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?

Graduation 2020: Tradition in the Midst of Change

Each year around this time, I’m invited to address a new group of graduates, to provide greetings and remarks at this important juncture in their lives. Over the years, I’ve sat in different parts of the commencement audience as a graduate, faculty member, parent, and speaker. It’s inspiring to listen to these speeches and a great honor to be invited to give one.

I’ve written before about the challenges of delivering one of these talks — to be inspirational, witty, and wise, all within nine minutes! Today, I want to talk about how graduation in 2020 is both different and not so different after all.

This year, so many things surrounding graduation — a ceremony marking the transition from learner to practitioner; a signal that the courses and tests and papers have all been completed, passed, and submitted; a celebration with the friends and family who accompanied the graduate on this journey — aren’t the same.

Social distancing and the larger response to COVID-19 meant an abrupt end to in-person classes and meetings with advisors for the last half of the spring semester. Coursework was completed in “distance mode,” through online discussions and video presentations. Tests evolved into computer-delivered multiple-choice questionnaires, with the ubiquitous empty box to be filled with the wisdom the student had acquired. Papers were submitted via email or uploaded to a course management website. And Zoom parties and video chats have replaced the hugs and handshakes that once marked the graduate’s accomplishment.

But how traditional are these “traditions” that 2020’s graduates are missing? Less so than we might think, I’ll bet. Over the last 50 years, graduation classes have become more diverse. The solemn pomp-and-circumstance procession has been replaced with joyful shouts of extended families and the sight of graduates’ small children wandering down the aisles.

And graduation ceremonies and celebrations have been cut short before for many reasons — both historical and personal — such as times of conflict, the necessity to enter the workforce immediately, or other family obligations, just to note a few. So just as graduation this year looks different, so too did graduation in 2001, in 1980, in 1970, and in 1950.

Graduation season this year is characterized by many trans-societal disturbances — a global health crisis, protests against systemic injustices, and vast economic uncertainty. The graduates of today will be called on to shape and serve a world that is deeply in need of their energy and expertise.

It’s not right to send them forth simply with an apology that the world isn’t like it used to be — there have always been uncertainties, challenges, and complexities. Instead, it is critical to remind graduates that the world awaits their skills and welcomes them to craft a path to a future of service and opportunity.

So my message to the 2020 Columbia University Department of Biomedical Informatics graduates, delivered via a 90-second live video instead of a 9-minute podium speech, applauded their accomplishments and expressed my deepest confidence that the world will be a better, healthier place because of their talent and training in biomedical informatics. As graduates of one of the 16 NLM-supported predoctoral and postdoctoral training programs in biomedical informatics and data science, these men and women represent a unique group of professionals equipped with the biomedical informatics and data science skills necessary to extract knowledge from data and return it to practice. 

I promised them, as I promise all of you, that the National Library of Medicine would travel beside the nurses, physicians, researchers, patients, and leaders of the future, serving as a consistent source of trustable knowledge about health, health challenges, and the technologies and information needed to advance health for all. 

What did you promise your graduate this year? 

Sustaining Commitment During Times of Challenge

It’s been more than two months since NLM’s physical workspace radically shifted to maximum telework. More importantly, it’s been six months since the world first heard of the novel coronavirus, which causes COVID-19.

So much has happened: millions of people infected worldwide, and many more millions affected by changes in employment, schooling, routines, and contact with family and friends. We collectively mourn with the loved ones of the more than 100,000 individuals who have died from COVID-19 in the United States and over 350,000 worldwide who have died.

As NLM Director, my feelings have vacillated from being overwhelmed by the challenges NLM faces in supporting NIH and society by fulfilling the need for data and information access to being exhilarated by NLM’s ability to swiftly meet those challenges. Some days I’m numbed by the 24-hour news stream about COVID-19; on others, I’m energized by reports of the search for new treatments and vaccines and the work of selfless health care providers.

Despite it all, I find that I am able to recommit my intellect and my efforts to help NLM and NIH stay on course.

The challenges that NLM faces most frequently arise from our goal to help scientists, clinicians, and professionals quickly access COVID-19 information and resources. We are working faster, with new partners, and drawing on the long-standing goodwill that we’ve cultivated with colleagues across NIH and throughout government. Partnerships and agreements are foundational to extending the reach of NLM resources and minimizing unnecessary duplicative efforts. We can’t do this alone.  

