Saluting All Veterans with a Salute to my Father, Thomas Michael Flatley

Occasionally, through Musings, I’ve introduced you to my family — my brothers, who sometimes read my posts; my sisters, with whom I’ve shared many joys; my mom, who proudly watches over my progress in life; and my son, who has been known to broadcast some of my posts to the Twitterverse. But I’ve never introduced you to my father.

My father served in World War II. This week we observe Veterans Day, a federal holiday to honor all military personnel, particularly living veterans, who have served the United States. I’ll talk more about my dad later in this post, but I want to take a moment to remind you of the strong link between NLM and the uniformed services.

NLM’s history dates back to 1836, when a field surgeon in the U.S. Army requested funds to buy medical textbooks. This growing collection officially became the Library of the Surgeon General (Army) and was later renamed the Army Medical Library.

In 1952, then Secretary of Defense Robert A. Lovett signed a directive converting the Army Medical Library into the Armed Forces Medical Library, a joint agency of the three military departments. Shortly after that, Congress transferred the Library to the Public Health Service and named it the National Library of Medicine (Public Law 84-941). These events coincided with our move to the campus of the National Institutes of Health in Bethesda, Maryland.

NLM’s relationship with the uniformed services continues to the present day.

By statute, our Board of Regents includes appointed representatives from the Surgeons General of the Army, Navy, Air Force, and Public Health Service. This representation is not merely ceremonial or historical; their perspectives and connections ensure that NLM continues to provide information and services that are useful to uniformed services personnel.

In addition, NLM is proud to count among its workforce many veterans who served or continue to serve our country as a member of our uniformed services. 

Left to right:
Dr. Brennan's grandfather, Michael Flatley, and her father, Thomas Michael Flatley (in uniform) walking down a street.
Left to right:
Dr. Brennan’s grandfather, Michael Flatley, and her father, Thomas Michael Flatley.

But one very special veteran has always guided my judgment and choices—my father, Thomas Michael Flatley. My dad was the seventh son of an Irish immigrant, Michael Flatley. Family lore said that the seventh son of a seventh son is destined to be king of Ireland. Well, Dad, like many Irish men, was married late, at the age of 32, to my wonderful mom, Lois, 10 years his junior. Then the children came along — Jean, Patti (me!), Kathy, Kevin, and Tim (looking promising), then Eileen, Brian, Sean, and Tom (the hope remains), followed by our lovely Bridget, ending the hope of a dynasty!

Dad was proud of his military service. He served in World War II as a transportation engineer making sure that supplies reached the Philippines. He managed logistics and used his military service to reach out to the indigenous population to make sure, to the extent possible, that the ravages of war did not disrupt the social justice commitment of those brave people. Dad realized that the U.S. engagement in the Philippines was not only about military force but also about information that fostered sustainability.

Throughout my childhood and growing up, Dad served in the U.S. Army Reserve. I remember every Thursday night and two weeks every summer when Dad went “to the Army”!

Dad died in 2006 and never got to see me in my role as director of the National Library of Medicine. This is a lot less sad than it sounds, for I carry him in my heart every day and most of my brothers and sisters were with me as I was sworn in as NLM Director. My dad would have liked this phase of my life!

But more importantly, Dad instilled in me a kernel of patriotism that brings deep satisfaction to my role as the director of NLM. We serve the public every day. We make health information accessible, available—whether through ClincialTrials.gov or through our enormous public access repository of full-text scholarly articles through PubMed Central. NLM brings health information to the people.

In honor of my dad, I am proud to salute our veterans and reaffirm that the National Library of Medicine stands with our uniformed services personnel around the world as we continue on our mission to make sure that the biomedical informatics research and health information resources of NLM are available to everyone, everywhere!

Marking an Anniversary

It’s Tuesday, which means it’s time for Musings.

It’s also time to celebrate! Musings from the Mezzanine is now 3 years old, and we’re marking the occasion with a new masthead, and some reflections.

