Well Informed: Clinical Informatics at the Forefront of the Pandemic

Out of plain sight during the frantic search for ventilators and masks, there was another critical conundrum facing doctors and hospitals as the coronavirus began carving a deadly path through the United States.

It was one that Dr. Charles Safran ’69 has devoted his illustrious career to as an informatician, an area of expertise that may have once seemed wonky.

How do hospitals facilitate the free flow of patient records over different database platforms? And how can health-care workers treat and evaluate people for a myriad of conditions without exposing patients or themselves to the virus?

Dr. Charles Safran '69 in front of Beth Israel Deaconess Medical Center

Safran had a unique insight into those challenges as the former chief of the Clinical Informatics Division at Beth Israel Deaconess Medical Center in Boston and a professor of medicine at Harvard Medical School.

“Any plan is good until you’re punched in the face if you’re a boxer,” Safran says. “The same is true for hospitals. How do we get telemedicine to work at scale, and oh by the way, you’ve got a week to make it work?”

Telemedicine had shown promise over the decades, but was stymied by regulations that did not allow doctors to see patients in other states, according to Safran, who built his first telemedicine application in 1996.

But then the pandemic hit.

“Why would you want to go to a downtown office in Boston potentially filled with people who might be sick with an infectious disease?” he says.

In 1983, fresh off completing his residency at Boston’s VA Medical Center, Safran joined the staff of Beth Israel Deaconess Medical Center and became an instructor of medicine at Harvard Medical School. One of his first projects was to conduct a clinical trial of computer software that allowed women to treat UTIs themselves. The women could use a computer terminal in a doctor’s office to be evaluated, go over treatment options, and print a prescription if appropriate.

In 1996, Safran spearheaded an initiative funded by the National Library of Medicine to prove the value of telemedicine. The project was called Baby CareLink and was used to monitor premature infants. The developers had hoped the application would eventually help children with acute leukemia, women with breast cancer undergoing bone marrow transplants, patients who had undergone kidney transplants, and those recovering from strokes. But it would take a pandemic to effectuate dramatic change.

“The patient, him or herself, is the least utilized resource in all of health care,” Safran says. “Maybe people don’t have to go to a physical office and waste all that time. There’s better operational ways of organizing health care.”

When the pandemic hit, several hospitals teamed up with the city of Boston and the commonwealth of Massachusetts to create a 1,000-bed hospital called Boston Hope in the convention center. It was a novel and cooperative approach, but one fraught with potential complications because of the different electronic recordkeeping systems used by the hospitals.

“So we have this sort of spaghetti of different data streams coming in,” says Safran, a former advisor to the Centers for Disease Control and Prevention.

But the technology is only as good as the backbone of the databases: coding. The language of computers needed to expand to include a whole new set of terms related to COVID-19. And it had to happen quickly and accurately.

“In health care, [figuratively speaking] if you’re ‘dialing someone’s telephone number,’ you have to get all 10 digits correct,” Safran says. “So in health care, a little bit of error causes someone to die. So we can’t afford a 4 percent error rate. We all face the same problem, which is how do you get the right information, in the right time, to the right person, in the right format, so they can act on it?”

]Safran is particularly proud of the mentorship role that he has played for some of the most innovative minds on the front lines of the pandemic. One of them is Dr. Larry Nathanson, an emergency physician at Beth Israel Deaconess Medical Center, who started training under Safran when he was an undergraduate at Boston University and developed pioneering approaches to treating the Boston Marathon bombing victims. Nathanson also set up a field hospital in Haiti after the earthquake.

]At Beth Israel Deaconess, the hospital has been able to reduce the number of health-care workers exposed to patients potentially infected with the virus through the use of iPads and a robot. It has also helped the hospital conserve personal protective equipment, known as PPE.

“You didn’t want to actually gown other people who didn’t necessarily have to be in the room,” Safran says. “But they could participate in the care remotely.”

]Clinical informatics has become more mainstream over the past decade. It’s a medical subspecialty with its own medical board examination.

Still, sometimes the work of an informatician is conflated with information technology, as was the case once with a chief of medicine at Beth Israel Hospital.

“He turned to me and said, ‘You mean you can fix my email?’ I said, ‘I’m sure I could, but that’s not what I do,’” Safran says.

—Neil Vigdor ’95