ECRI Institute's founder and president emeritus Joel Nobel passed away in 2014. A physician, innovator, and pioneer, Nobel led the organization for 30 years. His vision led to many patient safety and technology improvements.
Joel Nobel was the founder of ECRI, currently known as ECRI Institute, a U.S.‑based nonprofit nongovernmental organization engaged in health services research. He developed ECRI Institute's overall policies and programs, such as its healthcare technology assessment, product evaluation, risk management, and technical assistance services for the healthcare community. He created the concepts and operating plans for Health Devices, Health Devices Alerts, the Health Devices Sourcebook, the Healthcare Product Comparison System (HPCS), and many other ECRI Institute publications. He also developed ECRI Institute's international programs and its related World Health Organization (WHO) activities.
ECRI Institute was conceived in 1965 when, as a resident in surgery, Nobel developed an ongoing research program in resuscitation and emergency care. ECRI Institute's development accelerated when Nobel completed military service in 1968 and became ECRI Institute's full‑time scientific director. In 1978, he became president and was elected to the Board of Trustees.
As a general surgical resident at Pennsylvania Hospital, during which he designed and developed MAX, a mobile emergency life‑support and resuscitation system that became widely used in North America and Europe. It received extensive attention in the press and was the subject of feature articles in Life, Time, and Der Spiegel. MAX was one of the earliest examples of a strong focus on human factors design in medical systems, and it greatly reduced errors in resuscitation.
Nobel was the principal investigator for a number of federal, state, and foundation‑funded research and demonstration projects. He published more than 170 scientific papers and book chapters related to emergency medical services, healthcare technology, medical device safety, risk management, biomedical engineering, and hospital design. He also lectured extensively on these and other subjects in 29 countries.
In 1968, supported by a federal demonstration grant, he conceived and implemented the Hospital Emergency Command System in three test hospitals. The system provided instantaneous and simultaneous mobilization and control of telecommunications, emergency equipment, elevators, and pagers of key personnel to respond to resuscitation and other life-threatening emergencies. He also developed a unique, federally funded, cardiopulmonary resuscitation research program and evaluated all related equipment on the market. His 1969 report showed that 9 of the 18 models of resuscitators sold in the United States were ineffective, and their manufacturers withdrew them from the marketplace.
In 1970, Nobel conceived a formal program, modeled after Consumer Reports, to evaluate competing brands and models of medical equipment used by hospitals, and he developed the testing laboratories and staff needed. Health Devices, ECRI Institute's monthly journal began publication in April 1971 and continues to serve the healthcare community more than 45 years later providing comparative evaluations of a wide range of medical products and investigative reports of hazardous equipment and patient harm. Nobel wrote the first published protocol for management of medical equipment, operation of clinical engineering departments, and accident investigation and developed model record-keeping systems for these programs. The protocol was published in the July 1971 issue of Health Devices. He also introduced the concept and application of life cycle cost analysis to medical equipment procurement.
In 1973, Nobel began development of ECRI Institute's Universal Medical Device Nomenclature System—the first effort to implement a worldwide common language for medical technology. Today that system is used by more than 5,000 institutions in more than 60 nations. It was adopted by the U.S. National Library of Medicine for its Unified Medical Language System (UMLS), and by the European Union as its interim system and as the substrate for the Global Medical Device Nomenclature.
In 1974, supported by a W.K. Kellogg Foundation grant, Nobel developed ECRI Shared Services in response to several state hospital associations that wished to support their member hospitals' need for biomedical engineering services. Ten regional centers on the East Coast served 143 hospitals—one of the largest programs in the United States.
In 1976, Nobel conceived and began publication of Health Devices Alerts—an extensive worldwide database of medical product defects and problems. In 1977, he created the Health Devices Sourcebook, a directory of medical device and equipment suppliers and their products sold in North America. Now online, Health Devices Sourcebase is a worldwide database. He also planned and implemented the first statewide systems for inspecting ambulances and emergency medical care facilities for technical readiness.
