From a mute but eloquent alphabet of 4 characters emerges a complex biological 'literature' whose highest expression is human existence. The rapidly advancing technologies of 'nextgen sequencing' will soon make it possible to inexpensively acquire and store the characters of our complete personal genetic instruction set and make it available for health assessment and disease management. This uniquely personal form of 'big data' brings with it challenges that will be discussed in this keynote presentation. Topics will include a brief introduction to the linguistic challenges of 'biology as literature', the impact of personal molecular variation on traditional approaches to disease prevention, diagnosis and treatment, and the challenges of information retrieval when a large volume of primary observations is made that is associated with an evanescent and rapidly changing corpus of scientific interpretation of those primary observations. Experience with extracting high quality pheonotypes from electronic medical records has shown that Natural Language Processing capability is an essential information extraction function for correlation of clinical events with personal genetic variation. Any powerful set of information can be used or misused, and put those who depend upon it in jeopardy. These issues, and a lesson from the long running Jeopardy TV series, will be discussed.

In 2010 and 2011, 28 new fellows were elected to the American College of Medical Informatics, and were inducted into the college at ceremonies held in conjunction with the American Medical Informatics Association annual conferences in Washington, DC, in those years. A brief synopsis of the background and accomplishments of each of the new fellows is provided here, in alphabetical order. ... Dr Ammenwerth received her undergraduate education in medicine from the University of Essen in Germany, and a doctorate in medical informatics from the University of Heidelberg's Institute for Medical Biometry and Informatics. She also received a degree in habilitation in medical informatics from the University of Health Sciences, Medical Informatics and Technology in Tirol, Austria. She rose through the academic ranks and at the time of election to the college was professor of health informatics at the University for Health Sciences, Medical Informatics and Technology in Tirol.

OBJECTIVE: Healthcare organizations must de-identify patient records before sharing data. Many organizations rely on the Safe Harbor Standard of the HIPAA Privacy Rule, which enumerates 18 identifiers that must be suppressed (eg, ages over 89). An alternative model in the Privacy Rule, known as the Statistical Standard, can facilitate the sharing of more detailed data, but is rarely applied because of a lack of published methodologies. The authors propose an intuitive approach to de-identifying patient demographics in accordance with the Statistical Standard. DESIGN: The authors conduct an analysis of the demographics of patient cohorts in five medical centers developed for the NIH-sponsored Electronic Medical Records and Genomics network, with respect to the US census. They report the re-identification risk of patient demographics disclosed according to the Safe Harbor policy and the relative risk rate for sharing such information via alternative policies. MEASUREMENTS: The re-identification risk of Safe Harbor demographics ranged from 0.01% to 0.19%. The findings show alternative de-identification models can be created with risks no greater than Safe Harbor. The authors illustrate that the disclosure of patient ages over the age of 89 is possible when other features are reduced in granularity. LIMITATIONS: The de-identification approach described in this paper was evaluated with demographic data only and should be evaluated with other potential identifiers. CONCLUSION: Alternative de-identification policies to the Safe Harbor model can be derived for patient demographics to enable the disclosure of values that were previously suppressed. The method is generalizable to any environment in which population statistics are available.

BACKGROUND: Systematic study of clinical phenotypes is important for a better understanding of the genetic basis of human diseases and more effective gene-based disease management. A key aspect in facilitating such studies requires standardized representation of the phenotype data using common data elements (CDEs) and controlled biomedical vocabularies. In this study, the authors analyzed how a limited subset of phenotypic data is amenable to common definition and standardized collection, as well as how their adoption in large-scale epidemiological and genome-wide studies can significantly facilitate cross-study analysis. METHODS: The authors mapped phenotype data dictionaries from five different eMERGE (Electronic Medical Records and Genomics) Network sites studying multiple diseases such as peripheral arterial disease and type 2 diabetes. For mapping, standardized terminological and metadata repository resources, such as the caDSR (Cancer Data Standards Registry and Repository) and SNOMED CT (Systematized Nomenclature of Medicine), were used. The mapping process comprised both lexical (via searching for relevant pre-coordinated concepts and data elements) and semantic (via post-coordination) techniques. Where feasible, new data elements were curated to enhance the coverage during mapping. A web-based application was also developed to uniformly represent and query the mapped data elements from different eMERGE studies. RESULTS: Approximately 60% of the target data elements (95 out of 157) could be mapped using simple lexical analysis techniques on pre-coordinated terms and concepts before any additional curation of terminology and metadata resources was initiated by eMERGE investigators. After curation of 54 new caDSR CDEs and nine new NCI thesaurus concepts and using post-coordination, the authors were able to map the remaining 40% of data elements to caDSR and SNOMED CT. A web-based tool was also implemented to assist in semi-automatic mapping of data elements. CONCLUSION: This study emphasizes the requirement for standardized representation of clinical research data using existing metadata and terminology resources and provides simple techniques and software for data element mapping using experiences from the eMERGE Network.

OBJECTIVE: DNA biobanks linked to comprehensive electronic health records systems are potentially powerful resources for pharmacogenetic studies. This study sought to develop natural-language-processing algorithms to extract drug-dose information from clinical text, and to assess the capabilities of such tools to automate the data-extraction process for pharmacogenetic studies. MATERIALS AND METHODS: A manually validated warfarin pharmacogenetic study identified a cohort of 1125 patients with a stable warfarin dose, in which 776 patients were managed by Coumadin Clinic physicians, and the remaining 349 patients were managed by their providers. The authors developed two algorithms to extract weekly warfarin doses from both data sets: a regular expression-based program for semistructured Coumadin Clinic notes; and an advanced weekly dose calculator based on an existing medication information extraction system (MedEx) for narrative providers' notes. The authors then conducted an association analysis between an automatically extracted stable weekly dose of warfarin and four genetic variants of VKORC1 and CYP2C9 genes. The performance of the weekly dose-extraction program was evaluated by comparing it with a gold standard containing manually curated weekly doses. Precision, recall, F-measure, and overall accuracy were reported. Associations between known variants in VKORC1 and CYP2C9 and warfarin stable weekly dose were performed with linear regression adjusted for age, gender, and body mass index. RESULTS: The authors' evaluation showed that the MedEx-based system could determine patients' warfarin weekly doses with 99.7% recall, 90.8% precision, and 93.8% accuracy. Using the automatically extracted weekly doses of warfarin, the authors successfully replicated the previous known associations between warfarin stable dose and genetic variants in VKORC1 and CYP2C9.

MOTIVATION: Emergence of genetic data coupled to longitudinal electronic medical records (EMRs) offers the possibility of phenome-wide association scans (PheWAS) for disease-gene associations. We propose a novel method to scan phenomic data for genetic associations using International Classification of Disease (ICD9) billing codes, which are available in most EMR systems. We have developed a code translation table to automatically define 776 different disease populations and their controls using prevalent ICD9 codes derived from EMR data. As a proof of concept of this algorithm, we genotyped the first 6005 European-Americans accrued into BioVU, Vanderbilt's DNA biobank, at five single nucleotide polymorphisms (SNPs) with previously reported disease associations: atrial fibrillation, Crohn's disease, carotid artery stenosis, coronary artery disease, multiple sclerosis, systemic lupus erythematosus and rheumatoid arthritis. The PheWAS software generated cases and control populations across all ICD9 code groups for each of these five SNPs, and disease-SNP associations were analyzed. The primary outcome of this study was replication of seven previously known SNP-disease associations for these SNPs. RESULTS: Four of seven known SNP-disease associations using the PheWAS algorithm were replicated with P-values between 2.8 x 10(-6) and 0.011. The PheWAS algorithm also identified 19 previously unknown statistical associations between these SNPs and diseases at P < 0.01. This study indicates that PheWAS analysis is a feasible method to investigate SNP-disease associations. Further evaluation is needed to determine the validity of these associations and the appropriate statistical thresholds for clinical significance. AVAILABILITY: The PheWAS software and code translation table are freely available at http://knowledgemap.mc.vanderbilt.edu/research.

