The new RFI asks for comments on four themes:
- Role of NLM in advancing data science, open science, and biomedical informatics
- Role of NLM in advancing biomedical discovery and translational science
- Role of NLM in supporting the public’s health: clinical systems, public health systems and services, and personal health
- Role of NLM in building collections to support discovery and health in the 21st century
- Identify what you consider an audacious goal in this area – a challenge that may be daunting but would represent a huge leap forward were it to be achieved
- The most important thing NLM does in this area, from your perspective
- Research areas that are most critical for NLM to conduct or support
- Other comments, suggestions, or considerations, keeping in mind that the aim is to build the NLM of the future
a. Identify what you consider an audacious goal in this area – a challenge that may be daunting but would represent a huge leap forward were it to be achieved. Include input on the barriers to and benefits of achieving the goal.
I have chosen to focus my comments on the first of the four themes because the role of NLM is to advance the other themes – discovery, translation, and the public’s health – by advancing the first theme – namely the field of biomedical informatics, and data/open science within it. Therefore, the most audacious goal for all of NLM is to build and sustain the infrastructure of biomedical informatics, i.e., the people, technology, and resources to advance discovery, translation, and the public’s health.
Biomedical informatics must leverage both achievements that are new, such as digital and networking technologies, as well as goals that are enduring, such as improving individual health, healthcare, public health, and research. The NLM must promote, educate about, and fund biomedical informatics and related disciplines to the appropriate level they deserve in relation to the larger biomedical research enterprise. While research in domain-specific areas (e.g., cancer, cardiovascular, mental health) is important, biomedical informatics can provide fundamental tools to advance science in all domain-specific areas. To achieve this, we still need basic research in biomedical informatics itself, improving our knowledge and tools in many areas, including but not limited to human-computer interaction, natural language understanding, standards and interoperability, data quality, the intersection of people and organizational issues with information technology, workflow analysis, etc.
b. The most important thing NLM does in this area, from your perspective.
Although there are many institutes within NIH (e.g., NCI, NHLBI, and the Fogarty International Center) and other entities outside of NIH (e.g., AHRQ and PCORI) that fund research in informatics-related areas, NLM is the only entity that funds basic research in biomedical informatics. Most of the other institutes and entities that fund informatics support projects that are highly applied and/or domain-focused. These projects are important, but basic informatics research is also key to improving discovery, translation, and the public’s health.
The NLM is also unique in developing emerging technologies, some of which we cannot foresee now. When I was an NLM informatics postdoctoral fellow in the late 1980s, I could not have imagined the emergence of the World Wide Web, the wireless ubiquitous Internet, modern mobile devices, or the widespread adoption of electronic health records that we now have. There are likely new technologies coming down the road that few if any of us can predict that will have major impacts on health and healthcare. It is critical that the NLM and the research it supports enable these technologies to be put to optimal usage.
c. Research areas that are most critical for NLM to conduct or support.
Although it is critical for NLM to support research in biomedical informatics as applied to all areas of individual and public health and of healthcare and research, it is nearly unique in funding basic research in clinical informatics. A good deal of informatics research in the other NIH institutes is focused in basic science, e.g., genomics, bioinformatics, and computational biology. AHRQ and PCORI support clinical informatics research, but it is highly applied. Only NLM funds critical basic research in clinical informatics, and this function is vitally important as we strive to use informatics to achieve the triple aim of better health, improved healthcare, and reduced costs.
d. Other comments, suggestions, or considerations, keeping in mind that the aim is to build the NLM of the future.
Another critical function of NLM that has provided value and should be further augmented is its training programs for those who aspire to careers in informatics research. I count myself among many whose NLM fellowship training led to a successful career as a researcher, educator, and academician generally. NLM training grants have also provided support for my university to educate the next generation of informatics researchers who have gone on to become successful researchers and other leaders in the field.
A final problem is that I would like to see addressed is the name itself, "National Library of Medicine." This name does not connote all of what NLM does. Yes the NLM is a world-renowned biomedical library, and that function is critically important to continue. But NLM also provides cutting-edge research and training in informatics, and an ideal change for NLM would be a name change to something like the "National Biomedical and Health Informatics Institute," of which a robust and innovative National Library of Medicine would be a vital part.
I look forward to seeing other input to the new NLM strategic planning process and the resulting strategic plan that will set priorities going forward for this great public resource that has benefitted patients, the healthcare system, and students, faculty, and others who have worked in biomedical informatics to advance human health.