The Doctor is in Informatics

It was decades into Dr. Charles Van Duyne’s career when the worlds of medicine and computers started to collide, and for him, it was an auspicious perfect storm well worth the wait

By the time the Dallas/Fort Worth-based USMD Health System developed to the point where it needed a chief medical information officer on its payroll, Charles Van Duyne was an MD well into his so-called “golden years,” and the perfect person for the job.

Dr. Charles Van Duyne, CMIO, USMD Health System

Blame it on an early fascination with computers. Van Duyne yearned to get more familiar with technology during his college years (when computers were “the size of a small car and ran on inch-wide paper tape,” he recalls), but medical school monopolized his time—as did his subsequent career in medicine. Still, from the Apple 2 Plus with 48K of memory that he bought with his first real paycheck, to the PCs he tinkered with while in private practice for two decades, Van Duyne kept his second calling alive and well enough to see him through graduate school for a degree in medical information technology. He was sixty years old when that happened.

“I ended up right where I wanted to be; I just didn’t know it forty years ago!” he laughs.

While his twenty-first century grad school experience provided plenty of unexpected challenges—“like APA formatting and all the other things that didn’t exist when I first went to school,” he says—things came together nicely once he had his master of science in Medical Informatics degree in 2013. The CMIO role at USMD is where he’s been since then; it’s a position so new, Van Duyne himself largely influenced its description.

Nonetheless, he sees plenty of parallels to his previous world. “When you go to medical school, they give you a base of information and the tools you’ll need to do your job,” he explains. “With informatics, it’s the same thing in that you get the background knowledge […] and not tools, per se, but ways to accomplish what you need to accomplish. So in that sense, it’s a lot of the same thing.

“Instead of medical journals, I now read IT journals,” he continues. “I get a lot of satisfaction in learning how to identify, diagnose, and correct problems. I’m still helping patients—I’m just doing so on a much higher, global level.”

And in doing so for USMD, he serves a physician-led, integrated health system offering primary care and multiple specialties amongst its nearly 250 providers and fifty-plus office locations.

It’s a system keenly aware of progress on the healthcare spectrum, such as the shift from reactive to proactive care. Van Duyne has a unique vantage point, as he is directly involved in the development of USMD’s population health-management analytic tool. “Population health” has become an oft-heard term that refers to the identification of the most common risk factors of key populations and creating and implementing preventative measures to keep the population healthier. But Van Duyne is especially fond of the way the tools work toward better individual care.

“For instance, based on output from the analytic software, we [can] contact a diabetic patient whose blood sugar we are monitoring, and we find out that their car doesn’t work, so they can’t get to the drugstore to get their medicine,” he says. “Or a family member was sick, and they had to go take care of them and didn’t pay as much attention to their own needs. Or they need glasses because they can’t read the medication directions.

“We find out why a patient isn’t following their care plan and determine how to help them. It’s a lot more than giving them pills and shots and telling them what to check. The patient is a person, not just their medical condition.”

Another tool, known as the patient portal, brings a different dimension to the patient-centric movement. Considered “an engagement piece” by Van Duyne, the portal allows patients online access to personal statistics, test results, and other forms of non-urgent communication with their provider, letting them participate in their own wellness in a way that makes their
relationships with doctors more collaborative than ever.

“Instead of medical journals, I now read IT journals. I get a lot of satisfaction in learning how to identify problems, diagnose problems, and correct problems. I’m still helping patients—I’m
just doing so on a much higher, global level.”

The patient portal and the population health-management tool, which went “live” for USMD less than two years ago, are continually refined. With the help of the CIO and medical directors, Van Duyne has focused much of his time on the information technology needed to facilitate these tools, as well as serving as the organization’s liaison with vendors. But for all the challenges he cites with the process—which include getting all necessary data, homogenizing said data, and then extracting the most salient parts of it—one of the most frustrating came as a slew of government regulations that, according to Van Duyne, do precious little to improve patient care.

“The problem is [the electronic records] are still evolving and just aren’t great,” Van Duyne laments. “But government money pushed [the products] to the market before they were fully baked and ready for prime time. So now we’re finding, in phase two, that there’s a fair amount of mediocre products out there.”

With the government serving as the single largest payer in healthcare (via Medicare/Medicaid), its requests and requirements remain essential.

But Van Duyne is happiest thinking about the future of the medical- and information-technology intersection, which includes personalized healthcare and detailed online recommendations based on å such as genetic makeup. “That’s going to be the new big thing,” he says. “It’s not the same as population health, but I’m glad to see it happening.

“Because at the end of the day, the population is made up of [individual] people.”

Photo by Richard K. Dalton