Titus Schleyer, DMD, PhD

on biomedical informatics and health information technology

Tag Archives: Regenstrief

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.



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


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

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

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.


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


    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.