Fifty Years of Health Informatics Innovation
For fifty years, the University of Minnesota has been a center of innovation in health informatics. Between the 1970s and the 1990s, for example, Minnesota’s health informaticians produced cutting-edge research and developed innovative technologies in the fields of micropopulation simulation modeling, clinical decision-making and laboratory information systems, telehealth and home monitoring, and microbial biotechnology databases.
Throughout its history, the leadership of the Division of Health Computer Sciences (DHCS) and the Institute for Health Informatics has exemplified leading informatics research and fostered a culture of innovation. Indeed, when Eugene Ackerman, PhD (director, DHCS, 1969-1979) joined the faculty of the University of Minnesota in 1967, he brought with him a tradition of pioneering research in biophysics and the modeling of infectious disease epidemics. During his earlier tenure at the Mayo Clinic, Ackerman worked with his Mayo colleague, Lila R. Elveback, PhD and John P. Fox, PhD at the University of Washington, to develop population-based models of epidemic disease simulations. Laël Gatewood, PhD (director of DHCS from 1979-2000), who worked with Ackerman at Mayo before joining the University in 1967, served as a programmer on these modeling projects. In 1984, as a culmination of these research efforts, Ackerman, Elveback, and Fox published the groundbreaking book, Simulation of Infectious Disease Epidemics. This early research in epidemic disease modeling laid the foundation for Ackerman and Gatewood to establish the National Micropopulation Simulation Resource in 1983 with a National Institutes of Health Research Resource Grant. For more than a decade, Ackerman and Gatewood, together with the Resource staff and a team of NLM Training Grant Fellows and doctoral students developed simulation programs for modeling genetic disorders, chronic diseases, infectious diseases, neural networks, and social networks. While there were other simulation resources in the country, as Dr. Gatewood recalled, “there were none that were discrete event simulation. All of them were continuous modeling stochastic systems, primarily physiological systems… we were the only one that was discrete modeling.” Dr. Gatewood continued, the National Micropopulation Simulation Resource “continued us on the map, as far as mathematical modeling was concerned.”
Ellis Benson, MD who chaired the Department of Laboratory Medicine and Pathology from 1966 to 1989, also reinforced a culture of experimentation among the DHCS faculty. Professor emeritus Donald Connelly, MD, PhD joined the Department of Laboratory Medicine and Pathology as a resident in 1971 and the DHCS as a Public Health Service research fellow in 1972. He went on to serve as director of DHCS, then known as the Division of Health Informatics, from 2000 to 2006. As Dr. Connelly recalled, “The culture in Laboratory Medicine and Pathology was very conducive to doing strange things. In that day, computing in medicine was probably considered by most as a kind of strange thing.” Dr. Connelly’s colleagues would say, “‘Do what you’re interested in and Dr. Benson will call it laboratory medicine.’” For Dr. Connelly, “It was a heady time… because we were really doing new and interesting things. Just about everything you did was publish-worthy, because not many people were doing it yet.” Since the 1970s, Connelly’s research has focused on clinical decision-making related to effective laboratory testing and the development of information technology tools that clinicians choose to use in support of their patient care activities. In the mid-1980s, for example, working with University of Minnesota pediatrician Ted Thompson, MD Connelly developed a clinical workstation to improve the use of laboratory test results by clinicians in neonatal intensive care units. Later that decade, Connelly, NLM trainee, Bruce Sielaff, and Edward Scott, from the Life Blood Mid-South Regional Blood Center developed ESPRE, an automated decision support system that assists blood bank personnel evaluate physician’s requests for platelets. These were innovative clinical decision-making technologies that were, Dr. Connelly reflected, “one of the forerunners of those things that now challenge docs every step of the way.”
Another area of innovation has been in the work of Stanley Finkelstein, PhD. Throughout his career, Dr. Finkelstein has been a leader in the field of home monitoring and telehealth. In the early 1980s, for example, Finkelstein worked with University of Minnesota pediatrician and director of the Cystic Fibrosis Center, Warren J. Warwick, MD to develop the first home monitoring system for cystic fibrosis (CF) patients. As Dr. Finkelstein recalled, when Dr. Warwick’s “CF patients would come to see him—and they were coming on a regular schedule—they thought they were doing really well, but when they went through a full examination, he found that they really weren’t. Was there some way of getting a handle on their condition without them coming in?” The answer, they determined, was to establish a home monitoring program. As Dr. Finkelstein continued, “What we were interested in was how could we monitor the patient with a pulmonary function? There weren’t any really good ways. So we ended up using what they use in hospitals after surgery, an incentive spirometer… The advantage of that was it was real cheap and it was very easy to use.” Finkelstein then developed a system by which the patients could record and monitor their pulmonary function and provide regular updates to the hospital treatment team. Patients would record, in a paper diary, a set of measurements that they could make at home. They would then send the diary to Finkelstein’s team by mail every week and a member of the team would input the data. “The idea,” Finkelstein described, was to use these “weekly sets of data to develop some sort of a predictor or decision rule so that when we got the data and ran it through the decision rule, we could identify those kids that might be more at risk” of developing complications and call them into the clinic to be evaluated. The program ran successfully for several years, and in the early 1990s, Finklestein collaborated with University of Minnesota pulmonologist Marshall Hertz, MD to develop a similar home monitoring system for lung transplant patients.
The innovativeness of Minnesota’s health informaticians has not just been in the realm of clinical informatics. In the mid-1990s, Lynda Ellis, PhD and University of Minnesota biochemist, Lawrence P. Wackett, PhD launched the University of Minnesota Biocatalysis/Biodegradation Database. The database contains information on microbial biocatalytic reactions and biodegradation pathways for primarily xenobiotic, chemical compounds. At launch, the database contained information on just four catabolic pathways; today it contains information on 219 pathways. In a recent interview, Dr. Ellis described the moment she and Wackett decided to develop the database: “He said to me ‘has anyone done a database of biodegradation and biocatalysis?’ We didn’t have anything like Google. But I looked around and I said, ‘No, there doesn’t seem to be that.’ ‘Why don’t we do one? It was like these old movies where, you know, let’s put on a show in the barn?” The UM-BBD (which is now maintained by the Swiss aquatic research institute, Eawag) has been a remarkable success. As a 2008 review in Current Opinion in Biotechnology extolled, the UM-BBD is “The main—if not the only—public resource for qualitative studies on microbial biotransformations… [It] represents a colossal effort to collect primary data from literature on such processes.”
Since 1965, the University of Minnesota’s health informaticians have been leaders in the field of health informatics research. Thanks to the leadership of the Division of Health Computer Sciences, the Institute for Health Informatics, and the Department of Laboratory Medicine and Pathology, who created an environment that fostered creativity and innovation among the faculty, and to the faculty who provided support, encouragement, and opportunity to the NLM trainees and graduate students, the University of Minnesota has been and continues to be a center of innovation in health informatics.