Chief Medical Information Officer – Language and Understanding for Nuance Communications

Chief Medical Information Officer – Language and Understanding
Nuance Communications


My name is Nick van Terheyden, MD and I am the Chief Medical Information Officer – Language and Understanding for Nuance Communications and have been with the company for about 4 months. 


As part of the senior leadership team I get involved in a range of activities that include driving Nuance’s strategy and positioning of its Healthcare clinical language understanding efforts to derive meaningful structured data from free-form narrative, and helping healthcare organizations improve patient outcomes and meet various governmental and regulatory mandates. To achieve this I spend my time working with our development and technology teams and our product marketing team to understand the marketplace and key drivers for healthcare. I am frequently provided opportunities to meet with customers and spend time in the clinical setting to see the challenges faced by healthcare professionals faced with increasing patient workload, limited face time with patients and shrinking resources and reimbursement.

In addition to helping the company understand the market, I am responsible for helping the marketplace understand Nuance and what they offer to help solve the individual and institutional challenges in delivering high quality cost effective care. This aspect of the role has changed over the last few years with an increasing focus on social media, blogs and real time engagement as well as on the more traditional speaking and conference presentation activities. I deal with the press and analysts on a regular basis and participate in extensive legislative and lobbying efforts helping guide the changes to the healthcare system.  I also work with associations, standards and regulatory bodies to ensure both our compliance as well as guidance on the direction for these groups.


At the time I started down this career path clinician’s involvement in technology and even administration was limited, and the role Healthcare Informatics did not even exist. In fact, clinicians avoided these aspects of care preferring to focus their energies and skills on direct patient care. Computers were expensive large scale devices that were managed by an army of nerds and their utility in healthcare was still unclear. With the emergence of advanced imaging, the development of both Computerized Tomography (CT) and Magnetic Resonance Imaging (MRI), it became clear that technology was going to play an increasingly central role in healthcare.

From a basic standpoint a medical degree is a must and additional study focused on technology, and in particular healthcare informatics, have become an essential prerequisite for anyone entering this field. Remaining in practice is possible and some clinicians like to, others do not. I found it challenging to do both jobs well and stopped day-to-day clinical care a number of years ago but remain connected to healthcare, by reading clinical journals and tracking advances in medicine, diagnosis and treatment much like my clinically active colleagues.

Almost without exception all my roles and opportunities have come from personal relationships and networks of contacts, colleagues and friends in the industry.  Building a reputation and a track record of success is essential and being comfortable presenting to large audiences and at conferences is a key skill. There are many guides on presentation but I firmly believe that medicine itself was the best preparation for general business. Practicing as a doctor in a busy clinical setting  required me to:

–          Sell to patients both their treatment, the diagnosis and sometimes the outcome (good and bad).

–          Negotiate with stubborn immoveable viewpoints, especially in pediatrics where negotiation skills were finely tuned when persuading a 3 year old that they “needed” to be stabbed in the arm. Oftentimes someone had once told them this activity “wouldn’t hurt” but reality struck these strong willed individuals and undergoing a second, third or more needle stick was not in their plan and doing this procedure under duress was a sure fire way to fail and have to repeat.

–          Manage priorities and deal with urgent matters quickly and efficiently – this became a matter of life and death at a cardiac arrest/code call.

–          Organize resources and people in a complex team based environment – it did not get much more complex than dealing with a broad range of clinical specialties and, administration and the wide range of competing interests including the most important – the patient’s.

–          Coping under high pressure – I personally can’t think of many instances that create a higher level of stress or pressure than the life or death of a patient both urgently in arrest or code circumstances and in less time sensitive circumstances where decisions impact people in life long ways.

–           Learning on the job – medicine is filled with real time learning occasions that can occur at the most inconvenient moments but these often represent the best training opportunities and being flexible was essential to absorbing and retaining as much knowledge as possible in as short a period of time.

–          Training – medicine thrives on the multitude of training opportunities that arise at every moment and teaching is inherent in clinical practice. The mantra at my medical school was “see one, do one, teach one.”

In addition to the training from medical school I had many opportunities to learn specific business and technology skills. I spent time learning programming and cut my teeth on teletype terminals, punch cards and programmed in COBOL, FORTRAN, Assembler and used JCL and submitting batch jobs via hard-wired terminals. I progressed to visual basic, macro programming and built an Activity Based Costing Module in Excel.


What follows is modeled on the Hollywood principle to make a series interesting – compress activity that might span days, weeks and even months into a single day and one episode.