In 1982, supported by a grant from the Pew Charitable Trusts, he began a series of specialty newsletters focused on medical technology for clinical personnel, In 1983, he developed and implemented the National Implant Registry.
In 1984, he developed the Healthcare Product Comparison System (HPCS), now an extensive online database that compares specifications of medical products produced worldwide. HPCS also explains principles of operation, risks, and the specialized vocabularies associated with these products and provides guidance on purchasing.
In 1985, Nobel initiated an international working group to exchange information and undertake joint studies with directors from six European laboratories that also evaluated medical equipment. Nobel had a special interest in international health issues; he traveled to more than 70 countries, and worked closely with ministries of health, health organizations, and hospitals worldwide.
In 1986, supported by a W.K. Kellogg Foundation grant, Nobel initiated ECRI Institute's first technology assessment program. Its continuing development has brought ECRI Institute an extraordinary international reputation for excellence in this challenging multidisciplinary arena and led to designation of ECRI Institute as an Evidence-based Practice Center by the federal government.
In 1988, Nobel was invited by WHO to apply for special Collaborating Center status for ECRI Institute, and ECRI Institute has since fulfilled a growing international role. Nobel directed the establishment of offices in the United Kingdom to serve Europe (in 1996), in Malaysia to serve the Southeast Asia-Western Pacific region (in 1997), and in Dubai to serve the Arabic nations (in 1999).
In 1992, Nobel directed a unique project for the Ministry of Health in Turkey on technology assessment; planning, procurement, and management of medical equipment; and clinical laboratory and radiological quality assurance practices. The project, which also produced an essential equipment list system and acquisition priorities for 4,500 different medical products, was a prototype for the health systems of other developing countries and led him to develop similar projects in Bahrain, Oman, and other nations. The success of these projects led him to press development of ECRI Institute's medical equipment planning services and related software, now well proven in a series of projects in several nations for new hospitals and major renovations.
In 1997, he developed a project to monitor the quality of work undertaken by private contractors for the Ministry of Health of Malaysia. Projects followed in Hong Kong, the Philippines, and Thailand, as well as additional projects in Malaysia. That same year, the Institution of Engineers of Australia selected Nobel for its eminent speaker program and a five-city speaking tour. In 2003 he was appointed chairman of the Arab Health Awards program, an annual event in Dubai.
Between 1968 and 2006, Nobel participated directly in hundreds of consulting projects in various countries, often as the project leader. These projects included hospital and clinic development programs where he undertook feasibility studies, prepared project briefs and worked closely with architects, consulting engineers, equipment planners and interior designers in the schematic and design development phases. Much of his work was focused on design review of facility drawings and design and development of critical care units.
Under Nobel's leadership, ECRI Institute grew to a full-time staff of 250 that has served thousands of hospitals, health systems, government health agencies, and others in scores of countries. In the management arena, he established processes and standards that came far later in most other organizations. For example he prohibited smoking throughout ECRI Institute facilities in1968 and established on-site day care center in 1970. In 1971, Nobel crafted unique conflict-of-interest rules for ECRI Institute and all its employees to protect the organization's reputation for scientific and business integrity—rules that are, even today, tougher than any other institution's. In employment contracts, he made employees personally liable for the financial consequences if, as individuals, they were the cause of a sexual harassment suit against the institution.
In 2007 Nobel received the first annual Praxis Award in Professional Ethics from the College of Liberal Arts and Sciences of Villanova University.
In 2015, Nobel won two posthumous awards: The ACCE HTM Champion 2015 Award and the Benjamin Franklin Key Award from the Philadelphia section of the Institute of Electrical and Electronics Engineers (IEEE).
Nobel testified before the U.S. Congress on proposed legislation, ranging from national telecommunications policy to medical device regulation, and served as a consultant to many federal, voluntary, and international agencies as well as ministries and departments of health and hospitals. Among them were the American Heart Association, American Hospital Association, American Society for Quality, U.S. Department of Health and Human Services, U.S. Food and Drug Administration, Foreign Policy Research Institute, Inter‑Society Commission for Heart Disease Resources, The Joint Commission, U.S. National Institutes of Health, National War College, Veterans Administration, and WHO. He also represented ECRI Institute for WHO programs related to healthcare technology.
