Leaders in Medical Education

Dr. Rainer Fuchs, Chief Information Officer of Harvard Medical School

Daniel Fulop
Published on Feb 13, 2016. Updated on Invalid date.

Dr. Rainer Fuchs currently serves as Chief Information Officer (CIO) of Harvard Medical School and formerly held the position of Vice President of R&D at Biogen. He has also held senior leadership life science informatics positions in the biopharmaceutical sector at Aventis, Ariad, and Glaxo Wellcome. Dr. Fuchs received his masters in microbiology from the University of Frankfurt prior to earning his PhD in biochemistry from the University of Darmstadt.

How did you first become interested in research informatics?
I got interested in computers as an autodidact in the early 80s. While working on my PhD in Biochemistry (back in my home country Germany) I started to write software for sequence analysis and management of lab reagents. That was the time when my request to the university IT department for access to their mainframe was met with “why do biologists need computers”! Our lab was one of the first in Germany to get an automated DNA sequencer and while genome sequencing still sounded like science fiction, it was clear to me that biology would be increasingly data intensive and data driven. And while I enjoyed working at the bench, I didn’t really see myself spending the rest of my life filling in gaps in our knowledge around some obscure proteins – rather I wanted to be on the frontier of a new, emerging field. At the time I had established connections with folks at the European Molecular Biology Laboratory in Heidelberg, and after wrapping up my thesis I had a chance to join the EMBL Data Library as a staff scientist and become fully focused on informatics. Remember, this was before the internet was ubiquitous, and one of my first jobs was to help launch a network of national informatics center to distribute gene and protein sequence data to research labs across Europe. I wrote one of the first web servers for sequence comparisons, developed popular software for protein sequence analysis for the Mac, worked with the yeast and C. elegans genome projects to help incorporate their data into the EMBL/GenBank databases, and collaborated with some great friends and colleagues on very successful software such as Clustal. In 1994 I had a chance to change scenery and made the plunge into the commercial world. I knew nothing about drug discovery at the time, but I was intrigued by the vision the good folks at Glaxo in Research Triangle Park, North Carolina presented to me on the role genetics would play in identifying novel drug targets. I didn’t hesitate to jump on the opportunity to be one of the first employees in their new Genetics division and become their head of research informatics. I’ve been at the interface of life science and informatics in pharma and biotech ever since.

How has your background at Biogen prepared you for your current role as Chief Information Officer of Harvard Medical School?
At the technical/scientific level, the informatics problems I was trying to tackle as Vice President of R&D at Biogen were similar in many ways to what the various labs at HMS are interested in. Large scale genomics, proteomics, correlations of clinical observations and genomic variations, image analysis -- all problems I was closely involved with at Biogen. We also did a lot of additional things there, including chemoinformatics, clinical trial and drug safety data management, as well as IT and informatics support for regulatory submissions and process development, things I kind of miss here at HMS. Perhaps more importantly, the demands we were putting as users on the computational infrastructure at Biogen gave me a real appreciation of how important (and difficult) it is to provide appropriate computational resources to enable modern day leading-edge science. But arguably the key lessons I learned at Biogen that helped me succeed at HMS are on a totally different level. In any “C”-level position you need to be great at two things: First, strategic thinking. Create and “sell” a vision. Motivate your staff to focus on what has the most impact. Second, conversations. This may sound odd, yet in organizations such as Biogen and HMS you don’t get things done by command and control but through conversations with people at all levels. Sometimes I claim that “CIO” stands for Chief Inspirational Officer. To get things done you need to inspire your superiors and peers for your vision and enroll them as allies. You need to inspire your staff to commit themselves and then empower them to bring the best out in them. The culture at Harvard and HMS is one of decentralized decision-making, not one of authority. My time at Biogen gave me a great opportunity to hone the skills required to succeed in a complex, multi-faceted organization. And perhaps the most important skill in that respect that my friend, mentor, and former boss at Biogen opened my eyes to is a simple one: listen. Listen with your mind open for possibilities, always ready and willing to go out of a conversation with different views and opinions than when you went in.

In the foreseeable future, how do you see developments in technology most greatly impacting the medical field?
I see two main forces changing the field dramatically. First, the sheer amount of data we can generate on patients gives us insights into disease and treatment options never possible before. Between molecular diagnostics, biomarker discovery, and precision medicine we are going to see our response to disease be a lot more nuanced than the broadside approach taken in the past. The other technology trend that is already affecting the practice of medicine is the internet and social networking. Patients are now empowered to a degree unseen. Remember what buying a car was like not too long ago. You went to the dealer, haggled over the price, and left unhappy. Now you can go into the car dealership with hours of internet research under your belt to understand the dealer’s costs, what others have paid for the same car, etc. It puts you in a more comfortable position of knowledge and power. And the same is happening in the patient doctor relationship. It used to be that you simply had to believe what the doctor told you. Now your doctor’s opinion is only one (albeit critical) voice in a plethora of information streams on your condition and treatment options available from web sites, Facebook, Twitter, you name it. And as a doctor you’ll have to learn to deal with patients a million times more educated – and opinionated, for better or worse – than your daddy’s patient.

How would you improve health care? Medical education?
Medical education is going through major changes, and I am happy to see that at HMS we’re in the thick of it, with a dramatically changed curriculum we introduced this fall. Gone (well, perhaps not completely, but to a large extent) are the days of one hour lectures in which the presenter drones on about information you could pick up on the web in ten minutes. At HMS we have video captured of every lecture and made it available for online viewing, and our data showed that most students preferred video over real-time lecture – mostly because they could watch them in double speed! In our new curriculum, we’re shifting toward a “flipped classroom” paradigm. Every night students get video viewing assignments: short segments of material that form the foundation for small group in-depth review and discussions the next day. I like this very much as I see medicine in many ways more as art than science, and this new format allows you as student to consume basic information in more efficient ways and instead spend more time with experienced practitioners sharing their experience and insights into the subtleties of disease and interactions with patients.

As far as health care in general is concerned, I see a need to rethink the health care system to tie pay more directly to outcome. What other industry can you think of where you buy a product and can’t return it if it doesn’t work as advertised? Europe is leading the way in making drug companies stand behind their drugs and get reimbursed only when the medications actually work. Reimbursement is also more directly tied to pharmacoeconomic value. Obviously, this is highly controversial and creates possible ethical dilemmas (e.g., what is the value of a drug that extends life by three months, in other words, most cancer treatments out there today…). We also need to take a more holistic view on the costs of healthcare and not just singularly focus on isolated components, e.g, cost of drugs or medical procedures. The new hepatitis treatments are great examples as they carry a huge cost by themselves but also reduce the burden on the system at large.

Do you have any final thoughts regarding the future of technology in medicine as a whole?
One area of technology I am very excited about, specifically in medicine, is augmented reality (AR). Google Glass was one of the first examples, but failed for many reasons. Microsoft’s HoloLens looks interesting but also has some serious technical issues. But I predict that in less than 10 years we’ll have devices similar to regular eye glasses that have high-speed internet access and can overlay your field of vision with any kind of information you may desire. It doesn’t take much to imagine how this will revolutionize medical education and medical practice. As students investigate cadavers (real or simulated) their AR devices will guide them and explain what they are seeing. AR devices will assist surgeons and make procedures safer. In doctor-patient encounters physicians will be able to look up patient records, pull up reference materials, check for possible drug interactions, etc., without disrupting the interactions with their patients. And it may sound like science fiction but I am convinced that within 50 years, there will be ways to feed this kind of information directly onto the optic nerve or into the brain, so that augmented reality will actually be the only reality we all live in.