Year: 2009
Type: article
Abstract: The American College of Medical Informatics 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 now known more inclusively as biomedical informatics, is the Morris F Collen Award. Dr. Collen's own efforts as a pioneer in the field stand as the embodiment of creativity, intellectual rigor, perseverance, and personal integrity. At most once a year, the College gives its highest recognition to an individual whose attainments have, throughout a career, substantially advanced the science and art of biomedical informatics. In 2008, the College was proud to present the Collen Award to Robert A. Greenes, MD, PhD (Figure 1). ‘Bob’ Greenes, who like Dr. Collen himself was one of the pioneers in biomedical informatics, has had multiple achievements as a physician, computer scientist, researcher, educator, and eloquent spokesperson for the field. His career contributions make him most deserving of the recognition embodied in the Collen Award. Robert A. Greenes, M.D., PhD 2008 Collen Award Recipient. Bob was born on June 17, 1940 in Cleveland, OH. His parents owned a hardware store in the Polish neighborhood where he and his sister grew up. Upon graduation from Cleveland Heights High School, Bob did undergraduate work at the University of Michigan, where he majored in zoology and took a course in computing (Fig 2). He entered Harvard Medical School in 1962, where he looked for individuals doing work with computers in medicine and quickly sought ways to become engaged in clinical computing research. He later noted: I've had the wonderful luck and opportunity to begin my career in the field of biomedical informatics much at the same time that the field itself was beginning to take shape. In 1964 Octo Barnett1 came to Massachusetts General Hospital (MGH) to run the hospital portion of a project called ‘The Hospital Computer Project. I joined this project as soon as I learned about it. There was a lot of naïveté and optimism in those days. The idea was to implement a time-shared operating system on a PDP-1 computer, using teletype machines connected by 10-character-per-second modems. It was one of the first time-sharing systems in the country. Neil Pappalardo, Curt Marble, and I began to think about the possibility of developing medical applications using a new operating system and computer language that we would develop on a PDP-7 computer in the laboratory. Bob Greenes as undergraduate student, University of Michigan. This novel computer language evolved during the 1960s into what became known as the Massachusetts General Hospital Utility Multiprogramming System (MUMPS) and it formed the basis for many early applications at MGH. Closely involved with the development of MUMPS was Dr. Octo Barnett, who would later say of Bob Greenes: He was one of a brilliant group of young computer-niks who created a new language and a new vision of the potential role of computer technology in medical care. With the development of MUMPS, the Hospital Computer Project was awarded a grant from the NIH. Although the novel system was very limited in memory and speed by modern criteria, a series of remarkably successful applications emerged from the MGH group over the next few years.1–4 Some 40 years later, MUMPS (which has since come to be known as “M”) continues to be heavily utilized for both medical and nonmedical applications. Upon graduating magna cum laude from Harvard Medical School in 1966, Bob took what was an unusual path at the time. Instead of pursuing an internship and residency, he applied for a postdoctoral grant from the NIH to pursue his PhD in Applied Mathematics (with an emphasis on computer science) at Harvard. To our knowledge, he thus became the first physician in the country to obtain such a doctorate. This type of MD/PhD training later became a critical component of many biomedical informatics programs in the United States. Referring to his PhD training years, Bob has noted: This was a wonderful opportunity because the program was very flexible. I was able to take courses at both Harvard and MIT, including a course in decision and control taught by Howard Raiffa, one of the fathers and founders of the field of decision science. I decided to do a thesis on structured capture of progress notes by physicians' data entry in a hypertension clinic at Mass. General Hospital. To do this project, with the help of engineers we developed a touch-screen computer interface to a CRT display terminal. We did this by pasting aluminum strips on the screen at points where selections could be made and connecting those strips with wires to a capacitor circuit (Fig 3). Cathode-ray tube display terminal used at Massachusetts General Hospital in the late 60s. The touch screen input was based on capacitance sensitive strips underlying lines of text. Also involved in this early research was Edward H. Shortliffe, MD, PhD, President and CEO