Go as Far as You Can See. Then See How Far You Can Go.

Be ready for the next part of the journey.

It’s that time of year when the esteemed and well-known are asked to give graduation addresses. You remember those addresses—simultaneously inspirational, compelling, and entertaining and all in ten minutes or less!

This year, somehow, I have become one of those people, or by virtue of my position as the director of the National Library of Medicine, I am a good stand-in for one. I was invited to speak to the graduates of the School of Nursing at the University of Pennsylvania and the Frances Payne Bolton School of Nursing at Case Western Reserve University.

It’s an extreme honor to be invited, of course, but what was I going to say?

A recent book, The Sixteenth Rail: The Evidence, the Scientist, and the Lindbergh Kidnapping by Adam Schrager, provided my jumping-off point. The book itself—a look at how Arthur Koehler, a wood forensics expert, helped capture the kidnapper of the Lindbergh baby—is fascinating, but that expert’s personal story is what inspired me. His adherence to the scientific process and his willingness to serve made me think that in another incarnation he could have been a nurse or a librarian!

Koehler himself was inspired by the adage, “Go as far as you can see, and then see how far you can go.” When I read that, I knew I had the beginnings of my commencement address.

And so, to the new graduates, particularly those in the helping professions, I offer these comments.

Go.

Our work is action focused. No one gets to be a good nurse or a good librarian simply by watching.  And yet we must often take the initiative to make clear to others where and how we can be of service. The moments where a nurse or a librarian may be of assistance might not even be recognized by the person in need, who may be baffled by a problem, worried about some health concern, or just overwhelmed into inactivity.

As a dictum, “go” also places control of your career solely in your hands—a reminder that as skilled and educated professionals we have the freedom to direct our efforts and shape our futures.

As far as you can see.

At graduation, each graduate has his or her eyes on a unique horizon. For some it may be the start of graduate school in a few months. For others, it’s a new job in a new city. Still others may see family, volunteer service, or travel.

Pay attention to what you see and to what you see along the way. And for those in the helping professions, pay attention as well to how you see those who need your service. What do you notice about them—appearance, action, behavior? Cultivate your curiosity but always maintain your respect. See others the way you’d like them to see you—your strengths, your good will, your desires.

Use that input and that knowledge to guide your movements, to go forth purposefully, and to be fully engaged in whatever pursuits you deem important. But remember, even as you enter this phase of life, “as far as you can see” is nowhere as far as you can actually—and are likely—to go.

Once you get to that place— that as-far-as-you-can-see place—you will be a new you, with new confidence, new ideas, new desires, new lenses, new frameworks, and new goals. You will then have a new platform to launch into whatever is about to happen next.

See how far you can go.

As you stand in that new place, pause, look around, and don’t forget to glance backwards—even briefly. Your future isn’t defined by your past, but your past is what prepared you for it.

Take stock of what you need with you in that future—friends, finances, humility, humor, knowledge. And what you don’t have, build, acquire, borrow, or buy, so you’ll be ready for the next part of the journey.

Because the beauty of the journey is that there is always a new horizon to see, to move toward, and then to move on from.

How far will you go?

Head Nurse of the Library?

How a nurse’s way of knowing helps me do my job.

Many of you know I am a nurse. I began my career with a BSN from the University of Delaware (1975) and then completed an MSN at the University of Pennsylvania (1979). I also hold a license as a registered nurse.

I think of myself as a psychiatric nurse, although I spent a few years in the mid-1970s on the 3-to-11 shift in a busy surgical shock-trauma ICU. I have also served on the faculty of nursing at Case Western Reserve and at the University of Wisconsin-Madison.

It helps to understand nursing to see why being a nurse is such a great asset in my role as director of the National Library of Medicine.

To me nursing is fundamentally the diagnosis and treatment of the human response to disease, disability, and developmental challenges.

Note that phrase “human response,” i.e., how people react to the challenges in their lives.

Nurses focus on the human response, while the biomedical knowledge we have, like pathology or anatomy, helps us understand what a person is coping with and what kinds of complementary or supplementary supports are needed.

As noted nurse and author Virginia Henderson observed, nurses must actively engage with the patient to help him or her perform “those activities contributing to health or its recovery (or to a peaceful death) as he [or she] would do unaided had he [or she] the necessary strength, will or knowledge,” with independence from the nurse the common goal.

Nursing addresses the whole person and helps that person live to the fullest extent.

