'Culture can be changed.'
An early pioneer in medical informatics, Morris F. Collen, MD, one of seven founding partners of the Permanente Medical Group, turned 100 on Nov. 12.
Sunday at the opening session of the American Medical Informatics Association Annual Symposium, keynote speaker "e-Patient" Dave DeBronkart, noted that friends, former students, protégés and admirers of Collen tweeted last week during Collen's centennial birthday party in San Francisco using the hashtag #collen100. DeBronkart then remarked that the first hashtag appeared in 2006 -- when Collen was merely 93 years old.
"Culture can be changed," patient empowerment advocate deBronkart said, while showing a series of overtly sexist magazine ads from the 1950s through the '70s that no respectable company would dare design today.
[See also: ePatient Dave: voice of the patient.]
Indeed, culture change with a strong understanding of history was a main theme of the first half-day of AMIA 13.
In the same Washington Hilton ballroom where Jimi Hendrix played in 1968 – and where former President Ronald Reagan had just spoken before being shot outside the hotel in 1981 – Alexa McCray, president of the affiliated American College of Medical Informatics, presented the Morris F. Collen Award of Excellence to Peter Szolovits.
Szolovits, director of the biomedical informatics training program at Massachusetts Institute of Technology, has a background in computer science and engineering, not medicine. But when he first got to MIT in 1974, Szolovits connected with physicians who were trying to understand medical reasoning.
He had been looking for a way to apply his knowledge of CS and artificial intelligence. "Healthcare and medicine provided that environment," Szolovits said in a video that accompanied the award presentation.
Szolovitz, recalled that one doctor half-jokingly convinced him to learn Harrison's Manual of Medicine in one month. He did, not realizing that physicians typically don't study the book, but rather just use it for reference. "I figured it would take me 10 years to solve the problems," Szolovits said. Nearly 40 years later, he is still working on many of them, and, of course, has new problems.
"In 10 years, we will have solved it all," Szolovits said, to considerable laughter.
After the opening keynote, a breakout session focused on the culture of medical informatics.
Blackford Middleton, MD, who became chief informatics officer at Vanderbilt University Health System earlier this year after directing the Center for Information Technology Leadership at Partners HealthCare System in Boston, noted a common problem in translating informatics research to clinical care.
"Informaticians like to answer questions in their entirety," Middleton said. "Primary care physicians and patients don't always think that way." The latter just want to know what will work for a particular episode of care.
Middleton also said that IT staff at Vanderbilt tend to deploy new features and upgrades as soon as they are available. "We need to minimize the use of quick fixes" and make sure technical and clinical staff have "shared expectations," he suggested. For example, according to Middleton, clinical decision support can produce safer, more effective care, but it needs to be "seamless behind the scenes" for physicians to embrace it.
Bret Shillingstad, MD, a clinical informatics specialist at EHR vendor Epic Systems Corp., Verona, Wis., discussed how he has seen attempts at meaningful use turn into exercises in "meaningless use" when technology is installed simply for the sake of technology. "It needs to improve outcomes," Shillingstad said.
In discussing highlights of this week's conference, AMIA Scientific Program Committee Chair John H. Holmes, an epidemiologist and informatician at the University of Pennsylvania, called deBronkart the "perfect start to this meeting," because the e-patient – whether the 'e' stands for equipped, engaged, empowered or enabled – represents one of the greatest culture changes healthcare faces today.
"It's really about the patients and people who will be patients, which, of course, means every one of us," said Holmes.