Perspectives

The Academic Health Center History Project documents and preserves the institutional memory and historical events that chronicle the development of health sciences education and research at the University of Minnesota.

Serendipity

By Erik Moore August 3, 2011
Curiosities, Hospitals, Perspectives, Photographs

Serendipity is always a welcome feeling when working with archival materials, although it highlights the enormity of information available and the reality that one can never know everything they have.

Take this example that happened to me this week.

The photograph below is of a house on Washington Ave that was used as the University Hospital prior to the opening of Elliot Memorial Hospital in 1911. This is the only known photograph of the building in the archives. The photograph was taken shortly before the building was demolished in 1929.

The second item is a photograph scrapbook created by Mercedes Grace Berrisford, a 1910 graduate of the College of Science, Literature, and the Arts.

Little is known about Ms. Berrisford. She was married to Paul Berrisford, a 1912 graduate of the Medical School, and is believed to be the photographer of the pictures taken in the scrapbook. The first part of the scrapbook has pictures taken in 1910 around the time of her graduation. They are mostly campus scenes with occasional self-portraits. While looking through the photos I discovered this picture of the then still open University Hospital at 303 Washington Ave. The sign is still hanging over the entrance.

It is difficult to know whether anyone else had ever come across this photograph and recognized it as the house on Washington Ave. It is also difficult to imagine a world where all of these millions of pages of material might one day be so interconnected that serendipity will no longer play a part. Until then, enjoy the feeling.

Tentative discovery

By Erik Moore November 30, 2010
AHC documents, Medical school, Perspectives

If a tree falls in the forest, and no one is around to hear it, does it make a sound?

This metaphysical riddle challenges our ideas about reality and perception and whether or not our knowledge of how something works exists in an unperceived existence. It is also viewed as a technical question: without ears present to hear a sound wave, how can it be heard?

For all the things collected in archives, it is common to not have the exact item a person is looking for. This is sometimes due to the fact that it is lost or destroyed while at other times it is a result of having likely never existed in the first place.

In these situations the researcher is more often than not challenged with the metaphysical task of pairing known reality with perception of existence. The task is to take the documents that do exist and seeing whether or not they support a proposed theory. It is the metaphysical equivalent of the tree falling in the forest riddle: If a decision is made, and there is no record in the archives, can it be documented?

A recent research question dealt with such a gap in documentation. The topic seemed straight forward: When was the first medical ethics course taught in the Medical School? Every clue moved the researcher further back into time with less and less solid documentation. Working backward from the 1980s, the researcher discovered bits and pieces of evidence that further shaped an undocumented reality. Student advocates, departmental politics, and curriculum planning all lead to the late 1960s and focused squarely on the origins of the Department of Family Practice.

Definitive documents defining the development of the course or its justification were never found, but the archives provided historical mile markers and contextual evidence for the researcher to elaborate on this unperceived existence.

One document found along the way was an incomplete, undated copy of a medical ethics laboratory manual written by Elof Nelson, a chaplain at Fairview Hospital and the course instructor in the 1970s. Only the first 45 pages of the approximately 200 page manual are available. The remaining likely exists but is not yet preserved in the archives. The manual describes medical ethics as “search and tentative discovery [rather] than indoctrination.” The same can be said about historical research.

Read the partial lab manual below. It includes the full table of contents so in this case we know what we are missing.

First mention

By Erik Moore May 11, 2010
AHC documents, Curiosities, Digital, News, Perspectives

History is often focused on the first instance, the first mention in order to identify when something happened and how it relates to what followed. The New York Times offers a column ‘First Mention‘ that uses its own archives of news articles to determine when something was first reported. This isn’t too different from the way the Oxford English Dictionary traces the etymology of a word to its modern meaning.

As more and more documents are transferred to a digital format, our understanding of the ‘first’ of anything will become more accurate.

As an example, in the spring of 1954, the beginnings of open heart surgery took a major step forward at the University of Minnesota. A team of surgeons including C. Walt Lillehei, Richard Varco, Morley Cohen, and Herbert Warden developed and implemented a new technique called cross circulation.

On April 30th the University News Service held a news conference and issued a corresponding press release heralding the new achievement. Pushed out to the national media, the story of Dr. Lillehei’s success soon became a popular print and television phenomenon.

Historically, this was a major accomplishment in the world of surgery and captured the world’s attention.

From a digital archives perspective, we are now able to re-live those early first moments as presented to the public by locating the procedure’s first mention.

