Jonathan M. Teich

Publications of Jonathan M. Teich

• Improving clinical quality indicators through electronic health records: it takes more than just a reminder.

  Authors: Dean F Sittig, Jonathan M. Teich, Jerome A Osheroff, Hardeep Singh

  Pediatrics. 08/2009; 124(1):375-7.

• Grand challenges in clinical decision support.

  Authors: Dean F Sittig, Adam Wright, Jerome A Osheroff, Blackford Middleton, Jonathan M. Teich, Joan S Ash, Emily Campbell, David W Bates

  Journal of biomedical informatics. 05/2008; 41(2):387-92.

  There is a pressing need for high-quality, effective means of designing, developing, presenting, implementing, evaluating, and maintaining all types of clinical decision support capabilities forThere is a pressing need for high-quality, effective means of designing, developing, presenting, implementing, evaluating, and maintaining all types of clinical decision support capabilities for clinicians, patients and consumers. Using an iterative, consensus-building process we identified a rank-ordered list of the top 10 grand challenges in clinical decision support. This list was created to educate and inspire researchers, developers, funders, and policy-makers. The list of challenges in order of importance that they be solved if patients and organizations are to begin realizing the fullest benefits possible of these systems consists of: improve the human-computer interface; disseminate best practices in CDS design, development, and implementation; summarize patient-level information; prioritize and filter recommendations to the user; create an architecture for sharing executable CDS modules and services; combine recommendations for patients with co-morbidities; prioritize CDS content development and implementation; create internet-accessible clinical decision support repositories; use freetext information to drive clinical decision support; mine large clinical databases to create new CDS. Identification of solutions to these challenges is critical if clinical decision support is to achieve its potential and improve the quality, safety and efficiency of healthcare.

• Recommendations for clinical decision support deployment: synthesis of a roundtable of medical directors of information systems.

  Authors: Robert A Jenders, Jerome A Osheroff, Dean F Sittig, Eric A Pifer, Jonathan M. Teich

  AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium. 02/2007;

  BACKGROUND: Ample evidence exists that clinical decision support (CDS) can improve clinician performance. Nevertheless, additional evidence demonstrates that clinicians still do not performBACKGROUND: Ample evidence exists that clinical decision support (CDS) can improve clinician performance. Nevertheless, additional evidence demonstrates that clinicians still do not perform adequately in many instances. This suggests an ongoing need for implementation of CDS, in turn prompting development of a roadmap for national action regarding CDS. OBJECTIVE: Develop practical advice to aid CDS implementation in order to improve clinician performance. METHOD: Structured group interview during a roundtable discussion by medical directors of information systems (N = 30), with subsequent review by participants and synthesis. RESULTS: Participant consensus was that CDS should be comprehensive and should involve techniques such as order sets and facilitated documentation as well as alerts; should be subject to ongoing feedback; and should flow from and be governed by an organization's clinical goals. CONCLUSION: A structured roundtable discussion of clinicians experienced in health information technology can yield practical, consensus advice for implementation of CDS.

• White paper: A Roadmap for National Action on Clinical Decision Support.

  Authors: Jerome A. Osheroff, Jonathan M. Teich, Blackford Middleton, Elaine B. Steen, Adam Wright, Don E. Detmer

  JAMIA. 01/2007; 14:141-145.

• AMIA Position Paper: Clinical Decision Support in Electronic Prescribing: Recommendations and an Action Plan: Report of the Joint Clinical Decision Support Workgroup.

  Authors: Jonathan M. Teich, Jerome A. Osheroff, Eric A. Pifer, Dean F. Sittig, Robert A. Jenders

  JAMIA. 01/2005; 12:365-376.

• Clinical decision support in electronic prescribing: recommendations and an action plan: report of the joint clinical decision support workgroup

  Authors: Jonathan M Teich, Jerome A Osheroff, Eric A Pifer, Dean F Sittig, Robert A Jenders, CDS Expert Review Panel

  01/2005; 12:365-76.

