Every End has a New Beginning

Last week Francis Collins, MD, PhD, announced his plans to step down as the Director of the National Institutes of Health after serving in this position for 12 years. Francis is a force of nature — a tall man with a gigantic vision of how science can serve and improve society. I could recount for you the many ways Francis and his wife, Diane Baker, enhanced NIH.

It was Francis’ vision to establish the National Center for Advancing Translational Sciences at NIH, launch the All of Us Research Program – uniting one million people throughout the United States to advance science through the study of everyday health, and mobilize NIH and a network of partners to mount an effective campaign against the COVID-19 pandemic. Blending his scientific expertise with a deep love for music, Francis launched the Sound Health Initiative between NIH and the John F. Kennedy Center for the Performing Arts, in association with the National Endowment for the Arts, to bring together neuroscience and music to explore the potential for music to treat a wide range of conditions resulting from neurological and other disorders. 

Diane made it her mission to be sure that the children, patients, and families who came to the NIH Clinical Center for with hopes of life-saving therapeutics felt the support of the entire NIH community. Whether it was mobilizing volunteers to cook a Sunday dinner for families at The Children’s Inn at NIH or organizing fundraisers to provide free lodging and support for families whose children were undergoing treatment, Diane was there. Personally, Diane reached out to me when I arrived at NIH and encouraged me to find ways NLM could enhance its support to patients and families. This very invitation led to some wonderful connections that resulted in making NLM’s resources more valuable to more people.

Francis taught me what it means to have a boss with passion and vision. His personal engagement with data science and molecular biology made him keenly aware of the value of NLM’s mission to advance science. He listened carefully as NLM leadership made a case for modernizing our important resources that support broad access to genomic data and enable researchers, clinicians, patients, and the public find clinical trials information. Francis had a knack for putting NIH Institute and Center directors in front to tell the story of NIH’s accomplishments to Congress and the public. It is this very strategy that helped me recognize that the best spokespeople for NLM are those leaders who provide our services every single day.

We are at the dawning of a new era — for Francis and Diane, for NIH, and for NLM. Francis is not leaving NIH – he will continue to lead his research laboratory at the National Human Genome Research Institute, with a focus on the genomic basis for diseases such as type 2 diabetes. I am sure Diane’s passion for public service will continue to find new expressions.

Under new leadership, NIH will grow in new ways that I know will be grounded in our decades of accomplishments in understanding the basic mechanisms of disease, mobilizing research to improve public health, and data-driven discovery. NIH will persist in its commitment to advance health equity while addressing structural racism. NLM will continue to expand its investments in scientific communication, large-scale data resources, and the network needed to be sure that the opportunities and benefits of science reach people in communities across the country through our Network of the National Library of Medicine.

I send my best wishes to Francis and Diane with my deepest respect, gratitude for your support of the NLM and its mission, heartfelt thanks for what you have taught me, and a great blessing of the Irish:

May the blessings of each day
Be the blessings you need most
.

– Irish Proverb

THANK YOU, FRANCIS!

Pursuing Data-Driven Responses to Public Health Threats

In my 11th grade civics class, I learned about how a bill becomes a law, and I‘ll bet some of you can even remember the steps. Today, I want to introduce you to another way that the federal government takes actions – executive orders. As head of the executive branch, the president can issue an executive order to manage operations of the federal government.

In light of the COVID-19 pandemic, President Biden has issued executive orders to accelerate the country’s ability to respond to public health threats.

This is where I come in. As Director of the National Library of Medicine (NLM) and a member of the leadership team of the National Institutes of Health, I’m part of a group developing the implementation plan for the Executive Order entitled Ensuring a Data-Driven Response to COVID-19 and Future High-Consequence Public Health Threats.

This order directs the heads of all executive departments and agencies to work on COVID-19 and pandemic-related data issues. This includes making data that is relevant to high-consequence public health threats accessible to everyone, reviewing existing public health data systems to issue recommendations for addressing areas for improvement, and reviewing the workforce capacity for advanced information technology and data management. And, like all good government work, a report summarizing findings and providing recommendations will be issued.

Since March 2021, I have been meeting 2 to 3 times a month with public health and health data experts across the U.S. Department of Health & Human Services (HHS). Our committee includes staff from the Office of the National Coordinator for Health Information Technology, Food and Drug Administration, Centers for Disease Control and Prevention, Centers for Medicare & Medicaid Services, and Office of the Assistant Secretary for Planning and Evaluation.

After creating a work plan, our group arranged briefings with many other groups, including public health officials from states and territories, representatives from major health care systems, and the public, among others. We reviewed many initiatives to promote open data, data sharing, and data protection across the government sphere. We learned about the challenges of developing and adopting data standards, and the ability of different groups to come together to make data more useful in preparing the country to anticipate and respond to high-consequence public health threats. We discussed future strategies for data management and data protection, new analytical models, and workforce development initiatives. Our working group provided a report to the Office of Science and Technology Policy (OSTP), handing it off to the next team who will take the work process and keep moving it toward completion. In coordination with the National Science and Technology Council, OSTP will develop a plan for advancing innovation in public health data and analytics.

