In the 2013 list of the Top 10 Informatics Events of the Year presented at the AMIA Symposium in November, Daniel Masys, M.D., chose Morris Collen, M.D., turning 100 as the second most important event. I think he said something to the effect of it couldn't happen to a nicer guy…
Although retired from medical practice, Dr. Collen maintains an active role as a consultant to both the Kaiser Permanente Northern California Division of Research and Kaiser Permanente. Luckily for me, the folks at Kaiser reached out and offered me an opportunity to interview Dr. Collen, and it was a real honor, because he is still sharp and opinionated. In fact, the first thing we talked about was his current project, updating his textbook, "A History of Medical Informatics in the United States, 1950 to 1990," to bring it up to date. “The publisher asked me to update it to 2010, and I think I am pretty much there. I hope to finish it next year,” he said.”
Dr. Collen is something of a living legend in healthcare informatics. In 1948, he became one of the seven founding physicians of the Permanente Medical Group. He is recognized for his pioneering work in applying computer technology to medicine. He was one of the first people to apply the technology of his generation to record patient data and to realize it could be applied to efforts to prevent disease. His work was the foundation for Kaiser Permanente's Division of Research.
I asked Dr. Collen to reflect back on some of the changes he has witnessed over the last 50 years. “We have gone from an IBM 1440 computer that filled up a whole room to amazing technology developments today with the Internet, wireless access and the cloud,” he said. “We thought it was amazing that we had data on 100,000 members in the Northern California system. But now there are these humongous data sets. It is mind-boggling. Just in Kaiser Permanente’s Heathconnect system, there are something like 9 million people. And Kaiser is using all that stored information to focus on better quality of care, to help providers avoid adverse events through alerts and reminders.”
But as great as these advancements are, Collen said he is still disappointed that more progress hasn’t been made to make systems interoperable. He gives CMS credit for putting so many millions of dollars toward encouraging implementation of EHRs. “I think that’s wonderful, but we still have this problem that they aren’t interoperable. What should be done about it? Well, he noted that in the 1980s the Health Care Financing Administration required that hospitals deploy a unified system of coding called DRGs (diagnosis-related groups). “And every hospital had to use that DRG code to get paid,” he said. “I complement CMS for stimulating the EHR market, but I fault them for not requiring a uniform basis for interoperability when they had the chance. We are now paying the price for their failure to do so.”
Collen said that if cultural transformation with technical change is difficult in the healthcare setting today, it was perhaps even more so when health IT pioneers tried to inject technology into hospitals and doctors’ offices in the 1960s and 1970s. “I remember I had a surgeon slap my wrist when holding a clamp during an operation. ‘Don’t ever move from the way I told you to do it,’ he said. ‘I have been doing this operation the same way for 15 years.’ So it is a very hard thing for them to change a complex procedure,” Collen recalled. “I learned early on to spend time with the chief of service and if I could impress that person that the computer records had merit, they would pass that enthusiasm along, because it is essentially an apprenticeship model.
But switching from paper-based charts to electronic ones is a major change in how doctors record data and there are sociological problems that can hold back developments.
In closing our conversation, Collen reflected on the good fortune he had to work with Kaiser Permanente’s founders. “Kaiser had great leadership,” he said. He worked closely with Sidney Garfield, M.D., who had the organization’s vision about preventive medicine, and Henry Kaiser, the shipbuilding magnate. “The combination of these medical and business visionaries was remarkable, and I felt so lucky to be part of this unique organization.”