Titus Schleyer, DMD, PhD

on biomedical informatics and health information technology

Time to head to Washington, DC – for #AMIA2014!

Sandy packing up for #AMIA2014

Sandy packing up for #AMIA2014

It’s the time of year again where we gather up our booth items, such as brochures, giveaways (like our awesome t-shirt [free for qualifying participants]) and of course our “Belgian chocolate” coins, and head to the American Medical Informatics Association (AMIA) 2014 Annual Symposium in DC. (Thanks, Sandy, for getting it all together.) AMIA is the academic home of informatics, and the Symposium is the leading scientific meeting for biomedical and health informatics research and practice.

Many Regenstrief Institute CBMI faculty, staff and colleagues from other IU affiliates will attend the conference which runs from November 15-19, 2014, in Washington, DC. We are looking forward to reconnecting with colleagues, peers and old friends while catching some of their presentations.

Aside from the Schedule-at-a-glance, the best way to see what is happening and plan for the meeting is the Itinerary Planner. It is a great way to organize your attendance for keynote presentations, panels, papers sessions, the student design competition, and the many social events. Even better, the mobile app lets you access your itinerary on the move. We have also put together a (mostly) .

For this year’s Symposium, AMIA has created some new and exciting events, such as the “Scavenger Hunt” open to all attendees. This event is sure to bring more people to our exhibit booth #320 in search of the answers to the questions for the hunt. Other great events include Casino Night (a great way to meet people and try your luck at gambling at the same time), the four-mile Fun Run and the AMIA’s Got Talent! show. (I went there last year and had a blast –  here is a sampling of performances.)

Wear it proudly!

Wear it proudly!

We have two demonstrations, a couple of panels, four papers and seven posters from the Regenstrief/IU participants. Below you can find more information regarding these.

Starting the conference off are Titus Schleyer, Dan Vreeman, etc. with a didactic panel titled Squaring the Circle – Managing Local Healthcare Terminologies in the Age of Standardization on Sunday the 16th at 3:30 discussing current approaches to managing both standardized and local terminologies, elucidate challenges and opportunities, and future strategies to make the process more efficient and effective.

Be sure to catch Blaine Takesue, JT Finnell and Jon Duke Tuesday 11/18 (1:45) when they demonstrate Regenstrief’s homegrown teaching EMR (tEMR), designed to bridge the gap between what students are taught in medical school and what physicians need to know in real world practice.

We have several student presentations this year with the help of several CBMI faculty.

Regenstrief investigators Weiner, Zillich and Russ collaborated with others to design strategies to reduce prescribing errors Wednesday the 19th at 10:30).

We have seven poster presentations Monday and Tuesday:

Last, I am very proud to highlight a new AMIA program called High School Scholars: Building New Paths to Biomedical Informatics Education. This program encourages students at the high school level to participate in informatics research and development. Zeba Kokan, a student at Park Tudor School in Indianapolis (advised by Jon Duke), will present on Quality of Physician Documentation of Breast Cancer Family History.

Looking forward to a Regenstrief/IU/guests dinner at Petits Plats Tuesday evening to wrap up the Symposium while relaxing with colleagues, staff, and former trainees.

We are looking to recruit for several faculty positions, an assistant director of administration and a few system engineers within CBMI. We want to enhance the Regenstrief Institute’s leadership in Biomedical Informatics. You can help make that happen. Are you interested? For more information, please see the postings at http://bit.ly/RCBMI_OpenPositions.

Be sure to tweet about what is going on at AMIA: #AMIA2014 @RCBMI. See you there!

Time for a “biomedical informatics singularity” – Part I?

A common question in biomedical informatics circles these days is: What role does the traditional, academic biomedical informatics enterprise play in the increasing computerization of healthcare? Current signals are mixed. Some point to the essential quality (and track record) of informatics in building successful health information technology (HIT) applications. Others make it look as if informatics were irrelevant. In this post, I will take a look at the state of current affairs. In a future installment, I will discuss two other important questions: What role should informatics play in the continued development of health information technology (HIT)? And, how should it get to play that role?

Those of us who have been in informatics for a while have been part of an amazing story arc. It is rare to get to witness something close to the birth of a discipline (medical informatics in the 60s and 70s), and then see that discipline grow to exert a larger and larger influence in real life. Yet, this is exactly what happened with the modern discipline of biomedical informatics. From its humble beginnings with a few local computer systems in the medical space to its pervasive influence in healthcare today, biomedical informatics has had a truly astounding trajectory. Morris Collen’s History of Medical Informatics in the United States documents that trajectory very nicely.

100_0430At the same time, who works in informatics and how we work has changed significantly. Early on, it was the discipline of a few pioneers, many of them with a medical, some with a computer science or engineering background, and several with a combination. Those pioneers often developed visionary solutions that applied early computer technology to important, but highly specific problems, in a local context. Most or all of them had an association with and/or were funded by the National Library of Medicine (NLM), an institution who played a key role in the development of medical informatics. Many of the early medical innovations live on in healthcare computing applications to this day, whether in concept or actual implementation.

But, something changed along the way. Did traditional informatics become irrelevant? Depending on who you are, you may scoff at this notion. The American Medical Informatics Association, our major professional organization, now boasts  a membership of over 4,000 informatics professionals. Informaticians continue to produce important and seminal research findings, many of which get published in high-quality, (mainly) informatics journals. We sometimes make it into the press (but maybe not as often as we like). We help set important policies and standards.

Yet, as an informatician it is hard not to feel somewhat lost in today’s large and complicated health information technology landscape. Most academic software development, once focused on computer-based physician order entry, decision support and similar applications, has either atrophied or ceased. The number of NLM-funded training programs in biomedical informatics, as well as the number of trainees in them, has shrunk dramatically. Most informatics departments/centers continue to compete heavily for a largely shrinking federal pool of funds for grants. The NLM’s budget (~$350m) is a fraction of what many in the informatics community think it should be.

Instead, the HIT industry is now dominated by multi-billion dollar giants, such as Epic, Cerner and Siemens. A torrent of medical computing innovations, such as apps, devices, applications and services is gushing forth from an ocean of entrepreneurs, startups, and small and midsize companies, many of whom have never heard of “biomedical informatics.” Technology leaders, such as Apple and Google, are helping reinvent healthcare.  

Is it time for biomedical informatics to let one of its children, health information technology, grow up and move on to other things? It may seem to be the reasonable thing to do. The real-world innovations that basic and foundational informatics research have produced are quite a success, any way you look at it. Many would say that industry has a firm understanding of the innovations and advances that healthcare needs, is able to drive the necessary developments, and has the capital to do so. There might be little to no place for academic informatics research, basic or applied. 

However, in my opinion doing so may be the equivalent of walking away from a child when they need you most. I base that assessment on four major points: 

  1. Few in the HIT industry would contend that the development of clinical applications is finished. Many drivers require continual evolution and advancement of clinical applications. Among these are regulation, the continuing rapid expansion of biomedical knowledge, the continually changing healthcare workflow and disruptive innovations.8-29-2014 9-56-37 AM
  2. Most of HIT’s users are far from happy with the tools at hand. Satisfaction ratings with clinical applications are low across the board. Cumbersome, barely usable and, often, less than useful, these applications have contributed to a significant reduction of the time that clinicians are able to spend with their patients, as well as increased job stress.
  3. Truly disruptive innovation is unlikely to come from big vendors or institutions. Many large suppliers of HIT suffer from the “installed base” problem: As their customer bases grow, more and more resources must be directed to maintaining the existing base of code and functionality, and the path from idea to implementation gets longer and longer. In addition, the larger your customer base, the higher the degree of resistance to fundamental and disruptive changes in the software. As many historical examples show, disruptive innovations tend to emerge in small places in a bottom-up fashion.
  4. With the shuttering of most academic software development shops, an important wellspring of innovative ideas in the space has degenerated. The great thing about being an informatician is that we get “paid to dream.” No stockholder is waving a 10-k report in our face to demand an increase in the stock price or next quarterly dividend. We are able to look at problems from more fundamental and theoretical viewpoints. What emerges can become entirely new research and application fields, such as artificial intelligence, which arose from the early work on medical decision support at Stanford and other places.

