Giving Thanks Where Thanks is Due

One of the great joys of being the Director of the National Library of Medicine is the many opportunities for me to express gratitude. In the past, I have given thanks to NLM staff who are veterans (2021), for progress during my tenure (2020), and to our amazing NLM staff members (2019). This year, I am pausing to give thanks for the outstanding products and services developed and stewarded by our NLM staff, made available every day of the year to anyone with an internet connection—and even to some without!

First, I am thankful for our information collections in their many forms. The NLM Board of Regents oversees our Collection and Preservation Policy, which guides NLM as it meets its mission to acquire, organize, preserve, and disseminate biomedical knowledge from around the world. Our collection spans ten centuries from the 11th to the 21st, and ranges from the third oldest Arabic medical manuscript in existence to the “Rosetta Stone” of modern science, Marshall Nirenberg’s genetic chart, from genomic sequences essential for current and future research to information for mothers taking care of sick children.

Organizing the collections and making them findable and accessible builds on the knowledge of library and information science. This foundational knowledge means we can tag objects—real or virtual—with codes and terms that help with organization and retrieval. It also means we use our knowledge of library and information science to guide efforts to annotate and curate molecular data, literature citations, and images so they are accessible to the public. So I am grateful not only for the 66 miles of shelving that hold our precious objects, books, and journals here in Bethesda, but for the ever-powerful computer clouds that preserve our high-value research databases and 34 million bibliographic citations in PubMed. Libraries do more than house books; they use sophisticated knowledge to organize materials and make them readily available.

I am thankful for the ways that staff at NLM’s National Center for Biotechnology Information (NCBI) manages the submission, curation, and dissemination of our enormous genomic and molecular databases. From ClinVar (our collection of genomic sequences linked to clinical annotation) to the Sequence Read Archive (the world’s largest scientific data repository), our staff makes sure that depositors can effectively deposit data, scientific curators can conduct quality checks, and web and interface designers allow access to the data. A few years ago, the NCBI team led a cloud migration process to make available data from the entire 15-petabyte SRA resource on two commercial cloud providers. This bold step democratized sequence-based scientific inquiry and harnessed the computational power of cloud platforms, which contributed to industrial innovations and shortened the pathway for scientific discovery from days and months to minutes and hours. I am thankful for the role NLM plays in accelerating scientific advances and leveraging research resources for public health benefit.

NLM offers more than 1,000 easy-to-read health topic articles through our online consumer health information resource known as MedlinePlus. MedlinePlus is available in both English and Spanish, thereby assuring information access to speakers of two of the world’s most common languages. Through MedlinePlus Connect, our technical team also provides direct, tailored access to MedlinePlus resources automatically through electronic health records, patient portals, and other health information technology systems to deliver information from MedlinePlus to patients and providers at the point of care. I am thankful for the efforts of the MedlinePlus teams that bring timely and trusted information to the lives of everyone, everywhere.

I hinted earlier that there are two main pathways to access NLM products and services. Electronic access, supporting both human- and machine-readable forms, is by far the most common pathway to NLM. We also support the Network of the National Library of Medicine (NNLM) and its more than 8,000 members around the country in public, hospital, and academic medical center libraries to bring the power of NLM and its resources to the public. I am grateful for everyone who works as part of NNLM for their ability to bring NLM’s products and services to communities everywhere as well as how the needs and practices of those communities bring awareness of NLM.

As you pause this year in thanksgiving for the many public services that support you in everyday life, please remember to give thanks for NLM’s products and services. We think they are world class, and we are grateful for our ability to serve you.

The More AMIA Changes, the More It Stays the Same . . .

Right at this very moment, the American Medical Informatics Association (AMIA) 2022 Annual Symposium is underway in Washington, D.C., and we encourage you to visit NLM @ AMIA 2022 for updates on NLM’s products and programs. Now this may sound quite familiar to those of you who have attended AMIA annual symposiums in Washington, D.C., and other major cities over the past 30 years, but this year it is different. And yet, it is the same.

