Origins of these Conversations with Medical Informatics Pioneers Interviewers: Joan S. Ash & Dean F. Sittig Editors: Rebecca M. Goodwin, Joan S. Ash & Dean F. Sittig Origins of these Conversations with Medical Informatics Pioneers Conversations with Medical Informatics Pioneers: An Oral History Collection Interviewers: Joan S. Ash & Dean F. Sittig Editors: Rebecca M. Goodwin, Joan S. Ash & Dean F. Sittig Published by the U.S. National Library of Medicine, 2014-2015. Copyright Information Government information at NLM Web sites is in the public domain. Public domain information may be freely distributed and copied, but it is requested that in any subsequent use the National Library of Medicine (NLM) be given appropriate acknowledgement. Suggested citation: Ash JS, Sittig DF. "Origins of these Conversations with Medical Informatics Pioneers," Conversations with Medical Informatics Pioneers: an oral history collection. (Ash JS, Sittig DF, interviewers. Goodwin RM, Ash JS, Sittig DF, editors.) Bethesda: U.S. National Library of Medicine (NLM); 2015. Available from: http://lhncbc.nlm.nih.gov/project/medical-informatics-pioneers Photographs: When using NLM Web sites, you may encounter documents, illustrations, photographs, or other information resources contributed or licensed by private individuals, companies, or organizations that may be protected by U.S. and foreign copyright laws. Transmission or reproduction of protected items beyond that allowed by fair use Content distributed via the NLM Conversations with Medical Informatics Pioneers Oral History Collection may be subject to additional license and use restrictions applied by the depositor.. Oral History Collection Editors: Rebecca M. Goodwin, Joan S. Ash, and Dean F. Sittig Interviewers: Joan S. Ash and Dean F. Sittig Managing Editor: Rebecca M. Goodwin Copy Editing: Cindy Allen Design & Layout: Troy Hill, Bona Kim, John Harrington and Anne Altemus Photo Editing: Troy Hill Photo Captions: Nina Matheson, Patti Brennan, Kathy Cravedi, Pat Carson, Fran Sandridge, Betsy Humphreys, Don Lindberg, Don Detmer, Marie Gallagher, Ed Hammond, Clem McDonald, and Rebecca Goodwin Deeds of Gift: Rebecca Warlow, John Rees and Jeff Reznick Contact: wwwnlm@nlm.nih.gov Conversations with Medical Informatics Pioneers: An Oral History Collection American College of Medical Informatics Morris F. Collen Award of Excellence awardees gathered in California to celebrate Morrie Collen's centennial birthday on 11/12/2013. Pictured (front row, L-R): William Tierney, Robert A. Greenes, Nancy M. Lorenzi, Morris F. Collen, Marion Ball, Betsy Humphreys; (back row, L-R): Donald A.B. Lindberg, Don E. Detmer, Ted Shortliffe, Ed Hammond, Reed M. Gardner, Howard L. Bleich, and Warner V. Slack. Other Collen awardees (as of 2014) not pictured: Homer Warner, G. Octo Barnett, Robert S. Ledley, Joshua Lederberg, Jean-Raoul Scherrer, Clement J. McDonald, William Stead, Peter Szolovits, and Charles Safran. Origins of these the storage, retrieval, and optimal use of biomedical Conversations information, data, and knowledge for problem solving and decision making."1 with Medical were developed. In those early days, researchers struggled with slow central processing units (CPUs), Informatic registers, and programming that often required use Pioneers of machine-level instructions. Notwithstanding such extreme constraints, these dedicated investigators were able to begin exploring important informatics How this oral history collection began & grew. concepts and develop prototypes of many of the same applications and systems that are still in use today. INTRODUCTION BY Because medical informatics is a relatively new JOAN S. ASH AND DEAN F. SITTIG discipline, we are fortunate that many of the founders JANUARY 2015 actively involved. For this reason, in 2004, we decided Introduction 1 that the time was right to begin conducting a series of set of transcripts is to capture a portion of the history oral history interviews with informatics pioneers. We pioneers. in our NLM-funded research efforts since 2000 and We began by making a list of 36 potential interviewees along with a list of topics we felt we before that. should explore with Oral history is a them. We developed method for documenting a generic interview history in a vivid way guide with several by recording the voices very general, open- of those who have ended questions experienced it. An oral we wanted to ask history, while subject everyone-about to the frailties of the their education human mind, presents and early careers, accomplishments This story is presented and turning points, without the interference involvement of gatekeepers, such