Graduate Program in Biomedical Informatics
Brochure (pdf file) Executive Summary (pdf file)
Current Status of Biomedical Informatics at Vanderbilt
The Department of Biomedical Informatics is home to 13 faculty members
(11 with primary appointments).
Biographical Sketches of Core DBMI Faculty
- Randolph A. Miller, M.D.
- William W. Stead, M.D.
- Judy Ozbolt, Ph.D., R.N.
- Nancy M. Lorenzi, M.L.S., Ph.D.
- Dario Giuse, Dr. Ing.
- Edward K. Shultz, M.D., M.S.
- Nunzia B. Giuse, M.D., M.L.S.
- Constantin Aliferis, M.D., Ph.D.
- Steven Brown, M.D., M.S.
- Anderson Spickard, III, M.D., M.S.
- Mary E. Edgerton, M.D., Ph.D.
- Fern FitzHenry, Ph.D., R.N.
- Dominik Aronsky, M.D., Ph.D.
Randolph A. Miller, M.D., is Professor and Chairman of the Department
of Biomedical Informatics, Associate Director of the Informatics Center,
and Professor of Medicine at Vanderbilt University Medical Center.
Background: Dr. Miller completed clinical training at the University
of Pittsburgh in 1979 in Internal Medicine, and as a faculty member
there developed Quick Medical Reference (QMR) as a microcomputer-based
successor to the INTERNIST-I diagnosis program. His 1994 move to Vanderbilt
has afforded him the opportunity to develop a combined academic unit
and clinical informatics service that develops and evaluates biomedical
Prior Work: Dr. Miller has served as an Associate Editor of
the Journal of the American Medical Informatics Association (JAMIA)
since its foundation in 1993, and joined the Editorial Board of the
Annals of Internal Medicine in July, 2000. He was elected President
of the American Medical Informatics Association (AMIA) for 1994-95.
He has served on the National Library of Medicine Biomedical Library
Review Study Section (two terms) and the AHCPR Health Care Technology
Study Section. He has been Principal Investigator on a number of NLM/NIH-sponsored
R01 research and training grants, helped to lead IAIMS activities at
two institutions, and directed the University of Pittsburgh's participation
in the NLM's UMLS Poject.
Interests: development and evaluation of medical decision support
systems and their corresponding knowledge bases; clinical terminology
systems; ethical and legal implications of developing and using clinical
information systems; and, institutional-level informatics initiatives.
William W. Stead, M.D., is Professor of Medicine, Professor
of Biomedical Informatics, Director of the Informatics Center, and Associate
Vice Chancellor for Health Affairs, at Vanderbilt University Medical
Center. In these capacities, he is responsible for both the Medical
Center's working operation and decision support systems, the Medical
Center Library, and an inter-disciplinary faculty unit engaging in biomedical
informatics research and training. Dr. Stead has recently been named
Assistant to the Chancellor for Informatics and Chief Information Architect,
a new senior position to lead development of University strategies to
take advantage of advances in information technology and knowledge management.
Background: Dr. Stead received his B.A. and M.D. from Duke University
where he also served residencies in Internal Medicine and Nephrology.
Prior Work: Dr. Stead's medical informatics research career
began in 1970 with the construction of an automated, patient history
taker and evolved into a long-term interest in computer-based patient
records. He was co-developer of the TMR (The Medical Record) medical
information system, one of the early systems to be used in practice
to create a computer database containing all pertinent clinical data
about patients, while providing administrative management for the practice.
He served as principal investigator of the Duke University effort to
test and implement a model of an Integrated Advanced Information Management
System (IAIMS) based upon integration of distributed resources. At Vanderbilt,
he has lead the effort to develop a Fast Track approach to IAIMS. He
has developed an information technology architecture that allows an
institution to manage its data and knowledge assets separately from
its application programs. Dr. Stead is Editor-in-Chief of the Journal
of the American Medical Informatics Association. He is a Founding Fellow
of both the American College of Medical Informatics and the American
Institute for Engineering in Biology and Medicine. He has served as
President of the American Association for Medical Systems and Informatics,
and been a Board Member of the American Medical Informatics Association.
He has served on the NLM's BLRC Study Section. He is the current President
of the American College of Medical Informatics.
Judy Ozbolt, Ph.D., R.N., is Independence Foundation Professor
of Nursing (School of Nursing) and Professor of Biomedical Informatics
within the Department of Biomedical Informatics (School of Medicine).
Prior Work: Dr. Ozbolt is one of the leading nurse informaticians
in the country, and joined the Vanderbilt faculty in 1998. She was the
Dorothy Vossen Distinguished Lecturer, Creighton University School of
Nursing 1985 She became a Fellow of the American Academy of Nursing
in 1987. She served as Chair of the Priority Expert Panel on Nursing
Informatics, National Center for Nursing Research, NIH, from 1989-1992.
She served on the AHCPR Health Care Technology Study Section from 1983-1987.
She was elected to Fellowship in the American College of Medical Informatics
in 1990. She has served on the Board of Directors of the American Medical
Informatics Association for most the 1990s, including serving on the
Executive Committee, and being elected to the office of Secretary (1993).