Designée for the American Medical Informatics Association and recipient of the 2006 Collen award: I was personally excited to hear that Bob Greenes was selected as this year's Morris Collen awardee, since Bob has been arguably the single most consistent influence on my professional career since my early days as a Harvard undergraduate when I went over to Octo Barnett's lab and was paired-up with Bob as his research assistant while he was doing his PhD in the late 1960s. The field that we now call biomedical informatics was unrecognized as a discipline at that time, and others have pointed out that Bob Greenes was a visionary in his appreciation of what was coming and the kind of professional commitments that were needed. For example, Milton Corn, MD, Director of Extramural Programs at the National Library of Medicine, has noted: I think there was some appreciation, some ability to see the future, in Bob, that made him realize long before almost anybody else that the role of the computer in improving health care was going to be enormous … and he took a chance. After completing his PhD, Bob briefly worked in the commercial world, serving as President of a young company, Automated Health Systems, Inc, that sold MUMPS-based clinical information systems into the hospital marketplace. Recognizing that he preferred the academic research environment, Bob then jointed the faculty at Stanford Medical School for a year. However, he determined that he needed to complete his clinical training to have the kind of impact that he desired, so he returned to Boston to pursue a residency in radiology at Massachusetts General Hospital. After completing his training, he joined the Harvard Radiology Faculty, based at the Brigham and Women's Hospital, where he combined his clinical work in radiology with a rapidly growing research and education program in clinical informatics and decision support. He benefited from the strong support of his departmental leadership, one of whom, Professor and Chairman Steven Seltzer, would later say of Bob: The way I really got to know Bob was that for almost 20 years we shared an office cluster. It showed me that Bob had many special characteristics above and beyond his great intellectual talent as an informatician and as an excellent diagnostic radiologist. It showed me that he was patient, that he was flexible, that he was willing to share, and that he was always a good colleague and friend. Upon completing his medical training in 1978, Bob founded the Decision Systems Group (DSG), a research and training unit within Brigham and Women's Hospital's (BWH) Department of Radiology, which currently has over 100 alumni, many of whom have taken lead positions in academia and industry around the world. Bob continued to develop applications for use in the clinic (Fig 4), 5 and to contribute to the evolution of MUMPS.6 He also worked on a system for measurement, calculation, reporting, and retrieval of obstetric ultrasound examination,7 and a graphical tool for clinical decision support.8 Bob Greenes in the Department of Radiology, Brigham and Women's Hospital, Harvard Medical School. In the late 70s and early 80s, the fields of medical informatics and health decision sciences were not yet as specialized. The Boston area had a large number of faculty whose research was dedicated to medical decision analysis. In this rich environment, Bob collaborated with several pioneers in health decision sciences, such as Barbara McNeil, Stephen Pauker, Milton Weinstein, and Colin Begg. Bob published results of his decision analysis research in Medical Decision Making, then in its third year of existence,8 as well as several other journals.9–12 He collaborated with his former mentor, Octo Barnett, and Rita Zielstorff in the first IAIMS grant to Harvard Medical School.13 At the DSG, Bob led several federally funded projects related to medical knowledge management and decision support. A key contribution of the DSG was its role in the development of the Unified Medical Language System (UMLS). Dr. Betsey Humphreys, Deputy Director of the National Library of Medicine, has noted: In my mind, Bob Greenes will always be associated with the early years of the UMLS project. He was at that time utterly consistent, and throughout the rest of his career as well, in saying that what we really needed were some good tools that would make the UMLS resources more useful and usable to people. So Bob was really ahead of the curve and brave to be working solely or heavily on the tool side when there was absolutely nothing like platform independence (in fact, in a period in which platform independence was a pipe-dream). The UMLS effort was precedent setting, not only for the results but for the way in which the coordinated project, with contracts from the NLM to several leading informatics research sites, brought people together across institutional boundaries and showed how