This was a beneficial experience for me, and I certainly learned a great deal. Implementing a public health response system requires engagement with many HHS divisions, each of which brings a unique perspective and experience. I also developed new relationships based on trust and collaboration with these colleagues. At NLM, we have experts in data standards and data collection, and we oversee vast data repositories, so we have substantial domain-specific knowledge to contribute. I drew frequently on the knowledge and expertise of NLM staff to inform the process through analyses of information and the preparation of reports. I am grateful for all who helped and supported me.

I believe our country is prepared to have the data necessary to prevent, detect, and respond to future high-consequence public health threats. This is yet another way that NLM is helping shape data-powered health for the future. What else can we do for you?

Imagination: A Process. Not a Moment

Part 3 of a three-part series discussing the importance of imagination. Part 1 is here and part 2 is here.

Over the past two months, I’ve been sharing my ideas about the importance of cultivating imagination to stimulate innovation. Most of this is great fun, and I hope I’ve enticed you to do some of your own daydreaming, and maybe you’ve begun to see some of the impact in your own efforts. Imagination – the ability to envision that which has never been seen, heard, or experienced – is pleasurable, and adds collateral benefits, such as a reduced tendency to interpret unfamiliar stimuli as a threat, and an improved ability to generate novel solutions on the fly. Imagination doesn’t have to end with an inspirational idea. In this post, I’m encouraging you to consider imagination as a partner to help you implement those inspirational ideas and sustain their impact.

Take a look with me through the lens of imagination to see the impact that your imagination can have on the future of technology. Learn how NLM fosters this creative process and how we continue to support health care innovation with our tools and services.

As I reflect on my five years as the NLM Director, I realize that the most important contribution I can make to NLM extends beyond the generation of new ideas. It’s about building in the financial and human resources, as well as the processes to sustain the change envisioned through those new ideas. I need to share my vision with my leadership team and listen to the ideas of our NLM staff. To do this, I need to stimulate imagination in those around me. Novel ideas must also be evaluated for their fit with NLM’s mission. From there, we can create an implementation pathway, identify responsible parties, and develop a plan of action. Along the way, anticipated and unanticipated glitches may occur, and may require that we take a step back, revise, or recommit to the plan. Eventually, streams of ideas become programs that we sustain or sunset; new opportunities abound, and the process starts over again.

Imagination is my companion.  Cultivating my own imagination improves my ability to learn from others whose world views differ from my own, recognizing the difference not as a threat, but as an alternative. Imagination helps me envision a range of future states, conducting the mental ‘what if we did . . . .’ exercise and engaging others to join me in that exercise. Imagination-fueled innovation helps me determine whether a lack of ‘fit for the mission’ heralds a need to re-think the innovative idea or a recognition that we must re-examine our mission. And building the skill of imagination augments my practical problem-solving skills so that anticipated and unanticipated glitches can be addressed with creative strategies. Finally, imagination contributes to my (and others) abilities to foresee a future without a familiar and much beloved program, as well as one in which a fledgling program becomes a sustainable core of our enterprise.

One of the practical ways we built the capacity for sustaining innovation into the fabric of NLM was through the creation of the NLM Strategic Plan Implementation Council, led by Mike Huerta, PhD, Director of the Office of Strategic Initiatives and Associate Director of the National Library of Medicine. Mike led the development of the NLM Strategic Plan 2017-2027 and leads our ongoing evaluation of the plan and its implementation. But he doesn’t do this alone – he convened a group of 18 staff from across all divisions and all levels within NLM. Once a month this council meets and gathers information from all areas of NLM regarding how the Strategic Plan is guiding our work. The council systematically examines new projects, raises considerations about modifications that may make the plan more useful to us, and provides a forum for ensuring that the cool ideas envisioned in the Strategic Plan realize their full potential for NLM.

When I began this exploration of imagination and innovation, I found myself focused on the spark, the new idea, the act of innovation. As I have reflected over the weeks, highly engaged with my leadership team in a wide range of efforts addressing our core mission and positioning us towards the future, I realized that imagination unaccompanied by strategies of sustainability was foolhardy for the director of a large organization. Yet still, the move from fostering innovation to sustaining innovation does not require one to abandon the effort to imagine; it requires a continuous refreshing of imagination. This leads not only to the initial innovation but to the myriad steps needed to guide the innovation towards its full contribution.  

So – don’t fear that the value of cultivating imagination ends once the inaugural innovation is envisioned – you’ll need that skill all along the journey!

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!