In Celebration of the NLM Workforce on Labor Day

Since its inception in 1882, Labor Day has served many purposes in the United States. Celebrated on the first Monday in September, this observance is a creation of the labor movement and dedicated to recognizing the contributions and achievements of American workers. Over time, Labor Day weekend has become a symbol of the unofficial end of summer, the last hurrah before the beginning of the school year, the switch point from summer to fall sports, and even a day for major sales in stores around the country.

To me, as director of NLM, Labor Day signifies a time to express my gratitude for the efforts of the 1,700 people who work at the Library. We count among our workforce scientists and scholars, librarians and lawyers, biologists and budget specialists, trainees and volunteers, and a host of physical plant staff who manage our buildings and grounds. I am constantly in awe of the contribution each person makes that — taken together — transforms data into knowledge and knowledge into health.

NLM employees listening to a lecture in the Lister Hill Auditorium.
Recollecting days of gatherings at the Lister Hill Auditorium.

But as I pause to reflect on and celebrate the contributions of our talented NLM staff members, I would be remiss to overlook the unusual circumstances befalling our workforce during this time of COVID-19.

As one of the 27 Institutes and Centers at NIH, NLM continues to prioritize employees’ health. Since mid-March, most of our staff have been working remotely as we follow guidance for a maximum telework environment. I am beyond grateful for the handful of staff who continue to work on-site to ensure that our data centers keep running and building operations continue. I’ve noticed an exceptional amount of resilience and ingenuity among our staff — both on-site and remote workers — as they continue to deliver the services and products that are unique to NLM and continue to support research in biomedical and health data science.

So, this year on Labor Day, I want to highlight and commend the continued creativity of NLM staff.

Usually, much of our work is done in teams that hold regular, face-to-face meetings, and, in fact, these meetings are still happening — just by video chat. The daily huddles used by our Library Operations supervisors continue, now supported by new technologies. The brief personal check-ins that started many meetings also continue, but we must rely on verbal cues rather than visual ones when sitting down next to a colleague. Where we once came to recognize a colleague’s favorite shirt or special suit, we now glimpse the backdrops of family rooms and home offices. And some of our work colleagues joining each other on Friday evenings for virtual happy hours take advantage of customizable backgrounds to express an interest that colleagues might not have known about!

The rhythm of our work has also changed. We’ve lost the exercise and mental breaks that come from walking to that next meeting — or even the ability to have a walking meeting. (Although I hear that some of our colleagues take meetings while walking around their neighborhood to get their steps in!) The natural respite that comes with the need to move from place to place has disappeared, and some staff report spending their days in back-to-back video conferences instead. Through technology, we’ve been able to replicate the “Got a second for a question?” pattern in an effective, though somewhat less satisfactory, way.

Taking annual leave is different now, too. While it has always been challenging to schedule and prioritize time away, it is no less important now to find time to disconnect from work to rest and refresh.

Please join with me in celebrating the efforts of NLM staff on this Labor Day. Reach out to them, let them know you appreciate their labors, and remind them (and your own colleagues) of the importance of setting aside time to honor the achievements of workers around the nation!

Glad to Meet You Virtually: Reflections on the MLA Conference

I’ve just “returned” from the Medical Library Association (MLA) ’20 Conference Live Action Week held August 10–14. After much deliberation and rescheduling, this meeting, like so many others, was reimagined in a virtual format using video, text and chats, and online presentations to connect attendees.

Returned is a funny term because, of course, I didn’t travel any farther than from my desk to the table in my home office. But during those several days, I turned my focus away from my usual pursuits while I attended virtual sessions and participated in discussions to improve my understanding of how NLM can align its efforts with MLA to meet the health information needs of society.

MLA is a global organization with a membership of more than 400 institutions and 3,000 professionals in the health information field. NLM and MLA partner to address issues related to health information services and to support joint educational programs. MLA’s annual meeting provides NLM with opportunities to introduce new products and initiatives, get feedback on our services, and learn how to better support the medical library community.