When I began this blog three years ago, I wanted to use it to reach NLM stakeholders and offer them a chance to get to know me better. Over time, it’s evolved into an important vehicle for communicating advances in the NLM portfolio, describing key policy issues, and highlighting events and other perspectives. To my great surprise, Musings has become a powerful tool for advancing the work we do every day at NLM.

Last year, I decided to direct more of my attention in this blog toward the science of NLM — computational biology, biomedical informatics, and data science. I promised more posts about basic biomedical informatics, data science research, and new partnerships with domain scientists who are building tools that are accelerating discovery. In addition, I wanted to discuss in detail some complex policy issues, such as the data life cycle and the Library’s responsibility to support rigor and reproducibility within federally funded research.

Focusing on the science of NLM, we’ve reported on the work of some of our intramural scientists. For example, Teresa Przytycka introduced the Musings audience to network biology, characterizing the complex way that cells interact with each other as a suite of networks and nodes. Utilizing data from high-throughput experiments, Teresa’s research group has shown how those interaction networks can be leveraged to identify disease-associated groups of related genes.

We’ve had many articles featuring data science this year — from David Hale’s discussion of the innovative NLM Data Discovery portal to Jim Ostell’s announcement of the launch of NLM’s Sequence Read Archive (SRA) in the cloud, making SRA the largest database of publicly available high-throughput accessible via the cloud. We also addressed whether our data are ready and fit for artificial intelligence, and Susan Gregurick described how the National Institutes of Health (NIH) enhances data sharing through NIH-supported repositories, PubMed Central’s data deposit, the Science and Technology Research Infrastructure for Discovery, Experimentation, and Sustainability (STRIDES) Initiative, and a pilot with the generalist repository Figshare.

I’m proud of how we expanded the focus on public policy germane to NLM. Earlier this year, Dina Paltoo, along with Jerry Sheehan and Rebecca Goodwin, updated us on public policy initiatives affecting NLM, including data sustainability, net neutrality, and open science. They reported on the work of an NLM policy team that brings experts together to deliberate on how NLM should address such issues. And, just last month, I shared the congressional testimony that I submitted to the U.S. House Congressional Subcommittee on Appropriations for NIH Investments in Medical Research.

My blog has also become a place to showcase important events and a variety of perspectives. In February, we celebrated the contributions of African American scientists at NIH. Guest bloggers have periodically provided insights into new developments, such as the introduction to authority-based security by Kurt Rodarmer and the overview of NLM’s new Office of Engagement and Training by Amanda Wilson, and shared their thoughts on important issues, such as the discussion of data reuse by Melissa Haendel of the Oregon Health & Science University.

And, true to the blog’s name, I’ve continued to share my own musings as I’ve matured as an NIH director, including on communicating and leading in a time of change and on my role as a nurse who directs a national library, in response to the oft-asked question, “Didn’t you used to be a nurse?” I was delighted to highlight the 10 women who lead institutes and centers at NIH, which has become my most popular post. I also made a plea for the appropriate use of sick leave — please stay home when you’re sick, if you can.

It’s a privilege and a pleasure to develop this blog and to work with NLM Office of Communications and Public Liaison staff to bring these posts to you. Please let me know your thoughts and ideas — and maybe consider contributing something yourself!

Thanks News Outlets for Getting the PubMed Central Word Out!

How do people find out about PubMed Central?

Some people access NLM’s vast bibliographic resources through our website. Others arrive after a Google search or through platforms such as Ovid MEDLINE. But recently I was reminded that news outlets help people find articles in PubMed Central, too. 

While reading an article about consumer electronics and consumer health, I noticed a link provided by the reporter, which I followed to find the original source material. Low and behold, the link took me back home — to PubMed Central (PMC).

PMC is a free, full-text archive of biomedical and life sciences journal literature here at the National Library of Medicine at NIH. Since its inception in 2000, PMC has grown from comprising only two journals, PNAS: Proceedings of the National Academy of Sciences and Molecular Biology of the Cell, to an archive of articles from thousands of journals.

