Dr. Isaac Kohane: Making Our Data Work for Us!

Last weekend, Isaac Kohane, MD, PhD, FACMI, Marion V. Nelson Professor of Biomedical Informatics, and Chair of the Department of Biomedical Informatics at Harvard Medical School received the 2020 Morris F. Collen Award of Excellence at the AMIA 2020 Virtual Annual Symposium. This award – the highest honor in informatics – is bestowed to an individual whose personal commitment and dedication to medical informatics has made a lasting impression on the field.

Throughout his career, Dr. Kohane has worked to extract meaning out of large sets of clinical and genomic data to improve health care. His efforts mining medical data have contributed to the identification of harmful side-effects associated with drug therapy, recognition of early warning signs of domestic abuse, and detection of variations and patterns among people with conditions such as autism.

As the lead investigator of the i2b2 (Informatics for Integrating Biology & the Bedside) project, a National Institutes of Health-funded National Center for Biomedical Computing initiative, Dr. Kohane’s work has led to the creation of a comprehensive software and methodological framework to enable clinical researchers to accelerate the translation of genomic and “traditional” clinical findings into novel diagnostics, prognostics, and therapeutics.

Dr. Kohane is a visionary with a motto:  Make Our Data Work for Us! Please join me in congratulating Dr. Kohane, recipient of the 2020 Morris F. Collen Award of Excellence.

Hear more from Dr. Kohane in this video.

Video transcript (below)

The vision that has driven my research agenda is that we were not doing our patients any favors by not embracing information technology to accelerate our ability to both discover new findings in medicine, and to improve the way we deliver the medicine.

What does “make our data work for us” mean? It means that let’s not just use it for the real reason most of it is accumulated at present, which is in order to satisfy administrative or reimbursement processes. Let’s use it to improve health care.

Using just our claims data, we can actually predict – better than genetic tests – recurrence rates for autism. It’s the ability to show, with these same data, that drugs used for preventing immature birth in the genetic form are just as effective as those that are brand name; 40 times as expensive. It’s, as we’ve seen most recently, the ability to pull together data around pandemics within weeks, if and only if, we understand the data that’s spun off our health care systems in the course of care.

And finally, as exemplified by work on FHIR, which was funded by the Office of the National Coordinator and then the National Library Medicine, the ability to flow the data directly to the patient to finally allow patients’ access to their data in a computable format to allow decision support for the patient without going through the long loop of the health care system.

Because the NIH and NLM have invested in working on real-world sized experiments in biomedical informatics, on supporting the education of the individuals who drive those projects, and in supporting the public standards that are necessary for these projects to work and to scale, they’ve established an ecosystem that now is able to deliver true value to decision makers, to clinicians, and now to patients, as we’re seeing with a SMART on FHIR implementation on smartphones.

So, for those of you — the biomedical informaticians of the future who are clinicians — I strongly recommend that you don’t wait for someone else to fix the system. You have the most powerful tools to affect medicine, information processing tools. So, don’t wait to get old. Don’t wait to be recognized. You have the tools. Get in there, help change medicine. We all depend on you!

Four Years of Conversation with YOU!

Next month, it’ll be four years since I expanded my use of social media by delivering a weekly blog post. What a four years it has been!

During that time, Musings from the Mezzanine has posted every single week – sometimes twice a week – resulting in more than 200 blog posts with over 300,000 views! I owe the deepest of gratitude to staff in NLM’s Office of Communications and Public Liaison who work closely with me in the production of what appears to be effortless, but in fact, represents dozens of hours of staff time every week!

At its inception, I saw the blog as a chance for NLM stakeholders to get to know me as the new NLM director. While my name is familiar in the informatics community, the medical library and data science/computational biology communities were less familiar with me. NLM views each of these communities as important stakeholders, so this blog served as an important calling card.

I saw (and still see) the blog as a way to have a conversation through comments on individual posts, Twitter messages highlighting a new post, or connections stimulated by ideas advanced in the posts. Over the years, guest-authored blog posts became an important part of our approach, and I invited colleagues to use this platform to share important and timely information related to the mission of NLM and NIH. Sometimes we collaborate with leadership across NIH to announce NIH-wide initiatives, such as this summer’s launch of NIH’s Rapid Acceleration of Diagnostics (RADx) initiative to advance innovative ideas for new COVID-19 testing approaches and strategies, or to comment on the importance of testing and other public health strategies to address the global pandemic.

