Innovation through Imagination — Envisioning the Future of Technology-Supported Care

Part 2 of a three-part series discussing the importance of imagination.

I’ve been thinking a lot about imagination lately and how essential it is for stimulating innovative approaches to complex problems. We need innovation in health information technology (health IT) now more than ever with what we’ve been through — a global pandemic, rising calls for eliminating racial biases that contribute to health disparities, wildfires, and other perils. Imagination (the ability to envision what one has never seen, experienced, or heard about) helps transfer the recognition of the power and importance of medical informatics into real innovations that can improve the care of patients and reduce clinician burden.

Enormous patient needs for rapid diagnosis and treatment of unfamiliar and unpredictable diseases increasingly tax an overburdened health care system. Biomedical informatics professionals need to rise to the challenge of systems redesign, new architectures that account for distributed data structures, and the almost insatiable need for information in the moment — decision support under immense urgency and uncertainty. I believe that these new challenges require new ways of action.

In a previous blog post, I encouraged nurses to develop the skill of imagination because it

… stimulates innovation through the experience of a mental what-if, unconstrained by the realities of physics or finance. Imagination is a talent that can be learned and refined over time, benefiting from the reinforcement of envisioning that which might be, and using that vision as a test case for that which can be. 

Imagination expands the human repertoire of planning skills, moving beyond reflexive action and problem solving. Reflexive thought may lead to speedy solutions, and effective problem solving may contribute creative solutions that are responsive to identified constraints. I believe we need to meet tomorrow’s challenges now with solutions that will work into the future – a future that is likely to continue to be characterized by uncertainty and urgency. The future calls for creativity to stimulate innovation through imagination. Imagination may hold the key to devising biomedical informatics solutions that are rigorous enough to be relied upon in life-threatening situations, and robust enough to accommodate team approaches to unpredictable needs for innovative care strategies.

Philosopher Edward Casey recognized two types of imagination: spontaneous and controlled. Both are mental activities, engaging our active consciousness. Spontaneous imagination is characterized by surprise and instantaneity, like the playful stories of children or mental woolgathering while sitting in a beautiful garden. Controlled imagination is a purposeful strategy in which you focus on a specific idea or concept, and use mental powers of reasoning and forethought to anticipate future scenarios. While both types of imagination are important for effective design for biomedical informatics innovation, I am encouraging my colleagues to pay particular attention to growing their capacity for spontaneous imagination.

How does one grow the capacity for spontaneous imagination?

Contrary to the fast-paced, ‘get-it-done’ mindset that has characterized much of past years health IT efforts, a measured, slower pace is needed to create the right conditions for spontaneous imagination to emerge. This means intentionally setting aside time, short or long (without distractions or commitments) and placing yourself in a pleasant environment. It’s not necessary to come to this moment with a specific knotty problem or challenge to think through. In fact, such thoughts are likely to hamper the generation of spontaneous ideas. Spontaneous thoughts that may see far removed from your daily pursuits hold great value in training your mind to attend to new ideas and new fascinations. Avoid appraisals and self-criticism – there are many ways to train our mind to be attentive and aware, and setting aside time, perhaps 2-3 times a week, to just let your mind wander is a great start.

Why am I encouraging what sounds like new-age mantras during a time when we need solutions FAST? I am convinced by the research that cultivating open-ended periods of imagination complements already well-honed mental skills of planning and design. Opening your mind to better connect with what feels creative and interesting increases confidence in judgments about what is relevant in a situation. There is some evidence that spontaneous imagination evokes mental processes similar to meditation and results in improved problem solving and creative solution generation. Noted economist, Daniel Kahneman, advocates that decision makers balance the human tendency to think fast with deliberately thinking slowly to make better decisions. Developing the skill of spontaneous imagination is one way to improve one’s ability to think slow.