Today, PMC contains more than five million full-text records, spanning biomedical and life science research from the late 1700s to the present!

PMC supports the NIH Public Access Policy, ensuring access to publicly-funded biomedical research. It also helps NLM meet one of its fundamental responsibilities, outlined in our 1956 enabling legislation, “to preserve permanently the content of books, periodicals, and other library materials pertinent to medicine.”

PMC is not a publisher and does not publish journal articles itself. Instead, content is added to the archive through collaborations with publishers, scholarly societies, research funders, and international organizations.

In December 2017, we reported that more than one billion articles had been retrieved within a single year. Since then, more than 300,000 articles in PMC now have associated supplemental material, frequently including the data to support their research findings.

Almost two-thirds of the articles come from journals that automatically deposit any article reporting on NIH-funded research or from journals that fall under PMC’s full-participation category. Another 25% or so represents “digitized content,” an important collection of articles that, through a collaboration with the Wellcome Trust, provides online access to thousands of complete back issues of historically significant biomedical journals. And about 10% of the articles are “author manuscripts,” which have been peer-reviewed and accepted for publication in a journal. These manuscripts are deposited directly by authors complying with their funders’ public and open access policy to make funded research results available widely, sometimes after an embargo period.

We’ve long known that PMC is a boon to scholarship and clinical practice, yet I’ve wondered how the general public would find articles in PMC.

Now I know.

Journalists who want to direct readers to the authoritative source of their reporting use PMC to provide the full text of the journal article, bringing the power of NLM to an even wider audience. I’m proud that PMC is viewed as a trusted resource and delighted that we’re reaching the public in this way.

Addressing Social Determinants of Health with FHIR Technology

Guest post by Clem McDonald, MD, Chief Health Data Standards Officer at NLM; Jessica Tenenbaum, PhD, Chief Data Officer for North Carolina’s Department of Health and Human Services; and Liz Amos, MLIS, Special Assistant to the Chief Health Data Standards Officer at NLM.

We all know that whether you get an annual flu shot or smoke affects your health. But nonmedical social and economic factors are also large influences on health. For example, individuals will struggle to control their diabetes if they can’t afford healthy food or are sleeping on the street. Healthy People 2020 describes such circumstances as social determinants of health (SDOH). As our health system shifts to value-based payments models, health care systems are prioritizing outcomes, such as the level of glucose control, rather than how much care is delivered (e.g., the number of visits or tests). To achieve better health outcomes, leading organizations are working to identify and address SDOH needs as well as medical needs.

The North Carolina Department of Health and Human Services (NCDHHS) Healthy Opportunities program identifies four priority domains of non-medical needs that can be detected using the answers to screening questions. Screening for needs in these domains will be a standard operating procedure for all Medicaid beneficiaries as the state transitions its Medicaid program to managed care from fee-for-service. Health care providers will be able to refer individuals to community resources such as food pantries, homeless shelters, transportation services, interpersonal violence counselors, and other services that can address some of these nonmedical needs, and the organizations can then be reimbursed for approved services under Medicaid. A computer-based “closed-loop” referral system will enable the collection of information from social service organizations about the services provided, allowing NCDHHS to facilitate reimbursement, monitor the program, and assess its effectiveness. Electronic systems like the one being used in North Carolina are essential to capturing answers to the SDOH screening questions, triaging individuals to appropriate community resources for intervention, and tracking the effects of those interventions. North Carolina is building a “learning” Department of Health and Human Services, similar to a learning health system, with data collected through services provided used to inform future policy decisions.

