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A Symposium At the National Academy of Sciences Celebrating
The 50th Anniversary of the National Committee on Vital
and Health Statistics 1949-1999
2101 Constitution Avenue, NW
Washington, D.C.
June 20, 2000
SUMMARY
The National Committee on Vital and Health Statistics (NCVHS), established
in 1949, celebrated its 50th Anniversary on June 20, 2000 with a Symposium at
the National Academy of Sciences (NAS). The attendees included current and
former Committee members and staff, policy makers, other government officials,
members of the scientific community, and representatives of professional
associations.
The participants used the occasion to reflect on the Committees
accomplishments over five decades; to review the current status of health,
health care, and information in the U.S. and globally; and to consider future
directions and priorities for the Committee. The Symposium discussions pointed
firmly to the future by underscoring the need for timely action, with federal
leadership and NCVHS guidance, to harness the unrealized potential of
information to improve individual, community, and national health.
Health and Human Services Secretary Donna Shalala joined the Chair of the
NAS Committee on National Statistics, the three most recent NCVHS chairs, and
an HHS Data Council Co-Chair in offering congratulatory remarks. Each of these
speakers recognized the National Committees past accomplishments but
placed special emphasis on the important roles and contributions that lie ahead
for NCVHS following this victory lap. NCVHS Chair John Lumpkin
later observed with pleasure that his forward-looking predecessors seemed most
interested in reminiscing about the future and what we need to do.
The main focus and catalyst for discussion was two NCVHS interim reports
outlining facets of what former NCVHS Chair Don Detmer called an
Information for Health Strategy. The two closely related vision
documents, now under development by the Committee, are Toward a National
Health Information Infrastructure and Shaping a Vision for 21st
Century Health Statistics. (Both are published in this volume and also
posted on the NCVHS Website.)
The reports were presented by the Chairs of the NCVHS Workgroups that
developed them, followed by reactions from distinguished commentators. Rather
than proposing any changes to the visions, the Reactors focused on the need to
implement them as soon as possible, noting the challenges that can be expected
in doing so. The presentations offered complementary perspectives on using the
visions to bring knowledge to the point of service to improve the
populations health. Many speakers endorsed Dr. Detmers suggestion
that building the health dimension of the information superhighway would
require a roadmap, a budget, and a designated driver.
The following report summarizes each of the presentations and then reviews
the crosscutting themes in the Symposium. What emerged was a picture of a
health environment that is challenged, both positively and negatively, by the
information explosion, and that faces unresolved needs among which health
disparities and the lack of comprehensive privacy protections are top
priorities. The Symposium created momentum for action in this environment,
based on the evolving information strategy.
THE PRESENTATIONS IN BRIEF
Welcome
John E. Rolph, Ph.D., Chair, NAS Committee on National
Statistics
Dr. Rolph welcomed and congratulated the Committee on behalf of the National
Academy of Sciences (NAS) and its Committee on National Statistics (CNSTAT).
CNSTATs most recent health-related activity was convening a workshop on
the future of health statistics (November 1999). The National Center for Health
Statistics requested the workshop as a step in developing a vision for 21st
century health statistics. The workshops findings, scheduled for release
in August 2000, are consonant with those in the NCVHS interim report on the
same topic. A general theme of the workshop was that at present, the U.S.
health statistics system . . . cannot fully meet the nations current and
anticipated health information needs.
Opening Remarks:
Chair and Former Chairs
John R. Lumpkin, M.D., M.P.H., Chair, NCVHS
Dr. Lumpkin noted the importance of the Nationals Committees
partnership with CNSTAT and his hope that it would continue to grow. He
commented on the momentous changes during the Committees 50 years of
existence and the implications of those changes for the future. During that
period, information and knowledge have become a transforming force in the
world, facilitated by the technology of information and knowledge management.
Dr. Lumpkin welcomed each of his predecessors to the podium, also encouraging
participants to read the written reflections sent by former Chair Kerr White,
M.D. (Chair 1975-1979).
Don E. Detmer, M.D., Dennis Gillis Professor of Health Management,
Judge Institute of Management, Cambridge University (Chair 1996-1998)
After highlighting aspects of the Committees history, Dr. Detmer
shifted the focus to the future, observing that it is probably better to
invent part of the future than to inherit all of it. To this end, he
proposed that the Committee and the Department find a way to link the two
interim vision reports into a national Information for Health strategy, to
bring the right information to all the right places at the right
time. Realizing this vision will require partnerships among patients,
communities, and national bodies including NCVHS, the Department, and the
National Academy of Sciences. He also mentioned the need for monitoring systems
using solid statistical analysis, as well as progress toward global standards.