She was one of two candidates on the ballot for the Presidency of AMIA
in 1996. She was selected as a Founding Fellow of American Institute
for Medical and Biological Engineering in 1992, and has served as a
member of its Finance & Audit Committee, 1994-present. In 1994, she
served as Program Chair of the US national meeting in Biomedical Informatics,
the AMIA Fall Symposium. She served as a member, of the National Academy
of Sciences Committee on Evaluating Telemedicine Applications, Institute
of Medicine, 1995-1996. At Vanderbilt, she successfully convened, in
1999, the first international conference on consolidation of nursing
vocabularies and terminologies into a single standard, and conducted
a follow-up conference in 2000.
Interests: Dr. Osbolt's research interests include nursing vocabularies,
clinical informatics systems, and education and training in nursing
Nancy M. Lorenzi, MLS, Ph.D., is Professor of Biomedical Informatics
and Assistant Vice Chancellor for Health Affairs at Vanderbilt since
May, 2000. In her role as Assistant Vice Chancellor, she is leading
informatics-centric organizational change and knowledge management initiatives.
Prior Work: Relatively early in her career, Dr. Lorenzi was
elected to the Presidency of the Medical Library Association, a 5000-member
organization. She had served as a highly innovative Director of the
Medical Library in Cincinnati, and was one of the first Principal Investigators
of a National Library of Medicine sponsored IAIMS grant. She progressed
in administrative responsibility to become Associate Senior Vice President
at the University of Cincinnati, a position she has held for the past
15 years. She has been successful on a large number of interdisciplinary
projects involving: informatics, business administration/strategic planning,
medical librarianship, and sociology. She served as Chair of the International
Medical Informatics Association Working Conference on the Organizational
Impact of Informatics in 1993, and was the first Chairperson of the
IAIMS Consortium Board. Recently, she served as the Scientific Program
Chair of the annual national meeting in Medical Informatics, the AMIA
Fall Symposium, in 1999. She has served as principal investigator on
more than $2 million of NIH (and other agency) funded grant projects.
She has published significantly in the peer-reviewed literature and
authored a number of books considered to be definitive in her field.
She has won a number of awards and served on a important national and
international-level committees and task forces (including membership
on the NLM Study Section, the Biomedical Library Review Committee; election
to the White House Conference on Library and Information Services Steering
Committee; appointment to the Board of Directors of the Friends of the
National Library of Medicine; and, serving as Chair of one of five initial
Long Range Planning Committees on the future of the National Library
of Medicine, commissioned by the Director of the NLM).
Interests: Change management related to information technology
- more specifically, with respect to organizational and personnel issues
related to automation in the health care industry. Dr. Lorenzi is now
internationally recognized as a top expert on those areas.
- Lorenzi, N.M. Cincinnati STD/HIV Prevention Training Center. Pages
177-178 in Pocket Guide to Case of Medicine and Public Health Collaboration.
New York: New York Academy of Medicine, 1998.
- Submitted for Publication: Lorenzi, N.M. R.T.Riley. Organizational
Impact of Health Information Systems in Health Care. Textbook of Nursing,
edited by Professor John Mantas of the University of Athens, Greece.
Expected publication: October, 1999.
- Lorenzi, NM and Riley, RT. Knowledge and Change in Health Care
Organizations. In the book, Information Technology Strategies from
the United States and the European Union, Transferring Research to
Practice: Health Care Improvement. Based on the 1998 European Union
Conference in Columbia, Missouri, 2000.
- Stead, WW, Lorenzi, NM. Health Informatics: Linking Investment
to Value. JAMIA 6:341-348, 1999.
- Lorenzi, NM, Van Gennip, EM, Talmon, J, Nykanen, P. Special Issue:
Organizational Issues and Technology Assessment in Health Informatics
(21 papers), International Journal of Medical Informatics, December
- Lorenzi, NM, Riley, RT. Managing Change: An overview. JAMIA 7:116-124,
- Dewan, NA, Lorenzi, NM. Evaluation of Behavioral Informatics. MD
Computing. Expected publication: Summer 2000.
- Dewan, NA, Lorenzi, NM, Riley RT. Behavioral Health Care Informatics.
New York:Springer-Verlag. Expected publication: 2001.
- Lorenzi, NM, Riley, RT. Chapter: Public Health Informatics and
Organizational change. In O'Carroll, P., Yasnoff, Wa, et al., Public
Health Informatics and Information Systems. Expected publication:
- Dewan, N, Lorenzi, N. Behavioral Health Information Systems: Evaluating
Readiness and User Acceptance. MD Computing. July/August 2000;17(3):50-52
Dario Giuse, Dr.Ing., is Associate Professor of Biomedical Informatics,
and adjunct Associate Professor of Computer Science, at Vanderbilt.
Background and Interests: Previously a computer science faculty
member in the highly regarded Robotics Institute at Carnegie-Mellon
University, Dr. Giuse early research involved the areas of computer-aided
design, AI representational languages, design fusion, machine- based
translation assistants, human-computer interfaces, and medical informatics.