The SDOH needs being addressed in North Carolina exist across the country, so there is considerable interest in developing standards-based systems for capturing SDOH data anywhere in the United States without the need for separate development efforts at each stage. A powerful mechanism called Fast Healthcare Interoperability Resources®, or FHIR®, has emerged to enable standardization across a broad spectrum of health care processes. Developed by Health Level Seven International, FHIR is a modern, web-based technology for exchanging health care data that has strong and growing support from various stakeholders in the field of health care, including major electronic health record vendors; the tech industry, including Apple, Microsoft, Google, and Amazon; and federal agencies such as NIH, the Office of the National Coordinator for Health Information Technology, the Centers for Medicare and Medicaid Services, the Food and Drug Administration, and the Agency for Healthcare Research and Quality. NCDHHS is exploring the use of a FHIR-based data-capture tool for collecting SDOH information about nonmedical health needs and delivering the survey results to health care providers who can address the needs identified.

Created in the spirit of collaboration, NLM’s FHIR questionnaire app — an open-source tool that can be used, modified, or incorporated into existing tools by anyone — instantly converts a questionnaire that follows FHIR’s technical specifications into a live web form. It leverages the FHIR standard to collect questionnaire data, and generating a different form is just a matter of feeding the tool a different set of questions. FHIR forms can implement skip logic, the nesting of repeated groups of questions, calculations, validation checks, the repopulation of questions with answers from the individual’s FHIR medical record, and more. Of course, the same tool can also implement many other kinds of forms for capturing health care data, such as surveys that measure patient-reported outcomes. You can search more than 2,000 available questionnaires in NLM’s FHIR questionnaire demo app. Other NLM-developed, open-source FHIR-based tools for managing health care data are available here.

NLM and NCDHHS have worked together to develop an open-source, FHIR-based implementation of North Carolina’s Healthy Opportunities screening questions (see figure 1). Anyone with a FHIR-ready server will be able to download the form, enter data, and then route those data to the appropriate health information technology system.

Let’s get to work screening patients broadly while minimizing clinical documentation burdens through the use of standardized application programming interfaces!

 

Figure 1: North Carolina Department of Health and Human Services (NCDHHS)’s Social Determinants of Health (SDOH) Screening Form as a live FHIR Questionnaire demo.
Figure 1: North Carolina Department of Health and Human Services (NCDHHS)’s Social Determinants of Health (SDOH) Screening Form as a live FHIR Questionnaire demo.

 


Clem McDonald, MD

Clem McDonald, MD, is the Chief Health Data Standards Officer at NLM. In this role, he coordinates standards efforts across NLM and NIH, including the FHIR interoperability standard and vocabularies specific to clinical care (LOINC, SNOMED CT, and RxNorm). Dr. McDonald developed one of the nation’s first electronic medical record systems and the first community-wide clinical data repository, the Indiana Network for Patient Care. Dr. McDonald previously served 12 years as Director of the Lister Hill National Center for Biomedical Communications and as scientific director of its intramural research program.

Jessica Tenenbaum, PhD

Jessica Tenenbaum, PhD, is the Chief Data Officer for North Carolina’s Department of Health and Human Services. In this role, Dr. Tenenbaum is responsible for the development and oversight of departmental data governance and strategy to enable data-driven policy for improving the health and well-being of North Carolinians. Dr. Tenenbaum is also an Assistant Professor in Duke University’s Department of Biostatistics and Bioinformatics. Dr. Tenenbaum is a member of the Board of Directors for the American Medical Informatics Association and serves on the Board of Scientific Counselors for NLM.

Liz Amos, MLIS

Liz Amos, MLIS, is Special Assistant to the Chief Health Data Standards Officer at NLM. She is a graduate of the University of Tulsa and the University of Oklahoma.

Hispanic Heritage Month: Improving Access to Health Information

Hispanic Heritage Month (September 15 to October 15) celebrates the many contributions to U.S. society of people originating from Spain, Mexico, the Caribbean, and South and Central America.

Today, there are almost 60 million Latinx-identifying or Spanish-speaking people in the United States (about 18% of the total U.S. population). Representing our nation’s largest ethnic or racial minority, the median age of the Hispanic population is 29.5 years, which is younger than the median age of about 38 years for the overall U.S. population. About 50% are female, almost half are married, and, unlike their non-Hispanic counterparts, they tend to live in households with children. The number of U.S.-born Hispanics is growing faster than the number of Hispanic immigrants.