I was delighted to join my NLM colleagues Dianne Babski, acting associate director of NLM’s Division of Library Operations, and Amanda J. Wilson, chief of NLM’s Office of Engagement and Training, to update conference participants on NLM activities and share a new video introducing NLM. We centered our remarks around three themes: relevance, resilience, and reinvention.

NLM strives to be relevant to the evolving health information needs of professionals, researchers, and patients — our mission since NLM was established in 1836. Being relevant means understanding and anticipating information needs in a principled way. This requires a great deal of resilience across our organization as scientific communication advances, research paradigms shift, and the very words we use to characterize health problems and label health outcomes evolve. Remaining engaged, particularly during this time of maximum telework and urgent efforts to respond to the COVID-19 pandemic (in addition to focusing on our usual work), also requires resilience. So NLM is reinventing the way we do our work; the manner in which we engage our stakeholders; and our ability to deliver products and services to partners who are also facing challenges related to social-distancing measures, reduced hours, or the elimination of services due to cost-cutting initiatives.

During our presentation we shared an update on efforts to enhance our approach to reaching communities through the work of the evolved NNLM and its new name – the Network of the National Library of Medicine. This more focused and inclusive name acknowledges that not all members are libraries of medicine. Its new goal? To increase health equity through information – which adds an important new dimension to NNLM’s mission. This effort also involves an increased emphasis on reaching underrepresented populations and balances NNLM regions across communities served.

We encouraged medical librarians to consider how these themes — relevance, resilience, and reinvention — play out in their lives. It’s no secret that traditional opportunities for hospital librarians are disappearing at a time when their expertise is more relevant than ever. This change requires a measure of reinvention to determine how to add data science and data librarianship skills to a medical library training program and work history and identify new ways to serve the public with the original zeal that brought people to medical librarianship. During this time of challenge — and opportunity — medical library professionals are also being called upon to demonstrate the capacity to recover quickly from difficulties and the ability to spring back into shape, that is, to be resilient.

So, what was missing from this year’s conference?

I missed hugs! I missed the serendipitous encounters with far-flung colleagues as we rushed to another session but still found time to exchange greetings. I missed Teresa Knott’s smile and missed seeing former associates and NLM/Association of Academic Health Science Libraries fellows who have become professionals. I missed meeting in person with MLA leadership to continue learning how to become a better partner. And I missed seeing my NLM colleagues, both those who work here in Bethesda and those who work at other locations around the country.

Relevance. Resilience. Reinvention. Each of these is infused and strengthened during interactions with colleagues at national conferences and in our everyday workplaces.

How can NLM help ensure the presence of these qualities in your life during this time of virtual meetings?

Introducing the NIH Guide Notice Encouraging Researchers to Adopt U.S. Core Data for Interoperability Standard

Recently, NIH issued a guide notice (NOT-OD-20-146) encouraging NIH-supported clinical programs and researchers to adopt and use the standardized set of healthcare data classes, data elements, and associated vocabulary standards in the U.S. Core Data for Interoperability (USCDI) standard. This standard will make it easier to exchange health information for research and clinical care, and is required under the Office of the National Coordinator Health Information Technology (ONC) Cures Act Final Rule to support seamless and secure access, exchange, and use of electronic health information.

USCDI standardizes health data classes and data elements that make sharing health information across the country interoperable, expands on data long required to be supported by certified EHRs, and incorporates health data standards developed.

NLM is proud to support USCDI through continued efforts to establish and maintain clinical terminology standards within the Department of Health and Human Services.

Standardized health data classes and elements enable collaboration, make it easier to aggregate research data, and enhance the discoverability of groundbreaking research. USCDI adoption will allow care delivery and research organizations to use the same coding systems for key data elements that are part of the USCDI data classes.

