Patricia Flatley Brennan, PhD, RN, met with us earlier this year to discuss her experiences since becoming the director of the National Institutes of Health's (NIH) National Library of Medicine (NLM) in 2016. The following documents our questions and Dr Brennan's responses.
CIN: Have any major changes occurred in the NLM since you became director?
Dr Brennan: Yes, one major change has been the completion of a new strategic plan, which includes the following three pillars:
- Accelerate discovery and advance health through data-driven research
- Reach more people in more ways through enhanced dissemination and engagement
- Build a workforce for data-driven research and health
CIN: Much of what you have written lately focuses on the role of the medical librarian. How do you see informatics fitting into this?
Dr Brennan: The informatics community works to translate information into sustainable and scalable resources for care in support of those working at the point of care. There is a smaller nursing informatics resource group that is investigating the use of technology for delivering nursing care. I can see NLM supporting researchers attempting to use or develop better ways to get information into the practice environment. We work collaboratively with the National Institutes of Health's National Institute of Nursing Research. One of our mutual goals is to foster and accelerate the common data elements repository so that nursing studies are using terms and variables that can be integrated across different study areas. We want to help facilitate the rigor and reproducibility by enhancing the types of terminology people use and the kind of variables they collect in their studies. We spent time at the American Medical Informatics Association talking with the nursing informatics community about how we can accelerate innovation. We want to learn more about how to get the tools nurses know are useful into the daily lives of their patients. This requires empowering and energizing nurses to think about innovation and about new models of practice that might involve building technologies as well as thinking about those that could go through the Small Business Innovation Research program. I think there is an opportunity for the nursing informatics community to be more involved in the advancement of building technical solutions for patients. We need to excite the nursing informatics community to develop new informatics tools that could impact patient care and patient outcomes.
CIN: How can nurses and medical librarians support each other for the betterment of patient care?
Dr Brennan: Many medical librarians are concerned they are being pushed out of hospitals. Up until about 7 or 8 years ago, a library in a hospital had to be certified under The Joint Commission. Now that this is not required, librarians are more concerned with how to get information into the hands of clinicians and patients. One way to accomplish this is for nurses to be actively working with librarians in their institutions. If this is not occurring, we should explore the reasons why. For example, nurses may be unaware that their librarian can provide practice guidelines and other resources that can be used to develop patient education materials. Nurses and librarians also can work together in designing and selecting information systems for practice, including at the point of care. This is where the library community has a particularly strong skill in identifying resources that could be of interest. Other ways include involving librarians in designing, selecting, and deploying information technology systems for clinical practice. In building a collaborative relationship, librarians can better understand the problems nurses face and can help design solutions. For example, if a nurse is working with a patient to help them better understand a genome test, librarians can provide the latest practice guidelines and research and evidence that the nurse can use when talking to their patients.
CIN: How do we move from electronic health records (EHRs) to “bigger picture” ideas in informatics?
Dr Brennan: Often nursing informatics focuses on the operations and information in nursing practice; however, this can be restricted to institution-based information flows. I encourage the nursing informatics community to think about the information substream of nursing practice and the tools needed to manage that substream. Nurses continually gather information for an EHR from the patients' home, send information home with a patient, and send or receive patient information from another facility. Some beneficial information collected may not be in the EHR, such as family history or social information including whom the person lives with. The nursing informatics community could be particularly helpful in thinking about new ways of bringing this information into the practice environment. We suggest not waiting for the EHRs to catch up to where the nurses need to be but to begin adding to the electronic tools in the nurses' portfolio. This could be an app that tells about the person's neighborhood or a training module that makes use of current tools like an instructional video of a dressing change. I encourage nursing informatics to lead innovation in nursing.
One perspective on the differences between an innovator and a nursing informatics specialist is that the nursing informatics specialist often hasn't thought, discovered, or created the idea for the innovation. It doesn't mean that they can't—it just means we need to push our ideas more towards innovation.
Patricia Flatley Brennan, PhD, RN, director of the National Library of Medicine, National Institutes of Health, Bethesda, MD.
CIN: How can nursing informatics and informaticists support the mission of the NLM?
Dr Brennan: One important thing is to use our resources and tell us what you like and don't like. For instance, we have MedlinePlus Connect that allows our MedlinePlus patient information to be connected directly to an EHR so we can provide trusted and vetted knowledge into a patient's hand at the end of a visit. We want to hear about how useful this is and how well it's working. We know that over 13 million times a month somebody is accessing our information and resources. We want to find out if nurses find our information and resources valuable and how they use them. We strive for a two-way communication, so please give us feedback.
Also, fundamentally nursing is an information processing discipline, so to practice nursing we need to have good information tools in the hands of nurses at the point of need. This needs to be said over and over again. Informatics is not just about the C-suite or the EHR, and it's not just for researchers. It's about making sure nurses have the information they need for practice in a way that is trustable, accessible, and available at the point of need. One approach for consideration is for nursing informatics specialists to look at ways to become more aware of and possibly involved in public policy. For example, we know that many school nurses can't access a student's health record because there are age and family controls. If the nursing informatics community took on the challenge of getting school nurses access to the EHR, this could be a game changer.
I want to encourage nursing informatics specialists to read my blog, https://nlmdirector.nlm.nih.gov, as I bring a nurse's perspective to health information and informatics.
CIN: Are we making the bridge between the clinical side to research? How do we bridge that divide?
Dr Brennan: That's complicated.
In 2017, Jane Carrington mentioned in her state-of-the-science presentation that nursing informatics researchers tend to conduct research that evaluates the impact of technology on some nursing outcome or patient care system—which is fine. However, they tend to write the research findings in articles in journals that are read by nurses. So, this makes me think that the gap isn't necessarily between the nurses in practice and nurses in research. The gap seems to be between nursing informatics researchers and the other informatics communities that they need to interact with on an ongoing basis. We are recognizing that the building of clinical systems of care crosses many disciplines. I think nursing needs to be more involved in how those systems are being informed by the future realities of practice.
CIN: Do you have any advice for those pursuing a career in nursing informatics?
Dr Brennan: I am a proponent of the doctorate of nursing practice (DNP) as good preparation for the nursing informatics specialist. I believe that the skills learned and applied in the DNP program around systems change, systems evaluation along with learning how to get data out of the system, and making it useful for clinical problem solving can be enhanced by nursing informatics framing of those problems. Also, I think the understanding you get about advanced nursing practice concerns at a multidisciplinary level helps design better tools that support what nurses need to get done in a context of what patients need to have happen.
I also urge DNP students to have fun! If we lose the creative spark that nurses bring to informatics, we will never replace it. To me, the nursing informatics community is the guardian of innovation in nursing, yet we need to be able to take some risks as the tools that are going to be needed by the 21st-century nurse are going to be driven by the 21st-century nursing informatics specialist.
CIN: Is there anything else that you would like me to share that maybe I haven't asked about, or is there something you would like me to add to this?
Dr Brennan: It is important for me to have a nursing viewpoint on what the NLM should be doing regarding direct patient information. We are interested in hearing from the nursing community on how we can assist, help further the things that nurses are doing, and help people become better able to take care of themselves. I use a lot of Virginia Henderson's thinking and nursing framing when I talk about libraries being there for an individual. We need to look at turning this into a reality by providing training programs and making sure our information is understandable and at the right literacy level for each person. I would like to hear more about how we can better support nurses.
Link to Dr Brennan's blog: https://nlmdirector.nlm.nih.gov.