What’s the same? Well, for me and almost 3,000 other attendees, AMIA is our professional home. Through meetings and conversations, journal articles and webinars, and a host of new events and meetings, members build their knowledge about biomedical and health informatics, share that knowledge with colleagues, and advance the health of the public through informatics. We have built friendships, watched babies be born and grow into adults (including my son Conor), and grieved the loss of great leaders in the field. Colleagues have debated the wisdom of electronic health records that may have inadvertently contributed to clinician burnout and expanded the scope of our design and deployment efforts to encompass tools useful to consumers and language reflective of the diversity of society.

AMIA has welcomed young people into informatics and sponsored high school-student participation in national meetings. Special events now include rapid response to public health threats, special interest meetings for women in informatics, and expanded attention to diversity and inclusion. The fall symposium provides an opportunity for formal and informal mentoring, a quick hug with an old friend, and a reunion of those with whom we studied the basics of the field.

And yet, over 30 years, many things have changed! First and foremost, AMIA as an organization has grown, engaged new leadership, and developed new special interest groups. These each change the tenor of the meeting by adding new events to an already rich and attractive suite of offerings and bringing like-minded people together. The ideas shared and the research reported through the annual symposium have morphed throughout the years; now artificial intelligence takes center stage, tempered by thoughts of transparency and equity. A larger number of panels and industry sessions reflect the rapidly changing landscape of informatics. Electronic posters and smartphone apps take the place of what once were paper posters displayed in long corridors of bulletin boards and a three-inch-thick compilation—dare I say phone book size—of all the papers to be presented at the sessions.

And of course, the pandemic changed both everything and nothing. AMIA still hosted an annual symposium and participants still gathered, at least over video chat! Throughout the pandemic, AMIA offered virtual and hybrid conferences—this is the first annual symposium completely in person since 2019 and boy, was I ready for it!

So, rejoice with us—our annual touchstone of gathering for the science of biomedical informatics and the social support of friends and colleagues continued! Please plan to join us in 2023 and see for yourself what it is like!

Who Really Are Our Users, and How Can We Help Them?

Well, this is a question too big for even the largest biomedical library in the world to answer. Our users are everywhere, and in fact, the same user may approach us with very different needs or personas, such as the brilliant cell biologist who is also the mother of a sick toddler. Today, I am thinking of that huge army of applied clinical informatics specialists and how we might begin to help them.

Applied clinical informatics specialists form the technical workforce that make health information technologies work for patients and clinicians. These individuals often have a background in nursing, medicine, or another clinical specialization. Their advanced training and advanced certifications can attest to their understanding of how health care is delivered, the data and information resources needed to deliver that health care, the data underlying care, and the person-professional-technology engagement needed to better deliver care through effective use of information technology.

NLM is pretty clear about its role in supporting the enormous research and development efforts that design, deploy, and evaluate computer systems for health care and in making the basic and clinical biological and biomedical literature accessible to patients, clinicians, and researchers. To the best of my knowledge, NLM has not done enough to think about the applied clinical informatics community as a distinct stakeholder group, and it is now time to do so!

Applied clinical informatics professionals are skilled at designing, installing, and implementing electronic health records. Some of them specialize in evidence-based practice, bringing the research evidence into the point of care. Others focus on human computer interaction, striving to harness the power of computing to support practitioners and to avoid cumbersome or ill-designed clinical records systems. Still other applied clinical informatics professionals are crafting the decision-support tools that bring effective, ethical artificial intelligence into practice. Some serve key roles in their institutions’ value-based health care deliberations, bringing to light through data where health care interventions bring value to the patient and the system. And some applied clinical informatics specialists focus on translating science into care. These positions are critical to making sure that the advantages of information technology reach into the realm of clinical practice… and man oh man, are they busy!

This makes it hard for applied clinical informatics specialists to make use of NLM’s vast resources in the ways different from the typical researcher uses of these resources – as part of a larger process of building or evaluating research ideas, in a reflective manner, through exploration of several articles on the same theme, and with the time, the patience, and the purpose to discern lines of reasoning out of multiple articles. To best support the applied clinical informatics community, NLM needs to expand its ways of doing business, and find ways to make in-the-moment search for best practices or clinical guidance available. How can we do this?

