergone certain alterations. As to today's Web-based information, using as an example a fact sheet on Extramural Programs that recently went up on the NLM web site, she wondered what happened to the one it replaced. Did anyone save it? Should we do anything special to preserve such material? To what extent should we convert older journal articles to digital form to make them as accessible as the materials that will be entered into PubMed Central in the future? NLM has gradually been converting pre-1965 Index Medicus data into electronic form, and a contract has just been signed to undertake the digitization of the Index-Catalogue of the Library of the Surgeon General's Office. NLM's general approach is to use its own publications and services as test-beds; to collaborate with other organizations to develop a scalable national strategy; and then to acquire the resources necessary to meet its obligations in this area as a national library. One reason to concentrate on our own publications is to find out what works and thus be able to contribute effectively to national and international standards as they are developed. MedlinePlus will be a useful test-bed for developing procedures for collaboration with other libraries. Descriptions of web-based information developed by NLM should be easily integrated into web sites that provide access to local, state, and regional information. NLM also is developing special license arrangements with publishers that will allow the Library to fulfill its mandate as a national back-up and archive for medical information. Ms. Humphreys said that NLM staff have been meeting with representatives of the National Agricultural Library and the Library of Congress to arrive at some common practices for the preservation of electronic information.

Following Ms. Humphreys' presentation, Elizabeth Smigielski, an NLM Associate participating in the new optional second year of the program at the University of Louisville, presented to the Board of Regents a report outlining her Associate project determining how Metadata was being used at NLM. Metadata is data used for identification, description, and retrieval of networked electronic documents. It also helps to locate information on the Web. She briefly discussed and showed several types of Metadata--from simple HTML data tags to richer forms used in cataloging documents. She presented a table that listed the Metadata uses of various NLM divisions and she showed examples of how they used the Metadata to improve retrieval from their Web services.

Following these presentations, John Gage commented that NLM's plan to be a test bed for different collaborative arrangements and licensing schemes, as described by Ms. Humphreys, was the right approach. Pamela Andre of the National Agricultural Library said that it is important for the three national libraries to form a strong core in the information community and collaborate to develop standards--for example, for Metadata descriptions and standards for capturing electronic documents. Dr. Rowberg of the Library of Congress echoed this position.

IX. HEALTH INFORMATION FOR THE PUBLIC

Dr. Steven Phillips, NLM Assistant Director for Research and Education, introduced the subject by commenting that he believes medical professionals are accessing MedlinePlus and other consumer health services just as lay public does. MedlinePlus and the pilot public library project are both less than a year old and it is timely for the Board to receive a report on them. Dr. Phillips said that when MedlinePlus was introduced in October 1998, it was envisioned that it would have 300 "health topics" by the end of 1999. It is on schedule to meet that target. He described briefly the meeting of an ad hoc group in May 1999 to review the content of MedlinePlus and advise the NLM on its direction. The meeting, chaired by Martin M. Cummings, former NLM Director, looked in detail at one health topic--diabetes. The committee found that the information on diabetes was authentic, current, and well organized. They recommended that MedlinePlus should have answers to frequently asked questions, have pointers to other media such as CD-ROM and video, be easy to navigate with simple graphics, and have special sections for groups such as seniors. Drug information for consumers would be highly desirable. The scientific reviewers for MedlinePlus should be broadly representative of academia, clinical practice, and librarianship. Health professionals should be encouraged to suggest MedlinePlus to their patients as a source of good information. The group felt that NLM should be pleased with the progress it has made and should expand its coverage and continue to evaluate its content.

