With Gratitude

What is it like to be feted for a lifetime of work?

I never imagined I’d have the chance to answer that question, but I found out early last month when I received the Morris L. Collen Award from the American College of Medical Informatics at the annual AMIA meeting in San Francisco.

The accompanying celebration was full of the joy of family and friends. My sister Kathleen brought my almost 90-year-old mom out from Philadelphia, and my son, Conor, joined us from Seattle. As a result, my family got to meet my friends, and my friends met my family, creating a delirious mix of my professional, personal, and family lives over a three-day period. I soaked up the excitement, basking in the love and floating on people’s kind and generous words. The experience left me feeling complete and centered in a way I never had before, as if the intersection of these parts of my life simultaneously anchored and inspired me, reminding me where I’ve come from and the countless steps I’ve taken through a career in nursing, academia, and federal service and highlighting how these many threads have woven together to create the person I am and the work I’m doing today.

formal headshot of Dr. Patricia Flatley Brennan with the Collen Award medallion draped around her neck
Patricia Flatley Brennan, Collen Awardee

I also found tremendous joy and satisfaction in the attention the Collen Award brought to the work we do here at NLM and to the remarkable accomplishments of the Library’s previous Collen Award recipients: Don Lindberg, Betsy Humphreys, and Clem McDonald, all of whom were and are exceedingly dedicated to improving health care and biomedicine. Their contributions to the field have helped shape NLM into the trustable resource it is today, and I’m proud to stand in their company.

In fact, part of what drew me here for this phase of my career is to build upon their work providing outstanding, trustable health information in the service of patients and their families. After all, the most important person in the health care process is the patient. He or she is the reason for it all—the research, the training, the technology; the doctors, nurses, and orderlies; the biomedical engineers, informaticists, and medical librarians. We’re all here to improve the health and life of patients.

But there is more to be done.

I will be eternally grateful for the professional recognition I’ve received. The Collen Award is an honor I will treasure, and sharing that honor with my family and friends yielded memories I will cherish for a lifetime. But my work continues, and I’m thankful that it’s here, leading this amazing institution with its almost 1,700 women and men, each serving science and society in their own ways. Thank you all for being a part of my team. The world has never needed our efforts more than it does now.

Embracing the Future Change as Stewards of the Past

An Updated View from NLM’s History of Medicine Division

Guest post by Dr. Jeffrey S. Reznick, Chief of NLM’s History of Medicine Division.

Nearly two years ago, I wrote on this blog that embracing the future means engaging and grappling with change. Now, with our institution beginning to implement its new strategic plan, NLM’s History of Medicine Division continues to leverage its recent programmatic successes to embrace the change afoot here in the world’s largest biomedical library. As responsible and responsive stewards of the past, we have been working to anticipate and prepare for the needs the future.

As they have for so many other federal agencies, public-private partnerships have been key to our embracing change. Last year, in cooperation with Arcadia Publishing, we wrote, edited, and published a new and freely-available illustrated history of the Library, as part of Arcadia’s popular Images of America series. The book showcases the research and writing talents of our colleagues, including archivists, conservators, curators, historians, librarians, and technical specialists. Together, we showed that change has been a hallmark of the Library’s long history, through technical innovation, visionary leadership, and skillful work completed by a diverse and dedicated cadre of civil servants.

Public-private partnerships have also driven efforts to digitize, preserve, and make available our world-renowned collections. Last year, for example, in cooperation with our colleagues at the Wellcome Trust, we reached the half-million page milestone of the project to make freely available thousands of complete back issues of historically significant biomedical journals through PubMed Central (PMC) and its European counterpart, Europe PMC. Then, earlier this year, we completed the digitization of more than 12,000 pages of manuscripts from 15 archival collections in partnership with Adam Matthew Digital, a digital publisher of primary source collections from archives around the world.

