1. The Future of Pathology Informatics: The Biomedical Informatics Department Model Michael J. Becich, MD PhD Chairman and Professor Department of Biomedical Informatics http://www.dbmi.pitt.edu University of Pittsburgh School of Medicine becich@pitt.edu

2. Slide 2 Disclosures by MJB  Corporate Support for API and APIII – 750K projected for 2010 [Cerner, Misys, GE, IBM, IMPAC, McKesson - Cisco, Verizon, CAP Today - Aperio, Apollo, Applied Imaging, De-ID Corp, GE Medical Systems/Triple G, Nikon, Olympus, SCC Soft, Sysmex, SNOMED, PSA, ThermoFisher, Zeiss, multiple others]  Corporate Sponsored Research Agreements – 200K in 2010 [ Amgen and General Electric/Omnyx ]  Startup/Public Companies ( Royalties, Licensing or Stock - MJB ): – Omnyx – Joint Venture with UPMC and GE (http://www.omnyx.com) – iKaryos Diagnostics (pending) – Scientific Advisory Board (http://www.ikaryos.com/) – CBL Path (pending) – De-ID (licensing payments to DBMI and DBMI staff/faculty)  Consultancy – ThermoFisher – Physician Advisory Board (paid) – GE Global Vision and Lab Vision (speaker honorarium) – Pathology Education Consortium (PEC) with Bruce Friedman (volunteer) – Cancer Center Consulting – MD Anderson, Moffit Cancer Center, NFGC, U Buffalo, UMDNJ, U CO, VCU (honorarium) – CTSA Consulting – Northwestern, U AK, UC Davis, UCLA, U KY, U MD, U MN, UAB,, UC Davis, U WI/Marshfield, Wash U (honorarium)

3. Objectives To understand the Biomedical Informatics Department model and its impact on Future of Pathology Informatics (case history from Pitt) To outline why an academic department enables greater impact than a division in a department To understand how these two models work effectively together and understand the limitations and strengths of each model

4. The “Big 3” problems facing Pathology Informatics Today (the Yin BUT the Yang) Pathology Informatics (PI) through Pathology Informatics 201X (formerly APII and Lab InfoTech Summit) and the Association for Pathology Informatics (API) has a bright future BUT PI needs more research and development resources to scale up the mission Training programs in Pathology Informatics are growing in number BUT we need to train dozens of leaders per year to be able “transform” Pathology (and Medicine) Pathology Informatics has been somewhat successful at working with industry BUT far more work needs to be done to improve our impact on shaping the future through corporate and Health Information Technology (HIT) companies, licensing agreements and intellectual property development.

5. Why the Biomedical Informatics Department Model is the Answer to Pathology Informatics “Big 3” – Here’s the punch line!!! PathoIogy Informatics (PI) needs more research and development resources to scale up the mission – Biomedical Informatics (BMI) Departments can develop a research mission that financially supports infrastructure for PI (independent of clinical or basic science/pathobiology mission) – This alleviates the dynamic tension of Pathology finances today @ beyond PI needs to train dozens of leaders per year to be able “transform” Pathology (and Medicine) – BMI have several training program grants available to them (N=41 @ Pitt) – This alleviates the dynamic tension seen with clinical/basic Pathology training Far more work needs to be done to improve our impact on shaping the future through corporate and Health Information Technology (HIT) companies, licensing agreements and intellectual property development – This is a harder problem but the resources from the R&D mission can be focused on this very important problem facing all of medicine

9. Slide 9 Mission Statement for DBMI Three major goals: To provide national and regional leadership in innovation through research in Informatics To provide the highest quality of support for the clinical practice of medicine through regional and nationally recognized leadership in Clinical Informatics. To provide the highest quality of instruction in Informatics. This is supported by leadership in national member organizations and national educational forums with deep commitments to training and education.

10. Department’s Resources Key metrics Slide 10 MEASURESFY07FY08FY09FY10 % FY Change Projected FY11 % FY Change Projected Grants Directs$6,562,074$6,759,038$5,729,614$7,305,72628%$8,419,16015% Indirects$1,941,667$2,107,549$2,003,681$2,628,99731%$3,202,89622% Total Grants$8,503,741$8,866,587$7,733,296$9,934,72328%$11,622,05717% Publications44496968-1% FTE Faculty15141513.5-10% Revenue/FTE$571,488$674,265$588,083$735,90525% Pubs/FTE2.93.54.659% Indirect support (after rent/faculty “taxes”) means 70% goes to the Department mission!!!

