Training in clinical informatics empowers physicians to apply information technology in a systemic way that promotes efficiency, patient safety, and the improvement of health care systems.
However, many people are still wondering what a career as a Clinical Informaticist looks like. We interviewed ACEP Board member and Indiana University School of Medicine Clinical Informatics Fellowship Director John T. Finnell, MD, MSC, FACEP, FACMI, to explore career prospects and seek practical advice for those interested in pursuing a fellowship in clinical informatics.
What is your background, and how did you develop an interest in clinical informatics?
I was frustrated at how inefficient I was in our health care system. As a medical student, we had to hand-write discharge instructions for all of our patients in the ED. I frequently found myself frustrated that I couldn't reliably complete these for every patient. So as a student project, I developed a template for patients with head injuries, lacerations, etc. This allowed other providers to provide the same content to patients being discharged from the department. Throughout my residency, I developed tools to make me more efficient as a resident. During my ICU rotation, I built a templated note, so that when I was rounding at 4 am, I just had to fill in the fields for each patient. Even as faculty, I found similar inefficiencies. I didn't realize there was a field of clinical informatics until one of my residents mentioned it. I completed the U.S. National Library of Medicine fellowship at Regenstrief Institute from 2002-2005. Since that time, I've been the program director for the Training in Biomedical Informatics (T-15) program, as well as now the program director for the clinical informatics program.
How would you define the field of clinical informatics?
The field of clinical informatics is pretty broad overall. The primary focus of the fellowship is to train physicians to become leaders in the health care system, focusing on operations and IT. The goal of clinical informatics is to make systems smarter and more efficient for the entire health care system – from patients to providers. Our systems need to be designed to be intuitive, not interruptive, to maximize any clinical benefit.
What does a fellowship in clinical informatics look like?
Many programs utilize the didactic program at Oregon Health and Science University (OHSU) as part of their educational program. Our fellows are eligible to get a certificate through OHSU for completing their coursework. The additional win is that fellows are often in the same class and are collaborating on projects across the country. This is an excellent example of making our educational system more efficient. Not every informatics program in the country (and there are 30+ programs now) needs to talk about data security. As part of their rotations, most fellows are paired with the Chief Medical Informatics Officer of the health care system, or with part of their team. Many will shadow and participate in the meetings and projects being developed. In our program, our fellows continue to work clinically as well. This allows them to continue to develop their clinical skill set, as well as understand the nuances of the information system they are building. Finally, one of the key things that an applicant should look at is how the fellowships are funded. There are a variety of models, from external funding (from companies), internal funding (from the Dean's office), to our model where fellows work part-time clinically.
What does a career in clinical informatics look like?
This is a great question, and timely as well, as American Medical Informatics Association is currently looking into this. The primary focus is for graduates to be involved in some aspect of the health care system. Whether this is at the department, hospital, or system level would depend on their needs. Many fellows go into leadership positions within the health care system. This doesn't mean that fellows can't participate with vendors of systems, ie, working for Epic or Cerner – or related startup companies. Our fellows frequently use their elective time to work with some of these new and upcoming companies.
How do you blend your EM training with clinical informatics?
When I was a medical student, we didn't have any outside clinical data. If patients did have external data, we would frequently repeat the tests. As time has passed and there is more information sharing, there is often more data than we can consume during a typical visit. This leads me to some of the fun projects I've been fortunate enough to be involved with. My most recent activity revolves around bringing relevant clinical data to the forefront, depending upon the patient's chief complaint. So, in patients with chest pain, we would bring forward the most recent EKG, stress test, cardiac catheterization report, and cardiology note. Working with medical students over the past decade has demonstrated that with each chief complaint, there's often a set of clinical data providers would like to have. It's fun to imagine how we can make our practice more enjoyable.
Another project involves linking our prescription drug monitoring program (PDMP) with our health information exchange. Every time a patient presents to the ED, there is a new PDMP report available in the system, allowing smooth and easy access.
For those who do not have an informatics program at their residency, how does one learn more about the field?
If folks are interested in clinical informatics, they should consider joining, or at least looking at, AMIA. AMIA is … the parent organization for all of health care and clinical informatics. There is a fall symposium where many, if not all, of the training programs are present. This would give a resident an excellent chance to talk to the various training programs and find out which of the programs may be a better fit for them. There are opportunities to do electives, although these can be somewhat challenging with existing GME rules. Another option would be for students/residents to participate in an informatics project while they're doing their emergency medicine elective.
Since the practice pathway is closing, which types of informatics fellowships can I apply to?
First, the applicant should know they can be hosted by one of many primary specialties. The host department is typically more of an administrative relationship, and should not impact the educational program. Keep in mind that some programs only accept certain specialties within their fellowship. For example, some may not take a pathologist as a clinical informatics fellow. So, it would be good advice to check with the fellowship website or contact the fellowship directly to see if any of these programs would not accept in emergency medicine graduate. The other nuance of this administrative relationship is that when the primary specialty is being reviewed, all fellowships tied to the primary specialty are reviewed at the same time. If any of the fellowships have significant citations, this can impact the primary/hosting specialty.
Anything else you would like EM residents to know about the field of clinical informatics?
Whether you are going into academics or private practice, you should find a niche, something that keeps you involved and interested. There are many choices to choose from, and clinical informatics is just one of those. We often have applicants to our program, that were initially not aware of opportunity to pursue clinical informatics as a formal discipline. Lastly, I would be happy to chat with anyone interested in learning more about the specialty or like to spend time with us here at Indiana University.