  Clinical decision support (CDS) in electronic prescribing (eRx) systems can improve the safety, quality, efficiency, and cost-effectiveness of care. However, at present, these potential benefits haveClinical decision support (CDS) in electronic prescribing (eRx) systems can improve the safety, quality, efficiency, and cost-effectiveness of care. However, at present, these potential benefits have not been fully realized. In this consensus white paper, we set forth recommendations and action plans in three critical domains: (1) advances in system capabilities, including basic and advanced sets of CDS interventions and knowledge, supporting database elements, operational features to improve usability and measure performance, and management and governance structures; (2) uniform standards, vocabularies, and centralized knowledge structures and services that could reduce rework by vendors and care providers, improve dissemination of well-constructed CDS interventions, promote generally applicable research in CDS methods, and accelerate the movement of new medical knowledge from research to practice; and (3) appropriate financial and legal incentives to promote adoption.

• Conversion from intravenous to oral medications: assessment of a computerized intervention for hospitalized patients.

  Authors: Michael A Fischer, Daniel H Solomon, Jonathan M Teich, Jerry Avorn

  Archives of internal medicine. 12/2003; 163(21):2585-9.

  BACKGROUND: Many hospitalized patients continue to receive intravenous medications longer than necessary. Earlier conversion from the intravenous to the oral route could increase patient safety andBACKGROUND: Many hospitalized patients continue to receive intravenous medications longer than necessary. Earlier conversion from the intravenous to the oral route could increase patient safety and comfort, reduce costs, and facilitate earlier discharge from the hospital without compromising clinical care. We examined the effect of a computer-based intervention to prompt physicians to switch appropriate patients from intravenous to oral medications. METHODS: This study was performed at Brigham and Women's Hospital, an academic tertiary care hospital at which all medications are ordered online. We targeted 5 medications with equal oral and intravenous bioavailability: fluconazole, levofloxacin, metronidazole, ranitidine, and amiodarone. We used the hospital's computerized order entry system to prompt physicians to convert appropriate intravenous medications to the oral route. We measured the total use of the targeted medications via each route in the 4 months before and after the implementation of the intervention. We also measured the rate at which physicians responded to the intervention when prompted. RESULTS: The average intravenous defined daily dose declined by 11.1% (P =.002) from the preintervention to the postintervention period, while the average oral defined daily dose increased by 3.7% (P =.002). Length of stay, case-mix index, and total drug use at the hospital increased during the study period. The average total monthly use of the intravenous preparation of all of the targeted medications declined in the 4 months after the intervention began, compared with the 4 months before. In 35.6% of 1045 orders for which a prompt was generated, the physician either made a conversion from the intravenous to the oral version or canceled the order altogether. CONCLUSIONS: Computer-generated reminders can produce a substantial reduction in excessive use of targeted intravenous medications. As online prescribing becomes more common, this approach can be used to reduce excess use of intravenous medications, with potential benefits in patient comfort, safety, and cost.

• Clinical decision support in electronic prescribing: recommendations and an action plan: report of the joint clinical decision support workgroup.

  Authors: Jonathan M. Teich, Jerome A Osheroff, Eric A Pifer, Dean F Sittig, Robert A Jenders

  Journal of the American Medical Informatics Association : JAMIA. 12(4):365-76.

  Clinical decision support (CDS) in electronic prescribing (eRx) systems can improve the safety, quality, efficiency, and cost-effectiveness of care. However, at present, these potential benefits haveClinical decision support (CDS) in electronic prescribing (eRx) systems can improve the safety, quality, efficiency, and cost-effectiveness of care. However, at present, these potential benefits have not been fully realized. In this consensus white paper, we set forth recommendations and action plans in three critical domains: (1) advances in system capabilities, including basic and advanced sets of CDS interventions and knowledge, supporting database elements, operational features to improve usability and measure performance, and management and governance structures; (2) uniform standards, vocabularies, and centralized knowledge structures and services that could reduce rework by vendors and care providers, improve dissemination of well-constructed CDS interventions, promote generally applicable research in CDS methods, and accelerate the movement of new medical knowledge from research to practice; and (3) appropriate financial and legal incentives to promote adoption.

• Grand challenges in clinical decision support

  Authors: Dean F. Sittig, Adam Wright, Jerome A. Osheroff, Blackford Middleton, Jonathan M. Teich, Joan S. Ash, Emily Campbell, David W. Bates

  Journal of Biomedical Informatics.

