Regenstrief Institute, Inc.

Matt Burton, MD

Phone: 317-630-7924

Dr. Burton began his medical informatics fellowship September 2005.

Dr. Burton graduated from Purdue University with a B.S. in Chemistry, Molecular Biology, and Biochemistry. He then attended The University of Michigan Medical School where he was very involved in educational information systems before matriculating into a categorical general surgery residency at SUNY Buffalo. After completion of his intern year, he became the clinical product manager for a market leading mobile physician information system company in Boston, MA. Dr. Burton’s research and work history include diverse areas of interest including analytical biochemistry, transplant immunology, and Lean engineering and product development/ life-cycle processes.

In addition to his fellowship, Dr. Burton is pursuing a graduate degree in Health Informatics. He has broad interests in medical informatics including personal health records (PHRs), clinical decision support, quality- process and outcomes improvement, and systems life-cycle management approaches to clinician information and communication needs. His mentors include: Drs. Mike McCoy, JT Finnell, Gunther Schadow, Burke Mamlin, and Paul Biondich. His current project involves evaluating methodologies and open technologies for the delivery of regional clinical data abstracts to meet clinician information needs. Past projects included: infrastructure for the interoperability of a personal health record (Indivo) in a regional health information exchange; developing methodologies for data capture in ambulatory care settings; methods for combining clinical and administrative data for a regional pay for performance initiative; and the costs of adverse drug events in ambulatory care settings.

Mary Davis, MD, MS

Mary M. Davis, M.D., M.S. January 06 – June 08 Phone: 317-630-7248 E-mail: mdavis@regenstrief.org

Dr. Davis completed a B.A. in Biology/Psychology at Indiana University. She went on to attend Indiana University School of Medicine, after which she completed graduate work and a post-doctorate fellowship in the Department of Medical and Molecular Genetics, followed by a residency here in clinical and anatomic pathology and a fellowship in pediatric pathology. She became faculty in 1995 and directed the Division of Pediatric Pathology at Riley Hospital for Children from 1997-2005.

Dr. Davis joined the Regenstrief Institute in January 2006 to work with Drs. Susanne Ragg and Gunther Schadow on the NCI caBIG TBPT caTissue project and develop an integrated specimen information system (ISIS) for pediatric research at Riley Hospital. She is creating pathology data annotation tools for ISIS and working with Dr. Schadow in the HL7 anatomic pathology SIG to develop structured AP reports to facilitate electronic transfer of these data. She is also working with Dr. Clem McDonald and the Shared Pathology Informatics Network (SPIN) team to identify tissue specimens for various research projects.

Jeff Friedlin, D.O.

Dr. Friedlin commenced his medical informatics fellowship in July 2005.

Interests include Natural Language Processing (NLP), artificial intelligence, data mining, and de-identification of medical documents. He has developed a computer software program (called REX) that accurately extracts and codifies user-defined clinical concepts contained in free text medical reports, thereby enabling their use by apllications such as clinical decision support systems, research databases, etc. He is currently developing software which de-identifies various forms of medical documents.

Suren Mantena, MD, MBA

Phone: 317-423-5532

Dr. Mantena is a graduate of Kurnool Medical College in India. He completed a residency in Internal Medicine at St.John’s Hospital and Medical Center in Detroit. In addition he completed a Master’s in Business Administration with a focus in Health Informatics at the University of Illinois at Chicago.

Dr. Mantena joined the Regenstrief Institute in July 2006. He is pursuing several projects primarily in the areas of medication related clinical decision support, use of computer reminders to enhance primary care screening and treatment of osteoporosis, and use of health information exchanges to identify needed preventive services.

To address the issue of developing a standardized knowledge base for medication related clinical decision support, he evaluated the VA/KP SNOMED subset for representing the clinical terms used for drug indications and dosage support. Another project involves mining the INPC (Indiana Network for Patient Care) database to determine the geographic distribution of patients receiving care at the hospitals that are part of IHIE (Indiana health Information Exchange). This information will help us identify a suitable architectural design for a national health information exchange.

Martin Were, M.D.

