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ORGANIZATIONAL ASPECTS OF THE OCCUPATIONAL AND ENVIRONMENTAL MEDICAL INFORMATION SYSTEM The system would most reasonably be administered and supported by a mission-oriented federal entity, such as ATSDR, which could provide core funding, draw congressional support for the program, and work with national-level professional societies and corporate programs. The committee emphasizes the importance to the organizational aspects of the system of having continuity within one sponsoring agency and the personnel assigned. Because the proposed system would be of potential benefit to programs administered by the NIOSH, ATSDR, OSHA, CDC, NIEHS, and EPA, cooperation between these and other agencies and the sponsoring federal entity would enhance and expand the availability of information resources to all agencies. A group of experts in O-E medicine, representatives from practicing physicians, relevant industries, academic units, medical societies, and other professional associations such as the Association of Occupational and Environmental Health Clinics (AOEC) and the American Association of Poison Control Centers, should be convened to advise the sponsoring agency about the technical and procedural aspects of the new program. 21

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costs Although funding required to establish a regional center cannot be accurately estimated, some projection of operating costs can be estimated by looking at the costs of running a typical PCC as given in the Appendix. These costs are probably low since additional staff will be required to operate the center depending on the geographical area served anc' the numbers of information calls from professional health care groups. At the San Francisco Toxic Information Center, where public awareness and concern for the government is generally high, the annual average load on the system has been approximately 5,000 calls (1,000 information calls per million population). The number of these calls that were made by physicians was not made available. However the Minnesota Regional Poison Center received 1,000 information calls from physicians in 1989. All of these calls were related to hazardous substances. J The cost of sewing up and operating the national center are difficult to accurately estimate; the predominant element would be salaries for professional staff and administrators. The national center would need data collection and analysis experts and support staff necessary to award and monitor grants or contracts to regional centers. The subcommittee has made hypothetical cost projections (See Table AM for an O-E medical information system. In part, these estimates were based on the number of calls mentioned above and on the Worksafe lowa Programs, that provide training, education, and O-E consultation in addition to information services. The proposed O-E system should be implemented in phases, beginning with the creation of the national center. The national center would fund a small number of 22