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!

Request for Public Comment: Seeking Input on Nationwide AI Research Resource Implementation Plan

Guest post by Lynne E. Parker, PhD, Director of the White House National Artificial Intelligence Initiative Office, and Erwin Gianchandani, PhD, National Science Foundation Senior Advisor for Translation, Innovation, and Partnerships

The White House Office of Science and Technology Policy and National Science Foundation are looking for your input to shape the work of the National Artificial Intelligence Research Resource (NAIRR) Task Force. This Task Force is taking on a critically important initiative – building an implementation plan for a national infrastructure that would democratize access to artificial intelligence (AI) research and development (R&D).  

As directed by Congress in the National AI Initiative Act of 2020, the Task Force is serving as a Federal advisory committee to help create a blueprint for the NAIRR, which is envisioned as a shared computing and data infrastructure that would provide AI researchers and students across all scientific disciplines with access to computational resources, high-quality data, educational tools, and user support. This capability would help make AI R&D accessible to all Americans by lowering the barriers to entry for traditionally underserved communities, institutions, and regions. It would also fuel innovation by making it easier than ever before for Americans to pursue bold, visionary applications for AI.

The Task Force will provide recommendations for establishing and sustaining the NAIRR, including technical capabilities, governance, administration, and assessment, as well as requirements for security, privacy, civil rights, and civil liberties. The Task Force will submit two reports to Congress presenting a comprehensive strategy and implementation plan: an interim report in May 2022 and final report in November 2022.

To get this right, we want to tap into the deep technical expertise of the community and bring in a range of perspectives. We invite you to submit a response to our Request for Information before the comment period closes on October 1, and ask that you spread the word. This effort could set us on the path to transform our nation’s ability to harness AI across fields of science and engineering and economic sectors, and your insights could help shape our approach.

We appreciate your contributions and look forward to receiving your input.

Dr. Parker is the Founding Director of the National Artificial Intelligence (AI) Initiative Office and Assistant Director of AI in the White House Office of Science and Technology Policy (OSTP).  In these roles, she leads national AI policy efforts and coordinates AI activities across the Federal agencies in support of the National AI Initiative.  Dr. Parker is a professor of computer science at the University of Tennessee, on assignment to OSTP. She received her PhD from the Massachusetts Institute of Technology and is a Fellow of the American Association for the Advancement of Science and Institute of Electrical and Electronics Engineers.

Dr. Gianchandani is the National Science Foundation (NSF) Senior Advisor for Translation, Innovation, and Partnerships. For six years, he was the NSF Deputy Assistant Director for Computer and Information Science and Engineering. In this role, he contributed to the leadership and management of NSF’s CISE directorate, including formulation and implementation of the directorate’s $1 billion annual budget, strategic and human capital planning, and oversight of day-to-day operations. He received a BS in computer science and MS and PhD degrees in biomedical engineering from the University of Virginia.

Imagination – The Cornerstone of Innovation

Part 1 of a series discussing the importance of imagination.

Everyone is talking about the “new normal” now — the post-pandemic space after we return to the physical location of work, school or play— and asking, what will life be like? There are many calls for innovative thinking. One of the best things about a library is that it provides a foundation for innovation, but building the pathway between great science, good ideas, and innovative products and services takes imagination. NLM is a springboard for innovation in health care, from describing previously not-well-understood biological processes to creating new drugs and therapeutics. Even taking the leap from this springboard requires imagination!

Imagination is a process of the mind somewhere between cognition, recall, and play, that allows a person to create novel ideas, sensations, and visualizations. Somewhere between play and wool-gathering, imagination is the capacity of an individual to conjure up ideas that can be pleasing or frightening, phantasmagoric or peaceful. Sometimes the experience of imagination is a self-contained pleasure; other times it becomes a catalyst for new ways of living or new products and services that can help the public in different ways.

Imagination is the starting point for innovation. 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. Everyone can exercise imagination, and through this practice, make the world around them a better place!

Nurses are pretty good at applying imagination to complex patient care situations. Take, for example, Marie Van Brittan Brown an African American nurse living in the Jamaica neighborhood in the New York City borough of Queens. In the early 1960s, she and her husband Albert, an electronics technician, imagined a way to help people feel and be safe in their homes.

Figure 1: Diagram of the original 1966 patent request filed by Marie Van Brittan Brown and Albert L. Brown courtesy of the U.S. Patent and Trademark Office.

Being and feeling safe at home is particularly important for homebound individuals. Many homebound individuals live alone and are isolated. They may lack the physical ability or strength to investigate a strange sound outside or answer a ringing doorbell. Ms. Brown and her husband imagined that homebound people would feel safer at home if they had a way to see through the front door and interrogate a visitor and, if necessary, activate an alarm to alert the police that help was needed. Envisioning a set of peepholes, microphones, and a closed-circuit television, they created the first modern home security system. A monitor installed in the home or bedroom of the resident allowed ease of viewing and enabled the resident to speak to someone outside the door. Ms. Brown and her husband were awarded a patent in 1969 for this system.

