National Library of Medicine

Authorizing Legislation:  Section 301 and title IV of the Public Health Service Act, as amended.

Budget Authority (BA):

Program funds are allocated as follows: Competitive Grants/Cooperative Agreements; Contracts; Direct Federal/Intramural and Other.

Overall Budget Policy: The FY 2023 President’s Budget request for NLM is $472.0 million, an increase of $8.2 million over the FY 2022 CR level of $463.8 million. Funds are included to sustain intramural research in computational health and computational biology and enhance NLM’s most critical information services, including those that provide access to published biomedical literature, molecular biology and clinical data, and consumer health information. NLM will continue to build efficiency in processes that can be automated, such as indexing of journals in MEDLINE. NLM will award an estimated 28 new research project grants through its extramural programs. NLM will expand its graduate and post-doctoral training programs and launch new summer research experience programs in biomedical informatics and data science. NLM will continue its outreach programs that promote access and training in the effective use of NLM resources for scientists, clinicians, patients, and the public, while continuing to advance community engagement in the NIH Community Engagement Alliance (CEAL) Against COVID-19 Disparities and All of Us Research Program. NLM will also provide mission critical support for NIH- and government-wide priorities regarding data science goals, AI, and open science.

Intramural Programs

NLM’s intramural programs encompass three major activities: 1) Intramural Research and Training; 2) Biomedical Information Services; and 3) Outreach and Engagement.

Intramural Research and Training

NLM researchers develop and apply computational approaches to a broad range of information problems in biology, biomedicine, and human health. NLM investigators conduct research and training activities to understand the function and evolution of genomes; use computational approaches to support analysis of biomedical images; and determine how gene proteins change their structures and functions. NLM researchers interpret written text from clinicians and patients; develop methods to gain insights from large health databases; create and evaluate strategies to automate analysis of text; and use statistical methods to characterize the function and evolution of molecules. Investigators in NLM’s intramural research program collaborate across NIH to generate new knowledge, methods, and tools that help scientists and clinicians better understand basic biology and the natural history of disease to enhance human health.

In FY 2021, NLM expanded its response to the COVID-19 pandemic by developing or applying computational methods to:

• Understand evolutionary patterns of coronaviruses and SARS-CoV-2;
• Calculate parameters that affected early growth of COVID-19 infection rates;
• Develop methods to anticipate complications in lung transplant patients who have COVID-19;
• Validate the prediction of risk for blood clots in COVID-19 patients; and
• Facilitate rapid access to published research on COVID-19.

NLM researchers are helping to characterize biological phenomena and predict functional consequences. Recent advances include the use of computational approaches to automate processing and analysis of data pertaining to genetic sequence information. NLM is also leading research to understand how viruses change over time, which may help identify which viruses will be the most significant to public health.

Using computational tools to derive meaning and patterns from clinical and claims data, NLM researchers are improving the use of biomedical terminologies—including drug, clinical, and specialized terminologies—by assuring consistency and integrity across various systems. Some of this computational work led to discerning from Medicare data the various effects that drugs have on health outcomes. NLM is also using artificial intelligence to advance interpretation of medical images. For example, in collaboration with the National Eye Institute, NLM researchers developed an automatic method to detect eye disease from images— augmenting human judgment with greater precision.

NLM’s intramural research program offers a vibrant training environment, including long-term mentored research training and short-term rotations for clinicians. These opportunities allow mentored training in computational health and biology topics ranging from natural language understanding to clinical data mining to evolutionary genomics and protein structure. In FY 2021, NLM hosted 45 postdoctoral researchers, eight postbaccalaureate trainees, 16 summer interns, one postdoctoral fellow, three clinical fellows, and two visiting scientists. NLM created a new office of intramural training that provides centralized training and support to NLM trainees.

Biomedical Information Services

NLM’s biomedical information services support scientific discovery and innovation through the collection, dissemination, and exchange of data and information critical to medicine and health. Each day, more than seven million people and computer information systems use NLM’s web-based biomedical information services and download 270 terabytes of data. NLM accepts and processes more than 25 terabytes of data submitted by thousands of researchers and businesses every day. Growing demand requires that NLM regularly upgrade its services and use of modern technologies to improve operational efficiencies and accommodate the increasing volume and variety of data and information needed to support research and discovery. In FY 2021, NLM extended its migration to commercial cloud computing platforms to enable improved data security, support automated literature indexing processes, and enhance information services. NLM’s ongoing pandemic response included repurposing or extending existing research resources for public health purposes. NLM made notable progress in advancing its work in health data standards, as well as outreach and engagement to promote use of NLM resources.