In 2009, 11 new fellows were elected to the American College of Medical Informatics, and were inducted into the College at a ceremony held in conjunction with the American Medical Informatics Association conference in San Francisco on November 15, 2009. A brief synopsis of the background and accomplishments of each of the new fellows is provided here, in alphabetical order. Riccardo Bellazzi, PhD Dr Bellazzi graduated laurea cum laude with a degree in Electronics Engineering from the University of Pavia in Italy, with a concentration in planning and temporal reasoning in medical expert systems. He earned his PhD in Bioengineering at the Milan Politecnico and the University of Pavia, with emphasis on causal models and machine learning applied to clinical monitoring. Dr Bellazzi is currently Associate Professor of Medical Informatics in the Department of Computer Science and Systems (Dipartimento di Informatica e Sistemistica), Università di Pavia, Pavia, Italy. At the time of his election to the College, Professor Bellazzi was a lecturer in Medical Informatics, Machine Learning, Probabilistic Modeling and Bioinformatics applied to genomics and proteomics. He organized the National School of Bioengineering in 2007 with an educational program focused on Computational Genomics and Proteomics. Dr Bellazzi's research interests range across clinical and molecular domains, including data mining, web-based telemedicine for the management of chronic disease, mathematical modeling of biological systems, and the development of novel bioinformatics methods, particularly in the temporal analysis of gene expression patterns, proteomics and analysis of tissue microarray data. He has authored more than 200 publications, and has been an active contributor to both AMIA and IMIA conferences. He was an AMIA Student Paper award winner for work associated with his PhD thesis in 1992. Dr Riccardo Bellazzi is one of the renaissance figures of our field, whose work is having international impact in the emerging field of clinical bioinformatics. He will be the scientific program chair for Medinfo 2010 in Capetown, South Africa. His election to the College as an International Fellow recognizes these technical and organizational achievements that have had impact both in his own country and in the Americas. Atul Butte, MD, PhD Dr Butte received his Bachelor of Computer Science degree and MD from Brown University, and completed his residency in Pediatrics and Fellowship in Pediatric Endocrinology, both at Children's Hospital Boston. He later matriculated at MIT where he received a Masters degree in Medical Informatics and PhD in Medical Engineering and Medical Physics. At the time of his election to the College, he was an Assistant Professor in the Medical Informatics division of the Department of Medicine at Stanford, with concurrent appointments in Pediatrics and Computer Science. Dr Butte presented his first AMIA paper in 1999 on development of knowledge discovery methods in clinical laboratory databases employing relevance networks, work that he parlayed into a subsequent publication in the Proceedings of the National Academy of Sciences. He has been an innovative proponent of data mining of publicly available data resources, for the discovery of novel genome-phenome relationships, and the creation of genomic data-driven nosologies. Dr Butte has served on the AMIA Board of Directors and launched the first AMIA Summit on Translational Bioinformatics in 2008, which has been a resounding success. His election to the College recognizes these technical and professional service contributions. Wendy W Chapman, PhD Dr Chapman earned her Bachelor's degree in Linguistics and her PhD in Medical Informatics from the University of Utah. She was a postdoctoral fellow in Biomedical Informatics at the University of Pittsburgh, then joined the faculty there. At the time of her election, she was an Assistant Professor of Biomedical Informatics and Intelligent Systems. In this role, she has applied her skills in Natural Language Processing (NLP) to the field of Biosurveillance, and in this context has contributed significantly to our understanding of the strengths and limitations of syndromic case detection from chief complaints recorded in electronic medical records. She also served as associate director of the graduate training program at the University of Pittsburgh. With colleagues, Dr Chapman has developed algorithms and tools to facilitate sharing and information extraction from clinical reports, including the widely-used NegEx algorithm for detecting negation and the De-ID data scrubbing system. At the time of her election she was chair of the AMIA NLP working group and developed a NLP repository of de-identified clinical reports that is available to other researchers. Her election to the College recognizes these sustained technical and organizational contributions to the field. Hamish SF Fraser, MBChB Dr Fraser received his Bachelor of Science degree in Medical Science/Physiology and his MD from Edinburgh University. He earned his MRCP Medical Boards at the Royal College of Physicians of Edinburgh, along with a Masters degree in Knowledge based systems from Edinburgh University. At the time of his election, Dr Fraser was an Assistant Professor at Harvard Medical School and Associate Physician in the Division of Global Health Equity at Brigham and Women's Hospital. He also served as a Research Associate with the Children's Hospital Informatics Program in Boston and Director of Informatics and Telemedicine, for Partners In Health, a not for profit foundation devoted to improving global health. Dr Fraser began his research career working with ACMI fellow William Long on the evaluation of an Artificial Intelligence program for heart disease diagnosis, and has since developed an active research and development program in healthcare technologies for developing nations. He has created systems to support teleradiology in Africa, multiply-drug-resistant TB treatment in Peru, and HIV treatment in Haiti. His nomination notes that “unlike many other attempts, where unanticipated changes in requirements or narrowness of approach have scuttled promising projects, the ones Dr Fraser has built have ‘just worked’, have been accepted and loved by their users, and even political upheavals have failed to kill them.” The College considers this high praise indeed in parts of the resource-limited world characterized by poverty, illiteracy, and frequent turnover of political winners and losers. With colleagues at other US and international institutions, Dr Fraser has championed the development and deployment of the OpenMRS electronic medical records system platform in countries of sub-Saharan Africa, the Caribbean, and South America. Dr Fraser's nomination also noted that he “is a strongly motivated, highly productive and inspirational leader in the push to develop appropriate healthcare technologies for the developing world”. These enduring achievements are recognized and honored by election to Fellowship in the College. Rita Kukafka, DrPH Dr Kukafka received her Bachelor's degree in Health Sciences from Brooklyn College, a Masters in Health Education from New York University, and a Doctorate in Public Health with a concentration in Sociomedical Sciences from the Mailman School of Public Health at Columbia University. She also then completed a National Library of Medicine postdoctoral fellowship, and received a Master's degree in Biomedical Informatics from Columbia. At the time of her election Rita was an Associate Professor in the Departments of Biomedical Informatics and Sociomedical Sciences (Public Health) at Columbia, and director of the graduate education training program in Biomedical Informatics. Throughout her career, Dr Kukafka has promoted and fostered the growth of public health informatics as a field. She has pursued an informatics research program where social and behavior change theories are applied within biomedical informatics to inform the design, evaluation and dissemination of expert systems, and computer-mediated communications to practitioners and patients. She has been an active contributor to AMIA as a member of the Fall Symposium Scientific Program Committee, and an AMIA Board member. She has chaired the Consumer Health Informatics Working group for AMIA, and served on an Institute of Medicine study committee that asked the question, in the 21st Century, of ‘Who Will Keep the Public Healthy?’ Her election to the College recognizes these academic and community service achievements. Andre Kushniruk, PhD, MSc Dr Kushniruk received his Bachelor's degrees in Biology and Psychology from Brock University, a Master's in Computer Science from McMaster University, and a PhD in Cognitive Psychology from McGill University, in the first phases of a tour de force of higher education in Canada. He then began his academic career as a research scientist in the Department of Computer Science at the University of Toronto, and was subsequently appointed Assistant Professor of Computer Science at Trent University in Ontario. He was recruited to York University in Ontario as Associate Professor in the Department of Mathematics and Statistics, and served as faculty coordinator for the Information Technology Program there. In 2004 he moved to the University of Victoria, where he became Director of the School of Health Information Science, one of the most well known and comprehensive informatics programs in North America. He is currently a Professor at the School of Health Information Science at the University of Victoria and he also holds an adjunct appointment at the Mount Sinai School of Medicine in New York. Dr Kushniruk's work has demonstrated how usability engineering methods can be applied widely in health informatics. He received a Paper award at MEDINFO 2004 for a paper on ‘the relationship of usability to medical error’. Dr Kushniruk has developed novel approaches to application of qualitative analysis methods such as protocol and video analysis to support the assessment of user interactions with systems. These approaches have been adopted by a number of healthcare institutions, including both healthcare and research centers, nationally and internationally. Dr Kushniruk has been a tireless promoter of health informatics as a career in Canada, and has led the development of educational strategies, including promoting undergraduate health informatics education, web-based distance education up to the Master's level, and work on design of a new flexible PhD program to increase the number of trained professionals in the field. His election to the College recognizes these efforts that have both advanced the state of the art in technology evaluation, and broadened the educational opportunities in our field. Gilbert S Omenn, MD, PhD Dr Omenn received his AB degree from Princeton and his MD from Harvard. After internship and residency in Internal Medicine at Massachusetts General Hospital, he was a US Public Health Service officer and research fellow at the National Institutes of Health (NIH). He then undertook a fellowship in Medical Genetics at the University of Washington in Seattle, where he earned a PhD in Genetics. He stayed on as faculty at the University of Washington, became an Investigator of the Howard Hughes Medical Institute, and climbed the academic ranks to Professor of Medicine in 1979. He diversified his portfolio of achievement by serving as White House Fellow at the US Atomic Energy Commission in 1973–1974, Associate Director of the White House Office of Science and Technology Policy from 1977 to 1980, Associate Director of the federal Office of Management and Budget, 1980–1981, Visiting Professor in the Woodrow Wilson School at Princeton in 1981, and the first Science, Engineering and Public Policy Fellow of the Brookings Institution, 1981–82. From 1982 to 1997 he was Professor of Environmental Health and Dean of the School of Public Health and Community Medicine at the University of Washington, then moved to Michigan to become Executive Vice President for Medical Affairs and CEO of the University of Michigan Health System from 1997 to 2002 and Professor of Medicine, Genetics, and Public Health (continuing). Dr Omenn is a leader in the emerging discipline of Proteome Informatics. He launched the Human Plasma Proteome Project of the international Human Proteome Organization. The Human Proteome Organization has enhanced the development of protein-related research databases that are an essential infrastructure for work in protein identification, characterization, and systems biology. At the time of his election, Dr Omenn was Director of the University of Michigan Center for Computational Medicine and Bioinformatics and a senior director of the NIH National Center for Integrative Biomedical Informatics, one of the seven National Centers for Biomedical Computing. He has been active in the AMIA Translational Bioinformatics Summit meetings. He is an elected fellow of the American College of Physicians, American Academy of Arts and Sciences, American Association for the Advancement of Science (president in 2006), and member of the Institute of Medicine. His election to the College recognizes these academic and community service achievements. Roberto A Rocha, MD, PhD Dr Rocha received his medical degree from the Federal University of Paraná, in Curitiba, Brazil, and in 1990 completed a residency in Medical Informatics at the Department of Pathology, University of São Paulo School of Medicine, Brazil. He continued his informatics training in the USA and received a PhD in Medical Informatics from the University of Utah in 1996. Dr Rocha returned to his alma mater in Curitiba as Associate Professor, initially teaching Medical Informatics courses and later serving as Chief Information Officer of the University hospital. In 2001, Dr Rocha was recruited back to Salt Lake City as Assistant Professor of Biomedical Informatics at the University of Utah and Senior Medical Informaticist at Intermountain Healthcare. At Intermountain, he managed the enterprise teams responsible for knowledge and terminology management until mid 2006. For his contributions at the University of Utah, Dr Rocha was selected as the first recipient of the Reed M Gardner Award for Faculty Excellence in teaching and mentoring. In 2008, Dr Rocha accepted a position at Partners HealthCare as the Senior Corporate Manager for Knowledge Management and Clinical Decision Support at the Clinical Informatics Research and Development group, and a faculty member of the Division of General Medicine, Brigham and Women's Hospital, Harvard Medical School. Dr Rocha's nomination cites publications related to biomedical terminologies and clinical knowledge management, including mapping algorithms, information modeling techniques, and contributions to interoperability standards and collaborative knowledge engineering and peer review. His election to the College recognizes these sustained achievements. Titus Schleyer, DMD, PhD Dr Schleyer received his Doctorate of Dental Medicine from the University of Frankfurt am Main in Germany, and a PhD in Molecular Biology. He emigrated to the USA and received another DMD degree, from Temple University, along with an MBA in Health Administration. He stayed on at Temple and rose to Associate Professor and Chair of the Department of Dental Informatics in the School of Dentistry. In 2005 he moved to the University of Pittsburgh to become Associate Professor of Dental Medicine and Director of the Center for Dental Informatics, and Associate Professor of Biomedical Informatics. His nomination notes that Dr Schleyer is a pioneer in the discipline of dental informatics, a field that only recently has begun to mature. He is currently the highest-published author in the field of dental informatics. At the time of his election to the College, Dr Schleyer was principal investigator on a NIH RO1 grant entitled ‘A Controlled Terminology for Diagnoses and Findings in General Dentistry’. Prior to this award, no investigator in the USA had ever received an R01 award for a dental informatics research project. He is the fourth dentist to be elected to Fellowship in the College, among the approximately 150 000 active dental practitioners in the country. He has been an active contributor to the CTSA consortium and chairs the CTSA Communications workgroup. He has also chaired two ANSI standards committee working groups, for educational software and dental electronic health record information models. His election to the College recognizes these technical and professional service contributions. Jaap Suermondt, PhD Dr Suermondt received his Bachelor's in Mathematical and Computational Science, and Master's and PhD degrees in Medical Information Sciences, all from Stanford. He was hired by Hewlett-Packard (HP) Laboratories in Palo Alto and has advanced through the ranks there; he is currently Director of HP's Business Optimization Lab. Dr Suermondt's research career has focused on sound analytic approaches to real-world decision problems. He was an early contributor in several areas, including Bayesian networks, integrated clinician-focused workstations, data mining (particularly automated categorization, text mining, and quantification) and distributed computing. He originally joined HP to join a research team focused on clinical workstation development. He has engaged in many technical areas at HP both as a researcher and later as a manager and lab director, but he has maintained an ongoing interest in biomedical applications and the role of the technology industry in our field. Most of our fellows have a long list of publications; Jaap has both research publications and 25 patents in informatics and computing. Dr Suermondt has made significant organizational and scholarly contributions to AMIA. He has served as chair of the Working Group steering committee, as well as Chair of Membership committee, member of the scientific program committee for five Fall Symposia, and Chair of the 2008 Annual Symposium Scientific Program Committee. His nomination notes that “As an executive and research director at a mainstream technology company with a very broad, worldwide partner base, Dr Suermondt is in a position to influence the technology sector to represent the perspective and needs of medical informatics in general and ACMI specifically. He brings to ACMI research experience where he contributes breadth and depth, as well as solid management expertise.” His election to the College recognizes these technical innovations and sustained professional service. Elizabeth (Betsy) Weiner, PhD, RN-BC, FAAN Dr Weiner received her Bachelor of Science in Nursing from the University of Kentucky, a Masters of Science in Nursing from the University of Cincinnati, and a PhD in Higher Education, Social & Philosophical Studies, from the University of Kentucky. She joined the faculty of the University of Cincinnati College of Nursing and Health, and advanced through the academic ranks to full professor there. In 2000 she moved to Vanderbilt, where at the time of election to the College she was the Centennial Independence Professor of Nursing, Professor of Biomedical Informatics and Senior Associate Dean for Informatics in the School of Nursing. Dr Weiner has devoted her career to the development and evaluation of educational technologies for nursing. In the late 1980s, she received one of the initial IBM grants for innovative education. She and her collaborators created an award-winning informatics-based labor and delivery simulation. This program has changed the way that nursing students prepare for their clinical obstetrics experience; the videodisc has been employed in the curricula of 98% of the nursing schools in the country. At the University of Cincinnati she was Director of Academic Computing, and there developed an online course management software system called ‘Classware’ that preceded today's ‘Blackboard’ software. In recent years her work in educational technologies has been focused on emergency preparedness and response, and in this domain she and her colleagues received the 2007 Sigma Education Technology that the software developed was the in the nursing community worldwide for For this she was to join the faculty of the Masters in Medicine Dr Weiner has with the of Health and the University of to and educational needs for as their infrastructure to a hospital. She has served as a to in in the of online learning in emergency Her election to the College recognizes these technical and service to a global health not peer

In 2008, 11 new fellows were elected to the American College of Medical Informatics, and were inducted into the College at a ceremony held in conjunction with the American Medical Informatics Association conference in Washington, DC on Nov 9, 2008. A brief synopsis of the background and accomplishments of each of the new fellows is provided here, in alphabetical order.

Aliferis has published extensively on the application of machine learning methods to various classes of data, ranging from development of class prediction methods that use gene expression and proteomic data for cancer diagnosis, to automated methods for assessing the quality of the published literature and whether medical websites contain quackery.His nomination to the College notes that he is a superb teacher, and his students have won many awards at AMIA and IMIA conferences.His election to the College recognizes these sustained achievements.

