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A founding fellow of the American College of Medical Informatics, Dr. Stead received the organization’s most prestigious honor last year when he was presented with the Morris F. Collen Award for lifetime achievement.

William Wallace Stead, MD, spent most of his life on the Duke University campus … actually he spent his whole life there until moving to Nashville in 1991 to accept a position overseeing biomedical informatics at Vanderbilt.

Stead was literally born on the Duke campus where his physician father served as Chair of Medicine. He was raised in Durham, completed his undergraduate and medical degrees at the university followed by a residency in internal medicine and fellowship in nephrology. No one was surprised when the young physician joined Duke’s faculty, but the switch to Vanderbilt came as a shock for some.

“Having been born and raised in one place and not leaving until I was in my forties, many thought it would be traumatic, but we simply never looked back,” he recalled of the decision made with his wife, Janet, and daughter, Elizabeth. “We love Nashville.”

Clearly, the city owes Duke its gratitude for the depth of expertise Stead brings to his position as associate vice chancellor for strategy/transformation and CIO at VUMC.

In the summer between his sophomore and junior year of college, Stead became interested in computers and began loading up on math courses. At that time, there was no computer science department and certainly no field of biomedical informatics.

“What I did know was that I was interested in computers and the ways computers could affect medicine,” he said.

Stead already had an inkling of what technology could do for outcomes. During his last two years of undergraduate school, he had the opportunity to work on the Duke Myocardial Infarction Research Unit as part of an NIH-funded effort to ascertain whether digital computers would be more helpful than their analog counterparts in acute cardiac care.

“In essence, I got to do real time, digital computing in the late ‘60s,” Stead said. “That got me addicted to what you could do with that kind of technology.”

He added the project underscored for him that “the only person who could really influence how the computer was going to be used in healthcare was the doctor.”

Under the wing of Ike Robinson, MD, who was chief of nephrology and would eventually be the one to recruit Stead to Vanderbilt, the young physician was challenged with coming up with tools during the research year of his fellowship that could be tested during his clinical year.

Working with biomedical engineer Ed Hammond, Stead helped craft a computer-based medical record.

“You could tell it was pioneering because it was called ‘The Medical Record,’ and we succeeded in trademarking those words,” he laughed.

When Stead joined the Duke faculty, he was assigned to direct the dialysis unit at the Durham VA Hospital, which would ultimately become the test bed for The Medical Record.

Despite the successes computerization showed in terms of epidemiology and practice management, Stead said it was a struggle to figure out how to get those collective sets of function to work together. Instead of creating complex programs that were very specific, Stead, the system thinker, began to wonder how to manage information on a much broader scale.

He said that is when he and colleagues really began delving into the science of biomedical informatics. The group questioned how to structure information so that simple systems could make complex relationships clear.

“We certainly changed the balance between programming per se and what we would now call knowledge bases,” Stead noted.

A decade after his mentor Robinson moved to Vanderbilt as vice chancellor of health affairs, Stead was recruited to build a system that truly integrated information with outcomes.

“Ike gave us a broad canvas to try to create biomedical informatics as an academic discipline and then to take the results of the scientific work and use it to develop a decision support infrastructure that allows us to do the things we now do in quality, evidence-based medicine,” Stead explained.

He added Vanderbilt’s commitment to this area of academic pursuit is quite unique. Although less than 30 percent of American medical schools offer any type of unit in biomedical informatics, the discipline is Vanderbilt’s sixth largest academic department.

After years of working to put the actual tools in place, Stead and his colleagues began to employ those tools in the late ‘90s to eliminate unnecessary utilization. Several years ago, the team began fully integrating the technology into the workflow system to support clinical decision-making and best practices.

“Many other places provide many of the tools we provide,” Stead stated. “But we’re really one of the only places using those tools systematically to impact workflow. We do that better than anywhere in the country … frankly, than anywhere in the world.”

In today’s increasingly complex medical landscape, it has become imperative for practitioners to rely on technology.

“We need the right partnership between the human –– who provides judgment and pattern recognition –– with process –– which simplifies and standardizes –– and informatics –– which decreases dependence on memory and provides a forcing function,” he explained.

By bringing these different elements together, Stead believes it is possible for clinicians to make the right decisions at the right time.

“From research, we know that we do what is known as ‘best practices’ 60 percent of the time; and on average, 40 percent of the time we do things that aren’t necessary,” he said of the current status quo. “In my view, that’s a little better than a coin flip.”

For the last 18 months, Stead and his team have been working “to build a family of process-controlled dashboards.”

He explained this approach summarizes the results of the collective actions of all providers in real time to see if everyone is progressing to plan and throws up red flags if the team gets off course.

Despite his devotion to medical technology, Stead is the first to say he isn’t really a computer person.

“It drives my staff crazy that I still use a paper calendar,” he chuckled.

Instead, he is a systems person.

“I only use technology where it helps me. It’s what I could do with the computers that’s always appealed to me,” he stressed.

This intense interest in translating information into outcomes fuels Stead and his colleagues as they help change the face of modern medicine.



July 2008

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