Like many people who use imagination to stimulate innovation, Ms. Brown found herself far ahead of her time. In the 1960s, closed circuit TV was considered a military application, and home builders found the cost of the system to be too high. However, having the forethought to register their design and seek a patent, they provided the “prior art” that later stimulated over 30 patents.

What helps build the pathway from science to imagination to innovation begins with an idea that addresses an important problem. Imagination complements science, making it possible to see what science enables. Achieving the full promise of innovation again requires a dose of science because leveraging what is already known to what could possibly be is what brings an imagined future into an innovative reality. It takes imagination to sketch out a future, and even more imagination to find (or build) the elements needed to make that future real.

NLM stands as a partner in your imaginative journey. Keep practicing and let us know how we can help you innovate the future you can imagine!

What Did You Do with Your Summer Vacation?

Well, if you are spending the summer at the NIH, you’ve likely been engaged in one of our many activities designed to access critical data and advance our understanding of the human experience by linking data sets together. Today, we are inviting you to engage in some additional best practices in accessing controlled data in ways that support science and preserve privacy.

In 2020, the NIH Scientific Data Council charged its Working Group for Streamlining Access to Controlled Data to spend a year engaging in dialogue within the NIH and with our extramural colleagues to better understand the experiences of scientists and the strategies that both facilitate and impede access to data. The group also considered where in the research process NIH should inform, engage, and gain consent of participants sufficiently to support science driven by access to controlled datasets.

NIH stores and facilitates access to many datasets, both open and controlled, with the goal of accelerating new discoveries and thereby maximizing taxpayer return on investment in the collection of these datasets. Data derived from humans that are shared through controlled-access mechanisms reflect NIH’s commitment to protect sensitive data and honor the informed consent provided by research participants in NIH-supported studies.

NIH has supported multiple controlled-access data repositories that uphold appropriate data protections for both human data and other sensitive data, while meeting the needs of various researcher communities. However, as data access requests increase, new repositories are established, and new mechanisms of providing access to data are developed, it is apparent that opportunities remain to improve efficiency and harmonization among repositories to make NIH-supported controlled-access data more FAIR: Findable, Accessible, Interoperable, and Reusable and to ensure appropriate oversight when data from different resources are combined. While these trends are enabling datasets and datatypes to be combined in new ways that advance the science, datasets, and datatypes that may or may not be controlled may, when combined, create inadvertent re-identification risks.

To help the agency address these issues in a way that is responsive to community needs, we are hosting a series of webinars through the end of July. We call these “breakout sessions” because they follow an outstanding webinar presented on July 9 available here. Richard Hodes, MD, director of the National Institute on Aging, launched the 3-hour seminar with a talk titled Opportunities for Advancing Research Through Better Access to Controlled Data. Ana Navas-Acien, MD, PhD, brought the perspective of indigenous and communities of people traditionally underrepresented in research, and she emphasized themes of community engagement and broadening the consent framework to consider community-level accountabilities as well as individual assent. Lucila Ohno-Machado, MD, MBA, PhD, addressed privacy preserving distributed analytics as a strategy to promote science while preserving privacy of data. Hoon Cho, PhD, described privacy-enhancing computational approaches to privacy preservation.

You can find the schedule for the breakout sessions below. These sessions are specifically designed to listen to the expectations, hopes, and concerns from researchers and participants. These webinars are free and open to the public; registration is required.

Breakout Session on “Making Controlled-Access Data Readily Findable and Accessible” on July 22 from 3 pm to 5:30 pm EST

Breakout Session on “General Opportunities for Streamlining Access to Controlled Data” on July 26 from 12:30 pm to 2 pm EST

Breakout Session on “Addressing Oversight, Governance, and Privacy Issues in Linking Controlled Access Data from Different Resources” on July 28 from 3 pm to 5:30 pm EST

To generate interest and hear from the broadest possible group of stakeholders, NIH has released a Request for Information on Streamlining Access to Controlled Data from NIH Data Repositories. Please note the closing date is August 9. We look forward to hearing from you! Please visit Streamlining Access to Controlled Data at the NIH for all of the information described in this post.

Finally, we would like to personally thank the many NIH staff members who serve on the working group:

  • Shu Hui Chen
  • Alicia Chou
  • Valentina Di Francesco
  • Greg Farber
  • Jamie Guidry Auvil
  • Nicole Garbarini
  • Lyric Jorgenson
  • Punam Mathur
  • Vivian Ota Wang
  • Jonathan Pollock
  • Rebecca Rodriguez
  • Alex Rosenthal
  • Steve Sherry
  • Julia Slutsman
  • Erin Walker
  • Alison Yao

I hope your summer vacation was as productive as ours!

(left to right)
Patricia Flatley Brennan, RN, PhD, NLM Director
Susan Gregurick, PhD, Associate Director for Data Science at NIH
Hilary S. Leeds, JD, Senior Health Science Policy Analyst for the Office of Science Policy at NIH

Five Years and Counting!

