A strong-willed boy, he grew up on the city's southside selling newspapers in front of the old Claypool Hotel. In addition to drive and ingenuity, young Regenstrief had a head for business and a bent for practical analysis. By the middle of the century, he had developed the front-loading dishwasher, which revolutionized the home appliance industry and dramatically changed the role of the post WW II woman. (He also made himself a millionaire in the process.)
Regenstrief's genius was his ability to evaluate process and design ways to improve it without sacrificing quality. He recognized how technology could increase efficiency, so he mass-marketed dishwashers at reduced prices, producing more than a third of the worldŐs supply by the mid-1970s. His Connersville, Indiana, business - D&M Manufacturing Company - built 4,600 machines daily. The brands he produced, Lady Kenmore, Modern Maid, Admiral, and Norge, became household names.
As his legacy to society, the entrepreneur established the Regenstrief Institute for Health Care. He had come to Indiana University Hospital for his medical care and greatly respected the IU School of Medicine and its faculty. He viewed the School as an ideal environment to study how health care could benefit from innovations of industry. His hope was that, much as evolving technological innovations were changing daily life, they could also improve the quality and delivery of health care.
Research interests of the community of IU faculty who are Regenstrief Institute scientists include medical informatics, health services research, medical sociology, clinical epidemiology, aging, medical economics, diabetes and statistical methodology. Over the past 25 years, these scientists also have developed the Regenstrief Medical Records System (RMRS) which is used at more than 40 inpatient and outpatient facilities in and around Indianapolis and is the largest coded, continuously operated, computerized medical records system in the United States
Institute Director Clement McDonald, MD, a preeminent figure in the field of medical informatics, strongly believes that computer interpretable information about the process and outcomes of patient care is a prerequisite to better and more efficient health care. He is confident that the RMRS reduces errors, unnecessary testing and duplicate prescriptions while saving provider time. Dr. McDonald, a distinguished professor at the IU School of Medicine, cites an example of a patient who benefited from the RMRS when he talks about the system's attributes.
"Not long ago, a young Indianapolis girl arrived with her parents at the Methodist Hospital emergency room complaining of a bad cough," he recounts. "As she checked in, her name was routinely entered into the RMRS workstation. The RMRS printout notified the ER physician that the young patient had very recently had a sweat chloride test at Wishard Hospital and had not yet returned for the results of the test, which indicated that she had undiagnosed cystic fibrosis." The patient obviously did not have a simple case of bronchitis, and knowledge of her underlying illness allowed the physician to avoid a potentially disastrous outcome. She was admitted to the hospital, found to have pneumonia and appropriately treated.
The RMRS is a two-part, interactive system comprised of a PC-based order entry system and a central data repository. For example, a data entry may inform the physician that a test he or she has ordered was recently done elsewhere and asks if it needs to be repeated for comparison purposes. Results of previous laboratory tests, as well as information about previous emergency room visits, can save time and resources. The system advises the physician if the patient has conditions (for example, renal problems) which may suggest a different drug or test than ordered. At Wishard Health Services sites, medical reminders (for example, flu shots for elderly patients or mammograms for female patients) also appear on the screen.
The system's knowledge base is created and maintained by clinicians, and its clinical focus makes it uniquely valuable, according to J. Marc Overhage, MD, PhD, assistant professor of medicine and Regenstrief research scientist. It contains information from medical literature and hospital policies, as well as best practice data and the feedback constantly provided by its users. "The system is supportive and nudges the caregiver in a certain direction," he notes, "but the physician has the final say."
If the patient is at one of the many Wishard Health Services sites, records of prior visits, diagnostic reports such as EKGs and X-rays and prescription information are available on line, doing away with the need to request a file which may or may not be found in a timely fashion. At the end of the visit, the physician enters notes and a discharge summary and can request computer-generated signed prescriptions.
Patient data from the ERs at Methodist and Community Hospitals also are currently on line. When a patient arrives at one of these facilities, a health care provider checks system data. The system has data on about 30 percent of patients who come to the Methodist and Community Hospital ERs and more than 80 percent of patients who come to the Wishard ER. This year, with continuing National Library of Medicine grant support, the emergency rooms of St. Vincent (Indianapolis and Carmel) and St. Francis Hospitals and additional areas at Methodist will come on line. Each hospital will have its own separate file of ER visits and laboratory results which will function as an individual electronic medical record system; each hospital will control what is seen by other institutions.
In the future, all the data may be merged to create a truly integrated report, available when a patient arrives at the ER. For now, physicians at each hospital's ER can access independently maintained patient data at any one of the participating hospitals.
"Transmission of data increases quality of care because the more that caregivers know about a personŐs medical history, the more appropriate care they can give. Simultaneously, however, we must ensure the security of patient data," says Paul Dexter, MD, assistant professor of medicine and Regenstrief research scientist.
As with paper records, all RMRS medical records are confidential. But electronic transmission offers built-in safeguards to help ensure that records are not misplaced or end up in the wrong hands, frequent problems with paper records.
In the RMRS, encrypted data is transmitted via secure, private data lines, and access is granted on a need-to-know basis with strictly enforced sanctions over misuse of the system. Care providers who need access to the information, such as ward clerks, nurses and attending physicians, are assigned different access privileges according to their roles. They must have valid user identification and the correct password, which is changed frequently. If the user fails to end the session, the user-smart workstation automatically turns off.
A second major contribution further enhances the efficiency and accuracy of the RMRS and medical information keeping in general. The Regenstrief Institute's groundbreaking standardization of medical terminology, definitions and codes for laboratory results, test findings and other critical medical data enables users to communicate with each other accurately and precisely, and has sped the expansion of the RMRS.
The standardization of medical terminology was made possible by the development of
Regenstrief's massive database of medical identifiers, referred to as LOINC (Logical Observation
Identifier Names and Codes) and consisting of 13,000 standardized names and codes for test
and clinical measurements. LOINC is distributed worldwide for public use on the Web at
Is all this important to the physician? In a speech to a national group of medical
informatics colleagues, Dr. McDonald stated, "Information technologies are having a profound
impact on clinical practice and biomedical research. They are also changing the way medical
students learn and the way institutions are administered. There are mounting pressures to control
costs, to understand and improve clinical decision making, to provide more consistent high
quality care, and to assure that care is available to all members of our society. These factors
are making the use of electronic information systems for biomedicine an imperative."