Rethink the “typical library user” and be open to the atypical user. NLM also serves as the repository of record for biomedical knowledge. We have presumed that the synthesis and application of that knowledge is the responsibility of the reader. Perhaps now is time for us to find new ways to partner with outside organizations that can cast their special eye over our resources and to cull their knowledge for the applied clinical informatics specialist.

Work on translating our research findings into practical practices. NLM makes a substantial investment in developing new algorithms that find better ways to link clinical records together. We have a small but fledgling program, our tech transfer funding to stimulate new businesses relevant to the use of data in health care. Perhaps we should better advertise the availability of these funds and target the challenges experienced by applied clinical informatics practitioners.

Expand our abilities to cull basic science and clinical care innovations from the literature. Applied clinical informatics professionals have, as part of their job, the building of the information tools to bring science into practice. We need to learn from them so we can better expose our literature for their needs, keeping them abreast of new and emerging findings in the literature that will someday make their trajectory into practice.

Partner with specialty organizations to make sure that the important lifelong skill development of being an applied clinical informatics professional becomes a realistic process in their career trajectory.

A few months ago, I spent a morning speaking with applied clinical informatics professionals to affirm their interest in NLM supporting them in their work and to listen to their needs, dreams, and demands. In a future blog, I will tell you more about what I learned from them!

NLM’s Library Operations is Reimagining to Better Serve You

This blog was authored by staff who serve on the National Library of Medicine (NLM) Library Operations (LO) Strategies Working Group.

NLM is nearing its 200th anniversary in 2036, and NLM’s Library Operations (LO) is reflecting on its continuing mandate to acquire, organize, preserve, and disseminate biomedical information. LO is one of NLM’s largest divisions and comprises over 400 talented staff committed to furthering NLM as the world’s largest biomedical library and a leader in research in computational health informatics. We are re-envisioning our products, operations, and services for NLM’s diverse users around the world.

Last year, we created a “3Cs” framework—Collect, Curate, and Connect—to describe the work we do.

Each component represents the critical work LO performs, but the components do not function in isolation. They are interconnected and move together to achieve operational success.

Illustration shows 3 gears in the middle of various sizes. The gear on the left is titled “Collect” with text below that says acquire and preserve unique and trusted collection of biomedical information. The gear at the bottom is titled “Connect” with text below that says link our global audience to biomedical data and resources to make informed health decisions. The gear on the right is titled “Curate” with text below that says make biomedical information findable through data normalization, metadata, and data standards.
Embracing a Future of Data-Driven Discovery

Our 2021–2036 Long-Range Plan is strategic, thoughtful, and forward-thinking. It will address the challenges that come with the accelerated pace of changing technology, the rise and spread of health misinformation, evolving user expectations, and need for equal and inclusive access to unbiased information.

In support of the three pillars of the NLM Strategic Plan, LO will work collaboratively across NLM and the National Institutes of Health (NIH) to build a data-driven workforce and with global partners to ensure our work accelerates biomedical discovery while reaching as many people as possible.

The five goals of our long-range plan will enhance LO’s mission and prepare us for the future as NLM reimagines its work post-pandemic and moves into its third century.

Illustration shows a 5-step process with numbers on top, description of  steps in the middle, and simple illustrations at the bottom. Step 1 says create a modernized organizational structure. Step 2 says unify and transform NLM collections. Step 3 says support and promote the use of health data standards and terminologies. Step 4 says customer design experience support. Step 5 says know and equitably engage our users.

Goal 1: Create a Modernized Organizational Structure. We will focus internally on our organizational structure, work processes, and the workforce expertise necessary to meet the future needs and expectations of our global users.

Goal 2: Unify and Transform NLM Collections. We will redefine and manage NLM’s diverse collection of both historical and modern content as “one collection,” valued by the world for the knowledge it holds to advance data-driven discovery. We will accelerate digitization, increase digital acquisitions, improve the discoverability of collections data, and continue investing in the physical collection space for future preservation.

