Jonathan Teich, M.D. Chief Medical Informatics Officer, Elsevier.

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Jonathan Teich, M.D., PhD, is CMIO for Elsevier, a leading publisher of scientific, technical and health information. He also serves as assistant professor of medicine at Harvard Medical School and as a board-certified attending physician in emergency medicine at Brigham and Women's Hospital, where he has practiced since 1983. In the early 1990s, he founded the Brigham and Women's Center for Applied Medical Information Systems. He has been active in medical informatics and health information technology for more than twenty years.

Dr. Teich has authored or co-authored more than 100 peer-reviewed papers, books and editorials on medical informatics and healthcare information systems. He participates in numerous industry groups and government leadership councils, including the Roadmap for National Action on Clinical Decision Support, and boards and committees of the Health Information Management Systems Society and American Medical Informatics Association. He also is a member of the American Health Information Community's Quality Workgroup and a fellow in the American College of Medical Informatics.

Q HMT: What are the chief differences between a CIO and a CMIO?

"The CIO is traditionally someone who has operational responsibility for the information technology of an organization, and certainly plays an important role in supporting those needs across the hospital. Generally, the CMIO is a person, usually a physician, who provides a bridge between practical medical needs and information technology capabilities. Usually, it is someone who has a solid understanding of both, and who is there to translate clinical strategy into information technology possibilities and vice versa."

Q HMT: Would you characterize the CMIO as a bridge between CIO and the clinical side of medicine?

"Many organizations need to have someone in each role, and in these cases, they do work closely together. Certainly, the most successful organizations that have CIOs and CMIOs do have them working as very closely coordinated teams. However, I don't think that the CMIO may necessarily be qualified to make entire hospitalwide purchasing decisions about technology operations or physical plant, as a CIO does. On the other hand, the CIO may be very well suited to those responsibilities, but may not always be as knowledgeable about clinical and healthcare strategies. In these instances, certainly, there needs to be a bridge spanning the information technology capabilities and the clinical and health strategy needs of an organization. CMIOs function in a variety of ways and may report to a CIO in some cases. More often though, they're reporting to the chief medical officer, the chief quality officer or to a VP of clinical excellence--or a similar, senior clinical role--so they're really bridging those two disciplines."

Q HMT: Given the blending of IT and clinical technologies, is it an advantage today for CIOs to also be medical doctors?

"Organizations are still hiring CIOs with both of those roles in mind, and the best CIOs understand a great deal about healthcare processes and operations. But as IT plays an increasingly significant role in day-to-day operations, it is advantageous to separate and delineate the IT-leadership and medical-applications roles, to allow specific skill sets to be applied to each discipline. In general, a CIO doesn't need to be a physician, and the question is whether you compromise some other capabilities on the vital IT and strategic sides of the CIO's job if you require that."

Q HMT: How should CMIOs prepare today for the IT-driven evolution of healthcare?

"They need to do what good CMIOs do, which is be aware of both healthcare trends and technology trends.

"The well-informed CMIO, whether in a healthcare organization or in industry, needs to know what's coming down from Medicare; as well as, new never event preventions from the National Quality Forum, and also be aware of both new guidelines and new methods that may be coming out to make those guidelines computable and whether these methods have reached a computable state.

"So, CMIOs are an interfaced position. They need to be aware of both what the new needs are and what the new possible technologies are."

Q HMT: Should CMIOs act partly as educators for patients as well as other officers of the organization?

"It is very important to have an education role, or certainly a communications component at the very least. In some ways, the CMIO is the ultimate clinician champion.

"I've talked for many years about how there are different roles for physicians in HIT in the provider setting. One of the most important roles is the champion, which is a senior clinician who is paying very close attention to new technologies, who is personally involved in the implementation of new applications, and who also participates in decisions about emerging strategic issues. In addition, the champion functions as the early adopter who can communicate with peers.

"As a respected clinician, when a new implementation is under way and going through its inevitable bumps, the champion can stand up and say, 'I tried this several weeks or months before you, [and] you can trust me that we'll get past this bump.' This is vitally important to gaining adoption for a complex project.

"When I worked in [Information Systems] at Brigham and Women's, we sometimes defined a small project as something where people hate you for two weeks and a large project as one where people hate you for two months."

Q HMT: You are involved in the research and development of healthcare IT solutions. Do you find being an M.D. makes you particularly well suited for that type of work?

"I basically have three roles for Elsevier: the first is strategy and broad program planning; second is helping to envision and design innovative products; and, third is maintaining the connection between Elsevier and external industry, academic and government entities and activities. These roles require a number of different kinds of work experiences. Being an active physician, I have opportunities to see practical examples of how information is used and how it is changing--as they say, 'I'm also a client,'--and to bring those ideas from clinical practice back to be applied at Elsevier. Really, not a shift goes by in the Emergency Department at Brigham and Women's when I don't encounter at least one clinical case for which I really wish I had a new feature or a new information tool that could help me with that case. Additionally, as an M.D., a CMIO probably has a greater degree of confidence in interacting with other physicians in hospitals and other practices--they are often most comfortable speaking with another physician."

Q HMT: What would you tell your students on the CMIO path that are still in their education phase to be looking forward to in the next five years?

"I think that they'll be able to look forward to more organizations understanding both informatics and the CMIO role itself. I think that this will become increasingly a standard part of the roles in a healthcare organization. I also think it will become an increasingly common job in healthcare technology companies and healthcare knowledge companies. So first of all, you will see greater recognition of the need, as the Internet and all of our technology backgrounds continue to evolve. We will see more of the informatics training programs understanding this as well, and making sure that students have appropriate backgrounds not only on the technology side but also the business side. Even now we are starting to see combined Informatics and MBA programs, where people get a chance to understand healthcare business as well."