In addition to the New York Times’ pay service, Time.com offers free online access to their articles dating back to 1923. A simple search easily retrieves the May 10, 1954 announcement of cross circulation. Google’s News Archive Search also offers the ability to discover multiple articles on the subject from news sources across the country.

Closer to home, the University Digital Conservancy, the digital archives for the University of Minnesota, provides online access to the original news release on cross circulation issued at 2 PM on April 30, 1954.

There are even some remnants of film surviving from the press conference that have transitioned from analog to digital format. This may not be on par with today’s Driven to Discover videos but it surely captivated the interest of viewers at the time.

Tracking down these first mentions usually provide other insights that historical researchers are unaware of. For instance, until Herbert Warden started the pump in the above video, I had no idea that cross circulation was a LOUD technology; something akin to an air compressor in the operating room.

No vestige of a beginning, no prospect of an end

By Erik Moore June 22, 2009
Acquisitions, Medical school, Perspectives

The teaching of geology often starts with an introduction to the geologic time scale as a means to acquaint students with the concept of deep time and how to better comprehend eons, eras & epochs.

Although littered with catastrophic events such as meteorite impacts, volcanic eruptions, and earthquakes, the surface of the earth and the life forms it has supported have been most profoundly changed by the incremental affects of water, plate tectonics, and photosynthesis over the course of 4.5 billion years.

So, do archives have a deep time?

Occasionally, the events that bring records to the archives are cataclysmic: the death of an individual, the closing of an organization, or even a natural disaster. These same catastrophes all too frequently tilt toward the utter destruction of the materials and remove them entirely from the record.

But more commonly, records trickle in like water, move slowly from one place to another, and even proliferate through technological photogenic processes such as the photocopier and scanner.

These deep time thoughts, so to speak, came to me last week as I looked over a recently acquired collection of correspondence. The letters are to and from Hal Downey (1877-1959), a world-renowned hematologist who spent the majority of his life studying, teaching, and researching at the University of Minnesota.

The collection is largely exchanges between Downey and his colleagues in the U.S. and Europe before World War I through the late 1950s. Most notable are a series of letters related to Dr. A. Maximov, a Russian hematologist looking to escape the restrictive conditions of early Soviet Russia. Downey eventually helped Maximov secure a position at the University of Chicago.

However, it was actually a pair of letters that set my thoughts in motion. The first was a letter from E. W. McDiarmid the University Librarian dated February 26, 1946 on the occasion of Downey’s retirement. In his letter McDiarmid requested that Downey consider turning over to the archives any material he will no longer need in his retirement. He specifically asked for letters, committee reports, and departmental correspondence that may be in his possession.

Downey responded that “it is not likely that I have anything of importance” and that he hoped to remain in his lab space for years to come. He would remember the archives if anything seemed of value.

Sixty-three years later, Hal Downey’s daughter and two granddaughters deposited his valuable correspondence in the archives. The material joined a small collection of Downey’s manuscripts that were donated by his wife Iva shortly after his death in 1959. It was a lifetime between McDiarmid’s request and the actual deposit. It was a fraction of the University’s history. It was a blip on the geologic time scale.

If we are students of the earth then we realize that none of us are permanent residents of this planet, nor are our institutions. Yet, to invoke Hutton, archives exist because we see “no vestige of a beginning, no prospect of an end.” So, we create, document, preserve, and then begin again.

Read the letters between McDiarmid and Downey below.

Image Credit: A diagram of the geological time scale available from the US Geologic Survey. Source image available from the Wikimedia Commons.

Googling your health

By Erik Moore May 20, 2008
HIPAA, News, Perspectives

If the Health Insurance Portability and Accountability Act of 1996 (HIPAA) was designed to give patients more control over their medical records in the electronic age, what does it say if twelve years later we decide we’d prefer Google to manage it for us?

In a recent article in the New York Times, it seems patients are eager to do just that:

The Google record … allows the user to send personal information, at the individual’s discretion, into the clinic record or to pull information from the clinic records into the Google personal file.

The move toward online control and access to personal health information changes the previously static, analog patient record into a dynamic set of data that serves multiple purposes. Our concepts of record management and documentation might have to change as well.

Information ecologies

By Erik Moore October 15, 2007
Perspectives

Archives are often described as organic in nature and the material within the collections as containing organic-like relationships that archivists strive to preserve and to promote.

The organic metaphor fits nicely with the life-cycle model for records and records management: organic/inorganic; active/inactive; living/dead.

Management of electronic records and digital surrogates is casting a new light on an old problem with the organic/life-cycle metaphor: When does an active document become a record? Furthermore, does our own desire/ability to provide stewardship for a record determine whether or not it will become a part of the archival process? Are records outside of our traditional management process of less importance?