I encourage you to read more about the new guide notice in a joint post developed in collaboration with my NIH and ONC colleagues titled: “Leveraging Standardized Clinical Data to Advance Discovery.” And I ask you to consider, what could this notice mean for you? 

It’s My Birthday: An Ode to Aging and to Lifespan Research

When you grow up in a family of 10 kids, like I did, your birthday is a very special day. My mom and dad made sure that it was always a celebration, with breakfast pancakes, a picnic lunch in the park, and favorite foods for dinner. It’s a day that’s just yours. By now, I’ve had more than 65 birthdays, and I have to say, each one is better than the last! 

Like most people, I find that birthdays are a time for reflection, when you can pause and pinpoint where you are in the arc of your life. As a kid, it was a time of pure pleasure; as an adolescent, I wanted to be further along that arc. In midlife, I think I’m where I’m supposed to be, because I feel like I’m 39, think I look like I’m 49, believe I have a career worthy of someone who’s 59, and am approaching the wisdom of someone who’s 69. And although my reflections — both my thoughts and my likeness in the mirror — have changed over time, they all still reside within me, and every stage of my life informs each moment of my present.  

NIH also recognizes the value of the various life stages and their potential contributions to clinical research. Generating new knowledge for health through biomedical research stands to have the greatest impact if individuals from across the lifespan are included, as appropriate, in a study. 

This idea was deemed so important that NIH released the NIH Policy and Guidelines on the Inclusion of Individuals Across the Lifespan as Participants in Research Involving Human Subjects. In essence, this Inclusion Across the Lifespan policy states that individuals of all ages, including children (i.e., individuals under the age of 18) and older adults, must be included in all human subjects research conducted or supported by NIH unless there are scientific or ethical reasons not to. NIH is also hosting a virtual workshop, NIH Inclusion Across the Lifespan II, in September to review the lessons learned from this policy and examine evidence-based techniques for meeting the needs of this policy in research.

This commitment encourages individuals at all life’s stages and of all ages to participate in clinical research, as appropriate, where innovations and therapeutics are being created, tested, and evaluated. As a result, we’ll learn more about the effectiveness of new medicines on children or why some older adults maintain robust physical function well into their 90s, and participants will benefit from being involved in leading-edge research.

Along with requiring the inclusion of participants from across the lifespan in research studies, NIH also requires that summary results of those studies be made available to the public. Submission of the complete results for any clinical trial to must include information on the age of the enrolled participants overall and in each study arm. (A study arm is a group of people in a clinical study who receive a specific drug, medical device, or other intervention.) Age may be listed as categorical variables (data that can be divided into discrete groups such as children, adults, and older adults) or as a summary statistic, such as mean age with a standard deviation or median age with minimum and maximum values.

As we include individuals from across the lifespan in research, it’s important to be clear about which variables are being tested or measured. One way that NIH supports this is by encouraging researchers to employ similar concepts and terms across a range of research programs, for example, by using common data elements in clinical research, patient registries, and other human subjects research, in order to improve data quality and opportunities for comparison. NLM hosts NIH’s Common Data Element (CDE) Resource Portal, which provides access to information about NIH-supported CDEs, as well as tools and resources to assist investigators in developing protocols for data collection.

NIH’s focus on age in research endeavors is yielding positive results, and I’m happy to be able to share articles from NLM’s own PubMed collection that highlight research addressing various age groups. Here are a few specific to older adult populations:

And here are several specific to the pediatric population and those under age 18:

At this point in my life, I’m pleased to know that NIH and the National Library of Medicine supports science that is inclusive of populations across the lifespan, as well as literature and other accounts that record and make available the results of this type of research!

In the future, we will not only have a better understanding of what makes someone healthy or responsive to treatment at a given age, but we’ll be better able to use health data collected in the early stages of life to predict outcomes in older populations.

This scientific crystal ball will benefit all of us. What would you like to ask it?