Improving Access to Biomedical Literature
NLM provides trusted biomedical information to millions of researchers, clinicians, students, and the public. Users can access NLM’s flagship PubMed^® database of citations to the biomedical literature in many ways, including through mobile devices and desktop computers. In FY 2021, NLM added more than 1.5 million citations to PubMed, increasing the total collection to more than 33 million bibliographic citations. NLM’s PubMed also redesigned a structured search webpage to improve access to COVID-19 articles.

In FY 2021, NLM improved the transparency of procedures for publishers to apply to be a part of MEDLINE^®, NLM’s database of citations for biomedical literature. NLM launched a centralized MEDLINE website for a single point of access to information about policies, statistics, journal application, and review processes. NLM made significant progress in automated indexing to better serve users by applying computer algorithms to more rapidly process article titles and abstracts. In FY 2021, NLM accelerated indexing activities through automated practices for a subset of its more than 5,000 MEDLINE journals. This resulted in expanding automated indexing to include more than 400,000 citations from approximately 1,500 journals—facilitating researchers’ ability to quickly access the literature and evaluate the usefulness of articles for their purposes. NLM also manages and provides access to a free, online repository of digitized biomedical resources spanning 10 centuries and originating from nearly every part of the globe. NLM’s Digital Collection, searched by more than 300,000 people every year, includes books, manuscripts, still images, videos, maps, and other scholarly objects that support research and learning.

NLM leads the world in promoting free public access to the results of biomedical research through PubMed Central^® (PMC), NLM’s full-text archive of biomedical literature. In addition, 10 other Federal agencies use PMC as the most efficient and effective means to disseminate journal articles reporting on research they fund. NLM added more than 900,000 full-text articles to PMC in FY 2021—expanding this archive to nearly 7.5 million articles. Additionally, NLM enhanced the value of articles deposited in PMC under the NIH Public Access Policy by linking many of them to associated datasets and making available nearly five million articles in machine-readable forms to permit automated analysis through natural language processing. Through the NIH Preprint Pilot, NLM is making preprints of NIH-supported COVID-19 research, that is, scientific articles not yet peer-reviewed, available through PMC, resulting in the addition of more than 2,700 preprints by the end of FY 2021. These preprints have been viewed more than 2.5 million times and represent a promising new form of scientific communication. Additionally, by partnering with commercial cloud providers, NLM made available four million articles from its PMC database to enhance machine access to the literature and drive impactful analyses and reuse. NLM also worked with the publishing community to provide free and unencumbered access to more than 190,000 coronavirus-related articles under the Public Health Emergency COVID-19 Initiative. These articles were accessed nearly 175 million times in FY 2021 to support ongoing public health emergency response efforts.

Expanded Access to Molecular Biology Data
NLM resources must keep pace with a changing world to advance science, enhance human health, and address current and emerging public health emergencies. Rapid and reliable access to molecular biology data, commonly referred to as “genomic data,” is essential to support research and translate discovery into insights. NLM maintains an array of more than 40 integrated molecular biology databases and bioinformatics tools that are freely accessible, enable biomedical research, and power new discoveries.

In FY 2021, NLM improved its high-value molecular biology resources to ensure efficient and comprehensive data collection, including content related to coronaviruses. Notably, more than 16.5 million Sequence Read Archive (SRA) records—more than 50 petabytes of genetic sequence data—were made available on 2 commercial cloud providers as part of the NIH Science and Technology Research Infrastructure for Discovery, Experimentation, and Sustainability (STRIDES) Initiative. NLM automated quality control reviews for submission to its database of Genotypes and Phenotypes (dbGaP) resulted in faster submission processing time. dbGaP provides controlled access to data from large-scale studies examining the relationship between genes (genotype information) and physical characteristics (phenotypes). The dbGaP infrastructure is also accelerating access to COVID-19 data by providing a standard authorization framework to more than 100 different studies under NIH’s Rapid Acceleration of Diagnostics (RADx) initiative. Additionally, with the support of NIH, NLM staff worked to reduce the burden on researchers’ access to data by providing subject matter expertise on the NIH Research Auth Service (RAS), a novel, single sign-on to NIH data research resources. NLM repurposed its research molecular databases to support public health, including food safety. In FY 2021, NLM worked with the U.S. Food and Drug Administration (FDA) and CDC to process genome sequence data for more than 255,000 samples through its Pathogen Detection Pipeline, resulting in more than 800 actions to protect consumers from foodborne illness.