Fueling innovation through imagination will improve your ability to recognize nuances and triggers in situations, avoiding the pitfalls of reflexive thinking and expanding the design space. Imagination helps the innovator consider “what if . . .” rather than “how to”— defining the future state before designing the pathway to get there and illuminating consequences not previously recognized. Cultivating imagination increases one’s ability to tolerate uncertainty, resisting the impulse towards premature closure, and settling for adequate but potentially less-than-optimal solutions.

NLM does many things to help cultivate imagination-fueled innovation. We provide access to inspirational literature, and through effective use of the features of the My NCBI tool, you can customize your experience based on previous search interests and receive alerts when related articles appear in the biomedical literature. We fund research to discover new ways to help clinicians envision patients’ response to therapeutics. This includes the work of Antonina Mitrofanova, who is developing and sharing, through a web portal, a bioinformatics analytics system that identifies therapeutic resistance and predicts patients at risk of treatment failure. We promote open access to scientific data through our vast genomic and molecular databases, including our Sequence Read Archive, now freely available through commercial cloud services. And, through our Network of the National Library of Medicine, we work to connect communities around the country to research opportunities and trusted health information.

Imagination-fueled innovation will accelerate the design and deployment of biomedical informatics solutions to the challenges of responding to patient needs under increasingly unpredictable and demanding situations, from pandemics to natural disasters. Let’s partner with you to cultivate imagination and be the innovator only you can be!

Thanks, Dr. Fauci!

Perhaps the most famous NIH staffer right now is Anthony Fauci, MD, Director of the National Institute of Allergy and Infectious Diseases (NIAID), and one of the leading voices throughout the COVID-19 pandemic. Prepared by more than 50 years of government service and research on infectious diseases, Dr. Fauci is a public servant who brings reason, expertise, and a keen sense of how to mobilize the public health sector to act against this unprecedented threat to public health.

Like many others around the country and the world, my family and I think of Dr. Fauci as “our doctor.” He speaks to us, giving a personal response to ensure the public’s health. He understands the challenges of having family at a distance during times when travel and family gatherings are discouraged to reduce the spread of infection. He shares the joys of those reunions—full of hugs from family and friends—so long missed. It’s amazing to me that Dr. Fauci has been able to convey such warmth and concern to the world and be the deliverer of trusted knowledge in such a personal manner. More than once, conversation at a family dinner or on a family phone call has included the question, “But what does Dr. Fauci think about . . .?” followed by heartfelt wishes of gratitude from my mother and siblings!

I am privileged to be part of the NIH leadership team who meets weekly to advance the mission of the world’s largest research enterprise. While we address wide ranging issues from advancing biomedical science to NIH infrastructure and operations, discussions about NIH’s response to the COVID-19 pandemic still dominate. Like others, I find Tony a wise and experienced colleague, thoughtful in his contributions, and quick to bring a sometimes much-needed touch of humor into complicated conversations. I marvel at his stamina and the breadth of issues that engage his mind.

Tony Fauci has built a superb team of scientists, clinicians, and administrators within NIAID. The dedication and intellectual generosity evident in his contributions to our efforts are evident across NIAID – clearly an inspirational leader motivates and inspires!

So please join me in expressing gratitude to my colleague, Tony Fauci – a national treasure!

Request for Public Comment: Seeking Input on Nationwide AI Research Resource Implementation Plan

Guest post by Lynne E. Parker, PhD, Director of the White House National Artificial Intelligence Initiative Office, and Erwin Gianchandani, PhD, National Science Foundation Senior Advisor for Translation, Innovation, and Partnerships

The White House Office of Science and Technology Policy and National Science Foundation are looking for your input to shape the work of the National Artificial Intelligence Research Resource (NAIRR) Task Force. This Task Force is taking on a critically important initiative – building an implementation plan for a national infrastructure that would democratize access to artificial intelligence (AI) research and development (R&D).  

As directed by Congress in the National AI Initiative Act of 2020, the Task Force is serving as a Federal advisory committee to help create a blueprint for the NAIRR, which is envisioned as a shared computing and data infrastructure that would provide AI researchers and students across all scientific disciplines with access to computational resources, high-quality data, educational tools, and user support. This capability would help make AI R&D accessible to all Americans by lowering the barriers to entry for traditionally underserved communities, institutions, and regions. It would also fuel innovation by making it easier than ever before for Americans to pursue bold, visionary applications for AI.

