DIY CI: Tips for Getting into Clinical Informatics

Are you interested in a career in clinical informatics? Find out how to get involved while this emerging niche is still in the grandfathering phase.

Disclaimer: The recommendations belong solely to the authors and are not meant to represent their employers or EMRA.

Clinical Informatics is a diverse, interdisciplinary field that harnesses information to improve healthcare. It is uniquely multidisciplinary, as the ACGME defines it as “the subspecialty of all subspecialties that transforms health care.”¹ The field includes physicians from all specialties, nurses, pharmacists, data analysts, innovators, and many others. It varies widely from doctors wanting to use their computer programming training to develop applications and statistical analyses, to those with no programming experience who just want to improve the user experience within their electronic medical record (EMR). Clinical Informatics is a relatively new subspecialty, with full board status through the American Board of Medical Specialties and certified by the American Board of Preventive Medicine.

Presently we are in the grandfathering period for clinical informatics, which means someone who has practiced at least 25% clinical informatics for three of the last five years can apply to take the boards through the "practice pathway." You are also board eligible if you completed 2 years of formal graduate level education such as a National Library of Medicine (NLM) biomedical informatics training program. After the grandfathering period ends in 2022, a 2-year ACGME-accredited fellowship will be required. Currently there are 35 fellowships around the country, many hosted by departments of emergency medicine.

Most current emergency medicine residents would need to do a fellowship to qualify to sit for the exam. On the other hand, some informaticians aren't boarded and do well without any formal training/certification. The American Medical Informatic Association (AMIA) is planning to announce a health informatics certification for those who cannot or do not want to pursue formal fellowship and board certification. Unlike many subspecialties, there are many ways to build a career with clinical informatics, so it is best to just jump in and get involved with the part that interests you most...then see if you'd like to make a career of it.

12 Ways to Get Started
There is no one-size-fits-all for the field of informatics. However, here are some ways to get started:

1. Find a mentor: Contact EMRA’s Informatics Committee, ACEP’s Informatics Section, a nearby Clinical Informatics Fellowship program, your Chief Medical Informatics Officer, or your hospital’s informatics department. If you can’t find one, just ask one of us!
2. Take initiative: Invite yourself to an informatics meeting in your hospital network.
3. Read about informatics topics that interest you: for example, clinical decision support, processes (such as ED workflows) that could be improved with HIT, cybersecurity, information retrieval (search), and data science.
4. Submit requests to your information system’s help desk to solve problems. Reach out to your information system’s department to collaborate on solving that problem that has been driving you crazy and requires recurrent workarounds. Most EDs have a nurse analyst who can teach you how they handle requests. They are often receptive, just ask (nicely).
5. Write an algorithm for patient care based on your studies of the subject and in-house workflow.
6. Think outside the box: sometimes the best ideas are simple and don’t require significant money or technological know-how.
7. Start your own resident HIT forum, Slack Channel, or interest group.
8. Build an app to satisfy a specific workflow need or interest. There are many tools (such as Flutter or React native) that can allow you to make an app with a single code base.
9. Consider training: ACEP 10x10 Informatics Course, Master’s Degree in Informatics (or a related field), or other online courses.
10. Write a proposal for an order set, show it to your colleagues, then submit it for development.
11. Join AMIA.
1. Fall/November conference
2. Spring CIC meeting (CI Fellows attend this)
12. Find out how informatics is being done locally and join these groups.

Clinical Informatics 101
The term "informatics" is broad and usually refers to biomedical informatics, which encompasses bioinformatics (molecular and cellular biology including genomics) and health informatics (clinical, public health and consumer health informatics).

The ACGME defines clinical informatics 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."¹

How to Get Started
As an EM resident, Carrie Baker proposed and led her hospital system’s transition from a faxed, paper, call schedule to a software-based paging system. This technology-based solution allows all network providers to see who is on call for each service. She also assisted with two Epic Go-Lives as a Super-User during residency.

As a medical student, Jeff Nielson started taking classes in the department of informatics. He took an informatics elective and created an education resource database.

As a resident, Ben Slovis became interested in how data collected by the EHR could be used to improve the quality of patient care. A residency research project led to a NLM post-doctoral fellowship in biomedical informatics. This trajectory created the foundation for a career in decision support design, implementation and optimization, and informatics research.

