Answering the Call: Academic Health Sciences Libraries and COVID-19

Guest post by members of a large collaborative network of academic health sciences libraries

The COVID-19 pandemic and resulting public health crisis have had a profound impact, reshaping patient care, training, research, learning, and community engagement across academic medicine. Academic health sciences libraries are answering an urgent call to implement the virtual library as an extension of our embedded and integrated roles on campus. The closure of physical spaces during this time highlights the critical role of the virtual services, resources, and training provided by libraries and has accelerated the maturation of many remote resources and services to support and advance institutional missions of research, patient care, education, innovation, and public health.

Academic health sciences libraries are leveraging electronic collections and services and quickly pivoting to meet users’ needs in a variety of ways. Here are some of the actions libraries are taking in the areas of clinical care, education, research, resources, and outreach:

Clinical Care

  • Curating information resources to support health care providers who are transitioning to the front line in preparation for a surge in hospitalizations, including retirees reentering the workforce to care for patients
  • Providing comprehensive searching for evidence-based information on topics such as personal protective equipment, commonly referred to as “PPE,” sanitization and reuse to help safeguard frontline health care providers
  • Providing rapid evidence searching and synthesis services to support the treatment of high-risk patients and specialty care areas, in addition to informing clinical management decisions and public safety
  • Developing guidelines and providing government information on recommendations for the production of PPE face masks using 3-D printing capacity in library-based collaborative “maker-spaces” to align closely with institutional efforts to supply equipment for health care workers 

Education

  • Designing COVID-19 instruction modules and elective courses in partnership with medical education faculty
  • Integrating digital content, including alternatives to print materials, into the evolving online learning environment
  • Facilitating access to online medical education resources to support students preparing for board exams or engaged in clerkships
  • Advancing health literacy by teaching students to communicate effectively with patients and caregivers

Research

  • Creating online learning opportunities in data analysis, visualization, programming, research impact, and more to support and enhance research activities
  • Collaborating with researchers on conducting data analysis, writing for publication, and preparing grant applications during the hiatus of nonessential laboratory work
  • Providing training and consultation services to users on data collection and collaboration via electronic lab notebooks, data collection tools, institutional repositories, and other digital platforms

Resources

  • Maintaining electronic interlibrary loan services through a robust digital network
  • Managing access to peer-reviewed literature to support patient care and emerging research
  • Aggregating and curating COVID-19 resources to help people stay current with the latest articles, rapid reviews, and guidelines and to orient users to critical datasets and analytical tools
  • Negotiating with publishers for temporary expanded access to online content

Outreach

  • Reaching out to populations outside our own institutions to address global health issues
  • Identifying and promoting open-access resources to help providers and community groups
  • Curating consumer health web resources to point the public to authoritative sources of information
  • Providing online wellness activities for our communities

While physically separated, we are working to create stronger bonds among ourselves, connecting with colleagues across the nation and around the world to support one another. The interconnected and collegial nature of our profession is well established, with libraries and librarians enjoying a long history of strong professional networks and collaboration. Our professional associations, including the Regional Medical Libraries of the NLM-supported National Network of Libraries of Medicine, the Association of Academic Health Sciences Libraries, and the Medical Library Association and its regional Chapters, have been instrumental in cultivating and fostering these networks through regular communications, member support tools, and professional development opportunities. Our networks continue to be a vital foundation for our work and serve to connect us as we share, support, and address urgent information needs.

We acknowledge the toll this crisis is taking. We value the significant and substantial efforts we are engaged in to support and care for ourselves, our families, and our communities during this difficult time. As we continue forward, we offer these thoughts:

To researchers, students, and administrators: Connect with your librarians to establish new partnerships in the creation, collection, and sharing of knowledge. Look to the library for new strategies to advance learning, teaching, and research. Whether on our campuses or virtually, academic health sciences libraries foster health literacy, evidence-based practice, public access, and the creation and sharing of knowledge, while supporting the advancement of state-of-the-art patient care, research, education, and public health — far beyond what you may perceive as traditional library services.

To our colleagues: The current crisis, with its constant demands and urgent requirements, underscores the unquestionable value of librarians in the discovery, creation, and management of knowledge. Your professionalism and proactive innovation are both inspiring and impactful as we work together to address rapidly evolving information needs while developing and maturing critical services, resources, and training.