Many Symposium speakers later reiterated the importance of global connections
and standards.
Dr. Detmer praised the two NCVHS reports and urged steady movement toward
their implementation. He identified three essential conditions for this to take
place: an Information for Health roadmap, a budget, and a designated driver.
Dr. Detmer observed that the U.K., Canada, and Australia, among other
countries, all have maps or plans, and the U.S. needs one, too. These countries
also have far more government funding than the U.S. invests in its information
infrastructure. He suggested that 7 billion dollars, spread over seven years,
could move the U.S. infrastructure forward significantly. Regarding the need
for a designated driver, he asserted that the U.S. needs an agency or a
center . . . that leads the agenda and can channel the prevailing
enormous good intention and tremendous energy.
Judith Miller Jones, Director, National Health Policy Forum (Chair
1991-1996)
Ms. Jones commented on the high caliber of people in the field of health
statistics, where, like the children in Garrison Keillors Lake Wobegon,
everyone is above average. She noted that todays Committee
builds on 50 years of NCVHS achievements. Its work recently has been made more
challenging by the Health Insurance Portability and Accountability Act,
compounded by unresolved privacy concerns. Declaring that data and health
statistics are the bedrock of good policy, she promised to redouble her
efforts to improve information policy.
Ronald G. Blankenbaker, M.D., Associate Dean, University of Tennessee
College of Medicine, Chattanooga (Chair 1986-1991)
Dr. Blankenbaker praised the National Committee for approaching its work in
the spirit of the broad World Health Organization definition of health. This
resonated with Kerr Whites written observation that the health world is
starting to recognize the reality that the genesis of ill health and
disease involves many factors other than germs and genes.
Dr. Blankenbaker noted the challenge of managing burgeoning data and
information while also providing the kind of health care implied by the WHO
definition. He joined his colleagues in congratulating NCVHS for its work,
affirming that the Committee does make a difference.
Opening Remarks:
Department of Health and Human Services Representatives
Hon. Donna Shalala, Secretary of Health and Human Services
In introducing Secretary Shalala, Dr. Lumpkin commented on her seven years
of service as Secretary, longevity that is unusual for this position and that
manifests important qualities of commitment and leadership. He reviewed her
accomplishments, notably her support for upgrading the status of health
information, statistics, and knowledge management within the Department.
After acknowledging the leadership of Dr. Lumpkin, the former NCVHS chairs,
and NCHS Director Ed Sondik, Secretary Shalala congratulated the Committee on
its golden anniversary and expressed pride in what NCVHS and the Department
have accomplished together. She said of NCVHS members, I cant think
of a group of people who have worked harder to promote a better and healthier
life for the people of this country. The Committee is meeting her goals
for it, namely building a broad-based national health information
infrastructure and providing bridges to industry, the research and public
health communities, and the American people. She noted that there is much left
to be done to build a seamless web of information-gathering and
dissemination that still protects the privacy of individual citizens. She
promised to fight for more resources to accomplish these goals.
John Eisenberg, M.D., M.B.A., Co-Chair, Data Council
Dr. Lumpkin expressed appreciation for Dr. Eisenbergs advocacy for
health information and data policy within the Department.
Dr. Eisenberg congratulated the Committee on behalf of himself and his
co-Chair, Dr. Peggy Hamburg, joking that NCVHS now qualifies for AARP
membership. He thanked the Committee for its hard work and valuable service,
not just for the Department but for the entire nation, and he
hailed the close relationship between the Committee and the Data Council and
Department. NCVHS has provided a framework for bringing the benefits of
information and technology to health and health care, in a way that protects
the security and confidentiality of the information.
Dr. Eisenberg reviewed the Committees historic contributions to
advances in health information policy, noting its proposal for the first
national health survey, its advice on Health U.S., its leadership on
health data standards, and its close collaboration with HHS to develop the
regulations required by HIPAA. He praised the skill with which the Committee
brings together policy and diplomacy to help people come to a
consensus. In conclusion, he urged participants to look at a new World
Health Organization report, released June 20, which reflects the need to
measure both the health of the public and the performance of the health care
system.