The Centers for Disease Control and Prevention reports that people of all races who identify as Hispanic are more likely to develop chronic conditions such as cardiovascular disease, type 2 diabetes, and obesity. Each of these conditions can be managed, or even delayed or prevented, by engaging in healthy lifestyle behaviors that include physical activity, healthy eating, and regular check-ups.

So, the health and the health information needs of Hispanics in the United States, and the well-documented disparities that exist between the Hispanic population and other populations, is of critical importance to NLM.

Our powerful consumer health information resource, MedlinePlus, and our Spanish-language version, MedlinePlus en Español, are trusted sources of accurate health information, and we strive to make them culturally sensitive, relevant, and accessible. Our amazing PubMed literature citation database promotes access to research literature in both English and Spanish, and our molecular resources allow for exploring the intersection of genetics and nationalistic identity.

In addition to these online resources, NLM supports Hispanic individuals, families, and groups through our National Network of Libraries of Medicine (NNLM). Serving diverse communities, the NNLM provides another pathway for providing linguistically and culturally relevant health information.  

The NNLM is a powerful human network of over 7,000 academic health science libraries, hospital and public libraries, and community organizations that provide a point of presence in almost every county in the United States. Its eight Regional Medical Libraries (RMLs) make sure that up-to-date information about NLM’s resources are accessible to communities that are often underrepresented in biomedical research. Although all the RMLs provide access to information in English and Spanish, I’d like to highlight the efforts of two of our regions: the South Central Region, serving Arkansas, Louisiana, New Mexico, Oklahoma, and Texas, and the Pacific Southwest Region, serving Arizona, California, Hawaii, Nevada, and the U.S. Territories in the Pacific. Together, these two regions serve 28 million Hispanics — reaching almost half of the Spanish-speaking population in the United States.

The South Central Region supports the Spanish-speaking community specifically through many programs, including outreach to Presbyterian Española Hospital in Española, New Mexico, a special award to the University of North Texas Health Science Center to support a Library School student from a minority community, and emergency funding for Mobile Programming/Pop-up Program Resources & Tools to support disaster relief and response. The Pacific Southwest Region offers programs that engage community health workers/promotores through activities that address social determinants of health as an approach to health education and promotion in the Hispanic community.

But service to the Spanish-speaking public is not limited to the South Central and Pacific Southwest regions. The Middle Atlantic Region offers Spanish language health information resources on topics ranging from AIDS to cancer to diabetes. An interesting program from the Pacific Northwest Region is a grant to bring health information and access to MedlinePlus en Español over the airways from local public libraries to the region.

Because NNLM members are embedded in their communities, they can utilize NLM resources to meet the particular needs of that community. The professional librarians in these communities provide a feedback loop that helps NLM appreciate both the professional terminology associated with critical health concerns and the need to map local colloquial language for Medical Subject Headings (MeSH) to index the literature.  

The NNLM not only helps us extend the amazing federal investment from Washington, DC, to local communities, but also helps ensure that federal staff in Washington understand, in the vernacular, the health concerns of this important population.

During Hispanic Heritage Month — and throughout the year — it’s important to think about how NLM can better engage with the populations we serve. I welcome your suggestions to ensure that our vast and trustable resources serve everyone, everywhere.

Taking NLM’s Story to Capitol Hill

Last month, I had the honor of joining National Institutes of Health (NIH) Director Francis Collins, MD, PhD, and four other NIH Institute Directors to provide testimony before the U.S. House Congressional Subcommittee on Appropriations for NIH Investments in Medical Research. This was the first time in 12 years that NLM provided testimony to Congress.

Each of us was given the opportunity to deliver a three-minute opening statement. As you can imagine, distilling our many successes and contributions down to a three-minute statement was incredibly challenging. I wish that there had been more time because we have so many wonderful stories to share. We were also able to submit a written statement, which is provided later in this post.

