Informatics
Authors
Nicolas Kahl, MD
Chair, EMRA Technology, Telehealth, & Informatics Committee
UC San Diego Health
Ryan Korn, MD
Chair-Elect, EMRA Technology, Telehealth, & Informatics Committee
UC San Diego Health
Faculty Reviewer
James Killeen, MD, FACEP
Clinical Professor of Emergency Medicine
Clinical Informatics Fellowship Director
Departments of Emergency Medicine and Biomedical Informatics
UC San Diego Health
Special thanks to our 2nd edition writing team
Zachary Jarou, MD
Abdulaziz S. Alhomod, MD
INTRODUCTION
Description of the specialty
The Accrediting Council for Graduate Medical Education (ACGME) defines this fellowship as “the subspecialty of all medical specialties that transforms health care by analyzing, designing, implementing, and evaluating information and communication systems to improve patient care, enhance access to care, advance individual and population health outcomes, and strengthen the clinician-patient relationship.”
History of the specialty/fellowship pathway
In 2007, the American Medical Informatics Association (AMIA) began a process to define core content and training details for a proposed informatics fellowship. AMIA sent proposals to multiple medical specialty boards in 2008, and in 2009, the American Board of Preventive Medicine (ABPM) agreed to sponsor the fellowship. In 2010, a formal application was submitted, and in 2011, the ABPM committee officially accepted it.
Beginning in 2025, all physicians must complete a fellowship to take the board certification exam. (This requirement was to take effect earlier, originally in 2018, but its implementation was delayed due to the COVID-19 pandemic.)
Why residents choose to follow this career path
This training path is for residency-trained physicians who are interested in the application of information technology and protocols to promote efficient patient care, improve data access, and help prevent disease.
How do I know if this path is right for me?
Are you interested in the use of technology to help facilitate care for patients and assist with patient safety? Do you wish to design an interface between health care systems and providers that is more user-friendly? Are you interested in creating a strategy, budget, and team to introduce new technology to a health care system? If the answer is yes, this may be the fellowship for you.
Career options after fellowship
Career options include chief information officer (CIO), chief medical information officer (CMIO), physician champion for patient safety, quality improvement project leader, and risk management director.
Splitting time between departments
After being certified in informatics, physicians traditionally use their information training as part of their administrative duties while still maintaining clinical duties. For example, an EM physician may devote 70% to clinical duties and 30% to administrative responsibilities involving informatics projects.
Academic vs. community positions
Due to the introduction of electronic health records, it is certainly possible to use your informatics training at a community or academic institution. There is a significant need for informaticists at both types of venues — in rural or community settings and at academic institutions or higher-volume, tertiary-quaternary facilities. No matter the setting that fits you best, you’ll find yourself as the link between information services and the clinical service lines.
IN-DEPTH FELLOWSHIP INFORMATION
Number of programs
Currently, there are more than 50 programs:
- Banner Health/University of Arizona-Phoenix
- Baylor COM (Hybrid)
- Baylor Scott and White Health
- Beth Israel Deaconess Medical Center
- Boston Children’s Hospital
- Case Western Reserve University
- Cedars-Sinai Los Angeles
- Children’s Hospital of Philadelphia
- Columbia University/New York-Presbyterian
- David Geffen SOM at UCLA/UCLA Health
- Duke University SOM
- Geisinger Health System
- Hennepin Healthcare
- Honor Health
- Houston Methodist Hospital
- Indiana University/ Regenstrief Institute
- Kettering Health
- Louisiana State University Health Sciences
- Madigan Healthcare System
- Mass General Brigham
- Mayo Clinic
- Mount Sinai Health System
- New York University Grossman SOM
- Northwestern University Feinberg SOM
- The Ohio State University
- Oregon Health & Science University
- Partners Healthcare
- Regenstrief Institute, Inc.
- Rochester General Hosp/Rochester Regional Health
- Rush University Medical Center
- Stanford SOM
- SUNY Stony Brook University
- Thomas Jefferson – Sidney Kimmel/ChristianaCare
- The University of Arizona COM - Phoenix
- University of Arkansas
- University at Buffalo
- University of California Irvine
- University of California Los Angeles (Surgical Pathology/CI) (Hybrid)
- University of California Los Angeles (Transfusion Medicine/CI) (Hybrid)
- University of California San Diego
- University of California San Francisco
- University of Chicago
- University of Cincinnati – Cincinnati Children’s
- University of Illinois at Chicago
- University of Kansas
- University of Massachusetts- UMass Chan
- University of Minnesota
- University of South Florida – Morsani SOM/Moffitt Cancer Center
- University of Texas Health Science Center (UTHealth) at Houston
- University of Texas Southwestern Medical Center
- University of Washington
- University of Wisconsin - Madison
- Vanderbilt University
- Washington University SOM
- Waco Family Health Center
- Yale Center for Medical Informatics/New Haven Medical Center
As more programs become accredited, they are listed with AMIA here.