NLM enhanced research and accelerated the response to the COVID-19 pandemic by improving specialized SARS-CoV-2 virus resources for search and analysis by adding graphic interfaces and supporting data retrieval based on viral lineage. Through continued participation in the SARS-CoV-2 Sequencing for Public Health Emergency Response, Epidemiology, and Surveillance (SPHERES) consortium with the CDC, NLM helped improve understanding of SARS-CoV-2 transmission by providing easy and reliable large-scale access to the rapidly growing set of SARS-CoV-2 GenBank® genomes. NLM’s participation in NIH’s Accelerating COVID-19 Therapeutic Interventions and Vaccines (ACTIV) Tracking Resistance and Coronavirus Evolution (TRACE) initiative included the development of novel data processes and analysis methodologies to support weekly tracking of the frequency of SARS-CoV-2 sequence mutations and variants, including predictions about variants that may have an impact on therapeutics. NLM also worked with the Public Health Alliance for Genomic Epidemiology (PHA4GE) to develop a sample metadata standard for SARS-CoV-2 sequence data.

Public Accountability for Clinical Trials
The COVID-19 pandemic underscores the importance of having a reference repository of research studies for clinical care. NLM’s ClinicalTrials.gov is the world’s largest publicly accessible database of privately and publicly funded clinical studies. In FY 2021, NLM added information about nearly 38,000 new clinical research studies, nearly 7,000 of which were COVID-19 studies, including more than 5,000 listed with the World Health Organization. NLM also added more than 7,000 new results summaries in FY 2021. Making this information visible to the scientific community and the public improves transparency, accountability, and encourages public trust in science. With the support of NIH, NLM continued its ClinicalTrials.gov modernization effort with enhancements to its technical infrastructure. NLM involved stakeholders in this effort through a webinar attended by more than 900 participants, engagement with the NLM Board of Regents Public Service Working Group, and user research with more than 70 participants representing numerous relevant stakeholder groups.

Consumer Health Information
While NLM’s biomedical information services are accessible to the public, NLM’s MedlinePlus^® is specifically designed to meet consumers’ health information needs. Available in English and Spanish, MedlinePlus offers trusted, authoritative information for patients and families about a broad variety of health conditions, medical tests, drugs, and supplements, along with links to other credible sources of information. More than 400 million users accessed MedlinePlus in FY 2021. A companion to MedlinePlus, MedlinePlus Connect, provides direct, tailored access to MedlinePlus resources automatically through electronic health records (EHRs), patient portals, and other health information technology (IT) systems to deliver information from MedlinePlus to patients and providers at the point of care. In FY 2021, MedlinePlus Connect seamlessly responded to more than 153 million electronic requests from health IT systems. A related NLM offering, NIH MedlinePlus Magazine, provides the public with information about NIH-supported research and trusted health information. In FY 2021, NIH MedlinePlus Magazine migrated to a digital-only distribution platform reaching 36,000 subscribers and averaging 250,000 visitors each month, while also making print copies available as needed. The magazine is witnessing consistent growth with a 50 percent increase in performance.

Standards and Terminologies for Health Data Interoperability
NLM works across the NIH, the Federal government, and the health care delivery system to support the development, maintenance, and dissemination of health data standards that promote interoperability among EHR systems, as well as other clinical and research information systems. In FY 2021, NLM expanded three clinical language systems used for clinical terminology, laboratory tests and observations, and drug names to include terms and codes associated with SARS-CoV-2 and COVID-19. Through the addition of 10,177 new Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT^®) and 1,740 Logical Observation Identifiers, Names and Codes (LOINC^®) codes—more than 175 of which are COVID-19-related—NLM is directly supporting stakeholders’ ability to provide high-quality interoperable clinical and laboratory information. In addition, the new LOINC COVID-19-related terms help identify and codify laboratory data in support of FDA and CDC initiatives to standardize COVID-19 testing and report vaccination status. NLM updated drug names in RxNorm to include COVID-19 vaccines receiving FDA emergency use authorization and select COVID-19 investigational drugs. NLM launched the COVID-19 Vaccines and Medications in RxNorm webpage to make it easier for users to identify published COVID-19 vaccines and medications. In collaboration with the Office of the National Coordinator for Health Information Technology and Centers for Medicare & Medicaid Services, NLM continued enhancements to make it easier for clinicians and researchers to use harmonized sets of terms from these standards to measure quality of care related to COVID-19. NLM continues to provide and enhance NIH’s Common Data Elements (CDE) Repository, a freely available source of standard, structured, machine-readable definitions of data elements, standard variables, and measures used in NIH-funded clinical research. NLM developmental enhancements to the CDE Repository continue to improve the user experience and facilitate COVID-19 data services.

