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

When You Stand on the Shoulders of a Giant, What Do You See?

This blog contains my remarks from the 2022 Lindberg-King Lecture and Scientific Symposium: Science, Society, and the Legacy of Donald A.B. Lindberg, M.D., which took place on September 1, 2022. Watch a recording of the event here.

I had the great fortune of becoming the director of the National Library of Medicine immediately following the 30-plus-year tenure of Donald A.B. Lindberg, MD. I am sure that each of you here today treasures your own recollection of Don, maybe from a conversation or a laugh you may have had with this great leader, teacher, visionary, and colleague (and husband to Mary, father, grandfather, and friend). I am both proud and humbled to stand on the shoulders of this giant as I lead this incredible organization.

I know more viscerally than most about Don’s legacy as NLM director. I sit in the office he occupied, I walk the halls he walked, I work with the people he hired, and I see and experience the fruits of his judgement, investments, and vision.

I now sit where Don once sat, representing NLM at the leadership table of NIH with the other Institute and Center directors. With Don paving the way, I have a platform to extend NLM’s thought leadership and technical knowledge to guide NIH’s continued efforts to advance data-driven discovery. The good will and collaborative spirit engendered by Don across NIH opened doors for me and helped me continue his legacy to deliver on the promise of science accelerated by broad access to literature and data.

Don and I share a deep commitment to ensuring that the public benefits from NLM’s efforts to assemble, organize, preserve, and disseminate biomedical knowledge for society. It was his early vision that made MedlinePlus a trusted resource for consumer health information and ensured that the PubMed citation database and the PubMed Central full-text literature repository were open and accessible to everyone, everywhere, with an Internet connection, at any time and place.  

Don’s commitment to the public was also evident in his efforts to educate the next generation of biomedical informatics scholars. Frankly, I believe that of all of the aspects of his job, engagement with trainees was his favorite!

When you stand on the shoulders of a giant, you have a great advantage. The foundation Don built and the relationships he established provided me, the 4th appointed director of NLM, with a playbook right out of the gate. It is not enough to solely rely on his vision to guide our future as Don also inspired innovation; in one of our last conversations, he said to me, “This is your game—make sure you play it well!” In order to do that, I cannot simply stand on the shoulders of a giant; I must also keep my head up and my eyes forward to the future to envision new pathways and find new opportunities to bring forward the riches of NLM to the future benefit of science and society.

I close by inviting all of you to stand on the shoulders of this giant and meld your sights with his, for it is not by holding tight to that which he could see, but by using his vision as a stepping-off point for our own that will serve his legacy.

The Next Normal: Supporting Biomedical Discovery, Clinical Practice, and Self-Care

As we start year three of the COVID-19 pandemic, it’s time for NLM to take stock of the parts of our past that will support the next normal and what we might need to change as we continue to fulfill our mission to acquire, collect, preserve, and disseminate biomedical literature to the world.

Today, I invite you to join me in considering the assumptions and presumptions we made about how scientists, clinicians, librarians and patients are using critical NLM resources and how we might need to update those assumptions to meet future needs. I will give you a hint… it’s not all bad—in fact, I find it quite exciting!

Let’s highlight some of our assumptions about how people are using our services, at least from my perspective. We anticipated the need for access to medical literature across the Network of the National Library of Medicine and created DOCLINE, an interlibrary loan request routing system that quickly and efficiently links participating libraries’ journal holdings. We also anticipated that we were preparing the literature and our genomic databases for humans to read and peruse. Now we’re finding that more than half of the accesses to NLM resources are generated and driven by computers through application programming interfaces. Even our MedlinePlus resource for patients now connects tailored electronic responses through MedlinePlus Connect to computer-generated queries originating in electronic health records.

Perhaps, and most importantly, we realize that while sometimes the information we present is actually read by a living person, other times the information we provide—for example, about clinical trials (ClinicalTrials.gov) or genotype and phenotype data (dbGaP)—is actually processed by computers! Increasingly, we provide direct access to the raw, machine-readable versions of our resources so those versions can be entered into specialized analysis programs, which allow natural-language processing programs to find studies with similar findings or machine-learning models to determine the similarities between two gene sequences. For example, NLM makes it possible for advocacy groups to download study information from all ClinicalTrials.gov records so anyone can use their own programs to point out trials that may be of interest to their constituents or to compare summaries of research results for related studies.

Machine learning and artificial intelligence have progressed to the point that they perform reasonably well in connecting similar articles—to this end, our LitCovid open-resource literature hub has served as an electronic companion to the human curation of coronavirus literature. NLM’s LitCovid is more efficient and has a sophisticated search function to create pathways that are more relevant and are more likely to curate articles that fulfill the needs of our users. Most importantly, innovations such as LitCovid help our users manage the vast and ever-growing collection of biomedical literature, now numbering more than 34 million citations in NLM’s PubMed, the most heavily used biomedical literature citation database.

