Contemporary Issues in Medical Informatics: Good Health IT, Bad Health IT, and Common Examples of Healthcare IT Difficulties
Biography, Scot M. Silverstein, MD

Biography of Scot M. Silverstein, MD



¨        Medical Informatics professional with expertise in clinical and research IT management, design, implementation, and remediation of projects in difficulty in hospitals and the pharmaceutical industry.  


¨        Pioneer in recognition of fundamental differences between business-oriented computing and clinical computing, and of the specialized competencies essential for optimal design and management of biomedical IT.


¨        Independent expert witness on health IT-caused or HIT-related medical malpractice, evidence spoliation and related matters.


¨        Early advocate of web-based citizen journalism on EMR design and implementation errors and resultant patient safety hazards.


On Medical Informatics:

Medical Informatics is a cross-disciplinary field that studies information-seeking activities and tools, analytic processes, and workflows in biomedical research and clinical care delivery. It focuses upon the innovative use of computers in clinical medicine, molecular biology, neuroscience, and other areas of biomedical research. Specialized postdoctoral training in Medical Informatics is funded by The U.S. National Institutes of Health (NIH) at a number of universities, and is provided by other universities via internal funds as well.

The National Library of Medicine at NIH believes that clinical care, biomedical research and education, and public health administration can be improved by the inclusion of informaticists (in-context information specialists) into work and decision settings. Informaticists are information specialists who have received formal graduate training and practical experience that provides a cross-disciplinary background in both medical science and information science. Their cross training provides a unique perspective on the acquisition, synthesis and application of information to problem solving and program development in clinical and biomedical areas.



Highlights of Roles and Accomplishments in Medical Informatics:

  • Faculty, Drexel University, College of Information Science and Technology, Philadelphia, PA (2004-present)

    (Adjunct professor 2004; Assistant Professor and Director, Institute for Healthcare Informatics 2005-2007; Adjunct Professor Sept. 2007-). Established new Graduate Certificate Program in Healthcare Informatics via development of new online and classroom courses in healthcare informatics, clinical information technology, sociotechnical (culture change) issues and best implementation practices, healthcare IT policy, and related areas. Targeted to healthcare professionals as well as Doctoral and Masters' candidates in Information Systems (MSIS), Software Engineering (MSSE) and Library Information Science (MSLIS).


Graduate courses developed and taught:


·         Introduction to Healthcare Informatics

·         Organizational Issues in Healthcare Informatics

·         Special Topics in Healthcare Informatics:  Clinical Information Technology

·         Special Topics in Healthcare Informatics:  Social Informatics

·         Advanced Issues:  Planning and Evaluation Methods in Healthcare Informatics

  • Medical Informatics Journalist, Healthcare Renewal, Public Policy weblog (2004-present)

    Writer on contemporary issues in Medical Informatics at Healthcare Renewal (, website of the Foundation for Integrity and Responsibility in Medicine.  This site is consistently rated very highly in the Global Ranking of Top English-Language Health Weblogs.  The site is one of a select group of New York Times-recommended healthcare weblogs.  Listed in the AAAS-National Academies Compilation of Resources on Scientific Misconduct and Research Integrity (link).  Cited by Forbes Magazine as one of three “must read” health blogs by physicians, Oct. 2009 (link).
  • Director of Scientific Information Resources and The Merck Index at Merck Research Laboratories, Merck & Co., Inc. (2000-2003).

    Championed maximal access to state of the art scientific information resources to ensure R&D productivity and enhance drug safety.  Led multi-site library and scientific computing group serving over 6,000 Merck Research Laboratories scientists and executives globally. Managed staff of 50+ at West Point, PA and Rahway, NJ and budget of $13 million. Identified and substantially remedied a $4 million annual gap in Merck’s portfolio of informatics tools and resources critical to new drug discovery and development such as CAS SciFinder, Beilstein Crossfire, eJournals and advanced scientific databases.  Increased scientific literature dissemination tenfold over decade-long norms, to over one million articles per year, filling longstanding scientist needs for timely alerting to the latest scientific developments. Also managed the team that authored The Merck Index of Chemicals, Drugs, and Biologicals, 13th edition, the published and electronic encyclopedia of Medicinal Chemistry dating to 1889. The Merck Index is renowned internationally. Sales of the 13th Edition exceeded 150,000 worldwide. 
  • Director of Clinical Informatics at Delaware's largest healthcare system, the Medical Center of Delaware, now Christiana Care Health System (1996-1998).