Phone: 317-630-2528

Dr. Were completed a B.A. in Biochemistry at Harvard University. He went on to attend Harvard Medical School, and completed his residency at the Brigham and Women’s Hospital & Harvard Medical School in Boston.

Dr. Were joined the Regenstrief Institute in July 2006 after working as an Instructor in Medicine and Hospitalist at Emory University in Atlanta. He is primarily interested in medical informatics for developing countries, and will be working with the OpenMRS group. He is also interested in clinical messaging and is currently working on informatics approaches to improve the consultation process.

Carl Williams, M.D.

Phone: 317-630-7164

Dr. Williams joined the program in August of 2005. He completed residency training in ophthalmology at Henry Ford Hospital in Detroit, Michigan, is board certified, and had a private practice before joining our fellowship program.

Dr. Williams in currently interested in the expanded use of computer-based clinical decision support (CCDS) to improve quality and increase patient safety, which may, in part, be based upon the problem list. Problem lists can assist clinicians in quickly and accurately interpreting patient complaints and clinical findings, and to respond appropriately. But problem lists are not always accurate. Decisions based on inaccurate information can decrease quality and contribute to errors.

Dr. Williams is currently preparing a manuscript on the accuracy of the provider-generated problem list in the computerized patient record system of the Veterans Administration. The goal is to generate practical suggestions that might increase the usefulness of problem lists in automated clinical decision support and to enhance patient safety.

Paul Biondich, MD, MS

Dr. Biondich’s research interests include clinical decision support systems and the use of large scale, consolidated electronic health information infrastructures in this regard. He serves on national committees in pediatric medical terminology development for HL7, LOINC, and SNOMED, and is co-developer of a next generation medical record system for HIV care in Eldoret, Kenya.

Phil Breitfeld

Dr. Breitfeld was a pediatric hematologist-oncologist who decided to change careers to pediatric health services research. Under the mentorship of Bill Tierney, Dr. Breitfeld did a two-year NLM-funded fellowship, focusing on health services research and medical informatics. He completed three projects during his fellowship: (1) a clinical trial to test whether a portable decision support tool consisting of a hand-held computer can enhance enrollment of patients into therapeutic trials; (2) linkage of an administrative database with a clinical database to improve the quality of care of children with complex disease. His first study was to reliably identify children with cancer admitted to the hospital for fever and neutropenia; and, (3) a database project assessing whether variables found in the medical record can predict time to follow-up of abnormal screening mammograms.

Currently, Dr. Breitfeld is associate professor of pediatrics at Duke University Medical Center, pediatric hematology-oncology in Durham, North Carolina, and is director of the clinical oncology service and tumors program. He is also study chair for the study titled “Comparison of Chemotherapy Regimens in Treating Children With Relapsed or Progressive Rhabdomyosarcoma” sponsored by Children’s Oncology Group and the National Cancer Institute. This is a randomized phase II trial to compare the effectiveness of different combination chemotherapy regimens in treating children who have rhabdomyosarcoma.

Gail Casper

Dr. Casper’s project involved extracting a data set from the RMRS focusing on medication use, clinical characteristics, patient reported desire for participation in decision making, patient satisfaction ratings, resource/service utilization, and charges.

The study sample included retrospective longitudinal data (one year) for patients who had died from cancer- or AIDS-related causes. The primary goal of the project was to investigate the relationship between patient preferences and satisfaction as well as the link between health state (meds as proxy variables) and patient satisfaction. Dr. Casper is currently clinical instructor at School of Nursing, University of Wisconsin-Madison. She joined the Brennan Health Systems Lab, University of Wisconsin-Madison as a postdoctoral researcher in March of 2004 where her work involves conducting work analysis and participatory design with nurses.

James Christensen, PhD

In September 2004, Dr. Christensen joined the IU Regenstrief Medical Informatics Fellowship program, and the IU Department of Radiology as an Adjunct Assistant Professor to pursue advanced training in Medical Informatics stemming from his work on automated 3D image processing of brain images as an Assistant Professor in the Departments of Psychiatry & Radiology at the University of Louisville, School of Medicine. His research entailed, in part, the development of novel methods for automated processing and analysis of structural MR images and diffusion tensor images acquired for subjects and patients with psychiatric disorders including schizophrenia and dyslexia. Jim’s fellowship ended in 2006.