So, whether it realizes it or not, the world needs biomedical informatics. There are signs that some stakeholders in HIT have caught on to that. But, what do you think? I know that strong arguments can be made on either side of the debate. Let’s hear them!

Best!

Titus 

PS: What could the informatics community do (or do better) to enhance its contributions and significance to HIT? I will examine this question in a subsequent blog posts in a few weeks.

PPS: You may wonder why I included some pictures from the Hudson River Valley in this post. Today, my wife Alida and I are off to a two-week vacation, bicycling in New York’s Hudson River Valley. On the program is a self-supported tour from Bear Mountain to Rhinebeck and beyond.


Titus Schleyer, DMD, PhD
Clem McDonald Professor of Biomedical Informatics
Director, Center for Biomedical Informatics
Regenstrief Institute, Inc., 410 West 10th Street, Suite 2000, Indianapolis, IN 46202-3012
Skype: titus.schleyer, Ph: (317) 274-9204 (direct), cell: (412) 638-3581, E-mail: schleyer (at) regenstrief (dot) org, Web: http://www.regenstrief.org/cbmi/, Blog: http://titusschleyer.wordpress.com, General: http://about.me/titusschleyer

Help us improve healthcare … by joining the Regenstrief Team!

IMG_20130618_080807As some of you may know, the Regenstrief Center for Biomedical Informatics (CBMI) is recruiting for several faculty positions. I thought the new year might be a nice moment to tell you about the top 10 reasons to work at CBMI – and maybe get you or a colleague/friend of yours to check us out ;-). Even if you yourself are not interested in a faculty position here, maybe you know someone who would be. If so, please tell them about it!

  1. Improving healthcare is our heritage … and our future. Many people are familiar with the Regenstrief name in the context of informatics, but few are aware of our original roots in manufacturing. Sam Regenstrief, colloquially named the “Dishwasher King,” at one point produced 40 percent of the world’s Eskenazi Hospitaldishwashers. He got there through rigorous application of operations management and process improvement principles. One day, he had to go to (what was then) Marion County General Hospital (now Eskenazi Health) for a physical. What he saw in the crowded waiting room and elsewhere sparked the idea for the Regenstrief Foundation, which he endowed a short time later. Its mission: “to bring to the practice of medicine the most modern scientific advances from engineering, business, and the social sciences, and to foster the rapid dissemination into medical practice of the new knowledge created by research.” The Regenstrief Institute has stayed true to this mission since its founding. The CBMI supports this mission primarily through informatics and information technology research and development.
  2. We apply and evaluate informatics interventions in real-world settings. At CBMI, informatics is not just theory. We continually apply it in the real world. A strong and enduring (nearly half a century) partnership with Eskenazi Health has produced a long string of seminal advances in health information technology. In addition, our work with the Department of Veterans Affairs Medical Center, and four large integrated delivery networks with multiple hospitals and ambulatory care settings provide access to real-world clinical environments for conceiving, implementing and evaluating informatics solutions.
  3. Jeff Warvel and Gopher retirement partyRegenstrief offers a unique set of informatics resources. Here is a partial list of our core informatics assets and competencies:
    • the country’s largest health information exchange: The Indiana Network for Patient Care (INPC), established in 1995,  includes clinical data from over 90 hospitals, public health departments, local laboratories and imaging centers, and a few large-group practices. It is used by approx. 7,000 clinicians daily and carries over 4.7 billion pieces of clinical data for over 14.7 million unique patients.
    • The (new) Gopher: Built upon Regenstrief’s legendary Medical Gopher system, the new Gopher is a comprehensive computer-based physician order entry system. Designed by clinicians for clinicians, it is a platform for not only clinical data entry and management, but also for clinical decision support, electronic data capture for research and visualization of clinical data.
    • CareWeb: CareWeb is a Web-based results retrieval and reporting tool for clinical data from the INPC. Central Indiana clinicians access this system on average 200,000 times a day.
    • Data epidemiology: Through our clinical data repositories, we have extensive experience with the capture, curation, storage and analysis of clinical data.  These data have been and are a central resource for prospective and retrospective research, including clinical and pharmaco- epidemiology studies.
    • Interested in additional informatics research and application projects? Check out our Website.
  4. We live and breathe innovation: Our faculty innovate broadly across a variety of healthcare disciplines and domains. But, we do not stop there. Regenstrief has an internal Quarterly Innovation Challenge, open to everyone, which has funded over 15 projects during the last two years. Many of these projects are initiated by staff and several are on track to become fully-scale research projects. In addition, Indiana itself is innovation- and entrepreneur-friendly. BioCrossroads is a catalyst for the continued growth of Indiana’s robust life sciences industry. Among its many activities, BioCrossroads informs and educates; raises and invests venture capital funds in promising new companies; and builds business collaborations by bridging gaps across academia and industry.
  5. Explore exciting new directions with us. One reason I assumed the position of director of the CBMI are the vast potential opportunities that exist at Regenstrief. For me, the top ones include:
    • integration of genomic, proteomic and related information with electronic health records: Some people say “CPOE is so 20th Century.” For me, it is one of the continuing challenges in informatics. Think about this: The information that clinicians must take into account to make clinical decisions is growing day by day. New results from genetic and other tests, detailed data about a patient’s medication compliance, exercise habits, health literacy and environmental factors, and local population health trends – where does it end? CPOE and clinical decision support will become even more crucial to helping clinicians make optimal decisions in the future.
    • consumer health and personal health records: With the Indiana Network for Patient Care, we have a huge resource of clinical data generated in healthcare settings. However, BMI_pagethere is a large and growing complement of patient- (or people-) related data. Patient-recorded activity/exercise data? Glucose and blood pressure readings? Standardized assessments of average daily living functions? Much of these data can be highly valuable in healthcare and integrating them with the INPC would be a powerful combination.
    • data analytics and visualization: Data analytics has been one of our “bread and butter” activities for the last several decades. However, I think we can accelerate and be more efficient in how we create knowledge from the large databases we are sitting on. My boss, Bill Tierney, always says: “We could write thousands of papers based on the INPC data.” I say: “Ok, let’s do it.”
    • implementation science: The Regenstrief Institute and IU School of Medicine recently established the Center for Innovation and Implementation Science (CIIS), an organization dedicated to the development of methods to promote the systematic uptake of research findings and other evidence-based interventions into routine practice. Informatics tools are a key intervention and the CBMI is working closely with the CIIS to bring about real change in how clinicians practice.
    • cognitive systems engineering/human computer interaction (HCI): Those of you who know me will not be surprised that I am making this area a focus. Much of my own research has been on HCI aspects of clinical systems in dentistry. And, I have seen firsthand where approaches such as user-centered design and cognitive systems engineering can take us in terms of usefulness and usability of systems.
  6. Join a world-class team of faculty, staff and fellows. Many of our approximately 18 faculty are leaders in their fields/research areas, such as computer-based decision support, computer-based physician order entry, drug safety informatics, clinical data analytics, automated patient record matching, informatics standards, public and global health informatics applications, and dental informatics. Our faculty have a variety of backgrounds, such as internal medicine, medical specialties, dentistry, physical therapy, statistics and computer science. Five of our faculty are members of the American College of Medical Informatics and two of the Institute of Medicine. Two of our faculty, Clem McDonald and Bill Tierney, have received the prestigious Morris F. Collen Award of Excellence from the American Medical Informatics Association. Our staff consists of a dynamic and enthusiastic group of software engineers, database developers, project managers and administrative assistants. Recently infused with engineering talent from a variety of industries, our team possesses expertise in healthcare informatics; contemporary Web architectures, user interface and user experience methodologies; system integration; clinical decision support; and big data storage and retrieval. CBMI typically has between two and four fellows enrolled in its training program.
  7. Regenstrief is connected to Indiana University’s vast computational and academic resources. I have worked at two major universities (Temple and Pitt) and I am happy to say that every time I upgraded my experience with information technology support in academia. At Indiana University (IU), I have topped my experience to date. IU University Information Technology Services is a national leader in IT support among major universities, earning it a Computerworld’s 100 Best Places to Work in IT award in 2010 and 2011. Not only does UITS serve the everyday computing needs of the campus, it also supports research in and application of high performance computing, advanced networking and the evolving international cyberinfrastructure. Digital textbooks, virtual software delivery, and innovative learning environments support IU’s mobile students. IU is also a global partner in creating sustainable models for the collaborative development of teaching, learning, research and enterprise software.carnival
  8. We are a fun family. A lot of faculty and staff have commented to me that they like working at CBMI “because it feels like family.” Having been here for six months now, I have become part of that family. One of the best aspects of Regenstrief is that the kind of chasm between faculty and staff that you usually find in academia doesn’t really exist. Faculty and staff interactions are characterized by mutual respect, many close working relationships, a plethora of ideas and an easy, continual exchange. Plus, we know how to have fun! In the second half of 2013 alone, we had the Regenstrief Carnival, the RIFresh Initiative (which is, among other things, designed to inject fun into the workplace) and a wonderful holiday party.
  9. Indianapolis is a great place to live. I have lived in quite a variety of places in my life, ranging from Wildflecken, a small village in the Rhön mountains in Bavaria, to the metropolis of Philadelphia. I always had been wondering about what it would be like to move to the Midwest given the various comments I heard about it. I IMG_20130615_093039have to say I love it here. Indianapolis is a very compact and understandable city. It has a variety of interesting neighborhoods, plenty of great restaurants (some of my favorites include Bluebeard, Chef Joseph’s, Iozzo’s Garden of Italy, Meridian and, of course, the Rathskeller‎) and great cultural attractions. It is easy to get around – the local joke (essentially true) is that it is takes only about 20 minutes to go from anywhere to anywhere in Indy (ok, slightly longer on a bicycle). Of the nine miles of my bicycle commute, seven are alongside a canal and the White River. And, most importantly, the people are friendly and welcoming. One of our neighbors gave us a few home-cooked meals when we were moving in, a very welcome gesture. Another set of neighbors had a welcoming party in our honor.
  10. Make a difference … : We all know that the healthcare system in the United States is in deep trouble. We also know that informatics and information technology are two key ingredients in turning the situation around. We are looking for a few people who want to make a real difference. And, Regenstrief is one of the places where you can do that best!