The American College of Medical Informatics (ACMI) is an honorary society established to recognize those who have made sustained contributions to the field. Its highest award, for lifetime achievement and contributions to the discipline of medical informatics, is the Morris F. Collen Award. Dr. Collen's own efforts as a pioneer in the field stand out as the embodiment of creativity, intellectual rigor, perseverance, and personal integrity. The Collen Award is given each year, when appropriate, to pioneers in the field of Medical Informatics who best exemplify the teaching and practice of Morris Collen. In 2007, the College was proud to present the Collen Award to William Wallace Stead (Figure 1). Throughout his career, Dr. Bill Stead, has been able to visualize better ways of achieving the purpose of work, and then to drop to ground level to figure out how to execute on the next step in that direction. William Wallace Stead 2005. Bill Stead was born in Durham NC in 1948 as third child to Eugene Anson Stead, Jr. and Evelyn Emogene Selby. Gene Stead was Chair of Medicine at Duke. He trained a generation of independent thinkers and constantly broke the mold; changing the Duke curriculum to replace memory with research, using the Cardiovascular Databank to improve practice, and launching the physician assistant profession to increase access to care. Evelyn was at Gene's side every step; raising Nancy, Lucy, and Bill, co-authoring an early low fat cook book, and editing the journals Gene took on. Every person or event she touched became special. To many observers through the years, it seemed that Gene and Bill Stead were practically the same person. As Harry Jacobson, MD, Vice-Chancellor, Vanderbilt University Medical Center, observed, “They had both a loving relationship, but a mutual respect—and a mutual curiosity, intellectual curiosity about what we need to do in health care…that I think created a bond between the two of them that I thought was very unique.” When Bill was four, the family purchased land on Kerr Lake in North Carolina. With Evelyn as Architect and Gene as Builder-in-Chief, they began their lake house. They started with a bath room and enclosed it with a screened area. This made a place to live while they built the house around it (Figure 2). The project took 20 years to complete, and it showed Bill how to break projects up into phases and that big things could happen if you kept laying one block after another. In this regard, Clem McDonald, MD, Regenstrief Professor Emeritus of Medical Informatics at Indiana University, said of Bill, “He's a master planner…you know step-wise, progressive, he thinks a long time ahead how to get there. In many respects he's like his Dad that way. The politics and the people and the funding and the motivation and building the infrastructure and keeping your eye on the prize…I think he probably did that even more focused than his dad.” Building the house on Kerr Lake—Bill, his father Eugene, and sister Nancy, 1960. Bill is an Eagle Scout. Harry Rodenhizer was his Scout Master and Harry believed in letting the boys make mistakes and learn from them. The troop camped out every month, often hiking in and out. Bill's first experience in leadership and organization came as a Patrol Leader and Junior Scout Master. When Bill was 10, he learned to ski behind a runabout with a 12 HP outboard. Almost 50 years later, water skiing is still his favorite sport. Bill began his education at Durham Academy, continued at Durham High School, and finished at Duke University, where he received his BA in Chemistry and an MD and then completed a residency in Internal Medicine and fellowship in Nephrology. Bill's interest in applying computing to medicine began in 1968 when he joined Dr. Frank Starmer as an undergraduate work study student in the Duke Myocardial Infarction Research Unit. The unit's Sigma V computer was located next to the cardiac care unit and supported real time data acquisition and interaction. When Bill started medical school, the Duke curriculum compressed requirements into 2 years, freeing a full year for basic research. Medical computing was not an established research track at the time, so Dr. Harvey Estes, Chairman of the Department of Community Health Sciences, agreed that Bill could work with Dr. Ed Hammond in his computer lab and receive credit for independent study. Bill's father suggested he start this “3rd year research” during the summer between college and medical school. With that head start, he was able to finish medical school in 3 years by taking courses year round. Ed Hammond, Ph.D., Professor Emeritus, Community and Family Medicine and Professor, Biomedical Engineering, Duke University recalls that time: “When Bill first joined me, and in typical Stead fashion, he actually did the third year rotation before he ever started his first year rotation at Duke. The first project that Bill was involved with was the development of a video interactive questionnaire for patients with headache. Not knowing Bill Stead very well, I came back after a week's vacation and walked into the room and Bill had the walls covered with large white wrapping paper on which he had outlined all the frames for the interactive questionnaires. This project was very successful but somewhat ahead of its time.” In the summer of 1970, Bill joined Ed Hammond as one of a team of five medical and undergraduate students (Figure 3). Together they developed assembly language programs for the PDP-12 and merged them into GEMISCH, an application development and database management environment. Working with Dr. Al Heyman in Neurology, Bill used this environment to develop an interactive video questionnaire to capture the history of present illness directly from patients presenting with headache. The program's differential diagnosis was comparable to that of attending neurologists. Checking a printout from the Obstetrical Medical Record—Bill 1973. By 1972, Ed's team had combined history and physical “exam takers” into a prenatal electronic health record. When Bill started his OBGYN clerkship, the attendings were unhappy because it took too long to find what they wanted in the long printouts. He went back to the computer center and stayed up all night to re-write the print format to match the outline the students had been given for admission notes. The resulting system was used at Duke until 2002. Bill was in the last internal medicine and resident group at Duke who were “on call” five out of seven nights of the week. This clinical immersion was intense and left no time for computing. However, in 1975, Bill became a fellow in nephrology under the tutelage of Dr. Ike (Roscoe R.) Robinson. Dr. Robinson switched the usual order of clinical and research training for Bill. Starting with research, he allowed Bill to build tools that he could then test and refine during his clinical year. It was during the research year that Bill developed a working prototype of a general purpose electronic medical record. A dictionary of metadata managed clinical content and entity-attribute-value data structures handled sparseness. In time, Ed Hammond and Bill would evolve this prototype into TMR, a full function practice management system, which supported at its peak over 40 sites in 20 different settings ranging from a 2 person practice to a 60 bed cancer research hospital. Morris Collen, MD, Emeritus Director of Research, Kaiser Permanente, recalls that “Soon the TMR system was used in other medical centers in the United States. Since some medical information such as Word Process Narrative still requires a paper base record, Bill published the succinct disclaimer that TMR was a chart-less record and not a paperless record.” Early in his clinical fellowship year, Bill met Janet Mackey. Janet was the daughter of John and Mary Mackey. She grew up in Beverly, MA and graduated from Salem Hospital School of Nursing. She had come to Duke the previous year to accept a position on the Duke Inpatient Renal Unit. Bill and Janet were never apart after their first date, and they married in 1977. Bill skied to the wedding dinner and he and Janet foiled the guests who wanted to decorate their car by leaving the wedding by boat. Bill then joined the Duke faculty in Nephrology. Since Ike Robinson was both Chief of Nephrology and CEO of Duke Hospital, he arranged to split Bill's time between directing the dialysis unit at the Durham VA Hospital and serving as physician liaison for the Duke Hospital Information System. The dialysis unit provided a test bed for TMR. The hospital system, DHIS, developed at Duke and marketed by IBM as PCS/ADS, provided an opportunity to test ideas on an enterprise scale. Bill's and Janet's daughter, Elizabeth Mackey Stead, was born in 1984. Elizabeth graduated from Lipscomb University last year with a degree in elementary education and she now teaches in Nashville (Figure 4). Bill, his wife Janet Mackey, and daughter Elizabeth, 2006. In 1985, Bill stepped in as Director of Medical Center Information Systems at Duke. Two seasoned medical center administrators, Mr. Bob Winfree and Dr. Jane Elchlepp met with Bill two hours every week for his first four years to guide him as he learned to manage at this level of the organization. Bill obtained model development and implementation grant funding from the National Library of Medicine's Integrated Academic Information Management System, or IAIMS, initiative (Figure 5. Through this work he developed what he views as his primary technical innovation—an enterprise information architecture to manage the information from all applications in repositories independent from, yet accessible to, the applications, allowing new functionality to be purchased and plugged in or developed on site with less hassle and without upsetting other programs and processes. This architecture underpins Vanderbilt's clinical IT and a derivative is the foundation of the “Volunteer eHealth Intitiative,” regional data exchange demonstration project in southwestern Tennessee. Integrated Advanced Information Management System (IAIMS) Fair—Bill back row center, 1990. In 1991, Ike Robinson recruited Bill to Vanderbilt. Ike had been at Vanderbilt as Medical Center as Vice Chancellor and the Medical Center CEO for 10 years, and he was ready to give Bill a fresh canvass to build Biomedical Informatics as Bill thought best. They agreed to focus on linking information into workflow to help people make better decisions. Carol Aronson, Bill's long time assistant, agreed to come to help with the effort. Bill decided to bring all information management and utilization functions, including the library, into a center managed at the level of the medical center; to implement the information architecture from his Duke plan, and to establish biomedical informatics as a scholarly discipline within the new center. Together, these decisions turned the operation and decision support infrastructure of the medical center into an applied laboratory for biomedical informatics. Clem McDonald observes that “It's absolutely essential to the field that there be informatics programs that have enough critical mass and are embedded in the health care system at their place well enough to be able to do the inventive and imaginative things that the health care system needs.” What Bill still calls “the Vanderbilt experiment” is a journey. The first leg (1991–1994) involved basic infrastructure: construction of the Eskind Biomedical Library to make space for the academic program, connecting buildings with fiber optics for networking, refreshing transaction processing systems, and adapting them to the enterprise information architecture. In this setting, Dr. Harry Jacobson observes, “It is amazing how much you can get done if you have a few principles—like: it doesn't matter who gets the credit, don't sacrifice success for control, and treat other people like you want to be treated. I mean very basic principles…and Bill lives them.” The second leg (1994–2003) applied techniques from the science of biomedical informatics to come up with new ways to help people do their work. This leg began when Dr. Randy Miller and his team from Pittsburgh (Nunzia Giuse, MD, MLS; Dario Giuse, DrIng; Antoine Geissbuhler, MD, and Steven H. Brown, MD) joined the Vanderbilt team. Other established leaders joined in quick succession as Bill sought to assemble a critical mass of talent. Biomedical Informatics gained departmental status in the School of Medicine in 2001. Applied informatics breakthroughs included an enterprise-wide electronic medical record together with workflow, communication, and decision support tools, and new models for librarianship. As Randolph A. Miller, MD, the Donald AB and Mary M Lindberg University Professor of Biomedical Informatics, Medicine, & Nursing at Vanderbilt, notes, “You're not going to win every argument, but if you know that the person listening to the points of view understands the points of view—weighs them carefully, and will make a fair decision that he can explain to everybody—that's about as good as it gets. And that's how Bill does things.” The third leg of informatics development, beginning in 2002, rethinks the nature of biomedical and healthcare work given the “art of the possible” through informatics. This leg began when Dr. Harry Jacobson (who had succeeded Ike Robinson in 1997) and Bill partnered to launch the Vanderbilt Center for Better Health as infrastructure to accelerate change in healthcare. The Center's methods are helping Vanderbilt and partners manage the transition to systems approaches to evidence based personalized care. Over the course of this journey, the Informatics Center grew from two to over 500. The Department of Biomedical Informatics, with Dr. Dan Masys as current Chair, is the 6th largest in the School of Medicine with 55 faculty spanning clinical, bio-, and educational informatics. As each new unit was assimilated or formed, Bill took it over, ran it for a period, and then recruited a leader to take it to the next stage. Dr. Miller recalls, “At one point in time he was director of the biomedical library, at another point in time he was the acting chair of the department, at other times earlier in his career he was a programmer and a clinician…so it's because he's been in all of these roles that he has the right experience and the right know-how to make things happen.” Similarly, Donald Lindberg, MD, Director of the National Library of Medicine, observes that “If you say, well, someone saw the future and he sees the importance—that's great but that's preaching to the choir and it doesn't get you anyplace. I think a lot of us have done that, I think Bill has done more…I think Bill has figured out the importance of everyone in the institution sharing that vision in his own way…and being supportive of those ideas.” Bill has been at the center of the emergence of biomedical informatics as an organized field. He was a member of the first executive committee of the American College of Medical Informatics and later served as President of the College. He was program chair of the 11th Symposium on Computer Applications in Medical Care. As President of the American Association for Medical Systems and Informatics, he worked with Dr. Ted Shortliffe, President of the College, and Dr. Clem McDonald, President of the Symposium, to bring the resources of those organizations together in what became the American Medical Informatics Association (AMIA). He led the committee that developed the business plan for the Journal of the American Medical Informatics Association (JAMIA) and served as JAMIA's Founding Editor-in-Chief. In this regard, Dr. Lindberg, who was AMIA's first president, observes, “I think another thing that we wouldn't want to forget about Bill having done really well is to be the first editor of JAMIA. And I recall very well when he expressed an interest in that…and fortunately both of us were holding glasses in our hands, and we agreed very, very quickly that he'd be the ideal editor and he took it on and was the ideal editor.” Bill has followed in his father's footsteps to membership in the Institute of Medicine and service on the Board of Regents of the National Library of Medicine. He served as Presidential appointee to the Systemic Interoperability Commission. As Chair of the Board of Regents of the National Library of Medicine, he guided development of the for as with of the In to Clem McDonald him help the Library plan the to long plan was a master for Lindberg, to have that of master so And Lindberg, in his as think he and both the of was the going to be during that years we were for and how would into that of the And I think they each other and both did a Bill is intense when focused on work. He with the family and He the at the on Center He is at his best working or over dinner on a In this Ed Hammond notes, is an person and what Bill does is he has his own that he to test and make on the the until it This is the same and that Bill into all of the projects that he Bill is a pioneer in the of for the right and for information enough to support he to organization approaches to develop the intellectual to both Dr. Collen, the observes Stead the highest level for in all of medical and the practice of medical Dr. Lindberg a on the Collen Award a transition for Bill in which he from his own group and his own more of a he more with at the to to these new ideas and to the I to receive this from in the College. Janet and Elizabeth, stand up and in This is a to the many people who have and given It is a to the I have had the to I each of When we established the Collen Award in we wanted to the of the in a that showed people their how a career over I now want to to the people in the I have good and The good is that we we our history will back on the next years as the of biomedical informatics. a of and the of and the data from the and will we come up with a new to make clinical decisions. Information is in the critical of The new is that you information into the current to healthcare and get the As in the such an will as many as it To get the from information you have to change the of to and information to on memory and to a allowing people to and What does this mean to people their in biomedical need to what be or what it of it be need to get your it to a real In the you will figure out how information can the you do these you will a person and your career will be To it this is but not need to both think and