We celebrate the tremendous achievement by health sciences libraries to pivot to a fully online environment while providing largely uninterrupted access to resources and to valuable services and support during the COVID-19 pandemic. The examples above, and many more not included here, demonstrate the diverse ways that health sciences libraries are stepping up in the face of the current situation, and how libraries will continue to evolve and develop new solutions to meet information challenges.

Row 1 (left to right):
Marisa Conte, MLIS, Associate Director, Research and Informatics, Taubman Health Sciences Library, University of Michigan
John Gallagher, MLS, Director, Harvey Cushing/John Hay Whitney Medical Library, Yale University
Kristi L. Holmes, PhD, Director, Galter Health Sciences Library and Learning Center and Associate Professor of Preventive Medicine-Health and Biomedical Informatics, Northwestern University Feinberg School of Medicine
Janice M. Jaguszewski, MSLIS, Associate University Librarian and Director, Health Sciences Libraries, University of Minnesota 

Row 2 (left to right):
Barbara Kern, MLIS, Director, Sciences and Social Sciences and Director, John Crerar Library, The University of Chicago
Melissa L. Rethlefsen, MSLS, AHIP, Associate Dean, George A. Smathers Libraries and Fackler Director, Health Science Center Libraries, University of Florida
Anne K. Seymour, MS, Director, Welch Medical Library and Assistant Professor of Health Sciences Informatics, Johns Hopkins University

NLM Is Open for Business!

Last week, I shared what NLM is doing to aid in the response to COVID-19 while keeping all of our public-facing services available to the scientists, clinicians, patients, and families around the world who use them millions of times a day. This week, I want to give you an insider’s view of how the 1,700 women and men at NLM are making sure that all our services keep functioning at a high level of performance.

In keeping with guidance from the National Institutes of Health (NIH) and the Office of Personnel Management, NLM is encouraging remote work to continue Library operations.

This means that all our NIH and NLM telework-eligible staff are working safely from home. There are certain mission-critical functions that must continue onsite at NIH, and staff working in those capacities — security staff; data center staff; the nurses, physicians, and technicians at the NIH Clinical Center — must still come to the NIH campus. But the rest of us are working from afar. We’re brushing up on our telecommunications skills, Skype-ing through meetings, Webex-ing our conversations with colleagues, and texting and phoning as needed.

NLM, and the entire NIH community, is well prepared to keep our operations going while we’re unable to go to our offices at NIH.

All eligible federal staff have written agreements detailing telework arrangements, including the location of the telework office and related expectations. Most of our arrangements for contract workers include consideration for telework. NLM’s Office of Computer and Communications Systems helped equip our staff with the technology they need to work from remote locations and provided the training and support required to ensure secure communications with NLM servers.

We’re also working hard to stay in touch with all our staff.

We’re holding virtual town hall meetings. More than 1,200 NLM staff members attended our first virtual town hall and nearly 1,000 attended our second virtual town hall. These recordings are available for staff who are not able to join us “live.” This is important, as we strive to offer the greatest amount of flexibility to our staff who are adjusting to new ways of working and scheduling their days.

NLM divisions are holding their own virtual meetings and huddles to keep staff connected and coordinate work efforts so that services across the Library remain available. And we’re providing staff with telework tips and guidance on how to manage the professional and personal challenges of working remotely.

I’m proud to say that we haven’t missed a beat!

We’re still adding new citations to PubMed and expanding access to machine-readable full-text articles in PubMed Central, which serves as the repository for articles covered by the NIH Public Access Policy. Our researchers continue to pursue important questions in computational biology and image analysis. And we’re helping both intramural and extramural investigators register trials on ClinicalTrials.gov, including these clinical studies related to the coronavirus disease.

Some things have changed, though. Here’s what my day looks like now.  

Photo of Dr. Brennan's telework space
Dr. Brennan’s telework space

I get up a little later than I used to (since my commute is now very short!) and am ready for work by 8 a.m. Although I have a study in the second bedroom of my apartment, I’ve found that I like working by the front windows. My laptop has a camera, and I have many pairs of earbuds — which is a good thing, because I spend most of the day on videoconferences and phone calls. But I try to get up every hour or so to move about or take a walk around the block (keeping my physical distance!).