Section 3: Recommended Resources to get started
Webinars and more: Free resources include Dr. William Hersh’s blog and Web site, which includes videos and documents containing an overview of clinical informatics, machine learning, data science, and information retrieval and the OHSU Clinfowiki.

http://informaticsprofessor.blogspot.com/

http://informatics.health

http://www.clinfowiki.org/wiki/index.php/Main_Page

Podcasts

ACIF 'Go Live' Podcast
A podcast brought to you by the AMIA Clinical Informatics Fellows. This monthly podcast tries to explain current views on Informatics news and topics, bring interviews with thought leaders in the field, and hopefully keep listeners entertained along the way.

https://www.amia.org/membership/acif/go-live-podcast

HealthCare Tech Talk
This podcast discusses issues around each technology used in the delivery of healthcare, including Healthcare Information Technology, Informatics, Telemedicine and Clinical\Biomedical Engineering Technology. They haven’t released an episode since 2017, but the basic concepts they discuss are timeless.

https://podcasts.apple.com/us/podcast/healthcare-tech-talk/id817023985?mt=2

SMA's Digital Health and Innovation
This podcast attempts to educate and inform listeners on the various systems and methods that use information, data, and communication technologies to help resolve problems, reduce inefficiencies and costs, improve access, increase quality, and help make the practice of medicine more personalized and precise.

https://www.stitcher.com/podcast/digital-health-and-innovation

EMRA Informatics: Dr. Zach Jarou and Dr. Abdulaziz S. Alhomod co-authored the Informatics section of the EMRA Fellowship Guide. https://www.emra.org/books/fellowship-guide-book/informatics/

Scientific Journals: For the annual student membership rate ($50), the American Medical Informatics Association (AMIA) grants online access to the Journal of American Medical Informatics Association (JAMIA) and Applied Clinical Informatics (ACI) https://www.amia.org/membership-types. There are also free open editions of both journals online. AMIA partners with ACEP to offer an informatics intro class called the 10x10 (“ten by ten”), which you may find interesting during or after completion of residency: https://dmice.ohsu.edu/hersh/10x10.html.

Medical Terminologies: James J. Cimino. Desiderata for Controlled Medical Vocabularies in the Twenty-First Century https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3415631/

Clinical Decision Support: David W. Bates, Gilad J. Kuperman, Samuel Wang, Tejal Gandhi, Anne Kittler, Lynn Volk, Cynthia Spurr, Ramin Khorasani, Milenko Tanasijevic, Blackford Middleton, Ten Commandments for Effective Clinical Decision Support: Making the Practice of Evidence-based Medicine a Reality, Journal of the American Medical Informatics Association, Volume 10, Issue 6, November 2003, Pages 523–530, https://doi.org/10.1197/jamia.M1370

Programming: Data Camp offers introductory programming classes that are initially free. https://www.datacamp.com/courses/intro-to-python-for-data-science

Cybersecurity: The American Medical Association offers some free advice about cybersecurity. https://www.ama-assn.org/practice-management/sustainability/5-things-you-didn-t-know-about-health-care-cybersecurity

Textbooks
Biomedical Informatics: Computer Applications in Health Care and Biomedicine, Fourth Edition, edited by Edward H. Shortliffe and James J. Cimino (2014) Springer.

Health Informatics: Practical Guide, Seventh Edition, edited by Robert Hoyt and William Hersh (2018) Lulu.com.

ACEP’s Board member, Dr. Finnell, co-edited Clinical Informatics Study Guide by John T. Finnell and Brian E. Dixon

Conclusion
Informatics is a challenging field and there is room for any interested physician, at any point in their training. Seeing your work in action, and appreciated by physicians, can really complement the day to day emergency medicine work. As a growing field, it has room for everyone.

References

1. Accreditation Council for Graduate Medical Education. ACGME Program Requirements for Graduate Medical Education in Clinical Informatics. ACGME; 2019. https://www.acgme.org/Portals/0/PFAssets/ProgramRequirements/381_ClinicalInformatics_2019_TCC.pdf. Accessed January 24, 2020.
2. Silverman HD, Steen EB, Carpenito JN, Ondrula CJ, Williamson JJ, Fridsma DB. Domains, tasks, and knowledge for clinical informatics subspecialty practice: results of a practice analysis. J Am Med Inform Assoc. 2019;26(7):586-593. doi:10.1093/jamia/ocz051
3. Gardner RM, Overhage JM, Steen EB, et al. Core content for the subspecialty of clinical informatics. J Am Med Inform Assoc. 2009;16(2):153-157. doi:10.1197/jamia.M3045
4. Shortliffe EH, Cimino JJ. Biomedical Informatics: Computer Applications in Health Care and Biomedicine. Springer Science & Business Media; 2013. https://play.google.com/store/books/details?id=nim5BAAAQBAJ.
5. Donoho D. 50 Years of Data Science. J Comput Graph Stat. 2017;26(4):745-766. doi:10.1080/10618600.2017.1384734
6. Davenport Thomas H, Harris JG. Competing on Analytics: The New Science of Winning. Harvard Business School Press, 2007.