406 SAFRAN, Morris F. Collen Award JAMIA Special Features Presentation of Morris F. Collen Award to Professors Howard Bleich and Warner Slack CHARLES SAFRAN, MD The Morris Collen Award is given each year, when appropriate, to pioneers in the field of medical informatics who best exemplify the teaching and practice of Dr. Morris Collen. This year’s co-recipients, Drs. Howard Bleich and Warner Slack, who have been copresidents of the Center for Clinical Computing at Harvard Medical School and collaborators for nearly 30 years, have pioneered work in the field of medical consultation, patient–computer dialogue, and hospital-wide clinical computing systems. The work of these two has taken place principally at Boston’s Beth Israel Hospital. Howard Bleich arrived at Harvard and Beth Israel in 1967; he was joined by Warner Slack in 1970. Since then, the two Harvard professors have created, among other things, an integrated hospital computing system that is a model for many other institutions. Howard Bleich was born in Atlanta, Georgia, in 1934 but grew up in Washington, D.C., where his father worked for the Washington Terminal Company and his mother ran a dry cleaning and laundry business. He was the oldest of three sons, all of whom became doctors. His childhood interest in chemistry included Affiliation of the author: Center for Clinical Computing, Harvard Medical School, Boston, Massachusetts. Correspondence and reprints: Charles Safran, MD, MS, Chief Executive Officer, Clinician Support Technology, Associate Clinical Professor of Medicine, Harvard Medical School, 3 Speen Street, Suite 340, Framingham, MA 01701; e-mail: <[email protected]>. synthesizing organic explosives. He graduated from George Washington University and then went on to get his medical degree from Emory University. Further up the east coast, Warner Slack was born in East Orange, New Jersey, in 1933. His father was a nuclear physicist who worked on the Manhattan Project. The family moved to Pennsylvania, and Warner graduated from Mount Lebanon High School, where he minored in basketball and football. At Princeton, he played junior varsity football and picked up his degree and then got his medical degree from Columbia. Both Howard and Warner served in the Air Force in the ‘60s. Warner was with a M.A.S.H. unit at Clark Air Force Base in the Philippines, and Howard served part of his service time in Japan. Following his Air Force service, Warner went to the University of Wisconsin in Madison in the Departments of Medicine and Computer Science. It was here that, with other members of the Department of Medicine, he developed the first computer-based medical history system in which the computer could engage in an interactive dialog with a patient. The computer program created so much interest that it was the subject of a documentary on what was then called National Educational Television, the forerunner of PBS. The computer communicated via questions, explanations, requests and comments. The evaluation of the technique showed that the computer interview elicited more information than traditional questionnaire and interviewing methods. Journal of the American Medical Informatics Association Volume 9 Number 4 Jul / Aug 2002 407 Warner Slack and Howard Bleich. (Photo courtesy of Charles Safran.) At the same time, at Harvard and Beth Israel, Howard Bleich was also developing a computer program. His first study, “Computer Evaluation of Acid-based Disorders,” is now recognized as a pioneering work in the field of expert systems in medicine. Although this program wasn’t called artificial intelligence—the term wasn’t in common use then—many characteristics of artificial intelligence programs were present in this early work. The 3,500 medical rules in this expert system are comparable in complexity to those in artificial intelligence programs in medicine being studied today. In 1970, Warner was lured away from the University of Wisconsin to come to Harvard and Beth Israel to work with Howard. It’s a partnership that has lasted! The two of them set up a laboratory that was called “Laboratory for Computer Medicine.” And they started working independently on their own projects, Warner on what he called “patient–computer dialog” and Howard on “expert systems and consultations with the computer systems.” Clem McDonald, MD: Well, the combination of these two is really quite remarkable, maybe unique in all of academic history. Howard invited, as I understand it, Warner to join him at Harvard and made him an exact equal. And they worked as exact equals. They had different strengths, and they specialized independently. They each had some work they did only alone. But it was really quite remarkable to see them sitting together talking. They were comfortable, they were collaborative, they were supportive. They were stronger together because of their both working together. There aren’t many pairs that I know who could pull that off or who have ever pulled that off. Howard Bleich and Warner Slack, when they joined forces at the Beth Israel, had about 10,000 articles that they had ripped from various medical journals. At that time, they started putting these articles into a database, which they subsequently called “PaperChase.” This allowed them to search for articles for teaching realms and for reasons of their own personal research. 