Medical Informatics I: Principles of Database Design
Pre-Lecture Interview With the Marine Biological Laboratory:
MBL: We are here with Dr. Dan Masys, who is Director of Biomedical Informatics at the School of Medicine, University of California in San Diego. Dr. Masys, along with others, is teaching a course in Biomedical Informatics at the Marine Biological Laboratory in Woods Hole. Doctor, could you tell us a little bit about the session that you are teaching here that we just finished?
Daniel Masys: Well, medical informatics is both science and technology. It is the science of organizing information to make it useful, to make it retrievable so people can use it to solve health problems and understand health and disease better. It is the technology for implementing that science, such as databases, communication networks, and other forms of digital tools.
MBL: Now this goes across almost all disciplines from research to clinical, to administration, I understand, in the medical fields.
DM: We are surrounded by information and increasingly we are surrounded by so much information that only computers provide a plausible way to keep it under control and find out the facts that we need. That is what medical informatics is about.
MBL: Is this a discipline now in the sense of microbiology or cellular biology or things of that nature?
DM: For almost 25 years there has been a small group of researchers who have been pushing back the frontiers of our understanding, creating new methods for computerized analysis of data. From a very small beginning, medical informatics has grown to become a medical subspecialty in its own right, and one for which researchers are funded to do the same kind of research that bench researchers do with microbes and tissues.
MBL: What would you hope people would take away from a presentation like this?
DM: This is both a science and technology topic. Databases surround us in our environments and it is very, very easy to create databases. This session is focused on the principles by which one creates those databases so they can endure and serve the purposes for which they are designed. That is more an issue of science and thinking--"wetware" as they say in the trade--than it is technology. That is, the actual building it in the computer is easy, once you get the design correct.
MBL: What needs to happen next in the field of biomedical informatics, particularly in relationship to new areas to explore, databases?
DM: The nature of the field is changing dramatically, driven primarily by the completion of the human genome, where we now have millions of facts at the molecular level about this blueprint of humanity. It is beyond the range of human cognition to be able to understand this flood of data. Merging this molecular data with the centuries old understanding that doctors get from watching sick patients and trying to make them better, is the key challenge of biomedical informatics--merging the molecular unseen world with the world of clinical medicine and health care.
MBL: What kind of an individual does this take&scientist, information specialist, computer scientist?
DM: Medical informatics is inherently an intersection discipline. That is, it is the joining of computer and information science and the traditional disciplines of health care and basic biomedical research, and people that practice [medical informatics] come from both directions. There are computer scientists who learn biology and health care topics, and there are medical practitioners--doctors, nurses--who come and acquire the computer skills so they can work at that intersection.
MBL: What questions do you hope that this presentation will raise today in the members of this group in this workshop?
DM: Well, we hope as a result of this that the members of the class will think in greater depth and somewhat greater detail when they are building new systems, about how the data should be arranged, so that it not only serves the immediate purpose for which that system is being built, but serves future purposes, perhaps not even imagined, for these increasingly complex databases that are found in health care and research.
MBL: Now, I am correct that you were a researcher in oncology originally, or maybe you still are? What drew you to this side of the fence? I know that you were the director of the Lister Hill Center [the Lister Hill National Center for Biomedical Communications, (http://www.lhncbc.nlm.nih.gov/) the computer research and development division of the National Library of Medicine] for a while, but how did you get here?
DM: I started my career in computing, writing programs to track patients through cancer clinical research programs. Clinical trials that were very, very complicated recipes that tell the doctors exactly when to give the medicine and in what dose. In the late 70s and early 80s those recipes had gotten so complicated that we were making mistakes trying to remember. It was my conviction that a computer program that would tell the doctors exactly when to give the research medication, in what dose at what time, would improve the accuracy with which that research was done. And for that purpose I learned how to write computer programs, and that was the beginning of a second career for me.
MBL: That is great. What keeps you in science?
DM: There is this almost childlike fascination of discovering the unknown, of unraveling the complexities of health and disease, and this anticipation that one could leave a legacy of a world that is measurably better than the one that one grew up in, by virtue of understanding, at a molecular level and a clinical level, how to remove the many, many diseases that afflict mankind. Relieving of the burden of suffering is what propels all scientists in this area--the idea that we could leave the world better than we found it.
MBL: Finally, of the scientists living and dead, who would you most like to have worked with, or work with?
DM: Wow. For uncanny ability to create insights from almost inscrutable complexities, I would have thought it would have been interesting to have a conversation with Albert Einstein and his colleagues because they looked at a world that had a set of surface principles that they didnt believe. He discarded those and looked for deeper truths. I think that theme of science of looking for the hidden, the deeper message of what is controlling what we see outwardly, was very strongly evident in Niels Bohr, Albert Einstein, that class of folks. And it would have been wonderful to just listen to them talk. I would have considered it a privilege just to sit and be a little fly on the wall and listen to them think.
MBL: You couldn't pick a better group, I'll bet you. Doctor, thanks so much for your time, and we look forward to another presentation this even
DM: Thank you.
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