Medicine in the Computer Age: The ACP and Medical Informatics
The ACP and Medical Informatics
The American College of Physicians' historical involvement with medical informatics can best be described as education and enlightenment, not advocacy or product development. As a pedagogical organization, the College has focused on educating its members about the uses of computers in medicine. It has not endorsed medical software applications or developed such applications, but has encouraged its members and academic institutions to pursue such work through College programs including PIER (Physicians Information and Educational Resource).
Computers in Medicine and ACP Governance
Former ACP President Dr. Irving S. Wright, M.A.C.P., first called for the establishment of a committee dedicated to educating internists about computers in 1967:
"It is now clear that medicine is to be confronted with a new methodology, concept and language, based on the inevitable development of computerization and datamation. No medical student should hereafter be graduated without a reasonable understanding of this revolutionary movement. The greater challenge rests in the need for education in these techniques for the physicians in practice. No system has been set up to meet this need, and I believe that the College should move into a position of leadership."
His request was heeded, and a committee, the Ad Hoc Committee on Bioengineering, was formed by his successor, President R.H. Kampmeier, M.A.C.P., that same year.
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Irving S. Wright, M.A.C.P., ACP President, 1966-67 |
The following physicians constituted the first Ad Hoc Committee on Bioengineering: Kenneth G. Kohlstaedt, Chairman, Indianapolis, Indiana; Vergil N. Slee, Ann Arbor, Michigan; Ralph L. Engle, Jr., New York, New York; Alvan R. Feinstein, New Haven, Connecticut; Morris E. Collen, Oakland California; Morton Bogdonoff, Durham, North Carolina; Edmund D. Pellegrino, Stony Brook, New York; John G. Mayne, Rochester, Minnesota; Archie A. Hoffman, Washington, D.C.; and Octo Barnett, Boston, Massachusetts.
The Committee first met on March 8, 1968, and arrived at two recommendations. First, the Committee suggested that a special exhibit on computers be offered at the next Annual Session. In addition, the group strongly urged that "information about biomedical engineering be solicited for printing in the Annals of Internal Medicine." Both recommendations were implemented.
In 1969, Dr. Kohlstaedt, the Committee's chairman, recommended that the group be "more broadly based" so that it could address all technological applications in medicine, not just computer technology. To meet this need, the Board of Regents dissolved the Committee, and approved the establishment of a new Ad Hoc Committee on Bioengineering whose membership would reflect a wider array of expertise. According to the 1970 Annual Session program, this Committee sponsored numerous sessions on computers in medicine. After 1970, however, no mention of the Committee appears in Board of Regents minutes or other committee records, suggesting that the group was dismantled in 1970.
Between 1971 and 1981, the College's committees played a minor role in developing programs pertaining to computers. Some College committees, such as the Medical Practice and the Educational Activities Committees, occasionally included computer technology in their programs. Though the College was represented in the Alliance for Engineering in Medicine and Biology, it did not take an active role. ACP representatives to the Alliance did make recommendations for Annual Session programming, which were well received by the College's Scientific Program Committee. Accordingly, computers played a prominent role in Annual Sessions of that decade. Annals also continued to cover the topic of medicine and computers.
In 1981, the Board of Regents approved the establishment of the Telecommunications Subcommittee, an advisory group dedicated to assisting the College with computing and communications technology. The Subcommittee successfully lobbied for the inclusion of computers in the College's educational programs. Its mark on Annual Session programming is apparent; computers figure prominently in Annual Sessions of the 1980s. The Subcommittee also encouraged the development of post graduate courses on computers. In addition, the group advocated the inclusion of medical informatics in medical school curricula and the American Board of Internal Medicine examinations.
The group also provided guidance to the College's Education Division and the Educational Policy Committee as they developed plans to digitize the Medical Knowledge Self Assessment Program and other ACP publications.
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HyperMKSAP, 1993 |
Through it's work within the College and with external organizations, the Subcommittee helped define the College's role in the burgeoning field of medical informatics. The group strongly felt that the College should not develop medical information systems; but should provide expert advice to outside developers of these systems and should promote computers broadly through the College's educational products and programs. The College followed that recommendation. The Board of Regents, on the Subcommittee's advice, agreed that the College would not endorse particular computer applications, but would provide reviews of computer products for medical diagnosis and patient records through Annals.
The Telecommunications Subcommittee was also concerned with ensuring that medical informatics had a permanent place in the College's organizational structure. In 1985, the Subcommittee actively sought the establishment of a medical informatics department at the College's headquarters in Philadelphia. The Board of Regents found the Subcommittee's argument convincing and voted to include the department in the College's 1985 budget. With the pending establishment of a medical informatics department, the Education Policy Committee recommended that the Telecommunications Subcommittee adopt the name Medical Informatics Subcommittee. It did so in December 1985.
