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A closing word about priorities:

In my opinion, the highest priority is construction of the third NLM building. Even without this new structure, the fastest growing component of NLM’s budgets is payment for the space to house its people and enhanced infrastructure to support growth of computer systems. In addition to the square-footage, the three year delay in starting the new building since completion of the construction plans has masked substantial “delayed maintenance” on the two existing buildings needed to comply with current fire and safety regulations.

Second top priority is maintenance and expansion of the NCBI work with NIH institutes on the emerging genome/phenome studies using “whole genome analysis”. NCBI databases and systems will once again provide essential infrastructure for NIH and the biomedical research community worldwide. An increasing percentage of NIH resources is devoted to generating electronic data that increases the workload at NCBI. If this work is to continue successfully, a proportionate increase in resources is needed by NLM and should be included with the base of NLM’s budget allocation.

Third top priority goes to maintaining and enhancing NLM’s prominent information services to the U.S. and abroad. Even without imagining brand new information services, the expected increase in the size and use of the numerous current services will undoubtedly need and deserve increased support.

Fourth. As reflected in special Presidential and Departmental initiatives, the country badly needs and wants better electronic health records. NLM has contributed to this work by funding research, by development of the Unified Medical Language System, by development of Information Technology standards, and by purchasing national usage rights to appropriate proprietary standards. We expect the need for electronic record systems to become more acute in the future. NLM should continue to contribute significantly to the solution.

Fifth. Disaster information management also looms large as a national problem. So far NLM - indeed medical libraries and librarians in general - have not been enlisted in efforts to do better. This is a serious mistake. I believe that NLM could assist in seeing that medical librarians nationally contribute to solution of this problem. We project the need for substantial increases in this area.

Sixth. NLM contributes significantly to education and training programs for biomedical informatics professionals. We project the need for some increases, partly to allow for gradually increasing recipient costs, but also to fund a stepped up effort to achieve better workforce diversity, especially by recruitment of more minority students into the pools from which informatics professionals are drawn - e.g., medicine, nursing, pharmacy, biological sciences, engineering, computer science, library and information science.

Seventh. NLM’s outreach programs have been successful, and gradual increases in funding are projected. The work is carefully integrated with improvements to community and individual access to electronic information, efforts to reduce health disparities, and also to recruitment efforts.

I believe the Plan will provide genuine help and guidance to NLM over the next decade. Even great public institutions are surprisingly vulnerable - even fragile. I thank our Board and Advisers for their efforts on behalf of this great institution, the country, and for NLM’s future contributions to the country.

My special thanks for good insightful work and midnight oil burning to Dr. Elliot Siegel and Ms. Susan Buyer.

Donald A.B. Lindberg, M.D.