collaboration could work at a distance and with crucial involvement by trainees as well as faculty members. Bob Greenes would later note: I've come to believe that informatics is a terrific vehicle for social engineering. If one has a good idea and can bring people together to test it, to explore it, to expand on it, and to use it, we've actually created something that was not there before. Bob supervised research on information retrieval by one of his first trainees, Dr. William Hersh.14 He also addressed practical problems at the Department of Radiology by developing practical computer-based solutions. For example, derivatives of pioneer work on a structured reporting system for ultrasound studies, developed by Dr. Doug Bell under Bob's supervision, are still in use at BWH.15,16 Another early trainee, Dr. Rick Shiffman, worked on the representation of clinical practice guidelines as decision tables.17 Bob allowed his trainees to explore their own ideas, but also brought them back firmly to well-grounded problems that could be tackled effectively and in the time available to them. As Dr. Shiffman (now an associate professor at Yale University) recalls: Among the first projects I proposed to Bob was creating an expert system to help with the diagnosis of dysmorphic children. At the time Bob himself was thinking about knowledge representation using algorithms. And he counter-offered a suggestion that I pursue a problem he was wrestling with. Now one of Bob's most enviable qualities is his ability to focus on a problem until it gets solved. Each month I'd offer a fresh expert systems proposal at our meetings and each month he'd patiently re-describe for me the issue with the CAT scan, and how he thought it'd make a good fellow project. Dr. Bill Hersh, Professor and Chair of the Department of Medical Informatics and Clinical Epidemiology at the Oregon Health and Sciences University, also has fond memories of Bob's mentoring skills: An important aspect of Bob's mentorship is that he taught me how to be a mentor … he showed me that it's not just a matter of teaching someone or critiquing their work, but really keeping an eye out for their career and the directions that they're headed. Another former trainee, Dr. Luke Sato (Chief Information Officer for the Harvard Risk Management Foundation), notes: I was just really struck with the sophistication, the innovation, and the out of the box thinking that was taking place in his laboratory. He really forced us to think non-traditionally and challenged us on our assumptions and forced us to think beyond what was really capable at the time. These themes are often recapitulated by other trainees, such as Dr. Steven Labkoff, now a Senior Director with Pfizer's Global Business Unit: One of the most compelling things about working in the DSG was best summed up in a poem by Edgar A Guest. The poem was, “It Couldn't Be Done”. The poem outlines stepping up to huge challenges. It summed up Bob's philosophy about our projects. He seldom if ever said “it can't be done”, or “you can't do that” in general. In point of fact, the lab was a place which encouraged me to push the envelope, test the limits, and where possible, break through. It was this kind of creative freedom that helped me to try ground breaking things. It is a philosophy I've kept with me throughout my career in the business world. Bob led a group of talented physician trainees and computer scientists in the exploration of several new technologies that later became mainstream in informatics, such as a web-based prototype for scientific journal publishing in the mid 90s (a prototype for the New England Journal of Medicine's online publication was developed at the DSG),18 and a web system for Partners Healthcare System (a merger of BWH and Massachusetts General Hospital, two of the academic medical centers affiliated with Harvard Medical School).19 Other contributions from this period include participation in the InterMed Collaboratory,20 a consortium of leading medical informatics centers from 1995 to the early 2000s involving medical informatics researchers from Columbia, Stanford, McGill, and Harvard Universities. As part of InterMed, the GuideLine Interchange format (GLIF),21 a model for representing and sharing guidelines in a computer-interpretable format, was created. Under Bob's leadership, this line of research, as well as many others, was continued at the DSG (Fig 5). 