A New Era of Health Communications

I’ve been reflecting on how communications has transformed our lives, particularly since the COVID-19 pandemic radically changed our ability to interact with others.

Before NLM’s physical workspace shifted to maximum telework, I was walking to work when I passed a strange sight — the last vestiges of pay phones on the National Institutes of Health campus! Those decommissioned pay phones got me thinking about how technology changes over time, how essential communication technology has become, and how NLM’s approach to providing trustworthy biomedical data and health information must evolve as methods of delivery change. As technology advances, we have more choices and greater sophistication in the methods we use to meet our responsibility to deliver biomedical data and health information, as well as in the tools we use to interrogate that information.

Payphones sit outside of the National Library of Medicine, having been removed from use in the building.

The Lister Hill National Center for Biomedical Communications (LHNCBC), now more than 50 years old, provides a case study of how NLM’s efforts to communicate information have been transformed.

LHNCBC was established by a joint congressional resolution in 1968 to stimulate the application of modern communications technologies to the challenges of delivering health information worldwide to support health care services and enhance medical education.

In that same decade, push-button telephone pads were replacing rotary dials, and the Trimline telephone, with the earpiece, mouthpiece, and dial pad in the handset, was introduced. The ARPANET, the early version of the packet-switching internet, appeared soon after. Just as the Trimline phone presaged the design of mobile phones, the early design of LHNCBC laid the foundation for robust innovation in the use of telecommunications tools, computer networks, and high-performance visualization to deliver health information and ensure its use.   

An intramural division of NLM, LHNCBC develops advanced health information resources and software tools that are widely used in biomedical research and by health information technology professionals, health care providers, and consumers. As it seeks to improve access to biomedical information for individuals around the world, LHNCBC conducts and supports research and development on the dissemination of high-quality imagery, medical language processing, high-speed access to biomedical information, intelligent database systems development, multimedia visualization, knowledge management, data mining, and machine-assisted indexing.

In 1994, it launched the Visible Human Project, a landmark accomplishment that made a complete, anatomically detailed, three-dimensional representations of a human male body and a human female body publicly available. 

Current LHNCBC researchers come from a variety of disciplines, including medicine, computer science, library and information science, linguistics, engineering, and education. The Biomedical Informatics Training Program brings together talented individuals to learn from and collaborate with research staff.

Research and development conducted by the interdisciplinary teams across LHNCBC has led to many advances in biomedical communication and information dissemination, such as:

  • Consumer Health Question Answering — This project involves research on both the automatic classification of customer requests and the automatic answering of consumer health questions.
  • Discoveries from Mimic II/III and Other Sources — This effort examines and attempts to validate controversial findings from smaller-scale clinical studies through the interrogation of de-identified medical records and information from health information exchanges. Researchers also conduct retrospective epidemiological studies in areas that lack clinical trials.
  • Open-i — This experimental multimedia search engine retrieves and displays bibliographic citations and their related images by linking to images based on image features.
  • Unified Medical Language System® (UMLS) — This tool integrates key health care terminologies, classifications, and coding systems used by clinicians, billing systems, insurance companies, and researchers. Sources developed include the Metathesaurus®, Semantic Network, and SPECIALIST Lexicon. The UMLS supports health care communication through interoperability, specifically, the mapping of key terms from one vocabulary system to another.

The changes to LHNCBC since its creation in 1968 parallel changes in telecommunications over the past 50 years. Early work at LHNCBC demonstrated how technological advances such as fiber optic networks and semiconductors could be put to best use by the health care sector. Today, LHNCBC continues to improve health through methodological advances in clinical data science and health informatics. We recognize that contemporary communication relies on interoperable data, scalable methods and translation of discovery into operations.  

As health care becomes more highly distributed and NLM resources are increasingly used by individuals around the world and beyond, LHNCBC will continue to be a partner in accelerating health communication.

What trends in health communication do you see ahead? How do you think COVID-19 will shape health communications?