Following his fellowship, Dr. Christensen became a Post-doctoral Fellow in the Department of Radiation Oncology at the Medical College of Wisconsin. His paper, “Computer Automated Detection of Head Orientation for Prevention of Wrong-Side Treatment Errors”, has been accepted for presentation and publication for the American Medical Informatics Association (AMIA) 2006 Annual Symposium.

John T. Finnell, MD, MSc

Phone: 317-423-5512

Dr. Finnell is a graduate of the University of Vermont College of Medicine and board certified in Emergency Medicine. He is interested in the application of medical informatics to the practice of Emergency Medicine.

Dr. Finnell joined the Institute in 2002 where his research activities focused on building the infrastructure necessary to capture emergency department visit data. The departmental tracking system known as "WizErD" began capturing visit data on July 15th, 2003.

His first publication entitled "Community Clinical Data Exchange for Emergency Medicine Patients" explored the pattern of emergency healthcare delivery across Indianapolis over a one year period. They found that one-fourth of the emergency department patients with more than one visit also visited one of the other five hospital systems. These patients could potentially benefit the most from a shared clinical data network.

Currently Dr. Finnell is working on standardizing emergency department data in order to implement treatment guidelines established by ACEP, the American College of Emergency Physicians, which are initiated by the patient's chief complaint and triage data. He plans to augment the standard order set with "suggested" orders defined by these guidelines, and customized to the patient through their electronic medical record.

Shaun Grannis, MD

Dr. Grannis’s research interests include developing, implementing and studying technology to overcome the challenges of integrating data from distributed systems for use in health care delivery and research. His patient matching research has received recognition from the American Medical Informatics Association for outstanding contribution to the body of medical informatics knowledge.. He serves as technical co-chair for the national Health Information Technology Standards Panel’s biosurveillance workgroup to develop standards for population health information exchange. He is involved in multi-year studies that explore multiple facets of disease detection and public health surveillance challenges, including geographical de-identification, understanding temporal-spatial disease trends, and developing regional clinical reminders. He is leading a 4-year project integrating data flows from over 110 hospitals in the state of Indiana for use in disease surveillance and clinical research. He has worked with Indiana, Michigan, Texas, and other states to develop statewide data sharing initiatives. Dr. Grannis also maintains a clinical practice.

Abel Kho, MD, MSc

Dr. Kho completed a B.S. degree in Theoretical and Applied Mechanics at the University of Illinois in Urbana-Champaign. He went on to attend medical school at the Medical College of Wisconsin. He completed a Residency in Internal Medicine at the University of Wisconsin, Madison, where he stayed on to serve a year as Chief Medical Resident.

Dr. Kho joined the Regenstrief Institute in July 2003 after completing a chief residency in internal medicine. His work involves mining the RMRS to determine the utility of commonly ordered laboratory tests as predictors of mortality. His work demonstrated that certain uncommon elements in the manual differential are associated with high mortality rates in hospitalized patients and often go unrecognized. Other work includes validation of an algorithm based on ICD9 codes to accurately extract stroke patients from large databases. Dr. Kho is also exploring novel methods to detect hospital disease outbreaks in realtime using existing laboratory and geographic data.

Phil Kroth

Dr. Kroth was involved in two research projects during his fellowship. The then-current automated system for measuring and recording vital sign information throughout the hospital (VitalNet) was aging and needed to be replaced. VitalNet had been discontinued as a product by its parent company and there were no other companies that made an “off-the-shelf” system that could be a suitable replacement. Dr. Kroth created a replacement using a commercial bedside automated data capture (blood pressure, pulse, temperature and oximetry) system, a mechanical wall-mounted arm, a small quiet PC and LCD screen. The system was installed at Wishard Hospital and is fully operational in rooms servicing over 100 beds and in the critical care area as well. After the new system was up and running, Dr. Kroth performed an analysis of the efficiency of the system and users’ perceptions on how the new system impacts their work in the hospital. The objective of the second research project was to define a protocol and search the Regenstrief Medical Records System database to determine how effectively patients with osteoporosis were treated in the outpatient setting. His research showed chest X-rays showing vertebral compression fractures are a good case-finding system for patients with osteoporosis, and that these patients tend to be under-treated.