With the growing volume of historical digital content available both here and at other archives, NLM is also embracing change by encouraging fresh approaches to studying and analyzing these collections. Through our ongoing partnership with the National Endowment for the Humanities, we hosted Viral Networks: An Advanced Workshop in Digital Humanities and Medical History. The workshop brought together scholars of medical history whose research makes innovative use of methods, tools, and data from the digital humanities. We expect the resulting scholarship to demonstrate the impact of mining digital surrogates and their associated metadata in data-focused research and help inspire new audiences to make use of these unique historical materials.

As an example of what such original approaches can uncover, our blog series Revealing Data explores what researchers from a variety of disciplines are learning now from centuries of preserved data. Their work also helps us think about the future preservation and uses of the data we collect today.

In that vein, we have embraced change by broadening NLM’s archival collections to include born-digital formats such as websites, social media, and data sets. Our Web Archiving and Collecting Working Group is leading the way with its collections on Ebola, Zika, HIV/AIDS, and the opioid epidemic. These web-based collections preserve for future research the ephemeral online record of modern health crises, documenting the work and experiences of health care providers, researchers, government agencies, news agencies, patients, and caregivers.

We have looked to embrace change by creating exhibitions that break new ground in demonstrating the research and educational value of our collections. And through our blog’s Making Exhibition Connections series we have been exploring the impact of those exhibitions as they travel across the country and around the world. Our latest exhibition on the emerging genre of graphic medicine, for example, gives voice (and image) to the personal experiences of patients, medical professionals, and family caregivers as they work within or work to navigate the health care field, providing insight into the emotional aspects of those experiences.

Such fresh perspectives help us engage new audiences, which is one more way we are embracing change. The Washington Post recently published three different stories about our outreach to the public—highlighting our blog, Circulating Now, spotlighting our exhibition on the history of domestic violence as a health issue, and featuring a few of the Library’s rare books in a story about the historical medical connections in the Harry Potter novels.

Finally, embracing change means supporting others’ professional development and helping them advance in their careers, face challenges, seize opportunities, and succeed in a climate of change. Whether through mentorships, formal courses, or on-the-job learning, we are developing and supporting the next generation of leaders both in our division and across our institution. And the efforts are paying off. Staff have frequently published or presented on their work—at Penn State Health’s Humanities First Friday and the Orphan Film Festival, among many other venues—and their success translates to NLM’s success, as we reach new audiences and connect them to the Library’s historical collections.

As the future of the National Library of Medicine unfolds—indeed as our institution continues to change as it always has to serve the public—its History of Medicine Division will continue to embrace change and look to the future.

More by Dr. Reznick
With Dr. Frederick Gibbs, Teaching and Researching the History of Medicine in the Era of (Big) Data: Reflections
With Dr. E. Thomas Ewing, History matters…through partnerships that advance research, education, and public service

Two Years and Running Strong

Celebrating another blog birthday

A little over two years ago, I wrote my first post for NLM Musings from the Mezzanine. Since then, we have not missed a single week! (And a couple of weeks we published twice.) I attribute the streak in no small part to my muse and master, Mary Ann Leonard, who ardently translates my drafts into powerful prose and keeps me motivated with content maps, publication calendars, and the occasional inspirational push.

While I’ve authored 70 blog posts in that time, we’ve supplemented that with 37 guest posts from an array of colleagues, from NLM staff to hospital librarians to patient advocates. It’s a privilege to share their perspectives and expertise on topics ranging from biomedical informatics to basketball, with fair use, disaster preparedness, metagenomics and a host of others in between. And I’m happy to open this platform to them to highlight their ideas and expose their accomplishments, issues, challenges, or initiatives to a larger audience.

Out of the 107 posts published so far, I can’t help but have my favorites.  Walk with Me While I Walk with Those who Walked for Freedom allowed me to reflect on how different populations experience health and access to health care.  Vint Cerf inspired me to think about how NLM could deliver its services in outer space, an initiative that could help us better support communities here on Earth that lack electricity or stable internet. And the contributions from hospital librarians highlight the important roles libraries serve in clinical settings.