Interested? Take a look at http://bit.ly/RCBMI_Faculty, and then send me email or give me a call!

Titus


Titus Schleyer, DMD, PhD
Clem McDonald Professor of Biomedical Informatics
Director, Center for Biomedical Informatics
Regenstrief Institute, Inc., 410 West 10th Street, Suite 2000, Indianapolis, IN 46202-3012
Skype: titus.schleyer, Ph: (317) 423-5522 (direct), cell: (412) 638-3581, E-mail: schleyer (at) regenstrief.org
Web: http://www.regenstrief.org/cbmi/, Blog: http://titusschleyer.wordpress.com, General: http://about.me/titusschleyer

What are cool products/services @RCBMI?

So, the other day I asked my colleagues “What are cool products/services @RCBMI?” At the moment, we do not really have a good public, up-to-date listing of “What’s hot” at the Regenstrief Center for Biomedical Informatics. This will change in the future, but until that happens, I thought I might as well use a blog posting to get our list of “Top 10″ (in no particular order) out there. So, here goes:

  1. Regenstrief CBMI goes to Washington … : contains information on most of the presentations CBMI faculty and staff made at the American Medical Informatics Association 2013 Annual Symposium.
  2. Regenstrief Institute’s Gopher CPOE System: update on the (new) Gopher CPOE System being developed by RCBMI and implemented at Eskenazi Health. Additional information about the system is contained in the paper Regenstrief Institute’s Medical Gopher: A next-generation homegrown electronic medical record system.
  3. Customizing EMR functionality and user experience: description of the Rule Authoring and Validation Environment (RAVE), an advanced rule authoring tool for clinical care, quality improvement and research targeted at end users
  4. Open Medical Record System (OpenMRS®): The OpenMRS was created in 2004 as an open source medical record system platform for developing countries. The OpenMRS is a multi-institution, non-profit collaborative led by Regenstrief Institute, a world-renowned leader in medical informatics research, and Partners In Health, a Boston-based philanthropic organization with a focus on improving the lives of underprivileged people worldwide through health care service and advocacy.
  5. Open Health Information Exchange: a demo of an OpenMRS-related system for implementing open-source health information exchanges; includes Client Registry, Provider Registry, Facility Registry, Terminology Service and an Interoperability Layer that, taken together, demonstrate a shared health record.
  6. The CareWeb Framework: The CareWeb Framework is a modular, extensible framework for building clinical applications in a collaborative fashion.  A high-level overview is available at Creating a flexible EMR architecture.
  7. The Regenstrief Notifiable Condition Detector: A public health informatics system that automatically detects and routes positive cases of notifiable diseases based on routine electronic laboratory reporting (ELR). While certified EHR systems and components enable provider organizations to manually route ELR cases reportable under state laws, none have the capacity to for automatic reporting as demonstrated in this system.
  8. Logical Observation Identifiers Names and Codes (LOINC®): A universal code system for identifying laboratory and clinical observations. From serum levels of hepatitis B surface antigen to diastolic blood pressure, LOINC has standardized terms for all kinds of observations and measurements that enable exchange and aggregation of electronic health data from many independent systems. Used in 157 countries.
  9. The Regenstrief LOINC Mapping Assistant (RELMA): Available in a hosted as well as a standalone version, the RELMA facilitates searches through the LOINC database and assists efforts to map local codes to LOINC codes.
  10. The Unified Code for Units of Measure (UCUM): The UCUM provides human-friendly codes for all units of measures with precise semantics to facilitate unambiguous and computable communication between computer systems used in science, engineering and business worldwide. A detailed discussion is available at Unified Code for Units of Measure.

To be sure, we have more than just 10 cool technologies here at CBMI, but I thought I would stop here. Want to find out more? Write, call or visit us!

Happy New Year!