Nobel served as a member of the board of directors of Consumers Union (CU), publisher of Consumer Reports, from 1978 through 2005, and served two terms on the board's executive committee. Prior to that he served as chair of its Technical Policy Committee, as vice president of the Consumers Union Foundation, and as a member of CU's Publication Policy Committee. In 2003 he was appointed chairman of the Board--Staff Strategic Planning Committee. Although declining re-election to the board in late 2005, he was asked to continue as Chairman of the Strategic Planning Committee, and to remain on the board's Ethics Committee.
Nobel is listed in Who's Who in America, Who's Who in the World, Who's Who in the East, Who's Who in Medicine and Healthcare, Who's Who in Business and Finance, Who's Who in Technology Today, Who's Who in Science and Engineering, and American Men and Women of Science.
Nobel was a member of the American Heart Association, American Hospital Association, American Medical Association, American National Standards Institute, American Society of Anesthesiologists, American Society for Healthcare Engineering of the American Hospital Association, American Society for Quality Control, Association for the Advancement of Medical Instrumentation, Instrument Society of America, Navy League, Pennsylvania Medical Society, Philadelphia County Medical Society, Society for Advanced Medical Systems, Society of Critical Care Medicine, Naval Submarine League, and U.S. Naval Institute.
Nobel received his BA in English and political science with high honors from Haverford College in 1956. His honors thesis was entitled "The Koran as a Political Document" and dealt with the relationship of Islam to contemporary international politics. He also completed a historical and strategic appraisal of insurgency warfare that was circulated in government.
Following graduation from college, he traveled extensively in Southeast Asia and was attached as an observer to the Royal Hampshire Regiment conducting antiterrorist operations in Malaysia.
In 1958, he was awarded an MA in international relations by the University of Pennsylvania. He completed course requirements for his doctorate. His specialty was the Middle East, and his functional specialty was insurgency warfare and counter terrorism. As a consultant to the Foreign Policy Research Institute, he participated in projects dealing with emerging African nations, policy and technical issues associated with the potential use of bacteriologic and chemical warfare, and NATO--Warsaw Pact conflicts. He also prepared curriculum materials for use at the National War College.
While attending Thomas Jefferson University Medical College, he was awarded a Smith, Kline and French fellowship for the study of medicine in underdeveloped areas. He spent several months as a surgical assistant at the United Mission Hospital at Shanta Bhawan, Nepal, and also volunteered to provide medical care at a Tibetan refugee camp. After receiving his MD and both the Shain Practice of Medicine and Shain Surgery prizes upon graduation in 1963, he interned at Presbyterian Hospital in Philadelphia.
His neurosurgical residency at the Hospital of the University of Pennsylvania was interrupted by military service as a medical officer in the U.S. Navy. He served on a nuclear submarine and then in the Military Operations Branch of the Submarine Medical Research Laboratory. His responsibilities included field evaluation of gas chromatography techniques for monitoring closed ecological systems, evaluation of anti-swimmer defense systems, design of physiologic data acquisition systems, and evaluation of physiologic stress, hypothermia, and thermal protection during submarine crew escape procedures.
He also developed concepts for improved periscope observation capabilities, employing television light amplification, image and data (heading, position and periscope bearing) capture, and target matching.
Following his naval service, Nobel chose a full‑time research, rather than a clinical, career and established ECRI Institute and its programs. Nobel was licensed as a physician and was a diplomat of the National Board of Medical Examiners.
Joel J. Nobel was born on December 8, 1934, in Philadelphia, and had two sons and a daughter. The earth-sheltered home he designed and constructed won two awards for design and energy conservation and was featured in several magazines. His leisure interests included gardening, restoring old armored vehicles, and reading history. He was an experienced sailor and was qualified to fly single‑engine land-and-sea aircraft.