Wednesday, May 14, 2014

Aren't All Physicians Supposed to Be Experts in Clinical Informatics?

It was just a matter time.  "Clinical informatics" has become another medical specialty.

It seems that the clinical informaticians have their own organization (the "American Medical Informatics Association"or "AMIA"), an American Board of Medical Specialties-backed specialty designation, an accredited fellowship process and even a board examination.

And, like many other medical specialties, their experts are projecting a shortage of themselves and are naturally advocating for an expansion of their training programs.

The JAMA paper linked above provides a useful definition of the science:

"... a body of knowledge, methods, and theories that focus on the effective use of information and knowledge to improve the quality, safety, and cost-effectiveness of patient care as well as the health of both individuals and populations."

While the PHB appreciates the evidence-based definition, it can't help but be slightly disappointed at how this has played out. 

Years ago, when the promise of electronic records still exceeded their reality, there was an assumption among many of the PHB physician colleagues that a few strokes of the the electronic record keyboard would generate on-screen data roll ups. Possible examples included the percent of patients with high blood pressure who weren't controlled, the fraction of persons with diabetes who hadn't had basic immunizations or the number of persons with depression who weren't regularly filling their prescriptions. Us docs could use that information to improve quality, reduce care gaps and optimize costs, both at the point of care and for the entire panel.

In other words, the PHB assumed the EHR would enable all of us docs to become clinical informaticians

Alas, it was wrong.  To get the information, physicians will be expected to rely on another specialty to make up for the EHR's lingering shortfalls.


1 comment:

Justin Starren said...

15 years ago the Medical Student Objectives Project advocated for informatics competencies for every physician. All physicians should be able to use informatics tools and evaluate the results critically. That is very different from the skill set for board certified Clinical Informaticians. This new specialty is targeted at those who will be designing, selecting, implementing and overseeing EHRs and other clinical systems. We all studied pathology, but we do not expect every clinician to accurate diagnose a cancer from the microscope.