The organic/life-cycle model works best when there are clear beginnings and endings. It seeks to establish the birth, life, and death of a record at which point it becomes archival.

Many Australian archivists and some of their counterparts in Canada are promoting a continuum model to replace the life-cycle approach to records management. The records continuum model changes the organic metaphor from birth/death to ecological in its application. The information’s survival is not dependent upon our stewardship; instead, its use relies on the archivist’s ability to contextualize the information and manage it as a time/space object. The archivist’s job becomes less of a mission to preserve the information landscape and more of an undertaking to make ecological connections for our users and constituents.

To understand its practical application, a recent post by Lorcan Dempsey highlights the problem with life-cycle stewardship. Research, data, learning objects, and institutional records are less stewarded than other traditional material like books, serials, newspapers, and manuscripts. By creating better points of contact to these former materials that are intricately bound to the latter, Dempsey sees the potential for new unique resources previously out of reach for both the researcher and information professional. It emphasizes the continuing use of information, not its product.

Dempsey uses the University of Minnesota Digital Conservancy, an institutional repository, as an example of tool designed to provide context and access to information that does not fall neatly into a life-cycle model. This will also become more of a method to document and provide access to material that is part of the AHC History Project.

Questioning photographs

By Erik Moore September 4, 2007
Medical school, Perspectives, Photographs

The University of Minnesota has long been a leader in medical advances and technologies. Since the 1960s, the University has been synonymous with advances in transplant procedures. Prior to that, the medical school gave rise to corrective open heart procedures. Two of the men that were involved with this earlier era were C. Walton Lillehei and Richard Varco.

Lillehei’s research focused on maintaining normal oxygen levels within the blood while simultaneously operating on the heart by using an external pump and blood donor to by-pass the heart. Varco’s research along with John Lewis and Mansur Taufic investigated ways to decrease the need for oxygen by inducing hypothermia and creating a longer period necessary for by-passing the heart’s pumping action.

This picture captures a moment when these two men (Lillehei on the left, Varco on the right) are engaged in surgery. However, it does not take a heart surgeon to recognize a peculiarity in the photo. An avid viewer of Grey’s Anatomy or any other medical drama would be able to point out that the men should be wearing their masks and not letting them hang down from their necks.

The answer, however, is simple. Lillehei and Varco are performing surgery, but at the time of the photograph, the work they were doing was still in development. A majority of this work was done on laboratory dogs, as is the case in this picture (likely postmortem).

The photograph is at first simple and then complicated. It carries the weight of the researchers and their efforts and the risks and sacrifices of the subjects (both human and canine) and reminds the viewer of the give and take nature of science.

In archival terms, photographs should elicit questions regarding not only their content (as I have done above) but also their intended purpose and potential consequences. In doing so, the archivist and researcher cannot work in a vacuum. The photograph needs to be placed in its original context by using the archival sources and historical references available.

Obesity and the archival record, or, do these records make me look fat?

By Erik Moore July 27, 2007
HIPAA, Perspectives

Several news outlets have reported on a new finding published in the New England Journal of Medicine (vol. 357, no. 4, July 26, 2007) regarding the spread of obesity in social groups. The article, “The Spread of Obesity in a Large Social Network over 32 Years,” was written by Nicholas Christakis, MD, PhD, and James Fowler, PhD.

Their findings detailed the increased chances of an individual becoming obese if 1. a close friend became obese (57% increase); 2. an adult sibling became obese (40% increase); or, 3. a spouse became obese (37% increase). They also found that persons of the same gender also increased the chances of one obese person influencing another.

The data set used for the study comes from material collected for the Framingham Heart Study that began in 1948. A second cohort of the offspring of the first FHS was established in 1971 and a third cohort of offspring of the second generation began in 2002. The obesity study used only data from 5124 individuals in the second FHS cohort (1971). It tracked the social networks of the people by creating a database of information taken from handwritten administrative tracking sheets used to facilitate follow-ups with each participant. The tracking sheets included family names, relationships, addresses, and at least one close friend as a contact. This social information was not the basis for the Framingham study, but merely an administrative tool to be able to contact someone for their next appointment. The net result was 38,611 observable social networks among the participants.

This study demonstrates two interesting points in regards to archives. First, data collected for one reason can be creatively repurposed at a later time for another reason. This is one of the simplest arguments for retaining records in archives. Records are not kept merely to recreate the transactional nature of institutions and their activities, but instead provide for the use of information for other intentions.