On August 13, 2016, I became the first woman, nurse, and industrial engineer to serve as director of the National Library of Medicine (NLM). From its beginning in 1836 as a small collection of books in the library of the U.S. Army Surgeon General’s office, NLM has become a global force in accelerating biomedical discovery and fostering evidence-based practices. I am proud to direct this esteemed organization and delighted to guide it towards its third century beginning in 2036. 

This has been an exciting five years for NLM.

We accelerated data-driven discoveries and advanced training in analytics and data science across NIH and around the world. Our genomic resources played a crucial role in supporting NIH and the scientific community’s ability to understand a novel virus and address the COVID-19 pandemic. NLM investigators developed innovative uses of deep learning and artificial intelligence and applied them to a wide range of problems – ranging from interpretation of clinical images to improving search and retrieval of highly relevant citations from NLM’s PubMed biomedical literature database.

NLM pioneered strategies to link data sets to articles through our PubMed Central (PMC) digital archive, and doubled the size of the NLM-supported Network of the National Library of Medicine—reaching almost every congressional district in the United States with the capacity to connect NLM resources to communities in need.

We provided technical expertise to develop a secure single sign-on to a wide range of controlled data resources, and redeployed our research infrastructure to help public health authorities detect foodborne outbreaks and track the emergence of coronavirus variants. We also advanced our use of automated-first indexing to make sure that the published literature is available to our stakeholders as quickly as possible.

With the support and collaboration of other components of NIH, we are building a 21st century digital library that uses our collections to offer literature, data, analytical models, and new approaches to scientific communications that are accessible, sustainable, and available 24 hours a day and 7 days a week.

NLM’s archival collections continue to grow and evolve as the archival records of individuals, organizations, and other communities in health and medicine are increasingly created and communicated electronically or digitally. We expanded the formats and types of records we collect—and make accessible and usable— to include born-digital formats such as websites, social media, and data sets. For example, NLM deployed innovative techniques to prospectively curate and add COVID-19-related information from traditional news, social media, and other sources to our Digital Collections. These collections preserve for future research the ephemeral online record of modern health crises, documenting the work and experiences of health care providers, researchers, government agencies, news agencies, patients, and caregivers.

As a nurse and an industrial engineer specializing in health systems engineering applied to patient self-management, I bring a perspective to NLM that expands its mandate from supporting biomedical researchers and clinical practitioners to one that aggressively supports the health of the nation.

During my tenure, NLM’s footprint has expanded by:

  • Growing our research enterprise in support of data-driven discovery;
  • Supporting key priorities of the NIH in data science, access to secure data repositories, and community engagement;
  • Strengthening the integrity and efficiency of our internal resources to accelerate the acquisition, preservation, and dissemination of biomedical data; and
  • Expanding our commitment to public outreach and engagement.

Two guiding principles have shaped my work:   

One NLM

I initiated the One NLM concept as an organizing framework during my first year as director of NLM. One NLM creates a rallying point, making explicit that all our offices and divisions work in concert and in support of NLM’s mission. As described in my January 2017 blog post entitled, One NLM:


One NLM emphasizes the integration of all our valuable divisions and services under a single mantle and acknowledges the interdependency and engagement across our programs. Certainly, each of our stellar divisions . . . have important, well-refined missions that will continue to serve science and society into the future. The moniker of One NLM weaves the work of each division into a common whole. Our strategic plan will set forth the direction for all of the National Library of Medicine, building on and augmenting the particular contributions of each division.

Strengthening the NLM Senior Leadership Team

I employ a team model of leadership—engaging the deputy director, four division directors, and four office directors in biweekly meetings. With the support of external consultants, we engaged in a one-year leadership development activity focused on building capacity for joint decision making, improving risk tolerance, and creating an environment that supports trans-NLM collaborative problem solving. I found that continued engagement with individual members and the leadership team established an organizational milieu that led to improved trust in each other. And the team, which held up in good stead during a period of maximum telework in response to COVID-19, ensured the innovative mobilization of NLM resources to help NIH rapidly assume new research programs, respond to public health needs, and most importantly serve as a trusted source of information.

What I’ve Learned

While I remain true to my core values and beliefs, I’m not the same Patti Brennan as I was when I entered the ‘Mezzanine’ floor of NLM’s Building 38 nearly five years ago. I’ve learned to mobilize and reward the talents of the 1,700 people working at NLM to achieve common goals. I figured out how to work with a boss, something few academics ever actually face. I’m better at finding the niche into NIH conversations and policy-setting meetings where the talents of NLM and our deep understanding of data science accelerate NIH’s mission to turn discovery into health. I’ve created space in conversations for the voices of others, particularly the members of my leadership team with whom, I’ve learned, complement my vision and drive with their knowledge and discernment. It’s been a great ride!

How does the you of 2021 compare to the you of 2016?