In 2006, 13 new fellows were elected to the American College of Medical Informatics, and were inducted into the College at a ceremony held in conjunction with the American Medical Informatics Association conference in Washington, DC, on November 12, 2006. A brief synopsis of the background and accomplishments of each of the new fellows is provided here, in alphabetical order. Dr. Becich received his bachelor's, MD, and PhD degrees from Northwestern University, and undertook residency and fellowship training in anatomic pathology at Washington University in St. Louis. He advanced through the academic ranks at the University of Pittsburgh, and is now Professor and Chair of the Department of Biomedical Informatics, Director of Oncology and Pathology Informatics, and also Professor of Information Sciences and Telecommunications. In this capacity, he has had an important role in the National Cancer Institute's Cancer Biomedical Informatics Grid (CaBIG) and particularly the CaTissue application for research tissue banking. In addition to his scholarly contributions, Mike Becich is best known for creating the Advancing Practice, Instruction, and Innovation (APIII) conference and the Association for Pathology Informatics (API). His nomination to the College notes that “Frustrated with the slow pace of adoption of informatics ideas in mainstream pathology, Mike took the bull by the horns and established these wildly successful subspecialty activities” and that “he is a deep thinker about the future of collaborative informatics and its role in personalized medicine.” Dr. Becich's election to the College recognizes these diverse and sustained contributions to the field. Dr. Clancy received her bachelor's degree in mathematics and chemistry from Boston College and her MD degree from the University of Massachusetts School of Medicine. She undertook postgraduate training in internal medicine, and was a Kaiser Foundation fellow at the University of Pennsylvania. She was a faculty member in the Department of Medicine at Virginia Commonwealth University from 1983 through 1990, and her first informatics research project at that institution demonstrated the impact of adding a reminder to a computerized provider order entry system related to use of pneumococcal vaccine in high-risk patients. In 1990 she joined the staff of the Agency for Healthcare Research and Quality (AHRQ) and rose to become director of AHRQ's Center for Primary Care Research, and Center for Outcomes and Effectiveness Research. Her success in these endeavors led to her appointment as director of the agency in 2003. As noted in her nomination, her stewardship of AHRQ continues to advance not only quality and patient safety, but also the realization of the value of health informatics. She brings to the College substantial experience at the intersection of quality, safety, and informatics. Dr. Classen received his bachelor's and MD degrees from the University of Virginia, undertook postgraduate training in internal medicine at the University of Connecticut, and an infectious diseases fellowship at the University of Utah. He then obtained a master's degree in medical informatics, also from the University of Utah. As an assistant and currently associate professor of medicine, he undertook a series of studies of adverse drug effects and medication safety, and helped develop computerized decision support tools for antibiotic selection that have had sustained impacts on improving outcomes and shortening inpatient length of stay. These studies have been widely cited in the national dialog regarding reduction of medical errors. In 1997 he was named Intermountain Health Care's Researcher of the Year, and in 2000 he joined First Consulting Group and there leads their safety and health care quality initiatives and consulting practice. His contributions to building programs that measure and improve the quality and safety of health care are recognized by his election to fellowship in the College. Dr. Corrigan received her bachelor's degree in social services from Syracuse, an MBA from the University of Rochester, and a master's degree in industrial and operations engineering and a PhD in health services organization and policy from the University of Michigan. She served with the Physician Payment Review Commission in Washington, the Group Health Association of America, and the National Committee for Quality Assurance, where she helped create the widely implemented Health Plan Employer Data and Information Set performance measures. She was a principal researcher at the Center for the Study of Health System Change, executive director of the President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry, and Senior Board Director for the Institute of Medicine Board on Health Care Services, which produced the “To Err is Human” and “Crossing the Quality Chasm” reports. She is now President and Chief Executive Officer of the National Quality Forum, and her election to the College recognizes these influential activities and contributions. Michael Becich Carolyn Clancy David Classen Janet Corrigan Robert Dolin Steven Downs Dr. Dolin received his bachelor's degree in biology from the University of California at San Diego, received his MD degree from University of California at Irvine, and did his postgraduate training in internal medicine at University of California at Los Angeles. His primary interests have revolved around “semantic interoperability” and the development of richly expressive models of health care that can be used to trigger advanced decision support functionality. He is a member of Kaiser Permanente's Convergent Medical Terminology Team and has been a sustained contributor to knowledge representation standards in health care, and is on the Health Level 7 (HL7) Board of Directors and the Systemized Nomenclature of Medicine International Standards Board. He is one of the chief architects of the evolving Health Level 7 Clinical Document Architecture. His election to the College recognizes these important and creative efforts in knowledge representation and communication standards development for biomedical data. Dr. Downs received is bachelor's degree in cellular biology and chemistry from the University of Colorado, and his MD from Stanford. He was also the first student to complete the Stanford Medical Informatics training program and received a master's degree in medical information science from Stanford in 1986, which he later supplemented with postgraduate training in pediatrics at the University of North Carolina. He was a Robert Wood Johnson scholar in clinical epidemiology at Chapel Hill, and began his faculty career there as a assistant and then associate professor of pediatrics and biomedical engineering. From 1997 to 2002 he was the principal investigator of the Duke–University of North Carolina biomedical informatics training grant. In 2001 he moved to Indiana University, where he is associate professor and chief of general pediatrics at Wishard and Clarian hospitals, and founding director of the Children's Health Services Research Section in the School of Medicine's Department of Pediatrics. His informatics research interests have ranged over many topics. These include using the expected value of information for a variety of purposes, such as the scoring of student performance on computer simulations (which has been adopted by the American Board of Family Practice as an examination scoring method for recertification) and use of expected value of information as a basis for prioritizing physician reminders. His election to the College recognizes these sustained contributions to informatics research and education. Dr. Elkin received his bachelor's degree in applied mathematics from Union College, his MD from New York Medical College, and was a National Library of Medicine (NLM) Research Fellow in medical informatics at the Laboratory of Computer Science at Mass. General Hospital. There he acquired a research interest in health data representation and controlled vocabularies. In 1996 he moved to Mayo Clinic and has risen through the ranks there to become Professor of Medicine. He is the primary author of the American National Standards Institute standard on Quality Indicators for Controlled Health Vocabularies, and has been an active contributor to HL7, the American Society for Testing and Materials E31 Bioinformatics standards group, the American Medical Informatics Association's education committee, the G-7 Enable Project, and the International Standards Organization TC215 Health Data Advisory Group. He was principal investigator for a recently completed NLM R01 research grant to determine the “utility of automated systems for large scale mapping of concepts to controlled terminologies, with the aim of establishing methods for more complete, accurate and uniform descriptions of encounters between clinicians and patients.” His election to the College recognizes these research and international standards development activities. Peter Elkin Arie Hasman John Holmes Robert Kolodner Mark Leavitt Harold Lehmann Wayne Peay Latanya Sweeney In 1995 the College created the new category of International Associates to honor the achievements of medical informaticians outside of North America who have had an important impact on medical informatics in this country, and throughout the world. In 2006 Arie Hasman, PhD, was a newly elected international associate. Dr. Hasman is Professor of Medical Informatics and Director of the Department of Informatics at the University of Amsterdam in the Netherlands. He has been a longtime contributor to the International Medical Informatics Association and the European Federation of Medical Informatics, and has an international reputation for his research in signal and image processing, clinical decision support, and medical informatics education. Dr. Holmes received his bachelor's degree in sociology from the University of Pennsylvania, a master's degree in information systems design and doctorate in information science from Drexel University. Beginning in 1982, he rose through the ranks of research staff of the Clinical Epidemiology and Biostatistics Unit at the University of Pennsylvania, and on the occasion of election to the College has a primary appointment in the University of Pennsylvania School of Medicine as Assistant Professor of Medical Informatics. Over the past two and a half decades Dr. Holmes has developed and taught courses in informatics and database management for clinical research and epidemiology. His research interests are in the areas of evolutionary computation and machine learning approaches to knowledge discovery in databases, information systems infrastructures for epidemiologic surveillance, clinical decision support systems, semantic analysis, and information systems user behavior. He has done innovative work in the use of game-based approaches to reducing delays in seeking care for suspected coronary syndrome and a game-based intervention for 4th to 6th graders to teach children about appropriate antibiotic use. He has led development of several computerized interventions for reducing health disparities in minority populations, and established a national-scale surveillance system for capturing data on children involved in motor vehicle crashes. Recently he has been applying methods from population-based surveillance to proteomic and genomic data for molecular and genetic epidemiology and the genetics of complex traits. His election to the College recognizes his sustained contributions to informatics research and education. Dr. Robert Kolodner received his bachelor's degree from Harvard and his MD degree from Yale. After a medical internship at New England Deaconess Hospital he was a Clinical Fellow in Medicine at Harvard, and then completed his psychiatric residency at Washington University School of Medicine in St. Louis. He rose through the ranks of the VA informatics hierarchy, serving as Director of Medical Information Resources Management and Associate Chief Information Officer, and at the time he was nominated to the American College of Medical Informatics fellowship he was Chief Health Informatics Officer for the Veterans Health Administration (VHA) in the Department of Veterans Affairs (VA), Washington, DC. Over the course of his career, Dr. Kolodner has profoundly influenced the field of clinical information systems contributions to the VA Decentralized Hospital Computer Program (DHCP) and the Veterans Health Information Systems and Technology Architecture (VistA). As noted in his nomination, the VA is widely recognized as one of the leaders in systems approaches to health care delivery due in significant part to Dr. Kolodner's vision, thought leadership, and day-to-day guidance. Shortly after the College election, the President George W. Bush named Dr. Kolodner as Acting Director of the Office of the National Coordinator for Health Information Technology, succeeding Dr. David Brailer. Dr. Kolodner's election to the College recognizes these sustained contributions that have had a national impact. Dr. Leavitt received his bachelor's degree in electrical engineering from the University of Arizona, master's and PhD degrees in electrical engineering from Stanford, and an MD degree from the University of Miami School of Medicine. He undertook postgraduate training in internal medicine at Oregon Health and Science University. While practicing as an internal medicine physician he founded MedicaLogic, and served as its CEO and chairman until the company was acquired by GE Healthcare Information Technologies. He has been active in American Medical Informatics Association and Healthcare Information and Managements Systems Society professional societies, and served as advisor to the Markle Foundation “Connecting for Health” program and iHealth Initiative. He has a faculty appointment in the Department of Medical Informatics and Clinical Epidemiology at Oregon Health and Science University. Dr. Leavitt's vision for clinical systems led to MedicaLogic's groundbreaking electronic medical records applications, and his vision and accomplishments have been recognized by his appointment as the founding Chair of the President's Certification Commission for Healthcare Information Technology. His election to the College recognizes these sustained and influential contributions. Dr. Lehmann received his bachelor's and MD degrees from Columbia. After postgraduate training in pediatrics in New York and at Johns Hopkins, he received his PhD in medical information sciences from Stanford. He is currently Associate Professor of Pediatrics, Health Sciences Informatics, and Health Policy and Management at Johns Hopkins, and Director of Research and Training in Hopkins' Division of Health Science Informatics. Dr. Lehmann has published influential studies on Bayesian communication, which is the use of the Bayesian paradigm and Bayesian statistics to the interpretation and application of research data to local decision making, and also the application of Bayesian reasoning and decision analysis to systematic reviews of the literature, and application of decision analysis to pediatric clinical problems. As principal investigator of the NLM medical informatics training grant at Johns Hopkins, he has been a proponent of new curricula and informatics education for all medical students, not only those seeking graduate degrees in our field. He has chaired American Medical Informatics Association's Education Working Group and been a member of the American Association of Medical Colleges medical school objectives project. His election to the College recognizes his innovative research and sustained contributions to the education of health professionals. Wayne Peay received his bachelor's in history from the University of Utah and master's of library science from Columbia, while serving as Assistant Director of the Data Processing Department of the Medical Library Center of New York. He returned to the University of Utah, was appointed to a series of positions of increasing responsibility at the Eccles Health Sciences Library, and has been the library director there since 1984. Since 2001 he has also been the Director of the Midcontinental Regional Medical Library of the National Network of Libraries of Medicine. As noted in his nomination to the College, Wayne Peay has been a prime mover in virtually every initiative to use computers and networking technology to support education and improve information services in the state of Utah—conceiving the projects, obtaining the grant funds, overseeing implementation, and managing the inevitable stresses among participating organizations with very different missions and priorities. He has effectively deployed successive generations of new technologies, almost always on the leading edge of adoption and with a number of notable successes that predated broad Internet access and the development of the Internet. These efforts have improved access to high-quality health information in academic centers, community hospitals, public libraries, and other tribal and local organizations serving diverse populations. He has implemented the technical and interorganizational connections that are essential to delivering the promise of medical informatics. These efforts have been recognized by his election as a fellow of the Medical Library Association, inclusion on the National Honor Roll of the American Library Association, and now by election to the American College of Medical Informatics. Dr. Sweeney received her bachelor's degree in computer science from Harvard, and master's and PhD degrees in computer science from Massachusetts Institute of Technology. As a graduate student she won awards at the American Medical Informatics Association in 1996 and 1997 for her work on text de-identification, and was influential in crafting the data de-identification provisions of the Health Insurance Portability and Accountability Act Privacy Rule. She is the founding director of the Laboratory for International Data Privacy at Carnegie Mellon, where she is an associate professor of computer science, technology, and policy. She has developed numerous algorithms for data de-identification and re-identification. In addition to her scholarly publications, Dr. Sweeney's ground-breaking research in data privacy has been featured in Consumer Reports, Newsweek, Newsday, Business Week, and The Wall Street Journal, as well as on the television news magazine 20/20. Her vision and analytic approach to this emerging field have created a well-deserved international reputation, and serve as the basis for her election to the College.