Public Library Pilot Evaluation. Dr. Fred Wood of NLM's Office of Health Information Programs Development, briefly described the public library pilot project, previously reported to the Regents, that NLM implemented in October 1998. The goal was to learn about the role of public libraries in providing health information to the public and to see whether the NLM and its information products, with the collaboration of members of the National Network of Libraries of Medicine, could help in this. The project ran from October 1998 through June 1999, and involved more than 200 public libraries in 39 library systems. An evaluation component was built into the project from the beginning. Dr. Wood said that the most successful and valuable aspect of the evaluation was the feedback from the public librarians through teleconferences and written reports. Much was learned from several site visits. There were also focus groups and NLM monitored database usage by the public libraries. He said that although very few of the participating public libraries previously had a focus on health information, the public librarians considered health to be one of the top 10 subjects about which they were asked. The libraries in most cases used their $5000 grant either to buy or upgrade a computer, pay for an Internet connection, or purchase health information materials for their collection. Many of the libraries worked with the local press to publicize their new health services. The public librarians were unable to give NLM much feedback on the impact of the promotional materials. Librarian training (conducted through the NN/LM) had a great impact and was most welcome, but most of the public libraries were not equipped to conduct patron training. Dr. Wood said that the response of the public librarians to the project was most positive. In part, because of concerns about patron privacy, however, we learned very little about the public's reaction. Monitoring MedlinePlus traffic revealed relatively little growth in online searching on the part of the participants. On the basis of what they found, the evaluation team believes that NLM should maintain a middle-of-the-road approach to assisting public libraries. NLM should find a way to use the NN/LM to offer some training to public librarians around the nation. Promotional materials for consumer health and public libraries are needed. A Web-based train-the-trainer course for public librarians would be helpful in increasing the number of librarians comfortable dealing with consumer health questions. Public libraries in under served and minority communities should be given special attention by NLM. NLM plans to select several public libraries in 2000 to evaluate targeted consumer health activities on a smaller scale than the evaluation just concluded.

X. MedlinePlus DEVELOPMENT

Eve-Marie Lacroix, Chief of NLM's Public Services Division, said that the public library participants had direct and frequent input to NLM about their experiences with MedlinePlus. The service was greatly appreciated by the public librarians and they suggested many new health topics. NLM is working closely with NIH experts to improve and expand the content of MedlinePlus. Comments are also received from the public who use the site. Ms. Lacroix described two outside evaluations of MedlinePlus, one by Dr. William Cole and a second by the University of Maryland Computer Interaction Laboratory. The most common suggestion is that NLM add more health topics (there are now more than 200 and it is projected that we will reach 300 by the end of 1999). Other suggestions were to add drug information and to improve the search function. A new MedlinePlus home page was released last week. The next release will include a drug index written for consumers and a medical encyclopedia, she said. We are also working with the Medical Library Association Consumer Patient Health Information Section to build a database of libraries that have a consumer health collection and that are willing to serve the public. Ms. Lacroix demonstrated to the Board both the original MedlinePlus home page and the improved version just released. Among the improvements she showed, the topics, which are the heart of MedlinePlus, are now featured prominently with multiple access points.

Following these presentations, Dr. Herbert Pardes said that the participation of consumers in maintaining their health has become an extremely important issue; diabetes, the disease chosen in the MedlinePlus evaluation described by Dr. Phillips, is a perfect example of the value of this. Michele Klein Fedyshin commented that NLM's plan to add a source of drug information is well conceived; services for those with low literacy and those who are vision impaired are also important. Partnering with local institutions, such as hospital and public libraries, is also an exciting avenue. She suggested that NLM might consider installing MedlinePlus in a clinic to see how it is used at the "teachable moment." Ms. Alison Bunting said that it was reassuring to hear that the public won't inundate the medical library system with requests for journal articles--that substantial filtering would occur within the public libraries. Health science librarians will thus be encouraged to become partners with their public librarian colleagues. She suggested that school nurses would be a good target for an information campaign about MedlinePlus. It will be critical to survey users to get data about use and Ms. Bunting suggested that NLM put a brief questionnaire on the Web. Dr. Joseph Newhouse commented that users of public libraries are not a random sample of the consumer population: households with children are overwhelmingly heavy users of public libraries. The elderly, who have a disproportionate share of health problems, are not heavy users of the Internet. Outreach into senior centers would seem to be indicated, and he suggested working with the National Institute on Aging and the AARP. Dr. Henry Foster asked about how the system is updated and he also suggested that NLM not neglect the churches as a key element in reaching consumers, especially the African American community. Ms. Lacroix said that every page in MedlinePlus is thoroughly reviewed on a 3- to 6-month schedule. Ms. Humphreys reported that NLM's Dr. Mel Spann, at the May meeting to review the MedlinePlus diabetes information, also made a strong recommendation that NLM include churches among the groups it targets for outreach. We are hopeful that some of the outreach contract proposals we are now reviewing will include this group. Dr. Steven Phillips ended the discussion by saying that NLM is targeting many groups, and is also looking into the possibility of placing terminals with MedlinePlus in physicians' offices.