In the 1990s, the Medical Informatics Subcommittee continues to support the College's efforts to enlighten its members about computers through educational programs and publications. The Subcommittee also has helped develop programs, such as PIER, to assist and coordinate the development of clinical decision systems.
Computers at Annual Session
Just as the international medical community began to explore the use of computers for diagnosis and medical treatment in the 1950s and 60s, so, too, did the College. At its 1966 Annual Session in New York City, the College invited physicians S. Herbert Shubin, F.A.C.P, and Max H. Weil, F.A.C.P., to present a clinical investigation session titled, "Efficient Monitoring of Cardiovascular Function in Seriously Ill Patients with a Digital Computer."
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Annual Session Program, 1966 |
Three years later, the College gave computers a spotlight at its Annual Session in Chicago. A special education demonstration on "computers in medicine" was presented for three days. The College's Ad Hoc Committee on Biomedical Engineering and the Laboratory of Computer Science at Massachusetts General Hospital sponsored this demonstration which included interactive exhibits on the Public Health Service's on-line program for diagnosis of EKG data and Massachusetts General's patient information system (MUMPS).
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Computers in Medicine Demonstration, Annual Session, 1969 |
From 1969 onward, scientific sessions and demonstrations on the use of computer technology in diagnostic equipment and patient information systems were a mainstay at the College's Annual Sessions. Bioengineering, the use of engineering and computer technology in medical treatment, education and testing, was a major theme at the Annual Session in 1970. Three symposiums and one scientific session on the topic were included in the program. One session, "Computer Based Evaluation of Clinical Competence", was the first to address the use of computers for testing physicians' knowledge of internal medicine.
The international medical community began to explore the use of computers for clinical decision support systems in the 1970s. The College used Annual Session as venue for educating members about these new systems. At its 1977 Annual Session, a special lecture on "The Computer -- Artificial Intelligence and Medical Diagnosis," was presented to the attendees. The lecturer, Dr. Jack D. Myers, M.A.C.P., of the University of Pittsburgh School of Medicine, discussed "a computer program called, 'Internist'," designed to "serve as a consultant to the internist in complex and difficult diagnostic problems." Beginning in 1981, sessions on digital clinical decision support systems became a standard feature at every Annual Session.
While the College presented cutting edge sessions on computers and medicine, it also recognized the need to educate members about the basics of computer hardware and software. Beginning in 1983, hands on computer classes were offered at Annual Session. In 1984, these classes became "ticketed" events, demonstrating their popularity.
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Computer Tutorials, Annual Session Program, 1984 |
Another important computer milestone occurred at the College's 1986 Annual Session. For the first time, sessions titled "medical informatics" were offered. These sessions covered topics such as searching medical databases and the use of "medical expert systems." In the 1990s, medical informatics and evidence based medicine continue to be popular topics at the College's Annual Sessions.
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Medical Informatics Sessions, Annual Session Program, 1986 |
Medical Computing and Annals of Internal Medicine
Like Annual Session programs, articles found in Annals reflect the evolution of medical informatics during the past three decades. Annals first published an editorial on computers, "Devices for Diagnosis," in 1961. The author posited that large databases could be effectively used to help physicians diagnosis diseases, particularly rare diseases, but acknowledged that the costs of digital computers was prohibitive.
Thereafter, articles describing the use of digital diagnostic equipment and medical databases became common place in Annals. At the same time, editorials questioning the validity of using computers in medicine were also commonly found in this publication. Authors of these editorials often argued that computers were causing physicians to lose their clinical judgment skills.
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Analog-To-Digital Conversion System for Electrocardiograms, Annals, 1962 |
By the late 1970s, the use of computing technology in medical research had become so ubiquitous, that Annals articles were full of references to digital technology. During this period, few editorials decrying the use of computers in medicine appear in the journal. In the 1980s, widespread use of minicomputers and the marketing of medical software, led Annals to begin publishing reviews of medical computer applications.
Conclusion
Historically, the ACP has not chosen to be on the bleeding edge of technology, but has carefully and skillfully employed its educational products and programs to enlighten physicians about cutting-edge and more practical applications of computing and communications technology in medicine. The College has always been careful to judge computers from a scientific perspective, acknowledging that new technology must be quantitatively and qualitatively assessed before it is promoted.
If you have any questions or comments about this exhibit or would like to further explore ACP-ASIM's involvement in medical informatics, please e-mail the ACP-ASIM Archivist at hwillever-farr@acponline.org.
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