Imagine working on a million-piece jigsaw puzzle; now, imagine that the puzzle is missing a few hundred thousand pieces ­ all of which must be located in order to assemble the complete picture.

For health care specialists whose work involves piecing together "puzzles" of scientific information, the Yale Center for Medical Informatics (YCMI) can be an invaluable resource.

The YCMI staff explore how computers can help medical clinicians, researchers and educators collect disparate data and organize it in such a way that it is directly relevant to their work, explains Dr. Perry Miller, professor of anesthesiology and director of YCMI.

"Informatics can be defined as the creative use of computers," Miller explains. "If you're trying to understand a phenomenon ­ vision, smell, behaviors ­ you have to understand it on all different levels. So, to be able to fully integrate information, computers are important to organize it. What you really have is a constellation of databases ­ all sorts of information at various levels. And they all must be interoperable."

By establishing a connection to relevant data bases, and by organizing data into a form applicable to researchers' work, the YCMI explores how investigators can get up-to-date information in an organized, comprehensive format. It also facilitates joint projects, says Miller. "A major role of the center has been to help catalyze collaborative projects in different fields," he notes. "Members of the center have worked closely with faculty from many departments within the School of Medicine and the University as a whole. In areas of clinical medicine, the center collaborates with members of clinical departments and with the staff of the Yale-New Haven Hospital (YNHH)."

One recent project, a collaboration with the School of Medicine's department of pediatrics and YNHH, involved creating a computer database of the hospital's pediatric patients. Prior to the project ­ called SEURAT (Scanning for Evaluation, Utilization Review, Analysis and Training) ­ clinical information was handwritten on forms and kept in paper files. SEURAT helped increase efficiency by creating a database that could be collected in a relatively standardized way, processed by computers and accessed easily by health care providers.

Organizing data, however, was only part of the challenge, says Dr. Richard N. Shiffman, associate professor of pediatrics and a YCMI faculty member. Before the database could be set up, certain significant factors had to be considered. These included: accommodating the statewide Medicaid managed care program's requirements for clinical data collection and reporting; developing a system that would generate the most information, yet be compatible with existing databases and computer systems at YNHH; and devising a data collection system that easily could accommodate diverse statistics (different data that need to be collected at different ages as a child develops).

The YCMI scientists devised a set of age-specific, structured forms on which clinicians recorded clearly defined data gathered during office-visits (such as height, weight and blood pressure), along with other information. Links between data subsets were created, and the information was entered into appropriate tables in the SEURAT database.

As a result, a child's office-visit history can easily be accessed using SEURAT. Now researchers and clinicians can rapidly find such information as the dates of visits and providers seen; immunizations administered and screening tests performed; growth statistics; and other details about the patient. The data also can be aggregated to display patterns, such as the immunization history of a cohort of patients.

"Before SEURAT records were all kept on paper," says Shiffman. "Doctors sat down with a blank sheet of paper and used their memory about what is appropriate at each age" to determine what to record during office visits. "Now they use standardized documents. There's more consistency, more comprehensiveness."

During the transition period to SEURAT, which began in February 1996, an almost three-fold improvement in the documentation of some items was seen, and 90 percent of the health professionals using SEURAT said they preferred it to the previous system of collecting data, Shiffman notes.

Established in 1991, YCMI encompasses half of the eighth floor at 350 Congress Ave. YCMI staff currently includes three teaching faculty members, four research faculty members, three programmers, six postdoctoral fellows, two predoctoral students, and more than 25 collaborating faculty based in various departments throughout Yale. The ongoing projects at the center revolve around many fields of clinical medicine and also bioscience, with a particular focus on genetics and neuroscience.

In addition to presenting information in a format that computers can process and helping health care workers become comfortable using computers, YCMI helps with "developing standards for interchanging information," says Shiffman. This, in turn, helps clinicians make effective decisions, he notes. It is an area in which Shiffman is especially interested.

After 12 years in private practice, Shiffman became dismayed by the seemingly insurmountable level of paperwork involved in his day-to-day activities, and became interested in medical informatics as a way to help physicians increase efficiency. At Yale, Shiffman has worked on the SEURAT project, and also helped develop the software program "PalmAsthma," customized for a hand-held computer that helps doctors evaluate and manage asthmatic patients.