“Lan” Aronson received his bachelor's degree in mathematics magna cum laude from the University of Washington in Seattle, a master's degree in mathematics, and both master's and Ph.D. degrees in computer science from the University of Maryland. He has been a computer scientist at the National Library of Medicine's (NLM) Lister Hill National Center for Biomedical Communications since 1988. Alan R. Aronson Alan R. Aronson In a highly productive research program, he has developed a broad array of applications that use the Metathesaurus and other UMLS (Unified Medical Language System) knowledge components. Among these are MetaMap, which is a program that automatically maps text to concepts in the Metathesaurus, and a Medical Text Indexer System, which produces automated MeSH indexing of meeting abstracts and suggests appropriate MeSH headings to NLM's MEDLINE indexers. He also developed a Natural Language Processing (NLP) subset tag that has been incorporated into the Metathesaurus assist NLP researchers. Dr. Aronson's election to the College recognizes the substantial impact his innovations have had on the productivity of other researchers, and the utility of NLM's global information services. Dr. Bodenreider received his MD degree from the University of Strasbourg, France; a research degree in informatics, statistics and epidemiology; a master's degree in computer science and another one in medical information; and a PhD in medical informatics, all from the Henri Poincaré University. He began his career as a junior faculty member in France, working on the informatics of clinical toxicology and took a sabbatical year at the NLM. He has been there ever since, working as a staff scientist within the Lister Hill National Center for Biomedical Communications. Olivier Bodenreider Olivier Bodenreider His work has focused on applications of the UMLS. He has developed concept mapping algorithms that are used in national information resources, such as ClinicalTrials.gov, Genetics Home Reference, and Profiles in Science. His algorithms are also embedded in the production indexing aid system used by NLM indexers to index the biomedical literature for MEDLINE. He has been a prolific author, with 55 peer-reviewed publications over the past 15 years. He is widely recognized for his work in biomedical ontologies and has, in recent years, become increasingly involved in bioinformatics, making him an ideal contributor to ACMI's goal of more closely integrating the fields of clinical/medical informatics and bioinformatics. These skills and contributions to the field are recognized by his election to the College. Steven Brown received his bachelor's and MD degrees from Brown University. After internship and residency in internal medicine at Emory University, he joined the faculty at Emory and became involved in the creation of Emory's Computerized Record system named THERESA. His interest in informatics led him to an NLM-sponsored medical informatics fellow at Vanderbilt, and he received his master's degree in biomedical engineering in the years before biomedical informatics became an academic department. He is currently an associate professor of biomedical informatics at Vanderbilt. Steven H. Brown Steven H. Brown Steve has a long-standing relationship with the Veterans Administration (VA), having served as the Chief Information Officer of the Tennessee Valley VA, while becoming increasingly involved at the national level with data standards relevant to VA clinical systems. This includes serving as the VA representative to the federal Government Computerized Patient Record Framework project (GCPR) and being the national project leader for the VA's efforts to create standard drug reference terminologies. He was team leader for the RADARx project that developed automated methods for adverse drug event discovery, which received a VA national safety award. He also directs the national VA Compensation and Pension Exam Program (CPEP). CPEP is program dedicated to improving the quality of veteran's disability examinations via applied informatics and traditional quality improvement techniques. This program performs 500,000 examinations and distributes over $30 billion per year based on the results. Dr. Brown's sustained contributions have advanced a systems approach to health care within the VA that has had a favorable impact on the care of literally millions of VA beneficiaries, and his ongoing work is advancing the cause of interoperability for a true National Health Information Infrastructure. This scope and effect of his work is recognized by his election to the College. Dr. Effken received her bachelor's in psychology from the University of Hartford, a master's in nursing, and a PhD in psychology from the University of Connecticut. Juddith A. Effken Juddith A. Effken She worked as a staff nurse in several health care organizations and began her “informatics journey” as a hospital information system consultant in the mid-1980s. She moved from Connecticut to join the faculty of the University of Arizona College of Nursing in 1995, where she is currently an associate professor. Her research has been in several areas, including the application of ecological psychology to help refine clinical system user interfaces to improve recognition of critical events and reduce errors. She also introduced to nursing the use of computational modeling to address organizational change over time and simulate the effect of patient safety and quality innovations in a virtual environment. Her paper describing this method won the 2004 Harriet Worley award for contribution to the field of nursing informatics. She led the development of an online nursing doctoral program, and chairs the AMIA Nursing Workgroup task force that has obtained a Standard Occupational Code for Nursing Informatics from the U.S. Bureau of Labor Statistics. Her election to the College recognizes her substantial and sustained contributions to nursing informatics. Professor Rolf Engelbrecht directs the National Research Center for Environment and Health in Neuherberg, Germany. He is a past president of the European Federation for Medical Informatics and past vice president of the International Medical Informatics Association (IMIA) and Artificial Intelligence in Medicine, Europe. Dr. Engelbrecht has, over many years, investigated the use of “smart cards” as portable electronic medical records. He is a longstanding scholar, teacher, and author in biomedical informatics. Professor Engelbrecht is elected as an International Associate in recognition of the broad scope of impact of his efforts in advancing the art and science of biomedical informatics in Europe and worldwide. Rolf Engelbrecht Rolf Engelbrecht Dr. Florance received her bachelor's degree in medical anthropology from the University of Utah, a master's degree in library from Brigham Young University, and a PhD in information and library science from the University of Maryland. She has held medical library administrator positions at the University of Utah, Johns Hopkins, and the University of Rochester. She was project director for the Better Health project of the American Association of Medical Colleges (AAMC) and served as principal investigator of the Next Generation IAIMS project supported by NLM and conducted by AAMC to gather the lessons learned from the IAIMS program and guide its further evolution. Valerie Florance Valerie Florance She joined NLM in 2001 and is now Deputy Director of Extramural Programs. In this capacity, she is responsible for all NLM research grants relevant to clinical informatics and consequently plays a critical role in advising applicants, following applications through review, selecting applications for funding, and monitoring the progress of awarded grants. Valerie, along with Frank Davidoff, wrote a landmark paper on the new job category of informationist and was a member of the Medical Library Association's Informationist Task Force. Her election to the College recognizes these sustained and varied contributions to the field. Paul received his bachelor's degree in biological sciences from the University of Chicago and his MD from Rush Medical College. He completed postgraduate training in internal medicine at Rush Presbyterian and the VA Medical Center in Portland, OR. He is currently an associate professor in the Department of Medical Informatics and Clinical Epidemiology and Department of Medicine, Oregon Health & Science University and Assistant Director of Medical Education, Providence Portland Medical Center. Paul Gorman Paul Gorman Dr. Gorman is internationally known for his research on the information needs, information seeking, and information use (ISU) by clinicians. He significantly expanded understanding of ISU in health care by emphasizing primary care and especially rural primary care, by including nonphysician clinicians. Dr. Gorman expanded on conventional notions of information seeking by clinicians in his National Science Foundation–funded project entitled “Tracking Footprints in an Information Space.” He has worked with ACMI Fellow Joan Ash and other colleagues on the design and conduct of a multisite, multidisciplinary observational research program on physician order entry that has on an ongoing basis documented its limited application in U.S. hospitals. Dr. Gorman has been successful at applying concepts and skills of informatics research to the emerging patient safety agenda, as Principal Investigator or Co-investigator on four Agency for Healthcare Research and Quality–funded patient safety projects, including a current project focused on “Using IT to Improve Medication Safety for Rural Elders.” For these varied and substantial contributions to the field, he is recognized by election to the College. Robert Jenders received his bachelor's degree in computer science from Marquette University, his MD from the University of Wisconsin, and a master's degree in computer science from Northeastern University. After a fellowship at Massachusetts General Hospital, he joined the faculty at Columbia University, and for the past three years has been an associate professor of medicine at UCLA while practicing at Cedars Sinai in Los Angeles. Robert Allen Jenders Robert Allen Jenders Dr. Jenders began his work with Arden Syntax shortly after its initial publication as an ASTM standard in 1992 and has led efforts for its continued development as well as promoting its use by vendors and health care institutions. He has been the cochair of the Health Level 7 Clinical Decision Support Technical committee since 1998. Over this time, this committee has expanded its area of influence considerably to include several other key clinical decision support technologies including the “Infobutton,” computable guidelines, and order sets in addition to ongoing development and dissemination of the Arden Syntax. Dr. Jenders developed a multihospital immunization registry (EzVac) in New York City that facilitated data sharing among the participating institutions and with local government to allow better delivery of vaccination services. This work was reflected in his membership of the Workgroup on Immunization Registries of the National Vaccine Advisory Committee that published a national action plan in 1999. This work continues through participation in the technical working group of the National Immunization Program. His election to the College recognizes these varied and sustained contributions to the field. Holly Jimison received her bachelor's degree in mathematics from the University of Illinois, and her PhD in medical information science from Stanford University. She has been at the University of Oregon Health & Science University in Portland for the past 13 years in various capacities and is currently associate professor of medical informatics and clinical epidemiology there. Holly Brügge Jimison Holly Brügge Jimison Her research interests have ranged over a wide area, including methods for representation of probabilities and utilities within decision support applications, development of pattern recognition algorithms for automated electrocardiography analysis and ultrasound tissue characterization, adaptive algorithms for control of ventilators, use of multimedia for improving the informed consent process, and consumer health informatics. She is currently attempting to invent a new subspecialty of informatics named neural informatics, which is the understanding of how information processing occurs in the central nervous system. She is also is principal investigator of a research project entitled “Technology for Early Detection and Intervention of Cognitive Decline.” Her election to the College recognizes the depth and breadth of her varied contributions to the field. Dr. Lussier received his bachelor's degree in mechanical engineering and MD degree from the University of Sherbrooke in Canada and also completed postgraduate training in family medicine there. He then joined the family medicine faculty at Sherbrooke. He cofounded an electronic medical records company called Purkinje and began his informatics career developing and evaluating pen-based computer interfaces for clinical data. He helped extend the SNOMED vocabulary to add terms related to primary care and created the notion of semantic filters for problem-oriented views of medical records. Yves A. Lussier Yves A. Lussier With the human genome project underway, Yves saw that the future of medicine was going to be influenced by genomics and other forms of large volume, noisy molecular data. He is currently involved with the emerging specialty of “phenomics,” which is the systematic correlation of known chemical and functional properties of organisms with their genes and proteins. He has also engineered a gene chip for vertebrate viral detection that accurately detects any of over 1,700 known viruses that is currently being validated in China and Australia. His election to the College recognizes his scholarly, pragmatic, and community service contributions to the field. Judy Murphy is currently Vice President for Information Services at Aurora Health Care in Milwaukee, an integrated delivery network with 14 hospitals, 100 ambulatory centers and clinics, three home health agencies, and over 25,000 employees. Judy is a registered nurse by clinical training, and she created the now commonplace concept of charting by exception, which paved the way for efficient electronic record keeping by nurses. She consistently focuses on the perspective of the practicing nurse in the “applied” nursing informatics arena and possesses significant self-taught, real-life experience that enables her to consistently bridge the academic/practice gap. She effectively brings forth the voice of nursing into the operations of clinical information systems design and deployment. Judy Murphy Judy Murphy In her current role as Vice President, Information Services for a large integrated delivery network, Ms. Murphy leads a workforce of more than 125 in translating new informatics ideas into practical information systems. Additionally, for over ten years, Ms. Murphy has been teaching clinicians in project management through workshops at AMIA, Medinfo, Healthcare Information Management Systems Society, the International Nursing Informatics Congress, and other health information technology conferences. Her election to the College recognizes her contributions to organizational and technology management in health care settings. Dr. Rindflesch received his bachelor's degree in Arabic and master's and PhD degrees in linguistics, all from the University of Minnesota. He then went to the Lister Hill National Center for Biomedical Communications, where he has been working as a computational linguist since 1991. There he has developed and demonstrated the effectiveness of techniques for combining relatively simple “minimum commitment” (otherwise known as “shallow”) text parsing with electronic domain knowledge to extract domain concepts and interpret their relationships in biomedical text. Thomas C. Rindflesch Thomas C. Rindflesch Dr. Rindflesch has worked effectively with a wide variety of collaborators to make steady progress on developing programs that extract usable semantic information from text and has made his tools readily available for use by other researchers. He has also applied them to operational systems at the NLM, for example, using natural language processing techniques on the published clinical trials literature to audit compliance with registration of National Institutes of Health clinical trials in ClinicalTrials.gov. Dr. Rindflesch's election to the College recognizes the substantial impact his contributions have had on the productivity of other researchers and on the increasing value of NLM's global information services. Nancy received a bachelor's degree in mathematics and science from the University of Dayton and a master's degree in library science from the University of Maryland. She began a career of creating and evaluating informatics systems and services as a coauthor of an evaluation of NLM's prototype Hepatitis Knowledge Base system in the late 1970s. She was appointed as IAIMS System librarian at Columbia University, later served as Director of the Cushing/Whitney Medical Library at Yale, and is now Director of the Welch Medical Library. Nancy K. Roderer Nancy K. Roderer She has been a prime mover in the establishment of the Division of Health Information Sciences at Johns Hopkins University, where she is associate professor and currently interim director, which was designed to include public health issues from its inception. Her work positioned the University to compete successfully for an NLM Informatics Training Grant and, most recently, for Robert Wood Johnson funding for a Public Health Informatics Track within this broader training program. Her election to the College recognizes sustained contributions to the field for more than 25 years. Dr. Sharar received his MD from the Hebrew University and his PhD in medical information sciences from Stanford University. He also completed a master's degree in mathematics and computer science from Bar Ilan University and a second master's degree in computer science from Yale University, with an emphasis on artificial intelligence. Yuval Shahar Yuval Shahar In 1985, Dr. Shahar was appointed head of the Medical Computing Section of the Israeli Defense Force, working on strategic decision-support system connecting 32 hospitals. His first relevant journal paper appeared in 1991, and he has made continuous contributions ever since. He has served as the founding director of the Ben Gurion University Multidisciplinary Medical Informatics Research Center since 2000. Dr. Shahar has developed many ideas important to computer-based decision support and reasoning about clinical data that have become influential in the informatics community. His work on temporal abstraction of clinical data is well-known in both the informatics community and the computer-science community and has been incorporated in a number of deployed applications. His work on a computational knowledge-based framework known as RÉSUMÉ for automated abstraction of time-oriented data into meaningful, time interval–based concepts system is at the core of the query and interpretation module of Stanford University's EON system for guideline-based care, and has become the backbone of several new projects that Dr. Shahar has started at Ben Gurion University for mediation of temporal queries to patient databases over the Web for diagnosis, monitoring, therapy, and clinical research, which is a nice thing to have on your resume. He has also made substantial contributions to the field of computer-based clinical guidelines, is a member of the editorial board of several informatics journals, and an organizer of international symposia on artificial intelligence in clinical care. In recognition of the broad scope of impact of his academic efforts, the College honors Dr. Shahar as an international associate. Dr. Westbrook is Deputy Director of the Center for Health Informatics and Associate Professor of Health Informatics at the University of New South Wales. She has had an illustrious career of research in the areas of online evidence retrieval systems, health informatics evaluation, technology assessment, and health care evaluations through the manipulation and analysis of large health data sets. She is a fellow of the Australian College of Health Informatics and is now honored for the international influence of her work by election as an International Associate. Johanna Westbrook Johanna Westbrook

