Should clinical informatics become a new medical subspecialty?

By Mark Terry

As health information technology matures and becomes an integral part of all healthcare, more and more people will be needed who understand the field and can apply it to medicine. In an article published online this week in the Journal of the American Medical Association, two physicians--Don Detmer of the University of Virginia and Edward Shortliffe of Arizona State University--discussed the current state of clinical informatics as a board certified medical subspecialty.

Clinical informatics, Detmer and Shortliffe say, is more than simply "computers in medicine." Instead, they call clinical informatics "a body of knowledge, methods and theories that focus on the effective use of information and knowledge" to boost the quality, safety and cost-effectiveness of patient care.

Last October, the American Board of Preventive Medicine held the first board examination with the American Medical Informatics Association and other stakeholders. Approximately 500 clinical informaticians sat for the examination and about 90 percent received initial certification. Although promising, the authors expect those numbers to increase. By 2018, all candidates for the certification "will be required to have completed an ACGME-accredited fellowship in clinical informatics," they say.

The American Health Information Management Association is pushing for advanced degrees for health IT professionals, although it says clinical informatics should not be isolated to just physicians and IT professionals. A 2014 Nursing Informatics Workforce Survey published in February 2014 found a doubling of the number of nursing titles that specified informatics, and 43 percent of the survey respondents had a post-graduate degree.

Detmer and Shortliffe point out that there are numerous challenges ahead including:

  • Complexities with accreditation related to different medical specialties such as diagnostic radiology, internal medicine, and pathology;
  • Where funding for clinical informatics fellows will come from
  • Whether the limited fellowship positions will generate enough people to take the annual board examinations

"The new certification process for physicians who are subspecialists in clinical informatics should prove to be an important contributor to short-term improvements in systems and their implementation, as well as to the longer-term evolution of health information technology as it seeks to assert a positive influence on health, healthcare, quality, efficiency and reduction in costs," Detmer and Shortliffe say.

To learn more:
- read the JAMA piece

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