He has continued to apply his expertise in these areas at Vanderbilt,
including AI representational schemas, design fusion, machine-based
translation assistants, human-computer interfaces, and medical informatics
including medical knowledge acquisition techniques).
Prior Work: Dr. Giuse has a long record of research in the application
of computer systems to facilitate real-world work processes. The most
outstanding of his many accomplishments has been as chief architect
of Vanderbilt University Medical Center's clinical data repository and
electronic patient record system (currently called "StarChart") - work
that had led Dr. William W. Stead to appoint Dr. Giuse as Associate
Director of the Informatics Center in 1998. Dr. Giuse has been an instrumental
architect in designing, developing, and implementing the electronic
medical record system at VUMC. Dr. Giuse has directed the Medical Archival
System (MARS) project at VUMC and orchestrated its evolution to MARS/Starchart.
MARS/Starchart is a database management system based on a distributed
parallel processing design. The MARS/Starchart patient data repository
at VUMC contains electronic textual versions of all anatomic pathology,
clinical laboratory, and surgical pathology reports at Vanderbilt since
mid-1993. At present, MARS/Starchart at VUMC stores more than 13 million
documents including all pathology reports and clinical laboratory results;
radiology reports; discharge summaries; adult- and pediatric echo and
cardiac catheterization reports; admission, progress, and operative
notes; and physicians' letters to patients. It functions as a comprehensive
electronic medical record. MARS was originally developed in 1986 at
the University of Pittsburgh Medical Center (UPMC) by John Vries and
Russell Yount, and forms the basis of the electronic patient record
system at UPMC. In March, 1995, Vanderbilt University and the University
of Pittsburgh signed an agreement by which Vanderbilt gained access
to the MARS software for deployment at VUMC. In December 1998 Dr. Giuse
initiated a complete rewrite of MARS into MARS/Starchart with preservation
of the original architectural design of a distributed service model
and system layer and with a new database, parser layer, and a web interface.
MARS/Starchart is written in PERL with secure HTTP as its communications
protocol. MARS/Starchart runs on a distributed set of parallel processors
including 29 SUN Sparc20 workstations, 10 SUN Ultra30 workstations,
and 9 assorted web servers and data feeds composed of SUN Ultra 1/170
and 6/1360 engines with one test Cobalt Qube2 appliance. MARS has been
tied to the WizOrder interface (a clinician order entry and decision
support system) to allow seamless transition from patient-specific order
entry to patient-specific results review. More than 1000 individual
care providers use MARS/Starchart every day to access the electronic
patient record for clinical purposes. Recently, a new Web-based interface
has been developed and implemented at VUMC that allows SHTML access
both from within Vanderbilt, and remotely for authorized individuals
with "smart card" access tokens.
Edward K. Shultz, M.D., M.S., is Associate Professor of Biomedical
Informatics. He has assumed Dr. Stead's former responsibility for defining
an informatics technical architecture that will scale up to support
our evolving enterprise. He provides a bridge between the basic research
activities within the Department and the units that support operational
systems in the hospital, clinics, and affiliated sites.
Background: Dr. Shultz obtained his M.D. from Yale University
School of Medicine in 1979. He completed an Internship in Clinical Pathology
at Barnes Hospital, Washington University St. Louis, in 1979-80, and
Residency training in Clinical Pathology at the University of Minnesota
from 1980-84. During the latter training, he was supported by an NIH
Post-doctoral fellowship, in the Division of Health Computer Sciences
in the Department of Laboratory Medicine and Pathology at Minnesota,
and obtained a Masters degree in Biophysics.
Prior Work: Dr. Shultz joined the faculty at Dartmouth-Hitchcock
Medical Center in 1984, and began a long and productive career in the
fledgling field of Biomedical Informatics. Dr. Shultz has gained national
recognition through his research, teaching, at service while at Dartmouth,
and was promoted to Associate Professor of Pathology in 1990. He served
as Director of the NIH/NLM-sponsored Dartmouth Medical School Training
Program in Medical Informatics from 1989-1994, and Director of the Dartmouth
Program in Medical Information Science from 1988-1996. He was elected
to Fellowship in the American College of Medical Informatics in 1992.