SUMMARY: 2HAPI (version 2 of High density Array Pattern Interpreter) is a web-based, publicly-available analytical tool designed to aid researchers in microarray data analysis. 2HAPI includes tools for searching, manipulating, visualizing, and clustering the large sets of data generated by microarray experiments. Other features include association of genes with NCBI information and linkage to external data resources. Unique to 2HAPI is the ability to retrieve upstream sequences of co-regulated genes for promoter analysis using MEME (Multiple Expectation-maximization for Motif Elicitation) AVAILABILITY: 2HAPI is freely available at http://array.sdsc.edu. Users can try 2HAPI anonymously with pre-loaded data or they can register as a 2HAPI user and upload their data.

William W. Stead, MD, recently completed a decade of service to AMIA and to our profession as the founding editor of the Journal of the American Medical Informatics Association. We, the associate editor group who worked under him, take this opportunity to thank him for his profound contributions. Dr. Stead imparted a number of important characteristics to the editorship and to JAMIA by demonstrating: A massive, passionate commitment to moving the field forward through dissemination of scholarship and innovation. A commitment to scientific rigor and quality of publication, sometimes at the expense of decreased page count. A strong desire to represent the breadth and depth of this multidisciplinary field. A long view on the course of events, favoring broad perspectives over provincial ones. A palpable, deep and genuine respect extended to every author and reviewer, often expressed through tactful, direct, and honest feedback. An ability to find the kernel of good and truth in almost any paper and to help authors find it also—sometimes by working with authors to rewrite manuscripts interactively. A polite but persistent approach to editorial disagreements, combined with a polite and good natured acceptance of editorial advice, even when it differed from his perspective. A ready opinion—usually strongly held, on any topic—balanced by a willingness to remodel himself and his skill set to adapt to changing times. Bill Stead has been a visionary leader in biomedical informatics. He has brought extraordinary perspective and insight into creating a new journal “from scratch.” In an era when academic “triple threats” are said to be nearing extinction, he has shown that one can still understand and support clinical practice, conduct research and build an academic enterprise and contribute to excellent institutional management. One of his favorite expressions is, “We shouldn't do it if it isn't scalable and sustainable,” which he has applied both to development of informatics systems at Vanderbilt, and to practices within JAMIA. His keen business sense has helped to make JAMIA a break-even endeavor for the American Medical Informatics Association from its inception. His experience in team building has led to a cohesive and coordinated editorial board and staff that turns around submissions with exemplary efficiency. And on top of all that, he has big shoes. In recognition of his pioneering leadership, the American Medical Informatics Association will initiate a Janet and Bill Stead Lectureship (details forthcoming later). Thank you, Dr. Stead, for creating the “industry standard” for excellence in medical informatics editorial leadership.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) carried with it the expectation that compliance would be complete by April 14, 2003. The act includes provisions for Privacy and Security of personal health information as well as for electronic standards for communicating claims data and unique identifiers for health care providers and organizations. Most pertinent to JAMIA are the regulations regarding transmittal of personal patient information. It is important to note that these guidelines apply principally to Protected Healthcare Information (PHI), defined as “a subset of individually identifiable health information (IIHI) that is maintained or transmitted in any form … and relates to the past, present, or future physical or mental condition of an individual; provision of health care to an individual, or payment for that health care; and identifies or could be used to identify the individual.”1 While protecting patient privacy is important, it is also imperative that health care researchers be able to present data to support claims. In order to comply with HIPAA, JAMIA requires that all authors “de-identify” patient information in their text, tables, and figures, by deleting (or replacing with permuted data) the following from any part of the manuscript that contains patient information: Names All geographic subdivisions smaller than a state, including street address, city, county, precinct, zip code, and their equivalent geocodes, except for the initial three digits of a zip code if, according to the current publicly available data from the Bureau of the Census: (1) The geographic unit formed by combining all zip codes with the same three initial digits contains more than 20,000 people; and (2) The initial three digits of a zip code for all such geographic units containing 20,000 or fewer people is changed to 000. All elements of dates (except year) for dates directly related to an individual, including birth date, dates of admission, discharge, tests or procedures, date of death; and all ages over 89 and all elements of dates (including year) indicative of such age, except that such ages and elements be aggregated into a single category of 90 or older. Telephone and/or fax numbers Electronic mail addresses Social security numbers and/or medical record numbers Health plan beneficiary numbers Account numbers Certificate/license numbers Vehicle identifiers and serial numbers, including license plates Device identifiers and serial numbers Patient-related Web Universal Resource Locators (URLs) Internet Protocol (IP) address numbers Biometric identifiers, including finger and voiceprints Full face photographic images and any comparable images Any other unique identifying number, characteristic, or code In addition, JAMIA authors must alter any identifying patient information, such as diagnostic indicators present in a patient problem list, when the combination of attributes might uniquely identify an individual.

OBJECTIVE: The Patient-Centered Access to Secure Systems Online (PCASSO) project is designed to apply state-of-the-art-security to the communication of clinical information over the Internet. DESIGN: The authors report the legal and regulatory issues associated with deploying the system, and results of its use by providers and patients. Human subject protection concerns raised by the Institutional Review Board focused on three areas-unauthorized access to information by persons other than the patient; the effect of startling or poorly understood information; and the effect of patient access to records on the record-keeping behavior of providers. MEASUREMENTS: Objective and subjective measures of security and usability were obtained. RESULTS: During its initial deployment phase, the project enrolled 216 physicians and 41 patients; of these, 68 physicians and 26 patients used the system one or more times. The system performed as designed, with no unauthorized information access or intrusions detected. Providers rated the usability of the system low because of the complexity of the secure login and other security features and restrictions limiting their access to those patients with whom they had a professional relationship. In contrast, patients rated the usability and functionality of the system favorably. CONCLUSION: High-assurance systems that serve both patients and providers will need to address differing expectations regarding security and ease of use.

Abstract Motivation: High-density microarray technology permits the quantitative and simultaneous monitoring of thousands of genes. The interpretation challenge is to extract relevant information from this large amount of data. A growing variety of statistical analysis approaches are available to identify clusters of genes that share common expression characteristics, but provide no information regarding the biological similarities of genes within clusters. The published literature provides a potential source of information to assist in interpretation of clustering results. Results: We describe a data mining method that uses indexing terms (‘keywords’) from the published literature linked to specific genes to present a view of the conceptual similarity of genes within a cluster or group of interest. The method takes advantage of the hierarchical nature of Medical Subject Headings used to index citations in the MEDLINE database, and the registry numbers applied to enzymes. Availability: We have created a publicly accessible website that provides this form of gene expression interpretation at http://www.array.ucsd.edu. Contact: [email protected] 8 To whom correspondence should be addressed at: University of California, San Diego School of Medicine, 9500 Gilman Drive, La Jolla, CA 92093-0602, USA. 7 Present address: Genomics Institute of the Novartis Research Foundation, 3115 Merryfield Row, San Diego, CA 92121, USA.