XI. REPORT OF THE ASSOCIATE DIRECTOR FOR EXTRAMURAL PROGRAMS

Dr. Milton Corn, NLM Associate Director for Extramural Programs, briefed the Regents on NLM's collaboration with the National Heart, Lung and Blood Institute to improve effective heart attack treatment through medical informatics methodologies. In FY 1998, NLM and NHLBI issued 14 Phase I planning awards following competitive review of proposals in response to a Broad Agency Announcement. For FY 1999 and FY 2000, NLM and NHLBI agreed to continue this program by issuing competitive awards to successful Phase II applicants. Dr. Corn briefly described two recent awards: to Columbia University (for a computer system that develops educational material for at risk patients derived from individual clinical records) and to the Massachusetts General Hospital (to develop computer applications that will provide high level training and orientation for emergency room personnel). NLM also issued a Broad Agency Announcement for Phase I "proof" of concept" proposals to link informatics methodologies with other high technology approaches to the problem of early heart attack alert and treatment. This resulted in several innovative proposals, which Dr. Corn briefly described. Finally, he told the Regents that the NIH Center for Scientific Review, which is responsible for the bulk of peer review of research grant applications, has established a Panel of Scientific Boundaries for Review. The Panel is evaluating current review group organization and practice with a view to more open and more flexible approaches. The intent is to respond more quickly to new developments, to address technology better, and to encourage new, creative ideas. The examination is being carried out in two phases. The Board will be kept informed of developments and updated at future BOR meetings.

XII. UPDATE: DEVELOPMENT OF NLM LONG RANGE PLAN

Dr. Elliot Siegel, NLM Associate Director for Health Information Programs Development, said that beginning in the mid eighties, the Library has engaged in long range planning that has served the institution. It has spawned new programs (e.g., the Unified Medical Language System, the Visible Human program, and NLM'S outreach activities) and organizations (e.g., the National Center for Biotechnology Information). Dr. Siegel said that the present planning activity, which involves all NIH components, was prompted by an Institute of Medicine report last year. Because a short deadline was imposed, the Library decided on a fast-track strategy that will culminate with a plan by the end of 1999. Following this introduction, Susan Buyer, Chief of the Planning and Analysis Office, said that all NLM long range plan documents--the original (1985) plan and the several follow-on reports that have occurred since--are now on the Web. She described how, for the most recent planning exercise, NLM created a "track record" of accomplishments based on all the recommendations in all the earlier reports, and also included suggested program plans for the immediate future. With the track record and program plans as a start, NLM then sought long term recommendations from the outside experts who had been involved in the earlier planning. The track record was mailed to them (some 250 copies), and NLM also sought input via e-mail responses to the plan on the NLM Web site. More than 100 replies were received by the Library. Following Ms. Buyer's presentation, Dr. Siegel said that the track record was organized around four major goals that correspond to the structure of the original long range plan. He summarized for each of the goals the responses NLM received, categorizing them as either refinements of current program plans or those new ideas that go beyond the current plans. Among the advisors' recommendations: Goal 1 (basic services) "maintain the integrity of the collection, address NLM's needs for space, extend scope and coverage in disciplines related to biomedicine (such as chemistry, agriculture, and business management of health organizations), and address the Library's needs in the area of electronic publications; Goal 2 (outreach) --outreach to health professionals and the public must remain a high priority, the role of the National Network of Libraries of Medicine is crucial and its geographic structure might be reexamined, the public must now be a target for increased NLM outreach activities, special audiences (such as non English speakers, children, adolescents, and seniors) must have their needs addressed, international partnerships are encouraged; Goal 3 (advanced computer and communications technologies)--explore such things as advanced indexing technologies, electronic patient records, and use distance training and other methods to encourage the training of health science librarians; and Goal 4 (develop new forms of knowledge)--in areas such as molecular biology, digital libraries, the Visible Humans, and the Unified Medical Language System. Dr. Siegel said that the Regents Planning Subcommittee, which met yesterday, created a priority list of initiatives that NLM should undertake in the coming five years. Consumer health information is at the top of that list, followed by the preservation of electronic data, the introduction of new technologies for better communication, public policy issues (such as privacy), training for medical librarians and in bioinformatics, and international partnerships. Dr. Siegel said that following this meeting, NLM will produce a revised version of the track record and then convene a meeting at NLM of a number of those who have provided input and comment for the report. A final report will be delivered to the NIH by the end of the year and distributed at the next meeting of the Regents.