11. Why the Biomedical Informatics Department Model is the Answer to Pathology Informatics PathoIogy Informatics (PI) needs more research and development resources to scale up the mission – Biomedical Informatics (BMI) Departments can develop a research mission that financially supports infrastructure for PI (independent of clinical or basic science/pathobiology mission) – This alleviates the dynamic tension of Pathology finances today @ beyond

12. Understanding how training is accentuated by a Department A division (usually) is unable to support infrastructure to grant degrees or certificates – Currently offer certificates, Masters and PhDs – Most importantly have research and faculty projects to support post-docs with program to train them to write grants Critical mass of faculty to have training program – Currently 17 faculty and 35 affiliated faculty Training program grants need a critical mass of faculty and science – NLM T15 and ARRA supplements (equipment, curriculum development) – Doesn’t compete with clinical and basic science of “home” department

13. Current Trainees – 41 this year!!! 3 certificates, 9 MS, 24 PhDs, 5 post docs

14. Training Program Recruitment 2010 3 NLM predoc 1 NLM/ NICDR predoc 2 NLM ARRA postdoc 2 NLM ARRA predoc 2 Fogarty 2 GSR predoc 12 total slots to fill 28 US 16 International 15 Local 13 Non-local 22 Doctoral 11 MS 4 Cert 28 Pre-doc 16 Post-doc 44 applicants 18 accepted 14 accepted us 11 funded by us 4 students rejected us, went to: Stanford BIRT/BI-Deaconess OHSU Dayton-Robotics (ISP) 3 self funded (1 with own K funding, 1 with own Fulbright,1 with foreign governmental funding) 1 NLM ARRA postdoc slot still open

15. Why the Biomedical Informatics Department Model is the Answer to Pathology Informatics PI needs to train dozens of leaders per year to be able “transform” Pathology (and Medicine) – BMI have several training program grants available to them (N=41 @ Pitt) – This alleviates the dynamic tension seen with clinical/basic Pathology training – Ability to support Pis mission is greatly enhanced by Department infrastructure Administrative Support Financial Support and workflows

16. Slide 16 DBMI FY10 Highlights Education and Outreach Training Program underwent External Review by U Pitt – Ohno- Machado and Szolovitz participated and now have joined DBMI EAB Continue to invest in high quality post-docs – Successful in creating “pipeline” of K-funded junior faculty (Jiang, Beckhuis, others moving in rank) On-Line Curriculum Development – Plan certificates in Biomedical and Dental Informatics – feeder for training program recruits for MS and PhD students APIII merged with LITS; rebranded as Pathology Informatics 201X (in Boston) – will be most successful meeting ever – Over 90 abstract submitted – previous high 74 (2009) – Non-restricted educational support (grants) total $280,000 – previous high $155,000 – Registrations – predicting nearly 400 – previous high 285 – Planning Pathology Informatics certificate program in collaboration with DBMI – Launched new Journal of Pathology Informatcs – open source, soon PubMed Indexed – Next step merger of national member organization (Assoc Path Info) into 501c3

17. Slide 17 A ssociation for Pathology Informatics (API) http://www.pathologyinformatics.org http://www.pathologyinformatics.org “…to advance the field of pathology informatics as an academic and a clinical subspecialty of pathology…”

18. Why the Biomedical Informatics Department Model is the Answer to Pathology Informatics Far more work needs to be done to improve our impact on shaping the future through corporate and Health Information Technology (HIT) companies, licensing agreements and intellectual property development – This is a harder problem but the resources from the R&D mission can be focused on this very important problem facing all of medicine – DBMI has several successful commercial ventures but we are only scratching the surface – We will be focusing on this a another part of our contribution to Pathology Informatics

19. Baobab Health - founder Gerry Douglas – T.E.D. Award Winner and newest faculty @ Pitt DBMI http://baobabhealth.org/about/http://baobabhealth.org/about/

20. 20 Baobab Health – 10 years of work in Malawi Based on “open EMR” and CDA ~1,300,000 patients registered 40,000 lab tests across 3 sites 185,000 X- Ray/Ultraso und investigations 50,000 patients on ART therapy across 9 sites 160,000 HIV testing and counseling sessions across 5 sites KEY RESULTS ACHIEVED 16 SITES DEPLOYED AND 7 SITES IN DEPLOYMENT  Queen Elizabeth  Machinga DH  Zomba CH CENTRAL REGION  KCH  Lighthouse Trust  Martin Preuss  M’bangombe  Dedza DH  Salima DH  Kasungu  N’goni HC  Ntcheu DH  St. Gabriel MH  Mangochi DH  Matawale HC  Bwaila Hospital Baobab vision is to use technological innovation to improve the delivery of healthcare in the developing world VISION & VALUES Founded in 2000 46 employees of whom 43 are Malawian New sites (2011) Existing sites

21. De-ID Data Corp - http://www.de-idata.com/ http://www.de-idata.com/

22. Omnyx – http://www.omnyx.comhttp://www.omnyx.com

23. Conclusions Departments of Biomedical Informatics must partner with Pathology to foster strong multifaceted Pathology Informatics Divisions We need to focus on developing more academic pathology informatics trainees to head Departments of Biomedical Informatics – Computational Pathology fellowships (research fellowships) starting at Pittsburgh Three Departments of Biomedical Informatics (of 15) are headed by Pathologists today The Director of the National Library of Medicine – Don Lindberg, MD is a pathologist – Major funding source of Biomedical Informatics research and training Need to get more involved in the commercialization of technologies to impact Pathology Practice

25. End of Talk – e-mail me at becich@pitt.edu if you have questions/clarifications not covered in the discussion. NOTE: E-mail me if you want PDFs of articles or presentation.becich@pitt.edu HOLD THE DATES: Pathology Informatics 2011 – October 4-7 th Pittsburgh, PA Pathology Informatics 2012 – Chicago, IL Featuring a “Whole Slide Imaging (WSI)” Bake-Off Real Time Use of WSI systems by Pathologists