While watching the world from my apartment windows, I’m working hard to make sure that our staff have the necessary resources to do their work and that NLM continues to support NIH, scientists, clinicians, and the global community.

Every one of us at NLM, wherever we are, plays an important role in keeping the work of the Library going during these extraordinary times.

So, stay safe, wash your hands often, and keep your social connections active — just at a distance! Let us know how you are managing and, more importantly, how NLM can help you.

How Does a Library Respond to a Global Health Crisis?

Around the world, scientists, public health officials, medical professionals, and others are working to address the coronavirus pandemic.

At NLM, we’ve been working on multiple fronts to improve researchers’ understanding of SARS-CoV-2 (the virus that causes the novel coronavirus) and aid in the response to COVID-19 (the disease caused by the novel coronavirus). By enhancing access to relevant data and information, NLM is demonstrating how libraries can contribute in real time to research and response efforts during this crisis.

Harnessing the Power of PubMed Central® to Enable Data Science Research

With new initiatives launched in the past two weeks, NLM is using PubMed Central®, our digital archive of peer-reviewed biomedical and life sciences journal literature, to expand access to full-text articles related to coronavirus. These activities build on recent requests from the White House Office of Science and Technology Policy (OSTP) and science policy leaders of other nations calling on the global publishing community to make all COVID-19-related research publications and data immediately available to the public in forms that support automated text-mining.  

NLM has stepped up its collaboration with publishers and scholarly societies to increase the number of coronavirus-related journal articles in PMC, along with the available data supporting them. NLM is adapting its standard procedures for depositing articles into PMC to make it easier and faster to submit articles in machine-readable formats. We’re also engaging with journals and publishers that do not participate in PMC but whose publications are within the scope of the Library’s collection. A growing number of publishers and societies are taking advantage of these flexibilities.

Submitted publications are being made available as quickly as possible after publication for discovery in PMC and through the PMC Text Mining Collections for machine analysis,  secondary analysis, and other types of reuse.

This enhanced collection of text-minable content enables AI and machine-learning researchers to develop and apply novel text-mining approaches that can help answer some of the many questions about coronavirus.

Along these lines, NLM and leaders across the technology sector and academia joined OSTP on Monday, March 16 to announce the COVID-19 Open Research Dataset (CORD-19). Hosted by the Allen Institute for AI, CORD-19 is a free and growing resource that was launched with more than 29,000 scholarly articles about COVID-19 and the coronavirus family of viruses.  CORD-19 represents the most extensive machine-readable coronavirus literature collection available for text mining to date. This dataset enables researchers to apply novel AI and machine learning strategies to identify new knowledge to help end the pandemic. Researchers can submit text and data mining tools to be applied to the dataset via the Kaggle platform.

Providing Other Resources

NLM’s efforts to support coronavirus-related research and response efforts are not limited to PMC. Key among the Library’s other important resources are:  

  • NLM’s GenBank Sequence Database — NLM created the Severe acute respiratory syndrome coronavirus 2 data hub, where people can search for, retrieve, and analyze sequences of the virus that have been submitted to GenBank. Our GenBank team is expediting the processing of all SARS-associated coronavirus sequences. Depending on the quality of submitted sequences, they are being annotated and released to the public as fast as 20 minutes after receipt and, in almost all cases, within 24 hours of receipt.
  • NLM’s Sequence Read Archive (SRA) — NLM’s SRA is the world’s largest publicly available repository of unprocessed sequence data which can be mined for previously unrecognized pathogen sequence. For example, a team from Stanford University recently reported that in a search of certain metagenomic datasets in the SRA, they identified a 2019-nCoV-like coronavirus in pangolins (a long-snouted mammal). This type of genetic sequence research can play an important role in understanding how the virus originated and is spreading.

NLM has also made the SRA available through commercial cloud providers participating in the National Institutes of Health’s Science and Technology Research Infrastructure for Discovery, Experimentation, and Sustainability (STRIDES) Initiative. Researchers may now compute across the full SRA dataset for metagenomic research on the new coronavirus in ways not previously possible.