Following these presentations, Dr. Bond said that the Regents Planning Subcommittee was pleasedwith the numerous accolades for the NLM and the general consensus was that the track record well represented the goals and objectives as articulated in the Long Range Plan. Most of the recommendations were "around the margin" and the advisors generally recommended that the Library maintain its present course. The document should make clear that, although this is a three to five year plan, the NLM maintains the flexibility to be opportunistic and take advantage of beneficial circumstances as they present themselves. There was then a general discussion among the Regents touching on various aspects of the plan: the need for "passion" in describing the need for preserving the integrity of our medical heritage in digital form, the desirability of adding a "vision statement" to the plan, the need in a strategic plan to be able to make mid-course corrections, whether there should be an explicit goal for the NLM to "monitor discourse on public policy issues that relate to access to health information" (PubMed Central is a project that will no doubt give rise to such issues), and the need for "answers" and not just "information" should influence how NLM provides its services for clinicians.

XIII. UPDATE ON "PROFILES OF SCIENCE"

Dr. Alexa McCray, Director of NLM's Lister Hill National Center for Biomedical Communications, demonstrated the expanded Profiles in Science Web site. It now contains the papers of Dr. Lederberg in addition to those of Oswald Avery (whose section has been expanded). Dr. McCray showed the Regents a number of new features, including an exhibit section that outlines the entire site devoted to a scientist and how the PDF files allow one to zoom into a handwritten document, for example, to enlarge (and clarify) a specific section. She projected a variety of pictures, letters, and articles related to Dr. Lederberg's distinguished career. After the demonstration, Dr. Lederberg complimented the Library staff on developing an "elegant" system. He said that what has been put up so far is only the tip of the iceberg, and that much more of his material has to be checked carefully for data rights and for suitability for public release before it is added to the site. He then entered Profiles and showed the Regents a number of his documents and their annotations.

XIV. REPORT OF THE SUBCOMMITTEE ON OUTREACH AND PUBLIC INFORMATION

Dr. Henry Foster reported on yesterday morning's meeting of the Board Subcommittee on Outreach and Public Information. "Outreach" is an operational term for the Subcommittee's mission; "public information" applies to the programmatic aspect of that mission. He used the analogy of creating a vaccine: scientists creating it is a "process," having the public health establishment actually immunize the at-risk population is the goal. The Subcommittee heard reports about recent NLM press releases, the NLM Friends' retreat, NLM's recent dealings with the National Health Council, and publicity plans for MedlinePlus and the clinical trials database. Dr. Pardes asked whether NLM had considered the strategy of taking a particular health topic and investigating how to disseminate information about it to the right audience. Dr. Lindberg said that one such area in which NLM has had extensive (and successful) experience is toxicology/pharmacology and the Historically Black Colleges and Universities. He said that the role of the Subcommittee, which began in 1992 with the help of Dr. Lois DeBakey, is evolving. Dr. Tenley Albright suggested that individual Regents should be encouraged to help get out the word about the NLM's services to the professional groups with which they are associated. Admiral Moritsugu suggested that in this connection it would be useful for NLM to prepare a one-page summary of the most important points relating to NLM. This would be helpful for Regents in inserting a reference to the NLM when they give speeches or write articles. Mr. Gage commented that since today's news media worldwide eagerly look for stories about health and the Internet, NLM should be getting the word out to them about the good links to reliable health information on MedlinePlus; the new clinical trials database will afford another such opportunity.