in professional as journal editors, associations, and On the steps of the National Library of Medicine building, publishers, and Biomedical Library Review Committee, June 18, 1979. Top row advice for future colleagues, or the (left to right): Dr. Roger W. Dahlen, Dr. Donald A. B. Lindberg. informaticians- Front row (L-R): Dr. Warner V. Slack, Mrs. Barbara Coe Johnson, Dr. Ernest M. Allen, Dr. David J. Mishelavich, Mrs. Nina W. and then tailored Matheson, Dr. Merlin M. Mitchell, Mrs. Priscilla Mayden, Mr. the guide for each politics. The founders Robert Wedgeworth, Dr. Gail I. Bank, Dr. Sholom Pearlman, Mr. interviewee with more Warren A. Sawyer, Dr. John F. Sherman, Miss Jean K. Miller. of informatics are a group of people whose about their particular spoken words are lively, fascinating, and wonderfully research interests and most important projects. We descriptive. contracted with a professional transcription service While the history of medical informatics had dedicated to this type of work and as we travelled already been well documented by Morris F. Collen,2 we envisioned a collection of narratives in the form sites for our research, we contacted interviewees of interview transcripts that would portray the varied to arrange interviews. We had no external funding, perspectives of informatics leaders. We were inspired so we used our own resources for transcription and in part by the AMIA expenses, but we still Nursing Informatics managed to interview 17 History Project,3 and geographically available the National Library of interviewees from our list of 36. We usually did the Face of Medicine the interviews together exhibition,4 which in tandem, with JA asking the more general women physicians. questions and DS the Historic documentation more technical, probing alone cannot give a questions. true picture of all the Julie McGowan circumstances that stepped in to conduct the interview with Lawrence Ed Hammond, Barbara and Clem McDonald, and Kay Hammond visiting Annecy, France after the September 1992 Weed, for which we are Therefore, the goal of this MEDINFO meeting in Geneva, Switzerland. grateful. We were then 2 extremely fortunate, with NLM training program funds, to be able to hire a summer intern to help us individuals represented in their surroundings. In the interviewee to lightly edit the transcripts for clarity make you laugh, bring tears to your eyes, surprise you, motivate you, and teach you a great deal. For example: make them available. Finally, with the administrative support of Clem • Clem McDonald tells heartwarming stories about McDonald and others at the National Library of the early development of Gopher, the early order Medicine, which agreed to house them, we are entry system at the Regenstrief Institute; completing the process of disseminating the words of • Tony Komaroff describes the relationship these pioneers. The NLM is a natural partner because between evidence based medicine and decision of its commitment to maintain, preserve, and make support, and the beginnings of the use of clinical algorithms for the diagnosis and treatment of biomedical research and medicine, thereby ensuring patients; that this legacy is both safe and accessible for long- • Octo Barnett describes development in the term use.5,6 We hope you enjoy reading the transcripts as language still in routine use by the majority of much as we enjoyed producing them.7 What cannot electronic medical records today; be captured in the transcripts is the graciousness with which we were treated when we visited interviewees Attending an American College of Medical Informatics (ACMI) Winter Symposium, ca. 1998, (from top left) Dennis Reynolds Ben Williams, Ted Shortliffe, Mark Tuttle, Dean Sittig, Bob Riley (Nancy Lorenzi's husband), Nancy M. Lorenzi, William A. Yasnoff, Morrie Collen, Kay Hammond, Patti Brennan, W. Edward Hammond, Naomi Broering, Arthur Broering, Lawrence Kingsland, III, Kathleen A. McCormick, Lauren Kingsland, Gwilym S. Lodwick, Randy Miller, Janice Kennedy (AMIA executive, Thomas E. Piemme, Judy Piemme, William R. Hersh, Parvati Dev, Chris Chute, and Tom Lincoln. Introduction 3 • Robert Ledley tells us about how developing the 1960s for entering and communicating nursing orders; nearby automotive body shop to paint it; • Larry Weed tells tales about developing the • Homer Warner recalls reading the 1959 Ledley problem-oriented medical record format and and Lusted paper from Science describing use shares his views about the future of clinical documentation; realizing that he could actually do something like • Howard Bleich and Warner Slack describe the remarkable research partnership they have