Titus

Titus Schleyer, DMD, PhD

Clem McDonald Professor of Biomedical Informatics

Director, Center for Biomedical Informatics

Regenstrief Institute, Inc., 410 West 10th Street, Suite 2000, Indianapolis, IN 46202-3012

Skype: titus.schleyer, Ph: (317) 274-9204 (direct), cell: (412) 638-3581, E-mail: schleyer@regenstrief.org, Web: http://www.regenstrief.org/cbmi/, Blog: http://titusschleyer.wordpress.com, General: http://about.me/titusschleyer

Regenstrief CBMI goes to Washington …

Remember the old movie “Mr. Smith goes to Washington” with Jimmy Stewart? From November 16-20, the American Medical Informatics Association (AMIA) had its 2013 Annual Symposium in DC and Regenstrief Institute CBMI faculty, along with colleagues from other IU affiliates, “went to Washington.” This Symposium is the premier scientific meeting for biomedical and health informatics research and practice which takes place each year in the fall and brings together sterling informaticians from across the US and Canada, as well as many of our international colleagues.

The Symposium lived up to its – usually high – expectations as it has for the past 35 years. I might have been a little bit biased this year because I had the privilege of helping shape the program as the Applications Track Chair, along with Foundations Track Chair Katie Siek and SPC chair John Holmes. To increase program quality, we consciously lowered the acceptance rate to just over 30% from its more typical 40-43%. Together with over 2,400 attendees, we heard about conceptual and practical advances relating to biomedical information and innovations in design, technology, implementation of information systems and knowledge resources across the full spectrum of health care. Not only did we hear and learn about other’s advances and innovations, but we were able to share a few of our own with our peers.

Dave deBronkart (also known as e-Patient Dave), co-founder and board member of the Society for Participatory Medicine, gave an excellent keynote on Sunday about patient engagement in healthcare. He charmed informaticians with quotes such as “Come to the dork side. We have pi.” (That quote was just meant for Burke.) Dave even wrote a nice blog post about his experience at AMIA. From the attendee comments I heard as well as tweets about his talk, it appeared to be one of the most well-received keynotes ever given at AMIA. Even I was so taken in that I tweeted:

Pete Szolovits from MIT won the 2013 Morris Collen Award, a well-deserved honor (see the video here). For those of you who do not know much about Morris Collen, Bill Tierney wrote a very nice blog post about him on the occasion of his 100th birthday. Congratulations also go to JT Finnell, CBMI faculty member, and colleagues for receiving the AMIA Leadership Award for work on Advancing the Clinical Informatics Board Review Program. (Incidentally, JT was among the first people to pass the board exam the other day.)

After the opening session I ran a panel titled “Informaticians, CxIOs and Industry: Strengthening the Fabric of HealthIT with speakers Blackford Middleton from Vanderbilt, Bret Shillingstad from Epic and Marc Overhage from Siemens (my predecessor at Regenstrief). The panel presented viewpoints from key industry and academic leaders on strategies to improve informatics’ contribution to positive changes in healthcare. It was standing room only, and we had attendees from Epic, Cerner, Allscripts and many other HIT companies. One tweet from there that got a lot of attention:

AMIA’s Welcome Reception on opening day was held in the Exhibit Hall where Regenstrief Institute shared a booth with the IU School of Informatics. This was a perfect opportunity for AMIA attendees to visit the booths and ask questions of the exhibitors. Kudos to Emily Mitchell, our fellowship coordinator, for preparing for the exhibition, setting up the booth and staffing it!

Sunday evening was the American College of Medical Informatics (ACMI) dinner and new Fellow induction. I am proud to say that this year Paul Biondich, CBMI faculty, was one of the inductees joining Regenstrief ACMI fellows Bill Tierney, Steve Downs, Shaun Grannis and me. Paul’s accomplishment is even more noteworthy since he was one out of only six new inductees (of over 40 nominees) – making this ACMI election one of the historically most selective.

Monday our fellow Jianmin Wu presented a paper evaluating congruence between laboratory LOINC value sets for quality measures, public health reporting and then mapping the common tests. In the afternoon, investigators Shaun Grannis and Brian Dixon participated in a panel titled “How fit is electronic health data for its intended uses? Exploring data quality across clinical, public health and research use cases.” Concurrently, investigators Jon Duke and Burke Mamlin demonstrated an update on our Gopher Order Entry System for AMIA attendees. Regenstrief Investigators Brian Dixon and Shaun Grannis, and staff member Mark Tucker, presented a demo on The Regenstrief Notifiable Condition Detector, an automated public health reporting system using routine electronic laboratory data.

Tuesday IU colleague and Director of the Department of BioHealth Informatics at the IU School of Informatics Brad Doebbeling presented a paper discussing informatics challenges and strategies to prevent MRSA infections from a multihospital infection prevention collaborative viewpoint. Brad collaborated on this paper, which received an AMIA Distinguished Paper Award, with Abel Kho, former CBMI fellow, from Northwestern for several years.

CBMI investigators Brian Dixon, JT Finnell, Shaun Grannis, fellow Jianmin Wu and former fellow Jason Cadwallader also presented Variation in Information Needs and Quality: Implications for Public Health Surveillance and Biomedical Informatics, Opioid Abuse Risk Scoring within an Emergency Department, and A Practical Method for Predicting Frequent Use of Emergency Department Care Using Routinely Available Electronic Registration Data. Posters presented by Blaine Takesue, Brian Dixon, Josette Jones and some former Regenstrief fellows during the last two days of the meeting included:

• Health Literacy Redefined through Patient Engagement Framework
• Validation of Semantic Synsets in Natural Language Processing
• Patient, Caregiver, and Provider Perceptions of a Colorectal Cancer Personal Health Record
• Measuring and Improving the Fitness of Electronic Clinical Data for Reuse in Public Health, Research, and Other Use Cases
• Using SMART and i2b2 to Efficiently Identify Adverse Events
• Semantic Processing to Identify Adverse Drug Event Information from Black Box Warnings

Tuesday evening a large group of past and present Regenstrief folks embraced good food, a few drinks and a lot of conversation at a nice Italian restaurant, Bistro Bistro. It was great to catch with colleagues, staff and former trainees in a more informal setting.

Brian Dixon wrapped up on Wednesday with the inaugural and well-received “Year in Review for Public and Global Health Informatics.” The session reviewed recent literature in the areas of public health and global health informatics highlighting trends, knowledge, methods, and lessons from public health and the use of informatics in resource-constrained settings.

We have lots of hard work ahead of us to ensure next year we have even more new, exciting and innovative ideas that to showcase the Regenstrief Institute’s leadership in Biomedical Informatics. Are you interested in making that happen? We are currently recruiting for several faculty positions, ranging from the Sam Regenstrief Chair in biomedical informatics and a Chief Research Informatics Officer to midcareer and junior faculty positions. For more information, please see the postings at http://bit.ly/RCBMI_Faculty.

Thanks

Titus

PS Thanks to Sandy Poremba for helping put this blog post together.

 

Why do informaticians have such a hard time getting into the press?

Health information technology and informatics are all over the media these days. But, why do informaticians have such a hard time getting into the press? With all the great developments going on in our discipline, you’d think that we would see in-depth reporting on many topics, ranging from how we improve patient safety to how we can save money by making healthcare institutions more efficient.

This was a question that Kevin Johnson, Cornelius Vanderbilt Chair of Biomedical Informatics at Vanderbilt University, posed last week during his keynote at the Pittsburgh Biomedical Informatics Training Program 2013 Retreat. (I had the honor of being able to attend this retreat by virtue of having to pack boxes for our move from Pittsburgh to Indy. It was great to see all my of my colleagues and friends at the Department of Biomedical Informatics again.)

