Biography - John A. Sanders

Overview: I am a Ph.D. Biomedical Engineer specializing in medical imaging and healthcare information technology. My experience, insight, and vision allows me to define goals appropriate for an organization and to energize and lead diverse groups of people towards achieving those goals. I love working in these technology areas since they are perhaps the most fast-paced, diverse, and technology intensive areas in all of medicine. With more than 15 years experience leading IT and clinical technology development teams to successful completion of complex projects, I am confident in my ability to generate superior results for your organization.

My deep technical expertise has its orgins in the area of medical imaging, which has long been one of the most multidisciplinary, fast-paced, sophisticated, workflow-demanding, and highest performance areas of clinical IT. For many years imaging was a silo of advanced information technology expertise and I have a lot of experience building multi-facility high-performance systems and networks for data exchange before anywhere else in the hospitals were doing such things. Now general healthcare information technology has caught up and imaging systems are becoming (appropriately) a subcomponent in a larger data exchange and IT environment. The scope of my expertise and experience has also evolved accordingly and has expanded to encompass business and clinical record exchange, and the underlying IT infrastructures, throughout the healthcare enterprise. I have extensive experience with the systems and care pathways of many different clinical departments and services – both inpatient and outpatient.

There is a huge range of relevant technology that is encompassed by this specialty and I enjoy the challenges and rewards of mastering and integrating so many areas of interest. I firmly believe in the clinical and economic value of health information technology - encompassing medical imaging, electronic health records, and networked billing systems - and I have specialized in these valuable areas. I am confident in asserting that I am quite unique in being highly effective across so many different areas – ranging from biochemistry and medical physics through digital imaging, computer science, and information technology.

Combined with my practical nature and high energy, I can effectively handle all aspects of any situation – the identification of possible opportunities, determination of appropriate strategies and novel solutions, the marshalling of technology and human resources, and the management of collaborative and/or in-house implementation efforts.

Education: My education and training effectively supports a wide range of interests. My undergraduate education was in Chemistry and Biology (double major) at the University of Oregon, where I did Physical Chemistry research in the Institute of Molecular Biology.

I worked in industry for two years as a Biochemist in a Plant Physiology department (Shell Development Co.) before attending graduate school at the University of California - Davis. I found that I was more interested in the technology that enabled my cell physiology research and I decided to earn a Ph.D. in Engineering.

The Biomedical Engineering Ph.D. program at UC Davis was a relatively new joint graduate program with coursework split between the School of Medicine and the College of Engineering. I was based in the Computer Vision Laboratory in Electrical and Computer Engineering and specialized in digital imaging processing and computer graphics. To do anything new and interesting in imaging or graphics requires writing extensive amounts of software. This holds true for most aspects of technology and I have continually strived to study and improve as a software engineer in order to more readily accomplish my goals.

Even though the use of nuclear magnetic resonance for medical imaging was then a recent development, with no established laboratories or faculty at UCD, I managed to obtain a graduate fellowship to develop a research program in MRI. My dissertation work involved extracting and estimating blood flow quantities from MR images using knowledge of the imaging technique, models of the vascular structure, and the measured MR image characteristics. After they finally received a clinical MRI system, my dissertation experimental work was done in the Radiology department at the UCD Medical Center in Sacramento.

Academic Background: From graduate school I went directly into a research faculty position – a joint appointment between the Albuquerque VA Medical Center and the Radiology Department at the University of New Mexico School of Medicine. This academic appointment was based in a clinical Radiology department and my research and efforts were centered on issues involving a wide range of patient care. Medical imaging is at the center of a many care pathways in medicine and I have gained experience in a wide range of clinical departments and services.

In what I consider to be an appropriate bottom-up path, my professional career started out as an academic faculty working on subspecialized aspects of medical imaging – specifically MRI technologies. From there I have steadily branched out to operate at higher and higher levels with broader insight and responsibilities.

MRI is inherently a multimodal technique (T1, T2, density, flow, etc, etc) and provides information complementary to that from other modalities. In order to leverage all available information and apply advanced image processing, classification, and analysis techniques my efforts became drawn towards multi-modality imaging and multispectral image analysis. This included both the development of new types of image information as well as new ways to combine and analyze different types of image information.

At the time it became more obvious that creating new forms of information alone did not provide all the potential clinical value – that information had to be delivered to physicians and made readily available for clinical decision making. This underlies how I became involved with medical information systems and information technology and started setting up multi-hospital networking between Radiology departments before the hospitals themselves had capable networks. This is consistent with a common theme throughout my career - doing the most with what is available. In particular, combining different images with clinical record information from multiple sources so the combination provides even more clinical value.

An early illustrative example of this leveraging approach was my efforts to enable the use of image information during surgery. At the time I was doing an extensive amount of early work in multimodality functional imaging (especially using fMRI and MEG) in order to guide surgeons so they did not damage vital brain areas during a resection. I would create powerful planning images and visualizations of this new information so they could better understand what needed to be done during the procedure. However, I did not feel it was good enough to just hang these images on a light-box in the OR and let the surgeons try and figure out where they were inside the patient relative to what was shown in the images. To make a long story shorter… I did a lot of work on the development of image guided surgery (IGS) systems – both in developing initial demonstration systems and in working with companies to implement and validate commercial products. IGS has now become essentially the standard of care for many surgical cases. Success depends on more than just the technology itself, I have remained focused on the way technology fits within clinical workflows.