The Task Force will provide recommendations for establishing and sustaining the NAIRR, including technical capabilities, governance, administration, and assessment, as well as requirements for security, privacy, civil rights, and civil liberties. The Task Force will submit two reports to Congress presenting a comprehensive strategy and implementation plan: an interim report in May 2022 and final report in November 2022.

To get this right, we want to tap into the deep technical expertise of the community and bring in a range of perspectives. We invite you to submit a response to our Request for Information before the comment period closes on October 1, and ask that you spread the word. This effort could set us on the path to transform our nation’s ability to harness AI across fields of science and engineering and economic sectors, and your insights could help shape our approach.

We appreciate your contributions and look forward to receiving your input.

Dr. Parker is the Founding Director of the National Artificial Intelligence (AI) Initiative Office and Assistant Director of AI in the White House Office of Science and Technology Policy (OSTP).  In these roles, she leads national AI policy efforts and coordinates AI activities across the Federal agencies in support of the National AI Initiative.  Dr. Parker is a professor of computer science at the University of Tennessee, on assignment to OSTP. She received her PhD from the Massachusetts Institute of Technology and is a Fellow of the American Association for the Advancement of Science and Institute of Electrical and Electronics Engineers.

Dr. Gianchandani is the National Science Foundation (NSF) Senior Advisor for Translation, Innovation, and Partnerships. For six years, he was the NSF Deputy Assistant Director for Computer and Information Science and Engineering. In this role, he contributed to the leadership and management of NSF’s CISE directorate, including formulation and implementation of the directorate’s $1 billion annual budget, strategic and human capital planning, and oversight of day-to-day operations. He received a BS in computer science and MS and PhD degrees in biomedical engineering from the University of Virginia.

Going Back to School Safely

Guest post by Diana W. Bianchi, MD, Director, Eunice Kennedy Shriver National Institute of Child Health and Human Development at the National Institutes of Health

Originally released on the Director’s Corner blog.

As schools across the United States begin to resume full-time, in-person education, I am hopeful that this academic year may be a more typical one. The in-person school environment and the wide range of services offered there are critical for the development and well-being of our nation’s young people. Without in-person schooling, many children miss out on school-based meals, speech or occupational therapy, and after-school programs. Loss of such services disproportionately affects minorities, socially and economically disadvantaged children, children with disabilities, and those with medical complexities.

Generating robust scientific data to inform policies to return children to the classroom safely and equitably during the ongoing COVID-19 pandemic is of paramount importance not only for children, but also to allow their parents to return to work. We now have safe and effective vaccines available for adults and children ages 12 years and older, as well as established public health measures to prevent transmission of SARS-CoV-2, the virus that causes COVID-19. Yet the emergence of the more transmissible delta SARS-CoV-2 variant and the rising COVID-19 cases across the country remind us that we must remain vigilant and adaptable to changing circumstances.

NICHD manages the Safe Return to School Diagnostic Testing Initiative, launched earlier this year as part of the NIH Rapid Acceleration of Diagnostics-Underserved Populations (RADx-UP) program. This initiative addresses the needs of children with unequal access to COVID-19 testing and who face barriers to attending school remotely, including those who do not have adequate equipment, internet access, or adult supervision at home.

The RADx-UP Return to School projects combine frequent COVID-19 testing with proven safety measures to reduce the spread of SARS-CoV-2. They also are exploring the influence of vaccination for eligible staff and students, addressing vaccine hesitancy, and seeking information on circulating SARS-CoV-2 variants and breakthrough infections. Funding for the first set of projects was announced in April, and additional projects were funded in July. Currently, 16 projects are ongoing at schools across the country, including public, charter, tribal, early education, and special education schools. Participating schools serve racially and ethnically diverse populations, including African Americans, American Indians/Alaska Natives, Latinos/Latinas, Asian Americans, and Native Hawaiians and other Pacific Islanders. Critically, several projects include children with medical complexities and/or intellectual and developmental disabilities who may not be able to use COVID-19 mitigation measures such as wearing masks or social distancing.

