MIS Memories (UCSF Graduate Division, 1978-1983)

Those were heady days in 1978 when I commenced my journey to a master's degree in the Program on Medical Information Science (MIS) in UCSF's Graduate Division. I will be forever grateful to my brilliant, colorful, unforgettable professors -- Ron Henley, Scott Blois, Tony Wasserman, Don Simborg, David Stimson, Azad Bolour, Hyo Kim and more -- people with fire in the gut and a fervor to change the world.

In those days, the electronic medical record (EMR) was the Holy Grail, the topic of several classes and of my master's project (I wrote one from scratch and tested it in a live setting -- though rudimentary, it worked!) Amazingly, it is an elusive goal even today (2005). We are still struggling to implement the EMR in the majority of the medical institutions of this country.

Of course, in the intervening years technology has made great strides. Who of us MIS-ers will forget the day of the arrival of the mighty VAX? The Department's pride and joy, it was the size of a washer and a dryer, demanded special air conditioning, and ran a DEC operating system that we promptly scrapped in favor of the upstart Unix, a software movement as political as it was technological. Today, Linux and other Unix descendants are mainstream dull, but back then we were hell-raising nerds combatting corporate hegemony. Today, I write these words on my palmtop PC with more compute power than that roomful of VAX. But less heat.

So why do hospitals and clinics still struggle to implement electronic charts? I volunteered at several San Francisco hospitals where the sheer volume of paperwork (and the resources it consumes) is mind-numbing. Obstacles to the EMR are no longer technological; they are economic. The EMR is infrastructure and largely invisible to patients. What insurance company would choose to incur its added cost? Though its contributions to quality of care are substantial and proven, the expense cannot be justified as could, say, a new MRI machine that provides a billable diagnostic or therapeutic service. Yet progress is happening, spearheaded by Kaiser and its EMR vendor Epic. UCSF's hospitals, too, have a huge EMR initiative in place. All this is driven by HITECH, a predecessor (and essential precursor of) Obamacare. These changes are welcome!

When I started school at UCSF, my vision was a career that would wed healthcare and computing. The possibilities remain immense. Especially in imaging, evidence-based medicine, and other applications of information technology, great leaps in quality of care have happened and many more are on the way.

Alas MIS, the program that nurtured my techno-medical zeal, no longer exists. I graduated in 1983 and MIS lasted perhaps three or four years more. It drowned in a mire of politics, personalities, and above all economics. Especially in today's climate of tight State budgets, it's nearly impossible to retain professorial talent when private sector paychecks are so much fatter. However, the larger institution -- the Graduate Division of UCSF (alumni go here) -- continues to provide a rich, nourishing environment in which programs like MIS -- and people like me! -- thrive and prepare to change the world. Our teachers' fire burns on.

--Dan Keller, 2005 and 2019

Postscript: The economic roadblocks preventing EMRs (now we call them EHRs) were removed by Obamacare and HITECH and Meaningful Use (look them up). Insurance companies didn't have to pay after all. The taxpayers did. And I believe it was a worthy investment. But not entirely...