Along the way, nurses come to know people differently than the other clinical disciplines. And that knowledge, I’ve discovered, helps me as Library Director.

It affords me special insight into the public patrons who use our services. I can imagine a young mother using MedlinePlus in the middle of the night to figure out how to comfort a feverish child. I can anticipate the information needed by someone with a late-stage cancer diagnosis and recognize the need to complement journal articles on treatment options with literature on comfort measures and death with dignity. And I can appreciate the challenges of navigating the health care environment, from its specialized vocabulary to its unique culture.

A nurse’s way of knowing helps me set policies for integrating into the Library’s formal standards and language systems the terminologies that address the social and behavioral domains of health. Nurses live in those domains, as much if not more than the technical or scientific.

Perhaps most importantly, my experience as a nurse has taught me that each person has his or her own strengths, and that the Library’s resources should build upon those strengths to help the person make healthful choices, not just explain deficits.

But the benefits of being a nurse and a library director do not run only one way. Directing a library also lets me fulfill my nursing role, as I help others achieve the highest level of wellness possible.

As NLM director, I advocate for those in need, ensuring the literature is sufficiently inclusive. I improve patient care by guiding the fields of data science and biomedical informatics toward a future where professionals and patients interact to achieve care goals. And I model for younger nurses a career path that engages all that I am as a nurse while collaborating meaningfully across disciplines.

Being a nurse is not a job requirement for directing the National Library of Medicine, but it certainly is an asset. Advanced education as a health professional gives me an appreciation for how complex health care is and how important it is to engage all disciplines toward addressing that complexity. Engaging patients as partners in care motivates me to build resources that foster full participation of people in health. And experience as a team player in psychiatric services enables me to join with my colleagues from library science, information and computer science, linguistics, medicine,  and other disciplines to make the NLM the foundation of the future of health and discovery.

NLM’s Contributions to Healthy Communities

Public health lies at our core.

I’ve been on the job for eight months now, and I’m still learning more about the National Library of Medicine and its vast resources. These days, I’m broadening my understanding of how NLM  supports communities, population health, and public health.

The library has long had public health as an area of focus, both for its collection and its work. In 1993, the NIH Revitalization Act formalized some of our efforts by creating at NLM the National Information Center on Health Services Research and Health Care Technology (NICHSR).

Health services research (HSR) helps improve the quality and equity of health care for individuals and communities. NICHSR (pronounced “nik-H-S-R”) supports and promotes these efforts through its tools and by disseminating high-value information for the public health and health services workforce.

For example, in support of Healthy People 2020, a national program of specific objectives to improve the health of all Americans, NICHSR helps those in public health easily find the most up-to-date published evidence through a suite of preformulated PubMed search strategies. Their HSR and public health web portals deliver high-quality datasets, analyses, guidelines, and news, and the HSRProj database provides information about in-progress research before published results are available. And thanks to the newly-released NICHSR ONESearch, you can search across all NICHSR databases from a single point.

Committed to integrating resources for research and practice, NICHSR works closely with many of our sister federal agencies, such as the Centers for Disease Control and Prevention (CDC) and the Agency for Healthcare Research and Quality (AHRQ). Through the Partners in Information Access for the Public Health Workforce (PHPartners), which is a consortium of US government agencies, public health organizations, and health sciences libraries, NICHSR also works with national organizations such as the American Public Health Association, the National Association of County and City Health Officials, and the Association of Schools and Programs of Public Health. Together these collaborations deepen NLM’s work across the areas within public health while also promoting NLM’s public health resources to the communities who might benefit from them.

But NICHSR is not alone at NLM in working to ensure the health of communities and the people who live in them.

The NCBI Pathogen Detection System uses whole-genome sequencing to uncover potential sources of contamination during the outbreak of foodborne diseases. By comparing sequence data for bacterial pathogens obtained from food, the environment, and human patients to sequences in the NCBI database, we can determine if the bacteria are from the same outbreak, helping public health scientists trace the source of the contamination and target their response to the outbreak.

TOXNET, the flagship resource on toxicology and environmental health from the NLM Specialized Information Services (SIS) Division, delivers a collection of databases covering chemicals, drugs, occupational safety and health, poisoning, and toxicity risks, while SIS’s Disaster Information Management Research Center (DIMRC) supports disaster preparedness, response, and recovery by connecting people to quality disaster health information and fostering a culture of community resiliency.