Goal 3: Support and Promote the Use of Health Data Standards & Terminologies. We will position LO as a centralized leader in the production of and access to the terminologies, policies, data, and tools needed for wide-scale public use and research.

Goal 4: Provide Customer Design and Experience Support. We will support customers’ needs and translate them into product development and life cycle management by putting the principles of digital government strategy into practice.

Goal 5: Know and Equitably Engage Our Users. We will engage stakeholders to facilitate access, delivery, and dissemination of NLM’s collection and trusted NLM/NIH health information resources through community-driven engagement, training, and capacity-building programs.

The first phase of implementation for all five goals is currently underway, and we plan to continuously measure and assess our progress, evolve as needed, and continue to engage our stakeholders.

Our Commitment to Our Users

The interrelated 3Cs and five goals will allow us to continue to collaborate across our institution to serve NLM’s diverse users, enhance our role as a national library, maintain stewardship of the world’s largest biomedical collection, and serve as a key NIH institute. LO is committed to our continuous improvement, innovation, and data-based decision-making to support biomedical research discovery and integrity. Our core values of user focus, service, knowledge sharing, quality, and trustworthiness continue to serve as our beacon to confidently deliver on the goals outlined in this bold 15-year plan.

Libraries continue to evolve as their users’ needs and expectations change. How are you responding to the changing needs of your users?

Top Row (left to right):
Dianne Babski, Associate Director for Library Operations
Amanda J. Wilson, Deputy Associate Director for Library Operations
Jennifer L. Marill, Chief of the Technical Services Division
Jeffrey S. Reznick, PhD, Chief of the History of Medicine Division

Bottom Row (left to right):
Margaret A. McGhee, Chief of the Public Services Division
Deborah Lockett-Jordan, Senior Administrative Officer for Library Operations
David Gillikin, Chief of the Bibliographic Services Division

What’s New in NLM’s Extramural Programs?

Guest post by Andrew Wiley, Video Producer, NLM Office of Communications and Public Liaison (OCPL).

NLM recently released videos on two exciting projects funded through the Extramural Programs Division.

Using Machine Intelligence to Prevent Medication Dispensing Errors

With help from an NLM grant, Drs. Corey Lester, Raed Al Kontar, and Xi Jessie Yang of the University of Michigan College of Pharmacy in Ann Arbor, Michigan, are using machine intelligence (MI) to assist in the pill verification process and help avoid dangerous and costly pharmacy dispensing errors.

Pharmacists play a critical role in helping safeguard people and communities, and we acknowledge their assistance this October as we celebrate American Pharmacists Month. Dr. Lester and his colleagues are making sure that MI reports accurate information to encourage providers to make sound, trustworthy decisions. In doing so, pharmacists can ensure that patients get the correct pills in the correct bottle and create safer systems that can save lives. Dr. Lester’s proposal was to develop and design artificial intelligence, specifically a computer vision model, that could look at a picture of pills inside a medication bottle and accurately identify the contents of that bottle.

Watch the video about this research and find the transcript here.

After Foster Care: Empowering Youths with Personal Health Records

At Cincinnati Children’s Hospital Medical Center, Dr. Dexheimer is using NLM grant funding to help young adults who are aging out of the foster care system access their personal health records. According to Dr. Dexheimer, there are 427,000 children in the foster care system, and approximately 5,000 youths emancipate, or age out, every year.

Using the Health Hero online platform, Dr. Dexheimer is providing emancipated young adults with access to and control over their own personal health records and improving their health care knowledge as a result. Health care outcomes for these young adults are poor partially due to lack of access to their medical history. The video also includes two young women who recently emancipated from foster care, who were willing to share their stories and experiences using Health Hero.

Watch the video about this effort and find the transcript here.

Get More Video Content and Learn More About NLM

Visit Welcome to NLM to take a virtual tour and to learn more about NLM’s programs, tools, and resources. Be sure to subscribe to the NLM YouTube channel for access to more great video content.

Mr. Wiley is a video producer and writer for NLM OCPL. Before joining NLM in 2008, Mr. Wiley produced local television in Frederick, Maryland and worked as a video journalist for The Frederick News-Post.

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