Dr. Jonathan Teich, MD, PhD, Teich is chief medical informatics officer for Elsevier Health Sciences. He has been active in medical informatics and health information technology for over 20 years. Teich’s responsibilities include a combination of vision, strategy, and broad product design for the continuing transformation of Elsevier’s content base and publication resources into multi-level electronic reference, highly interactive clinical decision support (CDS), and other knowledge-based tools to support direct clinical practice and healthcare delivery.
Teich is an assistant professor of medicine at Harvard, and a board-certified attending physician in emergency medicine at Brigham and Women's Hospital (BWH). He was the founder and first director of the Clinical Informatics Research and Development department at Partners Healthcare System. He was the primary designer of many of BWH's clinical information applications, including the computerized physician order entry system, ambulatory record, clinical decision support systems, emergency medicine systems, and the handbook electronic information library.
He has authored or co-authored over 100 papers, books, and other publications in the field of medical informatics and healthcare information systems, with a particular concentration in clinical decision support. He is a co-author of the book, Improving Outcomes with Clinical Decision Support: An Implementer’s Guide. He co-chaired the panel responsible for the HHS-sponsored Roadmap for National Action on Clinical Decision Support, and from 2009-2012 he served as a subject-matter expert on CDS matters for the Office of the National Coordinator (ONC). He has served on the board of directors of AMIA, HIMSS, and the eHealth Initiative, and is a fellow of the American College of Medical Informatics and of HIMSS.
HIMSS: How did you become involved with HIMSS?
Teich: I've been involved with HIMSS for 20 years, starting as a presenter at the annual conference when I was leading research and development at Brigham & Women's Hospital in Boston, Mass. I had a connection to Pat Wise, vice president, healthcare information systems, HIMSS, because our Brigham team won two Davies Awards, and I then joined the Davies committee for the next few years. Later, when I was looking for an outlet to provide national outreach about clinical decision support, I spoke with Pat, who had moved to HIMSS with the Davies program. We worked together to form the clinical decision support (CDS) workgroup -- and I've been deeply involved ever since. In that time, I've been a member and/or chair of several HIMSS workgroups, task forces, committees, and the board of directors.
HIMSS: What has been the most rewarding aspect of your involvement with HIMSS?
Teich: I've said it many times - "HIMSS gets things done." When we proposed having new symposia and workshops on CDS, on quality and on innovation, it happened. When a few colleagues and I wanted to circulate our ideas for best practices in implementing CDS, it turned into the Improving Outcomes with CDS book series; the CDS 101 website; well-composed position papers for government policy, and more. HIMSS has the staff resources, energy and talent to sustain ideas and develop them into useful outputs.
In truth, though, the most rewarding part is getting to know and work with all those enthusiastic and talented staff members and volunteers. It has been a lot of fun and a great use of time and energy.
HIMSS: Please give a brief overview of Clinical Decision Support.
Teich: CDS is all about serving up information that is (a) tailored to the situation at hand and (b) presented in the most useful way. What does that mean in practice? It's about understanding what's going on right now with your patient, your workload and your current task, and determining exactly what information, in what format, will be most helpful to answering the question, "What do I do next?" Lots of people think of CDS as alerts and reminders. They are part of it, certainly -- but often there are more effective forms: intelligent order sets and care plans; relevant data displays and active presentation of relevant knowledge; smart documentation forms and broader tools such as analytics and expert simulators. In different workflows, different types of CDS are best at helping me to be a little smarter, to know more about what to do, and to avoid errors.
HIMSS: Please provide a brief description of the session you will be hosting at HIMSS14, “Improving Outcomes with CDS #1 (A Focus on CDS Selection, Design & Launch.)”
Teich: It will cover practical aspects of how to select and implement the best CDS interventions for different situations. I will talk about the different types of CDS, how you would choose them based on what you're trying to do, and some things to know when you are actually going forward. I will also talk a bit about an active area of my own work -- summarizing evidence and reference information to give you highly actionable task guidance -- and will also discuss a few remarkable new innovations happening in the CDS world. There'll be lots of visuals.
My colleague Jerry Osheroff, MD, will pick up from there in the next session and talk about great collaborative work in organizing your CDS activities and sharing best practices from one institution to another.
HIMSS: What are some of the challenges you encounter with CDS, with consideration of the use of Health IT? What solutions have you found to be successful?
Teich: CDS works very well for many things in many places. When it doesn't succeed, it often comes down to a few common problems. Those include: using ineffective intervention types; requiring too much additional work and thought for a user to process the CDS output; over-alerting; trying to impose a change in practice through the computer without first getting buy-in from the affected users; not understanding the local culture, in particular not realizing that you have to start with easy, helpful, supportive interventions before you get to the heavy-duty interruptions and alerts; not having clinical champions who can review new interventions before they are widely implemented; and above all, making the workday take longer. The solutions to each are realizing those potential problems and eliminating all the "befores," "nots" and "withouts!"
HIMSS: What advice would you give professionals just entering the healthcare or IT field?
Teich: Be excited, stay true to healthcare, and be flexible. Without question, we are going to see more information technology in health, not less, and so we will have a pressing need for people who can think practically, who really understand both the requirements of healthcare practice and the possibilities of advancing technologies. Understand the technologies people use today and how they do and do not support ideal healthcare workflow, and then keep your mind open to new solutions arising that can do it better. If you can keep that perspective -- and if you remember that you are trying to use technology to make things better for people and not the other way around -- you will have a very successful career.
Learn more and register for the session, “Improving Outcomes with CDS #1 (A Focus on CDS Selection, Design & Launch,” on Sunday, Feb. 23 at 1:45-2:15 p.m. at the Orange County Convention Center.