Kevin gave a wonderful keynote, which, as many informatics keynotes, began with a simple question: How do you explain what you do in informatics to your parents? Answering this question successfully is something we all struggle with, Kevin being no exception. (The only thing worse than not being able to explain informatics to your parents is not being able to replicate a successful explanation. Recently, the host at a dinner party asked me what I did for a living. I launched into a fervent description of how our exciting work was changing the world. A few weeks later, I saw her again and she said: “You know, it was really great how you defined informatics the other day. What was it exactly you said again?” As I struggled to recreate the moment and what I thought I must have said, she looked at me somewhat disappointed and said: “No, that wasn’t it.” After another vain attempt of mine: “No, that wasn’t it, either.” Ever since then, I feel like Joseph K. in Franz Kafka’s “The Castle.”)

In his keynote, Kevin did something really interesting. He did not talk about informatics as it is portrayed in research journals. He talked about informatics as portrayed in the newspaper, specifically the New York Times (which has done a great job reporting on HIT in recent years). He talked about informatics from the viewpoint of one of our main audiences, complete with how to tie everything back to the fundamental research domains we pursue collectively.

Kevin’s main point was that if we want to change public perceptions about informatics, we need to speak to the public. So, he tried to do that. Some time ago, after finishing a study on the financial impact of a health information exchange on the cost of emergency department care, he submitted it to JAMA. It was rejected. Shortly after that, he was talking to one of his colleagues about his experience of how JAMA had rejected the paper after the first try. His colleague said: “If you want your work to be talked about, including in the press, you need to get it into high-impact journals such as JAMA and NEJM.” Kevin: “But they said no.” His colleague: “They didn’t really mean it. If your work is important, you need to call them, explain it to them. Then they will understand and, ultimately, publish it.” Kevin: “Oh. … Well, I’ll bet you $100 that we can get it into the press if we get in published in JAMIA.” His colleague: “You’re on.”

So, Kevin lost $100. Why? Because despite meticulous preparation and a great strategy for dissemination, reporters from major newspapers don’t read the thousands of press releases about papers in hundreds of journals. They go to a few choice sources they trust.

We learned a few lessons from Kevin’s talk and the discussion that followed:

  1. Don’t stop trying to explain to your mother (or father, siblings, your son/daughter, other relatives, random conversation partners at a cocktail party, etc.) what informatics is. You may never succeed. But we definitely know you won’t succeed if you stop trying.
  2. Get your work into high-impact journals such as JAMA, NEJM and the Lancet. You will have to be patient. The readers of these journals are not informaticians. They don’t speak our language. Start writing about informatics in a way they can begin to understand.
  3. Let’s make JAMIA a valuable information resource for reporters. That means that the journal needs to continue to publish high-impact research, as well as help non-informaticians understand what it means. Maybe we need sidebars for key papers that explain the real-world impact.
  4. Be persistent. Journal editors and reviewers are powerful gatekeepers of what the world hears. If they don’t understand you, your message will certainly not be heard. If you don’t succeed at first, get help. Someone on your campus may have had quite a bit of success publishing in high-impact journals. Or, they may even be an editorial board member.
  5. Establish relationships with newspaper reporters and others. Become a trusted source of reliable information for them. One of the first things I did when I came to Regenstrief was to focus attention on doing that. Why? One of the criteria the Regenstrief Foundation uses to assess our performance is “local, regional, national and international impact.” One way it measures this: by how many times were have been cited/profiled in the New York Times, the Wall Street Journal and the mainstream press in general.
  6. Speak to the next generation. For many senior informaticians, social media don’t rate. (Let’s not go into the reasons for this here – that would more than fill another blog post.) However, who is on social media? Our future interns, trainees, colleagues, program officers at funding agencies, representatives, etc. You get the point: If we don’t talk to the future generation, we don’t exist. And much of the conversation these days, for better or worse, is happening on social media.
  7. Let’s make being in the media something academic informatics cares about. I am happy to report that the 2013 AMIA Annual Symposium is making a start. Danny Sands will present “The Year in Review: Informatics in the Media.” I anticipate this to be a very interesting and useful session. And, why not go further? Couldn’t AMIA make it a goal for the association to get more work of its members into high-impact journals? Let’s see “#informatics” trend in JAMA, the NEJM and the Lancet!

So, is trying to get increased exposure for informatics in the mainstream media worth a try? I am hoping I have convinced you that it is. Let’s do it!

Titus Schleyer  and Kevin Johnson

Titus Schleyer, DMD, PhD

Clem McDonald Professor of Biomedical Informatics Director, Center for Biomedical Informatics Regenstrief Institute, Inc., 410 West 10th Street, Suite 2000, Indianapolis, IN 46202-3012 Skype: titus.schleyer, Ph: (317) 423-5522 (direct), cell: (412) 638-3581, E-mail: schleyer@regenstrief.org Web: http://www.regenstrief.org/cbmi/, Blog: http://titusschleyer.wordpress.com, General: http://about.me/titusschleyer

Chances for healthcare innovation in Central Indiana? Better than their local perception

The other day, the Indiana Business Journal ran a column entitled BioCrossroads drops dreams for hospital innovation. In it, the columnist commented fairly negatively on a report by BioCrossroads entitled Healthcare Driven Innovation: An assessment of opportunities in Central Indiana. As a new arrival to Indianapolis, I thought the commentary was a little bit disingenuous and somewhat of a needless putdown of what is really possible. So, I took the initiative and wrote a few comments, many of which are applicable to healthcare innovation in general.

Instead of bidding adieu to “dreams for hospital innovation,” the report simply confirmed what many health systems already know: It is hard to emulate the Cleveland Clinic, whether that is with regard to clinical processes, outcomes, and quality of care, or its innovation model. What the report said loud and clear between the lines, however, is worthwhile repeating: Healthcare in the US needs innovation to chart its way out of the mess it is in. And that is why I moved to the Indiana University School of Medicine/the Regenstrief Institute from the University of Pittsburgh and its juggernaut medical center.

I am a biomedical informatician, since my earliest uses of a computer always focused on solving practical problems. Whether it was writing software to calculate the value of standing timber for my father (a forest superintendent) or programming algorithms for materials testing in a manufacturing company, improving real-world outcomes was always front and center for me. Now, I work for an Institute that has the same priority.

The report astutely examines current local healthcare innovation efforts and outlines a path forward. Many aspects of this path are unknown, but its general shape is clear: Innovating successfully in healthcare requires a balanced amalgam of healthcare institutions (specifically hospitals), clinicians (not just physicians), and entrepreneurship embodied by companies large and small. In this triad, it is often the institutions who are their own worst enemies. While most want to be like Stanford, MIT, or, in this case, the Cleveland Clinic, academic and clinical institutions often create a dizzying array of disincentives and barriers to the innovations they intend to produce. At Temple University in 1989, my first job in the US, the research office was so dysfunctional that any thought of commercializing an innovation was ludicrous. When I started at the University of Pittsburgh in 2002, one of my senior colleagues in biomedical informatics said to me: “If you want to innovate and commercialize, go elsewhere.” Six or so unsuccessful innovation disclosures with Pitt’s Office of Technology Management later, I took his advice.

So, I decided to go to one of the historically most innovative places in healthcare informatics, the Regenstrief Institute Center for Biomedical Informatics (CBMI), as its third director. It helped that even as dental student in Germany I was familiar with the work of its founder, Clem McDonald. (I now have the honor of holding a professorship endowed in Clem’s name.)

In the aggregate, the BioCrossroads makes a few simple points. Healthcare innovation requires the involvement of physicians and other clinicians. Hospitals and other healthcare institutions need sensible strategies to support and nurture this innovation. We need the help of entrepreneurs and the business community to make these initiatives fly in the marketplace. We need to take advantage of local assets and resources. And, we need to collaborate.