Outreach and Engagement

NLM’s outreach and engagement activities foster innovation, and raise awareness and support for the use of NIH and NLM information, data resources, and physical collections. Much of this outreach is conducted through the NLM-supported Network of the National Library of Medicine (NNLM®), a network of trusted ambassadors that leverages more than 8,800 academic health science libraries, hospital and public libraries, and community organizations to carry out regional and national programs.

In FY 2021, NLM reorganized the NNLM to more effectively serve the diversity of communities throughout the United States. After a national solicitation and competitive review, NLM awarded five-year cooperative agreements to each of seven institutions selected to serve as Regional Medical Libraries, and four institutions selected as NNLM National Coordinating Offices. Additionally, a new National Evaluation Center provides innovative frameworks and evidence-based evaluation tools and practices to ensure that programing provided by the NNLM meets community needs. In FY 2021, 1,731 NNLM health information access activities engaged 89,453 participants across 45 states, the District of Columbia, Guam, and the U.S. Virgin Islands. NNLM outreach activities on long-term research and clinical trials support the NIH Community Engagement Alliance (CEAL) Against COVID-19 Disparities and NIH All of Us Research Program engagement priorities.

Budget Policy: The FY 2023 President’s Budget estimate for NLM’s Intramural Programs is $381.2 million, an increase of $6.6 million from the FY 2022 CR level of $374.6 million. NLM will continue to support critical research and training in computational health and biology at current levels. Informed by the needs of NLM, NIH, and the broader biomedical research community, research priorities will incorporate activities to understand the function and evolution of genomes; use computational approaches to support analysis of biomedical images; discover how gene proteins change their structures and functions; develop methods to gain insights from large health databases; create and evaluate strategies to automate analysis of text; and use statistical methods to characterize the function and evolution of molecules. NLM will prioritize investments to improve molecular biology databases and bioinformatics tools, including the SRA, and other high-priority information services, such as ClinicalTrials.gov and PMC. It will seek additional efficiencies in its information services, including through use of automation of processes for journal indexing. NLM will also continue to support tools for updating and disseminating clinical terminology standards that support interoperability of electronic health data and advanced integration and analysis of genomic, clinical research, and observational health data. NLM will continue its outreach programs that promote access and training in the effective use of biomedical and health information through engagement with broad sets of stakeholders in the public and private sectors.

Extramural Programs

NLM’s extramural programs encompass three major activities: 1) Biomedical Informatics Research and Training; 2) Informatics Resources for Biomedicine and Health; and 3) Health Information for Health Professionals and the Public.

Biomedical Informatics Research and Training

NLM’s research grants advance fundamental and applied biomedical informatics and data science research, and develop novel computational approaches for biomedical research. In FY 2021, NLM funded 204 awards to investigators across the country, including 22 co-funded with other NIH Institutes and Centers. NLM-funded researchers develop methods to capture, analyze, visualize, integrate, and curate biomedical data to support discovery and decision-making. Active NLM-supported research projects are developing statistical methods for clinical data analysis, advancing visualization methods to support clinical decision making, and developing new machine learning methods. In FY 2021, NLM-funded researchers:

• Applied artificial intelligence and machine learning to predict treatment effectiveness and inform personalized medicine approaches.
• Leveraged high-throughput sequencing data from wastewater, and data from other sources, for virus surveillance and public health protection.
• Supported natural language processing of medical record data to improve patient care and monitoring.