Differences between programs
Be careful; not all programs are ACGME-accredited. Most programs use ERAS for their application process, but some have their own application that can be accessed either on their website or by emailing their program director and/or coordinator.
Length of time required to complete fellowship
The ACGME requires a 2-year fellowship.
Skills acquired during fellowship
During fellowship, you will receive training in each of the four core content categories: fundamentals of informatics, clinical decision-making and care process improvement, health information systems, and leadership/management of change. Some programs may offer additional training in coding languages such as SQL, R, Tableau, or Python.
Typical rotations/curriculum
Examples of rotations include: clinical informatics experience managing an electronic health record; quality improvement training; operational finances and project management; and research. Many programs encourage fellows to practice in their primary specialty to maintain their primary board skills.
Board certification afterwards?
Yes, assuming the program is ACGME-accredited; this exam is conducted by the American Board of Preventive Medicine.
Average salary during fellowship
Because this is an ACGME fellowship, salary is based on the appropriate PGY level.
PREPARING TO APPLY
How competitive is the fellowship application process?
Currently there are approximately 50 accredited programs, with each typically taking 1-2 fellows per year.
Requirements to apply
You must be board-eligible or board-certified in any ABMS-approved specialty to apply.
Research requirements
Research is not required but is highly recommended, especially if the research is completed on a topic relevant to informatics. Make sure you have your research projects near completion when you apply. It is better to have one completed research project than three projects in the data collection phase.
Suggested elective rotations to take during residency
Consider using your elective time to take an administrative or research elective. Some programs specifically have an informatics rotation, which would be an ideal rotation.
Suggestions on how to excel during these elective rotations
Your elective months can potentially connect you with attending physicians who may be your future letter of recommendation writers. Thus, it is imperative to treat every day on elective as an interview day. Treat everyone with respect and go the extra mile. It is always looked at positively when you arrive early and stay late to help. Be innovative. Strive to be both a team player and a leader. Read every night, and increase your knowledge base about informatics.
Should I complete an away rotation?
It may be worth considering an away rotation at a program that has an informatics fellowship. This may be a prime way to help “get your foot in the door” and display your interest and clinical skills.
What can I do to stand out from the crowd?
The best way to stand out from the crowd is to build a CV that displays clear leadership ability and a clear interest in the field of informatics. One example to consider is to develop a quality improvement project during residency that focuses on improving the electronic health records system at your institution.
Should I join a hospital committee?
Absolutely. Try to join a committee that is focused on informatics topics and allows you to make a meaningful contribution and/or allows for a leadership role.
Publications other than research
Writing case reports, blog posts, magazine articles, etc., is an excellent learning opportunity and a great way to get your name out into the informatics community.
How many recommendations should I get? Who should write these recommendations?
It is generally recommended to obtain three letters of recommendation. One of these letters must be from your residency program director and/or department director. The remaining recommendations should be from faculty who know you well, strongly support you, and can speak to your interest and skills in informatics. For example, physicians with whom you’ve worked on quality improvement projects, research projects, or on hospital committees may be a good resource for these letters.
What if I decide to work as an attending before applying? Can I still be competitive when I apply for fellowship?
You can absolutely still be competitive if you work as an attending before applying to fellowship. The key is to remain involved in activities, especially those related to this field. You do not want the activities on your CV to stop when residency ends. Also, be prepared to explain during your fellowship interviews why you made the decision to practice prior to applying for fellowship.
What if I am a DO applicant?
There are no barriers for DO applicants.
What if I am an international applicant?
Please contact individual programs regarding whether they accept international applicants (some programs receive funding that prevents them from taking international applicants). In general, international applicants are usually required to be certified by the Educational Commission for Foreign Medical Graduates (ECFMG). You also must have a visa (traditionally a J-1).
APPLICATION PROCESS
How many applications should I submit?