    Chief Medical Informatics Officer (CMIO) at Delaware's largest healthcare system, the Medical Center of Delaware, now Christiana Care Health System.  Improved quality of care, operational efficiency and medical error prevention though leadership of electronic medical records implementation and development of specialized research information systems in a 1,000-bed hospital system. Led strategic planning, design, and implementation of $10 million electronic medical records (EMR) system. EMR facilitated substantial, quantified improvements in immunization rates, preventive care delivery, appropriate treatment of chronic diseases, and error prevention. Re-engineered and made highly successful a complex Invasive Cardiology/Cardiac Surgery research information system project for quality improvement, clinical trials evaluation of new treatment modalities and devices, and outcomes assessment, in facility performing more than 6,000 procedures/year. An article by a Christiana Care executive gives management's views on the Medical Informatics-based re-engineering of this project.
  • Delaware Health Information Network (DHIN) technology committee of the Delaware Health Care Commission (1996-2000).

    Served as consultant on creation of the Delaware Health Information Network for governmental healthcare resource allocation, care quality monitoring, EDI and related areas. Authored foundational DHIN Plan of Study, accepted and executed by the DHIN Board in January 1999. Recommendations for prototype development process were accepted and executed by the DHIN board, March 2000. Implementation phase of DHIN underway.
  • Associate Research Scientist, Yale School of Medicine, Center for Medical Informatics (1994-1996)

    As faculty at the Yale School of Medicine, research focused on user interaction design of applications for biomedical research, clinical trials and direct patient care, and organizational issues affecting electronic medical records implementation in hospital and office settings. Was Co-principal investigator of Medical Informatics in an international collaborative genetics and birth defects project funded by a $17 million grant from a Middle Eastern country where incidence of inherited disease is significant. Developed and authored SAYGR, a clinical genetics information system, field EDC (electronic data capture) application and analytic tool for the pediatric genetics clinic and DNA diagnostics lab of the country’s major research hospital.  Invented novel user interaction design elements including interaction-by-schema, query-by-schema and Virtual Pedigree Template™ (VPT) pedigree capture metaphors that were very well received.
  • NIH Postdoctoral Fellow in Medical Informatics, Yale School of Medicine (1992-1994)

    Completed NIH-sponsored Medical Informatics Postdoctoral Fellowship at Yale, 6/94. Medical informatics has as its focus the innovative use of computers in clinical medicine, molecular biology, neuroscience, and other areas of biomedical research. During fellowship was investigator in Yale-New Haven Medical Center informatics projects including information sources mapping (facilitation of retrieval of Internet-based clinical information via domain-specific indexing and optimal user interaction design), medical image indexing and retrieval, cDNA hybridization selection (genetics) information system at Yale Boyer Center for Molecular Medicine incorporating a novel schema-based user interface, and decision support for early extubation at Yale-New Haven Hospital thoracic surgery ICU.
  • Over 40 years of hands-on computing experience. Experienced in use, programming and administration of Windows, UNIX and Macintosh computers, Internet, HTML, and Web technologies, biomedical data modeling and relational database design, and in computer selection, configuration and trouble-shooting to module level.


Education summary:

  • Postdoctoral Fellowship, Medical Informatics (2 yrs), Yale University School of Medicine.
  • Medical Residency in Internal Medicine (3 yrs) and Diagnostic Radiology (1 yr)
  • Accelerated Seven-Year Medical Program, Boston University.
    M.D. degree, Boston University School of Medicine. Formal clerkship in Biomedical Engineering.
    B.A., Biomedical Sciences.  Advanced courses in computer science including IBM370 assembler, minor in history of religion.


Additional accomplishments and items of interest:

Medical informatics professionals are often people of broad scientific interests. These interests lead to pursuit of Medical Informatics as a career, and are applied to advantage in difficult real-world settings in healthcare and industry. My interests include computing and radio-telecommunications technology (amateur radio). Below are several links containing additional information and pictures on these interests, and on the tools that facilitate these interests.


  • Applied informatics at Yale: novel user interaction design for a population genetics workstation and analysis tool for use in-the-field was very well received by busy scientists and clinicians overseas. My invention, the Virtual Pedigree Template™ genealogic capture and interaction metaphor, was found especially useful in gathering data on complex family trees in time-constrained, tense clinical settings. The importance of making the IT fit the user's needs (as opposed to the other way around) is often overlooked in the clinical IT industry.
  • Writing IBM System/370 Mainframe assembler in the mid-1970's at Boston University. The IBM 370/185 owned by BU was definitely “big iron.”  Low-level languages like C were in their infancy; serious work was done in assembler. A thorough knowledge of IT beyond "appliance operator of a magical tan box" has been quite useful in management of advanced Medical Informatics initiatives.
  • Learning computing on a classic Digital Equipment Corp. PDP-8/S computer, 1971-2. First computer commercially available off-the-shelf. Efficient programming was a must. 4K of 12-bit core memory, 300 cps high-speed paper tape reader, ASR-33 teletype (10 cps), cost $17,000. Received this letter from IBM on winning a programming contest in 1972 on the topic of chemistry.


Special competency in electronics:

  • Building an infrared-sensing cardiac monitor as a project in a biomedical engineering elective in medical school (Biomedical Engineering Laboratory, Boston University Hospital, 1980).