This is the second in a series of articles examining how NIH, among other government agencies, is infusing innovation into the federal workplace.

When a patient needs heart medicine, a doctor writes a prescription for a cardiac drug; a pharmacist fills it; and an insurance company processes the bills.

But while people generally recognize that heart and cardiac relate to the same thing, will the doctor’s computer come to same conclusion as the pharmacist’s computer? What about the insurance company’s computer? Do they really speak the same medical language?

In general now, they do, thanks to the Unified Medical Language System (UMLS). Without the UMLS, a lot more patients and members of the medical and healthcare community might very well be saying “OMG.”

That was far from the case when work on the UMLS began in 1984, the same year Dr. Donald A.B. Lindberg, M.D. became the director of the National Library of Medicine (NLM) at the National Institutes of Health (NIH).

NLM has since become the world’s largest biomedical library. With an annual budget of $275 million and 690 career staff, the NLM today seeks to acquire, organize and disseminate the biomedical knowledge of the world for the benefit of public health.

Millions of Americans get what’s generally regarded as unbiased, fully-vetted health care information each day through NLM sponsored resources such as MedlinePlus and MedlinePlus Connect.

But NLM also has become an online resource in special circumstances, such as in the event of of disaster. The NLM’s Disaster Information Management Research Center (DIMRC) provides disaster-related information. It also offers specialized services, such as its Lost Person Finder application which was used to reunite family and friends in the aftermath of the Haiti and Japan earthquakes.

Much of what NLM and the UMLS have become reflect the work of Lindberg.

Senior Statesman

Among his peers, Lindberg is known as the “country’s senior statesman for medicine and computers.” His career as a scientist, an innovator in applying computer technology to health care, medical diagnosis, artificial intelligence, and educational programs, spans more than 50 years.

But of all his many achievements, Lindberg is most proud of the UMLS.

“You have to tell a computer that ‘heart’ and ‘cardiac’ are the same thing,” Lindberg explained to Breaking Gov in a recent interview. “No one had done that before. We started this in 1984 knowing it was at least a 20 year job. Now we have a million concepts and in pretty wide use.”

Today, the UMLS links health information, medical terms, drug names, and billing codes across different computer systems. The software brings together many health and biomedical vocabularies and standards and enables interoperability between them.

The UMLS not only broke new ground in its application, but also in procurement and contracting.

“Working with eight universities, we had to find a legal way to do it,” Lindberg said. “Every six months we had to write a new set of purchase orders as who could do what, because we were doing things that had never been done before.”

Today, NIH has a dedicated Office of Technology Transfer that facilitates cooperation and sharing among researchers both inside and outside of government.

Innovators such as Lindberg know that innovation just doesn’t happen; it is the result of careful planning and recognizing “the most important thing you can give people is some of your time.”

Culture of Innovation

“There are lots of stock answers about innovation and culture of innovation,” Lindberg explained, saying it begins by having a keen perspective for the role of people in the process.

“The truth is that people have to be respected as individuals, not just employees; have a sense of purpose of the entire organization, not just their division; not be afraid to fail; and recognize some of the things we do are inherently long term,” he said.

“Part of our strategy also is don’t try to do everything yourself,” while also emphasizing that “planning is the cheapest thing an organization can do.”

NLM had no long term plan when Lindberg arrived. “My predecessors were good, made wise decisions and needed no plan, but I needed one.”

But rather than impose planning from the top down, Lindberg started from the bottom up.

“We heard that computers did a good job on text and characters, but they weren’t powerful enough to be very good for pictures and images.” That was common knowledge in 1984, but it was also common knowledge that soon the technology would catch up.

“We knew that when the technology improved, we could do more about pictures and imaging; and when it did we were able to do things like the Visible Human Project (VHP).” The VHP is a digital image library of anatomical cross-sections at 1 mm intervals representing the complete, normal adult male and female anatomy.

As technology has advanced, so has the work of NLM’s National Center for Biotechnology Information (NCBI). Established in 1988, the NCBI is a national resource for molecular biology information and genetic processes that control health and disease.

Learning Lessons, Lessons Learned

When Lindberg arrived at NLM, indexing of medical literature was done manually. As computers advanced that process, it has become nearly totally automated, making it easier for researchers to access NLM’s vast databases of medical knowledge.

Equal to Lindberg’s emphasis on using technology for research purposes, is his use of technology to forge closer relationships between librarians, researchers and doctors. There was even a time when doctors thought of computers as competition.

“I have done artificial intelligence for 30 years. It would be ‘here is what the docs are doing and here is what the computers are doing’,” he explained. “Today we have a successful model where the docs and the computers are working together as a team.”

Looking to the future, Lindberg is looking to harness the power of IBM’s Watson. Though the discussions are still in preliminary stages, Lindberg is seeking to use Watson’s power to develop logic that can answer the tens of thousands of questions NLM gets from patients, their families and the public in general.

“This underserved community of patients, families and the public is also an underestimated powerhouse. However, the questions we get are much harder to answer than I thought,” he said. “We need to know ‘what are the real questions people are asking?’ “

That’s where Watson’s logic and processing power can make a big difference.

“Answering these questions is going to help reduce the cost of care and get people to choose a course a life that is to their benefit. The person is an important part of the process, because if you are responsible for your own health; if you take care of yourself, you will come out better.”