I regularly monitor how posts are received, whether through comments or social media. Some posts can garner almost one thousand “shares,” while others struggle to get ten. What does that tell me? That perhaps I did not make my point clearly or strongly enough or that the content did not resonate with my readers. But when I hit the mark and my share count goes up, I feel thrilled to have connected with readers and to have conveyed messages they want to share with others.

I like hearing from people who’ve read the blog, and I appreciate the ideas and perspectives I gain from that exchange. Sometimes people post comments on the blog post itself—and I wholeheartedly encourage and welcome your input—but people also approach me at meetings or conferences to mention something they’ve read. My sisters are avid readers, and occasionally a brother or two will join the mix, so family visits can even prompt some discussion of what I’ve written or what’s going on here at the Library.

Regardless of whom I writing to, I’ve learned to consider how readers might perceive what I am saying and to use those insights to clarify my point, reframe the situation, or refine my argument. That process not only improves my writing; it also hones my thinking and helps me see more fully the topic, the situation, or the path ahead, all good things when you’re leading a large, complex institution.

In that way, the blog helps me work through ideas I’m wrestling with, but it also serves as a means of voicing concerns, announcing new initiatives or program changes, or sharing a bit about myself and how I approach my job as library director. But more than anything else, I appreciate the blog’s role as a weekly reminder to step back and contemplate the work we do here and our services to science and society.

In the coming year, I’m going to turn my attention more toward the science side of that equation. You can expect more posts about our expanded investments in basic biomedical informatics and data science research. I’ll keep you informed about new partnerships with domain scientists to build tools that will accelerate discovery. And we’ll be tackling some complex policy issues as well, such as the data life cycle and the Library’s responsibility to support rigor and reproducibility within federally funded research.

Through it all, week in and week out, I’ll continue to use this blog to open a window into the Library, its operations, and its commitment to biomedical discovery and the health of society. See you next Tuesday!

Wanted: Big Hairy Audacious Goals

We have a strategic plan. And that plan has three sound and notable goals. So why do we also need a big hairy audacious goal?

The easy answer is that the Blue Ribbon Panel tasked with reviewing NLM’s intramural research program suggested it.

But the real answer pushes us further: To break the limits on our thinking and spark urgency.

Such a bold, risky goal quickens the pulse, sparks excitement, even kindles a bit of fear.

If we are going to achieve that, then we had better get moving.

But what should that be?

The Blue Ribbon Panel offered three ideas (PDF), each building on NLM’s “remarkable track record of research innovation and impact.”

  1. Next-Gen PubMed
    Make PubMed the discoverability engine for the world. Transform it into the single point of access to an array of information types in the life sciences, including data sets, standards, clinical trials, federal health resources, and data science tools and methods. Integrate sophisticated inference capabilities that identify semantic relationships to pull together related content and deliver active learning capabilities and insights, not just hits.
  2. Computational public health
    Create automated tools for disease surveillance and prediction, combining data from disparate sources, including other federal agencies and global partners. Link clinical and epidemiological data to whole genome sequence data for microbial pathogens to rapidly detect, identify, and mitigate the impact of emerging pathogens, pandemics, or malicious attacks.
  3. Artificial Intelligence in medicine
    Build the tools and data management approaches that draw upon large volumes of personal health data to enable automated and precise diagnoses, prognoses, and patient treatment plans.

Whoa. What?!

Any one of these will take years—and a lot of work, skill, coordination, and even luck—to achieve, but then that’s the idea. Big, hairy, audacious goals aren’t meant to be easy. They’re meant to get us reaching beyond what we thought possible.

