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Graduate Program in Biomedical Informatics

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Current Status of Biomedical Informatics at Vanderbilt

DBMI Faculty

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., 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 software applications.

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 informatics.


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.

    Recent Publications

    1. 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.
    2. 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.
    3. 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.
    4. Stead, WW, Lorenzi, NM. Health Informatics: Linking Investment to Value. JAMIA 6:341-348, 1999.
    5. 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 1999.
    6. Lorenzi, NM, Riley, RT. Managing Change: An overview. JAMIA 7:116-124, 2000.
    7. Dewan, NA, Lorenzi, NM. Evaluation of Behavioral Informatics. MD Computing. Expected publication: Summer 2000.
    8. Dewan, NA, Lorenzi, NM, Riley RT. Behavioral Health Care Informatics. New York:Springer-Verlag. Expected publication: 2001.
    9. 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: 2001
    10. 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 this work.

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 (ACRL).

Reviewer: Yearbook of Medical Informatics: 1996-99; JAMIA: 1994-Present; SCAMC: 1989-93.

Recent Publications:

  1. 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.
  2. Giuse DA, Giuse NB. Knowledge Processing and Decision Support Systems. Yearbook of Medical Informatics 1999;3:473-475.
  3. 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.

Recent Publications

  1. "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).
  2. "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).
  3. "Temporal Representation Design Principles: An Assessment in the Domain of Liver Transplantation". C.F. Aliferis, and G. F. Cooper. AMIA 1998 Symposium Proceedings.
  4. "Synopsis of Decision Support Systems". C. Aliferis, in "Yearbook of Medical Informatics 1997", J.H.van Bemmel, A.T. McCray eds., Schattauer, 1997.
  5. "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.
  6. "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 Meeting.

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.

Recent Publications

  1. The Computerized Lecture. Wofford J, Spickard A III, Wofford M. J Gen Intern Med. In press.
  2. 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.
  3. Spickard A III, Hales JB, Ellis S. Outpatient morning report: a new educational venue. Acad Med, 2000;75:297.
  4. 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.
  5. 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 Center.

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 Center.

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 patient registries

Recent Publications

  1. 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.
  2. 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.
  3. FitzHenry, F. (1998). Nursing administrators and clinical information systems: Shaping the future. JONA, 28(11), 24,38,53.
  4. FitzHenry, F., & Snyder, J. (1996). Improving organizational processes for gains during implementation. Computers in Nursing, 14, 171-180.

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.

Recent Publications

  1. 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.
  2. 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.
  3. 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.
  4. 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)
  5. Aronsky D, Haug PJ. Automatic Identification of Patients Eligible for a Pneumonia Guideline. Proc American Medical Informatics Association Symp 2000 (in press)
  6. 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 (in press)
  7. 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).
  8. 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)

Non-DBMI Faculty

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 Aldroubi@math.vanderbilt.edu

Nancy Brown, M.D., Associate Professor, Medicine & Pharmacology. Nancy.Brown@mcmail.vanderbilt.edu

William Dupont, Ph.D., Professor, Preventive Medicine; Director, Division of Biostatistics William.Dupont@mcmail.vanderbilt.edu

Doug Fisher, Ph.D., Associate Professor, Electrical Engineering & Computer Sciences, Director, Graduate Studies, Computer Sciences dfisher@vuse.vanderbilt.edu

Al George, Jr., M.D., Professor, Medicine (Nephrology)& Pharmacology; Director, Division of Genetic Medicine Al.George@mcmail.vanderbilt.edu

Jonathan Haines, Ph.D., Professor, Molecular Physiology & Biophysics; Director, Program in Human Genetics jonathan@phg.mc.vanderbilt.edu

Doug Hardin, Ph.D., Associate Professor of Mathematics Hardin@math.vanderbilt.edu

Paul King, Ph.D., Assoc. Prof., Biomedical Engineering & Mechanical Engineering paul.h.king@vanderbilt.edu

Bonnie LaFleur, Ph.D., Assistant Professor of Biostatistics Bonnie.Lafleur@mcmail.vanderbilt.edu

Shawn Levy, Ph.D., Assistant Professor Molecular Physiology and Biophysics; Director of the Vanderbilt Microarray Shared Resource Shawn.Levy@mcmail.vanderbilt.edu

Terry Lybrand, Ph.D., Professor, Department of Chemistry and Center for Structural Biology Lybrand@structbio.vanderbilt.edu

Jason Moore, Ph.D., Assistant Professor, Molecular Physiology & Biophysics Moore@phg.mc.vanderbilt.edu

Dan Roden, M.D., Professor of Medicine & Pharmacology; Director, Clinical Pharmacology Dan.Roden@mcmail.vanderbilt.edu

Elaine Sanders-Bush, Ph.D., Vice-Chair Department of Pharmacology; Professor of Pharmacology Elaine.Bush@mcmail.vanderbilt.edu

Yu Shyr, Ph.D., Associate Professor Division of Biostatistics, Department of Preventive Medicine Yu.Shyr@mcmail.vanderbilt.edu

Elizabeth Weiner, Ph.D., Professor of Nursing and Biomedical Informatics Betsy.Weiner@mcmail.vanderbilt.edu


Service

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) Implementation project.

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" access tokens.

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.

The Eskind Biomedical Library

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.

 

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