For those of us who have dedicated our careers to medical informatics, it is easy to feel over-stimulated in the current times. Moore's Law has seemingly been generalized, beyond the hardware we use, to embrace every aspect of our professional lives. Opportunities to apply our science seem to double annually, in ways unforeseeable as recently as five years ago. A field that once was clearly focused on systems to support the care of hospitalized and clinic patients has extended its reach to health information resources for consumers, systems to enhance and protect public health, and systems that support research in genomics and proteomics. We have spawned subfields denoted by prefixes or qualifying phrases, such as “public health informatics,” to mark this trend. Moreover, a field that was solidly rooted in academic medical centers now finds professional representation in for-profit corporations both large and small, in government agencies, and in foundations and professional societies. The field has acquired a distinct entrepreneurial spirit, not at all unwelcome but somehow new and unfamiliar. As our relatively small field engages new problems in new settings, these novel activities are accompanied by an inevitable sense of dilution reflected in specific concerns about our collective future. If we expand our representation into new and diverse environments—as informatics engages Big Science, Big Government, and Big Industry—will there be a sufficient number of us in each of these environments to be influential? Will we retain our own culture or will we dissolve into the cultures of these expanding work settings? Will the information technology deployed in these settings build on the generalizable solutions we have developed and the experience we have accrued, or will these solutions be reinvented? Reflecting this concern, our name—“informatics”—has metamorphosed into something novel and unintended: in many circles “informatics” is coming to mean “anything one does with a computer” in contrast to the more specific research and development connotations that most readers of this journal would attach to the name. So, according to this novel conception, the authors of this manuscript are “doing informatics” as we compose the text using word processing software on our personal computers. It is, indeed, a strange and unsettling time, as many in the field of informatics worry about becoming irrelevant and losing our identity, while the appropriation of our name by most of the rest of the world might suggest that we are more important than ever. Whatever path we take, the future of medical or health informatics is evidently not going to be a straightforward evolution from the past. Under such circumstances, one completely understandable response is a xenophobic circling of the professional wagons, consolidating our identity around a set of very familiar clinically oriented problems as they manifest themselves in academic environments. Another response sees these torsions and exertions as an extraordinary opportunity to take a prominent role in leading biomedicine to wherever it may be headed, wherever that requires us to work. Such concerns are the non-exclusive purview of the elected fellows of the American College of Medical Informatics and established the theme of the College's 2001 Symposium. The stated theme of the symposium was “ACMI.com: The ‘Business' of Informatics in the 21st Century.” This theme, from the outset, was intended to be more metaphoric than literal, above all capturing the spirit of the times in which we live and work. If interpreted literally, the theme captured only a few aspects of the multifaceted changes affecting the field. As discussions occurred during the symposium, scientific, sociologic, and professional issues in the evolution of informatics overtook the business focus implicit in the program title. The symposium's broader points of departure, as stated in the formal call for participation, spanned multiple interrelated trends currently influencing the field: The emergence of “dot coms,” new information technology companies fueled by readily available venture capital that have attracted several prominent researchers from academe to the private sector An increased interest in information resources directly serving the needs of health care consumers The rapid development of the field of bioinformatics, applying information technology to computational problems in modern molecular biology The evolution of mega-systems of health care, and the corresponding emergence of the technologic challenge of integrating information systems across multi-billion-dollar businesses The appearance of a new generation of vendor products, including sophisticated electronic health record systems with intelligent features that had previously been available only to a small number of medical centers that had developed such systems locally The gradual emergence of new business procedures and policies governing health care, requiring care-providing organizations to acquire sophisticated information systems to support administrative and financial aspects of their operations The increasing interest in information systems addressing the health of identified populations, directing the development of information systems to monitor the health states of intact regions, and allowing early intervention in the event of disease outbreaks The symposium activities were designed to acknowledge formally, describe crisply, and analyze insightfully the implications of these sweeping changes, for the College specifically but also for AMIA and the field of medical informatics as a whole. To this end, the symposium's 3 days were organized into a flexible sequence of activities to promote shared understanding of the theme and its importance; to develop a set of more specific topics, not specified in advance, for detailed exploration; and ultimately to allow the participants to explore these more detailed topics and develop conclusions. The nature of the symposium theme led us to embellish the group, traditionally a self-selected set of ACMI fellows, with an experienced person from outside ACMI, to provide additional perspectives. We were fortunate that Dr. Bruce Hochstadt, a principal at Thomas Wiesel Partners, was able to join the 36 ACMI fellows in attendance. Dr. Hochstadt's primary professional concerns are health care information, services, and e-health companies. Dr. Hochstadt was a panelist in the symposium's opening session, contributed to the small-group discussions, and offered a summary perspective at the close of the proceedings. His participation enriched the discussions and lent external validity to the conclusions that emerged from the event. On the initial day of the symposium, an opening panel, moderated by Judy Ozbolt, explored the “changing milieu of informatics.”* Judy's introductory remarks framed the presentations and discussions that followed: What events and developments that we already see will strongly shape the future of health care and medical informatics? How should we respond? What business opportunities hold real promise for bringing the benefits of medical informatics to consumers and clinicians? And what surprise development is lurking over the horizon that may revolutionize again what is possible, what is desirable, and what is necessary? The panelists addressed these questions in the context of an initial set of four themes that had been identified in advance—modern biology, academic medical centers, e-health, and the business of health care. Subsequent deliberations in small groups addressed these same four themes. Following the group sessions, one member from each group prepared a summary on newsprint of the group's findings. These were on display as part of an informal poster session over breakfast the following morning. The second day of the symposium began with an address by Dan Masys, “Beyond the EMR: The Problems Needing Us to Solve.”† Dan's address spawned four themes that spanned and reorganized the ideas introduced on the first day. These themes subsequently became the organizing framework for further discussions and the presentation of the symposium's findings—1) genome-enabled science and health care, 2) education to reduce reliance on memory and opinion, 3) system-mindedness and error reduction, and 4) moving beyond the “guild mentality” in health care and education. Each theme was explored by small groups on the second day, with a poster session to report and share these deliberations on the morning of the symposium's third day. The third day was devoted to further exploration of these themes. We offer as the symposium's central findings an explication of each theme along with some elements of an action agenda for the field of informatics, to include members of AMIA and ACMI. This report's focus on four principal themes, while eliminating many details and side issues that arose during the event, captures the core of what was discussed. The “acmi.com” metaphor became more implicit as the discussions unfolded. Implicit in this exposition is a rejection of wagon-circling in response to the excitement of the current times. Instead we suggest—as an antidote to over-stimulation, differentiation, and dilution—focused attention on a core mission that can be expressed in terms of themes. Such focus can preserve and consolidate the field's identity while promoting substantial research and development to advance the health of the public through direct clinical care, biomedical research, and programs of education. The four themes discussed at the symposium and explicated below are not an exhaustive list, but rather a starting point, and perhaps a rallying-point for a field in serious danger of losing its way. Inevitably, a new and different culture of informatics will emerge as action related to these themes occurs in new organizational contexts and diversified workplaces. Genomic science can be seen in two ways—as a structural component to map the genome and thus understand nature's blueprint for biological action, and, as we increasingly understand how these molecular signatures affect living systems in action, as a functional component. With the structural map of many organisms now complete, we are moving beyond a primary focus on molecular sequence and well into the era of functional genomics, which now makes it possible to identify molecular signatures of specific diseases. Microarray technology to measure gene expression, the primary scientific apparatus of functional genomics, generates data that are multi-dimensional and noisy. Current analytic methodology, using statistical clustering algorithms and manual identification of gene loci, is crude but nonetheless has identified some important linkages between the approximately 10,000 known human genes, with 20,000 known expression patterns, and a small number of diseases such as large cell lymphoma for which gene expression is strongly predictive of prognosis.1 A next generation of analytic tools for functional genomics envisions the simultaneous measurement of the expression patterns of all the approximately 35,000 genes that the human genome is expected to comprise. These tools would automatically find correlations between gene expression patterns and normal metabolic homeostasis, nonspecific reactions to disease stimuli, and specific disease states. These correlations, in turn, will enable a next phase of genomics, “personal genomics,” whereby the gene maps of individuals can be used to diagnose risks and states of illness and to plan therapy. With a few exceptions, the community of scientists traditionally associated with medical informatics has not played a significant role in the work of structural genomics. This can and should change as we proceed into the eras of functional and personal genomics, because these eras require linkage of molecular data with “person data,” the traditional purview of our field. Moreover, the challenges to create ontologies that promote understanding of the problems to be solved, to build systems that are scalable to the magnitude of the computational challenges that the functional genomics problem creates, to identify new algorithms that offer efficient and creative solutions to the computational problems at hand, and to reconcile the various vocabularies used to represent information are challenges that medical informatics has addressed in the past. 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The 1999 debate of the American College of Medical Informatics focused on the proposition that medical informatics and nursing informatics are distinctive disciplines that require their own core curricula, training programs, and professional identities. Proponents of this position emphasized that informatics training, technology applications, and professional identities are closely tied to the activities of the health professionals they serve and that, as nursing and medicine differ, so do the corresponding efforts in information science and technology. Opponents of the proposition asserted that informatics is built on a re-usable and widely applicable set of methods that are common to all health science disciplines, and that "medical informatics" continues to be a useful name for a composite core discipline that should be studied by all students, regardless of their health profession orientation.