We’re also facing challenges brought on by the novelty of extended remote working, which lacks the typical cues that enrich interactions and the spontaneous hallway encounters that solidify goodwill in work groups. We have had to quickly develop innovative strategies to manage new challenges, such as how to streamline the deposit of viral sequences to GenBank or fulfill interlibrary loan requests when we can’t get to our stacks.

Our challenges are not solely related to the pandemic, though, and we are still focused on keeping NLM’s other work moving forward. We’re in budget-planning season, so we continue to have conversations about how to best use taxpayer-supported funds to accomplish NLM’s mission.

Even though we’re not physically in the NLM work space, we are moving forward with modernizing the NLM building (Building 38), examining schedules and funding plans and working with architects and the NIH Office of Research Facilities. And we continue to conduct and support research, acquire and index the literature, and devise new ways to bring information to those who need it.

What helps me do this? I draw strength from the amazing leadership team that guides NLM. This group of 10 women and men meet daily for 15 minutes to exchange ideas, develop new strategies, and monitor the needs of our staff as they work — at a distance — to keep NLM resources available globally, 24 hours a day. I am supported by NIH leadership — the 26 other Institute and Center directors and senior directors — and join with them to best position NIH as the most powerful research engine in the world to better understand the novel coronavirus and the clinical pathway of COVID-19 to accelerate the discovery of new vaccines and to make new therapeutics available.

And I am inspired by the range of services NLM offers the world. It’s hard not to be proud of such a great organization and its good work. Our National Network of Libraries of Medicine is helping local communities get specialized information about COVID-19 into the hands of the people who need it. Our extramural and intramural researchers have turned their talents to developing new ways to monitor the course of the epidemic and to understanding the fundamental biology of the virus.

At our NLM Town Hall meetings, brown bag discussions, and divisional meetings, I get to hear from Library staff. I learn about the strategies they use to maintain work-life balance, their tips for productive teleworking, and their favorite comfort foods. Engaging with staff helps center me in my role as NLM Director and gives me insight into how to best support them. More importantly, it helps sustain my commitment during times of challenge. 

What helps sustain your commitment during these challenging times?

Decoration Day, Pandemics, and the National Library of Medicine

This week we celebrate Memorial Day, a federal holiday to honor our veterans and remember the men and women of the U.S. military who gave their lives in the service of our country. Originally known as Decoration Day, this was a day for Americans to commemorate the memory of departed soldiers by adorning their graves with flowers, flags, and banners. For some reason, as a kid I preferred the name “Decoration Day” — maybe because I’ve always thought it’s important to celebrate patriotism. 

In an earlier post, I reflected on one of the most surprising experiences I’ve had as NLM Director, the emergence and recognition of a renewed sense of patriotism that brings a deeper awareness of purpose and satisfaction to my professional role. I trace this sense of allegiance and service to our country back to my youth, with my dad in the U.S. Army Reserve; my Uncles, Bill, Jerry and Ed, who were active duty Navy and Army officers; my cousins Joey and Bill who served in the Army Special Forces and the Navy; and, of course, all the young men friends who served in Vietnam. I was fortunate, though, that when I went to decorate graves on Memorial Day, I did so as a tribute to unknown soldiers, not as a grievous act of remembrance.

Did you know that NLM predates the first celebration of Memorial Day (“Decoration Day” back then) by more than 30 years? And that our roots are firmly grounded in military service?

NLM was established in 1836 when the Army Surgeon General requested funds from the U.S. government for medical books to refer to in the field, and the growing collection officially became the Library of the Office of the Surgeon General, United States Army. In our first 120 years we were, through various structures, a military medical library. It was only in 1956 that an act of Congress transferred the library to the Public Health Service and named it the National Library of Medicine.

One hundred years ago, our country was in the grip of a different pandemic — the 1918 influenza pandemic. Although we may think that this pandemic only spanned the year of 1918, it lasted more than two years, with effects reaching into 1920. My dad was born during the pandemic, and I’m often curious how my grandmother, Mary, coped with being pregnant with her eighth child (out of nine) in Philadelphia in the spring of 1919. We weren’t a military family back then, and I wonder where my grandmother sought help when she had questions about health, pregnancy, and child-rearing. Whomever she turned to, she must have received some good advice because all her children survived, and most lived well into their 80s, including my dad.

