Special Features

SAFRAN, Morris F. Collen Award
Special Features
Presentation of Morris F. Collen Award to
Professors Howard Bleich and Warner Slack
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
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.
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
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.