On August 9, NIH hosted a virtual workshop that brought together RADx-UP Return to School investigators and other researchers conducting school-based research on COVID-19 diagnostic testing to present data acquired to date, learn from each other, and support the safe return of children to in-person school.

Among other topics, workshop participants discussed the critical importance of engaging local communities in this research. Communities need access to the most up-to-date scientific evidence to weigh the benefits and challenges of implementing different COVID-19 mitigation strategies. Scientists need community input to understand the attitudes, knowledge, and barriers that may influence individual choices to enroll in COVID-19 testing programs and return to in-person learning. By working together, we can ensure a safe return to school for all.

Imagination – The Cornerstone of Innovation

Part 1 of a series discussing the importance of imagination.

Everyone is talking about the “new normal” now — the post-pandemic space after we return to the physical location of work, school or play— and asking, what will life be like? There are many calls for innovative thinking. One of the best things about a library is that it provides a foundation for innovation, but building the pathway between great science, good ideas, and innovative products and services takes imagination. NLM is a springboard for innovation in health care, from describing previously not-well-understood biological processes to creating new drugs and therapeutics. Even taking the leap from this springboard requires imagination!

Imagination is a process of the mind somewhere between cognition, recall, and play, that allows a person to create novel ideas, sensations, and visualizations. Somewhere between play and wool-gathering, imagination is the capacity of an individual to conjure up ideas that can be pleasing or frightening, phantasmagoric or peaceful. Sometimes the experience of imagination is a self-contained pleasure; other times it becomes a catalyst for new ways of living or new products and services that can help the public in different ways.

Imagination is the starting point for innovation. It stimulates innovation through the experience of a mental what-if, unconstrained by the realities of physics or finance. Imagination is a talent that can be learned and refined over time, benefiting from the reinforcement of envisioning that which might be, and using that vision as a test case for that which can be. Everyone can exercise imagination, and through this practice, make the world around them a better place!

Nurses are pretty good at applying imagination to complex patient care situations. Take, for example, Marie Van Brittan Brown an African American nurse living in the Jamaica neighborhood in the New York City borough of Queens. In the early 1960s, she and her husband Albert, an electronics technician, imagined a way to help people feel and be safe in their homes.

Figure 1: Diagram of the original 1966 patent request filed by Marie Van Brittan Brown and Albert L. Brown courtesy of the U.S. Patent and Trademark Office.

Being and feeling safe at home is particularly important for homebound individuals. Many homebound individuals live alone and are isolated. They may lack the physical ability or strength to investigate a strange sound outside or answer a ringing doorbell. Ms. Brown and her husband imagined that homebound people would feel safer at home if they had a way to see through the front door and interrogate a visitor and, if necessary, activate an alarm to alert the police that help was needed. Envisioning a set of peepholes, microphones, and a closed-circuit television, they created the first modern home security system. A monitor installed in the home or bedroom of the resident allowed ease of viewing and enabled the resident to speak to someone outside the door. Ms. Brown and her husband were awarded a patent in 1969 for this system.

Like many people who use imagination to stimulate innovation, Ms. Brown found herself far ahead of her time. In the 1960s, closed circuit TV was considered a military application, and home builders found the cost of the system to be too high. However, having the forethought to register their design and seek a patent, they provided the “prior art” that later stimulated over 30 patents.

What helps build the pathway from science to imagination to innovation begins with an idea that addresses an important problem. Imagination complements science, making it possible to see what science enables. Achieving the full promise of innovation again requires a dose of science because leveraging what is already known to what could possibly be is what brings an imagined future into an innovative reality. It takes imagination to sketch out a future, and even more imagination to find (or build) the elements needed to make that future real.

NLM stands as a partner in your imaginative journey. Keep practicing and let us know how we can help you innovate the future you can imagine!