I am personally not upset at all that the report concluded we can’t recreate the Cleveland Clinic Innovations model here. Maybe we shouldn’t. According to the report, the Cleveland Clinic started building its vertically integrated innovation and commercialization model in 1921. So, I’d say they have a pretty good head start. The commentary derides IU Health for its poor track record of commercialization through CHV Capital Inc. Well, if it’s any consolation, UMPC didn’t do a whole lot better, despite huge investments. So, the dream of the high-flying, royalty-gushing conveyor belt of startups might not be for many, anyway.

Taking a bright idea from its conception to successful commercialization is an extremely long and arduous road. Most startups in business in general fail. Thus it is in healthcare. As the report suggests, we may want to look at particular facets of the innovation value chain. Here are a few relevant comments:

  • Most healthcare institutions love solving a local problem, whether it is in administration, clinical care or operations. Solving this kind of problem usually saves money, improves outcomes or both. Helping hospitals and other healthcare providers do that has important benefits for the economy, health and quality of life.
  • Let’s create the right partnerships to help innovative ideas succeed. An innovative clinician needs partners on the business who understand the need, the solution and the potential market. I have seen a lot of good ideas go down the drain because the business people didn’t really understand what they were trying to market, who to market it to and why the innovation was needed in the first place.
  • Let’s stop tying ourselves in knots with our own homemade rules. I have listened to endless arguments in academia on who exactly owns the IP, how the revenues should be split, who gets the right to license the technology, etc. Guess what? 80% of zero is still zero, so let’s cut to the chase and help new ideas take wing with the least amount of bureaucratic overhead.
  • Healthcare is an information-intensive business. This will get only worse. According to a report from the Institute of Medicine, the number of data points required for individual clinical decisions will continue grow exponentially (reflecting our growing insights into the genomic and proteomic basis of disease). How do you do this without a computer? You don’t. Informatics and information technology are not just crucial for innovating in healthcare. They are crucial just for delivering basic care. Given the strength of Central Indiana in applied clinical informatics, we have huge opportunities in that space.
  • But, to take advantage of these opportunities, we need to collaborate. The Indiana Network for Patient Care is a good example of what happens when you do that. It certainly is not the only health information exchange in the country, but it is the largest and most mature. In general, Central Indiana looks to me to be one of the more collaborative healthcare markets I have ever lived in. Certainly, the Philadelphia and Pittsburgh areas cannot be held up as paragons of collaboration in healthcare.
  • The INPC provides us with possibilities that simply don’t exist anywhere else. Let me give you an example. The other day I was talking to a CBMI staff member about how to transmit health data from personal monitoring devices, such as health apps for blood pressure, glucose measurements, pulse rates, etc. Eventually, the discussion turned to the benefits of feeding patient-generated data directly into the INPC. The value of doing that to clinicians? Priceless.
  • We need to stimulate the dialogue among parties who normally would not be talking to each other. One of my first experiences at CBMI was the Electronic Medical Record Summit, a conference which brought, with generous support by Merck, major and minor health information technology (HIT) companies together, including Epic, Cerner, Allscripts, iSalus and IHIE. For a day, we discussed HIT innovation in the context of Regenstrief’s cutting-edge technologies.
  • Let’s not forget that Central Indiana is not the only place producing innovation. Right before I left Pittsburgh, I sat down with faculty colleagues at Carnegie Mellon University. I left with a whole bag of innovative technologies that were ready to be tested and evaluated in practice. Exactly the thing we could do in Central Indiana.
  • The Report justifiably identifies clinical research as a significant opportunity for the region as a whole. The more attractive we collectively become as a location for major funders to conduct research, the more we can contribute to generating knowledge. And, we are very well positioned today, as the extremely positive review of our application for a Clinical and Translational Science Award from the NIH illustrated. At IU Health, we incentivize research by making part of the bonus for each hospital CEO dependent on the number of research participants recruited. We use tools such as ResNet (Research participant recruitment Network), to identify potential participants from electronic data. And, at Wishard, our G3 software suggests patients eligible for particular studies as physicians type their notes.

So, what are the opportunities in Central Indiana? Stellar. Forget what the Cleveland Clinic does. Let’s do it the Hoosier way!

Titus Schleyer, DMD, PhD, MBA

Clem McDonald Professor of Biomedical Informatics
Director, Center for Biomedical Informatics
Regenstrief Institute, Inc., 410 West 10th Street, Suite 2000, Indianapolis, IN 46202-3012
Skype: titus.schleyer, Ph: (317) 423-5522 (direct), cell: (412) 638-3581, E-mail: schleyer@regenstrief.org
Web: http://www.regenstrief.org/cbmi/, Blog: http://titusschleyer.wordpress.com, General: http://about.me/titusschleyer

What’s the organizational value of 40, 4,000 or 400,000 clicks?

The other day a seemingly trivial incident stimulated a discussion of how to increase process efficiency at the Regenstrief Institute’s Center for Biomedical Informatics. The original email I sent (see below) was entitled “Are process improvement and efficiency part of our culture?” (This was somewhat of a trick question.) Suffice it to say that I tried to highlight an opportunity for saving time for everyone by including an .ics calendar appointment with a broadcast email reminder of an upcoming event.

My point was that sending a reminder for an event that did not make it easy for recipients to act on it was not exactly pointless, but, well, inefficient. Of course, part of the thinking probably was: “This is just an informal reminder, so whoever wants to come probably already made themselves a calendar appointment based on earlier messages.” True. But, in our messy informational environment that the digital revolution has created it is usually not a good idea to rely on some item buried far down in our inboxes. And, in the larger scheme of things, why would I have to get a reminder anyway if I already put the event on my calendar?

The email below chronicles my futile journey across the organization’s information artifacts to see whether there was an easy way to put the event on the calendar. I ultimately did what most people in my position would probably have done first: turf the job to my administrative assistant Sandy (who, by the way, is a great help, for calendaring as well as otherwise). But, her time is highly valuable to the organization, also, and should not be wasted gratuitously.

So, what is the big deal? A few mouseclicks and keystrokes. To date, when I wanted to convert an email message to an appointment in Outlook, I pushed “Forward,” selected all text, dragged it onto the calendar, copied or typed the appointment subject, and entered date and time information. Had the original email included an .ics calendar file as an attachment, I would have double-clicked on that, pushed “Save” and I would have been done.  (Of course, receiving an Outlook invitation directly would have cut that down even further, to one click.) Total savings: about 15-20 seconds.

Let’s say I do 20 tasks like this per day, at a cost of 20 seconds each. And, let’s say that that is true for the roughly 100 employees of BMI. That means that we collectively waste 400,000 seconds (or roughly 110 hours) a year (20 seconds x 100 people x 200 workdays/year). If we budget $100 as an average hourly rate across the organization, we are talking about $11,000. This may not sound like much, but is just the tip of the iceberg in terms of how inefficiencies inherent in or resulting from information technology drain our productivity.

As soon as I sent the email message below to all faculty and staff, two things happened: (1) People agreed with me that this was an important if largely invisible issue. And, (2) they started sharing all kinds of productivity tips related to appointments in Microsoft Outlook. From those tips, I learned how to:

For me, that sequence of events begs two major questions:

  1. How do you encourage organization-wide thinking and behavior about process improvement?
  2. How do you efficiently share everyone’s knowledge of the little tips and tricks that help you become more efficient?