It is my hope that NLM will have more opportunities to share with Congress further insights and details about how NLM’s biomedical informatics and data science research play an integral role in supporting the mission of NIH and how we — true to the NIH tagline — turn discovery into health.

Below is the written testimony that was submitted:

PREPARED STATEMENT OF PATRICIA FLATLEY BRENNAN, RN, PhD, DIRECTOR, NATIONAL LIBRARY OF MEDICINE

Madam Chairwoman and Members of the Subcommittee: I am pleased to have this opportunity to speak to you about the exciting work taking place at the National Library of Medicine of the National Institutes of Health (NIH).

ACCELERATING BIOMEDICAL DISCOVERY & DATA-POWERED HEALTH

The National Library of Medicine (NLM) plays an essential role in catalyzing basic biomedical science through its cutting-edge data science and informatics research, comprehensive information systems, and extensive research training programs. As the world’s largest biomedical library, NLM acquires, organizes, and delivers up-to-date biomedical information across the United States and around the globe. NLM operates some of the most heavily used Federal websites.

Millions of data scientists, health professionals, and members of the public use NLM’s electronic information sources every day to translate research results into new treatments, products, and practices and provide the foundation for clinical decision making by health professionals and patients.

Leveraging its 180-year history of organizing and disseminating biomedical literature, NLM is committed to the application of emerging data science capabilities to challenges in biomedical research and public health.

It does this by enhancing its data and information resources and providing leadership in both the acquisition and analysis of data for discovery. It continues to expand its core biomedical literature and genomic collections to include a broad array of health, clinical, and biological data types. It makes these data findable, accessible, interoperable, and reusable (FAIR) for research.

NLM is investing in new research programs to systematically characterize and curate data describing complex health phenomena and to devise new methods to uncover the knowledge held in data. It has restructured its 16 biomedical informatics training programs to address data science as they continue to foster excellence and support a diverse workforce. NLM is in the process of developing an efficient organizational structure to accommodate emerging directions in research and services.

RESEARCH IN BIOMEDICAL INFORMATICS AND DATA SCIENCE

NLM’s research programs support pioneering research and development to advance knowledge in biomedical informatics and data science. Its research portfolio spans such areas as artificial intelligence, computational biology, clinical decision support, public health surveillance, visualization, and discovery mining in digital data sets. This research encompasses areas of high importance to NIH and society at large, and for audiences ranging from clinicians and scientists to consumers and patients.

Research in data science produces novel analytical approaches and visualization tools that help scientists accelerate discovery from data and translate these findings to clinical solutions. It also aims to solve problems consumers face in accessing, storing, using, and understanding their own health data and to produce tools that make precision medicine discoveries available and more understandable to patients.

Biomedical informatics research is yielding advanced analytical methods and tools for use against large scale data generated from clinical care, leading to fuller understanding of the effects of medications and procedures as well as individual factors important in the prevention and treatment of disease processes.

Recognized as a leader in clinical information analytics, NLM supports and conducts research in areas such as medical language processing, high-speed access to biomedical information, analysis and use of high-quality imaging data, health data standards; and analysis of large databases of clinical and administrative data to predict patient outcomes and validate findings from clinical research studies. Leveraging extensive machine learning experience and field-based projects, NLM is now advancing analytical tools and deep learning techniques for application in image analysis research.

NLM’s biomedical informatics research also addresses issues in computational biology. Research creates new ways to represent and link together genomic and biological data and biomedical literature and produces analytic software tools for gaining insights in areas such as genetic mutational patterns and factors in disease, molecular binding, and protein structure and function.

Last year, NLM established a new partnership with the National Science Foundation to support research on advanced analytical methods specifically applied to health.

BIOMEDICAL INFORMATION SYSTEMS FOR RESEARCH AND HEALTH

NLM develops and operates a set of richly linked databases that promote scientific breakthroughs and play an essential role in all phases of research and innovation.