Partnerships are a critical asset to bring biomedical knowledge into the hands (and eyes) of those who need it. Over the last decade, NLM moved toward a new model for managing citation data in PubMed. We released the PubMed Data Management system that allows publishers to quickly update or correct nearly all elements of their citations and that accelerates the delivery of correct and complete citation data to PubMed users.

As part of the MEDLINE 2022 Initiative, NLM transitioned to automated Medical Subject Headings (MeSH) indexing of MEDLINE citations in PubMed. Automated MeSH indexing significantly decreases the time for indexed citations to appear in PubMed without sacrificing the quality MEDLINE is known to provide. Our human indexers can focus their expertise on curation efforts to validate assigned MeSH terms, thereby continuously improving the automated indexing algorithm and enhancing discoverability of gene and chemical information in the future.

We’re already preparing for the next normal—what do you think it will be like?

I envision making our vast resources increasingly available to those who need them and forging stronger partnerships that improve users’ ability to acquire and understand knowledge. Imagine a service, designed and run by patients, that could pull and synthesize the latest information about a disease, recommendations for managing a clinical issue, or help a young investigator better pinpoint areas ripe for new interrogation! The next normal will make the best use of human judgment and creativity by selecting and organizing relevant data to create a story that forms the foundation of new inquiry or the basis of new clinical care. Come along and help us co-create the next normal!

Your Privacy is an NLM Priority

Patient privacy — you might be scratching your head right now. NLM is a research enterprise and a LIBRARY for heaven’s sake! What does a library have to do with patient privacy? NLM protects the privacy of all people who use our resources, which are free and accessible 24/7. NLM complies with requirements for privacy and security established by the Office of Management and Budget, Department of Health and Human Services, and NIH. I encourage you to visit our Privacy and Security Policy guidelines.

No personal identifying information is required to search and access our vast data repositories and library resources. Anyone, sick or well, who wants trusted information about a disease, illness, or health condition can search through our MedlinePlus online health information service. With data available in English and Spanish, MedlinePlus offers high quality, relevant health information for patients and their families on more than 1,000 topics such as children’s growth and development, gene therapies, and self-care after surgery.

We do not link search strategies to any specific patron without their permission. NLM only links information for those patrons who sign up for My NCBI, which is a service that allows patrons to save and return to previous search results. This information is held in a safe, secure part of our computer systems open only to the individual.

NLM also provides expert guidance to other federal agencies for the most effective approaches to preserving patient privacy. Clem Mc Donald, MD, our Chief Health Data Standards Officer, serves as a member of the Health Information Technology Advisory Committee, which is an advisory committee to the Office of the National Coordinator for Health Information Technology that oversees a range of issues from promoting health IT excellence in communities to collaborations among federal agencies. We recently participated in the federal response to Executive Order 13994, Ensuring a Data-Driven Response to COVID-19 and Future High-Consequence Public Health Threats, leveraging our expertise in protecting patient data and preventing inadvertent re-identification from genomic information.

Patient participation in clinical trials and other research efforts advances science and creates the pathways to discover new clinical therapies and interventions. Sometimes, data generated in one study becomes useful in future studies; for example, when trying to understand how different groups of patients respond to the same therapy. NLM provides technical assistance to the National Institutes of Health in creating ways to store participant-level study information safely and securely making information useable for other researchers while making sure that personally identifiable information is not disclosed. We also help NIH create safe, secure data repositories of research data and implement mechanisms and oversight measures to ensure that data is available to researchers and managed in a way consistent with the original agreements for use of the data. We helped establish NIH’s Researcher Auth Service Initiative, a single sign-on for researchers that allows access to specific data sets in a controlled manner.

Our researchers also develop computational methods to protect patient privacy. This includes research investigating how to remove traces of identifying data from clinical records, while making those records useful for researchers to better understand the course of disease and determine the effectiveness of treatments. NLM’s Dr. Mehmet Kayaalp develops ways to let approved researchers use clinical records for clinical studies in a way that protects patient privacy. He describes his work this way:

Narrative clinical reports contain a rich set of clinical knowledge that could be invaluable for clinical research. However, they usually also contain personal identifiers that are considered protected health information and are associated with use restrictions and risks to privacy. Computational de-identification seeks to remove all of the identifiers in such narrative text in order to produce de-identified documents that can be used in research while protecting patient privacy. Computational de-identification uses natural language processing tools and techniques to recognize patient-related individually identifiable information (e.g., names, addresses, and telephone and social security numbers) in the text and redacts them. In this way, patient privacy is protected, and clinical knowledge is preserved.

Dr. Mehmet Kayaalp

So – we’re more than a library. We are a partner in preserving patient privacy while making sure that researchers and clinicians can discover the best new ways for taking care of patients.

How do you think NLM can better serve scientists and society?