Registration technology is the key to the IGS application, for most aspects of multimodal imaging, and even for many single-modality techniques. For example, nearly any serial measurement technique – perfusion, change detection, or functional imaging – requires registration for quantitative analysis. My academic research moved towards addressing the practical limitations of registration – how to handle registration of non-rigid structures, how to accurately do serial registrations for change detection, and how to obtain current information and keep the registration accurate in the presence of changes that occur during surgical interventions. My philosophy remains similar to how it started out for my dissertation research - use all available information to extract as much clinically useful information as possible and maximize the use of this information by its effective communication.

Simultaneously, more and more of my time was spent on building a recognized functional imaging center of excellence, managing clinical imaging operations and workflow, on developing and maintaining practical solutions and systems for moving image data across networks and between departments, and on implementing and applying technologies developed elsewhere so we could offer improved patient care.

Private Practice Background: I left academics to take a unique opportunity to pursue these efforts in a private practice environment and I joined a large radiology group in Denver – Radiology Imaging Associates PC.

There are at least two fundamentals issues in Radiology: 1) This field uses some of the most expensive, advanced, and rapidly changing technology in all of medicine; and 2) Radiologists are way too busy to be able to keep up with it all. It has always seemed obvious to me that another proper subspecialty of medicine is concerned with technology assessment, adoption, and management. Radiology is a medical specialty born of technology and is where the clinical value of technology is more evident. At the time RIA was a progressive and rapidly growning group that had the insight to recognize this and I became the only PhD among a group of 40 MDs. During my time at RIA the practice would expand to over 70 radiologists and approximately 400 employees servicing 9 major hospitals, 12 outpatient facilities, and many other contracted sites throughout the Colorado region. Also during that time technology would fuel the growth and I would become Chief Technology Officer overseeing all technology operations and an Information Technology staff of 14.

The IT sytems and technology management processes that were adequate for a small office practice soon became inappropriate for a large, distributed, and complex medical provider corporation. I was instrumental in pushing the development of enterprise-grade and best-practices changes to systems and operations that had become overly complicated and fragile during the rapid growth period. I spearheaded a comprehensive evaluation of internal processes, industry and market trends, and led the development of a technology strategic plan vital to sustained corporate progress. It took a while but I was able to energize and marshall the support of all levels of stakeholders and ultimately gain board approval for a strategic plan that positively transformed the operating processes, strategic directions and governance structure of the company.

As mentioned above radiology is a very diverse field with many diagnostic and interventional subspecialties. It also serves a wide variety of individual and corporate clients in environments ranging from small outpatient clinics to large medical centers. Each clinicial and business stakeholder has their own specific technical requirements and I was very happy to gain in-depth experience and expertise in a wide range of these areas. In general terms, my role can be described as answering the question "wouldn't it be nice to...". With such a large and complex environment this question would be raised either by myself, by corporate administration, and very often by the physicians themselves. It would be up to me to identify and assess a potential system or process improvement relative to current technology state-of-the-art and developing trends, and to design and implement the solutions. The solutions would come from a combination of any available commercial products, a joint/early development projects with suitable vendors, or from the inhouse development efforts of myself or my staff.

In this type of fully subspecialized and geographically-distributed reading environment, efficient workflow is critical - not just for images but for all clinical and business records as well. An large amount of my time was concerned with migrating our medical and business information systems towards modern enterprise-grade standards of data interchange and process workflows. This included the integration with systems outside of Radiology such as hospital HIS/EMRs, physician EHRs, and operational management and accounting systems.

As the business enterprise becomes more reliant on electronic document and record systems, systems performance and availability becomes extremely important. The functioning of the operation was completely dependent on a large number of critical infrastructure and data systems. Another large fraction of my time was involved in the design, specification, and implementation of ways to make our primary systems and services resiliant and redundant.

Consulting Background: (UNDER CONSTRUCTION) My consulting experience extends way back to when I was a faculty member. Especially in technical fields such as engineering, faculty members are generally expected to build industry contacts and bring in outside resources to their R+D programs by consulting with industry partners. Efforts and projects that were outside the time and scope of my current employment where handled on a consulting basis and I developed a modest practice.

Industry does its product development in a number of ways, but often they interact with cutting-edge academic departments to gather new technologies, use in-house engineering to commercialize the technology and develop a product, and finally use luminary customer sites to evaluate the product. I have found that a number of industry clients are interested in bridging the gaps in this process - particularly in having someone who can work with both the engineers and the clinicians to refine and develop a competitively superior product. They are even more interested in someone who can also operate earlier in the process - identifying emerging technology solutions to existing problems and helping guide the product development phase. To me this is the role of biomedical engineering and is something that I am very effective at.

I contend that nearly all current solutions to clinical problems involve some form of information technology. Now that even patient beds have RFID locating tags and stream monitoring data directly into EMRs, and medicine cabinets have automatic inventory tracking and record-linked decision support software, it is increasingly difficult to maintain the distinctions between clinical practice, clinical engineering, and information technology. I also believe that in addition to the CE-IT convergence, there is also an ongoing convergence with technology for business process and payment/accounting systems. Modern clinical practice has caught up with radiology in that 1) these critical systems are very interdependent and complicated and 2) very few people have the necessary range of expertise to sort it all out.

My background and expertise makes me uniquely suited to:

    Work with clinicians and engineers to characterize the important issues and identify technology options.
    Interact with administration at all levels to select and refine solutions so they are consistent with institutional goals and resources.
    Develop partnerships and lead implementation efforts so the solutions are effective and match stakeholder expectations.
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