22 GELLO, an expression language for GLIF, later became an HL-7 standard.23 Bob and the DSG family and friends (2007) Front: Lucila Ohno-Machado, Carole Greenes, Bob Greenes, Octo Barnett. Middle: Rosa Figueroa, Qing Zeng, Hyeon-Eui Kim, Ronilda Lacson, Staal Vinterbo, Margarita Sordo. Back: James Signorovitch, Esther Shilcrat, Christopher Tsai, William Solomon, Pankaj Sarin, Sassikiran Kandula, Sergei Goryachev. In 2005, at the celebration of the 25th anniversary of the DSG, Bob became the first incumbent of the Distinguished Chair in Biomedical Informatics at BWH and also received a leadership award from AMIA. Over 200 colleagues, family, and friends from around the world came to the Harvard Faculty Club to celebrate this memorable event. Bob founded and was the director of the BIRT program for 15 years. The BIRT program is the program in biomedical informatics, with and postdoctoral trainees who research in biomedical informatics in the Boston This consortium of MIT, and Boston Bob worked with Professor from in the of a program in medical informatics at the of Health Sciences and of The program was in and has over who now several positions in the industry and and are the Department of and Computer at or the Department of Health Decision at Harvard. his role as training program director and director of one of the that the Bob had the opportunity to with several trainees, and from (Fig His in this role to Bob's leadership and continued to education in biomedical informatics. The of his role has been not only by his trainees and colleagues, but also by such as Dr. Director of the National Library of I think Bob more to to and on to a I think he a problem as an opportunity for and what a good to begin with. I can years he was very with in the had some programs that allowed to make and of almost and he got a lot out of he used in this teaching so that a could ahead and develop a problem by the and of program I think he has been an excellent to many people. training program faculty Octo Barnett, Howard and Bob Bob in many on and academic and he on the Biomedical Library of the National Library of which he as Chairman in as well as in other at NIH. A fellow of the American College of Medical Informatics since year in which the was he to positions of leadership in a number of professional including the American Medical Informatics the of and the American College of He was President of the American College of Medical Informatics in and for many years on the Radiology Information Systems He is also a at and where he not only his own research but also often is to that his knowledge of the field and his ability to the that from computer and hardware to both the clinical and medical In he was to in the of of the National of Bob Greenes has over 200 in the fields of medical informatics and is an associate of the Journal of Biomedical He is the of a Clinical Decision the published by (Fig Bob also two to the now Biomedical Computer in Health and and Bob Greenes: Clinical Decision The After that kept Bob and his Carole in Boston for most of their both of their professional were in their decision to their and positions at University in and Bob was by the opportunity to as of a new Department of Biomedical created at as part of their contribution to a new medical in created with the University of The University of College of in with University brought a new medical to the in the United and the only United a medical The University of College of was founded in in and has been the only School of in the It was established with strong support by and and with an early to biomedical informatics into the medical as part of a collaboration the two his new role in Bob has been an new with faculty and advanced He and his have the new program in a and he has his for what is in the The has out to be a very and … with the of collaboration and the to and things to health and One of his faculty Professor him in and helped to the program established before Bob was I to and to be the of the formed of biomedical informatics, one of my was to a One of the first that came to my was Bob his in informatics education and his as a in his field. The leadership has been remarkably visionary in the for an academic program in biomedical informatics and working to the The President PhD, has been that the has Bob Greenes to this leadership He came to from Harvard and has a our of biomedical informatics. more I think of this as an of the kind of impact he had throughout his he in and and Dr. Professor of Computer and Director of School of and Informatics (which is the to the new Department of Biomedical has the at which Bob has biomedical informatics and made it an part of many clinical research and academic in is of the kind of Bob in of able to things as well as with very Bob his novel and his to be a and his to be the first in our field to the important to which he to his time and His special contributions to medical decision and its have been as by Octo of the work of we in clinical decision have benefited by on Bob's It is and for his career and contributions to biomedical informatics to have been with the Morris Collen Award for
DOI: 10.1197/jamia.m3172
Authors: L. Ohno-Machado, D. Ellison, E. H. Shortliffe
Language: English
Subfield: Health Information Management
Field: Health Professions
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2149654230