Currently, Dr. Kroth is assistant professor, assistant director, health sciences informatics program development, and he manages the medical informatics research fellowship program at the University of New Mexico, Albuquerque, New Mexico. He is also medical informatics consultant and information systems steering committee chair for an NIH grant titled “Integrating and Expanding Clinical Research Networks: RIOS Net and Underrepresented Populations,” and is co-director, clinical protocol and data management/medical informatics shared resource for an NIH grant titled “University of New Mexico Cancer Center Support.”

Mark Laflamme, MD, MSc

Dr. Laflamme joined Regenstrief in August 2003 after completing his internal medicine residency at SUNY Stony Brook and participating in research with the departments of computer science and medical informatics at Columbia University. During his fellowship, he worked with investigators on completed trials in videoconferencing with nursing home residents and their subsequent interactions with clinicians. In addition, he collaborated with the obstetrics-gynecology department regarding operative report electronic templates and refining order sets.

While seeing patients once a week at the Wishard Primary Care Center, Dr. Laflamme earned a master’s degree in the CITE program in 2005. He presented “Timeliness and Satisfaction When Comparing Dictation and Electronic Templates for Operative Reports” during the plenary session at the 2005 NLM Informatics Training Conference in Bethesda, Maryland.

Dr. Laflamme completed his fellowship this past year. He recently started a position as a physician consultant with NextGen (nextgen.com) headquartered in Horsham, Pennsylvania and with offices in Atlanta and California.

Burke Mamlin, MD

Dr. Mamlin has been involved in the design and development of computer applications for medicine at Regenstrief Institute for over two decades with a focus on physician order entry. He helped create the Medical Gopher Order Entry system and has led the development of a next generation of this system. He has extensive programming experience and continues to practice medicine as a general internist while mentoring informatics fellows. Dr. Mamlin is applying his experience at Regenstrief to the design and development of an electronic medical record system for developing counties ( www.OpenMRS.org ). Open MRS is used in the treatment and prevention of HIV/AIDS in Sub-Saharan Africa as part of Indiana University’s Kenya Program.

Anna McDaniel

The focus of Dr. McDaniel’s research is on the use of technology to support smoking cessation and nicotine dependence treatment. In a series of pilot studies, Dr. McDaniel examined how to change clinical practice patterns in the acute care setting to promote smoking cessation intervention. During her fellowship, she developed computer algorithms to deliver tailored patient information to enhance "bedside" smoking cessation intervention and nicotine dependence treatment for hospitalized smokers. Currently, her research has moved beyond using information technology to enhance decision-making by clinicians to consumer health informatics, using informatics methodologies to improve health care decisions by consumers, i.e., the decision to quit smoking.

One of Dr. McDaniel’s projects led to the development of an interactive, multimedia computer program to promote smoking cessation in low-income women and involved a team of five undergraduate students in New Media. Dr. McDaniel served as producer and writer for this instructional video on smoking cessation intervention principles. The videotape product resulting from this is: “Reversing Trends: Principles of Smoking Cessation Intervention for Health Care Professionals,” McDaniel A. (available from Health Care Excel, Inc 9502 Williamsburg Plaza Suite 102, Louisville, KY 40223).

Dr. McDaniel is currently the director of the health informatics graduate program at the Indiana University School of Informatics at IUPUI. She also serves as director of evaluation for the National Center of Excellence in Women's Health at Indiana University and is a member of the Indiana University Cancer Center.