To determine the severity of a patient's asthma, doctors need information about the patient's age, current level of asthma control, current medications, amount of exercise and other factors, explains Shiffman. Using PalmAsthma, physicians ask patients questions about these issues and record the answers using the computer keyboard or by actually writing on the 9-inch color screen. PalmAsthma then helps the physicians make a valid diagnosis about the asthma's level of severity and recommends appropriate treatment.

At Yale, training in medical informatics is supported by the National Library of Medicine. Eight postdoctoral fellows and predoctoral students currently are being trained at YCMI, with the goal of preparing them for careers in or involving medical informatics. After completing their training, several medical informatics specialists have remained at Yale as faculty members.

In addition to their computer expertise, YCMI faculty and fellows are typically fully trained in clinical medicine or in one of the biosciences, explains Miller. "Most of the people we train are physicians or molecular biologists, with significant prior experience with computing," says Miller. "They have been looking for a way to combine these two areas that interest them."

"Informatics is a means to an end, not an end in and of itself," notes Dr. Prakash Nadkarni, an associate professor of anesthesiology who is also a YCMI faculty member. "When you tackle almost any problem that becomes complex, sooner or later you need a way to organize data. A central component of informatics is organizing data."

Nadkarni, along with Dr. Gordon Shepherd, professor of neuroscience, and others are part of a national project known as the Human Brain Project. Work under this umbrella at Yale includes the development of databases focusing on the olfactory system; properties of neurons and neural activity; and computer modeling of neuronal function. Another of Nadkarni's projects, Trial/DB, a database supporting clinical trials, was built in collaboration with the Yale Cancer Center and has been used at other medical centers.

Serving at the medical school as a "database guru," Nadkarni is often consulted when people encounter difficulties organizing their data. In this regard, "we're sometimes like hired guns," he comments. "People come to us with their problems." Nadkarni, who likes to "tackle challenging problems," offers a department of epidemiology and public health course on database management titled "Database Management in Medicine and Epidemiology."

"[Computer] programs have become friendlier and friendlier, and easier to use," says Nadkarni. "I can teach students to set up databases that I would have had to set up myself 10 years ago."

Despite their usefulness, programs such as the YCMI are still relatively rare, according to Miller. "There aren't that many major programs in medical informatics nationwide. Being a new, interdisciplinary field, it doesn't have its own departmental base." However, the field is expanding, says Miller.

Shiffman agrees. "The discipline of medical informatics was founded at the intersection of computer science and medicine," he says. "The center is really a group of people with skills and talents in computer science and medicine who work together to advance frontiers of medical uses of computers. It is establishing itself as a legitimate discipline in its own right."

For more information about the Yale Center for Medical Informatics, including current projects, staff and training program, visit the YCMI web site at http://ycmi.med.yale.edu/ .

-- By Felicia Hunter

T H I SW E E K ' SS T O R I E S

Study finds undercurrent of anger in U.S. workplaces

Translating Shakespeare into sign language was a lesson in the art of communication

'Alternative' therapies not favored over conventional medical care, says survey

Robert Blocker to continue as dean of the School of Music

Mary E. Miller is new master of Saybrook College

Array of appointments announced at Graduate School

Emeritus Faculty

In the News

Women under 50 at greater risk of dying from heart attacks than are men

The world was a classroom for Yale students this summer

Center's creative use of computers aids medical research

Exhibits at Beinecke Library celebrate the pioneering spirit

Stanford-Yale forum will boost junior faculty's skills in legal scholarship

Psychopharmocologist Dr. Robert Byck dies; discovered properties of MSG, THC

Awards support research and outreach programs at Yale Cancer Center

Program on Nonprofit Organizations names new leaders

Hydrogeology expert joins School of Forestry

Yale Rep's coming season features broad spectrum of plays

Correction: Fourth scholar-athlete identified

Campus Notes

Bulletin Home|Visiting on Campus| Calendar of Events|Bulletin Board

Classified Ads|Search Archives|Production Schedule|Bulletin Staff

Public Affairs Home|News Releases| E-Mail Us|Yale Home Page