He was selected to serve on the Editorial Board of the Journal of the
American Medical Informatics Association in 1994. He chaired the national
Department of Veteran Affairs Expert panel on Inter-application communication
from 1992-1996, and served as a member of the Department of Veteran
Affairs Integration and Technology Applications Requirements Group from
1991-1996. Dr. Shultz's research experiences in biomedical informatics
have ranged from applications in clinical chemistry and mathematical
modeling techniques to computer-based innovative approaches to medical
education, and man-machine interfaces related to clinical systems. At
Dartmouth, he created the first hypermedia based model of a clinical
workstation, the Interactive Medical Record, which has had widespread
influence on the field. He has been interested in the area of telemedicine,
and created a home monitor for cystic fibrosis patients at Minnesota,
and at Dartmouth showed that computer linkage of diabetic patients in
their home environments to their providers could demonstrate healthcare
benefits. He was Principal Investigator on a Veterans Administration
Health Services Research and Development Award, "Medical Informatics
in Home Care" from 1987-90. He was Principal Investigator on two grants
from Apple Computer Corporation related to innovations in medical education:
"Computer Models for Independent Study" (1988-89), and "Workstations
for Medical Student Use" (1990-92). He served as Principal Investigator
on a Harms-Ophthalmology grant for "Computerization of the Medical Record"
during 1993-94. At Dartmouth, Dr. Shultz was the Director of the nationally
recognized Program in Medical Information Science for seven years and
the Director of a National Library of Medicine Informatics Training
Program for five years. Dr. Shultz participated in teaching postdoctoral
trainees (residents and fellows) in Pathology, as well as postdoctoral
trainees in biomedical informatics (through his directorship of the
NIH-sponsored training program). Dr. Shultz established the first computer
network at Dartmouth Medical School, gradually expanding the linkage
to include a pioneering microwave link to the affiliated Department
of Veteran Affairs hospital. Dr. Shultz served on a number of local
and national committees during his time at Dartmouth. He has served
as an ad-hoc reviewer on a number of NIH Study Sections related to computer
applications in medical care from 1988-present. He chaired the Automated
Data Processing Committee at Dartmouth's Veterans Administration Hospital
from 1985-88, and served as a member of the Pharmacy and Therapeutics
Committee from 1993-96. He chaired the American Medical Informatics
Association's Professional Specialty Program group during 1992-93. Within
the American Society of Clinical Pathologists, he has served as a member
of the Council on Informatics (1991-96), a member of the Educational
Materials Advisory Committee (1995-present), and a member of the Future
Directions Committee (1995-present). He chaired the Education and Hypermedia
section of the national meeting in medical informatics (SCAMC) in 1989,
and chaired the Education section of the American College of Medical
Informatics meeting in 1991.
Nunzia B. Giuse, M.D., M.L.S., is Associate Professor of Biomedical
Informatics, and Director of the Annette and Irwin Eskind Biomedical
Library at Vanderbilt University Medical Center.
Background and Prior Work: Prior to coming to Vanderbilt in
1994, Dr. Giuse established herself as an independent researcher in
the area of multi-center medical knowledge base acquisition strategies
while at the University of Pittsburgh. She conducted a systematic sequence
of investigations of medical knowledge base methodologies from 1988-95
that represents a significant contribution to the relatively new field
of medical informatics. This work has been described in a series of
publications in SCAMC Proceedings, Methods of Information in Medicine,
Artificial Intelligence in Medicine, and JAMIA. While at the University
of Pittsburgh, she was Co-Principal Investigator, Project Director,
or Principal Investigator on a number of research grants sponsored by
NIH/NLM and by the CAMDAT Foundation. Since coming to Vanderbilt, Dr.
Giuse has served as Principal Investigator for the NLM-funded grant
projects "Integrating Health Science Librarians into Biomedicine" (1995-96),
"AIDS Information Outreach Project" (1995), "Information Access for
Public Health Professionals" (1999-2000), and is an active participant
in Vanderbilt's IAIMS activities (1995-2000). Dr. Giuse plays a central
role in the Informatics Center's information outreach activities, and
members of her staff help to coordinates the VUMC Web-based presence.
She is very active in organizing the continuing training and professional
development of the Eskind Biomedical Library professional and para-professional
staff. She has pioneered the application of models from the adult learning
research literature to continuing professional education within the
library. She has also pioneered the idea of actively involving the library
in VUMC clinical activities, and has gained national recognition for
Presentations at Meetings: NLM Woods Hole Informatics Course:
2000; SCAMC: 1988-90; National Symposium on Computers in Medical Education:
1989-90; MLA: 1991-92, 1995, 1997-98; AMIA: 1992, 1998; NLM, Bethesda:
1996-97; ASIS Annual Meeting: 1988, 1990, 1992; MEDINFO: 1992.
Contributions to Meetings: Session Chair, AMIA Annual Fall Symposium,
1997; Area Chair, SCAMC, 1990; Local Arrangements Committee, Annual
ASIS Meeting, 1992.
Committee Memberships: Chair, Medical Informatics Section/ MLA
Career Development Grant Jury: 2000; ISI/Frank Bradway Rogers Information
Advancement Award Jury: 2000; MLA Task Force on the Books Publishing
Program: 2000-01; American Association of Health Science Library Directors:
1997-Present; Editorial Board, Bulletin of the Medical Library Association:
1997-2000; Regional Advisory Council, National Network of Libraries
of Medicine: 1996-99; Association of College and Research Libraries
Reviewer: Yearbook of Medical Informatics: 1996-99; JAMIA: 1994-Present;
- Giuse NB, Kafantaris SR, Huber JT, Lynch F, Epelbaum M, Pfeiffer
J. Developing a Culture of Lifelong Learning in a Library Environment.
Bulletin of the Medical Library Association 1999;87(1):26-36.
- Giuse DA, Giuse NB. Knowledge Processing and Decision Support Systems.