You should apply to all programs you would seriously consider attending if offered a fellowship position.
How do I pick the right program for me?
Pick a program that makes you happy in regards to career and personal life. Do not ignore your inner voice; if you feel uncomfortable, that program is not for you. Choose the program that believes in you and is supportive of your career goals. Finally, do not forget location. If you are unhappy when you go home after work, this sentiment will infiltrate your fellowship experience, and you won’t be nearly as happy or as productive as you otherwise would have been.
Common mistakes during the application process
Common mistakes include submitting an application past the deadline, submitting an incomplete application, choosing letter writers who are not 100% supportive of you, or having a CV that does not display an interest in informatics.
Application deadlines
Applications traditionally open in July and positions are filled by January. Contact each program regarding specific application timelines.
Tips for writing your personal statement
Your personal statement should not be a regurgitation of your CV but rather should show your personality and explain why you are interested in informatics. Is there a specific patient-technology interaction that first sparked your interest in the field? Perhaps your involvement in a hospital committee or maybe a mentor was pivotal in introducing you to the field. The best statements read as a story that engages the reader from the very first sentence. Consider ending your personal statement with your thoughts about your career goals after completing an informatics fellowship.
Is this a match process?
Yes, the AMIA implemented a binding match in 2022. Details, including information about fees and the match process, can be found on the AMIA’s clinical informatics fellowship match FAQs page.
What happens if I don’t obtain a fellowship position?
Take a hard look at your application and interview process to identify weaknesses that you need to address. It may be worth gently asking the programs that did not offer you a position if they have any advice to help you to improve. More importantly, we recommend that you find a trusted physician (such as your EM residency program director) to look at your application with a critical eye to find the gaps. Spend the next year addressing these gaps and apply again. Worst-case scenario, it is possible to create a niche within the field of informatics as an attending physician without completing a fellowship.
INTERVIEW PROCESS
How do I stand out from the crowd?
The best way to stand out from the crowd during an interview is simply by being yourself. Let your personality shine through. Come prepared to ask questions about the fellowship program. Make sure these are thoughtful questions that cannot be easily answered by looking at their website. Finally, know your application well and be prepared to answer anything from it.
What types of questions are typically asked?
- Why are you interested in informatics?
- Why are you interested in informatics at our institution?
- What are your 5- and 10-year career goals?
- Tell me about “blank” activity that you list on your CV.
- What are your strengths and weaknesses?
How many interviews should I go on?
Attend every interview that is offered to you by programs that you would seriously consider attending.
PREPARING FOR FELLOWSHIP
Textbooks to consider reading
- Englebardt SP, Nelson R. Health Care Informatics: An Interdisciplinary Approach. St. Louis, MO: Mosby; 2002.
- Shortliffe EH, Cimino JJ. Biomedical Informatics: Computer Applications in Health Care and Biomedicine. New York, NY: Springer; 2006.
- Coiera E. Guide to Health Informatics. 3rd Boca Raton, FL: CRC Press; 2015.
Important skills to practice while in residency to prepare for fellowship
Practice your leadership, research, and negotiation skills. Above all else strive to be a fantastic physician. Work on your understanding of electronic medical administration record (eMAR) systems, and eMAR and technology as it interacts between patients and the healthcare system. Become knowledgeable on how to create and implement quality improvement projects.
Tips on how to succeed as a fellow
The best fellows are the ones who are passionate and dedicated to their careers. Fellowship is a unique opportunity to learn about informatics under the guidance of many physician mentors. Take advantage of all that fellowship has to offer. Read every day, come into work early and stay late, and be amicable to everyone. Also, remember to stay balanced and take care of yourself and your family. A final logistical note: Apply for your medical license as soon as possible once you know where you’ve matched; some states move slower than others in approving and granting licenses, which may impact your clinical practice as you begin your fellowship.
CONCLUSION
Additional Resources
Journals
International Journal of Medical Informatics
Journal of American Medical Informatics Association (JAMIA)
Blogs
Podcast
http://www.healthcare-informatics.com/category/podcasts/podcast
National organizations
American Medical Informatics Association (AMIA)
Conferences
AMIA Clinical Informatics Conference (CIC)
International conference on healthcare informatics
Medical Informatics World Conference
How to find a mentor
At this time, we are unaware of any central website that connects interested physicians/residents to mentors within the field of informatics. Join the ACEP Emergency Medicine Informatics Section to find likely mentors.