Pregnant women, and indeed anyone with health concerns or questions during the current COVID-19 pandemic, have the National Library of Medicine to turn to for trusted health information. We’re working closely with NIH’s National Institute of Child Health and Human Development to help build a data collection system that can link records of mothers and babies to improve clinical care and maternal and child health outcomes research. We’re supporting the addition of language to the formal terminologies of health care, including LOINC (Logical Observation Identifiers Names and Codes) and SNOMED CT, to make sure that professionals have words to characterize the clinical landscape of COVID-19 in adults and children. And staff from our marvelous History of Medicine Division are actively connecting with researchers to guide them to unique and rare materials in our collections which document national and regional responses to the 1918 influenza pandemic, like this military hospital magazine from U.S. General Hospital No. 18 of Waynesville, North Carolina, which recorded experiences of soldiers, and this publication of the American Catholic Historical Society of Philadelphia which recorded the contributions of its volunteers to make sure they were not forgotten by future generations.

NLM stands as a trusted source of health information for the world, during times of crisis and in more normal times. We partner with Institutes across NIH, such as the National Institute of Allergy and Infectious Diseases, to promote up-to-date information and with other government agencies, such as the Centers for Disease Control and Prevention, to align as one voice across government. We continue to focus on our mission of conducting and supporting research; building, curating, and providing access to molecular biology and genomic, clinical trial, and other types of biomedical data; acquiring, organizing, preserving, and providing free online access to scholarly biomedical literature around the world; and providing access to biomedical and health information across the U.S. through the National Network of Libraries of Medicine

Please tell me how we can best help you. And please accept our good wishes to all of you remembering military family and friends as we once again celebrate Decoration Day during this challenging time.

Emergency Funding Allows NLM to Expand COVID-19 Research and Services

I’ve been inspired, but not surprised, to see all the incredible work that’s going on across the NLM and the National Institutes of Health (NIH) to respond to the challenges presented by COVID-19. At NLM, we’ve been working on multiple fronts to improve researchers’ understanding of the novel coronavirus (SARS-CoV-2) and the disease it causes (COVID-19). We were fortunate to receive $10 million as part of the Coronavirus Aid, Relief, and Economic Security (CARES) Act, which provides emergency funding for federal agencies to combat the coronavirus outbreak.

NLM is using this funding to support activities to improve the quality of clinical data for research and care, accelerate research including phenotyping, image analysis, and real-time surveillance, and to enhance access to COVID-19 literature and molecular data resources.

Improving quality of clinical data for research and care

The novel coronavirus is driving a need for standardized COVID-19 terminology and data exchange that will allow clinicians and scientists to communicate more effectively and consistently. NLM supports health data standards, and we are using supplemental funds to support the addition of codes for COVID-19-related laboratory tests within LOINC (Logical Observation Identifiers Names and Codes) and to provide implementation guidelines and training in use of the standards.

We are also expanding our ability to process and distribute new codes for major terminology sources used by health care providers, electronic health record systems, and commercial health care systems, which are vital to monitoring and measuring COVID-19 patient outcomes. More specifically, NLM is enabling sharing of COVID-19 terminology updates through the Value Set Authority Center (VSAC), which makes available value sets and clinical terminologies. Value sets are codes from standard terminologies around specific concepts or conditions and are used as part of electronic clinical quality measures or to define patient cohorts, classes of interventions, or patient outcomes. This important work will facilitate the analysis of electronic health record data and support effective and interoperable health information exchange.

NLM is updating terminology for coronavirus-related drugs and chemicals through resources such as the Medical Subject Headings (MeSH) used for indexing and cataloging biomedical literature, and ChemIDplus, a dictionary of over 400,000 chemicals (names, synonyms, and structures). This work aligns terminology to facilitate the identification of chemicals and drugs used to treat, detect, and prevent COVID-19 and other coronavirus-related infections, including severe acute respiratory syndrome (SARS), and Middle East Respiratory Syndrome (MERS).

