jerry osheroff, md, facp, facmi
Chief Clinical Informatics Officer
Healthcare business of Thomson Reuters
Adjunct faculty and clinical staff
University of Pennsylvania Health System

Q: Explain your role. What do you hope to accomplish in this position?

A: My role is to combine clinical and informatics training to help our company understand the healthcare challenges our customers face, and deliver solutions that effectively address them. This includes making sure that clinicians, patients, and others have the critical clinical information they need—when, where, and how they need it. This is what we mean when we talk about providing "clinical decision support" or CDS. The goal is good decisions that lead to good outcomes—care that is safe, high-quality, and cost effective.

My work toward this goal plays out through both company-focused and other broader activities. Some of what I do externally supports national efforts to improve care delivery and outcomes such as the Roadmap for National Action on CDS. I also work very closely with hospitals and other related organizations to help synthesize, disseminate, and implement best practices for improving outcomes. Examples here include guidebooks for CDS implementers.

All this external work is synergistic with internally-focused efforts helping our company provide solutions that address pressing healthcare needs. For example, I help filter implications of national efforts and trends into the products we develop, into how we articulate and convey our products' value proposition to the market, and into making sure we deliver that value. Conversely, coming from the CDS vendor perspective helps inform my contributions to national healthcare performance improvement efforts.

I also serve on the faculty and clinical staff of the University of Pennsylvania. This gives me the chance to put on the white coat and see the challenges and opportunities inherent in direct care delivery. I have the opportunity to participate (in a limited way) in care delivery, research, local clinical performance improvement initiatives, and of the education of a new generation of clinicians.

I'm very excited to be on the Thomson Reuters team. Because of our reach and the quality and scope of our solutions, we are in a tremendous position to help make healthcare better—better for our customers, better for clinicians, and most importantly, better for patients.

Q: You have a new book focused on CDS and medication use that is coming out this year. Can you tell us more about its message and why it is important to our customers? Also describe how our solutions may be employed to address this issue.

A: A central healthcare focus is optimizing health and wellness, and managing disease. Medications play a key role in these efforts. We use drugs to prevent, treat, and sometimes diagnose disease. A significant fraction of the population is taking medications at any given time, and we know that this causes a huge number of errors and adverse drug events (ADEs)—every single day. For example, research demonstrates that, on average, there is one medication error per inpatient per day, resulting in 1.2 preventable ADEs per 100 hospital admissions. There are serious problems from medications in the outpatient setting too—at least 500,000 preventable injuries or deaths each year. This frightening frequency of unsafe and inappropriate medication use—and the negative consequences that result—is a major part of what's broken in healthcare these days. In addition to the human costs from these problems, accrediting bodies, regulators, and payers are starting to exert major pressure on providers to fix the situation.

Our last guidebook gave healthcare providers general strategies to improve outcomes using clinical decision support, but it didn't give specifics for fixing any specific problem areas. Although the book was well-received (it's an award-winning bestseller), the feedback we heard from readers was that there is a hunger for more detailed guidance on addressing specific, pressing challenges with clinical decision support.

For the reasons I mentioned earlier, medication management is a high-priority improvement focus, and was a logical topic for this latest guidebook. In it, we build on the framework provided by the first book to outline specific details on driving CDS-enabled improvements in medication use and outcomes. We cover steps such as identifying local medication use problems, setting up CDS interventions (that optimize available clinical information systems) to get the right information to the right people to address these problems, measuring results, and continuously improving and managing knowledge assets and processes effectively.

Because our performance improvement offerings are so broad and deep, Thomson Reuters has analytic tools, services, and clinical decision support interventions that help organizations execute on the book's recommendations for each step in the improvement process. We're eager to leverage this new book to help our customers better apply our solutions toward addressing pressing medication challenges.

Q: You were also lead author of the 2006 white paper commissioned by the U.S. Health and Human Services Department titled, "A Roadmap for National Action on Clinical Decision Support." What steps have been taken to execute the recommendations outlined in the Roadmap?

A: The CDS Roadmap was developed by scores of experts and stakeholders, and tries to answer the question, "What do we need to put in place on a national level—for example, incentives, standards, infrastructure—to make clinical decision support interventions more widely available, useful, and used?" A lot of why providers struggle so much with getting CDS right, is that each organization has to handcraft or customize their CDS interventions, and then figure out how to get those interventions into their HIS systems and workflow—that is, they're not "plug-and-play."

The CDS Roadmap describes six strategic objectives needed to fully realize the promise of CDS to improve healthcare. The document has helped trigger a fair amount of activity by various stakeholders toward executing its recommendations. This includes the creation of new federal contracts and workgroups, for which the CDS Roadmap's strategic objectives also serve as a guide.

For example, the AHIC (American Health Information Community) ad hoc CDS Workgroup (on which I serve) recently delivered recommendations for focusing national CDS efforts on high-priority improvement targets. These were accepted by Health and Human Services (HHS) Secretary Mike Leavitt and AHIC. The AHIC Quality Workgroup, on which I serve as senior advisor, has likewise explored opportunities to better harness CDS in support of national quality goals.

The upshot is that a lot of different stakeholders need to come together on a national (and international) basis to ensure that CDS is used to its fullest to make healthcare what it could and should be. We're starting to see the necessary initiatives and collaborations emerging, and resources such as the CDS Roadmap are helping to focus and inform these efforts.

Q: You've been invited to lecture on clinical informatics as far away as Venezuela and The Netherlands. How do you see clinical informatics affecting the global healthcare industry?

A: The challenges and opportunities related to using information better to improve care delivery and outcomes are, in many respects, common throughout the developed world. The social and clinical nuances, the environmental details, and the available infrastructure may vary to some degree. However, the underlying goal and approaches for applying the best information to optimize wellness overlap to a large extent. I'm hopeful that, over time, we'll see broad international collaboration and cooperation on harnessing informatics to help solve these very difficult healthcare problems.

Q: You returned to school to obtain a medical degree after earning your bachelor's in electrical engineering. How did you switch from engineering to medicine and how has your original degree supported you in your career?

A: I've always been fascinated with how things work and fixing or improving them, and also wanted to design and create new things. Electrical engineering was a great way to do a lot of that. I enjoyed these studies, but felt the need for my professional life to involve much deeper connections with other human beings—which electrical engineering wasn't going to provide. Medicine—particularly internal medicine—seemed like a logical way to combine a desire to help other people, fix things, and think systematically.

It became increasingly clear to me during medical training that "the system" didn't enable doctors to solve problems like engineers—that is, with all the pertinent data and knowledge available to filter into the mix. And that really, really drove me crazy! The suboptimal outcomes I was seeing just weren't necessary. Healthcare seemed to be screaming for systematic, comprehensive, creative, engineering-type solutions for better information management.

One day early in my medicine residency, I met Dr. Chip Masarie, then of the University of Pittsburgh section of Medical Informatics. I told him about some of the things that were frustrating me about healthcare, and he spent a long time telling me about medical informatics. I remember feeling, "I have found my people!"

So, after my internal medicine training, I continued on at the University of Pittsburgh for simultaneous three-year fellowships in medical informatics and general internal medicine. All this training prepared me to pursue my passions through a very rewarding career so far—using my skills to understand, design, create, and deliver a better approach to healthcare information management that will lead to a better care outcome.