Titus Schleyer, DMD, PhD

on biomedical informatics and health information technology

Tag Archives: BioCrossroads

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: https://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: https://titusschleyer.wordpress.com, General: http://about.me/titusschleyer