Accelerating research

NLM’s vibrant intramural and extramural research programs are conducting and supporting research to advance the understanding of the novel coronavirus. Our intramural research program is using virus genomics, health data, and social media data to identify community spread of COVID-19. Our researchers are applying machine learning and artificial intelligence techniques to chest X-rays to differentiate viral pneumonia from bacterial pneumonia – expanding knowledge of the process of the SARS-CoV-2 viral infection and assisting in the identification of best practices for diagnosis and care of COVID-19 patients. NLM research in natural language processing contributed to development of LitCovid, a curated literature hub for tracking scientific publications about the novel coronavirus. It provides centralized access to more than 13,500 relevant articles in PubMed, categorizes them by research topic and geographic location, and is updated daily.

Our extramural research program is focusing on novel informatics and data science methods to rapidly improve the understanding of the infection of SARS-CoV-2 and of COVID-19. In April, NLM issued two Notices of Special Interest (NOT-LM-010 and NOT-LM-011) seeking applications (due in June) in these areas: the mining of clinical data for ‘deep phenotyping’ (gathering details about how a disease presents itself in an individual, fine-grained way) to identify or predict the presence of COVID-19; and public health surveillance methods that mine genomic, viromic, health data, environmental data or data from other pertinent sources such as social media, to identify spread and impact of SARS-Cov-2.

Enhancing access to COVID-19 literature and molecular data resources

NLM is also improving access to published coronavirus literature via PubMed Central (PMC). In response to a call by science and technology advisors from a dozen countries to have publishers and scholarly societies make their COVID-19 and coronavirus-related publications immediately accessible in PMC, along with the available data supporting them, nearly 50 publishers have deposited more than 46,000 coronavirus-related articles in PMC with licenses that allow re-use and secondary analysis. Articles in the collection have been accessed more than 8 million times since March 18. NLM will use supplemental funds to improve the article-submission system to better accommodate publisher submissions and accelerate release of these critically important articles. On the PubMed side of literature offerings, NLM supplemental funds will support integrating LitCovid metadata. Novel sensors are being developed to leverage LitCovid metadata when directing users to curated COVID-19 content. The new infrastructure will permit PubMed to rapidly add additional disease-specific sensors in the future.

On January 12, 2020, NLM’s GenBank, the world’s largest genetic sequence database, released the first SARS-CoV-2 sequence to the public and the first sequence collected in the United States in collaboration with the Centers for Disease Control and Prevention (CDC) on January 25. As of May 7, GenBank has 3,893 SARS-CoV-2 sequences from 42 different countries that are publicly available. We created a special site, the “Severe acute respiratory syndrome coronavirus 2 data hub,” where people can search, retrieve, and analyze sequences of the virus that have been submitted to the GenBank database. In late March, we joined the CDC-led SPHERES consortium, a national genomics consortium which aims to coordinate U.S. SARS-CoV-2 sequencing efforts and make data publicly available in NLM’s GenBank and Sequence Read Archive (SRA), and other appropriate repositories. Supplemental funds will allow GenBank to further enhance the submission workflow, establish and promote use of metadata sample standards, and develop a fully automated SARS-CoV-2 submission workflow that incorporates quality checks, as well as ‘automated curation’, to provide standardized annotation of the SARS2 genomes submitted to GenBank.

SRA is positioned as a ready-made computational environment for public health surveillance pipelines and tool development. SRA metagenomic datasets from both environmental samples and patients diagnosed with COVID-19 can reveal patterns of co-occurring pathogens, newly emerging outbreaks, and viral evolution. NLM supplemental funds are being used to prototype SRA cloud-based analysis tools to search the entirety of the SRA database. These tools can provide efficient search for SARS-CoV-2, identify genetic patterns, and monitor newly submitted data for specific viral patterns.

NLM supplemental funding  also supports the identification and selection of web and social media content documenting COVID-19 as part of NLM’s Global Health Events web archive collection. This content documents life in quarantine, prevention measures, the experiences of health care workers, patients, and more. We are also participating as an institutional contributor to a broader International Internet Preservation Consortium (IIPC) Novel Coronavirus outbreak web archive collection. 

These are many of the investments that NLM is making with this emergency funding. I will keep you updated as we continue to make progress on these initiatives.

Researchers: how can you envision using these tools in your own work? What else would be helpful? Let me know in the comments!