  There is a pressing need for high-quality, effective means of designing, developing, presenting, implementing, evaluating, and maintaining all types of clinical decision support capabilities forThere is a pressing need for high-quality, effective means of designing, developing, presenting, implementing, evaluating, and maintaining all types of clinical decision support capabilities for clinicians, patients and consumers. Using an iterative, consensus-building process we identified a rank-ordered list of the top 10 grand challenges in clinical decision support. This list was created to educate and inspire researchers, developers, funders, and policy-makers. The list of challenges in order of importance that they be solved if patients and organizations are to begin realizing the fullest benefits possible of these systems consists of: improve the human–computer interface; disseminate best practices in CDS design, development, and implementation; summarize patient-level information; prioritize and filter recommendations to the user; create an architecture for sharing executable CDS modules and services; combine recommendations for patients with co-morbidities; prioritize CDS content development and implementation; create internet-accessible clinical decision support repositories; use freetext information to drive clinical decision support; mine large clinical databases to create new CDS. Identification of solutions to these challenges is critical if clinical decision support is to achieve its potential and improve the quality, safety and efficiency of healthcare.

• Using information systems to measure and improve quality

  Authors: David W. Bates, Elizabeth Pappius, Gilad J. Kuperman, Dean Sittig, Helen Burstin, David Fairchild, Troyen A. Brennan, Jonathan M. Teich

  International Journal of Medical Informatics.

  Information systems (IS) are increasingly important for measuring and improving quality. In this paper, we describe our integrated delivery system's plan for and experiences with measuring andInformation systems (IS) are increasingly important for measuring and improving quality. In this paper, we describe our integrated delivery system's plan for and experiences with measuring and improving quality using IS. Our belief is that for quality measurement to be practical, it must be integrated with the routine provision of care and whenever possible should be done using IS. Thus, at one hospital, we now perform almost all quality measurement using IS. We are also building a clinical data warehouse, which will serve as a repository for quality information across the network. However, IS are not only useful for measuring care, but also represent powerful tools for improving care using decision support. Specific areas in which we have already seen significant benefit include reducing the unnecessary use of laboratory testing, reporting important abnormalities to key providers rapidly, prevention and detection of adverse drug events, initiatives to change prescribing patterns to reduce drug costs and making critical pathways available to providers. Our next major effort will be introduce computerized guidelines on a more widespread basis, which will be challenging. However, the advent of managed care in the US has produced strong incentives to provide high quality care at low cost and our perspective is that only with better IS than exist today will this be possible without compromising quality. Such systems make feasible implementation of quality measurement, care improvement and cost reduction initiatives on a scale which could not previously be considered.

• Automating complex guidelines for chronic disease: lessons learned.

  Authors: Saverio M Maviglia, Rita D. Zielstorff, Marilyn Paterno, Jonathan M. Teich, David W Bates, Gilad J Kuperman

  Journal of the American Medical Informatics Association : JAMIA. 10(2):154-65.

  There is scant published experience with implementing complex, multistep computerized practice guidelines for the long-term management of chronic diseases. We have implemented a system for creating,There is scant published experience with implementing complex, multistep computerized practice guidelines for the long-term management of chronic diseases. We have implemented a system for creating, maintaining, and navigating computer-based clinical algorithms integrated with our electronic medical record. This article describes our progress and reports on lessons learned that might guide future work in this field. We discuss issues and obstacles related to choosing and adapting a guideline for electronic implementation, representing and executing the guideline as a computerized algorithm, and integrating it into the clinical workflow of outpatient care. Although obstacles were encountered at each of these steps, the most difficult were related to workflow integration.

• The informatics response in disaster, terrorism, and war.

  Authors: Jonathan M. Teich, Michael M Wagner, Colin F. Mackenzie, Klaus O Schafer

  Journal of the American Medical Informatics Association : JAMIA. 9(2):97-104.

  The United States currently faces several new, concurrent large-scale health crises as a result of terrorist activity. In particular, three major health issues have risen sharply in urgency andThe United States currently faces several new, concurrent large-scale health crises as a result of terrorist activity. In particular, three major health issues have risen sharply in urgency and public consciousness--bioterrorism, the threat of widespread delivery of agents of illness; mass disasters, local events that produce large numbers of casualties and overwhelm the usual capacity of health care delivery systems; and the delivery of optimal health care to remote military field sites. Each of these health issues carries large demands for the collection, analysis, coordination, and distribution of health information. The authors present overviews of these areas and discuss ongoing work efforts of experts in each.

