A critical factor to the success of any program is a stable level of funding adequate enough to maintain staffing levels and meet programmatic requirements. As with NLM as a whole, the TEHIP program receives funds from two sources: funds legislatively appropriated to NLM and reimbursements from other government agencies.

As discussed in Chapter 2, the TEHIP program's budgetary appropriations have remained fairly constant over the past 29 years; however, fluctuations in reimbursements from other agencies have been significant. Reimbursement funding is the result of collaborative projects with other federal agencies, and the TEHIP program is funded in large part through interagency agreements. However, changing priorities, responsibilities, and resources within the various agencies have significantly affected the TEHIP program. Between 1992 and 1993, the reimbursable budget dropped by approximately 50 percent, from $2.45 million in FY 1992 to $1.27 million in FY 1993. Since 1993, the reimbursable budget has remained at that reduced level (the FY 1995 reimbursable budget was $1.23 million).

For the TEHIP program to be responsive to the changing demands of health professionals and to improve the utility of the databases, funding must be adequate to implement changes based on the results of the user profile analysis (Chapter 4) and on committee recommendations for improving access, navigation, and program evaluation. Fluctuating funding makes it difficult to plan future activities, to develop long-range goals, and to implement necessary program changes. As noted, however, a mechanism for using limited resources is the prioritization effort based on the results of the user analysis. Nonetheless, fluctuating funding will affect staffing and the ability to keep pace with the rapidly changing trends in technology necessary to make the most useful databases even more accessible to health professionals. The committee did not discuss what appropriate levels of funding might be and suggests that NLM determine the level of commitment to the TEHIP program and develop a cost analysis based on the needed improvements to the program. Clearly, the TEHIP program requires a stable funding base that is not subject to changes in the priorities and programs of other federal agencies.

Leadership Role for TEHIP

The committee has noted the need for a strong leadership role in promoting and marketing the TEHIP program. As NLM engages in new initiatives and research and development (R&D) projects that are relevant to the TEHIP

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