408 Howard Bleich, MD: I used to read Current Contents every week and send postcards with lots of reprints. And, after I had about four or five thousand of them, I couldn’t find them. And I filed them as best I could. And we had a computer laboratory. So one day I asked one of the programmers if he could write up a computer program to help me sort and find the reprints. And, that’s how it got started. He put a terminal in my office. And at night, the house staff started coming in and searching the literature, taking my reprints and not always returning them. And then one day, one of the residents said we should move the terminal to the hospital library. And then we got a grant from the National Library of Medicine to expand the file, not only my reprints but the library collections. We put a terminal in the library and, to our surprise, our hospital became the largest searcher of the MEDLINE database in the world. The Center for Clinical Computing set up by Howard and Warner has now computerized every department of Beth Israel and Brigham and Women’s Hospitals. The system serves the needs of physicians, nurses, house staff, other hospital personnel as well as patients themselves. McDonald: At Beth Israel, these two crafted one of the world-class best clinical systems of all times. It was one of the most reliable, most loved, most comprehensive. It was the Toyota of clinical systems. Howard invented, at least to my understanding, some major technology to make this work. It was a clustered system, and I believe a memory-sharing system, long before this kind of technology was commercially available. I consider myself lucky. I’ve had the privilege of working with Howard Bleich and Warner Slack for over two decades. They’re really both unique individuals, but they operate in a very interesting way as a team. In some ways they seem like an odd couple: On the surface, they couldn’t be more different. Howard is quite meticulous. He has a very ordered desk; he has computer files for everything, including jokes that he uses in speeches. Warner, on the other hand, doesn’t wear a watch. We all know in the laboratory not to give Warner the only copy of anything that’s important because it will get lost on his desk. William Stead, MD: I first met Warner Slack in 1970 when I was a medical student at Duke. I was developing a questionnaire for patients who had headaches, under the direction of Ed Hammond. Warner had developed similar kinds of questionnaires, and he was willing to share them, actually giving us the source code so that we could see how he had made this work. In the mid ‘70s, when I was trying to build a model of SAFRAN, Morris F. Collen Award a consulting program, Howard was willing to give Ed Hammond the complete source code of his acid-base system so we could re-program it in a different language, and he gave us 50 cases to make sure it worked the way it was supposed to. This total openness and collaboration, I think, has marked their style. This is a very generous thing in today’s climate. It would be unheard of for a researcher to give their computer code away now that we’re so concerned about intellectual property and the like. Well, that was never the way that Howard and Warner operated. They were really generous and they were deeply concerned about every person that worked with them. And this is reflected in the kinds of computer programs that they were able to develop. That human quality comes through in the way that they taught us to design computer programs and interact with other human beings. Donald Lindberg, MD: It’s fun to have a chance to congratulate Howard Bleich and Warner Slack in receiving the Collen medal. Certainly, it’s well deserved. Warner and I were together at the College of Physicians and Surgeons. Our wives were friends. So, we had a lot of the same background, and I think, a lot of mutual appreciation. In the case of Howard, I first met him, actually, through the National Library of Medicine. I was on the study section many years ago, and I was the primary reviewer of Howard’s proposal to make what ended up being called “PaperChase.” I don’t remember who were the other reviewers, but I do remember that I was able to defend it before the study section on the grounds that certainly this was going to be an honest piece of work. If it worked, it would be well reported. If it didn’t work, it would be honestly reported. Moreover, it was a good thing for NLM to have an alternative “Plan B” for our users to have another way to get to MEDLINE. And, of course, he’s made a grand success of the work. Stead: Summing up, their contributions are this clear focus on how to use a computer to do things that help real people, be they patients or be they physicians. Warner Slack has a saying about people, where he describes them as being someone who he would like to have in a foxhole next to him during a time of stress or battle. I can think of no two people other than Howard Bleich and Warner Slack who I’d rather have in a foxhole next to me in time of stress. They are generous, warm human beings. They’re great men. No two people better deserve to be this year’s co-recipients of the Morris Collen Award.
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