Friday, July 07, 2017

Digitizing History

This post comes from Grayce Mack, Student Assistant for the LSTA digitization project. Grayce is an MLIS student at Emporia State University who is about to graduate from the program and head off into the professional library world.

Last week we wrapped up work on our two-year digitization project Public Health in Oregon: Discovering Historical Data. Since June 2015, student archives assistants have been digitizing collection materials that document the fascinating history of public health in Oregon during the 19th and early 20th centuries. The collection includes county health surveys, patient records, reports from medical institutions such as the Portland Free Dispensary and the Oregon State Tuberculosis Hospital, and much more.

After scanning the collection, we began transcribing tables of data from the records into Excel. By creating digital spreadsheets of the information from these records, researchers will be able to use the historical data more easily and efficiently, and will allow researchers from data-driven professions to analyze records that are usually limited to study by historians. The content varies widely, from vital statistics to tuberculosis fatalities, even an annual budget of hospital groceries. We soon found that working with legacy health data presents unique challenges, including issues of patient privacy and data loss.

Our goal was to transcribe records as closely as possible, but this often proved difficult because they were written in a time before records needed to be machine-readable. Many records contained inconsistent terms and abbreviations, spelling mistakes, and data placed in the wrong columns. Combine these errors with century-old cursive penmanship, and we had our work cut out for us. On most records, when small corrections to original errors could be reasonably made, we changed the data and included a note on the digital record.

Other data we could not alter so easily. In order to maintain the integrity of the original record, we decided not to transcribe any data presented in an unstructured (or non-tabular) format, even when this resulted in some data loss. We also could not always transcribe non-textual symbols on analog records. Certain words on the original may be circled, written over, or underlined in red. These may have been important notations to the original users, but we often did not have a key to interpret their meaning, and, more importantly, no way to adequately represent these symbols in the Excel document.

We also ran into issues with transcribing and publishing protected health information (PHI) in our digitized records. While the medical records we transcribed are between 50 and 120 years old, HIPAA protections for patients still apply until 50 years after the death of the patient. If the date of death was unknown (which was frequently the case), we redacted PHI for patients born after 1867 or anyone whose birth date was also unknown.

Redaction goes beyond just omitting the patient’s name. Following the Safe Harbor methodology for satisfying HIPAA, we redacted names, addresses, cities of residence, phone numbers, family members, and admission and discharge dates. While it can be frustrating to lose valuable data during this process, redaction is a necessary and ethical safety measure to protect the legacy and families of patients of OHSU’s past institutions.

As the project comes to a close, we have scanned 8,634 pages of archival documents, redacted over 3,500 pages, and transcribed the data from around 6,700 pages. By redacting and transcribing historical health records, we learned about the challenges of preserving legacy health information. While it is impossible to digitize archival materials without losing some original data, we have expanded the usability of these enlightening historical records and can now share this collection with researchers all over the world.

Check out the collection to view the digitized records and transcribed data files. You can also visit our online exhibit for context about the history of public health in Oregon documented by this project.

Wednesday, July 05, 2017

Oral history: Karen Deveney, M.D.

by Rachel Fellman

We have another oral history project to highlight today: Dr. Karen Deveney, former head of the OHSU Surgery Residency Program and president of the Pacific Coast Surgical Association.

Karen Deveney, M.D. (courtesy of "Reflections on a trailblazing career in surgery") - click to link to article
Karen Deveney, M.D. (courtesy of "Reflections on a trailblazing career in surgery")
Dr. Deveney is a strong voice for women's and rural surgical education, and these interests are reflected in her background: she came from Gresham back when it was a country town. Although their home wasn’t yet a suburb of Portland, her father had the quintessentially Portland job of rose farmer. Her family had always been pioneers (her mother’s family came over on the Oregon Trail), but it fell to her to be the educational trailblazer, as her parents had come of age at the start of the Depression and had had no chance to go to college.

Growing up, Dr. Deveney only knew one doctor. He was the mayor of Gresham and seemed to move in a different sphere. So medicine never seemed to be on the table as a career choice. It took a few years of teaching at a tumultuous junior high school in San Francisco, where a Molotov cocktail was once thrown into the teachers’ lounge, to convince her that she wanted to take her education further. In this, she was encouraged by her husband, then a medical student; when she told him he was lucky to be doing something he loved, he suggested that she join him.

During admissions, the interviewer asked what a woman of her “mature years” was doing applying to medical school (the twenty-three-year-old applicant suspected that this was simply a euphemism for “married woman”). But her strong will, work ethic, and ability to collaborate with faculty prevailed. She became the second woman to finish a surgical residency at the University of California in San Francisco, and went on to do advanced work in colorectal surgery, creating a program at the San Francisco VA to research surgical outcomes and teach surgeons endoscopy and colonoscopy. She became half of a husband-and-wife team of surgeon-administrators.

In the late eighties, they were called home after her mother developed Alzheimer's. She was hired at OHSU to run the surgical education program, and given a mandate to build the best department on the West Coast.

For Dr. Deveney, the process of building that department was inseparable from the process of making it an environment where women could thrive. (Her husband, tapped to be chief of surgery at the Portland VA, shared similar priorities.) At the time she began, there were no women on the faculty, one or two female residents at best, and an unchecked culture of sexual harassment. Women were discouraged from going into surgery; “It was viewed as too difficult and that it was a very stressful, malignant situation. […] Even the faculty in other departments would tell female medical students, ‘Don’t go into surgery. You’ll have a miserable life. You’ll never be happy. And it will be terrible.’” 

Today, a third of the OHSU faculty are women, as are half the residents. Dr. Deveney is a strong believer in a “critical mass” of underrepresented people “that can work together to make a change in the culture of the organization.” She is passionate about women’s leadership, arguing that women offer “situational awareness, emotional intelligence […] the ability to be collaborative and not autocratic.” And with many women among the residents, the male residents feel that they have permission to be “more humanistic and more concerned about their family life,” rather than pushed to express nonstop machismo. Through judicious hiring, encouragement of diverse leadership, and strong discouragement of sexual harassment and bias on campus, OHSU was able to learn to value and welcome female students.

Dr. Deveney is also proud of her work developing a rural surgery rotation for OHSU, with year-long programs in Grants Pass and Coos Bay. Rural surgeons need to be generalists as well as specialists, and they’re expected to know their communities intimately – the job takes interpersonal as well as surgical skills. Rural hospitals also have a perpetual problem with recruitment and replacing aging staff. OHSU’s program began as an elective and later evolved into a rotation. Most of OHSU’s rotations are six weeks to two months, but residents work in rural surgery for a full year to give them a chance to connect with the community and build the experienced surgeons’ trust.

This rather long post still doesn't cover most of the oral history -- it's packed with reflection and advice. I encourage you to check it out here.