Two Visions of Information for Health
Moderator: Edward J. Sondik, Ph.D., Director, National Center for
Health Statistics
Dr. Sondik began by extending his own thanks to the Committee, its Chairs,
Executive Secretary Marjorie Greenberg, and her predecessor, Dr. Gail Fisher.
On the theme of rapid technological progress, he noted the short lapse in time
between the horse and buggy, figuratively and literally, and the deciphering of
the genome, as well as the implications of the latter breakthrough for the
health community. The Committee is very important, he said, in helping to guide
and catalyze responses to the technology that increasingly drives the
system.
With this he turned to the two featured reports, first introducing John
Lumpkin, who chairs the Workgroup on the National Health Information
Infrastructure (NHII).
Toward a National Health Information Infrastructure
John Lumpkin, M.D., Chair, NHII Workgroup
Dr. Lumpkin observed that the attainment of health is a shared
responsibility. The process is driven by the use of data, which, when converted
into information and knowledge, can lead to action to create better health
outcomes. Information allows us to understand the links among the many factors
that affect health. Although health care today is still approached much as it
was 100 years ago, relying on the information in the individual
physicians head, information technology offers the opportunity to
transform health care. This change can be brought about by following through on
the vision for the national health information infrastructure (NHII).
The Committee envisions the NHII not as a centralized database, but as a
means of connecting distributed health information into a secure
network, with strict confidentiality provisions. Making these connections
involves a data model, data standards, and connectivity standards. The purpose
of the infrastructure is to push knowledge to the point of service,
making todays wealth of information available for clinicians, patients,
and public health professionals to use in improving peoples health. These
capabilities are expected to dramatically reduce medical errors and other
adverse effects of care.
The NHII has three dimensions, representing the three categories of key
stakeholders: personal health, health care provider, and community health.
(Health statistics, the focus of the second vision report, is part of the
community health dimension.) The information and knowledge within each of these
dimensions is controlled by the designated stakeholder i.e., the individual,
the provider, or public health workers. Dr. Lumpkin described the core data for
each dimension and ways in which the dimensions and stakeholders will interact
and exchange information in this dynamic system. For detail on the provider
dimension, he referred the audience to the Report on Uniform Data Standards for
Patient Medical Record Information (which NCVHS sent to the Secretary in
September 2000).
He observed that the health care system now undergoing such transformation
still must address basic issues of inequity and disparities. By providing
decisional support and improving the quality of care, objective information
systems can help the nation overcome treatment and outcome disparities.
Privacy is another special challenge, and he outlined the confidentiality
protections that will operate within each dimension and in the transactions
between them. For example, the community health dimension will use information
in its least identifiable form, with controlled access on a need-to-know basis.
Despite precautions such as these, he acknowledged that protecting privacy and
confidentiality remains a major challenge, along with assuring equity of access
and treatment quality.
The next steps in the development and promulgation of the NHII are to
validate the vision, identify the barriers, and develop recommendations. Four
hearings are scheduled around the country over the next six months. Then
comes the hard part, when well be done with the talking and
it will be time for the doing. Dr. Lumpkin stressed the urgency of moving
to the action stage, in view of the proliferation of new health information
systems whose multiplicity will make change more expensive the longer it is
delayed.
Reactor: Edward Shortliffe, M.D., Ph.D., Chair, Medical Informatics,
Columbia University; member, IOM National Research Council
Dr. Shortliffe had earlier that day presented to NCVHS members the National
Research Council report, Networking Health: Prescriptions for the
Internet. He called the NCVHS vision for a national health information
infrastructure, as articulated in the NHII report, exactly right.
He focused his Symposium remarks on a complementary subject, the background and
potential role of the Internet, which he suggested is interwoven through
much of what you envision for the future of the NHII and indeed is likely
to potentiate it.
Dr. Shortliffes account of three decades of Internet development
portrayed the medical world as slow to take advantage of this resource. As the
infrastructure, standards, and consensus developed, parts of the medical world
got involved but in general medical applications lagged far behind others.
While consumers have embraced the health-related uses of the technology,
the health care community just didnt get it. Noting that the
prevailing culture in the biomedical and health world creates resistance to the
use of information technology, he said what is needed is nothing less than a
fundamental cultural change. Part of the problem is the fragmentation of the
health care industry, which exceeds that of other industries; other factors are
changing modes of practice and fear related to financial pressures. At this
stage, the health care community should support focused information technology
research as a component of biomedical research, to further such interests as
protecting privacy and achieving large-scale system integration.