Our landmark exhibition, Native Voices, preserves the healing cultures of American Indians, Alaska Natives, and Native Hawaiians and explores, among other things, how community lies at the center of Native conceptions of health. Through audio, video, photos, and stories, the exhibition—which is now traveling across the country—looks at how wellness of the individual is inseparable from harmony within the family and community and pride in one’s heritage.

This list, while far from comprehensive, gives a sense of the myriad ways this great library contributes to healthy communities. In fact, one could argue that everything we do ultimately has that impact.

And now we are looking for new and different ways to impact community health, this time through data and data-driven discovery. What ideas do you have about the types of data we should be collecting?

Illustration (top): Giovanni Maki, Public Library of Science (CC BY 2.5) | cropped, text removed

The Future’s So Bright I Gotta Wear Shades

And that future is all about you!

We’re halfway through the strategic planning process at NLM, with the second of four panels convening last week to explore the future of the public’s health.

Like the other topical panels, invited experts from around the US joined us to share their unique and important perspectives. I am grateful for the opportunity to glimpse the visions of these great leaders, because each meeting gives me new insights and inspires new directions, new possibilities, for the National Library of Medicine.

The topic of public health covered by the panel includes personal health management, clinical care services, and community and public health. We did not separate these in the discussion because people in health or illness pass through each of these care environments as they traverse the trajectory from health to illness and back again.

As our experts shared their visions of what might happen in or across their various sectors over the next 10 years, the message was strong: The future of health lies in the hands of the people who will experience those health journeys. The public’s health, whether experienced in a public health clinic, a hospital bed, or a patient’s home, is going to be increasingly driven by the vision, skill, preferences, and choices of the person, not the professional!

It became immediately clear to me that the library designed to support the intensive care unit in 1995 will be ill-equipped to support a community-situated, patient-centric health care environment in the next decade.

The library that supports acute care rests on several premises:

  • Biological knowledge dominates.
  • Point-of-care decision making is the rule.
  • Records became archives of the care experience.

The future of health lies in the hands of the people who will experience those health journeys.

With a person-driven model, the information needed for care is simultaneously more broad—encompassing social, behavioral, and environmental factors—and more precise—focused on individuals, not the statistical average. We must also reconsider how that information is delivered, so it aligns with the individual’s values regarding heath and health care and is relevant to his or her life experiences and understanding of illness.

So what needs to happen to NLM to make it a library that accelerates personal health, person-centered care, and public health?

We need to collect new kinds of information, such as studies that help us characterize health and illness in terms of the patient. We need to build new filters and integrate special search terms so the process of locating that information aligns with how people experience and understand their own health issues. Finally, we must present that material in a way that is both actionable and comprehensible by the layperson, which might call for translation services or plain language interpretations.

As we design NLM’s future, please let us know what you know. How will care practices and knowledge development in your domain change over the next five years? And how can NLM help you meet those challenges?

Ukuleles and Fishing Poles?

A living library helps you do.

Well, there goes the Wall Street Journal again. Just when we think they’re all about business, they do another feature in support of libraries of the future. This time Lucette Lagnado showcased libraries who lend everything from fishing tackle to musical instruments (subscription required for article).

Is this just a marketing ploy to pull the unsuspecting public into a library, only to have them leave with a fishing pole and a good book? Maybe, but maybe there’s more to it.

Here at the National Library of Medicine we regularly look for ways to help our patrons make better use of our resources. Toward that end, we carry out regular outreach to communities and audiences across the country and across the spectrum, from medical professionals and scientific researchers to students and the general public.

Outreach, by definition, means “to reach further than,” and in conducting outreach, we take this library further into those communities. In turn, the members of those communities are able to go further themselves, to learn more and to do more than they could have without us.

As part of our strategic planning process we are conducting an audit of the many approaches to outreach we employ. We send staff to powwows held by Native American nations and tribes, bringing on-the-spot coaching to attendees to help them find relevant health resources. We create YouTube videos to teach scientists how to effectively use dbGap, our best-known and most highly used database of genetic sequences. Through our National Network of Libraries of Medicine, we attend community meetings and health fairs to ensure people everywhere know about our valuable, authoritative health information. We make informative websites that walk users through the best ways to search PubMed, and we publish a magazine as a free, trusted consumer guide to the latest medical research and quality health information coming out of NIH and NLM.

At first pass, these efforts look like NLM has taken on a health information mission, just like the libraries visited by Ms. Lagnado seem like music rooms.

But look deeper.