Regarding (1), I thought that would be a non-issue before I took this position. From my original email:

“From what I read about the history of Sam Regenstrief, I understand that one key to his success in capturing 24% of the total dishwasher market in the United States in 1970 (see the book) was his relentless focus on process improvement and efficiency.”

So, I am thinking: “This is the Regenstrief Institute – they MUST be doing what made Sam Regenstrief great.” Wrong! The more I learn about our Center and the Institute, the more I realize how far we have strayed from our original philosophy. I could write a whole stack of Harvard Business Review Case Studies about our opportunities for process improvement.

Regarding (2), this is a tricky problem that several decades of research in computer-supported cooperative work (CSCW) have so far failed to solve. Judging from the literature, the answer is not just a software application that facilitates tip sharing. Succeeding with organizational knowledge transfer most likely requires a complex amalgam of culture, education, individual and group behavior, as well as technology. Which places have succeeded in this? What organizational development interventions are particularly effective? Are there useful software applications out there for this? Please write to me with your ideas and I will try to implement them here. I will let you know how it goes.

Thanks in advance!

—————————————————————————————————————————————–
Original email message
From: Schleyer, Titus K
Sent: Tuesday, July 02, 2013 5:40 PM
To: mi-staff-l@list.regenstrief.org
Subject: Are process improvement and efficiency part of our culture?
Hi everybody,

The other day, I had a simple problem in putting an event on my calendar which was easily fixed. However, in the larger picture, it is a good example of how suboptimal processes sap our resources in (often invisible but substantial) ways every day.

The event in question is the Quarterly Innovation Challenge on Friday, August 9th from 1-3pm in HITS 1110. I was wondering whether it already was on my calendar since I intend to participate. It wasn’t, so I went back to Jon’s reminder email from 6/27/2013. The email was not in the form of a calendar invitation and also did not include the event as an iCalendar attachment.

Of course, I could have just dragged Jon’s email on the Outlook calendar, used copy and paste a few times, and be done with it. However, I wanted to see how difficult (or easy) BMI would make it to get this appointment onto my calendar. So, I went to the Intranet, where I remembered seeing a calendar. I navigated to 8/9/2013 and – lo and behold – this event was (and is) not on there.

So, I got a cup of tea and inspected the poster about the Innovation Challenge on the way. I thought maybe it would contain a QR code that I could scan with my tablet, and maybe I could get to the appointment that way. No QR code, however.

In the end, I just forwarded the email to Sandy with the request to put it on my calendar. Most people probably would’ve said that that’s what I should’ve done in the first place. But, Sandy has better things to do than completing the non-value added task of adding something to my calendar.

I think there is a larger lesson in this trivial event. From what I read about the history of Sam Regenstrief, I understand that one key to his success in capturing 24% of the total dishwasher market in the United States in 1970 (see the book) was his relentless focus on process improvement and efficiency. So, I am a little bit surprised that we do not live and breathe his philosophy more than we do.

Ideally, I should have been able to put this appointment onto my calendar with one or two (double) clicks from any of the places I mentioned. Try it! Double-click on the attached file and push Save & Close. Done! (I look forward to seeing you there!)

Some people may argue about debating the value of a click. But I’m not debating the value of a click. I’m debating the aggregate value of thousands of extra clicks per person per year at our Center. I am debating the value of thousands and tens of thousands of non-value added tasks that break up our ability to get real work done. Those things have a real cost, even if they don’t show up on a balance sheet.

If we want to keep the legacy of Sam Regenstrief alive (and I think we should), we need to live and breathe his philosophy. Process improvement and efficiency must become our way of thinking, deciding and acting.

With that, I am off to kendo!

Titus

Titus Schleyer, DMD, PhD

Clem McDonald Professor of Biomedical Informatics

Director, Center for Biomedical Informatics

Regenstrief Institute, Inc., 410 West 10th Street, Suite 2000, Indianapolis, IN 46202-3012

Skype: titus.schleyer, Ph: (317) 423-5522 (direct), cell: (412) 638-3581, E-mail: schleyer@regenstrief.org, Web: http://www.regenstrief.org/cbmi/, http://about.me/titusschleyer

Informatics giant Clem McDonald honored with endowed chair in biomedical informatics

Yesterday, Indiana University School of Medicine and the Regenstrief Institute  held a ceremony establishing an endowed chair to honor Clement McDonald, M.D., a pioneer and innovator in the use of health information to improve patient care and outcomes.

Dr. McDonald, Distinguished Professor Emeritus and Regenstrief Professor Emeritus of Medical Informatics at the IU School of Medicine and former director of the Regenstrief Institute, is currently director of the National Library of Medicine’s Lister Hill Center for Biomedical Communications.

A distinguished clinician-researcher and one of the nation’s most accomplished experts in the field of electronic health record systems Dr. McDonald has inspired and trained scores of junior faculty and fellows at Regenstrief and IU. He developed the Regenstrief Medical Record System and for decades directed its use in clinical studies of innovations in medical informatics; many were conducted at Wishard-Eskenazi Health, one of the largest safety net public health care systems in the United States. This work has illuminated the ways in which electronic medical records can improve the quality and efficiency of patient care and its outcomes.

Schleyer McDonald Tierney at presentation of McDonald chair to it's first occupant Schleyer

Clem McDonald and Bill Tierney present endowed chair to its first occupant, Titus Schleyer

Today the Regenstrief Medical Record System is one of the longest continually operational electronic medical record systems in existence. Dr. McDonald also created the Indiana Network for Patient Care for the largest and most comprehensive regional health information exchange in the country, involving more than 90 hospital systems in Indiana and more than 19,000 physicians.

Dr. McDonald is also an internationally recognized pioneer in the development of health data standards. He is the developer of Logical Observation Identifiers, Names, Codes, an identification system for tests and results that is a clinical data standard used across the nation and around the globe. A member of the Institute of Medicine, Dr. McDonald is a recipient of the President’s Medal for Excellence from IU, the highest honor an IU president can bestow.

I have the good fortune and high honor to have been named the first Clem McDonald Chair of Biomedical Informatics.  It is hard to put into words what this means to me. The following  is the text of my remarks at the ceremony:

“Dear collagues and friends,

Thank you very much for being here today. It means a lot to me.

So, what do you say when you are honored with the title ‘Clem McDonald Professorship of Biomedical Informatics?’ Well, my first reaction was to be speechless.

My second one was: ‘They must have made a mistake. They cannot possibly mean me.’ Eventually, I realized that they were serious about it and that is why we are all here today.

Of course, then the problem becomes to say something meaningful in response. So, this has become the shortest speech in my life about which I have deliberated for the longest time. I even wrote it down, which is something I never do.

To be honored with a named professorship is profoundly humbling. I consider this the most important achievement in my life to date. Actually, that is not quite correct. My most important achievement is having married my wife Alida. So, this is the most important achievement in my professional life.

Second, I see this honor not as much as a recognition for past accomplishments but a challenge for the future. In science, we are used to ‘standing on the shoulders of giants.’ The preceding remarks have driven home exactly what kind of giant Clem McDonald really is. So, the question becomes: How do we prove ourselves worthy of Clem’s legacy? The named professorship is not just an honor and challenge for me, it is one for all of us.

The Center for Biomedical Informatics is a storied institution with a rich history of accomplishments. That is good, but more is asked of us than to rest on our laurels.