The second point is the fragility of data. The information used to gather the findings was part of a three generation (and counting) study of heart disease. It was available because it was part of an active project that was well-documented. Due to the size of the FHS and its findings, it is likely that the data sets produced will be well-maintained after its conclusion at the National Library of Medicine or elsewhere. However, other data sets with the same potential to be repurposed into new studies are not always as lucky. And, it is likely it will become more precarious for them in the near future.

Issues concerning the privacy of patient and human subject information are part of the archival management process. The Privacy Rule regulations under HIPAA have done little to address the long-term preservation of PHI materials in archives. It is much easier for principle investigators, institutions, and archives to simply destroy the data as a sweeping act of safeguarding. True, there are few alternatives under the current regulations, but it comes at a cost of re-useable information and perhaps at the cost of our own health and well-being.

Whose woods these are…

By Erik Moore June 5, 2007
Donors, Perspectives

Occasionally, it happens that the faculty papers or departmental records I make appointments to review are not the faculty member’s papers or the office’s records at all. Instead they are carefully crafted research collections or the archives of a professional society or another institution.

These collections within collections are often the result of a group or organization being unable to care for its records and as a substitute they are turned over to a well-meaning faculty member or administrator. Once that person retires or moves on to a different university, the records are left behind at an institution where there is no administrative connection and a dwindling provenance to their origin.

These materials can be just a few folders at the end of a box. They can also be multiple filing cabinets that could produce 18-20 linear feet of material.

It is easy to state that these materials fall outside the collecting scope for the project. However, the potential for loss becomes greater as fewer and fewer options become available for their long term storage and management. It highlights the utilitarian versus preservationist ethical dilemma in archival work. We preserve what we can, hopefully, in a sustainable method.

To paraphrase Robert Frost, “Whose records these are I think I know … But I have a mission to keep.”

RFID and the coming medical records storm

By Erik Moore May 9, 2007
HIPAA, Perspectives

On my way to Columbus, OH to present on the topic of privacy and medical records, I read several interesting pieces in The Economist (28 April 2007) in a special report on telecoms. One article was particularly interesting and timely given the subject of my presentation. It discussed the current/future applications of RFID (Radio Frequency Identification) technology in health care. Commonly used as Tattle-Tape(tm) to prevent theft from retail stores and libraries, the chips are now the size of bits of powder.

It noted that wireless technologies are not new in medical care – the pacemaker is a machine that can be adjusted wirelessly – but that the trend will be toward ubiquitous integration, including deep inside our own bodies. RFID chips will communicate with other devices in the examination room as well as outside of the doctor’s office to provide a 24/7 health monitoring program. Our cell phones will be the go-between for our body and our physician. We could be blissfully unaware of any changes to our health when our phone rings to notify us we are scheduled for a visit to the family doctor or even providing directions to the nearest emergency room for an evaluation.

But notification is not the only purpose RFID chips and other similar technologies can provide. Smart chips planted near a tumor can wirelessly power up to burn any new cancer cell growth in a particular area. Chips in the digestive tract can measure the absorption of medication and alert the pharmacist to needed changes in dosage and strength.

Today, the question is how do we protect privacy while providing access to information that can move medical advances forward and allow us to better understand historic patterns in public health? In the coming years the question will shift to how do we protect privacy when there is no separation of the patient and their medical record? What happens when a person is not only the subject of study but also the document itself? What will the medical record look like? What exactly will come to the archives?

Currently, HIPAA and the Privacy Rule are trying to balance the issues of privacy protection and research use. Formulated during the rise of the electronic medical record, the legislation and regulation may become as quickly outdated as Zip drives. It will be seen as a solution based on what the needs were, not what the needs will be. The act also presumes a government’s responsibility to its citizens to aid in privacy protection. Yet, in a wirelessly networked world the government-citizen relationship is blurred and the emphasis on geographic location will wane as the demand for information and the privileges afforded by technology will rise.

Perhaps the very technology that scuttles our notion of a medical record will be the solution to privacy and access. Long vilified as a potential breach to privacy, the RFID and similar technologies could be the literal key to access. Those with permission to review medical records or to provide access to others will be the only ones able to gain access to the information. Individuals will be able to opt-in to have their information included in studies or databanks depending on their preferences without the need for patient consent forms each time a researcher submits a proposal to a review board. Perhaps the technology will ultimately give the individual what the HIPAA legislation cannot, immediate control over who can and cannot have access to their medical history.

And of course, there will be a setting to send it all to the archives.

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