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!

What is the Role of a Mentor?

Guest post by Karmen S. Williams, DrPH, MBA, Assistant Professor at City University of New York Graduate School of Public Health and Health Policy, and Meera G. Subash, MD, Assistant Professor and Division Quality Officer for the Division of Rheumatology at the University of Texas Health Science Center, McGovern Medical School.

“Everyone, at every point in their career, has the potential to be a mentor as well as [to] seek a mentor. It is the combination of being and doing in mentorship that makes it such a rewarding and important part of a professional career.”

Medical informatics pioneer and NLM Director Patricia Flatley Brennan, RN, PhD, recently spoke these words when she joined us for a special podcast hosted by the American Medical Informatics Association (AMIA)—a crossover episode between For Your Informatics, led by the Women in AMIA Initiative, and ACIF Go-Live, directed by the AMIA Clinical Informatics Fellows.

Bryan McConomy, MD, began our inaugural episode with an introduction to medical informatics, highlighting the early work of Dr. G. Octo Barnett and his team’s development of the MUMPS integrated programming language at Massachusetts General Hospital in the 1960s. Being a relatively young field, we can look to the trailblazers who first used computers to augment clinical decision-making and improve health care discovery and delivery. We pay homage to the rich tapestry of innovative leaders and educators, such as Homer Warner, MD, PhD; Reed Gardner, PhD; Clement McDonald, MD; Margo Cook, RN; Lawrence Weed, MD; and Edward Shortliffe, MD, PhD, to name a few.

We started the History of Medical Informatics joint podcast series with those two AMIA podcasts with the understanding that we need to connect our past with the present. This ongoing series catalogs this history through the eyes of pioneers in the field of health informatics. By highlighting how historical events merge with contemporary topics of interest in health informatics, we intend to strengthen the bridge for new and upcoming professionals both in and outside of informatics.

In our episode titled “History of Medical Informatics – Mentorship” with Dr. Brennan, we focus on how mentorship was established in a field that, until recently, was virtually nonexistent. Dr. Brennan was not only our first guest on the joint series, but she was also featured in a March 2020 episode of For Your Informatics titled “Training the Next Generation of Informaticians,” which also offers valuable information on mentorship. She has been a full-circle guest by highlighting the past, present, and future of mentorship in health informatics.

Dr. Brennan will also be our keynote speaker at this week’s 2022 AMIA Clinical Informatics Conference, which will give us an opportunity to reflect on the real meaning of mentorship. What is mentorship? How did health informatics pioneers build mentorship in a new and novel field? What is the role of a mentor?

Dr. Brennan recalls some of the best parts of her mentorship experience, including having the freedom to explore, engage with like-minded individuals, establish trust, push boundaries beyond your starting point, and open new doors. Mentors are there for your failures in life, for the deeply embarrassing moments, and to help pick you up when you hit a bump in your career.

However, not all mentorships are created equal. There are some that are lifelong, while some are short term. Some aren’t always mutually beneficial, while others are mutually uplifting. Some mentors come from other fields, while others may be in the same field. The commitment to mentorship may be formalized or just a passing activity.

The style of mentorship can also vary. Some may bring a mentee into a research group to work side by side with them while some may only have periodic conversations. Either way, the mentor must be ready and willing to go through the process.

We’d like to share some wisdom we’ve received over the years: seek out people for a cup of coffee and find someone with whom you can share your successes and challenges. This is important because not all skills are learned in the classroom. For example, academicians need to know how to interpret faculty governance, engage with management, and position research and teaching. Dr. Brennan points out that “these things are difficult to learn on your own, and that’s where mentors can come in.”

The point is that mentorship must be purposeful and built on the trust needed to guide the direction of mentees’ careers and important life choices. It is a decision that should not be taken lightly. Mentorship in any arena is pertinent to career development, but it is especially valuable in groundbreaking fields like health informatics.

What is the best advice you’ve received from a mentor?

Headshot of Dr. Karmen S. Williams.

Dr. Williams completed a post-doctorate fellowship in public and population health informatics at Indiana University and Regenstrief Institute, where she focused on systemic informatics integration. Dr. Williams serves as the director of AMIA’s For Your Informatics podcast, which features individuals at all career stages to reveal the diverse world of biomedical and health informatics professions. She is a member of the AMIA Diversity, Equity, and Inclusion Committee; Women in AMIA Pathways Subcommittee; and AMIA Dental Informatics Working Group.

Headshot of Dr. Meera G. Subash.

Dr. Subash received her undergraduate degree from Stanford University and her medical degree from Texas Tech University Health Sciences Center School of Medicine. She continued to University of California San Francisco to complete both her Rheumatology and Clinical Informatics Fellowships. She is Epic Physician Builder certified, and her interest area is implementing and evaluating health IT and electronic health record tools to improve patient care in rheumatology and ambulatory care.

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