Yearbook of Medical Informatics 1999;3:473-475.
- Giuse NB, Kafantaris SR, Miller MD, Wilder KS, Martin SL, Sathe
NA. Clinical Medical Librarianship: The Vanderbilt Experience. Bulletin
of the Medical Library Association 1998;86(3):412-416
Constantin Aliferis, M.D., Ph.D., joined the faculty in July,
2000 as an Assistant Professor in the Department of Biomedical Informatics.
He serves as the Director of the nascent Degree Program in Biomedical
Informatics at VUMC.
Background: Dr. Aliferis earned his M.D. from the University
of Athens in Athens, Greece. He completed a Fellowship in Medical Informatics
at the University of Pittsburgh, and earned his M.Sc.and Ph.D. degrees
from the same university in Intelligent Systems/Medical Informatics.
Prior Work: Dr. Aliferis has published research in Epidemiology,
intelligent interfaces for data analysis, Bayesian Learning of Belief
Networks, Temporal analyses of the QMR Medical Decision-Support System,
and Machine Learning applications in predicting dire outcomes in patients
with community-acquired pneumonia. The area of Dr. Aliferis' Masters
and Doctoral thesis work, involves reasoning about time for clinical
purposes. In his doctoral dissertation, he pioneered extension of Bayesian
belief networks to include explicit and hybrid-granularity temporal
and causal modeling and dynamic abstraction. For his work he has received
recognitions including a finalist position in the 1993 Priscilla Mayden
Award competition, and awards in the Annual Student Paper competition
for the 1994 AMIA Fall Symposium, and the 1995 International Medical
Informatics Association's MEDINFO conference.
Interests: Dr. Aliferis devotes 50% of his efforts to the leading-edge
Vanderbilt-Ingram Cancer Center, where he will be applying machine learning
and other techniques to bioinformatics, and the other 50% of his efforts
to the areas of Evidence-Based Practice Informatics and of education
and training in Biomedical Informatics.
- "Predicting Dire Outcomes of Patients with Community Acquired Pneumonia".
G.F. Cooper, V. Abraham, C.F. Aliferis, J. Aronis, B.G. Buchanan,
R. Caruana, M.J. Fine, J.E. Janosky, G. Livingston, S. Monti, T. Mitchell,
P. Spirtes (submitted).
- "A Multimedia Health Promotion Software System for Teaching Accidents
and First Aids to Children and Young Adults". E. Petridou, C. Aliferis,
S. Palamas, E. Maragkaki, M. Hioni. (5th World Conference on Injury
Prevention and Control, 1999).
- "Temporal Representation Design Principles: An Assessment in the
Domain of Liver Transplantation". C.F. Aliferis, and G. F. Cooper.
AMIA 1998 Symposium Proceedings.
- "Synopsis of Decision Support Systems". C. Aliferis, in "Yearbook
of Medical Informatics 1997", J.H.van Bemmel, A.T. McCray eds., Schattauer,
- "Representing and Developing Temporally Abstracted Knowledge as
a means Towards Facilitating Time Modeling in Medical Decision-Support
Systems". C.F. Aliferis, G.F. Cooper, M.E. Pollack, B.G. Buchanan,
M.M. Wagner. Comput. Biol. Med., 27:411-434, 1997.
- "An Evaluation of Machine Learning Methods for Predicting Pneumonia
Mortality". G.F. Cooper, C.F. Aliferis, R. Ambrosino, J. Aronis, B.G.
Buchanan, R. Caruana, M.J. Fine, C. Glymour, G. Gordon, B.H. Hanusa,
J.E. Janosky, C. Meek, T. Mitchell, T. Richardson, and P. Spirtes.
Artificial Intelligence in Medicine, 9, 107-138, 1997.
Steven Brown, M.D., M.S., is Assistant Professor of Biomedical
Informatics and Chief Information Officer at the Nashville VAMC.
Background: Dr. Brown initially came to Vanderbilt from Emory
Univeristy (where he was an Assistant Professor of Medicine) in the
mid-1990s, through an NLM-sponsored Medical Informatics Apprenticeship
training grant. He obtained a Masters Degree in Biomedical Engineering
as part of his training at VUMC.
Prior Work: Dr. Brown is both a knowledgeable general internist
and a talented medical informatician. He had over a decade of experience
in using the THERESA hospital information system developed at Grady
Memorial Hospital, and this experience has been valuable in his position
at Nashville VAMC. Dr. Brown's research during his Masters Degree thesis
project was to analyze a list of over 900,000 problem statements entered
into the THERESA System at Grady Memorial (over the past decade). From
this list, using a variety of lexical processing techniques combined
with his own knowledge of medicine, Dr. Brown has distilled a list of
approximately 17,000 unique basic problem statements, and has mapped
them to the standard National Library of Medicine Unified Medical Language
System Metathesaurus. In 1999, he published the results of his problem
list vocabulary research in the Annals of Internal Medicine. Dr. Brown
recently assumed national prominence as the director of electronic clinical
vocabulary development for the entire VA System coast to coast.