Susanne Ragg

Susanne Ragg, MD, PhD completed substantial training in bioinformatics at the Technical University in Copenhagen, Denmark during the fall of 2000 and 2001. She visited Germany in the summer of 2001 to learn what is being done in informatics at the German Cancer Center in Heidelberg (where she has a former mentor, Dr. Poustka) and the Computational Diagnostics Group at the Max Planck Institute for Molecular Genetics in Berlin. She completed Stanford’s web-based bioinformatics course during the next several months (and subsequently taught this course to others on the IUPUI campus in Indianapolis). Dr. Ragg also learned the LINUX operating system and PERL programming. She arranged a visit to NIH where she learned a method for extracting RNA out of tumors in the clinical setting. Her formal mentor panel consisted of Dr. Clem McDonald (medical informatics), Dr. Howard Edenberg (molecular biology) and Dr. Terry Vik (pediatric hematology-oncology). During her fellowship, Dr. Ragg received a grant from the American Cancer Society for a project titled “Microarray Analysis of Childhood Acute Lymphoblastic Leukemia.”

Dr. Ragg is currently assistant professor, department of pediatrics, section of pediatric hematology/oncology at Indiana University School of Medicine, Indianapolis, IN. She is the recipient and principal investigator of an NIH K-23 Mentored Patient-Oriented Career Development Award, for the project period 04/1/04 to 03/30/09, entitled “Computational Methods in Osteosarcoma Trials.” Her mentors are: Clement McDonald, MD, Munro Peacock MD, and Richard Gorlick, MD. She is also principal investigator of an award from the Indiana 21st Century Research & Technology Fund, “Center of Excellence for Computational Diagnostics” for the project period 08/20/04 to 08/20/07.She is the principal investigator for the Indiana University Cancer Center National Cancer Institute bioinformatics initiative’s Participant and Adopter Grants for the project period 08/01/04-03/07/07.

Linas Simonaitis, MD

Dr. Simonaitis started his Medical Informatics fellowship in July 2004. He is Board Certified in Internal Medicine, and has worked as a Hospitalist and as a Primary Care physician prior to coming to Regenstrief.

Dr. Simonaitis is very interested in the Electronic Health Record, and in using Clinical Guidelines to provide Decision Support at the point of care. He is also interested in exploring Natural Language Processing, the ability of a computer to read through pages of free text and produce a succinct summary.

During his first year of the Informatics Fellowship, Dr. Simonaitis has been studying the use of XSL-FO (Extensible Stylesheet Language Formatting Objects), a W3C Consortium Standard. He created XSLT stylesheets, and used them with an XSL-FO Formatting Engine to transform XML patient data into PDF clinical reports. He helped to implement this process at Wishard Memorial Hospital. Subsequently, he studied usage statistics and administered a survey instrument to assess clinical-user acceptance of the new process.

More recently, he has been studying national drug codes and classification systems. He is planning a project to improve the indexing of medicines within the Regenstrief Medical Record System. The backbone of the new indexing system is expected to be the RxNorm codes developed by the National Library of Medicine.

Janet Tam

Dr. Tam’s research focused on the development of optimal viewer tools for presenting radiology imaging information to clinicians, and to study the effect of immediate imaging availability in one or more clinical settings. Dr. Tam reviewed several open source medical image viewers. The purpose of the evaluation was to obtain ideas on functionalities provided by the viewers. Using JAVA programming language, she also worked on development of a web-based image view program to process and display radiology images. She planned to extend the program to eventually display other medical images. The program was clinician oriented and not intended as a diagnostic reading station. In designing this viewer, Dr. Tam took note of several considerations such as the different skill levels of the users, its workability on a regular PC, the speed of image retrieval and display, and web browser security issues. She incorporated several image processing tools such as “Window and Level,” zoom functionality, magnifying glass and several measurement capabilities in her program.

Following completion of her fellowship in 2001, Dr. Tam was employed by Omniviz in Boston, MA, a company that provides unique, advanced visual informatics software, components, and services. She is no longer employed by them, and we do not know her current position or affiliation.

Sean Thomas

Dr. Thomas researched the use of handheld computers to display large clinical data sets. The Regenstrief Medical Record System allows physicians at Wishard Hospital to print out a clinical summary of hospital patients on one side of an 8.5 in. by 11 inch piece of paper (pocket rounds reports). Dr. Thomas worked on taking this data set and presenting it on a handheld computer. He completed his study by comparing the utility and usage rates of a Palm PDA compared to the traditional pocket rounds reports. The results showed the physicians preferred the paper reports for their density of information consent (compared to the small PDA), lack of log in requirement, ease of use, and ability to write notes on the paper reports.