Every day, NLM receives up to 15 terabytes of new data and information, enhances their quality and consistency, and integrates them with other NLM information. It responds to millions of inquiries per day from individuals and computer systems, serving up some 115 terabytes of information. This includes genomic data, such as that contained in the Sequence Read Archive, as well as citations to more than 30 million journal article records in PubMed.

On any given day, more than 2.5 million people use NLM’s PubMed Central (PMC) to retrieve more than 5 million full-text biomedical journal articles. PMC serves as the repository for NIH’s Public Access Policy and includes more than one million articles summarizing the results of NIH-funded research. Additionally, ten other federal agencies use PMC as the repository for publications collected under their public access policies.

Recently, NLM enhanced the ability to connect articles in PMC to openly available datasets that support reported research findings. Currently, more than 300,000 articles in PMC include datasets as supplemental materials. Others link to datasets hosted in other trusted repositories. The addition of this information has resulted in a 30 percent increase in daily downloads of supplementary material from PMC.

NLM also offers sophisticated retrieval methods and analysis tools to mine this wealth of data, many of which grow out NLM’s research and development programs.

For example, NLM tools are used to mine journal articles and electronic health records (EHRs) to discover adverse drug reactions, analyze high throughput genomic data to identify promising drug targets, and detect transplant rejection earlier so interventions to help clinical research participants can begin more quickly. Data analysis tools also support complex analyses of richly annotated genomics data resources, yielding important molecular biology discoveries and health advances for applications to clinical care. Such applications demonstrate how the benefits of big data critically depend upon the existence of algorithms that can transform such data into information.

As a major force in health data standards for more than 30 years, NLM’s investments have led to major advances in the ways high volume research and clinical data are collected, structured, standardized, mined, and delivered.

In close collaboration with other HHS agencies, NLM develops, funds, and disseminates clinical terminologies designated as essential for demonstrating meaningful use of EHRs and health information exchange. The goal is to ensure that clinical data created in one system can be transmitted, interpreted, and aggregated appropriately in other systems to support health care, public health, and research. NLM produces a range of tools to help EHR developers and users implement these standards and makes them available in multiple formats, including via application programming interfaces or APIs.

NLM is now providing support to develop tools to facilitate research use of the Fast Healthcare Interoperability Resource, or FHIR, standard that is being widely adopted for use in electronic health records.

ENGAGING THE PUBLIC WITH HEALTH INFORMATION

NLM uses multiple channels to reach the public with health information, including development of consumer-friendly websites, direct contact, and human networks that reach out to communities.

Direct-to-consumer information is made available in lay language through MedlinePlus, which covers more than 1,000 health topics. EHR systems can connect directly with MedlinePlus to deliver information to patients and health care providers at the point of need in healthcare systems. In collaboration with other NIH Institutes and Centers and other partners, NLM produces the print and online NIH MedlinePlus magazine, and its Spanish counterpart, NIH Salud.

The National Network of Libraries of Medicine (NNLM) engages more than 7,000 academic health sciences libraries, hospital libraries, public libraries, and community-based organizations as valued partners in conducting outreach to ensure the availability of health information and efficient access to NLM services. The NNLM provides a community-level resource for NIH’s All of Us program, ensuring a point of presence in almost every county in the U.S. The NNLM provides a robust network that reaches communities that are often underrepresented in biomedical research.

NNLM partners with local, state, and national disaster preparedness and response efforts to promote more effective use of libraries and librarians and ensure access to health information in disasters and emergencies. NNLM also plays an important role in increasing the capacity of research libraries and librarians to support data science and improve institutional capacity in management and analysis of biomedical data.

CONCLUSION

To conclude, through its research, information systems and public engagement, NLM supports discovery and the clinical application of knowledge to improve health. Its programs provide important foundations for the field of biomedical informatics and data science, bringing the methods and concepts of computational, informational, quantitative, social, behavioral, and engineering sciences to bear on problems related to basic biomedical and behavioral research, health care, public health, and consumer use of health-related information.