publication in JAMA in 1961); sustained for 45 years; and • Reed Gardner describes his early career as a • Betsy Humphreys reminisces about directing shepherd in southern Utah; • Ed Hammond tells how what he learned on naval project and other adventures during her lifetime submarines relates to informatics; of service at the National Library of Medicine. • Don Lindberg recounts many stories about how One of our interviewees offered the following advice: "Look at history, and look at it from the perspective of what was done. Then that becomes usable by me in • Nina Matheson describes the Delphi study she led and report she wrote which described the future role of medical libraries and led to the creation narratives provides a look at the history of medical informatics through the eyes of an amazing group of Advanced Information Management Systems thoughtful, innovative, and courageous individuals.7 (IAIMS) initiative; • Morris Collen describes the history of Kaiser Joan S. Ash and Dean F. Sittig • January 2015 view of many important policy decisions affecting • Tom Lincoln tells about using an early prototype of a tablet-like data-entry system in the 1970s at Rand; • Don Simborg describes an early computer-based system he developed at Johns Hopkins in the late Ed Hammond, Clem McDonald, Donald Mon, and John Don Detmer, Ted Shortliffe, Paul Tang, Morrie Collen, and Quinn at the May 2013 HL7 meeting in Atlanta, GA. Marion Ball discuss the IOM Computer-based Patient Record study at AMIA, circa 1991. 4 REFERENCES ACKNOWLEDGMENTS 1. Blois M, Shortliffe E. The computer meets medicine: Although no grant funding was used to directly support emergence of a discipline. In: Shortliffe EH, Perreault L, eds. Medical Informatics: Computer Applications in Health Care. V. conducting and transcribing these interviews, Joan S. 20. Reading, MA: Addison Wesley; 1990. Ash and Dean F. Sittig would like to thank the National 2. Collen MF. Fifty years in medical informatics. Yearb Med Library of Medicine and the Agency for Healthcare Inform. 2006:174-9. Available at: http://www.ncbi.nlm.nih.gov/ Research and Quality for funding our other research pubmed/17051312. Accessed September 10, 2014. and teaching efforts (such as serving as faculty at 3. American Medical Informatics Association (AMIA). Nursing Informatics History Project. AMIA. Available at: http://www. conducted), which involved considerable travel. Once amia.org/working-groups/nursing-informatics/history-project. Accessed September 10, 2014. we were at a site, we used our own time and resources for interviewing. We would of course like to thank 4. U.S. National Library of Medicine. Changing the Face of Medicine: Celebrating America's women our interviewees, who provided us with biographical physicians. 2003. Available at: https://www.nlm.nih.gov/ information and gave generously of their time both changingthefaceofmedicine/. Accessed August 12, 2015. during and after the interviews. We are especially 5. U.S. National Library of Medicine. History of Medicine Division. grateful to Julie J. McGowan and her son Alex for Available at: http://www.nlm.nih.gov/hmd/index.html. Accessed braving a snowstorm in Vermont to conduct the August 12, 2015. interview with Larry Weed. We would like to thank our 6. Archives and Modern Manuscript Program. Oral History research assistants Eric Gebhardt and Ana Stenescu, Collections. US Natl Libr Med. Available at: http://www.nlm.nih. gov/hmd/manuscripts/oh.html. Accessed August 12, 2015. whose editing and organizational skills helped produce these high-quality, vivid narratives. Thanks to Clem 7. Ash JS, Sittig DF. Conversations with Medical Informatics Pioneers: An Oral History Collection. (Goodwin RM, Ash JS, J. McDonald and Rebecca M. Goodwin at NLM Sittig DF, eds.). Bethesda: U.S. National Library of Medicine; for gathering the photographs that accompany these 2015. Available at: http://lhncbc.nlm.nih.gov/project/medical- interviews and making this collection available, with informatics-pioneers the support of the NIH/NLM Intramural Research Program and the NLM History of Medicine Division. Rebecca M. Goodwin is grateful to Joan Ash, Dean Sittig, and the medical informatics pioneers they interviewed to create this collection of oral history conversations. Thanks also to the family, friends, and colleagues of these pioneers, who generously sorted through their photographs and shared them to enrich this collection. Thank you to the many NLM colleagues who contributed to the collection. We hope you enjoy these stories, which help medicine. May they inspire you. Joan S. Ash, Dean F. Sittig and Rebecca M. Goodwin April 2015 Introduction 5 6 7