Anderson Spickard, III, M.D., M.S., is Assistant Professor of
Medicine in the Departments of Medicine and Biomedical Informatics.
He is currently the Director of the Medical Student Clerkship Program
for the Department of Medicine, the Director of Programs for Technological
Innovations in Medical Education for the Medical Center, and chair of
the Vanderbilt Task Force on Informatics in Support of Education
Prior Work: Since joining the Vanderbilt faculty in 1995, Dr.
Spickard has built an active practice and teaching contribution in Internal
Medicine and has conducted faculty development workshops and studies
of innovative approaches to medical education. He directs the Core Medicine
Clerkship in the third year of medical school and the Core Primary Care
Clerkship in the fourth year of medical school. Dr. Spickard also brings
his expertise in study design and the evaluation of medical education
to form partnerships between departments in the Medical Center that
are providing Vanderbilt innovative curricula and a sustained research
agenda in medical education. Dr. Spickard has won a number of local
teaching awards and was named the 2000 Teacher of the Year for the Southern
Region of the Society of General Internal Medicine (SGIM). And serves
on the Vanderbilt Academic Program Committee. He has served on the National
Program Committee for SGIM for a number of years and was instrumental
in creating the Innovations in Medical Education session that is a standard
format now at the national SGIM meeting. Dr. Spickard currently sits
on the SGIM National Education Committee, and is he is the 2000 chair
of the Tennessee Chapter of the American College of Physicians Annual
Interests: Dr. Spickard's research interests include all aspects
of medical education with a special focus on the design and application
of innovative informatics approaches to medical education.
- The Computerized Lecture. Wofford J, Spickard A III, Wofford M.
J Gen Intern Med. In press.
- Spickard A III, Muldowney H, Ryan S, Farnham, L. Outpatient morning
report: a national survey and one year prospective evaluation at
a large teaching hospital. J Gen Intern Med. In press.
- Spickard A III, Hales JB, Ellis S. Outpatient morning report:
a new educational venue. Acad Med, 2000;75:297.
- Spickard A III. Words hard to say and hard to hear. "May I give
you some feedback?" Editorial. J Gen Internal Med, 1998;13:142-3.
- Spickard A III, Corbett EC, Schorling J. A Randomized Trial of
Improving residents' teaching skills and attitudes towards teaching.
J Gen Intern Med, 1996; 11: 475-80.
Mary E. Edgerton, M.D., Ph.D., joined the faculty at the Vanderbilt
University Medical Center in July 2000 as an Assistant Professor with
a joint appointment in the Department of Pathology and the Department
of Biomedical Informatics.
Background and Prior Work: Dr. Edgerton is a Board certified
Anatomic and Clinical Pathologist with a doctorate in Biophysics.
She attended the University of Texas at Austin where she received
a B.S. in Physics. Following this, she was a Marshall Scholar to the
United Kingdom where she received her Ph.D. in Biophysics at the University
of East Anglia. She attended the Medical College of Pennsylvania.
After an internship in Internal Medicine there, she completed a residency
in Anatomic and Clinical pathology along with a Surgical Pathology
Fellowship at the University of Pennsylvania. During her fellowship
year, she was awarded an Arthur Purdy Stout Fellowship to study breast
pathology with Dr. David L. Page at the Vanderbilt University Medical
Interests: Dr. Edgerton worked in the analysis of large-scale
data sets in the oil industry using complex mathematical modeling
and in laboratory automation. Dr. Edgerton is working on bioinformatics
research related to correlating genetic expression in tumor cells
with both diagnosis (morphological features) and prognosis. Problems
in this area include collecting, organizing and retrieving patient
related data to characterize human tissues used in research along
with bioinformatics associated with high throughput genomic research.
Fern FitzHenry, Ph.D., R.N., Dr. FitzHenry is an Instructor
in the Department of Biomedical Informatics and an Information Services
Consultant in Information Management at Vanderbilt University Medical
Background and Prior Work: Dr. FitzHenry has a graduate degree
in business from Northwestern University in addition to her BSN and
PhD from the College of Nursing at the University of Illinois at Chicago.
Prior to entering academia, she worked as a health care professional,
health care systems vendor, and as an external consultant. She began
her career in the field of biomedical informatics in 1983. Since joining
Vanderbilt University Medical Center in 1997, she led the development
of patient registries for stem cell transplant, pediatric asthma,
and community acquired pneumonia. She plays a central role in Vanderbilt's
requirements definition and process changes needed for software development
to meet federally mandated clinical documentation requirements. She
is also a Fellow in the American College of Health Care Executives.
Interests: Dr. FitzHenry's research interests are in the adoption
of biomedical information innovations, the impact of payment systems
on biomedical informatics, health risk assessment in defined patient
populations, and biomedical informatics to support disease specific
- FitzHenry, F., & Shultz, E. K. (2000). Health risk adjustment
tools used to predict costs in defined populations. Journal of
Health Information Management,14(2), 31-57.