  • NLM Intramural Research Contributions —NLM has a multidisciplinary group of researchers comprised of molecular biologists, biochemists, computer scientists, mathematicians and others working on a variety of problems, including some that relate to SARS-CoV-2/COVID-19. One such project is LitCovid, a resource that tracks COVID-19 specific literature published since the outbreak. This resource builds on NLM research to develop new approaches to locating and indexing the literature related to COVID-19 including a text classification algorithm for screening and ranking relevant documents, topic modeling for suggesting relevant research categories, and information extraction for obtaining geographic location(s) found in the abstract.

NLM is also providing targeted searches within several of its other information resources to help users find data and information relevant to COVID-19. These searches, available through the NLM home page, include information on clinical studies related to COVID-19 listed in ClinicalTrials.gov, and articles related to the SARS-CoV-2/COVID-19 in PubMed, NLM’s database of citations and abstracts to more than 30 million journal articles and online books.

These resources are already proving to be useful to the scientific community and others working together to address this public health threat.

We continue to seek new ways to support these efforts and demonstrate how libraries can best contribute. Please send us your ideas of how NLM can help you respond to the global health crisis or how your library is contributing.

Individual and Organizational Health Literacy: A Key to the Future of Health

As the Secretary’s Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2030 prepares its new statement for Healthy People 2030, NLM has been asked to review and comment on the definition of health literacy. This request has provided a good opportunity for me to consider how NLM facilitates health literacy — but more about that in a minute.

As a concept, health literacy has generated much attention and debate over the past 15 years. In 2004, the Institute of Medicine (now the National Academies of Sciences, Engineering, and Medicine) released Health Literacy: A Prescription to End Confusion. This report laid the groundwork for the idea that health literacy is more than the capacity of an individual to obtain, process, and understand the basic health information needed to make appropriate health decisions. Health literacy also involves system-level factors such as education, health services, and social and cultural influences.

This idea — of organizational health literacy — encompasses the ways in which services, organizations, and systems make health information and resources available and accessible to people, according to their individual health literacy strengths and limitations.

The white paper Ten Attributes of Health Literate Health Care Organizations proposes that health literate organizations share the following characteristics:

  1. Has leadership that makes health literacy integral to its mission, structure, and operations
  2. Integrates health literacy into planning, evaluation measures, patient safety, and quality improvement
  3. Prepares the workforce to be health literate and monitors progress
  4. Includes populations served in the design, implementation, and evaluation of health information and services
  5. Meets the needs of populations with a range of health literacy skills while avoiding stigmatization
  6. Uses health literacy strategies in interpersonal communications and confirms understanding at all points of contact
  7. Provides easy access to health information and services and navigation assistance
  8. Designs and distributes print, audiovisual, and social media content that is easy to understand and act on
  9. Addresses health literacy in high-risk situations, including care transitions and communications about medicines
  10. Communicates clearly what health plans cover and what individuals will have to pay for services

NLM contributes widely to individual health literacy. We provide information in many forms, from scientific articles in PubMed Central to health and wellness information for patients and their families and friends through MedlinePlus.

But what do we do in support of organizational health literacy?

When it comes to the accessibility of health information and services, we leverage technology to provide a range of machine-accessible pathways to our offerings. For example, our ClinicialTrials.gov application programming interface allows organizations to extract the clinical trials located in an organization’s specific region and display them on the organization’s own portal.

NLM’s MedlinePlus Connect allows health organizations and health information technology providers to link patient portals and electronic health record systems to MedlinePlus, supporting the in-the-moment delivery of personalized health information. We also foster the goals of organizational health literacy through our National Information Center on Health Services Research and Health Care Technology, which provides information on health services research and quality improvement as well as resources for public health professionals.

Please think about how NLM can better support health literacy — either individual or organizational — and share your ideas with me. It’s a key to the future of health!


Envisioning a Future of Better Patient Self-Management

For years, I’ve talked about the “care between the care,” which occurs between patients’ visits to the hospital, clinic, or ER. It’s abundantly clear that the real action is happening in everyday life, yet so much of our clinician education, information technology development, and standards of practice address only that very short time when patients are in the presence of physicians, nurses, pharmacists, or other providers.

We need to devise more interventions that target the care that happens between provider visits.

