J. Marc Overhage can't say that he didn't know what he was in for when he came to work for the Regenstrief Institute, Inc., part of the IU School of Medicine and based on the IUPUI campus.
He knew his teacher and mentor, Clement J. McDonald, was the force behind the country’s largest and most detailed computerized system of medical records.
And the former School of Medicine student (he graduated in 1988) knew that when the day came that McDonald moved on to new challenges and the torch was passed, he might be the one closest to the flame.
Now, McDonald has been named the new director of the Lister Hill National Center for Biomedical Communications at the National Library of Medicine, part of the National Institutes of Health. That leaves Overhage to follow McDonald’s path as the director of medical informatics and the head of a groundbreaking system that has been lauded by President George W. Bush as an example for the nation.
Big shoes to fill, indeed.
The Regenstrief Institute was born in 1969 and bears the name of philanthropist Sam Regenstrief. Since its inception, it has had close ties to both the School of Medicine and the Health and Hospital Corporation of Marion County, through Wishard Hospital, also on the IUPUI campus.
Its researchers and medical informatics experts — people like McDonald and Overhage — have built the institute into one of the world’s leading centers of knowledge about health services and medical information. The computerized network built by McDonald, which in 2004 was expanded from the Indianapolis area to other parts of Indiana through the formation of the Indiana Health Information Exchange, is just one example of the way Regenstrief supports physicians, hospitals, medical facilities — and most of all, patients in need.
"He’s like an entrepreneur who has built a successful enterprise," says Overhage. "Our challenge now is to keep moving it forward, expand its uses, but remain true to his principles."
The records system has been growing for more than 30 years, and was the first to use computer reminders to improve patient care. McDonald and his staff achieved some other remarkable firsts in the medical profession, including:
From the start, creating a computerized system wasn’t about the technology, according to McDonald.
"It’s about the patients," says the white-haired, distinguished-looking informatics expert. "The system isn’t really important without that focus."
In fact, he came to the School of Medicine precisely "to put my passion for using technology to improve patient care; the school was really interested in an idea that nobody had tried before," he says. "I came here to do this — just this kind of thing — and the school and the institute allowed me to do it."
Thomas Inui, the president and CEO of the institute and a man who came to the IUPUI campus to be part of efforts like McDonald’s system, agrees.
"The fragmentation of patient information is not only costly, but quite dangerous," he has been quoted as saying. "There’s a critical need for effective information sharing, to monitor potential drug interactions, allergies, all sorts of historical data that might affect a physician’s treatment decisions."
Consider this, says Overhage. "As a doctor, each of my decisions for each patient can involve dozens, even hundreds, of variables," he says. "If you’re really smart, you might be able to handle a percentage of these, but without complete information, it’s an impossible task."
The Regenstrief system aims to reduce those variables with hard facts.
"I may have a lab result from one hospital, a radiology result from another, and background information from still another," Overhage says. "With our system, all that information is in a doctor’s hands at a moment’s notice. It replaces guesswork with solid information."
It’s a system that has drawn admiring gazes from people across the country and around the world, Overhage adds, all envious of what Regenstrief has achieved with its community partnerships.
"According to a lot of people I talk with, what Clem has been able to create makes us the yardstick," says Overhage. "Comparing where we are to where they say they are is like comparing the Flintstones to the Jetsons — they can’t believe how far we’ve been able to go!"
While the Regenstrief system has become an international model, McDonald is quick to praise the role played by the city’s five major hospital organizations: Clarian Health (including University and Riley hospitals on the IUPUI campus, plus Methodist Hospital), Community Hospitals, Wishard Health Services, St. Francis Hospitals and Health Centers and St. Vincent Health.
"If it weren’t for their willingness to share information, to use the system and help us make it work, it might never have flourished," McDonald says emphatically.
"Indianapolis is a unique city," he adds. "When we were starting out, we went to these hospitals — and they were competitors, mind you — and asked if they would participate in a project that had no track record. And they said yes. They always said yes. For them, the welfare of the patient came first. That always struck me as a wonderful example of our profession."
Overhage believes that Regenstrief’s track record for supporting physicians is the key to the collaboration. Clinical messaging allows for quick turnaround of results. The clinical data contained in the computerized records gives doctors a broader picture of a patient’s health status and needs. The online system also allows qualified medical people to check out alternative drugs that meet a patient’s needs and check for potentially troublesome drug interactions. And the full spectrum of data in the system can help monitor for health trends, potential outbreaks, etc.
"Mostly, we’ve been able to get the right Form with Function information into the right hands at the right time," adds Overhage. "That’s what has made Clem’s system so valuable."
Though technology has changed dramatically since the system was first launched in 1972, the project’s founding principles "remain the same as they always were," says McDonald.
"First, we need to be able to access patient records in a fast, practical method. Second, the computer looks at the data in the records to help plan long-term, preventive care," he adds. "And third, the data can help in research" to note health trends in the region, identify population groups facing similar risk factors, geographic concerns, etc."
McDonald considers the research aspects of the records system increasingly important. As information becomes more complete and more accessible, health-care professionals have a more complete picture not only of individual people, but the whole area.
"Just having data like that at your fingertips changes everything for a doctor," says McDonald. "And the technology helps physicians keep records current for treatments, medications and other observations.
"The technological tools we have available are powerful, and can do more and more," he adds. "The information could revolutionize research on the community level."
There are subtle ironies about McDonald, whose accomplishments long ago made him a distinguished professor of Indiana University and gave him an international reputation in the medical informatics field. Though his system uses technology for delivery into physicians’ hands, "the technology itself is really fairly basic," McDonald says. And though he had the vision of technology playing an integral role in keeping people healthy, he uses some low-tech tools: he still carries around a stack of 3-by-5 note cards filled with his thoughts, insights, observations, questions and more.
Overhage believes that technological evolution will give the Regenstrief records system new outlets and new tasks. For example, technology could offer patients and their doctors new options in the area of homebased care, not just at hospitals or clinics. After all, technology is often just a mouseclick away, and that can be done anywhere.
"What I think we’re seeing is the use of technology not just for medical care, but for health and wellness, too," Overhage says.
"People could do self-administered tests, ship the information to the system, which in turn would make it available to a doctor without an office visit by the patient."
McDonald’s training left an imprint on young Marc Overhage, one still evident today.
"When I first came here, I wanted to be a theoretical physicist, but I quickly realized that doctors got all the grants," laughs Overhage.
"I’ve always had a strong quantitative bent, and wanted to get into research.
"When I first came here, it didn’t take me long to realize that Clem was onto something important, and that it was really cool," he adds. "I told him I was interested in working with him, and he told me to come back when I could spend five years here. So I did." And it’s been more than a decade since Overhage joined his mentor.
How far has McDonald’s vision grown through three-plus decades?
"We thought we could do it in a year for a small subset of patients in the Indianapolis area," laughs McDonald. "But we’re still adding records: we now have five million records covering about 900,000 patients."
It’s a project he considers, oddly enough, permanently temporary.
"It is a work in progress, and always will be," he says. "If we do it right, there is always more we can do to help people."