University-based training program for biomedical informatics and data science
NLM is a leading funder of Ph.D.-level training in biomedical informatics and data science. NLM’s university-based research training program supports 16 universities across the country— enrolling nearly 200 predoctoral and postdoctoral fellows and trainees. NLM trainees are emerging as major leaders in diversity, equity, and inclusion for biomedical informatics. In FY 2021, NLM reopened the competition for its university-based training program with a new emphasis on original basic or applied research with one or more of the following biomedical application domains: health care or clinical informatics; translational bioinformatics; clinical research informatics; public health informatics; and consumer health informatics. This program encourages institutions to diversify student and faculty populations to enhance participation of individuals underrepresented in the biomedical, clinical, behavioral, and social sciences research enterprise. NLM also provides awards to sponsor short-term research experiences for undergraduates and others interested in careers in biomedical informatics and data science. In addition, in FY 2021, NLM supported two NIH National Research Service Award predoctoral fellowships, one focused on developing new methods to automatically detect surgical errors and the other to address complexity in heterogeneous health data.

Informatics Resources for Biomedicine and Health

The NLM Information Resource Grants to Reduce Health Disparities support projects that bring useful and understandable health information to populations affected by health disparities, as well as their health care providers. In FY 2021, NLM awarded two grants to reduce health disparities by: 1) increasing access to and dissemination of information resources on heart and blood vessel disease for Puerto Ricans; and 2) developing an accessible informed consent app-based toolkit for people who are deaf and hard of hearing, and want to participate in research. NLM’s Grants for Scholarly Works in Biomedicine and Health supports the work of health professionals, public health officials, biomedical researchers, and health science historians. In FY 2021, NLM awarded five grants for scholarly works about: the Great Epizootic (flu) of 1872; race and representation in law, politics, and the biosciences; race, retail and risk in urban African American communities; translation of genomic medicine in the 21st century; and the impact of complementary therapies on well-being over the past one hundred years.

Health Information for Health Professionals and the Public

The NLM Extramural Program oversees cooperative agreements that fund the NNLM to improve the health of the Nation by training U.S. health professionals to access biomedical information, enhancing individuals’ access to trusted health information, and building capacity for data management and science at health sciences libraries. In FY 2021, NLM issued a funding opportunity that supports the NNLM All of Us Program Center to serve as the coordinating center responsible for the engagement, programs, partnerships, activities, and trainings offered by NNLM in support of the NIH All of Us Research Program.

Budget Policy: The FY 2023 President’s Budget request includes $69.1 million for NLM’s Extramural Programs, an increase of $1.2 million from the FY 2022 CR level of $67.9 million. NLM will continue to accept investigator-initiated applications through NIH parent-grant announcements, as well as applications submitted to NLM’s own funding announcements. In FY 2023, NLM will support noncompeting grants at the previously committed level. NLM expects to award an estimated 28 competing research project grants and will aim to support early stage and new investigators at success rates comparable to those of established investigators submitting new applications. It will expand its university-based research training programs in biomedical informatics and data science from 16 to 18 universities across the country, with a total anticipated total enrollment of 170 predoctoral and postdoctoral trainees. It will launch new summer research experience programs at five universities to attract a diverse set of talented undergraduate and post-baccalaureate students to bioinformatics and data science careers. NLM will continue to support its unique resource grant programs and career transition programs. Through its cooperative agreement for the NNLM, NLM will continue to support efforts to advance community engagement in CEAL and the All of Us Research Program, and to retain support for its engagement and training programs.

Research Management and Support

NLM’s research management and support (RMS) activities provide administrative, budgetary, communications, and logistical support for NLM programs to ensure strategic planning and evaluation; regulatory compliance; policy development; international coordination; and partnerships with other Federal agencies, Congress, the private sector, and the public. In FY 2021, NLM created a new Office of the Scientific Director to provide oversight of its intramural research program and reorganized NLM’s Lister Hill National Center for Biomedical Communications to better align NLM investments with key research priorities. NLM also expanded its data science training program for all NLM staff, which has become a model for data science workforce development across government.

Budget Policy: The FY 2023 President’s Budget request includes $21.7 million for NLM’s RMS activities, an increase of $0.4 million from the FY 2022 CR level of $21.3 million. RMS will support NLM-wide planning and evaluation, including implementation and updating of NLM’s strategic plan. It will also support enhancement of NLM’s critical physical and information systems security infrastructure, policy development and administration functions, and improved coordination of trans-NLM and trans-NIH efforts in data science.

Conclusion:

NLM is a platform for biomedical data discovery and data-powered health. Through its research, information services, and engagement activities, NLM keeps pace with a changing world to advance science to enhance human health. Researchers, clinicians, and the public will continue to require access to the vast wealth of biomedical knowledge that NLM makes available. This work is essential to improve the health of the Nation.