• A roadmap for national action on clinical decision support.

  Authors: Jerome A Osheroff, Jonathan M. Teich, Blackford Middleton, Elaine B Steen, Adam Wright, Don E Detmer

  Journal of the American Medical Informatics Association : JAMIA. 14(2):141-5.

  This document comprises an AMIA Board of Directors approved White Paper that presents a roadmap for national action on clinical decision support. It is published in JAMIA for archival andThis document comprises an AMIA Board of Directors approved White Paper that presents a roadmap for national action on clinical decision support. It is published in JAMIA for archival and dissemination purposes. The full text of this material has been previously published on the AMIA Web site (www.amia.org/inside/initiatives/cds). AMIA is the copyright holder.

• An Easy to Use Tool for Creating and Maintaining User Dialogs

  Authors: Michael J. Franklin, Dean F Sittig, Marilyn D Paterno, Mark Segal, Rita D. Zielstorff, Jonathan M. Teich

• A Practical Method for Presenting Drug Interactions to Clinicians

  Authors: Marilyn D Paterno, Jonathan M. Teich, Diane L Seger, David W Bates

• Identifying Adverse Drug Events: Development of a Computerized Monitor and Comparison to Chart Review

  Authors: Ashish K Jha, Gilad J Kuperman, Jonathan M. Teich, Lucian L Leape, Brian Shea, Eve Rittenberg, Elisabeth Burdick, Martha VanderVliet, Diane Seger, David W Bates

  We developed an adverse drug event (ADE) monitor based on published rules, made modifications to improve its sensitivity and positive predictive value, and compared it to manual chart review and selfWe developed an adverse drug event (ADE) monitor based on published rules, made modifications to improve its sensitivity and positive predictive value, and compared it to manual chart review and self report. Over the study period, the ADE monitor (COMP) identified 279 ADEs while the manual chart review and self-report mechanism (CHART) identified 421; 79 cases overlapped. Cases identified by COMP were more likely to be severe (p=0.03) but were similarly preventable (P=0.10). Changes in the knowledge base substantially improved the sensitivity and positive predictive value of the rules.

• Identifying Hospital Admissions Due to Adverse Drug Events: Using a Computer-Based Monitor

  Authors: Ashish K Jha, Gilad J Kuperman, Eve Rittenberg, Lucian L Leape, Jonathan M. Teich, Brian Shea, David W Bates

  We developed an adverse drug event (ADE) monitor based on published rules, and used it to detect admissions to the hospital due to ADEs. Over the study period, the ADE monitor identified 76We developed an adverse drug event (ADE) monitor based on published rules, and used it to detect admissions to the hospital due to ADEs. Over the study period, the ADE monitor identified 76 admissions to the hospital due to ADEs. Of these, 21 were determined to be preventable. The hospital-wide rate of admissions due to ADEs was 1.4/100 admissions and the preventable ADE admission rate was 0.4/100 admissions. The 76 events were associated with $1.2 million in costs. The computer monitor required 11 person hours a week to execute.

• Protocols, Pathways, and Practice Guidelines: Defining Multiple Step Clinical Algorithms for Automated Navigation

  Authors: Marilyn D Paterno, Rita D. Zielstorff, Jonathan M. Teich, Mark Segal, Roberta Fox

• Reminders for Redundant Tests: Results of a Randomized Controlled Trial

  Authors: David W Bates, Gilad J Kuperman, Eve Rittenberg, Jonathan M. Teich, Andrew Onderdonk, James Winkelman, Anthony L. Komaroff, Milenko Tanasijevic

  We performed a randomized controlled trial (RCT) of the effect of giving providers reminders about apparently redundant clinical laboratory tests at the time of ordering. During the four-month studyWe performed a randomized controlled trial (RCT) of the effect of giving providers reminders about apparently redundant clinical laboratory tests at the time of ordering. During the four-month study period, 939 apparently redundant lab tests were ordered. Tests were canceled in response to reminders 69% of the time. Of overrides, 41% were justified. In the intervention group, 27% of the redundant tests ordered were performed, compared to 51% in the control group (p < 0.001).