As a University of Pittsburgh medical student and computer hobbyist in 1974, Randolph Miller, M.D., decided to study under the guru of the new field of "computer medicine," Jack Myers, M.D.
That early launch during the era of mainframe computers and key-punch cards gives 2003 AMDIS award-winner Miller a deep reservoir of experience, says Jack Ehrhart, M.D., who nominated him for the award.
"Randy Miller has been one of the pioneers, one of the champions of clinical decision support," says Ehrhart, who is vice president of medical affairs at McKesson Healthcare Information Technology Group in Atlanta, which has a business partnership with Vanderbilt.
"Randy is able to assimilate information," Ehrhart says. "He saw all this information out there, and he asked: How do you take it and focus it on your patient?"
Miller, now chairman of the division of biomedical informatics at Vanderbilt University Medical Center in Nashville, Tenn., says he first got acquainted with computers as a teenager in the mid-1960s, when he was president of his high school computer class. Visiting the Westinghouse Laboratories in Pittsburgh, he tinkered on the Burroughs B5500 mainframe, which used a computer language called ALGOL.
"There was no formal field of medical informatics," he says. "There were no high school computer courses."
As a medical student at the University of Pittsburgh, Miller sought out Myers, who was working on the Internist-1 Project, an ambitious attempt to provide diagnoses based on a wide knowledge base.
Myers, who died in 1998, was a "master diagnostician," and Internist-I reflected that ability, Miller says.
But as a trailblazer in a new field, Internist-1 had flaws, Miller recalls.
"Internist-I was not ready for human consumption," Miller says. "Its advice was either brilliant or out in left field."
Furthermore, he says it took 60 to 90 minutes to obtain a diagnosis, and "how many busy doctors have 60 to 90 minutes to spare?"
Miller joined the University of Pittsburgh faculty, and in 1984 he and Myers began work on the new attempt at computer-assisted diagnosis. The so-called quick medical reference, or QMR, used microcomputers for the first time by focusing on a specific problem rather than the whole diagnosis, Miller says.
He says QMR turned out to be a modest success and that, beginning in 1990, several thousand were sold to physicians for between $100 and $200 each.
Having made his mark, Miller was recruited in 1994 to Vanderbilt by William Stead, M.D., associate vice chancellor of health affairs and director of the informatics center. Stead hired Miller to integrate clinical decision support into a rudimentary computerized provider order entry system that Vanderbilt was about to introduce.
But physicians complained that the CPOE system was difficult to use, and the university put off implementation for almost a year while Miller and others revamped it. The updated system, called WizOrder, was constantly revised over the next few years, Miller says.
WizOrder is credited with an annual reduction of $5 million in pharmacy costs (not counting the value of adverse drug event prevention) and $1.1 million in X-ray costs at Vanderbilt, the university reports.
In a deal that is reportedly worth at least $20 million to the university, Vanderbilt in 2002 formed a business partnership with McKesson to market the CPOE system under the name Horizon Expert Orders.
Since it became available last year, McKesson's Ehrhart says Horizon has been sold to more than 18 healthcare delivery groups.
At 54, Miller has become a doyen of the biomedical informatics field-and a mentor for a younger generation of physician informaticists. In July 2002, he became editor-in-chief of the Journal of the American Medical Informatics Association, replacing Stead, who retired.
John Brill, M.D., chief medical information officer at Rush-Presbyterian-St. Luke's Medical Center in Chicago, recalls working under Miller during a month-long rotation at the University of Pittsburgh.
"He's the one who stimulated my interest in biomedical information," Brill says.
Randolph Miller, M.D., 54
* Residency: internal medicine, University of Pittsburgh, 1979