National Library of Medicine: An Informatics and Government Agency Exemplar

This week I am off to another meeting I attend every year, which is the National Library of Medicine (NLM) Informatics Training Conference, the annual meeting held for all trainees funded under the NLM Biomedical Informatics Training Grant Program. Also in attendance are program directors and faculty, NLM staff, VA informatics trainees, and a variety of other people. The meeting varies between being held at the NLM and the various sites; OHSU hosted the meeting in 2009.

At a time when Americans increasingly question the function and value of their government and its agencies,  the NLM is a shining testament to the good that the public sector can perform. It is hard to imagine a private entity carrying out the mission of NLM, especially as successfully as it has done so.

The NLM is the world's medical librarian, providing an entry way into the biomedical literature for anyone on the planet who types pubmed.gov into a browser. (The Pubmed system provides access to the MEDLINE bibliographic database, which contains the title, abstract, source information, and other metadata about scientific journals articles in biomedicine.) Even though most of the articles referenced in MEDLINE are from commercial publishers and not freely accessible, NLM delivers users to the publishers' electronic doorsteps. The NLM and its talented scientists and developers have pushed the envelope in many other areas as well, from genomics to imaging to public health. The NLM serves not only researchers and clinicians, but also consumers and policy makers.

Another critical role of the NLM is its scientific leadership in the field of biomedical and health informatics. The NLM funds research in informatics as well as the training of future scientists and leaders. While not the only federal agency involved in the use of information technology in health and biomedicine, it is clearly the foundational leader that facilitates the basic research to inform others who apply it.

No small part of the NLM's success is due to its excellent leadership in Donald AB Lindberg, MD, who has guided the Library for over two decades, longer than I and many others have been in the field. Dr. Lindberg has been remarkably prescient over the years. I remember him touting the virtues of the Human Genome Project when I was an NLM informatics trainee in the late 1980s. Subsequently he has been spot on in his seeing the development of new venues for publishing as well as the desire for patients and consumers to access health information online.

The NLM also has longevity. It has an illustrious history, dating back to its inception as the The Library of the Office of the Surgeon General of the Army, led in its early days by John Shaw Billings, MD. This year is the NLM's 175th year anniversary.

I have a great deal of gratitude for the NLM personally. Like many who work in informatics, my career would not be what it is without the help of NLM. I entered the field in a postdoctoral fellowship directly out of my medical training in 1987. The three years of fellowship funded by NLM allowed me to gain knowledge and skills as well as prepare for an academic career in the field. After completing my informatics training, I landed a faculty position at Oregon Health & Science University (OHSU), funded by a grant to OHSU under the Integrated Advanced Information Management Systems (IAIMS) program, an NLM initiative to develop the informatics human and technology infrastructure at academic medical centers. (In the 21st century, these activities are a normal part of doing business at academic medical centers.) The director of the OHSU IAIMS program, who recruited me to that first job, J. Robert Beck, MD, also obtained an NLM informatics training grant at OHSU, of which I now serve as PI and Director.

The NLM has also funded my research over the years, not only providing the resources for my own scientific contributions to the field but also giving me the experience and latitude to develop other aspects of my career. My first grant ever was a First Independent Research Support & Transition (FIRST) Award (also known as an R29). Since then I have had a number of subsequent grants both for research and education of trainees. These projects, from research to teaching, have enabled me to touch the life of countless others who have also achieved success in their careers in the field.

While it is obvious that the US government needs to make some painful decisions about long-term debt control, discretionary expenditures such as those on NLM have been beneficial to many people, not to mention the health of Americans and others around the world. When politicians and policy makers are deliberating, I hope they will consider the value and impact that government agencies like the NLM have made to so many people. I will always be grateful for what the NLM has done for me.