McDonald Schleyer 7-8-13 handshake

Clem McDonald and Titus Schleyer

After I gave my Work in Progress presentation a few weeks ago, Tom Inui came up to me and introduced himself. It was the first time I met him. He asked me a simple question: ‘Why did Sam Regenstrief fail?’ I’m thinking: ‘Wow, here comes the real interview.’ So, I am wracking my brain, trying to remember Sam’s biography that I had read more than a year ago. So I say: ‘Sears wanted to diversify from more than one supplier for dishwashers.’ Tom shakes his head. ‘Somebody offered him the design of the first microwave to build, but he didn’t take it.’ Well, I am not sure how many of us would have chosen to build microwaves in an age when their widespread use was unimaginable! Tom shakes his head again. Then he says quietly: ‘He kept doing what he was always doing.’

At a fundamental level, Sam did not change his ways in a changed environment.  It is a lesson that we would do well to heed.

Biomedical informatics operates in an environment radically different from what we had historically. Not anymore is informatics the domain of the few bright pioneers. Not anymore can it be content with producing stellar innovations confined to local settings. Not anymore does it exist in a vacuum.

No, informatics is now alive in the daily practice of healthcare. Its fruits are at work in every practice, hospital and health system. In short, it not only affects healthcare, it is healthcare.

That puts a particular burden on us. In keeping with Sam’s charge, we must ensure that informatics continues to improve healthcare.

I always like to joke that biomedical informatics is still in the Stone Age. Some people may scoff at that, but I think it is true. Many years ago, Paul David wrote in the American Economic Review:

‘Radically new technologies diffuse gradually, because it takes a long time for companies to learn how to use the new resources effectively. … Truly revolutionary applications often require major reorganizations of production, which may take a long time to discover.’ (P. David, The dynamo and the computer: A historical perspective on the modern productivity paradox, American Economic Review, 1990).

I think the same is true in healthcare. We have not even begun to discover how to use informatics to its full potential in healthcare.

Participating in and helping drive that discovery is one of our core responsibilities at CBMI. Sam Regenstrief charged us with improving healthcare. We have done that and will do it even better in the future.

But, I cannot do this alone. I need your help. In the process, we will have to work hard. We will need to do things in ways we haven’t done them before. We will need to reach out to others in unprecedented ways. But, most importantly, we will do it together.

In the process, one thing we will do is to honor Clem and his legacy. And, I can imagine few things as worthwhile as doing that.

So, I have been working here for four weeks and one day now. I’m sure many of you are asking yourself: ‘Well, what is Titus thinking? Does he like it here? Does he like us?’ I have to tell you: I love it here.  Coming to work here was like coming home. I know that we can achieve great things together. I see it in your loyalty to the Institute. I see it in the ways you think, decide and act. I see it in your eyes. For me, the fact that we can do it means we will do it.

With that, let us raise our glasses to Clem: For what we owe to you and for what we will achieve in your honor.

Thank you very much.”

PS: Official press releases:

PPS: Recording (.wav file, 40 min.) of remarks at the ceremony by:

  • Bill Tierney, President and CEO, Regenstrief Institute
  • Charles Bantz, Chancellor, Indiana University-Purdue University Indianapolis
  • Chris Callahan, Director, Indiana University Center for Aging Research
  • Clem McDonald, Director, NLM Lister Hill National Center for Biomedical Communications
  • Titus Schleyer, Director, Center for Biomedical Informatics, Regenstrief Institute

Hello world! A welcome (to and) from the Regenstrief Institute

Hi everybody,

With the start of my new job at the Regenstrief Institute in Indianapolis, I have also started a new blog. (Some of you may be familiar with my posts on the Dental Informatics Online Community Blog, but from now on most, if not all, of my blogging will happen here.) I wanted to tell you a little bit about what’s been going on since I moved here and what I’m planning for this blog.

IMG_20130618_080807

The Health Information and Translational Sciences Building (my office) (June 2013)

My new position here is Clem McDonald Professor of Biomedical Informatics and Director, Center for Biomedical Informatics (CBMI). Here is how this came about: Early last year, I got an email from the chair of the search committee, asking me whether I would consider applying for the position of director at the CBMI. Two thoughts crossed my mind: “I didn’t know you were looking for a director” and “Why me?” After a fairly lengthy recruitment cycle (not atypical for academia) I happily joined my 15 faculty and 70 staff colleagues full-time on June 1, 2013.

So, what does the Regenstrief Institute do? Our motto is “Advancing healthcare through research, development and education” and that is what we have been doing for about 40 years. Our center, the CBMI, is a global collaborative research and learning organization. We develop and evaluate innovative informatics solutions to improve patient care. We translate these solutions into cost-effective, operational systems, including a dynamic electronic medical record system called G3 at Wishard Hospital. And, we have research programs in:

  • computerized physician order entry
  • health information exchange
  • public health
  • global health
  • drug safety
  • reference standards
  • research infrastructure
  • data epidemiology

    IMG_20130615_093039

    Flowers at the Broadripple Farmers Market (June 2013)

If this sounds like a pretty exciting place to work, you are onto something. It is one of the major reasons why I’m here. When I was in dental school in Frankfurt, Germany, in 1985, I was already familiar with the work of the CBMI’s founder, Clem McDonald. Under his direction, CBMI was working on the Medical Gopher (“A Microcomputer System to Help Find, Organize and Decide About Patient Data”). Gopher was one of the first computerized physician order entry systems in the world, and its development has influenced informatics and health information technology in countless ways.

One of the things I have always admired about the Regenstrief Institute is its focus on practical applications in healthcare. Our business is to impact health care, regardless of whether that is locally, regionally or nationally. This philosophy resonates strongly with me. Ever since I touched a computer, I tried to solve real-world problems, whether that was helping my Dad with calculating the value of standing lumber, writing materials testing software for Fichtel&Sachs in Schweinfurt, or writing an expert system to schedule students’ clinical rotations at Temple University School of Dentistry. When I first interviewed for the position, I thought “Wow, these people are like me.” I felt like I had come home.

So, where to from here? The Regenstrief Institute is a storied institution with a rich history of accomplishments. Yet, the world of biomedical informatics and health information technology is changing, and the CBMI must adapt and evolve in order to continue to thrive. One priority for me is to make the innovations we produce here more accessible and usable to the rest of the world. Publishing papers in high-quality journal is wonderful, but not enough. We must affect the health and lives of people with the methods we develop and software we build. I am looking forward to doing that with our current partners, including Indiana University Health, Wishard Hospital, Community Health, and St. Vincent, as well as new ones. One of my other top priorities is to attract the best and brightest minds in informatics, computer science, and medicine and other healthcare fields from the US and around the world to work at a place that has few equals in terms of opportunity.

Aristotle (1637), by Jusepe de Ribera, is with...

Aristotle (1637), by Jusepe de Ribera, is within the IMA’s permanent collection. (Photo credit: Wikipedia)

On a personal note, I am enjoying getting acquainted with Indianapolis as a place to live. The people here are friendly, easygoing and open. Currently, I am living seven minutes away from work (by bicycle) and enjoy the short commute. Two weeks ago, I visited the Broadripple Farmers Market, and last week, my wife Alida and I bicycled around Columbus, Indiana (near the wonderful Brown County State Park.) In Indianapolis, we have already enjoyed the Indianapolis Museum of Art, the Rathskeller Biergarten and the Canal.

If you are in town, please make time to visit us! Contact me at schleyer (at) regenstrief (dot) org. I look forward to welcoming you!

PS: Official press release:

PPS: I have closed comments on this blog until I can figure out a way to keep too much spam from coming in. On the DIOC blog, we had about 600 spam messages to each real one. If someone knows how to improve on that signal to noise ratio, please let me know.

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