Finally, he pointed out that the national infrastructure on which the
Internet depends would not have come into being without a substantial
investment by the government. He stressed that government leadership
remains essential to promote needed cultural change, help carry the costs of
change, and bring the health world fully into the information age. Dr.
Shortliffe agreed with Dr. Detmer about the three components needed to realize
the NHII vision. All HHS agencies must be involved in this effort, and the
National Committee is well positioned to help the government figure out its
role. Now is the time to start the federal process, he said, even
as the Committee continues to elicit comments from around the country to flesh
out the vision.
Shaping a Vision for 21st Century Health Statistics
Daniel J. Friedman, Ph.D., Chair, Workgroup on 21st Century Health
Statistics
Dr. Sondik acknowledged Dr. Friedmans leadership in crafting the
vision for health statistics and moving that process forward.
Dr. Friedman said that the National Committee, NCHS, and the Data Council
are collaborating on developing the health statistics vision in response to a
1998 request from Dr. Sondik. The vision encompasses population health, the
health care system, and the interaction of the two at local, state, and
national levels, using both public and private data. An important goal of the
process, beyond developing the vision, is to define what is needed to implement
itwhich is going to be the really difficult part. A related goal is
to clarify the criteria for evaluating the health statistics system, today and
in the future.
Developing the interim report and getting national feedback to its content
represent the second of five phases planned for this process. The first phase
was dedicated to learning from the past and the present through commissioned
papers, consultative sessions in several communities around the U.S., forums at
professional meetings, and the CNSTAT workshop described above. Finding a
dearth of definitions of health statistics, the Workgroup developed its own,
emphasizing the use of statistics in designing, implementing, monitoring, and
evaluating health policy and health programs. Phases three through five of the
processfurther national consultation, completion of the vision, and
implementation are described below.
U.S. health statistics have been marked by unrealized potential, Dr.
Friedman said, due to this nations failure to deal adequately with
privacy and confidentiality issues, together with the existence of multiple
unconnected data silos and the lack of a consistent conceptual and
organizational structure. The result is a surfeit of data but a dearth of
information, as well as multiple unanswered questions, at both macro and
micro levels. One significant unanswered question, for instance, concerns the
impact of health care on health.
From the vision development process thus far have emerged ten very
rough-cut principles around which a detailed 21st century vision will be
constructed. Dr. Friedman commented briefly on each of the principles, which
are enumerated in the report. They include the need for privacy protection,
flexibility to address emergent issues and needs, usefulness at different
levels of aggregation and for different purposes, maximum access and ease of
use, and policy relevance. Broad collaboration among private and public
stakeholders will be needed to carry out this vision.
The next steps in the process are to receive further input through regional
hearings and comments from the public via the project Website as well as at
professional meetings, to map the current system against the conceptual
framework, to delineate and address specific privacy and confidentiality
concerns, and to produce a final vision report. The ultimate, and most
important, phase follows the release of the report: using this vision for
federal, state, and local population health information planning.
Reactor: Dorothy Rice, Sc.D., Professor Emeritus, Institute For Health
and Aging, University of California, San Francisco
Dr. Rice, who directed NCHS from 1976 to 1982, delivered the
keynote address at the November 1999 CNSTAT workshop on 21st century health
statistics. Dr. Sondik acknowledged her significant public health
contributions, in particular her analysis of the costs of smoking.
Dr. Rice characterized the interim report on health statistics as
very, very important and the beginning of hopefully a very
fruitful effort. After praising Dr. Sondik for stimulating the
development of the vision, she highlighted what she regards as the most
glaring gaps and cross-cutting issues addressed in the report. The most
serious gap concerns health statistics on sub-population groups, including
children and racial and ethnic minorities. Compounding this gap is the
difficulty of obtaining data on socioeconomic differences. More longitudinal
data are also needed We should start with children and follow them
through their life and she called for pilot projects to move that idea
forward. Our pluralistic healthcare delivery system creates special problems in
data collection, analysis, and dissemination, with proliferating data systems
and little sharing. The fragmentation of the system makes it imperative to
integrate statistical systems, using uniform definitions.
On the federal side, Dr. Rice noted the many knowledge gaps that remain
despite a broad array of surveys. For example, information on health insurance
coverage is available only from a Labor Department report on unemployment.
State and private data systems compound the fragmentation, and to these
problems are added those caused by the irregular quality of data sources. She
contrasted these with the more comprehensive California Health Interview
Survey, one of several current models of collaborative data collection
involving states, academics, and the federal government.