Getting up at 3:45 am in whatever time zone you happen to find yourself is not unusual. Seasoned road warriors know that catching the early flight is the best defense against getting stuck in airports waiting for delayed flights. Getting to the airport for a 6am flight has is advantages – the road are empty and car rides to airports are fairly predictable unless you meet unforeseen road works that have spilled over from night time activity. Early arrival in airports is not so predictable with many airports having limited staffing of security lines despite several flights leaving first thing.. The good news is that it provides much material for commentary on blogs, twitter and other social media as you observe the challenges and inconsistencies of air travel. Arriving at the gate afford an opportunity to check e-mail, check key blogs and feeds for any breaking news or interesting posts. Inevitably to keep presentations current there is likely to be some work to be done either before getting on the flight or during the flight to refine or complete the presentation scheduled for later that day.

For some flying is a burden but for me it is an opportunity to catch up on reading material that I accumulate when I am in my home office. Keeping up with the latest trends especially given the government renewed focus on the healthcare space and its attempt to jump start the digitization of healthcare and focus on improving quality and decreasing costs. Keeping track of the top bloggers, journal articles and onslaught of daily news letters is essential to staying current and being agile and responsive and is part of the role to keep my company on target today and thinking about future trends and developments.

Arrival at the destination usually involves some form of car rental and “getting there” – now much easier with the pervasive availability of GPS units versus the old style Mapquest printed map. The only downside of GPS units is you have to get the destination right and entering the wrong city can lead to some frustrating journeys many miles out of your way. Once at the destination meeting customers and spending time with them to understand their working environment and the variables that affect their working day is fun and rewarding. Sometimes watching someone leads to simple guidance and advice than can improve workflow or positively affect their efficiency. It is also my connection back to the patient who is the ultimate customer and the one we are all trying to please. Engaging with patients and watching clinicians and clinical support staff struggle with systems and technology can be eye opening and an activity I strongly encourage everyone involved in healthcare to participate in whenever the opportunity arises. Nothing brings home the importance of removing a confirmation dialog box” than seeing it pop up 40 times in a busy clinic frustrating the user and delaying patient care. What seemed like a brilliant idea in the office can translate into an efficiency nightmare for the user in the complex clinical world.

Delivering a presentation is a key part of activities and often times helping customers and other users understand technology, understand the legislative and industry changes and how this might impact them can offer tremendous value to customers. Being agile with timing is essential – being prepared to give a one hour presentation and having 20 slides to discuss and a demonstration is great until the clinicians walk in and say “tell me what you have, I’ve got five minutes”…. And they mean it. The largest component of this is developing trust and positive partnerships and relationships with clinicians and clinical sites. Understanding the pressures and challenges and helping navigate the complex technology that can be applied and knowing what works and what doesn’t and being honest about this builds a long lasting relationship that benefits everyone.

At the end of the day it’s either off to a nearby hotel, an onward flight to another destination and site or conference or a return trip home sometimes on the dreaded red eye. Whatever the choice being flexible and knowing that circumstances change both for travel and for customer is essential to personal sanity and good health. Sometimes things work out well and getting on an earlier flight and getting home sooner than expected can be a bonus. Other times delays, weather and cancellations can leave you stranded for hours – either way be prepared and accept it.

In between times preparing for the next presentation, submitting papers for consideration at conferences, connecting with press and analysts for interviews and sharing the knowledge internally with the company and colleagues is all part of the daily task list.


Being a Healthcare Informatics specialist requires studying and becoming a doctor first. During that process you may find studying business and technology to be helpful in the future but not essential.

Today there is a big emphasis on qualification and likely we will see the emergence of specialization of healthcare informatics as apart of a medical career. In some ways this is helpful formalizing some of the experience and training I have been fortunate enough to get in my career. In other ways this can add to the time taken to getting to the role you want and being a valued part of the team. I feel fortunate to have found a pathway that gave me great experience and doing a wide range of different jobs on the path to becoming a CMIO and enjoying each and every varied role. Matching that process might be difficult but capturing a range of experience concurrent with additional study that may be required in the future would be a great way to gain the experience and enjoy the process of learning. Early on you will need to decide if you want to continue to practice clinically – there are those who feel it is essential and those that don’t. Make up your mind and be happy with the decision. If you can gain experience outside the clinical world this will stand you well as you bring both worlds together.


As I say to the kids I coach in soccer, “Rule number one – have fun!” If you are not having fun it’s hard to be motivated. And like the song “Everybody’s Free (to wear sunscreen)” by Baz Luhrman:

“Don’t feel guilty if you don’t know what you want to do with your life…the most interesting people I know didn’t know at 22 what they wanted to do with their lives, some of the most interesting 40 year olds I know still don’t!

On life in general:

Life should not be a journey to the grave with the intention of arriving safely in an attractive and well preserved body, but rather to skid in sideways, chocolate in one hand, martini in the other, body thoroughly used up, totally worn out, screaming “WOO-HOO! What a ride!

Nick van Terheyden




Nuance Communications