To watch the entire proceedings, click here: https://appropriations.house.gov/events/hearings/investments-in-medical-research-at-five-institutes-and-centers-of-the-national

The Healing Nature of NLM’s Herb Garden

Guest post by Kathryn McKay, writer-editor at the National Library of Medicine 

Stressed?

Perhaps the scent of lavender or the sight of flowers could soothe you.

That’s what a group of gardeners have discovered while tending to the NLM Herb Garden. “When the herbs grasp your soul, you can’t just walk past them,” says Pat Keeney, who helped the garden bloom into what it is today. 

Volunteers from the Montgomery County Master Gardeners care for the more than 125 different herbs, right in front of the Library. Every Monday morning, about a dozen women and men plant and prune herbs and yank weeds. 

Between wiping sweat off their brows and sipping lavender tea, a few of the master gardeners told stories about their love affair with NLM’s Herb Garden. Each of the gardeners has a health story, whether as NIH patients, employees, or plant medicine historians. Started in 1976, the garden began as a way to highlight the healing power of nature.

In the 1980s when then-NIH employee Pat stumbled upon it, there weren’t many plants then—lavender, thyme, boxwood, a few snap dragons. So Pat started caring for them. She recruited friends to help, with varying degrees of success. When her friends started retiring, recruitment got easier. Now, she says, they are “luxuriating in gardeners.”

Summertime in the NLM Herb Garden.
Photo by Karen Kim

One of those gardeners is Jeanne Weiss. In 2014, Jeanne was diagnosed with pheochromocytoma, a rare condition in which tumors, usually noncancerous, develop in the adrenal gland. This diagnosis, along with Jeanne’s Cushing’s syndrome, led her to the NIH Clinical Center, where she received care for six weeks. This world-renowned research hospital provides care for people with rare and unusual diseases, mysterious illnesses, and health conditions that are under clinical investigation at NIH.

“I got the best care in the world. NIH saved my life,” Jeanne says. As a way of giving back, she started volunteering in the garden. Years later, that’s not what keeps her coming back. Jeanne volunteers to enjoy the plants and share her research into the history of the herbs.

She turns to a Lenten rose and explains how it was once used as a method of chemical warfare. “The Greeks put the roots in the water supply, which made people so ill, they couldn’t fight,” she says.

Holding up a leaf of the betony plant, Jeanne says with a wink and a smile that, according to folklore, “if you put a leaf in each nostril, one under your tongue, and a leaf in each hand and under each foot, you might cure your insomnia but not just any kind of insomnia—the kind you get from heartbreak.”

The NLM Herb Garden in front of the National Library of Medicine.
Photo by Kathryn McKay

Gardener Selma Deleon enjoys unearthing trivia on women’s health. “Lady’s mantle appealed to me because of its beauty, but it also amuses me,” she says. “It was called a ‘woman’s best friend’ because it was thought to stimulate the uterus, restore ‘feminine beauty’ after breastfeeding, and more.” She mentions how black cohosh was thought to minimize menopausal night sweats and hot flashes and how mountain mint brewed into a tea was drunk to cure menstrual disorders.

Selma sees the “circle of life in the garden” and “the joy of starting something and seeing its growth.”

Sandy Occhipinti understands. She says, “It’s therapeutic to work in and sit in a garden.” Sandy remembers a morning when a young patient from Peru needed exactly this kind of therapy.

As Sandy recalls, the Peruvian girl came to the garden with her father and her nurse. Because her immune system was compromised, this girl couldn’t play with her peers, but she could touch and smell the herbs. Sandy says, “The garden is a respite for so many different people of different nationalities.”

Sandy’s statement is as true for NLM’s staff as it is for visitors. We come from all over the world and we provide access to health resources used by people all over the world.

Thanks to the volunteers who care for it, the NLM Herb Garden provides a sanctuary for us all to relax and rejoice in the healing power of Mother Nature.

Photo of Kathy McKay

 

Kathryn McKay, MA, is a writer-editor at NLM. She is a graduate of the University of Delaware and Johns Hopkins University.