Like many directors of National Institutes of Health (NIH) Institutes, I have an active research program on the NIH campus. My lab, the Advanced Visualization Branch (AVB), is in the Division of Intramural Research at the National Institute of Nursing Research (NINR). The lab is motivated by one simple question: How can we help people with chronic conditions who are living at home better self-manage?

To address this question, we’re using a whole new set of methodologies involving immersive virtual reality (VR). VR is emerging as a robust research tool that lets investigators create realistic-appearing environments to study human behavior. This approach is particularly important for research on the challenges of self-management at home because the systematic study of behavior requires that we visit the same space repeatedly — something that’s hard to do with people in their homes in real life!

The AVB develops and evaluates augmented reality (AR) and VR experiences that engage participants in multisensory activities and examine their impact on health behaviors. Specifically, we develop interactive VR simulations that present health information to people with a variety of complex health conditions. These simulations provide visual cues that immerse participants in everyday settings.

Research demonstrates that teaching self-management skills is more successful and has a greater impact if those skills are taught in the environment where they will be used. There’s something about visual cues and spatial layouts that seems to reinforce the teaching process and help people develop new patterns.

Simulations that enable people to rehearse problem-solving behaviors in familiar, realistic-appearing environments foster improved health outcomes at home. AR/VR simulations also allow us to experiment with new ways of presenting information that aren’t possible right now but could be in the future.

Photo: University of WisconsinMadison

We could investigate, for example, whether a display of nutrition facts that hovers over a food container leads people to make more appropriate food choices. In addition, we’re developing methods to measure the impact of using AR/VR technology as a tool to aid disease-management nursing strategies during the transition from acute care settings to outpatient environments. Our work will help generate recommendations for how to best use emerging technologies in all types of patient care.  

The cross-disciplinary AVB team comprises staff with expertise in nursing research, informatics, neuropsychology, and digital engineering. The team creates virtual environments to observe, quantify, and assess objective indicators of behavior (e.g., performance, physiological) and subjective perceptions (e.g., mood, user experience, self-rated symptoms) in controlled, complex environments. The results are then used to evaluate individual differences in symptom expression, the delivery of effective health care education, and the utility of VR in engaging patients and improving health-related behaviors.

Photo: Advanced Visualization Branch, NINR

Currently, the AVB’s research focuses on environments for studying the impact of fatigue on everyday activities, evaluating interventions targeting dietary choices by individuals with chronic medical conditions, and helping people better use pillboxes for safe medication management at home.  

While the main focus of my work life is leading NLM, conducting a program of research at NINR enriches my thinking and helps me envision new ways for the Library’s resources to reach people. My research as a nurse-investigator will engender new ideas and help us devise new strategies for delivering the important, consumer-oriented information provided by NLM through our outreach initiatives and MedlinePlus.

Maybe you could help us, too! Researchers interested in the use of technology for patient self-management might consider submitting an application to our Personal Health Libraries for Consumers and Patients grant opportunity.


Share Your Thoughts on NIH’s Research Priorities

Guest post by Leigh Samsel, MS, NLM Planning and Evaluation Officer and NLM representative to the NIH-Wide Strategic Plan Working Group.

The National Institutes of Health (NIH) is developing its next NIH-Wide Strategic Plan, and we’re asking for your input. This plan will help NIH capitalize on new opportunities for scientific exploration.

Building on the previous NIH-Wide Strategic Plan, the new plan will guide NIH’s research efforts for Fiscal Years 2021–2025. The framework articulates NIH’s priorities in the following key areas:

  • Biomedical and behavioral science research
  • Scientific research capacity
  • Scientific integrity, public accountability, and social responsibility in the conduct of science

In addition, the framework identifies several cross-cutting themes that span the scope of these priorities.

The goal of this NIH-Wide Strategic Plan is to highlight major themes that encompass all of NIH. It is not intended to outline the numerous important research opportunities for specific disease applications, which are covered in the existing strategic plans developed by the 27 Institutes, Centers, and Offices that make up NIH.

I hope you’ll review the strategic plan framework described in the Request for Information (RFI) and provide feedback using the RFI submission site.

Responses to the RFI will be accepted through March 25**.  NIH is encouraging stakeholder organizations (e.g., patient advocacy groups, professional societies, etc.) to submit a single response reflective of the views of the organization/membership as a whole.