Dr. Thomas also developed a string replacement narrative text scrubbing system for use in Dr. McDonald’s National Cancer Institute-funded grant project Shared Pathology Informatics Network. With his first generation system, Dr. Thomas was able to eliminate patients’ names from all but one per 1000 pathology reports. Latanya Sweeney, who visited the Regenstrief Institute at the time for a day, thought he could refine the work and bring the failed scrubbing rate down a few orders of magnitude. This work was published in the 2002 AMIA proceedings.

Dr. Thomas was employed as a hospitalist at Queen’s Medical Center in Honolulu, one of the premier community hospitals using CPOE. He assisted in the design, implementation and study of ways to improve data delivery to physicians at the point of care, as well as improve documentation and the capture of billing information. He also played a crucial role in the continued improvement of the Logician EMR in the outpatient clinic.

Dr. Thomas assisted in the selection of a new hospital information system for Queen’s. He served as the physician lead for the implementation of the new system which included replacing existing ADT, CPOE, Pharmacy, OR and ED applications with an integrated application from Epic Systems. He was responsible for the analysis of physician workflows and the collection and development of physician content including order sets. Queen’s had a successful go-live of the new system in January 2006 and Dr. Thomas continues to serve an integral role in the refinement and enhancement of the system.

Dr. Thomas has played a key role in the AHRQ Planning Grant for the Holomua Project which is targeted at sharing clinical information between two of the larger hospital systems in the State of Hawaii and two community health centers. Dr. Thomas served as the technical lead and a member of the steering committee for the planning grant and continues to be active with the newly awarded implementation phase of the Holomua Project.

Currently, Dr. Thomas is assistant professor and chief, division of medical informatics in the department of internal medicine at the John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii. He is also the assistant medical director, clinical informatics at the Queen’s Medical Center in Honolulu.

Daniel J. Vreeman, PT, DPT, MSc

Phone: 317-423-5515

Dr. Vreeman's research interests are centered on understanding and promoting effective organization, analysis, management, and use of information in healthcare. The principle focus areas are: (1) The use of standardized clinical vocabularies to support electronic health information exchange, and (2) Investigation of medical informatics applications to improve healthcare delivery and research. Dr. Vreeman also has a primary role in the development of the LOINC database of universal codes for clinical observations.

More information on Dr. Vreeman's research and professional interests can be found at: http://dr.danielvreeman.net

Atif Zafar

Dr. Zafar was a general internist with the Indiana University School of Medicine and Health Service Research fellow. He conducted a trial of the accuracy and usability of voice recognition in a general medicine clinic setting. This research was divided into two phases. Phase I involved the integration of current generation voice recognition technology with an enterprise level medical record system. Phase II involved testing this technology in actual use.

Dr. Zafar compared the effectiveness of voice recognition as a data entry tool compared with typing. Outcome variables included total time to type or dictate a note, accuracy of the note (error rates), completeness of the note, error correction rates and acceptability of the system to physicians. Dr. Zafar presented his work entitled “Continuous Speech Recognition in a Medical Enterprise Setting” at the 1999 Annual NLM Fellows Conference, July 1999, Arden House, New York.

Following completion of his training, Dr. Zafar was administrator of a web-based program/curriculum for Indiana University School of Medicine research faculty and staff which provided pre-tests in order to gauge knowledge base, learning materials, and links to additional and more advanced learning materials.

Currently, Dr. Zafar is an associate professor of clinical medicine at the IU School of Medicine. He is the IT Director for the AHRQ National PBRN Resource Center and a key staff member of the AHRQ National Resource Center for Health Information Technology. His research involves studying the human-computer interface and is currently working with Purdue engineers to design an EMR application for mobile devices. He also is interested in electronic technologies for clinical education. He has lead numerous national teleconferences on health information exchange and helped to architect the new AHRQ Health IT Web Resource located at http://healthit.ahrq.gov.