Ending the HIV Epidemic: Equitable Access, Everyone’s Voice

A guest post by Amanda J. Wilson, Chief, Office of Engagement and Training; Leigh Samsel, NLM Planning and Evaluation Officer, Office of Strategic Initiatives; and Elizabeth A. Mullen, Manager of Web Development and Social Media, History of Medicine Division, National Library of Medicine at the National Institutes of Health.

This year’s theme for World AIDS Day is Ending the HIV Epidemic: Equitable Access, Everyone’s Voice. As the world’s largest biomedical library, NLM has a long history of supporting NIH’s efforts to end the HIV epidemic by providing equitable access to trusted biomedical information, supporting biomedical research, and highlighting the historical, social, and cultural context of this research. Expedient, reliable, free public access to NLM’s trusted biomedical information resources and literature collections advances the knowledge and treatment of HIV/AIDS worldwide, helps progress research to end the HIV epidemic and improves the health of people living with HIV.

Improving HIV/AIDS Health Information Access

NLM integrates multiple types of HIV literature, sequence, testing, and clinical trials data into a portfolio of resources that enables researchers to easily find related information and robustly supports global research to end the HIV epidemic. Free public access to citations to the scholarly literature is provided through NLM’s PubMed and Bookshelf, while free access to full-text is provided through PubMed Central and NLM Digital CollectionsGenBank and the Sequence Read Archive allow researchers to deposit and access publicly available DNA sequences, including HIV experimental and clinical genome sequences. NCBI Virus makes HIV and other virus sequences from RefSeq, GenBank, and other NLM repositories available. The HIV-1 Human Interaction Database includes information gleaned from literature about the interaction between human and HIV-1 genes and proteins.

NLM also provides a rich resource of easy-to-understand online health and wellness information available in English and Spanish via MedlinePlus. Among its wealth of content, MedlinePlus contains several HIV/AIDS topical pages. NLM supports an equitable distribution of information by providing resources and support to strengthen skills and literacies needed to access and use biomedical information for those affected by HIV/AIDS. The Network of the National Library of Medicine provides free health information training, from webinars to instructor-led classes to on-demand tutorials. Additional trainings on a variety of topics are added weekly.

A Long History of Support

NLM’s engagement and collections activities strive to capture the many voices in and around the HIV epidemic. A key historical partnership for engagement with the NIH Office of AIDS Research was the HIV/AIDS Community Information Outreach Program; beginning in 1994 as a resource for community-based organizations to improve the knowledge, skills, and technical means to access and provide the latest authoritative prevention, treatment, and research information electronically. The current iteration of the program concludes this month with 200 plus organizations conducting more than 350  projects in 38 states providing training, communications campaigns, and enhanced products and apps to raise awareness of HIV/AIDS information and discoveries over the 40-year history.

NLM has been collecting publications and archival materials related to HIV/AIDS since the first Morbidity and Mortality Weekly Report on the topic was issued in June 1981. The NLM HIV/AIDS Web Archive offers more than 150 websites documenting the biomedical, clinical, cultural, and social aspects of HIV/AIDS in the early 21st century. This month you can look for new additions and resources.

World AIDS Day 2021

Screen shot of NLM's History of Medicine Division's exhibit entitled "AIDS, Posters and Stories of Public Health"

This month, to help mark World AIDS Day, NLM will launch a new online exhibition—A People’s History of Pandemic: AIDS, Posters, and Stories of Public Health. The NLM exhibition will cover the archive of public health posters about AIDS rooted in the cultural output of artists, activists, and community workers. Their work, specifically the use of personal narrative as a visual-art strategy, along with language and the collective process of creating AIDS posters, continues to broadcast the message that, 40 years after the crisis began, attention to AIDS has not diminished. In mid-December, NLM’s Profiles in Science, will release a curated collection of digitized primary source materials related to the United States National Commission on AIDS, dating from the mid-1980s through the early 1990s. Learn more about the diversity of NLM’s historical collections related to HIV/AIDS on Circulating Now.

As we mark this year’s World AIDS Day, NLM is proud to continue its efforts to provide global access to trusted resources; share the voices of those affected by HIV; and provide the foundation for researchers, clinicians, patients, and families to engage and answer the call to end the HIV epidemic.

Photo of Amanda Wilson

Amanda J. Wilson is Chief of the NLM Office of Engagement and Training (OET), bringing together general engagement, training, and outreach staff from across NLM to focus on NLM’s presence across the U.S. and internationally. OET is also home to the Environmental Health Information Partnership for NLM and coordinates the Network of the National Library of Medicine.

Photo of Leigh Samsel

Leigh Samsel, MS, is responsible for formal reporting of NLM activities and for providing staff leadership to strategic planning activities. Leigh is currently serving as NLM’s AIDS Coordinator to the NIH Office of AIDS Research.

Photo of Elizabeth Mullen

Elizabeth A. Mullen, MS, is Manager of Web Development and Social Media for the History of Medicine Division (HMD) and Managing Editor of Circulating Now, a blog featuring new research, curatorial insights, and news about NLM’s historical collections.

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