The American College of Medical Informatics is an honorary society established to recognize those who have made sustained contributions to the field. Since its founding in 1984, 170 fellows have been elected to the College. Its highest award, for lifetime achievement and contributions to the discipline of medical informatics, is the Morris F. Collen, MD, award. Dr. Collen's own efforts as a pioneer in the field stand as the embodiment of creativity, intellectual rigor, perserverence, and personal integrity. And so it is that the College gives its highest recognition to those whose attainments have, throughout their careers, substantially advanced the science and art of medical informatics. The College is proud to announce that the 1997 recipient of the Collen award is Dr. Donald A. B. Lindberg. Born of Swedish–American parents in 1933, Don Lindberg grew up in Brooklyn, New York. An honors graduate of the Polytechnic Prep School in Brooklyn, he attended Amherst College, where he majored in applied mathematics and graduated magna cum laude in 1954. He returned to New York to attend the College of Physicians and Surgeons of Columbia University, and received his Doctor of Medicine degree in 1958. After an internship and residency in pathology at Columbia Presbyterian Medical Center, he joined the pathology department faculty of the University of Missouri School of Medicine in Columbia, Missouri, in 1960. With the support of Dr. Vern Wilson, Dean of the School of Medicine, young Dr. Lindberg was soon engaged in the unprecedented activity of computerizing the clinical pathology laboratory services for the medical center. He developed applications to improve the speed, quality, and consistency of laboratory results reporting. He developed expert systems to assist in pathologic diagnosis and began publishing articles in the field that would become known as Medical Informatics. By the mid-1960s, he had garnered an international reputation as an expert in the use of computers in medicine. The establishment of the federal Regional Medical Programs (RMP) initiative in the 1960s provided Dr. Lindberg and the University of Missouri RMP coordinator, Dr. Arthur Rickli, the opportunity and the resources to develop a number of innovative computer applications. Among these were an Automated Patient History Acquisition System that enabled patients to directly enter current symptoms into a computer terminal, employing graphics to reduce language barriers between patients and their physicians. The RMP center in Columbia provided information services to regional affiliates via “FACTBank,” an acronym for Fast Access to Current Text, using electromechanical access to stored microfiche of page images, searchable by Medical Subject Headings. It represented the state-of-the-art in electronic document storage and retrieval, providing access to any of thousands of microfilmed pages within 15 seconds. The Missouri RMP was also one of the first to operationalize the automated interpretation of electrocardiograms acquired via telemetry over phone lines. Dr. Lindberg's application of expert systems algorithms led to the development of CONSIDER, an early differential diagnostic program, and later the criteria table form of knowledge representation and reasoning upon which AI/Rheum—a diagnostic expert system in Rheumatology—was built. AI/Rheum is particularly notable for its ability to educate its clinician users to make the proper observations via a rich variety of textual and image-based reference information. Dr. Lindberg rose through the academic ranks during a 24-year career at the University of Missouri, becoming Professor of Pathology and Director of the Information Science Group. As his international reputation in the field of medical information systems grew, Dr. Lindberg was appointed to review groups and advisory committees of the National Institutes of Health, including the Board of Scientific Counselors of the National Library of Medicine. Thus, in 1984, the NIH in its nationwide search for a scholar and administrator chose Dr. Lindberg to be the Director of the National Library of Medicine. When Don Lindberg arrived at NLM, the institution had a 148-year history of steady service to health professionals. Medline was primarily a medical librarian's tool, available during regular business hours, Eastern time, five days a week. The new director began his relentless pursuit of increased availability, ease of use, and broader constituencies for NLM's online information services. Within a few months, Medline was available seven days a week, essentially 24 hours a day. To make the searching of NLM databases more user friendly, he introduced Grateful Med, a forms-based searching program for microcomputers, which marked the beginning of an era of new products notable for technical innovation and whimsical names. He sought best guidance for the future directions of the Library, and convened more than 120 experts in libraries, medical informatics, and health professions education to create a 20-year long-range plan for the NLM as a world resource. From the dozens of recommendations of the long-range planning committees, several emerged as top priorities for the institution. The information systems support for modern molecular biology and the nascent Human Genome Project were recognized by Dr. Lindberg as essential tools for the coming era of molecular medicine, and he led the Library in creating a National Center for Biotechnology Information. NCBI is now home to GenBank, the national DNA sequence databank, and has developed a spectacularly successful set of search tools and algorithms in use worldwide. Recognizing the potential provided by modern computing and communications technologies for representation of biologic structure, Dr. Lindberg endorsed the idea of a national reference dataset of three-dimensional anatomic data, the Visible Human project, which has become the focal point for development of interactive tools for education, research, and health care delivery. The project has captured the eye and imagination of public media and presages an increasing number of services for the lay public as well as for health professionals. These visible advances of modern information systems are built on an invisible but essential infrastructure, and infrastructure figures prominently in the Lindberg-directed National Library of Medicine. There is infrastructure support for academic medical centers to weave their information resources into a seamless fabric, via IAIMS, the Integrated Advanced Information and Management Systems grant program. Dr. Lindberg's personal vision for improving the infrastructure for representing medical meaning and coding is the goal of a decade-long investment in the Unified Medical Language System (UMLS). The UMLS provides an electronic rosetta stone in the form of a Metathesaurus linking a growing array of computerized naming and coding systems, and a variety of tools to build systems that recognize the common medical meanings behind hundreds of thousands of words, terms, and codes. In 1991 the White House selected Dr. Lindberg to be the first director of the national High Performance Computing and Communications program—a federal research and development initiative to build the next generation of computing devices, high speed digital networks to connect them, new software technologies to take advantage of their capabilities, and education and training in their use. Under Lindberg's direction, the program grew to more than a billion dollars and involved nearly a dozen different federal agencies. Importantly, this new initiative provided expanded funding for investigator-initiated medical informatics research in areas such as telemedicine and electronic patient records. Dr. Lindberg made sure that the national investment in advanced technologies for defense, aerospace, and the physical sciences was complemented by an investment in technologies for improving the nation's health. To garner the resources for the expanded national agenda of medical informatics research and development, Dr. Lindberg has been a persuasive proponent for health informatics in the U.S. Congress. The success of his efforts is reflected in a National Library of Medicine budget that has nearly quadrupled in size, from 43 million in 1983 to 160 million dollars annually. For many years Dr. Lindberg was the U.S. national representative to IMIA, the International Medical Informatics Association. He was a central figure in the creation of the American Medical Informatics Association and was named its first President in 1991. Emerson wrote: “The scholar is that man who must take up into himself all the ability of the time, all the contributions of the past, all the hopes of the future.” But scholarship alone does not explain the outstanding achievements of a professional career spanning nearly 40 years. For sustained success, scholarship must be guided by other qualities. Those who know Don Lindberg best reflect on the qualities which have made his career so rich with accomplishment. Joyce Mitchell, Associate Dean, University of Missouri School of Medicine: “At Missouri he's considered to be 30 years ahead of his time, and people who knew him when he was at Missouri still say that. What he was envisioning 30 years ago is just now taking place in terms of the use of computers in clinical care. One thing that he did while he was there that was just remarkable was to build the first clinical laboratory system in the whole world. And he did that because he saw there was a need to take care of patients better and to distribute data to the folks who needed the data to take care of patients. If you look now, it is a common part of our lives: everybody in the entire world has a lab system. He could envision that and create it, make it a reality as the first person in the world. “He can do that with other things as well. When he first started talking about the UMLS, he could see how that was a rate-limiting step in how you handle clinical information, and get started on the first steps, and pull the people around him to make that a reality, even though he knew that it was going to be at least a 20-year quest.” Mary Lindberg: “Perhaps his childhood, his upbringing, and his Swedish heritage have had something to do with that. He's very tolerant. He accepts people as they are, for the qualities they have, and has managed to surround himself with people of various talents and persuasions. I think it's been part of the secret of what he's done. And he never forgets, whether he is in a department of pathology or in an administrative position, or now as Director of the National Library, that the patient is important. That struck me about him when I met him as a medical student; his concern was for the patient. He did go into an academic field and has not been clinically involved in the sense of being a hands-on physician, but he is first and foremost a physician and his concern is for the patient. And when he collects the medical literature of the world, he's doing it with the idea of helping the physicians who are directly aiding and helping the patient. G. Octo Barnett, 1996 Morris F. Collen Award winner: “Since the early 1960s it has been my pleasure to work with Don in a variety of organizational activities—in AMIA, in the NIH, and in the National Library of Medicine, particularly in the development of electronic medical record systems and the UMLS. I've always been impressed by the imagination and ingenuity he has demonstrated in identifying exciting technologic initiatives, by the graciousness with which he led committee activities, by his willingness to change his position after such discussions, and by the candor he demonstrates in identifying certain positions as nonsense. In the last decade Don has played a very important part, demonstrating political savvy and very strong leadership in guiding a very important and enormously influential National Library of Medicine. “Don is a very warm and generous friend whose support and collaboration have been very important to me over these past 30 years. I am delighted that ACMI has chosen to honor him with this award.” Burton J. Hendrick wrote that: “The great glory of modern medicine is that it regards nothing as essential but the truth.” In pursuit of that truth, and the means to make it ever more widely available to others, the contributions of Donald Lindberg to the field of medical informatics and to all humanity make him a fitting recipient of the 1997 Collen Award for life-time achievement.

This issue of the Journal presents reports of five health care telecommunications projects that span a wide range of methods, applications, and users. One clearly discernible theme joining these projects is the celebration of the technical feasibility of conveying health-related information and direct patient services at a distance. For example, London et al. describe a demonstration project to improve cancer-related communications between a university cancer center and its affiliated community hospitals.1 Their information system components include use of the World Wide Web to communicate content and eligibility information for cancer clinical trials—an approach shared and expanded upon by Afrin et al., also in an oncology context2—and a low-cost teleconsultation system built on commercially available teleconferencing software and Integrated Services Digital Network (ISDN) phone service. Preliminary data presented for the oncology teleconsultation system point to the intuitively satisfying notion that videophone consultations appear better than voice-only communications among providers. An increase in patient referrals to clinical protocols at the university cancer center is described in the first year of system operation, although a cause-and-effect relationship is uncertain. Appealing as these observations are, there are still difficult, unanswered questions about the use of even the least-expensive two-way video systems used in support of health care provided collaboratively among institutions. In the case of the university-community network, the authors note that approximately $7,630 would be needed to purchase, equip, and pay annual telecommunications costs for each teleconsultation workstation if acquired solely for this purpose. In a year of operation on their nine workstation system, nine consults occurred, making per-consult costs unusually easy to estimate. Not included in the resource estimates were the labor costs of the time spent by the two interacting physicians and the approximately 30 minutes of staff time needed to gather and convert physical records, including diagnostic images, to electronic form (or to convert electronic information to a form usable by the teleconferencing system) prior to the consult session. Comparably detailed expense data are not available in the demonstration telemedicine and health information projects described by Lindberg,3 Balch and Tichenor,4 and Morris et al.,5 although evaluations are planned or under way. In an increasingly cost-conscious health care environment, information systems developers will confront blunt questions of comparative economics: If the same resources were applied to the same goal (in the cancer center case, increasing the number and quality of specialty consultations and improving inter-provider relationships) but with entirely different approaches, would more success result? The starkest contrast would be to simply “buy” the allegiance of community providers by nontechnical incentives, such as providing them office personnel support to assist with clinical trials and to promote communications opportunities. In Volume 1, Number 1 of this Journal, members of the Biomedical Library Review Committee of the National Library of Medicine provided guidelines for improving the quality of grant applications in informatics by project plans that support careful evaluation beginning with their earliest design phases.6 The same methodologies of rigorous evaluation will increasingly be needed to convince chief financial officers of health care organizations that telemedicine systems have a sound business justification as well as intuitive appeal. Whether we will achieve information systems for telemedicine that will not only save lives and advance the state of evidence-based medical practice but also make good economic sense is still an unanswered question in many health care settings, and this is fertile ground for innovation and evaluation.

The Institute of Medicine (IOM) of the National Academy of Sciences has recently published a report entitled Telemedicine: A Guide to Assessing Telecommunications in Health Care.”1 The report is the work of a 15-member committee and 6-member Technical Advisory Panel appointed by the IOM as part of a project sponsored by the National Library of Medicine with assistance from the Agency for Health Care Policy and Research. Telemedicine is defined in this monograph as “the use of electronic information and communications technologies to provide and support health care when distance separates the participants.” The committee confronted directly the problem that, in spite of over 30 years of technology development and demonstration projects, conclusive evidence of the effectiveness and cost-effectiveness of telemedicine is only sparsely represented in the published literature. As a corollary, they observe that demonstration and pilot projects historically have generally not survived after the end of grant funding or other subsidy, and they predict that current telemedicine projects may suffer the same fate. A variety of reasons contribute to the paucity of usable research data, but the committee found that the single most important cause has been the failure to build evaluation into the design of telemedicine projects from the start. Weak evaluation designs have been further eroded by the fact that neither health care nor telemedicine is static, and by the lack of methods to differentiate failures of system design from failures to implement systems as designed. The committee identified contemporary threats to telemedicine development, including high telecommunications costs, awkward and quickly outdated technology, low patient volumes, lack of physician interest, and limited insurance coverage. When resources are tightly constrained, the temptation to reduce or eliminate formal evaluation of a new system is strong indeed. As an antidote to these problems, the report provides a framework for prospective and systematic evaluation of telemedicine projects, including sets of sample evaluation questions that address outcomes of Quality, Access to Care, Cost, and Acceptability. Methods for developing evaluation plans are given, with attention to the issue that evaluations may focus on measurements of process and outcome at the clinical level, institutional level, and/or societal level. Two special recommendations deserve note. The first is that telemedicine projects should very early in their development have a business plan or project management plan that models the financial sustainability of the proposed system. The second recommendation recognizes that rapid change is affecting nearly all of the processes of health care delivery as well as the technologies upon which telemedicine depends. A partial statistical remedy for such “unstable environments” is that evaluation plans include a sensitivity analysis of the major assumptions, indicating how robust the conclusions would be if those assumptions must be revised during the study. If there is a single phrase that characterizes the spirit of the report, it is the words “… compared to the alternatives.” The committee repeatedly emphasizes the concurrent, prospective measurement of the health care processes that are the alternatives to a telemedicine-based process in pursuit of a specific health-related objective. Spending precious time and resources in the careful measurement of an established manual set of procedures that are the alternative to an exciting technology-based approach may seem anathema to the technology advocate, but without this discipline evaluations risk becoming, in the words of R. E. Clark, “a triumph of enthusiasm over careful analysis.”2 The 271-page IOM report has other features that recommend it, including a review of the historical development of telemedicine and a bibliography of over 330 references to specific telemedicine projects and to modern methodologies of technology assessment in health care. The committee makes the point that the evaluation of telemedicine has few elements that are unique; it deserves neither more nor less rigor than the evaluation of any other technology that influences the delivery of health services. In fact, an interesting exercise for a reader of this report is to mentally undertake throughout the monograph a “global search and replace” of the word “telemedicine” with the words “medical information systems” or even “medical informatics.” The message remains true and inescapable. In these times of convulsive change, as system developers attempt to hit a moving target from a moving platform, careful evaluation will be the only enduring proof that one has done something worth doing. “Telemedicine: A Guide to Assessing Telecommunications in Health Care” is available from National Academy Press (phone 800-624-6242) as a printed volume, and online at http://www.nap.edu

Some observers feel that the federal government should play a more active leadership role in educating the medical community and in coordinating and encouraging a more rapid and effective implementation of clinically relevant applications of wide-area networking. Other people argue that the private sector is recognizing the importance of these issues and will, when the market demands it, adopt and enhance the telecommunications systems that are needed to produce effective uses of the National Information Infrastructure (NII) by the healthcare community. This debate identifies five areas for possible government involvement: convening groups for the development of standards; providing funding for research and development; ensuring the equitable distribution of resources, particularly to places and people considered by private enterprise to provide low opportunities for profit; protecting rights of privacy, intellectual property, and security; and overcoming the jurisdictional barriers to cooperation, particularly when states offer conflicting regulations. Arguments against government involvement include the likely emergence of an adequate infrastructure under free market forces, the often stifling effect of regulation, and the need to avoid a common-and-control mentality in an infrastructure that is best promoted collaboratively.

Daniel R. Masys, MD; Moving Ahead on Webbed Feet, Journal of the American Medical Informatics Association, Volume 2, Issue 5, 1 September 1995, Pages 332–333, h

Since its founding in 1937, the National Cancer Institute (NCI) has supported a substantial program of information dissemination. Two peer-reviewed journals, begun in 1940 and 1959, are supplemented by a congressionally mandated International Cancer Research Data Bank (ICRDB), established in 1972. The NCI has made available online databases of published cancer literature and cancer research in progress for the past decade, using the National Library of Medicine (NLM) MEDLARS system. Recently, a clinical-practice-oriented cancer-information system called Physician Data Query (PDQ) has been developed for access at the NLM, as well as through commercial database vendors. The impact of the NCI information programs is currently under prospective evaluation.