Musings has shared how academic health sciences libraries are answering the call to provide uninterrupted access to resources and to valuable services and support during the COVID-19 pandemic, and provided information about the role of open access and evidence-based information to improve health for all species.

Over the past 18 months, the blog has become a central channel to communicate the new directions that NLM is moving toward and raise awareness of plans to update and upgrade PubMed, the first major new release of this important NLM service in more than 20 years. We often use the blog to explain how NLM is advancing biomedical informatics research or creating a new, more efficient organizational structure. While not replacing archival manuscripts and official news announcements, the blog stimulates conversations about important NLM investments, priorities, and activities.

The blog also allows me to reflect periodically on the wide range of responsibilities I hold as director of one the 27 Institutes and Centers at NIH.

I have positioned NLM to accelerate data science at NIH, and we have done a great job! Colleagues such as Jon R. Lorsch, PhD, director of the National Institute of General Medical Sciences and Susan Gregurick, PhD, associate director for data science and director of the Office of Data Science Strategy at NIH have contributed guests posts to reach even more readers.

I thank everyone who reads this blog, including my sisters and friends, and those of you who comment and provide particularly helpful or thought-provoking ideas; it means so much to me and my colleagues. Beginning in November, blogs will be published on Wednesday mornings, instead of Tuesday afternoons. If you’d like to get blog updates, sign up below!

Social media provides one opportunity for me, as a public servant, to demonstrate accountability. It helps me reveal what I am thinking, engage the public about the future NLM, and alert you to our accomplishments and initiatives.

Along the way, it also gives you an opportunity to share what’s on your mind, so please don’t hesitate to reach out and let me know if you would like to be a guest blog author. All voices and ideas are welcome!

We’re “Going to Have to Science the **** Out of This!”

When faced with the other-worldly, complex challenges of surviving on Mars after being left behind by his shipmates, Matt Damon, who plays an astronaut in the movie, The Martian, knows that his only chance of survival will require him to call on all of his scientific knowledge and understanding of the scientific method in order to meet his basic needs, explore new terrain, and establish new routines for everyday living.

Along the way, he must adapt to constant changes in the environment, technological disruptions, and the challenges of remote collaboration. Sound a little too familiar?  

The process of remote work that has become the new normal for most of NIH and NLM staff is beginning to resemble the experience of an astronaut stranded on Mars. It has required all of us to figure out how to meet our basic needs – food, socialization, activity, and rest; explore new terrain – home as the workplace; and identify new routines. We’ve continued to face man-made and natural challenges, such as fires, hurricanes and floods, been relegated to virtual meetings, and have worked collaboratively without the benefit of being in the same physical space. Yet, at no other time has it ever been so important for NLM to keep innovating for the future.  


I’m calling your attention back to the experience of our abandoned astronaut for a very specific reason — his use of scientific knowledge, insight, and experience to analyze opportunities and identify innovative solutions. This serves as a great model to illustrate the work happening at NLM.

NLM has prioritized the health and safety of our workforce while responding to COVID-19 and keeping our public-facing services available to the scientists, clinicians, patients, and families around the world who use them millions of times every day.  

We continue to work at the top of our game, adding nearly one million new citations in PubMed, expanding access to coronavirus literature through PubMed Central (PMC), and launching the first phase of the NIH Preprint Pilot to test the viability of making preprints searchable in PMC and increase the discoverability of early NIH-funded research results.

We’ve opened up new lines of research: our intramural investigators are applying their talents in computational modeling to examine microbiome in wastewater to detect evidence of the novel coronavirus, and using integrated comparative genomics and machine learning techniques to identify key genomic features that could differentiate SARS-CoV-2 from other strains of coronavirus that cause less severe disease.


Yet, it’s not enough to do just enough. We must continue to prepare to advance and support the future of scientific communication and build on the public’s trust in NLM.

It’s long been a hallmark of NLM to scan the external scientific environment, verify observed needs, and create scientific communication and dissemination tools to support the scientific environment.