XV. SYSTEM REINVENTION AWARD

Dr. Tenley Albright announced that the Vice President's National Partnership for Reinventing Government has made a "Hammer Award" to the National Library of Medicine for its work in systems reinvention. On behalf of the Board, she nominated the NLM last May, describing NLM's impressive track record in systems reinvention. Dr. Albright read from the award citation: "This team put 11 million mainframe articles and references on client-servers and made custom-build retrieval software that allows anyone to conveniently access it. The team placed more medical information online, improved its format, reduced processing time dramatically, put environmental health and hazardous substance information online, made the Visible Human available, provided mapping of the human genome, and introduced Profiles in Science. The availability of medical information has and will change medicine forever." She presented each of the 14 members on the Systems Reinvention Team with a certificate. Mr. Kent Smith noted that credit for the success of NLM's reinvention program actually should be spread among the many staff in all areas of the Library who joined in the effort.

XVI. VIDEO FROM "BREATH OF LIFE" EXHIBIT.

The Regents viewed a video clip made at the official opening of the major NLM exhibit: "Asthma: the Breath of Life." In addition to NIH officials, the ceremony featured several members of Congress, the Muppets, and two Olympic gold medal winning athletes who suffer from asthma.

XVII. ADJOURNMENT

The Board of Regents adjourned at 11:45 a.m.

ACTIONS TAKEN BY THE BOARD OF REGENTS:

The Board of Regents concurred with the recommendations of the Extramural Programs Subcommittee.

ATTACHMENTS:

Roster - NLM Board of Regents
Meeting Roster - Planning Subcommittee Meeting - September 27, 1999
Meeting Roster - Extramural Programs Subcommittee Meeting - September 28, 1999
Meeting Roster - Subcommittee on Outreach and Public Information Meeting - September 28, 1999

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

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

Enriqueta Bond, Ph.D.
Chair, NLM Board of Regents

Board of Regents
Extramural Programs Subcommittee Meeting
September 28, 1999
12 Noon - 1:00 p.m.

ATTENDEES
Subcommittee Members Present:

Raymond J. Fonseca, D.M.D. - Chair
Alison Bunting
Wendy Carter
Michele Klein Fedyshin
Joseph Newhouse, Ph.D.
Herbert Pardes, M.D.

NLM Staff Present:

Milton Corn, M.D.
Peter Clepper
Sharee Pepper, Ph.D.
John Seachrist
Frances Johnson

Board of Regents
Subcommittee on Outreach and Public Information
September 28, 1999
7:30 to 8:45 a.m.

Subcommittee Members Present:
Henry Foster, M.D. Chair
Tenley Albright, M.D.
Marion Ball, E.D.
John Gage

NLM Staff Present:

Robert Mehnert
Kathleen Gardner Cravedi
Dr. Steven Phillips
Dr. Elliot Siegel

National Library of Medicine
Board of Regents
Planning Subcommittee
September 27, 1999
Building 38 Board Room
12 Noon to 4:00 p.m.

Subcommittee Members Present:
Dr. Enriqueta Bond, Chair
Ms. Michele Klein Fedyshin
Dr. Jordan Baruch
Dr. Kenneth Walker
Dr. Herbert Pardes
Ms. Alison Bunting

NLM Staff Present:
Dr. Donald Lindberg
Mr. Kent Smith
Dr. Steven Phillips
Dr. Elliot Siegel
Ms. Susan Buyer
Ms. Betsy Humphreys
Dr. Lawrence Kingsland
Ms. Becky Lyon
Ms. Kathleen Cravedi
Dr. Alexa McCray
Mr. Donald Poppke
Dr. Milton Corn
Mr. Roy Standing
Mr. David Nash
Ms. Susan Anderson
Ms. Eve Marie Lacroix