Above all, she stressed the need to invest in health statistics, as a
demonstration of a judicious political commitment to quality health
statistics in the public and private sectors. Returning to Dr.
Detmers list of preconditions for the Information for Health strategy,
she asserted that NCHS should be the designated driver. One of the
next steps toward implementing this strategy, she said, should be an effort to
make people more conscious of the importance of health statistics,
thereby generating a constituency that would support a greater investment of
resources.
Gary Catlin, Director, Health Statistics Division, Statistics Canada
Introducing Mr. Catlin, Dr. Sondik noted the importance of looking to other
countries to learn how they have dealt with challenges like those the U.S. is
now facing.
Mr. Catlin said Canada has confronted and is confronting the same issues as
those outlined in the NCVHS health statistics report. A Canadian task force on
health information in 1990 recommended creation of a health information
coordinating council, citing concerns much like those identified by NCVHS. That
very influential report led to formation of the Canadian Institute
for Health Information (CIHI), an independent nonprofit organization that
serves as Canadas designated driver for health statistics. In
1994, Canada started a longitudinal national population health survey and
embarked on a series of cross-country consultations that resulted in the Health
Information Roadmap (posted on the CIHI Website).
The 1999 Canadian federal budget allocated $95 million to Statistics Canada
and CIHI over three-to-four years to implement the vision outlined in the
Roadmap. Some 38 projects are funded to answer two basic questions: How healthy
are Canadians? and How healthy is the health care system? Also under
development are a health infrastructure report describing the existing health
information system, and a two-year strategic plan for moving ahead.
Canada is also dealing with privacy and confidentiality issues, with one
focus being the development of harmonized privacy legislation among the
provinces and territories. Like the U.S., Canada envisions project-specific
linkages rather than a mega-database. 95 percent of Canadians gave
their consent to linking household survey information to administrative data
for the 1994 national population health survey. To combine privacy protection
with controlled data access for researchers, Canada is setting up research data
centers in universities around the country.
Mr. Catlin described a major initiative related to the Roadmapa new
community health survey that will begin in September 2000 and generate tailored
local and regional data for 130 health regions. Other Roadmap initiatives
include a pilot project involving person-oriented longitudinal health
histories, and the production of annual health reports. Starting in the Spring
of 2000, Statistics Canada began reporting on the health of Canadians, with
CIHI reporting on the health of the health care system. Dr. Catlin stressed
regular reporting as an essential byproduct of health statistics. This
reporting, he said, must be done with the public in mind and must
offer the information the public wants to know. He also affirmed a priority
mentioned by several previous speakers, the need to develop internationally
comparable health indicators for use in health surveys and reporting. Canada,
he said, would like to work with NCHS and others in moving this forward.
Mr. Catlin concluded by sharing lessons from the Canadian experience. They
relate to the challenges of standardization, the importance of cooperation and
consultation among a vast number of interests, the fact that the
public are amazed at what we dont know, and the need for a
long-term investment to realize the vision.
Audience Comments
Dr. Detmer proposed that the market value of health has gone up:
many people are getting interested in health because of environmental concerns
and other factors. Given the likelihood that this interest will stimulate a
greater willingness to invest in information, those responsible for information
for health must be ready to take action.
Dr. Myron Straf raised the possibility that with the proliferation of
private sector data, bad data will drive out good data and people
will lose sight of the relevance of population-based surveys. Dr. Lumpkin said
the question gets to the heart of how we use population-based data;
the latter are needed to provide the denominator that gives meaning to the
numerators derivable from administrative and clinical data. Thus, the
proliferation of data sources only intensifies the need for community- or
population-based sources. Dr. Lumpkin and Dr. Sondik noted the worrisome trend
toward the commodification of data.
Dr. Manning Feinleib suggested that basic scientists, especially those in
the genome project, should be treated as an important group of stakeholders and
involved at an early stage in considering confidentiality and other complex
issues.
Ms. Jones observed that more and more people want to know how their
individual data compare to population data, in order to know their relative
risk and improve their health-related decision-making. This is an application
for which health statistics could be used more effectively.
Closing Remarks: Dr. Lumpkin
In closing, Dr. Lumpkin noted that the Committee has recently completed
three significant reportson computer-based patient records, health statistics,
and the NHII. He continued, Now that we have said what we need to do and
advised the Secretary on what needs to be done, it is time to do
it. Looking ahead, he said the Committee has important work to do with
respect to privacy, security, population health and health statistics, and
functional status measurement, among other areas.