Think back to the 1980s. Something was happening within our country (genomics revolution on the horizon) and across NLM (building the foundation of the scientific communication tools needed to support genomics) that led to the emergence of the National Center for Biotechnology Information in 1988.

Many, many forces needed to be aligned to make this happen: the critical vision of how a library could accelerate a genomics revolution; the talents of one of the best scientific analytical and communications workforces; the political goodwill of a Congress invigorated by scientific opportunity; the specific language needed to create the authorization legislation; and, of course, a bit of vision, hubris, and innovation brought about by the NLM team of Drs. David Lipman, James Ostell, Dennis Benson and David Landsman..


So how do we “science the **** out of this” to create the future of 2030 from the foundations of 2020? Doing for science what the decade of 1980-1990 did for genomics.  

First, we begin with our strongest suit — collecting, organizing, and disseminating scientific literature. We’re doing this by aligning our investment in novel products, such as moving NLM’s  Sequence Read Archive (SRA) to commercial cloud platforms, while stimulating new investigations such as computational approaches to curation at scale to accelerate the automated indexing of large health data sets. We’ll build on our strong foundation that grows from and relies on systematic, public-informed decision making related to the acquisition, indexing and dissemination of biomedical and health information as stated in our authorizing legislation. We’ll rely on our 2017-2027 Strategic Plan guided by the NLM Board of Regents. We’ll also engage our researchers and staff, who interact with the public, to make sure that NLM’s offerings are available to the public, 24/7, without charge or restriction.


What other sciences can help with this? Organizational science can help us remain open to future growth opportunities that may look different from our past successes. Public health sciences can identify the end-users of NLM services and offerings ranging from patients to clinicians to researchers to policymakers, so that we can continue to ensure we are meeting their needs. The biological, physical, and clinical sciences signal the future ways that we might understand the health and wellbeing of all, with social sciences providing tools to reposition organizations towards the future they hope to shape.

However, the marooned astronaut in the movie did not completely rely on science alone. You might remember his (dis)pleasure at discovering the disco music left by his commander. (He didn’t really like her choice of music.) This minor plot point tells us that to effectively “science the **** out of this” requires that we continue to look to the arts and humanities to translate science into the human experience to help us understand what goes on inside of us, and show us what it means to be a human being. The arts and humanities are an important part of the way we bring our own inspirations and ways to design the future.

How will we make this happen? We’ll need to identify, align, and share new models for innovation. We’ll have to learn to relax the structure of video conference technologies to mimic the hallway and in-person conversations and reduce the sense of ‘presentation’ on the screen to become presence in the moment.

But most importantly, we’ll need your ideas and guidance. How do we keep innovation alive under the constraints of our everyday life in COVID-19? Can you help inspire us to innovate?

Congratulations, AAHSL Fellows!

For almost 20 years, NLM and the Association of the Academic Health Sciences Libraries (AAHSL) have worked together to support the development of the next generation of medical library leaders through a joint NLM and AAHSL Leadership Fellows Program.

Since its launch, this program has matched fellows and mentors in a one-year leadership development program that has been a tremendous success. Inspired by the visionary leadership of former NLM Deputy Director Betsy Humphreys, NLM sought to answer the challenge of how to best prepare professionals to lead academic health science libraries of the future. NLM builds on this tradition of support by offering the Associate Fellowship Program, which is an early career training program for medical librarians

To continue this tradition and respond to the needs of experts in the academic health science programs, NLM leadership established a program to attract and develop future leaders. The NLM/AAHSL Leadership Fellows Program provides a combination of in-person and virtual learning experiences for selected fellows and offers the opportunity to develop knowledge and skills in a variety of learning settings.

Fellows are paired with mentors who are directors of academic health sciences libraries. Mentors, who work closely with their fellows throughout the year and host a visit to their library, are the backbone of the program. Their participation makes it possible for fellows to be exposed to additional leadership styles and areas of expertise. Mentors continuously share that they too benefit from the program and appreciate the opportunity to reflect and learn from the cohort. Since the program began in 2002, 49 percent of fellow graduates have assumed director positions. 

