Titus Schleyer, DMD, PhD

on biomedical informatics and health information technology

Tag Archives: economics

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: https://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 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