- FitzHenry, F., Salmon, J. W., & Reichelt, P. A. (2000). Adopting
knowledge technology to "manage" care: Issues and status of physician
use. Journal of Managed Care Pharmacy , 6(1), 35-41.
- FitzHenry, F. (1998). Nursing administrators and clinical information
systems: Shaping the future. JONA, 28(11), 24,38,53.
- FitzHenry, F., & Snyder, J. (1996). Improving organizational
processes for gains during implementation. Computers in Nursing,
Dominik Aronsky, M.D., Ph.D., joined the faculty in November
2000 as an Assistant Professor in Biomedical Informatics.
Background: Dr. Aronsky completed his MD degree at the University
of Berne (Switzerland). He earned a postgraduate diploma in software
engineering from the Technical University Berne. His clinical work
included two years of residency in anesthesia and surgery. To pursue
his interest in medical inforamtics he was awarded an MD-PhD grant
from the Swiss National Science Foundation. He earned a PhD in Medical
Informatics from the University of Utah in October 2000.
Prior work: During his clinical work Dr. Aronsky investigated
and published research in laparoscopic endoscopy. In medical informatics,
his research focused on developing, implementing, and evaluating decision
support systems for real world clinical problems. For his dissertation
he developed and evaluated a population based Bayesian network for
the automatic, real time identification of patients likely to have
pneumonia. After identifying pneumonia patients computerized pneumonia
guideline evaluation is triggered. The pneumonia research led to a
number of collaborative studies such as the computerized and clinical
evaluation of different pneumonia guidelines, the application of natural
language processing systems for the interpretation of chest x-ray
reports, the use of DNR orders in pneumonia patients, and the application
of continuous quality improvement methods for coded data entry.
Interests: Dr. Aronsky is interested in interdisciplinary
research with a focus on developing, implementing, integrating, and
evaluating decision support systems for real time, clinical applications.
He is interested in collaborating closely with clinicians and other
researchers to develop and evaluate integrated systems that apply
a variety of machine learning methods. He is also interested in the
study design and the clinical evaluation of medical informatics systems.
- Aronsky D, Haug PJ. An Integrated Decision Support System for
Diagnosing and Managing Patients with Community-Acquired Pneumonia.
Proc American Medical Informatics Assoc. Symp 1999;:197-201.
- Aronsky D, Haug PJ. Assessing the Quality of Clinical Data for
the Computerization of the Pneumonia Severity Index Guideline. J
Am Med Inform Assoc. 2000; 7:55-65.
- Dean NC, Suchyta MR, Bateman KA, Aronsky D, Hadlock CJ. Implementation
of Admission Decision Support for Community-Acquired Pneumonia:
A Pilot Study. Chest. 2000 May;117(5):1368-1377.
- Fiszman M, Chapman WW, Aronsky D, Evans RS, Haug PJ. Automatic
Detection of Acute Bacterial Pneumonia from Chest X-Ray Reports.
J Am Med Inform Assoc. 2000 (in press)
- Aronsky D, Haug PJ. Automatic Identification of Patients Eligible
for a Pneumonia Guideline. Proc American Medical Informatics Association
Symp 2000 (in press)
- Chapman WW, Aronsky D, Fiszman M, Haug PJ. Contributions of a
Voice Recognition System to Computerized Guidelines in the Emergency
Department. Proc American Medical Informatics Association Symp 2000
- Aronsky D, Kendall D, Merkley K, James, BC, Haug PJ. A Comprehensive
Set of Coded Chief Complaints for the Emergency Department (Acad
Emerg Med 2000, submitted).
- Aronsky D, Dean NC. How Should We Make the Admission Decision
in Community-Acquired Pneumonia. (invited review paper for Med Clin
North Am July 2001: accepted)
In addition to the above faculty, the program has
several adjunct faculty, especially to augment DBMI faculty expertise
in the areas of basic molecular biology, genomics, and bioinformatics.
Akram Aldroubi, Ph.D., Professor of Mathematics
Nancy Brown, M.D., Associate Professor, Medicine & Pharmacology.