Last week, I was delighted to celebrate (virtually) the culmination of this year’s program:

Front row (Fellows):
Emily Glenn, MSLS; Erika Sevetson, MS; Gail Kouame, MLIS; Marisa Conte, MLIS, AHIP; Emily Hurst, MSLS, AHIP
 
Back row (Mentors):
Anne Seymour, MSIS; Debra Rand, MS, AHIP; Rick Fought, EdD, MLIS, AHIP; Kelly Gonzalez, MSIS, MBA; Rose Bland, MA, MPA, AHIP

Emily Jill Glenn, MSLS
Associate Director, Education & Research Services, McGoogan Library of Medicine
University of Nebraska Medical Center, Omaha, NE 

Mentor:  Anne K. Seymour, MSIS, Director
Welch Medical Library
Johns Hopkins University & Medicine, Baltimore, MD 

Erika L. Sevetson, MS
Director of Academic Engagement for Health, Biomedical and Physical Sciences
Brown University Library, Providence, RI 

Mentor:  Debra Rand, MS, AHIP
Associate Dean for Library Services
Donald and Barbara Zucker School of Medicine at Hofstra/Northwell and Corporate Director of Libraries for Northwell Health, Hempstead, NY

Gail M. Kouame, MLIS
Assistant Director for Research & Education Services, Robert B. Greenblatt, MD Library Augusta University, Augusta, GA

Mentor:  Rick L. Fought, EdD, MLIS, AHIP
Associate Professor and Director, Health Sciences Library
University of Tennessee Health Science Center, Memphis, TN  

Marisa L. Conte, MLIS, AHIP
Assistant Director, Research and Informatics, Taubman Health Sciences Library
University of Michigan, Ann Arbor, MI

Mentor:  Kelly R. Gonzalez, MSIS, MBA
Assistant Vice President for Library Services, Health Sciences Digital Library and Learning Center
UT Southwestern Medical Center, Dallas, TX

Emily J. Hurst, MSLS, AHIP
Deputy Director and Head of Research and Education, VCU Libraries, Tompkins-McCaw Library for the Health Sciences
Virginia Commonwealth University, Richmond, VA

Mentor:  Rose L. Bland, MA, MPA, AHIP
Director, Shimberg Health Sciences Library
University of South Florida, Tampa, FL

NLM’s commitment to this program has been steadfast, and the program’s continued success would not have been possible without the work that takes place in the field.

NLM/AAHSL Leadership Fellows are selected through a national competition, based on career directions and focused needs in their areas. As is typical in many mid-career mentoring programs, fellows do not need to interrupt their current career commitments to participate in the NLM/AAHSL Fellows Program.

Fellows spend twelve months with an expert mentor who is selected, in part, because of the match between what the fellow needs and what the mentor can provide. During most years, except for this year due to COVID-19, fellows typically engage in in-person exchanges, an intensive leadership institute, distance learning, and hands-on site visits. Fellows and mentors gather in Bethesda, MD for a capstone experience that includes a one-day visit to the National Library of Medicine. In addition to taking a deep dive into the functions of NLM, the fellows and their mentors can spend more time together face-to-face.

NLM recognizes that the health information needs of biomedical researchers and the general public rely heavily on the availability of professional health science libraries and the skills of well-trained medical librarians. As the world copes with the COVID-19 pandemic and the changing face of health science libraries, I remind all health science librarians of the NLM’s commitment to work together with you to elevate the resources provided by health sciences libraries to the world.

Diagram of NLM's Guiding Principles which are Resilience, Relevance, and Reinvention.
NLM’s guiding principle: Resilience, Relevance, and Reinvention.

We embrace a commitment to remain relevant to the evolving health information needs of our stakeholders, which requires a great deal of resilience and a willingness to reinvent the way we do our work.

What should academic health science libraries of the future look like, and what kind of leaders will they need?

Postscript:

Due to the immediate and long-term impact of COVID-19, the NLM/AAHS Leadership Fellows Program will be on a hiatus for one year. There will not be a 2020/2021 class. AAHSL plans to open applications for the 2021/2022 class in spring 2021. The program will complete its events for the current 2019/2020 class. Please visit the AAHSL website for future opportunities.

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!