In the context of NLM’s intramural research program, the Blue Ribbon Panel highlighted several attributes that such goals should possess:

  • Integrate multidimensional data, including temporally dynamic data
  • Impact many fields of biomedicine (including population health)
  • Challenge experts in user interface and user experience
  • Represent difficult multi- and interdisciplinary research challenges
  • Build on unique strengths at NLM and NIH
  • Provide measures of impact and success
  • Require interactions with other agencies
  • Raise profound informatics and data science research questions
  • Represent a substantial engineering challenge for scaling and dissemination

Can we do it?

The Blue Ribbon Panel thinks so. They noted that NLM has achieved tremendous ambitions in the past, including the Unified Medical Language System, the foundational work that enabled CRISPR-Cas, and machine indexing of the world’s biomedical literature.

But is one of their three suggestions the clear and compelling goal that will get us where we want to be?

NLM will be working with stakeholders to examine that question and to identify and lay the groundwork for its future research agenda, but in the meantime let me ask you:

If you wanted to galvanize research across NLM and inspire the larger scientific community, what would you do? Let us know below.

The Blue Ribbon Panel, comprised of nine external experts in biomedical informatics and data science, was asked to look at the following issues:

    • the strengths and weaknesses of NLM’s intramural research program as a whole
    • the quality of it research and training programs
    • the appropriateness of its organizational structure
    • its relationship to other NIH Institutes and Centers
    • its interactions with NLM’s highly regarded and widely used health information services and tools
    • the effectiveness of its review and evaluation processes
    • the suitability of its research facilities.

NLM has already begun reviewing the Blue Ribbon Panel’s recommendations (PDF) and charting a course forward. I’ll keep you apprised of our steps and strategies over the coming year.

Seeking Innovative Methods in Biomedical Informatics and Data Science

Guest post by Dr. Valerie Florance, Director of the NLM Division of Extramural Programs.

It is an exciting time to be a biomedical informatician or data scientist.

First, NLM has committed to transforming the infrastructure of biomedical research and health care. In support of that, NLM’s research grant programs help fund the computational, informatics, and information science aspects of biomedical research to develop and test novel methods with broad application to the research enterprise. NLM supports projects ranging from machine learning to information visualizations, virtual environments, and more.

Second, biomedical data are becoming more readily available. In fact, the production and availability of biomedical data that can be re-used for new research are expanding quickly as NIH works to ensure data generated in NIH-funded research are shared.

Third, Congress has funded several large-scale biomedical research programs at NIH, including the Cancer Moonshot, the HEAL Initiative (Help End Addiction Long-term), and the BRAIN Initiative (Brain Research through Advancing Innovative Neurotechnologies). These represent new opportunities for informaticians and data scientists to bring informatics and data science innovation into the heart of basic biomedical research.

For example, the HEAL Initiative, targeting the opioid epidemic, is studying the biological factors involved in chronic pain. One line of research focuses on discovering and validating biomarkers, biomarker signatures, and endpoints for pain (with a related workshop coming up November 14 and 15, in Washington, DC.). NIH has released multiple funding announcements supporting the HEAL Initiative, with NLM participating in those with computational or informatics elements.

Informatics also cuts across the work of the NIH BRAIN Initiative, which is aimed at revolutionizing our understanding of the human brain. The initiative is focusing its first five years (2016-2020) on developing tools and technologies to advance the field of neuroscience research. The second five-year period will concentrate on applying and refining those tools. A current request for information, open until November 15, 2018, seeks new ideas and directions for the next five-year period.

These two examples of large-scale biomedical research initiatives will benefit tremendously by the extramural community of informatics and data science researchers becoming involved. I encourage your input and participation.

If you do not already subscribe to the weekly update of the NIH Guide to Grants and Contracts, now’s the time to do so, as all new announcements for initiatives such as these will be published there in the coming months. You can also sign up to receive updates specifically about the HEAL Initiative, including webinars and other events.

It is an exciting time to be a biomedical informatician or data scientist, and it’s an even more exciting time to partner with NLM and NIH as we work to accelerate data-driven discovery.