Finally, he acknowledged the contributions of Executive Secretary Marjorie
Greenberg and Executive Staff Director Jim Scanlon and their staffs, without
whom the Committees accomplishments would be impossible. He then
adjourned the Symposium, inviting all participants to join the Committee and
staff at a reception in the Great Hall.
MAJOR SYMPOSIUM THEMES
Information for Health
Several speakers came armed with statistics to illustrate the rapid growth
of technology, the proliferation of data sources, and the sheer quantity of
data now available to health systems and health professionals.(1) Noting the difficulty of managing the speed
and volume of this explosion and the fragmentation that often
accompanies it, they portrayed these forces as both challenges and
opportunities. Proliferation, fragmentation, lack of standardization, and lack
of utility were all mentioned as information challenges in the health area,
both within the U.S. and internationally.
The point was made repeatedly that to be useful, data must be converted into
information and knowledge; and beyond this, that the potential value is only
realized when information and knowledge lead to action in such forms as service
delivery, reporting, and policy.
A major tension in this area concerns privacy, a theme that wove through the
discussions. Many speakers observed that the value of information for health is
contingent on having adequate privacy protections. This point was especially
salient in discussions of the two vision documents, where the Committee is
designing blueprints for the ideal information infrastructure and
applications that can only become a reality when adequate privacy protections
are in place.
These challenges notwithstanding, the major emphasis of the Symposium was
the demonstrated value and unrealized potential of information as a tool for
improving health. Brought to the point of service, information can
improve decision-making by policy makers, public health workers, health care
providers, and consumers. Information technology greatly increases the forms
and speed of communication. And given adequate laws, policies, and security
measures, it can improve privacy protections. Thus, a strong message to emerge
from the Symposium was that information can be a vital resource for health,
provided that it is guided by a national strategy based on clear principles and
goals. The elimination of disparities was highlighted as an especially pressing
goal for health care and population health systems, and one for which better
information can make a critical difference.
Time for Federal Action
The question, then, is how to develop the national strategy and use it to
take action.
Dr. Detmer moved the discussion in this direction with his call for action
and federal leadership and his characterization of the NHII and health
statistics visions as a nascent Information for Health strategy. Dr. Shortliffe
added a sense of urgency by asserting that now is the time to start the
federal action, a point Dr. Lumpkin repeated in his final remarks.
Two questions from Dr. Detmer Whats holding us up? and
What do we need to move forward? gave focus to the discussion. His
answer, using the information superhighway metaphor, recommended three forms of
facilitation: a roadmap, a budget, and a designated driver. Other speakers
elaborated on these themes, including Dr. Rices nomination of NCHS for
the role of designated driver.
In general, the Symposium discussions confirmed that the two NCVHS vision
papers are a good start toward a national health information strategy and
infrastructure. In the Canadian experience participants recognized an
instructive model and a promising source of future collaboration. Other
countries examples were also cited, notably those of Australia and the
United Kingdom.
As these nations have shown, developing and implementing an information
strategy requires an ample budget and strong leadership. The presenters agreed
that in the U.S., only the federal government can provide the leadership and
funding needed for this effort.
Dr. Rice and others pointed out that the information infrastructure in
general, and health statistics in particular, suffer from underinvestment. Dr.
Shortliffe contrasted the 18 percent that American Airlines invests in
information technology with the 2 percent invested by the health care industry.
Mr. Catlin reported that Canada has budgeted $95 million (Canadian) for its
health information roadmap. Dr. Detmer noted that the U.K. has $1.5 billion
(U.S.) budgeted to modernize their information infrastructure. He suggested
that the U.S. government think in terms of $1 billion a year for seven years.
Several presenters observed that the National Committee, through its
collective expertise, commitment, relationship with the Department, and 50-year
track record, is well positioned to advise the government on providing the
needed leadership. The initial stages have already begun, through the actions
highlighted in the Symposium: refining the visions for the information
infrastructure, engaging and consulting stakeholders, and laying the groundwork
for implementation.
This report was written by Susan Baird Kanaan.
(1) For example, Dr. Blankenbaker noted
that there were 10,000 journals in 1951 and there are more than 140,000 today;
and given the present trajectory of information generation, by 2020
information will double every 73 days.
November 5, 2001
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