William Dupont, Ph.D., Professor, Preventive Medicine;
Director, Division of Biostatistics
Doug Fisher, Ph.D., Associate Professor, Electrical Engineering
& Computer Sciences, Director, Graduate Studies, Computer Sciences
Al George, Jr., M.D., Professor, Medicine (Nephrology)& Pharmacology; Director, Division of Genetic Medicine
Jonathan Haines, Ph.D., Professor, Molecular Physiology
& Biophysics; Director, Program in Human Genetics
Doug Hardin, Ph.D., Associate Professor of Mathematics Hardin@math.vanderbilt.edu
Paul King, Ph.D., Assoc. Prof., Biomedical Engineering &
Bonnie LaFleur, Ph.D., Assistant Professor of Biostatistics
Shawn Levy, Ph.D., Assistant Professor Molecular Physiology and Biophysics; Director of the Vanderbilt Microarray Shared Resource
Terry Lybrand, Ph.D., Professor, Department of Chemistry and Center for Structural Biology
Jason Moore, Ph.D., Assistant Professor, Molecular Physiology & Biophysics
Dan Roden, M.D., Professor of Medicine & Pharmacology; Director, Clinical Pharmacology
Elaine Sanders-Bush, Ph.D., Vice-Chair Department of Pharmacology; Professor of Pharmacology
Yu Shyr, Ph.D., Associate Professor Division of Biostatistics, Department of Preventive Medicine
Elizabeth Weiner, Ph.D., Professor of Nursing and Biomedical Informatics
The DBMI has created the Clinical Informatics Service (i.e.,
the human support system developed to aid in the design, installation,
evolution, and maintenance of WizOrder and other clinical information
systems at Vanderbilt), WizOrder (an order entry system and clinical
informatics service, now in active use for 600 of the 650 beds of
Vanderbilt University Hospital), MARS/STARCHART (a sophisticated
medical record / clinical data respository system, in support of clinical
care and research), and PathworX (a care management/documentation
system which electronically links clinical care pathways to the patient
flowsheet). In addition to the above Vanderbilt has been an NIH-funded
IAIMS (Integrated Advanced Information Management Systems)
MARS/Starchart has been tied to the WizOrder interface to allow seamless
transition from patient-specific order entry to patient-specific results
review. More than 1000 individual care providers use MARS/Starchart
every day to access the electronic patient record for clinical purposes.
Recently, a new Web-based interface has been developed and implemented
at VUMC that allows secure HTML access both from within Vanderbilt,
and from remote sites for authorized individuals with "smart card"
Through WizOrder, a relational database of all orders entered on
all inpatients at Vanderbilt since January 1998 exists. WizOrder will
be extended to outpatient ordering in the coming 2000-01 year. These
informatics resources complement the available tissue/DNA samples
by providing detailed phenotypic information, which is readily interrogated.
Thus, WizOrder and MARS situate Vanderbilt uniquely to integrate genetic/molecular
biology information into clinical decision making.
Research Through MARS/StarChart and WizOrder
To give a concrete example of the unique integration of basic research
and clinical medicine in Vanderbilt made possible by the informatics
infrastructure created during the last 5 years, consider the following
example. At Vanderbilt it is possible to locate today all patients
who have specific words or phrases on their discharge summaries, EKGs,
Holter monitor reports, admission or procedure notes, etc. In the
future, when genetic information will be recorded for each patient,
it will be equally possible to use MARS/Starchart to find patients
with specific sequences of DNA base pairs from their recorded genomic
information. Because MARS/Starchart also contains patient information
such as clinical and anatomic pathology results, it would be possible
to quickly and efficiently review, for example, serum electrolyte
values on all patients with a specific SNP in a gene related to aldosterone
metabolism, or to review all surgical pathology reports containing
the words "cancer" or "carcinoma" for patients with a newly discovered
genetic sequence related to oncogenesis.
An initial implementation of these approaches will be in a series
of pharmacogenomics studies under way in the Pharmacology Department.
As all orders are centralized through WizOrder, each patient for whom
a QT-prolonging drug (Study 1) or warfarin therapy (Study 2) is prescribed
will be flagged. An Ascertainment Resource will receive these flags
automatically daily (by email). The patient's primary physician will
then be contacted for permission to approach the patient. The patient
will then be approached for participation, which in these studies
involves a DNA sample, a clinical history, and permission to follow
the patient's record for pre-specified outcome data. Another way in
which the WizOrder/MARS system will be implemented is that scripts
will be written and attached to WizOrder so that the pertinent patient
data will be directed to a special database which investigators can
access via any secure web browser. This ensures completeness, as well
timely, secure, and flexible access to the patient ID (as well as
any other data that may be pertinent to the study and for which there
is IRB approval).
Clinical Support Through MARS/WIZ
Order entry has long been recognized as an important component of
a complete Electronic Medical Record (EMR) system. The rationale for
integrating decision support into clinician order entry is well understood.
After several decades of building "stand-alone" decision support systems,
developers now recognize that such systems represent the electronic
analog of the physician's office bookshelf - a valuable source of
information that is infrequently used, despite its excellence. Integration
of MDSS into clinicians' daily workflow processed is the key to MDSS
implementation. The physical and psychological inertia of a busy clinician
engaged in an active patient practice setting makes any sort of workflow
interruption, whether manual or computer-based, difficult and costly.
Clinician order entry has been successful in only a few pioneering
institutions, and resistance to new implementations persists. Nevertheless,
reminders and decision support capabilities, integrated with some
form of order entry, have been demonstrated as effective means to
control costs and increase efficiencies.
Vanderbilt University Medical Center (VUMC) has a threefold mission--
patient care, research in the biomedical sciences, and education of
healthcare professionals. The Annette and Irwin Eskind Biomedical
Library (EBL) is dedicated to the implementation and realization of
the VUMC mission. It operates as an Integrated Advanced Information
Management System (IAIMS) library and is fully integrated with the
Health Center Information Management unit and the Department of Biomedical
Informatics as part of the Informatics Center. This unique setting
provides an exceptional opportunity for advanced training in Health
Sciences Librarianship and Biomedical Informatics.