What we are actually doing is bringing the library to life—ensuring NLM’s resources are accessible not only in the traditional, well-understood ways of reading and reflection, but by ensuring those accessing our resources have the skills to use them.

After all you can’t catch a fish by reading a book about fishing, and you can’t play the ukulele by simply looking at a musical score. You need to do, and the new “libraries of things” support that.

And when it comes to NLM’s vast resources, we help you do—to effectively find what you need, assess what you find, and apply what you learnto help us all reach further and do more than we did before.

“Rock Star” Librarian—Now That’s a Stereotype I Can Get Behind!

Earlier this month, the Wall Street Journal published a piece by Ellen Gamerman with the headline “The ‘Rock Star’ Librarians Who Choose What Your Kids Read” (subscription required).

The article highlighted how some librarians use social media, including Twitter and blogs, to recommend children’s reading selections—and end up with their own bit of low-level fame along the way.

As many commenters pointed out, this practice does raise some concerns, including adults choosing reading materials for kids, but to me, one message comes through loud and clear: new librarian stereotypes are emerging—and this is GOOD!

Those of you who follow me on Twitter or read a recent interview of me in The Washington Post know that stereotypes of librarians (and nurses) remain and are not always positive. Even when employed good-naturedly, these stereotypes can be unfair or untrue. I’d like to see them go away, but until they do, I suggest we undercut negative stereotypes by cultivating positive ones.

With that in mind, I’m all for the “rock star” librarian idea.

The National Library of Medicine relies on librarians here and in the field—in public libraries, hospital libraries, academic research centers, and K-12 schools. These librarians help people discover and use the quality health information NLM provides to stay healthy, manage illness, and learn about personal or public health issues.

The librarians in the 6,500 or so libraries linked through the National Network of Libraries of Medicine have a presence in almost every county in the United States! They reach out to health professionals and the public in their regions to assess information needs and provide resources. And they do it in ways that work for those audiences—whether via community meetings, webinars, training classes, or face-to-face consultations. These librarians are our rock stars.

What better term to use to describe the 21st century librarian!

It IS your father’s Big Data–and your mother’s, and your sibling’s, and even yours!

Let’s make it useful to them.

You’ve probably been hearing about big data everywhere—traffic patterns, video streams, genome sequences—and how it is changing lives, accelerating commerce, and even improving health. But most of the time the conversation focuses on what business professionals and scientists might need, want, or do with big data. It’s time to consider how the ordinary person can benefit from this data revolution.

But first, what exactly is big data and why should you (and your father, mother, siblings, and friends) care about it?

The term “big data” can be used to describe data with a range of characteristics. It covers high volume data (like the whole human genome) or data that streams at a high velocity (like the constant flow of image data from space exploring satellites). It also includes high variety data (such as the mix of chemical process, electrical potential, and blood flow observed during brain studies) that may have high levels of variability (like around-the-clock monitoring of traffic flows through busy highways). Ultimately, a key to big data is its high value, whether that’s important to commerce or to the discovery of new cancer drugs. Scientists are learning how to make discoveries through data, and businesses are learning to leverage big data to glean key customer insights.

But big data can be and is of value to the everyday person as well. It already helps us navigate through a new city using map and traffic apps and to find interesting information through search engines, among other things.

Here at the NLM we want find ways to help people use big data to help manage health and health concerns. It may help them know what to do in an emergency, to better understand their family risks for heart disease, or to learn just how much exercise might ward off Alzheimer’s disease.

Toward that end, we are funding a grant award, Data Science Research: Personal Health Libraries for Consumers and Patients (R01) (PAR-17-159).

We’re looking for researchers who want to partner with lay people to discover how to bring the power of big data into their lives. To do that, we need fresh approaches to biomedical informatics and data science, shaped to meet the needs of consumers and patients, whose health literacy, language skills, technical sophistication, education, and cultural traditions affect how they find, understand, and use personal health information. Novel data science approaches are needed to help individuals at every step, from harvesting to storing to using data and information in a personal health library.

If you’re a researcher interested in discovering new biomedical informatics knowledge to help consumers and patients make use of big data, this opportunity is for YOU! If you’re a clinician or a librarian, reach out to your science colleagues to form a partnership. If you’re a patient, find a researcher at your local university and invite yourself into the process of citizen science.

Much of the data behind the big data revolution originates from everyday people. Many of the benefits of the big data revolution could help improve the lives of everyday people.  In other words, it is your father’s, mother’s, siblings’, and friends’ big data—let’s make it useful to them!