** Update: The deadline has been extended until 11:59 pm, April 1, 2020.

Want to Learn More?

NIH is hosting two webinars in March to describe the planning process and answer questions. Those dates are:

  • Monday, March 9 – 1:30 pm – 2:30 pm EST
  • Monday, March 16 – 10:00 am – 11:00 am EST

Additional details about the webinars can be found on the NIH-Wide Strategic Plan webpage.

Your input is vital to ensuring that the NIH-Wide Strategic Plan for Fiscal Years 2021–2025 puts biomedical research on a promising and visionary path. I appreciate your time and consideration in assisting NIH with this effort.  

Leigh Samsel, MS, is responsible for formal reporting of NLM activities and for providing staff leadership to strategic planning activities.

What Does Black History Month Mean to Me?

Each year, in February, the United States celebrates Black History Month, commemorating the achievements of African Americans and recognizing their central role in the history of our country. While some advocate for yearlong awareness of issues that are often highlighted during Black History Month — such as voting rights and access to health care — I personally find that setting aside a specific time to reflect, as a nation, on these important matters can help prevent them from getting lost in the everyday conversation.

As I think about how NLM can better serve African Americans, I know we must take into account the fact that their health care experiences, which include issues of access and outcomes, frequently differ from those of other Americans. I find two initiatives at the National Institutes of Health (NIH), addressing the greater risk of maternal mortality among women of color and the health challenges related to heart disease and stroke experienced specifically by African Americans, particularly inspiring.

As I prepared this blog, a surprising insight, at least to me, was the connection between cardiovascular risk and maternal mortality. African American women in the United States have a pregnancy-related mortality ratio (number of pregnancy-related deaths for every 100,000 live births) of 42.8, which is more than three times the rate of white women. Furthermore, the high ratio of maternal mortality among African American women cuts across all socioeconomic levels. While there appear to be various factors that influence pregnancy-related deaths, cardiovascular disease, particularly risk factors such as high blood pressure, is implicated in many cases.

What can NLM do to foster health equity among African Americans, particularly African American women?

We can support research and open access to the literature that provides the foundation for developing clinical guidelines and informing clinical care. Key NLM health disparities and minority health information can be found on our MEDLINE®/PubMed® Search and Health Disparities & Minority Health Information Resources page. We developed this page in collaboration with the National Institute on Minority Health and Health Disparities and maintain the content to ensure we’re providing the most up-to-date resources available. While accessible to anyone, this page is primarily for health care professionals and researchers and provides the following:

  • A link to a comprehensive PubMed search on minority health and health disparities
  • The complete details of the search, so users can see the strategy used and can add specific terms, such as maternal mortality and hypertension
  • A list of links to additional NLM resources, NIH resources, and other federal resources on this subject, as well as to associations, foundations, and research centers

The Library also has information for patients and their families. Our world-famous MedlinePlus® online resource provides, in plain language, direct-to-consumer information (in English and Spanish) about diseases, conditions, and wellness issues. For example, a search using the terms pregnancy, African American, and high blood pressure returns almost 100 short articles and fact sheets that discuss how to recognize and manage high blood pressure during pregnancy. Sometimes a MedlinePlus search provides a pathway to unanticipated, but related, health information, such as the link between heart disease, stroke, and diabetes.

The goal of reducing maternal mortality related to cardiovascular problems among African American women requires a concerted effort linking basic science, clinical care, and patient self-management. It’s also critical to develop strategies across the full spectrum of prevention, including primary prevention of cardiovascular problems among African American women; secondary prevention that supports the early diagnosis of women at high risk for pregnancy-related cardiovascular complications; and tertiary prevention that includes aggressive care interventions before, during, and immediately after childbirth to better manage the problems of women who experience cardiovascular-related complications during pregnancy. 

The effectiveness of NLM is centered around our development and distribution of scientific literature that leads to biological discoveries and supports clinical care strategies; our curation of massive genomic and molecular databases that support scientists trying to isolate genetic precursors of disease and identify promising targets for pharmacological intervention; and our outreach to clinicians, patients, and family members about the vast professional and consumer-focused resources available to promote health and self-management. 

Let me know what else we can do to better serve the health needs of all African Americans and improve pregnancy-related health outcomes for African American women. Together, we can make the health of African Americans a year-round focus.